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Frontline Health Workers: The backbone of rural healthcare system

April 7, 2020

There is nothing typical about Anandwati’s day, a resident of Kursi village, Hardoi. She is a frontline health worker who is ready to step out of her house at odd hours or when she is not feeling well, only to help others in her village. Being an accredited social health activist (or ASHA), this comes naturally to her and to many such frontline health workers who are dedicated to relentlessly uplift the rural healthcare system.


On 7th April 2020, the world celebrates achievements and work of nurses and midwives who play a critical role in keeping the world healthy. They remain at the forefront of battling any disease or medical issue while addressing community questions, providing respectful treatment and care to the people in need. Their relationship with patients is based on trust and providing the necessary, skilful reassurances.


In rural India, frontline health workers act as an essential link to designated health facilities by bringing various services to people’s doorsteps. Accredited Social Health Activist (ASHA), Anganwadi (AWW) and Auxiliary Nurse Midwife (ANM) are an important force of frontline health workers who come from the communities that they are serving. Rural communities as setup are more close-knit than urban communities. The lack of advanced facilities and literacy makes it difficult to permeate the need for speciality healthcare and other essential information. These social realities make the task of frontline health workers even more challenging. They need to be actively involved in people’s lives not just from the purpose of providing institutional healthcare but also to gain additional insights which provide them with an agency in the community to lead the beneficiaries in a more developed and healthy direction. They have the responsibility of the entire community’s well being once they gain their trust and understanding.


The multi-dimensional nature of rural healthcare system makes involvements outside the conventional design essential for ensuring smooth delivery of services. Anandwati reminisces about the days when she first started working as an ASHA worker in 2006. She clearly remembers that her motivation received strong resistance from the community.


“It wasn’t an easy journey but I managed. People have closed doors on my face several times but the only motivation that I always had was I want to change the condition of my village because that’s the only way we can grow. Health is an important subject and it cannot be dealt
with leniency”, says Anandwati.


Shiv Devi, from Suthena village of Hardoi, is an Anganwadi worker who is popular as a messenger of health and sanitation in her village. The villagers proudly call her Jhansi ki Rani because she makes it a point to ensure everyone in her village is getting better healthcare
services and nobody is left behind.


“I’m always on my toes and I don’t delay work for any reason. Even if people are hesitant or reluctant to listen to me, I make it a point that I will change the condition of my village and get everybody on a healthier path.”


ASHAs, ANMs and AWWs have varying responsibilities. From conducting regular health surveys of families to assisting with deliveries, they cover major aspects of the healthcare system. Door to door visits to the poorest and most vulnerable, counselling families and pregnant women, spreading awareness on health, nutrition, family planning, child growth and development and immunisations are some of the roles and responsibilities that fall under the purview of these frontline health workers.


Their role is indispensable in the health system and hence they cannot or should not be taken lightly. Keeping the rural dynamics in mind, there is all the more need that they are trained and capacitated enough to efficiently manage the intricacies of rural healthcare. HCL Samuday is supporting the frontline health workers with a host of interventions aimed at enabling them to discharge their duties effectively and thereby uplift the health status in the villages of our country.


Anandwati proudly says that there is no longer any home delivery in her village. By regularly visiting and counselling pregnant women, making them understand the importance of healthy food, taking them for regular health checkups, frontline workers like Anandwati have helped successfully manage 84% High-Risk Pregnancy cases where mother and child were both at riskn due to several health issues, across three blocks of Hardoi, Uttar Pradesh.


Frontline health workers play a crucial role in health promotion and health literacy. On this World Health Day, when we celebrate the hard work of nurses and other frontline health workers, it is imperative that more respect, appreciation, and recognition come their way. With the right knowledge, skills, opportunities and financial support, they can act as more efficient health practitioners for beneficiaries and their families.

Training and Extension

Agriculture is a dynamic sector that deals with specialized knowledge which is ever changing. HCL Samuday regularly makes associated farmers aware of latest developments through Training and Extension intervention. The farmers are empowered to address existing issues and mitigate and adapt for future challenges.

With the objective of bringing agriculture technologies at farmers’ doorstep by establishing a ‘Center of Excellence’ in Uttar Pradesh, HCL Samuday is setting up Center for Agriculture Technology Transfer (CATT) in Hardoi district. It shall act as a ‘single window’ / ‘one stop support system’ aligning various interventions of state department of Agriculture with HCL Foundation as an intermediary and farmers as end users in a learning, decision making and problem-solving exercise.

Nutrition Garden

Nutrition Garden is a low cost, scientific model of home garden organically producing a variety of nutritious vegetables and fruits throughout the year. The primary objective of promoting nutrition gardens is to make ½ kg of fresh vegetables available for daily consumption to rural households. Secondary objectives include reduction in daily expenditure of HHs and increase in the consumption of green vegetables for improved nutrition.

2,714 households have benefitted by adopting a Nutrition Garden.

Community Mobilization and Institution Building

Interventions aimed at mobilizing community and facilitating institution creation lend long-term sustainability to the efforts for agriculture development.

     a. Farmer Clubs

Farmer Clubs are formed with the objective of propagating the idea of collective, uniting farmers in groups which work for the benefit of their community. 199 such clubs established so far under this intervention are providing a platform for knowledge dissemination and better market linkages.

        b. Farmer Producer Organisation

HCL Foundation is the promoting agency of Hardoi Kisan Producer Company Limited (HKPCL), a Farmer Producer Organization constituted in 2017 to address challenges faced by farming community in the project area. Comprising of 2,350 shareholders and governed by an 11-member board of directors, HKPCL registered a turnover of ₹ 6.85 crores in last financial year (2019-20).

       c. Vegetable Aggregation Points

Ensuring market is a crucial part of vegetable supply chain. To facilitate better linkages with market, 7 vegetable aggregation points have been set up across 3 blocks and regular communication is made to enable farmers to choose and opt for most suitable option. Realising better prices for produce, 917 Tonnes of vegetables, worth ₹ 1.30 crores, got aggregated at these centres in 2019-20.

       d. Farm Mechanization

Through Farm Mechanization, focus is on increasing income of farmers by improving affordability and accessibility of machines for precision agriculture. It is aimed at reducing farmers’ cost of cultivation and easing farm operations. Carried out in an entrepreneurial model, thus far 3,249 farms have been supported with advanced agricultural machinery and development of 45 entrepreneurs has been facilitated.

Crop Diversification

Due to lack of awareness and perishable nature of produce, few farmers practice vegetable cultivation. Crop Diversification intervention aims to bring sustainable income enhancement by adoption of diversified crop practices. HCL Samuday is pushing this agenda and the concurrent efforts made have engaged 13,500+ farmers so far in vegetable production.


After successful response of vegetable cultivation, various add-ons in Crop Diversification have been introduced so that farmers having disparate needs may opt for most suitable cropping pattern. These include –

  • Nano Orchard- a small area of land ranging from 840–1680 sqm is devoted exclusively for cultivation of fruit crops like Guava, Papaya, Banana, Apple, Ber and Thai Lime (seedless) along with vegetables taken as intercrop. 425 farmers have successfully established Nano Orchards.
  • Floriculture - promoting flower cultivation, HCL Samuday is propagating better practices and solving farmers’ erstwhile problem of unavailability of good variety. Marigold cultivation is being promoted under floriculture in project area.
  • VASUNDRA -Village Action for Sustainable Utilization of Natural Resource and Demonstration of Resilient Agriculture (VASUNDRA) has been initiated to enhance productivity of degraded fallow lands having high pH value. Adopting scientific methods of land reclamation through cultivation of resilient crops like Lemon Grass and Palmarosa combined with PH resistant horticulture crops like Amla, Ber and Lemon, so far 140 acres of land has been reclaimed.

Traditional Crop Promotion

Traditional Crop Promotion intervention focuses on training and demonstration of traditional crop farmers (Maize, Paddy, Wheat, Urad etc.) and bringing them under Package of Practices (PoP) based production system to increase productivity and adopt better crop management practices.

HCL Samuday has worked to enhance productivity by adopting soil and nutrient management, land development and institutional building for effective market linkages. 26,000+ farmers are currently engaged through this intervention and have adopted better practices on their farm.