India's ASHA and USHA workers demand rights amid unstable pay and risks

ASHA and USHA workers play a vital role in India’s healthcare system, yet they remain classified as 'volunteers' or 'activists' rather than formal employees. This status denies them basic labour rights, despite their involvement in critical tasks like health mobilisation, surveillance, and emergency escort services. Many now use digital tools such as tablets to update health records in real-time and conduct screenings for non-communicable diseases (NCDs). These workers often face physical violence and verbal abuse, particularly during sensitive health campaigns or when medical outcomes fail. Their earnings come mostly from task-based payments, leading to unpredictable incomes and underpaid labour. However, some states have begun addressing these issues by introducing fixed monthly honorariums. Andhra Pradesh, for instance, offers one of the highest payments at ₹10,000 per month. Sikkim recently followed suit, raising its honorarium to the same amount to offset the high living costs in hilly regions.

The USHA role is even more demanding due to challenges like migrant populations, social fragmentation, and identifying marginalised groups. While the shift toward stable monthly payments marks progress, workers still lack formal employment status. This leaves them without job security, social protections, or structured grievance mechanisms. Proposed solutions include formalising their roles, providing upskilling opportunities, and extending social security benefits. These steps aim to stabilise their incomes and improve working conditions for thousands of frontline health workers across the country.

The push for fixed honorariums in states like Andhra Pradesh and Sikkim signals growing recognition of ASHA/USHA workers’ contributions. Yet, without formal employment status, they remain vulnerable to exploitation and instability. Strengthening their rights and support systems could ensure better working conditions and more reliable healthcare delivery in rural and underserved areas.