Hope for a malaria-free India

It is World Malaria Day. The T3-TR team is introduced to a quiet woman, who has been pushed forward as spokesperson. Her sari is blue, a colour that tells of her status as an ASHA1. She introduces herself as Gitanjali Pati, an ASHA from a tiny village in Odisha, an Indian state on the Bay of Bengal.

Suddenly she smiles, and is no longer quiet. Gitanjali sparkles when she talks about being an ASHA. “I work as an ASHA to help people,” she says. Her work has empowered her and given her status in her village. When they need health advice, she says, people come to her door, where a board proclaims her status as accredited social health activist. A large proportion of her day is devoted to maternal and child care cases. In addition to being an ASHA, Gitanjali is a single mother and has seen her only son, Subranshu, through school. She herself has studied up to the 10th grade.

She proudly shows the team her ASHA diary, a fat notebook in which she records in minute detail the case histories of all the mothers she has helped with their pregnancies.  The name, weight, delivery date, place of delivery, weight of child, any complications, tetanus-BCG shots and folic acid tablets for the baby – so much information, beautifully written in rounded Oriya script.  She has filled five of these diaries over 6 years as an ASHA.

In addition to her focus on mother and child health, Gitanjali has also been trained in how to diagnose and treat malaria. She takes us through a large ledger of forms in which she records fever cases and the blood slides sent to the community health centre to test for malaria. The ASHAs in her village, she explains, are overseen by an Auxiliary Nurse Midwife, who not only supplies them with the medicines and diagnostic tests they need but is also their mentor and guide.

Gitanjali sees around 10 fever cases a month and, over the years, has become adept at making blood slides and doing rapid diagnostic tests for malaria. Her district had a high burden of malaria before 2009, but due to the provision of ACTs and better access to care the incidence has decreased. Fortunately her village is now relatively free of malaria, unlike neighbouring districts where the malaria burden is quite high.

The success of the T3-TR programme which will be rolled out by NVBDCP2 Odisha, NIMR3 and MMV, in June 2013, relies on the ASHAs like Gitanjali, the backbone of India’s health system, dedicated to improving the health of others. They form a large, literate, grassroots force of over 41,000 trained female community health workers across 30 districts in Odisha alone, strengthening the link between the public health system and rural communities.  Each village is divided into two sectors and the ASHAs attend a sector meeting and a village welfare (Gaon Kalyan Samiti) meeting each month, where they report on activities and decide next steps. They are also regularly trained in the basic care of TB, malaria, and leprosy.

For the T3-TR programme, Gitanjali and her fellow ASHAs will also be trained to use bivalent RDTs to test for both species of malaria, P. falciparum and P. vivax, and treat malaria patients in line with national treatment guidelines. Odisha has the highest reported burden of malaria in India and the meticulous tracking of malaria cases using newly introduced patient cards and electronic data system will provide deeper clarity into the local malaria profile, including cases of relapse or treatment failure, and help better target control activities.     

ASHA is a Sanskrit word that means hope. ASHAs, like Gitanjali, working to raise awareness within communities of the need to ‘Test, Treat and Track’ malaria, provide hope that one day India will be rid of malaria for good.

1. Accredited Social Health Activist

2. National Vector-Borne Disease Control Programme

3. National Institute of Malaria Research