Impact Stories

Building a Cadre of ‘Community Health Facilitators’

Author: Team SAMRIDH

Rural India suffered disproportionately from the second wave of the COVID-19 outbreak, reporting one in every two cases. In Bihar, the death toll increased by 73% as rural populations were either unable to travel to medical facilities for treatment, or were left unattended due to overcrowded healthcare facilities. COVID-19 prevention measures including masks, social distancing, and vaccination, are tools states can use to mitigate disease transmission and reduce the burden on health facilities. However, there is a lack of validated and transparent information regarding these measures available to the communities, and the high costs and access barriers of formal healthcare further act as deterrents.

Poor awareness of the various social welfare schemes offered to vulnerable communities is an added challenge. Bihar and Jharkhand, for instance, rank lowest among Indian states when it comes to household health insurance coverage (NFHS-4). In Bihar, only 54% of eligible families are covered under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme. Recognising these gaps, Centre for Development Orientation and Training (CDOT), is training Community Health Facilitators (CHFs) in Bihar and Jharkhand to enrol people into health insurance, improve health-seeking behaviour, increase COVID-19 awareness, educate community members on treatment and mitigation measures, and increase vaccine uptake, thus reducing the burden on healthcare facilities and adverse impact of healthcare expenses. The CHFs are selected from marginalized and underprivileged communities and trained to increase their competency on advising and referring community members to appropriate resources and spreading awareness on several health issues. Their larger aim is to set up a safety net by increasing the enrolment of communities under national security schemes and health insurance services.


Meena Thakur, from Singhani Panchayat in Jharkhand’s Hazaribagh district, joined CDOT as a CHF in December 2021. After an initial period of training, online and offline, by CDOT trainers, she was given charge of spreading awareness regarding appropriate healthcare solutions among 200 households.

“Through CDOT, I became familiar with health insurance and how best to assist the less fortunate with finding appropriate healthcare solutions. The training improved my understanding of government schemes, such as Atal Pension, and Health Insurance Bima. I am now better able to advice the larger community in their time of need. I also feel proud and empowered to be able to support my community with relevant information on diverse healthcare issues and regarding COVID-19 management and vaccination”, says Meena.

By acting as a bridge between the community and health authorities, and by virtue of the trust they enjoy within the community, CHFs like Meena are emerging as powerful influencers, helping families make informed, timely decisions, thereby contributing significantly toward providing quality, affordable, and accessible health services to the poor and marginalized.

With support from SAMRIDH, CDOT will be reaching out to 450,000 people. Until now, CDOT has trained 424 CHFs and a long-term economic and health impact is estimated for the individuals counseled and their families through the CHFs. With 42,591 people vaccinated in Bihar and Jharkhand, SAMRIDH’s support is enabling CDOT to scale vaccine outreach and administration.

By equipping community members with these skills, CDOT is playing a key role in enabling the last-mile delivery of healthcare services. Through training and capacity building of CHFs, they are contributing towards building an enduring culture of health through the establishment of a sustainable community support system