New Delhi: In the last five years, as many as 95 per cent of births in Maharashtra took place in a health facility, and only 5 per cent at home, the fifth round of the National Family Health Survey (2019-20) revealed. Not just that, the percentage of births in health facilities, mostly public facilities, in Maharashtra was seven per cent higher than the national rate of 88.6 per cent. In the last five years, the percentage of births in a health facility in the state has also increased by 5 per cent, from 90 per cent in 2015-16 to 95 per cent in 2019-20.
The credit for this success mostly goes to Accredited Social Health Activists — or ASHA workers of the state, who are female community health volunteers engaged under the National Health Mission (NHM). These volunteers are trained to aid people in accessing the benefits of the government’s various healthcare schemes and are tasked with a range of important responsibilities like facilitating immunisation to mothers, young children, helping mothers and family go for institutional childbirth instead of home deliveries, to reduce the risk of maternal and infant mortality. The ASHA workers also help monitor children with malnutrition and create awareness about family planning.
As a part of the Independence Day special, Team Banega Swasth India spoke with one of the ASHA workers from the state to understand their crucial role in this success and the challenges faced by them in this road.
Explaining the work ASHA workers do, Nirmala Manipat Koge, an ASHA worker from Amravati Zilla said,
Over the last few years, my day revolves around providing basic healthcare facilities to the people of my district. I help save lives in whatever way I can. A job of ASHA worker is to provide basic health care at the doorsteps of people. We are neither doctors nor nurses, but we have been given training to bridge the health care gap in places. From providing information on basic hygiene, why hand washing is important, when it should be done, to motivating expecting women and their families to go for institutional birth, giving them monthly, weekly check-ups they need and providing medicines to them along with checking up on the children and their health, we do it all.
Today, Nirmala Manipat Koge in her district is known as ‘Madam Ji’, who can be trusted with the healthcare related issues and is famous among expecting mothers, they call her for any small and big issues related to the pregnancy. Highlighting the kind of challenges, she faces on a day-to-day basis, Nirmala recalled one of the incidences, she said,
There was one delivery for which I was called, when I went for that, I saw, the woman’s water had broken, she was lying unconscious on the floor. I knew, I immediately had to take her to the hospital. I called the ambulance and she was taken to the facility. There, because the delivery was complicated, she was referred to a bigger hospital, which was away from the district and doctors had said, she will have to go for a C-section. That time, the family didn’t agree and decided to take her back home. But I was persistent, I knew, there could be bigger issues both with the mother and the baby. I got the Sarpanch, Police of the village involved and took the woman to the hospital, where she delivered her baby boy perfectly. So, it is just not an easy job, on a day-to-day basis, we have to fight social stigmas, convince families and educate them on very basic things.
In 2020, when COVID-19 pandemic struck in India, Nirmala Manipat Koge’s fight expanded. Not thinking about her life once, Nirmala decided to go out in the open and help her village people once again by providing them with basic information on health and hygiene, how they should take care of themselves and stay away from the virus. Explaining her work during the pandemic, she said,
I used to go to everyone’s house to see if they are doing fine and not exhibiting any signs of the virus. I used to tell them how they can keep the virus at bay by following few basic rules like hand washing, masking and avoiding social gatherings. When COVID-19 vaccination came, it came along with lot myths. People were afraid to get vaccinated, they thought, they will die if they take the vaccine. I went to each and every household in my district, convinced them day and night to get vaccinated and help save the community. With the help of village Sarpanch, we also launched a vaccination scheme, which stated, no work will be given to people without vaccination. And with our efforts, we were able to get the many people vaccinated for COVID during that time. In one day, I was able to get 211 people vaccinated from my district.
Nirmala Manipat Koge is a proud ASHA worker, she says this is her identity, which makes her feel very good, even her family is proud of her. She signs off by saying,
It feels good to be recognised with this label (ASHA). It might be a small job in people’s eye, but for me this is my duty and it is a very big thing. I am able to save lives, I am able to help women deliver healthy babies, I am able to take care of children of my village, I am able to help them lead a healthy life and make their future healthy, all this is a very big deal.
Today, ASHA workers like Nirmala Manipat Koge are recognised on an international stage. World Health Organisation has tagged the ASHA workers of India as ‘Global Health Leaders’ for their crucial role in connecting the community to the government’s health programmes, particularly in rural areas, and their efforts in the coronavirus pandemic in the country.
About ASHA Workers
ASHA (which means hope in Hindi) is an acronym for Accredited Social Health Activist. ASHAs are the grassroot health workers assisting the Ministry of Health and Family Welfare (MoHFW) in delivering primary healthcare, particularly for women and children, in both rural and urban areas since 2005. There are over 10 lakh ASHA workers in the country. In May 2022, the World Health Organisation’s Director-General Dr Tedros Adhanom Ghebreyesus honoured ASHA workers for their crucial role in linking the community with the health system, to ensure those living in rural poverty can access primary health care services, as shown throughout the COVID-19 pandemic. India’s ASHAs are among the six recipients of the WHO Director-General’s Global Health Leaders Award. The award ceremony was part of the live-streamed high-level opening session of the 75th World Health Assembly.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.