Healthcare Delivery in Rural India: Focus on Women & Children
Kiran Devi is the supervisor of the Anganwadi Center in East Champaran District performs growth checks in a rural village in Bihar, India, Photograph: ©Steven Wade Adams, Bihar, India 2025
This blog is the fourth and final article in a series that document my experience in Bihar and West Bengal in March 2025 documenting the work of C3 India to support women’s empowerment. Previous articles focused on 1) feminism in India 2) eduction as empowerment for girls in India and 3) entrepreneurship as an enabler of women’s agency in West Bengal.
The delivery of healthcare In rural India faces many challenges and involves a diverse array of players. These include government agencies, non-governmental organizations (NGOs) such as the Center for Catalyzing Change (C3 India), community health workers, and local practitioners. Various government initiatives such as the National Rural Health Mission aim to enhance access to essential health services, while NGOs in India fill in critical gaps in resources, coordination and training. Community health workers, known as ASHAs (Accredited Social Health Activists), play a key role by acting as liaisons between healthcare systems and the populations they serve. ASHAs promote awareness by performing outreach in the communities and facilitating access to various health services. Local practitioners, who may lack formal qualifications but possess significant practical experience, also contribute to healthcare delivery in rural India by providing immediate care and counseling to their communities.
In the communities in rural Bihar that I visited, C3 India is very active in promoting gender equity, social inclusion and respectful care through collective action. The goal in this particular health focused program is to ensure that women are aware of the full range of health care services and are empowered to advocate for themselves to demand equitable healthcare services.
One mechanism to promote such equity is through functional and responsive local health committees. A core element of C3 India’s participation in this program is to ensure training of the various participants while also ensuring optimized function of the committee itself. The committee for the health care center I visited was led of the local elected leader (mukhiya) but also had representation by several ASHA, health care workers, the Chief Health Officer and other community members. Together, they collectively strive to serve their community by addressing the multifaceted health challenges faced in rural areas, minimizing disparities and improving health outcomes for rural populations. Patients and their families can also register complaints and suggestions that the health committee must consider.
Submission of sugestions and complaints to the health care committee are encouraged at this local health center in rural Bihar. Photograph: ©Steven Wade Adams, Bihar, India 2025
A health care worker speaks at the local health committee in Bihar. Photograph: ©Steven Wade Adams, Bihar, India 2025
Neha, the Chief Health Officer at the local health center in East Champaran in rural Bihar is surrounded by ASHA who are critical to outreach and community engagement. Photograph: ©Steven Wade Adams, Bihar, India 2025
Neha, the Chief Medical Officer prepares to see a child patient at the local health center in rural Bihar. The girl is accompanied by her mother and an ASHA.
Neha, the Chief Medical Officer sees patients at the local health center in rural Bihar. Photograph: ©Steven Wade Adams, Bihar, India 2025
The Community Health Officer (CHO) plays a crucial role in the delivery of health care in rural India by serving as a vital link between the community and the larger health care system. CHOs are responsible for a range of activities, including providing primary health care services, conducting health education sessions, and mobilizing community resources to improve health outcomes. They often work in villages where access to hospitals and specialized medical facilities is limited, thereby bringing essential services closer to the people. By focusing on preventive care, promoting health awareness, and addressing local health issues, CHOs enhance the overall health infrastructure, ensuring that even the most remote populations receive necessary health services. Their presence fosters trust and engagement in the community, ultimately contributing to better health indicators in rural areas.
A young mother with her baby she has brought to a wellness clinic for a growth check. Photograph: ©Steven Wade Adams, Bihar, India 2025
The Anganwadi Worker (AWW) plays a crucial role in the delivery of healthcare services in rural India, significantly impacting maternal and child health outcomes. As community health facilitators, AWWs are responsible for implementing government health programs, providing basic healthcare services, and educating families on nutrition and hygiene practices. They serve as a vital link between the community and healthcare facilities, ensuring that mothers and children receive immunizations, antenatal care, and growth monitoring. By fostering a supportive environment, AWWs help to empower women and promote health awareness, ultimately contributing to the overall improvement of health indicators in rural areas. Their presence is essential in addressing the unique challenges faced by rural populations, making healthcare more accessible and effective.
Kiran Devi in East Champaran District performs growth checks in a rural village in Bihar which is recorded into electronic records for more effective monitoring and intervention. Photograph: ©Steven Wade Adams, Bihar, India 2025
Growth Monitoring Week is provided monthly at the Anganwadi Center in this small village with about 1000 residents. The goal is to monitor growth of the children to enable early recognition of illness and malnutrition. Additionally, the Anganwadi is also a preschool teacher at the center, which is a service provided by the local government. The Accredited Social Health Activist (ASHA) plays a crucial role in delivering health care in rural India by serving as a bridge between the community and the healthcare system. ASHAs are trained female volunteers who promote health education and facilitate access to essential medical services, including maternal and child health, family planning, and disease prevention. They conduct home visits, raise awareness about sanitation and nutrition, and encourage the use of health services available at local health centers. By building trust within their communities, ASHAs empower individuals to make informed health choices and contribute to improving overall health outcomes in rural populations. Their grassroots efforts are vital in addressing the unique health challenges faced by these communities.
Joint Action and Support Program: A partnership between the community and health care providers.
The JAS or Joint Action and Support program, plays a crucial role in enhancing the delivery of healthcare in rural India by implementing comprehensive strategies that address local needs. By partnering with community health workers, the JAS facilitates training and resource allocation, ensuring that healthcare services are both accessible and effective. The program places a strong emphasis on preventive care and education, enabling communities to engage actively in their health management. This partnership approach not only improves health outcomes but also empowers rural populations to take charge of their health challenges.
Did you miss my earlier articles in this series dedicated to feminism in India? Sign up for my newsletter and be the first to receive notification of my future articles on humanitarian work around the world. Previous articles in this series explored some of the barriers to female empowerment, the role of education to advance the agency and empowerment of girls and how a program in West Bengal is advancing women’s entrepreneurship and empowerment.