Social Audit of Select Sub Centres in Kerala

1. National Health Mission Kerala Social Audit of Select Sub Centres in Kerala

2. COMMUNITY PARTICIPATIONCOMPREHENSIVE HEALTH PLAN- HISTORICAL BACK GROUND • Kerala’s Decentralised Planning has been acclaimed all over the Country • One of the pioneer State that devolved concomitant transfer of all thee F’s- Fund, Functions & Functionaries to PRIs as enshrined in the 73rd Amendment. • 26 Departments including Health was brought under PRIs by Govt • Recommendation of SFC to earmark 25-30% of State Budget Outlay to LSGDs was approved by Govt & implemented from IXth Five year plan. • While other Departments successfully liaison with PRIs to recoup their loss in their Plan allocation - Health Department kept aloof. • The fall in State budget Plan allocation badly effected the functions of Department (in Districts/ CHCs/ PHCs) from IXth Five year Plan

3. LAUNCHING OF CHP • CHP was Planned , organised and conducted as a Decentralised People’s Campaign as a joint initiative of NRHM, Health Services Department and PRIs • Health and Health related Plans for all wards of Grama/ Municipal/ Corporations in the State for the XIIth Five Year Plan period were prepared in a campaign mood with massive participation. • All such Plans were consolidated at Grama panchayath level and later consolidated at Block / District levels and finally got approval of DPC. • 10976 Health Projects worth Rs. 2416.75 Crores and 10362 Health related Projects worth Rs. 4748.71 Crores were prepared during the massive campaign. • Piloted @ Alappuzha District in 2011-12- as per Go(Rt) No2529/2011/H&FWD dated on13.07.2011 • Considering the successful results, campaign replicated throughout the State- as per GO(MS) 210/11/H&FWD dated on 16/11/2011

4. STATE HEALTH SECTOR RESOURCES COMPARISON (In Crores)

5. TOTAL AMOUNT OF PROJECTS TAKEN UP LAKHS BEFORE CHP DURING CHP (XIIth Five Year Plan)

6. STRENGTHENING OF WHSNCs COMMUNITY ACTION FOR HEALTH CONVERGENT ACTION • Local Self Government Dpt • Education Department • Social justice Department • Suchithwa Mission • Health services and NRHM Fund resources • NRHM Contribution - 10000 • Suchithwamission - 10000* • Permissive grant from GP - 5000 • Volunteer contributions from society * In Municipalities & Corporations- Rs 20,000/ward

7. Social Audit COMMUNITY ACTION FOR HEALTH Social Audit (SA) is both a process and a method of understanding, measuring, verifying, reporting and thereby improving the overall performance of an organisation or specific to its programmes/projects

8. Purpose of Social Audit • To critically examine the performance, particularly from the stand point of beneficiaries so as to ensure accountability and transparency and ultimately in improving the service delivery • Empowers the beneficiaries through building a better understanding about the various aspects of the programme/project, thereby enabling them to demand for quality and need based service delivery

9. Objectives of SA of sub Centres • To increase awareness among local community about various services and programmes provided by the Sub centres • To provide a platform for multiple stakeholders to review and express their views regarding the overall functioning of Sub centre • To assess the gaps between perceived needs of community and the actual services delivered at SubCentre • To identify strengths/weaknesses, including the infrastructure facilities, in the functioning of the Sub centre

10. Approach/ Strategy • Participatory and inclusive approach involving stakeholders at different levels at various stages • Elected representatives of Dt/ Block/ GramaPanchayat • Medical Officer/ HI of PHC • Junior Public Health Nurse/ Junior Health Inspector and ASHAs at Sub centre • Beneficiaries of Sub centre area - Women, ScheduledCastes/ Scheduled Tribes, BPL

11. Pilot Districts/Sub Centres

12. Subjects/ Areas Covered • Staff and Infrastructure • Services/Programmes • Medicines/Equipments • Registers • Sub centre Committee • WHSNCs • Utilization of funds Tools of Data Collection • Observation Schedules • Interview Schedules • Guidelines on Focus Group- Discussion

13. Social Audit Process • Preparation of Project proposal, Discussions with Stake holders • Consultation Workshop on Scope, Methodology, Tools • Meeting with Grama Panchayat Council • Public Meeting at Sub centre level • Selection and Training of Field staff • Data Collection from Elected Representatives of Grama Panchayat • Collection of secondary data from Sub Centre • Data Collection from M.O /HI of PHC • Data Collection from health staff (including ASHAs) of Sub Centre • Data Collection of beneficiaries of Sub Centre • House- hold Survey

14. Social Audit Process (contd…) • Preparation of preliminary report • Public Hearing at Sub centre level (Jan Samwad) • Finalization of Reports

15. SUMMARY OF SA IN 4 SUB CENTRES

16. SA of Pantha Sub Centre, Thiruvananthapuram District • Commenced with a meeting of GramaPanchayat Council • Preliminary report submitted Nodal Agency • Public Hearing held at Sub centre • Final report submitted by Nodal Agency

17. Public Hearing (JAN SAMWAD) • The meeting presided by President, Grama Panchayat • Inaugurated by Hon. Minister of Health, Family welfare, Government of Kerala • Presidents of District Panchayat and Block Panchayat • Members of Block Panchayat and GramaPanchayat

18. Public Hearing (contd…) • Additional Director (Health) • District Programme Manager NHM Kerala • Medical Officer-in- Charge of PHC • Health staff, including of sub centre • More than 200 local persons residing within the service area of the Sub centre • Dr. V. Ramankutty, Professor, AchuthaMenon Centre for Health Science Studies, Thiruvananthapuram was Moderator

19. Public Hearing (contd…) • Public expressed their comments/ views/ expectations about the Sub centre, President of Kallikkad GramaPanchayat, Medical Officer- in- Charge of KallikkadPHC and health staff of Sub centre responded • Many of the inadequacies regarding infrastructure and facilities noted at the beginning of social audit were found to be resolved by the time Public Hearing was held

20. Based on Social Audit conducted in Pantha Sub Centre, Kallikad, PHC, Thiruvananthapuram, SA process was replicated to following sub centres

21. General Findings of SA Positive aspects • The Sub centre functions in Government building • Notice Board, Citizens’ Chart, and working hours exhibited • Waste management system exists • Review of Sub centre by PHC which in turn is monitored by the Panchayat Council • Health staff and ASHAs, have carried out extensive fieldwork on vector studies, source reduction and health campaigns • Almost all the services under safe motherhood, immunisation and family planning have achieved 100%, targets • There is no malnourished child • No children who are not immunized or only partially immunised • No maternal mortality or infant mortality during the period under review • All the Registers are well maintained and services delivered recorded correctly and is checked regularly by M.O

22. Deficiencies/Gaps • Lack of children’s weighing machine • Non availability of calcium tablets • Dearth of NCD medicines • Lack of computer/internet facility • No separate toilets for men and women • iron tablets for children, calcium tablets, zinc sachet, and vitamin A syrup were not available in some Sub centres • Lack of space for visitors • Scarcity of medicines

23. Deficiencies/Gaps (contd…) • Lack of almirah for keeping medicines • No provision for keeping office files • Visitors and health staff have to depend on public tap during summer • The beneficiaries of some Sub Centre do not have a proper understanding about the services available at Sub centre and often expects diagnosis/ treatment provided at PHC level • JPHN do not make household visits once in two months • large geographical to be covered • holding additional charge as Pharmacist at Thottoor PHC • JPHN is not residing at sub centre, as the building is in a damaged condition • In the case of immunisation targets have been met only for 5 items in Thottur

24. Conclusion/Recommendations • Good support from Grama Panchayat • There are variations in targets achieved • Lack of adequate infrastructure facilities • Non availability of some medicines • Performance of Sub centres in terms of services offered, behaviour of health staff, community satisfaction and field level programmes are high

25. Conclusion/Recommendations (contd..) • Mismatch between demand and supply of health care facilities at sub centre • This needs to be looked into and bridged with appropriate action/policy decisions • Public has to be made aware about the services and programmes of the Sub centre

26. The Way Forward- 2017-18 • Awareness building On Objectives/ Functions/ Facilities/Programmes of Sub centre/PHC • Develop Joint Action Plans- NHM Kerala, Grama Panchayat, DPM, DMO, PHC, Sub centre • Develop Policy Plans-NHM Kerala/Dept. of Health &Family Welfare, GoK • Social audit to be made a sustainable process • Social Audit in Primary Health Centres

27. Social Audit of Sub-Centers in KeralaBudget Summary – for One PHC # data collection and supervisory charges including their travel related expenses * include charges for tools finalization, data processing & analysis, preparation of preliminary & final reports, co-ordinating consultation workshops, FGDs and Public hearing

28. Social Audit of Sub-Centers in KeralaBudget Summary – for One Sub Centre

29. Hands on training for Health Functionaries to familiarize Sulekha Software @ KILA, Thrissur Orientation Training for Award Inspection Team Arogyakeralam Puraskaram 2014-15 Arogyadharshan Documentary

30. Secretaries of GoI , GoK and Senior officials reviewing CHP/ CAH

31. THANK YOU