As healthcare providers, Arogya Sakhis have initiated a movement, coaxing and convincing rural women and girls towards healthcare practices. Naseem Shaikh, Program Manager - Swayam Shikshan Prayog, offers a glimpse into their lives. The journey would have been incomplete without technological intervention. Mobile apps and tablets form the crux of the health infrastructure
By Kavitha Srinivasa
Rural women may not have the bandwidth to operate a bank account but they have morphed into community sanitation ambassadors. Branded as Arogya Sakhis, they earn their livelihood by conducting diagnostic rural health checkups. Arogya Sakhis is a movement stewarded by Swayam Shikshan Prayog, a Pune-based learning and development organization.
Who is an Arogya Sakhi?
An Arogya Sakhi can be understood as someone (seen here as woman) who gently nudges and cajoles the rural community towards basic healthcare measures. They give a clarion call for good health, a thought process initiated through health checkups and preventive diagnostic tests. Equipped with a mobile tablet, Sakhis upload results of the check-up which are then made available to a doctor. The diagnostic tablets are enablers, facilitating affordable health services for women at the doorstep. Rather, the mobile tablet has evolved into the neighbourhood doctor.
Realistically, Sakhis help in the early detection of diseases. Though there might have been someone out there in the village to alert people; such practices existed in a fragmented manner.
This is where Swayam Shikshan Prayog (SSP) a Pune-based learning and development organization, fits in with its Arogya Sakhis initiative. Its USP lies in its reach. Last mile Arogya Sakhi network, trained on comprehensive health have the know-how of theory and practice of health diagnostic devices. Experience makes them dexterous with technology. With increased skills, Sakhis reach out to the poorest of the poor, in their own and surrounding villages, where actual need is present and is difficult for other stakeholders to offer services.
How does the Arogya Sakhi programme work?
This is how the system works. We start with a village resource mapping, baseline assessment and village selection. Potential women with an entrepreneurial and community service mindset are identified as Arogya Sakhis and trained on health and preventive healthcare. Villages are selected by using following criteria viz. lack of health facilities, interior villages with transportation problem long distance to secondary facilities.
Arogya Sakhis create awareness about preventive health, hygiene, nutrition and safe practices for improved health.
Health camps in partnerships with government agencies throw light on the health status of women and their families, while women and adolescent girls are addressed through community meetings on preventive healthcare, hygiene and sanitation. Supported by Vodafone India Foundation, SSP conducted a pilot in its operational areas before scaling up the programme to 16 villages in Maharashtra.
It requires hand-holding and empathy to convince rural people about health care. So how you handle this?
The SSP team and Arogya Sakhis conduct awareness and promotion meetings. We also organize experience sharing meetings of the user to convince rural women and their families.
Arogya Sakhis conduct preventive diagnostic tests and door-to-door check-ups with tablets loaded with the Arogya Sakhi Application. They record test results on the tablet and receive analyzed reports online from the doctor appointed by SSP for the programme. They deliver analyzed health reports of women and other community members at their doorstep and provide counseling. They conduct follow up visits, do referrals and link high risk identified women and beneficiaries with the local HSP (health service provider) network for further treatment with discounted services. Arogya Sakhis also partner with HSP and health experts from government agencies for conducting health camps.
Arogya Sakhis are equipped with business skills and building an entrepreneurial outlook while providing her services — preventive tests as well as basic products like sanitary pads, nutritional mix and herbal medicines — for a sustainable livelihood.
What prompted you to start this venture? Is there any particular reason for focusing on preventive health services? Please can you share the experience?
SSP’s genesis is traced to the 1993 Latur earthquake, which has resulted in a community-led reconstruction partnership. The Latur crisis was a case study for post-disaster rehabilitation and an early learning experience in disaster reduction. It also opened out channels to mobilize rural women for large, community-centered efforts. Social activist Prema Gopalan founded SSP in 1998.
Inspiring tales of women working towards infrastructural reconstruction urged SSP to mobilize women into self- help groups (SHG), the focus being on disaster management, which evolved into a community resilience model.
Gradually, the process of making healthcare accessible and creating awareness of health care practices has triggered an entrepreneurial spark among rural women. Since the focus is on healthcare, they are identified as Arogya Sakhis.
Can you throw light on the technology involved?
Technology in the form of mobile apps and tablets are enablers for health infrastructure. Laboratories and specialized care centers ensure last mile connectivity. With tech tools, we reach out to many communities within a short span of time and hopefully with very little errors. As the target population represents low-income households, not too many organizations have come forward with affordable services. SSP is among the early players to cater to this segment.
Many Arogya Sakhis may be uneducated and lack the wherewithal to handle a bank account, but they effortlessly wield diagnostic point-of-care health devices including blood pressure machines, glucometers, testing for hemoglobin and peak flow meter to undertake medical tests that are uploaded to the cloud through the mobile tablet. The tablet sheds light on personal medical profile, history of medical conditions, test results and background information related to the individual’s health sourced through a door-to-door survey.
They gather the necessary information and upload it on the cloud server using the tablet. The information collected includes a personal medical profile, history of medical conditions, test results and health background.
Once the information is saved on the server, it can be accessed by a doctor located hundreds of miles away from the beneficiaries.
How is the Arogya Sakhi programme an income generating one?
The Arogya Sakhi programme has built income generation opportunities into the regular work of the Sakhis, including each test or other health service they perform; through the sale and delivery of health, sanitation and hygiene products and through the partnerships that are built with the health service provider network. Arogya Sakhis in 400 villages have begun to earn an additional income: When we started the Arogya Sakhi model, these Arogya Sakhis only had access to the project incentive of Rs 1000, but when they began to perform tests, their monthly earnings increased to Rs 1,500. Now the project incentives have stopped and their earnings come from preventive testing and health product sale. Each Arogya Sakhi earns Rs 500 to Rs 1000.
359 Sakhis provide health awareness, information, products and services across villages in Maharashtra. Health services cover over 5,000 pregnant women and 2,500 adolescent girls across 1.25 lakh households. Early identification of lifestyle illnesses across 60 villages has led to the adoption of preventive health care practices reducing health costs within a time frame of six months to one year.
Anemia among women and girls has been reduced by 10% and there’s been an increase of around 33% in the adoption of personal hygiene and community sanitation practices. This has happened within one or two years.
How have you ensured that the Arogya Sakhis programme is sustainable?
Sustainability is at the core of SSP’s strategy. It links health with women empowerment and livelihoods (both for community women as target group and Arogya Sakhis), which is more likely to result in sustained health outcomes. With the last mile network of Arogya Sakhis coupled with user-friendly mobile diagnostic devices makes it possible to reach out preventive health services to the most vulnerable target group — women and other community members — in areas where health infrastructures, laboratories and specialized care centers are absent. Since Arogya Sakhis earn through each test, with increase in the direct beneficiaries Arogya Sakhis earn more.
How much do Arogya Sakhis earn through each test, what is the monthly income?
She charges Rs 20 to Rs 50 Rs for the test. She earns Rs 500 to Rs 1000 a month and some good performers are earning more.
In the long run, Arogya Sakhi network forms a cadre of grassroots women leaders for long lasting health impact. It will help make communities more cohesive, endorse them as community as role models, who help change behaviors and leads to the adoption of preventive health practices during and well beyond the program period.
What is SSP’s Long Term Perspective?
SSP aims to make Arogya Sakhis self-sufficient through various income generation opportunities linked to healthcare. Ultimately, the Sakhi network will play a pivotal role in last mile connectors and in the distribution of health services. Building and strengthening local partnerships with the health service providers help in program sustainability. This helps in conducting awareness activities and referral services of high risk identified women and beneficiaries more efficient and effective.
What goes into a Health Kit?
The kit has non-medical equipment, which includes Tablets with software and Arogy Sakhi Application.
The Medical equipment and tests are conducted using:
· HB Meter – Hemoglobin measurement tool to indicate Anemia among girl and women
· Glucometer – Sugar levels to indicate Blood Glucose/Diabetes
· Blood Pressure Machine
· Peak flow meter – to examine lung capacity
· Digital Thermometer
· Weight/Height measurement – Body Mass Index
· Dental screening
· Pulse oximeter for SpO2
· Refractive Index Error test for vision
·USB and Bluetooth
Life of an Arogya Sakhi
Sukumar Gaikwad lives with her three children in a semi-pucca house in the Osmanabad district of Maharashtra. She works as a cook for the children in Aanganwadi and undertakes tailoring assignments from home. She is a member of the village Self-help group (SHG) since eight years. Before becoming an Arogya Sakhi she incurred heavy expenditure while traveling to meet a doctor. Early symptoms of illness are ignored and medical assistance is accessed only when the illness reaches to critical stages. When Gaikwad learnt about Arogya Sakhis, she expressed keenness. She underwent training on preventive health and nutrition and gained exposure to basic health, risks and preventive practices. In partnership with Sofomo Embedded Solutions, practice sessions were conducted to enhance Gaikwad’s capacities in handling diagnostic devices (Haemoglobin meter for anemia- HB, Diabetes, Blood Pressure, measurements for BMI, and more) and tablet devices. Her income has improved and she has spread the word in her community. “Women and girls have started coming to me to discuss their symptoms and I conduct single tests for them. Due to lack of information, they tend to get scared, but I’m able to calm them and provide information. Once they feel better or visit the doctor whom I refer, they spread the word during the monthly SHG meetings and village gatherings. More people enquire about the programme,” expressed Gaikwad.