Community Health Workforce: Roles and Responsibilities of MLHPs and VHSNC
Notes for nursing students
Table of Contents
1. Introduction to Community Health Workforce 2. Mid-Level Health Care Providers (MLHPs) 2.1 Roles and Responsibilities of MLHPs 2.2 Scope of Practice 3. Village Health Sanitation and Nutrition Committees (VHSNC) 3.1 Objectives of VHSNC 3.2 Composition of VHSNC 3.3 Roles and Responsibilities 4. Best Practices and Recent Updates 5. Connection Between MLHPs and VHSNC 6. Case Studies and Applications 7. References and Further ReadingIntroduction to Community Health Workforce
The Community Health Workforce forms the backbone of primary healthcare delivery in rural and underserved areas. This workforce includes various cadres of healthcare providers designed to extend healthcare services beyond traditional hospital settings directly to communities. Two critical components of this system are the Mid-Level Health Care Providers (MLHPs) and Village Health Sanitation and Nutrition Committees (VHSNCs), which together create a comprehensive approach to healthcare delivery at the grassroots level.
India’s healthcare system has evolved significantly with the National Health Mission (NHM) framework, which emphasizes decentralization of healthcare services and community participation. The introduction of MLHPs and strengthening of VHSNCs represent strategic initiatives to address healthcare disparities, improve access to primary healthcare, and promote community ownership of health outcomes.
Mid-Level Health Care Providers (MLHPs)
Mid-Level Health Care Providers are healthcare professionals who deliver primary care services at Health and Wellness Centers (HWCs) under the Ayushman Bharat program. They operate at the intersection between community health workers and physicians, filling critical gaps in healthcare delivery, particularly in rural and underserved areas.
Memory Aid: M.L.H.P
M – Medical care provider at grassroots
L – Liaison between community and healthcare system
H – Health promotion and disease prevention
P – Primary care services delivery
MLHPs are typically BSc Community Health or Nursing graduates, or Ayurveda practitioners who have received additional training in modern medicine through a specialized bridge program to deliver comprehensive primary healthcare services.
Roles and Responsibilities of MLHPs
MLHPs serve as the first point of contact for communities at Health and Wellness Centers, providing a range of preventive, promotive, curative, and rehabilitative services.
| Category | Responsibilities |
|---|---|
| Clinical Care |
|
| Public Health Functions |
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| Administrative Duties |
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| Coordination |
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Scope of Practice
The scope of practice for MLHPs encompasses a range of services across the lifecycle, focusing on comprehensive primary healthcare delivery:
- Maternal and Child Health Services: Antenatal care, postnatal care, newborn care, and child health services including growth monitoring and immunization
- Family Planning Services: Counseling and provision of contraceptives
- Communicable Disease Management: Screening, diagnosis, treatment, and prevention of common communicable diseases
- Non-Communicable Disease Management: Screening for hypertension, diabetes, oral cancer, breast cancer, and cervical cancer
- Mental Health Services: Basic psychological support and referrals
- Geriatric Care: Health screening and management of common geriatric problems
- Eye and ENT Care: Basic screening and primary management
- Oral Healthcare: Basic oral health screening and referral
Village Health Sanitation and Nutrition Committees (VHSNC)
Village Health Sanitation and Nutrition Committees are community-based platforms that serve as the cornerstone of decentralized health planning and monitoring at the village level. Established under the National Health Mission, VHSNCs represent a key mechanism for promoting community participation in health governance.
Memory Aid: V-HEALTH
Village-level
Health planning and
Empowerment through
Advocacy and
Local participation for
Transformative
Healthcare
Objectives of VHSNC
The primary objectives of VHSNCs are to:
Promote Community Participation
Encourage active involvement of community members in health planning and monitoring to foster ownership of health outcomes.
Ensure Access to Healthcare
Work towards removing barriers to healthcare access and increasing utilization of health services by all community members.
Address Social Determinants
Address social determinants of health including sanitation, nutrition, and environmental factors that impact community health.
Enable Decentralized Planning
Facilitate village-level health planning based on local needs and priorities to ensure context-specific interventions.
Composition of VHSNC
VHSNCs are constituted at the revenue village level with representation from various stakeholders to ensure inclusive decision-making and comprehensive approach to health issues.
| Member Category | Representatives |
|---|---|
| Elected Representatives |
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| Health Functionaries |
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| Community Representatives |
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| Special Focus |
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The total number of VHSNC members typically ranges from 15-20, ensuring adequate representation while maintaining operational efficiency.
Roles and Responsibilities of VHSNC
VHSNCs are entrusted with a wide range of responsibilities focused on improving health, sanitation, and nutrition at the village level. These include:
Memory Aid: PACE-MAKER
VHSNC’s key responsibility areas:
Planning village health activities
Awareness generation
Coordination of health services
Ensuring service delivery
Monitoring health programs
Addressing social determinants
Keeping records and accounts
Expenditure management
Reporting on health indicators
| Function Area | Key Responsibilities |
|---|---|
| Health Planning |
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| Health Service Monitoring |
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| Fund Management |
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| Sanitation & Hygiene |
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| Nutrition Promotion |
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| Community Mobilization |
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Best Practices and Recent Updates
Digital Integration in Community Health Workforce
Recent advancements include the implementation of comprehensive digital health records and mHealth applications for MLHPs and VHSNCs. The Ayushman Bharat Digital Mission has introduced tablet-based applications for MLHPs to maintain electronic health records, facilitate teleconsultations, and ensure continuity of care. VHSNCs are now being equipped with digital dashboards to track health indicators and monitor fund utilization in real-time, enhancing transparency and accountability.
Comprehensive Care for Non-Communicable Diseases
With the rising burden of non-communicable diseases (NCDs), MLHPs are now being trained in enhanced screening protocols, risk stratification, and management of common NCDs including hypertension, diabetes, and mental health conditions. The updated guidelines emphasize population-based screening, lifestyle counseling, and regular follow-up care. VHSNCs are being oriented to include NCD prevention in their village health plans and to create supportive environments for healthy behaviors.
Intersectoral Convergence Model
The newly implemented convergence model brings together health, nutrition, sanitation, and education departments at the village level. MLHPs now serve as nodal officers for coordinating multi-sectoral interventions, while VHSNCs have been restructured to include representatives from all relevant departments. This approach addresses social determinants of health through collaborative planning and implementation, maximizing the impact of limited resources and creating synergistic effects on community health outcomes.
Connection Between MLHPs and VHSNC
Mid-Level Health Care Providers and Village Health Sanitation and Nutrition Committees have complementary roles in strengthening primary healthcare at the community level. Their effective collaboration is essential for achieving the goals of comprehensive healthcare delivery.
Synergistic Relationship
- Technical Support: MLHPs provide technical guidance to VHSNCs on health matters and assist in developing evidence-based village health plans.
- Community Voice: VHSNCs represent community needs and priorities to MLHPs, ensuring healthcare services are responsive to local context.
- Service Delivery and Monitoring: MLHPs deliver healthcare services, while VHSNCs monitor service quality and community satisfaction.
- Resource Optimization: Collaborative planning between MLHPs and VHSNCs ensures optimal utilization of resources, avoiding duplication and addressing gaps.
- Accountability Mechanism: VHSNCs hold health systems (including MLHPs) accountable to the community, while MLHPs provide accountability frameworks for health service delivery.
The Community Health Workforce ecosystem functions optimally when MLHPs and VHSNCs work together to address both supply-side (service provision) and demand-side (community engagement) aspects of healthcare delivery. This partnership creates a responsive, accountable, and effective primary healthcare system that can address diverse community health needs.
Case Studies and Applications
Case Study: Integrated Approach to Maternal and Child Health
In a remote village of Rajasthan, the MLHP and VHSNC collaborated to address high rates of maternal and infant mortality. The MLHP conducted a health needs assessment and identified gaps in antenatal care coverage. The VHSNC mobilized community resources to establish a birth waiting home near the Health and Wellness Center for expectant mothers from distant hamlets.
The VHSNC used its untied funds to arrange transportation for pregnant women to attend antenatal check-ups, while the MLHP trained ASHA workers in high-risk pregnancy identification. Through regular VHSNC meetings, community barriers to institutional delivery were identified and addressed through targeted interventions.
Outcome: Within one year, antenatal care coverage increased from 65% to 92%, and institutional deliveries rose from 70% to 95%, with no maternal deaths reported during this period.
Case Study: Community-Led Sanitation Initiative
In a village in Uttar Pradesh facing recurrent outbreaks of waterborne diseases, the VHSNC, supported by the MLHP, implemented a comprehensive sanitation initiative. The MLHP provided epidemiological data on disease patterns and water quality testing results to identify contamination sources.
The VHSNC conducted a community mapping exercise to identify households without toilets and areas with poor drainage. They mobilized additional resources through convergence with the Swachh Bharat Mission and used VHSNC funds to create awareness about hygiene practices.
Outcome: Within 18 months, the village achieved Open Defecation Free status, installed community water purification systems, and reported a 70% reduction in waterborne disease incidence.
References and Further Reading
- National Health Mission. (2022). Guidelines for Village Health Sanitation and Nutrition Committees. Ministry of Health and Family Welfare, Government of India.
- Ayushman Bharat. (2023). Operational Guidelines for Health and Wellness Centers. Ministry of Health and Family Welfare, Government of India.
- Indian Public Health Standards. (2022). Guidelines for Sub-Centers with Community Health Officers. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.
- World Health Organization. (2023). Strengthening the Community Health Workforce for Primary Healthcare: Global Experiences and Lessons from India.
- Ved, R., Sheikh, K., George, A. S., & Raman, V. R. (2018). Village Health Sanitation and Nutrition Committees: reflections on strengthening community health governance at scale in India. BMJ Global Health, 3(Suppl 3), e000681.
- National Health Systems Resource Centre. (2022). Capacity Building Framework for Mid-Level Health Care Providers. Ministry of Health and Family Welfare, Government of India.
- Sharma, R., Webster, P., & Bhattacharyya, S. (2021). Factors affecting the performance of community health workers in India: a multi-stakeholder perspective. Global Health Action, 14(1), 1917517.
- National Institute of Health and Family Welfare. (2023). Training Module for Village Health Sanitation and Nutrition Committees on Community Action for Health.