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The Chhattisgarh state government has issued a strict ultimatum to nearly 16,000 contractual employees of the National Health Mission (NHM), demanding their return to duty within 24 hours or face termination. This directive comes amidst an ongoing indefinite strike that began on August 18, 2025, over a set of 10-point demands raised by the NHM workforce. The health and family welfare department’s decision marks a tense climax in protracted negotiations around contractual staff rights, impacting the delivery of vital healthcare services in the region.
Key Developments and Employee Demands
The NHM employees, represented by the Chhattisgarh Pradesh NHM Karmchari Sangh, have been striking over demands that include regularisation of contracts, establishment of a dedicated public health cadre, parity in grade pay with other health workers, and a 27% salary hike. Additionally, they seek comprehensive cashless health insurance coverage worth at least ₹10 lakh, paid medical and emergency leave, transparent evaluation of performance reports, defined transfer policies, reservation in regular recruitments, and compassionate appointments.
Despite executive committee interventions addressing some concerns—in particular instituting 30 days of paid leave for accidents or serious illness, a transparent annual performance evaluation with prior notice before any adverse action, and development of an online portal to streamline these processes—many employees remain absent without authorization. The government is proposing further measures like a 5% salary increase for contractual employees (pending state finance approval), health insurance rollout for all NHM staff, and forming a seven-member committee to review human resource policies, including grade pay and transfer protocols, with a report due in three months.
Government Response and Enforcement Measures
The health secretary, Amit Kataria, has directed chief medical and health officers across districts to issue termination notices if staff fail to resume duty by the stipulated deadline. Employees already received ‘show cause’ notices on August 29, 2025, but the persistent absenteeism is being classified as a violation of the Chhattisgarh Civil Service Conduct Rules and NHM Human Resource Policy. The enforcement of the ‘no work, no pay’ principle has been mandated, reinforcing the government’s stance on accountability in healthcare delivery.
Such stringent action reflects the critical nature of NHM employees’ roles as frontline providers of public health services. The government’s circular underscores that prolonged absence equates to a dereliction of duty, unacceptable on humanitarian grounds due to the essential role these workers play in ensuring public health safety and responsiveness.
Expert Perspectives
Dr. Neha Sharma, a public health policy analyst unaffiliated with the NHM, explains: “NHM contractual staff are crucial frontline workers, especially in rural and underserved areas where health infrastructure is limited. While their demands for job security, fair compensation, and benefits are legitimate, prolonged strikes can severely disrupt community health programs such as immunization, maternal health support, and disease surveillance.” She emphasizes the need for both dialogue and responsible action to balance workforce welfare and uninterrupted service delivery.
Another healthcare economist, Prof. Rajiv Menon of the Indian Institute of Public Health, notes, “Contractualization of health workers is a widespread challenge in India’s public health system. Short-term contracts often cause insecurity, impacting morale and retention. Regularisation and better benefits can improve workforce stability. However, operational continuity during labor disputes is equally important to protect public health outcomes.”
Context and Public Health Implications
Since its inception, the NHM has been India’s flagship health program targeting rural health. Contractual employees form the backbone of its field operations, delivering essential services like maternal and child health care, nutrition, disease control, and health education. Their absence can disrupt critical outreach activities and delay interventions in health emergencies.
The heightened standoff risks compromising these health gains by undermining service availability. Prolonged strikes during a period when India continues to face communicable diseases, non-communicable disease burdens, and emergent health threats could reverse progress in population health indicators.
Limitations and Counterarguments
While the government’s firm approach aims to maintain health service continuity, experts caution against overlooking employee grievances. Unaddressed workforce dissatisfaction can lead to long-term attrition and degrade service quality. Balancing enforcement with meaningful negotiation remains essential to avoid undermining the health system’s foundational workforce.
Further, contractual health staff often work under challenging conditions with limited social security. Accelerated termination without alternative arrangements may exacerbate socio-economic vulnerabilities among workers and their families.
Practical Takeaways for Readers
This situation highlights broader issues within public health systems: the tension between workforce welfare and service delivery. For readers, it underscores the importance of supporting policies that ensure fair employment terms for health workers, given their critical role in community well-being. It also reminds the public of the delicate dependencies in health services upon motivated and adequately supported personnel.
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
References
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Economic Times Health News. Return to work or face termination: Govt’s ultimatum to NHM staff on indefinite strike. https://health.economictimes.indiatimes.com/news/policy/return-to-work-or-face-termination-govts-ultimatum-to-nhm-staff-on-indefinite-strike/123960079?utm_source=top_story&utm_medium=homepage
