In a world where working in the health sector automatically means having to tackle challenges posed by the climate crisis to human health, the efforts of ASHA workers still remain invisibilised. It was May-day this summer for outdoor workers as the country reeled under severe heatwave conditions over large parts of Central and Northwestern India. Pivoting from one disaster to another, as heatwaves have given way for heavy downpours and flooding in the northeast, the country is still reeling with erratic climate disasters. Adding to this climate induced uncertainty is the indispensability of ASHAs in rural spaces of India owing to the dearth of specialised doctors such as paediatricians. Gynaecologists in Community Health Centres which saw a 80% national shortfall as per the health dynamics of India report. In the face of these overarching structural and institutional pitfalls in the health infrastructure of the country, ASHAs are the only link to some semblance of specialised healthcare that women in remote rural areas can hope for. There are many instances where ASHA workers have braved floods and extreme heatwaves to continue to care for pregnant women, often also raising awareness and shouldering their communities’ climate disaster preparedness. Working as community climate warning systems, ASHAs perform crucial functions of the State at the grassroots level. They form a crucial link between the public health system and remote communities.
It is well deduced by now that the climate crisis exacerbates the vulnerability of women. ASHAs are particularly exposed to the vagaries of erratic weather conditions which impacts their ability to care for communities. During the heat crisis there is a situation of heat begets heat for the ASHAs as they continually outdoors in oppressive temperatures. A study conducted by Heat Watch reveals that 83.7% of ASHAs working in Sonepat and Rohtak districts in Haryana spend almost 6–10 hours daily outdoors, and are exposed during peak heat hours. In addition, shockingly only 37.2% of ASHAs reported access to drinking water, and a third of those studied lacked even basic workplace facilities. As a result, ASHAs reported multiple health-related impacts and illnesses including high percentages reporting dehydration (68%), exhaustion (67%), and gastrointestinal or skin problems (55%). A striking 23% of the ASHAs reported outright heat stroke as one of the heat-related illnesses as well.
This supports assertions that heat is not a mere discomfort for ASHAs, it is life threatening. Devoid of adequate cooling infrastructure within their homes and in outdoor settings in the city, ASHAs struggle to complete their daily targets which are growing day by day. According to the guidelines of ministry of health and family welfare, 2012, the roles and responsibilities of ASHA workers include raising awareness on nutrition, hygiene, sanitation, and health schemes, counselling women on pregnancy, breastfeeding, contraception, and infection prevention, mobilising communities for immunisation, Antenatal care (ANC) among other tasks. Further as per the ASHA operational guidelines, 16 hours a week is the standard working hours mandated therein. However, the reality paints a bleak picture as according to a study 83% of ASHAs reported working for more than 30 hours per week, with many engaged in over 30 distinct tasks. Sequentially rising workloads with their remuneration dependent on their performance against their given targets in a given month compounds their exposure and vulnerability to heat.
Further, in a situation rich with irony ASHAs are provided training to deal with cases of heat stress among communities, there is no protective gear or training provided to ASHAs to protect themselves during field work. Access to adequate sanitation facilities impedes their propensity to continually hydrate themselves.
While touted as the backbone of India’s public health system, ASHAs themselves lack labour protections. During this year’s heatwave the ministry of labour & employment had continually issued nationwide heatwave advisories to protect workers and labourers. However, the main question remains if ASHAs fall within the nomenclature of workers as per the labour laws of the land. The National Health Mission refers to ASHAs as social volunteers. This nomenclature excludes the applicability of the labour laws of the land and the meagre protections that workers in India are entitled to. In a country where formalisation of labour brings with it protections to workers such as minimum wages, compensation, gratuity benefits among others, ASHAs still remain to be included in this protective bracket. This necessitates our critical focus on the design of the National Health Mission scheme. A perusal of the scheme may paint ASHAs’ role as part-time social volunteers but, in reality, their work refuses to fit into boundaries of traditional work. Involved emotionally with the communities they care for, ASHAs are employed in delivery of most governmental health schemes at the grassroots level. When reality is discerned, this scheme appears economically and emotionally exploitative for ASHA’s specially in the era of the climate crisis.
The primary health apparatus depends on the labour of ASHAs tirelessly working braving heat and rain, assuming an ownership towards their community. It is this ownership over care which drives an argument that a resilient ASHA worker with adequate social protection and compensation for their labour can single-handedly drive outcomes of climate resilience in the communities that she cares for. A resilient community health worker can substantially drive better climate and health outcomes for the whole community. It is when the government dispensation invests in such resilience that we can hope to build climate resilient communities at the grassroots levels.
(The views expressed are personal)
This article is authored by Prathiksha Ullal, senior resident fellow, Vidhi Centre for Legal Policy.
