Experiences of Frontline Workers in Rajasthan and Himachal Pradesh during the Covid-19 Pandemic
Published in February 2021, this report by Accountability Initiative – a research group at the Centre for Policy and Research, New Delhi – documents the experiences of health workers during the Covid-19 pandemic.
The report contains the results of a study on the changing roles and
responsibilities of health workers during the Covid-19 pandemic. The study was
conducted between November 2020 and January 2021 in Udaipur and Jaipur
districts of Rajasthan, and Kangra and Solan districts of Himachal Pradesh. The
researchers surveyed 351 frontline health workers – 71 anganwadi workers
(AWWs), 140 auxiliary nurse midwives (ANMs) and 140 accredited social health
activists (ASHAs) – and interviewed 14 of them.
The 40-page report is
divided into three sections: Introduction (Section 1); Research Design and
Methodology (Section 2) and Research Findings (Section 3).
Most surveyed workers said that they continued to provide key health services during the lockdown, including antenatal care, counselling pregnant women and lactating mothers, as well as immunisation. However, the report states, data suggests that the delivery of such services reduced in the lockdown months.
The health workers faced a significant increase in workload, having to do their existing duties along with new Covid-19-related tasks such as community surveillance and contact tracing. They were made to carry out more tasks, and cover a larger number of people.
The additional responsibilities meant that health workers had to undergo training for the new pandemic-related tasks, and also re-evaluate their regular health services keeping in mind safety precautions. They required PPE kits and transport subsidies for their new duties. The Himachal Pradesh and Rajasthan state governments both provided incentives to health workers for their additional tasks.
The surveyed health workers felt that they received adequate training and information to provide services related to Covid-19. However, they were not trained for such activities as coordinating with other health workers and departments, and grappling with the stigma around the disease.
The qualitative interviews revealed that many frontline workers purchased their own masks and sanitisers after having received an initial supply from the government. Their supervisors indicated that they should purchase their own equipment – this could either be because the quantity of resources provided by the government was less, or the quality was poor, or both.
Studies have found that frontline workers – particularly ASHAs and AWWs – often receive inadequate remuneration and irregular payments, and this reduces their motivation to work. AWWs, for example, receive an honorarium of less than Rs. 6,500 in Himachal Pradesh and Rajasthan – the report states. Yet, despite the government’s provisions, 83 per cent of surveyed workers reported having to buy or use their own safety resources. A higher proportion of workers in Rajasthan reported buying masks, sanitisers and gloves, as compared to Himachal Pradesh.
Only six per cent of the workers surveyed in Himachal Pradesh reported having received transportation subsidies or funds despite having to cover long distances for work. Through the qualitative interviews, the study found that there were instances where frontline workers had to arrange for their own transport for Covid-19 survey work without reimbursement.
From the qualitative interviews, the study found that being remunerated significantly contributed to a health workers’ motivation, and that the money formed an important component of their household income. This was especially relevant for workers who were single women or whose husbands were unemployed. The report states that the lack of financial incentives is likely to demotivate health workers, particularly in carrying out more tasks for longer hours due to the pandemic.
The qualitative interviews indicated that people were often hostile towards health workers due to fear contracting Covid-19 from them, and frustration because of the multiple household surveys and tests. In some cases, migrant returnees resisted testing and quarantining. There were instances where frontline workers were verbally abused, not allowed into peoples’ homes, and where people refused to obey Covid-19 protocols. The percentage of health workers surveyed who reported community backlash was 43 per cent.
Focus and Factoids by Gokul K.P.
Accountability Initiative, Centre for Policy and Research, New Delhi
Centre for Policy and Research, New Delhi