Halima Zulqarnain, Central President, All Sindh Lady Health Workers and Employees Union (ASLHWEU), Pakistan, said that community health workers are referred to as Lady Health Workers in Pakistan, and were appointed since 1994 at Rs 900 a month for family planning programme in rural areas. Despite doing vital work, they were not treated with due dignity like other healthcare professionals were. When they started the movement to get their due, they faced resistance - water was thrown on them, some of them were jailed, some suffered miscarriages in the struggle. One health worker also got a divorce when she went out on the streets demanding justice and rights.
Lady health workers were working during the lockdown but were not given sanitizer, PPE or compensation for this precarious job. Not surprisingly, more than 20 of them tested positive for COVID-19. Halima demanded safer working conditions for all lady health workers, dignity and respect like other healthcare professionals, and fairer wages, insurance and pension.
In Nepal, community health workers are called Female Community Health Volunteers. Gita Thingg, Vice President, Nepal Health Volunteers Association said that they have played a vital role in reducing maternal and infant mortality rates nationwide. In Nepal, the title of 'female community health volunteers' suggests 'voluntary' work but it is 24x7 work, says Gita. Snacks and basic travel allowance is not a justified compensation for this important service they provide. She demands that government must recognize the critical role they play in health system with dignity. Since 2010 she has been unionising in Nepal to claim the rights and benefits long overdue to female community health volunteers. "We are working, doing labour and we should accordingly get paid, and recognized with dignity and respect, and our rights protected" said Gita.
Jyotsana Shakya, Treasurer, Health Volunteer Organisation of Nepal said that her two family generations have worked as female community health volunteers. Even though the Nepal government ordered involvement of female community health volunteers in committees to respond to COVID-19, this was not well implemented at local level. Despite promise of Rs 1000 allowance by federal government, the local authorities have not paid them. Mask, sanitizer or PPE was not given to them. When they got tested for COVID-19, almost all of them tested positive and were not allowed to go back home. They were forced to stay in community homes and often the blame was on them. Her union has submitted demands to the government now which includes oximeter. Mayor of her region has assured her of support. They rightly want to be recognized as workers, not mere volunteers. She also demands health insurance for all.
Anand Grover, former UN Special Rapporteur on the Right to Health and senior lawyer in Supreme and High Courts of India, said that every person must have a right to health. Every person is entiled to good healthcare facilities and services which are available, accessible, acceptable, and of good quality - and government has an obligation to ensure this for all. Community health workers are not volunteers but workers - and - most important workers - because healthcare system is based on primary healthcare. If we do not have primary healthcare we cannot provide health for all. Unless we treat community health workers as 'workers' and not 'volunteers' how will they assert their right to be paid as per the pay-scale of the government?
Anand Grover said that community health workers have done their work with utmost sincerity, professionalism, and most importantly, passion - without the remuneration they are entitled to. He shared that Vidya vs state of Maharashtra legal case shows how an anganwadi worker was told by the High Court that she is entitled to be treated as worker according to industrial laws and thus can go to the labour courts for justice.
Public Services International and unions representing community health workers across South Asia launched a list of joint-demands that include:
- Recognition as public health workers
- Collective voice in decision-making processes
- Occupational safety and health protection
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