This is the 200th day of the Asha protest in Kerala. The workers have been holding on to stubborn hope for half a year. The Kerala Asha Health Workers’ Association (KAHWA) has now set up a small library and a sewing machine, at their protest site in front of the Secretariat. As a protesting Asha worker put it succinctly, “This conveys that we are not moving from here until our demands are met.”
Not much has changed in the governance since the strike began on February 10, 2025, after months of neglect and rejected appeals from the union to the state government – for a minimum daily wage of Rs. 700, Rs. 5 lakh one-time pension at retirement, removal of mandatory retirement age of 62 years, reduced workload and arbitrary tasks allocation, and regular payment of monthly wages. In response the state government did not increase their wages, gave a temporary freeze on the retirement age. The delay in monthly payments has reduced. The Health and Family Welfare Department issued the government order 736/2025/H&FWD on March 12, 2025, making the monthly honorarium conditional upon the fixed and performance based incentives instead of fulfilment of tasks listed in GO 483/2023 H&FWD, an order issued on March 2, 2023. The government also slandered the workers on strike as being politically corrupt and irresponsible, intentionally spread misinformation and blamed the union government.
The Bermuda Triangle of Asha benefits
Asha workers learnt of a betrayal towards the end of July, this year. That their colleagues who left the service have been eligible for a cash award of Rs 20,000 and a citation in recognition of their services, but never got it. It was in February 27, 2018, at the 5th Mission Steering Group (MSG) meeting, that the union government approved this recognition amount. MSG is the highest policy making institution under National Health Mission (NHM). The 9th MSG meeting held on March 4, 2025, increased the cash award from Rs 20,000 to Rs 50,000. Neither Asha workers nor their unions got a whiff of this, until media reported about this seven years later. Because of a question in the Lok Sabha by Kollam MP N K Premachandran on July 25, 2025, to which Minister of State for Health and Family Welfare Prataprao Jadhav responded.
Obviously perplexed, Asha workers enquired why no one received even the previously announced Rs 20,000. NHM state mission directorate, in response to an RTI query, nonchalantly stated that no one was given this money, because no Asha worker applied for it.
The Asha benefit package, which includes three insurance schemes, was another union government decision from 2018 yet to reflect in Asha workers’ lives. There were industrious Asha workers, who died while in service, whose families never received the Rs 2 lakh benefit from Pradhan Mantri Jeevan Jyoti Beema Yojana (PMJJBY).
An Asha worker recalled how one of their colleagues, now deceased, had chronic conditions and would eagerly share she was an Asha worker while visiting government hospitals, hoping that would get her some support. She would always get a disappointing “no” as an answer. Even at government hospitals she couldn’t afford certain specialty treatments and passed away. She didn’t know the 2018 decision of ASHAs along with their family members getting provided with health care annual coverage of ₹ 5 Lakhs under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
The package also announced the Pradhan Mantri Suraksha Beema Yojana (PMSBY) with a benefit of Rs.2.00 lakh for accidental death or permanent disability; ₹1.00 lakh for partial disability (annual premium contributed by GOI). In addition, since 2018, Asha workers over the age of 60 have been also eligible for a pension benefit of Rs 3000, where GoI paid half the premium and the worker had to put in the other half. For Asha workers, these too were new pieces of information; surprises delivered a bit too late.
Incentives are also missing
At the March 2025 meeting, MSG decided to increase the fixed incentive of Asha workers for routine and recurring activities from Rs 2000 to Rs 3500. MSG is the highest policy making institution under NHM. According to the NHM website, “The Mission Steering Group is fully empowered to approve financial norms in respect of all schemes and components which are part of NHM.” Despite its powers, the 9th MSG decisions are yet to be implemented, as is evident from the payment to Asha workers in Kerala from April onwards.
Kerala Health Minister Veena George, while speaking to the media, had promised that if the union government increases Asha incentives, the state government will also follow, in a 60:40 proportion. (Kerala to pay 40 per cent incentives, when the union government pays 60 per cent.) Earlier too the minister had claimed that state government has been matching the union government incentive in a 60:40 proportion. However the total amount of fixed incentive (adding both union and state components) that Asha workers in Kerala receive is just Rs 3000. Which means that Kerala has been giving just Rs 1000 as fixed incentive — not the 60:40 proportion that the state has been claiming.
What’s more, an RTI query revealed that the union government increased the fixed incentive to Rs 2000, from Rs 1000, in a cabinet decision in 2018-2019. However no Asha worker has ever received this Rs 1000 as their fixed incentive before 2018, according to KAHWA representatives.
This RTI query also revealed that since 2018, the union government has been giving Rs 1000 to all Asha workers as Team Based Incentives (TBI). However, KAHWA says that in Kerala, only one Asha worker each at a PHC got this Rs 1000. Getting this Rs 1000 was conditional to doing a duty at a Wellness Clinic under the PHC. This led to resentment among Asha workers, a valid emotion considering the severe financial stress in their lives. Since this was a concern, KAHWA even requested the state government to make this a rotational activity. It was only from this year in April that everyone started getting the TBI.
Worker not volunteer
Asha is an acronym expanded as Accredited Social Health Activist. There is no doubt that the framework for Asha, laid by the UPA government and later revised by the NDA government treats women who enrol as Asha as a “honorary volunteer” and complementary to the communitisation programme under National Health Mission. While the stated aim was to empower women and build leadership from the grassroots, this has established a system that has allowed for economic exploitation, particularly within a poorly maintained public health infrastructure – a consequence that may not have been fully anticipated. Health being a state subject as per the Indian constitution, state governments started using Asha workers to fill the paucity in the health infrastructure, without adequate compensation.
Kerala’s present LDF government is no exception to this. In fact the March 2023 government order mentioned above revises the nature of Asha in the state with more heavy lifting under the state government health programme called Aardram Mission. To get an idea of how poorly the workers get paid, just ask them how much they make from Shaili survey, a state government digital survey of people above 30 years, for finding incidence of lifestyle diseases. For every person surveyed the Asha worker earns just Rs 5. This elaborate questionnaire takes anywhere between 30 min to one hour per person. The per hour remuneration of a minimum wage earner is at least Rs 100, in Kerala. In that hour, an Asha worker earns just Rs 5-10 from their Shaili work. This is just one of the many instances of how little an Asha worker’s time and services are valued at.
Yet, the fact that the government is forcing ASHAs to work under exploitative conditions and effectively withholding their rightful pay is largely overlooked by mainstream media and academic discourse. Whatever noise that is made in these lines are by the unions and independent civil society.
Underpaid, overworked, Bahujan and women
Wage-earning Asha workers who lack job security get supervised by salaried employees with a stable government job — Medical Officers, Junior Health Inspectors (JHI) and Junior Public Health Nurse (JPHN). These officials mark their attendance, evaluate if the tasks are performed to their satisfaction and decide how much Ashas can earn for their labour in a particular month. They can even terminate the service of an Asha worker.
More importantly their everyday demeanour with Asha workers can go unchecked, as their superiors cannot monitor them constantly and Asha workers themselves hesitate to approach the grievance redressal mechanisms set up for them. This year, an Asha worker who met with an accident, needed one more month of leave, while she recovered at a hospital. Her medical officer threatened to deny her honorarium. Such stories are heartbreakingly normal for Asha workers.
This kind of power dynamic which places these women workers at the bottom is flawed right from the beginning.
In addition, the workers become all the more vulnerable, as many of them come from marginalised communities. A survey of 50 protesting Asha workers by social scientist Dr J Devika revealed that 20% of the protestors were of the SC category and 52% of the OBC category. Since the total percentage of Dalit people in Kerala is 9.8% (2011 census) there is an over-representation of Dalit Asha workers — in a highly extractive and underpaid job.
Since there is an over-representation of Hindu dominant caste communities in government service, the chance of an Asha worker encountering dominant caste JHIs and JPHNs is pretty high. (According to a report by Kerala State Commission for Backward Classes presented in the Kerala Legislative Assembly in July 2024, 19.8 per cent of government staff were Nair people, while according to 2011 census, their total population in Kerala stood at 14%.)
Asha workers see themselves as people who make necessary health services accessible to the community. But for the government official, these are low-income labourers, whose agency can be undermined. They are not offered any capacity strengthening opportunities other than the skills training for bare minimum health intervention and services.
Many of these officials are part of unions affiliated with CITU. This too increased the possibility of a backlash after the protest. Asha workers shared how some officials made it mandatory for Asha workers to visit the PHC almost daily, after the protest. There were also accounts of officials asking Ashas for everyday filing of reports. Once, on a Sunday, when we were sitting at the Secretariat site, a protestor received a call from their JHI, asking where they were. That this was on a weekend didn’t matter to the official.
Asha workers are not treated like volunteers, except at the time of deciding their pay.
“As if Ashas themselves were a caste”
While no Asha worker has raised complaints of explicit casteism, many have experienced class-based discrimination from the officials. They even get assigned tasks which disregard their role as a community healthcare worker — like cleaning hospital toilets ahead of an immunization drive, though this is outside the scope of NHM guidelines. Some have also shared that JPHNs would publicly berate them if they even find a small cob web in the toilet.
At a Primary Health Centre (PHC) in Thiruvananthapuram Ashas did all the dangerous field work at their PHC, during the pandemic year. According to the Asha worker who talked about this, while they slogged and exposed themselves to Covid patients without even PPE kits, “the medical officer, JHI and JPHN stayed in and enjoyed cool drinks.”
Another Asha worker shared how they were kept out of Onam celebrations for years, until a new medical officer, a woman, invited them in. “It is as if Asha workers themselves form a different caste,” she said.
Resisting injustice
But what has six months of the Kerala Asha Health Workers Association (KAHWA) strike achieved? Short answer: thousands of gritty women. A dictum we kept hearing from various protestors, each of whom were describing a separate instance of resistance, was “Prathikarikkathavare kashtappeduthum.” (They make it difficult for the ones who don’t stand up for themselves.)
Now, when they are given tasks which don’t come under NHM guidelines, they politely ask if there is a government order which mandates it. When a worker didn’t receive her full honorarium, as the JPHN made a clerical error, her fellow Asha workers insisted that she get paid. These may sound tiny but is a world of transformation for many workers.
Political ambitions
CPI(M) leaders have repeatedly painted Asha workers as people who were misled by political parties, as if they lack agency. The Asha workers in their imagination don’t have their own political views. Perhaps they forgot the statistics shared in the legislative assembly this year, by Health Minister Veena George. According to this, 729 Asha workers are people’s representatives, of which 113 are holding the offices of panchayath President, Vice President or Standing Committee Chairpersons.
Insightful Asha workers share that this number is only going to increase in the upcoming panchayath elections. Anithakumari R, an Asha worker who served as a panchayath ward member at Kadinamkulam panchayath from 2020 to 2025, says, “The panchayath elections are round the corner, right? Just wait and see. Asha workers are in great demand after the protest. All political parties are seeking Asha workers for wards reserved for women. The times have changed.” Indeed it has.
In 2011, the state government had issued an order to remove Asha workers who were elected as local body representatives. The aggrieved workers challenged it legally and got a stay order from High Court. In 2023, the GO 483/2023 H&FWD was issued allowing local body representatives to continue in their Asha service as long as they were not local body chairpersons, vice chairpersons presidents, vice presidents or standing council members.
Before this government order, whether or not they got the honorarium depended on the JPHN. Anithakumari didn’t receive the Asha honorarium even after 2023, till the end of her term as panchayath ward member. However in her panchayath, another Asha worker also became a ward member during the same term. Anithakumari says that the other Asha, who was a CITU member, got three remunerations — Asha honorarium, panchayath member honorarium and MGNREGA remuneration — all through her term. The JPHN who supervised this worker was also a CITU member, according to Anithakumari.
Jayachitra S elected as a Panchayath member from Pallichal panchayath in 2015 was asked by the JPHN to file a leave application, temporarily relieving her of her duties. She did as asked. At the end of her term, she learnt that her services as an Asha worker were terminated. “Perhaps the JPHN didn’t forward the application,” says Jayachitra. The vacancy has not been filled to this day.
Despite these setbacks, the order allowing the workers to hold the office of a ward member is seen as a hard won victory.
The ‘Anarchists’ behind the protest
CPI(M) and CITU leaders don’t see the irony of using the word “anarchist” as an insult, even though anarchism has been historically a left movement. They hurled this word at KAHWA, and used it in sentences meant to discredit the protest. They claim that the protest is not valid because KAHWA does not have “real Ashas.”
Since 2015 KAHWA has facilitated the organising and collective bargaining power of ASHAs across Kerala – from a membership of 3500 they now estimate their membership increased. Moreover more than 15000 Asha workers, including workers from major trade unions like CITU, have participated in the strike, as per the protest register maintained by KAHWA. We have talked to Asha workers from CITU-affiliated AWWFI, at the protest site. Some of the CITU Ashas have travelled from other Kerala districts to be part of KAHWA’s Secretariat day and night protest.
The number 15000 is more than half of the ASHAs in Kerala (totalled at around 26,000). Unions are commonly seen as men-lead, lazing headload workers asking for “nokku kooli” and disrupting the “efficiency” of organisations. That such a lazy definition of unions and total ignorance of picketing and strike organising exists in a literate, left leaning Kerala “model” is ironic. Unions exist as a safeguard for workers who can be easily subjected to exploitation otherwise.
Despite being a minority union, KAHWA has demonstrated that as a women-led union it has the support of public sympathy and can disrupt the status quo, as seen in their relentless campaigning in the recent Nilambur by-election. Their campaign “apamanichavarkku vottilla” (“no vote for the ones who insulted”) captured media attention, and forced M Swaraj, the LDF candidate, to eventually acknowledge that Asha honorarium need to be increased. His defeat may be because of many other factors, but never in the history of modern Kerala, a left candidate been openly challenged by women workers mobilising against the LDF apathy towards their rights. Beyond Kerala’s borders, the LDF government is often lauded as a final stronghold of the left. Its young leaders are even held up by the left’s social media channels as counterparts to figures like Cortez and Mamdani in American democratic socialist politics. Such comparisons, however, often reveal a significant misunderstanding of the American electoral system.
The left leaning liberals and elites are not far behind, celebrating the mayoral primary as a revolutionary breakthrough and a “sign of hope” in these dire times, while cosying up to the LDF here against whom workers, fisher communities and adivasis continue to struggle and strike. Apparently the glamour of the working class in the Bronx supersedes the unrefined mobilisations in their neighbourhoods. The recent elections in Nilambur, and its local candidates, also garnered attention. But what was conveniently sidelined was the ground-level victory achieved by the ASHAs, mobilising with their powerful slogan: ‘those who insulted us will not get our votes.’ Instead, their success was often reframed as a mere failure of a broader ‘secular project’.
The committee, which Kerala government appointed, to study the issues of the ASHAs reportedly submitted its recommendations in the last week of August. According to news reports, an increase in honorarium by Rs 3000 and a retirement benefit of Rs 1 lakh has been suggested. If we go by the Hema Committee playbook and the subsequent failure of political will and feminist solidarities then not much hope can be placed on his committee either. Increasing wages is a matter of finances more than empirical studies. When this committee was appointed, the protestors immediately noticed how the committee members were all bureaucrats. Earlier too such top-down approach had led to anti-worker policies. Moreover recommendations don’t translate to immediate action. So from the beginning, the protestors had decided to not move from the protest site until the government actually implements the order.
That the states in the South are being cornered and targeted by the Union government is understood and sympathised. But that does not take away Kerala state’s responsibility to protect its workers, women and other marginalised communities.
Side with the Ashas
Kerala recorded the highest inflation rate in the country, for the first three months of 2025. At a time when inflation has hit highest and soaring debts at household levels, it is the moral imperative of the left to step in and place safeguards so that the community systems do not collapse. The collective trauma of the 2018 floods and pandemic years has severely damaged the collective resilience of people to rebuild their lives. The current infrastructure projects are a direct assault on our natural ecosystems to repair and restore itself to functional levels.
The ASHA strike is far more than an isolated issue of unpaid women’s labor and under-resourced care economies. The indifference shown towards it exposes the state’s policy failures and raises questions about whether the left is indeed moving towards a more centrist and economically liberal approach. As we anticipate further political chaos with the upcoming state elections, caste census and delimitation, increasing instability in climate – conflict – trade nexus and the takeover of artificial intelligence systems in surveillance and labour, as common people we are severely unprepared. Whatever hope that can be mustered – be it just transitions or democracy or international solidarity – can be achieved with deliberate support of grassroots organisers and workers unions of the left. In the face of deepening capitalist inequalities and escalating climate breakdown, democratic socialism emerges as a powerful and perhaps essential alternative.
Siding with the ASHA workers’ strike is a crucial first step towards being on the right side of history.
