ASHA: The Price of Care

In a sleepy hamlet nestled within the lush landscapes of Baramulla, Shakeela tied her scarf tighter against the biting morning cold. Her breath was visible in the crisp air as she prepared to begin yet another day of relentless work. She glanced at the worn out leather bag slung over her shoulder—it held not just a few record books but the trust of her entire community. Shakeela is an ASHA worker, one of India’s one million Accredited Social Health Activists, and the unacknowledged backbone of the nation’s rural healthcare system. WHO’s 1975 monograph “health by the people” emphasized for countries to strengthen people-centric primary healthcare services. India responded a little late. However, In May 2002, Chhattisgarh became the first state in India to adopt a similar initiative called Mitanin meaning ‘a female friend’. India launched the ASHA program in 2005 as part of the National Rural Health Mission. It was extended to Cityscapes in 2013. These women-only volunteers work with usually 1,000 heads in villages and 2,000 people in urban settings.

Fifteen years have passed since Shakeela took on this role. For first exhausting ten years of her service, she didn’t get paid. In 2019, her honorarium was finally formalized: Rs 2,000 a month. Two thousand rupees for trudging miles on foot, for counselling frightened young mothers, for vaccinating crying children, and for braving a pandemic that brought the world to its knees. It wasn’t enough to buy winter shoes for her growing son, let alone feed her family.

Work is Worship?

The arrival of COVID-19 turned Shakeela’s life into a storm of chaos and fear. “The virus spares no one,” she told herself the first time she entered the home of a symptomatic patient. Armed with a mask that barely covered her face and gloves that tore after a few uses, she walked into danger without hesitation.

Her husband begged her to stop. “Shakeela, you have children to think of. If something happens to you—”

She cut him off with a calm resolve. “If I don’t go, who will?”

For six months, Shakeela worked tirelessly, delivering food and medicines to COVID-positive families, tracking contacts, and organizing vaccination camps. Her reward for this dangerous work was Rs 3,000 for the entire duration—less than the cost of one month’s worth of protective gear.

One night, she collapsed on the cold floor of a patient’s house. She hadn’t eaten all day, her hands trembled with fatigue, and her body felt like it would break. Three attendants lifted her gently and urged her to go home. But Shakeela stayed awake, sitting vigil beside the patient. When the morning sun crept through the cracks in the curtains, Shakeela left to check on a new- born in another village.

The Weight of the World

Shakeela’s story is not hers alone. Across Jammu and Kashmir, thousands of ASHA workers like her are overburdened, underpaid, and under-appreciated. They shoulder an overwhelming workload: registering pregnant women for antenatal care, counselling teenage girls on taboo health issues, tracking new-borns for postnatal check-ups, and ensuring immunizations for children.

“I am always running,” Shakeela says with her weary yet firm voice. “From Ayushman Bharat cards to leprosy surveys, from vaccination camps to meetings with Panchayat leaders, there is no end. They call us the backbone of rural healthcare, but they don’t even pay us a living wage.”

Her friend Mubeena, who serves as the General Secretary of the ASHA Workers’ Union in J&K, shares the frustration. “During the pandemic, we put our lives on the line. The government praised us, the Prime Minister called us warriors, and the world recognized us with WHO’s Global Health Leaders Award. But what use is recognition when we can’t feed our families?”

Hope fights despair

Shakeela’s work goes beyond medical care. In her village, she is a confidante, a guide, and a lifeline. Teenage girls whisper to her about health problems they dare not discuss with anyone else. Mothers trust her with their children’s lives.

But the emotional toll is immense. Shakeela vividly remembers the young woman who died in childbirth because the ambulance couldn’t reach their village in time. She remembers the children whose lives she couldn’t save despite her best efforts. “Sometimes, I feel like I’m failing them,” she admits, tears brimming at the corner of her eyes.

Yet, amidst her despair, Shakeela finds moments of pride. When a malnourished child gains weight because of her interventions or when a mother hugs her tightly in gratitude, Shakeela feels her burden lighten, albeit briefly.

Protests and Promises

On March 29, 2022, Shakeela wanted to join the swarm of ASHA workers protesting in Srinagar’s press enclave. They came from every corner of Kashmir, raising their voices for better pay and basic rights. But Shakeela couldn’t afford the bus fare. “Our grievances go unheard anyway,” she says, resigned.

Those who did make it to Srinagar voiced their demands with determination. Joining them was a fierce voice Mohammad Yousuf Tarigami, the only politician standing by their side. For a fleeting moment, the workers dared to hope. “ASHA workers are the lifeline of our health system, yet they earn a pittance, they deserve a decent honorarium, social security and career progression.” Tarigami told me at his official residence at Gupkar, Srinagar’s most powerful street. Will his boss Omar Abdullah now put a balm to the wounds of the ASHA’s?

The Reality of Recognition

Shakeela knows the truth behind the government’s flowery words and empty promises. Despite being credited with drastically reducing maternal mortality rates and spearheading successful vaccination drives, ASHA workers remain invisible to those in power. They are celebrated as heroes but treated as expendable.

“Hope sustains life,” Shakeela says quietly, reflecting on the meaning of her role. “But how long can we survive on hope alone?”

Outro

As Shakeela walks home at dusk, she feels a familiar mix of exhaustion and determination. Tomorrow will be another day of unpaid labour, unanswered calls for justice, and unshakable faith in her purpose. Shakeela is more than a worker. The stories of countless ASHA workers demand not just recognition but action—before hope turns to despair.

The author is a development professional currently engaged with Atlas Service Corps, Washington D.C.