Ritu Sharma

Swadesha Sharma

P. Sainath

Editor

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It’s 9 in the morning, and Azad Maidan in Mumbai is alive with young
cricketers getting ready for a fun weekend game. There are frequent cries of
joy and anguish as the game proceeds.

Barely 50 metres away, another ‘game’ proceeds silently with 5,000
participants. This one has been going on longer, the stakes are higher and
there is no end in sight for the thousands of Accredited Social Health
Activists (ASHA) – healthcare workers – protesting last month at Mumbai&#39;s Azad Maidan.
More than 50 women participants had to be hospitalised in the first week of the
agitation, which began on February 9.

Within view of the busy road, an ASHA in her early 30s sits down on
the ground. She glances around nervously, avoiding the stares of people passing
by. A group of women gather around, covering her with dupattas and
a chadar as she quickly changes her clothes.

A few hours later, at lunchtime, under the scorching midday sun, ASHAs
gather around their colleague, Rita Chawre, each holding empty tiffin boxes, plates, and even
lids. They patiently wait their turn as the 47-year-old serves them homemade
food. &quot;I manage to feed around 80-100 ASHAs protesting here,&quot; says
Rita who travelled around two hours to Azad Maidan daily from Tisgaon in Thane
district, along with 17 other ASHAs. 

“We are taking turns
to ensure no ASHA remains hungry. But we are falling sick now. And we are
tired,” she adds, speaking to PARI at the end of February 2024.

After 21 days, the ASHAs finally went home on March 1 after the Chief
Minister announced, “ASHA chi nirasha sarkar karnar naahi.
[Government will not disappoint ASHAs].” The CM, Eknath Shinde, was
speaking during the Maharashtra State Assembly’s Budget Session earlier that
day.

ASHAs are an all-women workforce that provides more than 70 healthcare
services. However, they are categorised only as ‘volunteers’ under the
Integrated Child Development Services Program (ICDS) and National Rural Health
Mission (NRHM). Hence, the payment they receive for providing healthcare
services is referred to as an ‘honorarium’ and not wages or salary. 

Apart from the honorarium, they are entitled to receive the PBP
(performance-based payment or incentives). The NRHM states that ASHAs receive
incentives based on their performance for promoting universal immunisation,
services for Reproductive &amp; Child Health (RCH) and other programmes.  

Clearly the money
is not enough as Rama Manatkar, one of the ASHAs, says, “Bin pagari, full adhikari [No money only responsibilities]! They expect that we work like officers,
but are not willing to pay us.”

The CM’s recent assurance – one of many official ones in the last few
months –has not resulted in a government resolution (GR), at the time of this
story being published. By all appearances, the ASHAs continue to have only
promises to go on. 

The thousands of
protesting ASHAs are determined to pin the Maharashtra administration to their
assurance – first made in October 2023 – to issue a GR implementing a salary hike.

“People trust ASHAs more than their own family! The health department
is dependent on us,” says Vanashree
Fulbandhe, also pointing out that a fundamental aspect of their role is
facilitating access to healthcare services for marginalised communities.
“Whenever there is a new posting of doctors, they ask: where is ASHA? Can we
get her number?” 

Vanashree has been an ASHA for 14 years. “I started with Rs 150…is
this not like vanvaas? When Lord Shri
Ram came to Ayodhya after 14 years, he was welcomed, wasn’t he? Do not welcome
us but at least provide us a maandhan [honorarium]
that will allow us to live with respect and honesty?” she adds.

And there’s another demand: could they please get their salaries on
time every month like everyone else? And not after delays of three months each
time. 

“If we keep getting delayed payments, how will we manage?” asks ASHA, Priti Karmankar who is
the District Vice President (zilla
upadhyaksha) for Yavatmal.
“An ASHA provides a service but she also works for her own stomach. If she’s
not paid, how will she live?” 

Even their travel
reimbursements for mandatory workshops and district meetings organised by the
health department, are delayed by three to five months. “We still haven’t
received payments for programmes assigned by the health department since 2022,”
says Antakala More from Kalamb in Yavatmal. “In December 2023,” she adds,
“we were on strike. They made us end it to conduct a leprosy survey. But they
still haven’t paid us.” Priti adds, “We didn’t even get the payment for last
year’s polio, hatti rog [Lymphatic filariasis] and jant-naashak [deworming] programmes.”

Rita joined as an ASHA in 2006 at a salary of Rs. 500. “Today, I get
6,200 rupees a month, of which 3,000 comes from the central government and the
rest from the municipal corporation.”

On November 2, 2023,
the state health minister, Tanajirao
Sawant had <a href="https://twitter.com/TanajiSawant4MH/status/1719939873099096496?t=2Up4fSv2RYrwWRN8ypm2uQ&amp;s=19">announced</a> that the 80,000 ASHA
workers and 3,664 gat pravartaks (group promoters) in
Maharashtra would get increments of Rs. 7,000 and Rs. 6,200 respectively along
with a Diwali bonus of Rs 2,000 each.

A furious Mamta says, “Diwali houn aata Holi aali [Diwali has passed and it is time
for Holi now] but we have nothing in our hand.” She adds, “We did not ask for
7,000 or 10,000 increment. Our initial strike in October was against the extra
online work. We were told to get 100 villagers registered daily on the Pradhan
Mantri Matru Vandana Yojana (PMMVY).”

The scheme, as its official website says, “provides a cash incentive
for partial compensation of the wage loss during pregnancy.” A similar target
was given for the newly launched U-Win app which aims to store vaccination
records of pregnant mothers and children.

Earlier in February 2024, over 10,000 ASHAs had marched from Shahpur
to the Thane District Collector’s office – a distance of 52 kilometres. “Chalun aloy, tangdya tutlya [We walked all the way, our legs
gave out]. We spent the whole night on the streets of Thane,” recalls Mamta.

The months of protest are taking a toll on them. “Initially there were
more than 5,000 ASHAs at the Azad Maidan. Many of them were pregnant and some
also came with their newborns. It was getting difficult to live here in the
open and so we requested them to go back home,” says Ujwala Padalwar. She is the State Secretary
of the Centre of Indian Trade Unions (CITU) and one of the organisers of the
protests. Many women complained of chest and abdominal pain, others suffered
from headache and dehydration and had to be hospitalised, she adds.  

Once the ASHAs were
discharged, they came back again to the ground, calling out in unison: “Aata aamcha ekach naara, GR kaadha! [We have only one call!
Just release the GR!].&quot;

On paper, an ASHA’s role is to bring public health services to
everyone. But after years of caring for the community, they often go above and
beyond. Take ASHA Mamta, who in September 2023, managed to convince a pregnant
Adivasi woman from Sonivali
village in Badlapur
to opt for hospital delivery instead of home birth.

She recalls: “The woman’s husband refused to accompany her and said in
clear words, ‘if anything happens to my wife you will be responsible’.” When
the mother was in labour, “I took her from Badlapur to Ulhasnagar all by myself,” says Mamta. The
mother did not survive the childbirth. The baby too had died in
the womb.

Mamta explains, “I am a widow, my son was in Class 10 at that time. I
left home at 6 a.m., and the mother passed away around 8 p.m. I was asked to
wait in the hospital veranda till 1:30 a.m. After the panchnama
was done they said, ‘ASHA tai now you can go’. Deed waajta me ektee jaau? [Am I supposed to go home alone at
1:30 a.m.]?” 

The next day when she visited the village to update the records, some
people including the woman’s husband abused and blamed her for the deaths. A
month later, Mamta was called for questioning by the zilla samiti. “They asked me ‘how did the mother die and what error
did ASHA tai make?’ If everything at
the end of the day has to be dumped on our heads, then why not increase our maandhan?” she asks.  

Throughout the
pandemic, the government praised the ASHA workers and hailed them “corona
warriors” for their crucial role in distributing medicines and tracing infected
patients from the remotest villages across the state. However, they barely
received any safety gear to protect themselves from the virus.

Manda Khatan and Shraddha Ghogale, ASHA
workers from Nandivali Gaon in Kalyan recall their pandemic experience,
“Once, a pregnant mother tested positive for covid after the birth. When she
learned that she was infected with the virus, she panicked and ran away [with
the newborn child] from the hospital.”

“She thought she [and her baby] would be caught and killed,” says
Shraddha. Such was the fear and
misconception around the virus.

“Someone told us that she was hiding in her home. We rushed to her
house but she had locked the doors,” says Manda. Fearing that she would take
some wrong steps, they stood outside her house until 1:30 a.m. “We asked her,
‘Do you love your baby or not?’ We advised her that if she continued to keep
the baby close to her, she would end up infecting it and would put the infant’s
life at risk.” 

After three hours of counselling, the mother opened the doors. “The
ambulance was on standby. There were no other medical officers or gram sevaks, just the two of us.” A teary-eyed Manda
narrates, “Before departing the mother held my hand and said, ‘I am leaving my
child behind because I trust you. Please take care of my baby.’ For the next
eight days, we went to her home daily to bottle feed the newborn. We would show
her the baby over video call. Till date, the mother calls us and thanks us.

“We distanced
ourselves from our own kids for a year,” says Manda, “but we saved the children
of other people.” Her child was in Class 8 while Shraddha’s was barely 5
years old.

Shraddha remembers when people in her village would shut
their doors. “They would run away seeing us in personal protective equipment
(PPE) kits thinking that we had come to catch them.” Not only that, “We would
wear the kits for the whole day. Sometimes we had to change four in one day.
Our face had turned black wearing them for hours. We would walk with them in
the sun. It would itch and feel like a burning sensation on our skin.” 



Manda interrupts and says, “But PPEs and masks came in much later. For
most of the pandemic period, we would wrap our pallus and
dupattas while moving around.” 



“So, our lives did not have value then [during the pandemic]?” asks
Mamta, “Did you give us some different kavach [protection]
to battle corona? You [government] gave us nothing when the pandemic started.
When our ASHA tais started getting
covid, they faced the same fate as the rest of the patients. Even when the
vaccines were at the trial stage, ASHAs were the first to volunteer.”



At one point in her life, Vanashree Fulbandhe had almost decided to
quit being an ASHA. “It started to take a toll on my mental and physical
health,” she says. The 42-year-old looks after a population of more than 1,500
people in Nagpur district’s Wadoda
village. “I remember once I was in extreme pain due to kidney stones. I had
tied a cloth around my waist and was still working.”



A patient and her
husband came to Vanashree’s house, “She was a first-time mother. They were
nervous. I explained to them I was not in a condition to do anything but they
insisted that I be present during the birth. It was difficult to say ‘no’ so
I went along with them. I stayed with her for two days in the hospital until the baby was born. Her relatives would see the cloth tied around my waist and
jokingly ask me, &quot;Is it the patient&#39;s delivery or yours!”

She recalls her routine during the lockdown when she would complete
her ASHA duties and deliver food to patients in isolation. “It eventually
took a toll on my health. I had very high BP for many days and I thought maybe
I should quit.” But Vanashree’s aunt reminded her that “what I am doing is punya [good deed]. She said two lives, [of the mother and
child] depend on me. I should never leave this job.”



As she narrates the story, Vanashree briefly looks at her phone. She
says, &quot;My family keeps asking when I will return home. I came here with
Rs. 5,000. I barely have Rs. 200 now.” She hasn’t received her monthly
honorarium since December 2023.   



Purnima Wase, an ASHA from Nagpur’s Pandhurna
village recalls a critical situation. “I
had assisted an HIV positive woman in her childbirth. When people
at the hospital found out she was HIV positive,” says the 45-year-old worker, “they acted as if it was a big thing. I told them, ‘When I, being an
ASHA, delivered the baby without any equipment other than gloves and my own
scarf, why should you act like this?’”

An ASHA since 2009, Purnima looks after a population of more than
4,500.  “I am a graduate,” she says. “I
get so many job offers. But, it was my decision to become an ASHA and I will
continue to be an ASHA all my life. Whether I get money or not, agar mujhe karni hai seva to marte dum tak ASHA ka kaam karungi
[Since I wish to serve, I will continue to be an ASHA until my death].”

The game of cricket
continues at Azad Maidan. Meanwhile the ASHAs have moved their fight off the
grounds.

State reassures protesting ASHAs...once again

آشا کارکنوں کو ایک بار پھر ملی صرف ’یقین دہانی‘

నిరసన తెలుపుతోన్న ఆశాలకు మళ్ళీ ‘మరోసారి’ హామీలిచ్చిన ప్రభుత్వం...

ஆஷா பணியாளர்கள் மீண்டும் வாக்குறுதி கொடுக்கும் அரசு

ਪ੍ਰਦਰਸ਼ਨ ਹੇਠ ਆਸ਼ਾ ਵਰਕਰਾਂ ਨੂੰ ਸਰਕਾਰ ਨੇ ਫਿਰ ਦਿੱਤੀ ਮਿੱਠੀ ਗੋਲ਼ੀ

ପୁଣିଥରେ ଆନ୍ଦୋଳନରତ ଆଶା କର୍ମୀଙ୍କୁ ମିଳିଲା ସରକାରୀ ପ୍ରତିଶ୍ରୁତି

സംസ്ഥാനം ആശാപ്രവർത്തകർക്ക് വാക്ക് കൊടുക്കുന്നു…വീണ്ടും

ಪ್ರತಿಭಟನಾ ನಿರತ ಆಶಾ ಕಾರ್ಯಕರ್ತೆಯರಿಗೆ ಸರ್ಕಾರದಿಂದ ಮತ್ತೊಮ್ಮೆ ಬರವಸೆ

हक़ के बदले में आशा कार्यकर्ताओं को फिर मिला सिर्फ़ ‘आश्वासन’

વિરોધ પ્રદર્શન કરતી આશાઓને સરકાર તરફથી ફરી એકવાર મળ્યા વાયદા

मितानिन दीदी: ‘फोकट मं सब्बो जिम्मेवारी’

आशा कार्यकर्ता: लड़ेली बहिनिया, लड़ेली महतरिया

ফাঁপা সরকারি আশ্বাসে নিরাশ প্রতিবাদী আশাকর্মীরা

প্ৰতিশ্ৰুতি ৰক্ষাৰ আকৌ এবাৰ প্ৰতিশ্ৰুতি আশাকৰ্মীলৈ

आंदोलक आशांना सरकारचं वचनः दिलासा का बोळवण?

Azad Maidan

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State reassures protesting ASHAs...once again

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