Last month, Union Health Minister JP Nadda praised the significant contributions of ASHA volunteers in the Rajya Sabha and promised that his ministry would consider their demands for salary improvements and provide more facilities.

These promises have been made for years, but no action has been taken. For nearly two decades, India’s ASHA workers have been the backbone of rural healthcare services—a silent yet resolute force bridging the gap between remote villages and formal medical services.

Initiated in 2005 under the National Rural Health Mission, this army of one million women has brought remarkable improvements in maternal and child health. Family planning, immunization, and other government health schemes reach people through ASHA volunteers.

However, sadly, ASHA workers toil under low pay, lack of job security, and minimal respect in challenging conditions. The COVID-19 pandemic highlighted their crucial role as they risked their lives conducting door-to-door screenings and vaccination campaigns. Yet, beyond occasional praise, these frontline warriors face systemic neglect.

If India is serious about achieving universal health coverage, it must urgently reform the ASHA program, ensuring fair salaries, better working conditions, and respect for its most essential healthcare workers.

A retired ASHA volunteer shared that officially considered ‘volunteers’, ASHA workers do not receive formal job benefits—no fixed salary, pension, health insurance, or maternity leave. Their performance-based incentives result in an average income of ₹5,000 to ₹10,000 per month, which is insufficient for survival. Payments are often delayed, forcing many to take up extra work.

Imagine, ASHA workers perform nearly 30 tasks simultaneously, from vaccination campaigns to maternal health counselling, often working 20+ hours a week. Many walk miles daily without transport allowances, PPE kits, or basic medical supplies. They can be dismissed at any time, leaving them financially vulnerable. Several have reported mistreatment by Auxiliary Nurse Midwives and medical officers, with minimal constructive supervision. Female ASHA workers face domestic conflicts, some even receiving divorce threats for their work. Upper-caste families often deny them entry, disrupting health services.

Irregular upskilling programs have left gaps in knowledge about mental health, disease monitoring, and emergency care. Despite these challenges, ASHA workers have played a vital role in reducing maternal and child mortality rates, increasing immunization coverage, raising awareness about TB and HIV, providing mental health support, and digitizing health records. Their deep community trust ensures last-mile healthcare delivery, whether during pandemics, floods, or regular maternity care. Yet, their sacrifices go unnoticed.

To empower ASHA workers, experts have already provided numerous suggestions to the government. Replacing incentive-based payments with fixed salaries, at least ₹15,000/month, plus performance bonuses, offering pensions, health insurance, and maternity benefits, providing transport allowances, smartphones, PPE kits, and rest areas at health centres, streamlining payments to avoid delays and corruption, regular skill development in mental health, NCDs, and emergency response, certifying ASHA workers as assistant nurses or public health workers through bridge courses with medical colleges, creating clear promotion pathways to higher health service roles, implementing strict anti-discrimination policies against caste and gender-based barriers, running family sensitization programs to reduce domestic conflicts, and reducing non-health tasks to focus on core medical duties are essential.

The ₹49,269 crore Building Construction Workers Welfare Cess Fund can be partially used to support ASHA welfare. States like Kerala and Tamil Nadu have already trialled better salary structures, and these models should be implemented nationally.

ASHA workers are not ‘volunteers’; they are essential health service professionals. If India truly values its rural health system, it is time to move beyond token gestures and provide them with the respect, salaries, and support they deserve. Their relentless service has saved millions of lives. Now, the system must protect them from exhaustion and neglect. Empower ASHA workers, or watch rural health services crumble. The time to act is now.