Foot soldiers of India's health programme, here's how much an ASHA worker makes

Clad in a pink sari, Anjali Kalbande is a known face in Mahanjanpura, a dusty village in Amravati. Her jovial demeanour and quick strides are equally famous. It’s difficult to keep pace with the 35-year-old, as she  goes from one household to another, giving information about community meetings and government schemes.

Kalbande is an ASHA worker. ASHA stands for Accredited Social Health Activists, who make up the community  of health workers instituted by the Ministry of Health and Family Welfare (MoHFW) in 2005, as part of the National Rural Health Mission  (NRHM).

Women like Kalbande are the first point of contact for most rural patients. On rounds, on a Thursday morning, visiting village households, she stops as a man walks up to her and shows some spots on his arms. She quickly inspects it and gives him details  of the doctor he must see. Her long day has just begun.

Kalbande, like all other ASHA workers, is the foot soldier, who also ensures that tuberculosis patients stick to their six-month DOTS (Directly Observed  Treatment Short Course); and provides the special vigilance that patients battling multi-drug resistant TB (MDR-TB) need.

A health worker in her  neighbourhood for 10 years now, about a 100 TB patients have recovered  under her watch. However, for all the hard work that she puts in, she  barely makes enough to make ends meet even in a tier-2 city. ASHA  workers’ job profile is based on incentives. If a TB patient successfully completes their six-month course, Kalbande gets Rs 1,000 as  honorarium. Most months she earns somewhere between Rs 2,000 to Rs 2,500 from several different incentives.

“Everyone listens to her. We need  people like her, who can handle the drunkards we have in this  village,” says Induabai Horar, a local resident.

Mahanjanpura has 950 households, and every month at least two new cases of TB are diagnosed  and need attention. Kalbande has her work cut out for her. For her  though, “money is not the motivation to do my job well. Even small  children of the village talk to me with respect,” she says.

Ground reality

In  Latur’s Rui village, with a population of around 1,200, 35-year-old ASHA worker Anita Limrajgire, has been waiting since April this year to get her dues.

“I’ve filed all forms necessary but I am yet to receive the amount due,” she says. The wait for the paltry sum to reach an ASHA worker can take weeks, sometimes months, and can be demoralising. No protective gear reaches them though their work involves talking to  patients with contagious diseases like TB.

ASHA workers have also been  roped in to promote institutional deliveries under the Janani Suraksha  Yojana. They are required to accompany a pregnant woman in the village  to the nearest government hospital for delivery. However, here there’s a  hint of conflict in their roles. “The nurse at the primary health centre does not inform me at times and takes the woman to the hospital herself.  Then I don’t get any money but she does,” says Limrajgire

An ASHA worker’s neighbours trust her, and the government and NGOs can rely on her to carry out their programmes. And while these women find their role  fulfilling, they wish the government was more sensitive to their
needs, too.

ASHA workers across India have for a long time been demanding that the government give them a fixed salary.

Reporting for this story was supported by the REACH Lilly MDR-TB Partnership Media Fellowship Programme.