ASHA workers’ protest: If the state takes pride in its public health system, it must also honour those who maintain it
These women have no formal employment status, no pension, no insurance, and no leave benefits. That this indifference is coming from a left-wing government is disturbing
First published in The Indian Express, March 27, 2025 ( https://indianexpress.com/article/opinion/columns/asha-workers-protest-public-health-system-9906788/)
For over a month now, the pavement outside Kerala’s secretariat in its capital city, Thiruvananthapuram, has been witness to a powerful protest as resolute as it is revealing. More than 26,000 Accredited Social Health Activists (ASHA) — the unsung heroes of Kerala’s famed public health system — have gone on indefinite strike, braving the streets, sun, and silence from the state government. And what are they demanding? Dignity. Fair wages. Recognition. Respect.
What makes this protest so remarkable is not just its scale or its persistence but the uncomfortable silence from a government that claims to be progressive. The Left Democratic Front (LDF) government — supposed to be a champion of worker rights— has refused to engage meaningfully with these women. These women, who spent the last two decades carrying out crucial community health work across the state, are now forced to fight not illness but indifference.
Kerala takes pride in its health system — it has the best health indicators in India. Life expectancy is the highest. Maternal and infant mortality rates are the lowest. Immunisation and outreach systems are robust.
This much-celebrated “Kerala Model” is built by the health workers, of which a very significant role was played by the daily labour of ASHA workers. These women, especially in rural and marginalised communities, conduct home visits, immunisation drives, and antenatal and postnatal care; track fevers; spread knowledge on nutrition, hygiene, and mental health; maintain disease surveillance; and give emergency responses.
During Covid-19, ASHAs were the frontline, ensuring contact tracing, quarantine monitoring, vaccination, and care for vulnerable groups. Yet today, those same hands are forced to raise fists in protest.
Currently, ASHA workers in Kerala receive a monthly honorarium of ₹7,000 from the state, a fixed incentive of ₹3,000, and minor task-based payments, bringing their average earnings to about ₹10,000. Of this, only ₹1,600 comes from the central government. In return, they work 10–12 hours most days, with no formal employment status, no pension, no insurance, no set working hours, and no leave benefits.
This makes their demands very reasonable: a monthly wage of ₹21,000, not merely task-based honorariums; a retirement benefit of ₹5 lakh; timely incentive payments; fixed working hours; and, most importantly, the government recognising them as formal health workers.
That this indifference is coming from a left-wing government is particularly disturbing. The same LDF, which has rightfully resisted unfair labour legislation at the Centre and coordinated nationwide strikes in solidarity with workers across sectors, now finds itself on the other side of the barricade.
Chief Minister Pinarayi Vijayan has not met the workers. The Health Department has merely restated budgetary constraints and procedural hurdles. The official stance appears to be one of dismissiveness, bordering on contempt.
Even worse, some ruling front leaders have resorted to vicious personal attacks, accusing the demonstration of being politically engineered, demeaning women on strike, and casting doubt on its genuineness and legality. The insinuation is clear: Protests are valid only when led by the ruling party’s affiliated unions; they are illegitimate if supported by others. They have specifically targeted the Socialist Unity Centre of India (SUCI), a smaller Left party that has stood in solidarity with the ASHAs.
This slander is not just misplaced — it is dangerous. When workers protest, the test of any government is its ability to listen, not its ability to label. When a protest’s legitimacy is judged not by the merit of its demands but by who leads it, we betray the very soul of democracy and left politics. A struggle that is led by women should not be dismissed because it isn’t controlled by the ruling party’s trade union. That’s not proletarian unity; that’s not solidarity — that’s control.
The central government is just as complicit as Kerala’s administration. The ASHA programme was launched under the National Rural Health Mission and continues to be centrally guided. However, the Centre has not increased incentives in two decades and refuses to grant ASHAs any form of job security or social protection.
Even though Kerala pays its ASHAs more than some other states, this does not justify inaction. The state and its people are the direct beneficiaries of this workforce. If the state takes pride in its public health system, it must also honour those who maintain it. To hide behind the Centre’s failures while silencing legitimate protest at home is political cowardice.
The ASHA protest in Kerala is not isolated — it is a continuum of a long and transformational legacy of working-class women demanding recognition and justice.
Perhaps it began with such historical struggles as the Matchgirls’ Strike in 1888 in London, where teenage girls and young women walked out of toxic matchstick factories demanding safer conditions and fair pay. The press and their employers vilified them, yet their strike succeeded in forcing regulatory reforms. The strike helped lay the foundation for Britain’s labour rights movement. Notably, Annie Besant, who supported the strike, would later go on to play a key role in India’s freedom struggle.
After years of being classed as volunteers, community health workers in South Africa, primarily women, fought for employment status in 2016. A court ruling in their favour compelled the government to acknowledge their employment rights. Their struggles for better wages and working conditions continue even today.
Closer to home, in many states like Maharashtra and Madhya Pradesh, ASHA workers have regularly taken to the streets to demand fair wages and were able to extract some concessions after long-drawn protests. These are all movements led by working-class women, often unsupported by mainstream political parties, fighting against invisibility and exploitation. Kerala’s ASHAs are now carrying that legacy forward.
From the Channar Revolt, where women fought for the right to cover their upper bodies, to the Pembilai Orumai movement in Munnar, where plantation workers struck work demanding better wages and working conditions, Kerala’s history has been shaped by women who refused to be silenced.
The 2015 Pembilai Orumai strike saw more than 10,000 tea plantation workers —almost all women—take to the streets. The “Irikkal Samaram” (Sitting Protest) led by Penkoottu in Kozhikode forced the amendment of Kerala’s Shops and Commercial Establishments Act, enabling saleswomen to sit during work hours. The United Nurses Association’s 84-day protest in 2012 transformed the labour landscape of private healthcare institutions.
The protest by the ASHA workers, therefore, is a continuation, not an anomaly. It is not solely about wages; it is also about the future of public health in India. The health system’s foundations will be undermined if the largely feminised care labour continues to be underpaid and dismissed as voluntary. The public may cheer for health workers in times of crisis, but if we do not support their right to a dignified life, that applause is empty.
The ASHA workers are fighting for a more honest definition of “public service”. The system they are challenging is one that demands everything and provides little in return. Their protest serves as a reminder that social progress is insignificant unless it extends to the very people who deliver it.
Radhakrishnan is an observer and writer on development and public policy
What makes this protest so remarkable is not just its scale or its persistence but the uncomfortable silence from a government that claims to be progressive. The Left Democratic Front (LDF) government — supposed to be a champion of worker rights— has refused to engage meaningfully with these women. These women, who spent the last two decades carrying out crucial community health work across the state, are now forced to fight not illness but indifference.
Kerala takes pride in its health system — it has the best health indicators in India. Life expectancy is the highest. Maternal and infant mortality rates are the lowest. Immunisation and outreach systems are robust.
This much-celebrated “Kerala Model” is built by the health workers, of which a very significant role was played by the daily labour of ASHA workers. These women, especially in rural and marginalised communities, conduct home visits, immunisation drives, and antenatal and postnatal care; track fevers; spread knowledge on nutrition, hygiene, and mental health; maintain disease surveillance; and give emergency responses.
During Covid-19, ASHAs were the frontline, ensuring contact tracing, quarantine monitoring, vaccination, and care for vulnerable groups. Yet today, those same hands are forced to raise fists in protest.
Currently, ASHA workers in Kerala receive a monthly honorarium of ₹7,000 from the state, a fixed incentive of ₹3,000, and minor task-based payments, bringing their average earnings to about ₹10,000. Of this, only ₹1,600 comes from the central government. In return, they work 10–12 hours most days, with no formal employment status, no pension, no insurance, no set working hours, and no leave benefits.
This makes their demands very reasonable: a monthly wage of ₹21,000, not merely task-based honorariums; a retirement benefit of ₹5 lakh; timely incentive payments; fixed working hours; and, most importantly, the government recognising them as formal health workers.
That this indifference is coming from a left-wing government is particularly disturbing. The same LDF, which has rightfully resisted unfair labour legislation at the Centre and coordinated nationwide strikes in solidarity with workers across sectors, now finds itself on the other side of the barricade.
Chief Minister Pinarayi Vijayan has not met the workers. The Health Department has merely restated budgetary constraints and procedural hurdles. The official stance appears to be one of dismissiveness, bordering on contempt.
Even worse, some ruling front leaders have resorted to vicious personal attacks, accusing the demonstration of being politically engineered, demeaning women on strike, and casting doubt on its genuineness and legality. The insinuation is clear: Protests are valid only when led by the ruling party’s affiliated unions; they are illegitimate if supported by others. They have specifically targeted the Socialist Unity Centre of India (SUCI), a smaller Left party that has stood in solidarity with the ASHAs.
This slander is not just misplaced — it is dangerous. When workers protest, the test of any government is its ability to listen, not its ability to label. When a protest’s legitimacy is judged not by the merit of its demands but by who leads it, we betray the very soul of democracy and left politics. A struggle that is led by women should not be dismissed because it isn’t controlled by the ruling party’s trade union. That’s not proletarian unity; that’s not solidarity — that’s control.
The central government is just as complicit as Kerala’s administration. The ASHA programme was launched under the National Rural Health Mission and continues to be centrally guided. However, the Centre has not increased incentives in two decades and refuses to grant ASHAs any form of job security or social protection.
Even though Kerala pays its ASHAs more than some other states, this does not justify inaction. The state and its people are the direct beneficiaries of this workforce. If the state takes pride in its public health system, it must also honour those who maintain it. To hide behind the Centre’s failures while silencing legitimate protest at home is political cowardice.
The ASHA protest in Kerala is not isolated — it is a continuum of a long and transformational legacy of working-class women demanding recognition and justice.
Perhaps it began with such historical struggles as the Matchgirls’ Strike in 1888 in London, where teenage girls and young women walked out of toxic matchstick factories demanding safer conditions and fair pay. The press and their employers vilified them, yet their strike succeeded in forcing regulatory reforms. The strike helped lay the foundation for Britain’s labour rights movement. Notably, Annie Besant, who supported the strike, would later go on to play a key role in India’s freedom struggle.
After years of being classed as volunteers, community health workers in South Africa, primarily women, fought for employment status in 2016. A court ruling in their favour compelled the government to acknowledge their employment rights. Their struggles for better wages and working conditions continue even today.
Closer to home, in many states like Maharashtra and Madhya Pradesh, ASHA workers have regularly taken to the streets to demand fair wages and were able to extract some concessions after long-drawn protests. These are all movements led by working-class women, often unsupported by mainstream political parties, fighting against invisibility and exploitation. Kerala’s ASHAs are now carrying that legacy forward.
From the Channar Revolt, where women fought for the right to cover their upper bodies, to the Pembilai Orumai movement in Munnar, where plantation workers struck work demanding better wages and working conditions, Kerala’s history has been shaped by women who refused to be silenced.
The 2015 Pembilai Orumai strike saw more than 10,000 tea plantation workers —almost all women—take to the streets. The “Irikkal Samaram” (Sitting Protest) led by Penkoottu in Kozhikode forced the amendment of Kerala’s Shops and Commercial Establishments Act, enabling saleswomen to sit during work hours. The United Nurses Association’s 84-day protest in 2012 transformed the labour landscape of private healthcare institutions.
The protest by the ASHA workers, therefore, is a continuation, not an anomaly. It is not solely about wages; it is also about the future of public health in India. The health system’s foundations will be undermined if the largely feminised care labour continues to be underpaid and dismissed as voluntary. The public may cheer for health workers in times of crisis, but if we do not support their right to a dignified life, that applause is empty.
The ASHA workers are fighting for a more honest definition of “public service”. The system they are challenging is one that demands everything and provides little in return. Their protest serves as a reminder that social progress is insignificant unless it extends to the very people who deliver it.
Radhakrishnan is an observer and writer on development and public policy
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