ASHA workers: Forgotten Covid-19 invisibles

As large parts of India went into a lockdown in the now distant month of March, 2020, a diverse group of volunteers, frontline workers and medical staff stepped in to fill the gap caused by a reduced workforce.

The feats of these frontline warriors have gained a legend and a sense of respect that will be analysed and narrated over endless discussions in the coming years. But memory is fickle and already, we see cracks in the imagination of how the entire response unfolded in the past several months.

Slipping rapidly through the gaps are ASHA (Accredited Social Health Activist) workers. A vital cog in the country’s primary healthcare response network, ASHA workers have faced continual neglect and an often-underwhelming recognition for their crucial work, not just during the pandemic but unfortunately over the years as well.

As an interface between the community and public health system, more than nine lakh ASHA workers work tirelessly with vulnerable communities across most of the country. In a normal year, an average ASHA staff has a relatively busy schedule. While being involved in various tuberculosis surveys, they also ensure care for pregnant and lactating mothers.

ASHA workers in Bengaluru are known to keep a close relationship with the families under their jurisdiction and provide continued support during pregnancy and post-pregnancy care. In between, they ensure that infants are regularly vaccinated and often remind parents to follow post-pregnancy guidelines.

When required, they are called in for duties as varied as polio and leprosy survey and have to often dabble into family affairs wherever cases of domestic violence occur. Essentially, they are the first line of defence whenever and wherever public health needs to be monitored and taken care of.

What is hard to find in ASHA workers with their ubiquitous pink uniforms is a frown or a complaint, or a hint of despair. The ASHA staff who are supposed to contribute a few hours each day towards their duty often end up working for several hours in a day covering upto 600 households under each Public Health Centre.

Mostly recruited from lower income groups, the ASHA worker is an epitome of an infinitely expansive warrior, often a key source of income for vulnerable families such as theirs.

Some workers mention that their day starts early for as long as they remember, having to cook for the household, clean up, send children to school and the husband to work before they step out on their daily interactions with community members. Often earning poor salaries, many workers are forced to supplement their income either by contributing more woman-days in the local PHC or taking up some other job.

When Covid hit the nation, ASHA workers were amongst the first respondents in the field. Dressed in PPE kits and facing unprecedented challenges, the entire nation for the first time came to see and appreciate the pink dressed workers working non-stop in urban sprawls across the country.

Often derided and shouted at, several ASHA workers not only conducted rapid field surveys but also helped man Out-Patient Departments (OPDs) for blood pressure and temperature-check as well as screening suspected Covid cases. Additionally, they were also involved in ensuring that people came to Covid camps for testing – an extremely challenging task as few people wanted to get themselves tested during the initial months.

Job description

Adding to their job description were activities such as checking upon individual households for Covid symptoms, keeping a track of people with co-morbidities and conducting regular health checks. Coupled with regular patient duty and regular non-Covid work, the profile of an ASHA worker during the pandemic was hectic.

But the average ASHA worker is saddened by her situation. An extremely low payment, inadequate recognition of their efforts and apathy towards their demands have seen morale dipping during the pandemic. At many places across the country, ASHA workers were deputed to collect swabs in the absence of professionals.

The rising caseload and continual exposure led to several workers falling sick during their intense field work. In what was among the most distressing visuals to come out of the pandemic was that of ASHA workers being derided and shouted upon as a result of inadequate information in the initial months of the pandemic.

Many ASHA workers were forced to go on strike in order to demand justice from the government but in many ways, their bitter complain is that none is concerned about them. In an era when frontline workers have been feted across the world, our country has neglected the foundation of our frontline healthcare response and in doing so, dishonoured the contributions made by these workers.

Often voiceless and belonging to the same vulnerable communities as the households that she caters too, the ASHA worker fervently hopes that her valid demands be met, and they be treated with more respect for their selfless contribution to the nation.

(The writer is Assistant Professor, Azim Premji University)