title: Are village health sanitation and nutrition committees fulfilling their roles for decentralised health planning and action? A mixed methods study from rural eastern India.
abstract: BACKGROUND
  In India, Village Health Sanitation and Nutrition Committees (VHSNCs) are participatory community health forums, but there is little information about their composition, functioning and effectiveness. Our study examined VHSNCs as enablers of participatory action for community health in two rural districts in two states of eastern India - West Singhbhum in Jharkhand and Kendujhar, in Odisha.
  
  
  METHODS
  We conducted a cross-sectional survey of 169 VHSNCs and ten qualitative focus group discussions with purposively selected better and poorer performing committees, across the two states. We analysed the quantitative data using descriptive statistics and the qualitative data using a Framework approach.
  
  
  RESULTS
  We found that VHSNCs comprised equitable representation from vulnerable groups when they were formed. More than 75 % members were women. Almost all members belonged to socially disadvantaged classes. Less than 1 % members had received any training. Supervision of committees by district or block officials was rare. Their work focused largely on strengthening village sanitation, conducting health awareness activities, and supporting medical treatment for ill or malnourished children and pregnant mothers. In reality, 62 % committees monitored community health workers, 6.5 % checked sub-centres and 2.4 % monitored drug availability with community health workers. Virtually none monitored data on malnutrition. Community health and nutrition workers acted as conveners and record keepers. Links with the community involved awareness generation and community monitoring of VHSNC activities. Key challenges included irregular meetings, members' limited understanding of their roles and responsibilities, restrictions on planning and fund utilisation, and weak linkages with the broader health system.
  
  
  CONCLUSIONS
  Our study suggests that VHSNCs perform few of their specified functions for decentralized planning and action. If VHSNCs are to be instrumental in improving community health, sanitation and nutrition, they need education, mobilisation and monitoring for formal links with the wider health system.
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, New Delhi, Haryana, India. aradhana@phfi.org.
authors.forename: Aradhana
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. rajkumar.ekjut@gmail.com.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Gope
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. nirmala.ekjut@gmail.com.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Nair
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. shibanand.ekjut@gmail.com.
authors.forename: Shibanand
authors.initials: S
authors.lastname: Rath
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. suchitra.ekjut@gmail.com.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Rath
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. rajesh.ekjut@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, New Delhi, Haryana, India. prabas.odisha@gmail.com.
authors.forename: Prabas
authors.initials: P
authors.lastname: Sahoo
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. pavitra.ekjut@gmail.com.
authors.forename: Pavitra Mohan
authors.initials: PM
authors.lastname: Biswal
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. vijay.ekjut@gmail.com.
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India. vikash.ekjut@gmail.com.
authors.forename: Vikash
authors.initials: V
authors.lastname: Nath
authors.affiliation: Sitaram Bhartia Institute of Science and Research, New Delhi, India. hpssachdev@gmail.com.
authors.forename: H P S
authors.initials: HP
authors.lastname: Sachdev
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. j.skordis-worrall@ucl.ac.uk.
authors.forename: Jolene
authors.initials: J
authors.lastname: Skordis-Worrall
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. h.haghparast-bidgoli@ucl.ac.uk.
authors.forename: Hassan
authors.initials: H
authors.lastname: Haghparast-Bidgoli
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. anthony.costello@ucl.ac.uk.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. audrey.prost@ucl.ac.uk.
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
authors.affiliation: Public Health Foundation of India, Plot no. 47, Sector 44 Institutional Area, Gurgaon, 122002, New Delhi, Haryana, India. sanghita@phfi.org.
authors.forename: Sanghita
authors.initials: S
authors.lastname: Bhattacharyya
mesh_terms: D026683:Advisory Committees / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration; D003256:Community Participation; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006285:Health Planning / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007194:India; D044342:Malnutrition / Q000453:epidemiology*; D011247:Pregnancy; D011634:Public Health; D012424:Rural Population; D012499:Sanitation / Q000379:methods*; D012959:Socioeconomic Factors