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Previous Projects

Public Health System Strengthening – Previous Projects

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.