How effectively do community health workers spread health awareness via women's self-help groups in rural India?

Abstract

In many lower-and middle-income countries, the public health system is made more accessible in rural areas through training lay people to become community health workers (CHWs) within their communities. This mixed-methods study aims to evaluate such a CHW program in rural Uttarkashi, India, which is being run by a non-government organization (NGO). In the CHW program to be evaluated, the CHWs give monthly health awareness classes during women's self-help group (SHG) meetings. By involving women's SHGs, community participation is supposed to be fostered and health knowledge spread. Therefore, it was hypothesized that communities with an active CHW should achieve a higher number of correct answers on a health knowledge test than communities without an active CHW. Moreover, using qualitative methods, we explored the SHG members' and CHWs' viewpoints on the impact of the awareness classes held during SHG meetings. Five focus group discussions were conducted with members of SHGs, as well as with NGO-trained CHWs and government-employed CHWs. Results confirmed that the respondents from a community with an NGO-trained CHW performed significantly better on the health knowledge test, although not uniformly across all sampling areas. The qualitative data revealed a substantial impact of the health awareness classes on behavior changes among SHG members and their families. Further, the NGO-trained CHWs collaborated well with other government-employed CHWs. In conclusion, the authors feel that is would be worthwhile to employ more NGO-run CHW programs throughout India, to supplement the government-run programs, especially in remote and underserviced areas.