Objective="Community ownership of government healthcare."
Details for Reform Option "Village Health Committees, Jharkhand"
Jharkhand is predominantly a rural state with 40% of the population belonging to Scheduled Castes (SCs) and Scheduled Tribes (STs). There are 32,628 villages and nearly 20,000-odd hamlets (Tolas) spread across a variety of topography in the state. Most of these villages are inaccessible due to reasons that are both natural and man-made. With limited infrastructure and scarce human resources, the government health system is unable to reach services to all these villages. Effective monitoring of the existing healthcare delivery system is also very difficult due to inaccessibility.
It was felt, therefore, if the community could be involved in the system and it if it could be made to own the system, that would go a long way towards improving service delivery in the state. Formation of Village Health Committees (VHCs) in each village or tola was one of the initiatives on this front. Partner NGOs (initially 10 in number), working in the area, facilitated the formation of VHCs and helped to identify a female village health link worker. This link worker in Jharkhand is called Sahiyya, which in the local dialect means friend. Sahiyya is also Jharkhand’s equivalent of the village level Accredited Social Health Activist (ASHA), recommended by the National Rural Health Mission (NRHM).
VHC is a people’s body. It comprises adult members selected by the Gram Sabha at a public meeting of the villagers. In order to facilitate the process of VHC formation, a facilitator is chosen from the partner NGO or village by a team under the leadership of Block Medical Officer. The facilitator can be a member of a Non Government Organisation (NGO) working in the area or an active youth. A facilitator is given orientation training in community mobilisation and VHC formation. He then organises a Gram Sabha meeting; all households are reminded a second time about the meeting, three days prior to the meeting, so as to ensure maximum participation by villagers. Thus the Gram Sabha members choose VHC members through a democratic process. The main role of the facilitator is to act as a link person between the government health system and the VHC.
The VHC acts as an apex community-based health and sanitation body in the village. Training is also given to the VHC members to prepare Village Health Plans (VHP). Village Health Plans are made in consultation with the village community.
Normal tenure of VHC members is two years. VHCs meet every month to evaluate their own and Sahiyya’s performance. Disciplinary actions can be taken against VHC members who are absent at 5 consecutive meetings or if majority of the members feel that he/ she is a non-serious member.
VHCs are encouraged to raise resources in the form of voluntary contributions in cash or kind from every household to the Village Health Kosh (VHK). The purpose of this village health fund is to meet the recurring expenses and to undertake collective community initiatives like cleaning of common wells, repairing village hand pumps, organising health camps and paying honorarium to Sahiyya. To manage the VHK, members select one of its members as treasurer. The statement of income and expenses are displayed before the Gram Sabha every year.
The prime role of the VHC is to identify the health needs of the community and to generate awareness on health issues. It formulates local implementation plans for the public health programmes in consultation of the Auxiliary Nurse Midwife (ANM) and Anganwadi Workers (AWWs). VHC also supervises and supports the activities of the Sahiyya (For details, please see entry on Sahiyya, PROD ref no 153).
As on 1 July 2006, there are nearly 3000 Sahiyyas and 2000 VHCs in place. Plans are that on average 800 VHCs will be formed every month. It has been observed, villages which have a VHC and Sahiyya the community is more aware of its entitlements under various health programmes; the demand for quality of services has also increased in such villages.
Approximate cost involved for the formation of VHCs, identification of Sahiyyas, 21-day training for Sahiyyas (8 modules), Training for VHC members, etc is INR 4 lakh (400,000) per block
Started in 34 blocks of 6 districts—Ranchi, Hazaribagh, Gumla, Jamtara, East Singhbhum, Seraikela Kharsawan.
Approximate time frame from planning to implementation is one year, following a pilot project in Ranchi district.
Community ownership: Community involvement in managing its own healthcare needs enhances ownership.
Increased demand: Raised awareness for the services increases the demand for them.
Community monitoring: Effective monitoring mechanism at village level.
Voluntary involvement: Mobilising the community for voluntary involvement in government programmes is difficult task.
Training: VHC members and Sahiyyas need training to identify their own health needs and to prioritise them to make an action plan.
Committed government officials.
Clear policies and guidelines.
Who needs to be consulted
NGOs and Faith-Based Organisations.
Concerned government officials.
Community leaders and facilitators.
Highly sustainable since it functions on community contributions and voluntary participation.
Chances of Replication
Replicable especially in low-performing states.
When resources are limited and services need to be delivered to the people, involving community to manage their own healthcare needs is the way to enhance their ownership in the system.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, May, 2006.