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Assessment of village health sanitation and nutrition committee under NRHM in Nainital district of Uttarakhand

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Background: The Village Health Sanitation and Nutrition Committee (VHSNC) is one of the major initiatives under National Rural Health Mission (NRHM) to decentralize and empower local people to achieve NRHM goal. Limited studies have been conducted to assess the VHSNC in India. Objective: To assess the composition of VHSNC and find out the deviations, if any, from the prescribed framework of guidelines, awareness of VHSNC members about their roles and to assess the functioning of VHSNC. Methodology: The cross-sectional study was carried out from July 2012 to June 2013 in two selected blocks (out of eight) in Nainital district of Uttarakhand. A total of 18 VHSNCs were studied, nine from Haldwani and nine from Bhimtal covering 48 revenue villages, 31 in Haldwani and 17 in Bhimtal block respectively. Out of 139 members in 18 VHSNC, 110 members were interviewed. Results: Mean age of the study subjects was 39.01 ± 8.5 years. Out of the 110 members studied maximum 73 (66.4 %) were female and 37 (33.6%) were males. Maximum subjects, 35 (32.8%) were qualified up to intermediate followed by 29 (26.4%) graduates. Maximum 78 (70.9%) participants belonged to Others (General) category, 30 (27.3%) belonged to scheduled caste and only two (1.8%) belonged to OBC category. There were no subjects belonging to scheduled tribe. Out of the 110 members interviewed there were 18 (16.4%) Gram Pradhans, 10 (9.1%) Female Health Workers, 20 (18.2%) ASHAs and 15(13.6%) Anganwadi Workers. There was very low awareness among the members about role of the committee. Maximum, 93 responses were for cleaning village environment which were given by all 18 Gram Pradhans, 16 ASHAs and ward members.
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ISSN PRINT: 0971-7587; ISSN ONLINE: 2248-9509 ASSESSMENT OF VILLAGE HEALTH | Semwal V et al
INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 25 / ISSUUE NO 04 / OCT DEC 2013 472
ORIGINAL ARITICLE
Assessment of village health sanitation and nutrition committee under NRHM
in Nainital district of Uttarakhand
Semwal V1, Jha SK2, Rawat CMS3, Kumar S4, Kaur A5
1, 4 Junior Resident, 2 Associate Professor, 3 Professor, 5 Assistant Professor, Department of Community
Medicine, Government Medical College Haldwani, Nainital, Uttarakhand
Abstract
Introduction
Methods
Result
Conclusion
References
Citation
Article Cycle
Address for Correspondence: Vandana Semwal, Junior Resident, Department of Community Medicine,
Government Medical College Haldwani, Nainital, Uttarakhand
E Mail ID: drvandanasemwal@gmail.com
Citation
Semwal V, Jha SK, Rawat CMS, Kumar S, Kaur A. Assessment of village health sanitation and nutrition
committee under NRHM in Nainital district of Uttarakhand. Ind J Comm Health, 25(4); 472 - 479
Source of Funding : Nil, Conflict of Interest: None declared
Abstract
Background: The Village Health Sanitation and Nutrition Committee (VHSNC) is one of the major initiatives under
National Rural Health Mission (NRHM) to decentralize and empower local people to achieve NRHM goal. Limited
studies have been conducted to assess the VHSNC in India. Objective: To assess the composition of VHSNC and
find out the deviations, if any, from the prescribed framework of guidelines, awareness of VHSNC members
about their roles and to assess the functioning of VHSNC. Methodology: The cross-sectional study was carried
out from July 2012 to June 2013 in two selected blocks (out of eight) in Nainital district of Uttarakhand. A total
of 18 VHSNCs were studied, nine from Haldwani and nine from Bhimtal covering 48 revenue villages, 31 in
Haldwani and 17 in Bhimtal block respectively. Out of 139 members in 18 VHSNC, 110 members were
interviewed. Results: Mean age of the study subjects was 39.01 ± 8.5 years. Out of the 110 members studied
maximum 73 (66.4 %) were female and 37 (33.6%) were males. Maximum subjects, 35 (32.8%) were qualified
up to intermediate followed by 29 (26.4%) graduates. Maximum 78 (70.9%) participants belonged to Others
(General) category, 30 (27.3%) belonged to scheduled caste and only two (1.8%) belonged to OBC category.
There were no subjects belonging to scheduled tribe. Out of the 110 members interviewed there were 18
(16.4%) Gram Pradhans, 10 (9.1%) Female Health Workers, 20 (18.2%) ASHAs and 15(13.6%) Anganwadi
Workers. There was very low awareness among the members about role of the committee. Maximum, 93
responses were for cleaning village environment which were given by all 18 Gram Pradhans, 16 ASHAs and ward
members.
Key Words
Village Health Sanitation and Nutrition Committee; NRHM
Introduction
An estimated 2.5 billion people (more than
35% of the world’s population) lack access to
adequate sanitation.(1) Water, sanitation and
hygiene has the potential to prevent at least
9.1% of the global disease burden and 6.3% of
all deaths.(2) The state of water, sanitation and
hygiene reflects the health of a nation and this
is particularly relevant in a country like India
where 68.84% of the population resides in
rural areas.(3) The definition of primary health
care embodied terms such as "self reliance"
and "self determination" and full participation
of the community was considered among the
prerequisites of the approach. Participation of
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 25 / ISSUUE NO 04 / OCT DEC 2013 473
people in the planning and implementation
process was considered both as a right and a
duty.(4)
The Government of India launched the
National Rural Health Mission (NRHM) in April
2005.(5) The Village Health Sanitation and
Nutrition Committee (VHSNC, earlier known as
Village Health and Sanitation Committee) is
one of the major initiatives under NRHM to
decentralize and empower local people to
achieve NRHM goal. VHSNC comprises of
village level health workers, representative
from Panchayat Raj Institution (PRI) and
representatives of various CBO including
groups who are marginalised.(6) The roles of
VHSNC include development of the village
health plan, monitoring of health activities in
the village and having a comprehensive
understanding of health related activities.
Untied fund is also made available to VHSNC
for various health activities including IEC,
household survey, preparation of health
register, organization of meetings at the village
level etc.
Uttarakhand is one of the states where NRHM
is currently operational since October 27th,
2005 but the VHSNCs came into existence on
25th of February 2009. Under the NRHM
implementation framework, the VHSNCs have
been constituted in all the villages and are
being provided with an untied fund of 10,000
rupees. There are 15431 VHSNCS operational
in Uttarakhand with 15431 operational joint
accounts.(7) The available reports do not give
enough information and a clear depiction on
the functional status of the VHSNCs.
Limited studies had been conducted to assess
the VHSNC in India. Earlier studies conducted
to assess VHSNC indicated that formation of
committees and fund utilization was not
according to guidelines and there were
irregularities in conduction of meetings.(8) In
one study most of the members were neither
aware about their membership in VHSNC nor
about the use of Village Health Fund (VHF).(9)
Another study revealed that some states did
not have bank accounts.(9,10) However, there
have been some studies that show effective
functioning of VHSNCs.(10,11)
Aims & Objectives
With this background the present study was
planned in Nainital district to assess the
composition of VHSNCs and find out the
deviations, if any, from the prescribed
framework of guidelines, awareness of VHSNC
members about their roles and to assess the
functioning of VHSNCs.
Methods
The cross-sectional study was carried out from
July 2012 to June 2013 in two selected blocks
out of eight in Nainital district of Uttarakhand.
The study district and blocks were purposively
selected. Bhimtal block from hilly area and
Haldwani block from plain area were selected
to represent the entire district as the district
comprises of hilly and plain zones. Motahaldu
PHC from Haldwani block and Bhimtal PHC
from Bhimtal block were randomly selected.
From each PHC, three sub-centres were
selected and from each sub-centre three
VHSNCs were selected. Thus a total of 18
VHSNCs were studied, nine from Haldwani and
nine from Bhimtal covering 48 revenue
villages, 31 in Haldwani block and 17 in Bhimtal
block respectively.
The respondents of the study included all the
members of the VHSNCs including Gram
Pradhans (GP) as chairman, FHW (Female
Health Worker), ASHA workers (Accredited
Social Health Activist), PRI members
(Panchayati Raj Institutions), AWW (Aangan
Wadi Workers), Gram Panchayat Adhikari
(GPA), Line men (Jal Vibhag) , teachers and
NGO representatives. The chairpersons of all
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 25 / ISSUUE NO 04 / OCT DEC 2013 474
18 VHSNCs were contacted and a list of
members along with their addresses and
phone numbers in their respective committees
was taken. Each of the enlisted members was
then individually tracked in their villages and
interviews were conducted. A total of 110
members out of 139 were interviewed. The
remaining 29 members were unavailable even
after 4 visits and were thus excluded from the
study.
Due permission was obtained from the
institutional ethics committee. A verbal
informed consent was taken from the
participants. For primary data collection, tools
were developed, pre-tested, and administered
to the subjects. Techniques used to collect the
data were interview using semi-structured
schedules. The secondary data was collected
using a separate check list that included
observation of records maintained at VHSNC.
Data was analyzed using SPSS v 20.
Result
Mean age of the study subjects was 39.01 ± 8.5
years. Table 1 shows that out of the 110
members studied, maximum 73 (66.4 %) were
female and 37 (33.6%) were males. Maximum
subjects, 35 (31.8%) were qualified up to
intermediate followed by 29 (26.4%)
graduates. Sixteen members (14.5%) were
postgraduates while eight (7.3%) had studied
up to 8th standard. Out of the 110 study
subjects, maximum 78 (70.9%) belonged to
others (general) category, 30 (27.3%) belonged
to scheduled caste. Only two (1.8%) belonged
to OBC category. There were no subjects
belonging to scheduled tribe.
Out of the 110 members interviewed, there
were 18 (16.4%) Gram Pradhans, 10 (9.1%)
FHW, 20 (18.2%) ASHAs and 15 (13.6%) AWWs.
Twenty one (19.1%) ward members, 7(6.4%)
Self Help Group Members and one (0.9%)
member from Mahila Samakhya Group were
also studied. Out of the Government officials
interviewed, nine (8.2%) were Gram Panchayat
Adhikaris along with four (3.6%) teachers from
education department and five (4.5%) line men
from water department (Jal Vibhag) (Table 1)
Table 2 shows response of VHSNC members
regarding their roles. Out of 110 participants
only 93 responded by giving multiple
responses. Maximum 93 responses were for
cleaning village environment which were given
by all 18 Gram Pradhans, 16 ASHAs and ward
members, 12 AWWs, nine FHWs and Gram
Panchayat Adhikaris, five members of Self Help
Group, four members of the Jal Vibhag , three
teachers and one member of the Mahila
Samakhya Group.
Thirty six responses were for arrangement of
clean water which were given by 10 Gram
Pradhans, eight ASHAs, five Gram Panchayat
Adhikaris, four AWWs and ward members, two
FHW, two members from the Jal Vibhag and
one member of Mahila Samakhya Group. Least
response (one) was for ensuring that there is
no maternal or child death and that response
was given by one ASHA worker (Table 2).
Table 3 shows that last meeting was held in the
year 2013 in only eight of the VHSNC while 7
VHSNCs held their last meetings in 2012. In one
VHSNC the last meeting was held in the year
2009 and no records were found in two
VHSNCs.
For activities of VHSNCs, only 43 participants
responded with multiple responses out of 110
participants. Out of 87 responses, 23 were for
cutting shrubs and this response was given by
11 Gram Pradhans, seven ward members and
one FHW, one ASHA, one AWW, one Self Help
Group member and one Gram Panchayat
Adhikari. Twenty two responses were for
cleaning of tanks and it was given by 10 Gram
Pradhans, four ward members, two FHWs, two
Gram Panchayat Adhikaris, one AWW, one
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 25 / ISSUUE NO 04 / OCT DEC 2013 475
ASHA, one Self Help Group member and one
teacher. Least responses were for toilets being
repaired and procurement of First Aid Kit and
both these responses were given by Gram
Pradhans (Table 4).
Discussion
Mean age of the study subjects was 39.01 ± 8.5
years. This finding is similar to the findings of
Pandey & Singh (2011) who reported that for
the female respondents, mean age was 34 ±
9.9 years and for the males, the mean age was
39 ± 5.1 years.12 NRHM guideline calls for 50%
representation by females in each VHSNC, this
seems to have been followed in district
Nainital as the present study reported 61.9 %
of the members to be women (Table 1).
Pandey & Singh (2011) found similar results
that women constituted 64% of the VHSNCs in
the 50 districts studied in Rajasthan.(12)
Recommended participation of female
members has also been reported by other
studies.(13,14,15) In the present study the
maximum members (70.5%) belonged to
others (general) category (Table 1). This finding
is in contrast to Pandey & Singh (2011) who
found that around 27% of the members were
SCs, 28% were STs, 21% were other castes and
24% belonged to the other backward castes
(OBCs).12 Singh & Purohit (2010) reported that
all the VHSNCs fulfilled the guidelines for
inclusion of SC/ ST/ OBC.(13) Mohan HL et al
(2012) found the representation of scheduled
caste and scheduled tribe representatives
among the non-functionary females has
increased from 40% to 44%.(16)
In the present study all VHSNCs were
represented by Gram Pradhan, ASHA, AWW,
FHW, Ward members and GPA but the
presence of members from Jal Vibhag, Self
Help Group, MSG and teachers was very low
(Table 1). NRHM guidelines state that 30% of
the members should be from an NGO and due
representation should be given to women
from SHG or other such organisations, VHSNCs
in district Nainital seem to be lacking in this
area. The findings of this study are also similar
to those of Singh & Purohit (2010) who
reported in their study that none of the VHSNC
had school teacher as its member, only 4 had
retired persons, 13 had AWW’s, only 2 VHSNCs
had ASHA workers, only 1 with representation
from SHG and ex-servicemen and only 4 with
NGO representatives.(13) Karpagam S. (2012)
found that the constitution of VHSNCs in terms
of its members from various areas did not
conform to the NRHM guidelines.(14)
In the present study it was observed that all the
members were of the view that cleaning the
village environment was the primary role of
the VHSNC. There were 36 responses for
arranging clean water and 14 for helping
destitute women. Very few members were
aware about the other functions of VHSNC
such as making Village Health plan (VHP),
celebrating Health Day or maintaining VHR,
(Table 2). Similarly Pandey & Singh (2011)
reported that maximum members thought
that raising health awareness was the VHSNC’s
key responsibility, preparing VHP was added
only after probing.(12)
Karpagam S. (2012) reported that the
members mentioned a number of health and
sanitation related activities but there was no
mention of important roles like generating
awareness about available health services,
developing VHP, maintaining VHR and health
information board, informing the health
authorities of key health and nutrition issues or
preparing Village health report Card.(14)
In the present study, it was found that
meetings were organised irregularly, last
meeting being in the year 2013 in only eight
VHSNCs followed by last meeting in 2012 in 7
VHSNC. In one VHSNC there had been no
meeting since the year 2009. In two VHSNCs
there were no records of any meeting (Table
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 25 / ISSUUE NO 04 / OCT DEC 2013 476
3). Pandey & Singh (2011) reported that
around 61% of ASHAs, 53% of the community
members and 41% of PRI members reported
having a VHSNC meeting every month,
whereas 37% of ASHAs, 44% of community
members and 59% of PRI members reported
that meetings took place on MCHN Day.(12)
Public Health Resource Network assessment of
VHSNC (2008) Chhattisgarh field study and
Orissa field study too suggests that meetings
were held occasionally.(9)
The present study revealed that 69 (62.7%)
members acknowledged that they had no
knowledge of the activities that had been
carried out since the last meeting, 37.3%
affirmed that some activities had been done by
the committee (Table 4). Most of the members
affirmed that cutting of shrubs was done.
These findings are corroborated by Public
Health Resource Network assessment of
VHSNC (2008) in Chhattisgarh field study which
found that none of the respondents were clear
about the activities that were undertaken by
the committee in the past one year,9 while an
Assessment of VHSNC by State Health
Resource Centre, Chhattisgarh (2013) reported
that 74% of VHSNCs were carrying out village
health planning.(15)
Conclusion
The composition of the VHSNC in terms of
female representation was as per guidelines in
all the VHSNCs studied, but adequate
representation by members of SHG and NGOs
was not present. Similarly the representation
from education department and Jal Vibhag was
not found as per the guidelines. Meetings were
held rarely and irregularly. Very few members
knew about the Village Health Plan and its
importance in the development of the
community and none of the VHSNCs studied
were involved in making the VHP. Knowledge
about the activities on Village health day was
found to be lacking in most of the members.
Recommendation
The paucity of knowledge has been a barrier to
develop the best strategy to overcome the
drawbacks of VHSNC. However, new research
initiatives with bigger sample size are solicited
to validate the outcome of the study.
References
1. World Health Organization and UNICEF.
Progress on Drinking Water and Sanitation:
2013 Update. United States: WHO/UNICEF
Joint Monitoring Programme for Water Supply
and Sanitation; 2013.
2. Pruss-Ustun A, Bos R, Gore F, Bartram J. Safer
water, better health: costs, benefits and
sustainability of interventions to protect and
promote health. World Health Organization,
Geneva, 2008.
3. Govt. of India (2012), Census 2011, Provisional
Population Report, Office of the Registrar
General and Census Commissioner India,
Ministry of Home Affairs, March 31st, 2011.
4. Mehtap Tatar. Community Participation in
Health Care: The Turkish Case. Soc. Sci. Med.
1996; Vol. 42(11):1493-1500.
5. National Rural Health Mission 2005-2012.
Mission document. (Last accessed on August
2nd 2013). Available from:
http://www.mohfw.nic.in/NRHM/Documents/
Mission_Document.pdf
6. NRHM Framework for Implementation 2005
2012: (Last accessed on August 2nd 2013).
Available from: http://www.mohfw.nic.in.
7. NRHM facility center. Statewise Progress under
NRHM Status as on 30.06.2012: Published on
September 25th, 2012.
8. An assessment of utilization of untied fund
provided under NRHM in UP, 200809 by
National Institute of Family Welfare New Delhi.
Available from http:www.mohfw.nic.in.
9. Prasad V. An Assessment of the status of
VHSNCs in Bihar, Chhattisgarh, Jharkhand and
Orissa in March 2008. Public Health Resource
Network: (Last accessed August 2nd 2013).
Available from: www.shsrc.org.
10. NHRM's Common Review Mission 2nd, 2008:
(Last accessed August 2nd 2013). Available
from: http://www.mohfw.nic.in
11. Why some water and sanitation committees
are better than others. A study in Karnataka
and Utter Pradesh Water and sanitation
program, South Asia: (Last accessed August
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2nd 2013). Available from:
http://www.wsp.org.
12. Pandey A, Singh V. Tied, Untied fund?
Assessment of Village Health Sanitation and
Nutrition Committee, involvement in
utilization of untied fund in Rajasthan, CHEERS
Rajasthan.(Last accessed on 2013 29th July).
Available from: http://www.chsj.org.
13. Singh R, Purohit B. Limitations in the
functioning of Village Health Sanitation and
Nutrition Committees in a North Western State
in India. Int J Med. Public Health. 2012 ;Vol.
2(3):39-46.
14. Karpagam S. An exploratory study of VHSNC
and ARS functioning. Karnataka; Karnataka
State Health System Resource Centre.
Bangalore: March 2012.
15. Village Health Sanitation and Nutrition
Committees (VHSNCs) in Chhattisgarh: An
Assessment. State Health Resource Centre.
Raipur: Chhattisgarh; July 2013.
16. Mohan HL et al. Village Health Sanitation and
Nutrition Committees: evaluation of a
capacity-building intervention in Bagalkot and
Koppal districts of Northern Karnataka.
BMC Proceedings 2012, 6 (Suppl 5):O2
---------------------------x--------------------------
Tables
TA B L E 1: BASEL INE C H ARACTERISTIC S O F TH E PARTICIPANTS ( N =110)
Characteristics
Frequency
Percent
Sex
Female
73
66.4
Male
37
33.6
Education
Post Graduate
16
14.5
Graduate
29
26.4
Intermediate
35
31.8
High School
22
20.0
8th Pass
08
7.3
Caste
Others
78
70.9
OBC
02
1.8
SC
30
27.3
Designation
Gram Pradhan
18
16.4
FHW
10
9.1
ASHA
20
18.2
AWW
15
13.6
Ward Member
21
19.1
SHG
07
6.4
GPA
09
8.2
Line Man (Jal Vibhag)
05
4.5
Teacher
04
3.6
MSG
01
0.9
TA B L E 2: RESP O N SE OF VHSNC M EMB ERS R E G ARD ING THEIR R OLES (N=93) *
Designation (no. of members responded)
Total
% of responses
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Roles of VHSNC
GP
(18)
FHW
(9)
ASHA
(16)
AWW
(12)
WM
(16)
SHG
(5)
GPA
(9)
JV
(4)
Teacher
(3)
MSG
(1)
(93)
Create awareness on Sanitation
2
0
2
0
1
0
0
0
0
0
5
3.0
Ensure there is no
Maternal /child death
0
0
1
0
0
0
0
0
0
0
1
0.6
Ensure immunization
is proper
1
0
1
0
0
0
0
0
0
0
2
1.2
Ensure supplementary
food
3
3
2
0
0
0
0
0
0
0
8
4.9
Arrange clean drinking Water
10
2
8
4
4
0
5
2
0
1
36
22
Clean village
Environment
18
9
16
12
16
5
9
4
3
1
93
56.7
Prevent epidemic
0
0
2
0
0
0
0
0
0
0
2
1.2
Help destitute women
4
3
4
2
0
0
1
0
0
0
14
8.5
Create awareness on Health Schemes
1
1
1
0
0
0
0
0
0
0
3
1.8
Total responses
*Multiple Response Table
164
100
TA B L E 3: YEAR O F LAST MEETIN G H ELD IN VARIOUS V HSNCS
VHSNC
Year of last meeting
1
No record found
2
2012
3
2013
4
2012
5
2012
6
2012
7
No record found
8
2012
9
2009
10
2013
11
2012
12
2013
13
2013
14
2013
15
2013
16
2013
17
2013
18
2012
TA B L E 4: THE ACTI V IT I ES PERFORM ED B Y V HS NC IN THE P A S T YEAR (N=41) *
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 25 / ISSUUE NO 04 / OCT DEC 2013 479
Activities
Designation (no. of members responded)
Total
(41)
% of
responses
GP
(17)
FHW
(3)
ASHA
(3)
AWW
(1)
CM
(8)
SHG
(1)
GPA
(6)
WD
(1)
Teacher
(1)
Cleaning & chlorinating tanks
10
2
1
1
4
1
2
0
1
22
25.3
Cutting shrubs
11
1
1
1
7
1
1
0
0
23
26.4
Constructing water tank
2
1
1
0
0
0
1
1
0
6
6.9
Cleaning drains
7
1
1
1
2
1
1
0
1
15
17.2
Maintaining roads
1
0
0
0
1
0
1
0
0
3
3.4
Repairing toilets
1
0
0
0
0
0
0
0
0
1
1.1
Purchasing First aid kit
1
0
0
0
0
0
0
0
0
1
1.1
Purchasing water filter
0
0
0
0
0
0
2
0
0
2
2.3
Spraying DDT
2
0
1
0
0
0
2
0
0
5
5.7
Distributing phenyl bottles
5
0
0
0
3
0
1
0
0
9
10.3
Total responses
*Multiple Response Table
87
100
... Similar to Uttarakhand and Tamil Nadu, over 3/4 th members of VHSNCs were females in the current study, which fulfill the criterion of GOI guidelines of having minimum 50% women members. [12,13] More representation of females in the studies across country is an encouraging sign and points toward more The majority (85.8%) of members in our study were general caste category while only few (14.2%) were from SC category and none from STs. A study conducted by Semwal et al. (2013) in Nainital district of Uttarakhand also showed that 70.9% participants belonged to general category, 27.3% belonged to SC category, and no member belonged to ST category. ...
... [12,13] More representation of females in the studies across country is an encouraging sign and points toward more The majority (85.8%) of members in our study were general caste category while only few (14.2%) were from SC category and none from STs. A study conducted by Semwal et al. (2013) in Nainital district of Uttarakhand also showed that 70.9% participants belonged to general category, 27.3% belonged to SC category, and no member belonged to ST category. [12] The reason behind no ST category member found in our study is that there are no tribes found in this region. ...
... A study conducted by Semwal et al. (2013) in Nainital district of Uttarakhand also showed that 70.9% participants belonged to general category, 27.3% belonged to SC category, and no member belonged to ST category. [12] The reason behind no ST category member found in our study is that there are no tribes found in this region. However, Chandigarh has the highest proportion of SC population (17%) among all Union Territories of India and ranks overall 8 th in India in terms of proportion of schedule caste, but their representation in VHSNC is quite dismal. ...
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Background: Village Health, Sanitation and Nutrition Committees (VHSNCs), one of the key interventions introduced by National Rural Health Mission, are an important mechanism to ensure community participation and ownership for decentralized health planning. Objectives: To assess the implementation status of VHSNCs and analyze the issues regarding their implementation in the villages of Chandigarh. Methods: A cross-sectional mix method study was conducted in the year 2015 in all 22 VHSNCs of Chandigarh. The data of VHSNCs' members were obtained using interview schedule and in-depth interview checklist, while record review checklist was used to assess functioning of VHSNCs. A scoring sheet was developed based on sociodemographic profile, public services monitoring, training status, untied funds utilization, and regularity of monthly meetings. The comparison of VHSNC indicators was done between villages under Panchayat and Municipal Corporation (MC). Results: Most VHSNCs' members are trained (except medical officers) and had their joint bank account (95.4%). Maximum fund is utilized for administrative purposes, leaving less for health and nutrition-related activities. Most villages (68.9%) got 25-30 score depicting that implementation status of VHSNCs under these villages is "promising," while one and six villages were "low performing" and "good performing," respectively. Public service monitoring indicator's implementation was better in villages under Panchayat as compared to those under MC. Conclusion: The performance of most villages having VHSNCs under Chandigarh was satisfactory. Few areas such as training of medical officers and supportive supervision of VHSNCs needs strengthening for achieving mandate of National Rural Health Mission regarding community ownership and decentralizing health sector.
... [9] The major chunk (65%) of the funds is utilized on the cleanliness activities which include cleaning of water sources like bawdis, wells and common village areas and clearing of bush and shrubs, etc., The main functions, therefore, according to all committee and community members were to clean the village areas, water sources, drains, etc., Semwal (2013) observed similar findings where they found that maximum responses were for cleaning village environment. [10] In a study by Ahmed (2017), Majority of the funds received by VHSNCs was utilized for sanitation and cleanliness of the village. [11] Provision of campers, chairs, tables, etc., to the AWCs was also done using VHSNC funds. ...
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Introduction: Decentralization through introduction of Village Health Sanitation and Nutrition Committees (VHSNCs) was a key initiative introduced in 2007 under the National Health Mission (NHM), India to address local health and sanitation issues. This study was done to assess the functioning of the VHSNCs. Aims and Objectives: 1. To assess the level of awareness among the VHSNC members about their roles and responsibilities 2. To assess the level of awareness among the community members about the committee and its functions. 3. To assess the pattern of disbursement and utilization of untied funds under VHSNCs. Methodology: A cross-sectional study of 30 VHSNCs conducted in district Kangra of state Himachal Pradesh. Information was collected through a review of records and in-depth interviews with community and VHSNC members. Results: All committee members knew about VHSNCs but the level of awareness among community members was comparatively less (67%). Some members were confused about their roles and responsibilities. Most active members were the FHWs, AWWs, ASHAs, Mahila mandal representatives, and the female ward panch. A major chunk (65%) of the funds is utilized on the cleanliness activities. For the nutritional part, the majority of the work is already being undertaken by the AWCs so there is no clarity regarding the functioning of the committee on this aspect.
... At the community level this is envisaged through the Village Health Sanitation and Nutrition Committees (VHSNC). Recent evaluations of VHSNCs revealed low awareness among members about their role and only few specified functions for decentralized planning and action were actually undertaken [18,19]. The PA documents call for a joining of forces by converging resources, skill and knowledge and outlines elements of engagement and specific contributions of a wide range of 'line departments' through the CAPs which is in sync with the WHO's call for 'grand convergence'. ...
Article
The Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages (PANChSHEEEL) project is a collaboration between University College London, Save the Children India, Jawaharlal Nehru University and Indian Institute of Technology Delhi to develop a socio-culturally appropriate, tailored, integrated and interdisciplinary intervention in rural India and test its acceptability for delivery through Anganwadi Centre (AWCs) and schools. Recognizing the socio-ecological determinants of under-nutrition, the POSHAN Abhiyan (POSHAN Mission) adopts a multi-sectoral approach to achieve five goals, of which two are directly related to children. The POSHAN Abhiyan resonates with the conceptual framework of the PANChSHEEEL study in its interdisciplinary scope and focus on local linka ges. This paper draws upon empirical evidence from the PANChSHEEEL Project in Banswara (one of the POSHAN mission districts), Rajasthan to help understand linkages between policy and practice, specifically the challenges of operationalizing 'convergence', the core strategy of the Abhiyan.
... [10,12] The study showed that though the meetings were held regularly, more than 70% attendance was seen in 40 (48.2%). Srivastava et al., [10] in her study, found that VHNSCs in the Eastern part of India struggled in arranging regular meetings with full attendance, whereas Semwal et al., [13] in his study, reported that among all 18 VHNSCs, meetings were organized irregularly. Regarding the members attending meetings, Pandey and Singh [14] reported that around 61% of ASHAs, 53% of the community members, and 41% of PRI members attended the VHSNC meetings; however, the present study also looked for participation of marginalized and vulnerable section which was only in 38 (45.8%) ...
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Background Community participation is one of the core principles of primary healthcare. The village health nutrition and sanitation committee (VHNSC), one of the elements in implementation of the National Health Mission (NHM), is an example of community participation. There are not many studies conducted to assess the actual participation of VHNSC in health-care delivery at the village level. Objective The objective of the study is to develop a VHNSC Maturity Index (VMI) and pilot it to assess the institutional maturity of VHNSC. Materials and Methods This community-based, cross-sectional study was conducted in 83 villages under four Primary Health Centres (PHCs) of the Wardha Community Development block. VMI was developed, Through several discussion sessions with VHNSC members and staff of the DCM; observations of VHND; attending VHNSC monthly meetings; the VMI was finalized after piloting it in all the four PHC areas. Results All the 83 VHNSCs were constituted as per norms led down under NHM. Forty-eight (57.8%) VHNSCs had developed an annual Village Health Action Plan, 72 (86.7%) VHNSCs had ≥4 meetings held in the past 6 months, and ≥70% attendance in the past 6 months was observed in 40 (48.2%) VHNSCs. A majority of 82 (98.8%) VHNSCs helped in organizing the village health and nutrition day, 59 (71.1%) VHNSCs monitored the implementation of national health programs. The entire untied fund received in the previous year was utilized by 68 (81.9%) VHNSCs. Conclusion The study shows that VMI can be used for continuous monitoring and assessment tool for VHNSC to evaluate and plan different health activities.
... According to Deepak abd Nayak, sufficient knowledge and skills about what he is doing, and be encouraging and reassuring to the victims must be equip in every first aider [17]. Numerous experts trust that in emergency situations, even a limited understanding of first aid would be an important service [18]. A little bit of knowledge and skill about basic first aid in emergency of bleeding, shock, sprain, snake bite, dog bite, and others should be have by almost everyone [17]. ...
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Having knowledge and awareness related to first aid in each individual person is important in terms of helping people in emergency situation since injuries are one of the leading causes of morbidity and mortality worldwide. On the other hand, first aid is the treatment for the purpose of preserving life and minimizing the consequences of injury and illness until getting help from a medical practitioner or nurse. Furthermore, some studies have found that individual person who equipped with adequate first aid knowledge had a positive impact on morbidity and mortality worldwide. Therefore, this literature review was aimed to evaluate the knowledge, awareness, and attitude related to first aid among university students. The finding of this literature showed that the level of knowledge, awareness, and attitude related to first aid among university students are varied and inadequate although they knew this course is important.
... The roles of VHSNC include development of the village health plan, monitoring of health activities in the village and having a comprehensive understanding of health related activities. Untied fund is also made available to VHSNC for various health activities including IEC, household survey, preparation of health register, organization of meetings at the village level etc. (Semwal V et al 2013) The NHM has provided guidelines for the framework, functions and responsibilities of these committees and has provided an 'untied fund' of rupees 10,000 per VHNSC per annum. It is expected that community leaders will participate in the governance and improvement of the health facilities of the area. ...
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The present study aims to assess the composition of VHSNCs; to assess the functioning of VHSNCs and find out the deviations, if any, from the prescribed framework of guidelines and, to understand awareness of VHSNC members about their roles. The proposed study is based on primary data collected with the help of structured questionnaire. The data was collected from one hundred Village Health Sanitation and Nutrition Committees in Punjab. Four districts of the Punjab state were selected randomly from each direction i.e North, South, East and West. The districts selected were Gurdaspur, Mansa, Mohali and Firozpur from North, South, East and West direction respectively. The study reveals that sampled VHSNCs in Punjab have 12 members per VHSNC. One-fourth of the chairpersons of the VHSNCs in Punjab were illiterate Only 23 per cent of the VHSNCs claimed to have prepared the village health plan. Meetings were organized on monthly basis in only half of the expected meetings per VHSNC. Large number of members was not attending the meetings organised by VHSNCs in Punjab. Majority of the funds received by VHSNCs was utilized for sanitation and cleanliness of the village. Majority of members were not aware about the components and objectives of VHSNC. All members reported that the untied fund is always helpful in solving the issues and problems of the village and the amount of untied fund given to VHSNCs should be increased.
... A mixed-methods study conducted in 2009 in the districts of Nainital and Udham Singh Nagar found that although such committees were functioning in the surveyed blocks, RKS members who weren't health personnel were not actively involved in decision-making and lacked clarity on their rights and responsibilities [18]. Similar findings were echoed by another study on the functioning of committees in two blocks of Nainital in 2012-13 [19]. ...
... VHSNCs are also to receive a yearly "untied fund" of Rs. 10,000 (US$150) to spend on local health needs as they see fit. Many committees, however, have been found to be largely inactive [21][22][23][24]. ...
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Health committees are a common strategy to foster community participation in health. Efforts to strengthen committees often focus on technical inputs to improve committee form (e.g. representative membership) and functioning (e.g. meeting procedures). However, porous and interconnected contextual spheres also mediate committee effectiveness. Using a framework for contextual analysis, we explored the contextual features that facilitated or hindered Village Health, Sanitation and Nutrition Committee (VHSNC) functionality in rural north India. We conducted interviews (n = 74), focus groups (n = 18) and observation over 1.5 years. Thematic content analysis enabled the identification and grouping of themes, and detailed exploration of sub-themes. While the intervention succeeded in strengthening committee form and functioning, participant accounts illuminated the different ways in which contextual influences impinged on VHSNC efficacy. Women and marginalized groups navigated social hierarchies that curtailed their ability to assert themselves in the presence of men and powerful local families. These dynamics were not static and unchanging, illustrated by pre-existing cross-caste problem solving, and the committee’s creation of opportunities for the careful violation of social norms. Resource and capacity deficits in government services limited opportunities to build relationships between health system actors and committee members and engendered mistrust of government institutions. Fragmented administrative accountability left committee members bearing responsibility for improving local health without access to stakeholders who could support or respond to their efforts. The committee’s narrow authority was at odds with widespread community needs, and committee members struggled to involve diverse government services across the health, sanitation, and nutrition sectors. Multiple parallel systems (political decentralization, media and other village groups) presented opportunities to create more enabling VHSNC contexts, although the potential to harness these opportunities was largely unmet. This study highlights the urgent need for supportive contexts in which people can not only participate in health committees, but also access the power and resources needed to bring about actual improvements to their health and wellbeing.
... VHSNCs are also to receive a yearly "untied fund" of Rs. 10,000 (US$150) to spend on local health needs as they see fit. Many committees, however, have been found to be largely inactive [21][22][23][24]. ...
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Background Health committees are a popular strategy for facilitating community participation in health, particularly in low- and middle-income countries. Their potential effects are mediated by a number of factors including the contextual environment in which they function. George and colleagues1 in 2015 put forward a framework that identifies four contextual spheres – porous and interconnect – that are most relevant to health committees: community, health facility, health administration and society. We apply this framework to an in-depth contextual analysis of an intervention to strengthen Village Health Sanitation and Nutrition Committees (VHSNCs) in rural north India, examining features in each sphere that influenced VHSNC outcomes. Methods Over the course of 18 months, 50 marginalised villages in a north Indian state received a government-designed and NGO-facilitated VHSNC support package, which included social mobilisation, VHSNC membership expansion, training and on-going facilitation for committee meetings and activities. Qualitative research through interviews (n=74), focus groups (n=18) and observation explored the contextual features that facilitated or hindered intensified community engagement by VHSNCs. Thematic network analysis enabled the identification and grouping of themes, and detailed exploration of sub-themes. Findings VHSNCs attempted to improve access to drinking water, expand immunisation coverage, secure nurses, doctors, and medical supplies for health centres, and improve the functioning of village schools and Anganwadi centres. Most action took the form of writing appeals to various government officials. Some VHSNCs contributed to concrete improvements, namely having a doctor re-posted to a health centre and enabling school children to access government benefits (free bicycles and a scholarship for orphans), and many people appreciated learning about health topics and health rights. However, success was modest within the period under study (12 months) and although VHSNC members appreciated some aspects of the intervention, there was also significant disappointment. Within the community sphere, VHSNCs were challenged by social hierarchies that prevented people from speaking out about local issues. Women's active participation was particularly curtailed by community concerns that village-level monitoring would disturb social harmony and gender norms. In addition, communities exhibited deep mistrust of government institutions, which made people wary of investing in VHSNC. Within the health facility sphere, VHSNCs were hindered by the severely under-resourced health system. VHSNCs faced a need for increased support to enable frontline health workers to facilitate their functionality. Within the health administration sphere, block-level health functionaries often lacked the power to respond to VHSNC requests – particularly so for hiring additional nurses and doctors to fill vacancies – leaving VHSNCs unsure of how to bring about much needed change. The chain of responsibility for aspects of VHSNC administration was opaque, which, for example, made it difficult for VHSNCs to identify why their INR 10,000 (USD 150) yearly untied fund was not released throughout the 18 months period. Furthermore, despite VHSNCs' inter-sectorial nature – working on health, sanitation and nutrition – they struggled to involve diverse government services and were only officially mandated by the Ministry of Health and Family Welfare. In the societal sphere, despite decentralisation reforms that empowered the locally elected system of government (Panchayat), many VHSNCs were still unable to engage the powerful elected representative (Sarpanch), and instead worked with the lowest-level elected representative (Ward Panch), who they considered powerless. Media engagement emerged as a potential avenue to effect change. The prevalence of market solutions to fill gaps in government service provision (such as private health care, schools and wells) reduced the willingness of some people to work on VHSNC activities, since they were already paying for private services. Discussion & recommendations Active facilitation by a dedicated NGO enabled VHSNCs to work with or overcome many community-level challenges to become functioning local bodies that took action to improve local health. The VHSNC-support intervention succeeded in its core elements of expanding committee membership through a participatory process, training VHSNC members, facilitating monthly meetings and helping VHSNCs to take local actions for health. Yet major contextual barriers at the community, health facility, administration and societal levels limited VHSNCs' capacity to improve local health services. We identify features of a supportive environment for VHSNCs. At the community level, VHSNCs would be bolstered by greater legitimacy through early successes, an emphasis on collaborative and supportive local monitoring, and focused capacity building for female engagement. At the health facility level, VHSNCs need minimally functional health services which to engage. Filling healthcare staff vacancies must therefore be a priority. On-going support and incentives for frontline health functionaries to facilitate VHSNCs would institutionalize the VHSNCs' functionality. VHSNCs would be more effective if they were able to understand clear pathways of accountability for services, so that VHSNC members know where to go to seek change. Making VHSNC support and funding a top-down responsibility rather than a bottom-up battle is vital for VHSNC sustainability. Finally, inter-sectorial coordination of health, sanitation and nutrition at higher levels of government would generate a more VHSNC-enabling context. At the societal level, VHSNCs would benefit from additional decentralisation of power, so that ward members can take village-level action, from the development of media engagement strategies, and at the broadest level, from robust public funding for universal health, nutrition and sanitation services so that no one has to rely on the private sector to secure the basic requirements for health and wellbeing. Grant funding (WHO's Alliance for Health Policy and Systems Research, Government of Canada's International Development Research Centre, National Health Systems Resource Centre) for research but no other competing interests
Article
The Government of India has adopted decentralization/devolution as a vehicle for promoting greater equity and supporting people-centred, responsive health systems. This article reports on our year-long intervention project in Karnataka, South India, and articulates insights of both practical and theoretical significance. It explores the intersection of the political goal of enhanced local level autonomy and the programmatic goal of more responsive health service delivery. Focusing on the Village Health, Sanitation and Nutrition Committees (VHSNCs) set up under the National (Rural) Health Mission (NHM), the project set out to explore the extent to which political and programmatic decentralization are functional at the village level; the consonance between the design and objectives of decentralization under NHM; and whether sustained supportive capacity building can create the necessary conditions for more genuine decentralization and effective collaboration between village-level functionaries. Our methodology uses exploratory research with Panchayati Raj Institution (PRI) members and functionaries of the Health Department, followed by a year-long capacity building programme aimed at strengthening co-ordination and synergy between functionaries responsible for political and programmatic decentralization. We find that health sector decentralization at the village level in Karnataka is at risk due to lack of convergence between political and programmatic arms of government. This is compounded by problems inherent in the design of the decentralization mechanism at the district level and below. Sustained capacity building of the VHSNC can contribute to more effective decentralization, as part of a larger package of interventions that (1) provides for financial and other resources from the district (or higher) level to political and programme functionaries at the periphery; (2) helps the functionaries to develop a shared understanding of the salience of the VHSNC in addressing the health needs of their community; and (3) supports them to collaborate effectively to achieve clearly articulated outcomes.
Article
World Health Organization's global goal of Health for All by the Year 2000 (HFA) and achievement of this laudable goal through the Primary Health Care (PHC) approach has been accepted unanimously by participant countries of the Alma-Ata Conference in 1978. Turkey is also among the countries that showed their approval to the concept. However, that approval of the policy did not generate particular attention among the policy-makers until the 1990s. The year 1990 can be regarded as a watershed in the Turkish health policy-making environment as attempts at producing a National Health Policy document that centred around the global goal of HFA and PHC commenced. This paper aims at discussing the commitment of Turkey to one of the prerequisites of the approach, or heart of the PHC as regarded by some: community participation. After a brief presentation of community participation the Turkish commitment to the concept is analyzed based on a research carried out among Turkish health policy-makers. It is concluded that the prospect for community participation in Turkey does not look good mainly because of the medical approach adopted by the policy-makers. The need for more discussion of the topic among the academic circles has been emphasized.
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