Running on Hope: Female Community Health Labor in Rajasthan, India (Policy to Practice)

This book is freely available in an open-access edition thanks to the generous support of Johns Hopkins University.

Throughout India, Accredited Social Health Activists (ASHAs) visit households in their communities to deliver essential health services and link community members with key health benefits. Like many other female Community Health Workers across the world, ASHAs are often portrayed as virtuous, passive volunteers, selflessly providing services to their neighbors.

The reality is more complicated and much more interesting. Drawing on ethnographic work in Rajasthan, Running on Hope follows ASHAs through striking personal transformations. From their positions as rural daughters‑in‑law—a particularly low‑power position in Rajasthan—ASHAs have, over years of work, gained unprecedented autonomy for young rural women. They have also gained a deep understanding of what many argue is the exploitation involved in their low‑ranking position in the health system. ASHAs often earn less than $100 per month for extensive work, well below the legal minimum wage.

To counter this, many ASHAs have joined unions—an endeavor that has ultimately proven disappointing: union leaders’ desires for political advancement are often at odds with ASHAs’ own needs. However, ASHAs do not have connections, money, or social power to organize effectively on their own, without a political patron. In Running on Hope, authors Svea Closser and Surendra Singh Shekhawat interview women who work as ASHAs to learn about their organizing goals, their roles in their community as conduits to health education and resources, and their hopes for a better future.