The Contexts and Complexities of Community Participation: Strengthening village health, sanitation, and nutrition committees in rural north India
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Date
2016-03-02
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Johns Hopkins University
Abstract
The Indian government’s Village Health, Sanitation, and Nutrition Committee (VHSNC) program seeks to improve rural access to the fundamental entitlements of public health. Although over 500,000 VHSNCs have been officially formed, they have so far failed to serve as viable local bodies. In 2013, the government introduced guidelines to invigorate VHSNCs.
This dissertation examines the contexts that facilitate and hinder VHSNC functionality, and explores the impacts of VHSNCs on marginalized communities and the non-governmental organizations (NGOs) that support them. The study draws on longitudinal qualitative research from rural north India.
The study found that contextual features at the community, health facility, health administration, and societal level were often at odds with VHSNC functionality. Despite challenges at the community level, inclusive VHSNCs were formed, and the members received training, held monthly meetings, and attempted to improve local public services. However, barriers in the other contextual spheres undermined committee capacity to bring concrete improvements (chapter 5).
VHSNCs created some opportunities for participants to re-negotiate power inequalities within the community, particularly around gender. Power inequalities between the communities and outside actors (e.g. government officials) were manifest in a “discourse of responsibility,” whereby outsiders sought to assign broad responsibility for improving public services onto VHSNCs. Some community members accepted this discourse and then blamed their peers for failing to take action, entrenching a negative collective identity. Others rejected the discourse, and positioned participation in the VHSNC as futile, since responsibility lay beyond VHSNC control (chapter 6).
The NGO that implemented the VHSNC-intervention played a crucial role in building community capacities to engage with government and helped overcome many community-level barriers to participation. These beneficial processes were made possible by the NGO’s “in-between status” as community advocate and government helper. Yet this role came at a high cost for NGO staff, who found themselves promoting VHSNCs with little control over key factors that influenced the program (chapter 7).
This study highlights the urgent need for supportive contexts in which people can not only participate in health committees, but also access the power and resources needed to bring about actual improvements to their health and wellbeing.
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Keywords
Village health committee, community participation, India, contexual analysis, social space, power analysis, gender, non-governmental organizations