Community based monitoring and planning of health services
Project : Community Based Monitoring and Planning of Health Services under National Rural Health Mission (NRHM)
Duration : Pilot Phase- June 2007 to November 2008
Continuation Phase- December 2008 to March 2012, April 2011 to March 2012 and April 2012 to March 2013, April 2013 to March 2014, April 2014 to March 2015, April 2015 to March 2016
Current phase – November, 2016 to March 2017
Funded by – NHM
The National Rural Health Mission (NRHM) was launched for the period 2005 to 2012 with the goal of improving the availability of and access to quality health care for people, especially for those residing in rural areas, the poor, women, and children. Community Based Monitoring and Planning was introduced as important component in order to ensure that the services reach those for whom they are meant. It was an outcome of consistent effort taken by Jan Swasthya Abhiyan. Community Based Monitoring is also seen as an important aspect of promoting accountability & community led action in the field of health. The monitoring process also includes outreach services, public health facilities and the referral system. It is assumed that, the most important input on what, where and how health services are needed and should be provided or improved, can be given most efficiently by the users/ beneficiaries of the services themselves. Community based monitoring places people at the centre of the process. Community Based organizations (CBOs), people's movements, non government organizations and Panchayat representatives monitor demand/need, coverage, access, quality, effectiveness, behavior and presence of health care personnel at service points, possible denial of care and negligence as well as directly give feedback about the functioning of public health services, including giving inputs for improvement. This has enabled people’s participation in monitoring health resources and direct dialogue with health officials. The platform ensures accountable as well as transparent practices.
Objectives of Community Based Monitoring
- To provide regular and systematic information about community needs, which will be used to guide the planning process appropriately
- To provide feedback according to the locally developed yardsticks, as well as on some key indicators.
- To provide feedback on the status of fulfillment of entitlements, functioning of various levels of Public health system and service providers, identifying gaps, deficiencies in services and levels of community satisfaction, which can facilitate corrective action in a framework of accountability.
- To enable the community and community-based organizations to become equal partners in the health planning process. It would increase the community's sense of involvement and participation to improve responsive functioning of the public health system.
Scope and structure of Community Based Monitoring
Community Based Monitoring process has been implemented as a pilot in selected nine states of India of which Maharashtra is one state. Thirteen districts are selected from Maharashtra - first phase districts namely Amaravati, Nandurbar, Osmanabad, Pune and Thane. In the second phase of CBMP, this activity has been expanded to Aurangabad, Beed, Chandrapur, Gadchiroli, Nashik, Kolhapur, Raigad and Solapur districts. The representatives of Health Officials, Panchayat Raj, Community Based Organizations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
- Publications- Preparation of monitoring tools, training, orientation and awareness materials like brochure, guidebook and documentation format.
- Formation of State Mentoring Committee that played important role of finalization of state appropriate frameworks.
- State level workshop and training of trainers (ToT)- Training of Community based monitoring team at different levels.
- District level workshop and training of trainers (ToT)- Formation of District mentoring team and training of block facilitators for implementation of community based monitoring activities.
- Formation of monitoring and planning Committees at village, PHC, block and district level.
- Orientation and training of CBM committee members at all levels.
- Data collection and preparation of report card- Data collected regarding status of health services at all levels by monitoring and planning committee members with the help of tools.
- District Media workshop for improving media coverage of activities and findings of the pilot phase of CBM.
- Jun sunwai- Block and district level community monitoring exercises include a Public Dialogue (Jan Samvad) or Public Hearing (Jan Sunwai) process once or twice in the year in each PHC, district and state.
- State review workshop, evaluation and process documentation.
SATHI as State Nodal NGO
SATHI-CEHAT has taken the responsibility to work as a state nodal NGO for this project, providing training material like guidebook, posters, Aarogya Hakka Calendar, tools for data collection and state level coordination with Government of Maharashtra as well as 13 districts and 29 Block nodal NGOs for implementation of Community based monitoring and planning activities.
District Nodal NGOs
In selected districts, selected NGOs have taken the responsibility for the activities in that district. The following organizations have been working as District nodal NGOs in the selected thirteen districts
First Phase districts
- Amravati – Khoj
- Nandurbar - Janarth
- Osmanabad - Halo Medical Foundation and Lokpratishthan
- Pune- Mahila Sarvangin Uthkarsh Mandal (MASUM)
- Thane - Van Niketan
Second Phase districts
> Aurangabad - Marathwada Gramin Vikas Sanstha (MGVS)
> Beed - Manavlok (Marathwada Navnirman Lokayat)
> Chandrapur- Youth Awareness and Rural Development(YARD)
> Gadchiroli - Aamhi Amchi Arogyasathi
> Kolhapur - Sampada Gramin Mahila Sanstha [SANGRAM]
> Nashik- Voluntary Association for Community Health and Nature (VACHAN)
> Raigad- Disha Kendra
> Solapur - Halo Medical Foundation
To know more about Community based Monitoring process under NRHM at national level click here. http://www.cbmpmaharashtra.org
Nutrition Rights Project
Project : Promoting a comprehensive and rights based approach to address malnutrition in Maharashtra
Duration : November 2012 to Sept 2015
Funded by : Narotam Sekhsaria Foundation
It is an accepted fact that nutrition is one of the most important determinants of health and well being of any population. This fact is especially relevant in the Indian context, not only in less developed states, but also in ‘developed’ states characterized by major inequities like Maharashtra where it has become clear that Maharashtra’s human development is not corresponding with its economic growth.
A broad and comprehensive approach to malnutrition is needed for identifying not only immediate but also intermediate, underlying and fundamental causes, and hence the need for major changes at multiple levels including large scale socioeconomic changes.
It is also imperative that whatever nutritional services Government is offering to tackle malnourishment should be accountable to the community if at all they should be effective.
To create an enabling environment for the reduction of malnutrition in Maharashtra through making nutrition services accountable and responsive, through generation of appropriate knowledge, reshaping relevant policies and programs, and promotion of the Community monitoring approach for improving health and nutrition services.
1. To promote community action towards making nutrition related programs [ICDS] accountable, responsive and effective in the intervention areas
2. To influence state level nutrition related policies and programs towards making these community oriented and responsive to accountability processes
3. To facilitate action research and innovations regarding approaches to improve nutrition at community level and to develop a contextualized understanding of the dynamics of food security and nutrition
4. To strengthen the discourse on Community Based Monitoring (CBM) of social services as a key mechanism to ensure social accountability of Public services, particularly Health care and nutrition
- Implementation of community based monitoring and action processes concerning nutrition related programs (ICDS and Jijau mission ) in selected areas in the first year of the project
- Capacity building of the activists of Partner organizations regarding CBMP of ICDS
- State level TOT workshop with activists for dissemination of guidebooks and training of the tools for assessment of Anganwadi
- Block provider's workshop in every intervention block to enhance the knowledge level and to build capacity of the local stakeholders like AWWs, ASHA, PRI members.
- Community mobilization and awareness in the form of street plays, AV, Posters, flip charts as well as meetings with members of various committees and local activists – with focus on women.
- Formation of the expanded body of village consisting of VHSNC plus School management committee (plus JFM / CFR where applicable) members as permanent invitees, who would be involved in monitoring Anganwadis.
B. Critical knowledge generation and Research:
- In the first phase Situational analysis of nutritional status of under-6 children will be done in the intervening areas.
- In the next phases some small research studies will be undertaken on emerging issues like Take Home Ration.
- State level workshop for advocacy with WCD and health departments to create a space for CBMP in ICDS.
- State level convention in collaboration with Right to food campaign will be undertaken.
D. Promoting CBMP as an approach to health and social services
- District / state level events for building social-political support for CBMP as an approach to make health and social services accountable and effective.
Regulation and accountability of the private medical sector
Project : Promoting Private sector regulation and accountability through regional and multi-state processes.
Duration : April 2014 to March 2015
Funded by : OXFAM India
Objective - Promoting awareness and advocacy on 'participatory, multi-stakeholder regulation of private healthcare sector in India' at both regional and state levels. This would be furthered by the following areas of activity:
- Capacity building of civil society activists towards demanding social accountability of private healthcare sector by conducting regional workshops on 'Social Accountability of Private Medical Sector and Clinical Establishment Act' in Northern, Eastern, Western and Southern regions of India in the first half of year 2013-2014, one workshop in each region. It is expected that civil society organisations from 2 to 3 states in each region would participate in each of these workshops. Each workshop would be for 2 days, with the objectives of –
A. Orienting civil society activists towards conceptual understanding of private medical sector in India and issues related to it like commercialisation, patients rights violations etc.; need for social accountability of private medical sector; and practical steps towards building such accountability mechanisms in the context of Clinical Establishment Act etc.
B. Imparting activists with an approach to document cases of patient's exploitation and violation of their rights in private medical sector in such a way that issues emerging from these cases can be highlighted in future as basis for advocacy for regulation Providing guidance and helping pro-active civil society organisations in strategising advocacy on social accountability of private healthcare sector.
- Developing quality information material on contemporary issues related with the regulation of private medical sector for civil society activists: A policy brief / advocacy document would be prepared on 'Regulation of private medical sector and Clinical Establishment Act'.
- Multi-stakeholder advocacy meetings would be conducted at different levels in the pilot state of Maharashtra, where a civil society coalition is quite active on this issue, which in itself is a pioneering example in the country. Experiences gained through activities in Maharashtra will feed into civil society processes at national level, to actively promote patients’ rights with focus on multi-stakeholder participatory regulation of private medical sector in the context of Clinical Establishment Act. Multiple stakeholders to be involved include representatives of doctors associations and hospitals associations, socially prominent individuals and political representatives, and a wide spectrum of civil society organisations.
- Bringing private healthcare related issues under public scrutiny by documenting and publicizing major problematic experiences of patients and testimonies of doctors.
Promoting participatory action on local Health budgets and medicine distribution in Maharashtra
Project Duration - upto 31st March, 2017
Funded by - International Budget Partnership
Goal - Responsive district health planning and effective medicine distribution in Maharashtra to ensure significantly improved primary health care service delivery with a broader framework of community accountability.
- Central role played by RKS members and CBMP committees in local need based health planning and budgeting, leading to more effective and appropriate functioning of health services. Strengthened spaces for participatory planning and accountability related to health services.
- Active involvement of CBMP committees in monitoring expenditures of Program Implementation Plan (PIP) budgets, ensuring effective utilization of these funds and improved service delivery.
- Demand driven and adequate medicine distribution in rural public health facilities based on key changes in medicine distribution system.
- Effective state level collaboration and advocacy with the help of the CBMP network for ensuring greater responsiveness of district health planning and medicine distribution processes.
To achieve these objectives, SATHI would collaborate with five partner organisations to conduct project activities in an intensive manner. Further, capacity building related to various activities would be carried out with 24 CBMP implementing organizations in 13 districts. The project would consist of a three pronged strategy to achieve these objectives – action oriented research and evidence building, capacity building of key stakeholders, and advocacy at various levels. To move towards attaining the stated objectives, we propose to carry out the following activities in this project:
- Activity 1 -Study of pattern of utilization of RKS (Patient welfare committee) funds in 6 selected PHCs and 3 Rural Hospitals from 3 districts of Maharashtra, linked with participatory interventions in planning of RKS funds by CBMP and RKS committee members, leading to more appropriate use of flexible funds.
- Activity 2 Capacity building of 24 civil society organisations from 13 districts on PIP related issues, for ensuring budget accountability and monitoring of district and block health plans.
- Activity 3 -Tracking implementation of community oriented and innovative components of PIPs as well as local level advocacy for its effective implementation in 2 Districts.
- Activity 4 - Action oriented analysis of medicine distribution system linked with advocacy for more responsive supply system in 3 selected districts of Maharashtra.
- Activity 5 -State level networking and advocacy to influence the public health system, towards more participatory local health planning and effective medicine distribution systems.