covid 19 frontline workers

For Demanding Gloves and Masks, BMC Contract Workers Face Police Case and Trial

While the workers had hoped that the corporation would heed their demands, they were accused of violating special laws during the pandemic and arrested.

Mumbai: In May last year, when Mumbai was facing the wrath of the second wave of COVID-19, a group of 20-25 sanitation workers had gathered outside the G North ward office of the Brihanmumbai Municipal Corporation (BMC). They had been working for over a decade as contractual employees but wanted to demand some of their most basic rights: adequate gloves and masks while at work. The workers had hoped that their collective representation would push the municipal corporation to meet their demands. Instead, they were accused of violating special laws imposed during the pandemic and arrested and eventually released on bail.

Close to a year later, the workers continue to face trial. Their demands, however, remain ignored.

43-year-old Shankar Kunchikorve, named as the “first accused” in the case, says he has worked with the BMC for over 12 years. “And each moment spent at the workplace was filled with neglect and humiliation,” he says. Shankar says, as contracted labourers, they are the worst treated and are expected to carry out the most difficult work.

“We continued to endure the ill-treatment for a very long time. But in the pandemic, we knew we could die. So, we demanded the contractors to provide us with gloves and masks on a daily basis,” Shankar adds.

Along with Shankar, Gangappa Shriram, Ramu Kunchikorve, Vicky Kunchikorve, Parashuram Shriram, Satish Kuchikorve, Shetappa Kuchikurve, Suraj Kunchikurve have also been named. The chargesheet claims more “unknown persons” participated in the “crime”.

All the workers belong to a nomadic community which traditionally handled monkeys and have worked for close to a decade with the corporation. This community has had a long history of criminalisation and they feel the corporation acted with bias against them and their caste identity made them an easy target.

The sanitation work across the corporation is handled by those belonging to marginalised caste identities. Their working condition is abysmal and their demands are seldom met. A large number of workers continue to work on contract and the BMC has done little to make them permanent employees.

Shankar and others, through the workers’ union, have already filed a petition for a permanent post in the BMC that is pending before the Bombay high court.

Shankar says, the corporation doesn’t miss out on a single opportunity to cause trouble for them. In the second wave of the pandemic, when many workers fell ill, the labourers worried for their wellbeing. “We would have to hop from one gully to another, looking for houses where people had fallen sick because of COVID-19. We had to pick waste from the houses of those infected and handle it with our bare hands. Anyone who demanded protective gear would be told to shut up or never come back to work.” Subsequently, Shankar claims, many workers fell ill.

The contracted labourers have not been treated as frontline workers or, in the government’s terminology, “COVID Yodha” or COVID warriors, Shankar adds. In the silent protest, the labourers were hoping to bring the BMC administration’s attention to their daily woes.

But since the state government had imposed a blanket restriction over public gatherings, the workers were booked under section 188 of the Indian Penal Code for “disobedience to order duly promulgated by public servant”, section 269 for “unlawfully or negligently indulging in an act which knows is likely to spread the infection of any disease dangerous to life” and others. Some of these sections are punishable with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

The complainant in the case, a police constable, has claimed that the accused persons had gathered without a mask. The labourers have denied the accusation.

The workers say they set out to work every day for over eight hours, working in the same group, but that act was never considered to be “unlawful”. “But it suddenly became an illegal act when we asked for our basic rights,” one of the workers, named in the FIR, said.

Since the workers are all on contract and are paid for their daily work, every court visit means loss of pay. And the labourers have had to visit the court on multiple occasions, only to be informed of the next date for hearing.

Their lawyer Maitrayee Gadhave says that while the police were prompt to file the chargesheet, a copy of it – which is every accused person’s right – was not made available for many months. “Finally, one copy was handed over in December and other accused were asked to take photocopies of the chargesheet,” the lawyer said.

Travails of ASHA Workers During COVID-19 Call for Renewed Focus on Public Health

ASHA workers and other community healthcare workers have experienced extra working hours, loss of pay and social apathy during the pandemic.

Walking into 2021, if there was one positive to be identified with the large-scale outbreak of a pandemic in 2020 in India, and the rest of the developing world, it would have been this: a primary focus given by most governments and their executive agencies to improve healthcare services and ensure more affordable access of them for large scale populations. This has been done irrespective of the ‘fiscal limitations’ and ‘weak governance systems’ cited earlier as reasons for making healthcare a lesser priority, and an area of investment to be outsourced to the private sector.

Notwithstanding, in the context of the Central government’s own response and by most of the states, one section of frontline healthcare workers, the ASHA workers, or the accredited social health activists, responsible for ensuring last-mile delivery of essential healthcare services (in areas of reproductive care, child nutrition, etc.), received little to no support even as most of the workers were put on COVID-19 testing duties in their localities, crumbling under the weight of rising infections and insufficient infrastructure.

Also read: ASHA Workers Are Indispensable. So Why Are They the Least of Our Concerns?

In an attempt to understand the working condition of most ASHAs, ANMs (auxiliary nurse midwife) and AWWs (anganwadi workers), our centre’s research team interacted with a number of medical professionals and workers associated with different urban primary health centres (PHCs) in Lucknow (Uttar Pradesh) and Pune (Maharashtra).

From the responses documented through audio-visual interviews, most ASHA workers raised serious concerns on being put on COVID-19 testing duties for weeks, preventing them from devoting time during the day to attend to pregnant women (including those in high-risk category) in their communities, which is also linked to their main source of incomes.

On average, work hours of most ASHAs increased by seven-to-eight-hour shifts, and the promised payments for extra time put into work have still not been credited into the accounts of more than 80% respondents spoken to.

Overworked and underpaid

Sarwari, an ASHA working with a PHC near Jama Masjid (Lucknow), says “Corona kal mein toh hum logo ki duty lag gai thi March se hi. Subah 8 Baje jate the; logo ke ghar jana, survey karna.. Kabhi kabar 3 baj jata tha.. Iske ilawa kabhi raat ko (maternal) case ki delivery ke vakt jana hota hai (We had our duty since March, leaving home at 8am and coming back as late as 3pm. We had no time to attend to our cases during the day so, had to rush late night for deliveries of high-risk pregnancies).”

Firoz Jahan (32), an Accredited Social Health Activist (ASHA) worker inquires with a beneficiary to attend the Vaccine camp at Murgkhana area in Lucknow city, India. Photo: Jignesh Mistry

Change in work commitments, and the scare created around the virus spread, made most ASHA workers undergo increased harassment from their own family members, who felt their vulnerability and exposure to the field, would bring the virus home, and many people within their own community refused to interact with them. This has prevented ASHAs from attending pregnant women.

Sarwari describes the trouble she faced from her own family and spouse, as her husband would often say, “Quit all this work. There is nothing in it. Just quit it. This is not how we want to earn this meagre sum of 2,000 rupees, and you don’t even get that paid in time..”

There were many instances when ASHA respondents raised concern about the lack of any consideration shown by state authorities about their own medical condition, especially a few who were pregnant themselves.

Also read: COVID-19 and India’s Unsung Frontline Health and Childcare Workers

With no provision of paid or sick leaves available to ASHAs due to the deeply exploitative nature of their (work) contract with the public health system, most respondents, having no one else to take care of their children at home, had to bring their infants to the field, while conducting the surveys and exposing themselves (along with their children) to a higher possibility of contracting the virus.

Dr. Andaleep Rizvi, a medical officer in charge of a few urban primary health centres in old Lucknow, echoes the importance of ASHAs to the community health system and how their well-being, professional requirements need to be put at the centre of any healthcare policy,

“The ASHA worker is a part of the community. It is easier to gain cooperation from the patients as they already trust the ASHA as she is from the community itself…”

Rizvi elaborates, “Because we were required to go to the houses of all COVID-19 positive patients, test others from their neighbouring areas as well, community members wouldn’t trust us. It became very important for a local to come along with us during the surveys conducted. ASHAs and a few Aganwadi workers played a huge role in this, aiding us during the screening and testing process. ASHAs have truly emerged as one of the ‘unsung heroes’ from this pandemic…”

Social apathy

Despite the vitality of their work and presence on the field, lived experiences of many workers tell a tragic tale. Vijay Laxmi, a 35-year-old ASHA worker, narrates the details of a threatening phone call she received after her case-patient was tested positive for COVID-19.

“Doh teen din rukne ke baad voh hume phone karke ulta-seedha bol rahi thi, ‘Tumhari vajah se hum Yahan aa gae hai, humne na corona hai na kuch hai tum bas hume bewakoof (word changed) banti hai. Tum agar area mein kam karna laxmi didi toh hum tumhe bataenge. Tumne hamare sath nainsafi kari’ (After staying at the COVID-19 centre for 2-3 days, she called me and abused, saying ‘It is because of you that I am here [at the COVID centre], I did not have Corona, you have tricked us. If you work in the area or if I see you again, I will come after you. You have done a great injustice to me and my family’).”

Samba Patel (R), Auxiliary nurse-midwife (ANM) along with Shikha Nigam (L), the ASHA worker. The ASHAs who are attached to the ANM as an assistant was also on the field for COVID-duty. Photo: Jignesh Mistry

While such resistance from many cases shocked ASHA workers on the ground at the time, even forced some of them to change their houses because of the threat faced from their own community members, in responses we received, the most disheartening experience(s) of ASHAs was at the district hospitals where they would bring a pregnant case for treatment, check-up or delivery.

Rekha describes her experience of Balrampur district hospital: “Sometimes, they (guards) didn’t let us enter, saying ‘So what if you are an ASHA! Get lost from here’… It was as if we have no respect or right to be treated with dignity any-where we would go; neither outside, nor in the hospitals… Why would a case or a community trust us?”.

Due to the crumbling infrastructure of most public-health district hospitals, many ASHAs asked their patients to have their final deliveries in ‘private’.

Also read: COVID-19 Adds to the Woes of India’s Underpaid and Overworked Care Workers

The meaning and the reference to the term ‘private’ requires a critical mention here. Most patients, as Rekha (and many others) explained, were even encouraged by ASHA — in absence of any medical support from the state — to have deliveries at home through ANMs, or alternatively, at private hospitals (if a patient’s family had the money to pay for it).

Dayawati, one of the AWWs, explains in detail about the scenarios of many cases in her own community that saw final maternal deliveries happening ‘privately’ at homes — without medical support/assistance or a doctor present — and in some cases, on way to a hospital (as referral transport and mobility was excruciatingly difficult during the lockdown weeks).

From the results of a recent survey done by Oxfam (India) with ASHAs across states of Uttar Pradesh, Odisha, Bihar and Chattisgarh, only around 23% of ASHAs spoke of receiving hazmat or bodysuits.

Overall, less than 75% had masks and 62% had gloves provided to do their duties at a time when ASHAs, AWWs were working with a heightened possibility of contracting the virus. Even those supplied with personal protective equipment (PPEs), didn’t receive proper training on how to use them on the field (less than 76% of total respondents said they received any training on the use of masks-PPEs).

An infant is injected with a vaccine by the Auxiliary nurse-midwife (ANM) at the camp in the Malahi Tola area in Lucknow city, India. Photo: Jignesh Mistry

Despite all the indignation received from a crumbling public health medical infrastructure; the failure of a government to ensure masks, PPEs for its community health workers; or, even the lack of timely payments for ASHAs working on the ground, what drove most workers to continue their labour was the voluntary will to help their own community, and those in need and in urgent care (especially the high-risk pregnant cases).

Sara adds: “Bas ek apni lagan thi ki aise musibat ke samay mein agar hum log bhi ghar pe baith jaenge toh baki logo ka kya hoga (The only thought and motivation to be out and work was that if we all sit at home even during these difficult times, what will happen to other people)”.

It is about time that a renewed focus on improving healthcare access, as highlighted from the response to a pandemic outbreak, translates into an actual vision and action plan to include (and ensure) the well-being of all its key stakeholders, especially the community health workers, and treat their instrumental work and contributions on the ground with dignity.

*Names of all respondents have been changed to protect their identity. All photographs have been taken by Jignesh Mistry (PAIGAM). More information on video-archives of interviews documented can be accessed from here.

This field-analysis is part of the Visual Storyboard initiative undertaken by the Centre for New Economics Studies (CNES) in collaboration with PAIGAM (People’s Association in Grassroots Action and Movement).

Deepanshu Mohan is associate professor of economics, and director, Centre for New Economics Studies (CNES), Jindal School of Liberal Arts, O.P. Jindal Global University. Jignesh Mistry is a senior research analyst and Visual Storyboard Team Lead, CNES. Sunanda Mishra is a research analyst with CNES. Advaita Singh and Shivani Agarwal are senior research analysts, CNES.

COVID-19 and India’s Unsung Frontline Health and Childcare Workers

ASHA workers, auxiliary nurses and midwives and anganwadi workers are bearing the double and direct burden of both COVID-19 related responsibilities and their regular maternal and childcare duties.

As the COVID-19 pandemic and its associated challenges keep unfolding in front of our very eyes, it becomes increasingly apparent that the endemic, i.e., the entrenched socio-economic problems extant in most parts of India, gets exacerbated during the period. Therefore, what we are encountering is not just a bio-medical pandemic, but a pandemic of extreme poverty, unemployment, food insecurity and healthcare deprivation.

In this context of the suffocating synergy between the ‘normal times’ and the ‘crisis times’, this article examines the contribution of the ‘unsung’ frontline health and childcare workers, namely, Accredited Social Health Activist (ASHA), Auxiliary Nurse and Midwife (ANM), and Anganwadi Worker (AWW), who seem to be bearing the double and direct burden of both COVID-related responsibilities and their regular maternal and childcare duties.

In one of its recently convened online discussions, the Pratichi Research Team got an opportunity to listen to the challenge-fraught yet high-spirited voices of a large group of frontline healthcare workers from different districts of West Bengal, including ASHAs, ANMs, AWWs, and district-level health counsellors.

The first-person account of the vicissitude of their life as ‘essential’ healthcare providers in this pandemic and of their resolve to face the myriad challenges frontally, yielded a key question: how to ‘centre’ the role and contribution of this hyperactive frontline at a time when many other essential services of both the state and the market are either disrupted or completely suspended.

Despite the private sector being the dominant player in the healthcare sector in India, it was intriguing to see that it did not emerge as the custodian of people’s health during a pandemic. Instead, the state had to take up the central role in steering the country through these troubled times. However, within the apparatus of the ‘grand’ state, the contributions of the frontline health and childcare workers have remained unsung.

They are, routinely and intriguingly, both controlled and neglected by the centres of authority, with usual policy indifference that the ‘core’ harbours for the ‘periphery’ in a hierarchical institutional structure. Since they are treated within the policy circle as workers receiving some honorarium, some describe them as the ‘state without honour’. Yet, during these times of crisis, they are the face of the state.

Also read: Does India Need a Digital Health Mission?

Making the ‘state’ visible in the eye of the masses

Many caregivers spoke about their heightened level of activity during both the ‘lockdown’ and subsequent ‘unlock’ periods, requiring them to work for 15 to 16 hours a day. Although their routine tasks of mother and childcare got disrupted during the early months of the national lockdown, in many districts of West Bengal, they are the ones, in contrast to many other government employees, who have resumed their services soon after, especially those related to child immunisation and maternal care, devising a number of innovative ways permissible under these restrictive circumstances.

To clear the backlog in these respects, they have begun offering essential services thrice a week instead of the earlier schedule of once or twice, attending to the children and the mothers in small batches of ten, positioned at safe distances from each other. Mothers seem to have overcome their initial apprehensions about revisiting the primary health centres, ‘as they have faith in us’, observed one ASHA staff.

ASHA workers strike in Bihar. Photo: Saurav Kumar

However, the supply of essential kits like the haemoglobin test kit and iron tablets is yet to be regularised, they said. Despite their efforts to keep up the level of institutional deliveries in government hospitals, there has been a clear decline in the same during this perilous season. Quite a few deliveries have taken place at private nursing homes, as some of the doctors of government hospitals have nudged, even intimidated, their patients to turn towards their private clinics through a ‘revolving door’, causing the frontline staff to lose the meagre incentive that they get for deliveries in government hospitals.

The equipment for their own protection – masks, sanitizer, and gloves etc. – were in short supply initially, their stock picking up a bit later on. And yet, they have continued their door-to-door visits in their neighbourhoods, tracing the spread of the virus, checking on the health status of the patients, suggesting feasible quarantine measures for them, and delivering important public health messages about the corona virus – the so-called ‘social vaccine’ – at the doorstep of the rural populace. Some of these rural health workers have been occasionally transported to city airports for thermal screening and health check-ups of travellers.

When many of us had locked ourselves up safely in our houses, Anganwadi workers went out to distribute the dry ration to their students and their families at regular intervals. They also stayed in touch with their supervisors and ASHA colleagues despite the centres being shut by the higher authorities. No doubt, at these troubled times it is these women working at the grassroots level who have made the otherwise “missing” state visible in the eye of the masses.

Also read: A COVID-19 Vaccine Is Part 1 – Part 2 Will Be India’s Mighty Logistics Challenge

Lack of benefits for contract workers

From a labour protection point of view, it is important to scrutinise what employment securities are made available, especially, to second ANMs, who are contract employees.

A few caregiver participants pointed out that it is the second ANMs who have been primarily shouldering the responsibilities pertaining to the handling of migration-induced contagion in the state. Their personal protection, incentives, transportation facilities, and resting opportunities are insufficient; their choices are few, but their market-like insecurities are abundant.

It is, therefore, important to probe the government’s treatment of its contract employees, especially during a public health emergency.

ASHA workers in Karnataka have boycotted work since July 10, demanding a fixed honorarium of Rs 12,000 per month. Photo: By arrangement

Seeing through the lens of gender

These women health workers conducted meetings with local communities before the arrival of the migrants to sensitise them about their role and cooperation in dealing with the imminent challenges. They also had meetings with the migrant workers to assist them through the process of home quarantine, offer counselling and support in case they contracted the disease, and shift them when necessary to block-level quarantine centres.

On a few occasions, when an entire village and its residents were socially ostracised by the locals because of this contagion, pushing them into starvation, women health workers approached the concerned block development officers and sought their intervention to ameliorate the situation. This enlarged their role in the public sphere, and required them to interact with migrant workers, police personnel, civic volunteers, and mostly men, which has been a source of challenge and even harassment for some of these women caregivers, as their accounts revealed.

At times, the migrant workers at the quarantine centres would show their wrath to these women due to poor services offered at the quarantine centres. Therefore, it is worth probing whether any seeds of transformation in the gendered power structure at the community level are visible due to their increased interaction with the people in the public domain.

Also read: On the Legal Front, How Prepared Is India for the Next Public Health Emergency?

The motivation factor

On asking what keeps them at their very demanding and risky job, despite the economic hardship and the extra work, the participants gave the audience an inkling of their motivation that transcends economics – they seem to value their work for its social relevance and its professional quality.

They indeed underlined the need for their professional development. They said, “We are community health workers, assigned to carry out a number of outreach activities. However, we are now allotted many additional ‘indoor’ duties at government-run ‘safe homes’. We are supposed to assist trained doctors in providing these services, but on the ground we are the ones who end up handling these tasks directly, for example, of giving oxygen to the patients when needed, even though we are not professionally trained to do so.”

“We love our work. These are times of tribulations, we often sacrifice the needs of our own families, find it painful not to be able to be with our own children, yet we feel obliged to stand by our fellow human beings.”

Therefore, it is time to centre the role of the frontline community heathcare workers by enhancing justice in India’s healthcare structure.

Pratichi Research Team is a part of the Pratichi (India) Trust founded by Nobel laureate Amartya Sen.

SC to Centre: ‘Ensure Frontline Worker Salaries Paid on Time, Quarantine Not Treated as Leave’

Solicitor General Tushar Mehta said that many states have complied with the directions but some of them like Maharashtra, Punjab, Tripura and Karnataka have not paid salaries to the doctors and healthcare workers on time.

New Delhi: Maharashtra, Punjab, Karnataka and Tripura are yet to follow directives on timely payment of salaries to healthcare workers engaged in COVID-19, the Centre on Friday told the Supreme Court, which said it cannot be “helpless” in implementing the directions.

The court directed the Centre to issue necessary directions for releasing salaries of doctors and frontline healthcare workers engaged in COVID-19 duty on time.

A bench of Justices Ashok Bhushan, R. Subhash Reddy and M.R. Shah asked the Centre to also clarify on treating compulsory quarantine period of healthcare workers as leave and deduction of their salaries for the same period.

“If the states are not complying with the directions and orders of the Central government, you are not helpless. You have to ensure that your order is implemented. You have got the power under the Disaster Management Act. You can take steps also”, the bench told Solicitor General Tushar Mehta, appearing for the Centre.

Mehta said that after the top court’s directions on June 17, necessary orders were issued on June 18 to all the states, with regard to payment of salaries to healthcare workers.

Also read: Centre Revises Quarantine Period to 1 Week for Doctors, Health Workers in COVID-19 Facilities

He said that many states have complied with the directions but some of them like Maharashtra, Punjab, Tripura and Karnataka have not paid salaries to the doctors and healthcare workers on time.

Senior Advocate K.V. Vishwanathan, appearing for petitioner Arushi Jain, said the high-risk and low-risk classification made by the Centre has no basis and the government advisory of June 18 after the top court’s order has no rationale basis.

He said that there is still non-payment of salaries to healthcare workers.

The bench was hearing a plea of Dr Arushi Jain, a private doctor questioning the Centre’s May 15 decision that 14-day quarantine was not mandatory for doctors.

The top court also took note of an application filed by United Resident Doctors Association (URDA) through advocates Mithu Jain, Mohit Paul and Arnav Vidyarthi that salaries of doctors are being deducted for the period of compulsory quarantine treating it as leave period.

To this, Mehta conceded that “the said period can’t be treated as leave” and said that he would take necessary instructions on the issue.

He said the Central government will take steps to ensure that the salaries of doctors and healthcare workers are paid on time.

The top court posted the matter for further hearing on August 10.

On June 17, the top court had directed the Centre to issue orders in 24-hours to all states and Union Territories for payment of salaries to doctors and healthcare workers as also for providing suitable quarantine facilities for those who are directly engaged in the treatment of COVID-19 patients.

Also read: As COVID-19 Sweeps Karnataka, ASHA Workers, AYUSH Doctors Strike for Better Pay

It had said, “The Central government shall issue an appropriate direction to the chief secretary of the states/Union Territories to ensure that the orders are faithfully complied with, violation of which may be treated as an offence under the Disaster Management Act read with the Indian Penal Code.”

Dr Jain had also alleged in her plea that frontline healthcare workers engaged in the fight against COVID-19 are not being paid salaries or their wages are being cut or delayed.

The Centre had earlier told the top court that the May 15 circular on the standard operating procedure (SOP) will also be modified, doing away the clause for non-mandatory quarantine for healthcare workers engaged in COVID-19 duty, and they will not be denied the quarantine.

On June 12, the top court had observed, In war, you do not make soldiers unhappy. Travel an extra mile and channel some extra money to address their grievances.

It had said that the courts should not be involved in the issue of non-payment of salary to healthcare workers and the government should settle the issue.

It’s Time to Recognise that Govt Plans Are Oblivious to the Realities of Care Workers

Not only is there disparity in salary, an inherent and punishing hierarchy, but pre-existing taboos and systematic devaluation of care work is likely to hit us particularly hard in this crisis.

In the last few days, disturbing news about care workers and doctors getting infected by COVID-19 have been reported from across India.

On April 3, 50 medics had tested positive. The numbers have exponentially increased since most of them are working without basic protective gears.

As of April 17, at least 600 medics in Delhi, 160 in Mumbai, 50 in Rajasthan have been affected. However, the real numbers are expected to be much higher. Moreover, these numbers don’t include primary health care professional like ASHA, ANM and Anganwadi workers on COVID-19 duty.

Sporadic agitations of care workers have taken place in different states like Karnataka, West Bengal, Punjab, and Maharashtra demanding quality personal protective equipment or PPE.

Care workers have also raised the issue that they are being treated as dispensable. For instance, primary health workers fall under the ‘least-risk’ category for protective gear distribution despite being tasked with door to door surveys.

Also read: Bihar: A Day in the Life of an ASHA Worker During Lockdown

In several places, doctors have been accommodated in comfortable hotels while nurses were provided overcrowded and dirty rooms or simply denied accommodation.

Continuous threat of violence

Government plans are oblivious to the realities of care workers despite them being tasked with vital roles. Several care workers face threats of eviction and aggression from neighbours. They are not being provided with transportation and food despite the lockdown.

Thus they are often being forced to skip meals and commute at odd hours on deserted roads, sometimes on foot. To add to the injury, primary health workers have not been issued travel passes. This not only affects their ability to do their job but also exposes them to police violence. There are even reports of them being chased out by communities during routine surveys.

Nurses are being forced to work continuous shifts and their leaves are being cancelled. Even when there are visible symptoms, they are not getting tested. As a result, when they fall sick, they either have to exhaust their sick leaves or take a loss of pay.

Primary health workers are even more vulnerable since they have almost no access to social security such as health benefits, leaves, etc. as they are “volunteer workers”.

In spite of these roadblocks, their demands are focused on access to necessary protective gear. They do so by pointing out the dangers that can befall upon others rather than using a narrative of self-preservation. Perhaps a reflection of how little we care about our care workers.

Care workers: Our frontline defence against COVID-19

As the popular narrative heralds them, health care workers are indeed our frontline warriors. Out of all health workers, a sizable section (nearly 30%) consists of nurses and midwives. This figure excludes nearly 1 million primary health workers. Here is an estimate:

Source: Indian Nursing Council Annual Report, 2017-18

Source: Ministry of Women and Child, Press Release & Ministry of Health and Family Welfare, 2019 Report.

Government apathy

On January 31, a day after the first COVID-19 case was reported in India, the Directorate General of foreign trade imposed a ban on the export of all medical protective gear.

But this was only a temporary measure since the government relaxed the order on February 8, allowing the export of surgical masks and gloves. This ban was further relaxed on February 25, allowing the export of eight more items. Needless to say, the WHO guideline on February 27 to stockpile on PPE fell to deaf ears.

India continued to export medical protective equipment as late as March 29. What is even more bizarre was that Minister of Textiles, Smriti Irani, while acknowledging the shortage of PPE insisted on centralising procurement of PPE through one government-owned company.

Despite being contacted by several PPE manufacturers in February, the government did nothing until March 21. Even without reading too much into the situation, it seems rather counterintuitive.

Also read: Doctors Are Running Out of Protective Gear. Why Didn’t the Govt Stop Exports in Time?

In order to mitigate the damages of their erroneous actions, the Ministry of Health and Family Welfare issued a press release on March 30 informing that 11 domestic manufacturers are going to be making PPE.

The Ministry of External Affairs is also in the process of importing 30 lakh PPE kits from Singapore and Korea in the second week of April.

However, this news was far from reassuring for multiple reasons. First, there have been several reports of the USA diverting PPE and testing kits meant for other countries, including India. Thus until these PPE kits arrive, it remains shrouded in uncertainty. Second, it is far too inadequate. Third, it remains unclear whether the safety needs of nurses and primary health workers will find primacy in the usage of these kits.

The baggage of history

Surprisingly, India’s COVID-19 task force has no representation of care workers.

The real reason for that perhaps lies in the history of this profession. Care work has been dominated by women globally, perhaps a result of the traditional binary which associates women with care (nursing) and men with cure (doctors). This has led to devaluation and feminisation of care work.

Even though it is intellectually, physically, and emotionally demanding; it is perceived as unskilled labour. Within the Indian context, apart from gender, this difference in the value is also mediated by caste.

This hierarchy can be traced back to our inheritance of untouchability and colonial past. Care work is seen as “impure” since it requires physical proximity and touch.

Thus, women from minority communities have historically dominated this profession. Given its roots in missionary work, it is often perceived as a divine calling rather than a profession.

As a result, this valorises the hardships associated with care work. This takes away legitimacy from their claims to labour dignity and rights. Overall, there is an implicit expectation of docility and deference from care workers.

With the rise of global demand for nurses, there has been a moderate increase in women from more dominant communities. This coincides with a further widening of wage.

Some nurses make less than Rs 4,000 working in private institutions, whereas the in-hand salary for a staff nurse with a basic GNM degree working in a government hospital located in a Tier 1 city would start at Rs 64,000. There have been several protests and legal petitions by nurses to standardise wages.

In contrast, ASHA workers get an honorarium of Rs 2,000 to Rs 4,000 per month, which varies from state to state. Even with this meagre salary, the onus to pay for travel and stationery is on them. Anganwadi workers earn between Rs 2,250 and Rs 4,500 and Anganwadi helpers between Rs 1,500 and Rs 2,250 per month.

They have organised several protests and been assured by the government of a raise in 2018. However, this promise is yet to materialise; in fact, many have not received their wages for several months.

This disparity in the salary, inherent hierarchy, pre-existing taboos and systematic devaluation of care work has led to chronic under-staffing and adverse working conditions.

Institutional support, such as the provision of transportation during night duty, paid sick leaves, and so on, have also been lacking. They are often not involved in decision making or leadership roles.

High pressure of work and expectation of deference have made it exceedingly difficult for care workers to organise and demand better working conditions. To make matters worse, nursing is categorised as “essential services” under the Essential Services Maintenance Act, 1968.

This Act gives the government the power to prohibit strikes in sectors deemed as essential services. The baggage of history is perhaps most visible in how care workers are being valorised, while their justified and essential demands are being completely sidelined in the current battle against COVID-19.

A moment of reckoning

COVID-19 has been a moment of reckoning on how crucial care work really is to the functioning of our society.

A majority of our healthcare professionals work in perilous conditions for paltry wages with little to no right to occupational safety.

Besides, they are rarely involved in decision making. It is perhaps telling that India’s total health care spending (3.5 % of total GDP, 2017) is the lowest among the BRICS country.

Given years of short-sighted planning, inadequate policy and increasing pressures of neoliberalism, care work was already in a state of crisis as evident from several protests to increase and standardise wages. But the government failing to recognise and protect our frontline of defence at this moment of crisis will have a catastrophic effect on our survival of this pandemic.

Madhurima Majumder is senior researcher, Sankaran Research Team, Centre for Equity Studies.