Previous Projects under Public Health Programme
Project Title: Improving delivery of Maternal health services for tribal communities in Maharashtra, in the COVID recovery phase.
Project Period: 1st June 2021 to 30th May 2022, extended upto 30th September 2022 and further extension upto 31st December 2022
Donor Agency: International Budget Partnership (IBP)
Background:
This project aims to Strengthen agency group’s understanding on delivery of RCH services aimed at increased access to maternal health services and schemes. Strengthen key maternal and child health entitlements and services and track post-COVID shifts in public health services to support community-based action. The grassroots level intervention will lead to mobilised communities and beneficiary women for maternal and child health services and related schemes. Grassroots experiences and findings regarding RCH services will be shared with frontline workers and local elected representatives, to strengthen maternal health services. Further, mobilised communities successfully relay ground level feedback regarding health and nutrition services to enable a system level dialogue with decision makers regarding monitory schemes. This set of interventions will constitute a vertical integration approach to health system reform, focused on maternal and child health services amongst tribal community in Maharashtra.
Project area- Amravati, Nandurbar, Thane, Yawatmal
Key activities-
- Strengthening the capacities of tribal communities and agency group in the project area to engage on RCH delivery of services.
- Evidence generated by the communities from project area on the gaps in the delivery of RCH services, as well as the related challenges in terms of the allocation and use of the health budgets.
- Strengthened tribal communities and agency group monitor and engage with health authorities and spaces (local to state and national) on improving the delivery of RCH services and schemes.
Project Title: Reconstructing Health Systems beyond COVID: Critically analysing official transnational investments, shaping policy discourse to promote Right to Healthcare (RTH) in Maharashtra.
Project Period: January 2022 to December 2022
Donor Agency: Rosa-Luxemburg-Stiftung
Background:
The COVID-19 pandemic has acted as a powerful ‘MRI scanner’ helping us to scrutinise India’s health system, starkly revealing the architectural weaknesses of the under-resourced, atrophied public health system, along with exposing the predatory nature of unregulated, commercialised, hypertrophied private health care. During this period poorly staffed public hospitals proved insufficient compared to the population’s health requirements resulting in inadequate facilities for COVID-19 patients, while many corporate and large private hospitals engaged in massive overcharging and profiteering.
Within India, Maharashtra state has suffered from not only the largest number of COVID cases and deaths compared to any other state, but strikingly also had one of the highest case fatality rates (among COVID cases, the proportion who died) compared to major states in the country.
The cross-state differences in COVID outcomes among major Indian states seem to be primarily related to differences in effectiveness of public health systems; Maharashtra with one of the highest COVID case fatality rates among Indian states has a highly privatised health system, with inadequate public health services. Compared to this, Kerala has much lower COVID case fatality rate, associated with a robust public primary healthcare system.
With such catastrophic impact of the pandemic, the stage has been set for healthcare and health systems to emerge as an agenda for urgent policy attention. In this setting, on one hand regressive solutions are being promoted by the establishment focussing on further privatisation, corporatisation, private sector oriented transnational investments, and securitisation of healthcare. On the other hand, there is high degree of social receptivity for progressive proposals centred on major strengthening of public health services, regulation of private healthcare providers, and fulfilment of health rights through a democratised healthcare system, based on public-centred universal health care. There is no doubt that the COVID-19 pandemic can become a critical turning point for the health system in India, and especially in states like Maharashtra. This is an opportune time to reimagine health systems and powerfully build socio-political will from below for comprehensive, people centred, rights-based health system change.
Given this context, SATHI proposes to conduct activities on two complementary fronts during the COVID recovery situation, which can help shape the policy discourse in the health sector in a pro-people direction. The first component would focus on studying and deconstructing official transnational development investments in the health sector, with focus on German development agencies, to understand the impacts which these influential investments have on health systems and access to healthcare for deprived and marginalised populations in India. The second component would be focussed on the state of Maharashtra (the second largest state in India, which has suffered the worst during the COVID pandemic), towards shaping policy discourse to promote major strengthening of public health systems and operationalisation of Right to Healthcare.
Key Inputs:
- People-centred Maharashtra Right to Health Care bill, and legal brief outlining steps for operationalisation of such bill is available in the public domain, publicised widely in media, and discussed with policymakers.
- Series of broad-based consultations on UHC in Maharashtra culminated in set of Policy briefs on critical health system themes which can be used for policy-level advocacy.
- A policy brief on innovative health system financing for Maharashtra aligned with the UHC objectives, with clear articulation on sources of additional resources for public health systems, is published and widely circulated among diverse stakeholders.
- Concrete evidence on patterns of inadequate remuneration and various key concerns related to ASHAs is placed in the public domain, gaining media attention and further opening space for policy-level dialogue and improvement in status and role of ASHAs.
- Contemporary status update and analysis of ESI health services in Maharashtra is shared with trade unions, employee associations, and activists working with the informal sector workers
Expected outcomes:
- Discourse on equity-oriented, tax-based, public health system centred Universal Health Care is amplified and provides a necessary counter-narrative to privatisation oriented, commercial insurance-based ‘Universal Health Coverage’ models.
- Draft people-centric right to healthcare bill and concrete proposals for raising additional resources for the UHC influences processes of enactment of state-level right to healthcare act.
- Trade Unions and other stakeholders use ESI-health services related updated information to strengthen demand for improved ESI health services. Similarly, ASHA associations use study findings to demand improved working and employment conditions for ASHAs, with positive implications for all frontline health workers.
Project Title: Promoting people’s health rights in Maharashtra, during and beyond the COVID-19 epidemic
Project Period: 1st July 2020 to 31st October 2022
Donor Agency: The Fund for Global Human Rights (FGHR)
Background:
People in India experience a fragmented and commercialised health care system which is dominated by for-profit private healthcare, responsible for around 70% of healthcare utilisation. With a mere 1.15 % of the GDP being invested in health, India has among the world’s highest levels of out of pocket expenditure on healthcare, leading to around 5.5 million people falling into poverty annually due to catastrophic healthcare expenses. A weak public health system, coupled with lack of accountability and regulation of private healthcare, results in frequent unethical, medically inappropriate practices, substandard and unaffordable healthcare, and exploitation of vulnerable people seeking treatment.
Maharashtra has been one of the worst affected states in the COVID-19 epidemic, with people experiencing major hardship in seeking healthcare from overwhelmed public hospitals and exploitation and overcharging in private hospitals despite the governments efforts to provide free and affordable healthcare to its citizens through extending coverage of central and state public insurance schemes to all citizens, capping of costs of treatment in private hospitals. However, reports of denial of treatment to vulnerable communities, discrimination, inflated billing, abuse of patient’s rights continue to be highlighted in media reports and documented by civic society.
The COVID 19 epidemic has underscored the urgent need for a strong and well-equipped public health system along with expansion and strengthening of urban health services, especially primary healthcare. Given the high degree of dependence on private healthcare, there is a need to ensure patients’ rights and regulation of the huge, unregulated private healthcare sector. This includes the need for social accountability of publicly funded health insurance schemes like PMJAY / MPJAY which are supposed to provide hospitalisation coverage to the entire population of Maharashtra by involving private hospitals.
Objectives:
- Rights based actions to improve access to rural health services in Maharashtra, especially linked with COVID-19 situation Promoting people’s mobilisation to ensure access to urban health services during COVID-19 epidemic
- Alliance building with healthcare workers on joint issues highlighted during COVID-19 epidemic
- Highlighting demands for regulation and entitlements related to Private health sector in context of COVID-19, campaign for Patients’ rights
- Conducting action-oriented research in COVID-19 situation, for supporting social action towards people-centered health systems
- Workshops to promote health sector reform as highlighted during the COVID-19 epidemic, taking forward the discourse on Universal Health Care (UHC) in Maharashtra.
Project Title: Activities for improving coverage of COVID 19 vaccination in selected rural and tribal PHCs in the state of Maharashtra.
Project Period: January to June 2022
Donor Agency: Azim Premji Philanthropic initiative (APPI)
Background:
Two unmissable trends in the Maharashtra vaccination coverage are- vaccination coverage is unequal and highly skewed towards urban areas; secondly, vaccination in less developed rural and tribal areas is particularly lagging. Among a range of issues causing poor coverage, one that needs to be addressed with urgency is the overall coordination of the vaccination initiative at the PHC level.
Objective- 100% coverage of vaccination in selected PHC’s population.
Project Title: Community Action for Health (National Health Mission, Maharashtra)
Project period : April 2021 to March 2022
Donor Agency : National Health Mission (NHM), Maharashtra
Background
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 organisations (CBOs), people’s movements, non-government organisations and Panchayat representatives monitor demand/need, coverage, access, quality, effectiveness, behaviour 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 Action for Health
- 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 fulfilment 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 organisations 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 Action for Health
Community Based Monitoring and Planning process has been implemented as a pilot in selected nine states of India of which Maharashtra is one state. Five districts are selected from Maharashtra in first phase. In the second phase of CBMP, this activity has been expanded to Eight districts. Now, it has successfully implemented in Thirteen districts namely Aurangabad, Beed, Nandurbar, Osmanabad, Pune, Palghar, Gadchiroli, Nashik, Kolhapur, Solapur, Sangli, Thane & Yawatmal. The representatives of Health Officials, Panchayat Raj, Community Based Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
Key Activities
- Publications- Preparation of monitoring tools, data collection formats, training, orientation and awareness materials like brochure, guidebook and documentation format.
- Formation of State Mentoring Committee that played important role of finalisation 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.
- Data collection, follow up and analysis of Indicators data i.e. Pregnant women and High-risk pregnant women, VHNSC data etc.
- District Media workshop for improving media coverage of activities and findings of the pilot phase of CBM.
- Jansanvad- PHC, Block and district level community monitoring exercises include a Public Dialogue (Jan Sanvad) or Public Hearing (Jan Sunwai) process once or twice in the year in each PHC, Block, District and state.
- State review workshop, evaluation and process documentation.
SATHI as State Nodal NGO
SATHI- Action Center of ANUSANDHAN TRUST has taken the responsibility to work as a state nodal NGO for this project, providing training material like guidebook, posters, tools for data collection and state level coordination with Government of Maharashtra as well as 13 districts and 28 Blocks nodal NGOs for implementation of Community based monitoring and planning activities.
Project Title: Ensuring integrated access to Health Care for vulnerable urban and rural populations, in context of Covid 19 epidemic in Maharashtra ; Extended work of Rural help desks and patient advocate in the urban slum area of Pune
Project period: 1st May 20 21 to 31st July 2021
Donor Agency: Association for India’s Development (AID)
Background:
The second wave of COVID has its onslaught with very virulent spread. For example, In Pune the daily count of the cases coming COVID positive were around 2200 in the first wave. In the second wave as on 3rd April 21 the daily count of COVID positive patients was 5720. The count is rising. THE SITUATION is not as encouraging as in Mumbai, but continuous decline in active cases for the last one week has raised hopes that the worst in the second wave might be over in Pune as well. Unlike Mumbai, Pune is still reporting more than 10,000 cases a daily, this number dropped below 6,200, the lowest this month. But during the past one-week, active cases in Pune have come down by more than 25,000. It peaked on April 19 when the city reported 1.25 lakh Covid-positive people. On Monday, this figure was just about one lakh, though still the second highest in the country after Bengaluru.
At the same time, rural areas in Maharashtra facing unique challenges as they are particularly vulnerable, with poor access to healthcare facilities. With all state efforts focused on epidemic containment, disruptions are being reported in provision of essential non-COVID related health services in rural areas, along with difficulties in accessing relief measures. The vulnerable rural population needs support to access even basic healthcare. The COVID and non-COVID patients in these areas would need support and facilitation to access healthcare facilities.
In urban India, in Big cities like Pune the public healthcare system is virtually at the same scale as was thirty years back. And at primary healthcare level there is big gap and neglect. Not surprising that in this situation, the poor and working class living in slums and low-cost housing, that comprises nearly 50% of the urban population is suffering to get access to quality healthcare that is affordable or free
COVID has exposed this harsh skeleton of nearly non-existent public healthcare in cities like Pune. COVID also has compelled the government to push its many schemes for poor and vulnerable and also out of compulsion the Maharashtra State Government has made the scheme like Mahatma Phule Jan Arogya Yojana – a scheme for nearly 900 secondary and tertiary procedures available to whoever asks for it, expanding the scheme to cover the entire population, beyond the normal eligibility criteria for poor people with Keshari Ration Cards only (BPL and above BPL).
Objectives:
A – Operating help desks, block level help lines and patient support systems, to ensure essential healthcare and information to rural people during the second wave of COVID epidemic in Maharashtra
B – To fulfil the objective stated above SATHI wants to run a project in the City of Pune which is called- “Patients’ advocates”
Project Title : Facilitating community-based communication and feedback system for addressing Health and Nutrition Services issues emerging due to COVID-19 epidemic in Maharashtra
Project Period: May to August 2020
Donor Agency: International Budget Partnership (IBP)
Background
One of the key challenges in COVID 19 outbreak is to reduce fear and misunderstanding among people around this outbreak by providing simple, authentic and scientific information. Hence various methods of awareness generation are required to control fear and panic situations and country is struggling to tackle the spread of misinformation. In Maharashtra, there is a need of spreading information in better forms of understanding and focusing the need of rural and tribal areas with the use of local languages.
Hence to tackle the current situation, SATHI in collaboration with state wide health and nutrition civil society networks is proposing various activities for bridging the communication gap between community and public systems. This would build upon state wide coalitions established in last 13 years, and would focus on online information dissemination to activists and communities in generalised manner, covering all existing CBMP and CAN areas. Further we propose focused and intensive intervention of feedback for service delivery facilitation in 3 districts which are worst affected by COVID 19 epidemic.
Objectives –
General objective – To operationalise rapid response mechanisms for communication and feedback, thus ensuring effective delivery of health and nutrition services in context of COVID-19 epidemic, in selected rural and tribal areas across Maharashtra.
Outcome –
- Training material on Covid-19 in the form of posters, video clips and modules for activists, VHNSC members, ASHAs and Anganwadi workers.
- Dissemination of training material to at least 100 activists, 4000 VHSNC members, 800 ASHA and Anganwadi workers from 13 districts and 28 blocks of Maharashtra.
Completion of online training (on Covid-19) of 100+ Health activists, 4000 VHSNC members, 800 ASHA and Anganwadi workers - Documentary evidence on denial of health and nutrition services from 28 blocks and analytical report.
- Detailed report on the intensive intervention activities.
Project Title: Building evidence, strengthening action for a sustainable and generalisable model of Community accountability of Health systems in Maharashtra, India (ARC)
Project Period: December 2017 to June 2020
Donor Agency: Accountability Research Center (ARC)
Background: Accountability Research Centre and Anusandhan Trust- SATHI (Support for Advocacy and Training to Health Initiatives) are collaborating on a project with research and action components, for developing an advanced model of community accountability of health and health related services and programs in Maharashtra, India.
This project builds upon both the foundation of Community Based Monitoring and Planning (CBMP) in Maharashtra, facilitated by SATHI with support from the National Health Mission over the last decade, and ARC’s substantial research and training expertise in the sphere of social accountability and participatory governance.
Objectives:
- Strengthening social accountability of public health and social services through promotion of multisectoral community based processes
- Promoting accountability of Private medical sector through national documentation of patients’ rights violations
Building robust evidence base regarding the impacts of community-based monitoring and planning (CBMP) efforts in Maharashtra’s public health system, through action linked research including both quantitative and qualitative components.
Project Title : Improving the Delivery of Nutrition Services for Scheduled Tribes in Maharashtra (IBP)
Project Period: November 2019 to April 2020
Donor Agency: International Budget Partnership (IBP)
Background-
SATHI proposes to address the challenge of pervasive malnutrition in Maharashtra, specifically targeting the tribal communities. While the preceding sections have clearly established that fully addressing malnutrition requires a comprehensive multi-sectoral approach, SATHI is proposing to contribute to reducing malnutrition among pregnant and lactating women and children up to six years of age in tribal communities by focusing on the core interventions of direct nutrition services and immediately related health care services.
SATHI will focus its efforts on two components of AAY, namely the nutritional services and the public health care services necessary to complement towards improving the nutritional status of women and children. To work on both aspects simultaneously will be too much for the short period for which initial funding support is being requested. So, SATHI is finally proposing that the full project concept is implemented in two distinct yet related phases.
The Objectives of this project will be in two phases-
Phase 1: Improving the delivery of direct nutrition services
Phase 2: Ensuring Core Public Health Services needed to Complement Nutrition Services
Project Title: Capacity building initiatives for Community based OrganiSations towards building and strengthening Health Rights action in Maharashtra and Bihar
Project Period: 1st October 2018 to 31st March, 2020
Donor Agency: Association for India’s Development (AID)
Background-
In the last phase of project intervention an attempt was made to build capacities of activists from around 10 Civil Society Organisations (CSOs) towards ensuring community action for Health in Maharashtra. All these were involved in generalised Community Based Monitoring and Planning (CBMP) process on voluntary basis since last 3-4 years. Based on technical inputs from SATHI, various community processes were implemented in totally new selected districts and blocks of Maharashtra. In each block, these organisations have facilitated generalised CBMP process such as health rights awareness activities, community-based data collection, documentation of cases of denial of health care and preparation for Jan samwads (Public dialogue programs). All these processes have contributed to initial improvements in health services.
The objectives of this programme will be as follows: –
- Providing technical and strategic inputs to mass organisations working in Maharashtra, focusing on continuation of ongoing health rights activities with exploring advance strategies and mechanisms towards deepening and expanding community accountability processes in Maharashtra
- Enhancing capacities of activists of MBSNS from Bihar in addressing more complex health system issues which require multi-level advocacy skills, including engaging exiting democratic bodies and institutions.
Project Title: Strengthening capacities of WaterAid India network partners for improving Water and sanitation facilities in health institutions through participatory planning
Project Period: October 2017 to March 2018
Donor Agency: WaterAid India
In the last phase of collaboration during the period October 2017 to March 2018, SATHI has significantly contributed for strengthening the ‘Healthy Start’ campaign in the form of building the capacities through national level convention and visiting the field of WaterAid network partners from Odisha, Telangana, Madhya Pradesh and Uttar Pradesh; provided ongoing technical and strategic inputs to WaterAid partners; contributed in developing various documents such as concept note and operational framework of intervention, awareness material etc. It is clearly evolved that there is need for continuation of this collaboration in order to consolidate the efforts are being taken for capacity building of WaterAid network partners; deepening and expanding interventions with regards to improve WASH facilities in Health institutions.
Expected outputs-
- Concept note including plan of activities for the entire intervention would be finalised and agreed upon.
- The key functional documents such as simple tool, IEC material, poster, community report card (as mentioned above) etc. would be developed with the inputs from WaterAid partners organisations.
- Technical support would be provided to partner organisations during the intervention phase, enabling them to overcome bottlenecks of a technical nature.
- Field visits in all intervention states for capacity building of WaterAid partner organisations.
- Exposure visit of team of representatives from WaterAid regional office and field partners to Maharashtra would be organised.
- One national level convention on RKS and WASH would be organised.
- A detailed report of activities would be drafted, focused on key lessons.
Project Title: Promoting participatory action on local Health budgets and medicine distribution in Maharashtra
Project extension Period: August to 31st March, 2017
Donor Agency: International Budget Partnership (IBP)
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.
Objective
- 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 utilisation 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.
Project Title: Community Based Monitoring and Planning of Health Services
Project Period: November, 2016 to March 2017, extended upto 30th October, 2017
Donor Agency: National Rural Health Mission (NRHM), Govt. of Maharashtra
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 Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
SATHI continues to work as State Nodal NGO 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.
Project Title: Promoting participatory action on local Health budgets and medicine distribution in Maharashtra
Project Period: 1st June 2014- 31st July 2016
Donor Agency: The International Budget Partnership (IBP)
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.
Objectives-
- 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 utilisation 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.
Project Title: Community Based Monitoring and Planning of Health Services
Project Period: April 2014 to March 2015
Donor Agency: National Rural Health Mission (NRHM), Govt. of Maharashtra
Background :
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.
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 organisations 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 Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
SATHI continues to work as State Nodal NGO 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.
Project Title: Promoting synergy between Quality Assurance (QA) and Community based Monitoring and Planning (CBMP) processes in selected areas of Maharashtra
Project Period: November and December 2013
Donor Agency: Govt of Maharashtra – SFWB
The Government of India launched the National Rural Health Mission in 2005 with the objective of effectively providing health care to the rural population, especially women and children and various underprivileged sections, by improving access, availability and quality of public health services. In order to achieve this objective NRHM has planned different strategies, in which establishing regular and systematic monitoring and evaluation systems for improving and ensuring the quality of public health services are core strategies of NRHM.
As one strategy in this context, Maharashtra Government has implemented a Quality Assurance (QA) programme under NRHM, with technical support from the Maharashtra State UNFPA office. QA programme activities were implemented in 18 districts of Maharashtra. The focus of the QA programme is to develop an internal system of assessment and feedback for enhancing the quality of health services, especially Reproductive and Child Health (RCH) services. QA programme is an internal feedback system, which provides an institutional platform to public health staff for understanding and resolving problems related to the functioning of public health facilities. The approach of the QA programme is to motivate public health functionaries for resolving problems within the system framework, so that they can provide good quality health services to the patients.
At the same time, the Community Based Monitoring and Planning (CBMP) process in Maharashtra provides an independent, external feedback system anchored in the community regarding availability, accessibility and quality of public health services. The main focus of the CBMP process is ensuring accountability of the public health system through community participation. This process is being implemented in 13 districts of Maharashtra. The approach of the CBMP process is to activate and motivate the community to raise demand for health services along with providing suggestions for improvement, as part of a bottom up approach.
Project Title: A Study of budgetary provisions, procurement and supply system concerning essential medicines in selected districts of Maharashtra
Project Period: April 2010 – March 2011
Donor Agency: The International Budget Partnership (IBP)
Availability of essential medicines in public health facilities is one of the serious concerns regarding the quality of health care services. This is also one of the major reasons for lower utilisation of the public health system. Some amount of evidence is already available to substantiate this fact including preliminary findings of the household survey conducted by SATHI. For example in the 60th round of National Sample Survey (2004), information was sought regarding the medical expenditure for treatment under different heads of treatment during stay at hospitals as an inpatient. Analysis of this data reveals that the range of proportion of total expenditure on medicines was from 57 to 66. The proportion of expenditure on medicines to total expenditure is higher in the public health facilities as compared to private health facilities. This clearly indicates that though the public health facilities are supposed to provide the health care services at minimal costs, due to non availability of essential medicines in these facilities, the actual costs borne by the patients are very high.
Project objectives
To improve the availability of essential medicines in primary health centers
Short term objectives
- To understand the procurement and distribution process in the state of Maharashtra
- To develop tools for monitoring the procurement and distribution system
Key research areas in this project are
- To study budgetary allocations- The budgetary allocations for essential medicines in the districts/ PHCs under study.
- Study of procurement of essential medicines in the state of Maharashtra-The procurement and distribution system of selected essential medicines in the state of Maharashtra with a view of understanding key gaps, bottlenecks and reasons for delay
- Study of availability of essential medicines in the selected districts -Actual availability of various essential medicines at select PHCs
Project Title: Community Based Monitoring and Planning of Health Services
Project Period: April 2009 to March 2010
Donor Agency: National Rural Health Mission (NRHM), Govt. of Maharashtra
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 organisations 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. Five districts are selected from Maharashtra namely Amaravati, Nandurbar, Osmanabad, Pune and Thane.
The representatives of Health Officials, Panchayat Raj, Community Based Organisations/ NGOs/ Peoples Movements and villagers are part of Monitoring and Planning Committees at Village, PHC, Block, District, and State levels.
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 5 districts and 15 Block nodal NGOs for implementation of Community based monitoring activities.
