June 19, 2021

Overworked and underpaid: India’s neglected community health workers

topic:	Women's rights
located:	India
editor:	Tish Sanghera

They’ve been on the frontline for over a year now, travelling door-to-door for contact tracing, carrying out surveys and spreading awareness on the coronavirus pandemic. But these mostly female community health workers have barely been paid for their efforts. 

Known as ASHA workers (A S H A), thousands across India are struggling under relentless workloads without adequate compensation. Initially hired to monitor village-level immunisation and support pregnant women and children, the government turned to ASHAs as soon as covid-19 hit. They were eager to strengthen India’s skeletal health infrastructure and fill large human resource gaps. 

But despite the critical and well-publicised role these women have played in India’s battle against the virus, many feel neglected by the government. Though they may now be working all day, compared to just a few hours before the pandemic hit, their pay is still stuck at a paltry Rs 2,250 ($30) per month - less than half the minimum wage.

Many are now striking, hopeful that someone in New Delhi will take notice of their demands. Their strike, however, is not just over poor or non-existent pay causing distress, but also a lack of PPE, sanitizers and masks. In a further perceived slight, ASHA workers are disgusted at the National Health Mission’s request that they download an app that would track their location and monitor their daily targets. They fear officials would use the app to increase their workload and use any missed targets as an excuse to withhold their salary. 

The poor treatment of ASHA workers lies in the fact they are seen as “volunteers” rather than fully fledged health professionals. Because of this, they have never been eligible to receive minimum wage. Since their role was designed initially to focus on maternal and child health, activists and researchers have also long pointed out that these areas are perceived as social work and are not highly regarded in India’s intensely patriarchal bureaucracy.

Ironically, community health workers like ASHAs were proven to play a critical role in previous virus outbreaks. When Ebola was declared a public health emergency in 2014, Nigerian health workers, which worked closely with communities and built up a lot of trust, were identified as a significant positive factor. Unfortunately, in India the government has been slow to uplift and promote ASHA workers, a step that could attract more people to join the network and fill the labour shortage.

Striking ASHAs and demands for inclusion in the minimum wage are not new events. Even before the pandemic, economists and policy experts were advocating for their cause. Many thought the Covid-19 crisis would hammer home the message that ASHAs should be valued and fairly compensated, but the status quo remains. It’s unclear if the current strikes will move the needle. 

For now, ASHAs seem stuck - while they can not afford to work for little pay, they can not afford not to either.

Image: Public Services International. 

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