Author: Abha Mishra
The success of a state’s healthcare system cannot be measured only by its hospital count, its machines or its doctors. What really matters is whether a sick child in a remote village, a woman in labour or a patient with suspected malaria gets access to medical help in time. In Chhattisgarh’s forested regions, last-mile healthcare delivery depends heavily on one group of women, the Mitanins. Nearly 72,000 Mitanins are the link that brings healthcare within reach of villages where hospitals are far, travel is hard and awareness is still limited.
A Mitanin is more than a link between the health department and rural families. She is someone the community trusts. Her work spans the care of pregnant women, child immunisation, newborn health and carrying information about government health schemes into homes that might otherwise never hear of them. In tribal communities, where women often find it hard to speak openly about health concerns, a Mitanin from the same village becomes an easier person to talk to. When needed, she helps get a patient to hospital and guides the family through treatment.
Chhattisgarh launched the Mitanin programme in 2002. The model later went on to shape the national ASHA worker network, demonstrating how essential community participation is to reaching the last person in the healthcare chain. But sustaining that effectiveness takes more than good intentions. It needs training, timely incentive payments, access to medicines and resources, and working conditions that respect what these women do.
Continued financial support is an important part of sustaining this network. The Chhattisgarh government has taken steps to ensure continued financial support for Mitanins and ensure timely and transparent payments. Allocation for the Mitanin Welfare Fund (Mitanin Kalyan Kosh) rose from Rs 111 crore in 2023-24 to Rs 325.5 crore in 2024-25 and Rs 336.8 crore in 2025-26. For 2026-27, Rs 350 crore is proposed for the fund. This increase signals the state’s strong commitment to the programme.
The payment system itself has also changed. Earlier, payments were often delayed at the block level and workers had difficulty in tracking how different components added up. Now, a state-level online system sends money directly into bank accounts, with a Mitanin passbook setting out the central, state and individual shares of each payment clearly.
A Mitanin’s responsibilities are not confined to any single illness or programme. They run from routine immunisation and maternal and child health to spreading awareness about malaria, tuberculosis and diarrhoea. During the COVID pandemic, Mitanins carried out community-level surveys, informed people about precautions and encouraged vaccination. When a health system faces a crisis, it is this local network that carries government guidance door to door.
Bastar’s progress against malaria is a notable example of the importance of Mitanins. For years, difficult terrain, forest villages and poor access to health centres kept malaria a persistent challenge there. It is now moving toward being malaria-free. Mitanins went house to house during the elimination campaign, testing residents with rapid diagnostic kits, identifying likely cases, building awareness and encouraging people to complete their full course of medication. The positivity rate of Bastar, 4.6 per cent at the campaign’s start, fell to 0.46 per cent by June 2024.
After November 2024, the government targeted roughly 16.77 lakh people across 2,527 villages in Bastar’s seven sensitive districts along with Gariaband, Khairagarh-Chhuikhadan-Gandai and Kawardha. The target was successfully met by Mitanins and Bastar’s annual cases later dropped significantly from 27.40 to 7.11. Meanwhile, the statewide rate declined from 2.63 in 2018 to 0.90 by 2025.
Mitanins have completely changed healthcare for mothers and babies in the rural regions of Chhattisgarh. Because of their dedication alongside overall healthcare upgrades, infant deaths declined from 95 to 37 per 1,000 between 2000 and 2024. Maternal deaths dropped from 159 to 124 per 100,000 by 2026. While better clinics and nutrition helped, Mitanins continued to remain the vital mediators that connect families to life-saving medical care.
Chhattisgarh’s Mitanin network provides an important lesson for public health. Investment in hospitals and equipment is essential, but it delivers real value only when people know when to seek treatment, can reach a health centre and complete their course of care. That depends on local trust and sustained engagement. Mitanins are the ones that build that trust and convert it into action. The road to a healthier Chhattisgarh runs through its hospitals, but it begins with the Mitanin in the village whom a family turns to when they need help.
The writer is Director, Policy Watch India Foundation; Views presented are personal.