Outbreak Management of Acute Respiratory Distress Syndrome (ARDS) in a Critical Care Unit
Negotiating power relations, gender equality, and collective agency: are village health committees transformative social spaces in northern India? Scott et al 2017 Student ID: 77297248 Village Health, Sanitation and Nutrition Committees Village Health, Sanitation and Nutrition Committees (VHSNCs) • Set up as part of India’s National Rural Health Mission in 2005. Since then over 500,000 committees have been formed across India • VHSNCs are viewed as a vehicle to enable and empower local communities to take control of improving their environment and local health services Health Committees are a commonly used form of community participation • • VHSNCs as a health promotion initiative, have the potential to reduce health inequalities • Empowerment can be achieved through wide spread participation • Promote progressive social change and rebalance distribution of power • Support and facilitate the creation of more positive, health enabling social norms. Fig 1 VHSNCs Guidelines Location and Setting Committee Members are provided with a detailed hand book which covers every aspect of conception of the VHSNCs as a health promotion initiative, through to evaluation. This includes: • • Setting: • Most are labourers or farmers Membership to include 50% women, and representation from marginalised groups such as scheduled castes and scheduled tribes. • High levels of gender and social inequality Citizen Control 7 Delegated Power 6 Partnership 5 Placation 4 Consultation 3 Informing 2 Therapy Frontline health worker, female, works from health sub-centre covering five or more villages (member of VHSNC in her own village, and invited guest for the VHSNCs in other villages • Poor access to essentials such water • Poor and sometimes inaccessible transport systems Anganwadi staff Preschool and nutritional supplementation workers, female two per village anganwadi (preschool) Ward member Lowest elected member of local government (panchayat) • Public services, including local schools are of poor quality • Low literacy rates; 80% for men and 50% for women VHSNCs exist as part of a range health institutions set up through the National Rural Health Mission (NRHM) participation 8 Auxiliary nurse midwife (ANMs) Accredited social health activ- Community health worker, female, ist (ASHA) one per village (1000 population) • Local government health centres are severely understaffed. Empowerment through General community members Includes member of savings groups and school management groups • Manujpur consists of roughly 300,000 people VHSNCs must be made up of 15 members. VHSNCs activity to include monthly village meetings, and quarterly cluster meetings. • Location: VHSNCs were set up across a rural block in North India with the pseudonym of Manujpur. Description of VHSNCs Members Citizen Power Tasks and responsibilities are identified and assigned by external agents such as the NRHM. Tokenism Fig 3 Non-participation 1 Manipulation Arnstein’s ladder of participation Fig 2 Fig 4 Implementation Research Study Local NGO called “SEEk” tasked with delivering support package to support performance of VHSNCs. As part of that a detailed study is delivered over 1.5 years to better understand the impact that VHSNCs have had in terms of mediating power relations within the community as well as mediating power relations between the community and outside actors Findings of the study and conclusions of the author Key Theoretical Concepts References: Fig1 1 Scott, K., George, A., Harvey, S., Mondal, S., Patel, G. and Sheikh, K. (2017) Negotiating power relations, gender equality, and collective agency: are village health committees transformative social spaces in northern India? International Journal for Equity in Health, (16). Fig 2 Arnstein, S. (1969) A ladder of citi- zen participation. American Institute of Planners Journal, 35(4), 216-224. Fig 3: Kumar, V. Mishra, A.J., and Verma, S. (2016), Health planning through Village Health Sanitation and Nutrition Committees: A qualitative study from India, International Journal of Health Care Quality Assurance, (29). Fig 4 Handbook_for_Members_of_VHSNC-English.pdf (nhm.gov.in)
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