Shillong, April 23: The government of Meghalaya has taken an innovative approach in implementing the Pradhan Mantri- Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), a centrally sponsored scheme under National Health Mission, that aims to strengthen the public health infrastructure across all levels.
The scheme focuses on developing capacities of health systems and institutions to ensure that they are equipped to respond effectively to current and future pandemics and disasters.
The approach adopted by the government of Meghalaya involves empowering Village Health Councils (VHCs) and fostering a sense of ownership amongst communities. The VHCs have been allocated subcentre construction works instead of contractors, which enables them to take charge of their own health infrastructure projects.
The formation of VHCs across the state has been envisioned as a community institution that will aid in mobilizing action on health and nutrition issues and serve as a critical link between the state health systems and community members.
The VHC general body comprises of the male and female heads of all households while the executive committee is composed of 10-20 elected members from the village. ASHAs, Agandwadi workers and Teachersare permanent members of the VHC.
The key roles of the VHCs are to generate demand for healthcare services, to create a sense of ownership by the community, to lead awareness campaigns, facilitate local problem-solving, and implementation of health infrastructure projects.
All new constructions are to be done through the VHCs under the guidance of the District Medical and Health Officer (DMHO) office with technical support from the Health Engineering Wing (HEW) and Junior engineers.
Ramkumar S, Mission Director, NHM, highlighted the benefits of involving the community in assessment, construction, and maintenance, which promotes ownership, encourages public health service use, and fosters health-seeking behaviour amongst the people.
It will also lead to improved institutional delivery rates and reduced maternal and infant mortality rates. Babu P. Thongni, Executive Member, Japung VHC, expressed his gratitude for the opportunity to have a sub-centre in their village and to have the ability to construct it themselves.
He recalled few of the challenges in the past where community members had to carry pregnant women on bamboo stretchers and walked for a couple of hours to reach the health facility.
He stated that the sub-centre would eliminate the need for villagers to travel long distances for immunizations, vaccinations and especially for safe deliveries of babies.
During the year 2022-23, the creation of 75 new subcentres has been identified to be implemented under PM-ABHIM and executed by the respective VHCs.
A team of engineers and community building associates under the Meghalaya Health Systems Strengthening Project (MHSSP) has been engaged to support the implementation process of the scheme.
Whereas SELCO Foundation has been engaged as a design partner for technical assistance in the built environment and design aspect of the construction of the Sub Health Centres.
Prior to the new subcentre construction activities to be executed by the VHCs, a detailed assessment of the site and land identified for new subcentre and assessment of the community, VHC willingness and preparedness are undertaken.
The purpose of the site and community assessment is to assess the feasibility of sites identified by the communities. The willingness includes assessing the community’s willingness and preparedness, availability of skilled workers, VHC-EC members’ capacity, and incorporating community ideas and knowhow.
IbamonlangNongbri, State Programme Manager, National Health Mission, explained that assessments were necessary to understand the varying levels of experience among the VHCs when it comes to construction. She also mentioned that some VHCs lacked skilled laborers in their village and needed to hire them from nearby villages.
The assessment is then followed with a Design participatory workshop, where the community, especially women, have a say on what to include in the design and what to exclude. The construction works carried out by the VHCs are being supervised by the designated engineers.
Feedback and recommendations from the assessment are incorporated into the project design by the engineers at the State level, and a final plan and architectural layout is then handed over to the VHC.
“Agropather village has been deprived of healthcare facilities due to poor road connections and transportation, leaving our community with no option but to depend on traditional healers for medical needs,” said Shri Prainter Momin, headman of Agropather village, North Garo Hills.
“The new sub-centre will play a crucial role in catering to cases such as complications during pregnancy, childbirth and overall health and wellbeing of the community. We hope that this new facility will be a lifesaver for our village and neighbouring villages.”
Initiatives such as this empower communities and encourage them to seek healthcare services, improving several health indicators in the state. This system can become a model for other states and help build a great relationship between health providers and the health seekers.
