Thiruvananthapuram: While CM Pinarayi Vijayan and then health minister K.K. Shailaja may have been the face of Kerala’s handling of the COVID-19 pandemic, which won international accolades, it it was local bodies and Accredited Social Health Activists (ASHAs) who managed the situation on the ground, from collating data to monitoring cases and distributing medicine kits. Five years on, ASHA workers are demanding their due.
Staging a sit-in protest outside the Kerala secretariat since 10 February, ASHAs in the state are demanding a raise in their honorarium from the current Rs 7,000 to Rs 21,000, a one-time retirement benefit of Rs 5 lakh, and the clearing of their pending dues.
On 27 February, Kerala government cleared the three months’ worth pending dues.
This was followed by Union Health Minister J.P. Nadda telling the Rajya Sabha Wednesday that the Mission Steering Group (MSG) of the National Health Mission (NHM) had decided to increase the financial incentives for ASHA workers.
However, the hundreds of protesters outside the secretariat say that they will not end their demonstration until all their demands are met.
A senior official from the Kerala health minister’s office said the protest hasn’t affected the health department’s work on the ground since, of the 26,125 ASHA volunteers in Kerala, only a few are protesting.
“We work here in the states. So who else should I raise our demands to?” 47-year-old Rajani VS, who has been protesting at the secretariat since 10 February, told ThePrint. She alleged that the Kerala government has not shown enough respect to the ASHAs as their monthly remuneration is never paid properly unless they resort to protest.
“We are the reason for the Kerala government’s achievements in the health sector. We collected the data that was shared by the chief minister, presented at his 6 pm press conferences during the pandemic,” Rajani said.
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Heavy workload & meagre remuneration
ASHAs are community-based volunteers employed as part of the central National Rural Health Mission (NRHM) scheme, launched in 2005 to ensure the reach of health services to India’s rural population. According to the NRHM mission document, ASHAs—“primarily a woman resident of the village” and “preferably” in the age group of 25 to 45 years—“will be the first port of call for any health-related demands of deprived sections of the population, especially women and children, who find it difficult to access health services”.
It adds that the volunteers are responsible for creating awareness about nutrition, sanitation, beside counselling women on birth preparedness, mobilising the community to ensure access to health related services, providing primary medical care for minor ailments, and even escorting or accompanying pregnant women and children to the nearest primary healthcare centres (PHCs) if they require assistance in treatment.
Though women employed full-time elsewhere are prohibited from being an ASHA volunteer, the workers, who have an ‘honorary volunteer’ status, are not considered government employees. The Kerala official quoted above said work hours are flexible and volunteers can decide them. They can also take up other sources of income if needed.
But the protesting volunteers have a different story to tell.
Bindu B, 51, who lost her husband to a heart attack during the pandemic, is the sole breadwinner of her household. She has been an ASHA since 2009 and is in charge of overseeing nearly 4,000 households in the Kannanmoola ward of Thiruvananthapuram district, along with three colleagues.
“We are always on the field. We have to give regular data for different schemes. And there is always a special survey to track diseases such as TB (tuberculosis) or cancer,” she told ThePrint. Besides this, Bindu and other ASHAs are also required to be on duty at the local PHCs six days a month, where their work ranges from managing the outpatients to queues.
Bindu says she earns nearly Rs 10,000 a month.
Under NRHM scheme, ASHAs are due a fixed monthly incentive of Rs 2,000 by the Centre. This was hiked in the FY2018-19 by the health ministry from the earlier Rs 1,000.
Additionally, they get performance-based incentives for their activities under various initiatives, such as Rs 50 for conducting monthly meetings with adolescent girls on menstrual hygiene, and Rs 200 per session for mobilising locals and attending Village Health and Nutrition Days or Urban Health and Nutrition Days.
In addition to the incentive from the Centre, every state provides ASHAs a monthly honorarium from its fund. The official quoted above said each volunteer in Kerala earns between Rs 10,000 and 13,000 every month.
In August 2024, data provided by the Minister of State (MoS) for Health and Family Welfare in the Lok Sabha showed that Sikkim pays the highest fixed honorarium of Rs 10,000 since 2022, followed by Andhra Pradesh, which provides the balance amount to match the total incentive of Rs 10,000 per month. Among states paying ASHAs the lowest are Tamil Nadu, which only pays a non-communicable disease (NCD) screening incentive of Rs 500, and Odisha and Manipur that pay Rs 1,000 as state honorarium per month.
“When LDF (Left Democratic Front) government came to power in 2016, state honorarium was Rs 1,000. We gradually hiked it to Rs 7,000. Now, they are demanding a sudden hike to Rs 21,000. We should ask if the demand itself is justified,” the Kerala government official quoted earlier told ThePrint. He said the central government should be equally responsible because there has been no hike in the Centre’s remuneration from Rs 2,000.
A Centre-state blame game
Over the course of the protest, the issue has also become a Centre-state government tussle as the LDF-led state government said the Centre should take a decision on the hike as ASHAs are deployed as part of the NRHM.
“It’s a central government scheme, and the issue is not just in Kerala. We do understand that their demands are valid. We are ready to raise the issue with the Centre. But they (protesters) have to understand that, and end the protest,” a second senior official with the health minister’s office told ThePrint. The official alleged that the Bharatiya Janata Party (BJP)-led Centre is evading its responsibility to address the issue.
The official noted that Kerala pays higher remunerations to ASHAs than many other states.
The issue was also raised in the ongoing session of Parliament by both Congress and the Left parties, including Alappuzha MP K.C. Venugopal, Thiruvananthapuram MP Shashi Tharoor and Communist Party of India (CPI) Rajya Sabha MP Sandosh Kumar P.
“Both the state and Centre are blaming one another when it comes to providing the honorarium they deserve. These workers are the backbone of the healthcare system, but they have been forced to protest in the sweltering heat of Thiruvananthapuram for almost a month now. I wish the issue is resolved at the earliest,” Venugopal said Monday.
Asha workers are working 24×7 in the health sector. They are the major contributors to the health sector in Kerala. However, they are only getting Rs. 233 per day, and that too, irregularly.
Moreover, they are not receiving any retirement benefits. For the last 30 days, they… pic.twitter.com/2TsIz4Pm1i
— Congress (@INCIndia) March 11, 2025
Last week, Kerala BJP leader and Thrissur MP Suresh Gopi met with Nadda on the issue.
Sandosh Kumar too raised concerns in Parliament over dues owed by the health ministry to Kerala under the National Health Mission. In response, Nadda told the Rajya Sabha that all dues owed to Kerala were cleared, but the state hadn’t submitted a utilisation certificate.
Reacting to the statement, Kerala Health Minister Veena George reiterated in the Kerala Assembly Tuesday that the state hadn’t received a cash grant under the National Health Mission in the year 2023-24.
(Edited by Sanya Mathur)
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