More than a million (mainly female) health workers — known as Accredited Social Health Activists (ASHAs) — form an effective frontline healthcare support system across India.
Thousands of Kerala’s 26,225 ASHAs have been demonstrating for the past month seeking better pay and benefits. During the Nipah, Zika and COVID-19 outbreaks, these ASHAs showed their capability to contain outbreaks and function as a local contact and support for communities.
They argue that the nature of their work has changed a lot over the years and ASHAs are now undertaking tasks above and beyond their initial intent. Further, they argue that a full-time commitment is needed to do the job to the level of expectation that governments have of these workers.
Across the country, these workers are still technicality categorised as volunteers, so they do not receive benefits and proper remuneration, despite playing a crucial role in delivering healthcare in rural communities. ASHA workers in Kerala, who receive a monthly honorarium of ₹7000 ($130.21) rather than a salary, want to increase their payment to ₹21,000 ($390.63) and receive retirement benefits.
Among other duties, Kerala’s ASHAs raise awareness about nutrition and supplements and provide advice as part of pre-natal, neo natal and antenatal care. Moreover, they have had to take on the additional role as midwives, due to a state-wide freeze on the recruitment of midwives.
ASHA workers are also responsible for Kerala’s 99% vaccination rate and are contributing to improving the state’s overall health care system.
Now, they are following in the footsteps of ASHA workers in Karnataka and Andra Pradesh, where similar strikes have led to increases in honoraria and other benefits.
Kerala is majority ruled by the Communist Party of India (Marxist). Despite the history and political ideology of this party, it is proving more difficult than in other states to get the needs of these workers recognised. They face a lack of acceptance and the women leading this fight and the Kerala Health Workers Association — the independent union leading the protest — have been subjected to verbal attacks.
Congress party and Bharatiya Janata Party state parliamentarians show great concern and support for the protest, however this is interpreted as political and opportunistic behaviour. The union and the ASHA workers are trying their level best to ensure that their needs and the public support they have generated in the past 30 days does not get stuck between political power plays.
In the scorching sun and heavy rain, the ASHA workers are fighting for their rights. Already, their protest is gaining a lot of public support, due to the strong links these workers have with ordinary people in the most underprivileged sections of society. These are the same people who voted for the current state government and are concerned about the lack of respect and extreme avoidance showcased by the ruling party towards these frontline workers.
It is high time that the ruling party of Kerala recognises the critical role played by ASHA workers in the overall functioning of the state’s healthcare system, makes a policy decision in the interests of improving healthcare delivery to the most marginalised sections of society and ensures that healthcare workers are able to make a good living.