India’s Women Frontline Community Health Care Workers Tracing COVID-19 Are Left Defenseless - Women’s Media Center

Overburdened and underpaid, India’s health workers, known as accredited social health activists (ASHAs) — all of whom are women — continue to work without sufficient PPE kits, facing harassment and stigma.

6/10/2021 9:02:00 PM

An all-women health care workforce acting as the interface b/w communities & India's public health system is on the country's front lines w/o PPE or proper compensation (or even recognition as skilled labor). And they're in COVID containment zones daily.

Overburdened and underpaid, India’s health workers, known as accredited social health activists (ASHAs) — all of whom are women — continue to work without sufficient PPE kits, facing harassment and stigma.

Ashwini Patel (Varsha Torgalkar)Overworked and underpaidViji Prabhakaran, 35, an ASHA working and living in a rural part of the Ernakulum district of Kerala — a south Indian state — walks three to four kilometers a day to trace patients in her village, maintaining a daily register by hand of the families she checks every day, sending this data on to her seniors in PHCs. She hardly has time for her regular ASHA tasks like explaining the benefits of various government schemes to appropriate beneficiaries—pregnant women, babies, young women—for which she gets additional incentives.

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“I’m asked to do duties at isolation centers where asymptomatic patients are treated. Seniors will also call me at any time of night when I’m with my family,” said Prabhakaran. “When we ask for a hike in honorarium, they tell us to leave the work.”Meanwhile, both Patil and Prabhakaran suffer abuse by patients and their families, who accuse them of spreading the virus. “People ask us not to come to their houses,” said Patil. “They don’t cooperate at all. And they lie saying they weren’t in contact with COVID-19 patients, but, after a few days, they test positive.”

“ASHAs are the backbone of the Indian health system in this pandemic,” said Raj. “And they work 10 to 12 hours a day without fixed work shifts.” In August 2020, ASHAs went on a nationwidestrikedemanding higher wages, PPE, and medical insurance. Some state governments increased their pay: Maharashtra raised their wages to Rs 2,000 a month. Other states increased their pay as well, but only negligibly.

Botle admits that there are often shortages of PPE kits, but added, “As far as the honorarium hike is concerned, they are activists, not employees. And besides, only the central government can make that decision.”The central government has yet to respond.

Now, raising public awareness about COVID-19 vaccinations, and how to register through the central government’sis left to the ASHAs.Renu Sigh, 40, an ASHA from Uttar Pradesh—a northern state of India that is currently experiencinga surge in COVID-19 deaths

—had a hard time in February and March, when the vaccination drive for Covishield (the Oxford-AstraZeneca vaccine) and Covaxin (the inactivated vaccine developed by native Bharat Biotech) began in India. “People had misconceptions, like vaccines aren’t effective or have many side effects,” she said. “We tried to answer all their misconceptions and convince them to come forward, but they wouldn’t come.”

Now that India’s facing a shortage of vaccines, however, ASHAs are being inundated with inquiries of when they would be available again. “People call non-stop or visit my home,” said Sigh. “Each center gets maybe 100 to 300 doses, which are gone within an hour. It is difficult to make them understand.”

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Some are now accusing ASHAs of favoring people with political connections or influence for vaccination, which only adds more distrust toward them.And, without support on any side, the ASHAs will remain the unsung—underappreciated, underpaid, and unprotected—heroes of India’s ailing health care system.

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