Impact of functional VHSCs on Maternal
Health and the delivery of
Antenatal and Postnatal health care by ANMs in
Mayurbhanj district of Odisha Sunita Singh
Jiban Krushna Behera
According to National Rural Health Mission guideline
There should be one Village Health and Sanitation Committee (VHSC) in every revenue village
Role of VHSC is to plan and monitor the activities under NRHM at the village level
The VHSCs monitor functioning of Auxiliary Nursing Midwifes (ANM) to ensure service delivery
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 VHSCs trained as part of Community Monitoring 7 VHSCs were selected randomly out of 81 villages which were not part of Community Monitoring.
The control villages didn’t have ANM trained under the community Monitoring process.
Parameters of VHSC under CM
The VHSCs were 3 months old
Structured as per NRHM guideline
Members were trained under CM process
Meeting at least once in a month.
The ANM, ASHA, AWW are present in the
meetings.
Village Health Register was already created
Data collection Methods & Tools
Method: Observation and Interview Observation of 28 Fixed Health day across 14 villages CM
and Non CM over two months Individual interview with 40 mothers who have delivered in
the last 3 months
Tools :Observation 1 VHSC scoring Tool- Composition of VHSC, Meeting held in last
three months, discussion topic, sensitization, preparation of village health register
2 Fixed health day scoring Tool- Presence of personnel, attendance of beneficiaries, Ante Natal Check-ups, Post natal Check-ups
Interview 3 Maternal health scoring Tool - Ante Natal Care, Intra Natal
Care, Post Natal Care and Neo Natal Care
Findings
Fixed Health Day Comparison
Participation of village level functionaries are uniform but presence of PRI, SHG & VHSC members are more in CM VHSC
FDH attendees - system
02468
10121416
VHSC
NVHSC
Maternal Health Services Score
Scoring is done based on following parameters ANC score – Registration, ANM visits, Wt check,
BP check, Abdomen, TT 2 doses, IFA, ANM advice INC score – Inst. Deliv., Deliv advice, ASHA
accomp, risk related counselling, ANM advice. PNC score – PNC check, No of checks, ANM
counselling on Diet, Rest, Hygiene, and Contraception
NNC score – Temp Monitoring, Counseling on Breast feeding and Immunization (BCG, Polio and DPT) received
ANC service at FHD camps compared
27
50
9
39
32
39
5
32
40 40
20 21
1
15
0
10
20
30
40
50
REGD BP WEHT ABDOM TT IFA ADVIC_ANM
ANC Care Health Day
NCM_VHSC
CM_VHSC
PNC services at FHD compared
22
43
34
67
34
67
27
54
2 4
0
10
20
30
40
50
60
70
CHEK DIET REST HYGN CONTRA
PNC Services
Non CM VHSC
CM VHSC
Services received by Women
7.13
4.6
5.8
1.9
5.6
0.28
6.2
1.1
0
1
2
3
4
5
6
7
8
ANC INC PNC NNC
Services
Maternal Health Service by ANM
VHSC
NVHSC
Maternal HealthServices CM-VHSC
villages Non CM-
VHSC villages
PREG_REG 12 WEEKS 70% 0%
PREG_REG 12-14 WEEKS 10% 65%
PREG_REG BY AWW 95% 95%
IFA BY ANM 95% 95%
INSTITUTIONAL DELIVERY 60% 60%
ANM ASST. HOME DEL 15% 0%
ASHA ACCOMPANY 65% 60%
ADVICE ON COMMON PROBLEM
90% 0%
Cont…..
CM VHSC villages
Non CM-VHSC
villages
Referral by ANM for immediate medical attention
50% 0%
Check up after delivery 65% 20%
Advice for early breast feeding
95% 0%
Advice for diet 95% 0%
Personal Hygiene 75% 5%
Neo Natal Care 95% 10%
Conclusion 1. In all the fixed health day ANM, AWW and
ASHA were present; but in CM VHSC villages PRI, SHG and VHSC members were also present
2. In both CM VHSC and non CM 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 CM VHSC villages
3. Most mothers received counseling in CM VHSC villages but none in non CM VHSC villages
4. Women from CM VHSC villages received more ANC, INC, PNC and Neo-natal care services compared to Non CM VHSC villages.
5. Non CM 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
and quality 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 is known to be low compared to ANC and Institutional delivery
The formation and training of VHSCs has substantially improved the range and quality of services given by ANM in the villages
Recommendation 1 Formation of VHSC under Community Monitoring
should be adapted for all States
2 There is need to ensure composition of VHSC as per the Guideline
3 Attendance in VHSC meetings of PRI, ANM and SHG members should be ensured
4 More rounds of VHSC member training is required
5 Community Monitoring should be upscaled in all the villages
6 Documentation of processes and outcomes
7 Constant re-evaluation of Community Monitoring processes
THANKS