**8. Strengthening the Panchayati Raj Institutions (PRIs) and village health nutrition and sanitation committee (VHNSC)**

DCM continuously engages with PRI members in all villages in its field practice area. Orientation sessions are organized through the rural and urban health training centers to empower the PRI and VHNSC members for health action at the community level. Due to its continuous engagement with the VHNSC, in most of the villages in the field practice area, monthly meetings of VHNSC members are ensured.

VHNSC has a vital role in decentralized health planning and monitoring. National Health Mission (NHM) envisaged VHNSC to function adequately with the involvement of community members and promote people's participation in the planning process. However, there should be a tool which facilitates in planning, implementation according to village-specific health plan, and community monitoring of health services at the village level [13].

Mahatma Gandhi Institute of Medical Sciences (MGIMS) has developed a community-led approach and ensures the provision of high-quality and affordable health care with emphasis on Maternal and Child Health (MCH), in partnership with local the community and health system. The strategy is to empower the communities to manage and own village-based primary health care. The DCM has initiated various community-based organizations in the villages—self-help groups of women, adolescents groups (more than 60 in numbers)—and empowered village health nutrition and sanitation committees (VHNSCs) in every village in a systematic manner.

The program uses the Integrated Model of Communication for Social Change (IMCFSC) to guide its BCC activities. IMCFSC uses an iterative process where "community dialog" and "collective action" work together to produce social change as shown in **Figure 2** [14]. The VHNSCs have been empowered for health planning, organization of Immunization Day, and monitoring of the health functionaries, and they work in close collaboration with the local health system and democratic body. There is an effort to link health and developmental activities at the village level.

Formal interaction of medical and nursing students with community-based organizations is arranged during their village visit; they witness the activities of community-based organizations. This helps aspiring doctors understand the role of individuals, families, and communities in preventing diseases; maintaining and promoting health; and improving health-seeking behavior.

Based on our experience of working with VHNSC, it can be inferred that most VHNSCs are moving in the right direction by addressing the social determinants

**Figure 2.**

*Integrated model of communication for social change.*

#### *Community-Oriented Graduate Medical Education: A Gandhian Approach DOI: http://dx.doi.org/10.5772/intechopen.93302*

of health (SDGs) for which they have been empowered to recognize the social determinants of health being important in improving the health of the community as a whole; however, it requires continuous support, hand-holding, and monitoring from both public health system and other stakeholders [15].

Community-based organization will be the key to bring about the overall development of the villages. Most importantly, communities need to control the process. The ultimate goal is for communities to have the confidence and competence to make informed choices from a range of appropriate options for sustainable and equitable development. The need of the hour is to bring about a holistic change in the lives of beneficiaries among the villagers by uplifting their socioeconomic and health status through effective linkages through community, governmental, and other developmental agencies. The VHNSC should be able to prepare an integrated village development plan with technical guidance from local organizations/ agencies [16].

As a part of their social responsibility, medical colleges need to play the role of catalyst to bring all the stakeholders (village-level committees, PRI members, health functionaries—ASHAs, AWWs, auxiliary nurse midwives (ANMs), MPWs, school students and teachers, NGOs, etc.) on one platform and make an integrated plan for the development of villages in their community development block area. Capacity building of the community and household will be pivotal if sustainable development is to be ensured and the Gandhian dream of Gram Swaraj is to be realized.

## **9. Conclusion**

At present, we have developed an interface between community, health system, and MGIMS, which requires further nurturing in a manner that all three stakeholders sustain their commitment. The MGIMS has been discharging its role to nurture and further develop this partnership in order to discharge its social responsibility in the short term and its social accountability in the long term.

"Gram-Swaraj, the economy of small scale: in the past 12 years, from the recession of 2008 to the economic crisis of 2020, we have seen that a globalised economy is too fragile. It crumbles in the face of local tremors like the real estate scam in the USA or the emergence of a new virus in Wuhan. Gandhi would remind us of the humaneness and stability of local production, local consumption, and local community of relationships. He called it Gram-Swaraj. Such change in economy would invariably be accompanied by the decentralisation of political power. Globalisation has produced authoritarian political leaders everywhere. For Gandhi, the true democracy, responsibility, and relationship can be better practised locally." [17].

#### **Acknowledgements**

The author is thankful to all his colleagues in the Department of Community Medicine at the MGIMS, Sewagram, for their direct or indirect contribution.

## **Conflict of interest**

The author declares no conflict of interest.
