Abstract
IntroductionIt is well acknowledged that India’s community health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system. Many ASHAs are currently working in fragile and conflict-affected settings. No efforts have yet been made to understand the challenges and vulnerabilities of these female workers. This paper seeks to address this gap by bringing attention to the situation of ASHAs working in the fragile and conflict settings and how conflict impacts them and their work.MethodsQualitative fieldwork was undertaken in four conflict-affected villages in two conflict-affected districts -Kokrajhar and Karbi Anglong of Assam state situated in the North-East region of India. Detailed account of four ASHAs serving roughly 4000 people is presented. Data transliterated into English were analysed by authors by developing a codebook using grounded theory and thematic organisation of codes.ResultsASHAs reported facing challenges in ensuring access to health services during and immediately after outbreaks of conflict. They experienced difficulty in arranging transport and breakdown of services at remote health facilities. Their physical safety and security were at risk during episodes of conflict. ASHAs reported hostile attitudes of the communities they served due to the breakdown of social relations, trauma due to displacement, and loss of family members, particularly their husbands.ConclusionsConflict must be recognised as an important context within which community health workers operate, with greater policy focus and research devoted to understanding and addressing the barriers they face as workers and as persons affected by conflict.
Highlights
It is well acknowledged that India’s community health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system
Conflict must be recognised as an important context within which community health workers operate, with greater policy focus and research devoted to understanding and addressing the barriers they face as workers and as persons affected by conflict
The ASHAs we spoke to noted that their experiences were common to their colleagues working in conflict-affected areas of the district
Summary
It is well acknowledged that India’s community health workers known as Accredited Social Health Activists (ASHA) are the bedrock of its health system. India’s Community Health Workers (CHWs), known as Accredited Social Health Activists (ASHAs), are the bedrock of its health system. Conflict-affected health systems in countries like Afghanistan, Burkina Faso have engaged CHWs to provide essential services under restrictive and sometimes dangerous situations [6]. In India, we found one study demonstrating the effectiveness of a lay health worker intervention in a rural conflict ridden district of Kashmir state [7], and another showing feasibility of community health worker supported tuberculosis patient tracing using GeneXpert in naxal conflict affected border areas of Chhattisgarh state [7, 8]. In neither case were ASHA workers involved even as they are employed in all of the conflict -affected regions of india, which include the erstwhile state of Jammu and Kashmir as well as six of the eight states in the northeast region
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