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Article #158: Enhancing Services of Panchayat Raj in Public Health

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Enhancing Services of Panchayat Raj in Sanitation will be aligned with the NRHM.
Public Health Several Health Programmes Monitoring by
* Ramaiah Bheenaveni PRI:
Panchayats in India are an age old ACCELERATED RURAL WATER SUPPLY PROGRAMME
institution for governance at village (ARWSP)
level. In 1992, through the enactment of Under ARWSP, the Central Government is to
the 73rd Constitutional Amendment, supplement the efforts of the State
Panchayati Raj Institutions (PRI) were Governments in providing access to safe
strengthened as local government drinking water to all rural habitations
organizations with clear areas of of the country.
jurisdiction, adequate power, authority The role of PRIs in implementation of
and funds commensurate with this scheme are :
responsibilities.  Panchayati Raj Institutions should be
Panchayats have been assigned 29 rural involved in the implementation of schemes
development activities, including particularly in selecting the location of
several, which are related to health and standpost, spot sources, operation and
population stabilization. The XI maintenance, fixing of cess/water tariff,
schedule includes Family Welfare, Health etc.
and Sanitation, (including hospitals,  The implementation of the Sector
primary health centers, and Reform Projects in the identified pilot
dispensaries,) and the XII schedule districts, are also to be carried out
includes Public Health. either by the District Panchayats or
"Thus the possible realm of influence of through the District Water and Sanitation
the Panchayats extends over a significant Missions (DWSM), which are to be
proportion of public health issues. The registered societies under the
Gram Sabha, where empowered has the supervision, control and guidance of
potential to act as a community level District Panchayat.
accountability mechanism to ensure that  Wherever PRIs are themselves firmly
the functions of the village Panchayat in in place and willing to take up the
the area of public health and family responsibility and are strong enough to
welfare, actually respond to people's do so, they implement the projects
needs". themselves instead of DWSM.
The 73rd Constitutional Amendment makes  At the village level, the individual
it mandatory that functions related to Rural Water Supply Schemes are to be
the provision of primary health care - implemented through Village Water and
maternal health and family welfare are Sanitation Committees which should be
the responsibility of the PRIs. Besides committees of Gram Panchayats.
the various development sector  Drinking water supply assets are
departments come under the functional transferred to the appropriate level of
jurisdiction of the district panchayat. Panchayats and such Panchayats are to be
Creating a health system with the empowered to undertake operation and
panchayats being made responsible for maintenance of drinking water systems.
supervising and monitoring health CENTRAL RURAL SANITATION PROGRAMME (CRSP)
services seems an ideal model. This programme aims at improving the
The National Health Policy, 2001, also general quality of life in rural areas;
emphasizes implementation of public accelerating coverage in rural areas;
health programmes through local generating demand through awareness
self-government institutions, especially creation and health education; and
relating to the national disease control controlling incidence of water sanitation
programmes. The Planning Commission set related diseases.
up a Task Force to review PRI involvement The role of PRIs in implementation if
in various sectors and to make this scheme are :-
recommendations on engagement of PRIs  Total Sanitation Campain (TSC) is a
specific to each sector. A Task Force community based programme where
Report pertaining to five major Panchayati Raj Institutons are in the
programmes within HFW and the particular forefront.
functions of PRI. The Task Force Report  As per TSC Guidelines, the
summarizes key functions for each of the implementation at the district level is
tiers of the PRI in respect of five major to be done by the District Panchayats.
programmes- Reproductive and Child Health Panchayats at block and village level are
(RCH), and programmes for Vector Borne to be fully involved for implementation
Diseases, Blindness TB Control of the programme.
Programmes, and STI/AIDS. Many of the  Where District Panchayat is not in a
activities proposed are related to position to implement the programme, it
identification of people in need of is being implemented by District Water &
services, in collaboration with the Sanitation Mission which is chaired by
health system and monitoring of village Chairperson of District Panchayat and the
level health workers, and Primary and Village Committees are chaired by the
secondary health care facilities. Chairpersons of Gram Panchayats. In the
Currently the PRI are not equipped to later case, the Village Water &
take on such planning and monitoring Sanitation Mission are part of the Gram
functions, nor is there a cognizance in Panchayat.
the health system of the role of PRI. SWAJALDHARA
Critical Role of Panchayati Raj This programme aims at providing
Institutions in the success of the Community-based Rural Drinking Water
National Rural Health Mission Supply. The key elements of this
PRIs are seen as critical to the programmes are namely, (i) demand-driven
planning, implementation, and monitoring and community participation approach,
of the NRHM. The NRHM is seen as a (ii) panchayats / communities to plan,
vehicle to ensure that preventive and implement, operate, maintain and manage
promotive interventions reach the all drinking water schemes, (iii) partial
vulnerable and marginalized through capital cost sharing by the communities
expanding outreach and linking with local upfront in cash, (iv) full ownership of
governance institutions. Key to the drinking water assets with Gram
success of the NRHM are: intersectoral Panchayats and (v) full Operation and
convergence, community ownership steered Maintenance by the users/ Panchayats.
through village level health committees The role of PRIs in implementation of
at the level of the Gram Panchayat, and a this scheme are :-
strong public sector health system with  Gram Panchayat shall convene a Gram
support from the private sector. Sabha Meeting where the Drinking Water
Underlying this is a commitment to Supply Scheme of People's choice
systemic reform within the health sector including design and cost etc. must be
for better regulation of medical finalized. Gram Panchayats are to
establishments, public health oriented undertake procurement of materials
medical education, strengthened services for execution of schemes and
management capacity, and effective and supervise the scheme execution.
rational human resource policies.  A resolution must be passed in the
Success of the NRHM in achieving its Gram Panchayat meeting calling for users
outcomes is significantly dependent on beneficiaries to contribute 10% of the
well functioning gram, block and district capital expenditure. However, GP can
level Panchayats. It is anticipated that remit towards community contribution from
in the NRHM, a Task Force will be set up its tax revinue (Not from Government
to specifically recommend and study the Grants) with the approval of Gram Sabha.
centrality of PRIs to the NRHM.  Gram Panchayat will decide whether
ASHA, the mechanism to strengthen village the Panchayat wants to execute Scheme on
level service delivery, will be a local its own or wants the State Government
resident and selected by the Gram Agency to undertake the execution.
Panchayat or the Village Health Committee  After completion of such schemes, the
(VHC). She will be supported in her work Gram Panchayat will take over the Schemes
by the AWW, school teacher, members of for Operation & Maintenance(O&M).
local community based organizations, such  Panchayat must decide on the user
as SHGs, and the Village Health charges from the community so that
committee. ASHA's role would be to adequate funds available with Panchayat
facilitate care seeking and serve as a to undertake O&M.
depot holder for a package of basic Conclusions:
medicines. She will be reimbursed on a However, the extent to which reproductive
performance based remuneration plan. health care is enhanced by the panchayats
The Village Health Committee (VHC) will depends on the funds and functions
form the link between the Gram Panchayat devolved to them for carrying out these
and the community. The VHC would be responsibilities. Clarity in the
responsible for working with the Gram separation of powers between the elected
Panchayat to ensure that the health plan representatives and the bureaucracy at
is in harmony with the overall local the local government are important in
plan. It is anticipated that this this context. While the development
committee will prepare a Village Health targets include reducing the incidence of
Plan and maintain village level data, maternal mortality and morbidity, the
supervised by the Gram Panchayat. question still remains whether the
Engaging the Gram Sabha and other groups institutional interventions and resources
in planning and monitoring the Village allocated are adequate to address these
Health Plan will presumably enforce problems. Gram Panchayat has a
transparency and accountability. supervisory role in ensuring proper
Under the NRHM, untied funds of about delivery of services. Many of them were
Rs.5000-Rs. 10,000 are to be placed with not aware of what comprised the role and
the ANM to meet unanticipated responsibility of panchayats in
expenditures and to ensure that lack of healthcare service delivery.
drugs and other consumables is not an References:
issue. At the sub center level planning 1. Manual on Target Free Approach,
and use of these funds will be supported Department of Family Welfare, Ministry of
by the appropriate tier of the panchayat. Health and Family Welfare, Govt. of India
Effective health care is not within the 2. Panchayat Raj Institutions In India An
realm of the health department alone. At Appraisal- National Institute Of Rural
the village level convergence is required Development, 1995.
with agencies providing nutrition, 3. Vijayanand, S.M, Decentralization and
sanitation, education, livelihood/poverty Health, Paper presented at Role of Local
alleviation and empowerment schemes at Government Institutions in Population
the very least. Beyond the functionaries Stabilization, Institute of Social
of each of the line departments, the only Sciences, New Delhi, February 2003.
institution at the village level which 4. Dash, Dhanlaxmi (2006) - Women
can coordinate all these functions is the Environment and Health, Manga Deep
PRI. In reality however there is little Publications, Delhi.
convergence at the village level in many 5. The Constitution ( Seventy-third
states, much less an active rolefor the Amendment) Act, 1992,
PRI in facilitating convergence. At the 6. Rosenstock IM. What research in
District level a District Health Mission motivation suggests for public health. Am
will coordinate NRHM functions. J. Public Health. 1960; 50:295-301.






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