Meet the saree-clad army

For Maharashtra’s Fattatewadi villagers, which has no ASHA worker (accredited social health activist), Aruna Rathod was a godsend for her neighbour, who went into labour in the middle of the night. Rathod, who rushed to help, first called the ambulance service on 108 only to be told, “no trained doctor was available to perform a delivery. I told them to come with the van anyway,” she says.

The 27-year-old accompanied her neighbour to the nearest Primary Health Centre (PHC) 7 km away, and took the lead, with a doctor assisting her, and helped deliver a healthy baby girl that night.

Aruna is one of the 164 Arogya Sakhis from Swayam Sikshan Prayog’s self-help women’s groups trained by non-profit ARMMAN to hand hold rural women through their pregnancy and their child’s infancy. ARMMAN is an acronym for Advancing Reduction in Mortality and Morbidity of Mothers, Children and Neonates.

Under a pilot project, each Arogya Sakhi is entrusted with 10 to 12 women from the third or fourth month of pregnancy onwards till the child turns one. The sakhis are trained to conduct diagnostic investigations such as blood sugar, haemoglobin etc. They are also trained to diagnose and help treat neonatal jaundice and diarrhoea.

In up to 250 villages in three districts — Osmanabad, Solapur and Washim — Arogya Sakhis are the go-to persons for audio fetal doppler tests. A foetus with an awry heart rate can pose a risk to the life of the mother, and abnormal heart rate can be picked up through the amplified sound with a fetal doppler machine. “The government-appointed Auxiliary Nursing Midwives do not have audio fetal doppler machines. The women are referred to us for it,” said Savitri Patil from Dongaon, Maharashtra.

Her training as an Arogya Sakhi helped save her husband’s life, too. When her husband suddenly collapsed, she had the presence of mind to check his sugar levels, and learned that it had risen to a lethal level of 590 dL/mg, she shared.

The Arogya Sakhi home-based care programme is the brainchild of Dr Aparna Hegde, founder, ARMMAN. India’s performance in attaining Millenium Development Goals, especially access to reproductive health, has been poor. Maternal mortality in India stands at 174 deaths per lakh.

The programme aims to plug gaps that include perceived apathy at government health care facilities and gender-issues. “Need for a chaperone leads to loss of daily wages for two people. Thus, many women avoid regular care during antenatal and infancy period leading to delayed diagnosis of high risk factors and complications,” she explained.

The pilot training was done over three years, ending in 2015. “Most sakhis help women in the capacity of trained health entrepreneurs,” said Dr Hegde. As per standard rates, for measuring weight of an expectant mother, the Arogya Sakhi will charge Rs 5, a blood pressure test would cost Rs 10, haemoglobin test Rs 20, while blood sugar or audio doppler, close to Rs 50 each. An Arogya Sakhi can earn over Rs 2,000 a month for extending diagnostic services. Women who’ve studied upto class eight minimum qualify for the programme.

“The programme is intended for areas lacking healthcare access. These health entrepreneurs can screen for high risk factors, and women and children can be referred to a tertiary level centre on time. It also empowers the women trained to provide financially for their families. We are looking at replicating the programme in Mewat district of Haryana, which has one of the worst health indicators,” said Dr Hegde.