Thiruvananthapuram: On March 21, on the 40th day of the agitation by ASHA workers, parliamentary affairs minister M B Rajesh, speaking for Chief Minister Pinarayi Vijayan in the Kerala Assembly, said that the government had done everything possible for the agitating ASHAs.

What Rajesh had in mind was a government order issued by the Health and Social Welfare Department on March 12. He said that the order had done away with the requirement that ASHAs had to complete at least five of the 10 monthly tasks assigned to them to receive their full honorarium of Rs 7,000. The March 12 order, the minister said, had made the payment of honorarium "unconditional".

In the world of magic, what Minister Rajesh did will be called misdirection. This is a skill employed by a magician to turn our focus to something else while he tricks us. Here, Rajesh's, and by extension the government's trick was to draw attention to the honorarium so that they could fool the ASHAs without anyone noticing what it had done with the 'fixed incentives' of ASHAs.

Along with an increase in honorarium and retirement benefit, removing honorarium conditions was also a major demand of the agitating ASHAs. It was a 2023 order that introduced the condition that ASHAs should complete at least five of the 10 monthly tasks to claim their full honorarium.

Here are the 10 honorarium tasks:
1) Prepare ward health report
2) Conduct ward review meeting
3) Participate in sub-centre review meeting
4) Participate in panchayat review meeting
5) Organise health awareness class/discussion/activity
6) At least ten visits to houses with vulnerable persons, elderly and terminally ill patients
7-10) Four 9 am - 5 pm duties a month at the sub-centre to which an ASHA is attached.

There are months, especially during the rainy season, when there is a surge in water-borne diseases like leptospirosis and vector-borne diseases like dengue and chicken pox, ASHAs find it hard to complete even five of these ten tasks. Hence, the demand to waive the conditions.

The unconditional claim, on the face of it, is true. Here is what the March 12 order states: "However, from now on the conditions that were fixed earlier will be done away with for the payment of ASHA honorarium."

From this, it can be logically concluded that the government is not going to check whether an ASHA has done two or four or seven of the tasks delegated to them. Even if they have completed just one task, ASHAs will be paid their honorarium in full.

But this is merely an illusory perception, created by keeping the second part of the order masked. The minister was also silent about the next part of the order in the Assembly, which concerns 'fixed incentives'.

Along with the fixed Rs 7,000 honorarium, ASHAs also have a fixed incentive of Rs 3,000. Till March 12, ASHAs could have received all their Rs 3,000 fixed incentives if they had made three kinds of house visits: visit to 50 houses in the wards under their watch (Rs 1,000), 20 visits to houses with pregnant women or children below the age of one (Rs 1,000), and 20 visits to houses of the extremely poor or where there are bedridden patients or where old people live alone (Rs 1,000).

The March 12 order has compressed all of these house visits into one block. So even if an ASHA makes all these three kinds of visits, her incentive would be Rs 1,000 and not Rs 3,000. For the remaining Rs 2,000, the order introduced two additional tasks.

One, make people participate in community clinics like well woman clinics and communicable diseases clinics. Therefore, to get Rs 1,000 as part of her fixed incentive, an ASHA has not only to persuade people in her wards to attend at least two such clinics but she also has to participate in them.

The second set of tasks, for the third Rs 1,000, is where the trick lies. These are the administrative jobs that are already part of the honorarium tasks: Preparation of ward health report, conduct ward review meeting, participation in sub-centre and panchayat review meetings.

After introducing two additional sets of tasks comes the coup de grace. The last sentence is worded matter-of-factly, not wanting to betray even a hint of the crushing administrative arrogance it carries. "ASHAs getting a fixed incentive of Rs 1,000 will be eligible for an honorarium of Rs 3,500."

Meaning, an ASHA will not get her full honorarium of Rs 7,000 if she for some reasons, including over work, is not able to perform more than one of the three sets of 'fixed incentives' tasks.

In short, the conditions have been retained.