Critically assess the government efforts in India to involve the community in primary healthcare activities and impacts of these efforts in various health indicators.

In the primary health care, the key government efforts include (1) community health workers such as ASHAs and ANMs (2) Community Health Centres (2)  Community based interventions such as in vaccination drives and awareness programmes about TB/HIV (4) involvement of the community and the urban / rural local bodies in National Urban / Rural Health Mission etc.
The basic objective of community involvement is to establish a people-government partnership in planning, implementation and utilisation of health activities in order to benefit from increased local self- reliance and social control over the infrastructure and technology of primary health care.  The efforts of the governments in India have been varied from state to state as heath is a state subject in seventh schedule.
Overall, we are far behind other countries in terms of proper community involvement. The main issues are callous attitudes of the governments, particular state governments and illiteracy among populace. We have a general absence of key requirements for successful enhancement of the role of communities and for integrating communities into the primary health planning process viz. conducive political environment; strong civil society; education and awareness; resources and investment and proper institutional mechanisms for participation and planning.
However, some efforts like ASHA and Community Health Centres have been successful as well as transformative for rural landscape.
As far as health indicators are concerned, there has been significant progress but community involvement isn’t the only reason. We can link ASHA /ANM with increased institutional deliveries; reduced MMR and IMR; reduced fertility rate. India’s total fertility rate declined to 2.2 – close to the replacement rate of 2.1 – from 2.7 over the decade. Further, without community involvement, the increase in immunisation coverage across the country with almost 70% of children fully immunised, compared to 44% in 2005-06 would not have been possible.