Manju Jeena, an Accredited Social Health Activist (ASHA) from Kandalei village of Khurda district, Odisha, has been working tirelessly to support COVID-19 related activities and ensure that her community has access to essential and other health services.

In her years of committed community service, Manju has built up significant social capital, enabling her to effectively negotiate in addressing COVID related stigma and resultant discrimination. When a young returnee migrant was denied entry into the village and his home, Manju took it upon herself to single-handedly address the stigmatizing behaviour of the community. She combined community awareness on COVID-19 with relentless advocacy to ensure that the returnee was able to stay in home quarantine. She rigorously undertook regular follow up on his health status and healthcare needs during the quarantine period.

During the lockdown, she continued to facilitate access to other essential health services. She encouraged and accompanied several pregnant women for institutional delivery. Going beyond the call of duty, Manju also sewed face masks at home and distributed them to the poor in her village.

At least 46,627 ASHAs in Odisha have emerged as champions against COVID-19 in rural and urban areas, addressing local health needs. They are seen to be working closely with Gaon Kalyan Samitis in the rural areas and Mahila Arogaya Samitis in the urban areas, community collectives within which ASHAs are embedded. They have used these forums to facilitate COVID preventive actions by promoting the use of masks/face covers when stepping out in public spaces, being attentive towards frequent hand washing, following physical distancing, enhancing awareness of COVID symptoms etc.

The ASHAs have created wide awareness about these through IEC activities like distribution of leaflets and posters at Swasthya Kantha (wall at village level).

Meanwhile, in Jharkhand ‘Sahiyas’ have been on their feet
On March 13, Kamarunisha and her husband Noor Mohammad, of Telo village in Bokaro district, returned home after participating in a Jamaat event in Delhi. They tested for COVID-19 at the airport and were advised home quarantine in their village.  The village ASHA, known in Jharkhand as Sahiya, Reena Devi, obtained this information during the household survey.

She immediately informed the medical officer-in-charge of the block, counselled the couple to follow home quarantine as per norms and followed up regularly regarding their health status and healthcare needs. Kamarunisha was quarantined at Bokaro General Hospital. Reena Devi coordinated with authorities for a medical team to be sent to the couple’s house the next day and helped in home quarantine for the family members.

She continued to actively follow-up of the couple and played a crucial role in creating awareness in the family as well as in the community for prevention of COVID-19. Timely action and persistent efforts by Reena Devi helped in preventing spread of infection to other members in the family and in her community.

The ASHAs in Jharkhand have been supporting delivery of healthcare services to the last mile, especially in the tribal areas. The state has about 42,000 Sahiyas, supported by 2,260 Sahiya Sathis (ASHA facilitators), 582 block trainers, 24 district community mobilizers and a state level community processes resource centre. Since the launch of the programme, the Sahiyas have been widely acknowledged for their commitment and agency in enabling access to health care, even in the hard to reach and remote tribal areas.

Sahiyas have been actively engaged in various activities related to COVID-19 since the outbreak started in March. The activities include creating awareness about preventive measures of COVID-19 like frequent hand washing with soap and water, use of masks/face covers when stepping out in public spaces, following proper etiquette while coughing and sneezing, etc. They are also involved in contact tracing, line listing and follow up of the COVID-19 cases.

Jharkhand conducted an intensive public health survey (IPHS) to identify the high risk population for COVID-19 during June 18-25. On the first day of the IPHS week, community meetings at the village level and in the cities were held for planning of field level activities. Subsequently, for three consecutive days, a house-to-house survey was conducted. About 42,000 Sahiyas played a crucial role in this survey. They conducted house-to-house survey of thousands of households to identify the local high risk population such as individuals with influenza like illness (ILI)/ severe acute respiratory illness (SARI) symptoms, population more than 40 years with co-morbid conditions, under-five children who missed vaccination as per the schedule and pregnant women due for ante natal check-up (ANC). Testing of individuals with ILI/SARI symptoms was also ensured the same day. The details of individuals identified with higher vulnerabilities are shared with the linked Sub Centre and block /district health teams for active follow-up. 

During the survey, the Sahiyas carried out multiple tasks (such as counselling for ANC/PNC, home based new-born care, home-based care of the young child, follow-up of those on treatment with chronic diseases), during their household visits, reducing the need to undertake multiple visits to the same household for different activities.

In Uttar Pradesh, 1.6 lakh ASHAs tracked over 30.43 lakh migrant returnees
Suresh Kumar, a 20-year-old from Bahraich, worked at a juice shop in Mumbai city. He returned home along with other migrant workers in a truck in early May, after travelling for five days. As soon as he reached home, the local ASHA, Chandra Prabha, met him and recorded his details. She informed the Rapid Response Team (RRT) of Bahraich district, which advised Suresh to quarantine himself at home. Chandra Prabha also counselled the family members and explained in detail the steps to be taken during home quarantine. She undertook regular follow-up visits and kept in touch with the family. Her alertness, motivational skills and support ensured that as soon as Suresh began experiencing symptoms, he was sent to the community health centre, Chitaura, which is also a designated COVID Care facility. Chandra Prabha also ensured that Suresh’s family members and his fellow migrants were referred for COVID testing. 

With the surge in the cases of COVID-19 in the country and the influx of migrant population from hotspot areas, one of the major challenges in UP was to cater to the healthcare needs of returnees and arrest the spread in its rural population. ASHAs have played a critical role in supporting the state’s COVID-19 management during this crisis.

In a gigantic exercise, UP’s 1.6 lakh ASHAs have tracked over nearly 30.43 lakh migrant returnees in two phases – 11.24 lakh in the first and 19.19 lakh in the second phase. They have assisted in contact tracing and community level surveillance. The ASHAs not only identified 7,965 persons with symptoms but also regularly followed up on their health status. They have facilitated sample collection from 2232 returnees of which 203 were found to be positive and were referred to COVID health care services. Nigrani Samitis (Vigilance Committee) have been formed in all the villages under the Gram Pradhan. The Samiti members/ volunteers community patrols keep in touch with the ASHAs and provide her details of the migrants in the village, who in turn help with the follow up on the migrants. ASHAs have played a critical role in sensitising the communities about the preventive measures to be adopted such as regular hand washing with soap and water, importance of wearing masks when out in public spaces, and maintaining adequate physical distancing. As a result of their efforts, there has been enhanced awareness about essential and non-essential healthcare services and how to access these. The ASHAs are provided basic protective gear like masks and soap/sanitizers as they go about their duties.

They show selfless commitment in Rajasthan
In Rajasthan, the pandemic coincided with the harvest season. Most ASHAs are also expected by their families in supporting harvesting activities. This year though, the intensive involvement of the ASHAs in the pandemic prevented most of them from doing so, leading to considerable resentment and resistance from their families. This was no different for Gogi Devi, but she continued with tenacity to serve as an ASHA and fulfil her role as  social mobilizer, community level care provider and link worker for the health facility.

Her efforts were rewarded when the Pradhan of the Gram Panchayat publicly applauded her role in COVID related measures for prevention and containment. This changed her family’s perspective, and they started appreciating her commitment towards her work. For Gogi Devi, her community’s acknowledgment and recognition of her work are strong motivation to sustain her to carry on tirelessly.

The work of ASHAs as integral pillars of COVID-19 response started immediately after the first case was diagnosed in early March in Jaipur. On March 8, all 9,876 gram panchayats of Rajasthan organised a special Gram Sabha, in which ASHAs took the lead in explaining COVID-19 modes of transmission, precautions and control measures, since they had all been trained in preparation for this public activity. This strategic initial effort was the key in securing the support of the gram panchayat representatives in ensuring prevention and control measures in their jurisdiction and also in supporting ASHAs and other frontline workers to undertake their tasks without any hindrance.
 
The contribution of the ASHAs, in collaboration with the state’s auxiliary nurse midwives (ANMs), enabled reaching out to households for active surveillance and information dissemination. In the midst of all this and while being vigilant about anyone with symptoms, ASHAs also continued to provide care for pregnant women, newborns and children. They also mobilized transport to health facilities in cases when ambulances were not available. 

Various ASHAs like Gogi Devi have played a critical role in spreading awareness about the symptoms and precautions against COVID-19. This has helped immensely in containment of the disease. They used the community trust and knowledge of the local social factors to build confidence among the people to support government efforts in containment and management of COVID-19.

(Compiled from PIB features)