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The Exploitation of Sanitation and Social Workers During COVID-19

Indian doctors and nurses have been seen at the frontline of this COVID-19 crisis. However, other essential staff like hospital sanitation and ward workers, MTS (multi-task staff), and community health workers like ASHAs (Accredited Social Health Activists) remain largely ignored even as they are exploited for their labor.

Sanitation workers clean up biohazardous waste and are responsible for cleaning and disinfecting rooms, wards, labs, toilets and general patient areas in hospitals. Ward staff take care of immediate patient needs and coordinate the limited supply of oxygen to patients. ASHA workers are often local women from local communities who are trained to support health initiatives in their areas. During this time of COVID-19, their work on monitoring cases and patients has been indispensable to community well-being. Most of these workers are hired on contract basis and are often deprived of benefits like medical insurance, labor rights, salaries, and even leave. There are often no plans in place for them and their families to prepare for COVID-19 if they catch it at work. Instead, they are overworked, mentally and physically drained, and exploited.

A lack of data

The Indian Medical Association has recorded that at least 734 doctors had died of COVID-19 from 2020 to now. However, there is no data on how many sanitation workers, ward workers, ASHA workers and others have succumbed as a result of exposure to the virus during work.

ASHA workers, for example, are some of the most exposed during this time. They often have to go door to door to monitor movement of people in and out of their areas, check people’s symptoms, or distribute food or medicines and essential needs during lockdowns.

Their usual work in the community involves acting as midwives, supporting immunization drives, or coordinating family planning awareness. But during COVID, most ASHA workers are doing work five times higher than usual and taking the risk that comes along with working with a highly infectious virus. In the state of Bihar, ASHA workers we spoke to said they were not even being given basic PPE to protect themselves.

Refused reasonable compensation

Many ASHA workers are not being paid for the extra work that they are being forced to do while on COVID duty, according to Shashi Yadav of All India Scheme Workers Federation, who is working in Bihar.

“These workers hardly make ₹3000-4000 (approximately $40-55) a month,” said Yadav. “We’ve demanded from the state government that they should at least get the minimum wage or ₹10000 ($130-140) per month for their services during COVID-19 period. But the government has not paid any heed to our demands. Last year after much protest and struggle on the part of the workers, the government announced an extra ₹1000 to each ASHA worker for each month during the COVID period.”

In 2020, Pradhan Mantri Garib Kalyan Package (Prime Minister’s Poor People Relief) Insurance Scheme for COVID-19 Health Workers was announced. It was supposed to end on March 24, 2021, but was soon extended for a period of six months in light of the new wave. But, according to workers that The Blueprint spoke to, many have not received payments since February 2021.

“We used to get our payments through the ASHWIN portal, but currently we’re not receiving any money,” said Shabya Pandey, an ASHA worker in Bihar, who told The Blueprint that she has not received payment since February 2021.

Anita Mui, an ASHA worker in Musahari, shed light on the non-existence of safety equipment. She said none of the ASHA workers in her area have received any masks or sanitizers making them more susceptible to getting COVID-19.

“We step out risking our lives for pennies. We’re helpless and we’re still working to survive,” she said.

Anita told The Blueprint that she got COVID-19, but the state did not step in to aid. All four members of her family are currently showing signs of COVID-19 with no help.

Getting COVID-19 on the job

According to Yadav, in 2020, around 10 to 12 of the local ASHA workers died of COVID-19 in Bihar. This year, over 10 have succumbed to the virus.

“None of them have received the ₹5,000,000 ($68,000) life insurance and the claims made are being rejected,” Yadav said. “We’ve asked the Health Ministry about this. They claim that 4-5 people in the state have received the benefits. But when we asked about the data, they couldn’t provide it. We’re still waiting for it.”

Sangeeta Sangam, an ASHA facilitator from Samastipur, Bihar contracted COVID while on duty. She’s been sick for the past 10 days, but so far, she hasn’t received any medical or financial assistance. Medications required to treat her symptoms are expensive and she is struggling on many fronts.

When The Blueprint spoke to Sangeeta, she was receiving IV support, unable to get up from her bed.

“Not just my lifelong savings were spent in the treatment, but I have also taken an additional loan of ₹25,000 ($335) because of the ongoing treatment,” Sangam said.

Calling essential workers “volunteers”

In Delhi’s Kalawati Saran Children’s Hospital, sanitation and health care workers are referred to as ‘volunteers’ to deprive them of the minimum wage and deny them any legal rights and benefits.

Surya Prakash, president of the Hospital Contract Sanitation Workers Union, says that this issue at Kalawati Hospital is a human rights violation.

“Benefits like PF (Pension Fund), paid leaves, health and life insurance and ESI (Employees' State Insurance) are mandatory statutory provisions which the employer is compelled to provide within 10 days of appointment,” Prakash said. “That’s why these corporations refer to these safai karamcharis (sanitation workers) and contract laborers as “volunteers”. It’s a sham in the name of employment.”

Sevak Ram, a safai karamchari at Kalawati, says he takes four buses daily to get to the hospital.

“On TV, you call us heroes and warriors but fail to even ensure minimum wages which is our fundamental right,” said Sevak Ram. “The minimum daily wage in Delhi is ₹639 ($8.70), but we get only ₹353 ($4.80) per day. The bus fare is around ₹60 to ₹70 one way. You calculate the amount I’m left with after these traveling expenses and tell me is it enough to survive and feed your family?”

When asked if he’s scared of the pandemic, he replies, “If I get scared, how will I earn my livelihood and what will I eat?”

The daily task of these workers in Kalawati includes sweeping, mopping, dusting, garbage and biomedical waste disposal such as syringes, blood, infectious test tubes, and ducts. The waste production has increased during COVID. These workers often get pricked by used infectious needles scattered on tables or floors of the hospital. If infected, they don’t even get a paid leave and must let go of the meagre daily wage. They are also asked to work as porters, clean laundry, and sometimes even perform administrative responsibilities. At times, they even face non-payment of wages and many workers have a pending amount to collect.

“The duties performed by these so-called volunteers are similar to the job performed by the permanent staff of the hospital, Advocate Gunjan Singh who’s dealing with the Kalawati Hospital case said. “The contractor, Sulabh International has been exploiting these people from the underprivileged sections of society. They engage them as volunteers but force them to do sanitation work and pay less than the minimum wages prescribed under the Minimum Wages Act for over a decade now. It is forced labor to say the least.”

Singh said they have a case against these violations.

Presently, there’s hope for a step in the right direction. On May 25, the Delhi High Court directed the hospital administration to look into these serious allegations. Time will tell what rights will actually be given to the workers.