Lessons from India's Rural Healthcare System - Part 2
According to WHO (2022), women comprise 70% of the global healthcare workforce. In India, the transformative power of three key women players (ASHA, AWW and ANM) ensures that essential healthcare reaches all, including the most vulnerable in communities. This model offers some key insights to developed countries like the US to enhance accessibility and build trust within its underserved populations to bridge the healthcare gap.
Connecting, supporting, and building trust: Accredited Social Health Activist (ASHA)
Often called frontline warriors, these women community volunteers are a familiar face. Being part of the community, they are aware of the challenges faced by families often supporting them as a community member. This gives them a strong social standing, respect, and trust of the people. ASHAs leverage this bond and together with their health training, effectively deliver health education and access to healthcare services. They support women throughout pregnancy and childcare after delivery, becoming companions in journey of women towards healthy and safe motherhood. Studies correlate presence of ASHAs with increased institutional deliveries, reduced maternal mortality, improved vaccine coverage, and greater adoption of contraceptives. Since their introduction under the National Rural Health Mission in 2005, ASHAs have successfully connected marginalized communities to essential care, improving rural health indicators. During the pandemic, this million-strong army of health champions played a pivotal role in tracking and monitoring of COVID-19 cases, and disseminating information.
Ensuring early essential care for vulnerable: Aaganwadi Worker (AWW)
AWWs, part of the Integrated Child Development Services (ICDS) launched in 1975, focus on child health, nutrition, and education. Building on the cultural norm of women in the family or village supporting each other to take care of young children, AWWs are selected from the community to run the Aaganwadi Centers (AWC). Referred to as “didi” (sister) in Hindi, they are trusted by mothers in nurturing of their children. AWWs, with training from government, provide pre-school education, supplementary nutrition to expectant and breastfeeding women, and children under six years. They also collaborate with ASHAs for health check-ups and immunization, to maintain growth charts, and keep a check on malnutrition among children in the community. Research and government evaluations show that AWCs positively impact children’s cognitive development and help in reducing stunting rates. This 1.39 million workforce forms the robust foundation of early childhood development and maternal well-being in rural India.
Bringing expert care closer to home: Auxiliary Nurse Midwife (ANM)
ANMs are trained professionals stationed at Primary Health Centers and Sub-centers, serving as the first contact for community with healthcare infrastructure. These, over 200,000 women, are trained to understand the socio-demographic and health profile of villages while delivering essential primary health services. They conduct deliveries, provide pre and postnatal care, and manage family planning initiatives with support from ASHAs. This collaborative work ensures high adoption of healthcare practices and respectful care. Data shows an increase in safe institutional deliveries, better breastfeeding practices, improved child health outcomes, and enhanced disease surveillance and control with the involvement of ANMs.
Integrating Technology: Smart phones and Tablets
Rapid integration of technology is revolutionizing healthcare delivery in India. ASHAs use smartphones to track mother and baby health outcomes, AWWs utilize POSHAN (nutrition) tracker to monitor child growth and nutrition service delivery, and ANMs use tablets to maintain digital health records and manage high-risk cases. The fast adoption of technology also presents challenges and requires continuous review, modification and simplification for frontline workers. Tech-enabled approach empowers them to be more accurate, efficient, and data-driven while catering to the needs of 67% population of the country residing in rural areas.
In addition to this network, women also form a part of rural healthcare ecosystem including pharmacists, lab technicians, and doctors. This powerful network of women healthcare workers isn't just unique to India. Other countries like Ethiopia with its Health Extension Workers program, has seen similar success in deploying community-based female healthcare providers for better health outcomes.
Conclusion
The evolution of women in India's rural healthcare showcases the power of community-centric approach and collaborative efforts. This model of leveraging local knowledge, cultural understanding, and social network along with inherent nurturing qualities of women has been crucial in humanizing healthcare at the grassroots level. These women, sometimes have to overcome structural challenges like limited resources, inadequate training, and societal barriers. Despite hurdles, these women, with their commitment and resilience have made significant contribution in improving health outcomes for the rural population.
While this workforce has been a game changer in transforming healthcare delivery, placing more women in decision-making roles is essential to fully realize their potential in reimagining healthcare and enhancing comprehensive community health.
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