By Rukmini Sen and Aishwarya Rajeev

Indian community health workers (or ASHAs), provide essential forms of care and labour during a health crisis. Yet their own lives are not safeguarded and they struggle for access to the very resources they need to do their jobs. How are they protesting and what are their demands? This May Day, or Labour Day, our guest authors ask if the pandemic might have generated a model of feminist care in policy making and public discourse. 

“During the pandemic, I was always stressed about doing my work well and getting home safe. Everyone says that through my work, I help other people. But what about me and my loved ones?”
-Hema, Accredited Social Health Activist ^[1]

The Coronavirus COVID-19 pandemic has been with us for more than three years now and it has impacted all known ways in which human lives are led. While the gendered burden of the pandemic has been well documented, in this essay we focus on Accredited Social Health Activists (henceforth ASHAs) or community health workers in India, trained to work as an interface between the community and the public health system. ASHAs were at the forefront of the Indian state’s COVID-19 mitigation strategy. In terms of numbers, there are over a million ASHAs spread across the country. Despite providing highly specialized care work, they are not considered to be workers and therefore paid paltry honorariums. The compensation for their services differs across states, ranging from Rs. 1,000 in some states to around Rs. 10, 000 in others^[2]. This remuneration is given to them in lieu of an astonishing number of tasks that these women carry out, because of which they actually work for more than 8 hours each day (Sinha, Gupta and Shriyan, 2021).

Even at the peak of the pandemic, ASHAs grappled with issues of lack of PPE kits, resources and safety measures. At the same time, they were heavily relied upon to carry out surveys, provide assistance to quarantined households, and spread awareness, among myriad other activities. For instance, there were reports of ASHA and anganwadi workers having to borrow or buy smartphones to conduct the door-to-door surveys, since most of them, coming from poor families, did not own one and were working for a pittance. Moreover, the hierarchy among health care personnel acutely became evident through the pandemic even with respect to easier access to PPE kits. There were also many instances of ASHAs facing stigma, as they were seen as carriers of the disease. For example, Odisha’s Matilda Kullu, an ASHA who was recently featured in a Forbes’ list, had to face instances wherein people would offer her water and then refuse to touch the glass later.

There have been various protests by ASHAs across the country, demanding their basic entitlements, and yet these have been met with apathetic silence. In some instances, police cases were registered against them for violation of social distancing norms, while others were threatened with termination, as per certain clauses under the Epidemic Diseases Act. They have not even been paid the meagre honorarium that they are entitled to, and this has been an issue even in pre-pandemic times. The process is made even more cumbersome by bureaucratic hurdles, complicated requirements and negligence by supervisors. ASHAs continue to fight for their rights, asking for minimum wages and other benefits. But even such basic demands have had limited gains till now. As noted by some ASHAs, “At the delivery rooms in many hospitals in the district, you’ll see a sign that says, ‘No entry for ASHAs’…We accompany women for deliveries in the middle of night, and they ask us to stay because they’re not confident enough and they trust us. But we’re not allowed inside….The government should recognise us officially as employees, not volunteers”. It is this voice of the ASHA worker bringing together the conflicting elements of trust, stigma and rights, that a feminist discourse on care as work and women health care workers as workers need to propagate.

In connection to the situation of ASHA workers as stated above, it may be relevant to ask whether a crisis like the pandemic can be a moment of renewal, a journey towards a new language of care and cooperation for healthcare workers? As Enloe (2020) asked, are women-led governments both more civically responsible and more likely to inspire trust, and thus the public’s compliance with health rules, than are governments led by men? Clearly, rather than only women-led, there were certain forms of feminist models of responding to the public health crisis of the pandemic that was followed by a few countries across the world. New Zealand PM Ardern’s insistence on saving lives and her kindness-first approach – urging her citizens to look after their neighbours, take care of the vulnerable, and make sacrifices for the greater good were welcome words in a world which was only insisting on social distance rather than social connectedness. Kerala’s Health Minister, K.K. Shailaja was definitely another such important voice announcing a people-centered health programme in which everyone is a participant. There was expansion of healthcare infrastructure, strict implementation of social distancing, training and support to health workers and a holistic approach to tackling the various kinds of losses that people were suffering from. With the experience of the pandemic, in a futuristic feminist care policy discourse, compassion-based workers’ rights need to be ensured, so that the ASHA workers are truly applauded as ‘frontline workers’. On the occasion of the International Workers Day, it is our affirmation that they deserve this, or else their recognition as on May 22, 2022, as one of six recipients of the World Health Organization’s Global Health Leaders Awards would remain merely ceremonious.

References

Enloe, C. (2020). Femininity and the paradox of trust building in patriarchies during COVID-19. Signs Journal of Women in Culture and Society, Feminists Theorize Covid-19. http://signsjournal.org/covid/enloe/

Sinha, D., Gupta, M. & Shriyan, D. (2021). High Risk without Recognition: Challenges Faced by Female Frontline Workers. Economic and Political Weekly, EPW Engage. https://www.epw.in/engage/article/high-riskwithout-recognition-challenges-faced

Author Bios

Rukmini Sen is Professor of Sociology at the School of Liberal Studies, Dr. B.R. Ambedkar University Delhi (rukmini@aud.ac.in).

Aishwarya Rajeev is a Ph.D. Candidate in Economics at the School of Liberal Studies, Dr. B. R. Ambedkar University Delhi (aishwaryarajeev7@gmail.com).

[1] Name changed to maintain anonymity

[2] The Indian Government increased the minimum honorarium for ASHA workers for routine tasks, from Rs. 1000 to Rs. 2000 per month, in 2018. The remaining amount over and above this basic honorarium, varies across states. For ex. in Telangana, ASHAs get Rs. 6000 (Sinha, Gupta and Shriyan, (2021), while West Bengal and Rajasthan pay a fixed minimum of Rs. 3000.