Rural nurses and female frontline community health workers in India are often the first point of contact between communities and the country’s public health system. Every day, these women support crucial on-ground activities related to primary healthcare services such as maternal care, child immunization against vaccine-preventable diseases, care for neglected tropical diseases, communicable disease prevention and control, and promote information on nutrition, sanitation, and healthy living. Despite being the backbone of the public health system, however, these women leaders remain underpaid and overworked, often bearing the burden of delivering services under multiple government programs without the necessary tools and training to do so.
This International Nurses Day 2024, we caught up with India Leadership Journey alumnae to uncover ways in which India’s public system can better support its nurses and community health workers. Edited excerpts below:
1. Ease the burden on frontline workers through digital solutions, increased funding, and streamlining the introduction of new programs
Community health workers in India are overburdened by the growing number of health care programs, a situation compounded by the launch of new programs day after day. This poses challenges to meet the demands of their roles while ensuring the effective delivery of healthcare services to their communities. To address these challenges, policymakers must be empathetic to the difficulties of doing fieldwork and rationalize the work allocation for community health workers. While planning new programs, decision makers must consider the entire public health ecosystem rather than relying on community health workers alone for implementation. Increased allocation of funds to community health workers and the systematic monitoring of their work are also crucial for ensuring their effectiveness and accountability.
To ease the burden placed on frontline workers, public health systems can replace multiple reporting registers by streamlining the data collection requirements of female frontline workers through a single digital platform for monitoring all health programs in the country. Expediting staff recruitment, closely monitoring vacancies, and creating a curriculum of routine capacity-building opportunities are other pathways for reducing their workload. Finally, advocating for gender-sensitive programming for health workers and promoting collaboration and agency among them can also enable them to identify and overcome their professional roadblocks.
2. Bring nurses to the center of public health decision-making
Nurses do the most work for the health and wellbeing of the country, but remain nameless, voiceless, and have limited influence in how healthcare functions in India. Their work is also not acknowledged and celebrated enough, a fact that is often internalized by them, adversely affecting their confidence and their self-perception of how their contributions have lifted India’s health. Who is immunizing our children and caring for the millions of pregnant women and new mothers? It’s our nurses.
Our public health systems need to start seeing beyond the nurses as only “working on the ground” and bring them to the center of action—in planning, in decision making. We must become fair—in the quantum of work our nurses do, in their wages, nurture them as we do our doctors, managers, and administrators, and ensure that their dignity is upheld.
3. Promote nurses’ leadership within the healthcare system
Rural nurses, particularly those within government setups and serving in outreach areas, encounter a range of significant yet often overlooked challenges, including insufficient sanitation amenities and seating arrangements at anganwadis (rural community centers). Delayed or inconsistent provision of incentives, lack of recognition for their commendable efforts, and the imposition of ambitious targets by the system exacerbate their demotivation. The absence of compassionate leadership within the healthcare system compounds these issues.
These challenges can be effectively tackled by promoting nurses’ leadership within the healthcare system. Engaging with nurses regularly and fostering leadership qualities among them can bring many of these issues within their sphere of influence. Moreover, developing compassionate healthcare leaders within the healthcare system who prioritize addressing long-standing, unresolved challenges that have become institutionalized without fully recognizing their impact on service quality—can also help in resolving these issues. By empowering nurses and instilling a culture of compassionate leadership, the healthcare system can better address the needs of rural communities and improve overall service delivery.
