vhsc and vhnd
TRANSCRIPT
Village Health Sanitation Committee
and
Village Health Nutrition Day
Presenter- Dr. Manju Pilania
PG 2nd year
Village Health & Sanitation Committee
Introduction
Composition
Function
Accountability, Monitoring & Reporting
Grants
Status of VHSC
Village Health, Sanitation & Nutrition Committee
Village Health & Nutrition Day
Service package
Responsibility of functionaries
Monitoring and supervision
What can go wrong
Decentralisation and People's Participation have
been considered key strategies for making health care
services effective and this has been highlighted in all
significant documents articulating people's rights to
health such as the Alma Ata Declaration, Bhore
Committee Report and, most recently, documents
pertaining to the NRHM.
NRHM envisages the “Communitisation” of public
health services enabling both, public health employees
as well as local communities to develop a feeling of
ownership in the Public Health Service Institution.
The NRHM is mandated to enlarge the ownership and management of health services beyond public health functionaries and involve common people.
To enable the realization of this vision at the grassroots, NRHM guidelines direct the District Health Administration to constitute Village Level Health Committees (VLC) cum Village Health and Sanitation Committee (VHSC) in villages under the Gram Sabha.
The Committee is entrusted with the responsibility of enhancing people’s participation in improving health care services in the rural areas by increasing awareness about health and health entitlements with special focus on women and children.
Lady Sarpanch/Panch to be nominated by Village
Panchayat -Chairperson
All mahila panches in the village
One Lady School teacher deputed by Head master
(preferably same village)
Multi Purpose Health Worker (Female)
All ASHAs
All Anganwadi Workers (AWW)
Pradhan of Sakshar Mahila Samooh (SMS)
Self Help Group leader from each Self Help Group
(SHG)
Three most educated adolescent girls out of which
atleast one should be from scheduled caste
Representative of NGO/ Social Activist Working in the
village
Representative of public health/drinking water
department in-charge of the village
Representative of War Widows
Village Chowkidar
Any other member with permission of VLC
To enable the VHSC to reflect the aspirations of the
local community especially of the poor households and
women, it has been suggested that:
At least 50% members of Committee should be women.
Every hamlet within a revenue village must be given due
representation to ensure that the needs of the weaker
sections especially SC / ST and Other Backward Classes
are fully reflected in the activities of the committee.
A provision of at least 30% representation from the Non-
governmental sector.
Representation to women's self-help group to enable the
Committee to undertake women's health activities more
effectively.
The committee will be headed by the ward member of
the village.
If there is more than one ward member in the village:
The woman ward member will head the committee.
If there is no woman ward member existing, male ward
member belonging to SC or ST will head the
committee.
If more than one women ward members or no women
ward members are available in the village, the ward
member of the larger ward will head the committee.
Wherever there is a Panchayat consisting of one
revenue village only, and if the Sarpanch is a woman,
she will be the Chairperson of the committee.
The Chairperson have the powers to call for and
preside over all meetings.
Authority to
review periodically the work undertaken at the
village level and
order inquiry regarding complaints of the
implemented programme.
Convenor of the VHSC would be
ASHA;
where ASHA would not in position it could be the
Anganwadi worker OR
ANM
Convenor can vary in different states as per state
health department guidelines.
In Haryana- AWW (selected by supervisor) is the
convener of this Committee.
To convene the meeting of the VHSC.
To ensure participation of all members in the meeting.
To record the meeting proceedings, maintain cash
book, provide monthly reports and financial report to
MO of concerned PHC.
To facilitate the village health plan.
She will be assisted by the ASHA in all activities.
To create awareness in the village about available
health services and their health entitlements.
To discuss the problems of the community and health
and nutrition care providers and suggest mechanism
to solve it.
To oversee the work of village health and nutrition
functionaries and to be involved in managing the local
sub-centre, which is accountable to the Gram Sabha.
To analyse key issues and problems pertaining to
village level health and nutrition activities and provide
feedback to relevant functionaries and officials.
To monitor all the health activities that are conducted
in the village such as Village Health & Nutrition Day,
mothers meeting etc.
To organize regular monthly meeting to discuss
various issues in the village and document the minutes
of the meeting.
The committee shall ensure that all the issues
discussed are recorded and action taken on the issues
discussed.
To discuss every maternal or neonatal death that
occurs in their village, analyse it and suggest
necessary action to prevent such deaths. (Death
Audit) Get these deaths registered in the Panchayat
To maintain a village health register, health
information board and calendar.
The VHSC will also play vital role for selecting and
supporting the ASHA from the community
The committee shall ensure that Public Dialogue is
organized at regular intervals (once in six month) in
the presence of MO of the PHC.
To discuss the bimonthly village report submitted by
ANM in the village level meeting and take appropriate
action.
To develop a Village Health Plan based on an
assessment of the situation and priorities of the
community
To present an annual health report from the village to
the Gram Sabha.
The ASHA/AWW should maintain a register where
complete details of activities undertaken, funds
received and expenditure incurred are to be
mentioned.
The register should be available for public scrutiny and
should be periodically reviewed by the ANM/MPW/
Sarpanch/ MO I/C.
The committee will maintain accounts and timely
submit the utilization certificate and statement of
expenditure for the money received to the Primary
Health Centre.
Monthly financial report of VHSC is submitted by ANM
to MO of PHC.
PHC - monthly compilation by LHV/ accountant –
submission to SMO
Block – monthly compilation by accountant and
submission to district from where it is submitted to
state level.
PHC level:
ASHA Facilitator, MO and LHV are responsible.
Block level:
SMO and Block Programme Manager are responsible.
State level:
State health department/ health mission is
responsible.
Funds are allotted by the State Health department.
Every village with a population of upto 1500 to get an
annual untied grant of up to Rs. 10,000 after
constitution and orientation of VHSC.
This untied fund will be deposited in a joint account of
Convenor and Chairperson of the committee.
The untied grant to be used by this committee for
household surveys, health camps, sanitation drives,
revolving fund etc.
VLC cum VHSC nominates one member to maintain a
separate cash book of funds given under NRHM, who
is paid Rs 50/- per month for maintaining this cash
book, out of the untied funds available with VHSC.
VHSC – convergence of various deptt. Like health,
Women and Child development, education and PRIs
(Panchayati Raj Institutions)
Civil Surgeons will initiate and coordinate with
Programme Officers (ICDS) and ensure that untied
funds meant for VHSC are immediately transferred
into the bank account of VLC cum VHSC.
Annual audit of VHSC funds under NRHM will be
carried out in coordination with Department of Women
& Child Development
A total of 483, 496 VHSCs have been formed in the
country, covering about 76% of the villages.
States such as Bihar, Uttar Pradesh, Haryana,
Himachal Pradesh, Kerala and Tamil Nadu have
formed the VHSC within the Gram Panchayat while
in the remaining it is at the level of the revenue village.
In Haryana, 6280 VHSC/VLCs formed for 6955
revenue villages.••
No. of VHSC’s to be constituted in Rohtak- 151
No. of VHSC’s Constituted in Rohtak - 149
Role of Village Health & Sanitation Committee (VHSC)
has been expanded so as to include ‘Nutrition’ part
and henceforth will be named as Village Health,
Sanitation and Nutrition Committee (VHSNC).
In addition to the defined activities of VHSC as per
NRHM framework of implementation, VHSNC will also
engage with and monitor status, issues and action
pertaining to nutrition.
Create awareness about nutritional issues and
significance of nutrition as an important determinant of
health.
Carry out survey on nutritional status and nutritional
deficiencies in the village especially among women
and children.
Identify locally available food stuffs of high nutrient
value as well as disseminate and promote best
practices (traditional wisdom) congruent with local
culture, capabilities and physical environment through
a process of community consultation.
Inclusion of Nutritional needs in the Village Health
Plan – The committee will do an in-depth analysis of
causes of malnutrition at the community and
household levels, by involving the ANM, AWW, ASHA
and ICDS Supervisors.
Monitoring and Supervision of Village Health and
Nutrition Day to ensure that it is organized every
month in the village with the active participation of the
whole village.
Facilitate early detection of malnourished children in
the community, tie up referral to the nearest Nutritional
Rehabilitation Centre (NRC) as well as follow up for
sustained outcome.
Supervise the functioning of Anganwadi Centre (AWC)
in the village and facilitate its working in improving
nutritional status of women and children.
Act as a grievances redressal forum on health and
nutrition issues.
Illiteracy of VHSC members
Lack of interest of PRI members
Improper fund flow
Lack of co-ordination among village health and
nutrition workers
Lack of accountability
Negligible participation of other women of community
Concept developed by integrated Nutrition and Health
Project (INHP)
major initiative under the National Rural Health
Mission (NRHM) to improve access to maternal,
newborn, child health and nutrition (MNCHN) services
at the village level.
Once every month (preferably on Wednesdays, and
for those villages that have been left out, on any other
day of the same month) at the AWC in the village.
at a site very close to their habitation, the villagers will
not have to spend money or time on travel.
platform for inter-sectoral convergence
VHNDs require convergent actions from
the Department of Health and Family Welfare
(DHFW) and
the Department of Women and Child Development
(DWCD) at state, district and block levels to plan,
implement and monitor the programme.
Community through VHSNC
1. Early registration of pregnancies.
2. Focused ANC.
3. Referral for women with signs of complications
during pregnancy and those needing emergency
care.
4. Referral for safe abortion to approved MTP centres.
5. Organizing group discussions on maternal deaths, if
any, that have occurred during the previous month in
order to identify and analyse the possible causes.
5. Counselling on:
Education of girls.
Age at marriage
Care during pregnancy.
Danger signs during pregnancy.
Birth preparedness.
Importance of nutrition.
Institutional delivery.
Identification of referral transport.
Availability of funds under the JSY for referral
transport.
Post-natal care.
Breastfeeding and complementary feeding.
Care of a newborn.
Contraception.
Infants up to 1 year :
1. Registration of new births.
2. Counselling for care of newborns and feeding.
3. Complete routine immunization.
4. Immunization for dropout children.
5. First dose of Vitamin A along with measles vaccine.
6. Weighing.
Children aged 1-3 years :
1. Booster dose of DPT/OPV
2. Second to fifth dose of Vitamin A
3. Table IFA – (small) to children with clinical anaemia.
4. Weighing
5. Provision of supplementary food for grades of mild
malnutrition and referral for cases of severe
malnutrition
All children below 5 years :
1. Tracking and vaccination of missed children by
ASHA and AWW.
2. Case management of those suffering from diarrhea
and Acute Respiratory infections.
3. Organizing ORS depots at the session site.
4. Management of worm infestations.
5. Counselling to all mothers on
home management and where to go in event of
complications.
nutrition supplementation and balanced diet.
1. Information on use of contraceptives.
2. Distribution – provision of contraceptive counselling
and provision of non-clinic contraceptives such as
condoms and OCPs.
3. Information on compensation for loss of wages
resulting from sterilization and insurance scheme for
family planning.
1. Counselling on
1. prevention of RTIs and STIs, including HIV/AIDS,
and referral of cases for diagnosis and treatment.
2. for perimenopausal and post-menopausal
problems
2. Communication on causation, transmission, and
prevention of HIV/AIDS and distribution of condoms
for dual protection
3. Referral for VCTC and PPTCT services to the
appropriate institutions.
1. Identification of households for the construction of
sanitary latrines
2. Guidance on where to go and who to approach for
availing of subsidy for those eligible to get the same
under the Total Sanitation Campaign.
3. Avoidance of breeding sites for mosquitoes.
4. Mobilization of community action for safe disposal of
household refuse and garbage.
1. Group communication activities for raising
awareness about
signs and symptoms of leprosy, suspected cases, and
referrals.
symptoms of TB, importance of continued treatment,
referral of symptomatic for sputum examination at the
nearest health centre
elimination of breeding sites for mosquitoes,
management of fever cases, i.e. importance of collection
of blood film for MP and its treatment.
2. Provision of anti-TB drugs to patients.
3. Reporting of unusual numbers of cases of any
disease or disease outbreak in village.
Communication activities for
1. prevention of pre-natal sex selection,
2. illegality of pre-natal sex selection, and
3. special alert for one daughter families.
4. Prevention of Violence against Women, Domestic
Violence Act, 2006.
5. Age at marriage, especially the importance of
raising the age at marriage for girls
1. Home remedies for common ailments based on
certain common herbs and medicinal plants like tulsi
found in the locality.
2. Information related to other AYUSH components,
including drugs for treating conditions like anaemia.
Chronic diseases can be prevented by providing
information and counselling on:
1. Tobacco chewing
2. Healthy lifestyle
3. Proper diet
4. Proper exercise
1. Diseases due to nutritional deficiencies can be prevented by giving information and counselling on:
Healthy food habits.
Hygienic and correct cooking practices.
2. Checking for anaemia, especially in adolescent girls and pregnant women; checking, advising, and referring.
3. Weighing of infants and children.
4. Importance of iron supplements, vitamins, and micronutrients
5. Food that can be grown locally.
6. Focus on adolescent pregnant women and infants aged 6 months to 2 years.
Actions to be taken before the Village Health and
Nutrition Day:
Visit all households (including poor households,
especially SC/ST families) and get to know all the
families.
Make a list of
pregnant women.
women who need to come for ANC for first time or for
repeat visits.
infants who need immunization, were left out or dropped-
out or missed during the pulse polio round.
children who need care for malnutrition or with special
needs, particularly girl children
TB patients who need anti-TB drugs
On the day:
Ensure that all listed women and children come for
services.
Ensure that malnourished children come for
consultation with the ANM.
Ensure supplementary nutrition to children with
special needs.
Ensure that all listed TB patients collect their drugs.
Assist the ANM and the AWW.
Ensure that the AWC is clean.
Ensure availability of clean drinking water during the
VHND.
Ensure a place with privacy at the AWC for ANC.
Keep an adequate number of MCH cards.
Coordinate activities with the ASHA and the ANM.
Ensure that the VHND is held without fail. Make
alternative arrangements in case she is on leave.
Ensure that the supply of vaccines reaches the site
well before the day's activities begin.
Ensure that all instruments, drugs, and other materials
are in place.
Carry communication materials.
Ensure that adequate money is available for
disbursement to the ASHA.
Ensure reporting of the VHND to the MO in charge of
the PHC.
Coordinate with the ASHA and the AWW.
Ensure that the members of the VHSC are available to
support the sessions.
Ensure participation of schoolteachers and PRI
members.
Ensure availability of clean drinking water, proper
sanitation, and convenient approach to the AWC for
participating in the VHND by all.
Jointly by LHV and the AWW Supervisor and submit
their joint report.
The holding of the VHND should be discussed
at the monthly meetings convened by the MOs at
the PHC level
at the executive committee meetings of the District
Health Society, of which the District CMO is the
convener.
The DPM will monitor it, and will also compile data on
it.
Each district and block should maintain a record of the
number of VHNDs planned and the number actually
held
During the supervisory visits, special attention should be
given to the following elements:
1. Women and children from vulnerable communities
should come forward to seek services.
2. ASHA should be available at the session site and
should be engaged in the tracking of women and
children, especially those from vulnerable
communities, for complete coverage.
3. All resources (human resources and materials)
should be in place.
4. The quality of the services available should be
satisfactory.
5. Issues related to the clients' satisfaction with the
services should be addressed properly and promptly.
6. BCC methods should be employed
Irregularity:
Crucial attendance and functionality of the ANM can
subject to uncertainties, unless replacements are
arranged.
Similarly, inadequate supplies of vaccines and related
equipment lead to missed opportunities in providing
services.
Small villages and habitations tend to get left out
unless carefully covered in the micro-plan.
Disorganization
Lack of space and forced inclusion of too many
activities during an NHD tends to make the event
chaotic, leading to long waiting times for clients, and
often, essential services are missed.
Lack of privacy for antenatal check-up prevents
particularly abdominal examination and correct
administration of TT vaccines.
Group counselling usually suffers in not being able to
retain the most appropriate group of women for long
enough till the ANM or AWW find time.
Failure to track due mothers and children:
Poorly organized and maintained survey and service
registers, and failure to identify due clients can undo
much of the benefits of organizing NHDs.
ANM often tends to depend on the AWW for a
complete listing of mothers and children.
If the AWW is poorly supervised and maintains poor
records, coverage inevitably falls.
Missed opportunities for nutrition and health
counselling:
Poorly trained and supervised ANMs tend to miss
opportunities to reinforce “messages” related to
birth preparedness,
newborn care,
Infant and Young Child Feeding (IYCF) and
even immunization
when interacting with mothers and children’s
caretakers during NHDs
Inadequate oversight:
The large number of NHDs that are scheduled on
each vaccine day, and
the inadequate numbers of available supervisors in
ICDS and health programs
make it difficult to organize adequate supervisory efforts.
Large villages, villages in the urban periphery and
multiple session sites:
Such villages offer more options for families to access
services.
However with families accessing services from
different locations in different months, it is difficult for
frontline workers to track timely utilization of services
and to enable timely receipt of these services.
Often there is duplication of effort by different workers
in such villages
NRHM. Ministry of Health and Family Welfare Government
of Haryana. Panchkula. VLC-VHSC Guidelines. May 09.
Institute of Rural Research and Development® Report on
Capacity-Building Needs: Village Level Committee-cum-
Village Health and Sanitation Committee. July, 2010.
NRHM. Ministry of Health and Family Welfare Government
of India. New Delhi. Update on the ASHA Programme. July
2011
NRHM. Ministry of Health and Family Welfare Government
of India. New Delhi. Monthly Village Health Nutrition Day.
Guidelines For AWWs/ASHAs/ANMs/PRIs. Feb 2007.
NRHM. Ministry of Health and Family Welfare Government
of India. New Delhi. Village Health Sanitation & Nutrition
Committee.
USAID Care INDIA. Nutrition and Health Day. Dec 2010.