Village Health Sanitation Committee

and

Village Health Nutrition Day

Presenter- Dr. Manju Pilania

PG 2nd year

Village Health & Sanitation Committee

Introduction

Composition

Function

Accountability, Monitoring & Reporting

Grants

Status of VHSC

Village Health, Sanitation & Nutrition Committee

Village Health & Nutrition Day

Service package

Responsibility of functionaries

Monitoring and supervision

What can go wrong

Decentralisation and People's Participation have

been considered key strategies for making health care

services effective and this has been highlighted in all

significant documents articulating people's rights to

health such as the Alma Ata Declaration, Bhore

Committee Report and, most recently, documents

pertaining to the NRHM.

NRHM envisages the “Communitisation” of public

health services enabling both, public health employees

as well as local communities to develop a feeling of

ownership in the Public Health Service Institution.

The NRHM is mandated to enlarge the ownership and management of health services beyond public health functionaries and involve common people.

To enable the realization of this vision at the grassroots, NRHM guidelines direct the District Health Administration to constitute Village Level Health Committees (VLC) cum Village Health and Sanitation Committee (VHSC) in villages under the Gram Sabha.

The Committee is entrusted with the responsibility of enhancing people’s participation in improving health care services in the rural areas by increasing awareness about health and health entitlements with special focus on women and children.

Lady Sarpanch/Panch to be nominated by Village

Panchayat -Chairperson

All mahila panches in the village

One Lady School teacher deputed by Head master

(preferably same village)

Multi Purpose Health Worker (Female)

All ASHAs

All Anganwadi Workers (AWW)

Pradhan of Sakshar Mahila Samooh (SMS)

Self Help Group leader from each Self Help Group

(SHG)

Three most educated adolescent girls out of which

atleast one should be from scheduled caste

Representative of NGO/ Social Activist Working in the

village

Representative of public health/drinking water

department in-charge of the village

Representative of War Widows

Village Chowkidar

Any other member with permission of VLC

To enable the VHSC to reflect the aspirations of the

local community especially of the poor households and

women, it has been suggested that:

At least 50% members of Committee should be women.

Every hamlet within a revenue village must be given due

representation to ensure that the needs of the weaker

sections especially SC / ST and Other Backward Classes

are fully reflected in the activities of the committee.

A provision of at least 30% representation from the Non-

governmental sector.

Representation to women's self-help group to enable the

Committee to undertake women's health activities more

effectively.

The committee will be headed by the ward member of

the village.

If there is more than one ward member in the village:

The woman ward member will head the committee.

If there is no woman ward member existing, male ward

member belonging to SC or ST will head the

committee.

If more than one women ward members or no women

ward members are available in the village, the ward

member of the larger ward will head the committee.

Wherever there is a Panchayat consisting of one

revenue village only, and if the Sarpanch is a woman,

she will be the Chairperson of the committee.

The Chairperson have the powers to call for and

preside over all meetings.

Authority to

review periodically the work undertaken at the

village level and

order inquiry regarding complaints of the

implemented programme.

Convenor of the VHSC would be

ASHA;

where ASHA would not in position it could be the

Anganwadi worker OR

ANM

Convenor can vary in different states as per state

health department guidelines.

In Haryana- AWW (selected by supervisor) is the

convener of this Committee.

To convene the meeting of the VHSC.

To ensure participation of all members in the meeting.

To record the meeting proceedings, maintain cash

book, provide monthly reports and financial report to

MO of concerned PHC.

To facilitate the village health plan.

She will be assisted by the ASHA in all activities.

To create awareness in the village about available

health services and their health entitlements.

To discuss the problems of the community and health

and nutrition care providers and suggest mechanism

to solve it.

To oversee the work of village health and nutrition

functionaries and to be involved in managing the local

sub-centre, which is accountable to the Gram Sabha.

To analyse key issues and problems pertaining to

village level health and nutrition activities and provide

feedback to relevant functionaries and officials.

To monitor all the health activities that are conducted

in the village such as Village Health & Nutrition Day,

mothers meeting etc.

To organize regular monthly meeting to discuss

various issues in the village and document the minutes

of the meeting.

The committee shall ensure that all the issues

discussed are recorded and action taken on the issues

discussed.

To discuss every maternal or neonatal death that

occurs in their village, analyse it and suggest

necessary action to prevent such deaths. (Death

Audit) Get these deaths registered in the Panchayat

To maintain a village health register, health

information board and calendar.

The VHSC will also play vital role for selecting and

supporting the ASHA from the community

The committee shall ensure that Public Dialogue is

organized at regular intervals (once in six month) in

the presence of MO of the PHC.

To discuss the bimonthly village report submitted by

ANM in the village level meeting and take appropriate

action.

To develop a Village Health Plan based on an

assessment of the situation and priorities of the

community

To present an annual health report from the village to

the Gram Sabha.

The ASHA/AWW should maintain a register where

complete details of activities undertaken, funds

received and expenditure incurred are to be

mentioned.

The register should be available for public scrutiny and

should be periodically reviewed by the ANM/MPW/

Sarpanch/ MO I/C.

The committee will maintain accounts and timely

submit the utilization certificate and statement of

expenditure for the money received to the Primary

Health Centre.

Monthly financial report of VHSC is submitted by ANM

to MO of PHC.

PHC - monthly compilation by LHV/ accountant –

submission to SMO

Block – monthly compilation by accountant and

submission to district from where it is submitted to

state level.

PHC level:

ASHA Facilitator, MO and LHV are responsible.

Block level:

SMO and Block Programme Manager are responsible.

State level:

State health department/ health mission is

responsible.

Funds are allotted by the State Health department.

Every village with a population of upto 1500 to get an

annual untied grant of up to Rs. 10,000 after

constitution and orientation of VHSC.

This untied fund will be deposited in a joint account of

Convenor and Chairperson of the committee.

The untied grant to be used by this committee for

household surveys, health camps, sanitation drives,

revolving fund etc.

VLC cum VHSC nominates one member to maintain a

separate cash book of funds given under NRHM, who

is paid Rs 50/- per month for maintaining this cash

book, out of the untied funds available with VHSC.

VHSC – convergence of various deptt. Like health,

Women and Child development, education and PRIs

(Panchayati Raj Institutions)

Civil Surgeons will initiate and coordinate with

Programme Officers (ICDS) and ensure that untied

funds meant for VHSC are immediately transferred

into the bank account of VLC cum VHSC.

Annual audit of VHSC funds under NRHM will be

carried out in coordination with Department of Women

& Child Development

A total of 483, 496 VHSCs have been formed in the

country, covering about 76% of the villages.

States such as Bihar, Uttar Pradesh, Haryana,

Himachal Pradesh, Kerala and Tamil Nadu have

formed the VHSC within the Gram Panchayat while

in the remaining it is at the level of the revenue village.

In Haryana, 6280 VHSC/VLCs formed for 6955

revenue villages.••

No. of VHSC’s to be constituted in Rohtak- 151

No. of VHSC’s Constituted in Rohtak - 149

Role of Village Health & Sanitation Committee (VHSC)

has been expanded so as to include ‘Nutrition’ part

and henceforth will be named as Village Health,

Sanitation and Nutrition Committee (VHSNC).

In addition to the defined activities of VHSC as per

NRHM framework of implementation, VHSNC will also

engage with and monitor status, issues and action

pertaining to nutrition.

Create awareness about nutritional issues and

significance of nutrition as an important determinant of

health.

Carry out survey on nutritional status and nutritional

deficiencies in the village especially among women

and children.

Identify locally available food stuffs of high nutrient

value as well as disseminate and promote best

practices (traditional wisdom) congruent with local

culture, capabilities and physical environment through

a process of community consultation.

Inclusion of Nutritional needs in the Village Health

Plan – The committee will do an in-depth analysis of

causes of malnutrition at the community and

household levels, by involving the ANM, AWW, ASHA

and ICDS Supervisors.

Monitoring and Supervision of Village Health and

Nutrition Day to ensure that it is organized every

month in the village with the active participation of the

whole village.

Facilitate early detection of malnourished children in

the community, tie up referral to the nearest Nutritional

Rehabilitation Centre (NRC) as well as follow up for

sustained outcome.

Supervise the functioning of Anganwadi Centre (AWC)

in the village and facilitate its working in improving

nutritional status of women and children.

Act as a grievances redressal forum on health and

nutrition issues.

Illiteracy of VHSC members

Lack of interest of PRI members

Improper fund flow

Lack of co-ordination among village health and

nutrition workers

Lack of accountability

Negligible participation of other women of community

Concept developed by integrated Nutrition and Health

Project (INHP)

major initiative under the National Rural Health

Mission (NRHM) to improve access to maternal,

newborn, child health and nutrition (MNCHN) services

at the village level.

Once every month (preferably on Wednesdays, and

for those villages that have been left out, on any other

day of the same month) at the AWC in the village.

at a site very close to their habitation, the villagers will

not have to spend money or time on travel.

platform for inter-sectoral convergence

VHNDs require convergent actions from

the Department of Health and Family Welfare

(DHFW) and

the Department of Women and Child Development

(DWCD) at state, district and block levels to plan,

implement and monitor the programme.

Community through VHSNC

1. Early registration of pregnancies.

2. Focused ANC.

3. Referral for women with signs of complications

during pregnancy and those needing emergency

care.

4. Referral for safe abortion to approved MTP centres.

5. Organizing group discussions on maternal deaths, if

any, that have occurred during the previous month in

order to identify and analyse the possible causes.

5. Counselling on:

Education of girls.

Age at marriage

Care during pregnancy.

Danger signs during pregnancy.

Birth preparedness.

Importance of nutrition.

Institutional delivery.

Identification of referral transport.

Availability of funds under the JSY for referral

transport.

Post-natal care.

Breastfeeding and complementary feeding.

Care of a newborn.

Contraception.

Infants up to 1 year :

1. Registration of new births.

2. Counselling for care of newborns and feeding.

3. Complete routine immunization.

4. Immunization for dropout children.

5. First dose of Vitamin A along with measles vaccine.

6. Weighing.

Children aged 1-3 years :

1. Booster dose of DPT/OPV

2. Second to fifth dose of Vitamin A

3. Table IFA – (small) to children with clinical anaemia.

4. Weighing

5. Provision of supplementary food for grades of mild

malnutrition and referral for cases of severe

malnutrition

All children below 5 years :

1. Tracking and vaccination of missed children by

ASHA and AWW.

2. Case management of those suffering from diarrhea

and Acute Respiratory infections.

3. Organizing ORS depots at the session site.

4. Management of worm infestations.

5. Counselling to all mothers on

home management and where to go in event of

complications.

nutrition supplementation and balanced diet.

1. Information on use of contraceptives.

2. Distribution – provision of contraceptive counselling

and provision of non-clinic contraceptives such as

condoms and OCPs.

3. Information on compensation for loss of wages

resulting from sterilization and insurance scheme for

family planning.

1. Counselling on

1. prevention of RTIs and STIs, including HIV/AIDS,

and referral of cases for diagnosis and treatment.

2. for perimenopausal and post-menopausal

problems

2. Communication on causation, transmission, and

prevention of HIV/AIDS and distribution of condoms

for dual protection

3. Referral for VCTC and PPTCT services to the

appropriate institutions.

1. Identification of households for the construction of

sanitary latrines

2. Guidance on where to go and who to approach for

availing of subsidy for those eligible to get the same

under the Total Sanitation Campaign.

3. Avoidance of breeding sites for mosquitoes.

4. Mobilization of community action for safe disposal of

household refuse and garbage.

1. Group communication activities for raising

awareness about

signs and symptoms of leprosy, suspected cases, and

referrals.

symptoms of TB, importance of continued treatment,

referral of symptomatic for sputum examination at the

nearest health centre

elimination of breeding sites for mosquitoes,

management of fever cases, i.e. importance of collection

of blood film for MP and its treatment.

2. Provision of anti-TB drugs to patients.

3. Reporting of unusual numbers of cases of any

disease or disease outbreak in village.

Communication activities for

1. prevention of pre-natal sex selection,

2. illegality of pre-natal sex selection, and

3. special alert for one daughter families.

4. Prevention of Violence against Women, Domestic

Violence Act, 2006.

5. Age at marriage, especially the importance of

raising the age at marriage for girls

1. Home remedies for common ailments based on

certain common herbs and medicinal plants like tulsi

found in the locality.

2. Information related to other AYUSH components,

including drugs for treating conditions like anaemia.

Chronic diseases can be prevented by providing

information and counselling on:

1. Tobacco chewing

2. Healthy lifestyle

3. Proper diet

4. Proper exercise

1. Diseases due to nutritional deficiencies can be prevented by giving information and counselling on:

Healthy food habits.

Hygienic and correct cooking practices.

2. Checking for anaemia, especially in adolescent girls and pregnant women; checking, advising, and referring.

3. Weighing of infants and children.

4. Importance of iron supplements, vitamins, and micronutrients

5. Food that can be grown locally.

6. Focus on adolescent pregnant women and infants aged 6 months to 2 years.

Actions to be taken before the Village Health and

Nutrition Day:

Visit all households (including poor households,

especially SC/ST families) and get to know all the

families.

Make a list of

pregnant women.

women who need to come for ANC for first time or for

repeat visits.

infants who need immunization, were left out or dropped-

out or missed during the pulse polio round.

children who need care for malnutrition or with special

needs, particularly girl children

TB patients who need anti-TB drugs

On the day:

Ensure that all listed women and children come for

services.

Ensure that malnourished children come for

consultation with the ANM.

Ensure supplementary nutrition to children with

special needs.

Ensure that all listed TB patients collect their drugs.

Assist the ANM and the AWW.

Ensure that the AWC is clean.

Ensure availability of clean drinking water during the

VHND.

Ensure a place with privacy at the AWC for ANC.

Keep an adequate number of MCH cards.

Coordinate activities with the ASHA and the ANM.

Ensure that the VHND is held without fail. Make

alternative arrangements in case she is on leave.

Ensure that the supply of vaccines reaches the site

well before the day's activities begin.

Ensure that all instruments, drugs, and other materials

are in place.

Carry communication materials.

Ensure that adequate money is available for

disbursement to the ASHA.

Ensure reporting of the VHND to the MO in charge of

the PHC.

Coordinate with the ASHA and the AWW.

Ensure that the members of the VHSC are available to

support the sessions.

Ensure participation of schoolteachers and PRI

members.

Ensure availability of clean drinking water, proper

sanitation, and convenient approach to the AWC for

participating in the VHND by all.

Jointly by LHV and the AWW Supervisor and submit

their joint report.

The holding of the VHND should be discussed

at the monthly meetings convened by the MOs at

the PHC level

at the executive committee meetings of the District

Health Society, of which the District CMO is the

convener.

The DPM will monitor it, and will also compile data on

it.

Each district and block should maintain a record of the

number of VHNDs planned and the number actually

held

During the supervisory visits, special attention should be

given to the following elements:

1. Women and children from vulnerable communities

should come forward to seek services.

2. ASHA should be available at the session site and

should be engaged in the tracking of women and

children, especially those from vulnerable

communities, for complete coverage.

3. All resources (human resources and materials)

should be in place.

4. The quality of the services available should be

satisfactory.

5. Issues related to the clients' satisfaction with the

services should be addressed properly and promptly.

6. BCC methods should be employed

Irregularity:

Crucial attendance and functionality of the ANM can

subject to uncertainties, unless replacements are

arranged.

Similarly, inadequate supplies of vaccines and related

equipment lead to missed opportunities in providing

services.

Small villages and habitations tend to get left out

unless carefully covered in the micro-plan.

Disorganization

Lack of space and forced inclusion of too many

activities during an NHD tends to make the event

chaotic, leading to long waiting times for clients, and

often, essential services are missed.

Lack of privacy for antenatal check-up prevents

particularly abdominal examination and correct

administration of TT vaccines.

Group counselling usually suffers in not being able to

retain the most appropriate group of women for long

enough till the ANM or AWW find time.

Failure to track due mothers and children:

Poorly organized and maintained survey and service

registers, and failure to identify due clients can undo

much of the benefits of organizing NHDs.

ANM often tends to depend on the AWW for a

complete listing of mothers and children.

If the AWW is poorly supervised and maintains poor

records, coverage inevitably falls.

Missed opportunities for nutrition and health

counselling:

Poorly trained and supervised ANMs tend to miss

opportunities to reinforce “messages” related to

birth preparedness,

newborn care,

Infant and Young Child Feeding (IYCF) and

even immunization

when interacting with mothers and children’s

caretakers during NHDs

Inadequate oversight:

The large number of NHDs that are scheduled on

each vaccine day, and

the inadequate numbers of available supervisors in

ICDS and health programs

make it difficult to organize adequate supervisory efforts.

Large villages, villages in the urban periphery and

multiple session sites:

Such villages offer more options for families to access

services.

However with families accessing services from

different locations in different months, it is difficult for

frontline workers to track timely utilization of services

and to enable timely receipt of these services.

Often there is duplication of effort by different workers

in such villages

NRHM. Ministry of Health and Family Welfare Government

of Haryana. Panchkula. VLC-VHSC Guidelines. May 09.

Institute of Rural Research and Development® Report on

Capacity-Building Needs: Village Level Committee-cum-

Village Health and Sanitation Committee. July, 2010.

NRHM. Ministry of Health and Family Welfare Government

of India. New Delhi. Update on the ASHA Programme. July

2011

NRHM. Ministry of Health and Family Welfare Government

of India. New Delhi. Monthly Village Health Nutrition Day.

Guidelines For AWWs/ASHAs/ANMs/PRIs. Feb 2007.

NRHM. Ministry of Health and Family Welfare Government

of India. New Delhi. Village Health Sanitation & Nutrition

Committee.

USAID Care INDIA. Nutrition and Health Day. Dec 2010.