The Accredited Social Health Activists were the heroes of our pandemic response. There are nearly a million (10.47 lakh) ASHA workers in India. Their work in the field makes the best case for investing in community outreach across various sectors. 

It’s no coincidence that the states with decent primary healthcare were able to respond better to the pandemic. Kerala and Karnataka have the best population coverage under primary healthcare (10,000 to 20,000 people per PHC). In states like Uttar Pradesh and Bihar, one PHC covers upwards of 50,000 people.

That’s not all. At the Community Health Centres (CHCs), there’s a 79.9% shortfall of specialists when compared to the sanctioned posts (this includes surgeons, obstetricians, physicians and paediatricians). According to the govt figures, more than 68% of these sanctioned posts are vacant.

The reasons for this shortfall are complex, but suffice to say that health workers held the fort during the pandemic.

So here’s the question:

1 Question. 

• How do we invest and scale community outreach across sectors? 

2 Perspectives 

• Consider the finances. In 2018-19, India spent nearly half of its health budget (47%) on its primary healthcare. But for the same year, we also had some of the highest Out-of-Pocket Expenditure (48.2% of total health expenditure) in the world. The government’s health expenditure as a percentage of its GDP stood at 1.3%, though it rose to 2.1% of our GDP in 2021-22, on account of Covid. This is still less than the 2.5% to 3% expected of most countries.
  
  In 2019-20, Rs. 4,761 crore (7%) of the total healthcare budget under the National Health Mission was spent on “Community-based initiatives” or ASHA workers and their programmes. While the government focuses on building long-term health infrastructure, keeping community health outreach going can be a good investment, as it will reduce the dependence on tertiary healthcare in the long run.
  
• Look at financial inclusion. The Indian Banking sector has had great success with using community outreach to drive financial inclusion. As of FY 2022, nearly 46.25 crore people were enrolled under the Pradhan Mantri Jan Dhan Yojana, a three-fold increase from the scheme’s announcement in 2015. 
  
  Its success can be attributed to the nearly 10-lakh strong network of Banking Correspondents (BC), and tech-enabled enrollment process. Along with fixed remuneration, the BCs had financial incentives linked to enrollment and overall usage of the accounts, which gave the programme a big boost.
  
  The scheme has its share of problems — the BC network doesn’t handle credit disbursement. And barely 10% of all BCs are women, despite them holding 56% of Jan Dhan accounts. Still, there are important lessons in using community outreach to drive development outcomes.

3 Factors

• Tech-enabled services. Tech can greatly increase the reach of various public programmes. In education, we are already seeing EdTech being used to drive quality outcomes, right from primary education to vocational training.
  
  In health, the ‘Tele-Mental Health Assistance and Networking Across States’ (Tele-MANAS) program anchored by NIMHANS in Bengaluru has been effective in providing mental health services during the lockdown, especially for migrant workers.
  
  Tech can drastically enhance the reach of organisations like Krishi Vigyan Kendras (KVKs) in the coming years. As climate change disrupts agriculture, we will need a nimble and effective way of disseminating real-time information. KVKs can leverage tech-enabled communication to drastically increase their presence in each of the districts they operate in. 

• Rethink contract services. Another underreported aspect of our pandemic response was the presence of contractual staff. Hiring short-term workers is an idea that is fast gaining traction.
  
  As an article in The Print pointed out, in Madhya Pradesh, large-scale hiring of contract or part-time teachers was a short-sighted move. Hiring contract workers with less pay, job security and other benefits to work alongside full-time workers creates friction and resentment — and it ultimately is counterproductive in driving developmental outcomes.
  
  Providing at-par salaries, basic health insurance and some paid leave even for frontline contract workers is one way out.

• Look for synergy. All things done, India Inc. collected about 24,856 crores for CSR spending. To put things into perspective, that’s roughly one-third of the Union Budget allocation for Health — not to mention the expenditure by states. Plugging infrastructure gaps and directly providing services has its role in development. But organisations are better off empowering and unlocking the potential of existing public systems.
  
  Aiding and enabling community workers in education, finance, health or social services is a great way to unlock Impact at Scale. Here are the forms it can take: Providing skill training for ASHA workers in one region, refurbishing the government dialysis centres, or digitally enabling government schools in a district are all examples of projects that create long-term impact.
  
  What are the other ways of community outreach we can be involved in? Do let me know in the comments!
  
  So let’s start by teaching our young students and working professionals the importance of speaking up, and speaking well!  
  
  What do you think? 

Until next time, 

*(P.A.C.E or the Personal Advancement & Career Enhancement, is a training programme incepted by the American clothing retailer GAP. It has a strong general skills training component)