Sixty-year-old Madhubala has been working as an accredited social health activist for 12 years in Delhi. But never before has her work made her more vulnerable. Like the 6,000-odd community health workers in the city, she has been conducting door-to-door surveys since March to identify residents with symptoms of the coronavirus disease.

Delhi has recorded more than 1,50,000 cases of Covid-19 and more than 4,000 people have died.

Madhubala, who works in Ranaji Enclave in West Delhi’s Najafgarh, said she did not get any protective gear from the government in the early weeks of the coronavirus outbreak. It was only in the last week of June that fresh masks were supplied regularly, but that did not include gloves or a hand sanitiser.

“If we have to put a [quarantine] stamp then we have to hold the patient’s hand. What if we get infected?” she asked.

More than 150 ASHA workers have tested positive for Covid-19 in the city, said Usha Thakur, the general secretary of Delhi Asha Workers’ Association. “For most of them, it was their families that took care of them or the union arranged for support,” she said. No government benefits were available to them, she said, even though they were “going into hotspots and containment zones without any protection”.

Worse, their monthly incomes had plummeted since regular health services like immunisation for which they earn incentives had taken a backseat to Covid-19 duty. Paid only Rs 3,000 as monthly fixed wages, ASHAs have long complained of financial insecurity. The pandemic only deepened it.

Since July 21, thousands of ASHA workers have been on strike in Delhi, demanding personal protective equipment and Rs 10,000 in monthly wages.

On August 9, close on the heels of a nationwide protest by 10 unions representing six lakh ASHA workers, hundreds of ASHA workers in Delhi gathered at Jantar Mantar. This protest was organised by the Centre of Indian Trade Unions, with Delhi Asha Workers’ Association and All India United Trade Union Centre participating in it.

Two days later, on August 11, Delhi Police filed a first information report against the frontline workers and the unions for allegedly violating safety protocols for coronavirus and for protesting at Jantar Mantar without permission. The FIR was filed under the Epidemic Diseases Act and Disaster Management Act against unknown persons, said Eish Singhal, Deputy Commissioner of Police, New Delhi. “They [protestors] came unannounced and we waited for them to bring the permissions but they did not get it,” he said.

The unions have not yet received a copy of the FIR, said Kavita Yadav, advisor to Delhi Asha Workers’ Association and state coordinator ASHA workers, All India United Trade Union Centre. “We asked the police for a copy but we have not yet received it and we do not have any details about it,” she said.

Singhal told that “someone needs to apply [for the FIR] and then only they will get it.”

ASHA workers protested at Jantar Mantar in Delhi, on August 9. (Photo credit: Usha Thakur)

Lack of protection

As thousands of ASHA workers continue to strike in Delhi, some of them alleged that they did not regularly get protective gear like masks, gloves, sanitisers or PPE kits to work with while conducting community surveys or entering containment zones for work.

ASHA worker Hema Dani said that her safety was not guaranteed given the proximity to Covid positive patients on a regular basis. Since March, workers like her have had to conduct surveys, gather family details and check for Covid symptoms.

After the doctor conducts the tests, the ASHA workers hand over the reports to the patients. If the patient tests positive, then it is their responsibility to put them in an ambulance and give them instructions about quarantining, using pulse oximeters and maintaining hygiene.

“I have made four people sit in the ambulance,” said 43-year-old Dani, who works in South West Delhi’s Dwarka. She said that she had not worn any protective gear except for a mask while making patients sit in the ambulance.

“Chunni bandh ke hi gayi,” she said. I wrapped a scarf around me. “I was very worried. I downloaded the [Aarogya] Setu App. It showed that I was in an orange zone and that I had come in contact with positive patients. I called my supervisor and told her. She said, ‘Aarogya Setu se tum pagal ho rakhe ho’. She said they did not look at the app.”

Some of these workers said that the proximity to symptomatic patients made them vulnerable along with their families. “Everyone at home is scared,” said 40-year-old Sujata Pandey, an ASHA worker in South West Delhi’s Kapashera. “If anything happens to me then everyone at home will get it. We also have a body. We have to work the whole day. There is no holiday for us.”

Pandey said that workers repeatedly had to ask for masks, gloves and hand sanitiser from the dispensaries. “There is no question of sanitiser,” she said. “The dispensary never had it.”

ASHA worker Madhubala said she was worried about where she would quarantine in her house if she started to develop symptoms of the virus. “There is no space in my house,” she said.

Lesser earnings

Currently, ASHA workers in Delhi earn a meagre monthly pay of Rs 3,000 and an additional Rs 1,000 as incentive after they complete a certain target of getting children in the area vaccinated, aiding pregnant mothers and helping their with the child deliveries among other health services, Thakur said.

Since March however, these community health workers have been made to focus solely on coronavirus. This has impacted their incentive-based earnings which have seen a sharp dip.

Forty-five year old Lakshmi Devi would earn around Rs 10,000 per month but since the lockdown, her earnings are limited to the fixed sum of Rs 3,000. Incentive-based work has stopped, she said.

“We get calls from the dispensary [for coronavirus-related surveys] at anytime,” said Devi, who resides in South West Delhi’s Dwarka and has been an ASHA worker since 2008. “Our area work has stopped because of which the children are not able to get vaccines and we cannot earn. We are not able to meet the targets.”

Other ASHA workers in Delhi had similar experiences of being unable to complete tasks in their area because of the work related to coronavirus.

“I get calls [from my supervisor] when I eat or when I bathe,” said Dani, 43. Since March, Dani has been the sole breadwinner of her family that includes her husband and her two children. Earlier, her husband worked as an office assistant and earned around Rs 22,000. But he has been unable to go to work since the lockdown and the company has not paid him his salary regularly, she said.

For Dani, this has meant an additional burden to make ends meet. But the continuous surveys and work related to the virus have kept her away from the incentive-based work.

“We have barely been seeing pregnant women or infants,” she said. “Some of them are scared to go to the clinics and they do not let us enter their homes because of the virus.”

ASHA worker Madhubala, who is the sole breadwinner in her household, said that she would be unable to continue working as a community health worker with the meagre pay. She lives with her husband and two children.

“We do not feel supported,” she said. “We eat very little at home. If I buy a kg of brinjal then my whole family has to manage with that for some time. Is there no respect for us?”

Another worker said that she did not want to continue to be on the frontline for a lesser pay. “They have kept us in front but our stomachs are empty,” said Pandey.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.