I pray to God that greed never sets in”: Community health workers’ reflections on care” during the COVID-19 pandemic

Indian Journal of Medical Ethics,


Background: Care provision received renewed attention during the COVID-19 pandemic as several healthcare providers vied for the coveted title of frontline warrior” while they struggled to provide care efficiently under varying health system constraints. While several studies on the health workforce during the pandemic highlighted their difficulties, there is little reflection on what care” or caring” itself meant specifically for community health workers (CHWs) as they navigated different community and health systems settings. The study aimed to examine CHWs’ caregiving experiences during the pandemic.

Methods: Twenty narrative interviews with CHWs including ASHAs (Accredited Social Health Activists) and ANMs (Auxiliary Nurse Midwives) were conducted in different states between July and December 2020.

Results: Our findings highlight the moral, affectual, and relational dimensions of care in the CHWs’ engagement with their routine and Covid-19 related services, as well as the technical” aspects of it. In this article, we argue that these two aspects are, in fact, enmeshed in complex ways. CHWs extend this moral understanding not just to their work, but also to their relationship with the health system and the government, as they express a deep sense of neglect and the lack of being cared for” by the health system.

Conclusion: CHWs’ experiences demand a more nuanced understanding of the ethics of care or caring that challenges the binaries between the technical” and moral aspects of care.