OVER 10,000 ASHA workers and facilitators from 16 states – Andhra Pradesh, Assam, Bihar, Gujarat, Haryana, Jammu & Kashmir, Kerala, Madhya Pradesh, Maharashtra, Odisha, Punjab, Tamil Nadu, Telangana, Uttar Pradesh, Uttarakhand and West Bengal – responded to the call by ASHA Workers’ and Facilitators Federation of India (AWFFI) CITU and gathered at Jantar Mantar on October 30, 2023. They voiced their demands for the regularisation of their roles, a minimum monthly wage of Rs 26,000, social security, pensions, and better public healthcare for all.

The 'ASHA Sangharsh Rally' was inaugurated by Tapan Sen, general secretary of CITU. He commended the ASHA workers for their remarkable state-level efforts and urged them to intensify their national-level struggles, while also reinforcing their collective actions to challenge the anti-national policies of this government, which is aligned with corporate interests and communalism.

PP Prema, AWFFI president, highlighted Kerala government's pro-worker policies. Madhumita Bandopadhyaya, AWFFI general secretary explained the federation's demands and its past achievements.

Around one million ASHA workers and facilitators nationwide operate under the NHM scheme. They serve as a vital bridge between rural/urban communities and public health services, offering essential health education and support to underserved populations, ensuring their access to healthcare facilities. These dedicated workers provide around-the-clock assistance, particularly for pregnant women and emergency healthcare services.

Initially tasked with eight responsibilities, ASHA workers now handle approximately 40 duties related to maternal and child health. Numerous studies have recognised the significant contributions of NHM and these workers to the healthcare sector. Their efforts have led to a notable reduction in infant mortality, dropping from 58 per 1000 live births in 2005 to 26 in 2023. Likewise, maternal deaths decreased from 167 per one lakh deliveries in 2005 to 95 in 2022. Routine vaccination coverage has surged from 27 per cent in 2005 to over 90 per cent in 2023, and institutional deliveries have risen from 43 per cent in 2005 to 99 per cent in 2023. These achievements are a testament to the dedication of ASHA workers, who operate in challenging environments while confronting social stigmas and biases.

Federation’s persistent efforts compelled the government to introduce a meager monthly payment of Rs 1,000 for specific tasks, which was later raised to Rs 2,000 in 2018. This amount falls significantly below the minimum wage. However, since 2018, despite the soaring cost of living, there has been no increase in this payment. Over the past five years, the allowance has remained stagnant, while the workload has tripled, and essential commodity prices have doubled. Additionally, incentives for various services have not seen an increase since 2005.

ASHAs bravely battled the COVID-19 pandemic, with some even sacrificing their lives. While the WHO recognised their services and declared them "World Health Leaders," the Indian government withdrew the modest Rs 1,000 monthly incentive meant for their exceptional efforts. ASHAs are now being retired without any benefits, disregarding the recommendations of the Indian Labour Conference and several parliamentary committees.

ASHAs confront numerous challenges daily, including irregular and delayed payments, excessive workloads without compensation, absence of leave provisions, mandatory digital reporting without access to necessary tools, and the lack of workplace safety. Many ASHAs tirelessly work in the field round the clock.

ASHA workers have recently organised successful, militant actions, many led by CITU unions and joint platforms. These actions include significant strikes in Haryana (73 days), Madhya Pradesh (62 days), Bihar (32 days), and Jammu & Kashmir (approximately two months). Ongoing strikes are observed in Delhi and Maharashtra. In states like Andhra Pradesh, Assam, Telangana, Uttarakhand, West Bengal, Gujarat, similar substantial struggles have occurred in recent years. These efforts have led to increased compensation and benefits, such as one-time retirement benefits. Despite the uniformity of service conditions, wage disparities persist among ASHA workers and facilitators in different states.

In light of these concerns, AWFFI issued a call for the "Delhi Chalo" (march to parliament) and ASHA Sangharsh Rally on October 30, 2023, to demand: regularisation, minimum wages and social security as per the recommendations of the 45th and 46th Indian Labour Conference; make NHM a permanent, universal health programme with quality service and adequate financial allocations; pending regularisation, increase the fixed basic wages and link to consumer price index, revise the incentives for various duties of ASHA workers; immediate payment of all dues of remuneration, allowances; ensure uniform working conditions throughout the country; no retirement until pension; implement ex-gratia and other social security measures; ensure six months of paid maternity leave, casual leave and medical leave; provide "ASHA Rest Rooms" in all PHCs /CHCs and hospitals; travel allowances in actuals; promotion policy; increased uniform allowance; workplace safety etc.

The rally also raised demands for the withdrawal of four anti-worker labour codes, prevention of health services privatisation, the enactment of a law for the right to universal healthcare, allocation of 6 per cent of GDP for the health sector in the budget, and adequate infrastructure before digitisation.

The rally was addressed by leaders of fraternal organisations like P Krishnaprasad (AIKS), B Venkat (AIAWU), Hannan Mollah (SKM-AIKS), and Savita (AIDWA). Jaibhagwan (MDMWFI) and Usharani (AIFAWH) expressed solidarity with ASHA workers and called for strengthening the scheme workers' movement across the country.

Leaders from various states who addressed the rally included Dhanalakshmi (Andhra Pradesh), Noni Likson (Assam), Sudha Suman (Bihar), Hasumati (Gujarat), Sunita Bhagat (Jammu), Dilshada (Kashmir), Kavita Solanki (Madhya Pradesh), Sakuntala Mahakut (Odisha), Seema (Punjab), Jayalakshmi (Telangana), Pushpa Patil (Maharashtra), Shiva Dubey (Uttarakhand), Sangeeta (Uttar Pradesh), and Sabina Yasmin (West Bengal).

The presidium included PP Prema, Sunita, K Dhanalakshmi, Sudha Suman, AT Padmanabhan, and Veena Gupta, along with office bearers Mamata (Assam), Priyanka (Maharashtra), Madhuja (West Bengal), Dileep Shukla (Uttar Pradesh), MB  Prabhavati, and VV Presannakumari (Kerala).

Two unaffiliated unions from Punjab and one from Uttar Pradesh also joined the struggle. The massive mobilisation, exceeding the quota from all states, demonstrated the widespread discontent with the Modi government. In response, the police and administration attempted to prematurely end the programme. Cultural activities, including songs inspired by struggles in various states, kicked off the event and energised the participants.

AR Sindhu, CITU secretary, outlined the scheme workers' future course of action, while Surekha, AWFFI secretary, delivered the concluding address and unveiled the action plan. The rally called for a door-to-door campaign against Modi government policies and encouraged participation in the Mazdoor Kisan Mahapadavat in the state capitals from November 26-28, 2023, as well as massive mobilisation of scheme workers in every parliamentary constituency in December 2023. It also urged the ousting of the communal, pro-corporate Modi government in the upcoming elections.