It was around 1am. Rekha was inside a small car heading towards Tumakuru District Hospital. A worried mother sat beside her, holding a baby who had fallen sick after a routine vaccination earlier that day. The village was asleep at that hour, but Rekha did not hesitate when the call came. She accompanied the family to the hospital and made sure the baby received treatment. A few hours later, she was back in her village Doddmalalavadi in Kunigal taluk of Tumakuru district, ready to begin another day of work.
Rekha, 32, is an ASHA worker under the Bhaktharahalli Primary Health Centre (PHC) and is responsible for nearly 1,000 people across three villages, D Gollarahatti, Doddmalalavadi and Vaanigere.
Her day is built around the health of pregnant women, new mothers and infants. She moves from house to house, checking on expectant mothers to ensure they take their medicines on time, eat healthy food and attend regular check-ups.
After a delivery, she visits the mother and baby at least eight times within 42 days to monitor their health. The 42-day period is crucial for maternal health. The World Health Organisation guidelines stipulate that the death of a woman within 42 days of delivery be considered a maternal death.
Given that pregnancy affects sugar and blood pressure levels, ASHA workers also need to keep track of changes in blood pressure and sugar levels.
Rekha’s own journey into this work began early. She was married at 17 and moved into her in-laws’ house. When financial difficulties arose in the family, she became an ASHA worker. Over the years, the work became both a responsibility and a routine that rarely follows fixed hours.
“People call in panic when their child is sick,” she says. “In my family they sometimes ask why I need to drop everything and go when people call at odd hours. But when they call like that, crying and worried, I never feel like ignoring them. At that moment I don’t think about whether it is day or night. I only think about the child and the family who are waiting for help,” says Rekha.
Beyond home visits, Rekha 's work also involves a large amount of work and documentation for both communicable and non-communicable diseases.
She maintains records for all 1,000 people in her area and uploads their information to the National Non-Communicable Disease (NCD) Portal. The data includes more than 30 details for each person such as information about diabetes, blood pressure, HIV, leprosy and other diseases; whether people take medicines regularly, and whether they visit hospitals for treatment.
Many ASHA workers, Rekha says, struggle with the digital demands of the job. “Some studied only till 8th or 9th standard and do not know how to use touch-screen phones properly,” she says, including herself in that category. Some, Rekha included, depend on their children to upload data, but others have left the job because of the pressure.
ASHA workers like Rekha are also crucial in preventing vector-borne diseases such as malaria and dengue. For this, ASHA workers are roped in to conduct larva surveys once every month.
Rekha goes house to house checking water drums, containers and even washrooms to ensure there is no stagnant water where mosquitoes could breed. She spreads awareness about dengue and chikungunya and uploads GPS-tagged photographs of houses as proof of work.
At the same time, she records everything in registers — her ASHA diary — adding to the workload.
“If we tell people our salary, they don’t believe it. ASHA workers have played an important role in reducing infant and maternal deaths, but still we are getting very low wages,” she says.
The government refuses to dignify their work with a salary, and instead calls it an honorarium. Rekha gets an honorarium of around Rs 7,000 a month. In the 11 years she has worked as an ASHA, the pay was increased only twice, and only after massive protests during which ASHA workers from across the state converged in Bengaluru, forcing the government to hastily clear pending salaries.
Even uniforms were given only after workers demanded them. Now, discussions about removing 7,000 ASHA workers in Karnataka and redistributing the workload have created fear and uncertainty among them.
Retirement benefits, she adds, are also limited in Karnataka. ASHA workers receive only Rs 20,000 after retirement, while some other states provide higher amounts
Despite the challenges, Rekha says the trust of the community keeps her going.
“The people in the village treat us like their own family,” she says. “Sometimes they don’t allow us to leave without eating food or having coffee. Even if we say no, they insist. Sometimes they even go to nearby shops to buy snacks specially for us.”
The connection often lasts for years. “When the child grows up, some mothers tell them, ‘See this aunty helped a lot during your birth.’ Hearing that makes me very emotional.”
Families also call her after a baby is delivered safely, even though it is not officially part of her work. When she visits, they often offer sweets and thank her for the support.
Rekha says that even ASHA workers who leave the job are not easily freed from its responsibilities. People continue to seek their help out of habit and trust. “They keep coming to ask for medicines or to go to the PHC,” she says. “Once an ASHA, always an ASHA, even if you quit the job.”
Alongside her work, Rekha recently completed a degree in Sociology and Kannada through correspondence from Tumakuru University in 2024. She hopes that one day the government may appoint ASHA workers as permanent employees.
Looking back, she sometimes wonders how life might have been different. “If I had completed my degree before becoming an ASHA I could at least have become a teacher,” says Rekha.
This article was written by a student intern working with TNM.