Objective="Community management of health services."
Details for Reform Option "Village Health Committees, Karnataka"
Despite a ruling by the Government of Karnataka that health workers form a 8-10 member Sub-centre Health Advisory Committee to support its health activities (under the India Population Project-IX), none had been formed because of a lack of training.
The Foundation for Research in Health Systems (FRHS) undertook a research project exploring ways of involving the community in Reproductive and Child Health (RCH) with decentralised planning.
It tried out a new concept of health committee in terms of structure, formation process and role. Its project implementation process began with a baseline survey, followed by committee formation.
Health committee members were selected by three methods: the Gram Sabha (an open village meeting for adults), the health workers, the Panchayat Raj: one member from clusters of 50-60 households in the village, with about equal representation of men and women. These members selected their committee president and secretary from among themselves.
The committees' role was to:
(i)participate in identifying people’s health needs and develop activity plans
(ii) to foster trust and understanding between community and health staff
(iii) to create health awareness and demand for new health services.
The project provided five inputs to facilitate committees’ functioning:
(i) Community facilitators (CF) who helped to form committees and motivated them to undertake village level activities (7 in all, one CF for two PHCs).
(ii) Start-up grant of INR 2000 per committee. Money spent had to be accounted for.
(iii) Identity cards to legitimise the committee members’ role and boost their status in the community.
(iv) Presidents meetings were organised at block level to give them an opportunity to share experiences among themselves and with district and state level health officers.
(v) A monthly newsletter, Arogya Midita (Health Pulse) to help motivate committees to organise more and better programmes.
The project was evaluated by doing a baseline survey at the beginning and an endline survey at the end of two years.
Health committees were formed in all the 64 rural sub-centres in the block. At the end of the two-year project (June 2002), nearly 90% of the committees were active.
They had conducted various health awareness and service camps and other health-related activities, some involving other Community-based Organisations (CBOs) and NGOs and others using local funds.
Cost of committee activities:
The total investment was INR 92,500.
The committees were able to spend INR 21,118.
They could mobilise INR 48,433 in cash and kind and create a savings of INR 71,382 for future expenditure.
Three additional cost items were: newsletter: INR 2,000 (€36)/per month, facilitators' salary (INR 5000(€89)/month/PHC) and Taluk (block) level committee presidents' meeting (INR 15,000(€322)/per year/Taluk).
For upscaling, it was proposed that the block extension educators could play the facilitators' role, therefore there would be no additional cost to the government. District could also use existing health newsletter without additional cost and presidents' meetings could be integrated with Taluk level officers' meeting.
The cost of the research project was approximately 25 lakh (€44,725) for two years (including researchers' salaries, base and end line surveys, dissemination workshops and the cost of all items mentioned above.)
The project started in July 2000 and ran for two years in Hunsur Block of Mysore District, Karnataka.
Three months to set up 28 comittees.
The project took about 8 months to start up the first half of the committees (set up under three different methods of committee formation). This also included the time taken for the baseline survey.
The second half (which built on the experiences of the first phase) took another 3 months.
Complementary: Committees have demonstrated their potential to play a complementary role to that of the government in providing preventive and promotive health services to the community, particularly to vulnerable groups like the very poor, elderly and adolescents.
Community led: Community selects members.
Demand creation: For RCH services.
Convergence: Their ability to network with other CBOs indicates that they can bring about convergence of various development activities at grassroots level.
Integration essential: If committees are seen as an independent initiative of civil society and cannot be integrated into the government system, then this might pose a threat to their sustainability.
Possible opposition: From government health staff who might view committees as yet another layer of "supervisors". The gram panchayat may also see committees as usurping their role as "watch dogs".
The five project inputs (see summary above). Initial facilitation by an NGO is also required.
Who needs to be consulted
Government health staff at district and state level, Gram Panchayat, NGO
Sustainable if the government recognises the committees as independent and doesn’t curb their initiative.
Chances of Replication
Replicable because community participation is a government policy and forming health committees is not expensive.
The project was funded by the Frontiers Group of the Population Council, New York.
Dr. Nirmala Murthy, Foundation for Research in Health Systems. August 2004.