The villagers in most part of rural India have to travel long distances to access health care. The social and cultural norms related to gender make it difficult for women to travel alone. Women usually travel with a chaperone to even visit a public heath care facility, thus leading to loss of wages for two persons. Women, often the sole breadwinners of the family, do not have time to seek care and cannot afford to lose the daily wages, even in emergencies, to visit the hospital.
Access to information, demand creation and hospital based provision of health services like monitoring and diagnostic investigations are not adequate in rural India. The health care costs are prohibitive leading to a lack of access to care in most villages. Preventive care and detection of complications require regular monitoring of the pregnancy and infancy. The diagnostic investigations like haemoglobin, blood pressure, weight measurement and urine testing for proteins at monthly intervals are necessary for regular monitoring; however, such a service is not available at home.
There is an urgent and unmet need for improved access to after work-hours home based individualized diagnostic, monitoring and curative services during the antenatal and postnatal period and during infancy. It is for these reasons that trusted women leaders are selected through community partners in villages and trained to become health entrepreneurs.
Arogya Sakhi home based Antenatal and Infancy care program visualizes creation of women health entrepreneurs who will provide affordable health care to their village for a nominal fee and in the process, empower themselves to provide for their own families.
As a part of Randomized Cluster Trial conducted with the support of DFID in 250 villages of Oshmanabad, Solapur and Washim district of Maharashtra, ARMMAN trained 166 Arogya Sakhis. The health entrepreneurs were trained to provide comprehensive home based antenatal, postnatal and infancy care including performing diagnostic investigations and prompt referrals in case of high risk factors.
Arogya Sakhis undergo a training comprising of 10 training modules of 2 day duration each. On-site training of Arogya Sakhi by the project doctor is an integral part of their training. Each Arogya Sakhi is provided with a medical kit including all necessary equipment needed to provide home based diagnostic tests.
The Arogya Sakhis act as the maternal and child health advocate of the village, assist the ASHA worker and act as a liaison between the community, ASHA worker and government health system. Since she is a trusted member of the community, the family trusts her to escort the woman of their family to the health care facility. In case of an emergency referral they act as a health advocate; thus sparing the family the need to chaperone her during work hours.
A 3-year project (2017-2020) is currently being implemented through 60 Sakhis in two rural/tribal blocks of Palghar district in Maharashtra. The sakhis aim to reach over 6000 women and children in Jawhar and Mokhada.