In the past week, more than 2.5 million cases of Covid-19 have been confirmed. Hospitals in Delhi and other cities have run out of oxygen, ventilators and essential medicines. Hospitals, morgues and crematoriums are overwhelmed and forced to turn many people away.

Although there was a steep decline in the official number of active cases by September 2020, the country was not equipped with the public health infrastructure to tackle the inevitable second wave of the pandemic. Instead, India in the early months of 2021 had largely relaxed its social distancing and quarantining measures and allowed mass congregations, festivals and political rallies. The central and state governments could have averted this public health catastrophe if they had spent the year strengthening the public health system and addressing the risks, instead the virus mutated and exposed the failures leaving frontline workers and the public to pay the price.

Health crisis

At only 1.2% of GDP, India spends one of the lowest amounts on public healthcare in the world. Whilst the government and the World Bank promised more health spending during the pandemic, most of the funds have gone to the private sector, continuing the trend of health privatisation.

According to a recent report by the Financial Commission 60% of hospital beds are in the private sector and only 1.4 beds are available per 1000 population. There’s also a significant deficit in the sub centres, primary healthcare centres and community healthcare centres, that provide the first rung of the public healthcare system.

In 2020, the government introduced life insurance coverage for frontline workers who had died due to covid-19 or while on Covid-19 duty, as part of the Pradhan Mantri Gareeb Kalyan Yojana. However, in March 2021 the government issued a circular to end the insurance, leaving the workers to fend for their own. After unions protested, the government extended it for another year. However, the majority of claims made by the families of frontline workers have been rejected or are still pending.

Vaccine production fails local community

India is one of the largest vaccine manufacturers, yet has only been able to vaccinate 2% of its 1.3 billion population.

India is one of the largest vaccine manufacturers, yet has only been able to vaccinate 2% of its 1.3 billion population. While rich countries are on their way to getting the majority of their population vaccinated, India needs to be able to draw on the unused public vaccine production facilities and produce generic vaccines as soon as possible. The government has allowed 1-2 pharmaceutical companies to monopolise production thus dictating prices to our government, consuming scarce public finances at a time when we need more public funds for a healthy recovery.

Impact on health workers

Approximately 70% of the workforce in the health sector are women. The system depends on the systemic exploitation of undervalued, underpaid women’s work.

The system depends on the systemic exploitation of undervalued, underpaid women’s work.

Health workers have made extraordinary sacrifices throughout the pandemic – contributing to the pandemic response, supporting our communities, and delivering essential public health services. While the government has declared us to be heroes and frontline warriors, we are yet to see meaningful appreciation. Most health workers have reached the point of physical and mental exhaustion. Even in normal times we are suffering from a shortage of health workers, with only 1 doctor for every 1511 people (below the 1:1000 WHO minimum norms) and 1 nurse for every 670 people (well below the 1:300 WHO minimum norm. The result of understaffing is indefinite long shifts, no days off, no leave to recuperate. Whilst constantly fatigued we have to deal with the constant risk of contracting the virus and infecting our family members. This has an enormous toll on mental health.

Frontline workers outside of hospitals are also risking their lives to keep the community safe. The primary healthcare centres across the country are overburdened with work with limited work-staff. The auxiliary nurses (ANMs), community health workers and the other frontline workers are working 24*7 to meet the demands of the government to combat the second wave of the covid-19 pandemic in the communities.

Frontline workers outside of hospitals are also risking their lives to keep the community safe.

Community health workers (CHWs) have been working relentlessly since the first wave of the pandemic playing a pivotal role in screening, contact tracing and ensuring basic medical services. However, they are still not being provided the basic protective gear as they run the drive for vaccination, while they still await their pending payments.

With health workers overburdened and daily cases rising at an exponential level, other municipal workers like ambulance workers, sanitation workers etc. are working long hours to keep the exhausted services running. Cremation grounds are overrun and crematorium workers are working around the clock at cremation grounds, often without appropriate safety and protective equipment.

Demands of frontline workers

• We demand that the central government declare Covid-19 as an occupational disease and guarantee compensation for workers who contract the disease in line with the advice by the World Health Organisation and in accordance with ILO Conventions 155, 161 and ILO Recommendations 164, 171 and 194 [1].

• We demand free health insurance coverage for all frontline workers and their families for free Covid-19 treatment. Central government should direct all facilities to provide free healthcare and free testing to health workers and other frontline workers including those hired through agencies and on short term contracts. Field and community health workers, including honorary workers, and their families should be entitled to free healthcare and free testing in the closest public hospital providing covid-care.

• We demand proper implementation of the life insurance coverage under the Pradhan Mantri Garib Kalyan Yojana. The insurance cover should be extended until this health crisis is deterred.

• We demand the central government direct all facilities to maintain appropriate working hours with breaks and overtime compensation.

• We demand regular payment of wages to all frontline workers and an additional payment of 50% of their wages as covid compensation.

• We demand recruitment of additional workforce to fill the existing gap. State governments should fill existing vacancies with a perspective of prioritising long-term hiring, by using the waiting list of the state equivalent of the Union Public Services Commission (UPSC) and the Staff Selection Commission (SSC) for recruitment of permanent workers and not on a contractual basis.

• We demand regularisation of the workforce as permanent health workers. Contractualisation of the workforce in municipal services should be stopped.

• We demand that the government implement all the demands of the Community Health Workers (CHWs), including their right to be recognised and regularised as public employees.

• We demand adequate funding into the health sector (minimum target 5% of the GDP) and the rebuilding of public services.

• We demand a stop to privatisation and commercialisation of health and other public services.

• Vaccines should be delivered on the basis of need, not wealth and therefore must be free to all.

• The government should move to use all unused vaccine manufacturing, particularly the public facilities, to produce generic vaccines.

  
  

[1] ILO Conventions 155 on Occupational Safety and Health, ILO Convention 161 on Occupational Health Services, Recommendations 164 on Occupational Safety and Health, Recommendation 171 on Occupational Health Services, and Recommendation 194 on the List of Occupational Diseases give more specifics on different aspects of occupation disease and health and safety.