CHHATTISGARH, India — Nearly 16,000 staff employed under India’s National Health Mission (NHM) have been on an indefinite strike since 8 August. In early September, the dispute escalated dramatically when the state government dismissed 25 union leaders, prompting the mass resignation of  more than 14,000 health workers.

The mass resignations have raised alarm about the stability of healthcare in Chhattisgarh, a heavily forested, predominantly rural state that is home to 32 million people.

While clinics and outreach programs are still functioning in some areas, experts warn that if the strike persists, immunisation, maternal health services, and disease control programs could face severe disruption, leaving patients in remote tribal districts without access to even the most basic care.

“We were called COVID warriors during the pandemic. We reached villages no one else could,” said a health worker from Raipur, speaking on condition of anonymity. “But what are we getting in return?”

At the centre of the standoff are demands for permanent contracts, pay parity with regular staff, and improved benefits. Union leaders say the dispute in Chhattisgarh is not an isolated battle, but a symptom of deeper structural problems in India’s health system – problems that resonate globally.

Demands behind the strike

Health workers under NHM, the country’s flagship public health program launched in 2005, are technically “contractual staff.”  They receive lower pay, fewer benefits, and no job security compared to state-employed counterparts, despite often performing identical roles.

“We have 10 demands, and our top priority is regularisation or at least grade pay equal to permanent health workers,” said Hemant Kumar Sinha, leader of the trade union, Chhattisgarh Pradesh NHM Karamchari Sangh, in an interview with The Indian Express.

Other demands include the creation of a dedicated public health cadre, annual performance evaluations, a 27% salary hike, cashless medical insurance worth at least one million rupees (around $12,000), and expanded leave and medical benefits. 

In mid-August, the executive body of the State Health Committee accepted four of the 10 demands raised by contractual NHM employees, but trade union leaders insist that all their demands must be accepted and implemented.

Precarious national workforce

The unrest in Chhattisgarh highlights a paradox: India has rapidly expanded its health workforce in recent years, but much of this growth rests on insecure contracts.

Between 2021 and 2024, more than 1.2 million professionals – including medical officers, specialists, nurses and public health managers – have been inducted nationwide under NHM, according to official data. 

The number of community health officers alone rose from 90,740 in 2021–22 financial year to more than 138,000 by 2023–24.

“Yet we continue to work without security or parity,” Sinha said. “Our services are treated as dispensable, even though the system cannot function without us.”

Similar grievances have flared across India. Earlier this year, NHM staff in Maharashtra staged protests after going without pay for three months. Workers in Bihar, Uttar Pradesh and Madhya Pradesh have launched strikes over delayed wages in the last few years , lack of insurance coverage, and stalled promises of regularisation.

Health policy analysts warn that the over-reliance on contractual staff is not just a labour issue but a systemic risk.

“Primary health care in India is essentially running on precarious contracts,” Ankita Verma, a Delhi-based public health researcher told Health Policy Watch. “When those workers withdraw, the entire rural delivery chain collapses.”

The situation is particularly critical in Chhattisgarh, where tribal populations in remote forested areas depend almost entirely on NHM workers for services ranging from maternal health to malaria control. Prolonged disruptions, experts say, could roll back years of progress in child immunisation and communicable disease surveillance.

Global temporary worker crisis

The crisis in Chhattisgarh is not unique. Around the world, governments have leaned on temporary or flexible contracts to stretch health budgets and scale up ambitious programs, often with similar results.

In Kenya, nurses employed under the Universal Health Coverage (UHC) programme in coastal counties have staged repeated strikes over short-term contracts, unpaid allowances, and lack of permanent status. 

Workers in the Kenyan towns of Mombasa, Kilifi, Kwale, Lamu, Tana River, and Taita Taveta demanded conversion to permanent and pensionable terms, arguing that constant uncertainty undermines service delivery.

In Nigeria, doctors in public hospitals walked out in September 2025 over unpaid salaries, wage arrears, and insecure postings. The strikes disrupted services in Abuja and other cities, adding pressure to an already strained system.

Labour analysts say these parallel struggles expose a global fault line. “The pandemic briefly highlighted the indispensability of frontline health workers,” said a global labour rights advocate while talking to Health Policy Watch. “But once the emergency faded, many governments reverted to treating them as expendable.”

Health toll mounts

For now, the standoff shows little sign of resolution. Health workers say they will not return to work unless their demands are met, while the government has so far doubled down by dismissing union members.

But the human toll is mounting. If the condition persists in the districts, people  may have to walk miles to private clinics and pay for services. Pregnant women in rural areas have to be referred to distant hospitals, often beyond their means to reach.

The state, in the centre-east of India, has a tropical climate that is one of the most climate-vulnerable states, experiencing extreme weather events,  including floods, heatwaves and droughts, according to the India’s Ministry of Health and Social Welfare. 

“Chhattisgarh is a state with the highest mines and mineral-based industries and air pollution is one of the biggest threats to the health of the population,” according to the Ministry. Heavy metal contamination of the soil is also a problem.

Malaria and dengue are prevalent in the hilly north and south, while other zoonotic diseases are increasing due to climate change.

Health advocates warn that if the strike drags on, Chhattisgarh could see rising maternal and infant mortality rates, surges in preventable diseases, and widening inequities in care.

“This isn’t just about wages,” said Verma, the Delhi-based public health researcher Verma. “It’s about the sustainability of India’s healthcare model.”

Test case for India 

The crisis poses a test not just for Chhattisgarh but for India’s approach to public health delivery. Can the country sustain an expanding workforce without offering stability and parity? Or will repeated cycles of protest and disruption continue to erode public confidence?

Globally, the lessons from Chhattisgarh may be equally pressing. As governments grapple with growing health burdens, many have opted for contract-heavy models that prioritise flexibility and cost-saving. But the fragility of such systems becomes apparent the moment workers walk away.

For the health worker from Raipur, the issue is less abstract. “We don’t want to abandon our patients,” she said. “But if the government treats us as disposable, how long can we keep going?”

Image Credits: Chhattisgarh Pradesh NHM Karamchari Sangh.