Sankar D Hari, Joseph Jaison, Benny Gloria, Surendran Surya, Sharma Santosh Kumar, Nambiar Devaki
Healthier Societies, The George Institute for Global Health, New Delhi, India.
Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Front Health Serv. 2024 Feb 29;4:1321882. doi: 10.3389/frhs.2024.1321882. eCollection 2024.
Accredited Social Health Activists (ASHA) are Community Health Workers (CHWs) employed by the National Health Mission of the Government of India to link the population to health facilities and improve maternal and child health outcomes in the country. The government of Kerala launched primary health reform measures in 2016 whereby Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs). The COVID-19 pandemic in 2020 impacted essential health service delivery, including primary care services. The CHWs network of Kerala played a crucial role in implementing the primary care reforms and COVID-19 management efforts that followed. We carried out a study to understand the perspectives of the CHWs in Kerala about their role in the recent primary healthcare reforms and during the COVID-19 pandemic management efforts.
We conducted in-depth interviews (IDI) with 16 ASHAs from 8 primary care facilities in Kerala from July to October 2021. We further conducted Focus Group Discussions (FGDs) ( = 34) with population subgroups in these eight facility catchment areas and asked their opinion about the ASHAs working in their community. We obtained written informed consent from all the participants, and interview transcripts were thematically analysed by a team of four researchers using ATLAS.ti 9 software.
Our study participants were women aged about 45 years with over 10 years of work experience as CHWs. Their job responsibilities as a frontline health worker helped them build trust in the community and local self-governments. CHWs were assigned roles of outpatient crowd management, and registration duties in FHCs. The COVID-19 pandemic increased their job roles manifold. Community members positively mentioned the home visits, delivery of medicines, and emotional support offered by the CHWs during the pandemic. The CHWs noted that the honorarium of INR 6,000 (US$73) was inconsistent and very low for the volume of work done.
The CHWs in Kerala play a crucial role in primary care reforms and COVID-19 management. Despite their strong work ethic and close relationship with local self-governments, low and irregular wages remain the biggest challenge.
经认可的社会健康活动家（ASHA）是印度政府国家卫生使命雇佣的社区卫生工作者（CHW），旨在将民众与卫生设施联系起来，并改善该国的孕产妇和儿童健康状况。喀拉拉邦政府于2016年启动了初级卫生改革措施，据此初级卫生中心（PHC）被升级为家庭健康中心（FHC）。2020年的新冠疫情影响了基本卫生服务的提供，包括初级保健服务。喀拉拉邦的社区卫生工作者网络在实施随后的初级保健改革和新冠疫情管理工作中发挥了关键作用。我们开展了一项研究，以了解喀拉拉邦社区卫生工作者对其在近期初级卫生保健改革以及新冠疫情管理工作中所扮演角色的看法。
2021年7月至10月，我们对喀拉拉邦8个初级保健机构的16名ASHA进行了深入访谈（IDI）。我们还在这8个机构服务区域内与人群亚组进行了焦点小组讨论（FGD）（共34次），并询问了他们对在其社区工作的ASHA的看法。我们获得了所有参与者的书面知情同意，访谈记录由一个由四名研究人员组成的团队使用ATLAS.ti 9软件进行主题分析。
我们的研究参与者为年龄约45岁、有超过10年社区卫生工作经验的女性。她们作为一线卫生工作者的工作职责帮助她们在社区和地方自治政府中建立了信任。社区卫生工作者被分配了在家庭健康中心进行门诊人群管理和登记的职责。新冠疫情使她们的工作职责大幅增加。社区成员积极提到了社区卫生工作者在疫情期间进行的家访、药品配送和情感支持。社区卫生工作者指出，6000印度卢比（73美元）的酬金与所做工作量不符且非常低。
喀拉拉邦的社区卫生工作者在初级保健改革和新冠疫情管理中发挥着关键作用。尽管他们有强烈的职业道德且与地方自治政府关系密切，但低工资且不规律仍然是最大的挑战。
