While Village Health Sanitation and Nutrition Committees (VHSNCs) plan community level solutions at the panchayat level, the experience in Tamil Nadu shows that very often issues that are common to several panchayats or require solutions at the block and district levels.
In order to expand the planning exercise to a higher level, the block and district nodal NGOs in Thirumanur block used their experience of federating women’s self help groups to create a block level federation of VHSNCs. Two active members from each VHSNC were selected as members of this federation. In addition, Gram Panchayat Presidents of these villages, Block Medical Officer, Community Health Nurse, Child Development Project Officer from Department of Women and Child Development, Assistant Educational Officer from the Education Department, Project Officer from Rural Development Department were invited to be members of this body. Some representatives from local NGOs were also invited.
Initially there were some problems in getting the members, especially from the various departments, as well as the Panchayat Presidents, to attend the meetings of this block federation. Subsequently this space has been used to discuss several issues and also find local solutions. For example, issues of some Village Health Nurses (VHN) not going to dalit hamlets to give immunization was brought up in this space and was immediately sorted out with the Block Medical Officer taking the concerned VHNs to task and ensuring that the problem was sorted out. The block NGO staff also believes that this space has given them an opportunity to raise issues like staff vacancies and create pressure on the department to fill these.
NGO staff in the programme feels that such federation of VHSNCs is a step forward and needs to be up-scaled to other districts. However, there have been some challenges too. Integrating this block level structure with the existing Rogi Kalyan Samiti has not been possible so far. Also, taking this process beyond the block level has also been a problem as the programme as of now does not cover the entire district. Up-scaling the CAH programme to the entire district, and similar federated structures formed at the district level with the involvement of the district collector will help in ensuring community participation and inter-sectoral convergence at the district level, they feel.