ABOUT THE PROJECT

This project is part of the PEER Programme- Women in Science Mentorship for career advancement (USAID) to encourage women researchers and scientists to excel in their research careers. It includes mentoring women researchers and a research project in the area of TB. The mentoring component includes focused mentoring sessions for the team of women researchers in the area of public health research and TB.

The research aims at assessing preparedness of urban ASHAs from Pune and Mumbai for delivery of primary healthcare in general and specifically in the area of TB control. The project is mixed-method exploratory research to learn the perspectives of key stakeholders- programme officials, supervisors and the community to understand the roles and responsibilities of urban ASHA, her training, knowledge and skills related to TB control and the challenges experienced by her. The research methods include a semi-structured survey of 200 plus ASHAs, focus group discussions of ASHAs (n=8) and in-depth interviews of key informants (n~15). The project is currently undergoing.

KEY ACHIEVEMENTS

• Ongoing recruitment of urban ASHAs experiencing difficulties related to inadequate remuneration- 57% vacancies in Maharashtra
• Retention of recruited urban ASHAs equally challenging on account of dealing with their false hope of becoming ‘permanent’ and waning interest against availability of other earning sources after COVID pandemic- higher attrition resulting in continuous need of recruitment
• Challenges related to training of urban ASHAs in terms of a disjoint between trainers and on-job supervisors, inadequate focus on reporting & documentation during training and a need to have a dedicated team of ‘trained’ trainers, use of e-platform & avoid delays in arranging training.
• Being ‘overburdened’ with ‘inadequate’ remuneration
• Support- Absence of a supportive supervisory structure and cadre for on-job support, weak community support with absence of functional Mahila Arogya Samiti, however mostly having supportive families
• Explicit gaps in TB related knowledge and training for TB especially about adverse drug reactions, nutrition, government schemes for patients and contact tracing
• Inadequate communication skills, ambiguity about TB related roles against available time and workload, weak supervision and concerns about remuneration further making them reluctant to take up TB related roles.

Presently urban ASHA is a potentially valuable but an unstable cadre. Her roles as an incentivized worker need to be defined, training norms to be refined and an improved eco system for her support to be revised. Furthermore, suitability of urban ASHA as a TB functionary and expected roles need more clarity. TB related knowledge gaps pointed in this study need to be addressed through comprehensive TB training of appropriate duration and supportive supervision.

PUBLICATIONS

• Purohit, V., Karvande, S., Shah, D. Y., Vallepawar O. B., Yadav, O. J. & Mistry, N. (2024). Engagement and preparedness of urban Accredited Social Health Activists (U-ASHAs) for delivery of tuberculosis (TB) care: Findings from two cities in Maharashtra, India. Indian J Community Med, (Accepted)

CONFERENCE PRESENTATION

• Karvande, S. Invited Presentation ‘Bolstering Health Services to Bridge the Health Gap’ at Clairvoyance 2023- The 25th Annual Conference of School of Health Systems Studies organized by TISS, Mumbai, 28th January 2023.

ABOUT THE PROJECT

Maternal and newborn health (MNH) was considered as a window for the training intervention project in Palghar. The objective was to generate a local resource of trainers and through them, build the capacities of community health providers for the provision of MNH and nutrition services. It involved training various cadres of a primary health system, nutrition-sensitive intervention focusing on the first 1000 days and context-specific subjects such as anaemia, management of low birth weight babies. The Sister Foundation for Research in Community Health (FRCH) conducted a pilot project in Pune during 2016-19 to build capacities and competencies of Auxiliary Nurse Midwives (ANMs) in MNH. The trainers of this pilot project were utilized as core trainers to train local master trainers in Palghar. A team of clinical experts from the UK and Nutrition Society of India (NSI), Mumbai Chapter, provided technical inputs for the development/ adaptation of the training material and conducting the training of trainers in Palghar.

The process of developing local resource of trainers (n=32) involved assessment of potential candidates, training of trainers, continuous hand-holding and frequent sessions of quality assessments using face-to-face and virtual platforms. Their teaching and pedagogical skills were equally emphasized as their clinical knowledge and skills throughout the project training activities for training 500 plus health providers. Use of mannequin for demonstration of clinical skills, a reverse demonstration by every participant, case-based learning, the mix of various cadres in every training batch, de-centralized and convenient training venue were some of the key features of all the training activities. Subsequent use of the Extension for Community Healthcare Outcomes (ECHO) virtual platform helped the participants to refresh their knowledge and served as an opportunity to nurture the culture of sharing, appreciation and constructive feedback. Self-learning strategies- writing articles in a biannual newsletter- ‘Dialogue’ and learning through and skills mall complemented the formal directed learning.