ASHA workers and facilitators have resolved to go on a nationwide multiple-day strike in August, seeking a hike in remuneration as announced by J P Nadda, Minister for Health, in the Parliament. They also resolved to hold mass sit-ins at district headquarters and submit memorandums on their demands to BJP MPs in May. 

These resolutions were announced at the national convention on ‘Two decades of NHM: Challenges, Struggles, Achievements and The Way Forward’,  organised by the ASHA Workers and Facilitators Federation of India (AWFFI), in New Delhi on April 12.

The convention, organised to mark the completion of 20 years of the National Health Mission, was attended by around 200 delegates from eight states.

The convention has also decided to ensure the massive participation of the federation members in the All-India General Strike called by the Central Trade Unions on May 20.

The convention declared consistent struggles for the right to statutory wages, social security, pension and dignified life for the ASHA workers and facilitators and the right to universal quality public basic health care for all in India.

The convention's presidium consisted of P P Prema, President of AWFFI, Veena Gupta, Vice-President and other leaders, including Sunita Rani, Delshada (J&K), Anandi (Maharashtra), Lokesh Rani (Uttarakhand), Taruna (Uttar Pradesh) and Hasumati (Gujarat). 

Veena Gupta placed the condolence resolution and welcomed all the delegates and leaders.

Leaders from various states, including Surekha (Haryana), Pushpa (Maharashtra), Firdousi  (J&K), Sangeeta (Uttar Pradesh), Sunita Chouhan (Uttarakhand,) Alka Ben Bhatt (Gujarat) and Leelavati (Rajasthan), discussed the declaration placed in the convention.

K Hemalata, President of CITU, after inaugurating the convention, addressed the gathering where she elaborated on the anti-worker policies of the government. She congratulated the ASHA workers for their magnificent struggles at the state and national levels and called upon them to intensify their struggles.  

Hemalata emphasised the need to fight against the labour codes and make the All-India General Strike on May 20 a grand success.

Madhumita Bandopadhyaya, General Secretary of AWFFI, placed the draft declaration on the journey of NHM and the ASHA workers’ movement in the last two decades and the challenges ahead.

The National Rural Health Mission (NRHM), now a sub-mission of the NHM, was launched by the Government of India on April 12, 2005, as a Centrally Sponsored Scheme (CSS) with the objective of providing affordable quality healthcare in rural India. 

In 2013, following the remarkable success of the NRHM, it was expanded to NHM. 

The main force behind the NRHM’s success is the grassroots workers who deliver crucial health services at the doorsteps – the Accredited Social Health Activists – ASHA Workers. 

ASHAs were not considered workers but volunteers, and unlike the other workers in similar schemes, the ASHAs were recruited on a piece-rate basis. 

Today, after two decades, ASHA workers, despite taking up a whole range of healthcare duties, including mental health, are still paid a pittance.

As extolled by the Mission Steering Group (MSG) of NHM in March 2025, the achievements of ASHA workers during this period were commendable. While the Maternal Mortality Rate declined by 83 per cent, the Infant Mortality Rate declined by 69 per cent, the under-5 mortality rate declined by 75 per cent, and the total fertility rate declined from 3.4 to 2.0 during the period. 

During the same period, India achieved certification from the World Health Organisation (WHO) for the elimination of maternal and neonatal tetanus and trachoma. TB incidence was reduced by 18 per cent, mortality rate was reduced by 21 per cent, malaria cases were reduced by 79.3 per cent, malaria deaths were reduced by 85.2 per cent, and many more milestones were achieved. 

It is noteworthy that not a single one of the above-mentioned achievements would have been possible without the hard work of ASHA workers. 

On the other hand, despite years of service, Ashas' work, working hours, sitting place, and salary are not fixed, so they have to face difficulty, humiliation, and inconvenience at the hospitals where they render services.

Many times, the ASHAs are asked to produce survey reports within a few hours even though they are not paid TA, DA, or for the stationary required.  

The piece rates are as low as Rs75 for a full day's polio duty. This is less than one-tenth of the proposed daily minimum wage. While on duty, they also face harassment, including physical attacks and sexual violence.

The very ASHAs who take care of the health of the pregnant mother and child in the country are denied maternity leave. They don’t have access to even toilets during their work hours, which is, on average, around 8-12 hours a day. 

During the COVID-19 pandemic, when the entire country was under lockdown, the ASHAs, acclaimed as the ‘World Health Leaders’ by the WHO, risked their lives to save the lives of lakhs of people, taking health services to the doorsteps, even without any safety gear, and some of them, as a result, have lost their lives. 

As the NHM is a central government scheme and the norms for recruitment, working conditions, duties, remuneration, etc., of the ASHA workers are decided by the Government of India, the responsibility of recognising, regularising, and improving their working conditions lies with the Government of India. 

However, instead of implementing the recommendations of various statutory bodies, including parliamentary committees and the Indian Labour Conference, the Government of India is not ready to regularise the workers and pay them minimum wages or social security. 

Instead, the government is reducing public health expenditures, privatising them, and drastically cutting down the budget for NHM. 

According to a WHO report, India ranks 184 out of 191 countries in terms of the GDP percentage spent per person on healthcare. Even the central share of NHM to the states is being withheld in the case of non-BJP governments. 

It is also to be noted that ASHA workers' unions throughout the country, through their brave and militant struggles against all odds, including arrests, jail, harassment, intimidation, and draconian ESMA, achieved many rights, including an increase in wages and established the ASHA workers' movement as a strong militant section of the trade union movement. 

The Minister for Health and Family Welfare, Government of India, declared in the Parliament that the NHM Mission Steering Group had approved an increase in incentives for various works done by ASHA workers. However, the very next day, the minister backtracked and evaded the issue. 

At the convention, the speakers expressed their anger against the Government of India and the minister. 

The convention was addressed by leaders of fraternal organisations, P Krishnaprasad (finance secretary, AIKS), Mariam Dhawale (general secretary, AIDWA) and Usha Rani, president of AIFAWH who extended solidarity and support to their struggles.

AR Sindhu, secretary of CITU, exposed the ruling communal corporate government and explained the future course of action of ASHA workers and other scheme workers during the concluding address. Sunita gave the vote of thanks.

The convention adopted a charter of demands, including institutionalising NHM and making all its staff, including the ASHA workers, permanent; allocating 6 per cent of GDP for the health budget; implementing the recommendations of the 45th and 46th ILC on scheme workers – regularisation, minimum monthly wage of Rs 26,000, monthly pension of Rs 10,000, and withdrawal of labour codes.