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