It took four visits to one house, during the second wave of Covid-19, for 42-year-old Avantika Giri to convince a family to get their child to the dispensary for routine vaccinations. An anganwadi worker for 14 years, Avantika travelled in buses at her own cost, often working overtime, for a pay of Rs 9,709 in Johripur, East Delhi.

The working hours are 9 am to 2 pm, but “I never went home before 5 pm in those months. Sometimes, I took my baby son along with me on rounds, even though I knew there were Covid patients in some of the houses I visited. But he fell sick, so I had no option,” she told IndiaSpend, outside Vikas Bhavan in New Delhi, close to the chief minister’s residence. Here, anganwadi workers and helpers, part of the government’s Integrated Child Development Scheme, have been on strike since January 31.

They are asking for retirement benefits, medical insurance and entry of non-governmental organisations in the Integrated Child Development Scheme, among other demands. The indefinite strike was called after two earlier strikes, one on September 7, 2021, and the second on January 6, this year, could not convince the government to give them the status of government employees, as per Shivani Kaul, president of the Delhi State Anganwadi Workers and Helpers Union.

Volunteers not employees

On February 24, the Delhi government agreed to an increase of Rs 3,000 in the pay for anganwadi workers and Rs 1,500 for helpers, claiming that it is the highest in the country. In a statement delivered over Facebook, the striking workers declared the raise “inadequate” and said that the strike is meant to draw attention to their working conditions and that they will continue to strike until all their concerns are addressed.

Anganwadi workers and helpers are considered volunteers and not employees. This makes them ineligible for safety nets, such as pensions and provident fund facilities extended to other government employees. Even their salaries are referred to as an “honorarium”. The website of the Women and Child Development department of the Government of Delhi states that “the work of the anganwadi worker is honorary and is not equivalent to any employment”.

India has over 25 lakh anganwadi workers and helpers, 20,518 of them in Delhi. Like Avantika, their job requires them to spend most of their time on their feet, visiting pregnant women and children in their homes, monitoring their diets, weighing them and ensuring that they get the nutritional supplements and vaccines they need. The job also requires them to make toys and develop games for the children who visit the anganwadi centres.

During the pandemic, they were tasked with the additional responsibility of distributing ration, which they did, often buying personal protective equipment for home visits, such as masks, with their own money, they said. The main job of anganwadi helpers is to clean the anganwadi premises for which they are paid half the honorarium paid to a worker.

“The anganwadi workers have a vast range of responsibilities,” said Rosa Abraham, an economist at the Centre for Sustainable Employment at the Azim Premji University in Bengaluru. “If they were doing this kind of work for a private employer, they would have earned more money than they do now as volunteers.”

“Unfortunately, such a job profile does not exist in the private sector, so we cannot put a price on it,” Abraham said. “But the demand for an increase in the honorarium is certainly justified.”

Covid-19’s toll

During the first two waves of Covid-19, anganwadi workers did their job at great personal risk, they told IndiaSpend.

“I asked her to stay home [because of the risk of contracting Covid-19], but she insisted that the children [who were unable to come to an anganwadi centre] needed the food,” said Amit Kumar of his wife, the anganwadi worker Sumanita Kumar. Sumanita tested positive for Covid-19 in the second wave, and died three days later, on May 4, 2021.

She was 46. Two weeks later, Kumar’s father also died of Covid-19. He receives Rs 2,500 each month from the Delhi government, in addition to the one-time compensation of Rs 50,000, he said.

Currently, the Delhi government is asking anganwadi workers and helpers to train women as part of a new programme, Saheli Samanvay Kendras, to empower women by skilling them to make them more employable. The women say they do not want to be part of this programme, which is housed in 21 anganwadis, in part because this would extend their work timing to 4 pm from the earlier 2 .pm

We reached out to the offices of the director and joint director of the Delhi government’s Women and Child Development department. The story will be updated when they respond.

“Polio, BCG, vitamin A, iron and now Covid-19, for all the vaccines meant for children and now adults too, I have to cajole the families and take them to the dispensary for vaccination,” said Avantika.

Avantika, an anganwadi worker from Johripur, East Delhi. Photo credit: Nushaiba Iqbal/ IndiaSpend

Although she is an Integrated Child Development Scheme worker whose main job is to ensure that the women and children in her care are well-fed, Avantika also supports polio drives and accompanies pregnant women and children to dispensaries for their vaccinations.

The Universal Immunisation Programme, which runs partly on the toil of Auxiliary Nurse Midwives, and anganwadi workers like Avantika, vaccinates children against preventable diseases. Mothers are given three tetanus vaccines and nutritional support throughout their pregnancy.

The expanded immunisation programme was first launched in 1978 for urban areas, extended to all districts in 1985, and maternal health was included in the programme in 1992. The Universal Immunisation Programme ensures timely procurement of vaccines, their transport to healthcare centres and cold storage facilities for vaccines. India’s immunisation programme is credited with eradicating polio in India.

By mobilising the people, anganwadi workers play an important part in the Universal Immunisation Programme, said Yogesh Kalkonde, a neurologist and public health researcher, who works on health problems among rural and tribal communities.

“Maternal antibodies provide protection to the child for up to six months. If the child receives all the vaccines up to the age of one, they are protected from diseases,” said Pavitra Mohan, a paediatrician and community health physician and co-founder of the nonprofit Basic Health Services that works on public health issues. “An unvaccinated child is more susceptible to disease. Moreover, [when] a large number of children are not vaccinated and the pathogens find a susceptible population large enough in which to circulate, we can expect epidemics of diphtheria, pertussis and tetanus.”

Unrecognised work

As Auxiliary Nurse Midwives and anganwadi workers were involved in the fight against Covid-19, and later in the Covid-19 vaccination drive, data from India’s Health Management Information System showed a decrease in routine health services, such as childhood vaccinations and maternal healthcare, as IndiaSpend reported in August 2020.

In March 2020, the number of fully immunised children, aged nine-11 months, in Delhi fell by almost a third compared to the previous year. The fall in vaccination continued throughout 2020-’21 and was still half of the pre-pandemic level in April and May 2021, the latest months for which data are available.

“People were scared of visiting the dispensary out of fear of getting infected,” said Avantika. “I was scared too, but I took as many women and children there as I could. Sometimes the dispensary would run out of vaccines when we got there, so I had to return the following day. Fewer children received the vaccine but I worked for much longer.”

In 2018, the central government had announced a hike of 150% (from Rs 3,000 to Rs 4,500 for workers and Rs 2,250 from Rs 1,500 for helpers) in the remuneration offered to anganwadi workers. The rest of their pay comes from the Delhi government.

If the current hike goes through, anganwadi workers will be paid Rs 12,720 in Delhi.

The anganwadi workers’ and helpers’ unions have termed these raises as inadequate. “The Delhi government and the Centre views us as a source of cheap labour. Given the rising inflation, our demand for raising the honorarium of workers to Rs 25,000 and that of helpers to Rs 20,000 is justified,” reads their strike pamphlet. They also want the government to meet their union representatives and address their concerns about working conditions.

“These women do things that are not mandated, sometimes until 11 pm,” said Kaul, justifying the demand for a higher pay.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.