Archana Ghugare’s ringtone, a Hindu devotional song, has been the background score of her life since March. By 7 a.m. on a mid-October day, the 41-year-old has already received two calls about suspected COVID-19 cases in Pavnar, her village in the Indian state of Maharashtra. As she gets ready and rushes out the door an hour later, she receives at least four more.
“My family jokes that not even Prime Minister Modi gets as many calls as I do,” she says.
Ghugare, and nearly a million other Accredited Social Health Activists (ASHAs) assigned to rural villages and small towns across India, are on the front lines of the country’s fight against the coronavirus. Every day, Ghugare goes door to door in search of potential COVID-19 cases, working to get patients tested or to help them find treatment.
With 8 million confirmed COVID-19 cases, India has the second-highest tally in the world after the United States and its health infrastructure struggled to cope with the surge in COVID-19 patients this summer. India spends only 1.3% of its GDP on public health care, among the lowest in the world. The situation is stark in rural areas where 66% of India’s 1.3 billion people live and where health facilities are scant and medical professionals can be hard to find.
India’s ASHA program is likely the world’s largest army of all-female community health workers. They are the foot soldiers of the country’s health system. Established in 2005, a key focus of the program was reducing maternal and infant deaths, so all recruits are women. They have also played an essential role in India’s efforts to eradicate polio and increase immunization, according to numerous studies.
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But even as health authorities have leaned on ASHAs to quell the spread of COVID-19 in rural areas, where a substantial number of new cases have been reported, many of these health care workers say the government is failing them. Pay was meager to begin with, but some workers have reported not being paid for months. Their hours have increased dramatically, but pay rises, when they have come, have not reflected the increased demands. Many ASHAs have also complained about not being provided adequate protective equipment for their high-risk work.
“They are the unsung heroes who are fighting to contain the unfettered spread of the virus in rural areas,” says Dr. Smisha Agarwal, Research Director at the John Hopkins Global Health Initiative. She argues it is vital to improve pay to boost morale and sustain this frontline workforce.
Ghugare was chosen from her village of 7,000 people in 2011. Since then, she has overseen countless births, meticulously monitored the health of thousands of newborn babies and strictly ensured immunization through door-to-door awareness campaigns. The personal relationships she built over the years have helped in the fight against COVID-19, giving her a good grasp of the medical histories of most of the 1,500 people assigned to her. “It’s all in