Inroads to a perfect health care system



“logo ki zindagi bachana, logo se milna, aapna gyaan batna aur kisi ke kuch kaam aana, isi wajah se main ab tak ANM hun..” [“It’s the joy of saving more lives, getting to know more people and contributing a bit in others’ lives, that I continue working as ANM ”]

57 year old Shobha Devi has been working as ANM (Auxiliary Nurse Midwife) for the past 28 years. In the course of her work she has travelled to hard-to-reach areas, often walked for hours to reach immunization sites, crossed rivers with a kit and faced different hardships due to extreme weather conditions. Summer, winter or rains, her duty remains the same, the only difference being that she gets transferred routinely every three years and if the authorities decide, even sooner. She goes to two different locations, three days a week for Routine Immunization (RI) and on other days her duty is at the Primary Health Centre (PHC).

At one of the RI sessions I offered her a ride back home and in the course of our journey she shared her experiences and concerns on how the system has improved and where it still lacks progress.

She began with how the ASHAs’ (Accredited Social Health Activist) efforts combined with awareness programs and education have helped to improve the immunization coverage over the years. The government too has worked significantly in this area and drastic improvements have been seen in the last 4-5 years.

However, the road to a perfect health care system in Bihar is still a long one and full of barriers. Her narrative involved telling me of how she has to travel 65 km to reach one of the sites and if she gets late in the evening she has no choice but to stay at the ASHA’s house. On some occasions she leaves the site early to reach home on time and take care of household chores.  At times, guilt is a factor for her, especially while leaving early as some recipients do not avail services on the same day and this often leads to mistrust within the beneficiaries.

She shares her concerns among which is the example of one of the sites where she has to carry out the immunization process alone as the ASHA isn’t very active and she doesn’t have another ANM to help her. She often asks the Aganwadi sevika to help her mak
e the due list and pack/unpack the kit and if needed, call the beneficiaries who are due for RI.


Another concern for her and other ANMs is them getting transferred before even getting to know the people, the ASHA and understand their location and all that goes with it.

She feels that there is a dying enthusiasm and lack of motivation among the new nurses and how they want to be stationed at PHC and not conduct RI duty.  According to her the main reason behind this is the lack of support from the system.

Transport, safety (during evening and night), non-availability of medicines and the lack of support staff and proper space to carry out RI are the major concerns that affect her work.

I asked her what a possible solution could be for all these problems, to which she responded – “After working for 10-12 years outside their home districts or village, ANMs should be transferred to their home locations.”

When asked how that would help, she said that a lot of times ANMs are not able to express their concerns as they have a fear of being transferred. At locations close to their homes they could save on time by not travelling long distances. Their safety would be ensured as they would know the people around. No child or mother would miss immunization and if needed, they would personally call on them.

She mentioned that being ASHA or ANM has actually mobilized women and helped them get out of their household settings and earn money and respect. However, the lack of support and recognition from the system has been detrimental for their work. Despite voicing their concerns, there’s no one to listen.

On my hour long journey with her I could sense how just being out of the house and earning an income gave her so much happiness and confidence. She was determined to do as much as she possibly could till her retirement. (She enjoys what she does and is determined to do much more)

As i dropped her off, I wondered how the system could be friendlier to the people in it, how dedicated members of this whole healthcare structure could be given better and more memorable experiences that drove them to perform better. If we sort out their tertiary concerns, they will truly be able to excel in their own work, leading to a better health care system that will definitely help save more lives.

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