Community Health Workers’ Challenges during COVID‑19: An Intersectionality Study

Abstract

Accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) as community health workers (CHWs) have been crucial in providing health assistance and information during the COVID-19 pandemic. These CHWs face various challenges, such as discrimination, long hours of work, and low wages, which were exacerbated during the pandemic. The study uses an intersectionality framework to understand CHWs’ marginalization and challenges. A qualitative study with ASHAs and ANMs was conducted in selected primary health centers (PHCs) and subcenters in Suryapet district, Telangana, in 2021. The in-depth interviews of 60 CHWs were analyzed using the software Atlas-ti. The inductive thematic analysis highlighted several challenges faced by CHWs. These challenges include barriers such as discrimination based on class and caste, pay parity, increased workload, lack of training, inadequate safety equipment, and instances of assaults and mistreatment. CHWs, who are often rural women with minimal education, face stigmatization and attacks from community members. They struggled with maintaining records and understanding online training and dealt with rapid adaptation to technology. The study highlights the importance of implementing policies and support systems to protect and empower community health workers. This includes training, fair compensation, safety equipment, and measures against discrimination and violence.