Community health workers (CHWs) as gamechangers in the urban slums

According to the World Health Organization, “the increased coverage of essential health services and improved equity in coverage envisioned by well-functioning community health worker programmes will result in fewer deaths and illnesses and lower disease burdens.” (Dimagi: What is a Community Health Worker?)

The concept of community health workers (CHWs) in the urban context is relatively a new concept or has not been very encouraging. Calcutta Rescue (CR), which works in the urban slums of Calcutta introduced the concept of CHWs in line with the ASHA concept during the peak hours of the pandemic to escalate its services and reach.

The role of CHWs’ service in the Calcutta Rescue slums during the pandemic

Calcutta Rescue (CR) works in the slums through its mobile clinics providing overall medical and nutritional support to the slum dwellers. The street medicine van moves into the slums and provides treatment, healthcare services and awareness. This service was greatly hampered during the initial phase of the pandemic. Though medicines and other nutritional benefits reached, awareness level was low. Besides the services did not percolate to the entire community and remained concentrated only amongst those who came to the medicine van to avail of the services. Its services got disrupted to some extent during the pandemic as CR followed its own Covid protocol. Hence CR introduced the concept of CHWs in the slums which was a most needed intervention given the pandemic situation.

In any community, people become ill and require access to health care facilities and treatment. The problem may be physical, such as diarrhoea, fever, injury or any other sickness. Women have special needs related to pregnancy and childbirth & children require immunization against common diseases. Regardless of the nature of the health issue, the health outcomes depend to a large degree on individual’s ability to access health care services. To counter this and to meet community demands for accessible & affordable services, CR had launched its outreach services through engaging of CHWs in 3 of its slum areas for a period of 3 months as a pilot project about 2 years back.

The concept of CHWs in the urban context is relatively a new concept (...). Calcutta Rescue, which works in the urban slums of Calcutta introduced the concept of CHWs in line with the ASHA concept during the peak hours of the pandemic.

The CHWs were very active in spreading awareness regarding Covid-19 and other health related illnesses. They played an important role in ensuring mass Covid vaccination. Sanitation and hygiene were the two key issues on which they emphasised. Thousands of children had fallen short of their immunisation schedule and antenatal care (ANC) and postnatal care (PNC) checkups for pregnant and lactating mothers were greatly hampered. The CHWs played a very important role in connecting these gaps by linking the patients with CR and the mainstream health system. The community was greatly benefitted by the CHW services which played a key role in helping the community to get these services.

To counter this and to meet community demands for accessible & affordable services, CR had launched its outreach services through engaging of CHWs in 3 of its slum areas for a period of 3 months as a pilot project about 2 years back.

Objective of introducing CHW services in Calcutta Rescue field

• To serve as a link between CR and the entire slum community
• To educate slum dwellers about various health and hygiene issues
• To promote good health practices and positive health seeking behaviors through health education sessions, and generating health awareness among the slum population, e.g importance of nutrition, mother & child health (ANC, PNC, promote institutional delivery importance of immunization), hygiene and safe drinking water etc.
• To disseminate information on health seeking behavior through awareness campaigns including health meetings, awareness sessions
• To ensure active participation of the community to make communities an active partner
• To network with government health care institution (in coordination with CR) for referral services and specialized treatment.

These CHWs now actively participate in various surveys that CR organises in the slums to plan intervention and study their impact.

The present scenario:

2 years post pandemic CR has 22 CHWs spread across 19 slums. CR’s patient reach has almost been doubled due to the reach of the CHWs in each of the slums. CHWs are trained from time to time so that with CR’s support they can give better health education related support in the slums. They are provided with a basic medical kit consisting of oral rehydration solutions (ORS) some basic medicines, condoms etc to cater to the immediate need of the slum community. These CHWs now actively participate in various surveys that CR organises in the slums to plan intervention and study their impact. CR living standard related constructions like public toilet, bathing space, hand washing stations are maintained by these CHWs by ensuring community participation. They have become an important pillar in the CR health programme related initiatives.

They are the health activist in the community who are creating awareness on health and its social determinants and mobilising the community towards local health planning and increased utilisation and accountability of the existing health services.

CR’s CHW concept is a small subset of the entire CHW program that runs across different regions. But this small programme proved extremely helpful and showed how they can be instrumental even during pandemics like Covid-19.

Calcutta Rescue’s key initiatives with CHWs

CR’s CHW concept is a replica of the rural ASHA model. However the level of training that they receive is very rudimentary compared to the ASHA workers. CR plans to regularly capacitate them on various health topics.

These CHWs being low paid, CR involves them in various surveys through which they make an additional income. Also they are incentivised based on their performance to keep them motivated.

CR’s CHW concept is a small subset of the entire CHW program that runs across different regions. But this small programme proved extremely helpful and showed how they can be instrumental even during pandemics like Covid-19.

Reference

• Dimagi. What is a Community Health Worker (CHW)? Your guide to understanding the impact of effective community health worker programs and how they work. https://www.dimagi.com/community-health-worker/