Caste plays a role in determining your position, your nature of work and your compensation package. And this happens even in case of junior positions.
In Uttar Pradesh, public health functionaries – ASHA (Accredited Social Health Activist) workers (or bahus) and ASHA sanginis – have been agitating for the past two months demanding payment of their salary arrears.
ASHA workers held protests at Primary Health Centres (PHCs) and Community Health Centres (CHCs) on 1 March 2023, at the offices of the district collectors on 13 March, and outside the residences of divisional commissioners on 17 March.
Just before the 2022 Assembly Elections, the Uttar Pradesh Government had announced that besides their salaries, the ASHA bahus and ASHA sanginis would be paid Rs 6,700 and Rs 11,000, respectively, as incentive.
A delegation of ASHA bahus told the Chief Medical Officer (CMO) of Kaushambi district that they were not able to cover their household expenses. The school fees of children, electricity bills, etc were unpaid and their families were on the verge of exploitation. The CMO had this to say in response, “So, your homes run on your income. What do your husbands do then?” When the ASHA workers told him that their husbands don’t have an income, the CMO asked, “Then why don’t you divorce them?”
It is a fact that the ASHA workers, who are contractual employees, do not enjoy as much respect in the community as other health staffers do. Some journalists and NGOs also allege that in return for commission, ASHA bahus send women from the rural areas to private hospitals for delivery.
This allegation does not hold water, given the claims of the ASHA bahus that they are unable to run their homes with their low salaries (just Rs 2000 per month) and incentives, and that they are in dire straits because of salaries that haven’t been released for the past 6-7 months. Women working as ASHA workers come from the lower strata of society, are socially, educationally and economically backward, and are forced to survive on very low incomes.
Anil Verma, state secretary of the All India Centre of Trade Unions (AICTU), Uttar Pradesh, says that 80 per cent of the ASHA bahus are Dalitbahujan. However, women of these communities form just 20 per cent of the ASHA sanginis.
ASHA sanginis are supervisors, each of whom monitors the work of 20 workers. There are 1,63,407 ASHA bahus and 6,799 sanginis in the 75 districts of the state. The total number of ASHA workers in the country is 10.4 lakh.
According to Verma, when the posts of ASHA workers were created in 2005, the idea was to use their services for enhancing maternal and child health and for that, five main tasks were entrusted to them. But now they have been burdened with 50-55 different tasks. While earlier, computer operators used to enter data, now ASHA workers have to do that using their mobile phones. Their services are used in census, tree census, animal census, and leprosy and TB surveys and so on – which are not part of their job profile. There are separate departments for leprosy eradication and TB control. But the ASHA workers are being forced to do the work of these departments. He also says that the 45th session of the Indian Labour Congress, held in 2013 during the second term of United Progressive Alliance (UPA) at the Centre, had passed a resolution saying that the ASHA workers be treated as government employees and be entitled to all the facilities enjoyed by the government employees. In 2017, speaking at the 47th session of the Labour Congress, Prime Minister Narendra Modi had also endorsed the demand that ASHA workers be treated as government employees.
Anil Verma says that the ASHA workers are being given a bad name with the allegations that they take commission from private hospitals and nursing homes. What actually happens is that the private hospitals, through their Public Relations Officers (PROs), invite ASHA workers to their facilities, present gifts to them and pressurize them to bring women to their institutions for delivery. Verma says that the allegation is a conspiracy by private players and the government.
ASHA workers are appointed by the Chief Medical Officers of the districts under the National Urban Health Mission from among the women residents of slum clusters under the District Urban Development Agency (DUDA) and other rural and urban areas. The ASHA workers are also called Asha bahus because they are the “bahus” (daughters-in-law) of the villages they work in. An eligibility criterion, among others, is that they should belong to the village where they are seeking appointment. The ASHA workers are supposed to act as an interface between the community and the public health system. Last year, the WHO conferred “Global Health Leaders Award” on ASHA workers.
Ground situation
Mamata, the ASHA worker of Baisaita village, in Meja block, says, “The honorarium is hardly enough to keep body and soul together. On top of that, it hasn’t been paid for the past six months. The ASHA bahus have become bonded labourers of the government.”
The husband of Bano Devi, an ASHA bahu of Fatuan village in Saidabad block, has become an invalid following a brain stroke. She has two daughters of marriageable age. Bano Devi was the sole breadwinner of the family.
Pramila, an ASHA bahu of Ghurepur village, works the fields in her free time to make ends meet. Her husband is also an agricultural labourer. They have three young children. The eldest is in Grade 1.
The husband of Sunaina, the ASHA bahu of Govindpur Tewar, is a farmer. They own two bighas of land, on which they grow wheat and paddy. But farming does not leave them with any surplus cash to meet daily expenses. Sunaina does not have money to pay the school fees of her three children.
Due to a spinal cord injury, the husband of Rekha Maurya, the ASHA worker of Bamrauli, cannot work. They need Rs 1,200-1,700 every month just for his medicines. Her daughter is in Grade 9 and son in Grade 12. School fees and electricity bill have to be paid every month. Rekha takes loans to purchase medicines for her husband. “When we demonstrated demanding payment of overdue salaries, the CMO of Kaushambi advised us that if our husbands do not work, we should divorce them,” she says, the shock written on her face.
Twelve-point charter of demands
Besides release of the withheld salaries, the ASHA workers have a 12-point charter of demands which includes raising the monthly salary from Rs 2,000 to Rs 21,000, making the services of ASHA workers and sanginis permanent, creating a cell to address sexual violence against them, extending benefits of Employees State Insurance Scheme (ESIS) to them and providing them with a health insurance of Rs 10 lakh and a life insurance of Rs 50 lakh.
(Translated from the original Hindi by Amrish Herdenia)
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