ASHAs Organise Huge March to Parliament

Ranjana Nirula

ON a chilly, foggy morning, on November 24, thousands of Accredited Social Health Activists (ASHAs) marched to parliament, carrying red flags and banners and raising slogans demanding recognition as workers, for minimum wages, for respect and better conditions of work: ‘We are health workers! Pay us wages!’  They made a colourful picture with many of them in uniform – some in pink, blue, green, navy, white sarees and some in white tunics. They were marching at the call of the All India Coordination Committee of ASHA Workers (CITU).

Their determination and unity was only too evident from the way they had braved long train delays due to fog, to reach the capital city, to place their problems before the government and to demand a solution to them.  In fact, large batches of ASHAs from Uttar Pradesh and Madhya Pradesh continued to arrive in the city late into the night, long after the rally was over, and some had to return from the station itself.

The ASHAs programme forms a critical component of the NRHM (National Rural Health Mission), which was set up in 2005 to run till 2012, to help improve the dismal state of health of the rural poor.

ASHA is a woman selected by the community, resident in the community, who is trained and supported to function in her own village to improve the health status of the community through securing people’s access to health care services, enabling improved health care practices.

ASHAs do all the basic work of the health department on the ground – helping to implement all government health schemes, creating awareness about good health and sanitation practices, counseling women and ensuring maternity care and safe childbirth, mobilising the community and facilitating them in accessing health and health related services, such as immunisation, sanitation and other services being provided by the government. They also conduct health checkups of school children, provide primary medical care for minor ailments and DOTs course for TB patients, prepare malaria slides, and conduct surveys for diseases like TB, leprosy, etc. Their work in encouraging and enabling institutional deliveries has helped in bringing down the infant and maternal mortality rates in the country.

The ASHAs have to inform about the births and deaths in their villages and promote construction of household toilets. In addition to all these functions, they also work with the village health and sanitation committee of the gram panchayat to develop a comprehensive village health plan.

All these tasks entail at least 5-7 hours work a day but the government considers the over eight lakh ASHAs as part time, voluntary health activists, who supposedly are involved in some other income generation activity and do this work only in their spare time. As a result ASHA workers are not paid any wages for all this work – all they receive for their labour and efforts are meager incentives for the tasks performed.  In fact, the incentives are so low that in most states ASHAs get only between Rs 500 to 1000 per month, and the majority belong to families with an income of only Rs 1000 to 3000 per month. Considering the crucial nature of the work they do, they should be regularised as health workers and paid the statutory minimum wages in the state.

The ASHAs understand that they will be able to perform their duties better if the government health facilities are improved, so they are raising this demand as well, for the benefit of the community. The government health services at present are grossly inadequate in terms of staffing and facilities – there are too few doctors, nurses, lab technicians, auxiliary staff, not enough equipment, medicines, inadequate infrastructure, etc.  

It is in this situation that ASHAs work and they confront many other difficulties as well.  Their incentives are not paid regularly and there is corruption in payment. They perform many tasks for which no payment is made. Medical kits and medicines are not provided regularly, and in many cases identification cards/uniforms are not issued. One of the worst problems is the harassment they are subjected to by the staff and employees in government health facilities, as they are considered mere ‘volunteers’ with no standing or status. When they take a patient to the health centre, the patient is taken inside but the ASHA, who has come from a far off village, has to wait outside, with no shelter, in all kinds of weather. They have no social security benefits or any conveyance allowance for visits to the health facilities. In many cases they end up spending more out of their own pockets than what they receive as incentives.

The CITU had formed the All India Coordination Committee of ASHA workers at a convention held in Delhi in February 2009 to draw attention to the problems of ASHAs and to organise them.  For the past two years, ASHAs have been struggling and agitating for regularisation as health workers, for minimum wages and better working conditions.  They have formed unions in 16 states and have conducted innumerable agitations for their demands, and in some states have been successful in getting some problems solved. Last year on May 4, 2010, thousands of ASHAs had marched to parliament and submitted a memorandum to the health minister Ghulam Nabi Azad, but got no positive response from him.    

The large gathering of more than 6000 ASHAs at Parliament Street on November 24, 2011 was addressed by many leaders and ASHAs from all the 15 participating states.   Ranjana Nirula, convenor of the All India Coordination Committee of ASHA Workers, addressing the gathering, detailed the deplorable conditions of work of ASHAs and how the government was treating their work, which is crucial for the health of the poor, just as an extension of their housework, to be done for free, for society. She stated that the government is extracting unpaid labour from ASHAs, instead of giving them their due recognition as health workers. Shamefully, funds are lying unutilised but the ASHAs are not getting their dues.

Tapan Sen, general secretary of the CITU, stressed the importance of ASHAs being recognised as workers and their being an integral part of the working class. Brinda Karat, CPI(M) Polit Bureau member and ex MP Rajya Sabha, in her impassioned speech spoke about the exploitation of ASHAs by the government and urged them to organise and struggle for their rights. Sitaram Yechury, Polit Bureau member of the CPI(M) and MP, Rajya Sabha, assured the ASHA workers that he would raise their problems in the parliament. A K Padmanabhan, president of the CITU stated that the CITU would continue to fight for the rights of the ASHA workers, along with all workers. A R Sindhu, convenor of the All India Coordination Committee of Mid Day Meal Workers pointed out how the government gives both these sections of workers a pittance while extracting hard labour from them. Sudha Sundararaman, general secretary of the AIDWA, Vijoo  Krishnan, joint secretary of the AIKS and Veena Gupta, secretary of the AIFAWH, assured the ASHAs of the support of their organisations.

A delegation led by Basudev Acharia, CPI(M) MP, Lok Sabha, and comprising of Ranjana Nirula and ASHA leaders from nine states met the health minister, Ghulam Nabi Azad and submitted a memorandum to him. The minister assured the delegation that the NRHM would be extended for another term. He conceded the demand for split payment for prenatal checks ups and delivery under the Janani Suraksha Yojana, but was adamant about regularising the ASHA workers as government employees, saying that they would not work if this was done. He did not agree for paying them a monthly remuneration, or raising the incentives, even though these have been recommended by the Parliamentary Committee on Empowerment of Women and the Mission Steering Group of the NRHM.  In fact, he stated categorically that all future schemes would be only incentive based.  Casualisation of the workforce and intensified exploitation is clearly the pattern being followed by the government.

When the response of the health minister was conveyed to the ASHAs, they took up the challenge and resolved to fight still harder to achieve their just demands.

They also decided to join the all India general strike called jointly by the central trade unions, in the forthcoming budget session of the parliament.

The ASHA workers returned from Delhi enthused by their growing unity and strength and determined to fight for their rights, as part of the working class movement.

Demand Charter

·        The NRHM be made a permanent programme

·        Pending regularisation of ASHAs as health workers, they should be paid a fixed monthly remuneration, equivalent to the statutory minimum wages in the state, in addition to the incentives

·        Government health facilities should be improved

·        Harassment of ASHAs should be stopped

·        Rest rooms for ASHAs should be provided in all health centres

·        All the incentives and TA/DA should be paid promptly and regularly through bank/post office accounts

·        Social security benefits including gratuity, insurance, pension should be provided to ASHAs

·        ASHAs should be given uniforms, ID cards, bus passes and a mobile phone allowance. 

·        They should be given appropriate training and promoted as ANMs.