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 [1].

The Accredited Social Health Activist (ASHA) was introduced by the National Rural Health Mission (NRHM) in 2005. Each ASHA covers a population of 1000, and fulfills various different roles. First, ASHAs function as a ‘link worker’, a bridge between the rural and vulnerable population on one hand and primary health service centres on the other. Second, ASHAs function as a ‘service extension worker’, whereby they are trained and provided with a kit that includes commodities such as condoms, oral contraceptive pills, delivery kits and simple life saving drugs. Third, they are the ‘health activists’ in the community who create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services [2].

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 [3].

Multipurpose health worker (male) have been recognized as critical to the achievement of universal health coverage by means for continuum of care. Some of the significant aspects of service delivery by MPHW Males are i) general curative care involving medicine distribution through home visits, ii) counselling male members of the community about health, iii) collection of blood sample for smear preparation (specially for malaria suspected cases- the beat program), iv) geriatric care and counselling related with non-communicable diseases, v) organizing and mobilizing community for health camps and, vi) co-ordination with health workers on nutrition and health day for weight and height check- up of children.

(their houses were permanently locked) and 19 families were non-cooperative. Rest 1123 families were interviewed.

Exclusion criteria: 1. Families who did not give consent for the study. 2. Those houses which were found locked even after the third visit.

Study tool: Semi- structured and predesigned questionnaire

Methodology: This cross-sectional study was conducted in village Nagkalan, the rural field practice area of Department of Community Medicine, Government Medical College, Amritsar, extending from the period of 1st January 2017 to 31st December 2017. After explaining the purpose of the study; written informed consent was obtained from the respondents.

The eldest adult member of the family present in the house at the time of the visit, served as the respondent and interviewed using a semi-structured and predesigned questionnaire at their place of residence. All questions were asked in the vernacular language of the respondent. A total of 1123 families were included in the final analysis. Criteria for socio-economic status was taken according to Modified Kuppuswamy Scale (2017).

Statistical analysis: The data thus collected was compiled and analyzed by using Microsoft Excel, and chi square test was used as test of significance.

Ethical Approval: Institutional Ethics Committee, Government Medical College, Amritsar.

Research Objective: To study regarding the availability and utilization of primary health care workers (ASHA, multipurpose health workers and Anganwadi) in village Nagkalan, district Amritsar, Punjab.

The present study revealed that out of 1123 families, more than half (64.8%) belonged to upper lower socio-economic status according to modified kuppuswamy scale (2017). 17.2%, 16.0% and 1.8% belonged to upper middle, lower middle, lower categories respectively, whereas only 0.2% belonged to upper socio-economic status (Table 1).

Table-1: Distribution of families according to their socio- economic status (n=1123) (Modified Kuppuswamy Scale 2017).

7.2% for imparting knowledge regarding prevention of local diseases, 4.5% for advice on diet and nutrition and 20.8% for other health related activities (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).

Table-5: Distribution of families according to frequency of visits by the MPHW (F) (N=1123).

Table-6: Distribution of families according to the purpose of visit by the MPHW(F) (multiple response allowed) (n=93)

Table-7: Distribution of families according to frequency of visits by MPHW (M) (n=1123)

Table-8: Distribution of respondents regarding awareness about existence of anganwadi centre in the village.

Table-9: Distribution of respondents regarding food provision at the anganwadi centre (n=772)

A study done by Bajpai et al in states of Rajasthan, Bihar, Uttar Pradesh and most parts of Chattisgarh in 2011 showed that 90% of ASHA demanded regular salary with incentives [7].

In a study by Singh et al (2010) in rural Lukhnow, it was found that ASHAs were able to connect with the community and convince women to utilize antenatal and postnatal services [8]. According to NFHS 4, there were 89.3% fully immunized children in the age group of 12-23 months in Punjab [9] and 91.9% in Amritsar district [10]. The present study revealed similar results where the ASHA worker visited 73.4% of the houses for immunization related activities showing that more importance is given to free immunization services provided by the government. However, coverage for mother and child health related (MCH) services was only 29.9%, probable reason could be the irregular visits by the ASHA worker and round the clock availability of private health clinics in the village.

A study done by Kaur et al in rural parts of Amritsar in 2015 showed that, 22% of the total families were ever visited by MPHW(F) [11]. In a study conducted in Andhra Pradesh by Mittra et al, about 80 per cent of the respondents reported that the ANMs were providing health education related to antenatal care, intranatal care, postnatal care and nutrition [12]. In the present study, only 93 (8.3%) families were visited by the MPHW(F) on occasional basis, while rest of the 1030 families (91.7%) were never visited by her.

The probable reason for less visits by the MPHW(F) in the present study could be that she was present at the subcentre providing services to people and was more dependent on the ASHA for home visits and visited the families only occasionally, when it became absolutely necessary in high risk cases.

According to a study done by Kaur et al in rural parts of Amritsar (2015), only 1.8% of the total families were ever visited by MPHW(M) [11]. A study conducted in the primary health centre and subcenters in Kanbha, Ahemdabad district, Gujarat by Shah et al (2015) on the working of the MPHW(M), revealed that the maximum time (30.17%) was spent by doing non work-related activities by the MPHW(M), followed by the time spent during the lunch breaks (17.8%), reports writing (10.87%) and traveling (10.13%), and minimum time was spent on health related services (0.96%) such as field activity, home visits and immunization.

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.

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.

• Tejbir Singh: Idea for the study, Guiding Author, Review and final editing
• Ritika Bakshi: Data Collection (Principal Investigator), Data entry, Analysis of the data, paper writing and final editing
• Jasleen Kaur: Review of data entry and data analysis, editing at each step during paper writing