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Cover page of the Journal of Health Sciences


 
 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 57-58

Utilization of accredited social health activists in the community-based assessment of noncommunicable diseases: Experiences from a tribal district of Chhattisgarh


Independent Public Health Researcher, Bhubaneswar, Odisha, India

Date of Submission23-Nov-2019
Date of Acceptance17-Dec-2019
Date of Web Publication23-Jan-2020

Correspondence Address:
Dr. Janmejaya Samal
C/O-Mr. Bijaya Ketan Samal, At-Pansapalli, Po-Bangarada, Via-Gangapur, Ganjam - 761 123, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_287_19

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How to cite this article:
Samal J. Utilization of accredited social health activists in the community-based assessment of noncommunicable diseases: Experiences from a tribal district of Chhattisgarh. Indian J Health Sci Biomed Res 2020;13:57-8

How to cite this URL:
Samal J. Utilization of accredited social health activists in the community-based assessment of noncommunicable diseases: Experiences from a tribal district of Chhattisgarh. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2020 Feb 28];13:57-8. Available from: http://www.ijournalhs.org/text.asp?2020/13/1/57/276423



Dear Editor,

Currently, noncommunicable diseases (NCD) constitute a significant portion of the disease burden both globally and in India. They contribute to premature death and morbidity and have a major impact on health-care costs, productivity, and growth of a nation.[1] According to a recent World Health Organization estimate, 70% of the total deaths are due to NCDs constituting 40 million people globally.[2] In India, around 5.87 million deaths are due to NCDs contributing to 60% of all deaths and two-third of the country's share on NCD in south-east Asian region.[3] With the impact of NCDs on health, productivity, and individual household's economy government of India launched national program for cancer, diabetes, cardiovascular disease, and stroke in the year 2008. The major aim of which is to prevent and control NCDs through behavioral change communication, community participation, opportunistic screening, and provision of services through public health facilities.[4] The National Health Policy 2017 also emphasizes the importance of NCDs, and the recent lunch of AYUSHMAN Bharat program focuses on the provision of comprehensive primary health-care services under the Health and Wellness Centers (HWCs) with a special focus on NCDs.

During May to June 2019, a month-wide campaign was launched in the state of Chhattisgarh to undertake community level screening of 30+ population under the catchment areas of HWCs. As a part of this, one of the tribal districts of the Bastar Division of Chhattisgarh were given a target of 11,000 population to screen during May–June 2019 under the catchment areas of 13 functional HWCs, 3 Primary Health Center-HWCs and 10 Sub Health Center-HWCs. This was conducted in two parts; community assessment using a community-based assessment checklist (CBAC) by the Accredited Social Health Activists (ASHAs) and community-based screening at the community and facility level.

The district where the study was conducted is predominantly a tribal district with 84% of the total population is tribal. This makes an obvious fact that the ASHAs in the district are also tribal as they get selected from the same community itself, by rule. By the same rule, with the initiation of the National Rural Health Mission in 2005 when the ASHA cader was introduced in the country their minimum educational qualification was fixed as the 8th standard; however, the greatest deviation is that most of ASHAs in the district are illiterate and is commensurate with the literacy rate of the district, 29%. In addition, the language spoken by these caders of ASHAs in the district is different from the official language-Hindi and is either Gondi or Halbi or many other dialects used locally. This posed the greatest challenge of using the CBAC format developed by the National Health Systems Resources Center, New Delhi, in English, which was translated into Hindi by the state. The following table lists out the major challenges observed and possible solutions for these challenges as without addressing the challenges, the next step of community-level or facility-level screening would be based on erratic data/assessment. [Table 1] delineates the major challenges in utilizing AHSAs in community-based assessment and possible approaches to mitigate those challenges.
Table 1: Major challenges in utilizing AHSAs in community.based assessment and possible approaches to mitigate those

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The author accessed the government of India's NCD portal (https://ncd.nhp.gov. in/) to figure out the performance of the district and found that the facilities were able to enumerate population and fulfill their target of screening the population and could able to enter the data into the portal; however, a clear look at the data show that the quality of data represented is hard to believe as the data that show the referral to higher facilities and the diagnosis is almost “zero” which creates a big question mark on the efforts of the government of India in the early detection and management of five common NCDs; diabetes mellitus, hypertension and three common cancers-oral, breast and cervical cancers. One of the recent studies conducted in Andhra Pradesh on the role of ASHA on comprehensive care related to NCD came out with different findings which are more advanced than the basic problem discussed in this correspondence. While in this district, the ASHAs are struggling with the basic problems of literacy the Andhra Pradesh study in the similar domain found that ASHAs are more enthusiastic in performing activities related to NCDs; however, they feel they are not necessarily the only part of NCD services, they wanted to be a part of the health system and they are overburdened with many other activities which are obviously far more nuanced than the basic literacy issues.[5] Thus, the government should think to mitigate this vary basic issue to make the tribal ASHAs empowered enough to perform their duties efficiently and effectively.

This correspondence does not intend to serve as a fault-finding document, as it may appear to be, rather showcases a deficient health system that requires correctional measures to make any national program successful and the NCD program in this case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
NonCommunicable Diseases Alliance. Proposed Outcomes Document for the United Nations HighLevel Summit on NonCommunicable Diseases. New York: NonCommunicable Diseases Alliance New York; 2011.  Back to cited text no. 1
    
2.
World Health Organization. Noncommunicable Diseases. Geneva: World Health Organization; 2017.  Back to cited text no. 2
    
3.
Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A Global Perspective on Cardiovascular Disease in Vulnerable Populations. Can J Cardiol 2015;31:1081-93.  Back to cited text no. 3
    
4.
Ministry of Health and Family Welfare. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Ministry of Health and Family Welfare; 2017.  Back to cited text no. 4
    
5.
Abdel-All M, Abimbola S, Praveen D, Joshi R. What do accredited social health activists need to provide comprehensive care that incorporates non-communicable diseases? findings from a qualitative study in Andhra Pradesh, India. Hum Resour Health 2019;17:73.  Back to cited text no. 5
    



 
 
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