Unrecognised Pillars Of Public Health: The Struggles Of Asha Workers In India

Abstract

India’s burgeoning population can afford an unorganised work force, however, whether the State can accord them formal status of ‘Employee’ is uncertain. The Accredited Social Health Activists (ASHAs) play a pivotal role in India’s rural healthcare delivery, delivering maternal and child healthcare, immunisation, and prevention of diseases. Although they play a critical role, they are defined as ‘volunteers’ perpetuating economic disparities based upon gender and excluded from formal employment privileges like fixed pay, pensions, and social security. This paper critically analyses their tenuous legal position under Indian labour laws and constitutional provisions, placing their work in the wider care and gig economies. Using International human rights instruments, such as the International Covenant on Civil and Political Rights (ICCPR), the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), the paper shows how India’s handling of ASHAs negates core labour rights. The article also contrasts India’s model with international best practices, examining structured community health worker (CHW) programs in Brazil, South Africa, Ethiopia, Rwanda, China, and Russia. In contrast to ASHAs, CHWs in these nations are formally trained, paid a fixed salary, and provided social security, ensuring financial security and professional status. India’s system based on incentives keeps ASHAs financially vulnerable and open to exploitation, further worsened by the COVID-19 pandemic when they were assigned frontline work without proper compensation or protection. By suggesting harmonisation of India’s policies with global standards and acknowledging ASHAs as a part of the public health infrastructure, the government can facilitate equity, dignity, and sustainability of healthcare delivery. Enforcing ASHAs’ rights will not only strengthen the workers but also the overall efficacy of India’s public health system. While acknowledging, defining, and sufficiently paying CHWs is not all about social justice, it’s an inevitable initiative to accomplish the universal health cover