ASHA workers in distress across Jammu and Kashmir

Over 13,500 women community health workers engaged under the National Health Mission in the Union Territory of Jammu and Kashmir risk life and limb to perform their duty, including COVID control measures, but earn a pittance.

At a rally by ASHA workers at Pattan in Baramulla in November 2020. They are the first point of contact for any health-related demands of the poor.

Raja Begum, 55, was not just a foot soldier of the National Health Mission (NHM) in Kashmir. Her dedication to her work had made her a household name in Zachaldara village in Kupwara district along the Line of Control with Pakistan. An Accredited Social Health Activist (ASHA), Raja Begum was instrumental in the implementation of the national health policy in her village of over 2,000 people through institutional initiatives on maternal healthcare, immunisation, nutrition, basic sanitation, registration of births and deaths, family planning, contraception, follow-up care of tuberculosis patients and much more, besides providing primary medical care for minor ailments.

Just like the over 13,500 ASHAs across the Union Territory of Jammu and Kashmir, Raja Begum was engaged in COVID-19 duties in addition to her daily responsibilities. She died on October 5. According to her family members, before her death she had been actively engaged in contact tracing of corona patients, their monitoring, and the vaccination campaign in the area. A doctor at the local community health centre said, “She died of post-COVID complications but was brought dead to the hospital.”

The first confirmed coronavirus case across the Pir Panjal in the Jammu region was reported on March 9, 2020. But the family of Chanchla Devi, an ASHA worker in Dharamkot village of Kathua district, believes that she died of coronavirus, which she contracted while on duty earlier. Middle-aged Chanchla Devi was rushed to the Government Medical College (GMC) Hospital in Jammu after she complained of breathlessness and fever. On February 18, 2020, a few hours after she was admitted to the emergency ward, the medical staff on duty pronounced her dead. The death certificate issued by the hospital, however, does not state the cause of her death.

Both Raja Begum and Chanchla Devi belonged to poor households. Chanchla Devi is survived by three children, including a college student and school-going daughter, and their unemployed elder brother. Raja Begum has three sons: the eldest, 33, is physically challenged; of the other two siblings, one, aged 26, is a labourer and the other, aged 22, is a college student. The husbands of the deceased are marginal farmers and work as part-time labourers to supplement family income.

Jammu and Kashmir has over 13,500 ASHAs, who are said to be the first point of contact for any health-related demands of the poor, especially women and children. They have been envisaged as community health “volunteers” under the NHM and are entitled to a monthly “honorarium” and not wages. An ASHA worker is paid a monthly honorarium of about Rs.2,000, which was revised from Rs.1,000 in 2019, and gets task-based incentives such as Rs.1 for every oral rehydration solution packet distributed and Rs.300 for each institutional birth.

In Jammu and Kashmir, during the peak of the first and the second waves of the pandemic, several viral videos on social media showed ASHA workers fording icy rivers, navigating treacherous tracks in forested mountains and walking long distances in the militancy-affected and restive border areas while carrying vaccine kits.

As rumours about corona conspiracy theories made the rounds, these workers were assaulted by orthodox villagers in some remote and hilly areas while doing contact tracing of COVID-19 patients or motivating residents to get vaccinated. But such challenges did not deter them in the fight against coronavirus. These front-line workers were rightly hailed as corona warriors.

Choudhary Mohammad Yasin, Director of the National Health Mission, in an interview to a news portal, kashmirlife.net, on August 21 underlined the “immense contribution” of ASHA workers in dealing with the pandemic. He referred to ASHA workers and their supervisory cadres as “properly trained professionals”, who work under a well-defined cadre and hierarchical system. He said: “Their services are always required and are important in the execution of any grass-root level implementation of Centrally sponsored schemes, [the] Health Department’s field operations or in dealing with any disaster situation. They have always done a commendable front-line job in every situation, be it the 2014 floods or the ongoing COVID-19 pandemic and their role has always been appreciated at all levels.”

Demand for social security

With fears of a third wave of the pandemic growing, ASHA workers are deeply distressed about inadequate wages and growing work demands. They have publicly denounced what they describe as exploitative employment practices of the Union Territory administration.

Disgruntled ASHA workers have held several protest demonstrations in recent months demanding proper safeguards and adequate remuneration. On May 24, for instance, ASHA workers held a demonstration in the Pattan area of North Kashmir’s Baramulla district. They demanded better wages and safety equipment, including personal protective equipment (PPE) kits, hand sanitisers, masks and hand gloves.

The recruitment of ASHAs began in 2005 with the aim of promoting institutional delivery. According to Anita Rani, working president of the ASHA Workers Union Jammu, “we have been given over 40 mandated tasks. An ASHA worker is supposed to do all the paperwork and ground surveys for most of the government schemes. A daily wage labourer earns Rs.600 a day or even more in Jammu and Kashmir. But an ASHA earns less than Rs.70 a day.”

To highlight their problems, ASHA workers have been staging protests at all the district headquarters under the banner of the Joint Platform of Scheme Workers Federations and the Centre of Indian Trade Unions (CITU). The ongoing protests are a part of a countrywide strike by underpaid workers engaged by the Central government for running social welfare schemes. Their demands include adequate insurance coverage, risk allowance, safety gears, compensation for death during the pandemic, regularisation of jobs, wages in accordance with the Minimum Wages Act, and pension.

Mohammed Yousuf Tarigami, Communist Party of India (Marxist) leader, has demanded an additional COVID-risk allowance of Rs.10,000 a month for all the contract and scheme workers engaged in COVID-19 duty besides adequate compensation in case of COVID-related deaths. Addressing a rally in Jammu on September 24, Tarigami demanded that all Centrally sponsored welfare schemes such as the Integrated Child Development Services, the National Health Mission, and the Mid Day Meal Scheme be made permanent. He also stressed on the implementation of the recommendations of the 45th and 46th Indian Labour Conference (ILC) for the regularisation of “schemes-workers” as permanent workers. The ILC, held every year regularly, has been discontinued since 2015.

In a protest held at Kathua town on October 5, ASHA workers shouted the slogan, “ Mehnat humari, loot tumhari, nahin chalegi, nahin chalegi” (Our hard labour and your loot can never go together). Said Jagdish Sharma, secretary of the Jammu and Kashmir unit of the CITU: “ASHAs want a total monthly salary of Rs.21,000 as per the Minimum Wages Act besides social security benefits such as pension, Employees’ Provident Fund [EPF], Employees’ State Insurance [ESI] and free medical treatment, and special allowance for COVID duties. How can one survive with Rs.2,000 a month when prices of essentials are skyrocketing?”

He urged the government to release the pending incentives of ASHA workers immediately. He also demanded that the Union Territory administration provide them with smartphones for reporting their activities. He said that the hardworking ASHA should be promoted to the rank of nursing orderlies on the basis of their work experience.

Said Sham Prasad Kesar, regional secretary of the CPI(M), Jammu: “In adjoining Himachal Pradesh, Haryana and Punjab, an ASHA worker gets a basic monthly honorarium of Rs.10,000. Here in Jammu and Kashmir, ASHAs work in the rough terrains of rural areas. But their plight, just like that of other scheme workers, has not changed even though Jammu and Kashmir has become a Centrally administered Union Territory.”

Vivek Bhardwaj, Financial Commissioner of Health and Medical Education, in a written reply to email queries, maintained that ASHA workers of the Union Territory were being paid Rs.1,000 a month as additional COVID incentive. Refuting his claims, however, many ASHA workers told this writer that COVID incentives had been provided last year for a couple of months only.

Bhardwaj, who is also chairman of the executive committee of the Jammu and Kashmir Health Society, has not acknowledged the death of any ASHA worker after August 20 this year. “Three ASHA workers have lost their lives from coronavirus in the Union Territory of Jammu and Kashmir,” he said, adding that the relatives of the dead had been compensated under the Pradhan Mantri Garib Kalyan Package, an insurance scheme launched by the Central government.

“The ASHAs who died of COVID-19 related duty are being provided Rs.50 lakh under the Pradhan Mantri Garib Kalyan Package and Rs.25 lakh by the Jammu and Kashmir government under the same package,” he said. “Three families of ASHA workers who died also got the benefit of the Pradhan Mantri Jeevan Jyoti Bima Yojana and one family’s case is being processed under the Pradhan Mantri Suraksha Bima Yojana [insurance schemes] and is likely to be paid shortly.”

Incidentally, the Pradhan Mantri Garib Kalyan Package Insurance Scheme announced by the Ministry of Health and Family Welfare for front-line healthcare workers dying while on COVID-19 duty was for 90 days from March 30, 2020.

Referring to Chanchla Devi’s case, Anita Rani pointed out that even though the aggrieved family had received a financial assistance of Rs.2 lakh under the Pradhan Mantri Jeevan Jyoti Bima Yojana, the government needed to do a lot more.

Mubina Akhtar, president of the ASHA Workers Union Kashmir, said: “There are ASHA workers in both the regions, Kashmir as well as Jammu, who have suffered fatal injuries in accidents during duty hours or have been suffering from life-threatening diseases. The government must formulate a policy to ease their economic burden as well.” Facing acute penury, she said, many such ASHA workers do not even have the means to get medical treatment.

On the demand regarding regular wages, Vivek Bhardwaj said that “the Jammu and Kashmir Health Society doesn’t have any proposal for enhancing the monthly honorarium of ASHA workers as per the Minimum Wages Act”.

Significantly, the unemployment rate in Jammu and Kashmir has jumped from over 13 per cent in August 2021 to 21.6 per cent in September, which is the worst among States and Union Territories in India, according to the Centre for Monitoring Indian Economy.

In October, about 2,000 contract-based multi-purpose health workers engaged in COVID care in government hospitals went on strike. For over a week, they held demonstrations in front of the GMC and Hospital and other major hospitals in the Jammu region. Agitated over the termination of their services, they decried the Union Territory administration’s “use and throw” employment policy.

On October 4, the protesting workers were given a job extension of another three months. At the protest site outside the GMC Jammu, Lt. Governor Manoj Sinha assured demonstrators that regular positions of paramedical staff would be advertised soon and “COVID Warriors” would be given due weightage in the recruitment process.

In the first week of November, however, the workers alleged in the local media that they were being silently shunted out by hospitals in a phased manner.

‘Treated like slaves’

Asserting that most of the ASHA workers in Jammu and Kashmir belong to the below poverty line (BPL) families, Anita Rani said, “They are socially vulnerable owing to one factor or another. There are divorcees. There are widows. In some cases, they are the only breadwinners of their families. Apart from their services to the Health Department, they have to do all the daily household chores.”

Many ASHA workers accuse their senior colleagues of harassment. Narrating her ordeal, an ASHA worker in Billawar block of Kathua district said that instead of allowing her to work in her own panchayat, she was assigned work elsewhere.

“I’ve to walk for almost an hour, cross a river and a hill to reach the community health centre where I’m posted. I’ve been requesting the authorities for the past 11 years to let me work in my panchayat but no one has paid heed so far,” said the ASHA worker, not wanting to reveal her identity.

“My husband and children ask as to what kind of job I have been doing that doesn’t give a steady income. They want me to leave this job…,” she said. The constant feeling of being undervalued at work and unappreciated at home has taken a toll on her mental health. She added, “I’ve started getting panic attacks. I can’t quit this job as I’ve invested 15 years in it, emotionally and professionally. ASHAs like me do hope that our demands will get addressed one day. But in reality, we are being treated like slaves.”

Even after working on 24x7 basis, Mubina Akhtar deplored that they were being treated as volunteers by the government. “This is grave injustice,” she said. “We want workers’ status and decent regular wages for our back-breaking hard work. That’s all!”

Said Anita Rani, “We have written to the Lt. Governor Manoj Sinha sahab , seeking an appointment for a meeting. If we don’t get any favourable response, we will move court as the last resort.”