One of the most prestigious awards in global health has given India’s task force, which includes more than a million women health-care workers, a prestigious award.
It doesn’t come with any cash prizes.
Archana Ghugare (42), a Pavnar-based health-care worker who works in the state Maharashtra, says that awards don’t fill stomachs.
Ghugare is an ASHA, which stands for Accredited Social Health Activists. This program is run by India’s Ministry of Health and Family Welfare and provides health care for low-income and rural communities. Although they are not doctors, they are given a wide range of important health-care responsibilities. These include advising mothers on breastfeeding and raising awareness about COVID vaccinations.
ASHA workers were one of six recipients of World Health Organization’s Global Health Leaders Awards aEUR”, sharing the honor with luminaries such as Dr. Paul Farmer. This award, which was established in 2019, honors individuals and groups who have made significant contributions towards global health.
While an honor can be gratifying, the wages for these workers are not.
They make an average of $60 per month and receive few benefits. Workers say that although the government has increased their monthly pay by a few dollars in recent years, it is still too low. Many ASHAs, or workers as they are called, hope that this moment will allow them to pressure the government to raise their salaries and other improvements.
Pay equity is an ongoing problem. ASHAs in India have protested several times over the past two decades, including during the 2020 pandemic. They are demanding better wages, and safer work environments.
Jim Campbell, WHO director for the Health Workforce program, tweeted “Let’s pray the award draws attention on their working conditions.”
Many ASHAs are proud of their work, despite their dissatisfaction about their pay. In keeping with the spirit of their acronym (asha in some Indian languages means “hope”), the workers are a symbol of hope for better health care, especially for the many underserved Indian populations.
NPR interviewed three ASHAs to find out their daily tasks and aspirations, aEUR”, and their reactions to the WHO award.
Ramrati Chauhan (a 42-year old ASHA) from Palwal, Haryana state says that she is very attached to the women who are pregnant she helps.
A woman went into labor one time. Chauhan, who isn’t a midwife, was unable to reach the woman in the time necessary to transport her to a hospital. The woman then lost her baby to complications. Chauhan says that he felt deep regret for not being able help the woman.
Chauhan visited the woman every day during her nine-month-old pregnancy again and advised her on the best ways to have children. Although there were some complications, Chauhan was there to help her get to the hospital in time. She gave birth to a healthy boy.
“When I pass their home now, the woman points at me and says to her son, That’s your mother, too. Chauhan says, “She saved your life.”
Chauhan claims that she keeps a journal of important moments in her life, which she can refer to when she is feeling discouraged about her job.
She says, “We have to fight [with the government] in order to get a raise even $20 to $25 per month.” Her current monthly income is about $100. Payouts vary from one state to the next depending on how many additional tasks a worker performs.
She claims that the government did not give her safety equipment aEUR” when the pandemic began, even though she had had to inspect for people who had been positive for COVID. She says, “We made our own masks.”
Chauhan says that the WHO award is not a first for ASHAs. She adds that they have been honored by local governments and municipalities many times. She believes that the government should recognize ASHAs as full-time workers and provide them with a steady income, pension, and other benefits.
Chauhan states, “We don’t ask for much.” “Only what is proportional to our hard work.”
The ASHA program was initially created in 2005. Health workers were considered volunteers who would work about 2 to 3 hours per day, with a little more on certain days. According to the National Health Mission, which is part of India’s Ministry of Health, these health workers are now paid approximately $2 to $3 an hour. ASHAs have seen their responsibilities grow over the years.
Archana Ghugare claims that she worked 14 hours per day during the peak of the coronavirus epidemic. Even today, she has a full-time job. She has been going door to door to find people in the community with a range of medical needs. This includes pregnant women and children under 14 who are eligible for COVID vaccinations.
“If the government gets so many things done for us, shouldn’t we get something back?” Ghugare asks. She says that payments are often late, sometimes even by 6 months. She is worried about how she will pay for her two daughters’ educations, one of which has a speech- and hearing impairment.
Ghugare remembers why she began this job when it was hard.
Ghugare was told by a dying HIV-positive lady that her last wish was a EUR” to Ghugare for her care of her daughter. Ghugare raised the girl after the woman died, but she didn’t adopt her or raise it. Instead, she gathered donations from the village to help fund her education. Ghugare says that she is now 22 years old and is studying to become a nurse.
She says, “People trust me because they know I am an ASHA worker. That trust should not be broken.”
Veena Dyani (37-year-old ASHA) is a busy scheduler from Nainidanda, at the foot the Himalayas.
She usually starts her day at 4 a.m., after preparing breakfast for her older children and her in laws who live with them. Then she heads out to home for visits. Routine duties include checking the weight of newborns and giving vitamin and folic acids tablets to pregnant ladies.
Sometimes, it is necessary for her to enlist the help of others in order to do her job.
Wild animals can attack Dyani’s village in the hillsy jungles. She pays a villager to go with her to safety when she walks through the woods to see the houses on the other side.
Even if her children don’t have to do schoolwork, they can help. Dyani must organize all the information she has collected about her patients at the end of each day. Sometimes, her children (ages 15, 17, and 20) write down the data in notebooks that she will submit to her bosses.
Her boss has been asking her lately to upload this information online, and take photographs of the community health-care meetings.
She is frustrated by this. “How are we supposed to do this online work?” Dyani, who is using a basic cellphone, says that not all ASHAs can afford a high-quality smartphone. Only a few states offer smartphones to ASHAs. A politician from her state had once promised that she would provide tablets for the ASHAs at a EUR” many years ago, but it hasn’t happened, she claims.
Even worse, she was last paid $65, in February. She is a widow and needs the money to support her family.
She says that “we are being exploited” and adds that she could make more as a day worker. She insists that she stays because she enjoys the work.
Her WhatsApp group of ASHAs was filled with congratulations messages when the news about the WHO award broke. She doesn’t care if she is recognized or not. She says that she will continue to do her job “aEUR” and advocate for her rights.
She says, “The ASHA itself [can’t] lose heart.”
Sushmita Pathak, a freelance radio journalist and print journalist based India, focuses on politics and development. Follow her @sushmitza
