New Delhi/Bhopal: Laxmi Kaurav, 38, an ASHA sahiyogini (facilitator) in Mehgaon Block of Bhind district in Madhya Pradesh (MP) was shocked when she looked at the messages on her phone on the morning of 19 September 2020: A “show-cause notice” with her name was circulating on a whatsapp group of ASHA workers.
Issued by the Block Medical Officer (BMO) of Mehgaon, the notice said Kaurav and 21 other ASHA workers—the acronym stands for Accredited Social Health Activist—had been absent from their “work stations” on 10 September 2020, the day the BMO conducted a “surprise inspection” of select villages.
The 18 September notice also said that the ASHA workers’ services would be terminated, if they failed to give “satisfactory reasons” for their absence.
Kaurav was livid but not entirely surprised at the timing of the notice.
A week earlier, ASHA workers across Bhind district had staged vocal protests in the election rallies of chief minister Shivraj Singh Chauhan as he campaigned for state by-elections.
What the women wanted was regularisation of tenure, fixed salary, insurance and a travel allowance. For additional Covid-19 duties, they sought a monthly honorarium of Rs 10,000, personal protective equipment (PPE) kits and tests to check if they were infected.
“We have been writing to the district health officials, state health ministry and to the chief minister since the pandemic started. None of them bothered to take notice,” Kaurav said. “So we decided to attend the CM’s rally and physically hand over our memorandum.”
After failing to get the chief minister’s attention at the rally, the ASHA workers stood up midway through his speech and waved their memorandum of demands. Police forced them back to their seats.
“Despite all the commotion, the CM continued with his speech,” recounted Kaurav. “If the CM has come for a rally he should be listening to what the people have to say. He gave a speech on his own experiences and left. What about people’s problems?”
Undeterred, the ASHA workers followed the CM’s election rallies between 10 and 12 September and staged similar demonstrations at each.
This display of dissent did not go down well with state government and district officials.
The “show-cause notice” threatened to terminate the services of 22 ASHA workers, most of whom were at the forefront of past and present demonstrations for ASHA workers’ rights in MP.
Frontline Health Workers
ASHAs, an all-woman community health workforce, are instrumental in delivering the central government’s reproductive, child and adolescent healthcare services as well as surveillance of communicable diseases at the community level.
Recruited in 2005, as part of the National Health Mission, they form the backbone of India’s health-information system. Many come from poor families and marginalised communities, such as Dalits and Adivasis, and female-headed households.
During the coronavirus pandemic, ASHA workers have served as a crucial link between community and state health service delivery and have been at the frontline of India’s Covid-19 response system, conducting door-to-door surveys and identifying those with symptoms.
They have tracked returning migrants from cities in the aftermath of the lockdown in March 2020, ensuring that quarantine protocols are followed. As we reported in an earlier series (here, here and here), they have worked long hours since February 2020 without adequate physical protection or indeed remuneration.
Frustrated by government apathy, ASHA workers and facilitators joined nation-wide protests along with anganwadi (creche) and mid-day meal workers on 7 and 8 August 2020. ASHA workers struck work and protested in several states, such as Delhi, Karnataka, Haryana. The response from state governments has been varied, from police cases to termination notices.
Madhya Pradesh State Vendetta
The MP notice, said ASHA workers as they questioned its claims, followed a pattern of state vindictiveness against dissent.
The notice claimed government officials inspected 22 villages several kilometres apart on one day. “How is this believable?” asked Kamladevi, one of the ASHA workers named in the show-cause notice.
The ASHA workers we spoke to questioned their “absence” from “work-stations”, as the notice claimed. ASHA workers are field agents, whose duties require them to be out on field visits, administering children’s iron supplements, conducting malaria surveys, checking in on families that require prenatal and antenatal care among others. During the Covid-19 pandemic, they have been out on the field for more than 12 hours everyday.
When we contacted BMO Shobharam Sharma, he denied any knowledge of the notice, even though it was issued from his office.
“I am on leave, I am not aware of what happened,” he said, disconnecting the call.
The block community mobiliser, who supervises the ASHA workers, too, disconnected our repeated calls and has been out of reach since.
Article14 sought comment from the district magistrate of Bhind and the health secretary of MP. We will update this story if and when they respond.
Madhya Pradesh: Brutality Against ASHA Workers
This is not the first time that the MP government has criminalised dissent by ASHA workers.
The demand for regularisation of their jobs and formal employee benefits, such as insurance and paid leave goes back to 2018.
On Gandhi Jayanti, 2 October that year, ASHA workers from 16 MP districts marched to chief minister Chauhan’s house in Bhopal. When Chauhan refused to meet them, they staged a sit-in 200 metres from his residence.
What followed was intimidation and surveillance, said the activists.
Kaurav said the police “barricaded and blocked” them. “We had no food, water, toilet facilities as we sat in the searing heat,” Kaurav recalled. As protests continued the next day, the police separated the leaders.
“We were told that we would be split into a delegation of five representatives to speak to the CM,” said Mamata Shinde, one of the protest leaders. “Then the police packed us into a van and took us for a ride for several hours across Bhopal from one ministerial residence to another. But we did not meet anyone.”
Meanwhile, police baton-charged the protesting women. Mamata Rajawat, the ASHA workers union in-charge of Bhind district, was seriously injured after she fell from a 30 ft tower she had climbed to escape the police.
Police detained the ASHA leaders and asked them to sign a blank document before the district magistrate of Bhopal. When the leaders refused, they were told they would be released on the guarantee that they would not protest for the next six months, said Kaurav, who was one of those detained.
After they were released, policemen in plainclothes followed and watched the ASHA workers, even when they visited injured colleagues at the Hamidia hospital in Bhopal, Kaurav said. At the hospital, the plainclothes police detained Kaurav for over 10 days, refusing to let her leave the hospital.
“At the hospital they tracked every move of mine. I was not allowed to leave the hospital premises,” said Kaurav. “Why did they let me leave the police station if they had to keep an eye on me?”
Kaurav recorded a video of herself being detained. This was circulated among local media as the story of the nazarband (house arrest) ASHA worker. She escaped Hamidia hospital after a group of ASHA workers formed a human ring to divert police attention.
“I was later told that the plainclothes policemen had threatened to arrest me if they saw me again,” said Kaurav, as she recalled the incident two years later. “It is possible that they did not have the necessary evidence to arrest me at that point.”
Soon after the October protests, MP elected a new government in November 2018 with the Congress party’s Kamal Nath as chief minister. The charges against the ASHA workers seemed to go into abeyance until just weeks before the March 2020 MP political crisis that led to the resignation of Kamal Nath and the return of the BJP’s Chauhan as chief minister.
“Just as the political crisis was brewing, we started receiving calls from the police station,” said Kaurav.
In January 2020, fresh arrest warrants were issued against ASHA leaders Kausar Jahan, Rachna Bardel, Kaurav, Rajawat, Shinde and Shehnaz Bano. They were charged under sections of the Indian Penal Code for “violent provocation” and “criminal assault on public servants” on public duty. All five ASHA workers filed for bail on 4 February.
ASHA leaders said that the current criminalisation is linked to the October 2018 protests.
“For 15 months we were not hounded. Suddenly, right before the BJP government came back to power in March, we had arrest warrants issued against us,” said Kaurav. “Everyone is busy with the pandemic right now. They will definitely come for us once the pandemic is over.”
Criminalising Dissent in Delhi, Haryana
This pattern of criminalising dissent of female health workers extends beyond MP.
The Delhi Police filed a first information report (FIR) against the Delhi ASHA Workers’ Association (DAWA), a group of 100 Delhi ASHA workers, and 10 trade unions, who organised protests at Jantar Mantar in New Delhi on 9 August to highlight the troubles of ASHA, anganwadi and mid-day meal workers during the Covid-19 pandemic.
“As soon as the protests gained momentum, they filed an FIR against all trade unions based on a spurious claim that we had not worn masks and had violated social distancing norms,” Kavita Yadav, state convenor of DAWA told Article14. All the 1,000 ASHA workers at Jantar Mantar protests had worn masks and followed physical distancing norms according to Yadav.
“We received a lot of media attention at Jantar Mantar,” said Yadav. “The government doesn't want that.”
In Haryana, the police filed an FIR with similar charges against four ASHA leaders, Sunita Rani, Sudesh, Anju and Vandana in Chandigarh during a protest in front of the Haryana legislative assembly on 27 August 2020.
“How can the state take away our democratic right to protest?” asked an angry Sunita Rani, the secretary of Haryana ASHA workers Union.
ASHA workers are constantly battling state, block and district officials for their incentives and larger rights.
“We have not received payment for tuberculosis work for over 10 months,” said Dhanalakshmi, an ASHA worker from Bhind district, MP. “Incentive money is sanctioned, yet it doesn’t reach our accounts.”
Instead, they are threatened with termination of service, FIRs and court cases.
ASHAs Demand Recognition And Remuneration
ASHA workers, the world’s largest community healthcare workforce, have been instrumental, as we said, in improving maternal and child health outcomes and reducing the communicable disease burden in India.
They are paid an honorarium of Rs 2,000 a month and incentives that range from Rs 1 to Rs 300 for specific tasks, such as immunisation, ante and postnatal care among others.
“ASHA workers were initially recruited as a cadre of community volunteers who would flag the health and sanitation concerns within their communities,” said Sulakshana Nandi, joint National Convener of Jan Swasthya Abhiyan, a national network that advocates for equitable health policies. “Today, they are made to do the leg work for most governmental schemes. In return, they are paid very little.”
While the Government views ASHA workers’ essential community outreach as low-skill and semi-literate women’s work, ASHA workers, over the last several years, have refused to be treated merely as volunteers.
“We are no longer ASHA workers of 2005,” said Kaurav, explaining the long standing demands of the workforce. “We have learnt to raise our voices for our demands.”
ASHA workers across the country have been demanding a salary of Rs 18,000 per month for workers and Rs 24,000 per month for ASHA facilitators. They are also demanding a career track where experienced ASHAs can be promoted to the level of Auxiliary Nurse Midwives (ANMs).
“ASHA cadres have moved way past their initial mandate of being community volunteers,” said Anant Bhan, a public health expert based in Bhopal. “Yet they are still being considered an incentive-based cadre. The health system wants a lot from them but does not provide for them.”
“If it is a cadre that the government wants to retain and expand its scope, regularisation, fixed salaries and a clarification of their position within the health hierarchy are fair demands,” said Bhan.
“There is no record of the time and labour we put in,” said Kaurav. “We keep meticulous records for the government but our work is invisibilised.”
(Sreya Dutta Chowdhury is an independent social science researcher. She works with Behanbox, a digital platform for gender stories and data, on a project on the issues of frontline health workers in the Covid-19 pandemic)
Previously on Article-14: