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