Frontline warriors of COVID-19: The story behind deep financial crisis of 33,000 ASHA workers that went unheard, unnoticed in Assam

Masuma Begum (name changed), a mother of four, and an Accredited Social Health Activist (ASHA) worker, living in Pandu area of Guwahati had to sell her mobile phone to tide over acute financial crisis. As a frontline worker of Covid-19 pandemic combat her mobile phone was crucial to keep record and communicate with health workers and officials. Even though she got a new phone after the story was published in local media, it did not make any difference to her financial crisis. Masuma’s real story as to what put her in deep financial crisis went unheard and unnoticed.

A biological mother of three, and an adopted daughter, Masuma is engaged in 24-hour service of combating Covid-19 pandemic. Due to continuous lockdown, her regular remuneration of Rs.3000/ was not deposited in her account in due time for two consecutive months. As all the thrust of healthcare services is on Covid-19 pandemic since last several months, and almost all the health officials and health-workers have been engaged in mitigating pandemic, the remuneration these ASHA workers used to get regularly from different health intervention programmes came down to zero during this period.

Masuma Begum says all these pushed her into acute penury during pandemic period, and she decided to sell her mobile phone, the only property she had that would bring her some money.

“I have been working as an ASHA worker since 2006. We have many issues to address. However, for the first time I am facing such a severe financial hardship,” she tells nezine.com.

Photo courtesy : NHM Assam

Masuma’s story of financial hardship during Covid-19 pandemic period, is also the story of over 33,000 ASHA workers, engaged in 24-hour duty as a frontline worker to fight the pandemic. While this women brigade is engaged in round the clock duty to combat the pandemic, there has been a drastic fall in their earning.

The Ministry of Health and Family Welfare in 2005, instituted ‘Community Health Workers’ namely Accredited Social Health Activist (ASHA) for promoting universal immunization, referral and escort services for Reproductive and Child Health (RCH) and other healthcare programmes as a part of National Rural Health Mission (NRHM). This was later changed to National Health Mission (NHM).

Although during initial period, ASHA workers were engaged in promoting universal immunization, referral and escort services for RCH now this women brigade is entrusted with 72 health related programmes including follow up and distributing medicines for Malaria, Filaria, several Non Communicable Diseases (NCD), diseases involving suffering due to worms, different kinds of skin diseases, Cataract, Dengue, Chikungunya, Diabetes among others.

During Covid-19 pandemic the Central government announced another incentive of Rs. 1000 to each ASHA worker for a span of three months. In return, they have been entrusted with wide-ranging duties including creating Covid-19 awareness in their respective localities, assisting health workers and medical staff in bringing Covid-19 positive cases from their home to hospitals, monitoring home quarantined patients, maintaining database and all other related works.

“The monthly remuneration of an ASHA worker is only Rs.3000. However, an ASHA worker normally receives an added incentive of Rs. 2,500-3,000 per month through various programmes. Thus, total income of an ASHA worker is Rs. 5,500-6,000 per month” says Bijan Das, a trade union leader and an office bearer of the Centre of Indian Trade Union, who is in charge of the issues of ASHA workers in Assam.

He says while there is monthly remuneration from different health intervention programmes of every ASHA worker came down to Rs.500-Rs.1000 each month during Covid-19 pandemic period, most of them are yet to get the incentive of Rs. 1000 per month for a period of three months, as promised by the Central Government. Masuma Begum, for instance, has so far received only Rs.1000.

Photo courtesy CITU Assam

Assam has over 33,000 ASHA workers. These women brigade, who are engaged in 24 hour service in Covid-19 pandemic combat as a frontline worker since January this year, have been offering their duties without sufficient protective gear including masks, gloves and hand-sanitizer, low income and with high risk of having Covid-19 positive.

“When we are facing acute financial hardship, our mobility is increasing during pandemic, as we have to visit the entire locality for spreading COVID-19 related awareness, keep each day monitoring of each family during their quarantine period, assist health-workers and medical staff to bring the patients from home to hospital, among others”, Masuma says.

Pandu area has been witnessing spurt in of Covid-19 cases and is one of the most sensitive areas in the city.

“During the initial period, we were entrusted to visit different villages to create awareness regarding handwashing, using of hand-gloves and masks, and restriction of their movements. However, the residents whom we had reached out used to laugh at us, as we ourselves did not have all those protective gears. It was a mockery of the situation. Then we raised the issue before the authorities and subsequently received some three-layer masks, a 200-millilitre hand-sanitiser bottle and some gloves. However, these are not sufficient,” says Bina Phukan (name changes), another ASAH worker in Tengakhat area in Dibrugarh district.

She says the government assured to provide ration to the families of COVID-19 positive patients during their quarantine period. However, in her locality where about eight to nine COVID-19 positive cases have been reported, no ration was distributed among the families during their quarantine period. People often think that the duty of providing ration too, also rests on ASHA workers. They ask the ASHA workers for ration when they visit them to regularly monitor the activities of these families under quarantine. When ASHA workers explain to them that they have not been given the duty of providing ration, some of the families under quarantine refuse to extend any cooperation. This has become a huge issue in these localities.

“The worst is that, while we are working with high risk of being infected by Covid-19 virus, the Covid-19 tests are not conducted for the ASHA workers in our area despite several demands” she alleges.

Bonima Neog (name changed) another, ASHA worker in Kahilipara area of Guwahati says that they have to face social stigma and anger from the family members of Covid-19 positive patients. In an extreme case, in which she and her fellow workers were threatened, they had to report to local police and file a FIR.

“It is our duty to keep track and records of family-members of COVID-19 positive patients during their 14 days home quarantine for which they have to visit them regularly. It is exceedingly difficult to face the anger of relatives and the members of a section of families having COVID-19 positive cases, as they hurl derogatory words at us. Equally, we have to face stigma and discrimination from our neighbours, as we have to move to those households having COVID-19 positive cases”, she says.

The ASHA workers have been extending their services even in high flood situation, to keep monitoring of quarantined families, addressing the issues of diarrhoea and other water-borne diseases making themselves more vulnerable. In fact, in most cases they are the first visitors to the households where Covid-19 patients are detected.

Photo courtesy NHM Assam

The ASHA workers in Assam took part in a nation-wide protest programme on June 25, maintaining social distance and demanding compulsory Covid-19 tests for all the ASHA workers, provision of PPE kits for those working in quarantine zones, providing Rs. 25,000/ as incentive for their round the clock duties during the pandemic. On July 9, they also took part in another state-wide protest programme.

During 2010, a scheme titled ASHA Kiran was announced to provide Rs. 25000 annually in case of illnesses of ASHA workers. An insurance scheme of Rs. 1 lakh too, was announced in case of death of an ASHA worker. However, these schemes are yet to be materialised, says Das.

“ASHA workers serve at the ground, visit every house in respective locality and are known and trustworthy faces during any health emergency. They have unique contribution in bringing down the Maternal Mortality Rate in the country from 254 during 2004-05 to 130 during 2019. During the COVID-19 pandemic period they have been offering services day and night without proper protective gear and even after facing acute financial hardship and all the stigma and discrimination. It is unfortunate that they have to come down to the street, to register their protest on basic demands during pandemic period”, he adds.

Ratna Bharali Talukdar