POLICY REPORT NO. 21

Enabling Social Accountability: The Community Health Worker Programmes of Chhattisgarh and Jharkhand

The Mitanin and Sahiyya community health worker programmes of Chhattisgarh and Jharkhand were initiated by civil society and state actors in the early 2000s. Employing mainly women, they were precursors to the Accredited Social Health Activist (ASHA) programme, launched across rural India in 2005.

Over the years, efforts were made by civil society participants to bring about a wider rights-based focus to the Mitanin and Sahiyya programmes. In the case of Chhattisgarh, Mitanin women have engaged in rights-based action concerning a range of health and social issues, including nutrition, sanitation, education, pensions, forest rights, land acquisition, legal justice, gender-based violence, and caste discrimination. Thousands of Mitanin women have also become Panchayat representatives in Chhattisgarh. In contrast, the entry of Sahiyyas into Panchayat leadership positions in Jharkhand has been less frequent, while rights-based activities led by Sahiyyas are relatively rare.

This Policy Report explores the reasons why rights-based action has become part of the institutional design of the two programmes to differing degrees. The study details some of the contextual and organisational factors enabling individual and collective action for social accountability.

While the origins of civil society engagement and wider culture of governance may not be easily amenable to change, the Report recommends ways in which the Sahiyya and ASHA organisations may be structured differently, in order to enhance activism by workers. One of these strategies entails the promotion of a leadership cadre ‘from below’, in which frontline workers are permitted to rise to leadership positions at cluster, block, district and (eventually) State-level. Allowing these leaders to subsequently carry out both training and monitoring roles would further encourage bottom-up planning and collective problem-solving. The creation of multiple platforms of group interaction between successive programme levels is also essential to enable the two-way exchange of information based on grounded experience, necessary for building both local and state capacity. Without such organisational changes, community forums involving ASHAs such as village health committees are likely to remain dysfunctional.



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