ASHA Workers During COVID-19 in India: At the Intersection of Gender and Work

Abstract

India requires expanded efforts for reaching the healthcare needs of its vulnerable community. Due to a shortage of qualified health workforce, particularly in rural India, less-skilled health workers are selected and trained to mobilise these efforts. These community health workers (CHWs) are primarily women who work as an interface between the communities and the health system. These workers face several systemic challenges like high workloads, insufficient training and little or no feedback about performance. But apart from these, the CHWs also face several challenges that adversely impact their individual and family health and well-being, disrupting their work–life balance. Performing multiple roles results in strain in the balance, affecting their job and quality of life. The imbalance was noticeable in CHWs playing a pivotal role in fighting the recent pandemic in a less resilient health system. We explore these experiences of imbalance across the Indian sub-continent based on published literature and broadcasted stories from social networking platforms, investigate these work and family stressors and outline the reasons for their occurrence among female CHWs. Some stories revealed inequitable access to COVID-19 prevention kits, gender disparities, unpaid wages and lack of psychosocial support for their mental well-being. At the same time, they negotiate through the structural nuances of the Indian health system. This triple burden of dealing with employment, family and structures during these COVID times has amplified their daily struggles as CHWs and women. The article hypothesises that a balanced work–life interface for CHWs matters for improved organisational performance, gender equality and a better quality of life for their children. We performed a systematic review of CHW-related literature and a thematic analysis of stories from social media and print media from March 2020 to March 2021. The research findings attempt to inform the organisation policies responsible for ensuring that their employees are treated fairly and provided with their employment rights. The Indian public health system that supports these CHWs need to engage in ethical work practices that are legal, fair and ensure decent treatment of the workforce by providing conditions that do not harm the staff.