Recurrent waves of pandemic has undoubtedly challenged the tenacity of public health system of India, over stretching the meaning of community health workers and bringing them to forefront of discourse. Where 66% of India is still rural, struggling to have one allopathic doctor in a population of 10, 926 people as against the recommendation of WHO to have 1 in 1000 people. Reach of health services to every nook and corner is a challenge of India having a population of over 1.3 billion people. Government of India in 2005 under National Rural Health Mission (NRHM) introduced a capillary link between the health system and rural community augmenting the health workforce by women volunteers known as Accredited Social Health Activists (ASHA).
UN (2020) mentions in its policy brief, the impact on women community health workers in tackling COVID-19. Even if, it seems too unrealistic to seek gender dimensions when the COVID-19 danger is intensifying and going beyond control of the entire health system in India. At present, the second wave of infection has already ripped India with ravaging variant of COVID-19, these women community health workers are performing as the first line of defense. Under extreme pressure from the system, they are over stretched to maintain their routine activities of survey, taking suspected cases for testing, dispel misinformation educating people in limited available personal protective equipment to them for their self protection against contracting the disease.
With skyrocketing number of cases, uncontrolled mortality and no risk prevention coverage either in form of health insurance or adequate protective equipment, vulnerability of ASHAs (named as Sahiya in the state) has further increased. Besides these, they are the first hand witness to, plight of Corona virus victims in hospitals and their family pleading for bed in hospitals, oxygen cylinders, medicines, apathy of the hospital staff towards patients and pricey treatment that has added to psychological trauma/fatigue. Above all, incidences of ASHA workers dying of COVID and indefinite estimates of ASHAs contracting the disease during their field duties in COVID without adequate protective cover has not just petrified the entire group but also raised ethical questions on our health system. With the small stipend of money and no employment benefits like: health insurance, sick leave, travel allowance etc. these workers undergo elevated levels of financial stress that has created ripples in their domestic lives.
Jharkhand, predominantly a tribal state has been hit severely by Corona virus like other states of India. The state witnesses second phase of COVID – 19 with all possibilities of new variant strain of virus that is far more infectious and swiftly spreading. This has put additional pressure on the health care system of the state. Given, the situation and rapidity of the spread of new variant it has increased the deprivation of medical care even for critical patients.
Urban Sahiya narrates that-
“In my area several people in one family affected with no noticeable symptoms. As before, this time there are no separate quarantine centers instead people are home quarantined. This keeps us under constant threat while interacting with families in the community”
Amidst spiking cases of highly infectious and fatal new strains of Corona virus, the tropical location of Jharkhand has paved way to vector borne and water borne diseases like: dengue, malaria and typhoid that has made the matter cluttered and worse for the health care system. It has further added on the workload of Sahiya with responsibilities for these diseases, having gained no extra monetary benefits for the duties in COVID other than a bonus in stipend. Says a Sahiya –
“As compared to the last time, when we were engaged for survey, testing and community mobilization, this phase we are involved in COVID vaccination drive and other duties related to dengue and malaria. I am still petrified, even if we are celebrated as “#corona warriors”, government will not take any charge of our medical needs.”
However, the situation in Rural Jharkhand remains even more debilitating, with no definite estimate of the upsurge in cases and mortality rate. Rural Sahiya underwent constant fear of contracting the infection due to instances of poor quality protective equipment being used especially for them with their needs nearly neglected due to enormous pressure on the health system to tackle the spiking medical urgencies.
“Our own protection is at stake. Last time we were given some masks and gloves which got old and torn off. We actually feel left out and very inferior in the system where most of the privileges are given to doctors and nurses in full time employment.”
Return of migrant laborers to their villages from cities has created another hotspot for emerging new variants of COVID-19. Sahiya is doing an epic task here too of tracking them and hence supporting in surveillance activities. However, this has bounded them with life threat being at the forefront of infection. With rising trend of the disease in rural areas pressure on Sahiya has also intensified to the extent of intimidating for loss of job and even payment of the little honorarium they receive. Says a Sahiya–
“I was compelled to continue my duty despite of myself being COVID +. I was admonished of losing my job and the stipend. Even to get payments clear, we still have to pay bribe. Now I am not even well supported by my family members to do this Sahiya work.”
Addressing challenges in contemporary situation
COVID 19 pandemic is an opportunity to recognize responses of the Health system and policy makers to pay attention to their lower status roles and formulate gender sensitive and balanced recovery efforts. It is important to reinvigorate the medical loop and preventive protocols in health programs to strengthen the health service system at the grassroots level especially an increase in trust between the two entities. Providing positive work space with a justified timely payment of their honorarium and basic benefits like: life insurance and travel allowance.
Ujjwala Gupta- is a mid career research and development professional and a member of International Sociological Association. She has been working on several community based issues including Family Planning, Maternal and Child Health, over the past twelve years with Development Sector as an independent consultant as well as on regular basis at various levels. She is an awardee of two very prestigious International Fellowships- Shastri Indo Canada Doctoral Research Fellowship and Policy Communication fellowship- Population Reference Bureau. She is a Doctoral student at Institute for Social and Economic Change, The University of Mysore in Bangalore, India.
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