The role of Accredited Social Health Activist (ASHA) volunteers and the use of cellphones in preventive medicine could be two significant tools in community health management and preventing secondary events in non-communicable diseases.
These are the two aspects that could be exploited if Amitava Banerjee, cardiologist and researcher in cardiovascular medicine at the University of Birmingham, attaches the project of Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) to his research on the burden of cardiovascular diseases in India and access to medicine.
The project ENDIRA had conducted camps in five panchayats - Mookannur, Karukutty, Thuravoor, Manjapra and Kalady – and more than 50 per cent of the targeted population was covered. This was the first time ASHA workers had been utilised for such a detailed survey. ASHAs are community health workers in the World Bank-sponsored National Rural Health Mission (NRHM), which is being implemented by the Union government across the country.
In Kochi, assessing the details of the ENDIRA study, he made field visits to the Angamaly belt where the survey was done on 1.14 lakh people in the community. Speaking to The Hindu, Dr. Banerjee, said about 90 per cent penetration of mobiles in the rural areas could be effectively used by ASHAs in preventive medicine, especially in patients who were at the risk of secondary events after heart attack or stroke.
They could remind people through text messages to take their medicine and also pass on other health and dietary information. It was one of the easiest ways to reach out to the patients and it could prevent a great deal of secondary events that generally prove fatal to many people with heart and other vascular diseases, he said.
The ASHAs can utilise the social bonding in the community and families to ensure that people do not forget to take their medicine. The need for primary prevention was rather large and would require huge resources in screening entire populations, said Dr. Banerjee. Secondary preventions were more plausible and ASHAs can take up the work in an effective manner. A study on drug compliance would also help researchers know how effective they are in preventing secondary events, he added.
The ENDIRA project was done by a group of 11 doctors from government and private hospitals, over the last two years holding health camps that also gave the people a health record. These health records were transferred to the respective primary health centres for the people to have their follow-up treatments.
Finding that the ASHA workers were well-trained in spite of many having only basic educational qualifications, Dr. Banerjee pointed out that ASHA workers could have a broader role in community health. He said that such work would map out new cases and also help researchers know what kind of drug compliance prevails here. About less than 20 per cent of people adhered to a drug regime, said Dr. Banerjee. It could also bring out whether non-compliance was because of lack of access to medicines in the system level, community level or individual level and also help understand the patient better. The availability of alternative medicine could be a reason for lack of drug adherence, he said.