While COVID rages on globally and across India a more spirited debate ranges in my mind. Was there a way to anticipate and proactively move on infectious and non infectious conditions in India?
One thing that COVID has exposed is the gross unpreparedness of the Indian healthcare system to deal with pandemics. But it also exposed how little we knew about the situation on the ground. Data available is inadequate and most of the data especially from the villages and districts is not captured.
At the front line for the fight against disease and other illnesses is the Indian Primary Care system. This system is mostly run by ASHA (Accredited Social Health Activists) If something is coming our way, they are the first to know. And while they have been around since the recommendations of the Bhore Committee recommendations were given in 1943, it is easy to see how they are ill-prepared to deal with anything.
This is some data that I have been able to ascertain from public sources.
|Number of ASHA Workers||9,00,000|
|Number of primary health centers||25,000|
|Average Salaries of ASHA Workers||INR 2,000/PM|
|Average costs incurred by ASHA WOrkers||INR 800/PM|
So this is the on-ground scenario. These workers have to fill multiple forms for child care, maternal care among others, and then they have made 10-15 home visits per day. There are key reasons why ASHA workers are important.
- They are local to an area, they understand the local customs and traditions
- They have the trust of the community, communitites in rural India do not like to discuss their health with strangers
- While are part timers, going from home to home makes them the best eyes and ears for the healthcare system
But given their situation and low pay, would it be interesting to see what we can do to help their situation. The government is spending close to INR 5000 Crore on the Ayushman Bharat Program. Next year the outlay is close to 10,000 Crore. But at a fraction of this cost, we can increase the pay for the ASHA workers and get much better coverage to prevent patients from getting hospitalized.
In the coming days, I would be focusing on how we can strengthen the primary care system and improve the overall effectiveness of the ASHA workers while providing them better remuneration for their tasks.
We did this video to talk about the challenges of the primary healthcare system. Below is the recording for the same.
As always we look forward to your comments and suggestions on the same.