Jaipur,Rajasthan: “Last year, the whole country banged pots and pans, lit lamps and clapped for healthcare workers like us. Now it feels like it was just lip service,” says Vidya Tailor, a 55-year-old Accredited Social Health Activist (ASHA) from Rajasthan’s Malpura village.

She is upset over the low wages that ASHA workers receive despite risking their lives as they have done through the pandemic. They have been going door to door for contact tracing, screening people from high-risk groups, and now making people aware of the importance of vaccination. At the peak of the pandemic, they were receiving an incentive of Rs1,000 per month — Rs33 per day.

ASHA workers are not only underpaid but also neglected, Manju Prajapat, a 50-year-old single mother of three from Rohida village in Sirohi, alleges. That’s why ASHA workers — most are the sole breadwinners of their family — have been protesting for better pay and incentives for more than four months in Rajasthan.

“The past year has been stressful for us. We have reached our breaking point. We worked from early morning till late evening. Our neighbours stopped socialising with me because there was a risk of contamination. But we had to continue our work as there was a lockdown in place and my family had no other source of income,” she rues.

Accusing the state government of apathy towards their needs, Prajapat says, “If the Rajasthan government does not hear our demands, our family may collapse.”

'Pay more, regulate work’

Rajasthan has 55,816 sanctioned posts for ASHA workers, of which 52,248 are presently occupied. These workers were instrumental in Rajasthan's battle against the novel coronavirus. They reached out to the rural population in the remotest areas of the arid state all through the pandemic.

ASHA workers took their protest to the state Rajasthan Women and Child Development Department, outside collectorate offices and even outside the premises of the Rajasthan Assembly. Their demands include being given permanent posts, an increase in the incentives they receive so they get around Rs20,000 to Rs30,000 every month, promotions to the post of supervisors, and management under one department instead of the present two i.e. the state health department and Integrated Child Development Services (ICDS).

ASHA workers have also been seeking 30 per cent reservation for recruitment as an auxiliary nurse and midwife and implementation of labour laws in their field so they can be covered by regularisation of jobs, fixed hours of work and insurance.

‘We contracted COVID-19 on job’

Soon after the central government called for a countrywide lockdown amid the spread of the coronavirus in March last year, it announced the Pradhan Mantri Garib Kalyan Package under the India COVID-19 Emergency Response and Health System Preparedness Package. This is an insurance scheme introduced for the benefit of all healthcare workers. It included a life insurance cover of Rs50 lakh in case of death due to the virus. For ASHA workers, it included an incentive of Rs1,000 per month — this works out to Rs33 per day for toiling long hours to help control the spread of COVID-19.

ASHA workers at work. Credit: Ajmal Khan

In addition to this monthly Rs1,000 payment —which ASHA workers say they have stopped receiving since June 2020 — they were given Rs2,700 per month as an honorarium by the Rajasthan government. They earn around Rs3,000 from carrying out duties under the National Health Mission, which is paid by the centre. This brings their average earnings to Rs5,700 to Rs 6,000 per month.

“For the first four months, we were given just Rs33 per day for risking our lives. We didn’t receive any increments or facilities after that. We still don’t get personal protective equipment (PPE) as no one arranged these kits for us. We faced abuse as people would call us names and shut their doors in our faces. Many of us even contracted COVID-19,” says Prajapat, who tested positive for the virus in October 2020 but claims no one from the health department or ICDS reached out to her. She had to pay from her pocket.

Sita Devi, an ASHA worker for 16 years, had also contracted COVID-19 in November 2020. “My family had to admit me to a private hospital for at least two weeks as the government hospital lacked beds. We had to spend Rs50,000.” Even she did not receive help from either of the departments, she claims.

“Why did they stop the incentive of Rs1,000? It was already a very low amount compared to the personal risk we undertook while being on the frontline,” the 45-year-old from Jaipur asks. “When the entire country was under lockdown, it was us ASHA workers who were trying to prevent the spread of the disease [on the ground],” Devi adds.

Assembly refuses to act on demands 

According to Ajmal Khan, founder and convenor of Rajasthan Pradesh Asha Sahyogini Karamchari Sangh — a body that works for the rights of ASHA workers — around 40 to 50 ASHA workers contracted the novel coronavirus over the course of their work. To ensure they get sufficient remuneration for their work, ASHA workers presented a memorandum of their demands to the government in the wake of their protest this January.

“Our memorandum says that the amount of Rs2,700 is too less as a monthly honorarium,” Ajmal says. “They get the additional money only after performing additional duties, such as conducting vaccination and sterilisation awareness drives, institutional deliveries, reporting of women and child death, collecting bank account and Aadhaar details and making lists for the census.”

Only if they are paid the additional Rs1,000 can ASHA workers earn up to Rs6,000 every month for the extra duties they perform regularly. “Most ASHA workers are single or widowed women who need the money to feed their families,” he emphasises.

ASHA workers last protested outside the Rajasthan Assembly during its Budget Session. State Women and Child Development Minister Mamta Bhupesh had met them on February 16 and asked them to call off their demonstration. “We have heard their demands,” Bhupesh claims. “Regularisation of their jobs is not possible but we are trying to increase their incentives and also bring them under one department instead of two so that their wages and incentives come from one department and there is no lack of communication”, Bhupesh adds. 

State Women and Child Development Minister Mamta Bhupesh talks to ASHA workers. Credit: Ajmal Khan

At present, the honorarium is paid by the ICDS under the state Women and Child Development Department whereas the state Health Department looks over the payment of the National Health Mission (a central project) incentive. In fact, in January 2021, Rajasthan Chief Minister Ashok Gehlot had written to Prime Minister Narendra Modi. In the letter, he described the role of ASHA workers as significant and requested Modi to increase the incentive paid to workers under the National Health Mission. The prime minister has yet to respond to Gehlot’s letter.

Furthermore, Khan alleges that the government has made many attempts to foil the protests. “Earlier, they even came out with a letter addressed to chief medical health officers across districts to stop paying the honorarium of Rs 2,700 to those workers who were participating in the protests. The letter was issued by the Mission Director of the National Health Mission,” he says.

When the matter was brought up in the Rajasthan Assembly, the Women and Child Development Department claimed that their wages had already been raised to Rs2,500 per month in 2019. “The job of ASHA workers is voluntary. They are local women who work for the community and that is why the service rules as per labour laws do not apply to them,” the department said in the assembly. “The Rs2,700 they presently get is an honorarium plus they also get other incentives on completion of the work such as vaccination drops, census work, taking care of a pregnant woman, awareness of schemes of family welfare, etc.," Bhupesh adds.

On the demand for a 30 per cent reservation for recruitment as an auxiliary nurse and midwife, the department said they had already given 5 per cent reservation to ASHA workers willing to join the training course for the posts.