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In their own words: how community health educators are bridging gaps in rural India

By Opportunity International Australia

Community Health Leaders are empowered to build health knowledge and provide basic services in their communities, while earning an income and growing their confidence. 

The challenges to accessing health care in rural India 

For women in rural and remote parts of India, employment opportunities outside of the home are often limited, and many abandon their own hopes of tertiary study and careers when they get married and move in with their in-laws. 

Basic health knowledge within these communities is quite low and rates of childhood stunting remain high. In Bihar, for instance, more than four out of 10 children suffer from stunting due to poor nutrition and other factors.

Health services and clinics are often a long distance away, meaning people have to miss work and face the costs of travel if they want to visit a clinic or hospital. Community Health Leader Pramila saw firsthand what this lack of health services meant in a community. “I experienced the shortage of medical services and doctors in my own community in Patna leading to maternal deaths,” Pramila said.

Families often delay seeking health treatment, which can result in much bigger out-of-pocket health expenses when they finally do seek treatment, perpetuating cycles of poverty.

One in eight people worldwide are at risk of falling into poverty due to out-of-pocket health spending.

Female health leaders in Bangladesh

Female Health Leaders provide education and health services to marginalised communities and families living in poverty

Female Health Leaders, trained by Opportunity International Australia’s local partner CDOT, in Bihar and Jharkhand, India are providing health education and services in their communities. Health education is tailored based on the needs in the community and focuses on women’s and children's health, including:

  • Menstrual and reproductive health
  • Child health
  • Nutrition for the whole family
  • Hygiene and the importance of sanitation.  

Health Leader Anjana found her community has been receptive to the health training: “I feel fantastic after taking up the job,” she said. “The program is a blessing for society. People listen to all the details about health and hygiene with interest as no one wants to fall sick.”

Health Leaders are making health care more accessible to women and families in rural areas by providing this health education, as well as teleconsultations and referrals for outpatient check-ups. These women earn a small stipend to provide health education in their communities. They are also able to sell in-demand health products including menstrual pads, nappies and health tonics to boost their incomes.

“Working as a (Health Leader) has made me gain a good reputation within the community,” said Health Leader Kanchan, from Bihar. “They feel that I can help them when they are sick by connecting them with good doctors online through the teleconsultation sessions. I am thankful to the program for making me financially stable and independent.”

Household surveys, conducted to identify the health needs of the communities, also found that seven out of 10 community members reached through this health education in Bihar and Jharkhand were living in poverty, and hold a ‘below poverty line’ card from the Indian Government. Below the Poverty Line (BPL) is a benchmark used by India's government to indicate economic disadvantage and identify individuals and households in need of government assistance and aid.

The survey also found that 94 per cent of people reached through this health education project belong to marginalised groups including ‘scheduled castes,' or designated groups of the most disadvantaged socioeconomic groups in India.

Families that improve their health knowledge through the training often provide feedback that they’re not getting sick as often and have reduced the costs of medication and doctor’s appointments for minor ailments like common colds, fever and diarrhoea.

Health Leaders in Bangladesh

Growing confidence and building their standing in the community

Women Health Leaders gain respect in their families and communities due to the valuable role they play in improving health knowledge and awareness and are considered a go-to for minor health issues. They are proud of the work they do and many say they have increased confidence as a result of their training and their role within the community.

“Now, I am able to earn a few bucks by myself, have the confidence to talk in front of a group of people without any hesitation, am recognised by people as someone who spreads awareness about health or can be contacted during any health-related issue or emergency,” said Health Leader Darshni of her experience.

Kanchan learned a lot through the training and gained confidence in using technology to conduct household surveys. “My experience of working as a (Health Leader) has been great,” Kanchan shared. “The training provided... helped me understand a lot of things about health, finance and technology.”

Darshni’s family and in-laws are supportive and proud of her role as a Health Leader. “It is a matter of honour for my family if they hear members of the community making statements like ‘your daughter-in-law is doing some really good work in the community’ or ‘your wife really helped us when we needed some assistance’,” Darshni said.

“I feel proud of the fact that I have truly helped people,” shared Pramila.  

 Health Leader in Bangladesh

Further training to boost incomes

In order to boost their incomes further, Health Leaders will receive training to sell affordable health microinsurance, with some also receiving training to be set up as banking agents, bringing financial services to their rural communities. This project in partnership with CDOT is expected to reach more than 300,000 people with health education, products and services. 

Opportunity’s Health Leaders initiative in partnership with CDOT is supported by the Australian Government through the NGO Cooperation Program (ANCP), along with other private philanthropists.

Opportunity International Australia’s health program is reaching communities in need – especially in rural and remote areas – in India, Bangladesh and Indonesia. There’s still more work to reach the communities which need support the most.

Community Health Leader Pramila with health consultant Madhavi

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