panchayats in implementing nrhm: an experience in assam

Panchayats in Implementing NRHM: An Experience

in Assam

Abstract: Panchayats, though not like the Panchayati Raj Institutions of these days, but are the age-

old institutions working at the village level. These Panchayats work as decentralised institutions to

bring socio-economic and political development to the people. These developmental activities

include health security, sanitation and population stabilisation etc. When we talk about health and

Panchayats, we must look at the policies like National Health Policy, 2000 and National Health

Policy, 2001 etc. which indicate and ensure the role of PRIs as a responsible agency to provide

decentralised health services. The 73rd

Constitutional Amendment, which has strengthened the PRIs

and drawn clear areas of their jurisdiction, authority and funds also indicates Panchayats’ role in

providing health services.

The UPA government, to improve and uplift the condition of health services in rural India started a

comprehensive national campaigning and launched a programme called National Rural Health

Mission (NRHM) on 12th

April, 2005. NRHM has taken up myriad of action plans and goals those

include increasing public expenditure to health, reducing regional imbalance in health

infrastructure, pooling resources, integration of organizational structures, optimization of health

manpower, decentralization and district management of health programmes, community

participation etc. These goals also reflect the Millennium Developmental Goals (MDGs).

This paper starts on the above narrated ground and basically tries to focus on the roles and

responsibilities of the PRIs in implementing National Rural Health Mission in Assam. Empirical

data collection and scientific observation methods are used while articulating the research findings.

Keywords: PRIs, NRHM, MDGs, UPA, Assam.

Pankaj Bora

Assistant Professor, Bahona College

Merrychaya Patiri

Research Scholar, Gauhati University

Bitapi Bora

Assistant Teacher, Bahona Boys

ISSN 2319-9725

April, 2014 www.ijirs.com Vol3 Issue 4

International Journal of Innovative Research and Studies Page 1067

1. Introduction:

Panchayats are one of the oldest decentralized democratic institutions working at the village

level in India to bring socio-economic and political development to the people. Panchayats

give power to the rural people. Through Panchayats people can participate in decision making

and policy implementation at village level. Panchayati Raj Institutions (PRIs) are considered

as vehicle for promoting development through popular participation (Misra, 2013). These

developmental activities include health security, sanitation and population stabilization etc.

When we talk about health and Panchayats, we must look at the policies like National Health

Policy (2000) and National Health Policy (2001), National Health Policy (2002), etc. which

indicate and ensure the role of PRIs as a responsible agency to provide decentralised health

services. The National Health Policy (2002) highlights the need for devolving programmes

and funds in the health sector through different levels of the Panchayati Raj Institutions

(Sekher, 2003). The 73rd

Amendment to the Constitution of India, which has strengthened the

PRIs and drawn clear areas of their jurisdiction, authority and funds also indicates

Panchayats’ role in providing health services.

The Government of India, to improve and uplift the condition of health services in rural

India, started a comprehensive national campaigning and launched a programme called

National Rural Health Mission (NRHM) on 12th

April, 2005. NRHM has taken up myriad of

action plans and goals those include increasing public expenditure to health, reducing

regional imbalance in health infrastructure, pooling resources, integration of organizational

structures, optimization of health manpower, decentralization and district management of

health programmes, community participation etc. These goals also reflect the Millennium

Developmental Goals (MDGs). So, these goals have global standards too.

This paper starts on the above narrated ground and basically tries to focus on the roles and

responsibilities of the PRIs in implementing National Rural Health Mission in Assam.

Empirical data collection and scientific observation methods are used while articulating the

research findings.

2. Objectives of the research:

The paper has both empirical objective and theoretical objective. Theoretically, it wants to

investigate the role of Panchayati Raj Institutions in uplifting health conditions and ensuring

health security. It also wants to know how PRIs as decentralized institutions work in

implementing NRHM. On the other hand, empirically it aims to find out how far good



governance and decentralized administration has contributed towards making the health

service more effective. To be more precise we can point out the objectives of the research

like:

i. Theoretical Objective: To see the relationship between health security and

decentralized governance.

ii. Empirical objectives:

a. To know how far PRIs are responsible towards implementing NRHM and

improving health security.

b. To trace the progress in NRHM in Assam.

c. To find out whether the PRIs are actually working towards making the health

sector healthy.

3. Methodology:

In this research paper, both primary and secondary sources for data collection have been

used. Secondary data are mainly official reports, articles from journals, book etc. The

research paper extensively depends on policy documents and statistical input drawn from

these government official reports and articles.

To collect primary data, the research has followed the non-participatory observation method.

The primary data collected from the field study conducted as a part of the field survey for the

ICSSR sponsored major research project titled “Implementing NRHM in Assam: A study on

the convergence among Institutions, Infrastructure and Practices” under the guidance of

project director Dr. Akhil Ranjan Dutta.

Theoretical support: The focal point of this research moves round the concepts like

decentralized administration, role of state, social security, and health security etc. The

objectives reflect that all these areas are the core areas of this research. Based on the concepts

and research questions, the research has concentrated in two meta-narratives and tried to find

out a clubbed approach to interrogate the objectives and justify the findings. The research

looks the notion of Health Security as a part of Social Security and hence used the

perspective of Social Security to support the research. As it is a research investigating the role

played by PRIs, we are justifying our articulations on the basis of theory of decentralized

administration. Clubbing both the approaches in one approach, we have experimented the



finding on the basis of the presumption that providing Social security and health security is

basic responsibility of a welfare state and they must ensure it in collaboration with

decentralized institution like PRIs.

4. Conceptual background of Panchayati Raj in India:

Democratic decentralization is a procedure to provide opportunity to strengthen the

democratic governance. The notion, democratic decentralization has dominated the

development discourses in contemporary period. It emerged as a popular policy in many

Asian, African and Latin American countries since the 1960s. The idea behind democratic

decentralization is that people will become the end as well as the means of development. It

rejects the idea of a highly centralized State and replaces it with the concept of distribution of

power to people at large. Here, people occupy the centre-stage of the development process.

India has also adopted the policy of democratic decentralization and introduced the

Panchayati Raj System and other decentralized mechanisms. They act as an institution of self

governance and people’s participation in rural areas of India (Bhattacharya(Mukhopadhyay),

2011, p. 344).

The Constitution of India, in Part IX, deals with Panchayat System and Municipalities

(Sarmah, Gogoi, & Bora, 2011, p. 13). The Constitution envisages a three-tiered system of

Panchayats. These are: The Village Panchayats at village level, The District Panchayats at the

district level, and The Intermediate Panchayat which stands between the Village Panchayats

and District Panchayats. The constitution says that all the seats in a Panchayats shall be filled

by persons chosen by direct election from territorial constituencies in the Panchayat areas

(Basu, 2011, p. 283). The 73rd

Amendment Act, 1992 of the Constitution came into force in

1993 introduced the Part IX from Article 243-243-O and Eleventh Schedule to the

Constitution. This amendment empowered the Panchayats with power in 29 subjects

(Bhattacharya(Mukhopadhyay), 2011, p. 249). Among the 29 subjects, health and sanitation

is also a significant one. This includes providing health services, regulation of hospitals,

primary health centers and dispensaries. Based on this amendment several policy initiatives

were taken, making the Panchayats core. In Assam too Panchayats carry out its role in

proving health security.



5. Status of the PRI framework in Assam:

The Government of Assam enacted the Assam Panchayat Raj Act, 1994 incorporating almost

all the features of the 73rd Constitutional Amendment Act, 1992. The terms of Panchayat in

the state expired in October 1997. The state government had put off the Panchayat elections

several times citing different reasons. The elections of the Panchayat bodies were held in

2001 (year not sure) and December 2007 and since then the PRI bodies are active in the State.

The PRIs have been actively involved with developmental process at all the levels including

in the planning, implementation and monitoring of the activities envisaged under Sarbha

Siksha Abhiyan, Public Health Engineering, Total Sanitation Campaign, and National Rural

Health Mission etc.

6. Conceptual background of Health Security and NRHM in India:

National Rural Health Mission (NRHM) 2005-12 is one of the ambitious projects of the

United Progressive Alliance Government pursued at a very crucial juncture in India’s

development trajectory. National Rural Health Mission (2005-2012) MISSION

DOCUMENT, the Government of India's document on NRHM, in its preamble highlights the

vision of the mission. To quote the document “Recognizing the importance of Health in the

process of economic and social development and improving the quality of life of our citizens,

the Government of India has resolved to launch the National Rural Health Mission to carry

out necessary architectural correction in the basic health care delivery system. The Mission

adopts a synergistic approach by relating health to determinants of good health viz. segments

of nutrition, sanitation, hygiene and safe drinking water. It also aims at mainstreaming the

Indian systems of medicine to facilitate health care. The Plan of Action includes increasing

public expenditure on health, reducing regional imbalance in health infrastructure, pooling

resources, integration of organizational structures, optimization of health manpower,

decentralization and district management of health programmes, community participation and

ownership of assets, induction of management and financial personnel into district health

system, and operationalizing community health centers into functional hospitals meeting

Indian Public Health Standards in each Block of the Country. The goals of NRHM are

reflection of Millennium Development Goals (MDGs) especially reduction of child mortality,

improve Maternal Health and combat HIV/AIDS, Malaria and TB. (Development Goals,

States of India Report, 2010)



The Goal of the Mission is to improve the availability of and access to quality health care by

people, especially for those residing in rural areas, the poor, women and children. The

document, with 16 sub-headings, expresses the present condition of health, vision of the

mission, strategies, plan of action, institutional mechanism, technical support, role of state

government, PRI and NGOs, focus on NE states, importance of AYUSH, fundings, targets,

outcome and monitoring and evolution of the action taken to meet the target. Here, the

document says that status of current public health is not satisfactory. In Government annual

budget, Public health expenditure has declined from 1.3% of GDP in 1990 to 0.9% of GDP in

1999. There are many other evidences of poor health standard in India which is explained by

the document. The document also states the vision of the mission where it categories 18

states, including states from NE, as high focus states with special attention. It expresses the

above mentioned goal as prime objective with definite time programmes which will be

aquired with some well designed strategies and plan of action where the state governments,

Panchyats and NGOs will play a positive role. The document has included the financial

matters, institutional mechanism and technical support and it gives emphasis to AYUSH. It

has also pointed out some statistical targets to be achieved by the mission on time. The

Mission has some monitoring and evaluation committees in three tier level- Block, Panchayat

and District, for well functioning of the mission and to bring health security. It basically

stresses on role of the Panchayats.

As the Mission empowers, the Panchayati Raj Institutions has to look at many areas in

implementing National Rural Health Mission. The Mission Document puts down that-

i. The respective states will indicate their MoUs the commitment for devolution of

funds, functionaries and programmes for health to their PRIs.

ii. In the institutional set up, at the district level, a District Health Mission (DHM) will

be set up that to be led by Zila Parishad. The DHM will control, guide and manage all

public health institutions in the district level like Sub-Centres, PHCs and CHCs.

iii. ASHA is the one of the main stakeholders of NRHM. ASHA would be selected by

and be accountable to the village Panchayat.

iv. In the village level, in the Panchayat a Village Health Committee would be organised

and this committee would be liable to prepare the Village Health Plan and promote

intersectoral integration.

v. For well functioning of the sub-centres there will be an Untied Fund for local action

of Rs. 10,000 per annum. This Fund will be deposited in a joint account of the ANM



and Head of the Panchayat i.e. Sarpanch and operated by the ANM, in consultation

with the Village Health Committee.

vi. In hospital management, Rogi Kalyan Samitis are held up and in such committee’s

involvement in PRI is the key factor.

vii. Training will be provided to the members of PRIs.

viii. Making available health related databases to all stakeholders including Panchayats at

all levels.

As the mission describes, the PRI plays a major role in implementing NRHM. It is through

PRIs the community participation is possible. So PRI as an institution for NRHM has a

significant role. The major PRI institutions are as follows.

Institutions Regulatory Boards Persons involved

District Health Mission

(PHCs, CHCs, SCS)

Zila Parishad District Health Head, NGOs, Private

professionals

Block level Panchayat

(PHCs)

Panchayat Samiti PRI representatives

Sub Centre Gram Panchayat PRI representative, Representative of

VHSC

Table: 1 Panchayat and Healthcare responsibilities

The PRIs are the decentralized level policy makers to render the services to the village level.

Village health Plan is counted as the policy framework for the implementation of NRHM.

Having a village health plan in each level is regarded as one of the activity of PRI in

implementing NRHM. To prepare the village health plan, Village Health and Sanitation

Committee (VHSC) will be appointed. So, VHSC is responsible to set up the health plan

taking into account all the villagers and their need. The village health plan includes some of

the action plans to implement like to orient and train the PRI members on basic health needs

in the village. The structure of VHSC is formed under the chairmanship of Gram Panchayat

members and representative from the community such as Gaon Budha, women's group, and

SC/ST/OBC/ minority communities etc. Hence, for the development of the village in each

village where ever there is an ASHA Village Health and Sanitation Committee has been

formed by providing untied grant for village level activities. The basic health needs are to be

fulfilled by different health schemes, the VHSC members have to aware the people about the

various schemes and the benefits of the schemes implemented by the government so that

people can demand the benefits of the schemes. Moreover, the VHSC is accountable to the



overall village health plan. In theory, the VHSC will try to mitigate the health and nutrition

related problems of the community by organizing Village Health and Nutrition Day (VHND)

twice in a week. But, how far these theoretical arrangements have taken the actual color is a

matter of academic debate and for that we need to look at reports and other available sources.

7. Report from the secondary reports:

As far as the implementation of NRHM is concerned, certain reports are there to review the

institutionalization, infrastructure and convergence of the different institutions. According to

the Assam report, 2009; 26,816 VHSCs has been constituted & 24,085 Joint Accounts have

been operationalised. Rogi Kalyan Samities are operational at 22 DH, 103 CHCs & 844

PHCs. All districts have started developing their own IDHAP.

Common Review Mission (CRM) was conducted by the State wise Review Team for Assam

undertook the visit to Assam during a scheduled time frame from the year of 2007 onwards.

These CRM reports had examined the institutions, infrastructures of NRHM for the period

from 2007 to 2011.

The first Common Review Mission conducted in 2007 revealed that Village Health and

Sanitation Committee had not been set up at the village level as the Panchayat election was

not held. In the findings of second Common Review Mission, regarding the PRI involvement,

State has reported that 20,309 VHSCs are constituted and fund released to them. But in the

report, it is mentioned though VHSCs have been constituted, but the members have lack of

capacity building. In many cases, these members were not properly guided about their

responsibilities.

The fourth Common Review Mission also revealed the disappointment in practicing of

implementation of NRHM, though the Panchayati Raj Institutions have been constituted, the

actual capacity building of these institutions have not been up to the mark.

But the fifth Common Review Mission has portrayed another picture of involvement of PRI

in NRHM. Under the NRHM, in each village a Village Health Sanitation (& Nutrition)

Committee (VHSNC) has been formed where the elected PRI members are the Chairman of

the committee and the ASHAs are the Member Secretary. 26,312 VHSNC have been formed

in Assam. The ASHAs are working in close co-ordination with the VHSNC members for

improving the health scenario of the village. Every year under NRHM, each VHSNC receives

Rs. 10,000/- which is used for providing safe drinking water, construction of sanitary toilets,



arranging emergency referral transport and organizing Village Health & Nutrition Day.

Source: (5th

Common Review Mission, 8th

-15th

November, 2011, Assam).

All the VHSNC members have been trained under NRHM regarding their roles and

responsibilities in the years 2009-10 and 2010-11. In 2010-11 and 2011-12, on sample basis

Model Village Plans have been prepared in each Block PHC. So, we have seen a mixed

picture of NRHM and its relation with PRIs in these reports. To have a better insight of it we

need a closer observation.

8. Observation from the field survey:

The structured interview schedule was mainly targeted for the stakeholders of NRHM like,

the ASHAs, the ANMs, the BPMs and the health care seekers. As stated earlier, the

stakeholders like ASHAs and ANMs have to work with PRI officials. Their cooperation is in

workings of policy developments and implementation of these policies and then to see how

far these stakeholders are able to make the convergence among institutions, infrastructures

and practices. The observation with the field experience reveals that some of the ASHAs we

interviewed are not satisfied working with the PRI members as they are not really

cooperative. As per their knowledge, the Panchayat members are corrupted and are not

regular and honest in using the untied fund. Some of the BPMs who have been interviewed

are also said that PRI members and the officials from department are not so much

cooperative. PRI have to lead the Mission in three ways- planning, control and monitoring

health institutions and funds. But, the people in general are not aware of the involvement of

the PRI members in the implementation of NRHM. The patients from Sualkuchi PHCs are

not aware of Village Health and Sanitation Committee and Village Health and Nutrition Day.

This is also seen during the field visit to Silchar Medical College where very few people

know about Village Health and Sanitation Committee and Rogi Kalyan Samiti.

9. Conclusion:

Though the PRIs in Assam in particular and in India as a general have a large potentiality in

improving the health indicators in reality and create awareness among people about the health

schemes and other necessary concerns. But there are some constraints to the workings of the

PRIs like lack of accountability, domination of political party, absence of regular periodic


International Journal of Innovative Research and Studies 75

elections etc. Along with that, PRIs are not in Sixth Scheduled areas like BTAD. Absence of

PRIs in these areas has resulted adversely in popularizing healthcare facilities in Assam.



References:

1. Basu, D. D. (2011). Introduction to the Constitution of India. New Delhi: LexisNexis

Butterworths Wadhwa Nagpur.

2. Bhattacharya (Mukhopadhyay), M. (2011). Democratic Decentralisation and

Panchayati Raj. In N. Chandhoke, & P. Priyadarshi, Contemporary India: Economy,

Society, Politics (pp. 344-357). New Delhi: Pearson.

3. (2010). Development Goals, States of India Report. Ministry of Statistics and

Programme.

4. Misra, S. N. (2013). Democracy, Development and Decentralisation: Rural

Development Through Institutional Intervention. Odisha Review, 126.

5. Sarmah, P., Gogoi, C. F., & Bora, P. (2011). Brief Understanding of Indian

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6. Sekher, T. V. (2003). Sensitising Grass Roots Leadership on Health Issues:

Experiences of a Pilot TV Project. Economic and Political Weekly, 4873.

7. 5th Common Review Mission, 8th-15th November 2011, Assam; National Rural

Health Mission, Ministry of Health and Family Welfare, Government of India.

panchayats in implementing nrhm: an experience in assam

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