SIXTEEN days of agitation and strike has forced the state government of Haryana to hold talks with the leadership of ASHA workers and CITU on February 1 and concede the workers demands. The next day, that is on February 2, victory processions were taken out in all twenty one district head quarters by nearly 20,000 ASHA workers to celebrate their huge victory.
As we all know National Rural Health Mission (NRHM) was launched by the UPA-1 government in 2005 to provide some relief in the government provided health services in the rural sector. This was the time when the Left parties were supporting the UPA government from the outside on the basis of a pro-people common minimum programme. Besides other services, NRHM was to provide free vaccination to pregnant women and children and delivery in a hospital instead of at home. To facilitate this work, ASHA workers were recruited; one each for every 1000 population. In urban areas, one ASHA worker was recruited for every 1500-2000 population. ASHA workers are also called USHA workers in some urban areas. The objective of the scheme was to bring down the unusually high number of deaths during delivery and infant mortality in India which is worse than in the neighbouring countries of Pakistan, Nepal and Sri Lanka. The results since the commencement of the mission have been quite encouraging and the numbers of hospital deliveries has considerably gone up. Since the launching of the scheme in 2005, mortality of child at the time of birth has gone down by 34 per cent and that of the mother at the time of delivery by 36 per cent. The credit for this great success rate goes mainly to the dedicated service provided by ASHA workers as the basic structure of the health care department continues to be quite weak. The success of the programme has led to its extension in the urban areas as well as by dropping the word "rural" from the nomenclature NRHM, it has been renamed National Health Scheme.
RESPONSIBILITIES OF ASHA WORKERS
Looking at it superficially, it would appear that the responsibility of ASHA workers is confined to hospitalised deliveries and vaccination. This might have been true at the time when the scheme was launched. However, the work load kept on going up with the passage of time, so much so that ASHAs are now required to provide approximately 35 kinds of services. Besides hospitalised delivery and vaccination, ASHAs have to ensure family planning by motivating newly wed couples not to have the first child till two years after marriage and to prepare women to have a three years gap between two children. They have to pay home visits for 42 days after the birth of a child to oversee its health, provide proper dose of vitamins, administer polio drops, give medicine to TB patients, follow up on underweight children, identification of malnourished children, preparing record of delivery deaths, hold monthly meetings of pregnant and young women, arrange meetings of village health committees, prepare malaria slides, maintain record of newly wedded couples, conduct tests for cancer, BP and diabetes and follow up survey, test salt samples, identification of KUSHT patients, etc. etc. Besides, ASHAs also have to do survey work on a specific disease in a particular district or area. ASHAs are also required to ensure the success of so many missions and fortnight campaigns that the government comes out with from time to time.
The health department conducts regular training programmes for ASHA workers to prepare them for their ever increasing responsibilities. Also, there are monthly meetings at the primary health centre, where the ASHAs performance is reported and discussed. Violence against women has been a subject at recent training programmes. Every PHC appoints one facilitator for every 30 ASHAs. The facilitator is from within the ASHAs and is required to visit every village in the area. Different state governments have fixed a small incentive for the facilitators.
What is worse is that despite being an integral part of the government provided health services, there is no regular recruitment of ASHAs who are appointed not even on a contract basis on a fixed salary. They are paid entirely at piece rate. ASHA workers are educated and mostly young. Thus it becomes a case of the exploitation of the labour of educated young women. It cannot be separated from the policies being pursued under the framework of the capitalist globalisation wherein maximum work is extracted while paying as little as possible. There are no wages: only incentives and that too performance-based. In the case of Haryana, when an average of the payments made over a period of 12 months was taken out, it was found that for all the back breaking work done as mentioned above, an ASHA worker was being paid an incentive of Rs 2500 to 3000 per month. And there are no fixed hours of work. On so many occasions, an ASHA worker has to accompany a delivery case to the hospital at night and or stay with the case in the hospital for a couple of days. In case of accidental injury or death, there is no provision even for compensation.
BACKGROUND TO THE AGITATION
CITU started organising ASHAs in Haryana in 2008. In 2009, ASHA Workers Union, Haryana was duly constituted which was registered in 2011. This is the only registered union of ASHAs in the state. Ever since its constitution, the union has always been agitating for and has secured some relief and facilities under the CITU guidance. A big state wide agitation in November 2013 forced the then Congress led state government to fix a minimum monthly emolument of Rs 500 which was later increased to 1000 per month. At the same time, the state government had to agree to pay 50 per cent of the centrally fixed monthly incentives as extra bonus from the state budget.
There has been no let up in struggles during the current BJP regime in the state. Twice there were state-level mobilisations. There were several meetings with the state CM and health minister but nothing more than empty assurances were given. Therefore, the state committee of the union at its meeting on December 20, 2017, decided to launch a big agitation. It was an opportune moment for us as the government had recently made some enhancement in the wages of NHM workers after an 11-day agitation.
AGITATION PLAN OF ACTION
The plan was finalised at a meeting of the state committee of the union on December 20. All the districts in the state were divided into four zones. Zonal convention was fixed to be held on December 29-30, 2017 in which district, CHC and PHC committee level workers were to be included. The convention was attended by about 400 workers. All 21 districts were divided into organisationally strong, average and weak categories. General body meetings of workers were held in the average and weak districts. Even CHC and PHC level meetings were held wherever felt necessary. These meetings were conducted by the state leaders of the union supported by the CITU district leadership as well as several leaders from the CITU state centre. The average membership of the union had been 6000 over the last three years. During the ongoing year the reported membership till December 20, 2017 was around 4000. Hence, it was decided to complete enrolment of past members as well as enhance membership. The performance was reviewed at a state committee meeting on January 11, 2018. Finding the preparations satisfactory, it was decided to launch a four-phased agitation : (i) mass participation in the nation-wide strike of the scheme workers on January 17 (ii) chain sit-ins at district hospitals/DC offices from January 18-25 (iii) state-wide strike from January 27-29 (iv) courting mass arrests all over the state on January 30. Finally, to continue the strike if there is no solution to the demands.
EXPERIENCES OF THE MOVEMENT
Performance at the nation-wide scheme workers strike on January 17 was to be the first indicator for the success or otherwise of the future agitation. On that day, 28,000 scheme workers came out to demonstrate on the streets of Haryana. Of these, the participation of ASHA workers alone was to the tune of 12,530 whereas their total number in the state is 19,855. Then began the chain sit-ins from January 18th onwards. Some districts went on a continuous strike from January 17th itself. Four or five union leaders and several members from CITU state centre toured the districts to review the performance during the chain sit-ins. Leaders of Sarva Karmachari Sangh, Haryana, the largest organisation of state government employees in the state and our fraternal organisation, also toured the districts. The district-level leadership also performed creditably. Whether it was a Sunday or any other holiday, ASHAs came to the dharnas, kept on going up with each passing day. Reports from districts were collected every evening and leadership would move to the district(s) or even local centres where any weakness was indicated. Regular instructions were issued to union and CITU district leaders in this regard. For the third time during the entire exercise a meeting of the state committee of the union was held on January 24 to review the performance up to that time and finalise the future programme of action. The sit-ins continued on January 26 as well after unfurling the tri-colour at all places.
The state-wide strike began on January 27. On January 28-29, workers formed up in processions and knocked at the doors of the BJP MLAs, MPs, and ministers in the state and central governments. There was hundred per cent participation in the three-day strike.
As per the call of the nation-wide coordination committee of trade unions, January 30th was to be observed as a mass court arrest day in Haryana. The atmosphere on the day became stirring when CITU workers came out in their red shirts holding red flags in their hands. At most places, workers refused to be let off at the end of the day and insisted on being taken to jails. It was with great difficulty that they could be convinced. The state committee of the union met for the fourth time on January 31 to review the performance so far and decide on the future course of action. Finally, after three hour long discussions of the union leadership with the state minister for health, when the minister publically announced to the media the government's acceptance of the ASHAs demands, the union called off the agitation at 5 pm on February 1.
ACHIEVEMENTS OF THE AGITATION
There were four rounds of talks with the government about the agitation. The first three rounds were at the officer-level and the final round under the chairmanship of the minister for health. Agreement was reached on the following demands:
A. S.No. Item Existing Payment Increase Total Now
1. Delivery in hospital 300/200 100/- 400/300
2. Vaccination 150 100/- 250
3. ANC 250 100/- 350
4. HBPNC 250 100/- 350
5. Family planning / 500 50/- 550
Gap between two children
There has been increase in payments to be made for several other items as well. As per the agreed increase in incentives, an ASHA with an average performance will get Rs 1200-1300 more per moth. In addition, the state government will pay 50 per cent of the increase as bonus from its own budget. The total increase in this case will amount to about Rs 2000 per month. Add to this the fixed increment and it becomes Rs 5000 approx (it may be noted that according to an agreement reached with the then state government in 2013, the government is committed to pay 50 per cent of the total incentives in a month as bonus). As of now, an ASHA in the state with an average performance gets Rs 4000 to 4500 (fixed incentives + 50 per cent bonus amount). Now, this amount will cross Rs 9000 which is the minimum wage in Haryana. This is what the union was demanding. A large number of ASHAs will be getting much more than this as the payments are performance based incentives.
B. Soon after coming into power, the BJP government had decided to impose certain conditions to be qualified after passing a departmental test. This was with a view to remove the facilitators. The Union had challenged it in the High Court and the order was under stay for the past two years. Now the government has agreed that no facilitator will be removed and the court case will be withdrawn.
C. All ASHA workers will be supplied android phones. The proposal will be soon finalised and its budget got approved.
D. The health department has agreed to provide an almirah and register to the ASHAs.
E. In case of death of an ASHA due to accident, compensation to the tune of Rs 3 lakhs will be paid. In case of injury, the entire cost of treatment will be born by the government. Policy will be framed to bring all ASHAs under insurance cover.
F. Work experience as an ASHA would be given weightage in the recruitment of ANM and staff nurse.
LESSONS FROM THE AGITATION
The BJP government in the state aided by the BMS tried their utmost to break the agitation. The association of NHM workers totalling about 11,000 in the state with BMS help had concluded an agreement with the government after an agitation in December 2017. These NHM workers are either officers over ASHA or senior ASHAs. They collaborated with the BMS and the state government at several places and to break the strike. They went to the extent of promising a settlement with the government, if the workers broke away from the Red flag union. But our tactics and tireless efforts of the leadership and the workers brought all these nefarious designs to naught. The organisation of the union emerged stronger even in districts where it was weak earlier. Workers in only one out of the 21 districts in the state were in touch with a trade union centre other than the CITU. After the successful strike, even they have come to the union fold and CITU. The union membership for 2017 is likely to cross 11,000 which till now hovered around 6,000. During the coming year 2018, the total membership is expected to be between 15,000 to 18,000.
As a result of the successful strike, CITU’s influence has considerably increased. The agitation was widely reported in the media. Leaders of other political parties also came to address the sit-ins at several places. When the victory celebrations were held in Rohtak on February 2, about 400 workers collected Rs 60,000 on the spot and gave the amount to CITU district committee.
ASHA workers are rendering a very basic service within the framework of government provided health services, particularly in rural areas. The attitude of successive governments has been to provide all health services through ASHA workers rather than recruit permanent employees. Our contention is that this sector should be recognised as an organised sector. ASHAs are an educated army of young women. They are being trained both by the government and their department, the task of organising them needs to be taken up on a priority basis as there is possibility of big success. They have the potential of mobilising other sections of workers as well.
CITU also wishes to acknowledge the cooperation of JMS, SFI, DYFI, Khet Mazdoor Union and AIKS in conducting this movement in several districts.