Digitalization at the Frontlines: Experiences of ASHA Workers in India

Digital technologies are increasingly permeating traditionally non-digital sectors, including India's public health system, through initiatives like the National Digital Health Mission. This mission seeks to improve healthcare outcomes by leveraging data to inform and optimize strategies. Through an intersectional feminist lens, this paper critically examines who bears the burden of these digitalization efforts and how they impact women frontline community health workers—Accredited Social Health Activists (ASHAs)—who are positioned at the lowest tier of the public health system and entrenched in precarious, informal labour.

The paper explores whether digitalization enables ASHA workers or perpetuates their marginalization, reinforcing existing power imbalances. While digitalization has brought benefits like enhanced accessibility, transparency, and ease of communication, it has also imposed additional pressures on ASHAs. ASHAs are increasingly tasked with digital responsibilities, transforming the nature of their community care work. They are now involved in extensive on-the-ground digital data collection, resulting in increased workloads, the dual burden of managing both digital and paper-based tasks, and the exploitation of their unpaid labour. Moreover, disparities in access to technology, digital skill gaps, and concerns over privacy violations have become critical issues, underscoring how ASHA workers' collectives have effectively resisted the harmful impacts of digital shifts in their work environment.

The research draws on multi-method qualitative fieldwork conducted across four Indian states—Kerala, Haryana, Rajasthan, and Meghalaya—and includes in-depth interviews and focus group discussions with ASHAs, as well as key informant interviews with trade union leaders and public healthcare officials. By examining ASHAs' responses to digitalization, this study highlights the broader implications of platformization beyond the gig economy, particularly in traditional sectors where women often occupy lowest hierarchical positions.