There’s a saying in the Chhattisgarhi dialect. Sukh mein sab hain, dukh mein Mitanin. Everyone is there in times of joy, but in sorrow, there are only Mitanins. The word translates to ‘friends’. A friendship, between women, one with the promise of compassion. In 2002, Mitanins also came to symbolise care, when the newly-formed State of Chhattisgarh designated women to play the role of community health workers. They were advocates for resource-deficient communities, friendly faces of a distant health system, agents of both change and care work.
Mitanins inspired the ASHA framework three years later. The Accredited Social Health Activist – a saree-clad cadre of almost 10 lakh women today – is a friend. Her care work dictates the reach and success of India’s health schemes. But agents of change tire too. Every ASHA logs in a ‘triple shift’, spread out between the home, community and health centres. Overworked and underpaid, they are caught in a frenzied rhythm: many do not eat well and sleep enough, and are at risk of anaemia, malnutrition and non-communicable diseases, found a new study supported by the Dr. Amit Sengupta Fellowship on Health Rights. It documented the limited autonomy the health workers have over their time, money and well-being.
Experts place the ASHAs’ triple burden along an axis of power inequities – where gender, caste, and informal economy intersect. As women ‘volunteers’, and not designated health care workers, ASHAs experiences cut across “layers of marginalisation”, says Bijoya Roy, a public health researcher at the Centre for Women’s Development Studies. There is an economic, physical and psychological violence embedded in their role, crafted carefully by a system that refuses to assign value to their labour. “ASHAs provide care, but they are not cared for by anyone, not by the system in any way.” It is only during the recent Interim Budget that the Central government announced its decision to provide free health insurance cover for all ASHAs and Anganwadi workers and helpers under the Ayushman Bharat Scheme. In 2018, the Ministry of Health and Family Welfare approved an ASHA benefit package, providing coverage for accidents, deaths and disability.
