Introduction-

2020, the year where the world was on a standstill. This year would be marked in the pages of history as a period where one event controlled the existence of millions. Where the lives of many were at stake, the ones who were saving the day were the frontline workers. A virus originating in China not only crossed the local borders, but went on to possess the international frontiers. While the entire world was contained within their homes, the frontline workers were working tirelessly to assume control over the impossible situation. These workers are ensuring that the citizens are supplied with health, food, shelter, and security. Routinely we hear testimonies of workers who are overworked, and scared, but still are choosing to fulfil their duties. While these workers diligently attend to their duties, the least that can be done for them, is to ensure that they have proper rights and authorities during this pandemic.

Who are the frontline workers, and what is their primary work? –

Frontline workers are a subcategory of essential workers, whose services are needed during difficult hours of a pandemic.[1] Frontline workers are often called as the backbone of the healthcare system of a country. These workers are responsible for making a connect between the community, and the official healthcare services. They come into play during pandemics and epidemics, to offer their services, in places where they are unavailable or unaffordable. They help the common man understand his health condition, and suggest the appropriate course of healthcare action.

In the United States, an inclusive list of frontline workers would include, healthcare workers, essential shopkeepers, agricultural workers, truck drivers, protective service workers, etc.[2] In the United Kingdom, the frontline workers are categorised into the following broad categories. Health and social care, education and child care, key public services, food and goods provisions, transport, local or national government, public safety and national security, and utilities and other key financial services.[3] In India, in addition to the hospital staff in the government and non-government hospitals, the frontline workers are usually women who belong to various communities, but have a common goal of serving the nation. Frontline workers in India fall within the purview of two ministries, being, the Ministry of Women and Child Development, and Ministry of Health and Family Welfare. Some of the well-known frontline working organisations are, Aganwadi Workers, Auxiliary Nurse Midwife, Accredited Social Health Activists (ASHA), etc. These organisations have been in function since the 1970s.[4]

In India, the frontline workers have been working day in and out to find cheaper and amicable health care solutions, by trying to travel to the remote villages, and making their services known. When pandemics strike, these workers are often expected to work in addition to their daily duties. Currently, the frontline workers in India, are performing functions including but not limited to, identification and reporting of positive cases, containment of areas where there has been a mass spread, raising awareness and prevention of spread of false rumours regarding COVID-19, conducting community education sessions, etc.

Pandemics prior to COVID- 19-

Although the COVID-19 widespread has become the topic of much debate of late, but the 20th and the 21st centuries have both been home to a host of pandemics. The Spanish Flu of 1918 killed around 50 million people worldwide. During this pandemic, it was reported that the nurses who acted as frontline workers were the worst hit community, since they were directly exposed to the virus, without any formal care and rights which they could enforce.[5] The 1957 Asian Flu cost approximately 1-2 million deaths worldwide. It was reported that, about 52% healthcare workers in New York, and 32% health workers in Chicago, who also became the victims of the flu could not find an antidote for themselves.[6] SARS Coronavirus of 2002 saw a total of 8000+ infected cases. As per the World Health Organisation, there were more than 1700 healthcare workers who were infected by SARS.[7] The Swine Flu or the H1N1 Virus was the talk of the town back in 2019. As per an article of The Times of India, no H1N1 vaccine was given to the healthcare workers in India until seven years from after its outbreak.[8]  The Ebola Outbreak of 2014 saw deaths of millions, but more than 500 healthcare workers lost their lives during these times.[9]

All these instances, including the current COVID-19 pandemic, are repletion of one fact alone, that is, better facilities and rights for the frontline workers are the need of the hour.

Challenges faced by frontline workers-

As mentioned earlier, the duties which the frontline workers have to perform during pandemic, are in addition to their routine work. These workers are basically doing two jobs side-by-side, where the workers often have to neglect their routine jobs and focus on the more pressing issues, such as containment of the pandemic. Testimony of a frontline worker working with ASHA[10], reported her inability to attend to daily functions such as immunisation, childcare services, women health services, etc.[11] Many of the health care providers, due to the fear of catching the infection themselves, have decided to contain themselves within the healthcare facilities, and have stopped frequent visitations to their homes. Due to their professional responsibilities, they have to curtail the fear in their minds of getting infected themselves, and have to completely isolate from their family members. In addition to this, as per the Government guidelines, these healthcare providers are required to wear the Personal Protective Equipment (PPE) whenever they are within proximity of COVID-positive patients. However, as per the submissions of many of these workers, owing to the current climatic conditions, it is impossible to wear the PPE kit for more than seven hours straight. Although the PPE kit is essential for the safety of these workers, they are highly inconvenient, as the workers are not even able to use the toilet wearing the kit.[12] All these instances, are definitely taking a toll on the mental health of these frontline health workers. The workers continuously have to side-line their apprehensions and fears and have to pull themselves up for the safety of the citizens.

Recognised rights of frontline workers-

During the earlier times, the frontline heath workers were always the silent sufferers, when it came to claiming their rights. But not anymore. During these difficult times, the workers have not shunned away their responsibilities, and are bravely volunteering themselves for the care of others, but this time with demand of proper care. Various worldwide movements are reported where it is seen that the frontline workers have organised systematic strikes to ensure greater security. In Illinois, nurses went on a planned strike resulting into higher base wages, hazard pay, fully paid sick leaves for COVID-19 testing, and the right to refuse working without PPE kits.[13] In Washington DC, a draft proposal of Essential Workers Bill of Rights has been passed. This bill is based on the underlying assumption that the frontline workers have the risk of contracting COVID-19 at a pace quicker than the general strata. Amongst other things, the bill focuses on health and safety precautions in terms of proper PPE kits to be provided to the workers without any extra cost, adequate compensation for the essential work done over and above their regular wages, fully paid sick leaves for the workers, their families, and their dependents without excessive paperwork, protection to the whistle-blowers who report infected colleagues or unsafe working conditions, proper support for child care, complete accounts of how the funds allocated to organisations are utilised, etc.[14]

As per the guidelines issued by the World Health Organisation, following have been listed as the recognised rights of the frontline workers-

·       Availability of PPE kits for minimising the occupational safety and health hazards.

·       Providing adequate information and training to the workers regarding usage and disposal of the PPE kits.

·       Provision of trainings for the workers regarding conduct of testing and treatment of patients in a safe manner.

·       Having a blame free environment, where the workers are freely able to report notable instances.

·       Having appropriate working hours and break time.

·       Right to refuse to work in environments which have become hostile and extremely hazardous to operate in.

·       Right to appropriate compensation.

·       Right to demand counselling sessions, and mental health awareness programmes.[15]

Situation in India-

In India, the positive cases are at all-time rise, and the responsibility on the shoulders of frontline health workers is heavy. Right from preparedness of hospitals in terms of intensive care facilities, availability of ventilators and isolation wards, and other supportive equipment, the healthcare workers have their hands full. However, the weak link in terms of demand for health care and supply by the frontline workers has been the unavailability of the PPE kits. There have been reported instances, indicating a shortage of PPE kits, which has not only reduced the pace of functioning of the workers, but has exposed them to a greater risk. Initially, India solely depended upon foreign exporters such as China for the PPE kits. Due to disruption of the international supply chain, immense roadblocks were created. Many of the frontline workers, had to share or reuse the PPE kits, defeating the whole purpose of isolated usage. Owing to the situation, thousands of healthcare workers contracted the disease, and many even lost their lives. The Government recently announced that the production of PPE’s has been started in the homeland, and has been increased to production of 2 lakh PPEs per day.[16]

As seen earlier, a considerable percentage of the frontline health workers are also in form of contract labourers, and Frontline Working Organisations such as ASHA. Since the Government, is not responsible for the contract labourers, these workers are often left high and dry although their efforts are equal if not more. These ASHA workers, have gone on record to state that they have received no formal training from the Government or any healthcare institutions for dealing with the COVID-19 patients. Most of their knowledge comes from WhatsApp forwards, and the articles they are able to procure online. Many a times, they don’t even know if they are officially deployed on the frontline, but have assumed their responsibilities regardless.[17]  The Circular issued by the Ministry of Health and Family Welfare on Guidelines for Rational Use of PPEs enlists the ASHA workers to be having low risk of infection, and therefore the only PPEs allocated to them are triple layer masks, and gloves. As a result, the ASHA workers are at the mercy of the gram panchayats or municipal corporations for provision of safety equipment. It is often found, that there is shortage of even the masks or the gloves which have been sanctioned to them by the Government, due to which these workers often reuse the same. In addition to this, the Government has announced only Rs. 1000 extra to these ASHA workers for COVID-19 survey conducted by them, which evidently is very less. In pursuance to the above, Amnesty International India has made the following demands from the Indian Government on an immediate basis-

·       Proper PPE kits for all ASHA workers, and a continuous supply thereof.

·       Decent wages for COVID-19 related work conducted by these workers.

·       Treatment and compensation for loss of work for the ASHA workers who have contracted the virus.

·       Provision of social security benefits such as the Employees State insurance, Employee Provident Fund, etc.

·       Adequate training and awareness programmes for the knowledge and benefit of these workers.

·       Bringing the ASHA workers within the definition of ‘worker’ as provided under various labour laws.[18]

On 20^th April 2020, the Department of Health and Family Welfare issued a Circular with regards to the Measures to be Undertaken to Ensure the Safety of Health Workers. The workers who were recognised within the Circular were doctors and health professionals working in Government and private hospitals, and the ASHA workers to a limited extent. This Circular provided for use of hydroxy-chloroquine for healthcare workers with confirmed positive status of COVID-19. The Circular also provided for more than five lakh PPEs to be supplied to various Government hospitals, and timely payment to frontline workers such as ASHAs and those working outside the Government sector. The Circular also spoke of psychological support to be provided to these workers. Trainings and clinical management programmes were also to be provided to the workers for their effective understanding and knowledge. The Circular also released various websites and YouTube videos which included detailed guidelines to be followed by the ASHAs and non-government workers as well. The Circular encouraged the workers to take up various courses uploaded on the Government portals for their own understanding. An accidental insurance cover was also to be provided to these healthcare workers.

Conclusion

On 22^nd March 2020, Indians clapped their hands in appreciation for the relentless efforts shown by the frontline workers. While this boosted their spirits, did it necessarily promise them safety? The frontline workers have been the backbone on which the entire society is living. Although the Government is currently coming out with numerous schemes every now and then, which could benefit the government and the non-government frontline workers, clearly, they are not in parallel with the magnitude of the virus. Due to the contagious nature of the illness, the frontline workers are highly susceptible to risk. Therefore, considering the above, the highest level of protection and care must be allocated to all kinds of workers deployed at the frontline presently. It is understandable that due to the shortage in the supply of PPE kits, a uniform method of providing the kits to all healthcare facilities across India would not be possible, but some method of alternate supply needs to be adopted. As per a survey, up to 70% of the health workforce are women.[19] Hence, certain laws keeping in mind the gender segregation in the labour market have to be made. Speaking about labour laws, this is definitely not the time to shun away protection to the unorganised sector such as the ASHA workers under the garb of law-enforcement. It is necessary, that all provisions and facilities made available by the Government for workers to be uniformly available to all. Inclusivity of the workers withing various labour laws, thereby gaining protection thereunder should be done. A mass sensitisation programme also needs to be conducted, whereby the general strata shows greater compassion and accommodation towards the frontline workers, so that instances such as violence and harassment against the healthcare workers as seen in some parts of the country can be prohibited. The Government has addressed this issue by passing an ordinance to protect the frontline workers by making this action a non-bailable offence with maximum punishment of about seven years imprisonment and Rs. 5 Lakhs fine. An itemised account of funds allocated for the care and protection of the frontline workers, is not only the right of these workers, but of the citizens of India at large. Similarly, an above industry standard pay scale has to adopted for these workers who are not only working overtime, but are risking their lives while doing so. Provision of various welfare schemes, such as progressive insurance coverages, provident funds, pensions, and over time allowances are the need of the hour. The frontline workers should also have a proper mechanism of seeking redressal and having their voice heard without the element of fear. Amongst other things, the right of refusal to work should also be provided to these workers. Even though these are pressing times, it is required to honour the choice of these professionals and respect their decisions with regards to not choosing to work.

The Right to Health and Healthy Environment is a fundamental right guaranteed by Article 21 of the Constitution of India[20]. Within the realm of the Constitution, are also these frontline workers who also deserve equal protection. If a proper web of rights is created for the protection of frontline workers now, it could serve as a ready reference for the years to come. In pursuance to this, a Bill such as the one proposed in Washington DC would be an effective solution.[21]

It is time for Indians, citizens and the officials alike, to literally join hands not just for clapping, but for helping the frontline workers better serve the society for the sake of humanity at large.