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Cited by 14Global Health Workforce IssuesHealthcare Systems and ChallengesHealthcare Systems and Practices

Working as frontline health facilitators, service providers, program supporters, and social health activists in Indian hilly terrain areas: A qualitative study of accredited social health activists’ experiences before and during the COVID-19 pandemic

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Gore, Manisha, Kawade, Anand, Smith, Pam, Pinnock, Hilary, Juvekar, Sanjay, RESPIRE Collaboration·2022·Journal of Global Health
DOI 10.7189/jogh.12.05052PMC PMC9798346
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Abstract

Background: Community health workers (CHW) contribute to achieving health targets of the Sustainable Development Goals (SDG) and Universal Health Care (UHC) in low- and middle-income countries (LMICs). In India, accredited social health activists (ASHAs) function as health facilitators, service providers, and programme supporters for rural and tribal communities and are at the frontline during the COVID-19 pandemic. We aimed to describe the ASHAs' work roles both before and during the COVID-19 pandemic, explore the tasks ASHAs performed throughout the pandemic, and understand its effects on the evolving role of ASHAs. Methods: We used qualitative data from a pre-COVID-19 study conducted in 2018-2019 including face-to-face interviews with purposively sampled ASHAs and their health care supervisors (n = 18) from rural Maharashtra state (India), and a follow-up study during the COVID-19 pandemic using telephonic interviews with a subset of participants from the pre-COVID-study (n = 8). Data were analysed thematically using MAXQDA v11.00. Results: The primary theme in the pre-COVID-19 study was ASHAs' role as described above, except as social health activists, linking beneficiaries to the local maternal and child health care services, distributing medicines for common illnesses, access to government schemes, and engaging in multiple health surveys. During the pandemic, raising awareness, screening of at-risk populations, arranging referrals, providing treatment and follow-up to COVID-19 patients, and supporting their family members. These activities increased the workload and health risks to ASHAs and their family, causing stress and tension among them. However, they had effectively carried out the new duties. ASHAs have improved their status, earning praise from families, society, and the government. They were honoured with the Global Health Leaders Award at the 75th World Health Assembly. Conclusion: ASHAs' contribution to the health system improved the indicators related to maternal and child health during the pre-COVID-19 pandemic. Additionally, they maintained frontline health care during the COVID-19 pandemic, demonstrating resilience despite the challenges of increased workload and stress. However, the COVID-19 pandemic highlights the need to respond to and understand the implications of ASHAs' evolving roles.

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  • ASHAs and Anganwadi teachers are instrumental in providing frontline health services in rural India, and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts.

    “As trusted members of their local communities, ASHAs and Anganwadi teachers are instrumental in providing frontline health services in rural India, [66–68] and both played important roles in combating the COVID-19 pandemic, including coordinating vaccination efforts [68, 69].”

    From Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study (2024) · cites this paper as [69]

    The Results (Service provider: First point of health care) describe ASHAs as frontline providers in villages, and the Results (Healthcare facilitator) document their COVID-19 work and say Anganwadi sevika and schoolteachers initially assisted. The paper does not establish that Anganwadi teachers provided frontline health services or that either group coordinated COVID-19 vaccination efforts; its discussion of child immunization concerns routine services. (LLM, conf=0.87)

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Research works printed but not linked: 27

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Authors
Gore, M., Kawade, A., Smith, P., Pinnock, H., Juvekar, S., & RESPIRE Collaboration
Affiliations
  • Symbiosis International University (IN)
  • KEM Hospital Research Centre, Vadu Rural Health Program, Rasta Peth, Pune, India
  • National Institute for Health and Care Research (GB)
  • University of Edinburgh (GB)
ORCID
Venue
Journal of Global Health
Publisher
International Society of Global Health
Published
2022-11-29
Volume
12
Pages
05052-05052
ISSN
  • 2047-2978 (ISSN-L)
  • 2047-2986
DOI
10.7189/jogh.12.05052
PMC
PMC9798346
OpenAlex
W4313241118
Cited by
14
References
0
Citations by year
2026: 3 · 2025: 2 · 2024: 8 · 2022: 1
FWCI
3.22
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Global Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
  • Government of the United Kingdom
  • National Institute for Health and Care Research (16/136/109)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
Keywords
Accredited Social Health Activists, community health workers, COVID-19 pandemic, frontline health workers, maternal and child health, health worker workload, occupational stress, rural Maharashtra, hilly terrain, health professionals' role
MeSH terms
COVID-19, Child, Community Health Workers, Delivery of Health Care, Follow-Up Studies, Humans, India, Pandemics

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