Since the corona virus arrived in India the frontline of the fight against it has been held by India’s beleaguered medical workers and doctors in the public sphere. Since February, when the first cases started to arrive, the crisis has ballooned to catastrophic proportions, india today has the third highest cases of infections in the world standing at over 2 million ! One in every seven Covid-19 cases comes from India. The death rate has increased as well, and according to official statistics up to 50,000 people have died from Covid-19. 

By Adhiraj Bose

Medical workers in public hospitals have complained against lack of protective kits, low pay, and falling infrastructure. Yet, they are on the front lines of the fight against the pandemic. The situation is particularly dire among the poor who live in the most unsanitary and crowded conditions in the slums of India’s cities and villages around India’s vast rural expanse, all in all a few million underpaid, beleaguered workers must care for over a billion people over nearly four million square miles of territory. Failure to prevent the pandemic from reaching this sphere would be disastrous to say the least, and yet the government had barely prepared public health to cope with this menace. 

The government had failed to prioritize the poor, when the virus did begin spreading among the urban poor, it was caught utterly unprepared. Nowhere is this contradiction visible than in the treatment of the ASHA workers. 


Who are the ASHA workers? 


ASHA is an acronym for Accredited Social Health Activist. The position was instituted by the Ministry of health and family welfare, as part of India’s National Rural Health Mission, started in 2005. The mission was one of the world’s largest social projects of it’s kind aimed at providing basic healthcare to the rural masses. It was aimed to be fully implemented by 2012 which would translate to 250,000 ASHA workers in ten states. By 2014 there were 859,331 ASHA workers in all 32 states of India. 

The role of the ASHA is very important. The Ministry of Health (and Family Welfare) defines them as : 

“ activist(s) in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services.” (I)

Among the various tasks that ASHA workers are involved in, includes basic medical care, first aid, and spreading medical education. In 2014 India had finally eradicated polio, and it wouldn’t have been possible without the help of ASHA workers. (II) 

The ASHA worker also acts as a depot holder for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc. The program is also significant for being entirely manned by women! 

Despite this vital service to some of the most vulnerable populations, the workers are paid not more than 6000 rupees (that is less than $90) a month. This pittance is meant to cover her own expenses and those of her family. It must be remembered that many ASHA workers are the only breadwinners of their family. The usual work day for an ASHA worker lasts between ten to twelve hours, with no breaks. Yet, even with this small salary does not reach the workers. (III)

During the covid crisis, the ASHA workers have been at the front line of contact tracing in the urban and rural sphere. With the chaotic situation of the migrant workers, this task assumed an even greater role as millions of people were suddenly displaced from their workplace with no means of going home, and just as suddenly, pushed back into work once the first lockdown ended. It was up to India’s army of ASHA workers to monitor and track their movements and report back on incidence of Covid cases among them. Without their tireless service, India would have been far far worse off in dealing with the crisis. 


Strikes of ASHA workers 


The Corona virus has only exposed problems which had already been present in the realm of public healthcare in India. For the ASHA workers, it has put on them an unseen amount of stress and danger. Much of India’s contact tracing activity relies on the ASHA workers, which means they would expose themselves to the risk of infection more than most. They are forced to do this work with minimal protection and the same low irregular salary. 

In January this year ASHA workers in Karnataka struck work to demand an increase in pay from the state and central government as well as payment of pending salaries. As reported in the Deccan Herald, some workers had been waiting for fifteen months for payment ! The introduction of a third party agent mobile App called ASHA soft only compounded their problems with salaries. The indefinite strike was called off on the 11th of January, and the workers rejoined services. In a show of commitment to their duty, they immediately got ready for a mammoth vaccination drive across the state of Karnataka. (IV)

While the strike action was local, the issues are not unique to Karnataka alone. All across the country, ASHA workers are deprived of adequate compensation and infrastructure. During the Covid crisis this situation only worsened. Under lockdown conditions, the responsibility to trace and track COVID cases came on the beleaguered shoulders of the ASHA workers. During their job, they had to face abuse, beatings, and the ever present danger of being infected by the virus that has so far killed three quarters of a million and above. 

As the limits of their tolerance grew thin, everything came to a head on the 21st of July when the ASHA workers in Delhi first struck work. Their main grievances, lack of protective equipment, irregular to non-payment of wages, and an increase of the minimum wage, payment of Employees State Insurance and Provident Fund. (V) Till date, neither the central nor state government has offered redressal. (VI) While the workers in Delhi struck, protests were being staged in Karnataka as well. In time, these protests coalesced into a much bigger nationwide strike which took place on 7th and 8th of August, just a week before independence day. 

The nationwide strike of ASHA workers mobilized 6,00,000 workers across the country, almost two thirds of all ASHA workers in india. Their agenda was the same, as before. By this time, dozens of them had died in the line of duty, succumbing to the virus due to lack of protection and medical care. The demand for protective equipment is not just a practical question, but one of life and death ! Moreover, with the virus continuing to spread and community transmission in India all but confirmed, it is only fair that the government step up and aid the front line health care workers like ASHA workers in any way they can ! The lackadaisical attitude by both central and state governments shown towards these workers is absolutely abhorrent and inexcusable. 


Government response and trade union support 


On the 11th of August, the ASHA workers of Delhi who had been in protest since the 21st of July, assembled at a popular protest site in Delhi, near Jantar Mantar. The workers had gathered peacefully and with all due consideration to safety norms and guidelines. On that day, the Delhi police charged them with contravening the ‘Unlock 3 guidelines’ . One hundred ASHA workers remain charged with this crime for protesting for their rights. The state which couldn’t grant them the most basic tools necessary for their service, or even pay them wages in time, now rewards their sacrifice with a police chargesheet! (VII)

Despite the two days protest, ASHA workers today seem nowhere closer to redressing their grievance since when they started. The ASHA workers were not alone in their struggle, for the strike on 7th and 8th of August they were joined by ten other Central Trade unions. (VIII)

A statement released by 10 central trade unions on Thursday said ASHA workers, staff of anganwadis, National Health Mission (NHM) workers and other schemes would go on strike. The workers  also staged protests and courted arrest on Sunday. The victimized workers are still battling the cases lodged against them, while having to deal with the virus and the government’s deliberate apathy. 

The situation the healthcare workers face is terrible, and it speaks to larger issues of the Indian state’s inability to provide for its own citizens in a time of crisis while being ever present in support of the capitalist class and wealthy elites. The government’s constant pandering to the private sector and threats to privatize healthcare further are signs of this. 

India already has one of the most privatized healthcare systems in the world, and suffers from numerous inadequacies, from lack of doctors and trained medical professionals to a lack of healthcare infrastructure. Private capital has been unable to solve any of these problems, and have proven themselves no more capable in handling a pandemic situation than public healthcare institutions. Despite this, the government, driven by nothing else than ideological and monetary convictions, wishes to keep pushing the bankrupt agenda of privatization as a panacea for our ills. 

The threat of privatization was one of the key reasons why the healthcare workers protested in the first place ! The government both at the federal (central) and state level already discriminate against ASHA workers and other front line healthcare workers, one can only imagine how India’s highly unregulated private healthcare institutions would act. 

In response to the government’s attacks the workers’ instinct is naturally to fight back. However, without political leadership and without an aggressive strategy, the strikes are failing to have the much needed deterring effect on the government. The Modi government has consolidated its power in the center and it is willing to enforce it in the most brazen and draconian manner, disregarding the mood of the people. 


Some conclusions:


It is beyond doubt, that the service of the ASHA workers is indispensable. ASHA workers put their lives at risk to ensure the COVID virus is contained, and community transmission is prevented. Yet, the Modi government treats them as if their lives don’t matter. Neither are they given adequate protective equipment, nor are they given their due wages and compensation for working round the clock, providing an essential service. This government shows which side it stands on, and it does not stand with the workers ! Thanks to the apathetic approach of the government, it is the rural and urban poor, the working masses of India, who stand to suffer the most. 

In this trying time, the healthcare workers of India continue to serve us with the greatest risk to their lives. A hundred ASHA workers have already died in the line of duty, and hundreds more may have been infected by the COVID-19 virus. All they ask for, is what is owed to them, and what they need to do their job safely, and in return the best the government can offer them is the threat of arrest at the hands of the police ! 

The issues they face did not begin with the COVID-19 crisis, they are the result of years of neglect and apathy towards public healthcare by successive governments. A study from 2019 shows that India is missing 6,00,000 doctors and 2 million nurses. Add to this the fact that India has one of the most privatized healthcare systems in the world, immediately the vast majority of Indians who are poor can’t afford access to healthcare, this despite having universal healthcare coverage. Most publicly owned hospitals lack necessary staff, equipment and infrastructure to handle a large inflow of patients and can’t even afford to pay their medicare workers enough. 

Such cases of infections among medical workers and professionals are doubly dangerous in the Indian context where neither do we have enough hospital beds to treat patients, nor do we have enough doctors and nurses to treat patients. The quality of care from the professionals vary as well, with medical quackery being an endemic problem in India. Of the availability of beds and ventilators and other critical equipment, less said the better ! India has only 713,986 beds for a population over a billion, that amounts to a paltry half a bed for a thousand people. The number of ventilators, essential for treating critical cases, the disparity becomes even more stark. 

For most of its history since independence, India has ignored its healthcare sector and allowed the rise of a vicious, exploitative profit driven healthcare sector which throws fifty seven million people into poverty every year. All of this has now come to a head in this time of pandemic as India finds itself unbelievably strained to fight the pandemic. As late as November of 2019 India was spending a paltry 1.29% of its GDP on healthcare. As a total of budgeted expense, India’s expenditure on healthcare is lower than its expenditure on rail transport and less than a third of what India spends on the ministry of defense. The neglect towards healthcare has come to bite India, and it is the poor and working class who suffer the most. 

While we welcome the strike actions waged by the Central trade unions, we must also raise the question of their failure. The government proves it is unshakable in its resolve to kill public healthcare, much to the detriment of the country’s poor and working class. To such an aggressive enemy, we must make our tactics and strategies equally aggressive. Firstly, the movement cannot be confined to economism and trade union actions, but must acquire a political dimension. Secondly, we must as far as possible, build national solidarity and a nation-wide movement. We must understand that it is only through militant mass action, with conscious political leadership that we can fight back against the class enemy.

At this time, I take this opportunity to appeal to the international workers of the world, to voice their support for the ASHA workers, and all healthcare workers of India, in these trying times. The healthcare workers need all the support they can get !