Accredited Social Health Activist (ASHA) program: India
Program Overview: India's National Rural Health Mission wishes to provide every village in the country with a trained female community health activist , ASHA worker. Selected from the village itself and accountable to it, each ASHA is trained to work as an interface between the community and the public health system. Read about program components in the title link (above).Number of Community
Health Workers (CHWs): 700,000
Year of Program Launch: 2005
Training Overview: 21-day, 12 hours per day training with forty to sixty other women. The woman is primarily trained in maternal-child health, ANC/PNC, family planning, and related secondary health topics. The focuses of additional trainings are ASHA responsibilities, lifestyle suggestions, and awareness of health and hygiene.
I was able to spend one week with Sister Mary and the ASHA workers in Bellary, talk with the women, and learn about the program.
Long-term commitment from all health workers can be witnessed by Sister Mary’s dedication to the P.K. Halli program. Twenty-five years ago, Sister Mary Matthews saw a healthcare deficit in P.K. Halli, India. With her medical background and passion for social work, she started health and education programs. Originally, no qualified health workers or programs existed in the Bellary Taluk, and basic health care was necessary for miners and maternal-child health. Sister Mary implemented the top-down, ASHA health program in this 25 km^2 region to a 6000-member taluk population (1:1000 ASHA to population ratio), because of her desire to:
“Reach the unreached, live with them, study their needs, and cater to their most immediate needs. The best way to work in community development is to be present.” – Sister Mary
The CHW program has benefitted this community by providing health awareness and illness prevention for maternal-child health. Today, Sister Mary connects qualified women to the ASHA program, visits SC and immunization sites, and advocates for grant funding. This region uses a topdown,governmental health structure to fulfill the community’s health needs. This includes monitoring and education by the ASHA workers, diagnoses and medicine administered by the SC and PHC, and more complex diagnoses and surgery provided by the hospital. Additionally, an emergency vehicle is available for deliveries, and public transportation is available for less urgent health needs. The government health systems work together. For example, walk-in immunization clinics are offered at least one Thursday per month and hosted by two ASHA workers, one SC nurse and one Anganwadi worker. During one visit, Sister Mary visited the immunization clinic and noticed a malnourished 3-month-old infant. Sister Mary learned that the child was not taking his mother’s milk and had diarrhea, so she directed the health workers to refer the infant to the local free clinic to regain health. In addition to the free clinic for emergency situations, the community also has a baby clinic that replaces the original dependency of home deliveries.
“A healthy child, a healthy mother, a healthy nation.” – Sister Mary
Case Study: MAYA Health: Karnataka, India
Program Overview: MAYA is an NGO based in Karnataka, India. Health is the newest systemic issue that MAYA wished to address with a goal to proactively support health through community health workers. India’s current health system is reactive instead of preventive Rural and urban poor communities are most affected by illness, catalyzing the cycle of unemployment, lack of education, and poverty. MAYA hopes to implement an individualized, bottom-up approach to change that. Read about program components in the title link (above).
Number of CHWs: 30
Year of Program Launch : 2013
Training Overview: A group of fifteen to twenty selected women are considered a Health Navigator (HN) enterprise, and are trained in community health for six months under the guidance of MAYA Health. The HNs are trained to track health parameters and keep community health records; develop patient diet and exercise plans; provide counseling on diet, lifestyle, and stress management; meet with doctors and influence community compliance; refer the community to other existing health service providers; and motivate community.
MAYA Health has been the group that I've worked with throughout this past six months. I've been working with Dr. Vasu, Neeraj, and Jithin to develop a application that would electronically record patient information, as well as initial developments for a reporting system.
Currently, the program is piloted in Channapatna, a semi-urban community. In this region, MAYA Organic is the identified existing NGO working in this community. The MAYA Health HN director, Rashmi, has worked with both MAYA Organic and now MAYA Health. Within the communities, women were selected to be the HNs. The original group of HNs now works with Rashmi and volunteer experts to learn more about health and entrepreneurial skills. The second group of HNs is in the 6month phase of field work and revision. After this oneyear period, each HN is expected to make a viable income based on the clients and community with whom she had registered and followed-up. Need-base training and periodic monitoring will take place by the local implementing organization and remotely by MAYA Health.
“Without health, there is no escape from poverty.” – MAYA Health
HNs work towards developing individual community ownership of one’s own health through taking responsible actions for diet, lifestyle, personal and environmental hygiene and sanitation. HNs connect the community with the ecosystem (existing health service providers) and also promote community participation in maintaining or improving health.
City Health Works: New York City, United States
I learned of this program through MAYA, because the executive director of City Health Works previously had worked with MAYA Labournet.
Program Overview: The City Health Works group was founded to combat chronic health issues through understanding a community’s needs and building trusted, long-term relationships with clients. A gap between the community and healthcare could include language barriers, simplifying and communicating health, and financial stress. The goals of this group include leading behavior change, disease prevention, and disease management through creating the Health Coach jobs in low-income neighborhoods. City Health Works creates healthier, stronger neighborhoods.
Number of CHWs: 10
Year of Program Launch: 2012
Training Overview: Coaches are trained and supervised to holistically evaluate health by the Director of Health Coaching and Health Coach Supervisor. Through physician input, the health coaches are able to learn motivational coaching, coping strategies, and health education. This insight allows the health coaches to recognize health issues in their patient interactions. As necessary, the Health Coaches are trained to connect clients with local health services. The Health Coaches are trained to motivate and educate the community in eating habits, medication management, stress coping skills, and financial management.
Case Study: The City Health Works program combats the healthcare concerns of Harlem, New York through individualized tools, support, and education for home life and doctor’s visits. The program focuses on preventive health through realistic goal setting for all areas of health (including areas of social, medical, and psychological health). Through the local workforce (Health Coaches), the patients have more accessible and affordable care. Because of this interaction, clinicians have insight into the home and life of a patient and can more efficiently and effectively diagnose and treat the patient.
“To shift the balance of our health system from disease to health, and from hospitals to communities.” - Manmeet Kaur, Executive Director
Healthy Northland: Minnesota, United States
Supported by the state health commissioner, Dr. Edward Ehlinger, Minnesota’s Statewide Health Improvement Program (SHIP), promotes health by integrating it into everyday life. Examples of promoting health include creating safe places to walk, allowing access to healthy foods, integrating health in work, and supporting breastfeeding in public.
Number of CHWs: 12 local coordinators
Year of Program Launch: 2011
Training Overview: Currently, Minnesota is the only state to offer a community health worker curriculum, and the standardized fourteen-credit certification program was developed by colleges in the state. In the Healthy Northland program, CHWs are trained with this program. A CHW’s goal is to connect communities with health and social service systems. Engaging with and educating the community is critical to ensure that people understand their health and resources. This engagement goes both ways, because the health and social services systems should be informed of community needs and perspectives. Chronically ill patients and people experiencing life-threatening emergencies are referred to doctors for screening and diagnoses. The CHW can aid clients in, filling out forms, enrollment, and predetermination paperwork.
For the last two years, Healthy Northland has developed SHIP methodologies in semi-urban and rural regions of northern Minnesota. Louise Anderson is the director of the Carlton, Cook Lake, and St. Louis district. Healthy Northland promotes five areas of a healthier lifestyle: active living, healthy eating, clinical care, tobacco-free living, and healthy communities. Relating well to the community is prioritized. To do this successfully, Healthy Northland has introduced groups of eight to ten paid, part-time community consultants who take time out of their work schedule to give input on proposed community programs.
Overall, work covers the following areas:
• Gather lifestyle and survey assessments
• Increase client selfefficacy to achieve wellness
• Educate clients on maintaining wellness and managing chronic conditions
• Identify individual and community needs
• Seek appropriate professional development opportunities
• Document all activities as detailed by direct supervisors
Summary! Each program:
1. Observes the health needs of a specific community.
2. Trains CHWs to met needs: bring health awareness and health/hygiene/sanitation education.
3. Allows the CHWs to connect with the community and the local health personnel and facilities.
Thanks for making it through! That was a semi-dense read. I hope you enjoyed learning about the different community health programs.
In other news, I just finished a cinnamon, mint hot chocolate and watched some pretty dry British comedy with my parents. Although I miss India, it's nice to be home. :)