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01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Public Health 1/2016

Are village health sanitation and nutrition committees fulfilling their roles for decentralised health planning and action? A mixed methods study from rural eastern India

Zeitschrift:
BMC Public Health > Ausgabe 1/2016
Autoren:
Aradhana Srivastava, Rajkumar Gope, Nirmala Nair, Shibanand Rath, Suchitra Rath, Rajesh Sinha, Prabas Sahoo, Pavitra Mohan Biswal, Vijay Singh, Vikash Nath, HPS Sachdev, Jolene Skordis-Worrall, Hassan Haghparast-Bidgoli, Anthony Costello, Audrey Prost, Sanghita Bhattacharyya
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AS was responsible for drafting the article. AP helped in the literature search to identify similar articles and contributed to drafting, reviewing and editing the article. SB also contributed to drafting and reviewing of the article. RG, ShR, SR, PS, PMB, VS, VN, AS and SB contributed to field data collection and analysis. NN, RS, HPSS, JSW, HHB and AC contributed to reviewing and editing the manuscript. All authors read and approved the final manuscript.

Abstract

Background

In India, Village Health Sanitation and Nutrition Committees (VHSNCs) are participatory community health forums, but there is little information about their composition, functioning and effectiveness. Our study examined VHSNCs as enablers of participatory action for community health in two rural districts in two states of eastern India – West Singhbhum in Jharkhand and Kendujhar, in Odisha.

Methods

We conducted a cross-sectional survey of 169 VHSNCs and ten qualitative focus group discussions with purposively selected better and poorer performing committees, across the two states. We analysed the quantitative data using descriptive statistics and the qualitative data using a Framework approach.

Results

We found that VHSNCs comprised equitable representation from vulnerable groups when they were formed. More than 75 % members were women. Almost all members belonged to socially disadvantaged classes. Less than 1 % members had received any training. Supervision of committees by district or block officials was rare. Their work focused largely on strengthening village sanitation, conducting health awareness activities, and supporting medical treatment for ill or malnourished children and pregnant mothers. In reality, 62 % committees monitored community health workers, 6.5 % checked sub-centres and 2.4 % monitored drug availability with community health workers. Virtually none monitored data on malnutrition. Community health and nutrition workers acted as conveners and record keepers. Links with the community involved awareness generation and community monitoring of VHSNC activities. Key challenges included irregular meetings, members’ limited understanding of their roles and responsibilities, restrictions on planning and fund utilisation, and weak linkages with the broader health system.

Conclusions

Our study suggests that VHSNCs perform few of their specified functions for decentralized planning and action. If VHSNCs are to be instrumental in improving community health, sanitation and nutrition, they need education, mobilisation and monitoring for formal links with the wider health system.
Literatur
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