Countries with good quality basic primary health care systems tend to have lower health care costs. Norway was one of the first countries to focus on ensuring efficient primary healthcare systems, a concept we think has global relevance.
As the term goes, frontline means the first point of contact. Frontline healthcare workers are the first direct link for the community and the country’s larger health systems (that includes clinics, hospitals, pharmacists, doctors and nurses). In the larger scheme of things, they are located in ‘communites’ or ‘remote locations’ far away from the bigger cities in a nation.
In India, the most important frontline health care workers are Accredited Social Health Activists (ASHAs) and Auxiliary Nurse and Midwives (ANMs). Besides these, Anganwadi workers are also healthcare providers wherever required. ASHA was introduced in the Indian Healthcare System in 2005 as an activist with the launch of National Rural Health Mission (NRHM). At the time of inception, ASHAs were intended to act as community activists in order to create awareness, provide counselling services, mobilise community and act as a reliable link between community and the healthcare system.
ASHA has been an important factor contributing to the positive outcomes of increases in institutional delivery and immunization. They have played an active role in disease control programmes (malaria, kala-azar and lymphatic filariasis, in particular) and improved breastfeeding and nutrition practices. The majority of states have placed an active training and support system for the ASHA to ensure continuing training, on site field mentoring and performance monitoring. Selected from the village itself and accountable to it, the ASHA is trained to work as an interface between the community and the public health system. Such has been the relevance of ASHAs and ANMs that they are now central to channelize India’s ambitious primary healthcare mechanism called Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A).
In its efforts to upgrade primary healthcare facilities in rural India, through various National Health Mission (NHM) programs, the Norwegian and Indian governments work through the Norway India Partnership Initiative (NIPI), established almost at the same time as when NHM was constituted in 2005. NIPI programs provide technical support to NHM, primarily using ASHAs and ANMs. Some of NIPI’s latest programs include Family Centered Care (FCC), Home Based Newborn Care Plus (HBNC+), RMNCH+A, which includes concepts such as timely immunization schedule, ensuring safe delivery practices, Kangaroo Mother Care, exclusive breastfeeding, prophylactic ORS distribution, regular growth monitoring amongst others.
NIPI partners Newborn project and Jhpiego work with the Ministry of Health and Family Welfare, Government of India.