IT rained all through the day and night on March 1, pouring down and flooding the streets.  Not only in Delhi but in almost all parts of the country.

But nothing could deter the determined ASHA workers from making their way to Delhi. They came from 13 states of India – from far off Tripura, Kerala, Telangana, Karnataka, Odisha, Bihar, and nearer J&K, Gujarat, Maharashtra,  UP, Punjab Haryana,  and Delhi. Some came in their pink, maroon or blue uniform sarees and others in sarees of many hues, braving all the hardships on the way, spending the cold night at the railway stations since the camp put up for them was flooded.

Who are these ASHA workers and why did they come?

ASHA stands for Accredited Social Health Activist and there are almost 9 lakhs of them, working under the NHM (National Health Mission). The NRHM (National Rural Health Mission) was started in 2005 for a period of seven years, to improve delivery of basic health services to the rural population. Its term was later extended for five years from 2012 to 2017 and it was renamed the NHM, as it was extended to the urban areas as well. The ASHA workers act as the link between the rural population and the public health services, imparting basic health education and services to the poor as well as helping them to access public health facilities.  However, they are treated as volunteers, paid a pittance as incentive for each of the tasks they perform, and they work in the most difficult conditions.   They are not recognised as workers by the government and are not given any of their rights as workers.  

 The ASHA workers have played a crucial role in contributing to an improvement in the health indices of the country, including an increase in institutional deliveries and decrease in the infant and maternal mortality rates and are the backbone of the NRHM/NHM.

They constitute one section of around one crore scheme workers working in different social sector schemes of the government like the ICDS, Mid-day Meal Scheme, NCLP (National Child Labour Programme), etc,  all of whom are grossly underpaid in the form of incentives, honorarium, etc.

Many studies have noted the important contribution made in the health sector by these workers. The Parliamentary Committee on Empowerment of Women (2009-10) in its Eleventh Report placed in both houses of parliament in September, recommended monthly remuneration for these workers, along with its other recommendations. The Mission Steering Group of the NRHM also made the same recommendation regarding monthly remuneration for ASHA workers.

In 2013, the 45th Indian Labour Conference discussed on the issues of these workers and recommended that they should be recognised as workers; they should be paid minimum wages; and they should get all social security benefits, etc.

However, the government has taken no action on these recommendations and has not even implemented its own year old circular raising some incentive rates.   To make matters worse, the government has reduced the allocation for the NHM by 25 per cent in the budget this year (from Rs 24491 crore for 2014-15 to Rs 18000 crore for 2015-16).

This is a serious setback to the public health system and will impact directly on the poorest sections of the population who are forced to utilise public health services. As it is, the financial allocation for health services in India is one of the lowest in the world, and 86 per cent of health expenditure is out of one’s pocket. This results in around 4 crore people being pushed into poverty, every year.  The stated health policy of the government and budget both lay emphasis on health insurance which will benefit the private sector health industry and still keep the vast majority of the poor population out of the purview of basic health services

Since the CITU started organising these workers in 2009 they have been struggling continuously for regularisation as government health workers, an increase in their emoluments and for improvement in their working conditions as well as in the public health infrastructure.  Through their struggles, they have been able to make some gains in their working conditions and incentives in some of the states, but their basic problems remain unaddressed.

Under the banner of the All India Coordination Committee of ASHA workers (CITU) the ASHA workers have demonstrated in front of parliament three times, and this fourth time they marched in the most adverse weather conditions, determined to force the government to pay heed to their demands.

They assembled at Jantar Mantar, coming in large and small groups, from different railway stations and parts of the city, carrying red CITU flags and their union banners. The meeting was inaugurated by A K Padmanabhan, CITU president who stressed on their justified demands and condemned  the callous indifference of the government, which exploits them mercilessly. Those who addressed the gathering and expressed their solidarity include  Brinda Karat, Polit Bureau member the CPI(M),  Krishna Prasad from All India Kisan Sabha,  Maimoona Mollah  from AIDWA,  Shankar Datta, MP, CPI(M), AR Sindhu, secretary CITU, general secretary AIFAWH, convenor MDMW, and  leaders of ASHA unions from all the states present.

A delegation led by  Tapan Sen, MP, general secretary CITU, and comprising of  Ranjana Nirula, convenor, and members of the  All India Coordination Committee of ASHA workers, VV Presenna Kumari  (Kerala), Parvesh (Haryana) and Sunita Bhagat (J&K) met the minister for health and family welfare, J P Nadda, and submitted a memorandum to him. The minister noted the major points of the memorandum and stated that he would discuss the issues with the prime minister. He agreed to hold further meetings with the organisations of  ASHA workers.   

While addressing the gathering, Tapan Sen exposed the pro-corporate approach of the new government and its policy of maximum exploitation of workers, which has been clearly exposed again in the budget.  He urged the ASHA workers to strengthen their unions and to unite with all the other sections of workers in the struggle for their rights and to force a change in policies of the government. 

While concluding, Ranjana Nirula urged the ASHA workers to forge unity with other scheme workers like the anganwadi workers and helpers, and midday meal workers, at the village level itself, to launch joint struggles of scheme workers, and to join the struggles of all sections of workers under CITU, as well as of the joint platform of trade unions. She also stressed on the necessity of recognising and fighting the attempts to disrupt the unity of the workers and  the people by the communal forces, who have come to power in the last general elections.

The AICCAW has given a call to burn effigies of the prime minister all over the country, independently and  along with the anganwadi workers and midday meal workers, till March 15.

The struggle for the demands of ASHA workers will continue. It will be intensified and  carried to higher levels, including strike.

Demands:

1.                    ASHA/USHA workers should be regularised as ‘ government health workers

2.                    They should be paid minimum wages of Rs 15,000 per month as has been demanded jointly by the Central Trade Unions.

3.                    They should get all social security benefits like pension, gratuity, maternity benefits, etc.

4.                    Pending regularisation as health workers, they should be paid a fixed monthly remuneration equivalent to the statutory minimum wage for skilled workers in the respective states, in addition to the specified incentives.

5.                    The NHM should be made a permanent health programme of the government, with universal application and adequate financial allocation.

6.                    The allocation for public health services should be increased to at least 5 per cent of the GDP.

7.                    The ASHA/USHA workers should be covered in various schemes available for workers like Aam Admi Bima Yojana, Rashtriya Swastha Bima Yojana.

8.                    All the incentives should be paid on time, on a regular basis and through bank/post office accounts.

9.                    Harassment of ASHA/USHA should be checked through setting up of an appropriate mechanism. 

10.                 Rest rooms for ASHA/USHA workers should be provided in all health centres.

11.                 They should be given uniforms, ID cards, bus passes, and all facilities applicable to BPL card holders.

12.                 Facilitators/coordinators should be recruited only from the existing ASHA/USHA workers.

13.                 ASHA/USHA workers should be given appropriate training, with 10 per cent reservation in nursing colleges for them.

14.                 ASHA/USHA workers should be promoted as ANMs after training.

15.                 Government health facilities and infrastructure should be improved on a priority basis.

16.                 Privatisation of the public health system should be reversed.