“Is beemari se bachne ke liye jo hamare dhaal hain jaise hamare doctor, swasthyakarmi, safai karmachari aur police aadi, unka samman karen, unhen sahyog den. In yoddhaon ki karo dekhbhaal to desh jeetega corona se har haal”
[Translation: To save ourselves from this disease, those who are our armours…like our doctors, health workers, sanitation workers and police etc., respect them and co-operate with them. Take care of these warriors and the country will definitely defeat the Corona virus.’]
During the first and second waves of Covid-19 this is an unsolicited caller-tune-cum-message that Indian callers were forced to listen to before making any call. This is how the Indian authorities urged the nation to respect health workers fighting the pandemic.
Prime Minister Modi himself saluted them in his public address on 7 May 2020. Calling them frontline Corona warriors, he said, “their selfless sacrifice is worthy of praise.” Even rose petals were showered on them from the air.
The government has patted its back before the world claiming that it has achieved remarkable success in the battle against Covid-19. Whatever success can be claimed though is almost entirely due to the toil of the frontline health workers. Unfortunately, while they got generous praise they did not get any additional material benefit from the government for their hard toil, risking their lives, in the fight against the Coronavirus.
Frontline health workers numbered 22.12 lakh as per government figures. This figure seems to be an understatement because a 2018 Indian Institute of Public Health study by Anup Karan et al estimated a total stock of 5.76 million health workers including 1.6 million allopathic doctors, 2.34 million nurses and midwives, 1.20 million pharmacists, 0.27 million dentists, and 0.79 million Ayush traditional medical practitioners.
Even the comparatively lower NSSO 2017—18 estimates put the figure at 3.12 million with allopathic doctors and nurse/midwives alone estimated at 0.80 million and 1.40 million respectively. This total however excluded other paramedics like ward-boys, ambulance drivers and lab technicians, and ASHAs and other community health workers and so on.
In fact, the Union Minister of State for Health and Family Welfare himself told the Rajya Sabha on 3 March 2020 that there were 3.07 million registered nursing personnel
in the country including 21,51,850 registered nurses and 8,92,829 Auxiliary Nurse Midwives (ANMs). Apart from them there are 10.4 lakh ASHA workers too. Besides these sections, there are other community health workers in many States, like women health visitors.
Of course, only a small section of private sector doctors and nurses and other medical personnel were requisitioned by the government for Covid-19 duty but their actual number was never revealed. In spite of that, 22.12 lakh appears to be a gross understatement.
Health Infrastructure Understaffed
Indian health infrastructure is grossly understaffed, especially in key areas like nursing. India had 1.7 nurses per 1000 population in September 2021 but the WHO norm is 3 nurses per 1000 population. India needs 4.3 million more nurses to meet the WHO norm. We can well imagine the workload if 2 nurses were to perform the work of 5. WHO recommends 1 doctor for every 1000 people but India has one doctor for every 1457 people. In this article, we will focus mainly on nurses and ASHA workers who are the backbone of the army of health workers who fought Covid-19.
High Risk and Low Rewards
The only significant support that the government could come up with for frontline workers was the announcement on 27 March 2020 that under the Pradhan Mantri Garib Kalyan Insurance Scheme the frontline health workers would be offered an insurance cover of up to Rs.50 lakh if the worker died contracting Corona infection while working.
Regarding the frontline workers in the private sector, only those requisitioned by the government for work in government health centres would be covered under this scheme and the vast majority of the rest had no mandatory risk cover from the employers, and hence those among them who died did not get any compensation.
As per a study by Anusha, R and Tanvi Singh published in The Leaflet even among those working in government hospitals hardly 0.013% benefited from this scheme. There are several reasons for this low figure which is much lower than the general Covid-19 mortality rate of around 1% for all cases.
For instance, the government, in its wisdom, excluded all those above 55 years of age from this insurance cover but they were not excluded from Covid-19 duty. They were also deployed to attend to Covid-19 patients despite belonging to the high-risk age-group.
Secondly, a vast majority of the private sector health workers were excluded.
Thirdly, the already harried families of Covid-19 victims among government health workers had to face lots of hassles in paper work to claim compensation. Along with the claim form, identity proof, proof of relationship to the deceased and death certificate had to be submitted. A clinical laboratory Covid-19 test report that the patient had been suffering with Corona infection had to be submitted along with a certificate from the employer of the person who died certifying that he/she was an employee and had contracted Covid-19. Often, many hospitals in many States did not conduct a Covid-19 test after death of a patient and often there was confusion on the cause of death in comorbidity cases. Many hospitals refused to certify that the death was due to Covid-19 if the health care worker was not directly in-charge of a Covid-19 patient even if he/she had contracted it from other patients being treated in the hospital.
Private doctors drafted to treat Covid-19 patients by the government were also supposed to be paid Rs.50 lakh compensation. In one case, the Navi Mumbai Corporation directed all the private clinics falling within its jurisdiction to keep their clinical establishments open to treat Covid-19 patients. When the wife of a doctor who died approached the court to seek compensation from the government, the Bombay HC ruled that directing the private clinics to remain open and treat Covid-19 patients would not amount to requisitioning them for work to treat Covid-19 patients in government hospitals!
Worse, when the Trinamool Congress MP Derek O’Brien raised a question in the parliament seeking the number of frontline health workers who died due to Covid-19 and the number of those whose kin were compensated, the Union Health Minister Mansukh Mandavia came up with the shocking answer. “The Centre does not maintain records on number of Covid-19 deaths among frontline health workers”, he said in the parliament on 8 February 2022.
He conveniently tried to pass the buck to the States.
“Health is a State subject. The government of India has maintained data of total cases and deaths as reported by States/UTs on a regular basis. Disaggregated data by profession is required to be maintained by the States. Accordingly, Union Government has requested States/UTs to furnish the requisite details,” he said. Only six among 36 States and Union Territories maintain separate record profession-wise on those health workers who dies contracting Covid-19 while at work, he added. In other words, the government declares a big-sounding scheme of Rs.50 lakh compensation to those health workers who die due to Covid-19 but doesn’t bother to collect and keep records of those who die due to Covid-19.
So the sole major support measure from the government to the health workers in the form of risk cover turned out to be hogwash. Only 1616 health workers, including doctors, had been paid a total of Rs.808 crore under this scheme till April this year. The government paid the premium for 22.12 lakh health workers and only 1616 (or 0.073%) among those were supposed to have died due to Covid-19. Only these many were paid the compensation while the death rate among all the Covid-19 patients in the country was slightly above 1%.
This discrepancy was never explained satisfactorily by the government authorities even though health workers are supposed to be at a higher risk than the general population. Nor did the government ever reveal the figure of number of health workers who were infected with Coronavirus.
B.Sivaraman is a researcher based in Allahabad, Uttar Pradesh