Bled Dry

How India exploits health workers

Caste and gender prejudices have underpinned the lowly public view of nursing and midwifery for the entire history of these professions in India. They remain low-status, badly paid and insecure today. Dinodia Photo
31 August, 2020

The COVID-19 crisis has been punctuated by frequent protests from healthcare workers—most often nurses and ASHA workers—complaining about unacceptable working conditions, inadequate staffing, low salaries, long hours of work, lack of personal protective equipment and so on. Instead of obtaining any respite, they have faced threats of dismissal or disciplinary action. Other than people clapping for them, and military helicopters showering petals over hospitals at the government’s command, almost nothing has been done for health workers during the pandemic. 

Faced with a chronic shortage of staff, state governments are looking at short-term measures to shore up the public health system. In May, the Maharashtra government asked Kerala to lend it some nurses for a few months. Tamil Nadu has hired additional nursing staff, as well as doctors, on six-month contracts; the nurses will be paid just Rs 14,000 a month. Many states and local governments are recruiting workers paid by the day to carry out community surveys. Anganwadi workers and ASHA workers have been roped in to perform many tasks. 

Meanwhile, the centre’s emergency allocation of Rs 15,000 crore for healthcare is to be divided between 28 states and eight union territories, and spent over four years. This represents just 0.075 percent of the stimulus package to deal with the economic fallout of the pandemic; even after all these months, there is no clarity on how it will be spent. The government has announced that Rs 2,000 crore from the PM CARES fund has been set aside to manufacture ventilators, but what about the specialised workers needed to operate them and the money to pay their salaries? 

The pandemic has, once again, exposed a broken health system. India has just 1.7 nurses—in both private and public employment—for every thousand people, against the World Health Organisation-mandated three. The vast majority of Indians lack access to affordable medical care; in per-capita health spending, India ranks among the lowest in the world. (Sri Lanka spends four times as much, and Thailand ten times.) State governments have passed ordinances to reserve beds for COVID-19 patients in private hospitals, but the failure to create robust regulatory systems ensures that people are either refused treatment or made to pay astronomical bills.