Paid less than unskilled labourers, Kerala community health workers go on strike

Women vital to healthcare in villages, urban wards seek better pay and reduced workload

- Rohini Mohan

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.

PAID JUST $3.50 A DAY When the Asha programme was launched in 2005, the honorarium nationwide was 500 rupees (S$7.50) a month.