Most mornings, Sathi Lal is woken up by the sound of her phone ringing at 5 or 6 am. Rubbing the sleep off her eyes, she answers the call of a worried individual – someone they know is very sick, coughing, could it be COVID-19? Sathi listens patiently, tells them what to do, and walks towards the kitchen. As she makes tea, she starts making calls. There are about a couple of dozen calls to make – to COVID-19 patients in her ward in Thenmala panchayat, Kollam. Balancing the phone in the crook of her neck, she gets on with the chores at home. Her work has just begun.
This is the typical day of an ASHA worker now, Sathi says. Once the calls to check the condition of the patients in her ward are done, she has other tasks lined up for the rest of the day. She has to report to the Primary Health Centre (PHC) whatever she’s learnt in her calls – details of newly infected persons, difficulties developed by other patients, and so on. In return, she gets a list of medicines that she then supplies to the patients in the ward.
“The PHC itself is a good 15 km away. And we don’t even get the travel fare for that trip, let alone the basic protective gear like masks and sanitisers. We had to go on strike to get some masks. At the vaccination centre or PHCs, we do not get Protective Personal Equipment (PPE), unlike other health workers. The least they could do is recharge these phones that we need to use all through the day,” Sathi says.
It has been a long ongoing struggle – this fight for payments, compensations, recognition – for the ASHA workers. Now, they are fighting a new battle to get the honorarium pending since March.
From a protest in August 2020
ASHAs – Accredited Social Health Activists – fall under the National Health Mission of the Union Government. They get an incentive from the Union Government as well as an honorarium that is deployed through the respective state governments.
“Every time there is a delay, we hold protests and then they pay. The last protest was in February this year, when 2,000 ASHA workers came together in front of the Secretariat demanding the pending honorarium for three months. The same night they credited the dues. We had to fight like this for all our needs, all these years,” says S Mini, state convener of the Kerala ASHA Health Workers Association.
When they began working 12 years ago as “volunteers”, the honorarium was Rs 100 a month, Mini says. They were to talk to women at public places about vaccination, TB injections for their children, and other such health-related issues.
Watch: A day in the life of an ASHA worker, from April 2020
“It is through relentless strikes that the Rs 100 honorarium was increased to Rs 6,000 now. The last Rs 1,000 hike was announced in this year’s budget. And even this honorarium comes with a number of criteria that the ASHA workers need to meet – being present in meetings, finishing certain tasks and so on. If any of these tasks are unfulfilled, they lose that much money,” says Mini.
The Union government incentive too comes with criteria – and varies depending on the number of tasks they finish in a month. It could be Rs 50 for getting someone to take an injection. “If the specified target was to get 10 kids injected and they could only get eight, then they lose the payment for that task,” says Mini.
Added to all the cuts is the delay that they just can’t bear. “Every time we ask about it, they tell us the ‘site’ (website where their details are accessed) has not opened. And when we protest on the streets, the site somehow opens that day and we get paid. But our situation is just too sad. We work for hours at a stretch and most of us walk several kilometres to reach houses for COVID-19 duty and don’t even get paid for it. Most of us are the sole breadwinners of our homes so when the honorariums get delayed, the whole family is affected,” says Omana, an ASHA worker in Thiruvananthapuram.
Omana visiting a house on COVID-19 duty in Thiruvananthapuram
Earlier ASHA workers used to do other odd jobs, such as stitching, to earn extra income. But at one point the state government said they should only work as ASHAs, says Mini.
It worsened with COVID-19, they say. Now even if they want to take up an extra job, they just don’t have the time for it. In addition to following up with patients in their ward and taking medicines to them, they also have duty at vaccination centres.
“At first we had to visit people’s homes and tell them to take the vaccine. At that time they were hesitant. Now with the surge in cases, everyone wants to take it. Registration is online and many of them either don’t know how to do it or don’t have smartphones. So we had to go home and register online for them. Now we tell younger people at their homes how to do it over a phone call. We also have to prepare lists of all those who are due for their second dose and send it to the PHCs. At 11 pm, they call and inform us which wards and which people are to get their injections the next day, and then we wake them up at that hour so they don’t miss it,” Sathi says.
After their long working hours making calls and home visits, they further need to spend time filling forms to report all the updates and answer several questions, says Mini. And going to places where patients gather – vaccination centres and hospitals – without PPE kits, causes them to turn into patients themselves, she adds. At least 30% of the health workers who test positive every day would be ASHA workers, she reckons.
“There are about 27,000 ASHA workers in the state. So for all major tasks – such as COVID-19 duty – the government needs such a force to get things done. But at all other times, there is absolutely no consideration for these workers, the majority of whom depend on the meagre pay for their livelihood. Their husbands are mostly daily wage labourers who had lost work during the pandemic. This honorarium is very important to them,” Mini says.