Because ASHAs are paid on an incentive basis, their incomes fluctuate from month to month. Although their basic monthly salaries are paid on time, ASHA workers often won’t see any money from the incentives for months on end.
"We don't receive any incentive money or sometimes we receive six months of incentive money at once. Many ASHA workers depend on this extra income for running their household. Sometimes they even have to pawn their jewellery to have food in their home," says Aruna.
Each ASHA worker serves up to 1,500 people. Many rural communities, which often include Indigenous Indian peoples such as the Adivasis, often have no access to medical facilities apart from the ASHA.
"Most of the people in my village love and respect us. They often say that they will do whatever ASHA didi [auntie] tells them to do, because they trust us to that extent. We get more respect than the doctors who work in our village," says Aruna.
In theory, ASHA workers are supposed to work only three to four hours a day, not including the time spent on travelling. But, as Aruna explains, they don’t have regular hours and when they are summoned to work, they have to drop everything and go, day or night, because it could be a medical emergency.
"I have a scooter so I can get home without depending on public transportation, but many women are left without any means to reach home safely,” says Gouri, adding that the government now provides a carpool system after ASHA workers raised safety concerns.
Now, ASHA employees want a change in their status. Last year, around 600,000 ASHAs, supported by various trade unions in India, went on strike demanding improved working conditions, better pay and the benefits of a permanent government employee. The fight is ongoing – in June, 70,000 ASHA workers in Mumbai called off a strike after they were promised a pay rise.
"We work more hours than any government employee, but are not compensated like full-time staff. When will the government recognise the importance of our work?" says Gouri.
They have also faced additional challenges during the pandemic. Fear and mistrust due to garbled messaging has led to pushback against vaccination in certain communities. Meanwhile, PPE shortages persist. An ASHA sangini in Lucknow, who supervises the work of other ASHA workers, stated that three of her staff have refused to work because of the professional and personal hazards they face at the moment.
At least 44 ASHA workers in India have died from COVID-19 – though the real number could be far higher than the official figures, which have been criticised for underreporting deaths. Colleagues say that the families of the employees who died as a result of COVID-19 have yet to be compensated.
It's important to note that the struggles of ASHA workers are not limited to just one state or region, but have spread across the country. Strikes have happened in several states due to issues ranging from non-payment of incentives to not receiving promised benefits.
Despite this, many ASHA workers say they are too fearful of the impact upon the communities they serve to undergo a mass strike. “I have discussed with my fellow ASHA workers about organising a protest, but the more disadvantaged among us are too scared to do anything in case they lose their job,” says Aruna. “But we see protests taking place in other states, and I’m hopeful that ASHA workers will get their due one day.”
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