India's forgotten health workers

900,000 female community health workers are on the frontline as part of India’s battle against Covid-19. But they are poorly paid, ill-prepared and vulnerable to attacks and social stigma.

“The government is paying us 1,000 rupees ($13; £10) a month for corona-related work. That is 30 rupees daily for putting our life in danger.” says Alka Nalawade, a community health worker in the western state of Maharashtra. “The value of our life is just 30 rupees [less than $1], according to the government,” she adds. Ms Nalawade is among the state’s 70,000 Ashas, short for Accredited Social Health Activists. She is a single mother, and has been doing this job for 10 years now in Pawarwadi village, where she lives.  Ms Nalawade says, the compensation does not reflect the dangers she and her colleagues face.

Ashas are drawn from local and largely rural communities, and are a crucial element in India’s primary and community health programmes. They go door-to-door educating people about maternal and child health, contraception, immunisation and sanitation, as well as enrolling them in health programmes and monitoring the results. Their role in the fight against Covid-19 is not that different - they visit the homes they have been assigned, educate families about isolation, and monitor people for symptoms of the virus. But the risk is far greater than anything they have faced before. For one, they don’t have the right gear, including masks or sanitiser. 

Several Ashas told the BBC that they use cotton masks which they wash daily so they can re-use them - and for sanitiser, they have a bottle of spirit that they mix with water. One of them, Karuna Shinde, says she carries a scarf with her, which she uses to cover her face. 

Rajendra Yadravkar, Maharashtra's junior health minister explains, “Ashas have been putting their lives in danger on a meagre salary. They should be protected. It’s the government’s responsibility to support them.”

They also face stigma for simply trying to do their job - people often stop them from entering their homes and make them stand outside while answering their questions for fear that the Ashas may infect them.

“We are working for the people, but if the same people are going to behave with us this way, what are we supposed to do?” asks Ms Nalawade.

The women also complain that they receive little recognition for their efforts.

"Nobody even mentions our work,” says Anjana Wankhede. “From the prime minister to the chief minister, everybody only praises doctors and police.”

She says that’s unfair since the government relies on the data that Ashas collect daily.

“We visit each and every household and provide these numbers to the government. The government talks based on these numbers, but they don’t talk about the Ashas who collect the numbers.”