Despite Increase in Wages, Government is Failing its Health Workforce

With the announcement of increasing remuneration for ASHA and Anganwadi workers, Prime Minister Narendra Modi is believed to have addressed one of their main demands. However, a closer scrutiny and ground reality speak a different story.

Firstly, doubling remuneration of ASHAs is an insult to their work, to say the least. It translates to an increase from Rs 1,000 to Rs 2,000, which is not what they have been protesting for, in Delhi, Rajasthan, Karnataka and Haryana. The remuneration of Rs 1,000 was decided in 2005, and since then, there has been no increase. In any case, most of ASHAs’ earnings are dependent on the incentives they receive for each task performed. For example, the central government pays Rs 250 for anti-natal care of pregnant women for nine months. To this, some states add from their own budgets and increase such incentives by little margins. In most states the monthly earning of ASHAs ranges between Rs 3000 and Rs 5000. PM’s announcement has not touched this bigger chunk.

Similarly, honorarium for anganwadi workers was also increased. Those receiving Rs 3,000 so far, would now receive Rs 4,500, and those receiving Rs 2,200, would now get Rs 3500. There was a slight increase in honorarium for anganwadi helpers as well.

This Diwali gift to nearly 30 lakh health workers, who are first point of contact in rural and urban poor areas, belittles their efforts and keeping the country healthy.

Workload

While most of the workforce follows a routine, there is no “a typical day” for an ASHA worker. She has been assigned 40 tasks for her catchment population. These tasks range from accompanying pregnant women for institutional delivery and counselling for nutrition to administering polio vaccine, and post-natal care for newborn babies. In addition, they carry out many campaigns from time to time. For example, checking coolers and water tanks during outbreaks of malaria or chikungunya for which they are paid Rs 1 per household. They are tasked with home visits for distribution of medicines for tuberculosis patients. They were also roped in by the government to collect information on eligible beneficiaries of National Health Protection Scheme.

Similarly, anganwadi workers have to perform numerous tasks. Apart from managing anganwadis, the rural child care centres, they have to regularly weigh all children up to the age of 6 years. They have to visit homes of children below three years of age, and pregnant and lactating women to guide them regarding nutritious and healthy food.  They organise a monthly health and nutrition day of the village.

Both ASHAs and anganwadi workers are the foot-soldiers of the government trying to improve health and nutrition in India’s rural heartland. Paying low wages while overloading them with work is a recipe for a crisis in a country with a heavy burden of illnesses.     

Not even minimum wage

The monthly remuneration given to ASHA and anganwadi workers defies government’s own policy of minimum wages. Minimum wages differ from state to state. It is Rs 13, 986 in Delhi, nearly Rs 11,000 in Karnataka and Rs 5,538 in Rajasthan. The rates mentioned here are for unskilled workers. If they are to be given wages for semi-skilled or skilled workers, which the ASHAs and anganwadi workers are, then the gap between their earnings and minimum wages will increase further.

There is a growing concern about minimum wage itself. The Seventh Pay Commission for the central government employees has recommended Rs. 18,000 as minimum wage.

One argument floated around for ASHAs’ work is that they are “voluntary social workers”, and hence should not demand wages. However, this is a predatory argument considering the amount of work they are tasked with. There is nothing voluntary about their work. As the same official is responsible to give them their wages, they don’t really have the option to work like a volunteer, i.e. someone who chooses when and how much to work. Also, unemployment rates are at an all-time high in the last 20 years, as shown by a report by the Azim Premji University. Supply of workers supersedes the demand. Unless an ASHA is working to the satisfaction of the government officials, she is at the risk of losing her job.

The announcement by PM Modi seems completely out of context when we consider these debates and the demands that the health workers have been making.

Churning in Haryana

PM’s announcement has also not kept pace with developments in certain states. These frontline health workers have been on streets in several states over past many years. In 2018, ASHAs and anganwadi workers of Haryana launched statewide movements. Protests by ASHAs under the banner of Haryana ASHA Workers Union started in 2017, culminating with the state government accepting their demands in February this year. With government failing to implement it, they went on a strike again from July 16, 2018. Despite heavy rains, they sat on the streets in their pink sarees and salwar kameez. Finally, the state government agreed to implement the February agreement on 21st July, and since then, their wages have increased in the state. An ASHA worker in Haryana today earns nearly Rs 9,000 due to the increase in incentives.

The anganwadi workers too staged agitation in the state, and their remuneration too was increased from Rs 8,000 to Rs 11,000.

Announcement by the central government is a result of such agitations which are embarrassing the government by mirroring their apathy toward women health workers who are the backbone of first line care in India.

However, other demands of the agitating health workers – such as giving them permanent jobs and social security – are still a far cry. The Diwali gift by the Modi government is simply not good enough to cheer for in the festive season.