Community Action for Health in India’s National Rural Health Mission: One policy, many paths

Gaitonde, Rakhal; Sebastián, Miguel San; Muraleedharan, V. R.; Hurtig, Anna-Karin

doi:10.1016/j.socscimed.2017.06.043

Cited by 15 publications

(17 citation statements)

References 15 publications

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“…Several of the stronger case studies in the systematic review are based in India, which has a rich history of non-governmental organization (NGO) and community engagement in health [ 10 , 12 – 14 ]. NGOs are a key constituency advising the National Health Mission's community strategies [ 15 – 17 ]. Feminist NGOs have a long history in advocating for health policies and programs to be more responsive to women's health needs and rights [ 12 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India

George

Mohan

Gupta

et al. 2018

Int J Equity Health

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BackgroundEfforts to work with civil society to strengthen community participation and action for health are particularly important in Gujarat, India, given that the state has resources and capacity, but faces challenges in ensuring that services reach those most in need. To contribute to the knowledge base on accountability and maternal health, this study examines the equity effects of community action for maternal health led by Non-Government Organizations (NGOs) on facility deliveries. It then examines the underlying implementation processes with implications for strengthening accountability of maternity care across three districts of Gujarat, India. Community action for maternal health entailed NGOs a) working with community collectives to raise awareness about maternal health entitlements, b) supporting community monitoring of outreach government services, and c) facilitating dialogue with government providers and authorities with report cards based on community monitoring of maternal health.MethodsThe study combined qualitative data (project documents and 56 stakeholder interviews thematically analyzed) with quantitative data (2395 women's self-reported receipt of information on entitlements and use of services over 3 years of implementation monitored prospectively through household visits). Multivariable logistic regression examined delivery care seeking and equity.ResultsIn the marginalised districts, women reported substantial increases in receipt of information of entitlements and utilization of antenatal and delivery care. In the marginalized and wealthier districts, a switch from private facilities to public ones was observed for the most vulnerable. Supportive implementation factors included a) alignment among NGO organizational missions, b) participatory development of project tools, c) repeated capacity building and d) government interest in improving utilization and recognition of NGO contributions. Initial challenges included a) confidence and turnover of volunteers, b) complexity of the monitoring tool and c) scepticism from both communities and providers.ConclusionWith capacity and trust building, NGOs supporting community based collectives to monitor health services and engage with health providers and local authorities, over time overcame implementation challenges to strengthen public sector services. These accountability efforts resulted in improvements in utilisation of public sector services and a shift away from private care seeking, particularly for the marginalised.

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Section: Introductionmentioning

confidence: 99%

Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India

George

Mohan

Gupta

et al. 2018

Int J Equity Health

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“…AB-HWCs will be credited with the real and lasting fixing of the primary health care system in India, if people start using services at the upgraded facilities, for broad range of health needs. A few more approaches and ideas for effective rollout of AB-HWCs are provided in Appendix 2 [34,35,62,[64][65][66][67][68].…”

Section: Discussionmentioning

confidence: 99%

“…Proposed additional measures to ensure success of AB-HWCs and to strengthen cPHC in India [34,35,[60][61][62][63][64][65][66]74] Shift health planning unit from districts to sub-district levels.…”

Section: Appendixmentioning

confidence: 99%

Health & Wellness Centers to Strengthen Primary Health Care in India: Concept, Progress and Ways Forward

Lahariya

2020

Indian J Pediatr

144

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In February 2018, the Indian Government announced Ayushman Bharat Program (ABP) with two components of (a) Health and Wellness Centres (HWCs), to deliver comprehensive primary health care (PHC) services to the entire population and (b) Pradhan Mantri Jan Arogya Yojana (PMJAY) for improving access to hospitalization services at secondary and tertiary level health facilities for bottom 40% of total population. The HWC component of ABP aims to upgrade and make 150,000 existing Government Primary health care facilities functional by December 2022. The first HWC was launched on 14 April 2018 and by 31 March 2020, a total 38,595 AB-HWCs were operational across India. This article documents and analyses the key design aspects of HWCs, against core components of PHC & the health system functions. The article reviews the progress and analyses the potential of HWCs to strengthen PHC services and therefore, advance Universal Health Coverage in India. Challenges emerged from COVID-19 pandemic & learnings thus far has also been analyzed to guide the scale up of HWCs in India. It has been argued that effectiveness and success of HWCs will be dependent upon a rapid transition from policy to accelerated implementation stage; focus on both supply and demand side interventions, dedicated and increased funding by both union and state governments; appropriate use of information and communication technology; engagement of community and civil society and other stakeholders, focus on effective and functional referral linkages; attention on public health services & population health interventions; sustained political will & monitoring and evaluation for the mid-term corrections, amongst other. Experience from India may have lessons and learnings for other low and middle-income countries to strengthen primary healthcare in journey towards universal health coverage.

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“…The CAH was a complex community-based intervention. As described above and in more detail elsewhere [28], despite finding a prominent place on the policy agenda, many attempts at facilitating its implementation, positive evaluations, and very positive political and bureaucratic support, the program was abruptly stopped. This research focused on official and civil society representatives in the state of Tamilnadu who were directly involved in its implementation, to study the roll-out of this project.…”

Section: Discussionmentioning

confidence: 99%

“…As it turned out, the post-pilot phase of the roll-out took very diverse forms. Finally only two of the original nine states in which it was piloted continued implementation of the original model, with the other states either altering it significantly or completely stopping it [28].…”

Section: The Innovationmentioning

confidence: 99%

Dissonances and disconnects: the life and times of community-based accountability in the National Rural Health Mission in Tamil Nadu, India

Gaitonde

Sebastián

Hurtig

2020

BMC Health Serv Res

Self Cite

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Background: There are increasing calls for developing robust processes of community-based accountability as key components of health system strengthening. However, implementation of these processes have shown mixed results over time and geography. The Community Action for Health (CAH) project was introduced as part of India's National Rural Health Mission (now National Health Mission) to strengthen community-based accountability through community monitoring and planning. In this study we trace the implementation process of this project from its piloting, implementation and abrupt termination in the South Indian state of Tamil Nadu. Methods: We framed CAH as an innovation introduced into the health system. We use the framework on integration of innovations in complex systems developed by Atun and others. We used qualitative approaches to study the implementation. We conducted interviews among a range of individuals who were directly involved in the implementation, focusing on the policy making organizational level. Results: We uncover what we have termed "dissonances" and "disconnects" at the state level among individuals with key responsibility of implementation. By dissonances we refer to the diversity of perspective on the concept of community-based accountability and its perceived role. By disconnects we refer to the lack of spaces and processes for "sense-making" in a largely hierarchically functioning system. These constructs we believe contributes significantly to making sense of the initial uptake and the subsequent abrupt termination of the project. Conclusions: This study contributes to the overall field of policy implementation, especially the phase between the emergence on the policy agenda and its incorporation into the day to day functioning of a system. It focuses on the implementation of contested interventions like community-based accountability, in Low-and Middle-income country settings undergoing transitions in governance. It highlights the importance of "problematization" a dimension not included in most currently popular frameworks to study the uptake and spread of innovations in the health system. It points not only to the importance of diverse perspectives present among individuals at different positions in the organization, but equally importantly the need for spaces and process of collective sense-making to ensure that a contested policy intervention is integrated into a complex system.

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Community Action for Health in India’s National Rural Health Mission: One policy, many paths

Cited by 15 publications

References 15 publications

Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India

Can community action improve equity for maternal health and how does it do so? Research findings from Gujarat, India

Health & Wellness Centers to Strengthen Primary Health Care in India: Concept, Progress and Ways Forward

Dissonances and disconnects: the life and times of community-based accountability in the National Rural Health Mission in Tamil Nadu, India

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