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This is the second article in a two-part series on how ASHA workers in Bihar were affected by the COVID-19 pandemic. Read part one here.
Patna (Bihar): Madhu Devi, a 42-year-old frontline health worker in Bihar’s West Champaran district, died on May 7 after showing COVID-19 symptoms. Just days earlier, she had gone to her local primary health centre (PHC) to assist in a childbirth. Today, her husband Surendra Shahi, an agricultural worker, is unable to find work. According to him, Devi, the only breadwinner in her family, earned around Rs 2,000 per month as an ASHA (Accredited Social Health Activist). Since her death, he has been unable to access any compensation and is struggling to make ends meet.
Last year, the Narendra Modi government announced a package worth Rs 50 lakh for families of frontline workers who lost their lives to COVID-19. More than one year since this scheme was announced under the Pradhan Mantri Garib Kalyan Yojana (PMGKY), none of the families of the 15 recently deceased ASHA workers in Bihar have been able to claim any compensation. This problem appears to be a national one – according to a recent report by The Leaflet, only 0.013% of India’s healthcare workers to date have received benefits under the PMGKY scheme.
The Leaflet report also highlights how the biggest hurdle is the Union government’s requirement that families must have certain documents to benefit from the scheme. The eligibility criteria is limited to two kinds of circumstances: death due to COVID-19, or “accidental death on account of COVID-19 related duty”.
According to FAQ 14 on the PMGKY website, it is mandatory to submit documents including a lab report that certifies that the deceased tested positive for COVID-19, along with a certificate from the healthcare institution/organisation/office that employed the person, stating that the deceased was an employee and was “deployed or drafted for care and may have come in direct contact with COVID patients”. For all the families we spoke to, securing these mandatory documents was difficult.
Lack of test reports and ‘proof of employment’ certificates, no help from PHCs
In mid-April, Geeta Devi, an ASHA worker in the Kaimur district of Bihar, started developing COVID-19 symptoms while on duty. She was denied admission to several hospitals and was also unable to get tested. Her husband, Rajvansh Singh, travelled back home from Himachal Pradesh and was later successful in admitting her to a private hospital at Durganti, Kaimur, where she passed away while being treated for COVID-19.
Since she was not able to get tested for the virus, her family won’t be eligible for the Rs 50 lakh insurance provided to frontline health workers. As their attempts to secure the scheme-related payments fail, Singh now hopes that at least his daughter-in-law can fill in the ASHA vacancy created by Devi’s death. “In government jobs, if anyone dies while in service, generally the job is passed on to a family member. Now since my wife passed away, even if I am unable to get any compensation, the least they can do for my family is give the job to my daughter-in-law.”
For frontline workers like ASHAs, especially in rural Bihar, getting tested for COVID-19 was an uphill task. For deceased ASHA worker Poonam Marandi, her own PHC in Banka district did not conduct any COVID-19 tests. Her family claimed that they then took her to the nearby Katoria Hospital, where they refused to test her. Marandi passed away a few hours after reaching the hospital.
Meanwhile, the Nitish Kumar-led state government had also announced a Rs 4 lakhs compensation for the families of all COVID-19-deceased. Even though the late Madhu Devi’s husband Surender Shahi applied for the Bihar government’s scheme, he remains unsure of the system’s ability to compensate him. “No one helped me out in my time of need, nor did the system work. Now I’m waiting for the compensation but there is no hope from local health officials at our PHC nor from our legislative representative (MLA Umakant Singh from the BJP),” he told The Wire.
Others reiterated the alleged apathy of the very PHCs that many of these scheme-based workers were employed by. Shashi Yadav, president of the Bihar ASHA Workers’ Union, said, “When an ASHA facilitator in Samastipur got COVID-19, no doctor in her PHC was willing to treat her. Many ASHAs who had COVID-19 symptoms were lying in the PHCs but doctors did not even want to touch them. They kept saying ‘Take her to a better hospital, not here!’ What help can be expected from them for compensation?”
Hurdles created by local health officials and Bihar authorities
Dr Dipa Sinha, who teaches at Ambedkar University, New Delhi, says that ASHAs as frontline workers have been the “most invisible” even prior to COVID-19. Noting how they have never been considered as employees by the government, she emphasised how the varying capacities of PHCs at the state level also affect the ability of families of the deceased to seek support from them (for availing of the compensation schemes). “In states like Bihar, for example, the vacancies in supervisory positions are also higher than in other states,” she added, pointing to how the lack of staff makes it difficult to provide any support.
In a recent background paper that Sinha co-authored, researchers found that as of July 2020, Bihar had 46.3% vacancies in supervisory positions under the Integrated Child Development Services (ICDS) scheme. The paper also notes how the monthly income for ASHAs in Bihar ends up being even less than the wages of unskilled manual labourers under the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) in the state, because of the “honorarium” status given to their work.
Azra Ismail, a research scholar at the Georgia Institute of Technology who has studied the work practices and technology use of ASHA workers over several years, noted how this treatment of ASHAs is “definitely a nation-wide phenomenon” and had to do with the basic assumptions and premise on which the National Rural Health Mission (NRHM) was set up in 2005. “ASHAs are seen as volunteers and not full-time government employees. Even after being trained to do many tasks that would be carried out by a medical professional, they are not considered to be at par because they do not have a professional degree. They are the very last rung on the healthcare system, so have limited power.”
The women who died while on duty in the first wave haven’t received any help either. Anita Devi, aged 49, an ASHA worker since 2005 in Pranpur PHC in Katihar, passed away on August 6, 2020. Her family was hoping for compensation and even applied for it. Her 30-year-old son, Ashok Kumar Singh, is now the only earning member in their family of five. “My mother managed the finances and ran this house. Since she is gone, my earnings are not enough to sustain five members of the family. We have plastic acting as a roof of the house and since the monsoon is here, it drips but I’m unable to get it repaired,” he told The Wire.
Talking about the compensation, he added, “We were told that we will get compensation and submitted all the required documents ,but now it has been more than 10 months and there has been no response. Now I’m losing hope. I don’t think anyone even cares.”
Research conducted by BehanBox in collaboration with Azim Premji University, prior to the second wave of COVID-19, found that at least a dozen ASHA workers in Bihar died during the first wave. The report, quoting Yadav, also added that none of the families of those who died had received any insurance compensation.
After two waves of the pandemic, frontline workers’ families across India, not just in Bihar, continue to struggle with seeking compensation. As of July, the Supreme Court also directed the National Disaster Management Authority to frame guidelines for ex-gratia compensation to the kin of every COVID-19 casualty. It remains to be seen whether such directions will be implemented.
Neel Madhav is an independent journalist based in Khagaria, Bihar. Sabah Gurmat is an independent journalist and student of law at the University of Delhi.