Sangita Minj resolutely walked across two rivers to reach an Anganwadi Centre at the Dharamjaigarh block in Chhattisgarh. In one hand, she was carrying an ice box with vaccination vials. In the other, a bag that she had packed the previous day with medical equipment, supplements, and medicines.
Her tasks for the day were clear: she knew that five children were to be immunized and three pregnant women were to receive periodic antenatal check-ups. This wasn’t all. Parents of a severely malnourished child to be counselled, three regular patients to be seen, and vitamin A supplementation to be done.
Being the Auxiliary Nurse Midwife (ANM) of the nearby Ayushman Aarogya Mandir, she knew that planning the day well was important. She would be able to offer services at the village to a community that lived far from the Block headquarters. This was an area where rains and distance caused much difficulty in accessing healthcare services.
The Anganwadi Centre would be the closest point of access for clinical care for all the people she would meet on that day.
She, the ASHA (called Mitanin in Chhattisgarh), and the Anganwadi Worker went about their duties — as they do one day every month — to organize a Village Health, Sanitation, and Nutrition Day (VHSND).
The policy
Conceptualized in 2007 by the National Health Mission, the Village Health and Nutrition Day (VHND) was to take place one day every month at each fixed location like clockwork. Expanded further in 2019, sanitation was added to the offerings.
The Anganwadi Centre would be the closest point of access for clinical care for all the people she would meet on that day.
Accessibility is central to the design. Health and health-related services are offered at a touchpoint that is close to everybody — including in the most remote parts of the country. As is true for all provisions offered in primary healthcare in the public system, the services are delivered at no-cost.
This is no easy feat to pull off. The range of aspects to be covered on the day requires careful planning. The ANM must list the people that she is supposed to immunize and place a demand at the nearest vaccine storage location in advance. On the day of the VHSND, she must collect vials from the vaccine storage location, take her bag with medical equipment and supplies, and make the journey to the VHSND site.
Simultaneously, she needs to communicate with the ASHA and Anganwadi Worker beforehand to make necessary arrangements on-site and keep the people who need to visit duly informed. This is to be done every month — for anywhere between four to eight VHSND locations that she is responsible for.
The system works in most parts of the country — albeit at varying levels of excellence. For this, the credit lies with the good people in the public system.
With resilience, they navigate both the complexities of operationalizing the moving pieces, and the challenges they face in difficult geographies.
Key services to be delivered at a VHSND
With resilience, they navigate both the complexities of operationalizing the moving pieces, and the challenges they face in difficult geographies.
A good VHSND
Asha Bara, who also works as an ANM in Dharamjaigarh block, noticed that the services that were being offered had become limited to immunization and antenatal care over time. She was keen to fix this. She initiated the changes systematically, one site at a time. Once the first VHSND location was chosen, the Mitanin and Anganwadi Worker had to be taken into confidence.
Within the Anganwadi, specific spaces at which to deliver services were earmarked the previous day itself. Screening areas were set up for measuring growth of children and vitals of pregnant women. Curtains were pulled out to create a private space for abdominal checkups. Spaces for counselling target groups on health also were decided. A drinking water station was put in place. People from the community were informed in advance.
On the next day, the Anganwadi transformed into a bustling space. To illustrate some activities on the day:
Adolescent girls were seated at one corner, being informed about the need for Iron Folic Acid supplementation.
Close to where growth monitoring of children was going on, a nutrition corner was set up where the Anganwadi Worker was telling mothers about why locally grown food is important for the health of their children.
The ANM was weighing pregnant women and noting down their vitals. They were given sufficient supplementation and told to rest well, eat well and take supplements on time.
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Like Asha Bara and Sangita Minj, ANMs from approximately 1.6 lakh Ayushman Arogya Mandirs across the country deliver healthcare services closer to home for communities through one or two VHSNDs every week.
The Mitanin was advising those in advanced stage of pregnancy to make sure that arrangements for their delivery were being thought through.
Through initiative, attention to detail, and by working as one team, they were successfully able to transform the VHSND into a vibrant one — where health-related concerns could be discussed and care accessed closer home.
Like Asha Bara and Sangita Minj, ANMs from approximately 1.6 lakh Ayushman Arogya Mandirs across the country deliver healthcare services closer to home for communities through one or two VHSNDs every week.