Empowering India’s Frontline Health Workers with COVID-19 Prevention Messages

The piece below originally appeared on The Challenge Initiative for Healthy Cities’ blog. TCIHC is led by the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins and partners with PSI to implement its programming in India.

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By Mukesh Sharma and Deepti Mathur, PSI India and Lisa Mwaikambo, Johns Hopkins Center for Communication Programs

India is the world’s second-most populous country, with more than 1.3 billion residents. Ensuring that young women and girls have access to family planning is central to the country’s future development, paving the way for more educated communities and a healthier population. But COVID-19 has placed a heavy burden on India’s health system, which now has to care for patients suffering from coronavirus, test people for the virus and other conduct other allied services.

Many health facilities have been converted into dedicated COVID-19 centers, which means fewer facilities for services such as family planning. Getting messages out to vulnerable populations, such as the urban poor, as to where they can seek family planning services is crucial. Also crucial is protecting frontline health workers that deliver those messages.

The Challenge Initiative for Healthy Cities (TCIHC) in India has supported the Government of India (GOI) in Uttar Pradesh (UP), Madhya Pradesh (MP) and Odisha by developing self-care messages for its frontline health workers, including urban Accredited Social Health Activists (ASHAs) and their supervisors, Auxiliary Nurse Midwives (ANMs).

TCIHC adapted existing GOI information, education, and communication materials related to COVID-19 with content specifically for ASHAs and ANMs that integrates family planning messages. The materials instruct ASHAs to take appropriate precautions during fieldwork while reinforcing their important role in helping women avert unwanted pregnancies. Given the lockdown restrictions, TCIHC facilitated this adaptation and finalization of the materials with the GOI through existing WhatsApp Groups.

Once finalized, state officials shared the materials – which were developed in Hindi and customized for all three states – via existing WhatsApp groups of the National Urban Health Mission (NUHM) with urban primary health centers (UPHCs), ASHAs and ANMs.

In Noida, an ASHA distributes family planning commodities. Credit: TCIHC/PSI India

Given that ASHAs see many clients who prefer birth spacing methods, TCIHC also incorporated messages that encouraged them to replenish and carry their stock of condoms and pills during household visits. TCIHC city teams also coached ASHAs to do telephone follow-up with IUCD clients and help injectable clients get their next dose from a nearby facility. In addition, TCIHC has developed an e-learning module for ASHAs that guides and mentors them on family planning counseling that was tested during the COVID-19 lockdown period. The insights gained were incorporated into the module, which will be rolled out across all TCIHC-supported cities in May.

More than 3,500 state and city government officials and 11,000 ASHAs and ANMs in UP, MP and Odisha (6,190 in TCIHC-supported cities) have been reached with these critical messages to ensure continuity of family planning services during the pandemic. TCIHC continues to regularly provide technical assistance and coaching to its government counterparts and frontline health workers remotely through WhatsApp, phone calls and emails during these uncertain times.

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