For Love of Money: Rewards of Care for India’s Women Community Health Workers

Abstract

What are the rewards of paid care work for frontline health workers? I focus on India’s women community health volunteers, the largest such workforce in the world. Appointed since 2007 and numbering one million, these women are paid per-case incentives to connect the poor and marginalized to government-run health services. Using 14 months of ethnographic fieldwork in Delhi and Punjab, including 80 interviews, I find that women community health volunteers (called Accredited Social Health Activists or ASHAs) experience extrinsic rewards in paid care work. ASHAs earn not only from their official wages, but also from two unofficial streams: a) a boost of income from non-ASHA work and b) commissions from private hospitals. I also find that the intrinsic rewards ASHAs report—emotional gratification, relative autonomy, and skill-building—are co-constituted with extrinsic rewards; that is, they are tied to their earnings. This calls into question the “Love versus Money” binary, used to frame much of the discussion on care work. I argue instead for a “Love of Money” framing—that is, money as a reward and money as begetting other rewards. My findings highlight the significance of globalizing the empirical research on paid care work.