Journal of Dr. NTR University of Health Sciences

CASE REPORT
Year
: 2018  |  Volume : 7  |  Issue : 4  |  Page : 311--313

Factors affecting the functioning of Rogi Kalyan Samitis in Uttarakhand state of India


Enakshi Ganguly 
 Department of Community Medicine, MediCiti Institute of Medical Sciences, Ghanpur, Telangana, India

Correspondence Address:
Dr. Enakshi Ganguly
Department of Community Medicine, MediCiti Institute of Medical Sciences, Medchal Mandal, Ghanpur - 501 401, Telangana
India

Abstract

Introduction: The Rogi Kalyan Samitis (RKSs) in Uttarakhand were formed at community health centers (CHCs) to monitor and improve the quality of services offered. Methodology: An independent study was taken up to study the progress made by RKSs in two districts of the state. This article presents the different factors affecting the functioning of RKSs. Data were collected from all member secretaries and at least 20% sampled members in all RKSs in eight CHCs. Results: RKS is not functioning properly in both the districts because of a number of inhibitory factors such as poor interest of the members and lack of awareness among members and the general community. Conclusion: Educational activities about spreading awareness regarding the existence and activities of RKS should be undertaken in those areas where the RKS is not performing well.



How to cite this article:
Ganguly E. Factors affecting the functioning of Rogi Kalyan Samitis in Uttarakhand state of India.J NTR Univ Health Sci 2018;7:311-313


How to cite this URL:
Ganguly E. Factors affecting the functioning of Rogi Kalyan Samitis in Uttarakhand state of India. J NTR Univ Health Sci [serial online] 2018 [cited 2019 Oct 17 ];7:311-313
Available from: http://www.jdrntruhs.org/text.asp?2018/7/4/311/249828


Full Text



 Introduction



Uttarakhand, the 25th state formed in the constitution of India, is progressing on multiple lines of development. However, in terms of health indicators, it has been lagging behind large states, thus being classified under the Empowered Action Group, receiving special focus under the National Rural Health Mission (NRHM). Unacceptable quality has been cited as a major reason for underutilization of public health services in the state despite the presence of sufficient infrastructure. One of the innovative strategies adopted under NRHM was formation of Rogi Kalyan Samiti (RKS), whose primary role was to ensure smooth functioning and maintaining the quality of services.[1]

The primary healthcare system in the state operates in a hierarchical manner with subcenters and primary health centers at the base and community health centers (CHCs) at the secondary level. The RKS has been framed at all levels including the CHCs to ensure provision of comprehensive quality care to the beneficiaries.[2] For smooth functioning of RKS, there is provision of funds' generation through government and nongovernment agencies. The RKS is empowered to mobilize resources through levying user charges, commercial use of assets like land of the institution, and donations in cash or kind from the public at large.[3]

The study was undertaken to appraise the performance of RKS as a part of mid-term appraisal of NRHM components and activities in the state of Uttarakhand. The objectives of this article are to report the facilitating and inhibiting factors for the smooth functioning of RKS in CHCs in Uttarakhand.

 Methodology



A cross-sectional qualitative study was conducted from October 2008 to December 2008 in two districts (Nainital and Udham Singh Nagar) of Uttarakhand in Northern India by the Department of Community Medicine of a teaching medical college. The two said districts were chosen according to feasibility to represent the hill and plain terrains, respectively, across the state. The study was ethically approved by the Institutional Ethical Committee of the medical college as well as the National Institute of Health and Family Welfare (NIHFW), New Delhi.

A semi-structured questionnaire, including questions for assessment of structure and functioning of RKS in accordance with Indian Public Health Standards (IPHS) guidelines, was developed with inputs from experts from NIHFW. The tool, after being pilot-tested in one nearby CHC that was later excluded from sampling, was finalized for field use. Four investigators received a 2-day training for conducting in-depth interview according to study protocol.

Eight CHCs in both districts were included in this study. The details of study methodology and sampling are described elsewhere.[4] In brief, all member secretaries of the RKS and at least three other members of the RKS, which included at least 20% of members for qualitative study selected by simple random sampling at each CHC, were interviewed in-depth using the pretested tool by the investigators. The interviews were conducted confidentially in a separate room and supervised by the principal or coprincipal investigator. Verbal informed consent was obtained from all participants before conducting the interviews, which were audio-recorded for transcription later.

The collected data were entered in Microsoft Excel and analyzed. The descriptive statistics of the participants and qualitative analyses are presented in this article.

 Results



A total of 8 member secretaries and 27 members of RKS in the selected CHCs participated in the study. The mean age of the participants was (mean ± standard deviation) 42.81 ± 4.37 years, all of whom were males with a majority (77.14%) following Hindu religion. The mean years of schooling were 15.88 ± 2.37 years. Their primary occupation was service, though some (15.67%) also did agricultural work in their own farms. The RKS members included government officials, political leaders, people's representatives, donors, and community leaders, whereas the member secretary was the medical officer incharge of the CHC [Table 1].{Table 1}

The participants reported a number of factors, mostly inhibitory in nature, which affected the smooth functioning of the RKS [Table 2]. The most frequently cited problem was that the members never reached a common consensus for deciding on purchasing of goods required for quality upliftment of the CHC services. Half of the RKS had members who had an indifferent attitude toward the goals and objectives of the respective RKS, and most of them were absent from the meetings under false pretexts. The meetings were conducted out of schedules and mostly witnessed frequent confrontations and laissez faire attitude among members.{Table 2}

These barriers hampered the goals of conducting ameeting, and decisions were not taken or not followed/implemented as a result. Sufficient amount and flow of funds for RKS was cited among the very few facilitating factors.

 Discussion



The RKS in Uttarakhand was an upgradation of a previously existing quality management body known as Chikitsa Prabandhan Samiti. The functioning of RKS was influenced by many factors. Presence of sufficient amount of funds for smooth functioning was the most important facilitating factor. These funds were mostly generated from user charges. The members did not have knowledge about the other methods of fund generation as suggested under RKS guidelines. Whereas other states like Madhya Pradesh and Gujrat presented examples of better fund generation by commercial renting of the hospital areas and community participation through donations, in addition to levying user fees.[2]

This study also points at lack of Information Education and Communication activities as a deterrent for smooth functioning of RKS in the state. It was seen that those members who had some insight regarding the objectives and functioning of RKS often failed to motivate or generate interest among other members, leading to an indifferent attitude among them. Many members were officials in other concurrent programs of the state with prevailing manpower crisis, and thus failed to find sufficient time to attend RKS meetings regularly, which was seen as an additional burden.

Among the other pertinent gaps for smooth functioning of RKS, awareness about the functions of RKS among the members, as well as the community in general, was missing. A study from Pune also reported nonawareness of community members as well as lack of clarity of objectives among RKS members in low-performing CHCs,[5] indicating that the findings of our study are pertinent till date, and that the situation of most RKS across the country might not be any different. Awareness may be generated at best through use of local print and electronic media or through branding that may enhance the impact. Peripheral government functionaries such as Accredited Social Health Activists, Auxiliary Nurse Midwives, and Anganwadi Workers may act as informers to the general as well as underserved populations and guide them, which may act as an image booster for RKS in addition to increasing utilization and coverage of services.

Acknowledgement

The authors acknowledge the help and guidance received from Late Dr. Deoki Nandan.

Financial support and sponsorship

Nil.

Conflicts of interest

This project received technical and financial assistance from the National Institute of Health and Family Welfare, New Delhi, under the RAHI-II Project.

References

1Ministry of Health and Family Welfare. National Rural Health Mission: Framework for Implementation (2005-2012). Ministry of Health and Family Welfare, Government of India, Nirman Bhavan, New Delhi. Available from: jknrhm.com/Guideline/Frame-Work.pdf. [Last accessed on 2013 Dec 12].
2Ministry of Health and Family Welfare. Communitisation of Rogi Kalyan Samitis. Available from: http://nrhm.gov.in/communitisation/rogi-kalyan-samities/introduction-for-rogi-kalyan-samiti-rks-hospital-management.html. [Last accessed on 2013 Dec 12].
3Department of Public Health and Family Welfare Madhya Pradesh. Rogi Kalyan Samiti Charter. Available from: http://www.health.mp.gov.in/rks/rks-english.pdf. [Last accessed on 2013 Dec 14].
4Rawat CM, Pandey S, Awasthi S, Tekhre YL, Kumar R, Nandan D. A rapid appraisal of functioning of Rogi Kalyan Samitis in Uttarakhand. Indian J Public Health 2009;53:171-6.
5Adsul N, Kar M. Study of rogi kalyan samitis in strengthening health systems under national rural health mission, district Pune, Maharashtra. Indian J Community Med 2013;38:223-8.