Village Health Sanitation Research Articles

Assessing Knowledge And Functionality Of Village Health Sanitation And Nutrition Committees In India: A Mixed-Method Research

Assessing Knowledge And Functionality Of Village Health Sanitation And Nutrition Committees In India: A Mixed-Method Research

IJCM_249A: Assessment of availability of drugs & logistics on Village Health Sanitation and Nutrition Day (VHSND) sessions of Raipur district, CG- A cross-sectional observational study

Background: Maternal and Child health remains one highly pervasive and damaging condition in low-middle-income countries. To improve the situation Govt. of India in 2007 initiated VHSND, as an effective platform for delivering healthcare services at the doorsteps of the unserved and underserved village population, improving awareness and access of the community for health services thereby leading to improvement in the health indicators.,(VHSND) are community-based health initiatives designed to bring essential healthcare services to the doorsteps of rural populations. These sessions serve as a crucial platform for promoting health, hygiene, and nutrition awareness within villages. Organized regularly, VHSNDs aim to address a spectrum of health issues, ranging from maternal and child health to sanitation and nutrition. The success of VHSNDs relies heavily on community participation. These sessions not only offer immediate health services but also empower communities by fostering a sense of ownership over their well-being. By engaging with local residents, VHSNDs contribute to the overall improvement of health indicators and the quality of life in rural areas. In summary, VHSNDs play a vital role in bridging the healthcare gap in rural communities, emphasizing preventive healthcare, and promoting a holistic approach to well-being. They embody the collaborative efforts of health professionals, community leaders, and residents to create healthier and more resilient villages. Objective: 1. To assess the status of logistic availability on VHSND sessions of Raipur District Methodology: A cross-sectional study was conducted to assess the status of logistic availability on 30 VHSND sessions of Raipur district during March- July 2023 in Chhattisgarh by observation and pre-tested pre-designed semi- structured questionnaires. Results: It was observed that out of 30 VHSND sessions site, 77 % were held as per the micro plan and from those 90% ANM, 97% ASHA, 84% Anganwadi workers, 57% Anganwadi helpers, and only 10% PRI members were present at the site of the session. Only 56% of session sites were supervised by supervisors, 28 (93.33%) session sites had drinking water facilities, 21 (70%) sites had toilet facilities, and only 25(83.33%) sites had electricity connectivity. BP Instrument, Stethoscope, Weighing scale, Hemoglobinometer, Glucometer, Disposable syringe 5ml, Disposable syringe 0.5 ml, Disposable syringe 0.1, MCP card, Examination table, were above (90%) present in most of the VHSND sessions. Out of 30 Sessions Stadiometer (19) Fetal Doppler (15), Curtains (21), Stepping stool for climbing on the examination table (17), and Referral slip (5) are present in the VHSND sessions. Nischaya kit, VDRL, HIV, and RDK for malaria kit were present in 74%,43%,97%, and 93% respectively. Iodized salt testing is not available in any sessions. All vaccines were available 100% except BCG, DPT, and Td, which were present in 87%,93%, and 90% sessions. AEFI Kit was available in 80% of sessions. Condom, OCPs, and Centchroman were present most of the site of the sessions but Inj. MPA, IUCD, and emergency contraceptive pills were available only in 14%,37%, and 14% of sessions respectively, 7.23 (77%) of the session sites have Information displayed about the day, time, and site of the VHSND session, Conclusion: Most of the session sites were held as per the micro plan, there is some lacuna in the availability of logistics although a majority of essential items were found at session sites special focus needs to be given to fetal doppler, HIV kit cold-chain maintenance, Iodized salt kit, Cotrimoxazole, Anti-malaria drugs, Td, and BCG vaccine. Satisfactory maternal and child health services were provided in many sessions.

Evaluating Maternal Health Services Within the Reproductive, Maternal, Newborn, Child Health and Adolescents (RMNCH+A) Framework Amidst the COVID-19 Pandemic in Rural India: A Comprehensive Mixed-Methods Analysis.

Background Around half of the pregnant women in India do not receive full antenatal care. During the year 2020, routine health services were further affected by COVID-19. This study was conducted to assess the effect of the pandemic on the delivery/utilization of reproductive, maternal, newborn, child health, and adolescent(RMNCH+A) services. Methodology The study, conducted in Wardha district, Maharashtra, from July to December 2020, aimed to assess maternal health. In Wardha block, 200 pregnant and postnatal women were surveyed using a multistage sampling approach. Adequate knowledge was gauged through Mother and Child Protection Card comprehension. Health system data for April to December 2020 was compared with 2019 district-wide. In-depth interviews were conducted with beneficiaries, including pregnant and post-natal women and healthcare workers. The qualitative inquiries involved medical officers, supervisory staff, community health officers, an auxiliary nurse and midwife (ANMs), Taluka Health Officers, and focus group discussions with accredited social health activists (ASHA), Anganwadi workers (AWW), and Village Health Nutrition and Sanitation Committee members. Results Essential services were delivered to both antenatal and postpartum women, though family planning services and health education were the worst affected. Among the survey respondents, 75% of the post-partum women were not using any contraceptives. District-wide coverage of post-abortion/MTP contraception fell by around 90% as compared to the previous year. The most common difficulties faced by the respondents in availing of the services were related to finances and arranging transport to visit health facilities. Conclusion Learning from the current pandemic for system strengthening, adequate manpower, and planning to prevent disruption of essential services and promoting e-health and m-health initiatives may prevent such catastrophic events in the future from affecting the delivery of routine services.

Evaluation of impact of engaging federations of women groups to improve women's nutrition interventions- before, during and after pregnancy in social and economically backward geographies: Evidence from three eastern Indian States.

Undernutrition-before, during and after pregnancy endangers the health and well-being of the mother and contributes to sub-optimal fetal development and growth. A non-randomized controlled evaluation was undertaken to assess the impact of engaging federations of women's group on coverage of nutrition interventions and on nutrition status of women in the designated poverty pockets of three Indian states-Bihar, Chhattisgarh, and Odisha. The impact evaluation is based on two rounds of cross-sectional data from 5 resource poor blocks across 3 States, assigning 162 villages to the intervention arm and 151 villages to the control arm. The cross-sectional baseline (2016-17) and endline survey (2021-22) covered a total of 10491 adolescent girls (10-19 years), 4271 pregnant women (15-49 years) and 13521 mothers of children under age two years (15-49 years). Exposure was defined based on participation in the participatory learning and action meetings, and fixed monthly health camps (Adolescent Health Days (AHDs) and Village Health Sanitation and Nutrition Days (VHSNDs)). Logistic regression models were applied to establish the association between exposure to programme activities and improvement in coverage of nutrition interventions and outcomes. In the intervention area at endline, 27-38% of women participated in the participatory learning and action meetings organized by women's groups. Pregnant women participating in programme activities were two times more likely to receive an antenatal care visit in the first trimester of pregnancy (Odds ratio: 2.55 95% CI-1.68-3.88), while mothers of children under 2 were 60% more likely to receive 4 ANC visits (Odds ratio: 1.61, 95% CI- 1.30-2.02). Odds of consuming a diversified diet was higher among both pregnant women (Odds ratio: 2.05, 95% CI- 1.41-2.99) and mother of children under 2 years of age (Odds ratio: 1.38, 95% CI- 1.08-1.77) among those participating in programme activities in the intervention arm. Access to commodities for WASH including safe sanitation services (Odds ratio: 1.80, 95% CI- 1.38-2.36) and sanitary pads (Odds ratio: 1.64, 95% CI- 1.20-2.22) was higher among adolescent girls participating in programme activities. Women's groups led participatory learning and action approaches coupled with strengthening of the supply side delivery mechanisms resulted in higher coverage of health and nutrition services. However, we found that frequency of participation was low and there was limited impact on the nutritional outcomes. Therefore, higher frequency of participation in programme activities is recommended to modify behaviour and achieve quick gains in nutritional outcomes.

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial.

Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN. DERR1-10.2196/42450.

Accountability of PRIs and Community Participation in Village Health Nutrition and Sanitation Committees in Uttar Pradesh

Accountability of PRIs and Community Participation in Village Health Nutrition and Sanitation Committees in Uttar Pradesh

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.

Accessing Maternal Health Care in the Midst of the COVID-19 Pandemic: A Study in Two Districts of Assam, India.

BackgroundCOVID-19 pandemic and the subsequent national lockdown in India compelled the health system to focus on COVID-19 management. Information from the field indicated the impact of COVID- 19 on the provision of maternal health services. This research presents users' and providers' perspectives about the effect of the pandemic on maternal health services in select districts of Assam.MethodsThe study was undertaken to understand the status of maternal health service provision and challenges faced by 110 pregnant and recently delivered women, 38 health care providers and 18 Village Health Sanitation and Nutrition Committee members during COVID-19 pandemic. Telephonic interviews were conducted with the users identified through simple random sampling. Healthcare providers and the community members were identified purposively.ResultsMost of the interviewed women reported that they could access the health services, but had to spend out-of-pocket (for certain services) despite accessing the services from government health facilities. Healthcare providers highlighted the lack of transportation facilities and medicine unavailability as challenges in providing routine services. The study revealed high proportion of Caesarian section deliveries (42.6%, n = 32) and stillbirths (10.6%, n = 8).DiscussionThis research hypothesizes the supply-side (health system) factors and demand-side (community-level) factors converged to affect the access to maternal health services. Health system preparedness by ensuring availability of all services at the last mile and strengthening existing community-reliant health services is recommended for uninterrupted good quality and affordable maternal health service provision.

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.

Assessment of knowledge and their practices regarding malaria among members of Village Health Sanitation Committee in rural Uttar Pradesh: A cross-sectional study.

Background:In 2019, the global number of malaria cases was estimated at 229 million. An estimated 409,000 deaths were attributed to malaria in 2019. Under-five children are the most susceptible to malaria, accounting for 67% (274,000) of all malaria deaths worldwide in 2019. This study aimed to assess knowledge and practices regarding malaria among Village Health Sanitation Committee (VHSC) members in rural Uttar Pradesh.Methodology:This cross-sectional study was conducted in the villages of four districts of Uttar Pradesh with high malaria burden. In the present study, 484 participants were interviewed from four districts of Uttar Pradesh.Results:Nearly all the participants (97.1%) have heard about malaria. Majority of the participants (97.1) were aware that mosquito bites spread malaria. However, many participants were also having a false awareness that malaria is spread by other modes like drinking contaminated water, touching each other, eating contaminated food, and so on. More than half of the participants told that mosquitoes are responsible for malaria breeds in stagnant clean water (25.6%) and stagnant dirty water (28.5%). Nearly half of them were aware that mosquitoes’ biting time was sunset (42.1%) and sunrise (7.8%).Conclusion:In the present study, many participants were having a false awareness that malaria is spread by other modes like drinking contaminated water, touching each other, eating contaminated food, and so on. Even the knowledge regarding any government program for the prevention and control of malaria of the mosquitoes was very weak. There is an urgent requirement of increasing knowledge among the VHSC members to reduce the malaria burden in the country.

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.

Health system preparedness & community participation in Japanese encephalitis/acute encephalitis syndrome (JE/AES) prevention in a tribal district of Odisha, India.

Background & Objectives:Japanese encephalitis/acute encephalitis syndrome (JE/AES) is one of the major zoonotic arbodiseases that has a significant effect on human and animal health. Though many studies have been published on the epidemiology and transmission mechanisms of JE/AES, but there is little evidence on health system preparedness, including community-based engagement. This study was undertaken to explore a multi-stakeholder perspective on health system preparedness for the prevention of JE/AES in a tribal district of Odisha, India.Methods:This study was conducted at Malkangiri district of Odisha. A total of nine focus group discussions (FGDs) among women having under-five children, community volunteers, and community health workers (CHWs), and 20 in-depth-interviews (IDIs) among community leaders, healthcare providers, and programme managers were conducted. The FGDs and IDIs were digitally recorded, transcribed, translated and analysed using content analysis approach.Results:Health system preparedness for the prevention of JE/AES was improved, including effective vector management, implementation of the surveillance system, and vaccination programme. The JE vaccine was introduced under Universal Immunization Programme in Odisha in 2016. Behavioural Change Communication activities were provided with the support of community volunteers on Village Health Nutrition and Sanitation Day (VHNSD) under Gaon Kalyan Samiti (GKS) platforms. The CHWs were actively involved in vector management and raising sanitation and hygiene awareness.Interpretation & conclusions:Community participation and coordination between different stakeholders have a significant impact on the successful implementation of the programme. It was suggested that there was a need for a sustainability approach to active participation, orientation and capacity building training among CHWs and community volunteers to successfully implement the programme.

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.

Social Accountability and community participation in Village Health Nutrition and Sanitation committees in Uttar Pradesh

Background: A First step towards community involvement is Participation. The government of India under its flagship program, the National Health Mission, advocates and actively encourages community participation and has setup Village Health Nutrition and Sanitation Committees (VHNSCs) at village level. Aim & Objective: The objective of this paper is to examine “The Level of Community Participation in the Village Health Sanitation committees” in the state of Uttar Pradesh. Methods and Material: A cross-sectional mix method study was undertaken in 3 districts, covering 15 villages, in Uttar Pradesh between August to October 2019. The quantitative component included a pre-tested semi structured questionnaire. Further, Focused group discussion (FGDs) and key informant in-depth interview were undertaken for more information. Informed consent was collected from all the participants. The quantitative data was analyzed using SPSS 21.0 while the qualitative data was analyzed manually, based on themes. Results: The average size of the household was 5, 65% respondents were educated, 88% were Hindus, 47% were from other backward class and 50% had below poverty line cards. In the year 2019, 7% of the respondents participated in the Gram Sabha and 5% in village health nutrition and sanitation committee meetings. Statistically significant variations were noticed where less than 20% of the schedule castes and schedule tribes had lower participation than other castes in any of the village level committees. Lack of time was one the key reasons cited for non-participation. Conclusions: To ensure adequate participation from all castes it is important to schedule meetings at times convenient may encourage more community participation.

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.

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.

Antenatal Care Service Utilization Among Adolescent Pregnant Women-Evidence From Swabhimaan Programme in India.

Purpose: Pregnant adolescent girls (15–19 years) are more vulnerable to poor health and nutrition than adult pregnant women because of marginalization and lack of knowledge about the antenatal care (ANC) services. The present study aims to test this hypothesis and assess determinants of ANC service utilization among currently adolescent pregnant women.Methods: Data were drawn from the baseline survey of SWABHIMAAN project, which had been conducted in three states of India: Bihar, Chhattisgarh, and Odisha. Out of a total 2,573 pregnant women (15–49 years) included in the sample, about 10% (N = 278) were adolescent girls (15–19 years) at the time of the survey, and the rest were adults. Sample was selected from the population using simple random sampling, and information was collected using pretested questionnaires.Results: For all indicators of ANC service utilization, performance of adolescent pregnant women was better than adult pregnant women. However, significant variations were reported in the level of services received by adult pregnant women for different indicators. Religion, wealth, food insecurity, Village Health Sanitation and Nutrition Day meeting, Public Distribution System and Integrated Child Development Services entitlements, and knowledge of family planning methods had a significant effect on the ANC service utilization.Conclusion: Adolescent pregnant women have shown better utilization of selected indicators than their adult counterparts. Utilization of full ANC services starting from first trimester itself for adolescent pregnant women is an urgent need in present context. Intervention program must pay attention to such adolescent married girls who are entering into the motherhood phase of their lives.

Participation of Village Health Nutrition and Sanitation Committees (VHNSC) on Social determinants of health (SDH) in a District in Maharashtra.

Background: Community participation is one of the core principles of Primary Health Care. VHNSC is example of community participation and is formed to take collective actions on health issues and its social determinants of health (SDH). It is envisaged as being central to local level community action to support decentralized health planning. Work on actual participation of VHSNC on SDH is almost negligible. Therefore, the present research study was conducted to find out the participation of VHNSC on SDH. Aim: To assess the involvement of VHNSC on SDH. Methods and Material: Knowledge on SDH and health actions of VHNSCs were studied using a questionnaire which was pretested and suitably modified. The study was conducted in all the 83 VHNSCs under 4 PHCs namely Waiphad, Anji, Kharangana Gode and Talegaon were choosen as per feasibility. Results: Members of all VHNSCs had knowledge about access to safe drinking water, sanitation and nutrition as SDH. Members from 6 (7.2%) VHNSCs could not relate literacy with health. Most had to be probed regarding knowledge about addiction to tobacco and alcohol; social deprivation and availability of emergency transport. Conclusions: VHNSC are moving in the right direction however they require continuous support, hand holding and monitoring from government and other NGOs.