Panchayati Raj Institutions and NRHM
in India are an age-old institution for governance at village level.
In 1992, through the enactment of the 73rd Constitutional
Amendment, Panchayati Raj Institutions (PRI) were strengthened as local government
organizations with clear areas of jurisdiction, adequate power, authority and
funds commensurate with responsibilities.
Panchayats have been assigned 29 rural development activities, including several, which are related to health and population stabilization. The XI schedule includes Family Welfare, Health and Sanitation, (including hospitals, primary health centers, and dispensaries,) and the XII schedule includes Public Health. Thus the possible realm of influence of the Panchayats extends over a significant proportion of public health issues. The Gram Sabha, where empowered has the potential to act as a community level accountability mechanism to ensure that the functions of the village Panchayat in the area of public health and family welfare, actually respond to people’s needs.
Increasingly it is being realized that strategies for achieving low infant, under five and maternal mortality depend on a functioning continuum of high quality services from community to secondary and sometimes higher levels of care. In addition community support for such services comes through behavior change to increase utilization as well as demand high quality services. In the RCH 2 implementation document, specific mention is made of plans to support PRI (and urban counterparts) in design, implementation, monitoring of RCH related interventions. This is also seen as a potential to address the social determinants of health through engagement with communities and PRI rather than a biomedical approach. It is also expected that PRI involvement will increase community understanding of issues of accountability for quality and reliability of health care services.
Critical Role of Panchayati Raj Institutions in NRHM
The National Rural Healthcare Mission, designed to integrate health and family welfare related interventions and address health from a holistic preventive, promotive and curative viewpoint takes a much more significant view of PRI engagement. The fulcrum of the NRHM programme is a social activist(ASHA) at the village level, who will work with the village level resource team in providing preventive and promotive health care services. It is expected that she will be supervised and supported by the panchayats.
Thus there is opportunity for PRI involvement to address the non technical components of health care seeking, provided all PRI representatives are exposed to a perspective building exercise on health within the framework of gender and equity.
Linkage from the village to Gram Panchayat to Block and District
At the village and Gram Panchayat level: The Village Health Committee (VHC) will form the link between the Gram Panchayat and the community. The VHC would be responsible for working with the Gram Panchayat to ensure that the health plan is in harmony with the overall local plan. It is anticipated that this committee will prepare a Village Health Plan and maintain village level data, supervised by the Gram Panchayat. Engaging the Gram Sabha and other groups in planning and monitoring the Village Health Plan will presumably enforce transparency and accountability.
Under the NRHM, untied funds of Rs. 10,000 are placed with the ANM to meet unanticipated expenditures and to ensure that lack of drugs and other consumables is not an issue. An account has been opened with the Sarpanch for operationlization of the activities planned. At the subcentre level planning and use of these funds will be supported by the appropriate tier of the panchayat.
Block Level: At the block level a Block Co-ordination Committee with the Block Nodal Officer /Block Panchayat President as Chairperson and the involvement of PRIs and civil society will be formed for effective functioning and convergence. This will be linked to the Meeting of the Block level Committeess under the Pradhan.
District level: At the District level the District Health Mission will coordinate NRHM functions and are under the Zila Pramukh.
ASHA and the PRIs
The selection of ASHA is the responsibility of the Gram Panchayat where it will be finalized in a meeting of the Gram Sabha.
success of ASHA scheme will depend on how well the scheme is implemented and
monitored. It will also depend crucially on the motivational level of various
functionaries and the quality of all the processes involved in implementing
(a) At the village level ASHA will receive support from the women’s committees (like self help groups or women’s health committees), Village Health & Sanitation Committee of the Gram Panchayat, peripheral health workers especially ANMs and Anganwadi workers, the trainers of ASHA and mainly the Panchayat members.
(b) At the block level, ASHA scheme will have a Block Co-ordination Committee with the Block Nodal Officer /Block Panchayat President as Chairperson and the involvement of PRIs and civil society.
(c) The Gram Panchayat would lead the ASHA initiative in selection of ASHA, providing regular support in undertaking many health related tasks through its statutory health committee, developing the village health plan and in the compensation incentive. All ASHAs will be in this Village Heath & Sanitation Committee of the Panchayat either as members or as special invitees
(d) The state level NRHM committee will monitor and support the District Health Society and District Nodal Officer.