ASHA Workers: The Unrecognized Pillars of India’s Rural Healthcare

 ASHA Workers: The Unrecognized Pillars of India’s Rural Healthcare

ASHA workers serve as the vital link between government healthcare initiatives and marginalized communities. Despite their crucial role, they remain classified as volunteers rather than formal employees, surviving on inconsistent, task-based incentives rather than stable salaries. This International Women’s Day, we spotlight their struggles and resilience.

A Life of Service: Sunita Gautam’s Journey

Sunita Gautam’s story is one of perseverance. After losing her husband while pregnant with her youngest son, she spent five years navigating odd jobs and financial hardship. In 2018, she found purpose through the Accredited Social Health Activist (ASHA) program in Saharanpur, Uttar Pradesh. Overnight, she transitioned from an overlooked widow to a trusted healthcare advocate in her village.

Beyond providing government-mandated healthcare services, Gautam fights against gender inequality, child marriage, and lack of education. She collaborates with the Milan Foundation, a Delhi-based NGO, to offer leadership training and advocacy for women and girls in her community. ASHA workers like her are not just caregivers—they are educators, counselors, and protectors of public health.

Bridging the Trust Gap in Rural Healthcare

The ASHA program, introduced in 2005 under the National Rural Health Mission (NRHM), has successfully bridged the gap between government healthcare and rural populations. Selected from within their communities, ASHAs build trust that facilitates medical interventions. However, this vital role comes with immense challenges.

Gautam, like thousands of ASHAs, often works around the clock. Whether assisting with childbirth at midnight or helping a critically ill elder, her duties never pause. Yet, her earnings range from a meager ₹3,000 to ₹5,000 per month, depending on the number of deliveries, immunizations, and tuberculosis cases she handles. Classified as ‘volunteers,’ ASHAs are excluded from formal employment benefits such as pensions, job security, and adequate salaries.

A Struggle for Fair Wages and Recognition

Across India, ASHA workers have staged protests in states like Maharashtra, Uttar Pradesh, Odisha, Delhi, West Bengal, and Kerala, demanding fair compensation and recognition. In Kerala, over 26,000 ASHAs faced months-long delays in their ₹7,000 honorariums, with additional incentives of ₹5,000 remaining unpaid. Their demands include an increased monthly honorarium of ₹21,000 and a retirement benefit of ₹5 lakh.

Varalakshmi, Karnataka State Honorary President of Akshara Dasoha Union, highlights the systemic injustice: “The 46th Indian Labour Conference recommended that ASHA workers be recognized as employees, yet they remain temporary scheme workers, denied fair wages and statutory protections.” She explains that ASHAs are paid only if government beneficiaries meet eligibility criteria—meaning months of dedicated healthcare efforts can go unrewarded.

The workload of ASHAs extends far beyond medical duties, encompassing community surveys, nutrition tracking, and emergency assistance. Despite covering 300–400 households each, their labor remains undervalued.

The Pandemic’s Toll on ASHA Workers

During the COVID-19 pandemic, ASHA workers were frontline warriors, going door-to-door without protective equipment. They were the first to respond to outbreaks, yet lacked masks, sanitizers, and safety protocols. Fr. Teyol Machado SJ, a community development activist, recalls, “ASHAs had to beg for basic PPE at health centers, only to be scolded for taking supplies meant for ‘real’ healthcare workers.” Worse, they were blamed for delays in testing and treatment outcomes, despite lacking the authority or resources to change systemic inefficiencies.

Radhika (name changed for privacy), an ASHA worker from Kerala, continued working despite testing positive for COVID-19. “I couldn’t afford to rest. We had to arrange vaccinations for everyone,” she recalls. Even after multiple protests, payments for their February honorariums remain pending.

The Exploitation of a Critical Workforce

The ASHA initiative has undeniably strengthened India’s rural healthcare system, but at what cost? These women, who manage maternal care, immunization drives, TB and HIV monitoring, and emergency response, are trapped in a cycle of unstable wages and job insecurity. The root of the issue lies in the scheme-based nature of their employment. By labeling ASHAs as ‘volunteers,’ the government sidesteps its responsibility to provide them with essential protections.

According to the National Health Systems Resource Centre, India had approximately 980,000 ASHA workers in 2020, with a ratio of one ASHA per 979 rural residents. Despite their sheer numbers and impact, they remain invisible in labor policies.

“When nearly a million women work in this sector, they must at least be recognized as workers,” says Varalakshmi.

Looking Ahead: A Call for Change

It’s time for India to acknowledge and compensate ASHA workers fairly. Their services are indispensable to public health, yet they continue to fight for basic labor rights. As the backbone of India’s rural healthcare system, ASHAs deserve stable salaries, pensions, and protection under labor laws. Recognizing them as formal employees would not only uplift their lives but also strengthen the entire healthcare ecosystem.

The question remains: When will India recognize those who dedicate their lives to caring for its most vulnerable?