The state of Assam in northeastern India is showing how primary health care not only makes health services accessible to communities: it is also an effective way to prepare for and tackle health emergencies.
At the heart of Assam’s response to COVID-19 are community health workers, locally known as COVID-19 warriors. They are leading surveillance efforts, enabling early detection, isolation and treatment and keeping the virus from spreading further.
Ms Suchitra Goala, 45, is a community health worker (CHW) in Karimganj District in Assam, a state in northeastern India. She is what is known locally as a ‘COVID-19 warrior’. Since the pandemic took hold in March 2020, she has been supporting her local community in the COVID-19 emergency response. In India, CHWs are called accredited social health activist (ASHA), and they serve as the link between communities and health care facilities.
“Being a community health worker and a COVID-19 warrior, I am so proud that I have been contributing in my best possible way to support my fellow villagers during the COVID-19 pandemic. It is so heartening to share that I could ensure the home quarantine of 45 people, who returned to my village from other states after the lockdown relaxed. I participated in the Assam Community Surveillance Programme when I visited house-to-house in my area as a part of active community surveillance,” Suchitra said.
Testing, tracing and treatment through the increasing network of primary health care (PHC) centres are crucial to the national response to COVID-19. WHO, through the UHC Partnership, was already working closely with Assam State health authorities to strengthen PHC centres across the state when COVID-19 struck. The PHC network has provided a solid base, not only to make progress towards universal health coverage (UHC), but also to tackle the challenges that COVID-19 brings to communities.
Community surveillance brings ‘assurance’
Assam has population of 31.2 million people who live in 33 administrative districts. For one month, from 7 May 2020, the Government carried out the Assam Community Surveillance Plan—an intensive surveillance in all 28,000 of its villages. This approach was called “COVID-19 plus”. Community health workers or accredited social health activists visited door-to-door to list potential cases and link them with team members to conduct screening on the following day.
The response to this first phase was encouraging. With support from WHO, the State decided to carry out a second phase. Intensive testing was carried out at potential hotspots, like market areas, interstate truck and bus terminals and parking lots.
Screening teams also randomly tested people who are at high risk of getting COVID-19 such as health workers, police, transport workers and hotel staff. This intensive testing approach was instrumental in identifying many COVID-19-positive patients, making timely treatment and isolating the patients possible. This also helped keep the virus from further spreading.
Flexible support to the COVID-19 response
WHO’s support to Assam, through the UHC Partnership, began in April 2019. This work is focused on supporting the implémentation of India’s ambitious Comprehensive Primary Health Care (CPHC) flagship programme to be rolled out through functioning Health and Wellness Centres, in order to achieve UHC. With COVID-19 emerging in March 2020, State authorities requested additional technical assistance for the COVID-19 response. With the flexible and bottom-up approach that underpins the work of the UHC Partnership, WHO was able to respond to the State’s needs.
The UHC Partnership works in 115 countries to help governments accelerate progress towards UHC through funding from the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom - Foreign, Commonwealth & Development Office and Belgium.
WHO participates in a range of Government committees, which oversee health policy and implementation matters in Assam. Some of the direct interventions include developing standard operating procedures and guidance on different initiatives as well as drafting technical briefs for both the state and national Government. WHO has also shared global and India-specific COVID-19 updates and useful information on appropriate tools and guidelines. Support for the training of ‘COVID-19 warriors’ who operate at the community level to enhance surveillance and case management was also provided.
As Assam strives to tackle the enormous challenge of COVID-19, its leaders recognize the importance of a strong PHC approach to respond to the needs of communities. PHC, in “ordinary” times, and particularly in times of crisis, is a solid way to engage the community and make health services more accessible. It is a crucial step towards achieving UHC and ensuring health for all.