From Toddlers to Enablers: Mobilising Beneficiaries of Community Health Service providers in Maharashtra to Lobby for the rights of ASHA and Anganwadi workers

Poor doctor to patient ratio in India necessitates dependence on community health care workers.

Two female government health workers standing across a containment zone during COVID-19 pandemic

India has the largest network of community health workers in the form of Anganwadi workers (approximately 27 lakh women) under the Integrated Child Development Scheme, and another nine lakh women work as Accredited Social Health Activists (ASHA) under the National Rural Health Mission. These women themselves hail from the vulnerable sections of the society they serve. They have emerged as ground level repositories of data on health of children, adolescents, pregnant women and lactating mothers.

They played a critical role through the waves of COVID-19: first, in tracing, tracking and treating the infected people in the absence of vaccine and later in allaying the phobia against it when vaccines were ready. They provided nutritional supplements to the new- born babies, children and mothers during the lockdown risking their own lives, despite being ostracized as the potential ‘carriers’ of the virus themselves.

These Corona-Warriors remain volunteers and hence receive a low honorarium.  They are employed in a government scheme but are not considered as government servants.  They are not government servants but cannot contest an election. Infant mortality and the number of ‘wasted’ children rise when they go on a long strike, but they are not ‘essential’ workers. These are some of the paradoxes these women struggle with. If the rate of return on community health is as high as 1$: 10$, (WHO: 2015), it is only appropriate that the beneficiaries who represent the civil society stand up as collaborators initiating a Social Dialogue process.

Their struggle so far has manifested through two modes: i. negotiating with the government after street protests and strikes, and ii. Moving the courts. Both processes are tedious, resource intensive and slow. 

In order to lobby for the rights of the community health workers, a novel idea developed by Dr. Suchita Krishnaprasad with support from FES India & Anganwadi Karmachari Sanghatana, Maharashtra,  is to reconnect with previous beneficiaries of the workers who in turn can facilitate or take part in dialogues to improve their working conditions.   A working paper has been developed based on this idea. This working paper is a step towards enabling this process by creating a platform of the beneficiaries consisting of i. those who can lobby with the policy makers by the virtue of their position in the society today, ii. The college -going students to sustain the energy of the platform & iii. Parents of specially -abled children who acknowledge the critical support they have received through these workers.

It is an innovative step to engage the society in ensuring that workers who invest their lives in community health receive a decent share of the return they offer to the wider society.

Please contact FES India if you would like to receive a copy of the working paper at info(at)fes-india.org.  


Suchita Krishnaprasad is a former Associate Professor and Head of the Economics Department at Elphinstone College, Dr. Homi Bhabha State University, Mumbai. She has also worked as a consultant and external collaborator with the ILO. Her area of expertise includes labour, development economics and industrial relations.

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