Our vision is a world free of poverty in which every individual has the freedom and power to create and sustain a just society in which to live.
Our mission is to empower the poor to participate in and benefit from the Indian growth process through integrated action in the fields of primary health, elementary education, financial inclusion and sustainable livelihood. This will be achieved through active collaboration with the government and independent organisations.
Building Systems for Healthy Communities
ICICI Foundation’s work in Jharkhand
In Jharkhand, two out of every five mothers receive no health care during pregnancy. Acute shortages of doctors and nurses in the state means that few people have access to medical care at the local level, resulting in poor health indicators in rural Jharkhand1. Since ICICI Foundation believes that good health is fundamental for achieving inclusive growth, improving access to primary healthcare in Jharkhand continues to be an integral part of our work.
Since 2008, ICICI Foundation has worked in partnership with the Government of Jharkhand through the Jharkhand Rural Health Mission Society (JRHMS), National Health Systems Resource Centre (NHSRC), and an NGO called Child In Need Institute (CINI). The goal of this partnership has been to support the public health system by strengthening community processes of the National Rural Health Mission (NRHM), a national healthcare programme for rural populations that focuses on 18 states with poor health indicators – including Jharkhand. A key element of the NRHM involves engaging communities as participants in the public health system by establishing Village Health Committees (VHCs) and training community health workers called Accredited Social Health Activists (ASHAs). In Jharkhand ASHAs are referred to as ‘Sahiyyas’, meaning “friends” in the local dialect.
The primary strategy of the state-civil society partnership formed by ICICI Foundation and its partners in Jharkhand has been to support VHCs and Sahiyyas by establishing a Village Health Committee-SahiyyaResource Centre (VSRC) that is responsible for designing, planning and implementing the Village Health Committee and Sahiyya programmes across Jharkhand.
Establishing a model for health: Setting up the Village Health Committee-Sahiyya Resource Centre (VSRC)
Sahiyya: A friend of health
In Jharkhand, Sahiyyas function as bridges between their communities and the government health system. They act as community mobilisers by helping the government spread awareness about health programmes and good health practices. When properly trained and supported, Sahiyyas can be extremely effective in improving public health in rural areas.
From September 2008 to March 2011, ICICI Foundation and its partners focused on establishing the Village Health Committee-Sahiyya Resource Centre (VSRC) to train and support Sahiyyas. Having identified weaknesses in trainings and the absence of a support structure for Sahiyyas to function effectively as health activists as the primary gaps in the implementation of the VHC-Sahiyya programme, ICICI Foundation worked closely with the government to establish a VSRC team to standarise the training and develop supportive supervision structures within the VHC-Sahiyya programme.
The VSRC has now taken charge of the training for Sahiyyas in all districts and has developed innovative and contextualised training materials and modules so that the trainings are relevant, comprehensive, and informative. Unlike the national modules issued from Delhi, the new modules focused on Jharkhand-specific language and themes. The team took special care to design modules that were both easy to understand and connected to the local communities. To date, 40,964 Sahiyyas have been trained with this new training material.
Empowering the Sahiyyas to work towards attaining the health entitlements of their communities is essential for the effectiveness of the programme. To address this need, the VSRC created a module on leadership that seeks to ensure that Sahiyyas understand the importance of their own role and can raise the health concerns of their community at appropriate forums.
The VSRC has developed a variety of innovative formats to help the Sahiyyas in carrying out their work. For instance, the Sahiyya Passbook, a book given to each Sahiyya that helps them keep track of their performance-based incentives was developed by the VSRC team.
The VSRC has also started the circulation of a monthly theme-based Sahiyya bulletin, to be given to every Sahiyya.
Another tool to mobilise the Sahiyyas and encourage community participation in the health system are the district-level SahiyyaSammellans. These yearly Sammellans provide a forum for all Sahiyyas in a district to come together and share their experiences. Rewards for good-performing Sahiyyas are also given out during these sammellans. Government officials attend the Sahiyya Sammellans, which gives Sahiyyas an opportunity to have direct access to district officers and health functionaries.
The VSRC is also responsible for working with the state government to create a year-long plan for community health initiatives.
Strengthening Community Resilience: The Village Health Committee
Village Health Committees are groups of around ten villagers, including Sahiyyas, anganwadi workers and other stakeholders, who meet monthly to discuss the health-related issues of their village. According to the NRHM’s guidelines, there should be one Sahiyya for every 1000 people and one Village Health Committee at the village level.
The VHCs collectively plan and supervise health and sanitation programmes in their village. This involves looking after both preventive and curative aspects of community health and providing a forum to mediate health-related problems and demands of the villages. The VHCs also monitor the implementation of public health, nutrition and sanitation works in their villages.
The government has allocated untied funds of Rs.10,000 to each Village Health Committee for undertaking health and sanitation-related work in their villages. The VSRC has monitored the transfer of the government funds for 26,636 VHCs. In the course of their monthly meetings, VHCs collectively decide how their untied funds will be utilised. Common uses of the funds include transportation for serious patients to hospitals and minor repair work on sanitation facilities.
In addition to training the Sahiyyas, the VSRC is responsible for training the VHC members. A training module for VHC members was designed, planned and carried out by the VSRC team to better acquaint them with their roles and responsibilities.
In keeping with the spirit of bringing about government accountability in public health service provision, the VSRC supported the launch of a state-wide community monitoring initiative. In the pilot phase, one block in each district organised a public dialogue for communities to interact directly with the functionaries of the health and Integrated Child Development Services (ICDS) departments. Prior to the block-level dialogues, the VSRC trained two members in every VHC in assessing the available health and development services to prepare report cards that are presented at the public dialogues.
In September 2010, through the VSRC, ICICI Foundation helped facilitate the official registration of the Jharkhand State Health Systems Resource Centre (SHSRC), the culmination of two years’ work. The SHSRC will help the government’s Department of Health & Family Welfare to deliver health services across the state and provide support for the VHC-Sahiyya programme.
Now that the proper support systems are in place, the Sahiyyas have renewed determination to improve the health of their communities. As one Sahiyya said, “Jharkhand ke swasthya ke liye mehanat karna hai Sahiyya ko” (“Sahiyyas have to work hard for Jharkhand’s health”).
Despite the vast gains in knowledge and training, there are several concerns that the VSRC would work to address in the coming years, including the loss of information through multiple layers of trainers and training cadres, and also coordinating state-wide trainings in a geographically diverse state.
Ensuring the sustainability and implementation of our work: Transitioning programme ownership to the government
In 2011-2012, ICICI Foundation will work towards strengthening the new systems that have been put in place and transitioning ownership of the programme to the government.
VSRC will establish planning and monitoring committees from the village level to the state level and will also seek the support of the Panchayati Raj Institutions, the local elected governing bodies of clusters of villages. There are approximately 56,000 Panchayati Raj members in the state, and their cooperation could significantly augment the programme and improve community participation.
The increased confidence and skill levels of the Sahiyyas is clear. Thanks to their restructured training and government support, the VHC-Sahiyya programme is set to bring about significant changes to the state’s health.