ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Mid-level Healthcare Providers

Insights from West Jaintia Hills District, Meghalaya

The experiences and challenges in health service delivery, faced by the newly created cadre known as mid-level healthcare providers or community health officers, are explored through an empirical study conducted in selected health and wellness centres of West Jaintia Hills district. Findings show that while the CHOs are motivated to work given the opportunity available in the public health system, they also encounter many challenges in terms of increased work burden, poor training, and other systemic problems confronting the public health systems in Meghalaya.

The authors sincerely thank the anonymous referee for their comments and suggestions which have helped in making the article more insightful. They also thank all the respondents for taking out time to discuss the challenges they are facing while on work.

To achieve universal health coverage (UHC), the Government of India (GoI) launched the Ayushman Bharat programme in September 2018. The two main pillars of the Ayushman Bharat consist of transforming around 1,50,000 sub-centres and primary health centres (PHCs) into health and wellness centres (HWCs) at the primary level. The second pillar is popularly known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), an insurance coverage up to `5 lakh for seeking medical care at secondary and tertiary hospitals for poor and vulnerable households. The main objective of HWCs is to provide comprehensive primary health care (CPHC) through the expanded range of services such as reproductive and child health (RCH) services, communicable and chronic diseases. It is through the team of health workers at the HWC that CPHC is provided to the people at the community level.

Before the upgradation into HWCs, front-line workers at the sub-centre for every 5,000/3,000 population in the plain/hilly areas primarily included auxiliary nurse midwives (ANMs), multipurpose workers (MPWs-male), and the accredited social health activists (ASHAs). In order to provide the expanded range of services at HWCs, a new cadre of health worker was introduced in 2018 known as community health officers (CHOs) or mid-level healthcare providers (MLHPs). To become a CHO/MLHP, one must have a basic degree of Bachelor of Science in Nursing (BSc Nursing) or General Nursing and Midwifery (GNM) or Bachelor of Ayurvedic Medicine and Surgery and must have undergone the six-month bridge course (GoI 2018). The bridge course is a certificate program­me rolled out by the Indira Gandhi National Open University (IGNOU) after signing a memorandum of understanding with the Ministry of Health and Family Welfare (MoHFW), GoI. Thus, the CPHC team comprises the CHO/MLHP who is the team leader, two ANMs, one MPW and ASHAs at the village level. The introduction of the MLHPs at the HWCs of India is considered to be one of the most ambitious health systems reforms in the country. It is also one of the key strategies to address the severe shortage of trained and qualified medical doctors in rural areas in order to provide care to the population residing “in the last mile” (Moola et al 2019). It is also important to note that CHOs now constitute one of the largest cadres of non-physician providers at the primary level. The success of HWCs to a large extent depends on the skills and competence of CHOs (Garg et al 2022).

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Updated On : 26th Sep, 2023
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