Workers (CHWs) working in rural India with the Society for Education, Action and Research in Community Health (SEARCH). SEARCH is a non profit organization established in 1985 to reach the vulnerable, semi-tribal and deprived district of Gadchiroli in Maharashtra state.

In 1994, SEARCH enrolled women like Ms. Gadpayale who could read and write and were willing to train to deliver health care in the community. In 1995, local women became part of an experiment in public health to deliver Home-Based Neonatal Care (HBNC). The experiment attempted to reduce the high rate of neonatal mortality. By the end of 1998, the third year of the intervention, infant mortality had dropped by half.

The Community Health Workers were drawn from a region covering 39 villages, and were mostly educated to elementary school level. This was one of the conditions of entering the program. The other was family consent.

“Not all husbands agreed to this, so they chose only those women whose husbands agreed. That was the criteria to get involved. You have to put the work first,” says Ms. Gadpayale, speaking on behalf of the group.

Ms. Gadpayale and her fellow workers, many of whom are small farmers and also work in the home, serve as health messengers educating the larger community on prevention and treatment of common ailments.

During the COVID-19 pandemic, they were eager to learn and work on new health topics.

Women went door-to-door with surveys, checking for symptoms and quarantining those who were symptomatic. They also provided sanitizer, masks, and information about social distancing. In return for their health service to the rural and tribal families of Gadchiroli, the health workers can access free healthcare for themselves and their families at the tribal friendly hospital at SEARCH. They are paid a fixed monthly wage of 500 rupees, equivalent to $6, along with pay for additional services they provide in their villages.

“We get paid for work depending on what is needed in the community. Now that we have been working for a while, the needs are not as great as before. It can be from two to six hours per day. We also receive an annual gift. Every year is different, sometimes the gift could be a bicycle or a mobile phone as that helps with the work also.”

Remembering the situation prior to the formation of her group, Ms. Gadpayale illustrates the harsh reality for children in particular. “There was nothing available in terms of healthcare. Kids were dying. A lot of babies were premature, preterm, malnourished. We have helped those kids. Now they are all adolescents. They say ‘it is because of you that we are what we are today!’”

Ms. Gadpayale and her group provide home-based advice on care, non-communicable diseases, maternal and newborn health, and nutrition. They distribute iron tablets and folic acid to eligible women, pregnant women and mothers, they treat infection by administering antibiotics and make hospital referrals for those most at risk. So far, they have cared for 19,952 children and their mothers. “We really enjoy this work because it is new and outside of our normal routine. It is a challenge for us and we learn. We are proud of the children we have saved!”

In terms of ongoing challenges, Ms. Gadpayale says that sanitation is still a concern in the community and she concedes that there is a lot of work to be done. Despite this, she is hopeful and has a word of advice for young people.

“We don’t have much education and look at what we have managed to do for health in the community. Imagine what you can do with the education you have”.