Empowering Communities: Lessons in Health System Strengthening

1. Empowering Communities: Lessons in Health System Strengthening Community Action for Health (CAH) functions as a key component under the National Health Mission (NHM), placing people at the center of the process of ensuring that the health needs and rights of the community are being fulfilled.The right to health serves as a cornerstone of social justice, encapsulating the right of people everywhere to have access to quality health services, good nutrition, education and freedom from discrimination. This year’s World Health Day also emphasized the importance of the right to health, with the theme ‘My Health, My Right’. A key method to strengthen not just the right to health but also the systems supporting health services is to ensure strong community engagement in the implementation of health-related services and policies. Engaging communities is widely believed to have a positive impact on the effectiveness of health programmes, enhancing social capital, community empowerment and an improved health status with reduced inequalities. Community Action for Health is viewed as the first systematic and health sector-wide institutional mechanism for civil society engagement in health services. The process of communitization involves, among other things, creation of a cadre of female community health workers or accredited social health activists (ASHA) as well as creation of ‘Rogi Kalyan Samitis’. CAH has developed and evolved as a means to improve health outcomes by strengthening community participation and ensuring empowerment by making communities more accountable for their health needs.

2. The CAH processes involve strengthening the Village Health, Sanitation and Nutrition Committees (VHSNCs), Rogi Kalyan Samitis (RKSs) and Planning and Monitoring Committees (PMCs) at the primary block, district and state levels, creating community awareness on NHM entitlements, roles and responsibilities of service providers as well as training of VHSNC, RKS and PMC members. Undertaking community level enquiry to assess the availability, range and quality of health services, developing village and facility level reports to reflect the status of health services and organizing Jan Samwad or public dialogue for advocacy with health providers and managers are also included within CAH processes. Another key task for CAH includes corrective action and planning to address emerging issues and gaps. Several states have developed unique models to address local health challenges. In Chhattisgarh, the Swasth Panchayat Yojana, operational since 2005-06, has woven community health empowerment into the fabric of the state’s local governance. It is run by the state’s Health and Family Welfare Department with support from the State Health Resource Centre (SHRC) and aims to leverage the democratic engagement of the state’s VHSNCs and Mitanins (Community Health Workers) to monitor, assess and act upon health issues in each village and panchayat. VHSNCs meet every month to monitor the health situation in their respective villages, based on which two to three action items are identified every month. The Swasth Panchayat Sammelan is organized annually to initiate public dialogue at the block level where pressing health concerns are raised in front of relevant officials. The SHRC also conducts

3. Swasth Panchayat surveys on an annual basis, insights from which feed into a panchayat-level score card that is presented to the Sarpanch. Additionally, hamlet-level data is analysed to arrive at consolidated panchayat-level indicators and a composite panchayat-level Health and Human Development Index, showcasing a model that truly places the community at the center of health improvement. The state of Assam has developed a unique model to strengthen primary health care services as well as tie in members of the community to ensure the services reach vulnerable sections of the state. This model is a part of the state’s National Health Mission plan and involves a Memorandum of Understanding (MoU) with Tea Garden hospitals under Public Private Partnership (PPP) to provide health care services to all employees of the tea gardens and its adjoining areas in the state. The tea community is a relatively marginalised and socially excluded group within the state. This approach helps bring primary health services closer to these communities and involves them in delivery and monitoring of these services. An example in this context is the use of ASHA workers in order to deliver routine immunizations and maternal health services within the tea estate hospitals in the state under this model. It has been observed that the availability of quality services and community outreach initiatives has helped build trust and led to high health seeking behaviour in the state. Lessons in Health System Strengthening in India