Unseen Warriors of COVID: Give us what is ours, say Mumbai's ASHA workers struggling for job security and pay hike

Editor's note: As the second wave of coronavirus infections ravages parts of India, millions of front-line workers and citizens are caught up in the middle, providing their services to distressed families on one hand while trying to cope themselves on the other. This is part eight of a series profiling the stories of these people.

The Accredited Social Health Activists (ASHAs) hired under the Centre’s National Health Mission(NHM) have been crucial to Mumbai’s fight against the COVID-19 pandemic since 2020.

They, along with other healthcare workers, have been on field each day for door-to-door contact tracing, screening COVID-19 patients, ensuring that the high-risk and low-risk contacts are quarantined and following up with them to check for symptoms, oxygen levels and temperature regularly until they recover.

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They do that in addition to their 72 other regular duties which include pre-natal and post-natal care for pregnant women, immunisation drive for children, population-based screening for disease surveillance, arranging meetings for Mahila Arogya Samiti under NHM and distribution of condoms and necessary medicines, among many other responsibilities, according to the Performance Improvement Plan documents of the National Urban Health Mission, the urban wing of NHM, for 2020-2021.

The varied list shows that they have always been working as the frontline health workers even before the pandemic.

However, the incentives for these activities range from Rs 15 to Rs 500 per activity; the earning is based on the number of patients catered to under each category of work.

A team of one Community Health Volunteer (extreme left), one Auxiliary Nurse Midwife (extreme right) and six ASHA workers leave the Shanti Nagar Health Post (H/E Ward) for field surveys. Image procured by author

The Municipal Corporation of Greater Mumbai has been implementing the NUHM since 2013-2014 in Mumbai city and suburban areas.

According to a letter, dated 6 December 2019, written by the Executive Health Officer (EHO) to the NUHM director, 725 ASHA workers were sanctioned under the Municipal Corporation of Greater Mumbai (MCGM) for the year 2019-2020. Of which only 220 ASHAs were working then.

ASHA workers’ representatives said that number has now come down to around 150.

Insufficient honorarium as compared to the cost of living, pending payments, added responsibilities and no fixed employment are the issues that urban ASHA workers face while they continue to carry out their COVID-19 responsibilities in addition to their regular work.

Payment pending for months; no hike

ASHA workers receive only Rs 1,650 each from the Centre and the state, that is, their monthly basic total income is around Rs 3,300. In addition to this, some added incentives may raise the total income to Rs 4,000.

“We were getting COVID allowance of Rs 1,000 per month. Before this we got Rs 1,650 only as a basic salary. People don’t believe us when we say this. But it is the truth,” said 40-year-old Shubhangi Gaikwad, who has been working as an ASHA worker at the Shanti Nagar NUHM Health Post in H-East Ward of Mumbai.

Four ASHAs visiting a COVID-19 patient at Dowri Nagar slum area in H/E ward of Mumbai, for screening and contact tracing. Image procured by author

“Ever since the pandemic began in March 2020, we had been encouraging people to follow procedures. We received the COVID allowance only till September or October. Since October, we have not received anything,” said 42-year-old Anuja Panchal who has been working as an ASHA for six years  at the Shanti Nagar Health Post.

“Our work is not very different from the Community Health Volunteers (CHVs) whose basic salary is Rs 5,000 to 9,000. We also do the same thing, but do not receive the proper payment for it,” she added.

When asked about the money spent on traveling to areas located in the interiors of the wards, 43-year-old Meena Gurav said, “We walk in the scorching sun, we don’t spend on auto rickshaws. How can we spend Rs 40 to 50 on auto every day from Rs 3,000 to 4,000 that we receive? Even that has been pending since two months.”

According to the ASHA workers’ union leaders, there is a glaring gap between the honorarium provided to rural and urban ASHAs. However, they still believe that the urban ASHAs would be paid the arrears soon.

43-year-old Meenal Gurav said people still try to hide the fact that they have tested positive for COVID-19. Image procured by author

“Mumbai ASHA workers are yet not receiving the hike because of the delay caused by the municipal corporation. We have written many letters too in this regard. Since 2014, MCGM has been looking after the implementation of NHM in Mumbai, but they say that training of ASHAs is pending and give other reasons that really can't be verified,” said Rajesh Singh from the union, Maharashtra ASHA and Gat Pravartak Sanghatana.

“The COVID allowance also varied and ranged from Rs 300 to Rs 1,000. There were inconsistencies in that too. ASHA workers in some areas received it and some did not,” he added.

The EHO in the 2019 letter had proposed a hike for ASHA workers’ honorarium under the MCGM at par with the CHVs who receive Rs 5,000 to Rs 9,000 as their basic salary for the year 2020-2021. However, nothing in that regard has happened yet.

Coping with social stigma

ASHA workers have been the first victims of the public's fears of COVID. Many of the workers spoke about dealing with social stigma while discharging their everyday duties.

Shubhangi Gaikwad, 40, who has been working as an ASHA for over a year, said people don't believe her when she discloses her salary and allowance. Image procured by author

“We faced a lot of complications in the beginning. But we dealt with people patiently because we know they are scared of COVID-19,” said Shubhangi Gaikwad.

“We do not get into arguments with them as we have to return to the same area for work. We have to explain patiently and convincingly. This is how we are carrying out our responsibilities,” she added.

The women said there were times when people even tore their books, slammed the doors on their faces and refused their entry into chawls.

When asked about the current situation, Anuja Panchal said, “Now we have developed a rapport with them. They recognise us now and are trying to understand our work.”

In addition to the stigma they face at work, ASHA workers are facing similar treatment at home and in their neighbourhoods. To cope, they say they have stopped engaging with neighbours and avoid conversations about work.

Sheetal Harale said her line of work has left her facing trouble at home. Image procured by author

“Our families don't let us play with our kids. Our in-laws don't let us do anything at home and also direct barbs at us," said 33-year-old Sheetal Harale, who has been working as an ASHA worker for five months.

Talking about the difference between the first and second wave of the pandemic, Meena Gurav said, “People still try to hide the fact that someone has tested positive and are afraid of shifting to the quarantine centres.”

“They feel someone will beat them there or will charge them for the services. So, we speak to them politely and patiently that there’s nothing like that and they will return to their homes safely. We explain everything to them,” she added.

Demands for honorarium raise and fixed employment

While they have been at the forefront of various disease surveillance programmes including tuberculosis, leprosy, HIV-AIDS and other health-related schemes or campaigns and now COVID-19, they are still struggling to be recognised as full-time employees instead of mere community volunteers, activists or helpers.

42-year-old Anuja Panchal has been working as an ASHA for six years at the Shanti Nagar Health Post. She is well known to the people in the areas of H/E ward. Image procured by author

“We are not recognised as employees and do not get any other security benefits. At least give us our honorarium on time. It is rightfully ours,” said Anuja Panchal.

“We have worked for tuberculosis, cancer field surveys and now the field work for ‘My family, my responsibility’ programme… We have done everything and have submitted all the reports. We should at least get a payment of Rs 10,000 for all the different duties we do and the risks involved in our work,” she added.

Raju Desle, leader of the Maharashtra ASHA and Gat Pravartak Sanghatana, said “We have demanded at least Rs 18,000 monthly basic income for the ASHA workers, because they have been working for COVID-19 in addition to their 72 regular duties.”

In a letter, dated 5 April 2021, to the Chief Minister’s Office, Desle and other members of the organisation flagged issues regarding unjustifiably low wages and delayed payments for overworked ASHAs in urban areas.

“On 17 July 2020, the state government proposed a hike of Rs 2,000 for ASHA workers, but Navi Mumbai, Mumbai and other municipal corporations have not yet been covered under the proposal. And those who have implemented the proposal, pay Rs 300 to 400 lower than the set amount under various pretexts,” the letter provided by Desle read.

“ASHA workers also have been working for 7 to 8 hours per day during the pandemic including the weekends and holidays, and will be pushed to do so in future too. Hence, they should be given permanent employment in the state government service,” the letter read.

Multiple calls to the state programme director of NUHM went unanswered.

A list of questions concerning the implementation of NHM in urban areas and the issues faced by ASHA workers was sent to the state NHM department and the nodal officers of NUHM.  The article will be updated if and when they respond.