Labour of Love: Meet the unsung women community health volunteers of Mumbai

Community health volunteers marking a resident for home quarantine. Pic courtesy: Manjula Katakdhond

Manjula Katakdhond has not cuddled or played with her seven-year-old grandson in 14 months. When she returns home at 3pm daily - after six hours of tracking Covid-19 patients, tracing their contacts, and instructing them on hospitalisation or home quarantine - she is forced to keep distance even within her own house. "My grandson never left my side earlier but now he is more attached to his mother, she has been working from home," reflects the community health volunteer (CHV) who operates in Dharavi's Shastri Nagar area.

Katakdhond is among roughly 4,000 community health volunteers attached to the Brihanmumbai Municipal Corporation (BMC) who have made such personal sacrifices to be on the frontlines of the pandemic resistance. Their responsibilities have swelled in recent months as cases surged and they began going door-to-door to create awareness about the vaccination programme. Their regular work has not stopped either. As an important link between primary health centers (PHCs) and the people, the CHVs continue to provide curative healthcare particularly to pregnant women and newborns.

Dupattas doubled up as masks

If not for reminders from CHVs, instantly recognisable by the blue i-cards around their neck and the clipboard in their hand, some locals would not have maintained safe distance or worn their masks correctly. "We can't slow down," says Neha Kadam, a long-time CHV working in Byculla's Dagdi Chawl. "If we don't manage to locate even one patient, I lose sleep imagining how the infections will multiply. It will be even more work for us." This sense of duty and urgency keeps them on field from 9 am to 2 pm - they say they remain on call in the after hours too - going in search of high-risk contacts first, then low-risk. In the second surge, there have been many more cases in buildings than in slums, observes Kadam, who has been tracking and tracing 40 people a day.

As messengers who actively visit the local community, the aarogya sevikas have also been squarely and regularly in the line of fire. Working on the frontlines has acquainted them with both the scientific and sociological symptoms of the disease. The infected often panicked and hid, fake addresses were offered to stop friends and family from being traced, business owners tried to fire employees whose kin had tested positive, notes Katakdhond who has worked on community health since 1995. "I have never seen anything like (Covid) before. When I stamp people for home quarantine, they ask ‘we are daily wage workers, who will bring us food'? How do you answer that?"

Last year, CHVs dealt with a dearth of medical and protective gear, causing them to use dupattas and the ends of saris as makeshift face covers. While they are relatively better equipped with masks, sanitisers, and temperature scanners now, different shortages impede their work in the current wave. After being turned down at the hospital, locals blame them for the lack of beds and vaccines. Registering online for a jab appointment has been cumbersome too as people are not tech savvy and the apps are glitchy. They handle fears, questions, and rebukes delicately. "We cannot lose our cool because we have to keep returning to the community," explains another CHV from Shastri Nagar in Dharavi who requested not to be named.

A community health volunteer out on Covid awareness duty. Picture courtesy: Vidula Patil

Meagre salaries, essential but not permanent

The relief experienced at the cusp of 2021, when cases had declined, was short-lived. Contact tracing and testing duties, which had reduced by January, climbed back into the agenda two months later. Yet in January, a Rs 300 daily allowance that was being paid for Covid relief work was stopped on the grounds that it was a measure only for last year's complete lockdown period. "It was given to all BMC employees to cover costs when transport was not available. But CHVs live nearby," counters Dr Mangala Gomare, executive health officer, BMC. While the burden of work has been mounting, and transport is still limited, authorities are not bringing the allowance back into discussion. "CHVs are not BMC employees at all. They are honorary," adds the officer.

This is at the heart of the CHVs's disappointments. The municipal authority has for long depended on their labour but has not embraced them as employees. The volunteers first began working in Mumbai in 1989, says Vidula Patil, general secretary of the Mumbai Mahapalika Arogya Seva Karmachari Sanghatana, a union for municipal health workers. "Initially it was part of a World Bank programme. Now the BMC has been running it." Since 1999, the volunteers have asked to be recognised as employees. The Industrial Tribunal in 2004 decided they are workers and that the corporation was their employer. The High Court upheld this decision in 2017, notes Patil. The order has since been challenged in the Supreme Court.

The volunteers currently receive Rs 9,000 a month, from which tax is deducted. This sum was raised from the Rs 5,000 they received earlier, following protests. Yet, it is well below the Rs 15,000 monthly pay which a September 2020 order from the state labour commissioner's office deemed the volunteers were entitled to, as per the Minimum Wages Act of Maharashtra. The labour commissioner's office had directed the BMC to pay Rs 32.87 crore as arrears from 2015 to 2016 within 15 days of the notice, according to an Indian Express report. That order was challenged by the BMC and is currently with the High Court. An order by the provident fund commissioner noted that they are also entitled to PF payments but this has been challenged too, Patil adds. "There are a lot many cases pending. All matters are sub judice," responds BMC's Gomare.

Asha Banu Soletti, a professor at the Tata Institute of Social Sciences (TISS) who works closely with ASHA workers (the rural counterparts of CHVs), says the physical, mental and financial strain of their role notwithstanding, these women display immense pride in their work. This checks out in the account of Byculla-based volunteer Kadam. It takes her an hour and a half at the end of each day to disinfect herself and her belongings. The summer heat is punishing too. "When Covid started, my family said I should leave the job, that life is more important than a job. I said whatever the risks, it is my job. I am in the medical field too."

Because of their impermanent status, many volunteers who have put in more than two decades of service have retired in recent years with no benefits to their name. "The court has recognised CHVs as employees but not the BMC," says the union leader. "On the last day at work, they are simply told that they have retired. From the next morning, their attendance will not be marked."