BHOPAL: The Accredited Social Health Activists or ASHA workers hired on contract by state governments have emerged as perhaps the most important frontline workers in managing the pandemic and strengthening the country’s public health provision.

Although they have been performing door-to-door COVID19 surveys, documentation, creating awareness in communities and ensuring timely treatment they are deprived of adequate protective gear in most areas, and are still classified “low risk” under the Centre’s PPE guidelines.

Shouldering important responsibilities, over 600 ASHA workers in the city continue to be overburdened and underpaid. In Bhopal only 1,200 anganwadi workers and 600 ASHA workers have been hired and trained to serve 24 lakh people in this urban area.

Overstretched, each ASHA worker here is responsible for 4,000 people on average and each anganwadi worker for 2,000.

*Reema, an ASHA worker from Bhopal, told The Citizen how “With men of our houses having lost their jobs during the lockdown, it was tough for me to make ends meet on my own. Since we are attached to the community at a deeper level, there are no fixed hours really. Often ASHA has to help people during late hours. There have been frequent fights at home because they want me to stay safe and not go into the containment zones. But I understand it’s my duty.

“What makes me sad is just the undermining of our own health needs while we continue to support the health system.”

ASHA workers in Bhopal do not have the right to safe working conditions. According to health worker Hajra Kazmi, “Most women come with their newborns as well as their other kids, making distance challenging to implement. We can’t just depend on masks and gloves. We are constantly overburdened with documentation, record maintenance, COVID surveys, follow-up surveys in containment zones, distribution of ration packets. Apart from this we have also been directed to resume routine services at the centres.”

*Meena, another ASHA worker suggested that “A clear distinction of duties has to be made between workers going for on-ground surveys, and those going to the centres to render services such as immunisation and documentation, to avoid the further spread of infection.”

She said that while it is advisable to shower and change into clean clothes and shoes before entering homes, many workers are constrained to use community washrooms in their localities, and it has been tough for them to stick to the prescribed safety norms.

As community health workers, ASHAs are the first medical/care providers for many families. With government health departments overstretched in belatedly tackling the pandemic, other essential services like immunisation are being neglected.

According to Kamlesh Ahirwal, the District Immunisation Officer for Bhopal, each month roughly 4,500 children are due for vaccinations in Bhopal. They are supposed to be vaccinated every month, but right now the district is tackling a backlog of almost three months. Since the lockdown health workers and people alike have been unable to go to health centres. It was only after anganwadi centres were ordered reopened for the purpose that immunisation services resumed.

Ahirwal told The Citizen that, “Seen from the point of family, it is always child-centric. When we offer immunisation services, especially in the outreach which is one of the most trusted services in ASHA and anganwadi centres, we see parents coming in large numbers.

“But what needs to be remembered is that vaccines have a fixed time protocol. The timing is decided by the National Technical Advisory Committee and the Government of India to give maximum protection to children.

“Vaccines if delayed can fail to provide optimum protection leading to the outbreak of deadly diseases like measles. The reduction in routine immunisation coverage, particularly if it continues, means that many children will be unvaccinated or undervaccinated, putting their lives at risk.”

A.T.Padmanabhan, president of the Asha Usha Sahayogi Ekta Union in Madhya Pradesh (part of the CPI-affiliated CITU) observes that most ASHA workers in the state “are paid a mere monthly sum of Rs.2,000 which is clearly insufficient to address the health demands of their families. Instead of increasing their salaries, they have been given ‘incentives’ or a small sum per service rendered.

“Since the outbreak of Coronavirus, the MP government has yet to pay three ASHA workers who lost their lives due to the infection the sum of Rs.50 lakh promised as ‘death cover’ by the government. Meanwhile, the absence of regular checkups for ASHA workers and a lack of protective gear is putting their lives at risk.”

Many ASHAs have not been paid their regular honorariums for the last three months. With incentives suspended during the lockdown, the Centre did announce a fixed honorarium of Rs.1,000 for ASHAs performing COVID-related duties, which they say they have yet to receive.

In any case the incentives decided for ASHA workers are seldom paid in full. In many areas the state government is more than a year behind in paying ASHA workers their due incentives for work performed.

Now with ASHA and anganwadi workers being asked to take up more responsibilities on the frontlines, in hazardous conditions and without being paid their due, the state and central governments are pushing them deeper into economic distress and the loss of dignity. India’s medical and healthcare system is showing the consequences of this neglect.

*Names changed

Cover Photo: Representational Image. Courtesy: