Opinion | ASHA Workers’ Struggle In Kerala: A Fight For Dignity, Rights, And Fair Wages
The ASHA workers’ fight is not merely about wages—it is a struggle for justice, dignity, and recognition
For over two decades, Accredited Social Health Activists (ASHA) workers have formed the backbone of India’s public health system. Tasked with providing essential healthcare services at the grassroots level, they serve as the vital link between the government and rural communities, ensuring that even the most marginalized populations have access to basic healthcare. Despite their indispensable role in strengthening public health, ASHA workers remain one of the most underpaid and overworked professionals in the country.
The ongoing protest by ASHA workers in Kerala is not just a call for higher wages—it is a battle for dignity, recognition, and fundamental labour rights. At its core, it is a feminist uprising against the systemic devaluation of care work, which remains overwhelmingly performed by women and persistently under-compensated. Their struggle exposes the state’s neglect of informal healthcare workers and the broader failure of governments to move beyond rhetoric and implement policies that provide fair compensation to those who sustain public health.
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Kerala, long hailed for its progressive governance and robust healthcare system, now finds itself under scrutiny for its treatment of ASHA workers. Their demands are not only a test of the state’s commitment to labour rights but also a national imperative that requires urgent attention from the state government, central authorities, trade unions, and civil society at large.
CRUCIAL ROLE OF ASHA WORKERS IN PUBLIC HEALTH
ASHA workers are a cornerstone of India’s healthcare system, particularly in rural areas. Their responsibilities include maternal and child healthcare, immunisation programs, disease surveillance, and spreading awareness about hygiene, nutrition, and preventive care. They are instrumental in ensuring inclusive institutional deliveries, administering polio drops, monitoring tuberculosis patients, and facilitating access to government health schemes.
During the Covid-19 pandemic, ASHA workers proved their immense value, conducting door-to-door screenings, assisting in vaccination drives, tracking infections, and ensuring timely referrals to hospitals. Many risked their lives without adequate protective gear, medical insurance, or additional allowances. While the government and society at large hailed them as “corona warriors," their working conditions and remuneration did not reflect this appreciation. Their labour, though physically arduous and socially indispensable, remains politically marginalised, existing at the periphery of institutional recognition and policy discourse.
Despite their critical role, ASHA workers remain classified as “volunteers" rather than full-time government employees. This designation strips them of essential labour protections, including fixed salaries, pension benefits, and job security. Instead, they are paid through a task-based incentive system, leaving them in a constant state of financial instability. The Kerala protest underscores the urgent need to rectify this injustice.
CORE DEMANDS OF ASHA WORKERS IN KERALA
The ongoing agitation, completing a month, is driven by inadequate wages and the absence of social security for Kerala’s ASHA workers. Currently, they receive an honorarium of Rs 6,000 to Rs7,500 per month—significantly below the state’s minimum wage for full-time workers. Given the rising cost of living and the demanding nature of their work, which often extends beyond regular hours without overtime pay, this amount is grossly insufficient.
ASHA workers demand a fixed minimum wage of at least Rs 10,000, replacing the unpredictable task-based payment system with a stable income. They seek formal recognition as employees, as their current classification as volunteers deprives them of essential labour rights, including job stability, provident fund benefits, pensions, and healthcare allowances. Inclusion in social security schemes is another key demand, ensuring access to health insurance, accident coverage, and retirement benefits—ironically denied to those working in healthcare.
Beyond wages, they face precarious employment, excessive administrative burdens that divert them from core healthcare duties, and chronic delays in incentive payments for tasks like immunization, maternal care, and health surveys, pushing them into financial distress. Their struggle is not just for fair wages but for dignity, security, and rightful recognition as essential healthcare workers.
Further, it exposes a fundamental contradiction in the political economy of care work: the systemic devaluation of labour essential to public well-being. Their classification as “volunteers" reflects a broader trend in neoliberal governance, where states outsource critical welfare functions to precarious, underpaid workers while maintaining a façade of social commitment. This not only entrenches gendered and class-based hierarchies in labour but also underscores the paradox of an economy that relies on care work while refusing to acknowledge its economic and social worth.
The stark disparity in compensation further illustrates this neglect. Recently, Kerala revised and raised the salaries of Public Service Commission officials to Rs 2.25 lakh per month, along with high-end travel benefits for executive nominees. Meanwhile, essential care workers—such as Anganwadi staff, midday meal providers, and ASHA workers—continue to be undervalued and grossly underpaid. This imbalance reflects a structural bias that prioritises bureaucratic roles over the frontline labour that sustains public health and welfare.
A GOVERNMENT THAT PREACHES WELFARE BUT FAILS ITS WORKERS
Kerala, long hailed as a leader in public healthcare, now faces a credibility crisis as ASHA workers expose the contradictions in its governance model. The Left Democratic Front (LDF) government, despite its pro-labour rhetoric, has been slow to address its demands. Chief Minister Pinarayi Vijayan’s administration cites financial constraints, yet this argument rings hollow when juxtaposed with the state’s spending on large-scale projects, political events, etc. If Kerala can allocate resources for ambitious initiatives, it must also ensure fair wages and social security for its frontline healthcare workers. The protesting ASHa workers have now intensified their move with an indefinite hunger strike, which was announced when thousands from across the state gathered outside the Government Secretariat in Thiruvananthapuram and staged a big blockade.
The crisis, however, is not Kerala’s burden alone. The ASHA programme falls under the National Health Mission (NHM), a centrally sponsored scheme, and the Centre’s inadequate funding has forced states to bear the financial strain. This uneven distribution of responsibility has led to wage disparities across states, underscoring the urgent need for a national policy overhaul. The ASHA workers’ struggle reveals a deeper structural failure—one that demands both state and central governments to move beyond rhetoric and recognise care work as indispensable to public health and social justice.
A PATTERN OF NEGLECTING INFORMAL WORKERS
The ASHA workers’ protest in Kerala is part of a larger pattern of neglect faced by India’s informal workforce. Millions of workers in essential sectors like healthcare, sanitation, and education continue to be exploited under the guise of “volunteerism" or contractual employment. Anganwadi workers, mid-day meal cooks, and sanitation workers also face similar issues—low pay, lack of job security, and poor working conditions despite their vital contributions to society.
This reflects a structural problem in India’s labour policies, where the government relies on an informal workforce without providing them with adequate rights and protections. The reluctance to formalise employment in these sectors is not just an economic issue but a moral failure. When governments prioritise fiscal prudence over the dignity of workers, it creates a system where exploitation becomes the norm.
SOLIDARITY AND THE ROAD AHEAD
Public support for ASHA workers is surging, with trade unions, civil society organisations, and healthcare professionals rallying behind them. Protests, sit-ins, and marches across Kerala have intensified pressure on the government, while media coverage has propelled their struggle into mainstream discourse. However, protests alone will not bring change unless policymakers acknowledge their demands and take decisive action.
The Kerala government, which prides itself on progressive governance, must lead by example. Ensuring fair wages and social security for ASHA workers is not just a policy decision—it is a moral imperative. Failure to act would not only betray its pro-worker stance but also set a dangerous precedent for other states. The central government, too, must take responsibility by increasing public health funding, formalising ASHA employment, and establishing a fair wage structure that guarantees financial stability. Expanding social security schemes to include informal healthcare workers is essential to protecting those who safeguard public well-being.
The ASHA workers’ fight is not merely about wages—it is a struggle for justice, dignity, and recognition. Kerala now faces a defining choice: uphold its reputation as a model state for labour rights and public health or risk eroding its credibility by neglecting its most essential workforce. No society can claim to be just while its frontline healthcare workers remain undervalued. If India aspires to build a resilient public health system, it must start by ensuring ASHA workers receive the dignity, respect, and financial security they rightfully deserve. Anything less would be a betrayal of the principles of justice and equity that a welfare state is meant to uphold.
Amal Chandra is the author of ‘The Essential: On Healthcare and Pandemic Management’, a policy analyst, and a columnist. Follow him on X at @ens_socialis. Views expressed in the above piece are personal and solely those of the author. They do not necessarily reflect News18’s views.
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