Examine the role played by the frontline health workers like ASHAs, ANMs and Anganwadi workers in achieving desirable health and nutritional outcomes. Mention the issues faced by these frontline workers and also suggest measures that can be taken to empower them.

Why?

Frontline health workers endure triple shifts across home, community, and health centers, facing overwork, underpayment, and health risks amid gender, caste, and informal economy inequities.

Approach:

• Introduce by highlighting role of frontline health workers, including ASHAs, ANMs, and Anganwadi workers in achieving health and nutritional goals in India, especially in rural areas.
• In the main body, write about the role played by frontline health workers – maternal and child health, preventive healthcare services, early detection and intervention, etc. Address Issues faced by them like overwork, underpayment, gender and caste discrimination, etc. Suggest measures required to empower frontline workers – social protection programs, capacity building, incentives, etc.
• Conclude by summarizing the role of frontline health workers in strengthening India’s healthcare system and improving health outcomes nationwide.

Answer:

Frontline health workers, including ASHAs (Accredited Social Health Activists), ANMs (Auxiliary Nurse-Midwives), and Anganwadi workers, play a crucial role in achieving desirable health and nutritional outcomes in India. These workers are the backbone of India’s healthcare system, particularly in rural and marginalized communities.

Role played by frontline health workers:

• Promotion of Maternal and Child Health: by providing essential healthcare services such as antenatal care, immunizations, and postnatal care.
  • ASHAs conduct home visits to monitor pregnant women.
• Community Mobilization and Awareness: by organizing health camps, community meetings, and educational sessions to disseminate information on proper nutrition, hygiene practices, and disease prevention strategies.
  • In Uttar Pradesh’s Poshan Pakhwada, Anganwadi workers mobilized communities, overcoming misconceptions to promote child nutrition.
• Early Detection and Intervention: Through regular growth monitoring and screenings, they facilitate early intervention and referral to appropriate healthcare facilities for further evaluation and treatment.
  • Monthly weighing of children by Anganwadi workers to detect growth deficiencies early.
• Support for Women’s Health: by empowering women with knowledge and resources to make informed decisions about their health and well-being.
• Delivery of Preventive Healthcare Services: such as immunizations, deworming, and reproductive health education campaigns and promote overall well-being.
• Monitoring and Management of Communicable Diseases: such as tuberculosis, malaria, and HIV/AIDS by conducting door-to-door screenings, facilitate treatment adherence, and provide support to affected individuals and families.
• Data Collection and Reporting: at the grassroots level, which is essential for planning and implementing effective healthcare interventions.

Issues faced:

• Lack of Professional Recognition: Many frontline health workers, especially ASHAs, are recognized as ‘volunteers’ rather than professional healthcare workers, limiting their access to benefits and professional growth opportunities.
• Delayed or Inadequate Compensation: The payment of incentives and honorariums is often delayed, and when paid, may not reflect the volume and importance of their work.
• Insufficient Training and Support: which may not fully prepare them for the range of health issues and situations they encounter in their work.
• Occupational Health Risks: The nature of their work exposes frontline health workers to various health risks, including infectious diseases, without adequate protective measures or health coverage.
  • During COVID-19 pandemic, many frontline workers lacked PPE.
• Social and Gender Discrimination: Being predominantly women they face challenges, including harassment and lower social status, impacting their work and personal well-being.
• Inadequate Infrastructure and Resources: such as transportation or medical supplies, hampers the ability of frontline workers to perform their duties effectively.

Measures required to empower:

• Formal Recognition and Fair Compensation: Recognizing ASHAs, ANMs, and AWWs as formal healthcare workers and ensuring timely, fair compensation.
  • Implementing a fixed honorarium and covering logistical costs to reduce out-of-pocket expenditures.
• Health and Safety Measures: Providing health insurance and safety measures, especially considering their exposure to environmental hazards and health risks.
• Capacity Building and Support: Enhancing skills through regular training, supportive supervision, and motivation to deliver quality services.
• Community Support and Involvement: Engaging community leaders and members in supporting frontline workers and acknowledging their contributions.
• Technological Empowerment: to reduce their workload, improve data accuracy, and facilitate easier access to healthcare information and services.
• Promotion and Career Advancement Opportunities: within the health system to motivate and retain skilled workers.
  • Government scholarships to pursue nursing or public health degrees.

Empowering ASHAs, ANMs, and AWWs is crucial for advancing India’s health and nutrition outcomes, ultimately leading to a healthier and more nourished population.

‘+1’ value addition:

• ASHAs, ANMs, and AWWs concentrate efforts on the critical first 1,000 days of a child’s life, from conception to two years, crucial for cognitive development and preventing malnutrition.
• The recent Interim Budget announced free health insurance cover for all ASHAs and Anganwadi workers and helpers under the Ayushman Bharat Scheme.
• In 2018, the Ministry of Health and Family Welfare approved an ASHA benefit package, providing coverage for accidents, deaths and disability.