India's ASHA and USHA Workers Gain Monthly Pay After Years of Instability

A major shift is underway in how ASHA and USHA workers are paid across several Indian states. These frontline health workers, long classified as 'volunteers', now receive a stable monthly honorarium in some regions. The change aims to address long-standing concerns over income instability and lack of worker protections.

The new system also introduces digital tools, with workers now using tablets and smartphones to update health records in real-time. Yet, despite their expanding roles, legal recognition as formal employees remains out of reach. ASHA (Accredited Social Health Activist) and USHA (Urban Social Health Activist) workers have traditionally relied on task-based payments. This model led to unpredictable earnings, as most of their income depended on completing specific assignments. Their duties include health mobilisation, running medicine depots, escorting patients, and disease surveillance. Recently, they have also been trained to conduct door-to-door screenings for Non-Communicable Diseases.

The USHA role is often more demanding than ASHA’s. Urban workers must navigate migrant populations, social fragmentation, and the challenge of identifying marginalised groups who lack official documentation. Both roles, however, come with risks. Workers frequently face verbal abuse or physical violence, particularly during sensitive health campaigns or when medical outcomes fail to meet expectations.

A growing number of states have begun offering fixed monthly honorariums to address these issues. Andhra Pradesh, Sikkim, Kerala, Karnataka, and West Bengal are among those leading the change. Beyond payment reforms, discussions now focus on broader improvements: transitioning to a formal monthly salary, upskilling programmes, grievance redressal mechanisms, and extending social security benefits.

Digital integration has also become a priority. Workers now update the Reproductive and Child Health (RCH) Portal in real-time using mobile devices. This shift aims to streamline data collection and improve service delivery. The move toward monthly honorariums marks a step toward financial security for ASHA and USHA workers. Yet, their classification as 'volunteers' still denies them basic labour rights and protections. With states adopting different approaches, the push for a uniform salary structure, better training, and stronger safeguards continues. The changes reflect a growing recognition of their essential—but often risky—role in public health.