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Madon S, Krishna S. Theorizing Community Health Governance for Strengthening Primary Healthcare in LMICs. Health Policy Plan 2022; 37:706-716. [PMID: 35077543 PMCID: PMC9189612 DOI: 10.1093/heapol/czac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
In recent years, community health governance structures have been established in many low and middle-income countries (LMICs) as part of decentralization policies aimed at strengthening primary healthcare systems. So far, most studies on these local structures either focus on measuring their impact on health outcome or on identifying the factors that affect their performance. In this paper we offer an alternative contribution that draws on a sociological interpretation of community health governance to improve understanding of how the government’s policy vision and instrumentation translate to interactions that take place within local spaces at field level. We study 13 Village Health Sanitation and Nutrition Committees (VHSNCs) in Karnataka, India, from 2016 to 2018 focusing on sanitation, nutrition and hygiene which remain impediments to improving primary healthcare amongst poor and marginalized communities. Three local governance mechanisms of horizontal coordination, demand for accountability and self-help help to explain improvements that have taken place at village level and contribute to the creation of a new theory of community health governance as evolving phenomenon that requires a constant process of learning from the field to strengthen policymaking.
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Affiliation(s)
- Shirin Madon
- *Corresponding author. Department of International Development/Department of Management, London School of Economics & Political Science, London WC2A 2AE, UK. E-mail:
| | - S Krishna
- Foundation for Research in Health Systems and Indian Institute of Management, Bangalore, India
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Sharma S, Rawat S, Akhtar F, Singh RK, Mehra S. Assessing community health governance for evidence-informed decision-making: a cross-sectional study across nine districts of India. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-05-2021-0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe authors intend to assess the village health sanitation and nutrition committees (VHSNC) on six parameters, including their formation, composition, meeting frequencies, activities, supervisory mechanisms and funds receipt and expenditures across nine districts of the three states of India.Design/methodology/approachThe cross-sectional study, conducted in the states of Uttar Pradesh (five districts), Odisha (two districts) and Rajasthan (two districts), used a quantitative research design. The community health workers of 140 VHSNCs were interviewed using a semi-structured questionnaire. The details about the funds' receipt and expenditures were verified from the VHSNC records (cashbook). Additionally, the authors asked about the role of health workers in the VHSNC meetings, and the issues and challenges faced.FindingsThe average number of members in VHSNCs varied from 10 in Odisha to 15 in Rajasthan. Activities were regularly organized in Rajasthan and Odisha (one per month) compared to Uttar Pradesh (one every alternate month). Most commonly, health promotion activities, cleanliness drives, community monitoring and facilitation of service providers were done by VHSNCs. Funds were received regularly in Odisha compared to Rajasthan and Uttar Pradesh. Funds were received late and less compared to the demands or needs of VHSNCs.Research limitations/implications This comprehensive analysis of VHSNCs' functioning in the selected study areas sheds light on the gaps in many components, including the untimely and inadequate receipt of funds, poor documentation of expenditures and involvement of VHSNC heads and inadequate supportive supervision.Originality/value VHSNCs assessment has been done for improving community health governance.
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Kim R, Bijral AS, Xu Y, Zhang X, Blossom JC, Swaminathan A, King G, Kumar A, Sarwal R, Lavista Ferres JM, Subramanian SV. Precision mapping child undernutrition for nearly 600,000 inhabited census villages in India. Proc Natl Acad Sci U S A 2021; 118:e2025865118. [PMID: 33903246 PMCID: PMC8106321 DOI: 10.1073/pnas.2025865118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There are emerging opportunities to assess health indicators at truly small areas with increasing availability of data geocoded to micro geographic units and advanced modeling techniques. The utility of such fine-grained data can be fully leveraged if linked to local governance units that are accountable for implementation of programs and interventions. We used data from the 2011 Indian Census for village-level demographic and amenities features and the 2016 Indian Demographic and Health Survey in a bias-corrected semisupervised regression framework to predict child anthropometric failures for all villages in India. Of the total geographic variation in predicted child anthropometric failure estimates, 54.2 to 72.3% were attributed to the village level followed by 20.6 to 39.5% to the state level. The mean predicted stunting was 37.9% (SD: 10.1%; IQR: 31.2 to 44.7%), and substantial variation was found across villages ranging from less than 5% for 691 villages to over 70% in 453 villages. Estimates at the village level can potentially shift the paradigm of policy discussion in India by enabling more informed prioritization and precise targeting. The proposed methodology can be adapted and applied to diverse population health indicators, and in other contexts, to reveal spatial heterogeneity at a finer geographic scale and identify local areas with the greatest needs and with direct implications for actions to take place.
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Affiliation(s)
- Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, 02841 Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 02841 Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, MA 02138
| | | | - Yun Xu
- SuperMap Software Co. Ltd, Beijing 100015, China
| | - Xiuyuan Zhang
- Institute of Remote Sensing and Geographic Information System, Peking University, Beijing 100871, China
| | - Jeffrey C Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, MA 02138
| | | | - Gary King
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA 02138
| | - Alok Kumar
- Department of Medical Health and Family Welfare, Lucknow 226018, India
| | - Rakesh Sarwal
- National Institution for Transforming India Aayog, New Delhi 110001, India
| | | | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA 02138;
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115
- National Institution for Transforming India Aayog, New Delhi 110001, India (Non-Resident)
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Hasan MZ, Leoutsakos JM, Story WT, Dean LT, Rao KD, Gupta S. Exploration of Factor Structure and Measurement Invariance by Gender for a Modified Shortened Adapted Social Capital Assessment Tool in India. Front Psychol 2019; 10:2641. [PMID: 31920771 PMCID: PMC6918543 DOI: 10.3389/fpsyg.2019.02641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
Social capital is defined as the nature of the social relationship between individuals or groups and the embedded resources available through their social network. It is considered as a critical determinant of health and well-being. Thus, it is essential to assess the performance of any tool when meaningfully comparing social capital between specific groups. Using measurement invariance (MI) analysis, this paper explored the factor structure of the social capital of men and women measured by a modified Shortened Adapted Social Capital Assessment Tool (SASCAT-I) in rural Uttar Pradesh (UP), India. The study sample comprised 5,287 men (18-101 years) and 7,186 women (15-45 years) from 6,218 randomly selected households who responded to SASCAT-I during a community-level cross-sectional survey. Social capital factor structure was examined by both exploratory and confirmatory factor analysis (CFA), and MI across genders was investigated using multigroup CFA. While disregarding gender, four unique factors (Organizational Participation, Social Support, Trust, and Social Cohesion) represented the structure of social capital. The MI analysis presented a partial metric-invariance indicating factor loadings for Organizational Participation and Social Support were the same across genders. The gender-stratified analysis demonstrated that a four-factor solution was best fitted for both men and women. Men and women of rural UP interpreted social capital differently as the perception of Trust and Social Cohesion varied across genders. For any future applications of SASCAT-I, we recommend gender-stratified factor analysis to quantify social capital's measure, acknowledging its multidimensionality.
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - William T. Story
- Department of Community and Behavioral Health, The University of Iowa, Iowa City, IA, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Ved R, Sheikh K, George AS, VR R. Village Health Sanitation and Nutrition Committees: reflections on strengthening community health governance at scale in India. BMJ Glob Health 2018; 3:e000681. [PMID: 30364368 PMCID: PMC6195149 DOI: 10.1136/bmjgh-2017-000681] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/01/2022] Open
Abstract
India’s National Health Mission constituted Village Health Sanitation and Nutrition Committees (VHSNCs) as a key mechanism for community health governance. Health committees provide citizens with the opportunity to shape health systems and policies. Yet much remains to be learnt on how best to sustain health committees as vehicles for community health governance at scale. This paper reflects on the authors’ experiences of introducing revised guidelines and an institutional support package for VHSNCs in two pilot settings in India and outlines lessons we learnt for sustaining community health governance at geographic scale. We describe the importance of ensuring norms for equitable participation, aligning committee rules with existing forms of decentralised government and providing key supports in terms of engaging NGOs as key implementation facilitators. Integration with rigid and unresponsive government administrative structures however remains a persistent challenge for scaling up health committees. With sustained financial support and strategic deployment of key personnel, VHSNCs could pave the way for more equitable and effective community participation in health governance at scale.
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Affiliation(s)
- Rajani Ved
- National Health Systems Resource Centre, New Delhi, India
| | - Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - Asha S George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Raman VR
- WaterAid India, New Delhi, India
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Maurya D, Virani A, Rajasulochana S. Horses for Courses: Moving India towards Universal Health Coverage through Targeted Policy Design. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:733-744. [PMID: 29147931 DOI: 10.1007/s40258-017-0358-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The debate on how India's health system should move towards universal health coverage was (meant to be) put to rest by the recent National Health Policy 2017. However, the new policy is silent about tackling bottlenecks mentioned in the said policy proposal. It aims to provide universal access to free primary care by strengthening the public system, and to secondary and tertiary care through strategic purchasing from the private sector, to overcome deficiencies in public provisioning in the short run. Yet, in doing so, it ignores critical factors needed to replicate successful models of public healthcare delivery from certain states that it hopes to emulate. The policy also overestimates the capacity of the public sector and downplays the challenges observed in purchasing secondary care. Drawing from literature in policy design, we emphasize that primary, secondary and tertiary care have distinct characteristics, and their provision requires separate approaches or policy tools depending on the context. Public provisioning, contract purchasing and insurance mechanisms are different policy tools that have to be matched with the context and characteristics of the policy arena. Given the current challenges of India's health system, we argue that tertiary care services are most suitable for insurance-based purchasing, while the public sector should concentrate on building the required capacities to dominate the provisioning of secondary care and fill gaps in primary care delivery, for India to achieve its universal coverage ambitions.
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Affiliation(s)
| | - Altaf Virani
- Lee Kuan Yew School of Public Policy, Singapore, Singapore
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