How Indian community health workers are strengthening the country’s backbone



Sushma Sambhaji Lugare has traveled a distance of 34 kilometers every day on her scooter since 2018 from her village in Yavatmal district to the primary health center in Jawala, Maharashtra. The community health worker plays an important role in health awareness and, over the past two years, has sensitized the rural population to the virus and persuaded them to follow the appropriate behavior for COVID. Some have also found unique ways to boost the morale of their patients. SheThePeople spoke with several of them to understand the challenges they face and how they ensure that no one is denied primary health care facilities. Here are some interesting stories:

Lugare works as a community health worker who provides screening for non-communicable diseases to the inhabitants of the region and treats them while providing them with the necessary drugs. On days when she is not at the health center for care and screening, she is in the village among the people to make them aware of their care needs.

Like Sushma, all Community Health Workers (CHOs) should work with the Certified Social Health Activist (ASHA) and Auxiliary Nurse Midwife (ANM) in the area. The ASHA employee goes door-to-door asking people to fill out surveys which are then given to the ANM who provides the information to the CHO. Patients receive free primary and secondary treatment and, if they need additional medical care, they are referred by the CHO to district health centers.


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Indian community health workers: the work they do

CHOs are placed in health and wellness centers across the country in accordance with the Ayushman Bharat Program central government for primary and secondary prevention and treatment of several diseases. The device was created in 2018 and the government plans to place 1 20,000 CHO in health centers by 2022.

Sushma, like all of the CHOs who applied for the position, completed a six-month community health certification course. Most of them were nurses in health centers before being appointed to this post and have expanded their medical training. They provide everything from basic emergency care, reproductive and child health services, oral health services, communicable and non-communicable disease diagnostics, free breast and cervical cancer screenings. uterus and rehabilitation care. They also strive to make people aware of various issues such as contraception, sexually transmitted diseases, hygiene issues, among others.

Measures taken for women’s health:

CHO Hemprabha Upadhyay, 31, from Madhya Pradesh, says: “The most important awareness raising activities relate to menstrual hygiene and reproductive health. This involves making frequent visits to schools, teaching teenage girls what and how to put on sanitary napkins, providing them with the menstrual kit. “

33 year old man Muktadir Hussein from the Dhubri region of Assam found it particularly difficult to bring in patients for check-ups. “Most of the people in my area are uneducated and women don’t feel comfortable seeing a male doctor. So I had to do many health promotions. Now, after three years, I finally see women entering the health center. Hussain also had to face hostility from villagers as he was seen educating the public against the early marriages plaguing the area.

Most of the community health workers spoke to ShePeople that women in their area need a lot more persuasion than men when it comes to getting medical help. A 31-year-old Alka Khalkho from Gumla, Jharkhand explained that women in his area preferred to stock up on birth control pills rather than asking their husbands to use condoms. She said women often lack the support of their spouses when it comes to their health and only receive treatment when things get worse.


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“They feel very embarrassed to talk about their health. Especially when it comes to family planning issues. We provide them with condoms, Mala D tablets, Antara injections (injectable contraceptive), ”CHO Noor Jahan of Mandi district, according to Himachal Pradesh.

“Things are a little easier with the help of ASHA workers because they know the villagers much better than the CHOs. They also help us understand the mentality of the people around us and the health conditions of women in the region. Over the past three years, we’ve seen a big breakthrough in getting women to self-examine for breast cancer, ”she adds.

The pandemic and additional responsibilities:

In the days of COVID-19, their work is increasing exponentially as it was not just about the disease they needed to prevent from spreading, but also the reluctance of the rural population to seek treatment. It was also necessary to fight against the stigma surrounding the virus. CHO Noor Jahan said, “To tell you the truth, I had to have myself tested so many times in front of the villagers so that they could see that the test swab is not dangerous.” After following the government’s mandate of testing people, tracking cases and tracing contacts, CHOs are now also involved in the deployment of vaccines.

CHOs in 12 states across the country have received training on emergency response to COVID-19 by a non-profit organization, Project NISHTHA led by Jhpiego. Through various webinars, study materials and frequent awareness campaigns, the project was able to provide technical assistance to health workers so that they can perform their duties while being informed. CHOs told us about the help they received from NISHTHA and several said they felt supported and inspired by the program. The central government congratulated more than 31 CHOs, ASHA and ANM workers on Universal Health Coverage Day 2021, December 13, for their contribution during the pandemic.


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When hospitals ran out of patient beds during the second wave of the pandemic Maibam Ranita Devi from Awang Wabgai, Manipur had people at its health center do different breathing exercises which also included yoga and dance movement therapy.

She said, “We kept the activity in a public school, all isolated, and had them do some creative dance moves. They seemed to be distracted and genuinely enjoyed the process. All CHOs are trained to provide yoga classes to members of their community.

From left to right: ANM Saro Devi, CHO Alka Khalko, Agent ASHA Baren Minj

Main roadblocks:

Rashmi Pandey, 30, from Sanwer region, Indore district, Madhya Pradesh, always had to travel to remote rural areas on her own, but was first scared when working in Ujjain. She was with her team, mostly women, who were screening some migrant workers in the area for COVID-19 during the lockdown peak. The workers needed food and Pandey met their rage. “They started asking me for food and things got so bad that I felt like they were going to hit me.” She was then saved by the village authorities.

Noor Jahan from Himanchal Pradesh encountered problems traveling to rural areas during the COVID-19 era, when public transport was not functioning. Anyway in rural areas, there is a transport problem and if you do not have your vehicle it is especially difficult to reach certain places and that also adds pocket expenses. We would be able to do a much better job if the government helped fix this problem, ”she said. Like most CHOs, she also has a male Multi-Purpose Worker (MPW) on her team who speaks for her when people only want to listen to a man.


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Sushma Sambhaji Lugare, 24, says she can walk the distance between her village and the primary health center freely every day because the MPW also travels with her.

Most of the CHOs are women and that does not suit the patriarchs of the village households. Some CHOs also cannot visit certain villages due to the caste system still applied in most villages. They also face violence when it comes to maintaining the caste systems prevalent in many Indian villages.

Jharkhand Beren minj, 37, who works as an ASHA employee in Gumla district has not been paid a single penny in the past six months and continues to do her job every day. When asked why she did not inquire about the delay in her due payments, she seems hesitant and replies: ” Dhan bech bech kar kisi tarah ghar chal rha hai. “Somehow we operate by selling wheat crops. ASHA workers en lakhs are protesting their late payments in states such as Maharashtra, Kerala, Madhya Pradesh, Gujarat, Punjab and the national capital New Delhi since last year.

Despite the challenges, health workers served their communities with an unwavering spirit. In the words of Muktadir Hussain of Assam, “When I go to villages for awareness campaigns and treatment, I consider myself to be someone who does public service and I am proud of it. “


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