Are functioning Village Health and Sanitation Committees associated with regular fixed-day visits of Auxiliary Nurse Midwives and performance of their stipulated duties under NRHM Jiban Krushna Behera Dr Sudharani Acharya Society for Developmental Action (SODA) Odisha with support from Sunita Singh (CHSJ)

According to National Rural Health Mission guideline The Argument According to National Rural Health Mission guideline There should be one Village Health and Sanitation Committee (VHSC) in every revenue village VHSC role is to plan and monitor the activities under NRHM at the village level VHSCs are prime contributors for the success of NRHM The VHSCs focuses on functioning and activities to ensure service delivery of Auxiliary Nursing Midwifes (ANM) The VHSCs ensure stipulated duties of the ANM related to maternal health on Fixed Health Days & service delivery.

Geographical Area Bangriposi block in Mayurbhanj district of Odisha Mostly inhabited by tribals 67.8 % Literacy rate is 38%. One of the districts for Community Monitoring – First phase

Selection Procedure 7 villages with functioning VHSCs ( using scoring system) 7 villages are selected randomly from the rest 81 villages where there is no VHSC. Note : Care was taken to select villages where the ANM is not common with community monitoring villages.

Parameters of VHSC Functioning The VHSCs 3 months old Adequate representation as per NRHM guideline Members were sensitized Meeting at least once in a month. The ANM/ASHA/AWW are present in the meeting. Prepared village Health Register

Data collection Methods & Tools Method: Observation and Interview Observation of 28 Fixed Health day in 14 villages ( 7 X 2 X 2 months) Individual interview with 40 mothers who have delivered in last 3 months ( 20 X2 ) Tools : 1 VHSC scoring 2 Fixed health day scoring 3 Maternal health scoring

Data Analysis The data was entered in excel sheet and analyzed

FINDINGS: Fixed Health Day Comparison Note: Participation of village level functionaries are uniform but presence of PRI, SHG & VHSC members are more in VHSC villages Note: Participation of village level functionaries are uniform in both the villages but presence of PRI, SHG & VHSC members are there in VHSC villages

ANC service at FHD camps compared VHSC – 28 women checked; N_VHSC – 39 women checked

PNC services at FHD compared Note : PNC services were available at 14/14 VHSC village FHD and 9/14 non VHSC village FHD. VHSC – 30 women received services- ave. 4.8/8 services/woman; N_VHSC – 16 women-1 woman received 3 services in one FHD out of 9 FHD.

Maternal Health Services VHSC villages Non-VHSC villages PREG_REG 12 WEEKS 70% 0% PREG_REG 12-14 WEEKS 10% 65% PREG_REG BY AWW 95% IFA BY ANM INSTITUTIONAL DELIVERY 60% ANM ASST. HOME DEL 15% ASHA ACCOMPANY ADVICE ON COMMON PROBLEM 90%

More….. VHSC villages Non-VHSC villages 50% 0% Check up after delivery Referral by ANM for immediate medical attention 50% 0% Check up after delivery 65% 20% Advice for early breast feeding 95% Advice for diet Personal Hygiene 75% 5% Neo Natal Care 10%

Maternal Health Services Score The number of services received by each woman was converted into a score with base 10. ANC score – Registration, ANM checkup, Wt check, BP check, Abdomen, TT 2, IFA, ANM advice INC score – Inst. Deliv., Deliv advice, ASHA accomp, risk related counselling, ANM advice. PNC score – PNC check, No of checks, ANM counsel, Diet counsel, rest counsel, Hygiene counsel, Contraceptive counsel NNC score – Temp related, Breast feeding related counseling and BCG, Polio and DPT vaccine received

Services received by Women Difference – 1.4 times for ANC; 2.1 times for INC, 20 times for PNC and 5.6 times for NNC between mothers in VHSC and Non VHSC villages.

Limitation of the study The study is done in one block. Situation may be different in other blocks. Assessment study was done by the same NGO that was responsible for implementing VHSC formation and training

Conclusion In all the fixed health day ANM, AWW and ASHA were present; but in in VHSC villages PRI, SHG and VHSC members were also present In both VHSC and non VHSC village Fixed health day, IFA distribution and TT injection is being done but check-ups of abdomen, BP and measurement of weight is being done primarily in VHSC villages Most mothers received counseling in VHSC villages but not so in non VHSC villages Women from VHSC villages received more ANC, INC, PNC and Neo-natal care services compared to Non VHSC villages. Non VHSC villages hardly received any PNC or Neo Natal Care services

Some Positive Indications… Formation of VHSC in the village is promoting the presence of SHG, PRI and VHSC members during Fixed Health Day Presence of trained VHSC members improved the range of services being provided during the FHD Women from villages with trained VHSC receive substantially more services – especially with regard to PNC and neo-natal care PNC and neo Natal care are known to be low compared to ANC and Institutional delivery PNC and neo Natal Care are important to reduce MMR and NMR which are persistent problems.

Recommendation 1 Formation of VHSC under Community Monitoring should be done as soon as possible in other villages 2 There is need to ensure proper composition of VHSC members 3 Attendance in VHSC meetings of PRI, ANM and SHG members should be ensured 4 More rounds of VHSC member training is required in order to ensure their roles and responsibility 5 The Community Monitoring should be upscale in all the villages of this country

THANKS