ASHA and Anganwadi workers have been agitating for many years now, demanding workers status and justified wages, but the Union Government have been denying them both. State governments on the other hand say that they are Central scheme workers and hence the Union Government has to decide on their demand. States throw the ball in Centre’s court, and the Centre says that states can increase their honourariums and incentives.

Take latest example of Kerala government, where ASHA workers are currently agitating, demonstrating in front of the Secretariat. Though the state government has released the entire backlog of honorarium and incentives due to ASHA workers, the Health Minister of the State washed her hands of the issue saying that it was up to the Centre to do what was right for the ASHAs. Even CITU-led ASHA Workers’ Federation has said that it was not the state government, but was the Centre which was not giving them their due.

The agitating ASHA Health Workers’ Association, which is leader the current strike in some districts of Kerala, has vowed that they would escalate their agitation and to fight till their demand to hike the monthly honorarium from Rs7,000 to Rs21,000 and that of retirement benefits of Rs5 lakh were conceded by the government.

The Minister of Health of Kerala Veena George has said to the media on February 27 that ASHA was a Central Scheme and that it was up to the Centre to accept ASHAs as a regular workforce with appropriate benefits. She has even revealed whatever is given to ASHA workers, the major share is borne by the state. She also claimed while the state government had been hiking the honorarium, the Centre had not revised the incentive pattern of ASHAs, which had remained the same right from the inception of the scheme.

The Kerala Health Minister Ms George even said that the state recognized the work of ASHA and was in favour of raising their remuneration and that the state had raised this demand several times with the Centre to no avail. The centre had not even provided the state its share in 2023-24 for the payment of incentives to ASHAs – the amount of which is about Rs100 crore, but that it was the state which bore that burden too.

Everybody agrees, even senior National Health Mission officials, Ministers of State Governments, and Union Ministers, that ASHAs deserved to be paid better. Where lies the problem then? Both the state governments and the Centre fear that accepting the demand of ASHA workers to be accepted as workers with open floodgates to many other categories of scheme workers to be given the same status. Giving employee status and subsequent benefits would need huge finance, which is scarce. They forget that lack of willingness to given rightful wages and benefits is injustice itself. State and Centre just throwing the ball in each other’s court.

Even recently, former Union Minister of State for External Affairs and BJP leader V Muraleedharan, who med agitating ASHA workers, has even audacity of saying that state is well within its rights to change the employment status of ASHAs as a regular workforce and to pay them a regular salary and benefits. Then the question is why his party BJP led government at the Centre should not do this?

During the recent election campaign in Delhi, the issue of giving worker status and justified wages to ASHA and Anganwadi workers was raised. Anganwadi workers in Delhi earn an honourarium of Rs12,720 every month, whereas the helpers receive Rs6,810 a month. ASHA workers earn a monthly stipend of Rs3000 and additional amounts for completing specific tasks, which can add up to Rs7,000-Rs8000. Workload for both has been increasing over time, and cost of living crisis is aggravating. However, they are not even getting minimum wages since they are not treated as workers. Minimum wage in Delhi for unskilled worker is Rs18,066 per month. ASHA and Anganwadi workers in Delhi are getting much less than the minimum wages.

What the states are doing is not more than tokenism. The latest example can be taken from the West Bengal, where the government has announced to give mobile phones to ASHA workers so that they can feed the data in time. However, it is not enough to justify the still going exploitation of ASHA and Anganwadi workers.

According to a reply made by Union Ministry of Health and Family Welfare in August 2024, ASHAs were envisaged to be community health volunteer and entitled to tasks and activity based incentives. ASHAs receive a fixed monthly incentive of Rs. 2000 per month for routine and recurring activities. Additionally, they are provided performance-based incentives for a varied set of activities under various National Health Programmes. States/UTs in their Programme Implementation Plans (PIPs) have also been given flexibility to provide a range of monetary incentives to the ASHAs. After the launch of the Ayushman Bharat scheme with operationalization of Ayushman Aarogya Mandir, ASHAs are now additionally eligible for Team Based Incentives (TBIs) along with ANMs based on monitored performance indicators (up to Rs. 1000 per month).

Union Ministry of Health and Family Welfare also said in the reply that Anganwadi Workers (AWW) and Anganwadi Helpers (AWH) are “honorary workers” from the local community who voluntarily come forward to render their services in the area of child care and development to help the community for which Anganwadi Worker is paid honorarium at Rs.4,500/- per month and Anganwadi Helper is paid honorarium @Rs.2,250/- per month on cost sharing basis between the Centre and State/UT along with performance linked incentive ofRs.250/- per month for AWHs and Rs.500/- to AWWs. In addition, States/UTs are also paying additional monetary incentives/honorarium to these functionaries from their own resources which vary from State to State.

Under the National Health Mission (NHM), Government of India provides financial and technical support to States/UTs to strengthen their health systems, based on the requirements posed by them through their Programme Implementation Plans (PIPs), within their overall resource envelope.

It is worth noting that National Health Mission is a centrally sponsored scheme, funding pattern between the Centre–State is 60:40 for all States except 8 North Eastern States and 3 Himalayan States/UT (Himachal Pradesh, Uttarakhand, UT of Jammu &Kashmir) where funding pattern is 90:10. UTs without Legislature have this scheme 100 % Centrally funded.

All the administrative and personnel matters related to health human resource lies with the respective State/UT Governments. Details of protests conducted by ASHAs are discussed in State level meetings/National Programme Co-ordination Committee meetings based on the feedback received from States/UTs, admitted the reply. However, the Centre is yet to come out with appropriate decision, despite protest agitations by ASHA and Anganwadi workers.

There are also great statewise differences in the total honorarium and incentives to be paid to ASHA and Anganwadi workers, since states provide fund in the range of Rs 500 to Rs 10,000 per ASHA worker. It is also a matter of concern especially when real value of the honourarium, if adjusted for price rise and inflation, has considerably reduced. (IPA Service)