Last week I spent time with female health workers in Kurhani, a block in the Muzaffarpur district of Bihar, India. Coincidentally, Kurhani also happens to be the most populous block in India, boasting of a population of almost half a million. When one public health facility caters to that large a population, the load on each health worker is a lot more than usual. The female literacy rate of a mere 35.8%, in Muzaffarpur district, hasn’t done anyone any good either.
As I sat in the meeting hall of the local health facility with about a hundred of the most over-worked ASHAs (Accredited Social Health Activists), I got talking to a few of them. “Sure, I like being a health worker. At the same time, being a woman, what other options do I have here?” exclaimed one of them. In a state where the agricultural sector is still the largest employer of women with 92% of them working in it, has the ASHA instituting health program come as a more lucrative option?
According to a report by the Institute for Human Development, in Bihar, 36.42 lakh person-days of employment have been provided to households so far, whereby women have received a mere 28.8% of this employment through Mahatma Gandhi National Rural Employment Guarantee Scheme (NREGS). Has the National Rural Health Mission been a better National Rural Employment Guarantee Scheme for the 70,000 plus women that it has employed?
The job of an ASHA is to deliver first-contact health care and be the contact person for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services. The ASHA mobilizes mothers and children for deliveries and immunization rounds, in addition to filling up child-high piles of monitoring registers (which, since a lot of them are illiterate, is done by their husbands or kids). Even as an ‘activist’, an ASHA receives outcome-based remuneration and financial compensation for training days. Facilitating an institutional delivery gets her Rs. 600 ($9.03); Rs.150 ($2.26) for getting a child to complete an immunization session; and Rs. 150 ($2.26) for each individual who undergoes family planning procedures. (Source: http://www.pbnrhm.org/docs/asha/incentives_to_asha_2015_16.pdf)
During another visit, last month, I met a health worker in Goroul block of the Vaishali district who was running for panchayat elections. Being an ASHA, she said, had given her the courage to fight for the local elections. “I have constructed a sphere of influence within my jurisdiction as an ASHA. I hope for these women to vote for me.”, she added.
With an acute lack of opportunities and innumerable socio-cultural restrictions, the National Rural Health Mission has no doubt been an extremely effective employment generation program for women in rural Bihar. A policy with such well-defined success parameters, of reducing infant and maternal mortality rates, has also resulted in ensuring job security for women giving them a sense of dignity, respect, and pride.
Here’s wishing the hardworking fleet of 70,000 ASHAs in Bihar a happy International #LabourDay!