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Cited by 40Community Health and DevelopmentICT in Developing CommunitiesPublic Health and Social Inequalities

Beyond form and functioning: Understanding how contextual factors influence village health committees in northern India.

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Scott, Kerry, George, Asha S., Harvey, Steven A., Mondal, Shinjini, Patel, Gupteswar, Ved, Rajani, Garimella, Surekha, Sheikh, Kabir·2017·PLoS ONE
DOI 10.1371/journal.pone.0182982PMC PMC5570342
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Abstract

Health committees are a common strategy to foster community participation in health. Efforts to strengthen committees often focus on technical inputs to improve committee form (e.g. representative membership) and functioning (e.g. meeting procedures). However, porous and interconnected contextual spheres also mediate committee effectiveness. Using a framework for contextual analysis, we explored the contextual features that facilitated or hindered Village Health, Sanitation and Nutrition Committee (VHSNC) functionality in rural north India. We conducted interviews (n = 74), focus groups (n = 18) and observation over 1.5 years. Thematic content analysis enabled the identification and grouping of themes, and detailed exploration of sub-themes. While the intervention succeeded in strengthening committee form and functioning, participant accounts illuminated the different ways in which contextual influences impinged on VHSNC efficacy. Women and marginalized groups navigated social hierarchies that curtailed their ability to assert themselves in the presence of men and powerful local families. These dynamics were not static and unchanging, illustrated by pre-existing cross-caste problem solving, and the committee's creation of opportunities for the careful violation of social norms. Resource and capacity deficits in government services limited opportunities to build relationships between health system actors and committee members and engendered mistrust of government institutions. Fragmented administrative accountability left committee members bearing responsibility for improving local health without access to stakeholders who could support or respond to their efforts. The committee's narrow authority was at odds with widespread community needs, and committee members struggled to involve diverse government services across the health, sanitation, and nutrition sectors. Multiple parallel systems (political decentralization, media and other village groups) presented opportunities to create more enabling VHSNC contexts, although the potential to harness these opportunities was largely unmet. 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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  • Women's collective action has led to funding, demand, construction, repair, and maintenance of water services and latrines.

    “Women's collective action has led to funding, demand, construction, repair, and maintenance of water services [56, 61, 73, 78, 89, 91, 125, 129, 163, 165, 168, 169, 193, 296] and latrines [129, 139, 147, 168, 170, 174, 175].”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [125]

  • Women have organized to form lending groups to support women-led WASH businesses, provide community education about water safety, monitor open defecation, and respond to sanitation-related harassment.

    “Women have organized to form lending groups to support women-led WASH businesses, [66] provide community education about water safety, [56, 61, 73, 78, 89, 91, 125, 129, 163, 165, 168, 169, 193, 296] monitor open defecation, [145] and respond to sanitation-related harassment.[174]”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [125]

  • Limited income and asset access and control, including over land, constrained women's access to sanitation and limited independent decision-making about latrine construction; women reported using public pay-per-use toilets and incurring higher costs than men due to more frequent need.

    “Similarly, limited income and asset access and control, including over land, constrained women's access to sanitation [119, 124, 125, 135, 147, 168, 171, 174, 186, 187, 191, 217, 239, 240, 270] and limited independent decision-making about latrine construction [119, 124, 135].Women reported using public pay-per-use toilets [168, 171, 174, 227, 239, 270] and incurring higher costs than men due to”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [125]

  • Women have faced difficulties accessing government subsidies or loans large enough for latrine construction and reported willingness to make financial sacrifices, like paying higher rent or accepting a lower wage job, to gain toilet access; in India, even women with economic and decision-making power could not build latrines without land ownership.

    “Women have faced difficulties accessing government subsidies [125, 135] or loans large enough for latrine construction [131] and reported willingness to make financial sacrifices, like paying higher rent [191] or accepting a lower wage job, [174,217] to gain toilet access.In India, even women with economic and decision-making power could not build latrines without land ownership [124,187,190].”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [125]

  • Women expended great amounts of time meeting sanitation needs and fulfilling sanitation-related responsibilities, including long walks to sanitation sites when lacking private home toilets, waiting in long toilet queues, going for sanitation in early morning or late at night to avoid queues or ensure privacy, or open defecating rather than walking to and queuing at latrines.

    “Women expended great amounts of time meeting sanitation needs and fulfilling sanitationrelated responsibilities [64, 66, 121, 122, 125, 127, 128, 132, 133, 135, 138, 141, 168, 173, 174, 182, 184, 185, 187, 189,190,195,219,226,228,236,239,240,248,250,256,265].Women in India, [125,195] Kenya, [256] and South Africa [265] reported long walks to sanitation sites when they lacked private home toilets,”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [125]

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  1. [19]Pawson R, Tilley N. Realistic Evaluation. London, UK: SAGE Publications; 1997.

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Authors
Scott, K., George, A. S., Harvey, S. A., Mondal, S., Patel, G., Ved, R., Garimella, S., & Sheikh, K.
Affiliations
  • Johns Hopkins University (US)
  • University of the Western Cape (ZA)
  • Public Health Foundation of India (IN)
  • National Health Systems Resource Centre (IN)
Corresponding author
Scott, Kerry
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2017-08-24
Volume
12
Issue
8
Pages
e0182982
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0182982
PMC
PMC5570342
OpenAlex
W2747538276
Cited by
40
References
39
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 7 · 2022: 9 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 1
FWCI
5.30
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UWC Research Repository (University of the Western Cape) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • UWC Research Repository (University of the Western Cape) (submittedVersion)
Funders
  • Alliance for Health Policy and Systems Research (201104232)
  • International Development Research Centre (107313-001)
Topics
  • Health Sciences › Health Professions › General Health Professions › Community Health and Development
  • Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
community participation in health, contextual factors, women's empowerment, social hierarchy, caste, gender norms, administrative accountability, political decentralization, media, North India
MeSH terms
Community Participation, Female, Health Services, Humans, India, Male, Nutritional Status, Organizations, Rural Population, Sanitation, Women's Health, Focus Groups

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