Exploring Community Participation through Local Health Facility Committees in Punjab: Extent of Decision Space, Capacity, and Accountability

Abstract

Background: The Ayushman Bharat-Health and Wellness Centers (HWCs) program envisages collective action for health through the formation of facility-level committees-Jan Arogya Samitis (JAS), at the HWCs. Objectives: The study aimed to appraise the constitution and functioning of the JAS, identify the enablers and barriers in carrying out its functions, and explore the perceived level of decentralization among elected and nonelected community members in Punjab state of India. Materials and Methods: A sequential mixed methods study was conducted in a block of Punjab. The first phase consisted of quantitative assessment of the constitution and functioning of JAS, which was followed by in-depth interviews with the JAS members to understand the enablers and barriers for the functioning of the committee. The final phase comprised interviews with the elected local body representatives and community members to understand their perceived extent of decision space, capacities, and accountability for a series of healthcare functions. Results: It was noted that JAS performed the functions of leading health promotional activities and enabling quality service delivery. However, the committees played a passive role in supporting village-level committees, monitoring services, and facilitating social accountability, majorly due to awareness gaps. The perceived extent of decision space, capacity, and accountability was found to be low to moderate with significantly higher decision space and accountability reported by elected representatives, in comparison to service recipients. Conclusion: The study emphasizes the need of consistent support for strengthening local health governance through the structured capacity-building program for all the members of health committees and regular supportive supervision.