An Accredited Social Health Activist (ASHA) worker can spend an entire day walking through broken roads, dangerous terrains, uneven lanes, crossing neighborhoods, stopping at houses to monitor pregnant women, checking with fevered people, vaccinating infants, and giving medicine to the elderly, only to return home with an unease that her work has not yet even begun. She explains, persuades, repeats instructions, checks records, notes symptoms, and listens to worries that are never written anywhere — none of this fully settles as complete work, until a screen confirms it.

My work on ASHA workers and the digitization of their work in Kashmir documents this tension, where ASHAs fully perform their tasks in the field, and yet the completion of the task remains incomplete because the digital system has not accepted it. Even after completing field visits, the mobile network fails, or the app does not synchronize, hence the task remains pending or requires redoing.

Introduced in 2005, under the National Health Mission, ASHAs are community-based women frontline health workers and the first point of contact between households and public health systems.

ASHAs are often described as the backbone of the Indian public health system. Introduced in 2005, under the National Health Mission, ASHAs are community-based women frontline health workers and the first point of contact between households and public health systems. They cover maternal care, immunization drives, disease surveillance, nutrition campaigns, and household-level health communication in villages and low-income urban settlements.

India has more than one million ASHA workers, making them one of the largest community health workforces, yet they are not classified as salaried employees but volunteers who receive task-based incentives and minimum honoraria rather than wages.

Their employment structure has long been debated among labor scholars, critiquing the exclusion of ASHAs from the protections associated with formal employment, such as minimum wage guarantees, pension structures, paid leaves, or full security coverage. Their payments are disbursed unevenly across states depending on a fragmented incentive structure earned by supporting institutional deliveries, ensuring vaccination completions, and completing reporting targets, etc.

This is where an important parallel emerges with the global digital labor struggle, though ASHAs are not platform workers in the conventional sense. One of the central demands of workers governed through digital systems has been that labor protection must not narrowly depend on formal employment classifications.

Whether a worker is called a contractor, volunteer, consultant, or community mobilizer, it does not alter the fact that labor is being reorganized.

Whether a worker is called a contractor, volunteer, consultant, or community mobilizer, it does not alter the fact that labor is being reorganized.

From health outreach to continuous digital reporting

Despite the nomenclature, ASHAs’ work is increasingly mediated through mobile applications, digital dashboards, geo-tagging systems, biometric attendance, and mandatory digital documentation.

ASHAs’ work is increasingly mediated through mobile applications, digital dashboards, geo-tagging systems, biometric attendance, and mandatory digital documentation.

ASHAs from far-flung areas of Kashmir, for instance, face connectivity issues during winters, when the electricity shuts down for months due to snow; they are required to show up anyhow. “They (authorities) say phones should be active all the time, somehow charged all the time,” one of the workers shares.

At the inception of the ASHA programme in 2005, they were critical resources in providing healthcare to underserved populations; they were not imagined as digital workers.

The labor of these community health workers was rooted in social familiarity, as women from local communities were chosen to provide health services in homes where institutions would barely have access. Their authority in persuading the families depended less on the institutional power and more on human contact. They knew the temperaments of people—who would agree and who would hesitate before immunization, which households concealed illness, and which pregnancy required repeated follow-ups because transportation to the healthcare center was uncertain. Their work was slow, gradual, persuasive, and often invisible.

Today, ASHA workers don’t just have to track due dates for immunization, antenatal checkups, and referral schedules; they also have to navigate mobile applications, passwords, application crashes, interface changes, and repeated data entry requirements.

Today, ASHA workers don’t just have to track due dates for immunization, antenatal checkups, and referral schedules; they also have to navigate mobile applications, passwords, application crashes, interface changes, and repeated data entry requirements. Manual registers are still filled in addition to the same data being entered into apps—the same data needs to be entered twice, first by hand and then digitally. The result is not the doing away with old bureaucratic labor but its doubling.

The hidden extension of their labor after days of fieldwork shows the burden of the digital, which includes retrying failed uploads, correcting entries, asking children and relatives to help with data entries, application updates, and synchronizing data.

This is one of the quietest transformations in the workday of a frontline health worker, where her labor only exists when it leaves a digital trace through the doubling of work.

Surveillance through attendance, geo-tagging, and image-proof

The workers are not only expected to explain the upload failures and attendance not being registered online, but this is also where surveillance enters their work quietly. Their physical presence at work, which is not enough, is regulated through a technical language for surveillance—‘attendance verification, geo-tagging, reporting efficiency, transparency’.

“If we want to take a day off or stay at home, we can’t do that anymore. We don’t have the time to stay at home. Now that all the work is digital,” another worker explains how the device extends her workday beyond the field, making connectivity a part of labor where rest becomes conditional.

By attaching all the data to reporting, their care work is made traceable.

In effect, ASHAs are entering into a new work regime where their labor is inseparable from the digital. By attaching all the data to reporting, their care work is made traceable. The worker’s routes, timing, location, and activity become legible to the system.

This transformation necessitates urgent attention as the current debates on algorithmic management remain limited to platform economies in understanding how managerial authority is exercised through automated systems.

In the case of ASHA workers, the authority is not directly coded digitally but is layered in the public health hierarchy in which ASHAs report upward through Female Multipurpose Health Workers (FMPHWs), meetings at Primary Health Centers (PHCs), block facilitators, and medical officers who review village-level data, attendance, incentive-linked tasks, and service delivery targets. Applications and dashboards do not replace the supervisory structures; they rather tighten them by allowing the managerial decisions to be shaped by what is visible on the screen.

Regulating the conduct of workers

The digital systems exercise algorithmic management in a way that determines which part of the labor becomes invisible—affective, and which becomes legible—cleaner data.

This is precisely why digitalization does not just include recording labor but a reorganization of the labor. Even though the work of ASHAs fundamentally depends on the non-measurables—trust, timing, repetition, and negotiation, what gets counted as labor begins to press against what is relational. The digital interface captures the outcomes with far more ease than the labor that produces the consent, which has no record.

For instance, a long visit to persuade a hesitant family about vaccination may take days, but the digital systems record only a completed field. The affective labor that is required to produce a single completion remains outside of the measurement.

This also creates a shift in the conduct as workers begin anticipating the digital mechanisms of documentation while performing care.

This also creates a shift in the conduct as workers begin anticipating the digital mechanisms of documentation while performing care. While they think about whether the entries will upload later, whether the previous field was saved, or whether a particular detail should be written separately in case the app fails, their work moves into a digital anticipation anxiety.

It is not to say that the workers care more about the digital records than people, but it creates a constant judgment in their minds about which part of their day would become visible before the authority. Another ASHA worker from Kashmir, on account of generating Ayushman cards, defines how much labor disappears behind a single submission: “I had almost 350 cards. We had to go door-to-door and deliver them to their homes. Some people had linked them to their Aadhaar numbers, some hadn’t…for those who didn’t have it linked, we had to link it by scanning their faces. And that would not happen in the evening. There were a lot of trees around (poor lighting), so the phones were unable to scan faces. Sometimes a card would take three or four days. We would look for sunlight and then try at five or seven places to scan the face. Each PVC card would take almost half an hour.”

Scholars studying frontline health workers in India describe this as a hidden technical burden absorbed silently by women workers inside already feminized care structures. The administrations acquire cleaner data because women workers do the physical and technical labor throughout the day and after work hours.

The experiences of ASHAs show a complex algorithmic control embedded in the public sector and welfare work, especially where women work from the margins of formal recognition.

While the ever-expanding reporting does not guarantee an equal valuation of labor, many accounts, including reporting by BehanBox, document ASHA workers expressing how public health systems rely on them for far more than before, while the institutional recognition and compensation lag behind.  The teenage daughter of another ASHA worker shares, “Authorities don’t cooperate in the sense that if they (ASHAs) can’t figure out something on their own, they have to assist them…what they do in turn is that they treat them very rudely.”

The language of digitalization often suggests smooth governance, but what the frontline health workers experience is a downward friction — network failures become workers’ delays, technical device limitations mean workers’ inadequacy, and incomplete submissions become workers’ responsibility.

The language of digitalization often suggests smooth governance, but what the frontline health workers experience is a downward friction — network failures become workers’ delays, technical device limitations mean workers’ inadequacy, and incomplete submissions become workers’ responsibility. ASHAs’ labor reveals the other side of digital governance—algorithmic control is not just limited to app-based gig work, it permeates sectors that are publicly imagined as welfare work or state services.

Sensitive data without security

The doubling of their work also happens in the least secure forms of labor in the public health system. As ASHAs routinely handle highly sensitive information such as Aadhaar numbers, bank account details, family planning details, maternal records, immunization schedules, and health conditions that many households hesitantly disclose, the device through which most of these details are entered, carrying fragments of intimate identity details from house to house, is an ASHA worker’s personal phone device.

Formal digital training and security measures for handling such sensitive details remain inconsistent. The state increasingly depends on these women to generate accurate digital health data while they remain exposed to digital insecurity themselves.

The workers are left to adopt personal coping strategies to save themselves from the fear of data theft. Some ASHAs do not use social media altogether and remain constantly cautious of where their phones are.

The workers are left to adopt personal coping strategies to save themselves from the fear of data theft. Some ASHAs do not use social media altogether and remain constantly cautious of where their phones are. “I think if, God forbid, something happens to the data, then it is all on me. I don’t let anyone touch my phone. I don’t use it too much myself. This job requires extra precaution. At times, I could use my phone for other things, for example, I could keep my child busy with it for a while, but I have to be careful. There is so much data; if it leaks, then that is a different headache,” one of the workers shares.

The insecurity is not abstract, as many ASHAs report being scammed through unfamiliar messages, unexpected calls about payment verification, while also facing uncertainty about whether a mistaken entry could affect someone else’s records.

In the interviews recorded in my report, they do not speak in the language of cybersecurity but in a language of fear—the fear that a technical mistake will be returned to them as blame. Such fear is structurally produced as a digital error quickly becomes a personal failure.

Such fear is structurally produced as a digital error quickly becomes a personal failure.

The daughter of an ASHA worker who often helps her mother navigate the malfunctioning systems describes how quickly technical issues turn into humiliation. “You don’t know how to operate things,” they are told. ASHAs are held responsible for digital infrastructures they neither designed nor control.

Why this matters for labor standards

Debates on labor standards for algorithmic management cannot remain limited to formal platform economies; they must account for workers like ASHAs whose labor remains outside platform classification but sits increasingly inside the platform logic in more complex ways.

A narrow definition of platform work risks missing the sectors where digitalization is growing faster under the language of public good.

The language that is used to celebrate ASHA workers often obscures a harsh reality of these workers being intensely monitored and underpaid, even while they help expand the organs of digitalized governance. Better labor standards in digitalizing non-platform work should begin with a simple recognition of digital reporting and digitization of work as labor and not an invisible extension of the existing duty.

Better labor standards in digitalizing non-platform work should begin with a simple recognition of digital reporting and digitization of work as labor and not an invisible extension of the existing duty.

The burden of device costs, internet expenses, and technical maintenance and failures cannot continue to be absorbed by the daily wage workers whose income is already fragile. Digital attendance systems require safeguards where technical malfunctions do not become the workers’ responsibility. Similarly, citizens’ records should not only account for data protection, but should also include workers through whom the data travels.

Until such standards catch up, the contradiction remains unresolved—a woman worker may spend an entire day doing critical public health work across difficult terrains and harsh social conditions and still return home waiting for a signal to count her labor.

Research for this piece was conducted under the National Gender Fellowship 2024. Learn more about the fellowship here.