Kundan Kumari is a community health volunteer who works as the government’s ASHA (accredited social health activist), and is also a Swasthya Sakhi of the CSR supported project Jagruk Mahila–Swastha Parivar, which is implemented by S M Sehgal Foundation. She works in Samastipur block, Samastipur district, Bihar.
Being an ASHA worker for many years, she is experienced, and maintains a list of all the women of reproductive age and the children in her village. Kundan has attended many government trainings, but these trainings have a large number of trainees where too much information is provided amidst disturbances and interruptions, thus it is difficult to properly absorb the knowledge provided. Besides there is inadequate follow up and assistance provided with regard to the practical challenges faced at the field level.
Kundan is an exemplary health worker, hardworking and curious to learn new things. She regularly makes door to door visits to supervise the health status of households, provides appropriate health advice or direct the family to referral services, informs the people of the various government services that they are eligible for, undertakes COVID symptoms survey, distributes iron and calcium tablets to expectant and lactating women, makes sure that vaccinations are done, among other activities. She keeps some common medicines with herself to be used during her work, which includes paracetamol, multi vitamins, zinc tablets, oral rehydration solution (ORS), vitamin A syrup, iron folic acid (IFA) tablets, calcium tablets, and a first aid kit.
Her help is effective as she maintains good rapport with all health workers including auxiliary midwife nurse (ANM), Integrated Child Development Services (ICDS) worker and helper, doctors, Village Health Sanitation & Nutrition Committee (VHSNC), panchayat members, and ambulance service providers.
Kundan is a regular attendee of the project’s Swasthya Sakhi trainings and monthly meetings, and communicates the information she acquires here to the people. This includes the importance of maintaining a gap between two children, about government schemes, health nutrition and sanitation, institutional delivery, and family planning. She visits all the newborns and measures the baby’s temperature and weight, demonstrates the correct posture of breastfeeding, informs when and what to begin including as supplementary food to the infant. If Kundan finds that the baby is underweight, she instructs on kangaroo mother care (the posture of keeping the baby on the body of mother or guardian so that baby’s body temperature is maintained, to protect it from pneumonia.)
Kundan has made herself approachable at all times, day or night, to the people of her village. The behavioral changes due to the efforts made in the community, as experienced by Kundan, are as follows.
1.Initially Kundan found it challenging to approach women for vaccinations of their children, as the child temporality suffers from fever and dizziness after vaccination. But now the women have become aware of the importance of vaccinations and they bring their children for vaccinations on time to the center.
2. Earlier the women used to throw away the IFA tablets, as they initially cause some dizziness and sleepiness. Now they know that the tablets are necessary to increase the blood in the body and be protected from anaemia, so they ask for the tablets and take them regularly.
3. Now the mothers breastfeed their baby up to six months and then start adding supplementary food along with breastfeeding. They take care of quantity and variety of foods to be given.
4. The women used to neglect their health, including symptoms like headache, body ache and vomiting, believing that they would recover by themselves in time. But now they visit the doctor whenever suffering from common or severe illnesses.
5. The women now keep essential documents ready for applying for various government schemes such as Janani Suraksha Yojana (JSY), Pradhan Mantri Matriv Vandana Yojana (PMMVY), Mukhya Mantri Kanya Suraksha Yojana (MKSY) and Ayushman Bharat Yojana (ABY).
6. Previously the people hesitated using contraceptive measures like pills, condoms, and injection because of erroneous beliefs including that pills cause infections and side effects. However, now they have realized the importance of maintaining a gap between children and family planning, for which they have begun adopting these methods.
7. After having two or three children, the women prefer family planning for which they take assistance of the Swasthya Sakhi.
8. Previously women were not ready to attend awareness sessions, citing household activities, but now they do not miss sessions and participate in the activities, as they have realized that this endeavour is for their better health and well being.
Authors: Mati Murmu and Ellora Mubashir
(Mati Murmu is project coordinator, S M Sehgal Foundation, Samastipur and Ellora Mubashir is communications specialist, Partnerships, S M Sehgal Foundation)