Pandemic, Primary Health Workers and work trajectories: A Memoing Representational Study

More than 65 per cent of the population in India lives in rural areas with the highest overall burden of disease. The Indian rural health care system is composed of the three-tier system comprising Sub-Centres, Primary Health Centres, and Community Health Centres with a considerable shortfall in health facilities at different levels - 18 per cent at Sub centre level, 22 per cent at PHC level and 30 per cent at CHC level. The real facts and figures of the epidemic in rural areas are not known yet except for broad distribution patterns. The course of events with respect to preventive strategies to control COVID-19 especially the experiences in states like Kerala which has comparatively well-developed health infrastructure are important as a lesson for managing future emergencies. In the present study, the responses and experiences of the frontline health workers including ASHA workers toward the pandemic are documented. We followed a Memoing approach- largely similar to in-depth interviews- based on conversations with primary level health workers including ASHA workers and Junior Health Staff. The conversations which lasted for about one hour and in some cases more were presented by the respondents as experiential representations and memoranda on which reflective notes were prepared by the authors who conversed with the staff. The conversations mainly echoed the complaints, concerns and criticisms of the staff regarding the program and the severe limitations that they faced in COVID control. Based on the narratives as well as representations, we could identify interlinked dominant and minor specific-context related issues which are important for equity-based universal health coverage. Firstly, training of primary health workers in Primary Emergency Health care is important in order to counter unpleasant human interactions and also for maintaining security. The training is also important to counter misinformation which is hampering positive health actions. Secondly, it is important to reinvigorate the medical loop and preventive protocols in health programs to strengthen the health service system at the grassroots level especially enhance the trust between the workers and the people. COVID 19 pandemic is an opportunity to recognize and reinforce the role of primary care workers and formulate gender-sensitive and effective control strategies.