Abstract
BackgroundIn order to improve the availability, accessibility, quality, and use of the public health system, the Government of India has engaged the community and local population in planning and monitoring health service delivery in rural areas. The Indian Government instituted the Village Health and Sanitation Committee (VHSC), which serves as a forum for village planning and monitoring. This study evaluates the impact of these village-level bodies on utilisation of health services in Indian villages. MethodsThe paper analyses the third waves of the District Level Household Survey (DLHS) implemented in 2007–08. DLHS is the only health survey that is representative at the district level. The evaluation uses a quasi-experimental method, propensity score matching, to separate the causal effect of VHSC on utilisation of health services. Several village-level and individual-level characteristics are used to find a control village comparable to the treatment village. FindingsPreliminary results indicate that 29% (6554/22 824) of the Indian villages instituted VHSC by 2008. Households in VHSC villages are more likely to seek modern care and visit health facilities than are those in non-VHSC villages. VHSC participants are significantly more likely to visit modern health facilities when their children are sick with either fever or diarrhoea. In-facility births are also higher in the treated villages after controlling for socioeconomic confounding variables. The percentage of women seeking antenatal and postnatal care is also higher in VHSC villages than in non-VHSC villages. All these results are statistically significant at the 95% level, although data are preliminary. InterpretationThe National Rural Health Mission aims to empower the community and local bodies to take leadership of health and sanitation issues at the local level. Grassroots community bodies such as VHSC are important steps in decentralising policy formulation and community participation. Community-based participatory methods have emerged as a response to conventional approaches that historically have failed to make notable improvement in population health in developing countries. FundingNone.
Published Version
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