A day in the life of an ASHA worker in Uttar Pradesh

“We are working very hard as frontline workers since the first wave of Covid-19 started. But we have neither got the recognition we deserved nor the money for extra work.”

The lament of Anju, an ASHA worker for the last four years in Phulpur tehsil near Allahabad, Uttar Pradesh represents the sentiments of a bulk of the state’s over 1.5 lakh ASHA workers. And her story is also typical of what most of her colleagues go through on a daily basis.

Anju has a small family with 3 children. Her eldest son is an electrician and earns through repairing pumps, coolers and fans. He has also learnt to do household wiring and coil binding for electric motors. It is his contribution to the family income that is helping in the education of his two siblings, one of whom is preparing for AIEEE and the other is studying in Class 12.

“I get up before 6 in the morning and have to leave the house by 8.30 after preparing tea, cleaning the house, washing clothes and cooking. The children are big enough to go to school on their own, but I have to prepare and serve breakfast before I leave. Moreover, I have to pack some food for myself” says Anju.

ASHA workers are supposed to report for work by 9 a.m. According to Anju, in a village with a population of 4000, there are 4 ASHAs, which means each has to take responsibility for at least 500 households. They have not only to help pregnant women to go for institutional deliveries; they also have to conduct vaccination campaigns convincing villagers to get their children vaccinated for measles. They also have to go door to door for different kinds of surveys.

“Since last year we have been going house-to-house to check if anybody has fever, cough and any other symptoms of Covid. It was a big risk for us because we live in small houses in close proximity of our family members, who become susceptible to Covid infection.”

COVID Response Watch LogoASHA workers are Accredited Social Health Activists working under the National Health Mission but are considered volunteers, not permanent government employees.  They only work for an honorarium, which is quite low in Uttar Pradesh. However, they get paid extra for mobilising pregnant women for institutional deliveries, sterilization and participating in various health projects.

According to Anju, in a month there may be a maximum of 3 deliveries but some months go without a single case. So, it averages out to 1 delivery a month for which they are paid Rs.600 only. For one measles vaccine they get Rs.100 and for a booster dose only Rs.50. For families with more than 3 children, one case of sterilization gets them Rs.300 and for those with more than 2 children, they get Rs.1000.

A survey could give them a thousand rupees. In a single day 40-50 households have to be covered and the day’s report submitted at the Centre by 3 p.m. Photos have to be sent through WhatsApp, but many times the internet doesn’t work. For identifying a leprosy patient we get Rs.200 and for getting the person treated we get Rs.500. For organising a meeting Rs.100 is given and Rs. 25 for registration of birth or death.

“I get paid a maximum monthly honorarium of Rs.4000, but that is only ‘commission’. If I don’t get any other cases, I will not earn anything. We also have to pay for transport  (tempos or buses) for routine work, and medicines in case we fall sick, because most of the medicines are not available in the hospital. Often we walk in the rain and heat, just to save money or time when frequency of buses is low. So, we earn only Rs.2000-3000 per month, not more,” says Anju, who is also one of the leaders of the Uttar Pradesh ASHA Workers’ Union  in Allahabad district.

The situation at the ground level is pathetic she says. “During the first wave of Covid, we were given masks and sanitizers initially. Then there was always a shortage and we were supposed to buy them from outside. The money spent is never reimbursed, but we have to care about our own safety. We were not given gloves and were supposed to keep washing our hands or sanitizing them. Once we were given masks with valves, which do not protect us against the virus. So we had to purchase surgical masks to wear inside them and keep changing or washing them daily. How is it possible to work like this without proper protection? We were in an extremely vulnerable state. Only after stopping work for 2 days were we given proper masks. But not for long.”

The ASHA workers had to suffer a lot more during the second wave of Covid pandemic because the virus was much more virulent.

“When we went to people’s homes to inspect about Covid cases, especially of migrants who had come home from the metro cities, they would react by saying we were carriers of the disease and chase us out. They did not want to get tested and quarantined or sent to hospital. Many would just close their doors and let out a volley of bad words whenever they saw us anywhere close to their homes. They would never understand that we are working only to keep them safe. On the other hand, we had no protective gear except for a mask. We were ourselves risking not only our own lives but also those of our family members. One of my colleagues, who works in a different village infected her husband, though she did not show symptoms. She got no support from the PHC or local hospital. They only kept giving paracetamol tablets. She has not joined duty yet and her husband has now passed away after changing 4 hospitals. Nobody from the Health Department helped. Only the ASHA Workers’ Union was arranging things, including the funeral. She has sold much of her land to pay hospital bills.”

Most of the ASHA workers themselves have no faith in the local health system, because of the lack of equipment and callous attitude of the doctors. If proper treatment is given in time, many patients’ lives can be saved. But neither are any tests performed nor proper medicines given in time. It is for this reason that they even take loans to get treatment in private hospitals.

“When we have to get tests done outside, purchase medicines from outside and depend on private hospitals for oxygen and ventilators, what is the use of these local health centres and government hospitals?” says Anju.

She recounted the case of one local teacher Rajendra Prasad, who had Covid and was referred to the Swarup Rani Nehru Medical College, the main Covid hospital in the district.

“He was a very healthy and a strong man. But due to lack of proper treatment he passed away. He has left behind a young wife, old mother and a 4-year old child. Now there is no earning member in the family, so they cannot pay rent. They are all staying in the school premises. This incident sent shock waves through the village. So, villagers were afraid to get themselves tested. If are afraid that if they are referred to the same government medical college, they might not return home like “Master Saab,” says Anju.

Anju tells us that the vaccination drive for Covid is going on at present. Initially, people were afraid to take a shot because they had heard about some side effects. Some had even heard rumours about people dying after taking the vaccine, and they believed it because it came from close sources like relatives and family friends. After a lot of convincing the momentum has built up a bit.

“You know that village folks cannot be convinced through pure logic. They have to see people who have taken the vaccine and have recovered after mild symptoms. Some used to ask me if I could guarantee that nothing would happen. How could I say that? Officials and monitoring teams will visit and go, but we have to live here.”

When targets are not completed, the ASHAs are scolded and pressurised. “But how can we change peoples’ mindset?” Actually, after talking to Anju one could make out that they have not been trained at all. For example they don’t even know the names of the vaccines that are being given, nor are they aware of their efficacy or possible side effects. They have only been told to explain to people that this “teeka” that is being given will protect them against Covid-19, that’s all.

Anju is happy that the All India Central Council of Trade Unions (AICCTU), that they are part of, is helping them to raise their legitimate demands.

“At first the ASHAs would not join the  trade union for fear of being fired. But things are changing. One of our colleagues died due to Covid. In Bihar, the victim’s kin would get 50 lakhs compensation, because they have a strong union. We here are still fighting her case as her family was given nothing. Sometimes we help by contributing money from our pockets for treatment of ASHA colleagues.

We were to get Rs.1000 per month for extra work during the pandemic. But we got it only for April and not for the successive months. But our Union is working hard to get organised at state level, and we are often threatened by police when we go on strike. But we tell our patients we would still help in taking them to a private hospital if they want. We are trying to build a strong state-level union and news about our struggles has appeared in the local newspapers” says Anju.

Besides Allahabad, some ASHA workers are organising themselves in Rae Bareli, Bhadohi, Auraiya, Lucknow, Kausambhi, Gonda and in Jaunpur. There is a lot more to do to build a state-level organisation, but the mood of these workers is upbeat.

Kumudini Pati is a researcher based in Allahabad

* Names of ASHA workers have been changed to protect their identities.

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