The appointment of an ASHA worker in Madhupur village is helping the community, especially women, make informed decisions about healthcare. Here’s how the village got an ASHA worker.
Champa Debsharma lives in Uttar Dinajpur, a district bordering Bangladesh in West Bengal. Her district has some of the lowest human development indicators, especially for health. According to the 2010 UNDP district report, the Maternal Mortality Rate (MMR) in the district, at 191 deaths per 100,000 live births, was higher than the national average of 178; the overall MMR for India has declined over the years too 112 but Uttar Dinajpur still has amongst the highest rates. The Infant Mortality Rate has also been higher than the state and national averages.
Debsharma says that with no trained health-worker to turn to, the condition of pregnant women was particularly bad in her village of Madhupur. Women could not access prenatal and antenatal care, neither could they provide appropriate medical care to their children, not only because of the lack of health infrastructure but also due to the lack of information.
Women and their families in the village had no way of knowing about immunisation dates, supplements, cash transfer schemes, and so on, that they were entitled to. This huge gap existed because the village did not have an ASHA worker (Accredited Social Health Activist), frontline healthcare providers and promoters, the foot-soldiers of India’s public health system.
Over 80% of West Bengal’s villages don’t have ASHA workers, few have Village Health and Sanitation Committees either.
ASHA workers work as the first point of contact for any health-related issue in a village; they are responsible for providing preliminary care, especially to pregnant women and children, connecting patients to the right facilities, holding village and block-level meetings to inform and discuss healthcare in the area. They also provide counselling on issues like family planning.
When Community Correspondent Dipti Debsharma heard of the problem, she made a video documenting the problems women in the village faced. She then held a community meeting in which she screened the video in order to devise a plan of action to resolve the issue.
The community had approached the panchayat before Dipti made the video as well but were told that recruiting an ASHA worker was not within their (panchayat’s) mandate. Dipti spoke to the Panchayat again and the Panchayat decided to follow on the issue with the Block Medical Officer of Health (BMOH). Dipti also approached the chief ANM (auxiliary nurse-midwife) at the panchayat-level Sub-Health Centre who also acknowledged the need for an ASHA worker. Eventually, after one and a half years of making the video, an ASHA worker was appointed.
Dipti then decided to meet the BMOH (Block Medical Officer of Health) to document the process of change. The BMOH, however, refused to speak to her and even snatched away her camera to delete the footage, threatening Dipti with a police complaint.
The response of the BMOH, a government official overseeing one of the most important aspects of development, healthcare, is abominable, especially so when the district ranks lowest on most maternal and child health parameters in the state. In terms of Primary Health Centre and Community Health Centre infrastructure, Uttar Dinajpur was ranked 15 out of 18 districts. In terms of health outcome, which is closely related to health infrastructure, it was ranked 18.
Only about 20 percent pregnant women in West Bengal get full antenatal care.
The state, overall, also delivers poorly on maternal and child health, with 87% of the villages not having an ASHA worker. Apart from the recruitment of ASHA workers, the NRHM (National Rural Health Mission) also makes provisions for the creation of a Village Health and Sanitation Committee but most villages in West Bengal don’t have these committees either, owing to low levels of literacy and economic backwardness. As a result, only about 20 percent pregnant women in West Bengal get full antenatal care.
Luckily for the residents of Madhupur, an Asha worker has finally been appointed and the community, especially women, have a sense of relief. “I have learnt a lot after the ASHA worker was appointed,” says Champa Debsharma, a resident. Panchami Debsharma, the newly-appointed ASHA worker says that women now have access to services and information and are able to make decisions regarding their own health. “I have also learnt a lot after being appointed to this position”, she adds.
Frontline health workers perform an indispensable task; India’s improvement on MMR and IMR indicators is widely attributed to the role of ASHA workers and it is not only important to train and recruit ASHAs but also keep them incentivised and motivated.
Video by Community Correspondent Dipti Debsharma
Article by Alankrita Anand, a member of the VV Editorial Team