Covid-19: India health workers' families fight for compensation

Shanti Devi, a government community health worker, died from Covid in May.

Her daughter Malti Gangwar said that in the days following her death, the family received several calls from the health department. Her late mother's colleagues even urged her to apply for the same job.

"There was talk about insurance money and they all seemed very co-operative. They asked me to fill in a form to apply for the job, which I did. But I don't know what happened after that."

Four months on, the Gangwars are still waiting. Neither the compensation nor the job have materialised yet.

In March 2020, India's federal government promised 5m rupees ($68,000; £50,000) to the family of every health worker who died fighting Covid. But a BBC investigation, based in part on Right to Information requests, shows that a lack of data, bureaucratic hurdles and a discriminatory policy have left many of these families traumatised.

The BBC spoke to several families who said they felt let down by a government that had promised to stand by them. Only a handful of them agreed to be interviewed. Others feared that speaking out could hurt their chances of being compensated. The government did not respond to our questions.

In July, when the government was asked in parliament how many healthcare workers had died from Covid, the junior health minister said they did not maintain occupation-wise data on cases and deaths.

The Indian Medical Association (IMA) told the BBC that Covid-19 killed nearly 1,600 doctors, and the Trained Nurses' Association of India has reported 128 deaths so far. The government said more than 100 Ashas (female community health workers) died while performing Covid duties - and this was before the devastating second wave in April and May this year. That amounts to at least 1,800 deaths among health workers. There are no numbers available for how many ward boys - assistants - and other contract workers in hospitals have died.

But the fact that the government had no centralised data was a stunning revelation, given that Prime Minister Narendra Modi had personally cheered healthcare workers and their families at the start of the pandemic.

He encouraged ordinary citizens to light lamps, and the Indian air force showered flower petals from helicopters on hospitals in various cities. Finance Minister Nirmala Sitharaman had called doctors, nurses and other healthcare workers "Gods in white uniform" while announcing the compensation package.

Shanti Devi's family said the delay in compensation was especially hurtful and demeaning because it was people like her that the policy sought to honour - a community health worker involved in the "direct care of Covid patients".

"The family's financial condition is not very good. Anything we receive will be helpful," her brother said.

The family said they had reached out to the administration but were yet to hear back.

Shanti Devi and hundreds of thousands of other Asha workers are at the bottom of India's public healthcare system - at the village or neighbourhood level - and essential for any public health programme, from creating awareness to monitoring impact.

Shanti Devi, who was in her early 50s, had done the job for nearly 25 years with little in terms of remuneration, her family said. And with Covid, the risk of going door-to-door was especially huge.

The government said it received 1,342 compensation claims between 30 March 2020 and 16 July 2021 and they have settled 921 claims so far. The remaining 421 are still being processed or have been rejected.

One of the rejected claims belonged to 56-year-old Sujata Bhave, who lost her husband to Covid in June 2020.

Dr Chittaranjan Bhave was a private doctor - an Ear, Nose and Throat (ENT) specialist - in Mumbai.

"Initially he was seeing patients online but he never felt satisfied because it was difficult to examine ear, nose and throat on video calls," Ms Bhave said.

Soon after he began examining patients in person, he caught the virus and was admitted to hospital. Ms Bhave never saw him again.

Her husband's speciality, she said, meant that many of his patients had symptoms similar to Covid-19 - throat infections or coughs.

But her claim for compensation was denied because "her husband had not been working in a government-designated Covid ward when he got infected".

It was "humiliating", she said. "It is definitely not the case that only public doctors faced the virus and private practitioners did not. This was unfair."

The government's policy, which insists on compensating only government doctors, has been criticised by the medical community, especially since government hospitals could not manage the burden alone.

In fact, the policy explicitly says that "private hospital staff/ retired/ volunteer/ can also be drafted for Covid-19 related responsibilities" and that they will "be covered subject to numbers indicated by ministry of health and family welfare". In some instances, private practitioners were forced by the government to work.

Dr Nilima Vaidya Bhamare, who lives in Mumbai, said that last year the local municipality notified private doctors that they would lose their licence if their clinics did not remain open through the pandemic.

"This happened because the government realised it did not have the infrastructure," she said. "Despite all this [they] are not willing to honour claims or extend facilities to us. We will have to go to court because the government is unwilling to listen."

K Sujatha Rao, India's former health secretary, said the policy was "very restrictive".

"It should be expanded. The people who ought to be given absolutely high priority are our health workers. The government ought to be much more large-hearted, and whether they are private sector or public sector, I really wouldn't make that distinction at this point."

In November 2020 a parliamentary report, which noted a large number of vacancies in public hospitals, recommended "adequate remuneration and financial incentives along with insurance coverage" for all healthcare workers.

"The doctors, who have laid down their lives in the fight against the pandemic must be acknowledged as martyrs and their families be adequately compensated," it said.

But several health workers and their families told the BBC this was not their experience.

"I'm feeling very sad," said Dr Jayesh Lele, IMA secretary general. "The PM gave doctors a lot of respect but what is the effect of it all?"