Contents
Introduction
Doorstep healthcare programmes improve access, but their sustainability and equity hinge on genuine community participation, which strengthens governance, fosters trust, and addresses systemic inequities in India’s diverse health landscape.
Doorstep Healthcare Expansion
- Recent initiatives such as Tamil Nadu’s Makkalai Thedi Maruthuvam (2021) and Karnataka’s Gruha Arogya (2024) deliver primary and NCD care at people’s homes.
- Similar efforts in Odisha (Ama Clinic), Kerala (Aardram Mission), and Assam’s home-based care for elderly and chronic patients aim to reduce treatment delays, improve coverage, and enhance follow-up compliance.
- These schemes represent a paradigm shift from passive access to proactive service delivery, yet risk becoming top-down if community voices are excluded from design and monitoring.
Why Civic Engagement Matters in Health Governance
- Strengthening Accountability: Platforms like Village Health Sanitation and Nutrition Committees (VHSNCs) under the National Health Mission (NHM) were meant to ensure bottom-up planning. Effective committees can monitor service delivery, oversee untied funds, and press for timely supplies, reducing leakages and corruption.
- Enhancing Public Trust: Involving citizens in health planning, review meetings, and grievance redressal builds mutual respect between providers and communities. Example: Kerala’s Aardram Mission integrates Kudumbashree women’s collectives in primary health centre (PHC) governance, boosting utilisation and satisfaction.
- Ensuring Equity in Outcomes: Participatory governance helps reach marginalised groups—SC/ST hamlets, urban slums, migrant workers—who otherwise face barriers in accessing care. The Bhore Committee Report (1946) and Alma-Ata Declaration (1978) both recognised community participation as essential for equitable health systems.
Current Gaps in Participation
- Tokenistic Engagement: Committees often meet infrequently; decisions remain dominated by medical professionals with little lay voice.
- Structural Hierarchies: Women, minorities, and low-income groups are under-represented.
- Measurement Bias: Programmes judged by targets (number of beneficiaries reached) rather than participatory process quality.
- Alternative Channels: In absence of functional forums, communities turn to protests, media campaigns, or litigation to be heard.
Policy Measures to Deepen Participation
- Functional & Inclusive Platforms: Revitalise VHSNCs, Mahila Arogya Samitis, and Ward Committees with clear mandates, regular meetings, and capacity-building. Allocate adequate untied funds and ensure their transparent utilisation.
- Civic Empowerment: Public campaigns on health rights, governance structures, and feedback channels. Use schools, panchayats, and SHGs to nurture health literacy and civic responsibility.
- Capacity Building for Health Workers: Train administrators and medical officers in participatory planning, community facilitation, and social accountability tools. Incorporate public health and governance modules in medical curricula.
- Digital & Social Accountability Tools: Mobile-based dashboards for community monitoring of service delivery. Public display boards at PHCs with service commitments, budgets, and contact points.
- Inter-sectoral Collaboration: Link health committees with nutrition, sanitation, and livelihood missions to address social determinants of health.
Global & Indian Lessons
- Brazil’s Unified Health System (SUS): Municipal health councils with citizen representation influence policy and budget allocation.
- India’s ASHA programme: Demonstrates how community-based workers can link households with formal health systems, improving maternal and child health indicators.
Conclusion
Empowered communities are the backbone of sustainable doorstep healthcare. Strengthened participation will make India’s health governance more transparent, equitable, and trusted, ensuring programmes serve people’s rights—not just performance targets.
