HOW EFFECTIVELY DO COMMUNITY HEALTH WORKERS SPREAD HEALTH AWARENESS VIA WOMEN’S SELF-HELP GROUPS IN RURAL INDIA?
In many lower- and middle-income countries, the public health system is made more accessible in rural areas through training lay people to become community health workers (CHWs) within their communities. This mixed-methods study aims to evaluate such a CHW program in rural Uttarkashi, India, which is being run by a non-government organization (NGO). In the CHW program to be evaluated, the CHWs give monthly health awareness classes during women’s self-help group (SHG) meetings. By involving women’s SHGs, community participation is supposed to be fostered and health knowledge spread. Therefore, it was hypothesized that communities with an active CHW should achieve a higher number of correct answers on a health knowledge test than communities without an active CHW. Moreover, using qualitative methods, we explored the SHG members’ and CHWs’ viewpoints on the impact of the awareness classes held during SHG meetings. Five focus group discussions were conducted with members of SHGs, as well as with NGO-trained CHWs and government-employed CHWs. Results confirmed that the respondents from a community with an NGO-trained CHW performed significantly better on the health knowledge test, although not uniformly across all sampling areas. The qualitative data revealed a substantial impact of the health awareness classes on behavior changes among SHG members and their families. Further, the NGO-trained CHWs collaborated well with other government-employed CHWs. In conclusion, the authors feel that is would be worthwhile to employ more NGO-run CHW programs throughout India, to supplement the government-run programs, especially in remote and underserviced areas.
2. Ministry of Health and Family Welfare, Government of India. Five years (2009-2014). Achievements & New Initiatives. New Delhi, India: Aravali Printers 2014.
3. The Million Death Study Collaborators. Causes of neonatal and child mortality in India: A nationally representative mortality survey. Lancet 2010; 376:1853–60.
4. Viswanathan K, Rakesh PS, Balakrishna S, et al. Prevalence of chronic respiratory diseases from a rural area in Kerala, southern India. Indian J Tuberc 2018; 65:48-51.
5. Lehman U, Friedman I, Sander D. Review of the utilisation and effectiveness of community-based health workers in Africa. Global Health Trust, Joint Learning Initiative on Human Resources for Health and Development (JLI), JLI Working Paper 2004; 4:1-44. https://pdfs.semanticscholar.org/7a0c/fd44975b00b045c7957c9327a87c9fcc6b63.pdf (accessed 23 Jun 2020).
6. Government of India, Ministry of Women and Child Development, Child Development Bureau and National Institute of Public Cooperation and Child Development. Potential good practices. The ICDS experience. 2013 April; P144. https://icds-wcd.nic.in/Best%20Practices.pdf (accessed 23 Jun 2020).
7. Scott K, Shanker S. Tying their hands? Institutional obstacles to the success of the ASHA community health worker in rural north India. AIDS Care 2010; 22(Suppl 2):1606-1612.
8. Haines A, Sanders D, Lehmann U, et al. Achieving child survival goals: Potential contribution of community health workers. Lancet 2007; 369(9579):2121-31.
9. Amrita Self-Reliant Village. Transforming Rural India. 2014; P16. https://amritaserve.org/wp-content/uploads/2018/09/Amrita_SeRVe_Brochure_2014-1.pdf (accessed 23 Jun 2020).
10. Amrita SeRVe. Self-Reliant Village. Wellbeing for all. Health workers in Amrita SeRVe Villages. 101 Village Project. Mata Amritanandamayi Math. 2017; P5. https://amritaserve.org/wp-content/uploads/2018/09/2017_health_brochure.pdf (accessed 23 Jun 2020).
11. Rajani KG, Vijay Lakshmy KV. Involvement of SHGs for women empowerment in Kerala – a theoretical approach. International Review of Research in Emerging Markets and the Global Economy (IRREM). An Online International Monthly Journal 2014; 1(2):66-80.
12. Jones KM, Specio SE, Shrestha P, et al. Nutrition knowledge and practices, and consumption of vitamin A-rich plants by rural Nepali participants and nonparticipants in a kitchen-garden program. Food & Nutrition Bulletin 2005; 26(2):198-208.
13. Sheshadri S, Coley C, Rao BR. Training India’s first female toilet builders: An argument for improving sanitation through women empowerment and social inclusion. In International Conference on Sustainable Development, UN Sustainable Development Solutions Network, New York 2015 Sep 23 (Vol. 24).
14. Tripathy P, Nair N, Sinha R, et al. Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: A cluster-randomized controlled trial. Lancet Glob Health 2016; 4:e119-28.
15. Kim J, Ferrari G, Abramsky T, et al. Assessing the incremental effects of combining economic and health interventions: The IMAGE study in South Africa. Bull World Health Organ 2009; 87:824-32.