Review Series

Evidence
Role of Village Health
Committees in Improving
Health and Nutrition Outcomes:
A Review of Evidence from India
March 2008 4
Context (AWW) and Accredited Social Health Activist (ASHA) and
to be involved in managing the local sub-centre, which is
The Government of India is promoting a decentralized accountable to the Gram Sabha.
approach through changes in major programs such as the
National Rural Health Mission (NRHM) and the Integrated This paper provides highlights from an evidence review on
Child Development Scheme (ICDS). The NRHM places VHCs. The purpose of the evidence review was:
significant focus on creating and supporting Village Health To analyze the available evidence to determine the key
Committees (VHCs) to promote decentralization. lessons learned in the area of the role of Village Health
Committees in improving health and nutrition outcomes.
The VHC is intended to be a part of the local self-governance
structure of the Panchayati Raj Institutions specifically the
Village Council called the Gram Sabha. The purpose of the Evidence Review Process
VHCs is to build and maintain accountability mechanisms Considering the importance of VHCs for decentralization and
for community-level health and nutrition services provided achieving improved health and nutrition, leaders from the
by the Government. The NRHM provides guidelines on the central and state Government (including Health and Family
framework, functions and responsibilities of VHCs and has Welfare and Women and Child Development Department
provided for a flexible “untied fund” of Rs.10,000 per health officials) agreed that it was important to conduct an evidence
sub center facility to support local actions. The role of the review on this topic. The USAID-funded Vistaar Project
VHCs, as mentioned in the NRHM guidelines is facilitated the evidence review, which was conducted by
■ To create awareness in the village about available health national experts in this field.
services and their health entitlements
The Project team identified existing evidence within India
■ To develop a Village Health Plan based on an assessment for the review, through a literature review as well as direct
of the situation and priorities of the community requests for information from many experts working in this
■ To maintain a village health register and health field. The team initially identified over 30 interventions that
information board and calendar
■ To analyze key issues and problems pertaining to village
level health and nutrition activities and provide feedback
to relevant functionaries and officials; and
■ To present an annual health report from the village to
the Gram Sabha
The NRHM guidelines suggest that the VHC should include
representatives from the village Panchayat, Community-Based
Organizations and NGOs, other community representatives
and village health and nutrition workers and they note that
the committee should include members from disadvantaged
communities (e.g., scheduled castes, scheduled tribes,
minority groups). The VHC is also expected to oversee the
work of village health and nutrition functionaries such as
the Auxiliary Nurse Midwife (ANM), Anganwadi Worker

1
had a focus on community involvement and VHCs and then meetings of VHC, development of village health plans,
short-listed seven of them, based on these criteria: monitoring of village health plans)
■ The intervention should have a focus on community Of the seven interventions selected for the review, two
involvement similar to the NRHM concept of a VHC were led primarily by the Government, one by a medical
■ There should be enough data and documentation on the college and four were collaborative efforts of multiple non-
effort to understand the inputs as well as the outputs Governmental agencies. See Table 1 for more information
and outcomes (e.g., data on indicators such as regular about the interventions reviewed.

Table 1: Overview of Interventions

Intervention Name Lead Agencies Focus Areas
Community-Led Initiatives for Child Dept. Community Medicine, Fostering partnerships between “Village Coordination Committees” and the
Survival (CLICS) (6, 8, 9) Mahatma Gandhi Institute of Medical Dept. of Community Medicine, using a social franchising model in Wardha,
Sciences Maharashtra
Improving Community Participation Foundation for Research in Health System Supporting community involvement and decentralized planning in Mysore,
in Decentralized Planning of RCH and Dept. of Health & Family Welfare Karnataka
services (18) (Government of Karnataka)

Integrated Village Planning Government of Uttar Pradesh and UNICEF Establishing mechanisms to foster collaboration between the community and
Model (11, 22, 23) Government service providers in Lalitpur, Uttar Pradesh
Communitization of Grass-root Government of Nagaland Supporting and promoting community ownership of public resources and assets
Health Services (1, 19) and decentralizing authority over service delivery in Nagaland
Community Mobilization for Child in Need Institute (CINI) and Govt of Promoting community level social mobilization networks in Ranchi, Hazaribagh
Improving Mother and Child Jharkhand and Gumla districts of Jharkhand
Health through Life Cycle
Approach (2-5, 7, 12, 13)
“Swajal” Project (Village Water Government of Uttar Pradesh, Supporting demand driven community participation in seven districts of Uttar
and Sanitation Committee Government of Uttaranchal Pradesh and 12 districts of Uttaranchal
component) (10) and World Bank
Community Health Activist Government of Chhattisgarh Introducing and supporting a cadre of village health activists to increase
(Mitanin) Program (17, 20, 21) demand for health services and improve health service delivery in Chhattisgarh

The Vistaar Project team prepared summaries of the selected interventions including available data on effectiveness, efficiency
and expandability of these interventions. These summaries were provided to the lead implementing agencies for their
feedback and then shared with the expert reviewers prior to the expert review meeting. (These summaries are available on the
IntraHealth website: https://www.intrahealth.org).
The team worked with Government officials and recognized experts to form a panel of experts in this field to conduct
the evidence review. The expert group included Government officials and representatives from NGOs, academia, donors,
professional associations, and other sectors. (See Table 2)
A group of 24 recognized technical experts met for two days on August 29 and 30, 2007 to review the seven selected
interventions. The experts worked in a consultative manner to achieve the following objective:
To analyze the available evidence to determine the key lessons learned in the area of fostering strong village health committees.

Table 2: List of Experts

Mr. AkhileshTewari Sarthi Development Foundation, Uttar Pradesh Dr. Rajiv Tandon USAID, New Delhi
Dr. Anant Kumar Xavier Institute of Social Service, Jharkhand Ms. Ruth Vivek Centre for Health and Social Justice, New Delhi
Mr. Anup Hore Krishi Gram Vikas Kendra, Jharkhand Mr. S. P. Sinha Ministry of Health and Family Welfare,
Mr. B. B. Goel State Innovations in Family Planning Services Government of Jharkhand
Project Agency, Uttar Pradesh Ms. Sarovar Zaidi ICICI, Mumbai
Dr. Deepak Raut Central Bureau of Health Intelligence, Ms. Sonali Sinha Ministry of Health & Family Welfare,
Government of India Government of Jharkhand
Dr. J. L. Chittoria Directorate of Family Welfare, Government of Prof. Subodh Dpt. of Community Medicine,
Uttar Pradesh Sharan Gupta MGIMS, Maharashtra
Dr. Madhulika Jonathan UNICEF, Jharkhand Dr. Suranjeen Prasad Child in Need Institute, Jharkhand
Ms. Manjiri Bhawalkar Abt Associates Inc., Cambridge, MA, USA Dr. T.B. Prasad TATA Steel Rural Development Society,
Mr. Mukesh Kumar CARE India, New Delhi Jharkhand
Dr. Nirmala Murthy Foundation for Research in Health Systems, Dr. T. Sundararaman National Health System Resource Center,
Karnataka New Delhi
Ms. Paromita Das Vikas Bharti, Jharkhand Ms. Tanvi Jha Child in Need Institute, Jharkhand
Dr. Prakash Gurnani UNICEF, Jharkhand Ms. Uma Prakash Dpt. of Women Empowerment & Child
Development, Government of Uttarakhand
Mr. Rajan Kumar Ministry of Health & Family Welfare,
Government of Jharkhand

Note: Other invited experts were unable to attend.

2
Lessons Learned few simple indicators, to monitor progress on the plan
■
Outcomes have improved where the VHC has linked with
The expert reviewers identified a number of lessons learned the Government to support service providers and where
about VHCs for application within the framework of NRHM the VHC has linked with block level officials
and grouped them into the categories of:
Linking VHCs with Government Systems and Services
■ Community orientation to the role of VHCs ■ The VHCs can consider using the citizen's charter
■ Community representation in the VHCs
mechanism to establish linkages with the Government
■ Civil society participation and support to VHCs
systems and institutions [including the Panchayati Raj
■ Village ownership of the VHC and the Village Health Plan
Institutions (PRIs) ], as well as with Government health
■ Village Health Plan development
services (e.g., for transport, referrals)
■ Implementation and monitoring of the Village Health Plan ■ The VHC seems to work better when it supports and
■ Linking the VHC with Government systems and services
serves as an ally with the health system (e.g., supporting
Community Orientation to the Role of the VHC the community-level health and nutrition workers such
■ The evidence from these interventions shows that as the AWW and ANM), rather than acting mainly as an
successfully establishing a VHC is a long and formal outside critic or activist group
process. It takes time to gain acceptance and generate Other Lessons
community participation and ownership and there are ■ It is helpful if there is seed money available to use for
complex local socio-political issues that may need to be
start-up activities of the VHC
addressed
■ One model for use of the "untied fund" of
Community Representation in the VHCs Rs.10, 000 (made available under the NRHM) that appears
■ The VHC should have wide representation from different successful is for a village health worker (e.g., ANM) and
sections of the village population, including women, the VHC to have a joint account with the elected head of
different castes and classes, and adolescents to ensure the Gram Sabha or Sarpanch
responsiveness to the various health needs in the village ■ Existing groups like SHGs and livelihood groups can help
■ The evidence shows that it is important to have gender form a VHC or form the basis for a VHC
sensitive leadership of the VHC to enhance outcomes
Evidence Gaps
Civil Society Participation and Support to VHCs
In addition, the experts identified several important evidence
■ The support of civil society agencies, such as NGOs, CBOs, gaps, where additional knowledge is needed. These are:
Self Help Groups can be very helpful in setting up of the ■ The best roles for outside groups like CBOs and NGOs
VHCs and meeting related NRHM objectives ■ Strategies to include adequate representation from
Village Ownership of the VHC and the Village Health Plan distant or isolated hamlets and very vulnerable and
marginalized groups in the VHC
■ It takes time and skills in facilitation and communication
■ Lessons about the working relationship between the VHC
to lead to a village’s understanding and ownership of a
and the Gram Panchayat
VHC and Village Health Plan
■ Evidence with more outcome level data to show what
■ There are challenges, but the VHC can improve the
works in terms of VHC
functioning of the Government service delivery at
Primary Health Centers and Community Health Centers
■ The VHC may function better and have better
In Summary
relationships with the Government health services if The evidence review process is a useful approach to build
the VHC is established and able to help select their own consensus among experts and program leaders, inform
health and nutrition functionaries (e.g., ASHA) program planning, and assist with decision making. The
■ Regular meetings of the VHC are associated with more Vistaar Project experience shows that this process is most
successful outputs and outcomes valuable when:
■ It is conducted in an open, inclusive and participatory
Development of the Village Health Plan
manner
■ The evidence shows that it is helpful for the VHC to ■ The focus is on learning lessons, not identifying the “best
identify local health problems and gaps, focusing on both model”
the demand and the supply side ■ The audience is clear, and the evidence is reviewed from
■ Gathering the needed information and preparing a their perspective (i.e., in this case, the evidence was
Village Health Plan requires considerable, sustained effort reviewed for application in Government programming)
Implementation and Monitoring of the Village Health Plan The Vistaar Project greatly appreciated the opportunity to be
■ It seems advisable for the VHC to start with a simple, a part of this evidence review and is honored to join with the
feasible Village Health Plan that has clear objectives and technical experts, implementing agencies, and Government
targets program leaders and implementers who are using evidence to
■ The VHC should develop a monitoring mechanism, with a improve MNCHN program impact.

3
 References
1. Bahl. Arti. .Comunitization of Grass root Health Services, Nagaland. PROD Reference No. 128. Policy Reform Options
Database. September 2005. Accessed on 29 July 2007 at http://www.cbhi-hsprod.nic.in/sear_desc1.asp?SD=25&SI=6&
ROT=2&qryAll=Nagaland
2. Chatterjee Purvita. ICICI Bank Bid to Build Brand Through Social Work. The Hindu Business Line. Sunday, 5 July 2003.
3. Child in Need Institute. Strengthening NGOs Capacity to Improve Maternal and Child Health. *Unpublished
Presentations for Dissemination of Mid-Term Assessment Report of Churchu Block, Sardar Block-Gumla, Hazirabagh
District Block. Ranchi, Jharkhand: Child in Need Institute. December 2006.
4. Child in Need Institute. Gumla Baseline Report . Ranchi, Jharkhand: Child in Need Institute. December 2006.
5. Child in Need Institute. Hazaribagh Baseline Report . Ranchi, Jharkhand: Child in Need Institute. December 2006.
6. CLICS. Community Led Initiatives for Child Survival. CLICS Homepage. Accessed on 29 July 2007 at http://www.clics.
org.in.
7. Davey, Anuradha. Pictorial Tools for Behavior Change Communication for Tribal Population, Jharkhand. PROD
Reference NO. 204. Policy Reform Options Database. October 2006. Accessed on 29 July 2007 at http://www.cbhi-
hsprod.nic.in/sear_desc1.asp?sd=27&SI=18&ROT=1&qryAll=Jharkhand
8. Department of Community Medicine, MGIMS. Community-Led Initiatives for Child Survival Household Ennumeration
2003. Wardha, Maharashtra: Department of Community Medicine, MGIMS, Sewagram. 2003.
9. Department of Community Medicine, MGIMS. *Unpublished Project Documentation on Community-Led Initiatives
for Child Survival. Wardha, Maharashtra: Department of Community Medicine, MGIMS, Sewagram. 2006-2007.
10. Energy and Infrastructure Unit, South Asian Region, World Bank. Implementation Completion Report (CPL-40560;
SCL-4056A) on a Loan in the Amount of US$40.7 Million (Original Amount US$59.6 Million) to the States of Uttar
Pradesh and Uttaranchal for the Uttar Pradesh and Uttaranchal Rural Wateer Supply and Environmental Sanitation
(SWAJAL) Project. Report No. 27288, Document of the World Bank. November 2003. New Delhi/ Washington D.C.:
Vision The World Bank.
11. Fukuda, Wakana, Mizumoto Ann and Tyagi, Kunal. Of the eople, For the People, By the People. Water and
Sanitation Service Delivery: Gram Panchayat Environment Plan, Lalitpur, Uttar Pradesh. Knowledge Community on
We believe in a world where Children in India: Turning Knowledge into Action. *Case Studies. 10 November 2006. Accessed on 29 July 2007 at
http://www.kcci.org.in/frontframe.asp?id=41&description=Case%20Studies.
all people have an equal 12. Krishi Gram Vikas Kendra, Child In Need Institute and Social Initiatives Group-ICICI Bank. Ranchi Low Birth Weight
opportunity for health and Project: Baseline Survey Summary Report. Ranchi, Jharkhand: KGVK, Daulatpur, West Bengal: CINI, Mumbai,
Maharashtra: SGI-ICICI Bank. October 2006.
well-being. 13. Krishi Gram Vikas Kendra, Child In Need Institute and Social Initiatives Group-ICICI Bank. Ranchi Low Birth Weight:
Reducing Incidence of Low Birth Weight using a Community Based Life Cycle Strategy. Study Protocol. Ranchi,
Jharkhand: KGVK, Daulatpur, West Bengal: CINI, Mumbai, Maharashtra: SGI-ICICI Bank. October 2006
Mission 14. Ministry of Health and Family Welfare, Government of India. Report of the Working Group on Public Health Services
(including Water and Sanitation) for the Eleventh Five-Year Plan (2007-2012).
New Delhi: Ministry of Health and Family Welfare. October 2006.
To mobilize local talent to create 15. Ministry of Health and Family Welfare. National Rural Health Mission (2005-2012): Mission Document, Accessed on
29 July 2007 at http://mohfw.nic.in/NRHM/Documents/NRHM%20Mission%20Document.pdf
sustainable and accessible health 16. Ministry of Health and Family Welfare. Panchayati Raj Institutions and Health and Family Welfare Programmes – An
Executive Summary, Accessed on 29 July 2007 at http://mohfw.nic.in/NRHM/exe_sum_PRI_health_min.htm
care 17. Mishra, J.P. Mitanin Program, Chhattisgarh. PROD Reference No. 49. PROD November 2003 (Updated March 2006).
Accessed on 29 July 2007 at http://www.cbhi-hsprod.nic.in/sear_desc1.asp?SD=25&SI=5&ROT=1&qryAll=Chhattisgarh
18. Murthy, Nirmala. Village Health Committees, Karnataka. PROD Reference Number 39. Policy Reform Options
Database. August 2004. Accessed on 29 July 2007 at http://www.cbhi-hsprod.nic.in/sear_desc1.asp?SD=25&SI=6&ROT
=1&qryAll=Karnataka
19. Sandham, Oken Jeet. Unique Experiment of Communitization in Nagaland. KanglaOnline. Accessed on 29 July 2007
The Purpose of 20.
at http://www.kanglaonline.com/index.php?template=kshow&kid=117&
State Health Resource Center, Government of Chhattisgarh. Outcome Evaluation of the Mitanin Program: A Critical
the Vistaar Project is: 21.
Assessment of the Nation’s Largest Ongoing Community Health Activist Program. Chattisgarh: SHRC. 2004.
State Health Resource Center, Government of Chhattisgarh. *Unpublished Documents and Presentations pertaining
to Mitanin Program. Chhattisgarh: Government of Chhattisgarh. 2006-2007.
22. UNICEF. *Unpublished Presentation ‘Integrated Village Planning: A Joint Initiative of UNICEF and Government of
To assist the Government of U.P.; Implemented by Sarathi Development Foundation.’ New Delhi/ Uttar Pradesh: UNICEF. 2007.
23. UNICEF and Sarathi Development Foundation. *Unpublished Concept Note ‘Integrated District Approach and Village
India and the State Governments Planning.’ Lalitpur, Uttar Pradesh: UNICEF and Sarathi Development Foundation. 2007.
of Uttar Pradesh and Jharkhand
in taking knowledge to practice
for improved maternal, newborn,
and child health and nutritional
status

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