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.
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
Key research areas in this project are
Objectives of Community Based Monitoring
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.