Underpaid ASHA Workers In Maharashtra On Strike For Fair Pay

The white/pink-saree-clad ASHA workers, often referred to as the 'foot soldiers' of public health, find themselves in a never-ending battle for dignity, recognition, and fair compensation. As the country struggles with the escalating demands for quality healthcare, these unsung heroines stand united in their fight for what they rightfully deserve: fair compensation.

Unsung Heroines in Sarees Demand Fair Compensation & Justice

ASHA, an acronym for Accredited Social Health Activist, not only embodies hope in its literal translation but also represents hope for countless communities across India. Established under the aegis of the National Rural Health Mission in 2005, ASHA workers represent a cohort of volunteers drawn from local communities who undergo specialized training to become conduits of healthcare information and support and serve as the vital nexus between underserved populations and essential healthcare services. 

At the 75th World Health Assembly, more than one million accredited female health workers were lauded for their crucial role in bridging the gap between communities and the health system. However, the current scenario paints a stark contrast to the recognition they received on a global stage.

Triple Shifts and Unseen Struggles

Led by the unwavering union leader, Rajendra Sathe, ASHA workers are undertaking an indefinite strike, drawing attention to their triple shifts—at home, in the community, and at health centers. These dedicated volunteers, primarily married, widowed, or divorced women aged between 25 and 45, symbolise the grassroots ethos of community engagement. Possessing requisite communication skills and a minimum educational background of up to Class 8, these volunteers are entrusted with the noble mandate of fostering health awareness and facilitating access to healthcare resources within their respective communities. Despite their crucial role in fostering health awareness and facilitating healthcare access, their tireless efforts often go unnoticed.

The advent of the COVID-19 pandemic thrust ASHA workers to the forefront of India's public health response. Tasked with community surveillance, contact tracing, and implementing quarantine protocols, these frontline warriors played a crucial role in containing the spread of the virus. Despite facing challenges such as stigma and resource constraints, their commitment remained unshaken. Yet, their indispensable contributions have not translated into financial stability.

The Heart of the Struggle

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As contractual workers, ASHA workers face the harsh reality of toiling without the security of permanent employment or the benefits accorded to government employees. Their monthly earnings, dependent on incentives tied to specific healthcare interventions, often hover between Rs 1200 to Rs 3000, leaving them vulnerable to economic instability. The heart of their struggle lies in the quest for equity and formal recognition of their invaluable service.

Key Demands Echoing in Unity

The core demands of  ASHA workers are clear and resolute:

1. Salary Increase: ASHA workers seek ₹7,000, while block invigilators demand ₹10,000. The urgency of addressing this matter is emphasized to prevent escalating frustration among the workers.

2. Inclusion in NHM Workforce: Beyond financial aspects, the demand includes the inclusion of block invigilators in the 30 percent of workers of the National Health Mission (NHM) to be absorbed as state employees.

3. Smartphones for surveys: Acknowledging the importance of digital surveys, ASHA workers request smartphones for conducting surveys, stressing the need for adequate facilities.

The Timeline of Broken Promises

Dr D. L. Karad, chief coordinator of the Maharashtra State Labour Employees Union Joint Action Committee, reveals a timeline of assurances given by state health minister Tanaji Sawant. Despite commitments made in November to implement salary increases, the government has yet to fulfil its promises, leading to the intensification of the protest. Chief Minister Eknath Shinde's assurance to deliberate on the matter during the upcoming state cabinet meeting is also met with scepticism as the protest gains momentum. The urgency for decisive action becomes palpable as the voices of ASHA workers demand not just attention but concrete resolutions.

ASHAs: Volunteers or Victims of Power Inequities?

A recent study supported by the Dr Amit Sengupta Fellowship on Health Rights sheds light on the struggles of ASHA workers, revealing the risks of malnutrition, anaemia, and non-communicable diseases. Their struggle extends beyond personal demands; it is a collective fight for the countless lives they touch daily. Experts also highlight that ASHAs operate within an axis of power inequities, where gender, caste, and the informal economy intersect. Designated as 'volunteers' rather than healthcare workers, they traverse layers of marginalization, facing economic, physical, and psychological violence embedded in their roles.

ASHAs not only grapple with healthcare duties but also endure extreme weather conditions without official recognition as 'workers.' Monetary barriers compound ASHAs' struggles, with out-of-pocket expenditures, delayed wages, and fixed honorariums creating a form of 'economic violence.' Gender and caste hierarchies also deepen their marginalization, with reports of abuse, harassment, and assault receiving scant attention. The lack of protective measures and acknowledgement of their vulnerability to heat stress adds up to the pyramid of systemic neglect they face. 

The white/pink saree-clad ASHAs, once labelled as 'volunteers,' now stand against economic and social precarity, demanding respect and compensation commensurate with their invaluable contributions to the nation's health. The question that looms is whether the system will acknowledge their worth before it reaches a breaking point.