Rahul Chakradhari is a pharmacist and a permanent employee at a Primary Health Centre (PHC) in Rasela, a village in Chhattisgarh’s Gariaband district close to the Odisha border. However, the current circumstances have forced him to go beyond the scope of his duties. He isn’t just dispensing medicines; he is also prescribing them in some cases.
Chakradhari says he is forced to do so because of a staff crunch caused by a State-wide strike of over 14,000 contractual National Health Mission (NHM) workers. One in every three healthcare workers — from doctors and nurses to pathologists and auxiliary nurse midwives — is not reporting for duty. The strike over 10 demands, key among them being permanent employment, better pay and good working conditions, has entered its 24th day, impacting healthcare facilities at every level, from district hospitals to Arogya Mandirs (health and wellness centres).
At the Rasela PHC, the Registered Medical Assistant — the second in the hierarchy after the medical officer or doctor in-charge — and the only nurse, both contractual NHM workers, are on strike. A PHC serves 20,000-30,000 people according to NHM norms, and is considered the first contact point between the village community and a doctor. The doctor at the Rasela PHC has been pulled out to serve at a Community Health Centre elsewhere due to the strike-induced shortage of medical professionals.
Also read: Over 14,000 contractual staffers of NHM quit as government sacks 25 agitators in Chhattisgarh
“This is the season when viral fever cases spike. Anywhere between 60 and 70 patients come to the hospital. I am forced to attend to them in consultation with Dr. Rahul Netam over the phone sometimes. The absence of a nurse means a handicap as far as injections and complex maternal care cases are concerned,” he says.
Every health centre has similar stories: stalled immunisation, programmes not running, routine check-ups affected, reporting of non-communicable diseases impacted, and funds for specific projects remaining under-utilised.
Protestors have cited 10 demands, including permanent employment rather than contract-based employment, a 27% salary hike, and the establishment of a public health cadre. The Chhattisgarh government claims it has fulfilled five of the demands, including a salary hike, but only of 5%. NHM workers say they are stretched in a variety of ways, including working in difficult-to-reach locations and not having the safety net regular government employees have.
NHM workers have been on protest since August 18 in their respective district headquarters. “Samvida matlab shoshan (contract means exploitation),” says a speaker at the Tuta protest ground in Raipur as an enthusiastic bunch of protesters gathers there to respond with chants of “ladenge, jeetenge (we will fight, we will win)”. Through songs and acts like a jal satyagrah, refusing to drink water, they demonstrate their anguish. In some districts, they also protest outside the office of the Bharatiya Janata Party, the party in power at the Centre and the State.
Demands and supply
“The NHM (formerly National Rural Health Mission) started in 2005 on a mission mode for reproductive and child health with 2,000 employees. Gradually its scope expanded to health care and the roles and individual responsibilities have only increased. We are seeking parity with other health workers who do the same work as we do, and are equally well-trained,” says Hemant Sinha, one of the leading voices of the protest.
Since then, he has been part of groups demanding permanent employment for the contractual employees who include both medical and non-medical support staff across 100 categories. Hiring happens at the State and district levels.
Also read: NHM enhanced workforce, curbed several public health concerns: Centre’s report to Cabinet
At present there are 16,000 NHM workers, of which most District Programme Managers (coordinators), some new joinees, and those on maternity or other long-term leave are keeping out, he says. According to a senior government official, 60% of the funds for the NHM comes from the Centre while the State foots the remaining 40%. The administrative control remains with the State, says the official.
Sinha says the immediate nudge for the protest came from a political commitment. “The BJP in its manifesto had promised that a committee will be formed for regularisation of all contractual employees. We had protested during the tenure of the previous Congress government with similar demands, and back then, BJP leaders, including Cabinet ministers of today, had supported the cause,” he says. The BJP formed the State government in 2023. He adds that before going on strike, the association had submitted 160 memorandums to the government.
Protesters outside a BJP district office in Gariaband. Several health workers said the ruling BJP, which formed the government in the State in 2023, had promised to regularise their jobs during the Assembly election campaign.
| Photo Credit:
Shubhmoy Sikdar
A spillover effect of the protest is also visible. Dr. Kirtan Sahu, the Block Medical Officer at Chhura CHC, who is an employee, says that the non-communicable disease programme has taken a serious hit because all 36 community health officers of the block are protesting. At Raipur’s district hospital in Pandri area, a staff nurse says that they have been burdened and are having to do many more night shifts than they would usually do.
Amrit Bhonsle, Gariyaband district president of NHM workers’ union, cites the case of a security guard administering an injection to a patient at the district hospital — an incident that the State’s High Court took cognisance of — pointing out that it was a serious violation of “medical ethics and professional standards”.
Leaders such as Sinha say that other States such as Manipur have absorbed NHM workers as regulars. In Madhya Pradesh, they are not permanent employees, but still get grade pay, gratuity, jobs on compassionate grounds, and have job security till the age of 62. A government official, however, points out that in M.P.’s case, the policy was made for all contractual workers.
People suffer
Across Gariaband and Chhattisgarh’s capital Raipur, many Arogya Mandirs are locked. Some health centres in Raipur bear a signboard expressing regret for the inconvenience, citing the contractual employees’ strike. Others, like the one in Mana area on Raipur’s outskirts, barely a few kilometres from the protest site in Nava Raipur’s Tuta, are locked with neither patients nor NHM staff in sight.
Some of these areas have no private healthcare system either. A Comptroller and Auditor General of India (CAG) report tabled in the State Assembly last year noted that there was an overall human resources shortage of 34% (25,793) against the sanctioned strength (74,797). It also said the Government of Chhattisgarh (GoCG) had not formulated any human resource policy for the health care sector to ensure availability of doctors, nurses, and paramedics in healthcare institutions as per the Indian Public Health Standards norms.
Devshree Dhruv, a physiotherapist posted at Chhura Community Health Centre, the unit just above Rasela PHC, is on strike. She expressed regret for not attending to a three-year-old girl suffering from cerebral palsy as the child had made “decent progress with regular visits and proper care”.
It’s the same for Anju Sahu, in her 50s, who recently underwent a knee surgery and has arrived at the CHC with the help of a walker only to learn from Dhruv that she won’t be giving her physiotherapy because of the strike. For a previous session, the elderly woman had gone to Raipur nearly 100 km away.
Trials and tribulations
In centres far from even PHCs, the entire population in tiny villages is dependent on healthcare services reaching them. Sangeeta Bramhnotiya, a district programme manager, who works on contract in Narayanpur district of the insurgency-hit Bastar region, says there is an additional financial burden on last-mile health workers such as herself.
Those most-affected by the strike include pregnant women and families living in remote villages.
| Photo Credit:
Shubhmoy Sikdar
“We have to go to schools and anganwadi centres in remote areas on foot through jungles, rivers, and mountains and stay there. If there is a road, it is so rough that our vehicles get stuck, in which case our own clothes get completely dirty, adding to laundry and repair costs,” she says, as she sits on strike.
Their vehicles are mostly personal two wheelers, on which they carry essential items like medicines, registers, and health cards, she adds. “Children suffering from serious diseases have to be brought to bigger hospitals like those in Raipur (250 km away) or Jagdalpur (120 km away) for better medical treatment, at our own expense, by our staff many times,” says Bramhnotiya.
“I am a doctor and yet my monthly income of ₹25,000 is barely enough to make ends meet. Imagine being in a health setup and unable to afford health care for my own. I am long overdue for a surgery that will cost me ₹7 lakh and the only way I can spend that much is by selling my ancestral land,” says Tarun Patel, 40, an Ayush Medical Officer at Chhura Health Centre in Gariaband. While he is on a contract, other medical officers earn in lakhs, he adds.
Still going
In the first week of September, 25 leaders of the protest, including Sinha, were suspended from work. This was met with mass resignation, with almost all the protestors saying symbolically in unison that they were all resigning.
Health Minister Shyam Bihari Jaiswal has thus far maintained that five of the 10 demands, have been accepted and appeals to the NHM workers to return to work.
Sinha says that while other contractual workers in the State received no salary increments between 2018 and 2022, NHM workers received 5% annually based on their performance review. One of the demands is to make the appraisal process transparent.
The workers are demanding a written order for the government’s announcements and until all 10 demands are fulfilled, they intend to continue the protest. “We have come a long way and we won’t give up as this pivotal point,” says Sinha.
