The protest by ASHA (Accredited Social Health Activist) workers in Kerala has now entered its 65th day, with workers camping in front of the Secretariat in Thiruvananthapuram, demanding a substantial hike in their honorarium. Despite their relentless and selfless service to the community, especially during the catastrophic 2018 floods and the unprecedented COVID-19 pandemic, the workers feel abandoned, neglected, and unheard.
The ASHA working group was established in 2007 with the objective of integrating community health initiatives into the public healthcare system. At its inception, the workers were promised a daily wage of Rs 232 for merely two hours of work. Initially, the honorarium amounted to a meagre Rs 500 per month, which was subsequently raised to Rs 1,000.
Currently, the workers receive approximately Rs 7,000 per month, but this amount is conditional, with several restrictive criteria that are challenging to meet. This discrepancy between their growing responsibilities and stagnant remuneration has been a persistent grievance.
Expanding responsibilities and unmet promises
Over the years, the duties of ASHA workers have expanded far beyond the originally defined two-hour commitment. During the devastating floods of 2018, ASHA workers displayed remarkable courage and dedication, playing a pivotal role in public health and relief efforts. The COVID-19 pandemic further transformed their role from limited outreach to full-fledged frontline healthcare, often working round the clock. They were instrumental in conducting house-to-house visits, monitoring patients, distributing medicines, and facilitating vaccinations—all while risking their own lives. Their efforts extended to supporting pregnant women, newborn babies, rabies and tuberculosis patients, and countless others in dire need of medical care.
Today, ASHA workers are essentially on call 24 hours a day, rendering it impossible for them to take up any other means of livelihood. Their demand for an increase in daily wages from Rs 232 to Rs 7,800, as promised in the 2021 LDF manifesto, is rooted in both necessity and fairness. The proposed hike would ensure a monthly income of around Rs 21,000, comparable to wages earned by other workers in Kerala, such as migrant labourers who receive Rs 1,200 for seven hours of work and domestic workers who earn Rs 500 for three hours of service. When we compare the price range of essential household commodities in Kerala, the wages of Rs 232 per day is shockingly inadequate.
Economic hardship and social injustice
A recent study conducted by the Centre for Development Studies highlighted the grim reality faced by ASHA workers. The study surveyed 50 workers, all of whom were found to be struggling with severe financial constraints. Thirty-six belonged to marginalised communities, including Scheduled Castes, Scheduled Tribes, and Other Backward Classes. Seven out of the 10 Scheduled Caste women surveyed do not own homes, while the remaining three face overwhelming financial burdens. Even among those who have their own homes, 17 out of 28 are entangled in mortgage troubles, with many on the brink of losing their properties.
The study further revealed that 15 out of the 50 families surveyed depend solely on the meagre income of the ASHA worker for sustenance. In 22 of the remaining families, the male members are incapacitated due to illness or disability, leaving the entire financial responsibility on the ASHA worker’s shoulders. This precarious situation has fuelled their demands for a one-time retirement benefit of Rs 5 lakh at the age of 62, a minimum pension, and medical insurance through salary deductions.
Meanwhile, the prominent labour unions in Kerala oppose the ASHA workers’ strike while they paradoxically support similar protests in other states of India. This double standard has not only disillusioned the workers but also led to widespread public outcry.
The current officials have come under sharp criticism for lack of grassroots activism and their perceived disconnect from the realities faced by ASHA workers. Many protesters feel that the officials lack the insight and empathy needed to address their grievances.
Unity in diversity at protest site
The protest site in front of the Secretariat has transformed into a powerful symbol of unity and secularism. ASHA workers from diverse religious and social backgrounds have come together for a just cause, displaying remarkable solidarity and resilience.
Many of the protesters are well-educated, with qualifications ranging from higher secondary education to postgraduate degrees, including some with B.Ed. qualifications and research backgrounds. Their articulate and multilingual presentations to national media have garnered widespread support from the public.
In a striking act of defiance, some ASHA workers recently cut their hair and hung it on the protest stage—a symbolic representation of their frustration and willingness to sacrifice their dignity to make their voices heard.
The irony of the situation is stark—those who have healed countless people during epidemics and disasters are now left to fend for themselves. It is the collective responsibility of the state and Union governments to address their demands with empathy and urgency. The financial extravagance prevalent among bureaucrats and ministers must be curtailed to allocate resources for these tireless healthcare workers.
The ASHA workers’ protest is not just a fight for fair wages but a demand for dignity and social justice. It is time for the government to recognise their invaluable contributions and restore their sense of worth by meeting their rightful demands.
Kerala, a state that prides itself on social equity and justice, must rise to the occasion and ensure that those who served the state in its darkest hours are treated with the respect they deserve.
Praveen Sakalya is a college teacher, researcher, and social observer based in Kerala.