Mariyammma has worked as an ASHA (Accredited Social Health Activist) in Uyyalawada village of Andhra Pradesh’s Prakasam district for nearly 14 years. Through most of this span, she received very little income for her work, like many ASHA workers across states. After the YSRCP government came to power, her salary was hiked from Rs 3,000 to Rs 10,000 since August 2019. But this hasn’t made much difference to Mariyamma’s life. As she turned 60 in January this year, she was forced to ‘retire’ from work. Mariyamma, who lost her husband two years ago, says that both her sons do not have stable employment, which made her the primary breadwinner at home. The abrupt retirement without any benefits has put her family in a vulnerable financial state.
The salary hike to Rs 10,000 announced by the Jagan Mohan Reddy led government was a significant move, and a result of years of persistent struggle by ASHA workers in the state. With the hike came increased work responsibilities, which further shot up with the pandemic. ASHA workers and union leaders now say that the salary hike has come with the partial status of a government employee, with the associated drawbacks like enforcing retirement age and exclusion from welfare schemes. Despite the added workload, the workers do not get employee insurance, pension fund and retirement benefits.
‘Abrupt, disappointing retirements’
According to P Mani, honorary president of the Andhra Pradesh ASHA Workers’ Union, at least 250 ASHA workers have been forced to retire across the state in August, with Visakhapatnam district alone seeing 70 retirements. Workers and union leaders told TNM that in the fourteen-odd years since the ASHA program was started in the state, retirement was never mandatory at 60.
When the previous TDP government increased ASHA workers’ salary to Rs 3,000, the government order passed in this regard in August 2018 mentioned that ASHAs “who have completed 60 years will be permitted to retire and they will be covered under the scheme of old age pension.” The recent order from August 2019 increasing the salary to Rs 10,000 issued under the YSRCP government does not mention any retirement benefits.
Mariyamma, however, did not choose to retire. She insists that she can continue to work even now, as she needs the income.
“Setting a retirement age of 60 years is fine. But earlier, workers would voluntarily retire if they felt the need, and the opportunity would be given to a member of their family if possible,” she said.
Mani says that now, retirement has been made mandatory as it is done for government employees, but without any security. Noting that Anganwadi workers and helpers are given Rs 50,000 at the time of retirement, she says ASHA workers deserve similar provisions after toiling for more than a decade with little income.
K Dhanalakshmi, Secretary of the union, points out that some states provide a one-time honorarium amount of Rs 20,000 under NHM (National Health Mission) for ASHA workers retiring after ten years of service. But the retiring ASHAs in Andhra Pradesh, like Mariyamma, haven’t received this amount either.
“They have not asked me for any documents or signatures to make a record of my retirement. I was hoping that my daughter-in-law would be given the job, but the authorities have not been responding to our requests,” Mariyamma says.
Padma, who works as an ASHA in Vizag, points out the recent salary hike does not erase the years of labour done by the women, with minimal pay. “We have been underpaid all these years. Only in 2018, the honorarium went up to Rs 3,000. For the past one year, we are receiving Rs 10,000 per month. But before that, for nearly 12 years, all these women have essentially done free service. They should be given at least Rs 50,000 to Rs 1,00,000, so that they can retire with some security,” says Padma.
Pandemic and workload
Even as scores of ASHAs are made to retire, workers say that the average population that each of them cover has gradually been increasing. In some cases, ASHAs in the state say they are covering a population of 3,500 to 4,000 in rural areas, and at least 2,500 in urban areas.
While ASHAs always had a considerable workload, usually managed along with household work, with the pandemic, work has become a “hellish” experience, says Kusuma, who works in Polavaram mandal. Apart from their regular work, ASHAs now monitor COVID-19 patients under quarantine, check on people who have arrived from other states or countries, and conduct door-to-door surveys.
According to union Secretary Dhanalakshmi, at least 1,000 among the 40,000-odd ASHAs in the state have contracted COVID-19. Since the onset of the pandemic in the state in March, Dhanalakshmi says 20 ASHAs have died due to various reasons even as they were involved in COVID-19 duties, while six ASHA workers have succumbed to COVID-19. None of their families have received any support, she says.
Incentives announced by the Union government, like the compensation of Rs 50 lakhs under the Pradhan Mantri Garib Kalyan Package for health workers who died while treating COVID-19 patients, or the additional monthly incentive of Rs 1,000 for performing COVID-19 duties, granted under the 'India COVID-19 Emergency Response and Health Systems Preparedness Package' for the months of January to June.
No more welfare schemes?
With an annual salary of Rs 1,20,000, ASHA workers’ individual income lies exactly at the income limit for the Below Poverty Line category in Andhra Pradesh (for rural areas). With this, many ASHA workers who hold white ration cards and were previously availing welfare schemes are now deemed ineligible, say union members.
Several workers said that while most ASHAs have received the Amma Vodi scheme (financial assistance for mothers of school kids) launched earlier in January, the more recently launched Cheyutha scheme (financial assistance for women of SC, ST, BC and minority communities in aged 45-60 years) has been denied to many of them, along with other benefits like pension for widows. There is now fear among workers that they may not receive the next instalment of Amma Vodi either, Padma says.
Some ASHAs say that since the latest salary hike, there has been an attitude among supervisors that the workers do not require any other assistance. In some cases, ASHA workers say that supervising ANMs (Auxiliary Nurse Midwife) have been putting pressure on them to buy smartphones in order to fill in survey data online, while ANMs and village volunteers have received devices from the government for such jobs.
Mani points out that by only considering the recent pay hike, the government is overlooking their social conditions and their past status.
“Just because of the hike, suddenly people’s socio-economic conditions haven’t improved dramatically. Some of the workers are single or widowed women, without any financial assets. The government should at least conduct a survey to find the ASHAs who still need welfare. They shouldn’t be denied just because they are ASHAs,” Mani says.
Noting that municipal workers with a higher income than ASHAs are receiving welfare benefits, Mani says that in a similar manner, vulnerabilities beyond economic poverty must be considered for ASHAs as well. “Instead of acting like they’re doing favours, authorities need to understand that these are the rights of ASHA workers,” Mani says.