1. 14th World Congress of Public Health, Kolkata
Establishment of village level health units for sustaining universal health coverage in Madhya Pradesh, India Rakesh Parashar, Aboli Gore, Faiz Ahmed Kidwai  
14th World Congress of Public Health, Kolkata
Dr Rakesh Parashar
MPTAST - FHI360

2. Introduction: Gram Arogya Kendra (Village Health Center)
A decentralized service delivery system which caters to the last mile population with basic health services and provides a platform for convergence of health and nutrition services.
Gram Arogya Kendra (GAKs) are established at existing Anganwari Centers
Functional in about villages in the state.
The health services are delivered by ASHA (Accredited Social health Activist) on regular days and by ANM (Auxiliary nurse and midwife) on the village health and nutrition day (VHND).

3. Study Objectives
This study tries to inform the health planners and manager about the Gram Arogya Kendra (Village Health Centers) running in Madhya Pradesh as a mechanism for Universal Health Coverage by :
Assessment of utility of and acceptance of Gram Arogya Kendras in village residents and health workers
Understanding operational challenges in service delivery at GAKs
Assessment of functionality of Gram Arogya Kendras

4. Methodology
Semi-structured Interviews (Purposive sampling)
50 Village residents from 20 villages
20 ASHAs
10 ANMs
5 Medical Officers
Status check of functional items on a 57 item checklist
350 GAKs randomly selected from 5 districts
Data collection during April-May 2014 in 5 randomly chosen districts of Madhya Pradesh

5. Results

7. Scores on 4 groups of parameters on the 57 item checklist

10. Results
Key responses from the interviews of health workers and village residents

16. Results Summary: Acceptance
An overall positive attitude and acceptance in village respondents observed, which is backed by good utilization of existing services as well as willingness of utilization in future.
The ASHAs perceive their role better now with a responsibility of providing medication to villagers
The ANMs find their workload to have reduced , however with added responsibility of monitoring ASHAs work
The Sector Medial Officers appreciate the presence of GAKs and find it a good concept to reduce geographical limitation and out of pocket expenditure for basic health problems.

17. Results Summary: Challenges
ASHA :
to manage their work
seek more support from ANMs
fixed remuneration for this activity with provision of more dedicated space.
Village residents :
demand for more medicines and for more time spent by ASHA
Medical officer’s visit at least once a month.
ANMs : Rrecord updating by ASHA at GAK remains a problem.
Medical officers find management of supplies and monitoring visits by themselves and ANMs a challenge.

18. Study Limitations
Small Sample with purposive sampling for interviews
Study doesn’t include view point of health planners and managers at higher levels
The functionality assessment is limited to infrastructure, supplies and other input parameters, doesn’t cover service utilization and service quality statistics
The researchers are not exclusive from the implementers of the GAK concept

19. Discussion and Conclusions
WHO Health System framework- 2007, Six building blocks of health system
Service Delivery - Village level health units, Gram Arogya Kendra
Health workforce
Information
Medical products, vaccines and technology
Financing
Leadership and Governance
Extended and decentralized service delivery can improve level of health equity and outcomes through improved access and coverage

20. Universal Health Coverage
Elimination of geographical barrier
Reduced travelling for minor health issues
Avoiding local private practitioners
Early symptom check
Better early referrals
Improving Access
Reducing out of pocket expenditures
Improved health outcomes
Universal Health Coverage

21. Village level health units in Madhya Pradesh, India have shown good acceptance by and large from the beneficiaries and health workers.
Continuity of availability of provisioned medicines and supplies with monitoring and measurement of service delivery, utilization and service quality needs to be continuously improved for effective service delivery at these village level units.

22. Thank You Possible research themes in future:
Service delivery – Coverage , Utilization , Quality
Outcome measurement
Impact on overall village health and functioning of health system
Change in social equations-dynamics related to health within the villages
Models of effective monitoring and sustaining supply chains
Thank You