For the past 12 years, Savita Salunkhe has been serving as an ASHA worker in Kolhapur's Tardal village. This April, when a Tardal resident in her late 70s passed away within four days of taking the COVID-19 vaccine, Savita and her fellow ASHA workers found themselves fighting a virus of a different sort: a narrative had begun to spread within the community, that the "vaccines are killing people".
When Savita began examining the details of the case, however, she found that the woman had been feverish before taking the shot. The frightened grandmother had refused to eat for two days after receiving the vaccination. Later, her symptoms escalated and she succumbed.
It took Savita and her colleagues over 15 days and countless hours to clarify these details. Only after multiple rounds of discussion and visits by the ASHA workers did Tardal residents resume taking their jabs. "People just weren't ready to take vaccines," Savita says.
ASHA workers, along with Anganwadi sevikas and school teachers are surveying their communities for over 400 days now
ASHA (Accredited Social Health Activist) workers, appointed under the National Rural Health Mission, are women health activists from the same village. A 2019 National Health Mission report states, "A total of 9,70,676 ASHAs are in position against a target of 10,22,661 ASHAs in the present update." They are tasked with over 50 responsibilities, some of which include vaccination, community health awareness, maintaining records of children, counselling women on pregnancy and birth preparedness, and helping community members access healthcare facilities.
The second wave of the COVID-19 crisis in India has meant longer hours for these frontline workers, exacerbated by unsafe working conditions, hostility from their communities, and minimal compensation or support from the authorities. There is also misinformation with respect to vaccinations that these workers must combat within the communities they serve.
As of 12 May 2021, Kolhapur had reported over 82,763 overall COVID-19 cases, with the number of deceased at 2,840 " a fatality rate of 3.5 percent, the highest in Maharashtra. Thus, Shubhangi Kamble, tasked with monitoring the health of 1,500 people in the district's Arjunwad village, is relieved that 80 percent of the residents above the age of 45 are now vaccinated. But reaching such milestones has been a challenge for ASHA workers like her. Enumerating some of the myths that dissuade people from being vaccinated, Shubhangi says, "Many labourers keep asking me if they can walk in the in the scorching heat after they take a vaccine. [Or] there are rumours that those who are menstruating shouldn't take the vaccine." She actively works to bust such misinformation.
The misinformation extends to other aspects of COVID-19 as well. "'If I have a heavy fever which doesn't go away for a week, only then I should think of getting a test'," says Shubhangi, of a refrain she commonly encounters during her surveys. "Even after a year, people don't understand that COVID patients can be asymptomatic too."
ASHA workers have been tasked with containing community transmissions in Kolhapur's villages, but in many cases, they say families withhold information when they have symptoms. This is partly due to the ostracism COVID-19 positive individuals faced during the first wave of the pandemic. ASHA worker Gayatri Khutale from Shiye village, in Kolhapur's Karvir taluka, says, "Friendships have turned into hatred in the villages because of COVID suspicion." Karvir taluka remains the worst affected in Kolhapur with maximum reported infections. Meanwhile, in Tardal, Savita Salunkhe says people have started putting up images of their negative COVID test reports on their WhatsApp profiles. To get a swab test, people from the village travel over 10 km to the Public Health Centre facility in Hatkanangle. But "even if the report is negative, it takes a lot of time to convince [neighbours] otherwise and anyone who goes to the testing centre is looked at with suspicion," Savita states.
At times, ASHA workers themselves become the targets of people's apprehensions with respect to the pandemic. When Mandakini Kodak was conducting her survey of Pernoli village, in Kolhapur's Ajra taluka, earlier this month, an older woman threatened her with a stick and abused her. Mandakini immediately informed the Corona Dakshata Samiti about the incident. (Every village in Maharashtra has this committee " comprising elected officials, Gram Sevaks, and other members from civic bodies " to help alleviate the COVID crisis.) However, "none of these samiti members in any part of Ajra are working. Even when we face abuse, they don't help us. These committees are only on paper," says Mandakini.
In the last 20 days, Pernoli reported 30 COVID cases, and the inputs from these surveys by ASHA workers are important in limiting local transmission, especially as they help in contact tracing. When the vaccination drive began, health officials at Pernoli sub-health centres were asked to generate lists of people above the age of 45. Mandakini says ASHA workers like her would receive calls from the health officials even at night, for this list. "If they are working for over a decade, how can they not have even basic records?" she asks.
With COVID surveys and other responsibilities, ASHA workers put in over 10 hour workdays. Their COVID records are to be sent to the concerned Public Health Centre by 2 pm every day, without any delay, says Savita. They receive 'performance-based incentives' for the tasks they do, and their average monthly stipend is between Rs 3,500-4,000.
Last April, Firstpost had reported how ASHA workers were buttressing rural Maharashtra's COVID-19 fight, despite lack of adequate safety measures and limited pay, among other hurdles. Those challenges continue.
On 26 March 2020, the Central Government had announced a Rs 50 lakh insurance scheme for the families of frontline healthcare workers who died of COVID. A year later, the secretary of the National Health Mission sent a letter to chief secretaries of all the states and union territories mentioning that the scheme concluded on 24 March 2021. The Ministry of Health tweeted, "The claims under PMGKP will be settled by the insurance company till 24 April 2021. Thereafter a new dispensation will be provided to cover the Corona Warriors, for which the Ministry is in talks with the insurance company." But "this insurance scheme never existed in the first place for ASHA workers," says Mandakini. "Last year, they took our signatures on blank paper. If it were insurance, why weren't we made to sign the papers mentioning the insurance company or any other details? They are fooling ASHA workers."