ASHA Workers in Hyderabad, Overworked, Underpaid, and Face Administrative Neglect

Hyderabad: Samriddhi, a mother of two teenagers, begins her work early in the morning. After cleaning her home and preparing meals for her family, she sets out for her workplace, a Primary Health Centre in Musheerabad. She changes three buses to reach her centre—which is far because, during COVID, her landlord kicked out her family from her rented home near the PHC, seeing a risk of contracting the virus from an ASHA worker. All Accredited Social Health Activists (ASHA) must mark their attendance at sharp 9 am in the register at the centre as well as send a photograph of their arrival to the Medical Officer. For the next eight hours, workers are responsible for tracking every ailment that can cause potential health risks to the population in their area.

There are about 30,000 ASHA workers in Telangana, of which 2,400 registered workers are in Hyderabad. "Each worker directly reaches out to a population of 2-3,000. We are responsible for identifying the pregnant women in our areas and registering their names. We take care of their needs for the next nine months and even during and post deliveries. We have to inform them about their diets, medications, and precautions during this time. At the time of delivery, be it 2 O'clock at night, we have to be with them immediately and take them to the nearest hospital," said Samriddhi. When

asked how she reaches out to them living so far away from her workplace, she says at times her husband drops her off, and other times, she has to book a cab and go. Her husband, a security guard, is not always available.

She told Deccan Chronicle that all ASHA workers have not received their salaries for the past month. "The answer back from the government is lack of budget. We are not regularised workers with a fixed salary but the burden of work is more than a government employee," she said. At a sit-in protest on Saturday in front of the health commissioner's officer in Koti, hundreds of ASHA workers from across the state gathered and demanded more regularized salaries, up to Rs 18,000 with social security benefits.

Despite working eight hours a day, the workers get a salary of Rs 9,750 per month, which too, is remitted only if they fulfil their targets of reaching out to pregnant women in their areas. This is their primary work. Besides this, they have been asked to maintain records for the elderly people, newly-weds, Blood Pressure, Tuberculosis and Leprosy patients in their areas. To maintain these records, they do door-to-door surveys within a 3-km radius around their PHC. "Now, they have also asked us to make online entries for ABHA (Ayushman Bharat Health Account) cards, where we have to register at least 25 members every day. That work falls under ANMs, but we have been asked to do it. We have also been asked to make our records available online every week. Not only this, for every government exam or election, we are roped in," said Diya, an ASHA worker in Begumpet.

Having worked for 12 years, Samriddhi gets Rs 9,900 as a salary. The new joiners, she says, get only about Rs 3-4,000 as they are yet to make contacts in the community. "We have known the people in the area so we can fulfil our targets. But the new ones do not even get this amount in full," she said. Despite being in the system of healthcare, workers are not provided with any safety equipment. "We have no security or ex-gratia even If we die," she says. ASHA workers have no leaves, no Sunday or other week offs. They do not get any travel or phone and internet allowance.

They are the head-runners of all government healthcare campaigns. Every monsoon, they are required to make lists of malaria and dengue patients and observe the patients for five consecutive days. They are responsible to keep track of other monsoon-related fevers as well.

Over time, especially post-COVID, the work pressure has increased, the workers said. "We have been warned by the DMHOs that our attendance, targets and whatever work is assigned to us, must be up to the mark as our performance determines the salaries we get. However, it is never more than the pittance that we get," said Vibha, a worker in the Amberpet area. "Even if we go out at night to help pregnant women with deliveries, we are not asked by our medical officers or DHMOs the next day about the challenges we face. We are not allowed to ask for the next day off. They click pictures and forward them in their WhatsApp groups, as proof that work is being done. But no one cares who or how that work is done, with what difficulties," says Diya.

As per the sources in the government, the government of India funds, contributing to about 60 per cent of the total funds, have not been transferred for the past six months. While the state government has tried to push the boundaries for timely payments, the centre's delay has finally begun to affect the workers. However, the workers say that the problem of delayed salaries have persisted for the past two or three years. "Last August, salaries were paid but the next two months were delayed. Then some amount was received in November but then again no salaries for the next month. This irregularity persists, no matter which party is in the power," Samriddhi said.