Satyavati Singh, an ASHA from Delhi, India. Credit: Raj Yagnik/Save the Children.

Satyavati Singh is an ASHA (Accredited Social Health Activist) with 31 years experience working in her local community in the South of Delhi. She works with Nav Srishti an NGO which is supported by Save the Children. Her work has even inspired her daughter Antima to be come a Community Health Volunteer.

It has been through immense patience and hard work that Satyavati has acquired an accreditation of being the community’s trusted problem solver, solace and life saver. “I just love to accept challenges and move ahead to make a valuable difference in their lives”, says Satyavati. She further adds, “It is a real challenge for a frontline health worker to be accepted by the community. She has to initially understand their needs and give them comfort so that they eventually come to her and allow her space to serve them selflessly.”

As for Satyavati, It took her three months to make her presence felt within the community. She would pay first, second, third and fourth visit to every household before they could accept her health lessons and abide by her advice on nutrition of mother and child, immunisation, hospital delivery and family planning. “If not today, at least at some point of time, they will listen to us and follow our advice”. To pull the community towards her, a health worker has to be really patient and Satyavati is a living example. “Be a part of them if you really want to save their lives and bring smiles”, is Satyavati’shonest suggestion to all health workers.

Neonatal mortality rate  (per 1,000 live births) (2011) 32
Under-five mortality rate (per 1,000 live births) (2011) 61
Maternal mortality ratio (per 100,000 live births) (2010) 200
Number of doctors, nurses and midwives per 10,000 people (2010) 16.5
Births attended by skilled personnel (2011) 57.7%
Total expenditure on health as a percentage of gross domestic product (2011) 3.9%
General government expenditure on health as a percentage of total expenditure on health (2011) 31%

In India, existing social health insurance schemes offer coverage to formal sector workers and central government employees, and recent schemes offering free care for below-poverty-line populations are being implemented and scaled up across 23 different states. With a third of the population still living on less than one dollar a day, there is a high burden of communicable diseases, particularly affecting newborns and infants, with limited progress towards MDG 4 – India is home to the largest number of newborn and child deaths. Large discrepancies in health outcomes persist from district to district based on awareness levels and access to health facilities. The most marginalised and vulnerable poor living in remote villages and unplanned urban settlements like slum clusters are the least likely to have access to basic health services.

The availability of skilled health professionals is currently below the 22.8 per 10,000 threshold, but scale-up to meet indicative thresholds by 2035 appears feasible. However, inequalities in access (both geographical and income-based) persist. Female physicians are 17% of the total of physicians and the ratio of nurses to physicians is below the OECD average. Policy mechanisms for HRH development, including government leadership and collaboration with key stakeholders, and mechanisms to provide reliable data on the health workforce require strengthening.

Community-based health workers like ASHAs (Accredited Social Health Activists), Auxiliary Nurse-Midwives and Anganwadi workers, are key in improving the health of mothers and children. Save the Children works closely with these health workers to build their skills and capacity, help ensure their better integration with the public health service and increase the recognition of their work. This document shares the experiences of health workers who have committed their lives to improving the health of communities in the poorest parts of Delhi.

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