Village Health & Sanitation Committee, NRHM

1. Village Health & Sanitation
Committee
Dr. Suraj Chawla
Department of Community Medicine,
PGIMS, Rohtak

2. CONTENTS
Background
Composition of VHSC
Roles & Responsibilities
Grants available
Utilisation of untied grant
Accountability
Evaluation of VHSCs
Challenges in empowerment of VHSCs
Recommendations for capacity building and
empowerment of VHSCs

3. BACKGROUND
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, the Bhore Committee
Report and, most recently, the documents
pertaining to the NRHM.
It is widely understood and accepted that for
services to maintain quality and to be effective;
people must have ownership and control.

4. BACKGROUND
Though in practice people's participation has
been narrowly interpreted as their participation
in implementation, ownership can only truly be
brought about by their participation and control
over all processes leading to the delivery of
services, starting from planning itself.
One of the modalities of allowing local, village
level planning for health care has been the
concept of the “Village Health & Sanitation
Committee”.

5. BACKGROUND
The NRHM places significant focus on creating
and supporting Village Health Committees
(VHCs) to promote decentralization.
The VHC is intended to be a part of the local
self-governance structure of the Panchayati Raj
Institutions specifically the Village Council called
the Gram Sabha.
The purpose of the VHCs is to build and
maintain accountability mechanisms for
community-level health and nutrition services
provided by the Government.

6. BACKGROUND
Though systems of decentralised governance
such as the PRIs and Community participation in
local health planning have both been slow to
take off and weak, in the few places where they
have been made functional through various
mechanism (such as in the State of Kerala), their
role in providing the impetus for positive and
sustainable change cannot be denied.

7. COMPOSITION OF VHSC
Gram Panchayat members from village
ASHA, Anganwadi worker, ANM
SHG leader
Village repersentative of any Community-Based
Organization working in the village
Secretary of primary teacher association
If none of the above is a member of SC & ST, then
one member from each category should also be
nominated by the Sarpanch or Mukhiya.

8. COMPOSITION OF VHSC
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.

9. COMPOSITION OF VHSC
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.

10. COMPOSITION OF VHSC
Chairperson:
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.

11. COMPOSITION OF VHSC
Chairperson:
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.

12. COMPOSITION OF VHSC
Convenor:
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.

13. ORIENTATION & TRAINING
Every VHSC after being duly constituted will be
oriented and trained to carry out the activities
specific to the villages to meet the NRHM goals.
Objectives:
To develop VHSC as a strong vibrant group
To develop understanding regarding health
issues
Empower the VHSC members
Strengthen the group to work

14. ROLE OF VHSC
To discuss the problems of the community and
the health and nutrition care providers and
suggest mechanism to solve it
To create awareness in the village about
available health services and their health
entitlements
To develop a Village Health Plan based on an
assessment of the situation and priorities of the
community

15. ROLE OF VHSC
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 maintain a village health register, health
information board and calendar

16. ROLE OF VHSC
To oversee the work of village health and
nutrition functionaries such as the ANM,
Anganwadi Worker (AWW) and ASHA and to
be involved in managing the local sub-centre,
which is accountable to the Gram Sabha.
To discuss the bimonthly village report submitted
by ANM in the village level meeting and take
appropriate action.

17. ROLE OF VHSC
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.
T0 organize regular monthly meeting to discuss
various issues in the village and document the
minutes of the meeting.
The VHSC will also play vital role for selecting
and supporting the ASHA from the community

18. ROLE OF VHSC
The committee shall ensure that Public Dialogue
is organized at regular intervals (once in six
month) in the presence of MO of the PHC.
The committee shall ensure that all the issues
discussed are recorded and action taken on the
issues discussed.
To present an annual health report from the
village to the Gram Sabha.

19. ROLE OF CHAIRPERSON
The Chairperson have the powers to call for and
preside over all meetings.
May himself/herself call, or by a requisition in
writing signed by his/her, may require the
convener to call a meeting of this committee at
any time and on the receipt of such requisition,
the convener shall forthwith call such a meeting.
Authority to review periodically the work
undertaken at the village level and order
inquiry regarding complaints of the
implemented programme.

20. ROLE OF CONVENOR
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.

22. GRANTS
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.
In addition, each sub-centre will also have an
untied fund for local action of Rs. 10,000 per
annum. This fund will be deposited in a joint
bank account of the ANM & Sarpanch and
operated by the ANM, in consultation with the
Village Health Committee.

23. UNTIED FUND
The untied fund is a resource for community
action at the local level and shall only be utilized
for community activities that involve and
benefit more than one house hold.
The committee will utilize the fund after taking
resolution in the VHSC monthly meeting and
also share the information of utilization of fund
with the villagers during village meeting or
public dialogue.
The committee will not withdraw the total
amount of Rs. 10,000/- at one go.

24. UTILISATION OF UNTIED FUND
The fund can be utilized for village level activities
such as
Cleanliness and sanitation drive
School health activities
Transferring the patient to health facilities
Health awareness activities
House hold surveys
Improving the facilities of the Anganwadi Centre
and any other developmental activities for the
village/community.

25. UTILISATION OF UNTIED FUND
The fund can be utilized for arranging all the
essential instrument required in organizing Village
Health & Nutrition Day by the ANM, such as
BP instrument
Weighing machine
Examination table
Screen for maintenance of privacy during health
check up

26. UTILISATION OF UNTIED FUND
For arranging the tea/snacks for the gathered
women, children and other beneficiaries during
the Village Health & Nutrition Day.
For providing Rs.100/- to ASHA for organizing
monthly Village Health & Nutrition Day.
The committee will contribute on behalf of 10
poor BPL families in a year @ Rs. 300/- for
allotment of sanitary latrine under Total
Sanitation Campaign

27. UTILISATION OF UNTIED FUND
For wall writing of slogan on health and
sanitation
For making signboard in the meeting place of
VHSC.
During emergency like flood or any epidemic
the committee will utilize the fund for the relief
camps or supplies such as in case of flood it can
supply Halogen tablet for purification of water,
ORS, Bleaching powder etc.

28. ACCOUNTABILITY
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.

29. REPORTING
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.

30. MONITORING
PHC level:
ASHA Facilitator, MO and LHV are responsible.
Constitution of VHSCs
Organizing monthly meetings
Providing Support in training
Facilitation in development of VHP
Facilitation in conflict redressal

31. MONITORING
Block level:
SMO and BPM are responsible.
Providing Support to PHC functionaries
District level:
CMO and DPM are responsible
Making data base and profile of VHSCs
Facilitation in development of VHP
Facilitating monthly meetings
Address the issue raised identified by VHSC

32. MONITORING
State level:
State health department/ health mission is
responsible.
Provide Support and training modules

33. INSTITUTIONAL STRENGTHENING
Target:
To constitute Village Health and Sanitation
Committee in all 6.38 lakh revenue villages of
India
Efforts so far:
4.98 lakh VHSCs have been already constituted
and provided Rs 10000 as untied fund
(As on 31st Dec. 2010)
Source: NRHM Progress so far 2011 (MOHFW)

34. CURRENT STATUS IN HARYANA

35. HARYANA SCENARIO
To enable the realization of “communitisation”
at the grassroots, state health department under
NRHM guidelines directed the district health
administration to constitute VHSCs in villages
under the Gram Sabha.
In Haryana, before constitution of the VHSCs,
the Village Level Committees (VLCs) were
constituted and were being administered by
Women and Child Department through ICDS
with Anganwadi Worker (AWW) as its convener.
(Sept. 2006)

36. HARYANA SCENARIO
Initially, VHSCs were constituted as a separate
body and was administered by District Health
Department through District Hospital with
Auxiliary Nurse Midwife (ANM) as its convener.
Later, as the roles and responsibilities of both the
Committees were similar, the VHSCs were
merged with the VLCs and committee was
renamed as VLC-cum-VHSC.

37. HARYANA SCENARIO
The VLC-cum-VHSCs are now administered by
Women and Child Department. AWW is the
convener of this Committee.
Funds under NRHM meant for VHSC are
transferred into bank accounts of VLC cum
VHSC.
Funds will be deposited into these accounts
directly from district office of the Civil Surgeon.

38. HARYANA SCENARIO
However, it has been observed that the funds
provided by NRHM for health related activities
are either not being utilized properly due to
reluctance on the part of AWWs or are being
misused in some instances.
Therefore, for ensuring proper utilization of these
funds, it is proposed to make a health
functionary, namely ANM, the joint account
holder of this account alongwith the AWW &
Head of VLC cum VHSC.

39. HARYANA SCENARIO
Annual audit of VHSC funds under NRHM in
coordination with Department of Women &
Child Development is required to be done.
VLC cum VHSC nominates one member to
maintain a separate cash book of funds given
under NRHM, who is paid Rs 100/- per month
for maintaining this cash book, out of the untied
funds available with VHSC.
As on 31st Dec 2010, 6280(93%) VLC-cum-VHSCs
have been formed in the State of Haryana.
(Source mission flexipool 2011: NRHM)

40. HARYANA SCENARIO
(As on 31st Dec. 2010)

41. EVALUATION OF VHSCs

43. FOURTH COMMON REVIEW MISSION
REPORT 2010:
VHSCs are formed and functional in all villages
of Assam, Maharashtra, Kerala and Orissa, 97%
of villages in Chhattisgarh, in 50% of villages in
Arunachal.
They are formed but poorly functional in Assam,
Uttarakhand, Uttar Pradesh, Rajasthan and
Madhya Pradesh.
However, VHSCs seem to have little role in
conducting and monitoring VHNDs or
advocating expansion of scope of these
opportunities.

44. FOURTH COMMON REVIEW MISSION
REPORT 2010:
VHSCs are uniformly lacking in clarity about
their mandates. This is seen even in Assam where
a special orientation was conducted for
members.
The spirit of representing marginalized and
vulnerable sub-sections in the Committee is
absent, especially in Punjab and MP.

45. HARYANA SCENARIO

46. EVALUATION…
Report on Capacity-Building Needs: VLC cum-
VHSC ( Published in July 2010)
A study was conducted by Institute of Rural
Research and Development (IRRAD) in 13
villages of four blocks (Taoru, Nagina, Nuh and
Firozpur Zhirkha) of Mewat to assess the
effectiveness of currently constituted VLC-cum-
VHSCs.
Data was collected from members of the VLC-
cum-VHSC

47. EVALUATION…
Study revealed that the efficiency and impact of
VLC-cum-VHSC appears to be very limited.
More than 50% of the VLC-cum-VHSC members
have inadequate knowledge about the
constitution of VLC-cum-VHSC, their roles and
responsibilities and entitlements and
Government schemes on Health.
No formal training has ever been provided to
them before being made VLC-cum-VHSC
members

48. EVALUATION…
There is no involvement of members in budget
planning and subsequent expenditure. They are
not even aware of the annual grant given to the
Committee for various activities.
The VLC-cum-VHSC meetings and activities are
not organized as stipulated in the guidelines and
the participation of members in these meetings
and activities, whenever conducted, is
insignificant.

49. CHALLENGES IN EMPOWERMENT OF
VHSCs
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

50. RECOMMENDATIONS FOR CAPACITY BUILDING &
EMPOWERMENT

51. CAPACITY BUILDING &
EMPOWERMEMT
To ensure effective functioning of VLC-cum-
VHSC in the villages as stipulated in the
guidelines, it is mandatory to design and
conduct a capacity-building program to
capacitate and empower VLC cum-VHSC
members and ensure their participation.
Simultaneously, awareness generation activities
about the functions of the committee would be
conducted in the villages to make the
committee accountable to the village
community.

52. CAPACITY BUILDING &
EMPOWERMEMT
The program should aim at reviving and
strengthening the VLC-cum-VHSCs to empower
them to access health entitlements for the
community and ensure quality health for all in
the villages.
Training program should be designed to
accommodate the needs of the members.
The training should specifically focus on
increasing the participation of illiterate members
and organizing activities as per the guidelines
and utilization of funds allotted.

53. CAPACITY BUILDING &
EMPOWERMEMT
Training areas
Concept of Health
Health institutions and programmes
Social aspect impacting health status
Demand generation of health care services
Planning and monitoring
Team building
Operational issues
Roles and responsibilities

54. REFERENCES
http://www.nrhmcommunityaction.org/pages/ga
llery/alwar-vhsc-training-workshop-223.php
http://www.mohfw.nic.in/BULLETIN%20ON.htm
http://www.mohfw.nic.in/NRHM/Documents/NR
HM_The_Progress_so_far.pdf
http://nrhm-
mis.nic.in/ui/reports/CER1Reports/National%20Fa
ctSheet.pdf
http://nrhm-
mis.nic.in/frmConcurrentEvaluation.aspx

55. REFERENCES
http://haryanahealth.nic.in/menudesc.aspx?page
=91
http://haryanahealth.nic.in/menudesc.aspx?page
=89
http://www.smsfoundation.org/pdf/Report%20o
n%20Capacity-Building%20Needs-
VLC%20cum%20VHSC.pdf
http://mohfw.nic.in/WriteReadData/l892s/99044
601204thcrm2010.pdf
Evidence review process/vistaar project

56. Thank you