Last-mile health workers transforming reproductive care in UP (Special to IANS)

Kherabad (Lucknow), Sep 4 (IANS) Lying on a cot with flies fluttering around, Rani was oblivious of her surroundings when Preeti Shukla first met her. Reduced to bones, she could hardly move a finger. Her swollen belly was the only indicator of her advanced stage of pregnancy and despite being severely anaemic her family refused to take her to the nearby hospital.

Rani would have suffered miscarriage due to heavy loss of blood, or died on the delivery table, had Shukla not reached her in time. Shukla, 28, is Community Resource Person (CRP), a trained women healthcare volunteer, who reached Rani when she was seven months pregnant.

“It was tough to convince her or her family to shift her to the CHC (Community Health Center). She was so weak that even fetching and drinking water would tire her. She would sleep the entire day. I had a tough time explaining her family about the deadly consequences,” Shukla, who works in Kherabad administrative block near Lucknow, told this visiting writer.

Today, a much-stronger Rani happily takes care of her first-born two-month-old daughter.

Shukla is part of a new work force of 390 CRPs hired by Technical Support Unit (TSU), an independent group formed last year to assist Uttar Pradesh government in addressing the problem of reproductive, maternal, newborn, child and adolescent health.

Shukla and others like her were employed to meet the challenges faced in 100 backward blocks in India’s most populous state which has 200 million people, one-sixth of the country’s 1.2 billion population. These blocks have a population of 31 million and are situated within the state’s 25 high-priority districts.

The CRPs are a crucial link in the healthcare chain.

They are trained to mentor the frontline ASHA – Accredited Social Health Activist – workers in planning, improving communication skills and mobilizing communities to improve the health of mother and child.

A graduate and a mother of two, Shukla leads a team of 39 ASHAs and mvisits several villages in a month in search of expecting and new mothers in need of assistance.

Recounting her experience, Shukla, who was a teacher till a year ago before taking up healthcare activism, said: “One of the ASHAs came to me saying that in one of the villages a two-year-old boy was not being immunized and even the family was not supporting her.”

She went with her to meet the boy and his family. “I spoke to his parents about the health problems the child will face when he grows up and how he would blame them later. The father understood and we faced no problems in immunizing the child from then on,” Shukla said.

According to TSU Team Leader Bharat Lal Pandey, a CRP is also supposed to grade the work of ASHAs – who provide the last mile assistance in the healthcare chain – on parameters like listing pregnant women in the Village Health Index Register (VHIR), coverage of ante-natal care services, institutional deliveries, post natal care and family planning.

They also have to prioritize mentoring those ASHAs who face difficulties in achieving better health coverage while keep a hawk-eye on the village register.

Pandey said that since ASHAs are drawn from the villages itself, many of them are illiterate and cannot write in the register. “The CRPs handhold them,” he said.

Above the CRPs, the TSU has appointed the Block Community Supervisor (BCS). There are 150 such supervisors.

The BCS is the overall incharge, keeping an eye on the work of the ASHAs and the CRPs.

“My job is to give support to the ASHAs and the CRPs and supervise their work. We focus more on ASHAs whose work has been graded below 50 percent. We hold weekly meetings where we discuss problems and find solutions,” Hukum Singh, a BCS, who joined last year, said.

He has 124 ASHAs and three CRPs under him.

Shukla, who proudly claimed that her status in society and in her family had improved after she became a CRP, said that apart from ensuring vaccination of children, a major part of the job is to create awareness about family planning schemes.

At times she gives her own example to convince villagers.

“My youngest child was born five years ago and then I went for the Copper-T (contraceptive). There are times when I am trying to convince a woman who has had four children and planning for another and then I give her my own example. People understand personal stories better than just facts and figures.

“I tell them very clearly that if they go for another baby than they will not be able to give the child good food, better education and a quality life. This jolts them most of the time,” she aded

She said their aim, apart from improving the health scenario in the state, “is also to create awareness among people, which is the only way ahead,” Shukla added.

(Kavita Bajeli-Datt is a Delhi-based freelance journalist. She can be contacted at

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