Some 26,000 rural public health workers in Kerala have been on strike since February 9 to press their demands that the state government, led by the Stalinist Communist Party of India (Marxist) or CPM, provide them a living wage and, on retirement, a rudimentary pension.

Popularly known as ASHA (Accredited Social Health Activist) workers, the rural public health workers provide frontline public health services in rural areas where there are few if any doctors, and no hospitals or other health care facilities.

Nationally there are more than a million rural ASHA workers, the overwhelming majority of them women. All are extremely poorly paid, although they perform vital functions, including providing vaccinations and advice on nutrition and family planning and help in monitoring pregnancies. Due to the absence of health facilities and personnel, they are also often compelled to provide preliminary medical diagnoses.

Although the ASHA workers are treated abysmally by Indian authorities, they have at times been lauded by the media and government officials as “frontline warriors,” because of their role in combatting major health crises—above all the COVID-19 pandemic—but also outbreaks of the Nipah virus and dengue, and disasters like last year’s landslide in Kerala’s Wayanad district.

The Kerala ASHA workers’ strike has won widespread support, with workers, along with prominent artists and intellectuals, voicing their support.

The CPM-led state government, meanwhile, has responded with smears and is now threatening to hire 1,500 “apprentice” health workers in a bid to break the strike.

Currently, the Kerala ASHA workers receive a monthly stipend of just 7,000 rupees (US$80), and a further 3,000 rupees in allowances. All told, this amounts to compensation of roughly 420 rupees, or $4.80, per workday.

The striking workers’ primary demands are for a monthly wage of 21,000 rupees, permanent employment and retirement compensation of 500,000 rupees. Their salaries have stagnated in recent years, even as prices for food, energy and other essentials have spiked.

The strike is being led by the Kerala Health Workers Association (KHWA), which claims to be an “independent” union. The union has received support and, no doubt, advice from both the Congress Party, the official opposition in the state legislature, and the Stalinist Communist Party of India (CPI), which is itself a junior partner in Kerala’s CPM-led Left Democratic Front government.

By posturing as supporters of the strike, the Congress and CPI are trying to make political capital at the CPM’s expense, while working to ensure that the ASHA workers’ struggle is kept under the KHWA’s control and within the confines of establishment politics and pathetic appeals to the CPM to be more reasonable.

Of India’s 28 states, Kerala is currently the only one to have a purportedly “left,” CPM-led government. While the CPM claims to prioritize people over profit, it and the CPI have for decades functioned as an integral part of the Indian political establishment. In the states where they have held office—Kerala, West Bengal and Tripura—they have implemented what they themselves call “pro-investor” policies. Nationally, over the past three decades, they have supported, in the name of opposing the far-right Hindu BJP, a succession of right-wing governments that imposed the bourgeoisie’s neo-liberal agenda and forged a strategic partnership with US imperialism.

Leaders of the CPM-affiliated Centre of Indian Trade Unions (CITU) and the CPM have harshly denounced the striking ASHA workers. They have accused them of being anarchists and seeking to spread the “strike infection” among workers.

Seeking to isolate and browbeat the strikers, Kerala Health Minister and CPM leader Veena George has asserted that Kerala’s ASHA workers are the highest paid in the country—implying that they should be content with a monthly stipend that leaves them mired in poverty.

The CPM Stalinists are also using the phony statements that the opposition parties, including the Hindu supremacist BJP, have made in support of the strike in an effort to discredit the ASHA workers’ struggle. They are smearing the strike as an opposition plot to destabilize India’s only “left” government.

These are transparent lies.

The Stalinist CPM is attacking the ASHA workers because they fear their militant struggle could become a catalyst for a broader movement of the working class. Such a movement would undercut the efforts of Kerala Chief Minister and CPM Politburo Member Pinarayi Vijayan to woo global investors by promoting Kerala as a haven for cheap-labour production.

In late February, Vijayan hosted a two-day “Invest in Kerala Global Summit,” which attracted more than 3,000 delegates and reportedly garnered investment pledges of over 1.5 trillion rupees ($17.2 billion) from as many as 374 companies, both foreign and domestic. Prior to and during this summit the LDF government promised to enhance the “ease of doing business,” a euphemism for gutting environmental and other regulations. Vijayan is also seeking to sell off public assets, by adopting a “public-private partnership” (PPP) model for state-owned enterprises, including the Kerala State Road Transport Corporation (KSRTC) that provides relatively low-priced inter-town bus service for villagers and lower-income city dwellers.

If they are to prevail in their struggle, the ASHA workers need to take it into their own hands and out of those of the establishment-aligned KHWA union officials. They also  urgently need to broaden it, by fighting to make their struggle the spearhead of a working class mobilization against the evisceration and privatization of public services, the proliferation of contract labour, and the slashing of social supports.

The KHWA leadership is adamantly opposed to mobilizing the strong support for the strike among workers and the rural poor, as well as sections of the middle class, as indicated by the messages of support from the award-winning novelist Arundhati Roy, actress Kani Kashruti and Malayalam writer P. Geetha.

The KHWA has made no attempt to spread the strike to ASHA workers in other states, or to tie it to a broader working class challenge to the deplorable state of public healthcare. For decades, under both Congress Party and BJP-led national governments, the Indian state at all levels has spent no more than 2 percent of GDP on healthcare—that is, generally less than what it funnels into its massive nuclear-armed military.

On March 8, International Women’s Day, the union organized a token protest outside the state government Secretariat in Thiruvananthapuram, Kerala’s capital. The KHWA is now calling for a larger protest at the same venue on Monday, March 17, which will mark the strike’s 36th day. However, its aim is not to mobilize broader working class support, but rather to maintain control over an increasingly restless rank and file.

The striking ASHA workers should form rank-and-file committees independent of the KHWA union apparatus, its Congress Party and Stalinist CPI allies, and all representatives of the rival capitalist parties and their trade union lackeys.

Workers can only assert their class interests and mobilize their social power insofar as they break free of the entire capitalist political establishment, and consciously repudiate its various reactionary nationalist, communalist and ethno-regionalist appeals.

Even as the CPM and Congress Party trade accusations against each other in Kerala, they are working together on the national stage to tie the mounting social anger against the Narendra Modi-led BJP government to the opposition INDIA alliance. Led by the Congress Party and including a wing of the fascistic Shiv Sena, the INDIA alliance aims to replace the current government with one no less committed to big business policies and the India-US anti-China “Global Strategic Partnership.”

A critical task of an ASHA workers’ rank-and-file committee would be to broaden the struggle, seeking to mobilize support from and develop a working class counter-offensive, involving all workers, public and private sector alike, in Kerala and across India. This should include direct appeals to ASHA workers across India for a joint struggle for permanent jobs and common terms of employment—including a 21,000 rupee minimum monthly salary—for all, and a vast infusion of state funds into expanding public health care, through the seizure of the ill-gotten wealth of the Ambanis, Adanis and other billionaires. It should also include forging fighting ties with healthcare and other workers around the world through the International Workers Alliance of Rank-and-File Committees (IWA-RFC).