ASHAs have been protesting in front of the Kerala Secretariat in Thiruvananthapuram — voicing a slew of demands, including a hike in their honorarium.
Published Mar 11, 2025 | 5:00 PM ⚊ Updated Mar 11, 2025 | 5:00 PM
ASHAs in Kerala.
Synopsis: ASHAs in Kerala have been protesting against the Kerala government asking for better pay and benefits. South First spoke to some ASHAs to understand their concerns and their demands.
“I may not be on strike, but my heart is with them. Politics aside, we deserve better pay and benefits. Don’t divide us by the color of our flags.” Sreedevi, an Accredited Social Health Activist (ASHA) from Cheranelloor near Kochi in Kerala who braved her inner fears, along with her husband, to be a lifeline to her brother, told South First.
On 12 July 2024, while the dim glow of lights flickered over the anxious faces waiting outside the operation theatre at Aster Medcity Kochi, three lives from the same family lay inside, under the surgeon’s knife.
On the right-side bed was Sreedevi’s husband, Vipin, and on the left, her only brother, Sreenath. Between them lay Sreedevi herself who had made an unshakable decision — to give her brother a second chance at life by donating her Kidney.
Her husband, in an act of equal courage, was donating a portion of his liver to his brother-in-law. Meanwhile, just outside the sterile walls of the operation theatre, two small figures stood silently, Goutham Krishna (10), and Gowry Nanda (12) — waiting with hope.
Their mother had assured them everything would be fine, but even in her steady voice, there was a weight they had never heard before.
Sreedevi with her children.
Sreedevi knew fear. She had seen it in countless eyes as an ASHA worker, standing beside families in their most vulnerable moments. But she also knew resilience. It was that strength, drawn from years of witnessing pain and struggle, that had guided her to this decision.
Even after walking out of the hospital, stitched and healing, she returned to her work, not just for the money, but because, for her, service was a calling, not just a job. As an ASHA responsible for nearly 2,500 people across 606 houses, everyone in the community felt like family to her.
Even from her hospital bed, her mind was restless with concerns: Were the elderly receiving their insulin on time? Were pregnant women taking their vitamins properly? Were they maintaining their weight as advised? Had the children received all their vaccinations?
A thousand such questions raced through Sreedevi’s mind because, for ASHA workers like her, the job isn’t about the ₹7,000 honorarium or the ₹2,000-₹3,000 incentives.
It’s their unwavering commitment that has helped shape Kerala’s exceptional healthcare system. It is the dedication of ground level workers like Sreedevi that truly defines the state’s healthcare success.
ASHAs have been protesting in front of the Kerala Secretariat in Thiruvananthapuram — voicing a slew of demands, including a hike in their honorarium.
Their primary demands include a hike in monthly honorarium from ₹7,000 to ₹21,000, clearance of pending wages, revocation of the retirement age cap of 62, and a lump sum retirement benefit of ₹5 lakh.
Sreedevi and her team during an Anganwadi camp in Cheranalloor
As Sreedevi narrated her journey as an ASHA worker, her phone alarm rang at exactly 3.20 pm. When asked about it, she smiled and told South First, “This is when my kids arrive from school. I set this alarm to remind myself, even in my busiest moments, that they are waiting for me,”
“Most days, I’m not home when they return, and they manage everything on their own. I’m fortunate to have family support, but many ASHA workers don’t,” she added.
Sreedevi joined as an ASHA in Cheranalloor Panchayat on 15 October 2019.
Just five days after completing her training, she found herself on the frontlines of the Covid-19 pandemic.
“I didn’t sleep a single night during that period. My ward had pregnant women and cancer patients, high-risk individuals who needed constant monitoring. Every time a case was reported, we’d get calls from the Covid cell for patient details. I knew my patients’ medical histories, allergies, and ongoing treatments better than their own families did.”
The awards won by Sreedevi.
For Sreedevi, each day brings a new responsibility. “Mondays are for palliative care, Tuesdays focus on women’s wellness. On Thursdays, we attend the NCD (non-communicable disease) clinic to screen patients for blood pressure, diabetes, hypertension, and cancers. On Fridays, we conduct a vector survey in our ward, monitoring sanitation to prevent disease outbreaks and the rest of the week is filled with surveys, health camps, and hospital duties.”
“Earlier, ASHAs had to do two hospital shifts per week, but managing it was difficult. The National Health Mission has now limited it to one shift per week, though some panchayats still continue with two,” Sreedevi said.
Currently, she is conducting a lifestyle disease survey, SHAILI, which also requires updating Aadhaar details for individuals over 30. “Initially, we were told we’d receive ₹20 per household, but now it’s just ₹5, and we’re unsure if even that will come. After this survey, we have to do a leprosy survey as well, covering the same 606 houses again with the same questionnaire.”
”My house is full of trophies and certificates, and I’m building a new shelf for them. But what about the honorarium we get? It’s inhumane. Before Covid, the workload was lighter, but even now, we never complained. We work 24/7, we deserve better pay and incentives,” Sreedevi said.
Ayishumma.
For Ayishumma, a woman from an orthodox Muslim family, social service and public interaction were once unimaginable.
However, after her marriage, circumstances changed. When her husband moved abroad, she found herself with ample time and a passion for engaging with people. This led her to join as an ASHA in 2010.
Now, with over 14 years of experience, Ayishumma leads the ASHA team in Cheranalloor Panchayat. She has in-depth knowledge of the payment criteria, how the system functioned earlier, and the changes over the years.
“We receive an honorarium of ₹7,000 only if we successfully complete 10 specific criteria, ₹700 for each. These include preparing health reports for the ward, conducting ward meetings, attending sub-centre and panchayat meetings, performing four duties at PHCs (Primary Health Centres) or sub-centres, engaging in health-related activities in places like churches, making home visits to vulnerable individuals, conducting general home visits (at least 50 houses), visiting children under one year and pregnant women (at least 20 visits), and checking on people who live alone or are bedridden (at least 20 visits),” she explained to South First.
“If we miss even one house, the entire ₹700 is deducted from our honorarium,” she added.
Ayishumma also highlighted the disparity in earnings.
Ayishumma spent time with elderly people during her home visit.
“For vaccinations, we receive ₹20 per child, and if a child completes full immunisation within the first year, we get ₹1,000. Reporting a pregnancy within the first three months earns us ₹300. However, in suburban areas like Cheranalloor, many families prefer private hospitals for pregnancy care and immunisation,” she said.
“Our duty is to promote government hospitals and services. We can’t force people, so we don’t always receive the amount. Many came to PHCs on our request because of the bond we share with each one, built over years of service and maintaining a smile even through our personal struggles.
Additionally, the number of pregnant women and children varies across wards, some ASHAs handle six to eight cases, while others have only one to two, leading to significant differences in incentives.”
Ayishumma manages 480 houses, serving nearly 2,000 people. She acknowledges that mobility is a major challenge for many ASHAs.
“Sreedevi and I have two wheelers, allowing us to respond to emergencies, even at midnight, and buy medicines when needed. But many ASHA workers don’t own vehicles. They rely on buses or autos, and if they miss a bus, they have to spend ₹200–300 on transportation just to attend meetings and secure their ₹700 payment.”
Honorarium and Incentives details of ASHA workers.
Despite financial struggles, ASHAs like Sreedevi and Ayishumma are in a comparatively better position than many of their colleagues, such as Suja and Jebi, who single-handedly support their families.
One of them walks miles with a prosthetic leg to serve the community, paying for her children’s education, covering rent, and running the household, all while enduring domestic violence. Yet, their smiles never fade.
Panchayat member Benny Francis highlights their plight: “Everyone talks about honorarium increments and incentives, but what about the dues? They haven’t received payments for the last two months. Still, none of them will compromise their service, hoping that one day, things will get better,” he told South First.
Suja takes pride in caring for her family alone as her husband recovers from surgery. “To earn ₹13,000, we need at least 15 pregnancy cases a month. But with fewer children aged 0–5, immunization incentives are low. Maybe some ASHAs have earned ₹13,000 a month, but not consistently. Most of us have never made more than ₹7,000,” she explained to South First.
As they share their struggles, Ayishumma receives a call. “My child fell from the bed! I’m panicking,” a worried new mother says. Ayishumma immediately reassures her, “Go to the PHC, the doctor is there. Call me if you need anything. Don’t panic, dear,” she responds with a mother’s affection, a quality inherent to women.
She smiles and adds, “Our phones feel like a part of our body now. Calls come nonstop—for minor doubts, BP checks, catheter removal, and even buying vitamin tablets,” she told South First.
ASHAs of Cheranelloor grama panchayath of Ernakulam district.
ASHAs, despite working around the clock, earn a mere ₹233 per day — far below fair wage standards. The Labour Code on Wages Bill, 2019, guarantees protection for unorganised workers, yet ASHAs, designated as volunteers, are excluded from these benefits.
Special initiatives include a pilot program for managing non-communicable diseases and a decentralised cancer care program, where ASHAs assist in awareness, early detection, and palliative care. A tracking system for pregnant women and young children is also in place to prevent immunisation dropouts.
ASHAs, typically local women aged between 25 and 45 years with at least a 10th-grade education, are selected through a rigorous community-driven process.
Their role extends beyond healthcare delivery — they mobilise communities, promote hygiene and nutrition, counsel on reproductive health, and facilitate access to government services. They receive performance-based incentives for immunisation drives, maternal health services, and sanitation programs.
Despite being the backbone of rural healthcare, ASHAs lack essential benefits like insurance, ESI, and pensions.
As Ayishumma told South First, “We serve everyone and educate people about health insurance and government schemes, but we don’t have any special insurance or ESI benefits ourselves. We are ashamed to even say this in public.”
(Edited by Muhammed Fazil.)
