India's healthcare landscape is marked by a notable challenge: a substantial shortfall in healthcare professionals relative to its vast population.

According to a report by NITI Aayog, India has a ratio of merely 64 doctors per 1,00,000 people, which is considerably lower than the global average of 150. This disparity raises a crucial question: how can India effectively bridge this significant gap in healthcare provision? 

One promising answer lies in the integration of Artificial Intelligence (AI) into community health systems. AI offers the potential to augment healthcare services, enhance the efficiency of existing medical staff, and provide innovative solutions to the pressing challenges faced by India's healthcare sector.

But how can AI be integrated effectively into the existing healthcare framework? And in what ways can AI support and enhance the work of the current healthcare workforce?

The Community Health Map serves as a starting point in answering these questions. By mapping out the various activities, specific stakeholders, and existing innovations in community health, it provides a comprehensive overview of the current landscape.

The starting point: Understanding the ecosystem

To address the challenges in community health, it’s crucial to thoroughly understand the ecosystem. This begins by asking some fundamental questions:

Who are the key stakeholders?

ASHA (Accredited Social Health Activist)

They are the bridge between the community and the healthcare system, focusing on basic health, sanitation, and the implementation of government health schemes. They play a pivotal role in spreading health awareness and assisting in basic healthcare delivery at the grassroots level.

“I belong to the village I serve. I spread health awareness, aid in basic healthcare delivery, promote sanitation and assist in implementing government health schemes at grassroots level.”

ANM (Auxiliary Nurse Midwife)

ANMs are more clinically oriented, providing essential health services including child delivery, immunization, and guiding ASHAs in their work. They are crucial in maternal and child health and also play a significant role in community health awareness and sanitation efforts.

“I have been posted to the village I serve. I offer essential healthcare services, assist in maternal and child health, provide medical aid, conduct immunizations, and promote community health awareness.”

AWW (Anganwadi Worker)

AWWs focus on the health, nutrition, and education of children aged 0-6 years. They manage Anganwadi centers, provide basic education, nutritional support, and conduct health check-ups, ensuring a healthy start for the youngest in rural communities.

“I belong to the village I serve. I run anganwadi centers (childcare centers), offer basic education, provide nutrition support and conduct health check-ups for children.”

What do these stakeholders actually do?

Community health in India involves a wide range of activities, each designed to address different aspects of health and well-being in rural areas.  These include preventive care, health education, maternal and child health services, immunization programs, disease surveillance, and the implementation of various health schemes.

ASHA Workers

• Undergo frequent trainings for various programs

• Promote immunization, spread awareness door to door

• Spread awareness, provide referral and escort services for other healthcare programs

• Promote construction of household toilets

• Create awareness on health and its social determinants

• Provide information to the community on nutrition, basic sanitation and hygienic processes

• Respond to calls for any health related demands, especially women and children

• Counsel pregnant women and mothers

• Provide referral and escort services for reproductive and child health (RCH)

• Mobilize community for health and sanitation

• Provide first- contact healthcare

• Maintain drug kit

• Enter data of the work done

• Claim incentives

ANM (Auxiliary Nurse Midwife)

• Provide Antenatal and antepartum services through outreach and at facility 

• Conduct safe institutional delivery and provide Intrapartum care 

• Provide Postpartum and postnatal services through outreach and at facility

• Assess danger signs, monitor growth and provide appropriate referrals for infant and child

• Deliver other essential General services - administer injectables, provide immunization, insert IV line

• Distribute FP commodities to the beneficiaries and support in other FP services - create awareness, provide FP services

• Create awareness, conduct screening and appropriate referral for VBD, CD and NCD under various National Health Programs

• Manage and update drugs and equipment 

• Conduct allied supportive practices that aid in quality of health services - Counselling

• Plan and organize various services, - organize VHND

• Record and report information - maintain various records, report MMR, etc

AWW (Anganwadi Worker)

• Manage procurement and store raw materials for hot cooked meals (HCMs)

• Supervise the preparation and distribution of HCM by Anganwadi Helper (AWH)

• Organize and stores take home ration (THR) packets/dry ration 

• Mobilize children and conducts early childhood care and education (ECCE) activities

• Mobilize and documents the national immunization schedule and health check-ups

• Conduct half yearly child assessment and Growth monitoring for children (0-6 yrs), enters the data in POSHAN tracker

• Identifies different forms of undernutrition among children 0-6 years

• Organizes Community Based Events (including Godbharai, Annaprashan etc.) at the AWC

• Counsels and demonstrate for maternal nutrition, breast feeding, complementary feeding and undernourished children 

• Refers beneficiaries to appropriate health facilities

• Documents and discuss HCM, THR, growth monitoring and referral related issues in sector meetings

What are the existing innovations in the sector?

Innovations are burgeoning, especially with the integration of technology. Mobile apps for health monitoring, telemedicine services for remote consultations, digital health records, and AI-powered diagnostic tools are some examples.

Government initiatives like the POSHAN Tracker app focus on holistic nutrition, while ANMOL aims at digitizing healthcare records. Such innovations are critical in bridging gaps and enhancing the efficiency of healthcare delivery.

The Community Health Opportunity Map

Reflecting on the opportunities

With this map in hand, the next step is to identify where the system might be lagging. Are there villages where health awareness is low? Do some ANMs need more training in digital tools? Is the data being collected used effectively to improve health services?

By examining each aspect of this map, we can pinpoint these gaps and work towards solutions.

• Could AI-driven diagnostics help ANMs in remote areas?

• Can AI-powered tools streamline ASHA’s data entry tasks?

• What if AWWs had access to AI tools for nutritional planning?

The integration of AI in community health could be transformative. It means more efficient healthcare delivery, better use of resources, and ultimately, a healthier population.

As we look towards a future where technology and healthcare intertwine more closely, the possibilities are endless. It's not just about bridging gaps; it's about creating a new landscape of healthcare delivery, one that is more equitable, efficient, and accessible.

The journey towards integrating AI in community health in India is not just a path towards technological advancement, but a stride towards a healthier nation.

Our team would like to thank Tanya Sinha for her contribution to the community health map.