Exclusive: Modi’s ‘Diwali Gift’ of Better Pay Turns Out to Be a Lie, Bihar ASHA Workers Now on Indefinite Strike
The backbone of India’s rural health systems, ASHAs remain the most overworked, underpaid (if paid at all) and neglected.
In September 2018, Prime Minister Narendra Modi, in his typical fashion, made big promises. He promised to hike the monthly honorarium of Accredited Social Health Activist (ASHA), ANM (Auxiliary Nurse Midwife) and Anganwadi workers across the country. “Those who drew an honorarium of Rs 3,000 will from now on get Rs 4,500 and those who used to get Rs 2,200 will get Rs 3,500,” he had said, dubbing this hike a “Diwali gift”.
Modi announced that these revised incentives would come into effect from October and would reflect in their salaries November onwards. This wasn’t all. The PM also explicitly assured these workers that they would be brought under social security schemes like Pradhan Mantri Jeevan Jyoti Bima Yojana and Prime Minister Suraksha Bima Yojana.
Come December, not a single one of these promises has been implemented. No fixed pay, uncertain status of employment and an unhealthy working environment have forced ASHA or health workers in Bihar to launch an indefinite strike on December 1. As per 2017 govt data, there are 85,879 ASHA workers in Bihar. As a consequence of the strike, Public Health Centres (PHC) across the state have not been functioning properly. The government, however, has not reached out to them yet.
ASHA workers in the eastern state have specific demands that include: recognition as government servants, monthly salary (fixed pay) instead of stipend, and inclusion in the Below Poverty Line (BPL) category.
Shashi Yadav, Bihar State secretary for the All India Progressive Women’s Association (AIPWA) and Bihar president for ASHA Workers’ Union, told NewsCentral24x7 that health administrators and seniors in the district health departments often misbehave with ASHA workers. They want the government to take note and ensure that the workers don’t face any form of harassment.
While some reports suggest that ASHA workers in Bihar are paid Rs 3,000 per month, Yadav refutes the claim. ASHA workers receive no fixed salary and only get performance-based incentives for promoting universal immunisation, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes. Among other things, they are also responsible for creating awareness on health issues and assist villagers in accessing health and health-related services like Antenatal Check-up (ANC), Postnatal Check-up, and supplementary nutrition available at the Anganwadi and primary health centres.
According to a Down to Earth report, these women are required to engage in 43 activities like preparing a malaria slide and providing DOTs (Directly observed treatment) for tuberculosis patients, among other things, depending on the area. For each activity, they are paid in the range of Rs 15-Rs 1000. At the end of the month, a combined sum of these incentives is what they are supposed to get. “The incentive amount for us is not fixed. We are paid very less for the activities. They usually give us a lump sum amount. Moreover, sometimes we receive the payment at the end of one month and sometimes after three-four months. Neither the time nor the amount is certain. The government should pay us Rs 18,000 per month,” Yadav said.
Communist Party of India (Marxist-Leninist) [CPI-ML] leader Dipankar Bhattacharya also underlined that the health workers get a pittance as “incentives” in lieu of a salary.
ASHA workers are now on an indefinite strike in #Bihar. They are the backbone of the healthcare system, but the government doesn’t even give them the basic recognition of employees. And they get a pittance as ‘incentives’ in lieu of a regular salary. Justice for #ASHA workers. pic.twitter.com/GUEGiwXmjr
— Dipankar (@Dipankar_cpiml) December 1, 2018
Manju Devi, a Patna-based ASHA worker, laments that sometimes, they are not paid any money at all despite their hard work. “While we put a lot of effort to make vaccination drives successful, in case one worker covers less than 50 per cent, she doesn’t receive any payment. If one manages to vaccinate 80-100 per cent of the target population, then only the incentive is paid,” Devi told NewsCentral24x7. Their demand is to remove this incentive-based method of payment, so that their hard work during such drives does not go to waste.
While most of these workers joined the ASHA programme due to financial needs, they have a strong urge to learn new things and achieve “something more”. “The government can provide us Auxiliary Nurse Midwifery (ANM) training,” Yadav suggested with optimism. “We also want to learn new things and get some sort of promotion. Should we simply remain ASHA workers all our lives?” she remarked.
According to a National Health Mission January 2017 report, there are 85,879 ASHA workers in Bihar, while the target was to recruit 93,687. The government is not recruiting new health workers in the state at present, which has increased the work pressure on the existing workers. “We want these vacancies to be filled,” Yadav said.
Even though the ASHA workers are not working, they have not stalled emergency services in PHCs. On December 10, these women plan to gherao district surgeons across the state and on December 11 they have planned to protest in front of the district collectorates. After that, they will assemble in Patna to protest and take their demands to Chief Minister Nitish Kumar’s doorsteps on December 13-14, Yadav said.