Latest news with #Ashas
The Star
3 days ago
- Health
- The Star
Paid less than unskilled labourers, community health workers in India go on strike
BENGALURU: Thousands of community health workers in the south Indian state of Kerala have been on strike for more than 110 days. Their demands? Better pay, reduced workload, social security and dignity. This is not the first time they have protested against work conditions, nor are they the only state's health workers in India to do so. In Kerala's capital, Thiruvananthapuram, female community health workers known as Accredited Social Health Activists (Ashas) have been in a day-and-night protest opposite the state secretariat since Feb 10. Yet four meetings with state Health Ministry officials have been inconclusive. Under the national Asha programme, every village or urban ward has a resident health worker who helps ensure people's access to vaccination, safe childbirth and seasonal epidemic checks. In Kerala, these women were on the front line of the state's famously superb Covid-19 response that earned praise from the World Health Organisation. After the devastating 2018 floods in Kerala, they were also at the forefront of preventing rampant waterborne diseases. The health workers' grievances of poor pay and lack of respect stand at odds with Kerala's highly reputed public health system, which has achieved better disease control and maternal mortality and immunisation rates than most other states. Studies credit these healthcare triumphs to decentralised governance and the community engagement by more than 26,000 grassroots health workers. The Indian government defines Asha work under a national programme as voluntary, and the workers' payment an honorarium, not a wage. The workers are paid largely by the local state governments, with each state setting its own honorarium. When the Asha programme was launched in 2005, the honorarium nationwide was 500 rupees (US$5.83) a month. In Kerala, it has been gradually increased in response to protests every few years, up to 7,000 rupees a month since 2024. This still amounts to around 230 rupees a day, only a third of Kerala's legal minimum wage for unskilled labourers, which is 700 rupees. Ashas are also eligible for up to 3,000 rupees a month in performance-based incentives – this is paid by the state and national governments in a 60:40 ratio. 'I was shocked to discover how little the front-line workers of Kerala's proactive health system are paid. It's insulting,' said Dr Gopika Swarna Bai, a community health physician from Kerala who is now doing her residency in Mumbai, where Ashas are paid 13,000 rupees a month. 'Ashas know every household. For example, they spread awareness of a mass drug administration for filariasis for weeks, bring the 100 people, find chairs and shelter for them on a fixed date for doctors like me to just go and administer injections,' Dr Gopika added, noting that government nurses and doctors could be transferred, but Ashas have 'backyard knowledge' as they stay put in a region for decades. All states have raised the honorariums over the years in response to demands and protests. Neighbouring Karnataka increased the fixed honorarium from 5,000 to 10,000 rupees in January after an eight-year campaign by health workers. The north-eastern state of Sikkim has paid Ashas 10,000 rupees a month since 2022; Puducherry in the south pays them 18,000 rupees. In West Bengal, health workers retiring at 65 years old get a one-time payout of 500,000 rupees – the same amount Kerala's Ashas want. Striking health workers in Kerala are demanding minimum wages, which would amount to 21,000 rupees a month. Bindu B., a community health worker in the Kannammoola ward of Thiruvananthapuram city, points to 'the hypocrisy of the communist-led state government that enjoys the plaudits of being people- and worker-centric leaders, but treats women workers almost like slaves'. The 51-year-old, who has been an Asha for 18 years, spoke to The Straits Times on May 30 as she was headed to the protest site, even though there was an orange alert for rainstorms that week. At least 12,000 Ashas like her have endured extreme rain and heat for over 110 days, and held dramatic protests, including a 41-day hunger strike and cutting their hair off. Some of them are now on a statewide march, spending the night under bus shelters or on school verandas as they reach out to Ashas who may not have been able to travel to the Thiruvananthapuram protest site. 'The government's response is that they don't have funds, that the central government has not transferred the budget,' said S. Mini, state vice-president of the Kerala Asha Health Workers Association, which is helming the ongoing strike. Kerala is among several states, such as Tamil Nadu and Telangana, led by opposition parties demanding a greater share of taxes from Indian Prime Minister Narendra Modi's Bharatiya Janata Party government at the centre. India spends a mere 1.14 per cent of its budget on public health. 'Understanding Kerala's financial situation, we asked the (Kerala) Health Minister to increase the pay for now by 100 rupees a day, so that we can get 10,000 rupees a month at least,' said Rosy Mardra, 51, an Asha who was part of the delegation that met officials, of the last meeting. 'They refused even that.' Kerala's Health Ministry has yet to respond to ST's queries. A state official, who requested anonymity, pointed ST to a recent central government study that found the state's financial health poor, ranking 15th among 28 states owing to high social welfare spending and limited revenue growth. He also argued that Kerala paid the honorariums more regularly than other states that promised more, but Ashas have refuted this claim, saying they sometimes do not get paid for over three months. Rosy, struggling to repay loans she took to send her two daughters to college, was enraged by what she called 'the government's cruel excuses'. 'Amid this financial crunch, how come the Kerala government has 100 crore (one billion) rupees to celebrate its fourth anniversary, but does not give us 100 rupees more?' she asked. The cost of living in Kerala is higher than the national average. Some estimates put average monthly expenses excluding rent at more than 27,000 rupees per month. Almost all Ashas in Kerala are from low-income families, and three-quarters are sole breadwinners while a quarter are Dalits, who are at the bottom of India's caste hierarchy, said feminist scholar J. Devika, who conducted spot surveys of striking health workers. 'Families in Kerala are kept safe by these women's cheap labour. They've clearly had enough. Without committed, financially secure Ashas, the state's health indices and disease control will collapse,' she added. Since joining the service at the age of 32, Bindu's work hours have ballooned from two hours a day, per government guidelines, to at least 12 hours a day of fieldwork and report writing. She is responsible for 950 households, and performs 100 tasks each month assigned by the national health programme. These include registering pregnancies, ensuring child immunisations, doing leprosy checks, detecting sources of waterborne diseases, and monitoring fevers or other symptoms in vulnerable populations during epidemics. Kerala has assigned her ten other responsibilities, such as conducting surveys for the local government and digitising a lot of health data. Some days, she is chlorinating wells, and other days, she is collecting diabetes data from every household. The latest task, which many Ashas told ST was a trigger for the ongoing strike, was the Kerala government's app-based statewide screening for non-communicable diseases. Launched in 2023 to detect and prevent lifestyle diseases, the Shaili app's initial phases have shown 45 per cent of the population at risk for diabetes, cancer, tuberculosis and hypertension. But Ashas alleged that having to ask 60 questions a household within tight deadlines over a glitchy app, which does not work in areas with poor data networks, made the job so onerous that it affected other tasks. 'Even as the workload grew and took on a compulsory nature, the pay remains an honorarium fit for volunteers,' social activist Shradha S. said, also a co-founder of a menstruation awareness collective in Kerala. 'The current pay is too little and too erratic, and I keep having to take loans to get by,' said Bindu, who recently took on a second job to make ends meet. After dusk, she delivers medicine for a neighbourhood pharmacy. It pays her 10,000 rupees a month. 'After my husband died a decade ago, my son had to drop out of college to work, and I married my daughter off early at 20 years to have one less mouth to feed,' she told ST. To Bindu, the strike was 'the only step left to save me from dying of exhaustion'. The strike has had a few wins, with Kerala's Health Minister, Veena George, announcing that the Ashas' monthly pay is no longer tied to the fulfilment of ten state tasks, although the fine print reveals that it is still tied to the incentives. The state has also formed a committee to investigate the need for a pay hike. But Chief Minister Pinarayi Vijayan has stated that the government will not engage in further negotiations. As the monsoon sets in, the health workers will also have to begin awareness campaigns to prevent waterborne and mosquito-related diseases like dengue, filariasis and malaria. Cognisant of the impact of their absence on the community, and struggling without any income for three months, most Ashas have gone back to work now. But many are still making time to spend a few hours at the protest site. 'What began as a simple protest seeking fair compensation and lower workload has now turned into a cry for respect and parity,' said Rosy. Bindu has been going to the protest site and conducting her fieldwork despite requiring rest for a ligament tear. 'In my area, there is one palliative care patient with cancer; 13 senior citizens, of whom eight are on (intravenous drips); 150 children are under five years old; 14 kids are under one year (old). I know where mosquitoes breed regularly. This week, four people had a fever – I took them for testing, and two turned out positive for Covid-19.' She asked: 'Who will know people in this detail if I don't go to work? 'Why doesn't the government see us?' - The Straits Times/ANN
Straits Times
5 days ago
- Health
- Straits Times
Paid less than unskilled labourers, community health workers in India go on strike
Through intense rain and heat, over 26,000 community health workers in Kerala have demanded minimum wages, less workload and retirement benefits. PHOTO: COURTESY OF KAHWA, HARSH Paid less than unskilled labourers, community health workers in India go on strike – Thousands of community health workers in the south Indian state of Kerala have been on strike for more than 110 days. Their demands? Better pay, reduced workload, social security and dignity. This is not the first time they have protested, nor are they the only state's health workers in India to do so. In Kerala's capital, Thiruvananthapuram, female community health workers known as Accredited Social Health Activists (Ashas) have been on a day-and-night protest opposite the state secretariat since Feb 10. Yet, four meetings with state health ministry officials have been inconclusive. Under the national Asha programme, every village or urban ward has a resident health worker who helps ensure people's access to vaccination, safe childbirth and seasonal epidemic checks. In Kerala, these women were on the front line of the state's famously superb Covid-19 response that earned praise from the World Health Organisation. After the devastating 2018 floods in Kerala, they were also at the forefront of preventing rampant waterborne diseases. The health workers' grievances of poor pay and lack of respect stand at odds with Kerala's highly reputed public health system, which has achieved better disease control and maternal mortality and immunisation rates than most other states. Studies credit these healthcare triumphs to decentralised governance and the community engagement by more than 26,000 grassroot health workers. The Indian government defines Asha work under a national programme as voluntary, and their payment an honorarium, not a wage. T he workers are paid largely by the local state governments, with each state setting its own honorarium. Paid just 230 rupees (S$3.50) a day When the Asha programme was launched in 2005, the honorarium nationwide was 500 rupees (S$7.50) a month. In Kerala, it has been gradually increased in response to protests every few years, up to 7,000 rupees a month since 2024. This still amounts to around 230 rupees or S$3.50 a day, only a third of Kerala's legal minimum wage for unskilled labourers, which is 700 rupees. Ashas are also eligible for up to 3,000 rupees a month as performance-based incentives – this is paid by the state and national governments in a 60:40 ratio. 'I was shocked to discover how little the front-line workers of Kerala's proactive health system are paid. It's insulting,' said Dr Gopika Swarna Bai, a community health physician from Kerala who is now doing her residency in Mumbai, where Ashas are paid 13,000 rupees a month. 'Ashas know every household. For example, they spread awareness of a mass drug administration for filariasis for weeks, bring the 100 people, find chairs and shelter for them on a fixed date for doctors like me to just go and administer injections,' Dr Gopika added , noting that government nurses and doctors could be transferred, but Ashas have 'backyard knowledge' as they stay put in a region for decades. Striking health workers in Kerala are demanding minimum wages, which would amount to 21,000 rupees a month. PHOTO: COURTESY OF KAHWA, HARSH All states have raised the honorariums over the years in response to demands and protests. Neighbouring Karnataka increased the fixed honorarium from 5,000 to 10,000 rupees in January after an eight-year campaign by health workers. The north-eastern state of Sikkim has paid Ashas 10,000 rupees a month since 2022; Puducherry in the south pays them 18,000 rupees. In West Bengal, health workers retiring at 65 years old get a one-time payout of 500,000 rupees – the same amount Kerala's Ashas want. 'Government's cruel excuses' Striking health workers in Kerala are demanding minimum wages, which would amount to 21,000 rupees a month. Ms Bindu B ., a community health worker in the Kannammoola ward of Thiruvananthapuram city, points to 'the hypocrisy of the communist-led state government that enjoys the plaudits of being people- and worker-centric leaders, but treats women workers almost like slaves'. The 51-year-old, who has been an Asha for 18 years, spoke to The Straits Times on May 30 as she was headed to the protest site, even though there was an orange alert for rainstorms that week. At least 12,000 Ashas like her have endured extreme rain and heat for over 110 days, and held dramatic protests, including a 41-day hunger strike and cutting their hair off. Some of them are now on a statewide march , spending the night under bus shelters or in school verandas as they reach out to Ashas who may not have been able to travel to the Thiruvananthapuram protest site . 'The government's response is that they don't have funds, that the central government has not transferred the budget,' said Ms S. Mini, state vice-president of the Kerala Asha Health Workers Association that helms the ongoing strike. Kerala is among several states, such as Tamil Nadu and Telangana, led by opposition parties demanding a greater share of taxes from Prime Minister Narendra Modi's Bharatiya Janata Party government at the centre. India spends a mere 1.14 per cent of its budget on public health. 'Understanding Kerala's financial situation, we asked the (Kerala) health minister to increase the pay for now by 10 rupees a day, so that we can get 10,000 rupees a month at least,' said Ms Rosy Mardra, 51, an Asha who was part of the delegation that met officials, of the last meeting. 'They refused even that.' Kerala's health ministry has yet to respond to ST's queries. Ms Bindu B., 51, has been a community health worker in Kerala for 18 years. PHOTO: COURTESY OF BINDU A state official, who requested anonymity, pointed ST to a recent central government study that found that the state's financial health poor, ranking 15 among 28 states due to high social welfare spending and limited revenue growth. He also argued that Kerala paid the honorariums more regularly than other states that promised more , but Ashas have refuted this claim, saying they sometimes do not get paid for over three months. Ms Rosy, struggling to repay debts she took to send her two daughters to college, was enraged by what she called 'the government's cruel excuses'. 'Amid this financial crunch, how come the Kerala government has 100 crore (one billion) rupees to celebrate its fourth anniversary, but not give us 10 rupees more?' she asked. The cost of living in Kerala is higher than the national average. Some estimates put average monthly expenses excluding rent at more than 27,000 rupees per month. Almost all Ashas in Kerala are from low-income families, while three-quarters are sole breadwinners, and a quarter are Dalits, who are at the bottom of India's caste hierarchy, said feminist scholar J. Devika, who conducted spot surveys of striking health workers. ' Families in Kerala are kept safe by these women's cheap labour. They've clearly had enough. Without committed, financially secure Ashas, the state's health indices and disease control will collapse,' she added. Ever-increasing workloads Since joining the service at the age of 32, Ms Bindu ' s work hours have ballooned from two hours a day, as per government guidelines, to at least 12 hours of fieldwork and report writing. She is responsible for 950 households, and performs 100 tasks each month assigned by the national health programme. These include registering pregnancies, ensuring child immunisations, doing leprosy checks, detecting sources of waterborne diseases, and monitoring fevers or other symptoms in vulnerable populations during epidemics. Kerala has assigned her 10 other responsibilities, like conducting surveys for the local government and digitising a lot of health data. Some days, she is chlorinating wells, and other days, she is collecting diabetes data from every household. The latest task, which many Ashas told ST was a trigger for the ongoing strike, was the Kerala government's app-based state-wide screening for non-communicable diseases. Launched in 2023 to detect and prevent lifestyle diseases, the Shaili app's initial phases have shown 45 per cent of the population at risk for diabetes, cancer, tuberculosis and hypertension. But Ashas alleged that having to ask 60 questions per household within tight deadlines over a glitchy app that does not work in areas with poor data networks made the job so onerous that it affected other tasks. 'Even as the workload grew and took on a compulsory nature, the pay remains an honorarium fit for volunteers,' said social activist Ms Shradha S. , also a co-founder of a menstruation awareness collective in Kerala . 'The current pay is too little and too erratic, and I keep having to take loans to get by,' said Ms Bindu , who recently took on a second job to make ends meet. After dusk, she delivers medicines for a neighbourhood pharmacy. It pays her 10,000 rupees a month. 'After my husband died a decade ago, my son had to drop out of college to work, and I married my daughter off early at 20 years to have one less mouth to feed,' she told ST. The cost of living in Kerala is higher than the national average. Some estimates put average monthly expenses excluding rent at more than 27,000 rupees per month. PHOTO: COURTESY OF KAHWA, HARSH To Ms Bindu, the strike was 'the only step left to save me from dying of exhaustion'. The strike has had a few wins, with Kerala's state health minister, Ms Veena George, announcing that their monthly pay is no longer tied to the fulfilment of 10 state tasks, although the fine print reveals that it is still tied to the incentives. The state has also formed a committee to investigate the need for a pay hike. But Chief Minister Pinarayi Vijayan has stated that the government will not engage in further negotiations. A heart for the people As the monsoon sets in, the health workers will also have to begin awareness campaigns to prevent waterborne and mosquito-related diseases like dengue, filariasis and malaria. Cognisant of the impact of their absence on the community, and struggling without any income for three months, most Ashas have gone back to work now. But many are still making time to spend a few hours at the protest site. 'What began as a simple protest seeking fair compensation and lower workload, has now turned into a cry for respect and parity,' said Ms Rosy. Ms Bindu has been going to the protest site and doing her field work her despite requiring rest for a ligament tear. 'In my area, there is one palliative care patient with cancer. Thirteen senior citizens, of whom eight are on IVs, 150 children are under five years old, 14 kids are under one year. I know where mosquitoes breed regularly. This week, four people had a fever – I took them for testing, and two turned out positive for Covid-19. 'Who will know people in this detail if I don't go to work?' she asked. 'Why doesn't the government see us?' Rohini Mohan is The Straits Times' India correspondent based in Bengaluru. She covers politics, business and human rights in the South Asian region. Join ST's Telegram channel and get the latest breaking news delivered to you.
Hindustan Times
11-05-2025
- Health
- Hindustan Times
Maternal health needs all of us: Midwives, men, and the power of shared care
In a government hospital in Rajasthan, a young woman named Lakshmi enters for her prenatal checkup, her heart pounding with fear. It is her first pregnancy, and so many unknowns lie ahead. Will she face this journey alone? Then something unexpected happens… she is greeted by a midwife who wears pink scrubs and a moustache. Yes, a male midwife. He speaks softly, explains everything clearly, and includes her husband in the conversation, showing him how to support her. In that moment, Lakshmi's isolation transforms into connection. Her fear dissolves into confidence. This is not just Lakshmi's story. This is the future of maternal healthcare in India, where no woman walks alone. India has reduced maternal deaths by 78% between 2000 and 2023. This means one million more mothers are alive today, raising children and building communities. How did this happen? Over the past two decades, India's commitment to maternal healthcare has been driven by a series of government-led initiatives that are empowering women to make more informed choices about their care. During village health, sanitation and nutrition days, Ashas and auxiliary nurse midwives (ANMs) deliver essential services at the grassroots. At the same time, major schemes like Janani Suraksha Yojana (JSY) have boosted institutional deliveries whereas Janani Shishu Suraksha Karyakram (JSSK) guarantees free healthcare for mothers and newborns. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) further offers free, quality antenatal checkups. Newer programmes such as Surakshit Matritva Aashwasan (SUMAN) and LaQshya have enhanced the quality of maternal care and labour rooms. Because of India's efforts to support family planning, there has been a 56% uptake of modern contraceptive use, with each woman having on average two children, empowering women to plan their families and pregnancies better. These efforts, strengthened by continuous community outreach, have improved maternal and newborn health outcomes. But here is the hard truth: many women still face risks that are largely preventable. In states such as Bihar, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand, and Assam, many women, especially from underserved communities, continue to face life-threatening risks during childbirth, especially in remote areas. These women are not statistics. They have names, families, hopes, and rights. Progress means ensuring that every woman, regardless of where she lives, her financial and social identity, has access to the care she needs to bring new life into the world safely and with dignity. The solution is not complicated. It lies with having more midwives. Around the world evidence shows that when midwives are trained and integrated into health systems, they can deliver nearly 90% of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services. Recognising this, India has been building something remarkable since 2018: a group of highly skilled nurse practitioners in midwifery. Across 12 states, eight national and 14 state midwifery training institutes are shaping a new generation of midwives. The institutions do not just teach clinical excellence… they nurture compassion, empathy, and respect. Many are embracing cutting-edge tools like virtual reality simulations, giving trainees hands-on experience before they step into labour rooms. These midwives are not just healthcare providers; they are guardians of safe birth and champions of women's dignity. And now increasingly, they are men. However, when male nurse in a conservative community decides to become a midwife, he faces multiple challenges. His friends taunt him. His family questions. Society raises eyebrows. Yet he persists. Why? Because he sees something others do not: that bringing life into the world should not be a women's burden alone. Real strength is not shown by standing outside the delivery room, it is demonstrated by standing beside a woman during her most vulnerable hours. At SMTI (State Midwifery Training Institute) Jaipur, male midwives often share a common insight: 'It is not about big gestures. It is the small things that matter, welcoming and reassuring her when she comes into labour, explaining procedures clearly, respecting her choices, involving her family.' These male midwives are cultural catalysts, redefining masculinity one birth at a time. The change extends beyond the hospital. Husbands who once paced nervously outside are now invited in to hold hands, to wipe tears, to witness the miracle of their child's first breath. And something remarkable happens: Men who participate in birth tend to participate in childcare. They support recovery. They become advocates for women's health. In communities across India, fathers who have been present during childbirth share a common sentiment: 'I thought giving birth was a woman's business. Now I understand this is a family concern.' Midwifery-led care can prevent two-thirds of maternal and newborn deaths by 2035. Every $1 invested in midwives brings up to 16 times the return in social and economic benefits. With 26 million births a year and a shortage of 1.8 million healthcare workers, India needs smart, urgent solutions. Midwives, trained faster and at lower cost than doctors, can bridge the gap handling normal pregnancies so doctors can focus on complex cases. The way ahead is simple: Expand midwife training, bring more men into the profession, promote family-centered births, and strengthen community support for women's health. Above all, maternal health must be seen as a basic human right. UNFPA stands committed to India's midwifery movement. Together, we can ensure that every birth is safe, every mother is valued, and every family has the chance to flourish. Andrea M Wojnar is UNFPA India Representative and Country Director Bhutan. The views expressed are personal
Time of India
10-05-2025
- Health
- Time of India
Maradu municipality approves Rs 3,000 monthly honorarium for ASHAs
Kochi: In a significant move to address long-standing demands, Maradu municipality approved a monthly honorarium of Rs 3,000 for Accredited Social Health Activists (ASHAs). The decision was taken during an emergency council meeting convened on Friday and marks a crucial step towards recognizing the contributions of grassroots health move follows persistent protests and formal appeals by ASHAs, who sent letters to local self-government minister, principal director, district planning committee and other officials, demanding a hike in monthly pay. The proposal was passed unanimously, except for one abstention by division 1 councillor and ASHA worker Shalini Anil Raj, who opted out of the the municipality earmarked an additional Rs 2,000 in its annual budget as a special allocation for ASHAs. However, implementing this provision required both council approval and state govt sanction. The recent council meeting not only endorsed the proposal but also agreed to increase the amount to Rs 3,000 per worker per month."Ashas play a key role in Maradu's health services. When there is a collective struggle by them, we found it important to take an initiative to support them," said municipality chairperson Antony Ashanparambil. Earlier, Ashanparambil donated his monthly honorarium to ASHAs in solidarity with their protest in added that the resolution has now been forwarded to state govt for final approval and requested that necessary steps be taken to ensure immediate implementation of the decision.
BBC News
13-03-2025
- Health
- BBC News
Asha: Indian health workers protest for better pay and recognition
Thousands of frontline healthcare workers in southern India's Kerala state, who have been holding demonstrations for the past month seeking better pay and recognition, have vowed to continue their 26,225 female workers, known as Accredited Social Health Activists or Ashas (Hindi for hope), have been holding protests near the state government headquarters in the capital city of protesters, who provide crucial medical support in the country's rural areas, say they plan to "lay siege" to the state secretariat in the coming week, if authorities continue to ignore their Ashas, who number more than a million across the country, are fighting for better salaries and for official "worker" women are currently categorised as volunteers, which means they are not guaranteed any benefits from the government, despite playing a crucial role in delivering healthcare in rural and underserved Monday, Shashi Tharoor, an MP from Kerala, said the Asha volunteers were "unsung heroes" of India's healthcare system and the "protests highlight the systemic undervaluation of community health workers in India and in particular in Kerala".India's federal health minister recently told parliament that the government would raise incentives for the workers. Authorities in Kerala, meanwhile, have released three months of pending state's health minister also said Kerala would request the federal government to recognise these women as regular workers and not state government, however, has insisted that the money it offers to the Ashas is the highest in the country. But the protesters said state authorities had not engaged in talks with them and accused them of instead employing tactics to suppress their week, police removed the plastic tarpaulin sheet the protesters had tied overhead at the site of their sit-in demonstration, exposing them to direct Ashas - who get an honorarium of 7,000 rupees and not a salary because they are volunteers and not workers - say they want the payment to be increased to 21,000 rupees ($240.8; £186.2) and retirement state's Health Minister Veena George, however, says that 90% of the Ashas earn between 10,000-13,500 rupees per month, including incentives."They are entitled to maternity leave, and measures are taken to prevent excessive workload," she some of the protesting women counter these Thankamony, one of the protesters, said she received only 6,300 rupees as honorarium in October 2024."They deducted 700 rupees for a meeting I missed because I was sick and had to go to hospital."When the 45-year-old joined the Ashas 17 years ago, she worked only for an hour or two a day, she said."Now I am so burdened with work that a whole day does not suffice," she told the BBC."This is a matter of social justice," Saboora Arifa, one of the Asha protest co-ordinators told the BBC. "Those who work eight hours a day are not volunteers. We have every right to get worker status." In a country where millions of Indians, especially in the remote areas, do not have access to quality healthcare, the Asha workers have played a vital role over the job involves going door-to-door to raise awareness about nutrition, sanitation, immunisation and providing neonatal and antenatal care, among other played a crucial role during the Covid pandemic, especially in Kerala which was first to report a Covid case, and have been credited for successfully containing outbreaks of Zika and Nipah Joe Thomas, a Melbourne-based public health policy analyst, believes India should change its perception of these community health workers whose contribution to primary health is universally workers are doing the job of midwives in Kerala after the state's health authorities froze recruitment of midwives, he told the BBC. "The maternity care support has slowly been shifted to Ashas."According to him, 90% of the women in Kerala get prenatal care like testing, nutrition supplements and advice from Asha volunteers."Kerala takes pride in achieving 99% vaccination," says Dr Thomas. "The credit for its vaccination success goes to the Ashas. Their contribution to primary health in Kerala is that they are the only people working on prevention." The protest in Kerala is only the latest in a series of protests by these community health workers across this year, neighbouring Karnataka state increased its honorarium amount to 10,000 rupees after Asha volunteers went on last year, volunteers in Andhra Pradesh held several state-wide protests. This month, the state became the first in the country to give its workers a gratuity of 150,000 rupees ($1,723; 1,330), along with paid maternity leave of 180 days, and raised retirement age from 60 to 62.
