Major issues of CHWs
Ashavani Statement to the Government
REGULARISATION OF CONTRACT WORKERS AND ASHA VOLUNTEERS IN THE NATIONAL HEALTH MISSION: A STATEMENT
The following statement has been prepared by Ashavani, in consultation with Ashas volunteers and National Health Mission workers and submitted to the Ministry of Family and Child Welfare, Delhi in 2017.
A stable work force gives a firm foundation to the health care of the nation. The entire work force of the National Health Mission is contractual/voluntary. Critical changes are required to sustain their morale and performance. Employing lakhs of people as non- permanent staff for a decade in a government program, is a gross violation of the workers’ rights.
According to the press release of MOHFW (July 22, 2014) the contracted workers include Medical Officers, Specialists, Ayush Doctors, Staff Nurses, ANMs, Paramedics, District Program Managers and District Account Managers. In addition, ASHA Facilitators are also on contract.
Adequate funding should be allotted by MoHFW and suitable guidelines should be issued from the MoHFW to all the states and union territories for the following :
All the states and union territories should regularize all NHM contract workers.
Similar pay and benefits should be given for all the contracted workers within NHM in all the states.
All NHM contracted workers should receive social security under Employees’ State Insurance Act, 1948 (ESI Act), Employees’ Provident Funds Act, 1952, Workmen’s Compensation Act, 1923 (WC Act)
Maternity Benefit Act, 1961 (M.B. Act) and Payment of Gratuity Act, 1972 (P.G. Act)
All salaries should be linked to the inflation rate. Norms for increments should be devised.
There should be representation of NHM workers in all policy related bodies set up for regularization.
The Accredited Social Health Activist (ASHAs) form the largest section of NHM. These are village women working for their own villages. ASHAs have not been included in any of the state plans for regularisation. This is because the Ashas are not recognized as workers but designated as volunteers. The following changes should be incorporated within the NHM and guidelines and funding should be released to the states by the Ministry of Health and Family Welfare:
1. The recommendations of the 45TH SESSION OF THE INDIAN LABOUR CONFERENCE (NEW DELHI), May 2013 should be implemented. These are:
1.1 Ashas should be seen as unorganized workers.
Therefore, Ashas should be called as Community Health Workers, not as volunteers.
1.2 The Ashas should be paid according to the Minimum Wages Act 1948
Ashas are getting inadequate and delayed incentives. Therefore, there should be immediate implementation.
1.3. The Central Government has legislated the Unorganized Workers Social Security Act 2008 wherein Central Government has been given the responsibility of providing the following social security cover to the unorganized workers: a) Life and Disability Insurance b) Health and Maternity Benefit c) Old Age Pension.
These benefits should be implemented for Ashas.
2. The recommendations of the MoHFW Report of The Task Force on Comprehensive Primary Health Care Rollout 2014 are:
2.1 Recognize ASHAs as an institution that would be required in perpetuity.
2.2 Clear job descriptions, career progression and long term HR strategies for ASHAs are essential.
Therefore, the Asha Program should be designed in accordance with the recommendations. Further it should be incorporated as a National Health Program.
3. The Parliament Committee on Empowerment of women 2010-11 had recommended a clear definition of the responsibilities of Ashas, not overlapping the work of ANMs and Anganwadi workers.
Therefore, a clear list of basic Asha responsibilities should be defined centrally and implemented by the states. displayed in all Primary Health Centres.
In view of several research and evaluation reports, the Ashas are completing their Asha responsibilities during their wage earning hours. They face financial loss and pressure from their families and communities.
Therefore, regarding Asha payments:
4.1. Ashas should receive a fixed monthly amount regularly for the centrally defined basic tasks.
4.2. Ashas should be paid incentives for extra tasks.
4.3. Ashas should not be given any unpaid tasks.
4.4. Ashas should be reimbursed for all out of pocket expenses at the Primary Health Centres. Some of the major expenses are for mobile phones, travel and for photocopying the forms they are asked to get filled.
5.There should be a representation of two Ashas in all Asha monitoring committees. There should also be representation of Ashas in any bodies set up for deliberations for regularisation in the Asha program.
From: Dr. Kavita Bhatia, Independent researcher, Owner and manager ASHAVANI (The voices of women health workers in India) An independent e-resource and advocacy e-centre
Notes: 1. With acknowledgements for the valuable inputs of Ashas, Asha associations, NHM workers and NHM workers’ associations.
AND THE STRUGGLE GOES ON……
On the 17th of January 2018, the National Health Mission workers went on a national strike. According to the Central Trade Unions, more than one crore scheme workers are working under various central and state government schemes including around 27 lakh Anganwadi, Mini Anganwadi Workers and Helpers under the ICDS Scheme, nearly 28 lakhs Mid-Day Meal Workers under the MDM Scheme and around ten lakh ASHA Workers under the NHM, lakhs are working under SSA, NRLM, NCLP, Small Savings Schemes etc.
These schemes deliver basic services of health, nutrition education, and small savings mobilisation etc. These workers are not recognised as workers but as volunteers. They are not paid minimum wages nor do they have any social security benefits but an ‘honorarium’ or ‘incentive’ they are paid a pittance as low as Rs.1000 per month for ten months a year in the case of mid-day meal workers.
The 45th Indian Labour Conference recommended that these workers must be recognised as workers. Various trade union federations of scheme workers have been conducting struggles raising these demands independently and jointly.
The following demands were made:
1. Implement the recommendations of the 45th ILC on scheme workers: recognition as workers, minimum wages not less than Rs.18, 000 per month and social security including monthly pension not less than Rs.3000 to all scheme workers. Give coverage of EPF and ESI to scheme workers.
2. Adequate financial allocation in the Union Budget 2018-19 for the Centrally sponsored schemes including ICDS, MDMS, NHM, SSA, NCLP etc. to ensure increase in wages for the workers to the level of minimum wages and universalization of the schemes with adequate infrastructure and quality services.
3. No privatisation of the schemes in any form and no subversion by way of cash transfer or exclusion of beneficiaries.
The continual non- regularisation of health services like India’s NHM has several fallouts:
1. This is a mass infringement of workers’ rights, as pointed out by the strikers. There are other fallouts too.
2. We must not overlook also that it is an institutionalised exploitation of lakhs of village women as most of the scheme workers are women. Demoralisation is setting into these first generation women participants in the workforce.
3. The informalisation of public health care work force ensures that the state abdicates its responsibility towards health and health workers, while it does not stint to take credit for achievements like improved immunisation coverage and child survival.
4. If we do not regularise health services, we run the risk of steadily moving towards privatisation and thus squeezing out the poorest from free coverage of health care. These are likely to largely be women, elderly and challenged persons.