Sanitation program in the Indian village

Village health and sanitation committee

Introduction

Decentralization and People’s Participation have been considered key strategies for making health care services effective and this has been highlighted in all significant documents articulating people’s rights to health such as the Alma Ata Declaration, Bhore Committee Report, and, most recently, documents pertaining to the NRHM.

The NRHM is mandated to enlarge the ownership and management of health services beyond public health functionaries and involve common people. To enable the realization of this vision at the grassroots, NRHM guidelines direct the District Health Administration to constitute Village Level Health Committees (VLC) Village Health and Sanitation Committee (VHSC) in villages under the Gram Sabha. The Committee is entrusted with the responsibility of enhancing people’s participation in improving health care services in the rural areas by increasing awareness about health and health entitlements with a special focus on women and children.

Objectives of the VHSNC

1. To provide an institutional mechanism for the community to be informed of health programs and government initiatives and to participate in the planning and implementation of these programs, leading to better outcomes.

2. To provide a platform for convergent action on social determinants and all public services directly or indirectly related to health.

3. To provide an institutional mechanism for the community to voice health needs, experiences, and issues with access to health services, such that the institutions of local government and public health service providers can take note and respond appropriately.

4. To empower panchayats with the understanding and mechanisms required for them to play their role in the governance of health and other public services and to enable communities through their leadership to take collective action for the attainment of better health status in the village.

5. To provide support and facilitation to the community health workers — ASHA and other frontline health care providers who have to interface with the community and provide services.

Composition of VHSC

· Lady Sarpanch/Panch to be nominated by Village Panchayat -Chairperson

· All Mahila punches in the village.

· One Lady School teacher deputed by Headmaster. (preferably in the same village)

· Multi-Purpose Health Worker. (Female)

· All ASHAs, All Anganwadi Workers (AWW), Pradhan of Sakshar Mahila Samooh, (SMS)

· Self Help Group leader from each Self Help Group. (SHG)

· Three most educated adolescent girls out of which at least one should be from a scheduled caste.

· Representative of NGO/ Social Activist Working in the village.

· Representative of public health/drinking water department in-charge of the village Representative of War Widows, Village Chowkidar,

· Any other member with permission of VLC.

· To enable the VHSC to reflect the aspirations of the local community especially of the poor households and women, it has been suggested that: At least 50% of members of the Committee should be women. Every hamlet within a revenue village must be given due representation to ensure that the needs of the weaker sections especially SC / ST and Other Backward Classes are fully reflected in the activities of the committee. A provision of at least 30% representation from the Nongovernmental sector. Representation to women’s self-help group to enable the Committee to undertake women’s health activities more effectively.

Chairperson

The committee will be headed by the ward member of the village.

· If there is more than one ward member in the village: The woman ward member will head the committee.

· If there is no woman ward member existing, male ward member belonging to SC or ST will head the committee.

· If more than one women ward members or no women ward members are available in the village, the ward member of the larger ward will head the committee. Wherever there is a Panchayat consisting of one revenue village only,

· if the Sarpanch is a woman, she will be the Chairperson of the committee.

Role of Chairperson

The Chairperson has the power to call for and preside over all meetings.

Authority to:-

· review periodically the work undertaken at the village level and

· order inquiry regarding complaints of the¡ implemented program.

Convenor

The convenor of the VHSC would be ASHA; where ASHA would not in the position it could be the Anganwadi worker OR ANM Convenor can vary in different states as per state health department guidelines.

Role of convenor

· To convene the meeting of the VHSC.

· To ensure the participation of all members in the meeting.

· To record the meeting proceedings, maintain cash book, provide monthly reports and financial reports to MO of concerned PHC.

· To facilitate the village health plan.

· She will be assisted by the ASHA in all activities.

Accountability

· The ASHA/AWW should maintain a register where complete details of activities undertaken, funds received and expenditure incurred are to be mentioned.

· The register should be available for public scrutiny and should be periodically reviewed by the ANM/MPW/ Sarpanch/ MO I/C.

· The committee will maintain accounts and timely submit the utilization certificate and statement of expenditure for the money received to the Primary Health Centre.

Reporting

· Monthly financial report of VHSC is submitted by ANM to MO of PHC.

· PHC — monthly compilation by LHV/ accountant — submission to SMO

· Block — monthly compilation by accountant and submission to the district from where it is submitted to the state level.

Monitoring

· PHC level:

ASHA Facilitator, MO, and LHV are responsible.

· Block level:

SMO and Block Programme Manager are responsible.

· State level:

The state health department/ health mission is responsible.

Grants

· Funds are allotted by the State Health Department.

· Every village with a population of up to 1500 to get an annual untied grant of up to Rs. 10,000 after constitution and orientation of VHSC.

· This untied fund will be deposited in a joint account of Convenor and Chairperson of the committee. The untied grant to be used by this committee for household surveys, health camps, sanitation drives, revolving funds, etc.

· VLC cum VHSC nominates one member to maintain a separate cash book of funds given under NRHM, who is paid Rs 50/- per month for maintaining this cash book, out of the untied funds available with VHSC.

Convergence

· VHSC — the convergence of various depths. Like health, Women and Child development, education, and PRIs (Panchayati Raj Institutions).

· Civil Surgeons will initiate and coordinate with Programme Officers (ICDS) and ensure that untied funds meant for VHSC are immediately transferred into the bank account of VLC cum VHSC.

· Annual audit of VHSC funds under NRHM will be carried out in coordination with the Department of Women & Child Development.

Conclusion

Preliminary results indicate that 29% (6554/22 824) of the Indian villages instituted VHSC by 2008. Households in VHSC villages are more likely to seek modern care and visit health facilities than are those in non-VHSC villages. VHSC participants are significantly more likely to visit modern health facilities when their children are sick with either fever or diarrhea. In-facility births are also higher in the treated villages after controlling for socioeconomic confounding variables. The percentage of women seeking antenatal and postnatal care is also higher in VHSC villages than in non-VHSC villages. All these results are statistically significant at the 95% level, although data are preliminary.

References

· NRHM. Ministry of Health and Family Welfare Government of Haryana. Panchkula. VLC-VHSC Guidelines. May 09.

· Institute of Rural Research and Development® Report on Capacity-Building Needs Village Level Committee-cum-Village Health and Sanitation Committee. July 2010.

· NRHM. Ministry of Health and Family Welfare Government of India. New Delhi. Update on the ASHA Programme. July 2011.

· Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA (S Kumar Ph.D.); and Department of Economics, University of Connecticut, Storrs, CT, USA (N Prakash Ph.D.)