Monthly honorarium and performance-based incentives for them are late by months

Beena K. tries to blink away the tears clouding her eyes when she recalls her “tough” first year as an Accredited Social Health Activist (ASHA) worker in Feroke panchayat in Kozhikode over five years ago.

The 42-year-old homemaker worked with the Department of Health and Family Welfare’s Mahila Swasthya Sangh programme, intervening in early-age marriages to picking leprosy patients off the road, before she was recommended by the panchayat to the National Rural Health Mission’s ASHA programme in September 2007.

“The harder I worked in the field, the worse became the harassment from junior health officials. It was tough, and I answered them by working all the more in the field. Gradually, the people started trusting me. There came a time when parents would not allow their children to be vaccinated unless I was there,” Ms. Beena said.

But she is gradually losing hope. There is a certain despondency written on her face. The monthly honorarium of Rs.500 the government had fixed for over 30,000 ASHA workers is already seven months late. So are performance-based incentives such as Rs.20 for each vaccination and Rs.100 for registering a palliative patient.

On the other hand, work has increased manifold over the years.

“When we were recruited, we were told that it will be 1,000 people per ASHA worker. Now, each of us has about 400 houses under our care. This is because a lot of ASHA workers are leaving as they were unable to afford the erratic payment of honorarium and incentives,” Asiya K.T., an ASHA worker from Ramanattukara panchayat, said.

They, all women aged between 25 and 45, form the bridge between the community, especially the rural poor, and the public health sector.

Their services range from monitoring waste disposal to prevention and control of communicable diseases, palliative care, nutrition, community-based mental health programmes and registering cancer and HIV/AIDS patients for health care.

“We get the honorarium once in six months or a year, though we have to be paid on a monthly basis. These women, whose work over the years has seen a marked decrease in infant mortality rate and improvement in maternal health in the State, are treated with no respect. A Union Budget hike in our honorarium to Rs.700 has not yet been implemented,” Krishnaveni Sharma, State general secretary of the Kerala Pradesh ASHA Workers Congress, said.

Ms. Sharma said it would mean a lot for the ASHA workers if their honorariums were paid every month.

Ushakumari K.L., who joined ASHA after stints as a Kudumbasree health volunteer and anganwadi staffer, said she often ended up paying from her pocket for tea and snacks for patients she collected for attending medical camps.

“Our work within the community has helped us gain the confidence of the people. We have learnt to be public persons.

“Those who snubbed us as women who did not stay at home now respect us for what we do,” pointed out Nusrath T, an ASHA worker and Feroke panchayat member.