Mumbai: While frontline healthcare workers, such as ASHAs (accredited social health activists), are seen as the solution to many public health problems, most of them in urban areas are not adequately trained in tuberculosis care andmanagement.
Around 85 per cent of the 222 urban ASHAs working in Mumbai and Pune didn’t know that night sweats and chest pain are symptoms of TB. At a meeting held on Tuesday, the Foundation for Medical Research ,FMR), which interviewed the ASHAs, found that three out of four ASHAs knew about cough with sputum for two weeks or more being a TB symptom.
“But eight out of 10 of them didn’t know that contact tracing in families helps detect new cases. Half of them hadn’t heard about the government’s direct benefit transfer scheme for nutritional support,” said the researchers.
At the function, BMC officials, however, said inducing more ASHAs into Mumbai’s healthcare system would boost detection of TB and help eliminate it by the government-fixed deadline of 2025.
It is estimated that 3,500 per 1 lakh population develop TB every year. “But, in Mumbai, we are only able to detect 2,500 per 1 lakh population. With the door-to-door surveillance that ASHAs are capable of, we could detect more people early and work towards the 2025 elimination,” said BMC health executive officers Dr Mangala Gomare,
She said the BMC is planning to strengthen its ASHA team from roughly 700 at present to 5,000 in the next few months. “We also have 3,000 community health workers. The only difference is that they draw a fixed salary, while ASHAs get incentives for each of the tasks they complete,” she added.
ASHAs interviewed by FMR said their TB training was limited to three to four hours during their induction programme. “Urban ASHAs are potentially valuable but an unstable cadre at present,” he said. Dr Nerges Mystery of FMR,
She said the role of the ASHAs needs to be defined, training norms refined and there needs to be an improved ecosystem for support. “The frontline cadres need to be reformatted and reorganized according to emerging needs of India. The study has clearly pointed to knowledge gaps related to TB to be included in the training of urban ASHAs,” added Dr Mistry.
BMC officials said many e-materials are available for ASHAs but a proper training program needs to be planned. Talks are on with UNICEF to conduct specific training modules for ASHAs. Assistant Mumbai TB district officer Dr. Usha Shelar said ASHAs would be most useful in detection of TB in the pediatric age.