The Kolkata rape and murder case, a 31-year-old trainee doctor who was brutally raped and killed by a civic volunteer at the campus of Kolkata’s RG Kar Medical College and Hospital on August 9, 2024 is only one among the recent of horrific such crimes in a country that records 86 or 87 rapes every day. (Details can be read here) The young doctor was attacked while on night duty. Her body was found the next morning, bearing severe injuries to her eyes, face, mouth, neck, limbs, and private parts. The violence and brutality that the deceased had to suffer at the hands of the accused shocked the nation and led to widespread calls for vengeance and justice. Thousands of doctors and other medical staff had, thereafter, taken to the roads to protest the increasing instances of violence against medical professions, especially women, and to demand stringent laws providing for their safety.

The Supreme Court had, on following the nationwide outrage, taken suo-moto cognisance of the Kolkata rape and murder case, on a Sunday, August 18, and the bench of comprising Chief Justice of India DY Chandrachud, Justices JB Pardiwala and Manoj Misra heard the matter on August 20 and over the next days. The Supreme Court had reportedly said that “The reason why we have decided to take this suo moto matter is because this is not a matter related to a particular murder which took place in a hospital in Kolkata. It raises systemic issues related to the safety of doctors across India.”

In the first order issued by the bench on August 20, the bench directed the prompt establishment of a “National Task Force” (NTF) comprising of medical professionals to give recommendations –within three months–on the modalities to be followed all over the country to ensure the safety of medical professionals in their work spaces. The bench noted that several states such as Maharashtra, Kerala, Telangana, West Bengal, Andhra Pradesh, Tamil Nadu etc. have framed state laws to deal with violence against doctors. However, these laws do not address deficiencies in institutional safety standards. “Therefore, we must evolve a national consensus. There must be a national protocol to create safe conditions of work. If women cannot go to a place of work and feel safe, we are denying them equal opportunity. We have to do something right now to ensure that the conditions of safety are enforced,” CJI had orally stated during the highly publicised hearings.

It is essential to note that the said National Task Force will constitute a total of ten members (details below). The order provided that the NTF will be headed by Surgeon Vice Admiral Arti Sarin AVSM, VSM. Director General Medical Services (Navy). The other members of the task force are Dr D Nageshwar Reddy, Chairman and Managing Director, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, Dr M Srinivas, Director of Delhi-AIIMS, Dr Pratima Murthy, Director, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Dr Goverdhan Dutt Puri, Executive Director, AIIMS Jodhpur, Dr Saumitra Rawat, Chairperson, Institute of Surgical Gastroenterology, GI and HPB Onco-Surgery and Liver Transplantation and Member, Board of Management, Sir Ganga Ram Hospital, New Delhi. In addition to this, the NTF will also include Professor Anita Saxena, Vice-Chancellor, Pandit B D Sharma Medical University, Rohtak, former Dean of Academics, Chief Cardio thoracic Centre and Head Cardiology Department AIIMS, Delhi, Dr Pallavi Saple, Dean, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, and Dr Padma Srivastava, formerly Professor at the Department of Neurology, AIIMS Delhi.

The bench said the cabinet secretary and the home secretary to the Union government, secretary, Ministry of Health, chairperson, National Medical Commission and president, National Board of Examinations shall be the ex-officio members of the task force.

The bench has also directed that the NTF formulate an action plan under two sub-heads –Preventing violence, including gender-based violence against medical professionals; and providing an enforceable national protocol for dignified and safe working conditions for medical professionals.

The intervention of the SC and formation of the National Task Force has been hailed by many as a significant step towards ensuring the safety of the medical professionals as well as changing the scenario of impunity and lawlessness when it comes to committing violence against medical staff.

While it is certainly a step in the right direction, such a significant move has unfortunately excluded a large section of health care professionals hailing from the informal sector. Despite a wider definition by the World Health Organisation (WHO) on who constitutes health workers, it appears that this vast network of women health workers in urban and rural India may not figure at all, especially as their work situations are not structured and easy to find solutions for.

The order specifies that the medical professions being referred to in the order are only interns, residents, senior residents, doctors, nurses and all medical professionals. This further begs the question of The same brings us to the question of whether, by limiting the ambit of the NTF to the aforementioned medical staff, the Supreme Court has implied that the issue of violence against medial professions is an issue of concern or restricted to only middle class workspaces and urban areas, when predominantly informal workers in the cities and health workers in rural areas –such as Accredited Social Health Activists (ASHA workers) and Anganwadi workers and gender violence issues faced by them –will not be looked into by the NTF?

The World Health Organization (WHO) defines health workers as people who work to improve health, including doctors, nurses, midwives, and other professionals. The same also includes health sanitation workers. The WHO classifies health workers into five broad categories: health professionals, health associate professionals, and personal care workers in health services, health management and support personnel, and other health service providers. Despite this, the said order of the Supreme Court overlooks the equally critical and vulnerable segment of rural health workers, including Anganwadi workers and Accredited Social Health Activists (ASHA).

Who are India’s ASHA workers? Employed under the Ministry of Health and Family Welfare since 2005—over 10.52 lakh ASHAs (2022 figures) who are trained female community health activists from our village communities who are those that reach our communities on basic public health.[1] Besides Anganwadi workers and helpers are part of the union government’s “services’ programme though there have been demands for regularisation and de-casualisation of their work. They provide and reach early childhood care, pregnant women and lactating mothers, monitor children’s growth and –with healthcare professionals—also reach and provide health needs like primary healthcare, referral services and immunisation. Presently, India has close to 12,93,448 Anganwadi workers and 11,64,178 Anganwadi helpers, not an insignificant number.

These individuals, who are the backbone of rural healthcare, face not only violence but also systemic neglect, low pay, and lack of support, making their struggles invisible in the broader discourse. While formal sector medical professionals receive attention and advocacy, the plight of these rural workers remains largely unaddressed, highlighting a glaring disparity in how we value and protect different tiers of our healthcare system. With a significant section of the medical staff absent from even being considered by a task force established especially to consider the concerns raised by medical professionals. Can safety be ensured for those in the medical fraternity of India without ensuring that those who are the most marginalised, ignored and vulnerable are excluded from being granted protection?

Details of the Supreme Court order:

The Supreme Court observed in its order that Medical Associations have persistently highlighted the lack of workplace safety in healthcare institutions.  Noting that medical professionals, including doctors, nurses, and paramedic staff, have increasingly become targets of various forms of violence while carrying out their duties, the intervention of the Supreme Court thereafter outlines a solution. With hospitals and medical facilities operating 24/7, these professionals work tirelessly around the clock. The unrestricted access to all areas within healthcare institutions has further exposed them to potential threats. In moments of distress, patients’ relatives often hastily blame unfavourable outcomes on the perceived negligence of medical staff, exacerbating the vulnerability of those dedicated to saving lives.

Specifically referring to the difficulties faced by women, the order stated “Women are at particular risk of sexual and non-sexual violence in these settings. Due to ingrained patriarchal attitudes and biases, relatives of patients are more likely to challenge women medical professionals. In addition to this, female medical professionals also face different forms of sexual violence at the workplace by colleagues, seniors and persons in authority. Sexual violence has had its origins even within the institution, the case of Aruna Shanbag being a case in point. There is a hierarchy within medical colleges and the career advancement and academic degrees of young professionals are capable of being affected by those in the upper echelons. The lack of institutional safety norms at medical establishments against both violence and sexual violence against medical professionals is a matter of serious concern.” (Para 7)

According to the judges of the Supreme Court, the issue of safety of medical professionals goes beyond merely protecting doctors; rather it is to be taken as a matter of national interest to ensure the safety and well-being of all health providers. The court noted in its order that as more women enter the workforce in advanced fields of knowledge and science, it is crucial for the nation to guarantee safe and dignified working conditions. The constitutional principle of equality mandates this, leaving no room for compromise on the health, safety, and well-being of those who care for others. The bench then states that the nation cannot afford to wait for a tragedy, such as a rape or murder, before implementing real and necessary changes.

The order stated “The constitutional value of equality demands nothing else and will not brook compromises on the health, well-being and safety of those who provide health care to others. The nation cannot await a rape or murder for real changes on the ground.” (Para 7)

In the present order, the bench led by CJI Chandrachud identified several critical issues affecting medical professionals:

1. Medical staff on night duty often lack adequate rooms for rest, with no separate facilities for men and women.
2. Interns, residents, and senior residents are frequently subjected to 36-hour shifts in environments lacking basic hygiene and sanitation.
3. The absence of security personnel at hospitals is more common than not.
4. Medical professionals often face inadequate toilet facilities.
5. Housing for medical staff is often located far from hospitals, with insufficient transportation options.
6. Many hospitals lack properly functioning CCTV cameras for monitoring.
7. Patients and their attendants have unrestricted access to all areas of the hospital.
8. There is a lack of screening for weapons at hospital entrances.
9. Hospital premises are often dingy and poorly lit.

The bench has ordered the constitution of a ten-member National Task Force so that a national consensus can be reached—through thorough consultation with all stakeholders—on the urgent need to establish protocols addressing the issues being faced by the medical fraternity.

Through its order, the bench empowered the NTF to make recommendations on all aspects of the action-plan on preventing violence and providing an enforceable national protocol for dignified and safe working conditions, as well as any other aspects which the members seek to cover. The order further noted that “The NTF shall also suggest appropriate timelines by which the recommendations could be implemented based on the existing facilities in Hospitals. The NTF is requested to consult all stake-holders.” (Para 14)

The Ministry of Health and Family Welfare will provide all logistical support including making arrangements for travel, stay and secretarial assistance and bear the expenses of the members of the NTF, the order stated.

As a part of clarification of who all will fall under the phrase medical professionals, the order stated that “It is clarified that the phrase medical professionals used in this judgment encompasses every medical professional including doctors, medical students who are undergoing their compulsory rotating medical internship (CRMI) as a part of the MBBS course, resident doctors and senior resident doctors and nurses (including those who are nursing interns).” (Para 13)

The complete order may be read below:

It is pertinent to highlight here that previously, in the month of July of 2024 itself, the Supreme Court bench of Justices Sanjiv Khanna, Sanjay Karol and Sanjeev Kumar had refused to entertain a petition filed by the Delhi Medical Association (DMA) seeking measures to prevent violence against doctors by observing that legislations are already in place. Moreover, the bench had clarified that the petitioners were at liberty to approach the concerned courts in respect of particular instances of violence. Thus, within a period of a month, the Supreme Court went from dismissing the issue of violence against doctors and medical staff by observing it as individual cases to the same being a “systemic” concern, following the outrage in the Kolkatta murder-rape case.

The order may be read here:

“Systematic” exclusion?

Healthcare workers (HCWs) are individuals who deliver care and services to the sick and ailing. This involves team effort from doctors, nurses, laboratory technicians, pharmacists, ambulance drivers, medical waste handlers, Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), Anganwadi workers and several others. ASHAs, ANMs and Anganwadi workers form an integral part of the grassroots-level health workers under the National Health Mission.  As part of the government’s National Rural Health Mission (NRHM), a new group of baseline health workers called Accredited Social Health Activists (ASHA workers) was formed in 2005 to address health related demands of the rural population, especially women and children, who find it arduous to access basic health services.

In the ongoing conversations about the protection and recognition of healthcare professionals, the vital contributions of ASHA (Accredited Social Health Activists) workers, Anganwadi workers and sanitation workers are often marginalised, overshadowed by the focus on urban and elite doctors. These individuals are the cornerstone of India’s rural healthcare system, delivering essential services to some of the country’s most remote and underserved populations. Yet, despite their critical role, they are largely excluded from the protections, benefits, and honour that are routinely extended to their urban and formal sector counterparts. This exclusion highlights a deep-seated inequality within the healthcare system, where the labour of rural health workers is undervalued and their safety and well-being are neglected.

ASHA workers and Anganwadi workers, who are exclusively women, operate under some of the most challenging conditions imaginable. ASHA workers, for instance, are often responsible for covering large geographic areas, traveling on foot to visit households, educate families on health practices, and provide crucial services such as immunizations, prenatal care, and family planning. These tasks are physically demanding, and ASHA workers frequently face long hours without adequate rest or compensation. In some regions, they are expected to work for less than the minimum wage, a paltry sum considering the importance and intensity of their work. Anganwadi workers, who run rural childcare centres and play a pivotal role in early childhood development, face similar hardships. They manage not only the educational needs of children but also their nutritional and health needs, often without adequate infrastructure or support.

The vulnerability of these workers is further exacerbated by the lack of formal employment status. ASHA and Anganwadi workers are often classified as “honorary” or “voluntary” workers, which means they do not receive the same benefits as formal employees, such as health insurance, pensions, or job security. This classification leaves them in a precarious position, where they are expected to perform essential public health functions without the protections that should accompany such responsibilities. In addition, they are frequently exposed to violence and harassment, both from the communities they serve and from within the healthcare system itself. Instances of ASHA workers being attacked or threatened while conducting COVID-19 tracing or vaccination drives have been reported across several states, including Uttar Pradesh, Bihar, and Maharashtra. Similarly, Anganwadi workers often face neglect and abuse from families who do not fully understand or appreciate their role, yet they continue to work under these difficult conditions with little acknowledgment.

When it comes to the violence that Anganwadi workers and ASHA workers face, the data is scarce. However, even the minimal data shows that there is a severe problem. A 2016 mixed-method study involving 396 ASHA workers from rural Northern Karnataka found that 94% of participants had experienced violent incidents in the preceding six months. Similarly, a study conducted in Kashmir during the 2010 unrest, which focused on 35 ambulance drivers, revealed that 89% of those interviewed had faced more than one incident of physical harm, 54% had suffered physical assault, and 83% had experienced job-related psychological trauma. Despite the presence of a significant number of ASHA workers, Anganwadi workers and other informal medical workers and aides in India, there is a glaring lack of comprehensive studies investigating the violence they face. The scarcity of data highlights the profound gap in understanding and addressing the risks these essential workers’ encounter. These studies also provide that the violence that these workers face stems from failures at multiple levels. Grassroots and mobile workers, who operate outside of health facilities, lack any form of security, while those stationed at health facilities receive only minimal protection. Owning to a lack of research on this issue, more recent figures could not be quoted.

Despite these overwhelming challenges, ASHA and Anganwadi workers have been resolute in their fight for better working conditions and fair treatment. Over the years, they have organized numerous protests, strikes, and campaigns to demand higher wages, job security, and formal recognition of their roles. In 2020, thousands of ASHA workers went on strike across the country, demanding a fixed monthly salary of ₹10,000 and better protective equipment during the COVID-19 pandemic. Anganwadi workers have similarly taken to the streets, protesting against the inadequate wages and lack of support from the government. Their struggles have led to some victories, such as wage increases in certain states and greater visibility of their demands in public discourse. However, these gains are often piecemeal and do not address the systemic issues that continue to marginalize these workers.

The exclusion of ASHA and Anganwadi workers from the protections and accolades afforded to doctors and other medical professionals indulged in the formal sector is indicative of a broader systemic inequality within India’s healthcare system. While doctors and hospitals that are urban and in the formal sector receive government attention and resources, the women who provide essential healthcare in rural areas are left to fend for themselves. This disparity not only undermines the health and well-being of ASHA and Anganwadi workers but also threatens the overall effectiveness of India’s public health efforts. For the healthcare system to function equitably and efficiently, it is imperative that these workers receive the recognition, protection, and compensation they deserve.

In addition to this, the exclusion of informal sanitation workers from the protections and recognition given to other healthcare professionals further underscores the deep inequities within India’s labour force. These workers, often operating in hazardous conditions with little to no safety equipment, are responsible for some of the most crucial yet dangerous tasks in maintaining public health. They handle the cleaning of sewers, public toilets, and waste disposal sites, tasks that expose them to harmful pathogens, toxic substances, and life-threatening situations daily. Despite their critical role in preventing disease outbreaks and ensuring public hygiene, they remain invisible in the broader narrative of healthcare protection and support.

Informal sanitation workers hail from the most marginalised communities and are trapped in a cycle of poverty and discrimination. They work without proper training, protective gear, or job security, making them extremely vulnerable to injuries, infections, and even death. The risks they take are immense; it is not uncommon for sanitation workers to suffocate or drown in poorly ventilated and hazardous environments such as septic tanks and sewers. One keeps hearing of there being numerous reports of sanitation workers dying due to asphyxiation while cleaning septic tanks, a task often performed manually in the absence of mechanized alternatives. Despite these dangers, they receive minimal compensation and are often denied basic rights like healthcare, insurance, and pensions. Their exclusion from national safety protocols and labour protections is a stark reminder of the systemic neglect faced by the most vulnerable workers in India’s public health infrastructure.

As India a as country continues to address the safety and well-being of medical professionals, we must also confront and correct the disparities that leave rural health workers vulnerable and marginalized. If our efforts to enhance safety and protection focus solely on more visible or privileged segments of the healthcare workforce, we risk perpetuating existing inequalities and leaving behind those who are most in need. Ensuring the protection and empowerment of ASHA workers, Anganwadi workers and informal sanitation workers is not just a moral obligation; it is crucial for the success of India’s public health system. Their work is indispensable, and their contributions should be recognized and valued as such. The time has come for a comprehensive approach that ensures their rights, safety, and dignity, aligning the nation’s healthcare system with its constitutional commitment to equality and justice for all.  For true progress, our reforms must extend beyond just some more visible and central urban centres and formal sectors to encompass semi-urban, non-formal and rural healthcare workers, such as ASHA and Anganwadi workers, and informal sanitation staff. By acknowledging and addressing the unique challenges faced by these essential yet overlooked groups, we can create a more inclusive and equitable system that genuinely safeguards all those who dedicate their lives to public health. Only through such comprehensive and compassionate measures can we hope to achieve a truly effective and just response to violence against healthcare workers.

[1] Despite long standing demands for being recognised as government workers, ASHAs are not instead classified as holding an “honorary/volunteer” position. They serve populations of approximately 1,000 in rural areas and 2,000 in urban settings.

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The illusion of the glamourous Malayalam cinema falls apart: Justice Hema Committee report provides insight into systematic harassment and exploitation of women actors

The post ASHA workers, Anganwadi workers and sanitation workers overlooked in India’s healthcare protection reforms appeared first on SabrangIndia.

Another name added to the long list of Covid deaths on the night of May 10, 2021 at the RML hospital in New Delhi. However, the demise of ASHA Workers’ All India Coordination Committee Convener Ranjana Nirula hit harder for many activists and workers whose grief and remembrances flooded Twitter and Facebook platforms at the mention of “Ranjana Nirula ASHA.”

The former CITU Treasurer and All India Democratic Women’s Association (AIDWA) Central Executive Committee member was a powerful voice that focused on the grievances of the under-appreciated medical workforce of India – Accredited Social Health Activist (ASHA) workers.

CPI(M) expresses deep condolences on demise of Com Ranjana Nirula, working committee member and former treasurer of the CITU. She was convenor of the All India Coordination committee of ASHA Workers(CITU). She was under going treatment for COVID-19 related complications. pic.twitter.com/sO5o6CsY97

— CPI (M) (@cpimspeak) May 10, 2021

“Comrade Nirula fought for the rights of workers and continuously stressed on the necessity of recognising and fighting attempts to disrupt the unity of workers and people by communal forces. The working class and the Left movement has lost one of its champions today,” said the Communist Party of India (Marxist) on Tuesday.

Even before the onslaught of the Covid-crisis, the over-50-year-old Convener repeatedly praised them as the backbone of the health department. By 2020, she spoke about the workers being used as unpaid labour for contract-tracing, detection and awareness.

She told media persons that the whole operation of India’s fight against Covid-19 would have crumbled if not for these frontline workers. Even today, the female workforce continues as a crucial part of the healthcare system but lacking basic necessities such as payment incentives, PPE kit and other protective gear.

Com. Ranjana Nirula, friend, colleague, committed Communist. With a twinkle in her eyes and a ready smile. Lal Salam! pic.twitter.com/w0eQW3WLYq

— Subhashini Ali (@SubhashiniAli) May 11, 2021

As for Nirula, the trailblazer was also a founding leader of AIDWA Delhi and the Working Editor of The Voice of the Working Woman since 1998. The journal was brought out by the Coordination Committee of Working Women, which was set up in 1979.

“Com Ranjana has guided many activists in the movement. She was very affectionate and always reached out to people whenever they needed help. Her always smiling face, warmth, enthusiasm and determination will be missed by all of us,” said AIDWA General Secretary Mariam Dhawale.

Her life though dedicated to activism and the rights of on-ground workers also impressed many people who met the personality in their lifetime. Below are a few Facebook posts of such instances.

https://www.facebook.com/kalpana.karunakaran/posts/10224531867459829

https://www.facebook.com/kuldeep.kumar.71216/posts/4596216607073547

https://www.facebook.com/kai.j.friese/posts/10225533156575690

As of May 11, as many as 37,15,221 active Covid cases have been recorded with 2,49,992 deaths. As reports of Covid-death under-reporting continues, obituaries become one of the few alternatives to track the human cost of the ensuing health crisis.

Related:

Strike 2: Centre now says no data on Covid-19 deaths of medical staff!
10 central workers’ unions to observe strike for ASHA, anganwadi workers
ASHA Workers on Covid-19 duty demand safety gear, healthcare, insurance and better wages

The post ASHA activist Ranjana Nirula succumbs to Covid-19 appeared first on SabrangIndia.

All community level scheme workers’ unions are going on two day strike on August 7 and August 8 to protest against non-availability of PPE kits, insurance as well as risk allowance.  All scheme worker unions affiliated with central trade unions like Indian National Trade Union Congress (INTUC),  All India Trade Union Congress (AITUC), Hind Mazdoor Sabha (HMS), Centre of Indian Trade Unions (CITU), All India United Trade Union Centre (AIUTUC), Trade Union Coordination Centre (TUCC), Self Employed Women’s Association (SEWA), All India Central Council of Trade Unions (AICCTU), Labour Progressive Federation (LPF), United Trade Union Congress (UTUC) will be a part of this strike.

Community level workers such as those associated with anganwadis, Accredited Social Health Activist (ASHA), Midday Meal, National Health Mission (NHM), Samagra Sikksha have been working relentlessly right from the beginning of the lockdown to help the government mitigate and control the spread of Covid-19 virus. Anganwadi workers and ASHA workers have constantly been on the ground helping in contact tracing, ensuring that within their areas/villages people entering from other districts are kept under quarantine if needed and such other community level tasks that needed to be carried out to keep the spread of the virus in check. Many of these workers themselves contracted the virus and fell prey to it. Yet, no safety kits came from the government.

In many cases, they were not even paid their monthly wages on time, sometimes they were delayed for months together.  In Bihar, the ASHA workers have been on strike since 6 August 2020. In some states and areas where the Covid-19 situation is very bad, the scheme workers will work wearing black badges. August 9 is being regarded as Quit India Day with the slogan of “Save India Day” when the workers will be a part of the satyagraha.
 

The demands of the scheme workers have been put down as follows:

1.   Withdraw the proposals for privatization of basic services including health (including hospitals), nutrition (including ICDS and MDMS) and education Stop Privatisation of PSEs and Services.
2.  Make the Centrally Sponsored Schemes like ICDS, NHM and MDMS permanent with adequate budget allocation.

3. Implement the recommendations of 45th and 46th Indian Labour Conference for regularization of scheme workers as workers; Pay Minimum wages Rs.21,000 per month and pension Rs.10,000 per month; Provide Employee State Insurance (ESI) and Employee provident Fund (EPF) to all scheme workers.
4.   Enact legislation for right to universal healthcare as in case of right to food and right to education
5.   No Pro employer change in Labour Laws in the name of codification; No increase in working hours and freezing of Labour laws in the name of Covid Crisis. Include scheme workers in the category of workers.

6.   Free ration /food for all the needy and Rs.7,500 per month for all non tax paying families for six months; ensure Jobs and income for all.
7.   Safety gear for all frontline workers, especially the ASHA workers, anganwadi workers and those in the health sector; PPEs for those who are engaged in containment areas and red zone; Frequent, random and free Covid-19 test of all frontline workers; Do not engage those who are above 60yrs and those who have health problems in Covid-19 Duty.

8.   Rs 50 lakhs insurance cover to all frontline workers covering all deaths on duty and Pension/jobs for the dependants of the workers and also coverage of treatment for Covid-19 for the entire family.

9.   Additional Covid Risk Allowance of Rs.10,000 per month for all the contract and scheme workers engaged in Covid -19 duty, especially ASHA and anganwadi workers and workers in NHM. Payment of all the pending dues of wages and allowances etc., of all the Scheme workers immediately

10.  Compensation of minimum Rs. 10 lakhs for all those who got infected while on duty,
11.  The existing insurance schemes (a) Pradhan Mantri Jivan Jyoti Bima Yojana, (b) Pradhan Mantri Suraksha Bima Yojana and (c) Anganwadi Karyakarti Bima Yojana must be implemented properly with universal coverage applicable to all scheme workers.
12.  Mid Day Meal Workers must be paid Rs.10,000 per month for the period when the schools are closed including the summer holidays; No contractorisation or centralised kitchen.
13.  Increase the budget allocation for Centrally Sponsored Schemes. Provide adequate additional ration with good quality for all the beneficiaries of Integrated Child Development Scheme (ICDS) and Mid-Day Meal Scheme (MDMS) immediately; include return migrants in these schemes.
14.  Provide free and adequate COVID tests and treatment to all non tax-paying people; Ensure adequate facilities in quarantine centres and hospitals. Strengthen the public health system and the health infrastructure; Allocate 6% of GDP for the health sector.
15.  For Finance mobilisation, projects such as “Central Vista Project” be scrapped. Tax the super rich and recover the dues from willful defaulters for resources.

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Himachal Pradesh CM lauds efforts of anganwadi workers during  Covid-19 pandemic

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They are officially called, Accredited Social Health Activists (ASHA). Over ten years ago, the Centre of Indian Trade Unions (CITU) demanded that they be called Asha Workers. The name stuck, however they are yet to be officially recognised as workers, and given workers rights.  

Today, over nine lakh ASHA workers and facilitators are a part of the army of  frontline health workers who are out in the field working on implementing various Covid-19 related policies and protocols on the ground. These include door-to-door surveys, especially of those who have traveled recently, monitoring quarantine, recording health conditions, and following up of various government schemes launched to combat the spread of Covid-19  pandemic in the country.  Many of them are doing so without any medical grade masks or protective gear, unless they buy one on their own.  

They have recently lodged a peaceful protest, and if not heard, are likely to intensify it till their demand for better work conditions, health services and fair wages is met. On June 25, thousands of ASHA workers united, at the call of the All India Coordination Committee of ASHA Workers (CITU), and held a protest at various states, including Jammu and Kashmir, Punjab, Assam, Haryana, Madhya Pradesh, Maharashtra, Odisha, Gujarat, Andhra Pradesh and Kerala. They held protest stand-ins at various local health centres and submitted memoranda to the local authorities as well as state and Central Health Ministers at state and central level. 

According to Coordination Committee’s Convenor Ranjana Nirula, “When they (ASHA Workers) ask officials they are told to use their dupattas, or buy their own masks, as they travel long distances and go door-to-door to survey and guide people about Covid 19. Many have been infected and several have died.”

None of that seems to have made it to national headlines, nor have state governments recognised them as ‘frontline workers’ or hailed them as ‘warriors’ fighting the pandemic. The workers are instead reminded about how they are doing ‘seva’ or social service, and treated more like volunteers rather than workers who should be paid adequate dues for the job they do. “They face exploitation by calling them seva activists and volunteers, now these women are asking to be treated as professionals,” said Nirula. These workers have had it with being treated like unpaid labour, and being deprived of their rights as workers. 

“We have been fighting for their regularisation as workers. Now, they risk Coronavirus infection without PPEs,” said Nirula.

Especially now as Covid-19 lockdown and fears are also keeping the men folk at home, and increasing the number of challenges the ASHA workers are facing. The men in their families do not want them to go out to work and ‘bring disease back home’, and the men in the houses they visit also resist the questions asked.

“They are not provided transport, food, water, or rest facilities when they are out on the field, many have not been paid their March salaries yet,” said Nirula, adding that the ASHA workers have even been attacked while out on duty, in Haryana, Punjab  and Kashmir allegedly by police, even though they were in uniform. The authorities ‘apologised’  when local unions raised the issue, however that is too little, too late.

All India Coordination Committee of ASHA Workers (CITU), and held a protest at various has demanded the following:

1.    Regualrise ASHA Workers and all NHM workers as permanent workers, pay minimum wages and ensure social security and pension as per recommendations of the 45th and 46thILC. 

2.    Safety gear for all frontline workers, especially those in the health sector; PPEs for those who are engaged in containment areas and red/containment zone

3.    Frequent, random and free Covid-19 test of all frontline workers 

4.    Rs 50 lakhs insurance cover to all frontline workers (covering deaths on duty); coverage of treatment for Covid-19 for the entire family

5.    Additional incentive of Rs.25,000 per month for all contract and scheme workers on Covid -19 duty. Payment of all pending dues of ASHA workers immediately

6.    Compensation of  Rupees Five lakhs for all those who got infected while on duty

7.    Free and adequate COVID tests and treatment to all non tax paying people 

8.    Ensure adequate facilities in quarantine centres and hospitals

9.    Free ration /food for the needy and Rs.7,500 per month for all non tax paying families for six months

10. Strengthen the public health system and the health infrastructure

11. Allocate 6% of GDP for health sector

12. Withdraw  proposals for privatisation of public health infrastructure and services 

13.  Enact legislation for right to universal healthcare 

14. Make NHM a permanent health programme of the government, with universal application and adequate financial allocation

As they wait for those demands to be considered by the Centre, there has been a bit of good news for over 65,000 ASHA workers in Maharashtra. They may soon get a Rs 2,000 incentive for their  Covid-19 related work. They have so far been earning about Rs 10,000 per month, reported the Hindustan Times. “State Health Minister Rajesh Tope has finalised a proposal for their salary hike which would be discussed in the Cabinet meeting. If the proposal is cleared, the ASHA workers would get a monthly hike of Rs 2,000,” an official from the Health and Family Welfare Department told PTI.

Related: 

Reports of glaring vacancies of ASHA workers in Covid-19 hotspots, no pay

The post ASHA Workers on Covid-19 duty demand safety gear, healthcare, insurance and better wages appeared first on SabrangIndia.

A look at the data of various state governments has revealed that there is a huge gap in the vacancies for Accredited Social Health Activist (ASHA) positions in several urban Covid-19 hotspots, The Indian Express (IE) reported.

ASHA workers have emerged as lifesavers during the pandemic as they conduct door-to-door health surveys and collecting samples from suspected patients and those at quarantine centers. IE reported that Maharashtra’s hardest-hit Covid-19 districts have the most ASHA vacancies – Jalgaon has 83% vacancy (1,267 Covid-19 cases), Aurangabad 63% (1,982 Covid-19 cases), Pune 65% (7,141 active Covid-19 cases), Mumbai 64% (34,576 active cases), and Solapur 55% (960 active cases). Mumbai only has 260 urban ASHA workers, while Pune has 324.

Half of Maharashtra’s approved ASHA positions (3,560 out of 7,493) in 27 municipal corporations are vacant, while 43% (1,051 out of 2,423) positions in its 33 municipal councils are vacant, according to state government data. In comparison, just 0.5% (324 out of 61,215) positions are vacant in the state’s rural districts, IE said.

Vijay Kandewad, Joint Director at Maharashtra’s National Health Mission told IE, “There is a need. In urban areas, we are utilising all workers in all departments for corona… (But) some of our posts are vacant.”

In the same way, Madhya Pradesh’s urban centers too have many vacant positions – Indore has 20% vacant positions (946 active cases), Bhopal has 25% vacancies (663 active cases), Ujjain 28% (80 active cases) and Gwalior 52% (47 active cases). These are all equal to or above the state’s average vacancy rate of 20%, according to state government data, IE reported.

The need for frontline ASHA workers comes forth in the numbers cited. India on an average tested 20 contacts for each positive case as per the Indian Council of Medical Research (ICMR) while Maharashtra tests 7.6 contacts, West Bengal 7.6, Delhi 8.9, Madhya Pradesh 11.6 and Gujarat 11.7.

In Delhi, IE reported that there were lesser vacancies at 351 out of 6,345. Each of Delhi’s 11 districts has an average of 500 ASHA workers. In Gujarat the reported vacancy was only 3 percent – Ahmedabad has 2,562 ASHA workers, Surat 1,852, Vadodara 1,698 and Rajkot 1,619.

In West Bengal, IE reported Ajoy Chakrborty, Director of Health Services as saying that there was a need of ASHA workers in urban areas. He told IE, “Rural contamination was largely stopped by ASHAs. But their corresponding honorary health workers (in urban areas) have a major challenge. They are not experienced like ASHAs. We were on track to fix this, but we need more time,” adding there were almost nil ASHA workers in urban areas and 10 percent in rural areas.

Incentive for ASHA workers

Himachal Pradesh Chief Minister Jai Ram Thakur said that as ASHA workers had helped contain the pandemic in the state, the state government had decided to give them Rs. 2,000 as incentive for June and July, Hindustan Times reported. He mentioned that they had not only educate the masses about the use of masks and importance of social distancing, but also sensitized people in home quarantine to follow norms to ensure their safety.

Last week, the Karnataka government too was contemplating to offer permanent financial help for ASHA workers by forming a co-operative society and self-help groups or them so that they could get loans at lower interest rates from 0 to 4 percent, Deccan Herald reported.

Karnataka Co-operation Minister ST Somashekhar told Deccan Herald, “For the hard work of Asha workers during COVID-19 situation, Co-operaton Department is collecting money from profitable co-operative institutes, and distributing Rs 12.07 crore as incentive to 42,000 Asha workers in the State.” He also distributed a Rs. 3,000 incentive cheque to each ASHA worker symbolically.

Unhappy with safety measures, pay

While ASHA workers go about their work diligently risking their lives, there have been reports from various parts of the country that these workers are not given PPEs, masks, sanitizers or gloves to ensure their safety.

In Andhra Pradesh’s Srikakulam district, a total of 3,000 ASHA workers have been working in Covid-19 duties, reported The Hans India. The district workers told the publication that they hadn’t been provided uniforms for the last three years. They hadn’t any facility for transport, food or water while attending duties and most are yet to be tested for Covid-19. They also said that their monthly salary was Rs 4,775 and that recently the Central government provided Rs 5,725 as its share, making their total salary as Rs 10,500 per month; but it has not been crediting for the last two months for Asha workers even in crisis period.

The ASHA workers’ district union general secretary K Naga Mani told The Hans India that Asha workers will observe ‘Demands Day’ across the country on June 25 demanding both the Central and state governments to recognise their services as emergency and provide protective equipment to defend themselves from Covid-19 and job security.

In Bhopal too, AT Padmanabhan, President of the Asha Usha Sahayogi Ekta Union in Madhya Pradesh told The Citizen that most ASHA workers in the state are paid a mere monthly sum of Rs.2,000 which is insufficient to address the health demands of their families. He alleged that instead of increasing their salaries, they have been given ‘incentives’ or a small sum per service rendered.

He also said that the regular honorariums are yet to be received by ASHA workers performing Covid-19 duties. Shouldering important responsibilities, over 600 ASHA workers in the city continue to be overburdened and underpaid. In Bhopal only 1,200 anganwadi workers and 600 ASHA workers have been hired and trained to serve 24 lakh people in this urban area, The Citizen reported.

To top the work of testing and surveys, the ASHA workers are also burdened with documentation, maintaining records and distribution of food – all this without essential safety gear. With most ASHA workers not having individual washrooms in their homes, the reliance on community washrooms also undermines their health and safety.

In May, 2020, the Nagpur Bench of the Bombay High Court had order the Nagpur Municipal Corporation (NMC) to release the salaries of ASHA workers for the months of April and May by the first week of June, The Times of India had reported. At the time, NMC workers’ union member Jammu Anand highlighted how they had been working for meagre salaries. The workers were being paid Rs. 2,500 a month and had not received their salaries since January. The court had rebuked the NMC for treating workers in an “unfortunate manner” and directed the Centre to increase their remuneration.

The New Indian Express had reported in May that only seven percent (around 3,000) ASHA workers out of the 40,000 had received the incentive of Rs. 3,000 announced by the Karnataka government. The families of those ASHA workers who lost their lives during the pandemic and were promised Rs. 50 lakh as insurance had still not received the same.

In Ludhiana, ASHA workers had launched a protest against the government when it had asked them to arrange for smartphones for the door-to-door survey on their own, Hindustan Times reported. The workers not only protested this, but also said that the details of patients being asked by the State government – name, parents names, mobile number, gender, age, occupation and ailments of all persons aged above 30, seemed to be an infringement of privacy.

Tracking the news emerging from various states, it is only evident that the most important link in the chain, the ASHA workers are overworked and underpaid for all the efforts they put in.

Related:

‘Killing Dissent’ – How the government has been silencing opposing ideas and voices
Central government mum on the vaccination of children being impacted during lockdown
Poor Pay, Poor Training Impede India’s Army of Health Workers

The post Reports of glaring vacancies of ASHA workers in Covid-19 hotspots, no pay emerge appeared first on SabrangIndia.

The post ‘Killing Dissent’ – How the government has been silencing opposing ideas and voices appeared first on SabrangIndia.