50 days, hunger strike, heads shaved: Why Kerala’s ASHA workers are protesting

ASHA workers, the foundation of India’s public health system, have been demonstrating in Thiruvananthapuram for 50 days, claiming that the government is overlooking their requests. In a heightened display, many chopped their hair, with a few going as far as to shave their heads to amplify their protest on Monday.

A group of protesters initiated an indefinite hunger strike at the protest site, located outside the Secretariat, last week. The laborers are seeking retirement benefits, a raise in honorarium, and formal acknowledgment as employees.

One protester, overcome with emotion before shaving her head, told news agency PTI, “It’s our lives that are being cut. This is our protest against ministers who turn a blind eye to our pain and problems. How are we supposed to survive on a meagre Rs 232 per day?”

She warned that if the government continued to ignore their pleas, the protesters would not back down, even at the cost of their lives.

Mini S, a protest leader, explained that the drastic step of cutting their hair was a way to register their deep frustration. “None of our demands have been considered with empathy. This is not an emotional outburst; it is a strong and deliberate protest. And we will take this fight across the state,” she said.

After the hair-cutting demonstration, the protesters paraded along the crowded MG Road, displaying their cut hair as a representation of their fight. Comparable demonstrations were noted in Alappuzha and Angamaly, where a few male supporters also shaved their heads in support of the ASHA workers.

According to a report , the ASHA workers have presented a list of 20 demands, with one fundamental request at the heart of it all – to be recognized as formal workers and receive fair compensation for their work.

• Retirement at 62: Withdraw the order to forcefully retire ASHA workers, who have worked for decades, at the age of 62 without any retirement benefits.
• Retirement benefits: Kerala must provide Rs 5 lakh to ASHA workers as retirement benefit, similar to West Bengal.
• Permanent employee status: Grant ASHAs permanent health department employees after 16 years of service.
• Revise strict honorarium criteria: The current rules unfairly disqualify many from benefits.
• New IDs and uniforms: Issue ID cards and uniforms with NHM emblem
• Medical assistance: Offer medical assistance for work-related accidents and posthumous benefits.
• Free treatment for ASHAs: Ensure free medical treatment in government hospitals, including medical colleges.
• Stop unnecessary transfers: Allow ASHAs to remain in their assigned wards unless absolutely necessary.
• Week off: Reduce workload and grant Sundays off.
• Timely payment for surveys: Avoid assigning constant surveys and ensure timely incentive payment for conducting surveys.
• Provide smartphones: Provide smartphones for official duties.
• Increase phone allowances: Increase phone recharge allowance in proportion to cost hikes.
• Recruit new ASHAs: Instead of overburdening the existing workforce, appoint new ASHAs.
• Using ASHAs for non-health-related public programs: Restrict ASHA workers’ duties to healthcare alone. Prevent the misuse of ASHAs for government events and panchayat duties.
• Increase pay, salary on time: Increase honorarium and incentives, and ensure salaries are paid by the 5th of every month. At present, the Union government provides Rs 2,000 per month, while Kerala adds Rs 7,000 extra.
• Increase incentives: The incentive structure has been stagnant for years.
• Raise daily wages: Pay wages for pulse polio preparation days and increase the daily wage to Rs 600.
• Clear work standards: Establish clear work standards and implement them at the grassroots level.

The Left government in Kerala has indicated that a substantial rise in honorarium is not possible and has transferred the obligation to the central government to meet the demands of the ASHA workers. The government stated that it has not obtained any cash grant from the central government for the year 2023-24 under the National Health Mission (NHM) to fund several Centrally sponsored schemes, such as ASHA.

Nevertheless, the central government has disputed these assertions, stating that it has provided what was owed, but the utilisation certificate has not been received from Kerala. It was stated that as soon as the certificate arrives, the necessary funds would be provided to the ASHA workers and the state. Union Health Minister JP Nadda recently declared in Parliament that the Mission Steering Group of the NHM has approved an increase in incentives for ASHA workers, yet a specific timeline has not been given.

ASHA workers were introduced in 2005 under the National Rural Health Mission (NRHM) to provide essential healthcare services to underserved communities. According to the National Health Mission, “ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services.”

“She would be a promoter of good health practices. She will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals, ” the document further read.

The government envisioned having ‘One ASHA per 1,000 population,’ and as of June 2022, there were over 1.05 million ASHAs in India, making them the world’s largest volunteer workforce