Several reports from different states in India have highlighted the risk that health workers have been exposed to as they treat COVID-19 patients.
These risks can be attributed to the virulence of the infection and the lack of preparedness of hospitals in dealing with the pandemic. There are several important aspects for preparedness of hospitals and these include creating isolation wards and intensive care facilities, ventilators and other supportive equipment, protocols for treatment and infection control and personal protective equipment for health personnel.
The availability of these inputs has been varied across both public and private hospitals in India. But the weakest link has been the availability of PPEs – that includes sanitisers, masks, gloves and gowns – for health workers. Shortage of such essential protective gear has affected doctors, nurses, technicians, and sanitary workers in hospitals and frontline workers in the community.
Personnel in the public and private hospitals have faced a shortage of PPEs. Several nurses and doctors have tested positive for COVID-19 even in internationally accredited tertiary private hospitals in Mumbai and Delhi. In early April, we did not have the required machinery to stitch PPEs and had to depend on China for its supply. The PPEs imported from China fell short of the prescribed standards so they had to be dumped. A great deal of time was lost in getting the required number of PPEs because of import dependency for a range of medical equipment.
A significant number of doctors and nurses have already contracted COVID-19 from patients during the lockdown. This directly raises questions about the availability and accessibility of Personal Protective Equipment (PPE) for healthcare personnel. If PPEs are in short supply, then its availability for the lower rungs of health workers in an institutional and community setting is compromised.
While doctors and nurses were vocal in raising concern about the shortage, equally at risk of acquiring the infection were the technicians, nursing orderlies, cleaning staff and security personnel in a hospital. Although the government claims that the problem of availability has been alleviated with the production of PPEs ramped up to two lakhs per day, there have been questions about its quality and distribution.
Many nurses and doctors have reportedly had to share, and reuse their PPEs owing to limited supply, even though PPEs are made for one-time use. In Maharashtra, which has the highest number of COVID-19 cases, the shortage of PPEs at the secondary and tertiary hospitals may have possibly been alleviated, however as shared by health activists, at the primary level the shortage of PPEs continues.
The public health workforce today is highly differentiated in terms of job security, wages, entitlements and privileges owing to extensive contractualisation in the public sector. As a result, a mix of permanent, contract and outsourced workers work side by side in the same institution. The outsourced workers, owing to the temporary nature of their engagement, do not have a voice at the decision-making table and their predicament goes unheard.
Since these workers are on a contract, the government is not accountable for their vulnerabilities and risk of exposure to COVID-19. What this epidemic has highlighted is the callous attitude of the government and the public towards even the doctors and nurses in hospitals. Evoking the National Disaster Management Act means that all public sector employees in hospitals are forced to work irrespective of the risks and dangers that they are exposed to. As a consequence, several private hospitals shut down when their health workers contracted the infection.
The COVID-19 epidemic has exposed the manifold layers of vulnerability that health workers face in hospitals. Those who occupy the lower rungs in the work hierarchy face additional risks – low wages, job insecurity, poor protective measures and increased susceptibility to infection. The community-level workers like ASHAs workers face a similar predicament. They are given the task of creating awareness and identifying potential COVID-19 cases but are not being remunerated adequately for the risks that they have to face on a daily basis.
The COVID-19 pandemic has demonstrated the need for strengthening the public health systems. It is an opportunity for the Indian government to reimagine public health by increasing investments and also to correct some of the anomalies that have become entrenched.
An important aspect that requires attention is investment in human resources for health. Outsourcing, contracting, and other precarious employment mechanisms have created divides within the workforce, where one lot is privileged with access to government benefits, and others are grappling with job insecurity and poor wages.
Standing at the juncture of relaxing the lockdown, and resuming economic activity, as we move ahead dealing with COVID 19, the concerns of health care workers spanning across the hierarchy need to be addressed. The recent case where government doctors in the national capital did not receive their salaries for the last three months exemplifies the callousness of the government.
Political gimmickry is employed to ‘honour corona warriors’ while basic protective equipment is not being provided! If this is the reality for government doctors who have secure employment then one can only imagine the plight of contract workers in the health sector. Similar to a large section of the unorganised working class, health workers are fatigued but are left to fend for themselves during the COVID-19 pandemic.
Rama V. Baru is a professor and Seemi Zafar is a research scholar at the Centre of Social Medicine and Community, Jawaharlal Nehru University, New Delhi.