Success stories from South and Southeast Asia: Organising as a tool to achieve regularisation and recognition

Through training, we have learned that we are workers and that we have right to demand basic services such as maternity benefits, provided funds, safety etc. We have not only protested on the ground but have also utilised legal routes to achieve our demands - Sumedha Mane, CHV, Mumbai, India

We came together to demand regularisation as government servants. The media covered our struggle, and the authorities felt pressure of our unity. We also lobbied members of parliament. We have achieved regularisation and created history for CHWs across the world. - Raheela Tabassum, LHW and General secretary of the National Lady Health Workers Federation, Pakistan

Background

The United Nations University – International Institute for Global Health and Public Services International co-organized a virtual panel discussion on 12 November 2025 during the 4th International CHW Summit. The session provided a platform for community health workers, trade union leaders, and Ministry of Health representatives to reflect on success stories of collectivisation in India, Nepal, Pakistan, and the Philippines, and to identify lessons for ensuring CHWs’ dignity and rights in other contexts.

The community health workforce, like the broader health workforce, is highly feminised in South and Southeast Asia. Despite their essential contributions, CHWs are not recognised as public health workers and often lack job security, social protection, and fair pay. Rather than accepting these conditions, CHWs, supported by unions such as PSI, are increasingly organising to demand recognition, regularisation, and rights.

Success stories of collectivisation efforts shared by CHWs

Raheela Tabassum, a lady health worker (LHW) and the general secretary of the National Lady Health Workers Federation (NLHWF), Pakistan, described how years of mass mobilization and strategic use of legal tools helped 125,000 LHWs secure formal recognition and regularisation as public servants. This achievement has strengthened their job security and improved accountability within the health system. Dr. Sabeen Afzal from the Ministry of Health highlighted that while Pakistan’s regularisation of LHWs is a major milestone, it must be supported by institutionalised training, stable financing, and strong monitoring mechanisms to reinforce the bridge between communities and formal health systems.

Sumedha Mane, a community health volunteer (CHV) from Mumbai, India, explained how CHVs, ASHAs, and Anganwadi workers organised a 45-day strike demanding fair wages, maternity entitlements, and occupational safety. Their collective action pushed the municipal corporation to introduce incremental benefits, strengthening both working conditions and their bargaining power.

From Nepal, CHVs Basanti Maharjan and Gita Thing shared how organising efforts led to partial recognition and benefits such as uniforms, allowances, and insurance coverage. They stressed that their struggle continues as they advocate for regular worker status, better incentives, and stronger mental health and leadership support.

Barangay Health Workers from the Philippines discussed how, despite formal training and accreditation, they are not recognised as public health workers and rely on inconsistent municipal allowances. To assert their rights, they developed the Magna Carta for Barangay Health Workers, calling for standardised compensation, job security, civil service inclusion, hazard pay, medical benefits, and representation in health boards.

Persistent challenges

While CHWs have achieved important gains through strategic collectivisation, resistance from governments,  except in Pakistan,  in recognising them as public sector workers remains a major barrier to ensuring dignified working conditions. CHWs continue to face burnout, long hours with little rest and frequent exposure to harassment, gender-based violence and unsafe environments during community visits. Stress and emotional strain were highlighted by many speakers. In Pakistan, new challenges such as outsourcing, short-term contracts, and donor-driven programmes are threatening job stability, showing that even after formalisation, privatisation can erode hard-won progress. Despite strong unions in some countries, cross-country collaboration is limited, and CHWs are rarely included in health governance structures, reducing their influence over policies shaping their work and wellbeing.

Lessons learned

• Success stories from the four countries show that strategic organising, using a multipronged approach, can lead to major gains such as formal recognition, better pay, and stronger worker rights.
• Working closely with ministries, as in Pakistan, helps secure proper training, reliable budgets, and clear career pathways, making reforms more sustainable.
• Generating evidence on CHWs’ economic and health contributions from UHC to immunisation and maternal health  strengthens long-term investment.
• Recognising CHWs as essential health workers, and understanding their work as gendered labour, reinforces the case for decent work, fair wages, safety, and mental health support.

Conclusion

The webinar highlighted that while CHWs are central to primary healthcare in South and Southeast Asia, they continue to face deep structural barriers rooted in gender inequality, informal employment, and weak state recognition. Successes from Pakistan, India, Nepal, and the Philippines show that collective organising, legal action, and union alliances can drive real progress. Yet persistent vulnerabilities remind us that progress must be sustained through policy reform, stable financing, and the full inclusion of CHWs in governance.