ASHA workers battle COVID-19 amid poor pay, safety

The day starts at the crack of dawn for Geeta Mandal. This Accredited Social Health Activist (ASHA) in her mid-thirties from Kachukhali village in West Bengal’s Sunderbans goes out to work at nine in the morning.

Her work entails 7–8 hours’ walk, going door-to-door, screening people for any Covid-like symptoms, coordinating treatment, creating awareness about vaccination and general safety protocols.

This she does in addition to her routine works that include immunisation of children against diseases such as polio, measles, etc., taking pregnant women to health centres for delivery and promoting other healthcare schemes of the government.

But her rigorous day starts much before she steps out of home. “I go to work after completing all my household chores like cleaning the house, doing the laundry, washing dishes and cooking food for our family of five,” Mandal says.

If that sounds gruelling and one starts sympathising with her ordeal, Mandal is quick to add that hers is nothing in comparison to what many of her ilk have to undergo, particularly during this pandemic period.

According to a calculation made by the health and family welfare ministry in February this year, 9,29,097 ASHAs out of 9,60,690 have been deployed across the country for “containing local transmission of Covid-19”.

They collectively form the first line of defence in the country’s fight against the Covid-19 pandemic, particularly in rural areas.

Many of these frontline warriors are waging the battle against the pandemic without adequate safety equipment.

“After a Covid patient in my area, Goghat in Hooghly district, died of Covid in May, I was asked by the block medical officer to go and physically verify it even though I did not have any safety kit and proper training for the job,” complains ASHA worker Nandita Laha.

Safety equipment is the recurring demand of ASHA workers across the country as many among them died after contracting the deadly virus while discharging their duties.

As per the figures provided in Rajya Sabha in February this year, 44 ASHA workers had fallen prey to Covid-19 in the country until then.

The associations of ASHA workers say the actual figure is much more, particularly after the second wave of Covid-19 ravaged rural India as well.

“In Maharashtra alone, 68 ASHA workers and 3 ASHA facilitators have died of Covid-19 so far,” says Shyam Kale, a leader of the All India Trade Union Congress (AITUC) and an adviser to the union’s ASHA workers wing.

According to the health ministry’s data revealed in Parliament in February, only 4,16,333 ASHAs assigned to Covid containment duties had been provided adequate safety kits. This is less than 50 per cent of the ASHAs battling the Covid pandemic.

More work, less pay, no safety

The lack of personal protection equipment (PPE) is just one of the many problems currently plaguing the mainstay of India’s rural healthcare system, according to Kale.

During the pandemic, the workload of ASHA cadres increased manifold, he says, but ironically their income in most cases plunged.

“Most of us routinely clock over 12 hours of duty while the rest of the time we are on call,” says Sabiyana Yasmin, an ASHA worker from Memari in East Burdwan district of West Bengal.

An ASHA worker in Bengal gets an honorarium of ₹4,500 and a Covid-19 incentive of ₹1,000. Besides, there are incentives for tasks such as immunisation, pre- and ante-natal care, motivation for male and female sterilisation, promoting spacing of births, attending monthly sector meetings, facilitating Gaon Kalyan Samiti meetings etc.

Before the pandemic, apart from her fixed honorarium, Yasmin says, she used to earn an incentive of ₹2,200 to ₹2400 in a month. Now the earnings from incentives have dropped due to suspension of many of her routine works.

Kale says the drop in income due to loss of incentives is in the range of 40–50 per cent. Several ASHA cadres did not get the mandated Covid incentive either, he claims.

The fixed component of the honorarium also varies from state to state, ranging from ₹2,000–₹10,000.

The Maharashtra government increased the fixed monthly honorarium by ₹1,500 in June after ASHA workers went on a nine-day strike seeking wage hike. The state’s about-68,000 ASHA workers will now get ₹5,500, excluding incentives, Kale says.

Taking cognisance of a complaint that the ASHA workers across the country were not getting their dues and safety equipment, the National Human Rights Commission (NHRC) served notices to the Centre and the state governments in May this year.

Demanding better pay and working conditions, ASHA workers also held a nationwide strike on May 24.

“We are only getting assurances from the government but no concrete steps have been taken to improve the lives of ASHA workers,” Kale alleges.

Apart from wage hike and protections, unions representing the ASHAs are also demanding that the health workers be recognised as government employees, free medical treatment for entire family and the benefit of ₹50 lakh insurance to the family of deceased ASHA workers on the lines promised to all healthcare providers, according to Kale.

Public wrath

To make things worse for them, these underpaid and unprotected Covid warriors also have to often endure discrimination and violence.

There are reports of ASHA workers being assaulted for vaccine shortage as well as for conducting vaccination drive.

An ASHA worker in Odisha’s Charbatia village was assaulted and her property ransacked by angry villagers on May 24 after they failed to get vaccinated due to short supply of doses.

The irate villagers allegedly even looted ₹37,000 and gold ornaments that she had kept for her son’s wedding.

If ASHA worker Dalli Nath had to face public ire for the unavailability of vaccine, her counterpart from Uttar Pradesh, Geeta Singh was allegedly assaulted for collecting details of residents for Covid-19 vaccination. The incident happened in Gorakhpur’s Dumaria village on June 3.

There have been many more such cases of assault on ASHA workers in West Bengal, Haryana, Delhi, Telangana and other parts of the country.

Last year, a man hit a 17-year-old girl on the head with an iron rod at Butana Kundu village in Haryana’s Sonipat district to take revenge on her mother, an ASHA worker, for pasting a home quarantine notice outside the man’s home.

“I can go on narrating many such horrible instances taking place at regular intervals across the country,” Kale says.

It is however not that ASHA workers started facing such assaults only after the onslaught of Covid-19 pandemic.

They faced public wrath for other health related mishaps like the delivery of a baby gone wrong in a hospital, says Sabiyana Yasmin

“We have been tasked to save people from this pandemic but we can save others only if we can save ourselves,” she adds.