Feminist labour organising: Community Health Workers in India Achieve Historic Victories

Across South Asia, millions of women serve as the backbone of public health systems, providing essential care to underserved communities as Community Health Workers (CHWs). Despite their critical role during the COVID-19 pandemic and beyond, these workers have long been rendered invisible by systems that devalue feminised labour.  

With an estimated 1 million Accredited Social Health Activists (ASHA workers) in India alone, and hundreds of thousands more CHWs across South Asia, these workers deliver healthcare to over 500 million people in underserved communities. The organising efforts described here, while initially focusing on five unions representing approximately 30,000 CHWs, have created ripple effects throughout the broader CHW workforce, demonstrating how strategic organising can amplify impact beyond direct participants. 

ASHA programme started in India in 2005. Even after two decades, their oppression continues. Paid as little as USD30-50 per month, denied formal employment status, and deliberately misclassified as "volunteers" rather than workers, CHWs represent a stark example of how women's care work is systematically exploited and undervalued. This exploitation is no accident – it is the deliberate misclassification of essential labour performed predominantly by working class women. 

However, since 2020, a powerful movement has been growing. Through feminist organising approaches developed by Public Services International (PSI), a global federation of public service unions representing 30 million workers in 154 countries, community health workers are challenging these structures of oppression, building collective power, and winning significant victories. 

This feminist approach to organising goes beyond traditional labour organising by explicitly addressing gender-based power dynamics both within unions and in society at large. It centres women's experiences, builds leadership from the ground up, and connects workplace struggles with broader gender justice issues. For CHWs, whose work sits at the intersection of gender discrimination and labour exploitation, this approach has proven particularly effective. 

The Transformative Power of Feminist Organising 

From Pandemic Crisis to Collective Power (2020) 

When COVID-19 struck, CHWs found themselves on the frontlines – conducting contact tracing, monitoring quarantined households, and raising awareness about prevention measures – often without adequate protective equipment or hazard pay. This crisis highlighted both their essential role and their extreme vulnerability. 

In response, PSI launched an online leadership development and capacity-building initiative during the height of lockdowns, focusing specifically on empowering CHWs to organise collectively and advocate for their rights. PSI began the training programme with five women leaders each from three unions in India – Mumbai Mahanagar Karmachari Mahasangh (MMKM) in Maharashtra, Nagpur Municipal Corporation Employees Union (NMCEU) in Maharashtra, and Hind Mazdoor Sabha (HMS) in Kanpur, Uttar Pradesh. 

Despite the limitations of virtual engagement, the results were remarkable. Women who had previously remained silent in union meetings began to find their voices.  

Building Momentum Through In-Person Training (2021-2022) 

As pandemic restrictions eased, PSI developed a comprehensive in-person training curriculum that explicitly addressed the intersection of gender and work. The programme expanded to include around 30 CHWs across three cities, with childcare support provided during workshops to enable mothers' participation – modelling in practice the support systems the movement advocates for in policy. 

Workshop activities encouraged CHWs to analyse how patriarchal structures shape their working conditions both at home and in their communities. Through these discussions, participants collectively developed charters of demands that included not only economic improvements but also gender equality measures such as maternity benefits and protection from harassment. 

By 2022, the training further expanded to include two additional unions – Indian National Municipal & Local Bodies Federation in Hyderabad, Telangana and Tamil Nadu Government Officials Union (TNGOU) in Tamil Nadu.

Creating Sustainable Leadership Through "Train-the-Trainer" (2023-2024) 

By 2022, it was clear that while direct training had created strong individual leaders, a more scalable approach was needed to reach thousands of CHWs across the region. Building on the foundation of trust and capacity established in the earlier phases, PSI shifted toward a model that would multiply leadership capacity and ensure the movement's sustainability beyond external support. PSI introduced a transformative "Training of Trainers" approach in 2023. Eight Trade Union Educators from each of the five participating unions were selected through a deliberate process that ensured representation across geographic areas and included both experienced leaders and emerging voices. 

These educators received intensive training not only in organising content but also in facilitation skills, conflict resolution, and adapting materials to different learning styles. They formed peer learning networks, supporting each other's growth while bringing the training to their local unions.  

This process of political awareness-building and critical consciousness development has been exemplary, transforming how these women understand their work and their collective power. Women who once remained silent in union meetings are now leading campaigns, developing strategies, and mentoring newer members. By 2024, several unions were independently conducting their own training programmes. By creating spaces for CHWs to analyse their conditions through a gendered lens, the programme has helped them understand that their struggles are systemic injustices that require collective solutions. As Sumedha a young CHW from MMKM shared: "Earlier I thought unions were just for making demands. Now I understand we are building power for ourselves." 

Mumbai's Historic 45-Day Strike (2024)

The most powerful demonstration of this new organising capacity came in 2024, when CHWs from MMKM  led a meticulously planned 45-day strike in Mumbai. It successfully transformed working conditions for thousands of CHWs. 

Women-Led Strategic Planning and Execution 

Drawing on their organising training, CHWs developed and implemented a sophisticated two-phase approach: 

1. "Kaam Bandh" Movement (Work Stoppage): From 11-17 June 2024, CHVs and ASHA workers across all wards completely stopped work, creating immediate pressure on the Brihanmumbai Municipal Corporation (BMC). 

2. "Dharna" Movement (Rotating Protest): From 18 June - 28 July 2024, the union implemented a rotating ward-wise protest system, an ingenious solution to a common challenge in healthcare worker strikes – maintaining essential services while keeping pressure on authorities. Each day, CHWs from different wards would participate in protests while their colleagues in other wards continued providing critical healthcare services. This approach prevented authorities from dismissing the action as irresponsible or endangering public health, while ensuring that protest momentum could be sustained over the remarkable 45-day period. 

The union's demands were comprehensive, addressing both immediate material needs and structural recognition: 

• Implementation of the provision of minimum wages order given by the industrial court 

• Maternity leave rights (6 months as per law) 

• Cancellation of employment breaks (given to 2016 CHWs to prevent claims of continuous employment) 

• Pension and provident fund benefits 

• Recognition and respect as employees rather than "volunteers" 

• Career path for ASHA workers to become CHWs when positions open 

  

Building Pressure Through Multiple Channels 

What made this campaign particularly effective was its multi-pronged approach. The women CHW leaders: 

• Maintained detailed records of participation, with careful tracking of attendance from 24 different wards 

• Held strategic meetings with various state ministers, municipal representatives and government officials 

• Distributed demand letters to officials at multiple levels of government 

• Engaged media to publicise their cause and the impact of the work stoppage 

Union ward representatives meticulously documented every aspect of the campaign, meeting regularly during the campaign creating detailed pathways of what is working and what is not working. Sunita Sutar, a ward union representative and union educator made presentations about these activities at national meetings – demonstrating the growth in women's leadership capacity. Media coverage became a powerful ally. When newspapers reported disruptions in vaccination trials for tuberculosis due to the work stoppage, it created additional pressure on the BMC to resolve the dispute. 

Historic Victory 

After 45 days of sustained action, the CHWs secured significant victories: 

• Maternity leave rights secured (6 months as per law)  

• Increase in CHWs' honorarium by INR 2,000 (USD 23) 

• Increase in ASHA Workers' honorarium by INR 5,000 (USD 57) 

• Proposal for aprons and uniforms for CHWs and ASHA Workers approved 

• Increase of INR 1,000 (USD 11) in annual bonus for CHWs (total bonus INR 12,000 (USD 138)) 

• Organisational growth with 600 new ASHA workers joining the union 

Beyond these material gains, this strike demonstrated the power of women-led organising, with planning, execution, and documentation led by the CHWs themselves. 

Building a National Movement Across India 

Mumbai's success is part of a broader pattern of organising happening across India, with similar approaches being implemented by: 

• Nagpur Municipal Corporation Employees Union (NMCEU) in Nagpur, Maharashtra 

• Hind Mazdoor Sabha (HMS) in Kanpur, Uttar Pradesh 

• Indian National Municipal & Local Bodies Workers Federation (INMLBWF) in Hyderabad, Telangana 

• Tamil Nadu Government Officials Union (TNGOU) in Tamil Nadu 

In each case, small groups of committed CHWs have built powerful movements through consistent organising, leadership development, and strategic action. 

Broader Victories Across South Asia 

All five unions have achieved significant improvements: 

Better Pay: 

• Regular payment of wages across all unions (before, payments were often delayed by 5-6 months) 

• Annual wage increases of at least INR 500 (USD 6) for all unions, with some winning INR 1,000-2,000 (USD 11-22) raises 

• After sustained strikes, ASHA workers’ honorarium in Maharashtra is as high as INR 13500 (USD 155) 

Better Working Conditions: 

• Uniforms and uniform allowances in multiple regions 

• Increase from one uniform to two uniforms yearly in several areas 

• Health insurance coverage secured in 2024 

Women's Leadership: 

• Women now actively participate in union planning and leadership 

• More women hold visible positions in union leadership  

• A young CHW from Mumbai who joined the training programme, was selected to represent India at PSI’s international young workers' meeting in Sri Lanka 

Adapting Organising Tools to Women's Lived Experience 

A critical element of the PSI approach has been adapting traditional organising tools to women CHWs' specific contexts. When power mapping exercises initially proved challenging because many women lacked knowledge about governance structures, facilitators adapted by: 

• Starting with mapping power dynamics in the community and household before moving to institutional power 

• Using real-life examples of successful campaigns from similar contexts 

• Breaking complex analyses into smaller, more manageable steps 

• Combining analytical tools with storytelling approaches 

These adaptations made organising tools more accessible while still developing strategic thinking capabilities. By 2024, CHWs were effectively using these tools to plan sophisticated campaigns like the Mumbai strike. 

Building Sustainable Feminist Leadership 

Perhaps most transformative has been the shift to a "training the trainers" model, where CHWs themselves become educators and organisers. By identifying and developing 8 CHWs from each union as educators, PSI has created a sustainable system for ongoing leadership development and membership engagement. 

In all the 5 unions, the leadership training programme has continued to progress since PSI's first training delivery in 2021, with key ASHA workers participating and then training others. As the Nagpur union reported: "The union can regularly organise leadership training. PSI support in building the union has truly helped inspire a large number of workers whose commitment to the union has increased many times over." 

This approach recognises that true transformation requires not just winning immediate demands but building power and leadership capacity that can sustain a long-term movement. It embodies the feminist principle that those most affected by injustice should lead the struggle against it. 

As one CHW leader from Tamil Nadu expressed: "We are not just fighting for better wages. We are fighting for recognition that what we do is real work, skilled work, essential work. When we win, our communities win too." 

The Road Ahead: From Local Victories to Systemic Change 

The journey has not been without challenges. Initial scepticism from male union leaders, deeply internalised gender norms that made some women reluctant to speak up, and the practical difficulties of balancing organising with family responsibilities presented major obstacles. Organisers addressed these challenges by engaging supportive male allies within the unions, creating women-only spaces for building confidence and solidarity, and implementing practical support like childcare during meetings. When faced with government officials who refused to recognise CHWs as workers rather than 'volunteers,' the movement responded with meticulously documented evidence of their essential role in healthcare delivery, effectively countering the narrative of devaluation. 

The journey of CHW organising in South Asia demonstrates the revolutionary potential of feminist approaches to building worker power in the care sector. Through intensive advocacy work, CHW representation was secured at the Care discussion at the 2024 International Labour Conference, marking a significant milestone in achieving recognition at the international level. This participation has created momentum toward standard setting that will lead to future international labour conventions and recommendations that can be adopted and implemented into national labour laws. 

From being invisible workers, CHWs have become recognised stakeholders in discussions about healthcare systems, gender equality in the workplace, and the future of care work. Their lived experiences are informing policy discussions at multiple levels. 

On this International Women's Day, we celebrate these remarkable women who are not only improving their own working conditions but advancing a transformative vision of public health – one that values care work, recognises women's labour, and builds public health systems that serve communities equitably. 

Their struggle reminds us that when women organise, they can dismantle systems of exploitation and build new models of solidarity and care that benefit all of society. These Community Health Workers demonstrate that feminist labour organising is not just about improving conditions—it's about transforming power itself. 

To learn more about the CHW campaign: 

• Visit the campaign page: Community Health Work is Work! 

• Follow the Facebook page: facebook.com/CommunityHealthWorkers 

• Read media coverage of the Mumbai strike: Mumbai: Tussle between BMC and health workers halts TB vaccine trials