Abstract / Summary
In India, following the launch of the National Rural Health Mission, strengthening community processes gained momentum through the operationalisation of Village Health, Sanitation and Nutrition Committees (VHSNCs). Despite their potential, the role of VHSNCs in improving access to care for Non-Communicable Diseases (NCD) remains underexplored. This study aimed to describe the process of revitalising VHSNCs and to examine the mechanisms through which this contributed to improved NCD care among a tribal population. This implementation research used a mixed-methods design in a tribal block of Maharashtra from 2020 to 2022. VHSNCs under two intervention Primary Health Centres (PHCs) received the intervention, while those under other two PHCs served as active controls. The intervention focused on strengthening VHSNCs through structured capacity building, onsite supportive supervision, and facilitation for planning and implementing health activities. Changes in VHSNC functioning and NCD service coverage and utilisation were assessed using structured facility and committee assessment tools. NCD indicators were analysed using a difference-in-differences approach. In-depth stakeholder interviews were conducted to understand mechanisms and enabling factors influencing improved NCD care. A total of 97 VHSNCs (50 intervention, 47 control) were included. In the intervention arm, VHSNC functioning improved across key domains, including regularity of meetings, member participation, reconstitution, adherence to procedural norms, and intersectoral convergence. Screening for hypertension and diabetes increased by 42% and 56.3%, respectively. Outpatient attendance for these conditions increased more than tenfolds in intervention PHCs. Referral linkages, outreach activities, and health promotion efforts also improved compared to control areas. Qualitative findings highlighted effective planning, convergence across sectors, community empowerment, and expanded VHSNC roles as key mechanisms driving improved NCD service delivery. Continued training and supportive supervision were identified as essential for sustaining gains. Revitalising VHSNCs can play a critical role in improving access to NCD services among vulnerable tribal populations. Strengthening routine processes, ensuring functional regularity, and enabling community-led planning and action are key to enhancing NCD care.