ASHAs in UP: 'We are free servants or what?'

“ Ek minute bhi late nahi ho sakte warna humari class lag jayegi [I cannot be late, not even a minute or I am screwed],” said Reeta Bajpai as she took hasty strides towards the Mahanagar Public Inter College in Lucknow Cantonment assembly constituency. That was the polling station where she’d been assigned duty – though not the one where she votes herself. The college is about a kilometre away from her home.

She was walking that distance at 5:30 a.m. carrying a big bag containing a digital thermometer, sanitiser bottles, and several pairs of disposable gloves and masks to be distributed at the venue. With Lucknow voting in the fourth phase of the Legistlative Assembly elections along with 58 other constituencies in nine districts on February 23, it was to be a particularly busy day for her.

The elections in Uttar Pradesh are over – and the results are out. But for one very large group of women there are results that might yet come in – which they know could be very distressing, possibly life-threatening. Results arising from risks they were forced to undertake in the conduct of the assembly polls in India’s most populous state.

They are the 163,407 ASHAs (Accredited Social Health Activists) who were compelled to work at the polling booths – without any formal written orders. And ironically – since their task was to maintain hygiene and sanitation at the polling centres – with scant personal protection for themselves. That, in a state which saw the Covid-19 related deaths of close to 2,000 schoolteachers in April-May 2021. The teachers had been ordered to work, against their will, as polling officials in the panchayat polls of April that year, at the height of the pandemic.

The devastated families of the teachers who died, fought for compensation, and many received Rs. 30 lakh on that score. The ASHAs have no written documents, orders or instructions with which to push their case against what they see as punishment work that also kept many of them from voting.

Covid-19 is the result they fear. And they are yet to start measuring its impact on fellow ASHAs through the earlier phases of voting.

More than 1,300 ASHAs in Lucknow were posted at polling booths after having received mere verbal orders and duty instructions through the primary health centre (PHC) they report to. They were assigned election duties by the state health department.

“We were called to the Chandan Nagar PHC,” says Reeta, “and given oral instructions to maintain sanitisation on the day of voting. We were told to spray disinfectants, check temperature [of voters], and distribute masks.”

ASHA workers were assigned similar duties all through Uttar Pradesh during the assembly elections held between February 10 and March 7, 2022.

“There was a sheet with the names of ASHA workers and the [polling] stations they were assigned to, but without a signature,” says 36-year-old Pooja Sahu, who was assigned duty at Sarvangeen Vikas Inter College polling station in Lucknow.

“Tell me, if there was a stampede at the polling station, or something happened to us, who was going to take responsibility?” asks 41-year-old Shanti Devi in Chitrakoot city, who was on poll duty on February 27. “Without a written letter how can we prove we were called on duty? All the ASHAs are scared to raise their voice. In such times, if I speak too much, I would also be in danger. After all, I had to come and go all alone.”

Yet Shanti Devi did speak up when she saw the other staff at her polling booth signing an attendance sheet. She asked the presiding officer if ASHAs too needed to sign somewhere. “But we were laughed at,” she says. “They said that we were not appointed by the Election Commission and so we didn’t need to mark our presence by signing.” Shanti is one of over 800 ASHAs in the district who have had similar experiences.

Another ASHA worker in Chitrakoot, 39-year-old Kalawanti, was silenced by a PHC staffer when she asked for her duty letter. “My husband is an assistant teacher at a government primary school and I had seen his duty letter about a week before,” she says. “I thought I would also get one since I was assigned duty too. But after receiving the sanitising material from the PHC, when I asked about the written order, prabhari Lakhan Garg [the PHC in-charge] , and BCPM Rohit [Block Community Process Manager] said that ASHAs would not get the letter, and oral orders were enough to come on duty.”

On election day, Kalawanti had to be at the polling station for 12 hours. But her work did not end when here duty ended there. She received a call from the auxiliary nurse midwife of her PHC. “After I returned home,” she says, “the ANM called me and gave me an ultimatum. She told me that I was to complete the survey of an entire village and submit the report by the end of the next day.”

Not only was Kalawanti’s attendance at the polling booth not considered as work, she was also not paid for it. None of the ASHAs received any remuneration for working the same amount of time as the other staff on duty at the station. “They would not give us letters,” says Veena Gupta, president of UP ASHA union. “With the letter comes allowances. All the staff on election duty got some allowances, but ASHAs and anganwadi workers didn’t. They were made to spend their own money on travel and, in a nutshell, exploited,” she adds.

It was not the first time.

ASHAs, the underpaid and overburdened key actors in the National Health Mission, have been on the forefront of the public health infrastructure since 2005. But they are also subjected to the government’s neglect, apathy, and sometimes sheer injustice.

When the coronavirus pandemic was raging through the country, the ASHAs were deployed to do critical but additional work of conducting door-to-door tests, monitoring migrant workers, ensuring adherence to pandemic protocols, helping patients access Covid-19 care and vaccines, and collecting data and reporting them to the PHCs. They worked extra hours , with poor safety gear and delayed payments – not to mention the enormous personal risk of being in the field for 8-14 hours a day, visiting 25-50 houses on average, even on weekends.

“Our workload has increased since last year [2020]. But we should also get paid for the extra work, na ?” asks 32-year-old Ratna, an ASHA in Chitrakoot. ASHA workers in UP get Rs. 2,200 every month as honorarium. Along with performance-based incentives under the various health schemes, they may earn a total of Rs. 5,300.

In late March 2020, under the Covid-19 Health System Preparedness and Emergency Response Package, the union government allotted a monthly ‘Covid incentive’ of Rs. 1,000 to ASHAs – it was to be paid from January to June 2020. The incentive continued until March 2021 when the emergency response package was extended.

In May, the Ministry of Health and Family Welfare (MoHFW) directed the states to pay out the Covid incentive from April to September 2021 with unspent funds from the previous financial year. But in the second phase of the Covid emergency package – implemented from July 1, 2021 to March 31, 2022 – incentives for frontline workers including ASHAs were dropped from the list.

A survey

https://www.article-14.com/post/promised-mostly-never-paid-rs-1-000-covid-wage-to-million-health-workers

on the working conditions of ASHAs and their payments in April 2020, found 11 states out 16 states lapsing on paying the due Covid incentive. “And not a single state was paying the regular incentives for activities such as immunisation that were suspended during the lockdown,” the report says, based on interviews with 52 ASHA workers and ASHA union leaders.

Even after doing all the extra tasks related to the pandemic, Ratna hasn’t received the ‘Covid incentive’ since June 2021. “I got just 2,000 rupees for April and May last year [2021],”she says. “Now you can calculate how much was pending, given that it had to be a thousand per month.” Ratna’s unpaid incentive amount comes to at least 4,000 rupees. And this after getting her payment vouchers signed by the ANM – which in itself is a task.

“You won’t believe how challenging it is to convince the ANM to sign our payment vouchers, and that we have done all the work assigned to us,” Ratna says. “If I am unable to work on a day due to some emergency or a health issue, she will say ‘you didn’t work well this month’ and deduct that month’s 1,000-rupee incentive, which an ASHA deserves for working the rest of the 29 days of the month in the frontline,” she adds.

Across the country, over 10 lakh rural and urban ASHA have been fighting for recognition of their work against a system that thrives on their underpaid labour. As a report by Citizens for Justice and Peace says: “They [ASHAs] don’t fall under the ambit of the Minimum Wage Act, and don’t enjoy the maternity benefits and other schemes offered to regular government employees.”

Ironically, while in the time of Covid-19 they acted as a crucial link in pandemic control strategies of the central and state governments, ASHA workers often suffered due to lack of medical attention and even treatment. Many ASHAs in UP died performing their duties during the pandemic.

“I had got a phone call from home in late April last year [2021] saying mummy was unwell,” says 23-year-old Suraj Gangwar recalling the days before he lost his mother, Santi Devi, in May 2021. “As soon as I heard about it, I rushed to Bareilly from Delhi. She was already in the hospital by then.” An engineer by profession, Suraj works in a private firm in Delhi and remains the only earning member in the family of three now.

“My mother would never miss a day in the field, and would do her duty as an ASHA diligently,” says Suraj. “She was on her toes throughout the pandemic, but now that she is gone, the health department does not give a damn. They say we cannot get compensation.”

Suraj and his father have tried meeting and requesting the chief medical officer (CMO) and other staff at the Nawabganj community health centre in Bareilly for help, but to no avail. Showing us his mother’s RT-PCR report and death certificate, he says: “The CMO said that we would be eligible for compensation only if we had a death certificate from a hospital that mentioned she died of Covid-19. Now where to get that from, as no hospital admitted her? What is the use of such fake schemes that only ensure that those in need don’t get any help?”

Even before the memories of last year’s horrors could fade, the 160,000-plus ASHAs in UP were roped into an unpaid, demanding and risky job again this year during the assembly elections. Union president Veena Gupta sees this as a calculated move. “If you ask me, this 12-hour-long unpaid duty is a strategy by the state to ensure that these women were stuck doing their duties, and didn’t cast their votes – because they fear that it could go against them, given the way they have neglected the demands of ASHAs, and the way they have been paying our honorarium.”

Reeta was determined to vote, though. “I am planning to go and cast my vote at my polling station at four in the evening,” she had told PARI at the time. “But I can go only when another ASHA comes here to do the duty for some time, in my absence. That polling station is around four kilometres from here,” she added. Like all other ASHA workers, she was supposed to manage her replacement on her own, without any help from the health department.

Made to report at polling stations early in the morning, the ASHAs were given neither breakfast nor lunch. “I saw lunch packets coming for the staff on duty and they had it in front of me but I did not get any of it,” Puja, an ASHA worker in Lucknow’s Alambagh area, told PARI.

While all the other staff on duty got their lunch packets at around 3 p.m., the ASHAs got no lunch nor a break to go home and eat. “Please see for yourself how all of us have been asking for a lunch break. They could allow us to go home, eat and come back. Our homes are not very far. Every ASHA gets duty around their home itself,” Puja said, showing us messages from a WhatsApp group of ASHA workers in Alambagh.

Annu Chaudhary, a general nurse and midwife, or GNM, who was also with Reeta at the polling station, was furious about not getting food while the police and other government staff on duty were receiving them. “How fair do you think this is to us?” she complained. "We are treated like nobodies. Why don’t we get the facilities that others on duty do?”

ASHA workers in Chitrakoot had yet another task added to their list of poll duties: taking out the garbage. Shivani Kushwaha was among the many ASHAs in the district called to the PHCs and given a big dustbin along with the sanitising material. “They also gave us a few PPE kits,” she says, “which we were supposed to give to voters who tested Covid-positive at the polling station. And we were instructed to stay at our station throughout the day, from 7 a.m. to 5 p.m. After that, we were to deposit the dustbin along with the used or unused PPE kits at the Khutaha sub-centre.” This meant that they walked about a kilometre from the main road to reach the premises with all the filled bins.

Kushwaha’s voice quivered with agitation as she spoke. “We have to ensure sanitisation and hygiene, so we will do it. But give us a proper letter at least, like you gave to the other staff. And why do we not get any payment for election duty while the government staff do? What are we, free servants or what?”

Jigyasa Mishra reports on public health and civil liberties through an independent journalism grant from the Thakur Family Foundation. The Thakur Family Foundation has not exercised any editorial control over the contents of this reportage.