Village Health & Sanitation Committee Dr. Suraj Chawla Department of Community Medicine, PGIMS, Rohtak
CONTENTSBackgroundComposition of VHSCRoles & ResponsibilitiesGrants availableUtilisation of untied grantAccountabilityEvaluation of VHSCsChallenges in empowerment of VHSCsRecommendations for capacity building andempowerment of VHSCs
BACKGROUNDDecentralisation and Peoples Participation havebeen considered key strategies for makinghealth care services effective and this has beenhighlighted in all significant documentsarticulating peoples rights to health such as theAlma Ata Declaration, the Bhore CommitteeReport and, most recently, the documentspertaining to the NRHM.It is widely understood and accepted that forservices to maintain quality and to be effective;people must have ownership and control.
BACKGROUNDThough in practice peoples participation hasbeen narrowly interpreted as their participationin implementation, ownership can only truly bebrought about by their participation and controlover all processes leading to the delivery ofservices, starting from planning itself.One of the modalities of allowing local, villagelevel planning for health care has been theconcept of the “Village Health & SanitationCommittee”.
BACKGROUNDThe NRHM places significant focus on creatingand supporting Village Health Committees(VHCs) to promote decentralization.The VHC is intended to be a part of the localself-governance structure of the Panchayati RajInstitutions specifically the Village Council calledthe Gram Sabha.The purpose of the VHCs is to build andmaintain accountability mechanisms forcommunity-level health and nutrition servicesprovided by the Government.
BACKGROUNDThough systems of decentralised governancesuch as the PRIs and Community participation inlocal health planning have both been slow totake off and weak, in the few places where theyhave been made functional through variousmechanism (such as in the State of Kerala), theirrole in providing the impetus for positive andsustainable change cannot be denied.
COMPOSITION OF VHSC Gram Panchayat members from village ASHA, Anganwadi worker, ANM SHG leader Village repersentative of any Community-Based Organization working in the village Secretary of primary teacher associationIf none of the above is a member of SC & ST, thenone member from each category should also benominated by the Sarpanch or Mukhiya.
COMPOSITION OF VHSCTo enable the VHSC to reflect the aspirations ofthe local community especially of the poorhouseholds and women, it has been suggested that: At least 50% members of 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.
COMPOSITION OF VHSCA provision of at least 30% representation fromthe Non-governmental sector.Representation to womens self-help group toenable the Committee to undertake womenshealth activities more effectively.
COMPOSITION OF VHSCChairperson: 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.
COMPOSITION OF VHSCChairperson: 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, and if the Sarpanch is a woman, she will be the Chairperson of the committee.
COMPOSITION OF VHSCConvenor: Convenor of the VHSC would be ASHA; where ASHA would not in position it could be the Anganwadi worker OR ANMConvenor can vary in different states as per statehealth department guidelines.
ORIENTATION & TRAININGEvery VHSC after being duly constituted will beoriented and trained to carry out the activitiesspecific to the villages to meet the NRHM goals.Objectives: To develop VHSC as a strong vibrant group To develop understanding regarding health issues Empower the VHSC members Strengthen the group to work
ROLE OF VHSCTo discuss the problems of the community andthe health and nutrition care providers andsuggest mechanism to solve itTo create awareness in the village aboutavailable health services and their healthentitlementsTo develop a Village Health Plan based on anassessment of the situation and priorities of thecommunity
ROLE OF VHSCTo analyse key issues and problems pertaining tovillage level health and nutrition activities andprovide feedback to relevant functionaries andofficialsTo monitor all the health activities that areconducted in the village such as Village Health &Nutrition Day, mothers meeting etc.To maintain a village health register, healthinformation board and calendar
ROLE OF VHSCTo oversee the work of village health andnutrition functionaries such as the ANM,Anganwadi Worker (AWW) and ASHA and tobe involved in managing the local sub-centre,which is accountable to the Gram Sabha.To discuss the bimonthly village report submittedby ANM in the village level meeting and takeappropriate action.
ROLE OF VHSCTo discuss every maternal or neonatal deaththat occurs in their village, analyse it and suggestnecessary action to prevent such deaths. (DeathAudit) Get these deaths registered in thePanchayat.T0 organize regular monthly meeting to discussvarious issues in the village and document theminutes of the meeting.The VHSC will also play vital role for selectingand supporting the ASHA from the community
ROLE OF VHSCThe committee shall ensure that Public Dialogueis organized at regular intervals (once in sixmonth) in the presence of MO of the PHC.The committee shall ensure that all the issuesdiscussed are recorded and action taken on theissues discussed.To present an annual health report from thevillage to the Gram Sabha.
ROLE OF CHAIRPERSONThe Chairperson have the powers to call for andpreside over all meetings.May himself/herself call, or by a requisition inwriting signed by his/her, may require theconvener to call a meeting of this committee atany time and on the receipt of such requisition,the convener shall forthwith call such a meeting.Authority to review periodically the workundertaken at the village level and orderinquiry regarding complaints of theimplemented programme.
ROLE OF CONVENORTo convene the meeting of the VHSC.To ensure participation of all members in themeeting.To record the meeting proceedings, maintaincash book, provide monthly reports andfinancial report to MO of concerned PHC.To facilitate the village health plan.She will be assisted by the ASHA in all activities.
GRANTSEvery village with a population of upto 1500 toget an annual untied grant of up to Rs. 10,000,after constitution and orientation of VHSC. Thisuntied fund will be deposited in a joint accountof Convenor and Chairperson of the committee.In addition, each sub-centre will also have anuntied fund for local action of Rs. 10,000 perannum. This fund will be deposited in a jointbank account of the ANM & Sarpanch andoperated by the ANM, in consultation with theVillage Health Committee.
UNTIED FUNDThe untied fund is a resource for communityaction at the local level and shall only be utilizedfor community activities that involve andbenefit more than one house hold.The committee will utilize the fund after takingresolution in the VHSC monthly meeting andalso share the information of utilization of fundwith the villagers during village meeting orpublic dialogue.The committee will not withdraw the totalamount of Rs. 10,000/- at one go.
UTILISATION OF UNTIED FUND The fund can be utilized for village level activities such as Cleanliness and sanitation drive School health activities Transferring the patient to health facilities Health awareness activities House hold surveys Improving the facilities of the Anganwadi Centre and any other developmental activities for the village/community.
UTILISATION OF UNTIED FUND The fund can be utilized for arranging all the essential instrument required in organizing Village Health & Nutrition Day by the ANM, such as BP instrument Weighing machine Examination table Screen for maintenance of privacy during health check up
UTILISATION OF UNTIED FUND For arranging the tea/snacks for the gathered women, children and other beneficiaries during the Village Health & Nutrition Day. For providing Rs.100/- to ASHA for organizing monthly Village Health & Nutrition Day. The committee will contribute on behalf of 10 poor BPL families in a year @ Rs. 300/- for allotment of sanitary latrine under Total Sanitation Campaign
UTILISATION OF UNTIED FUND For wall writing of slogan on health and sanitation For making signboard in the meeting place of VHSC. During emergency like flood or any epidemic the committee will utilize the fund for the relief camps or supplies such as in case of flood it can supply Halogen tablet for purification of water, ORS, Bleaching powder etc.
ACCOUNTABILITYThe ASHA/AWW should maintain a registerwhere complete details of activities undertaken,funds received and expenditure incurred are tobe mentioned.The register should be available for publicscrutiny and should be periodically reviewed bythe ANM/MPW/Sarpanch/MO I/C.The committee will maintain accounts andtimely submit the utilization certificate andstatement of expenditure for the moneyreceived to the Primary Health Centre.
REPORTINGMonthly financial report of VHSC is submitted byANM to MO of PHC.PHC - monthly compilation by LHV/ accountant– submission to SMOBlock – monthly compilation by accountant andsubmission to district from where it is submittedto state level.
MONITORINGPHC level: ASHA Facilitator, MO and LHV are responsible. Constitution of VHSCs Organizing monthly meetings Providing Support in training Facilitation in development of VHP Facilitation in conflict redressal
MONITORINGBlock level: SMO and BPM are responsible. Providing Support to PHC functionariesDistrict level: CMO and DPM are responsible Making data base and profile of VHSCs Facilitation in development of VHP Facilitating monthly meetings Address the issue raised identified by VHSC
MONITORINGState level: State health department/ health mission is responsible. Provide Support and training modules
INSTITUTIONAL STRENGTHENING Target: To constitute Village Health and Sanitation Committee in all 6.38 lakh revenue villages of India Efforts so far: 4.98 lakh VHSCs have been already constituted and provided Rs 10000 as untied fund (As on 31st Dec. 2010) Source: NRHM Progress so far 2011 (MOHFW)
HARYANA SCENARIOTo enable the realization of “communitisation”at the grassroots, state health department underNRHM guidelines directed the district healthadministration to constitute VHSCs in villagesunder the Gram Sabha.In Haryana, before constitution of the VHSCs,the Village Level Committees (VLCs) wereconstituted and were being administered byWomen and Child Department through ICDSwith Anganwadi Worker (AWW) as its convener.(Sept. 2006)
HARYANA SCENARIOInitially, VHSCs were constituted as a separatebody and was administered by District HealthDepartment through District Hospital withAuxiliary Nurse Midwife (ANM) as its convener.Later, as the roles and responsibilities of both theCommittees were similar, the VHSCs weremerged with the VLCs and committee wasrenamed as VLC-cum-VHSC.
HARYANA SCENARIOThe VLC-cum-VHSCs are now administered byWomen and Child Department. AWW is theconvener of this Committee.Funds under NRHM meant for VHSC aretransferred into bank accounts of VLC cumVHSC.Funds will be deposited into these accountsdirectly from district office of the Civil Surgeon.
HARYANA SCENARIOHowever, it has been observed that the fundsprovided by NRHM for health related activitiesare either not being utilized properly due toreluctance on the part of AWWs or are beingmisused in some instances.Therefore, for ensuring proper utilization of thesefunds, it is proposed to make a healthfunctionary, namely ANM, the joint accountholder of this account alongwith the AWW &Head of VLC cum VHSC.
HARYANA SCENARIOAnnual audit of VHSC funds under NRHM incoordination with Department of Women &Child Development is required to be done.VLC cum VHSC nominates one member tomaintain a separate cash book of funds givenunder NRHM, who is paid Rs 100/- per monthfor maintaining this cash book, out of the untiedfunds available with VHSC.As on 31st Dec 2010, 6280(93%) VLC-cum-VHSCshave been formed in the State of Haryana.(Source mission flexipool 2011: NRHM)
FOURTH COMMON REVIEW MISSION REPORT 2010: VHSCs are formed and functional in all villages of Assam, Maharashtra, Kerala and Orissa, 97% of villages in Chhattisgarh, in 50% of villages in Arunachal. They are formed but poorly functional in Assam, Uttarakhand, Uttar Pradesh, Rajasthan and Madhya Pradesh. However, VHSCs seem to have little role in conducting and monitoring VHNDs or advocating expansion of scope of these opportunities.
FOURTH COMMON REVIEW MISSION REPORT 2010: VHSCs are uniformly lacking in clarity about their mandates. This is seen even in Assam where a special orientation was conducted for members. The spirit of representing marginalized and vulnerable sub-sections in the Committee is absent, especially in Punjab and MP.
EVALUATION…Report on Capacity-Building Needs: VLC cum-VHSC ( Published in July 2010) A study was conducted by Institute of Rural Research and Development (IRRAD) in 13 villages of four blocks (Taoru, Nagina, Nuh and Firozpur Zhirkha) of Mewat to assess the effectiveness of currently constituted VLC-cum- VHSCs. Data was collected from members of the VLC- cum-VHSC
EVALUATION…Study revealed that the efficiency and impact ofVLC-cum-VHSC appears to be very limited.More than 50% of the VLC-cum-VHSC membershave inadequate knowledge about theconstitution of VLC-cum-VHSC, their roles andresponsibilities and entitlements andGovernment schemes on Health.No formal training has ever been provided tothem before being made VLC-cum-VHSCmembers
EVALUATION…There is no involvement of members in budgetplanning and subsequent expenditure. They arenot even aware of the annual grant given to theCommittee for various activities.The VLC-cum-VHSC meetings and activities arenot organized as stipulated in the guidelines andthe participation of members in these meetingsand activities, whenever conducted, isinsignificant.
CHALLENGES IN EMPOWERMENT OF VHSCs Illiteracy of VHSC members Lack of interest of PRI members Improper fund flow Lack of co-ordination among village health and nutrition workers Lack of accountability Negligible participation of other women of community
RECOMMENDATIONS FOR CAPACITY BUILDING & EMPOWERMENT
CAPACITY BUILDING & EMPOWERMEMTTo ensure effective functioning of VLC-cum-VHSC in the villages as stipulated in theguidelines, it is mandatory to design andconduct a capacity-building program tocapacitate and empower VLC cum-VHSCmembers and ensure their participation.Simultaneously, awareness generation activitiesabout the functions of the committee would beconducted in the villages to make thecommittee accountable to the villagecommunity.
CAPACITY BUILDING & EMPOWERMEMTThe program should aim at reviving andstrengthening the VLC-cum-VHSCs to empowerthem to access health entitlements for thecommunity and ensure quality health for all inthe villages.Training program should be designed toaccommodate the needs of the members.The training should specifically focus onincreasing the participation of illiterate membersand organizing activities as per the guidelinesand utilization of funds allotted.
CAPACITY BUILDING & EMPOWERMEMTTraining areas Concept of Health Health institutions and programmes Social aspect impacting health status Demand generation of health care services Planning and monitoring Team building Operational issues Roles and responsibilities