A study to evaluate the functioning of primary health care workers at the village level in rural Amritsar, Punjab, India

A study to evaluate the functioning of primary health care workers at the village level in rural Amritsar, Punjab, India Bakshi R.1, Singh T.2*, Kaur J.3, Arora A.4, Verma R.5 DOI: https://doi.org/10.17511/ijphr.2019.i5.05 1 Ritika Bakshi, Tutor/Demonstrator, Department of Community Medicine, Government Medical College, Amritsar, Punjab, India. 2* Tejbir Singh, Associate Professor, Department of Community Medicine, Government Medical College, Amritsar, Punjab, India. 3 Jasleen Kaur, Assistant Professor, Department of Community Medicine, Government Medical College, Amritsar, Punjab, India. 4 Ankit Arora, Senior Resident, Department of Pharmacology, Lady Hardinge Medical College, New Delhi, , India. 5 Richa Verma, Ex Junior Resident, Department of Community Medicine, Government Medical College, Amritsar, Punjab, India.


Introduction
The primary health care workers have been conceptualized as social and cultural intermediaries strengthening the interface between the existing health system and the community. Their role is to facilitate the community participation and take necessary actions to address and remove social and cultural barriers that lead to poor health [ The multi-purpose health worker female works at the level of subcentres; towards maternal and child health, family planning, health and nutrition education, for maintaining environmental sanitation, immunization for the control of communicable diseases, treatment of minor injuries, and first aid in emergencies and disasters. In remote areas, such as hilly and tribal areas where transport facility is likely to be poor, MPHW (F) are also required to conduct home deliveries for women [  belonged to upper socio-economic status (Table 1).     (Table 3). It was observed that the association between socio-economic status and house to house visits performed by the ASHA was found to be statistically significant (Table 4).     reported that they were never visited by the MPHW(Male) ( Table 7).

Materials and Methods
The study further revealed that out of total 1123 families, 1113 (99.1%) of them were aware about the existence of anganwadi centres in their village.
Out of those who knew about the anganwadi centre (1113), 772 (69.4%) ever visited and were able to correctly tell about the location of the anganwadi centre (Table 8).
It was also observed that out of those who ever visited the anganwadi centre (772), majority of them (68.8%), reported that the food availability at the centre was occasional and mostly irregular. 92 (11.9%), 137 (17.7%), and 12 (1.6%) said that the workers distributed food items to them once yearly, once in 6 months and once in three months respectively (Table 9).

Discussion
In the present study, majority of the respondents  The study also further showed that none of the According to a study done by Thomas et al (2015) in anganwadi centres in Ludhiana, it was seen that the coverage of the services and attendance in the anganwadi centres was low for children (11.3% only) and nil for pregnant women, lactating mothers and adolescent girls. Also, the provision of supplementary nutrition to the beneficiaries was inadequate [16].
According to the present study, distribution of food items was irregular and occasional which was a major reason for dissatisfaction among the population. The probable reason could be the irregular and less disbursement of funds and supplies from the government to the anganwadi centres, due to which they were unable to distribute the food on timely basis.

Limitations
In the present study, the eldest adult member who was present at the time of the visit was taken as a respondent which could be considered as a limitation because males are not very familiar with the health workers specially female health workers, who mostly deal with females, adolescents and children of the house.
Increased chances of recall bias could also be present due to which exact number of visits and duration between each visit could not be conveyed by the respondent.

Conclusion
The present study concluded that the home visits by the multipurpose health workers was very less, probably because their services were more concentrated at the level of the subcentre; while ASHA still contributed towards the home visits, though on an occasional basis. The main reasons cited for the visits by the ASHA were immunization of children, MCH related activities and for the treatment of minor ailments.
Most of the families were aware about the existence of Anganwadi centre in the village; however majority of them reported that the food availability at the centre was occasional and mostly irregular. ASHA and Anganwadi worker being the peripheral level workers, play an important and imperative role in providing the primary health care services to the rural community and for motivating people to utilize the existing health services.
The primary health care workers can make a valuable contribution to the community development by improving access to and coverage of the community with basic health services which would further lead to improved health outcomes, and therefore it becomes important on their part to carry out the field visits on a regular and periodic basis, for the better in-depth understanding of the health needs at the grass root level.

What the study adds to existing knowledge
There is an urgent need of supervision for the primary health care workers so that their responsibilities and activities could be analyzed and evaluated and any kind of limitations could be addressed at the grass root level. Adequate and timely supply of food items must be ensured at the Anganwadi centres so that the nutritional requirements of the population is met.