Key National Health Mission survey stalled in slum as workers fear returning to field
A survey of the National Health Mission (NHM) to identify tuberculosis patients has been hit in Indore after four ASHA workers carrying questionnaires were roughed up and driven away from a slum, where locals suspected they were attempting to update the controversial National Population Register (NPR).
The Accredited Social Health Activists (AHSAs) had just begun their survey in the city’s Khajrana area, where six to seven patients stayed, when dozens of locals reportedly came out with sticks and brooms, threatened to lynch them, and drove them away. One of the workers fainted on the spot, and had to be carried back home in a rickshaw. The NHM’s TB survey has been stopped in the area for now.
“We had already identified eight patients and given them medicines, and reached a house where they refused to talk to us,” said Irshad Khan, one of the ASHA workers who were undertaking the NHM survey. “But then a woman came from inside with a broom. She started shouting that we were seeking phone numbers for the NPR, after which others gathered around us,” added Ms. Khan. “They manhandled us and tried snatching the paper where we had noted down details of patients. Eventually, we had to tear it up and run away to save our lives.”
Ms. Khan, who lives in a neighbouring locality, said that in her own slum, residents had asked workers not to carry out any surveys given the vicious atmosphere in the country.
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“It was terrifying for us. They even hurled slippers at us. Never have we faced such resistance before. It could have cost us our lives,” she said. “At my basti, however, every child knows me. But here we were strangers, which still shouldn’t have been an issue as we were there to identify patients,” noted Ms. Khan, adding, “I fear going back to the field”.
Farzana, another health activist, claimed they were even asked to lift their veils, to prove they were not men. “We were just doing our work. We were not there to get beaten up. I don’t know how we’ll do our work anymore,” she said, adding that they even showed the authorisation letter to locals, who remained obstinate and suspicious.
The ASHA workers, who serve as an interface between communities and the public health system, number about 64,000 in Madhya Pradesh and are tasked with promoting good health practices, counselling pregnant women, facilitating locals in accessing health facilities and containing malnutrition.
According to a December 9 State government notification, the NPR updation exercise would be undertaken in the State from May, while the tuberculosis survey is being conducted from February 17 to March 3. Despite Chief Minister Kamal Nath’s assurance that the Congress government wouldn’t allow the NPR to be updated, local census officials, speaking on condition of anonymity, asserted that they were yet to receive any communication from the State government to stop the exercise.
“This was the first survey where we faced resistance,” said Pravin Jadia, Indore’s Chief Medical and Health Officer. “Just last month, we smoothly conducted a survey for immunisation.”
Admitting it was an unprecedented challenge, Dr. Jadia said, “ In the future, we’ll approach community and local leaders first to explain to them about a survey. Still, if the majority in an area don’t support us, then we may have to stop the programme.”
Shailesh Sakalle, Deputy Director, NHM State unit, said, “Conducting surveys is one of the primary functions of ASHA workers. If they are not allowed to undertake household surveys, access to public healthcare may be affected”.
Observing that the Centre aims to eradicate tuberculosis from the country by 2025, Dr. Sakalle wondered how that goal could be met if the current challenges were not resolved. “If we are not allowed to identify patients, how will we achieve this? We have apprised superiors of the incident, and they may issue an advisory to ensure smooth conduct of surveys,” he added.
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