The exploitation of frontline ASHA workers amid COVID-19

ASHA workers are at the forefront of the coronavirus crisis, but delays in wages, lowered compensation and little recognition for lives lost due to the virus have left them without recourse.
Lugging a vaccination box and carrying a child on her back, an ASHA worker on her way to vaccinate people, wades through a water stream
Lugging a vaccination box and carrying a child on her back, an ASHA worker on her way to vaccinate people, wades through a water stream

This story is a part of the TNM COVID-19 reporting project. To support this project, make a payment here.

When Jayalakshmi, a frontline worker as part of the Accredited Social Health Activists (ASHA) system in Telangana, was infected with COVID-19, she could not find a hospital bed amidst the deadly second wave that claimed over 1.5 lakh lives in the country. The period between March and May was marked by a severe shortage of beds and oxygen cylinders, and Jayalakshmi, who worked with the Kadthal Primary Health Centre in Nirmal district, was unable to find room at the district’s government hospital. She was then rushed to another hospital in the neighbouring district of Nizamabad, but there was no oxygen. On April 27, she lost the battle with COVID-19.

Jayalakshmi, the ASHA worker who died due to COVID-19

Her name was added to a grim statistic that has emerged in the state — she is among 10 ASHA workers who died in Telangana due to the coronavirus while performing duties that put her in the forefront of the crisis.

When the role of government ASHA workers was first created in 2005, these women were primarily meant to help rural communities access health-related services, including postnatal care for women and Integrated Child Development Services. But since the pandemic, they have been tasked with the arduous work of combating the disease, from conducting COVID-19 tests to checking patients in home isolation. Though ASHA work is semi-voluntary in nature — workers are paid based on tasks performed — the paltry earnings are hardly fair compensation. And according to the ASHA workers’ union, the death toll for their colleagues is much higher than the official account — at least 20 other ASHA workers have died in the state due to the virus, without any proper recognition from the state government. In the neighbouring state of Karnataka, 22 ASHA workers had died since the pandemic in March 2020, out of which 16 of them had died due to COVID-19. Among those who died due to COVID-19, only two of them have received compensation so far, according to Samyuktha ASHA Karyakarteyara Sangha (SAKS) - the union of ASHA workers in Karnataka.

“Jayalakshmi left behind a 19-year-old son and 17-year-old daughter who are pursuing their education. The family is in desperate need of money to continue their education, but all we get is meaningless petal showers. What is the use when we are forced to struggle like this?” said B Sujatha, TVCHU president of Nirmal district.

Under the Union government’s ‘Pradhan Mantri Garib Kalyan Package Insurance Scheme’ for Health Workers fighting COVID-19, the family of deceased ASHA workers should receive a compensation of Rs 50 lakh. Out of 26,000 workers in Telangana, 30% of them have been infected with COVID-19, the union said.

But none of the deceased ASHA workers’ family members, including Jayalakshmi’s, have received any ex-gratia so far, according to Telangana Voluntary and Community Healthworkers Union (TVCHU), the state association of ASHA workers led by the Centre of Indian Trade Unions (CITU). While the DMHO had collected Rs 50,000 in donations for Jayalakshmi’s family, the much-needed Rs 50 lakh compensation is nowhere in sight. 

For workers and activists, it’s a stark reminder that the work of these women are neither acknowledged in life or death. 

“It is pure exploitation,” said Bhanupriya Rao, who researched the working conditions of the ASHA system. “Many women from the marginalised communities join as ASHAs thinking that since they are working for the government and that their jobs will be regularised at some point. But all their hopes have faded. Despite a decade into service, their income must have increased by a mere Rs 1,000. Perhaps, the only job with such a petty raise,” she said.

Overworked without any incentives

In September 2020, the Telangana government had ensured ASHA workers received a fixed monthly amount of Rs 7,200 for three months, including the state government’s incentive of Rs 750 and the Union government’s Rs 1000. 

“For the work we do, it was very less. And this was for just three months. In the second wave, the state government has not announced any incentives. There is a need to give incentives for COVID-19 duty. The only time we are not working is when we sleep. We are extremely exhausted,” said P Jayalakshmi, state president of TVCHU. 

Sujatha, an ASHA worker and Nirmal district president of TVCHU, doing a health survey

Due to the COVID-19 crisis, on an average, work hours have increased from 6-8 hours a day to almost 12-15 hours of work per day, while being on call for almost 24 hours, a study carried out by Behan Box said. Behan Box carried out the study to highlight the role of the frontline workers fighting the COVID-19 crisis. The study was conducted in 10 states which include Assam, Bihar, Haryana, Jharkhand, Karnataka, Maharashtra, Madhya Pradesh, Delhi, Telangana, and Uttar Pradesh.

Workers at the forefront of the COVID-19 response, including ASHA workers, Anganwadi Workers (AWWs) and Auxiliary Nurse Midwives (ANMs), say that they have been severely overworked and underpaid during the pandemic. “We are denied basic human needs. During the vaccination duty at PHCs, we are not provided with water or food,” Sujatha, Nirmal District president of TVCHU said. The TVCHU has even asked officials to provide these facilities, including furniture for them to sit on during shifts. “How can we work without basic needs from 9 am - 4pm?” Sujatha said.  

As part of the COVID-19 duty, the ASHA workers are asked to carry out health surveys in villages, conduct COVID-19 tests, and monitor the health of COVID-19 patients under home isolation, though without adequate safety equipment from the government.

“We are being harassed. We are not provided with any leaves since the pandemic set in. Even when we go for a funeral, we are asked to immediately report to duty,” Sujatha  added. 

Job regularisation has been one of the key demands of the ASHA workers in Telangana. In 2019, the Andhra Pradesh government fixed the salary of ASHA workers at Rs 10,000, though incentives were removed. Last week, the Maharashtra government announced that ASHA workers would get an increment of Rs 1,000 in their wages and Rs 500 as COVID-19 allowance per month from July along with a smartphone, following protest by the frontline workers.

But in most states, ASHAs do not have a fixed salary and they rely on incentives received only after logging tasks as listed under the National Health Mission. This includes mobilising the community and facilitating people’s access to health at village, sub-centre, primary health centres, immunization, Ante-natal Check-up (ANC), Post-natal Check-up (PNC), and sanitation. 

In Kerala, ASHA workers are given an honorarium of Rs 6,000 a month with the last thousand rupee hike announced in this year's budget. Even this amount is paid only if they meet a number of criteria, such as being present in meetings and finishing certain tasks. If any of the tasks are unfulfilled, they lose that much money.

In an earlier interview to TNM, state convener of Kerala ASHA Health Workers Association S Mini said that there is often a delay in paying them on time, and every few months they end up holding protests in the streets to get their pending honorarium.

On March 21, the Telangana government announced a pay hike of 30% to all government employees, and contract and outsourcing workers who are part of the government machinery. While ASHA workers are included in the Pay Revision Commission, the workers feel they have been “cheated” out of job regularisation.

“What exactly does a hike of 30% to a salary of Rs 7,500 mean? It hardly makes a difference. How will we make a living with such a nominal amount? We need job security with fixed income and benefits like pension and health insurance cover. This has been our longstanding demand,” P Jayalakshmi said. 

TNM reached out to Telangana Commissioner for Health and Family Welfare Vakati Karuna, to verify the claims around infections, incentives and the official death toll of ASHA workers due to COVID-19. The commissioner did not respond to several requests for comment. 

Conditions across the country

According to the Behan Box study, the income of ASHA workers in Telangana fell anywhere between Rs 3,000-5,000 during the pandemic, and in Haryana and Bihar by Rs 1,000-1,500. 

Behan Box conducted interviews with 95 ASHA workers across the 10 states, out of which 86% of them reported a drop in the income due to the suspension of routine tasks, such as immunisation, pre and ante natal care. Over 31% of ASHA said that they had not received the Central government mandated COVID-19 incentive of Rs 1000 between January to September. 

Both the ASHA and AWWs were pushed into debt burden during the pandemic due to inadequate remuneration and delay in payments amidst job losses in their families, Behan Box’s study revealed. ASHA workers were forced to invest in smart phones for their children’s online education and expenses out of their pockets to buy protective gear.

Out of the 201 respondents, including the Auxiliary Nurse Midwives (ANMs), 19% of them said that they have sold household assets and pawned jewellery to meet expenses or borrowed from self-help groups, family members, co-operative banks for loans.

In Karnataka, ASHA workers have been forced to work 12 hours a day, according to SAKS. The study by Behan Box reveals that Karnataka is not the only exception.  

The Karnataka state government provides a fixed sum of Rs 4,000 each month to ASHA workers. The remaining pay comes from the Union Government based on incentives received depending on the amount of work. ASHA workers on average are able to do Rs 3,500 to Rs 5,500 of work.

Adding to their complications, the Karnataka government has linked the Reproductive Child Health portal with the Union government’s ‘ASHA Soft’ — a portal where ASHA workers have to feed in data regarding the work done by them in order to claim incentives. SAKS alleges that due to this software, ASHA workers lose about Rs 1000 to Rs 1500 on average since many are not equipped to use the software. What’s more, it’s alleged that work is often not recorded properly, causing further loss of pay.  

With inputs from Shishir Rao

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