‘Dekho didi, yeh toh humara kaam hai. Hum karte hi rahenge. Lekin aisa bhi nahi hona chahiye ki kyunki hum yeh karenge, ki humko izzat nahi denge? Yeh jo paise late aate hai, corona ke time jo madad nahi karte, yeh sab nahi hona chahiye.’ (‘Look didi, this is our work. We will keep doing it. But it shouldn’t be that just because we will keep doing it regardless, we don’t get treated with respect. Our payments coming late, the fact that we received no help during Corona, these things shouldn’t keep happening.’)

1Sunita-ji spoke as we were all getting up to leave from the Anganwadi centre, not in response to a direct question, but as a way of wrapping up the interview. To her, and to the other ASHAs I interviewed, two things stood out: the idea of work, and the idea of respect. Through this paper I have attempted to bridge the gap between understanding how work and respect are intertwined and simultaneously denied to these ASHA workers.

2Community health as a concept is founded not only on principles of building stronger and more cohesive public health systems, but on certain entrenched understandings of who can take on the burden of this care in the first place. By relying on the labour of women from marginalised communities, the ASHA scheme is an example of how existing paradigms of work and labour can serve to reinforce gendered inequalities, which further has implications for their families and the larger communities within which they and their work are located.

3This paper weaves together the discourses of what constitutes work and how states can negotiate these definitions by undervaluing and devaluing the labour of women through ideologies of service, compassion, and care. The nomenclature of ASHAs as volunteers and activists, change makers and honorary workers serves to create a system wherein the public health system and burdens of immediate care are subsidised through the underpaid and under acknowledged labour of women, while at the same time creating a narrative that such schemes are based on a uniquely Indian performance of seva. Multiple studies have pointed out that governments across the world who rely on the subsidised labour of women to perform community health tasks can afford to pay them regularised salaries at the very least (ILO, 2018; Chandrasekhar and Ghosh, 2016). This paper has been an attempt to show that referring to ASHAs as volunteers rather than workers is a political choice on the part of the state.

4At the heart of this research are the voices and experiences of the ASHAs themselves. By drawing on frameworks of ordinary ethics and paradigms of seva, I have tried to show how the ASHAs construct their work and their lives through constant negotiations, seen and unseen, with the state-defined expectations of what they, as community health workers, should be doing. Care and seva are not just positive and altruistic expressions of service to one’s community, but are embedded within complex and constantly changing structures of economic inequality, gender, caste and class in India. This paper, therefore, has also been a call to develop a more holistic understanding of the kinds of demands for care that are placed on the ASHA workers, and an acknowledgement that their labour goes beyond being health activists and change makers in their community and beyond the prescribed notions of public health and medicine.

5By examining how ASHAs themselves negotiate the making of their roles in different ways: within their family, their neighbourhood, in the eyes of the state - this paper has been a contribution to the growing academic literature on community health workers across the globe. More broadly, however, I have attempted to raise questions about how we can understand the role of the state when it comes to devaluing women’s work, and how women themselves compete with these devaluations through everyday resistances within ordinary life and social relations.

6Future avenues for research could potentially expand on the ideas that emerged through this paper, probing further into the ways in which the (Indian) state has subsidised its social welfare through the labour of already underprivileged groups. Existing literature on ASHAs in India has done significant work in terms of visibilising the unfair and often harmful treatment of these workers. However, this paper is also a call to go beyond current discourses of their working conditions and examine how these are structural inequalities, based on entrenched systems of oppression and devaluation, and why they exist.