Over one million ASHA workers are at the forefront of India's response to the COVID pandemic that rages on. This workforce of rural women has not been provided with even the most basic safety gear such as masks and sanitiser. The Rs 1,000 a month COVID19 duty incentive has also not reached them in months.
These ASHA workers march on singing, beating plate, and shouting slogans to make people aware about COVID19. Photo: Neetu Singh
Saroj Singh can’t remember the last time she worked fixed hours in a day. It’s been more than a year of the COVID19 pandemic now that she is working day and night responding to the call of her duty.
“Apna gaon to bachana hai na, yehi soch ke duty kar rahein hain. [We have to save our village, this is why we are doing our duty],” 42-year-old Singh told Gaon Connection.
Singh is an ASHA worker in Borsad village of Rewa district in Madhya Pradesh. She is a part of over one million women community health workers, known as Accredited Social Health Activists or ASHAs, instituted by the Indian government’s Ministry of Health and Family Welfare as a part of the National Rural Health Mission.
These frontline women workers are leading from the front as the country faces a massive second wave of the COVID-19 pandemic with daily new coronavirus cases touching 386,452 and 3,498 deaths in the last 24 hours.
In this raging pandemic, ASHA workers like Singh have to daily survey the village, screen people for COVID19 symptoms and help them reach the health centres. They also have to keep a check on the migrant workers returning to their villages. Additionally, they have to educate and motivate villagers to go for the COVID vaccination. All this is over and above their regular work demands.
Unlike the last year, when the pandemic began and frontline workers were provided face masks and sanitisers by the government, this year a large chunk of this rural health workforce, hasn’t received basic protective gear while the COVID cases surge on a daily basis and the virus has made inroads into rural India.
“Some days I buy masks, other days I stitch those myself. Every day we have to go out in the field,” an exasperated Singh, an ASHA worker from Madhya Pradesh, told Gaon Connection. Earlier that day, in the peak summer heat, she, along with a local villager of Borsad who had ‘cold and fever’, walked to the health centre for a check-up.
Similar voices — tired, worried and angry — emerge from other rural areas of the country.
“We got masks and sanitisers during March and April last year, but this time we got nothing. We buy masks and sanitisers, even though we do not get a single penny from the government,” 40-year-old Renu Devi, an ASHA worker who hails from Mirzapur village, Gorakhpur, Uttar Pradesh, told Gaon Connection.
According to the United States Centers for Disease Control and Prevention, a public health agency, wearing a double mask – cloth and surgical – reduces exposure to the coronavirus by nearly 95 per cent. It helps in preventing leakage of air and fit the contour of the face better.
But, many ASHA workers in India, such as Saroj Singh and Renu Devi, do not even have a basic surgical mask provided by the government as the second wave of the pandemic sweeps the country.
“I have got a mask only once in March this year. I was given acha wala (N95) mask. But we have to go out in the field every day, we cannot keep wearing the same mask. I used to wash that mask with hot water, it could only last for two to three days,” 42-year-old Aparna Sarkar, an ASHA worker from Khairapali village of Malkangiri district in Odisha, told Gaon Connection.
“Last year, I got over twenty masks and two bottles of sanitisers. I was even provided with a face shield. But nothing much this year even when risks are more,” added Sarkar. She fears she might contract the virus as she visits ten-twenty rural households every day. She already contracted the disease once last year.
“These ASHAs have been allotted the task of household survey and distribution of medicines to those who show COVID like symptoms but there’s nothing done to ensure their safety,” Jaipur-based Chhaya Pachauli, member, Jan Swasthya Abhiyan, told Gaon Connection.
“Only in certain villages where COVID cases have been reported in large numbers or where there have been COVID deaths that the ASHAs have been given some masks and sanitisers,” she said adding that “this is certainly not enough. In most places, ASHAs have not been provided any masks or sanitisers in Rajasthan this year as yet.”
Since the beginning of the pandemic, public health experts have been demanding safeguards to protect these frontline women workers.
“ASHAs have been working all through the pandemic because the government, from panchayat functionaries to state level, has been giving them work. They also feel a sense of responsibility towards the community. These frontline women keep working despite remaining unrecognised and unpaid for their efforts,” Raipur-based Sulakshana Nandi, national co-convener of Jan Swasthya Abhiyan, told Gaon Connection.
“Both the central and the state governments do not recognise the efforts put in by these ASHAs. The government is exploiting them,” she added. This national level campaign works on public health and health rights issues.
Last year, the central government introduced Pradhan Mantri Garib Kalyan Package Insurance scheme for all healthcare workers including ASHAs engaged in COVID19 response. The insurance scheme provides a life insurance cover of Rs 50 lakhs [Rs 5 million] in case of death due to the coronavirus.
The scheme terminated on March 24 this year. After severe criticism, the insurance scheme was extended for a period of one year on April 20. However, the Centre is yet to clarify about the insurance of ASHA workers who have died between March 25 and April 19 this year.
“In my knowledge, five ASHAs have died in this period [March 25-April 19] in Chhattisgarh alone. Will they get any insurance coverage? The central government has not given any clarifications,” said Nandi. “The data on deaths of ASHAs is also not maintained by the central government,” she added.
ASHA workers find the government’s promise of insurance ironic.
“Admi jab jeeta hai tab ek rupaya bhi nahi milta, ab pata nahi pachas lakh marne ke bad bhi milega ki nahi (While we are alive we are not getting money, we are not even sure if we will get fifty lakh rupees even if we die),” Devi, an ASHA worker in Uttar Pradesh, wondered.
She claimed that many ASHA workers were not even receiving the promised Rs 1,000 a month for doing the corona duty. So Rs 50 lakh post death seemed a bit too far fetched.
An incentive of Rs 1,000 per month is provisioned for ASHAs engaged in COVID response, under the country’s COVID19 package. According to the health ministry’s press statement issued on February 2 this year, “till November, 2020, 9,53,445 ASHAs and 36,716 ASHA Facilitators have received supplementary Covid19 payment. No such delay has been reported.”
However, a large number of ASHAs complain that they received this Rs 1,000 a month incentive till June or July last year. Nothing after that even though they have continued their COVID related work all through the past one year.
“Last year, we got money [Rs 1,000 a month] only for two months. We were told that we will get money this year, but nothing has come so far” said Singh, who has been working as an ASHA for the past 10-12 years.
Sarkar, an ASHA worker from Odisha said she received Rs 1,000 a month incentive from the state government only for seven months last year. This year, she has got nothing.
According to Nandi, the governments should have fixed remuneration for ASHA workers. “As other health services, including regular vaccination and institutional deliveries are affected because of the pandemic, ASHAs are also not getting their regular incentives. Anyway, they are getting less incentives and now they are not even getting the thousand rupees per month for Covid related work that was announced,” she said.
As per her, ASHAs in Chhattisgarh have received Rs 1,000 only for two months in the fourteen months of their COVID duty since the pandemic started last year.
Meanwhile, ASHA workers in Uttarakhand say they have been receiving the incentive of Rs 1,000 every month. But that isn’t enough, especially when one is risking her life to dispense her duty in the pandemic.
“Ek hazaar rupay me kya hota hai? Itne me ghar kya chalta hai? (What happens in one thousand rupees? Can we manage household expenses with this?)” Hema Gurrani, an ASHA worker in Badreshwar village of Almora in Uttarakhand asked Gaon Connection. She confirmed receiving the Rs 1,000 COVID19 incentive every month.
Gaon Connection reached out to the district collectors of Rewa in Madhya Pradesh, and Gorakhpur in Uttar Pradesh. Both were out in the field, their respective offices informed. The story will be updated after we receive their response.