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A Cross-Sectional Study on Occupational Health and Safety of Municipal Solid Waste Workers in Telangana, India.

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Community Health Workers' Challenges during COVID-19: An Intersectionality Study.

Jyothi Kurapati1, C T Anitha1

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Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine
|June 13, 2025
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Community health workers, including Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs), faced significant challenges like discrimination and increased workload during the COVID-19 pandemic. Addressing these issues is vital for supporting these essential health providers.

Keywords:
ANMsASHAsCOVID-19-pandemicchallengesfrontline health workersintersectionality

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Area of Science:

  • Public Health
  • Sociology of Health
  • Health Workforce Research

Background:

  • Community health workers (CHWs), such as Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs), are vital for healthcare delivery, especially in rural settings.
  • The COVID-19 pandemic amplified existing challenges faced by CHWs, including discrimination, long working hours, and inadequate compensation.
  • An intersectionality framework is crucial for understanding the complex layers of marginalization experienced by CHWs.

Purpose of the Study:

  • To explore the multifaceted challenges encountered by ASHAs and ANMs working as CHWs during the COVID-19 pandemic.
  • To analyze the impact of discrimination, workload, and technological adaptation on CHWs' well-being and effectiveness.
  • To identify policy and support system needs for empowering and protecting CHWs.

Main Methods:

  • A qualitative study was conducted in the Suryapet district of Telangana in 2021.
  • In-depth interviews were carried out with 60 ASHAs and ANMs.
  • Data were analyzed using inductive thematic analysis with Atlas-ti software.

Main Results:

  • CHWs experienced discrimination based on class and caste, pay inequity, and increased workloads.
  • Lack of adequate training, insufficient safety equipment, and instances of mistreatment and assaults were reported.
  • CHWs, often rural women with limited education, faced stigmatization and struggled with record-keeping and adapting to online training and technology.

Conclusions:

  • The study underscores the urgent need for policies and support systems to protect and empower CHWs.
  • Recommendations include enhanced training, fair compensation, provision of safety equipment, and measures against discrimination and violence.
  • Empowering CHWs is essential for resilient public health systems, particularly in the post-pandemic era.