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A cover image showing two images of ASHA workers checking an old woman's oxygen saturation with an oxemeter and helping a couple with medication for their baby in rural India
ASHA workers are helping India's rural population access basic healthcare. Photo courtesy: D. Nagalaxmi

Health

Mental Health Is a Privilege for These ASHA Workers Battling Low Pay and No Protection

‘These women see grief, poverty, and anxiety daily and don’t even have the tools to process it.’

Kuldeep Kaur needs to buy face masks and gloves but she finds she doesn’t have enough money for these essentials, otherwise she and her family may have to go hungry for a couple of days. “I’ve been using the same mask for a while now,” the 49-year-old said.  

Kaur is an ASHA worker (Accredited Social Health Activist) for the Indian government under its National Rural Health Mission, and like millions of other ASHA workers, Kaur acts as an intermediary between the government and the country’s large rural population, building health awareness, acting as a primary medical officer, and implementing the health policies at the ground level. Most ASHA workers are women, many of whom are the sole source of income for their homes. But for the past year and a half, since the start of the pandemic, these essential workers have tackled quickly deteriorating conditions with little to no pay, recognition or protection, leading to another kind of healthcare crisis. 

Overworked, underpaid 

“We barely get 1,500 (~$20 USD) a month, and that too not regularly for anywhere between 4-12 hours of work. We get calls for help at odd hours of the day and work without any days off,” Kaur told Re:Set. Living and working in Punjab’s Dugri village, Kaur’s daily routine includes going house to house, spreading awareness about COVID-19, its safety protocols, and the vaccine. She then visits homes where there are suspected cases, conducts tests, provides basic medication and information on how to quarantine and treat the virus. She also accompanies those who have tested positive to the local hospital and acts as their attendant, helping them get a bed and any other care they may need. For all this work in a day, Kaur earns around 33 on average, approximately $0.44, and does not receive protective gear like gloves, masks, or PPEs from the Punjab government.

An image of ASHA workers in Delhi protesting low wages and no protective gear from the government, set against a blue background

ASHA workers in Delhi protest lack of health insurance, low wages and no protective gear as their working conditions have worsened during the pandemic. Photo courtesy: Shweta Raj

When they are made to travel across the village from homes to dispensaries and hospitals, they pay out of their own pocket for the transport, Kaur explained. While ASHA workers come under and are recruited by the central government, state governments can add their own incentive system for them. Re:Set reached out to the governments of Delhi and Punjab for comment but did not receive any response at the time of publication. 

ASHA workers are paid anywhere between 1,500 and 4,000 (~$20 – $53) per month, depending on the state they work in, the number of homes they visit, the people they help, and educate about the virus. “When we go to hospitals or dispensaries with patients as their attendants, the health officers there are supposed to record our presence and submit it to the local government. They record it if we go to private hospitals, but many government centres don’t even put our names down. Our earnings depend on these records and when we aren’t recognized it directly affects our income,” she told Re:Set. 

Rita Bhardwaj, an ASHA worker in Delhi’s Sangam Vihar, tells Re:Set the risk she takes to ensure people in her area are safe is a lot more than the allowance the government gives. “How am I supposed to feed myself and my family when they pay me 1,000 for work that is worth five times more. I not only have to help others quarantine, but also quarantine myself at home, so that my family is safe. How is that fair?” she asked.

Fight for basics 

It is conditions like these that have led to ASHA workers across the country taking to the streets over the past few weeks to protest the callousness with which they are being treated.

Last week, close to 70,000 ASHA workers in Maharashtra staged a week-long protest against the low pay and high risk factors of their job, which ended only when the state government decided to partially meet their demands by increasing their monthly salaries by 1,000 (~ $13) and giving them a COVID allowance of 500 (~ $6.74) per month. A similar protest was held in the state of Telangana, where ASHA workers went online to show the dire situation their local healthcare centres are in — with no N-95 masks, gloves, or sanitizers. 

The plight is the same in most states, says D. Nagalaxmi, the state secretary for the Karnataka Rajya Samyuktha ASHA Karyakatheyara Sangha, a workers union that advocates for the rights and safety of ASHA workers. 

“We’ve been demanding a minimum wage of 10,000 (~ $134) for the workers for months now, but despite the violations of basic labour laws, the government has not relented,” she told Re:Set, adding that the government has failed to even provide proper compensation to the family members of the workers who have lost their lives to COVID-19 in the course of their duty. “In the last two months alone, Karnataka has lost more than 10 ASHA workers and none of them have received any compensation or recognition,” she said. 

An image of ASHA workers talking to people in a village in rural Karnataka about healthcare precautions, set against a blue background

An ASHA worker speaks with a family in Karnataka, where 10 ASHA workers died to COVID-19 in May and June. Photo courtesy: D. Nagalaxmi

Things are even worse in the country’s national capital which was the worst hit during the second wave with close to 30,000 cases and 448 deaths in a day, at its peak. 

“ASHA workers are the frontline workers on the ground, having as much contact with the virus as doctors. But, they are called volunteers and hence, the government isn’t liable to pay them full-time salaries or even see them as frontline workers,” said Shweta Raj, president of the Dilli ASHA Kamgar Union, another workers’ union.

According to her, the government provides ASHA workers with three face masks, some gloves and sanitizer to use throughout the month, ironically violating its own guidelines which state that masks need to be disposed of after single use and hands need to be regularly sanitized. “When these women protest, they are told to wash and reuse the same masks. So, they are forced to spend whatever little money they have on protecting themselves, when it is actually the government’s job,” she told Re:Set. 

Mental health, a privilege

While these women fight to improve their dire working conditions, sparing a thought for their mental health becomes a privilege. “The feeling of instability and uncertainty is all they have,” Raj said, adding that the priority for most of these women is daily survival, so evaluating how they feel or think is a luxury they can’t afford. 

But the effects are nonetheless there. 

“An ASHA worker lost her 10-year-old son to COVID last month and is struggling to work. She told me that she used to have a tremor in her hand years ago, which abated but has returned since the death of her son. These women see grief, poverty, and anxiety on a daily basis and don’t even have the tools to process it,” said Raj, adding that the women also face suspicion from many of the people they help, as they are viewed as possible carriers of the virus and need to fight misinformation every day. “They don’t get respect from the government or the people they help. How can they function normally without getting the dignity they deserve?” she said. 

While many ASHA workers have quit due to the pitiable conditions, most have stayed on, says Raj. “For many, this meagre salary is the only thing keeping them from abject poverty. So they will do what it takes to feed their families.” 


Also read: Fear and Lack of Government Outreach Are Fueling Vaccine Hesitancy in India’s Transgender Community


 

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Mental Health Is a Privilege for These ASHA Workers Battling Low Pay and No Protection