Village Health Sanitation And Nutrition Committees Research Articles

Assessment of Communitization through Knowledge, Attitude, and Practice Status of the Members of Village Health Sanitation and Nutrition Committees

Background: Village Health, Sanitation, and Nutrition Committee (VHSNC) is an important tool and measure of communitization and way of decentralization to plan & monitor health care down to the village level. Objective: To assess the communitization through knowledge, attitude & practices (KAP) status of its members. Material & Method: Observational, cross-sectional study conducted over the period of two years in all 13 blocks of Pune District in Maharashtra state. Data were collected using prestructured and pretested proforma from seven members per VHSNC. Qualitative data variables were expressed by using frequency & percentages. Quantitative data variables were expressed by Chi-square tests (95% CI). Results: Mean age of members was 40.77 ± 9.30 years. The majority of them, i.e., 76%, were females. The distribution of social categories shows that 20% of members were SCs/STs and 19% OBCs. The majority, i.e., 34%, were found to be educated up to secondary education. The mean KAP score of all members was documented to be 39.05, which indicated unsatisfactory communitization. KAP regarding VHSNCs was highest among Anganwadi Workers, followed by Auxiliary Nurse Midwives, Multipurpose Workers, Sarpanchs, Accredited Social Health Activists, Gram Panchayat members, and others. A significant association was found between the KAPscore of members with their education, designation in VHSNC, and background. (p < 0.05) Conclusion: The Communitisation across the district, as indicated by the KAP score of members, was found to be unsatisfactory. Thus, efforts through the capacity-building program for the members of VHSNC will be beneficial.

ASSESSMENT OF VILLAGE HEALTH SANITATION AND NUTRITION COMMITTEE IN UTTAR PRADESH

The study examines the functionality of the Village Health Sanitation and Nutrition Committee (VHSNC) in the district Barabanki of Uttar Pradesh. The role of Panchayati Raj Institution's (PRI) and utilization of untied funds by the VHSNC is also assessed. The survey collected information from 20 VHSNC of Haidargarh block that were spread across six health sub-centre's. 100 VHSNC members were interviewed including 16 Accredited Social Health Activist (ASHA) who function as Member secretary of the VHSNC and 18 Gram Pradhan's who function as president of the Committee. Response of the community on the awareness and functioning of the VHSNC was also collected by randomly interviewing 200 households from the selected 20 VHSNC. Findings suggest that almost half of the community is unaware of VHSNC in their village. However, those who know about the presence of VHSNC in their village are appreciative of the kind of work that VHSNC does.

Theorizing community health governance for strengthening primary healthcare in LMICs.

In recent years, community health governance structures have been established in many low and middle-income countries (LMICs) as part of decentralization policies aimed at strengthening primary healthcare systems. So far, most studies on these local structures either focus on measuring their impact on health outcome or on identifying the factors that affect their performance. In this paper we offer an alternative contribution that draws on a sociological interpretation of community health governance to improve understanding of how the government’s policy vision and instrumentation translate to interactions that take place within local spaces at field level. We study 13 Village Health Sanitation and Nutrition Committees (VHSNCs) in Karnataka, India, from 2016 to 2018 focusing on sanitation, nutrition and hygiene which remain impediments to improving primary healthcare amongst poor and marginalized communities. Three local governance mechanisms of horizontal coordination, demand for accountability and self-help help to explain improvements that have taken place at village level and contribute to the creation of a new theory of community health governance as evolving phenomenon that requires a constant process of learning from the field to strengthen policymaking.

Village health, sanitation, and nutrition committee: Do the village level functionaries aware of their roles?

ABSTRACTBackground:National Health Mission intended to achieve decentralization and community participation through creating and supporting Village Health Sanitation and Nutrition Committees (VHSNCs). The services offered through VHSNC include maternal and child health, family planning, sanitation, communicable diseases and health promotion, and nutrition. The study was carried out to assess awareness on the implementation of the functioning of VHSNC implementation among village-level functionaries in the Dehradun district.Methods:A community-based cross-sectional study was conducted in the Doiwala and Raipur blocks of Dehradun district from June 2019 to July 2019. Members of VHSNC with at least 3 months of membership were included in the study. A pretested semi-structured questionnaire was used to collect sociodemographic variables and questions about their awareness and responsibilities in implementing VHSNC. Data were collected by personal interviews using Epi-Collect and analyzed by SPSS 23.Result:Out of 69 members, 64 (92.4%) had formal education until high school. Only around 50% of members knew about the essential documents related to the VHSNC. Sixty-five members (98.48%) believed that the committee had the primary role in health-related services in the village, 54 (81.82%) members also marked providing safe drinking water as a function, 48 (72.73%) were in favor of access to clean public toilet and sanitation facilities while some others added role in Public Distribution System.Conclusion:Around half of the members were partially or completely aware of the functioning of VHSNCs. Providing them with further awareness is required.

Assessing community health governance for evidence-informed decision-making: a cross-sectional study across nine districts of India

PurposeThe authors intend to assess the village health sanitation and nutrition committees (VHSNC) on six parameters, including their formation, composition, meeting frequencies, activities, supervisory mechanisms and funds receipt and expenditures across nine districts of the three states of India.Design/methodology/approachThe cross-sectional study, conducted in the states of Uttar Pradesh (five districts), Odisha (two districts) and Rajasthan (two districts), used a quantitative research design. The community health workers of 140 VHSNCs were interviewed using a semi-structured questionnaire. The details about the funds' receipt and expenditures were verified from the VHSNC records (cashbook). Additionally, the authors asked about the role of health workers in the VHSNC meetings, and the issues and challenges faced.FindingsThe average number of members in VHSNCs varied from 10 in Odisha to 15 in Rajasthan. Activities were regularly organized in Rajasthan and Odisha (one per month) compared to Uttar Pradesh (one every alternate month). Most commonly, health promotion activities, cleanliness drives, community monitoring and facilitation of service providers were done by VHSNCs. Funds were received regularly in Odisha compared to Rajasthan and Uttar Pradesh. Funds were received late and less compared to the demands or needs of VHSNCs.Research limitations/implications This comprehensive analysis of VHSNCs' functioning in the selected study areas sheds light on the gaps in many components, including the untimely and inadequate receipt of funds, poor documentation of expenditures and involvement of VHSNC heads and inadequate supportive supervision.Originality/value VHSNCs assessment has been done for improving community health governance.

Does local democracy improve public health interventions? Evidence from India

AbstractHealth care decisions in many low‐income countries often require a close political agency relationship between healthcare decision makers and constituents. This is especially the case for maternal and child care as well as preventative interventions when resources are scarce. This article examines the effect of the introduction of the National Rural Health Mission in India, introducing Village Health, Sanitation and Nutrition Committees (VHSNC), a self‐governance mechanism to strengthen the political agency in village health care decision making. We study the effect of exposure to VHSNC on both maternal and preventative child health care. We find that exposure to VHSNC's increase the utilization of several maternal health care services, but does not systematically increase the uptake of preventive health care. The effect of VHSNC is more intense in larger villages and areas closer to district headquarters, and is driven by an increase in the utilization of the public healthcare network.

Are Village Health, Sanitation, and Nutrition Committees Functional? Evidence from Chhattisgarh and Madhya Pradesh.

Background:The Village Health, Sanitation, and Nutrition Committee (VHSNC) is a participatory effort aimed to strengthen the village-level agencies and to provide better health and sanitation services. However, there is a lack of evidence on the functionality of VHSNCs.Objectives:The present study aimed to explore the functionality of VHSNCs in the selected localities.Materials and Methods:The study was conducted in five districts of Chhattisgarh and Madhya Pradesh states. Using a multistage sampling method, a total of 508 VHSNCs were studied. The VHSNCs were considered as the unit of study. From each VHSNC, some key functionaries and its members were interviewed using a semi-structured interview schedule to understand the nature and effectiveness of its functioning. The researchers closely observed the meetings of VHSNCs and their records. Data were analyzed using descriptive statistical methods along with the impressions from the field notes.Results:The result of the study indicates that the functionality of the majority of the VHSNCs is not promising. Inadequate participation and improper implementation of key tasks are evident.Conclusion:The functionality of the VHSNC can be improved through the active involvement of Panchayati Raj Institutions and local communities.

Empowering Village Health Sanitation and Nutrition Committee members on dengue prevention and control: An educational interventional study in rural areas of Mysuru, Karnataka

Objectives: Dengue, among all the vector-borne diseases, continues to be a major public health problem in India. Dengue once considered being problem in urban areas, now it is increasingly found in rural areas. Thus, empowering the village level functionaries like members of Village Health Sanitation and Nutrition Committee (VHSNC) can help in prevention and control of dengue in the rural areas. The present study was conducted to assess the effectiveness of educational intervention on perception regarding dengue and its prevention among VHSNC members. Material and Methods: This prospective interventional study was conducted among all 305 VHSNC members of two randomly selected primary health centers of Mysuru talukas for the period of 6 months. Baseline levels of perception on dengue were collected using a pre-tested structured questionnaire. Educational intervention on various domains of dengue and its prevention was provided using audiovisual aids, handouts, and group discussion. Endline survey was conducted 1 month after the education sessions to assess the effectiveness intervention. Results: A total of 305 VHSNC members participated in the study. In pre-test survey, only 189 (61.9%) had ever heard of disease dengue. In post-test survey, 274 (91.3%) had heard of dengue. There was a statistically significant improvement in perception regarding, preventable nature of dengue, mode of transmission, breeding and biting habits of mosquito, source reduction measures, and personal protective measures against mosquito bites following educational intervention. Conclusion: Educational intervention was found to be effective in empowering village level stake holders like VHSNC members regarding dengue and its prevention.

Evaluation of village health sanitation and nutrition committee in Himachal Pradesh, India.

Introduction:Decentralization through introduction of Village Health Sanitation and Nutrition Committees (VHSNCs) was a key initiative introduced in 2007 under the National Health Mission (NHM), India to address local health and sanitation issues. This study was done to assess the functioning of the VHSNCs.Aims and Objectives:1. To assess the level of awareness among the VHSNC members about their roles and responsibilities 2. To assess the level of awareness among the community members about the committee and its functions. 3. To assess the pattern of disbursement and utilization of untied funds under VHSNCs.Methodology:A cross-sectional study of 30 VHSNCs conducted in district Kangra of state Himachal Pradesh. Information was collected through a review of records and in-depth interviews with community and VHSNC members.Results:All committee members knew about VHSNCs but the level of awareness among community members was comparatively less (67%). Some members were confused about their roles and responsibilities. Most active members were the FHWs, AWWs, ASHAs, Mahila mandal representatives, and the female ward panch. A major chunk (65%) of the funds is utilized on the cleanliness activities. For the nutritional part, the majority of the work is already being undertaken by the AWCs so there is no clarity regarding the functioning of the committee on this aspect.

Revamping village health sanitation and nutrition days for improved delivery of maternal and child health services at village level - Experiences from a pilot phase study.

Village health sanitation and nutrition day (VHSND) was conceived under the National Rural Health Mission to deliver maternal and child health and nutrition services at the village level in the anganwadi center. Multiple challenges, including a lack of convergence of frontline workers, were affecting service delivery at VHSND. As a public-private partnership Piramal Foundation proposed to revive the concept of VHSND. The present study was aimed to demonstrate a model of VHSND to provide primary care related to maternal and child health and nutrition at the village level in 25 aspirational districts across seven states of India. The descriptive study was undertaken as a pilot phase. Of the purposively identified 506 VHSND sites, monitoring data on delivery of six basic primary care services at VHSND, collected as part of routine operations were compared for 229 sites for the month of September 2018 (baseline) and January 2019 (endline). In model sites, there was the increased availability of drinking water and functional toilets; a significant improvement of availability of equipment for providing antenatal care services, immunization, and growth monitoring. However, the supply of drugs at these sites did not show a statistically significant change. There was also a significant improvement in the engagement of the Village Health Sanitation and Nutrition Committee (VHSNC) in the villages of the model VHSND sites. The model demonstrated the significant changes with effective supervision and participation of VHSNC members, demand generation activities complemented with improved supplies and widening range of services at the VHSND are required to be undertaken.

Decentralization in India's health sector: insights from a capacity building intervention in Karnataka.

The Government of India has adopted decentralization/devolution as a vehicle for promoting greater equity and supporting people-centred, responsive health systems. This article reports on our year-long intervention project in Karnataka, South India, and articulates insights of both practical and theoretical significance. It explores the intersection of the political goal of enhanced local level autonomy and the programmatic goal of more responsive health service delivery. Focusing on the Village Health, Sanitation and Nutrition Committees (VHSNCs) set up under the National (Rural) Health Mission (NHM), the project set out to explore the extent to which political and programmatic decentralization are functional at the village level; the consonance between the design and objectives of decentralization under NHM; and whether sustained supportive capacity building can create the necessary conditions for more genuine decentralization and effective collaboration between village-level functionaries. Our methodology uses exploratory research with Panchayati Raj Institution (PRI) members and functionaries of the Health Department, followed by a year-long capacity building programme aimed at strengthening co-ordination and synergy between functionaries responsible for political and programmatic decentralization. We find that health sector decentralization at the village level in Karnataka is at risk due to lack of convergence between political and programmatic arms of government. This is compounded by problems inherent in the design of the decentralization mechanism at the district level and below. Sustained capacity building of the VHSNC can contribute to more effective decentralization, as part of a larger package of interventions that (1) provides for financial and other resources from the district (or higher) level to political and programme functionaries at the periphery; (2) helps the functionaries to develop a shared understanding of the salience of the VHSNC in addressing the health needs of their community; and (3) supports them to collaborate effectively to achieve clearly articulated outcomes.

Awareness regarding utilization of untied funds among the members of Village Health, Nutrition and Sanitation Committees (VHNSC) in selected villages of Wardha district

Background:Village Health, Sanitation and Nutrition Committee (VHSNC); an initiative of National Rural Health Mission offers people opportunity to access the basic services: Health, Nutrition and Sanitation at the village level itself. To achieve the desired goal, VHNSC members must have a good knowledge regarding guidelines for utilization of funds.This study tried to assess the knowledge of the members of VHNSC regarding the allocation of fund and utilization of the untied fund as compared to the guidelines.Methodology:Â It is a cross sectional study carried out in 13 villages of Bhidi for a period of 2 months, August 2015 to September 2015. Convenient sampling was followed. All members of VHNSCs who gave consent were included in the study. Data analysis was done in the Epi info version 7.Results:In this present study majority of participants were Anganwadi workers (28.1%) followed by housewives (26.6%), with 85.9% members being female. 92.2% had some knowledge about utilization of fund and 70.3% had correct knowledge about the amount of fund received for VHNSC per annum. According to 71.9% fund was inadequate. 89.1% mentioned that fund utilization was mainly for nutrition purposes (89.1%), followed by referral to higher centre (59.4%), sanitation (39.1%). Main challenges faced were inadequate fund (57.8%), in coordination with President (25%), in coordination between members(23.4%), late receival of funds(12.5%), lack of interest of members(10.9%), no bank account (10.9%) etc. 84.4% members had no training.Conclusion:Study findings suggest that use of untied fund by VHNSCs is not as per the guidelines mainly due to limited awareness of guidelines among VHNSC members. Quality training for VHNSC members is the need.

Village Health Sanitation and Nutrition Committees: reflections on strengthening community health governance at scale in India

India’s National Health Mission constituted Village Health Sanitation and Nutrition Committees (VHSNCs) as a key mechanism for community health governance. Health committees provide citizens with the opportunity to shape health...

Perception and Practices of Village Health Sanitation and Nutrition Committee (VHSNC) members prevention and control of Dengue

Background Dengue in all its forms is a major public health problem in India. Once considered being problem in urban areas now it is increasingly found in rural areas. Members of Village health sanitation and nutrition committees are the major stakeholders for health wellbeing sanitation and nutrition related activities at the village level. Thus understanding their knowledge on dengue will give an idea about their potential utility prevention and control of the disease. Methodology This cross-sectional study was conducted among all 305 VHSNC members of two randomly selected primary health centers of Mysuru talukas for the period of six months. Perception and practicesof members on dengue and its prevention were collected using a pre-tested structured questionnaire.Results Among 305 VHSNC members participated in the study only 189 61.9 had ever heard of dengue.99 52.4 were aware that dengue is a preventable disease and 63.5 knew that disease is transmitted by mosquito. 30 knew that the mosquito breeds in fresh artificial collection of water. 54.1 participants reported to use bed nets followed by 98 32.1 mosquito repellent coils 60 19.7 mosquito repellent creams. Overall majority 120 39.3 were having poor perception regarding dengue followed by 95 31.1 fair 75 24.6 satisfactory and 15 4.9 good.Conclusion The perception and practices regarding dengue and its prevention were found to be poor among village health sanitation and nutrition committee members in selected primary health center areas of Mysuru.

Government helper and citizen advocate? A case study of the multiple roles and pressures facing a nongovernmental organization contracted by government to strengthen community health in northern India.

SummaryWhile nongovernmental organizations (NGOs) can potentially strengthen valuable citizen political engagement, NGOs that are increasingly oriented towards donor and government contracts may instead contribute to depoliticizing development. Amidst competing pressures, NGO experiences and agency in managing multiple roles require examination. We present a qualitative case study of an NGO implementing a government‐designed intervention to strengthen Village Health, Sanitation, and Nutrition Committees (VHSNCs) in rural north India. Despite a challenging context of community scepticism and poor government services, the NGO did successfully form VHSNCs by harnessing its respected interlocutor status, preexisting relationships, and ability to “sell” the VHSNC as a mechanism for improving local well‐being. While the VHSNC enabled community members to voice concerns to government officials, improvements often failed to meet community expectations. NGO staff endured community frustration on one hand and rebuffs from lower‐level officials on the other, while feeling undersupported by the government contract. Consequently, although contracted to strengthen a community institution, the NGO increasingly worked alongside VHSNC members to try to strengthen the public sector. Contrary to assumptions that NGOs become “tamed” through taking government contracts, being contracted to deliver inputs for community participation was intertwined with microlevel political action, though this came at a cost to the NGO.

Doing implementation research on health governance: a frontline researcher\u2019s reflexive account of field-level challenges and their management

BackgroundImplementation Research (IR) in and around health systems comes with unique challenges for researchers including implementation, multi-layer governance, and ethical issues. Partnerships between researchers, implementers, policy makers and community members are central to IR and come with additional challenges. In this paper, we elaborate on the challenges faced by frontline field researchers, drawing from experience with an IR study on Village Health Sanitation and Nutrition Committees (VHSNCs).MethodsThe IR on VHSNC took place in one state/province in India over an 18-month research period. The IR study had twin components; intervention and in-depth research. The intervention sought to strengthen the VHSNC functioning, and concurrently the research arm sought to understand the contextual factors, pathways and mechanism affecting VHSNC functions. Frontline researchers were employed for data collection and a research assistant was living in the study sites. The frontline research assistant experienced a range of challenges, while collecting data from the study sites, which were documented as field memos and analysed using inductive content analysis approach.ResultsDue to the relational nature of IR, the challenges coalesced around two sets of relationships (a) between the community and frontline researchers and (b) between implementers and frontline researchers. In the community, the frontline researcher was viewed as the supervisor of the intervention and was perceived by the community to have power to bring about beneficial changes with public services and facilities. Implementers expected help from the frontline researcher in problem-solving in VHSNCs, and feedback on community mobilization to improve their approaches. A concerted effort was undertaken by the whole research team to clarify and dispel concerns among the community and implementers through careful and constant communication. The strategies employed were both managerial, relational and reflexive in nature.ConclusionFrontline researchers through their experiences shape the research process and its outcome and they play a central role in the research. It demonstrates that frontline researcher resilience is very crucial when conducting health policy and systems research.

Negotiating power relations, gender equality, and collective agency: are village health committees transformative social spaces in northern India?

BackgroundParticipatory health initiatives ideally support progressive social change and stronger collective agency for marginalized groups. However, this empowering potential is often limited by inequalities within communities and between communities and outside actors (i.e. government officials, policymakers). We examined how the participatory initiative of Village Health, Sanitation, and Nutrition Committees (VHSNCs) can enable and hinder the renegotiation of power in rural north India.MethodsOver 18 months, we conducted 74 interviews and 18 focus groups with VHSNC members (including female community health workers and local government officials), non-VHSNC community members, NGO staff, and higher-level functionaries. We observed 54 VHSNC-related events (such as trainings and meetings). Initial thematic network analysis supported further examination of power relations, gendered “social spaces,” and the “discourses of responsibility” that affected collective agency.ResultsVHSNCs supported some re-negotiation of intra-community inequalities, for example by enabling some women to speak in front of men and perform assertive public roles. However, the extent to which these new gender dynamics transformed relations beyond the VHSNC was limited. Furthermore, inequalities between the community and outside stakeholders were re-entrenched through a “discourse of responsibility”: The comparatively powerful outside stakeholders emphasized community responsibility for improving health without acknowledging or correcting barriers to effective VHSNC action. In response, some community members blamed peers for not taking up this responsibility, reinforcing a negative collective identity where participation was futile because no one would work for the greater good. Others resisted this discourse, arguing that the VHSNC alone was not responsible for taking action: Government must also intervene. This counter-narrative also positioned VHSNC participation as futile.ConclusionsInterventions to strengthen participation in health systems can engender social transformation. However they must consider how changing power relations can be sustained outside participatory spaces, and how discourse frames the rationale for community participation.

Beyond form and functioning: Understanding how contextual factors influence village health committees in northern India.

Health committees are a common strategy to foster community participation in health. Efforts to strengthen committees often focus on technical inputs to improve committee form (e.g. representative membership) and functioning (e.g. meeting procedures). However, porous and interconnected contextual spheres also mediate committee effectiveness. Using a framework for contextual analysis, we explored the contextual features that facilitated or hindered Village Health, Sanitation and Nutrition Committee (VHSNC) functionality in rural north India. We conducted interviews (n = 74), focus groups (n = 18) and observation over 1.5 years. Thematic content analysis enabled the identification and grouping of themes, and detailed exploration of sub-themes. While the intervention succeeded in strengthening committee form and functioning, participant accounts illuminated the different ways in which contextual influences impinged on VHSNC efficacy. Women and marginalized groups navigated social hierarchies that curtailed their ability to assert themselves in the presence of men and powerful local families. These dynamics were not static and unchanging, illustrated by pre-existing cross-caste problem solving, and the committee’s creation of opportunities for the careful violation of social norms. Resource and capacity deficits in government services limited opportunities to build relationships between health system actors and committee members and engendered mistrust of government institutions. Fragmented administrative accountability left committee members bearing responsibility for improving local health without access to stakeholders who could support or respond to their efforts. The committee’s narrow authority was at odds with widespread community needs, and committee members struggled to involve diverse government services across the health, sanitation, and nutrition sectors. Multiple parallel systems (political decentralization, media and other village groups) presented opportunities to create more enabling VHSNC contexts, although the potential to harness these opportunities was largely unmet. This study highlights the urgent need for supportive contexts in which people can not only participate in health committees, but also access the power and resources needed to bring about actual improvements to their health and wellbeing.

Social accountability and education revives auxiliary nurse-midwife sub-centers in India, reduces travel time and increases access to family planning services

Background: Uttar Pradesh (UP) is the most populous state in India. The maternal mortality ratio, infant mortality rate and fertility rates, are all higher than the national average. Sixty per cent of UP inhabitants live in rural communities. Reasons behind the poor state of health and services in many areas of UP is inadequate knowledge and availability in communities of healthy behaviors and information on available government health services.
 Methods: World Vision Inc. implemented a three-and-half year mobilizing for maternal and neonatal health through birth spacing and advocacy project (MOMENT), partnering with local organizations in rural Hardoi and urban slums of Lucknow districts in UP. World Vision Inc. used print, audio and visual media, and house-to-house contacts to educate communities on timing and spacing of pregnancies, the benefits of seeking and using maternal and child health (MCH) including immunization, and family planning (FP) services. This paper focuses on World Vision’s Social Accountability strategy – Citizen Voice and Action (CVA) and interface meetings – used in Hardoi that helped, educate and empower Village Health Sanitation and Nutrition Committees (VHSNCs), and village leaders to access “Government Untied Funds” to improve community social and health services.
 Results: 40 VHSNCs were revived in 24 months. Nine local leaders accessed government untied funds. In addition, increased knowledge of the benefits of timing and spacing of pregnancies, MCH, FP services, and access to community entitlements, led the community to embrace, work together to contribute their time to rebuild and reopen 17 non-functional Auxiliary Nurse Midwife (ANM) subcenters. 17 ANMs received refresher training to provide quality care. Sub-center data showed 1,121 and 3,156 women opted for intra-uterine contraceptive device and oral pills respectively and 29,316 condoms were distributed.
 Conclusion: In Hardoi, UP, education, using CVA, and interface meetings are contributing to increasing the number of government sub-centers that integrate contraceptive services with others such as immunization and antenatal care, bringing care closer and more accessible to women and children, and reducing travel time and cost to families who would have otherwise sought these services from higher level facilities. Social accountability can help mobilize communities to contribute to improving services that affect them.

Assessment of village health sanitation and nutrition committees of Chandigarh, India.

Village Health, Sanitation and Nutrition Committees (VHSNCs), one of the key interventions introduced by National Rural Health Mission, are an important mechanism to ensure community participation and ownership for decentralized health planning. To assess the implementation status of VHSNCs and analyze the issues regarding their implementation in the villages of Chandigarh. A cross-sectional mix method study was conducted in the year 2015 in all 22 VHSNCs of Chandigarh. The data of VHSNCs' members were obtained using interview schedule and in-depth interview checklist, while record review checklist was used to assess functioning of VHSNCs. A scoring sheet was developed based on sociodemographic profile, public services monitoring, training status, untied funds utilization, and regularity of monthly meetings. The comparison of VHSNC indicators was done between villages under Panchayat and Municipal Corporation (MC). Most VHSNCs' members are trained (except medical officers) and had their joint bank account (95.4%). Maximum fund is utilized for administrative purposes, leaving less for health and nutrition-related activities. Most villages (68.9%) got 25-30 score depicting that implementation status of VHSNCs under these villages is "promising," while one and six villages were "low performing" and "good performing," respectively. Public service monitoring indicator's implementation was better in villages under Panchayat as compared to those under MC. The performance of most villages having VHSNCs under Chandigarh was satisfactory. Few areas such as training of medical officers and supportive supervision of VHSNCs needs strengthening for achieving mandate of National Rural Health Mission regarding community ownership and decentralizing health sector.