Involvement of Panchayati Raj (Local Self Government)

Institutions in Health: A Qualitative Analysis

Y.L. Tekhre*, Nisha Rani** and S.P. Singh***

Introduction: Madhya Pradesh was the first State to organize elections to the Panchayats after the 73rd Constitutional Amendment. According to PRI Act, out of 29 subjects under the Eleventh Schedule, five subjects are directly associated with the health and family welfare, which are: Drinking water, health and sanitation (including health centers), family welfare, women and child development, social welfare (including welfare of physically and mentally challenged persons). According to the recent amendment from MP Govt. dated 12th April, 2005, there is a provision of two committees: Gram Nirman Samiti and Gram Vikas Samiti [Village construction committee; and Village Development committee]. The Gram Vikas Samiti can construct any number of samities according to their need. Practically Village Health Committee (VHC) is one of them. There is a tendency to execute only schemes sponsored by the State or union government; hardly any programmes are carried out from PRIs own resources, most States have failed to give the Gram Sabha a mandate by clearly defining its functions and authority.

Status of Panchayati Raj Institutions in India

State/India Total number of

Village Panchayat Total number of Block Panchayat

Total number of District Panchayat

Madhya Pradesh 22029 313 45

India 231729 6087 537 Source: Ministry of Rural Development, Government of India, September, 2005

According to the Panchayati Raj provision functioning of health care providers, facilities and services are not percolating appropriately to the villagers. Practically, the VHC members and health care providers do not have adequate interlink and smooth coordination. Essentially, immunization, Anti Natal Care [ANC], safe delivery, and minor ailment are major factors in contribution mortality and morbidity; therefore, the capacity building of VHC needs to be strengthening in these areas including participation in National Rural Health Mission [NRHM]; it is unambiguous that the core strategies of NRHM to empower Panchayat to manage, control and be accountable for public health services. Therefore, there is a need to intervene through action research towards capacity building in the area of health and family welfare in which the Village Health Committee [VHC] can take a lead to execute and implement these programme at their village. As a catalyst and think tank, the NIHFW can initiate operationalised and institutionalized such a prestigious committee under PRIs for their sustainable performance. Keeping in view of the above a field visit was made in the month of July 2006 in two blocks

namely Patan and Kundam of the Jabalpur district based on non-tribal and tribal correspondingly.

The primary data in the form of in-depth interviews with key informants/stakeholders and Focus

Group Discussions (FGDs) were organized with PRI members in the villages. This empirical

paper briefly summarizes the contemporary situation of involvement of PRIs in health and

functioning of VHCs in a district of Jabalpur in the State of Madhya Pradesh. Especially on

issues and challenges and opportunities that NRHM is probably to face in the village settings.

The ultimate purpose of gathering the empirical facts to operationalised and institutionalized

such a prestigious committee (Village Health Committee) under PRIs for their sustainable

performance through need based interventions. The basic rationale of the visit was to

investigate the functioning of village health committee and its further scope for intervention

towards its better functioning. Several stakeholders, e.g. Sarpanch, members of the village health

committee, secretary of village panchayat, health supervisor, chief executive officer, block medical

officer etc. were contacted.

Why we need action research in the field of Panchayat: The action research is required in the

field for finding out workable solutions for the existing problems. The solutions are analysed in

the context of given situations with a view to determining their replicability in larger areas.

Therefore, collection of detailed information about the projected/identified problems is a

prerequisite before starting on action research. At the same time, if some possible solutions have

been indicated from other research studies or observation, these are utilized for actual field trials

and procedures are worked out to make their application effective. Finally, the main object of

action research is to find out the adaptability and workability of solutions under varying conditions.

Meanwhile human factors are also taken into consideration while finding out practical solution; in

brief, it is a dynamic process which is essential for successful implementation of given solutions;

if certain changes in the situations and techniques are considered necessary, these are done to find

out the correct processes for the acceptability and the success of the programme.

Panchayati Raj has now universal coverage throughout the country. It is now involved directly

and/or indirectly in all economic and social development in the rural areas. In spite of provision

and inherent mechanism, many of the Gram Panchayats have not formed village health committees

properly, even that formed, they are not functioning appropriately. Many of the health committees

were lying only on paper; the functional village health committees face difficulties while

discharging their responsibilities because of lack of coordination, poor participation, with no

purpose agenda and pathetic leadership and so on. Article 7-D of the M.P. Panchayati Raj Avam

Gram Swaraj Act clearly states the powers, functions and duties of the committee. Every

committee shall be responsible and accountable to the Gram Sabha and shall work under its control

and supervision.

VHCs in the Village Panchayat may be the ideal platform to prioritize and implement various

health programmes and schemes systematically; because this committee will take care of all gamut

of health plan and implementation of the schemes in the village. Keeping in view of the nature of

action research, changes in situation or approaches are introduced as per the needs and

requirement. The most important strategy for achieving this aim is: capacity building of VHCs

under PRIs.

Rationale to consider VHC for intervention: How the Panchayat could play a major role in the

health of the community is determined by various aspects i.e. selection of the VHC member, their

activeness, activities carried out, role and responsibilities, networking, conducting meetings and

ultimately coordination with other agencies and organisation in the village. It has been realised

that after massive efforts and decades of providing basic health care and building up of impressive

and huge infrastructure, the programmes are unable to reach, those who need it most, and the needs

not addressed appropriately. Review of Literature and field observation: Recent survey of Mahila Swasthya Sangh [MSS]

mentioned that there were no mechanism and clear-cut agenda and strategy to work with VHC.

The main reasons were lack of coordination, leadership and transparency. Not only this, the MSS

members were not able to coordinate or assimilate of developmental welfare programmes, which

were deeply useful to overall development of the community. On the other hand, there were no

participatory mechanism, orientation and males’ involvement was missing. It concludes that

people’s participation, coordination and cooperation between PRIs and government agencies and

adequate planning at the local level can help in realization of the cherished dream of administrative

decentralization and empowerment at grassroots level (Satya Prakash, 2002).

A survey of ‘panchayats’ working in 19 States, conducted by the National Institute of Rural

Development, Hyderabad, lists the number of principal reasons why these constitutionally

mandated rural bodies find themselves unable to discharge their functions satisfactorily. Few of

them are: absence of a national consensus across party lines on what should be the status of the

PRIs; high level political authorities are unwilling to give up control over finance and development

schemes; the stronghold of the bureaucracy over PRIs continues; functional and financial

autonomy has not been granted to the PRIs; PRIs are perceived as lower level agencies of the

government, diluting their conceived status as units of self-government; there is a tendency to

execute only schemes sponsored by the State or union government; hardly any programmes are

carried out from PRIs own resources; most States have failed to give the Gram Sabha a mandate

by clearly defining its functions and authority.

In the village health committee – mandatory in Maharashtra- there is lack of clarity of the role of

the committee, and lack of interest, leading to poor attendance in meetings. Instead of the

Panchayat Sarpanch, Gram Sevak, etc., it would be better if local people who are interested in this

work were made members of the committee. Since the committee does not seem to have a definite

role of powers, it looses any impact. Here again, as in case of the Community Health Worker, the

concept is excellent, but has not flowered in action. This shows there is lack of human approach,

there is no empathy between the healer and the patient; when it has been demonstrated through

studies that rapport is essential for fast recovery.

A survey of 60 panchayats in 21 districts of Madhya Pradesh, conducted by Charkha, [an NGO,

2003] find that as many as 90 per cent children do not get mid-day meals; only 24 per cent panches

were aware about some of the activities of health; all of them were unhappy with the functioning

of health care services. Institutional deliveries were less than fifty per cent; the visit of health

workers restricted upto only 46 per cent panchayats; there were no latrines in 83 per cent

panchayats. The level of people’s participation in the village development was so meager, only 35

per cent people participate in plan making and 28 per cent people were involved in the

implementation of plans; most of the village panchayats were not having VHC; moreover, there

were no systematic mechanisms to address the health related issues to the villagers by the

Panchayat.

A working paper report mentioned that at Gram Sabha level, there is a complete absence of

knowledge on the part of representatives and Panchayat Secretary as to how these committees will

be functioning. This report also highlights that voluntary organisations have utilized

instrumentalities of Gram Swaraj to form committees for specific tasks. The result of micro level

and participatory research conducted by PRIYA, VHAI and Institute of Social Sciences, in

different states indicates that performances are better wherever NGOs and other local groups are

working with PRIs (Manoj Rai, Priya, 2004)

The Panchayat members were not aware of various schemes and programmes run by government,

NGOs land various international agencies regarding safe water and sanitation; the prevalence of

water borne dise3ases was quite common among children below five years of age because of

unhealthy surrounding and unhygienic behaviour of the community; therefore, motivation of PRI

members is urgently needed (NIHFW, 2006).

What is requisite towards Capacity Building of Village Health Committee under Panchayati Raj Institutions: we need to study the existing status of Village Health Committees in Panchayati Raj and develop a need based intervention towards capacity building of Village Health Committees to implement health and family welfare programmes in general and to explore facilitating and obstacle factors faced by health committee in particular. We also need to assess the impact of intervention in the area of health and family welfare programme taken by the village health committee. At this juncture a situation analysis followed by an action research, ‘before-and-after without control design’ may be an appropriate strategy to adopt in the line of attack.

Why the action plan is more important in village health committees under NRHM:

practically to follow the policy guidelines, towards implementation of the scheduled activities and

programmes, on the way to fulfill our objectives within a time period and to utilise human resource

and materials appropriately. On the basis of state of affairs aabboouutt 7733 ppeerrcceenntt ppooppuullaattiioonn ooff IInnddiiaa

lliivveess iinn vviillllaaggeess;; iinn tthhee mmeeaannwwhhiillee,, tthhee rruurraall hheeaalltthh sscceennaarriioo iiss mmoorree ddiissmmaall,, mmoosstt ooff tthhee hheeaalltthh

iinnddiiccaattoorr aaffffeeccttss tthhee nnaattiioonnaall ddeemmooggrraapphhiicc pprrooffiillee.. IItt iiss aallssoo wweellll kknnoowwnn ffaacctt tthhaatt ffuunnccttiioonniinngg ooff

PPrriimmaarryy hheeaalltthh cceenntteerrss aanndd ssuubb cceenntteerrss aarree mmoorree ccrruucciiaall.. OOnn tthhee ootthheerr ssiiddee iiff wwee aannaallyyssee tthhee

oobbjjeeccttiivvee ooff tthhee NNRRHHMM,, iitt iiss cclleeaarr tthhaatt hhee NNRRHHMM iiss aann aaccttiioonn oorriieenntteedd,, tthheerreeffoorree wwee rreeqquuiirreedd aaccttiivvee

kknnoowwlleeddggee bbaasseedd PPRRIIss aanndd ddeecceennttrraalliisseedd ppllaannnniinngg pprroocceessss aatt tthhee ggrraassssrroooott.. The major components

of the action plan in relation to health can be chalked out as follows:

1. Background of the district/block/village and the purpose of action plan in its introduction.

2. Situation in the district/village and may be about the strengths, opportunities, weaknesses

and threats.

3. Problems and the ones to be tackled on priority basis.

4. Clearly specified objectives.

5. Strategies to meet the objectives.

6. Major activities to be performed/services to be provided.

7. Resources required and the source of same/resource mobilization.

8. Responsibility for individual activity/service and its level of application.

9. Monitorable timetable.

10. Foreseeable constraints or risks.

Sr.

No Basic steps Key questions

1 Situational analysis

Projection/prediction of health situation

Identification & definition of problems

Where

are we

now?

2 Selection of priorities

Establishment of goals and objectives

Where do

we want to reach?

3 Listing key alternative strategies

Try/examine strategies in relation to resources

Selection of feasible strategy/choosing options

Listing of activities

Making an implementation plan

How

Will

We

reach?

4 Monitoring and control of operations Are we going in the right

direction?

5 Evaluation Have we reached?

6 Re-planning

ASPECTS OF THE ANALYSIS OF THE SITUATION IN THE VILLAGE BY THE VILLAGE

HEALTH COMMITTEE MEMBERS AS STAKEHOLDERS

A COMMUNITY ASPECTS

Demographic Population, Distribution, Age-Sex, Indicators

Socio-Economic Per-capita Income, Below Poverty Line, Housing, Occupation, Communication etc.

Geo-climatic Terrain, Climate, Accessibility

Socio-Cultural Attitudes, Beliefs, Practices

Educational Literacy, Female Literacy, Institutions

B HEALTH ASPECTS

Earlier performance Achievements in relation to expected Levels/CNA

Health status Morbidity (Incidence/Prevalence) & Mortality Pattern

Health facilities Govt. Voluntary, Private (Allopathic/ISM & H etc.)

Resources Human, Monetary, Material

Training Sites, Trainers, Facilities, Categories being trained

At the meantime, SWOT Analysis is required to prepare an action plan. This is more justifiable Assess the external environment to see how it will affect the organisation as well as how the organisation can influence the environment. In other words, identify the constraints (or threats) and the opportunities through systematic scanning of the environment. The external environment may consist of a number of social, political, technological and economic influences. Assessment of the department’s internal strengths and weaknesses; after scanning the

environment, one must turn inward to see how the programme is performing in terms of meeting

its objectives with present strategy and whether it need to change strategy. This should involve not

only appraising the objectives, but also to its other organisational functions such as administration,

education, services, management of financial and human resources and general management.

Surveillance towards involvement of Panchayati Raj Institutions in Health: In the state of

Madhya Pradesh there is a provision of two committees in the Gram Sabha, namely (i) Gram

Nirman Samiti and (ii) Gram Vikas Samiti. Under the Gram Vikas Samiti other committees can be

formed according to their needs. Traditionally, the formation of Village Health Committee has

been taken place after the Panchayat election in Madhya Pradesh in the month of January, 2006.

Outcome of the Field Visit:

Functioning of Village Health Committee: Village Health Committee is fashionable in many

terms; stakeholders and other people know little bit about its existence, membership and functions,

roles and responsibilities were not known in detail. After the panchayat election [January, 2006]

only two committees are in existence: Development committee and construction committee. There

is no place for ‘Village Health Committee’ as such, this committee has to be run by Development

Committee. Though, there is no provision for separate and independent Health Committee; in

practical this committee has been formulated with the health supervisor almost in every village.

More or less all the process of formulating of VHC is on paper and record is kept with the Block

level officials preferably with the health supervisor.

The other members and stakeholders were not aware about the membership and its criteria adopted

in formation of the committee. Hardly any meeting has been taken so far towards any health issue

or action plan in practical. In the meantime there is no clear-cut agenda even the meeting has been

taken place. There were no fix times for conducting a meeting of VHC. Almost all the respondents

regardless of their status pointed out that the major role of the VHC is to keep watching on the

health related activities in the village. They further narrated the entire work of VHC in three

dimensions: (i) to take care for family planning, (ii) to provide medicine and, (iii) to send the

people for treatment. Members of VHC and other stakeholders were not familiar with the health

programmes in their respective villages.

Surprisingly, non of the stakeholders and office bearers of PRI was aware of the selection criteria

of VHC, neither he was attentive about how frequently the meeting takes place whether regular,

irregular, monthly, quarterly, half yearly, yearly or any time. Similarly, in the agenda items of the

meeting of VHC, most of the respondents were not able to share it in detail. On the other hand, as

we are expecting and there is a need of the hour to have networking and intersectoral coordination

in the health sector, it was found that hardly any unit, agency or any other NGO is in touch or

partner in any aspect of health activities in the area. When we discussed about Village Health

Action Plan in the village, it was brought into being that no such plan has been made so far; only

water management has been chalked out. Panchayat is serious and providing bore pump water to

all segments of population in the village.

There were no incidences of any training/orientation or any sort of input even clarification or

discussion formal/informal to the VHC member related to their work and health related matter;

but as a contrary, block level official, Chief Executive Officer (CEO), remarked that these

members were provided some orientation towards their roles in relation to health issues, although

he didn’t give the details of it. Virtually, there is no record at the Panchayat level about the meeting

of VHC and minutes as mentioned by the Health Supervisor [HS]. This usually was kept at the

block level under the custody of Health Supervisor. Most of the VHC members were not aware of

Eligible Couple Register, Village Health Register and Village Health Action Plan. In the same

way, the level of participation and cooperation in strengthening of VHC among villagers was found

very low.

Socio-cultural backgrounds of the members were as customary. The representatives of the weaker

section and women’s participation were taken care of. As far as satisfactions of the present status

of the VHC were concerned, this was dismal. Most of the VHC members and stakeholders were

confused. They were basically not conscious about the roles and responsibilities of VHC. At the

same time, many of the members were rigorously asking that ‘is there new scheme to introduce in

the village for health?’; when was it discussed with reference to RCH and common health needs

of the villagers. They generated their interests and came forward towards capacity building of

VHC in their village.

Situational Analysis of the Visited Villages: an on average, the population of the village was

1200. The village panchayat members were found about 9-21. About 40 per cent were Mahila

Sarpanches, and of course, there were SC/ST reservation also. The posts of the ANM were found

vacant in 4 places (out of 20 Sub-Centers). Almost all of them were not residing in their sub-centre

headquarters. Barely 30 per cent of panchayats were having sub-centre buildings. On the contrast,

approximately every panchayat was encompassed with Panchayat Bhawan. The arrangement of

DAI (traditional birth attendant) was found in each and every village according to the requirements

and size of the population of the panchayat. All of them were trained and 80 per cent deliveries

were conducted at home.

The activities of ICDS were found quite well in terms of its population coverage and functioning

of Aanganwadi centre, but at the same time there was no much link or coordination with health

department towards delivery of RCH and MCH services at the village level. As on today

Aanganwadi Worker and Sahaika (helper) are not associated with ANM or any health worker for

health activities nor are they linked with village health committee, even health committee members

were not assimilated them of their jurisdiction. Surprisingly, according to the health supervisor,

wherever the women Sarpanches were found, conventionally the formation of Mahila Mandals has

been completed, but again it was in segregation without adopting any process of conducting

meeting and taking into consideration of the panchayat members; yet again the activity and

functioning of the Mahila Mandal were misplaced.

Existence of NGOs were found negligible in both the blocks (villages in which visit was made);

though some of the projects were taken up by the NGOs who were from urban set up and located

at long distance; respondents were not able to recall the accurate purpose and activities of these

NGO.

Most of the leaders and Sarpanches were supportive and pleased that ANM to be in their villages

(in relation to residential arrangements), even they were readily agreed to provide residential

accommodation through panchayat, but the practical difficulty to reside in the sub-centre

headquarter were found in many fold. Most of the ANMs spouses were posted somewhere else in

government or non-governmental services. Their wards were studying in convent or English

medium schools in the urban areas in which they reside.

Selection of ASHA by Panchayat and Role of VHC under NRHM: Only the Sarpanch,

Secretaries of the Gram Panchayat and other Members of VHCs are aware of the status of ASHA’s

selection in the village. Though, the selection process has not been explained to any one. With the

help of Health Supervisors, Sugamkarta (representative/facilitator of the NGO) has completed the

task of selection of ASHA, but most of the stakeholders were not fully aware of the selection of

criteria and the function of the ASHA. Even in the method of selection of ASHA, the general

norms were not followed (the general norm will be ‘One ASHA per 1000 population’); as a matter-

of-fact, there was one ASHA in 2000 population. This pattern was also tag along in tribal areas.

When it was explored further towards criteria for selection of ASHA from the Health Supervisor

(male), there were no clear-cut answer were found in terms of communication skills, leadership

qualities and be able to reach out to the community, yes the educational conditions were absolutely

fulfilled in all the areas. It was interesting that the other stakeholders like Gram Vikas Adhikari

and School Teachers were also very much interested to take part in the process of ASHA’s

selection. Rarely meetings of the Gram Sabha were convened to select the ASHA, there were no

short listed names of ASHA, VHC has very limited role at the juncture.

There were no problems as such of VHC, because they were not oriented at any point in time about

their work and responsibilities. Recently, the training of ASHA at block level has been started.

Moreover, the members of the VHC were absolutely unaware of this training/orientation; this

matter has not been discussed at any platform in the Panchayat. Therefore, there is an adequate

scope emerged towards the capacity building of the VHCs under PRI.

Suggestions made by the Members and other Panchayat Officials towards Capacity Building

of VHC: It was optimistic by almost all the members of VHC and Panchayat members about the

strengthening/capacity building of the VHC in many respects. Particularly on periodicals meetings,

preparing the health action of the village, participation of the villagers in various reproductive and

child health activities, institutional delivery and management of high-risk delivery, coverage of

immunization and supervision of minor ailments to the common people. Interestingly, the

stakeholders at village panchayat level made most of the suggestions, not from the block level

officials in general. Most of the block level officials verbatim that ‘Gaon ke logon ko bhi mauka

de ki unki kounsi samasya hai, abhi kewal teekakaran aur delivery ka hi kam poora ho pa raha

hai’. (There should be given more opportunities to the villagers to explain their health problems,

now a day only immunization and delivery is on the top priority). The other suggestions from block

level officials of PRI and health officials were that ‘reward should be provided to the best VHCs

in future for their work’.

In the memory of the members, no camp was organised in their respective villages regarding any

aspect of health and family welfare, nor any type of collaboration and networking has been taken

place in relation to promotion of health activities. It is just simply because of non-initiative,

otherwise people were willing to originate various health activities of innovative ideas. In case of

future intervention in the VHC, this was welcomed and enthusiastic in vision of entire stakeholders

(village as well as block level). Interaction and counselling with the health officials was

highlighted mostly by the wide variety of respondents; they further narrated that many myths and

misconceptions can be removed through one to one interaction and group talk in the village. Some

of the educated and persons who are involved in this process, they can contribute a lot about many

issues and aspects of health related features.

On other side, the several respondents in both the blocks suggested mobile health facilities; this

idea was more in tribal blocks as compare to other blocks (non tribal block; plan geographical

area). This facility was considered rigorous because of in-access of health services in the periphery

villages, particularly for institutional delivery and treatment of minor ailments.

In view of the respondents VHC may be a first contact unit in the Panchayat; its members were

considered middle level contact persons. Exceptionally, a very few of the ANMs were residing in

their headquarter villages, in this situation, the role and responsibility of the VHC were felt

significant. Moreover this was also a common feeling among the respondents that peer pressure

and common efforts in the areas of community mobilisation and community participation, the

involvement of the members of the VHC is serious. Therefore, it is clear from the opinion of the

stakeholders that interventions related to these issues and aspects were found adequate.

The other suggestions were in the area of lack of human resources in the health sector; due to lack

of health facilities and medical and paramedical staff particularly doctors’, institutional deliveries

were not covered completely, they perceive that these posts were not found fulfilled as per norms.

Hence, in view of the block level officials ‘number of doctors should be increased; the Medical

Officer must visit in the village at least once in a month. Below Poverty Line (BPL) population

are getting benefits but at the same time those in Above Poverty Line (APL) lists they are facing

problems, so VHC should be empowered for health activities in decentralised manner to serve the

underserved’.

Suggestions exclusively in the area of capacity building of VHCs were found in many folds; first

of all it was felt that the officials must reside in the headquarters, camps for general health checkup

should be organized periodically, there should be an interactive session in the area of health and

family welfare, the provision of mobile van (ambulance) has to be made in case of emergency,

particularly in the rainy season. Some sort of activities must be chalked out which are related to

community mobilization and interest of the common people. Above all, there were felt needs of

the respondents that panchayat and particularly VHC must be given proper knowledge about their

roles and responsibilities, they perceive that neither members of the panchayat nor VHC members

are literate and educated to take the lead towards better health of the villagers.

Keeping in view of the above discussion and findings, it can be derived that there is a sufficient

scope of intervention towards capacity building of VHCs at the village level. The VHCs are not

good enough to take the leadership role for implementation of various health activities including

performance of NRHM. These interventions are primarily appropriate in the area of MCH and

RCH related issues and aspects particularly coverage of immunization, ANC registration, safe

delivery, counselling and group meetings, conducting small health camps and treatment of minor

ailments.

The following tentative interventions were found comfortable to be implemented according to the

situations and findings of field visit.

Nature of tentative interventions in the area of health and family including in the villages by the village health committee: 1. Pre intervention workshop to chalk out the nature of need based intervention. 2. Formation of Village Health Committees and its functioning

3. Orientation training to the VHC members and other stakeholders for sensitizing about Health and Family Welfare Programmes

4. Identification and prioritizing the health problems in the village 5. Formation of Village Health Plan 6. Identification of opportunities and strength to implement the programme 7. Implementation process of the health and family welfare programmes 8. Involvement of Mahila Mandals/Mahila Swasthya Sangh, self-help groups, Integrated Child

Development Scheme and NGOs 9. Setting the criteria of selection of ASHA and role of village health committee in NRHM 10. Monitoring and evaluation mechanism of the member of VHC

Abbreviation

ANM Auxiliary Nurse Midwife

APL Above Poverty Line

ASHA Accredited Social Health Activist

BPL Below Poverty Line

CEO Chief Executive Officer

HS Health Supervisor

MCH Maternal and Child Health

NGO Non-Governmental Organisation

NRHM National Rural Health Mission

PRI Panchayati Raj Institution

RCH Reproductive and Child Health

SWOT Strength Weakness Opportunities and Threat

VHC Village Health Committee

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* Dr. Y.L. Tekhre, Reader, Department of Social Sciences, National Institute of Health and

Family Welfare, Munirka, New Delhi-110 067 email: yade_lal@yahoo.co.in (Mobile)

9868182696

** Mrs. Nisha Rani, Researcher and Freelancer (Socio-cultural and Psychological Research),

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*** S.P. Singh, Finger Print Expert and Writer, National Crime Record Bureau, Ministry of

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*****