ASHA, Anganwadi workers deserve pay, social security, not just applause

The government has been utilising the services of millions of frontline health workers to deal with Covid-19. Of them, the ‘volunteers’ employed under the Integrated Child Development Services (ICDS) which has been in vogue since 1975, namely anganwadi workers (AW), anganwadi helpers (AH) and the Accredited Social Health Activist (ASHA) workers, employed under the National Rural Health Mission (NRHM) in existence since 2005 (hereafter ‘community health service workers, or CHSW), deserve special attention. According to the government, there are 1.33 million anganwadi workers and 1.05 million ASHA workers. Under their respective schemes, they provide multiple functions, such as child physical (including nutrition) and emotional and mental healthcare, maternal care, immunisation, family planning, reducing gender-based violence, etc.

The Ministry of Health and Family Welfare, Government of India, gave special training to the CHSW to help them provide a variety of services in the Covid-19 context, such as to spread safe practices, identification of a virus suspect/contact, etc. The Telangana government has additionally asked the trained AWs to assess the psychological impact of lockdown on women, children and the aged. Thus, we see that they perform multiple valuable functions and are warriors in humanity’s fight against Covid-19. Their work assumes vital importance as they have a strong and institutionalised community presence. However, their services are hardly mentioned, though they suffer from existential and identity crises. In fact, a PIL lodged in the Supreme Court seeks directions for protective measures for nurses, which is a welcome move as nurses are a highly exploited lot. The Supreme Court must suo motu include the CHSW also in its directions.

However, news reports reveal many bad experiences of these workers. For example, they have not only been subjected to undesirable treatment (like heckling, physical assaults) in some places, in others they have not been provided with adequate and fresh personal protective equipment like masks, gloves and sanitisers. In some places, they continue to use oft-used masks or even their dupattas and pallu (end of the saree) as substitutes. They work for long hours as the infection incidences rise, often sacrificing their family time. In some states, they did not receive their meagre income even during this tough period.

At the same time, press reports demonstrate unquestionably their selfless, untiring and invaluable frontline work, often risking infection as some of them have health deficiencies like diabetes, etc., which make them more vulnerable. While state governments have possibly settled the issues mentioned above arising out of the Covid-19 crisis, these workers suffer from some fundamental and long-pending labour market deficits that merit serious and considerate action by the government.

These workers are women who hail from low-income families, not well-educated, some of them widows, join the community health service at a young age and continue without any career prospects. There is a formal recruitment process and the ASHA workers receive rigorous training. Given the kind of extensive community health services they perform, it cannot be dismissed as unskilled work by any stretch of imagination.

However, the government has always maintained that since they are ‘volunteers/honorary workers’, it will only pay honoraria as determined from time to time. Their honorarium is a consolidated pay with no cost-of-living allowance and there are no structured guidelines for their periodic revision as would be the case in any kind of employment. Hence, in several regions, their honoraria are less than the minimum wages of unskilled workers.

Then, any rise in them is advertised by the ruling party as a large welfare measure. For example, the honoraria for AW and AH were revised from ₹3,000 to ₹4,500 and ₹1,500 to ₹2,2,50, respectively, in October 2018 -- after seven years! The honoraria of these workers are shared between the central and the state governments and hence their incomes show regional variations. The ASHA’s compensation system is rather complex, comprising variable components that are linked to defined tasks (e.g. ₹100 for full immunisation; ₹50 for reporting child death; ₹1,000 for 42 contacts over 6-7 months of TB treatment). It is notable that the scheme-based workers work under poor conditions, are given meagre insurance cover and not entitled to social security.

The CHSW have conducted numerous struggles for many years on several demands and won several rights, like even the minor rise in their honoraria. The core demands are: fixed and higher wage, social security, the status of ‘workers’ and, since they work under government schemes, they should be treated as ‘government employees’. These issues were discussed in the tripartite body, Indian Labour Conference (ILC) in 2015 and the Conference Committee in which government representatives were present endorsed all their demands. However, the government rejected them on specious grounds. Since they are volunteers and performing part-time work, they cannot be termed as workers nor as government employees. On technical grounds, it declared that they are not eligible to cover under ESI and EPF schemes. They cannot be paid the minimum wages as they do not hold any civil post per the Supreme Court judgement in 1998. And since the government deems them to be ‘volunteers’, their trade union and collective bargaining rights issues do not exist.

The Finance Minister announced ₹50 lakh insurance cover for 90 days to health workers, including community health workers, and Maharashtra has announced a ₹25 lakh insurance cover for anganwadi workers. While these are laudable, if the applause by the political leaders is genuine, then a befitting reward to these precarious workers would be conferring ‘workers’ and ‘government employees’ status on them, with attendant benefits. It will not only uplift millions of families as these workers hail from low-income families, it will also enhance gender justice as they are women workers. Does the government have the heart and the will to do so, at least after having used their services extensively at a time of national crisis?

(The writer is Professor, XLRI, Xavier School of Management, Pune)