In South Delhi’s Sangam Vihar, 41-year-old Ritu has been deployed to overlook the work at a COVID vaccination centre. But Ritu, who is an ASHA in the area, has not been vaccinated.
“I have lost a lot in life,” Ritu said. “While my work was supposed to be a solace, it has become difficult because we are not given any respect or rights. Despite vaccinating hundreds of people, I have not been vaccinated myself.”
Ritu, who has three children, lost her eldest daughter in an accident last year. Dealing with this huge loss and the added anxiety of work has taken a toll on her well-being. “I have always been vocal in raising the issues we ASHAs face, but now I feel dejected and lost,” she added.
Accredited Social Health Activists (ASHAs) are an all-women healthcare workforce that acts as the interface between communities and the public health system in India. Even though they are known as “health activists” according to the Ministry of Health and Family Welfare, their struggle to be recognised as frontline workers and receive access to basic necessities has been ongoing for a long time.
An ASHA is a resident in the community trained and deployed to improve the health status of the people by securing their access to healthcare services. Her job responsibilities are three-fold including the role of a link-worker (facilitating access to healthcare facilities and accompanying women and children), that of a community health worker (depot-holder for selected essential medicines and responsible for treatment of minor ailments), and of a health activist (creating health awareness and mobilizing the community for change in health status).
But for all this work, ASHAs are paid between Rs 1,000 and Rs 3000. ASHAs are also called volunteers according to the government guidelines, however, the amount of work they are expected to perform is more akin to a full-time job.
The women work for three to four hours, depending on the task, every day. This, however, does not include the time women spend travvelling. Ritu, while explaining her ordeal, said that she, along with her team, has also been doing door-to-door services to make people aware about vaccination.
When asked why ASHAs have not been vaccinated, sources from the Delhi government cited lack of vaccines as the reason. “It is a known fact that vaccines are not available in appropriate quantities and the state government is still struggling with it. There might be a possibility that not all healthcare workers have been vaccinated,” a source associated with the Delhi government said.
Despite numerous calls and messages, the South Delhi District Magistrate did not respond to the queries.
Demands for safety equipment go unheeded
Every day in the morning, Seema (name changed) picks up her survey papers and leaves for work. Wearing a mask and gloves, 44-year-old Seema, an ASHA worker, has been following this routine ever since the pandemic hit the country.
Working in Delhi’s Sadar Bazaar area, Seema complained that ASHAs are not provided with proper safety equipment: Personal Protective Equipment (PPE), masks and sanitisers. “We randomly get calls to conduct door-to-door surveys, especially with the onset of COVID, but are not given any safety equipment,” Seema said.
In Delhi, hundreds of ASHA workers have been protesting against the state and the Central Government, demanding safety equipment, permanent jobs and a raise.
Shweta Raj, president of Dilli ASHA Kamgar Union, who has been at the forefront raising the voice for the women, said, “In the pandemic, the real frontline workers, who are actually stepping out on the field, have not been provided with masks or gloves, due to which many are getting affected with COVID-19. We are also hearing reports of deathS from many dispensaries. ASHAs are called volunteers, but when it comes to work, the demand is high. The government instead of helping has not been doing anything, this is a clear violation of basic human rights for these women.”
When questioned about the demands of the ASHAs, the Chief Minister’s Office responded that they have not received any information regarding the issue. “As of now, we have not received any information about the protest or the demands put forward by the ASHAs,” an official from the Chief Minister’s Office said.
According to an Oxfam India survey released in September 2020, 75 percent of ASHAs were given masks, 62 percent were given gloves, and only 23 percent received full bodysuits. Per the Ministry of Health and Family Welfare, ASHAs were meant to receive face shields, masks, gloves, head caps, and sanitiser; in reality, however, they have to struggle with these amenities on their own.
“We still don’t get masks or gloves when we go for duty. Isn’t it the responsibility of the government to provide us with this?” Seema added.
Overburdened with work, little pay
Seema is fearful that her work will affect her family life. And with good reason. Already, she is unable to return on time every day and be there for her family.
Seema said she was infected with COVID-19 in March, when she was conducting door-to-door surveys in the locality. Her two children and husband also caught the virus. “The only comfort is that none of us were seriously ill,” she added.
However, she said she still fears the virus, especially its potential impact on her family.
Ritu, who has been an ASHA since 2008, said many on her team have been infected with COVID. However, despite this, there is no compensation or relief for ASHAs. Seema, who was hesitant to return to work, said she joined ‘immediately’ after recovery. She had little choice in the matter, seeing as she needed the money.
“COVID-19 has hit us all. There is no money at home. I want to change jobs, but there is nothing available,” she added.
An ASHA’s performance is based on her assessment of the services after which she receives points.
“We have various tasks to cover on the basis of which our salary is decided. If in one month, we have three tasks and we cover them, we get three points, post which we receive a pointer assessment. If we receive six points, only then do we receive Rs 3000 as our monthly salary. If we do not get six points then we are paid according to the amount of work we do,” Seema said.
Since COVID-19 hit India, countless people have lost their jobs. Even though Ritu and Seema are employed, their income remains painfully low. Managing their homes and families during the pandemic has increased manifold the mental stress they face.
Both Ritu and Seema said issues of women’s health aren’t even mentioned, let alone discussed. Add to that the pay disparity and harassment they face.
The ASHAs, who are on the ground and are taking care of COVID-19 patients, said they have to constantly deal with harassment.
“We have been working in COVID wards and attended to COVID-positive patients because it is our duty. Yet, we are treated in a humiliating way. We are not even allowed to enter a doctor’s office,” said a dejected sounding Seema.
They also complain of mistreatment by patients and their families when they are on survey duty. “We receive respect from no one, whether other healthcare workers or people we go to help,” Seema added.
Since the COVID-19 outbreak began in India, there have been more than 28 million cases in the country.
ASHAs have also been tasked with tracing patients; creating awareness about the virus and hygiene practices; addressing psychological trauma, stigma, and discrimination; and supporting Primary Health Care (PHC) nurses at overburdened centers.
During the second peak of the pandemic, Delhi was one of the worst-hit cities. In May, when thousands died due to lack of oxygen supplies, ASHAs were on the ground.
And yet, their pleas remain unheard.