At the frontline of the country’s battle against COVID-19 , Accredited Social Health Activists, or ASHAs, in Haryana have gone on strike after they were issued new Jio 4G SIM cards and their old SIMs disabled to ensure they migrate to android phones for better monitoring of service delivery. But the workers, paid poorly with salaries often delayed, say they cannot afford smartphones to use the new SIM cards.
“In the last week of July, our existing mobile numbers were disabled and we were offered new 4G SIM cards along with Internet data package. These will only work on a smart phone, which many ASHA workers can't afford. We have not been able to perform our duties since this move and have been told that if we don’t activate the new number, we won’t get another one,” says Sudha Pal, general secretary of the Haryana ASHA Workers’ Union.
The ASHA workers say they were promised smartphones in 2018, but the procurement has been delayed.
Ms. Pal and 200 other ASHAs have been protesting outside the office of the Chief Medical Officer of Faridabad for over a week now. An estimated 20,000 ASHAs are on strike across 22 districts of Haryana. They completed 10 days of stir on Sunday.
Crucial tool
Mobile phones help ASHA workers remain in contact with beneficiaries in their area, receive calls seeking assistance such as during child birth, and send updates and GPS locations of new COVID-19 cases.
The issue has fuelled anger pent up among frontline workers — ASHAs, Anganwadi Workers and Auxillary Nurse Midwives — who have been given additional responsibilities since March, which include spreading awareness about preventive measures against coronavirus infection as well as detecting and referring suspected COVID-19 cases.
They have been delivering these services despite the lack of any protective personal equipment or security from attacks while out on surveys. This is in addition to their routine work which for an ASHA worker includes screening pregnant women, lactating mothers as well as children for communicable and non-communicable diseases, vaccination, care during pregnancy and child birth, among others.
Meagre income
Their income, which is a combination of a fixed honorarium of ₹4,000 and additional earnings from task-based incentives, has gone down since the COVID-19 outbreak as they are not able to deliver services which fetch them some extra money. For their COVID-19 related activities they were promised an incentive of ₹1,000 in March, and another ₹500 by the State government. They are yet to receive the latter.
In fact, 42-year-old Jeevanti Devi is yet to receive her salary for July. She supervises 418 households, or a population of 1,894 people in Faridabad’s Indira Nagar where sewage from small factories, workshops and houses collects in open drains and overflows onto the streets making the area vulnerable to infectious diseases.
“I got my salary for June after a month’s delay in August, but many others haven’t received even that yet. We have no information about the ₹500 due to us from the Haryana government as incentive for our COVID-19 activities. Many of us are single mothers and ₹4,000 is not sufficient to make ends meet. The earnings from incentives are uncertain — if there are fewer deliveries in a month, I make less. In a good month, I can earn upto ₹5,000, but mostly I earn ₹1,000- ₹1,500 [extra],” says Ms. Devi.
While the government has announced an insurance cover of ₹50 lakh for death due to COVID-19 or accidental work during COVID-19 related duty, it doesn't cover family members who may fall ill after coming in contact with the workers.
The Hindu ’s queries to the Haryana government’s National Health Mission official did not receive any response.
Vital role
“Since ASHA’s live in the community and belong to that community, they have a much deeper knowledge of and connection with the families. Without such a connect, it will not be possible to ensure the last mile delivery of health services. We would not have been able to achieve the gains we have of institutional delivery and reduction in maternal mortality but for the ASHAs. They are also the ones helping us with the TB and malaria control programmes,” said former Union health secretary K. Sujatha Rao, in an e-mail. She added that Haryana’s ASHA workers can't be expected to use a technology without provision for a suitable equipment.
Orb Media, an independent journalism organisation, highlights a study published in the British Medical Journal in 2012, co-authored by Nita Bhandari, which showed that interventions by community health workers as per government guidelines led to fewer still births in the intervention clusters, due to improved neonatal care practices in both home-born and institution-born infants and reduction in neonatal mortality for babies born at home.
Earlier this month, ASHAs, anganwadi workers, and workers of National Health Mission and Mid-Day-Meal scheme joined a nationwide two-day strike on August 7 and 8 called by the Joint platform of Scheme Workers’ Federations and Unions affiliated to the Central Trade Unions.