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The “Ten-thousand Committee”: Reviving VHSNCs in Jharkhand
Oommen C Kurian and Savvy Soumya Misra
A campaign vehicle in Kuchu village as part of Campaign against Child Marriage and Anemia. Photo © Sanjay Sarangi of CINI
Activation of Village Health and Sanitation Committees (VHSNC) improve health.
‘Dus Hazaar wala samiti’- this is how people in Olattu refer to their VHSNC now. Olattu is a village in Ranchi, Jharkhand, a state that did not have any panchayat elections till 2010. The Panchayati Raj Institutions (PRI), thus, are in a nascent stage at the moment and bringing the VHSNCs on track was a challenge.
Dormant for many years, the committee – a community based monitoring system under the National Rural Health Mission (NRHM) – was activated after intervention by Child In Need Institute (CINI) and Oxfam India in some parts of the state.
There was palpable excitement and a strong sense of collective well-being about the samiti. The term ‘Dus Hazaar wala samiti’ comes from the planning exercise around the untied funds of Rs 10,000 available with VHSNC; the committee does the planning and the Gram Sabha executes it.
The village has become so involved now that though the money isn’t regular (the money for year 2014 hadn’t arrived till December) the gram sabha and the women self help groups (SHGs) chipped in with finances to conduct planned activities.
During a visit to Hazaribagh, Sudama Devi, a member of VHSNC steers the conversation to an eight-month-old baby sleeping in her mother’s lap. It was a complicated delivery and the baby had to be put on a ventilator. The committee had an emergency meeting and decided to fund the treatment — not just by using the untied funds but also by individual contributions from all 22 members.
The Mukru village VHSNC, of which Sudama is a part of, hasn’t received funds for 2014 but they have raised resources through fund collection; the funds have been used to buy chairs for the anganwadi, a weighing machine and two big cotton mats.
According to the latest Jharkhand Economic Survey, the state has the second highest proportion of poor (using the official Below Poverty Line) at 37 per cent, significantly higher than the national average of 21.9 percent. Chhattisgarh has the highest BPL population at 39.93 per cent. Health indicators of the state have improved in the last few years — Infant Mortality Rate (IMR) has declined from 48 (per 1000 live births) in 2007 to 38 in 2012; Maternal Mortality Ratio (MMR) reduced to 219 (per 100,000 live births) in 2010-12 from 261 (per 100,000 live births) in 2007-09i .
Despite the improvement, critical gaps remain. Primary healthcare in the state is in disarray; there is a shortfall of over 65 per cent in Public Health Centres (PHCs), 35 per cent in sub-centres and 22 per cent in Community Health Centres (CHCs). Only about half of the eligible women in the state deliver births in safe conditions – either in health institutions or in presence of trained health providers. Only 70 per cent of eligible children in the state receive full doses of all recommended immunizationii.
Since the Panchayati Raj systems are in the process of getting built, the monitoring of health system by PRI does not always work the way people expect. But things have moved in some parts of the state – case in point are the 70 villages where Oxfam India has partnered with CINI to leverage and activate existing village level institutions and strengthening capacities of community on ensuring better delivery of health and nutritional services.
VHSNCs have now become a pressure group within gramsabha and block and are in process of developing their guidelines. District level federations of VHSNCs are also being built. The community was unaware of the existence of untied fund for the VHSNC earlier. But with proper planning, now, villagers ensure that funds are spent on sanitation, drainage, Village Health and Nutrition Days (VHND), repair of hand pumps etc.
It was interesting to note that in Olattu, the committee spent a part of the fund to buy a bed in the local sub centre as examination of women was being done without one.
Like a well-oiled machine, VHSNC meetings feed into the gram sabha. In Ormanjhi, in Ranchi district, the gram sabhas meet on the 19th of every month; VHSNCs hold a discussion before that so that all decisions can be discussed at the gram sabha. A committee comprising members of gram sabha and VHSNC jointly monitor the anganwadis and Sub Centres — “The villagers now keep a tab of every penny spent,” says Kanti Devi.
Kanti of Mukru village in Hazaribagh is one among the many who have been given Community-Based Monitoring(CBM) training. In Mukru village the joint committee has seven members.
Numbers of VHSNC members, in the Oxfam India project villages, range between 15 and 21. Women, traditionally, were barely part of these meetings. Gram Sabha meetings were dominated by influential men. Meetings were held at night and women were made to sign on registers during their SHG meetings.
Their participation has increased in the last three years due to the intervention of CINI. VHSNC meetings are held regularly, the guidelines mandate a 50 per cent participation of women and this has certainly contributed to the numbers. However, despite efforts by CINI, men still try to push women into the background but they have started facing stiff resistance. In Palu village out of 25 VHSNC members, 21 are women.
The committee has not just helped improve health services; it has played a key role in advocating against child marriage. An active VHSNC has helped change the perspective of the SHGs as well. At a SHG meeting in Kuchu village, it was decided to pool in money to form a drug fund and help patients who cannot afford medicines; earlier money was pooled in for donating to temples.
Jharkhand may be on its way – albeit at a slow pace – to improve some of the human development indices but a lot is left wanting. There is a mix of hopes and despair in the ongoing work. Hopes that the achievements from the 70 villages will create a ripple effect across other districts of the state and despair at the thought of a public healthcare delivery system not responding sufficiently to demands from below.
Fearing a public backlash, Sanjay of CINI shares that the expectations from the health care delivery system have grown exponentially as against the rate of improvement of service delivery. Doctors are often on election or VIP duty and there are often no medicines at the PHCs. “What will you do with awareness alone? ”he asks.
"The authors work with the policy, research and campaigns team of Oxfam India"
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