The George Institute for Global Health, 311-312, Third Floor, Elegance Tower,Plot No.8,Jasola District Centre, 10025, New Delhi, India.
Faculty of Medicine, University of New South Wales, Kensington, Australia.
BMC Health Serv Res. 2021 Aug 17;21(1):829. doi: 10.1186/s12913-021-06780-y.
It is well acknowledged that India's community health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system. Many ASHAs are currently working in fragile and conflict-affected settings. No efforts have yet been made to understand the challenges and vulnerabilities of these female workers. This paper seeks to address this gap by bringing attention to the situation of ASHAs working in the fragile and conflict settings and how conflict impacts them and their work.
Qualitative fieldwork was undertaken in four conflict-affected villages in two conflict-affected districts -Kokrajhar and Karbi Anglong of Assam state situated in the North-East region of India. Detailed account of four ASHAs serving roughly 4000 people is presented. Data transliterated into English were analysed by authors by developing a codebook using grounded theory and thematic organisation of codes.
ASHAs reported facing challenges in ensuring access to health services during and immediately after outbreaks of conflict. They experienced difficulty in arranging transport and breakdown of services at remote health facilities. Their physical safety and security were at risk during episodes of conflict. ASHAs reported hostile attitudes of the communities they served due to the breakdown of social relations, trauma due to displacement, and loss of family members, particularly their husbands.
Conflict must be recognised as an important context within which community health workers operate, with greater policy focus and research devoted to understanding and addressing the barriers they face as workers and as persons affected by conflict.
众所周知，印度的社区卫生工作者，即认证社会卫生活动家（Accredited Social Health Activists，简称 ASHA），是其卫生系统的基石。许多 ASHA 目前在脆弱和冲突环境中工作。目前还没有人努力了解这些女性工作者的挑战和脆弱性。本文旨在通过关注在脆弱和冲突环境中工作的 ASHA 的情况以及冲突如何影响他们及其工作来填补这一空白。
在印度东北部阿萨姆邦的两个冲突地区——高哈蒂和卡尔比昂格朗的四个冲突地区进行了定性实地考察。详细介绍了大约 4000 人服务的四名 ASHA。通过使用扎根理论和代码主题组织为作者开发代码簿，对转写为英文的数据进行了分析。
ASHA 报告说，在冲突期间和冲突结束后，他们在确保获得卫生服务方面面临挑战。他们在安排交通和远程卫生设施服务中断方面遇到困难。在冲突期间，他们的人身安全和保障受到威胁。ASHA 报告说，由于社会关系破裂、流离失所造成的创伤以及失去家庭成员（尤其是丈夫），他们服务的社区对他们持敌对态度。
必须认识到冲突是社区卫生工作者运作的一个重要背景，需要更多的政策关注和研究，以了解和解决他们作为工人和受冲突影响的人所面临的障碍。
