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“If we are paid Rs 600 for a delivery, we have to give Rs 100 as commission,” she said. The ASHAs are paid their money online, but since this is a long and bureaucratic process, they end up paying money to mediators who help them fill out their online forms and vouchers and speed up approvals needed from doctors and medical officers. “The peons charge us money when we deposit our vouchers,” said Tarrannum. “If we do not bribe them, they will not send the vouchers for further clearance,” she added. Agra’s chief medical officer Dr BS Yadav feels ASHAs can be given fixed payments but does not want them to become permanent employees under the National Health Mission. “I can tell you that 50% of ASHAs working in scores of villagers in Agra are totally inactive,” he said. “The inactive ASHAs either don’t work or work as agents of private hospitals. If such people will be given fixed wage, this will be a huge loss for the government.” Yadav suggests that ASHAs’ performances may be tracked over time and deserving workers get fixed wages. Even though ASHA workers are demanding that their jobs move from being contractual to being made permanent positions, Dr Neelam Singh does not this think this is a good idea. Singh is a gynaecologist and founder member of the non-profit organisation Vatsalya that works to prevent sex-selective abortions. “Once they will become permanent, they will start behaving like government employees,” said Singh.
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