Protests erupt outside Bengal’s health department as ASHA workers demand pay hike, benefits

The recent protests by Accredited Social Health Activist (ASHA) workers in West Bengal, demanding increased honorarium, life insurance, maternity leave, and permanent employee status, bring to the forefront critical issues concerning India's public health infrastructure and the welfare of its frontline workers. These protests are not isolated incidents but reflect a nationwide struggle by ASHA workers for better recognition and working conditions, highlighting systemic challenges within the National Health Mission (NHM).

**Background Context and What Happened:**

ASHA workers were conceived under the National Rural Health Mission (NRHM), launched in 2005 (later subsumed into the National Health Mission in 2013), as a crucial link between the community and the public health system. They are community health volunteers, primarily women, tasked with a wide range of responsibilities including promoting institutional deliveries, immunization, family planning, nutrition, sanitation, and disease surveillance (e.g., TB, malaria, COVID-19). They play an indispensable role in extending primary healthcare services to the remotest corners of India, especially in rural and underserved areas. However, their status as 'volunteers' rather than 'employees' means they receive an honorarium, not a fixed salary, which is often meager and performance-based. The protests in West Bengal, like many others witnessed across states such as Maharashtra, Uttar Pradesh, and Karnataka, are a direct outcome of this precarious work status and inadequate remuneration. Their demands for a higher fixed monthly honorarium, social security benefits like life insurance, maternity leave, and regularization as permanent government employees stem from the recognition of their extensive workload, critical contribution, and the inherent job insecurity and lack of benefits associated with their current status.

**Key Stakeholders Involved:**

Several key players are involved in this complex issue. The **ASHA workers** themselves are the primary stakeholders, advocating for their rights and improved working conditions. The **Central Government**, through the Ministry of Health and Family Welfare, is responsible for the overall policy framework and funding of the National Health Mission, under which ASHA workers operate. While the central government provides a significant portion of the honorarium and incentives, the **State Governments** are crucial implementers, managing the ASHA workforce, and often supplementing the central honorarium. The state health departments are the direct interface for ASHA workers. Beyond these, **local communities and beneficiaries** are indirectly but significantly impacted, as the effectiveness of primary healthcare services relies heavily on the motivation and availability of ASHA workers. Trade unions and civil society organizations also play a role in organizing and amplifying the demands of ASHA workers.

**Why This Matters for India:**

This issue holds immense significance for India across social, economic, and governance dimensions. Socially, ASHA workers are predominantly women from marginalized communities, making their struggle a matter of **social justice and gender equality**. The lack of fair wages and social security perpetuates their vulnerability. Economically, their low honorarium represents an undervaluation of critical public health work, largely performed by women. Investing in their welfare can significantly boost India's human development indicators, particularly maternal and child health outcomes, which are directly linked to ASHA's efforts. From a governance perspective, the protests highlight the challenges of effective implementation of large-scale health programs like NHM, particularly the tension between central policy guidelines and state-level execution and financing. The reliance on an informal, low-paid workforce for foundational public services raises questions about the long-term sustainability and equity of the healthcare system. The COVID-19 pandemic starkly exposed their indispensable role, as they were at the forefront of contact tracing, surveillance, and awareness campaigns, often at great personal risk and with minimal additional compensation or protection.

**Historical Context and Future Implications:**

The concept of community health workers has roots in India's public health history, evolving from village health guides in the 1970s to Anganwadi Workers and Auxiliary Nurse Midwives (ANMs). ASHA workers represent a strategic evolution to strengthen primary healthcare at the grassroots. However, the model of 'honorary' work, while intended to foster community ownership, has arguably led to exploitation given the expanding scope and intensity of their duties. The future implications are profound. If the demands for better pay and benefits are not adequately addressed, it could lead to increased attrition, demotivation, and a decline in the quality and reach of primary healthcare services, particularly impacting vulnerable populations. Conversely, recognizing ASHA workers as permanent employees with appropriate benefits would not only be a step towards social justice but also strengthen India's public health infrastructure, contributing significantly to achieving Universal Health Coverage (UHC) and meeting Sustainable Development Goals (SDGs) related to health. It would also set a precedent for better treatment of other frontline informal workers.

**Related Constitutional Articles, Acts, or Policies:**

The demands of ASHA workers resonate deeply with the **Directive Principles of State Policy (DPSP)** enshrined in Part IV of the Indian Constitution. Specifically:

* **Article 39(e)** calls upon the State to direct its policy towards securing the health and strength of workers, men and women.

* **Article 42** mandates the State to make provision for securing just and humane conditions of work and for maternity relief.

* **Article 43** directs the State to endeavor to secure a living wage and conditions of work ensuring a decent standard of life for all workers.

* **Article 47** places a primary duty on the State to raise the level of nutrition and the standard of living and to improve public health.

While ASHA workers are not classified under the formal 'employee' category, their demands for life insurance and maternity leave align with the spirit of labor laws like the **Employee's Compensation Act, 1923** (formerly Workmen's Compensation Act) and the **Maternity Benefit Act, 1961**, which aim to provide social security and support to workers. The **National Health Mission (NHM)** itself is the overarching policy framework, operating under the broader goal of providing accessible, affordable, and quality healthcare. Addressing ASHA's concerns is crucial for the effective functioning and equity of the NHM and fulfilling the constitutional mandate of public welfare.