Convergence at the village level appears integral to the functions of both programmes but also to all the related departments.. Such convergence is critical to the success of the National Rural Health mission. The National Rural Health Mission (NRHM) is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. The key to the success is through inter-sectoral convergence, community ownership through Village Health Committees at the level of the village.
An Accredited Social Health Activist (ASHA) is expected to work with communities for social mobilization and improve access to services. ASHA’s role will be to facilitate care seeking and serve as a depot holder for a package of basic medicines. The AWW, schoolteacher, members of local community based organizations and the Village Health Committee are expected to support the ASHA in her work.
The location of the AWC and AWW (mostly local women) and the functions of nutrition and health make them a natural ally for the health sector. Key participants in the ICDS scheme are children below six years, pregnant and lactating women, specifically marginalized women. Thus the programme design of ICDS is such that it can make significant contributions to malnutrition and mortality- the success in ensuring healthy childhoods and outcomes for pregnant mothers.
The child health strategy concentrates on the: essential newborn care, breastfeeding, immunization, and care of the sick newborn and child through outpatient/home based care and inpatient care. This approach is called the Integrated Management of the Neonatal and Child hood Illness (IMNCI).
ASHA, (Accredited Social Health Activist), the mechanism to strengthen village level service delivery, will be a local resident and selected by the Gram Panchayat or the Village Health Committee. She will be supported in her work by the AWW, school teacher, community based organizations, such as SHGs, and the VHC. Her role would be to facilitate care seeking and serve as a depot holder for a package of basic medicines. She will be reimbursed by the panchayat on a performance based remuneration plan. The Village Health Committee (VHC) will form the link between the Gram Panchayat and the community, and will ensure that the health plan is in harmony with the overall local plan.
Capacity building of PRI is required in thematic areas and leadership skills, negotiating, monitoring, ability to withstand patronage and political interference. Capacity building processes need to be tailored to literacy levels, sex and circumstances of PRI members. Joint orientation and sensitization meetings between PRI and health and medical professionals could help to bridge the gap in education and social strata. Developing Citizen Charter of Rights and Codes of conduct also lay down guidelines for boundaries of operation and accountability which is already addressed under RKS. NGOs could be involved in PRI strengthening in a variety of ways, including: consciousness raising, provision of technical advice, support in participatory planning, capacity building and facilitating monitoring processes, such as community and social audits to improve accountability. The sensitization / training is covered under RCH II and also in NRHM Additionalities. There is no separate budget proposed.
School authorities and the students will be involved in health activities. This includes using of students in health programs, school health programs in the schools in sensitizing the students etc to health needs. Teachers may also be utilized for propagation of health information to the students in turn who will disseminate the messages to the parents and community.
The facility survey also indicates that majority of the households are not provided with potable and safe drinking water. Similarly, sanitation facilities are also very scarce. Under the convergent efforts of the line departments, it is hoped that these issues also would be addressed during the program period.
VH&ND is another area where convergence has started. The committee will oversee under the aegis of SHM & DHM. This committee will not only address the health need but also covering all the aspects of sanitation. For all these activities, it is proposed that convergent activities will require resources and time. Therefore, the proposal is as below:
1. Convergence meetings: At state level 2 times per year with all the departments. And at the district level, 2 such meetings will be organized per district.
2. Workshop on innovations: One workshop per district and 2 workshops at state level will be organized.