By Jashodhara Dasgupta
As the world grapples with the COVID-19 pandemic and its impacts, it is becoming abundantly clear that future preparations for health resilience need serious rethinking. The model many countries have followed thus far relied upon lowered investments in social protection and public health services, banking heavily on unpaid and underpaid care work by women to fill in the gaps.
Experiences in India
The pandemic has exposed the flaws of this model in India, triggering enormous stress on an under-resourced public health system, overstretched frontline workers, and women struggling with enhanced burdens of household care work. As we move towards the recovery phase of the pandemic, it may be worthwhile exploring longer term solutions around crisis management that can potentially tackle this cluster of issues and bolster women’s economic agency.
The gendered health workforce
India’s investment in public health has over the last decade and half failed to live up to the expectation of the minimal 2.5% of the Gross Domestic Product. The weakening public health system has resulted in significant gaps in the health workforce and encouragement of a predatory private sector. The only strengthening has been at the lowest end of the health hierarchy, where over a million community women called ASHAs (Accredited Social Health Activists) are working as health volunteers, usually paid piecemeal on the basis of tasks completed. Care work in the community is managed by ASHAs, cooks in the school mid-day meal programme and the older cadre of Anganwadi Workers (AWW) and Helpers who run community centres for supplementary nutrition and part-day care for children.
Notionally, the state is the employer that has appointed these women workers; but by labelling them ‘volunteers’ and retaining them in informal working arrangements, the state has erased its own obligations around fair wages and social security. Women’s workforce participation is at an abysmal 19% in India, and at a downward slide. The precarious nature of women’s economic activity is a consequence of complicity of the state, market, community and household which reinforces entrenched gender norms that define women as caregivers—nurturing and self-sacrificing while simultaneously reducing their capacity to be in formal full-time economic activity.
With the onset of the COVID 19 pandemic, India had to confront the inadequacy of its short-sighted economic outlook that disregarded public investments in the care sectors and relied on the private sector: reminding us of the urgent need to strengthen public services. The pandemic has stripped bare the shortcomings of the under-resourced health system, with staff and equipment shortages in hospitals, protests by nurses, and rapid spread of infection among the workforce. The only way to check the community spread of the infection was to press the informal ‘volunteers’ into action. With peripheral health facilities barely functioning, the frontline workers were hurriedly marshalled for the crucial tasks of community surveillance, quarantine tracking and public health awareness. The women workers have stepped up to the new role, despite being inadequately trained and prepared. They remain under-compensated, under-protected and at risk of both infection and injury when they venture into the community.
Looking to the future
Learning from this, health planning in the post-COVID era has to anticipate future shocks of epidemics and climate change disasters that will require robust decentralized mechanisms for primary health care and social protection. While substantially increasing per capita spending on health, India can creatively use the opportunities presented by the crisis to think ahead on how women’s participation in the paid workforce can be safeguarded and expanded. A good start would be to formally acknowledge its own responsibilities as an employer to these estimated seven million women ‘volunteer’ workers who are providing ‘essential care’: the ASHA, mid-day meal cooks, AWW, Helpers and so forth, and provide them with formal terms of employment including improved working conditions.
Women’s workforce participation can be further bolstered by massively deploying skilled cadres such as trained community nurses to respond to community health needs identified by them. It is also an opportune moment to ramp up public provisioning of care services for children and elders, which will simultaneously generate more employment while reducing the burden of women’s unpaid care responsibilities, and free them for more productive economic participation. The universal provision of these basic services such as health, childcare and social protection will not only enhance India’s attainment of SDG goals but also create millions of jobs for women.
The Feminist Policy Collective in India is a voluntary group committed to transforming the policy and financing agenda to achieve women’s rights and gender equality. The Collective is engaged, among other things, in examining the continuum of paid, underpaid, unpaid and care work beyond the binaries of visible and invisible; or productive and reproductive frameworks. The Collective proposes to work towards enabling the reflection of this continuum in the economic policy and statistical framework in order to transform the status of women in the economy.
The image is of Rekha Rewat an accredited social health activist (ASHA) in Madhya Pradesh, India