Every morning Kiran Jha wakes up and leaves for work by 8 a.m. [0230GMT], visiting households on her block and asking residents to wear masks and checking their well-being.
The 50-year-old is a government-accredited social health activist [ASHA] and is among the million-strong army of women health workers who are on COVID-19 frontline duties.
Jha hails from the Araria district in the eastern state of Bihar, which has more than 90,000 workers who have been asked to conduct COVID-19 surveys.
Despite no formal training to spot signs of COVID-19, no provision of safety gear, including masks and hand sanitizers, and poor late payments, Jha and her colleagues have conducted three rounds of surveys which will be used by the health ministry to gauge the COVID-19 situation.
“We get paid 1,000 India rupees [$13] for one round of the survey, which may take several days/weeks of collation at the district level,” said Jha, who is an ASHA facilitator [trainer] for the area. “Since March, we have conducted three such surveys, but have only been paid once. Four months of putting our lives at risk, and we have earned only $13.”
With no public transport, she has had to walk miles each day to complete surveys, spread awareness, conduct contact tracing and monitor residents under quarantine.
Between April and June, at least five of the ASHA community health workers died in Bihar from COVID-19, along with two auxiliary mid-wives workers, according to a report by the state’s health department.
Bihar currently has the lowest number of COVID-19 tests per million in India, leading to 20,612 diagnosed cases and 180 deaths. Chief Minister of State, Nitish Kumar, has announced a total lockdown between July 16 and 31.
“We are scared to knock on the doors these days, especially because we do not receive appropriate gear. Most workers tie hankies on their faces. My two children maintain a distance after I return home and my husband does not approve,” said Jha.
For the meager income they receive, much lower than India’s minimum wage, many ASHA workers are now being pressured by family members to quit their jobs and not put their families at risk.
– Community health workers at forefront of virus war
The accredited social health activist program was launched by the Indian Health and Family Welfare Ministry in 2005; aiming to provide “every village in the country with a trained female community health activist,” according to the ministry. Each worker is responsible for at least 1,000 people.
The country now has a total of 970,000 women working under this program, according to AR Sindhu, the convenor of the All India Coordination Committee of Working Women, an organization of women workers.
The grassroots-level health workers are responsible for implementing government health schemes in the rural area, including checking and facilitating pregnant women, registering women for an antenatal check-up, distributing iron tablets, door-to-door vaccination and TB surveillance control. No health scheme can be implemented at the community level without the help of ASHA workers.
As the coronavirus pandemic is putting extra pressure on the already-fragile healthcare system in India, the community health workers have taken more burden on their shoulders as their works now include surveys, detecting positive cases, tracing primary and secondary contacts, patrolling containment zones and distributing food and medicine. They have also been asked to strictly monitor returning migrant workers from states for at least 28 days.
India has so far reported over one million positive cases of coronavirus, following the US and Brazil in crossing that mark. The country also reported more than 25,600 virus-related fatalities.
“Our work has been credited with improvements in access to maternal health care and malaria and filariasis reduction. Despite this, we are poorly paid and do not get any risk allowance,” Sindhu told Anadolu Agency.
More than 15 ASHA workers died in March, but their families did not receive ex-gratia or allowance from the government, said Sindhu, who is also the general secretary of the All India Federation of the Aanganwadi workers [nutrition providers] and helpers.
In an earlier notification, the health ministry applauded their work and increased remuneration from $13 to $26.
“The contribution of the ASHA workers enabled reaching out to households for active surveillance and information dissemination. In the midst of all this and while being vigilant about anyone with symptoms, ASHA workers also continued to provide care for pregnant women, newborns and children,” according to a health ministry statement last week.
The workers, however, said they have not received the new incentives.
In March, the government introduced a welfare scheme, which provided COVID-19 related death insurance of $66,150 to health care workers. However, the scheme did not include the ASHA members because they are termed peace-rated workers, said Sindhu.
ASHA workers in many states recently staged a protest demanding safety and health for all. They submitted a 14-point charter which included public health services be improved and a budgetary allocation for health be increased to 6% of the GDP.
They demanded they be regularized as health workers and given adequate payment, an allowance for COVID-related work, free medical treatment and insurance, including the Rs 50 lakh [$66,150] insurance.
Roughly 42,000 community health workers in the southern state of Karnataka have been on an indefinite strike since July 10 asking for protective gear and incentives.
In a recent Amnesty International report, the rights group said the frontline health care workers like ASHA members and sanitation workers in India are at a greater risk of becoming infected but are neglected.
“We have asked the government to provide us at least free treatment. Some ASHA workers could not even afford their treatment after they got infected during fieldwork,” Sindhu added.
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