The one good thing that the coronavirus pandemic has done for the healthcare workers is this: India, today, recognises their importance like never before. Although the larger debate has brought this collective recognition for doctors and nurses, we have given almost no headspace to those responsible for the last mile delivery of essential medical services—the ASHA workers, or the Accredited Social Health Activists. This is evident from a survey that shows only 75 per cent ASHA workers were provided with masks, and only 62 per cent received gloves to perform their duties. This is despite the evidence that use of masks reduces the transmission rate of coronavirus infection.
The survey was conducted by Oxfam India and its partner organisation to understand the working conditions of ASHA workers in four states — Uttar Pradesh, Odisha, Bihar and Chhattisgarh. A total of 306 ASHA workers were contacted over the phone for the survey.
According to the survey, just 23 per cent workers have received hazmat or bodysuits. ASHAs are working at the grassroots level and meeting several people every day, many of whom could be Covid infected. This puts them at a heightened risk of contracting the disease. So, it is imperative that every ASHA worker is provided with adequate and quality PPE (Personal Protective Equipment). But without training them on how to use PPEs, mere supply is useless. The survey shows that only 76 per cent of the respondents received training on PPE usage and infection control.
India’s unsung Corona warriors
While many Indians have shifted to work-from-home during the lockdown, not much has changed for ASHAs. If anything, they have additional Covid duties over and above their regular tasks.
Their core responsibilities such as distributing iron tablets, checking on immunisation schedules of babies and pregnant women, undertaking periodic checks on tuberculosis (TB) patients, among others, have been supplemented with additional duties of contract tracing, spreading awareness on prevention of Covid, keeping a close watch on incoming migrant workers to ensure they follow quarantine protocol and reporting suspected Covid cases.
Long working hours, small pay cheques
Despite the lockdown and other curbs on movement, ASHAs are performing their duties to the fullest. They are working tirelessly to prevent Covid transmission while also ensuring that the delivery of other health services remains uninterrupted. The survey reveals that nearly 29 per cent respondents were working more than 8 hours, while 42 per cent were working between 6-8 hours, every day.
ASHA workers are volunteers who receive honorariums and incentives in lieu of their work. However, 64 per cent respondents claim to have received no incentives for the Covid-related responsibilities undertaken by them. Only 43 per cent ASHAs are receiving their monthly honorariums on a regular basis.
The Narendra Modi government has announced an insurance scheme to protect healthcare workers in Covid times under the aegis of Pradhan Mantri Garib Kalyan Yojana. The scheme provides an insurance cover of Rs 50 lakh per person to frontline healthcare workers — sanitation staff, paramedics and nurses, ASHA workers and doctors. However, the survey reveals that only 38 per cent ASHA workers knew about the scheme. In the absence of the requisite knowledge about the scheme, claiming the insurance sum becomes difficult. There have been several reports in the media highlighting the troubles of the claimants. So, the government must ensure awareness among the frontline workers.
Violence and discrimination
Instances of violence and discrimination against healthcare personnel have multiplied manifold during the pandemic, risking the lives of the Covid warriors. The survey shows that 33 per cent respondents were subjected to some form of discrimination or violence while performing their duties. It is difficult for healthcare workers to fulfil their obligations while their safety is at risk. The rising incidents of violence against healthcare professionals compelled the Modi government to introduce an ordinance for their safety. However, to ensure that the message is loud and clear, a strict implementation of the legislation is a must, not just during the pandemic, but also in the post-Covid era.
A long legacy of neglect of women rights
The plight of ASHA workers is another example of exploitation of women. In a male-dominated healthcare sector, they work without any provision of weekly leaves or minimum wage. Key caregiving tasks — home visits for pregnant women, spreading awareness on vaccination or sanitation and mass mobilisation drives — remain ‘unpaid’. Like other working women, they, too, bear the double burden of unpaid care work where they have to undertake household chores. Retaining ASHA workers as volunteers, who need only be paid an honorarium and not a minimum wage, reinforces the patriarchal norm of care work as the women’s natural area of labour. While several state governments have accepted demands for better honorariums, incentives and PPE kits after nationwide protests, a comprehensive acknowledgement and acceptance of work rights of ASHAs is still due.
On World Patient Safety Day, the government must recognise the significant role ASHA workers play in India’s public health system and pay cognisance to their long-term work status and wage related demands. They must be employed in full-time roles on decent pay-scales to strengthen India’s healthcare system, particularly in rural areas.
Agrima Raina @AgrimaRaina is a public health professional who works at Oxfam India as consultant – health. Views are personal.