COVID-19 Pandemic and Frontline Health Workers in Assam (India): Roles and Challenges faced by the Accredited Social Health Activists (ASHAs)

Abstract

Abstract COVID-19 was one of the most devastating health crises that the world witnessed in contemporary times. Health workers were at the forefront, responding to the crisis, saving millions of lives. Faced with an unprecedented situation, India’s frontline health workers (FHWs) in the public health system, played a critical role as first responders. There are limited studies that have explored and documented their contribution from the north eastern states of India. Methods: In this qualitative study, we discuss the roles of FHWs during COVID-19, and the challenges they faced while working at the primary level public health facilities. The study was conducted in Dibrugarh, Dhubri, Kamrup and Kamrup Metropolitan districts representing spatial, socio-economic and geographical diversity and disparity of the state. Multiple modes of inquiry (in-depth interviews, group discussions, and telephonic interviews) were conducted with the ASHAs and other stakeholders. Findings: The ASHAs have performed different roles in terms of creating awareness, health education, adopting preventive measures, disease surveillance, testing, quarantine and isolation of patients. They were instrumental in continuation of the essential health services and COVID-19 vaccination. Tremendous increase in their tasks, long working hours without proper break, insecure and risky work conditions without adequate safety measures, stigma, violence, and discrimination at community level, frequently changing guidelines, delayed and inadequate compensation were some of the main challenges faced by the ASHAs in Assam. Conclusions: Working at the bottom of the public health system hierarchy, the ASHAs in rural and urban areas performed most of their responsibilities despite risks. Their contribution in increasing the community’s trust in the public health system, through their educational role and by being the first point of healthcare providers has been phenomenal.