Community Health Workers (CHWs) play an important role in building awareness, countering stigma and maintaining essential primary healthcare service delivery in different parts of the world. In India’s case they are in the form of Accredited Social Health Activist (ASHA) workers, who are taking full charge of the public health effort for safe working conditions and fair remunerations in this pandemic. It is essential that they are provided adequate Personal Protective Equipment (PPE) and proper training for its usage in the early stages of the dreadful pandemic like COVID-19. It is also appropriate to ensure role clarity, training, supportive supervision, health and well-being for them.

In view of the shortage of human resource in the health system the Government of India recruited ASHA workers to connect marginalised communities with health care under the National Rural Health Mission (NRHM), 2005. There are 9,00,000 ASHA workers, who are acting as a bridge between the government and common citizens. They are working hard in these challenging times as health care facilitators, health activists and service providers and putting their lives at high risk. The current situation of the country has brought out the hidden but no less intense struggle of the ASHA workers. The struggle concerns  the limited support they get from an inflexible and fragile public health system. ASHA workers are also facing increased resistance from communities when they go out in the field to monitor safety measures against the spread of the pandemic. They feel stressed when they fear the mistrust of local people while finding out COVID patients within an allotted area. They face trouble in various places in the country. They appeal for protective measures to save themselves from infection and also to ward off physical attack from hostile people.  Let us have a pan Indian survey to trace some of the problems faced by the ASHA workers.

In Karnataka lack of cooperation from local people and unavailability of safe drinking water and proper sanitation facilities have forced the ASHA workers not to drink water during their duty.

In Gosaiganj, Lucknow, the pink sari-clad ASHA workers stay outdoors most of the day, with ‘makeshift masks’ formed by dupattas. Their allotted work is to survey around thirty to fifty houses in a day depending on the risk levels of the area. They have an increased risk of exposure to the coronavirus, which also endanger their families. Such fears aggravate even further, especially given the gendered nature of domestic care work, forcing many of them out of duty in such challenging times. Lucknow has an ASHA team which has ‘ASHA Sangini’ as the leader. She reported that three of her workers have dropped out from work at present for fear of personal and professional risks.

ASHA workers in Faridabad, Haryana, and Bengaluru, and Belagavi in Karnataka, are facing the ire of local people who are dissatisfied with the government’s handling of the pandemic. People assume that the ASHA workers are in direct contact with political parties and on this pretext they attack the workers conducting surveys. Local people show huge resistance to cooperating with the workers. Now in some places police accompany the workers to protect them. Such protection is important in view of the fact that ASHA workers already face an increase in workload in terms of increase in number of working hours. Apart from their existing duties they also have additional workload now, including spreading awareness of the pandemic, regular check-up by house-to-house visit.

On the top of it, due to delay in payments, ASHA workers in Pedapalli district, Telangana, have decided to leave the work. This is not an exceptional event as delayed payment problem plagues ASHA workers in many parts of India. Very often they are the only source of income for their families. The problem is even more complicated because while they do not get their meagre allowance the medical staff and sanitation workers are receiving regular salaries.

In central Delhi, recently an ASHA worker reported positive for coronavirus. It is not unexpected because they were not provided PPE kits to work in the containment areas. Their meagre payment and inability to pay for treatment lead their families to prevent them from going out to the field and take life risk.

ASHA workers are also coping with the increase in demand of medical supplies and birth control methods of women’s reproductive concerns. Men are not used to be in home for a very long time. The women complain of physical demands their husbands are making on them. Being helpless due to the home quarantines and lockdown extensions they are begging the workers for protections to be used. An ASHA worker in Ajmer had to intervene when the police stopped a pregnant woman on her way to an abortion clinic. The workers are also running out of calcium and iron tablets and facing difficulty in providing them to the concerned people.

An ASHA worker from Barabanki district, Lucknow, reported that the swirls of rumours through social media have made their work more challenging. People have the fear that contact with the virus means immediate death. The workers have to work very hard to clear the confusion among the anxious and distressed people who have never faced such pandemic before.

We must appreciate the role of the ASHA workers, who are working very hard to put the welfare of the community before their own safety. They are putting aside their fear of coronavirus and the nation needs their service more than ever before as the foot soldiers fighting the COVID-19 battle. Their main motto is, “Kaam karna hai, toh karna hai” (work that has to be done, has to be done).

It is amply clear that ASHA workers face multiple problems in such crisis times. But their problems need to be addressed with due care at the governmental level. It is because they at the ground level make the public health system robust and responsive. They are not to be underestimated as “low-level health workers”.