State ASHA workers battle abuse, poor salary and lack of proper training

Gurugram On April 23, Rekha Sharma, 39, an ASHA (Accredited Social Health Activists) worker in Ballabgarh, had gone to a society in Sector 65, Faridabad, to conduct a door-to-door survey for coronavirus disease (Covid-19) outbreak. As she was questioning the members of a family about their travel history, they started insulting her. Within minutes, a crowd gathered around her and started abusing her.

“People were aggressive and abusive. They fished out wooden sticks from their houses and threatened to take us hostage. Within ten minutes, a police team arrived at the spot. Although they tried to intervene, they too were assaulted sticks and rods,” she said.

Five people were arrested in the incident, which left Sharma and two police officials injured. Sharma’s case is not an isolated incident. A day later, another ASHA worker was allegedly assaulted by three men who had accused her of collecting data for the controversial National Register of Citizens (NRC), while conducting the survey in Nuh. Last week, another ASHA worker was harassed while her daughter, who was accompanying her, was allegedly assaulted by a family when it was asked to quarantine.

Incidents of physical violence against frontline workers, such as medical professionals and ASHA workers, have been reported from across the state. The ASHA workers are tasked by the district administration to conduct door-to-door surveys in residential areas and collect data on people’s medical history. They are also required to advise residents about precautions, use of masks and social distancing norms. However, despite their difficult job requirements and stressful conditions, the ASHA workers in the state are battling several other challenges. These include harassment, violent attacks, inadequate training and lack of devices such as smartphones.

Fighting misinformation

One of the toughest challenges faced by ASHA workers is the misconceptions people harbour against the exercise of collecting information. Parmila Sarvakar, an ASHA worker in Gurugram, said, “When we ask questions related to symptoms or travel histories, people get agitated and refuse to cooperate. They are sceptical and assume that the government is gathering information for other purposes. Some assume that the government will provide them with free ration. We are helpless at times as we are not giving away any free ration but simply taking down medical details,” said Sarvakar.

Sajida, an ASHA worker in Nuh, said that she was assaulted after people thought that she was collecting details for the National Population Register (NPR). “On April 21, I had gone out to conduct a Covid-19 survey along with an Anganwadi worker in Nuh. In one house, people got irritated upon seeing us and asked us as to why we were conducting an NPR survey. They took away all our forms. I was beaten up in front of the sarpanch when I asked them about their symptoms,” said Sajida.

As the ASHA workers come under the National Health Mission (NHM) the Haryana head of NHM said that workers have to write to the chief medical officer (CMO) and the deputy commissioner (DC) of their respective areas, asking for security. The mission director (MD) of NHM Haryana, Prabhjot Singh, said, “Assigning police does not fall under my domain; rather it is the duty of the deputy commissioner. The superintendent of police (SP) and the DC are required to maintain the law and order situation of their area.”

Challenges of collecting information

The health department has directed the ASHA workers to cover at least 50 houses in a day. Several ASHA workers said that people often withhold information about their illnesses due to the stigma attached to the disease and the fear of being quarantined.

Hemlata Goyal, an ASHA worker in Faridabad, said, “In certain cases, people do not disclose the correct information. People are scared to report that a family member has flu-like symptoms as they fear that the health department will quarantine them,” said Goyal.

Several ASHA workers said that the changes in guidelines for collecting information have also compounded the problem. Before April 9, the ASHA workers were given a three-point survey form requiring details, such as a person’s name, address and whether or not they were feeling well. The workers said that two days later, another elaborate form was given to them, asking them to return to the houses, where the survey had been completed.

Meera Devi, a senior ASHA worker in Gurugram, said, “On April 11, we were given a 13-point form, requiring details of high-risk people, including details about a possible pregnancy, diabetes, high blood pressure, a heart condition, cancer, tuberculosis, kidney ailments, asthmatic conditions and their age.”

“People got irritated when they were asked for additional details for a second time. A few of them even abused us,” said Sajida.

Lack of training

ASHA workers alleged that they were provided training for barely two hours, which included inputs on how to differentiate between symptoms of coronavirus and influenza and how to recognise people who were at a higher risk of contracting the virus.

“We were given training only for a few hours on how to do the survey. The training was verbal and nothing was given to us in writing,” said, Rekha Kumar, an ASHA worker and facilitator in Mewat.

The ASHA workers also said that earlier they were given physical forms to fill up the information, which was handed over to their supervisors, who would then upload the information. But now they have been asked to upload the information on a smartphone, which many of them do not have.

“Our seniors told us in the last week of April that we need to buy smartphones to fill in the details of the coronavirus survey. Most of the ASHA workers come from poor families and they cannot afford an android phone,” said Devi, an ASHA worker from Gurugram.

Officials of NHM said that buying android phones won’t be an issue for the frontline workers but they can’t specify any date by which the phones will be given to them.“We have not sent out any written guidelines for the ASHA workers to purchase android phones. The process to procure mobile phones is underway,” added Singh.

No monetary rewards

Another issue bothering these workers is that while Haryana government has doubled the salaries of some frontline health workers, such as doctors, nurses and health workers, the ASHA workers have been left behind. Several ASHA workers complained of discrimination and demanded higher salaries and smartphones that would enable them to carry out their jobs.

“The state government has discriminated against us. We are only getting ₹4,000 as salary. We don’t even know if the insurance announced by government covers us and whether our family members will even get the sum insured after our death,” added Goyal.

Chief Minister Manohar Lal Khattar, however, had earlier announced that a life cover of ₹50 lakh against Covid-19 announced by the Government of India will be given to all doctors, nurses and Group C and Group D employees posted in Covid isolation wards, Covid ICU and Covid OTs. The ASHA workers fall under Group D category of employees. Khattar also announced an additional life insurance cover of ₹10 lakh for various employees including ASHA workers, Anganwadi workers, police personnel and sanitation workers who are working in the containment zones and for all accredited and recognised journalists in Haryana, up to June 30, 2020.

“The insurance cover is for ₹50 lakhs and government of Haryana is providing another ₹10 lakh ex-gratia amount also to them,” said Prabhjot Singh.

Personal protection

The ASHA workers said that they are provided with personal protective equipment (PPE) when they go out to the containment zones. Sarita, an ASHA worker in Gurugram, said, “We are given PPE kits when we go out and do a survey in a high-risk zone. When the survey had started initially, we were not given masks but then after a week or so we were provided with masks, one soap and a hand sanitiser. We have coped with every situation and are trying to survive in challenging circumstances.”