Evaluation of community-based participatory governance interventions to improve access to health-related public entitlements in India

Abstract

PurposeAs the investment in social and health protection remained poor in India, the most vulnerable citizens lack access to existing health related government initiatives with transformational benefits due mostly to the lack of “accurate information”. The purpose of this paper is to explore and demonstrate the impact of participation of the community through a structured intervention that promotes awareness, enables the community to ensure entitlements, and enhances the utilization of government initiatives.Design/methodology/approachThrough a baseline–endline study using a quasi-experimental design, this research provides empirical evidence of such intervention on awareness and utilization of health, nutrition and developmental initiatives. It involved survey of 400 households from the four study locations before and after the interventions. The pre-post estimation in the “proportion of respondents who were fully aware” was analyzed to measure changes in knowledge. Mc-Nemar test was applied to measure the statistical significance of these changes.FindingsThe results indicate that the intervention of “empowerment centers” has increased knowledge and utilization of the various government schemes, services and facilities that are routine and offer benefits all household members, in general, and women as well as children, in particular. The intervention was found to be successful in improving the local governance systems; empowering communities, linking communities and local level government systems across all sectors, as well as bringing in inter-sectoral linkages across governments systems.Research limitations/implicationsAlthough there have been many interventions of community participation for reducing inequities across the globe, there is a dearth of documentation and evidence generation. More efforts are required to evaluate such interventions, identify which interventions work and how they can be adapted to different contexts. This also requires exploration of the social processes and contextual realities underlying these interventions.Originality/valueTo the best knowledge of the authors, this research is one-of-its-kind that assessed an intervention targeting cross-cutting schemes and services, beyond just health interventions. The evidence points to the success of grassroots level inter-sectoral community actions, in the form of empowerment centers, to improve awareness and utilization of government interventions through participatory governance, and points to the expanding scope of learning and adapting such interventions to different contexts and scopes.