Improving Health System and Strengthening NRHM through Community Action
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Improving Health System and Strengthening NRHM through Community Action Experiences, Lessons Learnt, Challenges and Way Forward. AGCA Secretariat Population Foundation of India December 24, 2013. Outline. The accountability framework under NRHM

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Agca secretariat population foundation of india december 24 2013

Improving Health System and Strengthening NRHM through Community Action Experiences, Lessons Learnt, Challenges and Way Forward

AGCA Secretariat

Population Foundation of India

December 24, 2013


Outline

Outline

  • The accountability framework under NRHM

  • Community action under NRHM – process, experiences and gains

  • Challenges

  • Way forward – status of implementation in states


Community action in nrhm

Community Action in NRHM

  • Mechanisms to improve accountability and enable better delivery of services

    • Builds community awareness on health entitlements

    • Provides a platform for community feedback and dialogue with service providers

    • Initiates corrective action and planning with community engagement

      Leads to improved coverage and accessibility of health services

      In essence brings ‘public’ back into public health


Accountability framework under nrhm

Accountability Framework under NRHM

  • A three pronged process:

    • community based monitoring,

    • external surveys and

    • routine program monitoring

  • Communitization of the health institutions

    • Prominent display of information on funds received, medicines in stock, health right entitlements

  • Public reports on Health at the State and district levels to report progress to the community


Advisory group on community action agca

Advisory Group on Community Action (AGCA)

  • Group of civil society experts constituted by the MOHFW in 2005 with Population Foundation of India (PFI) as the Secretariat

  • Mandate :

    • Advise on developing community partnership and ownership for the Mission

    • Provide feedback based on ground realities, to inform policy decisions

    • Develop new models of Community Action and recommend for further adoption to the national / state governments


Cah immediate outcomes

CAH - Immediate Outcomes

Community Based Planning and Monitoring

(CBPM)

programme in

Bihar - India


First phase of community monitoring 2007 09

First phase of Community Monitoring (2007-09)

9 States, 36 districts, 1620 villages

  • Assam

  • Chhattisgarh

  • Jharkhand

  • Karnataka

  • Madhya Pradesh

  • Maharashtra

  • Orissa

  • Rajasthan

  • Tamil Nadu

Uttaranchal

Uttar

Pradesh

Rajasthan

Assam

Nagaland

Bihar

Manipur

Jharkhand

Madhya

Pradesh

Gujarat

W Bengal

Chhattisgarh

Orissa

Maharashtra

Andhra

Pradesh

Karnataka

Tamil

Nadu


Process

Process

1. Education and awareness :

  • Community awareness on health entitlements

  • Training of Village Health Sanitation and Nutrition Committees (VHSNC) and Rogi Kalyan Samities (RKS) members

  • Display of Citizen’s charter and service guarantees

  • Monitoring and information sharing

  • Collection of information and sharing of report cards, community experiences of health services

  • Multi stakeholder Monitoring and Planning Committees at PHC, Block and District levels

  • Public dialogue

  • Periodic public dialogue (Jan Samvad) - Engagement with providers based on community evidence


Community action under nrhm experiences and gains

Community action under NRHM - experiences and gains

Five Tangible benefits:

1. Construction work completed

2. Improvements in status of delivery of health services

3. Enhanced trust and improved interaction

4. Community based inputs in planning and action

5. Reduction in out of pocket expenditure


1 construction of sub centre completed

1. Construction of Sub-Centre completed

Story of change - Maharashtra

  • In Jamshet village, Thane district, construction of a sub-center was incomplete for over two years

  • Village health committee members discussed the issue in a series of Gram Sabha meetings and in Block monitoring committee meetings

  • A large group of community members went to the sub-centre to ‘complete’ the construction through ‘Shramdaan’

  • The sub-center building got completed and is fully functional


2 performance of health services improves rajasthan sep 2008 oct 2009

2.Performance of health services improves -Rajasthan (Sep 2008-Oct 2009)

Number of Villages

Poor

Average

Good


Key outcomes

Key outcomes

3. Enhanced trust and improved interaction between provider and community

  • Improvement in service delivery - ANC, PNC, immunization,

  • Responsiveness of provider to community needs

  • Improved provider attitude and behavior

    4. Community based inputs in planning and action

  • Active involvement of PRI members in planning and functioning of health facilities

  • Appropriate planning and utilization of untied funds at VHSC, PHC and CHC


Key outcomes1

Key outcomes

5. Reduction in out of pocket expenditure

  • Reducing demands for informal payments

  • Ensuring timely and full payments of Janani Surksha Yojana

  • Significant reduction on outside prescription


Key challenges

Keychallenges

  • Capacity constraints to institutionalize and scale up community monitoring

  • Allocation of adequate resources

  • Mechanisms to address systemic gaps emerging from CBMP process and feeding into the planning process

    - vacancies/ posting, procurement and distribution of drugs and supplies, training of health functionaries

  • Institutionalizing minimum service guarantees, grievance redressal mechanisms


Implementation status

Implementation status

  • Scaled up - Maharashtra, Tamil Nadu, Jharkhand, Chhattisgarh

  • Modified – Karnataka, Chhattisgarh

  • Re/Initiated – Odisha, Rajasthan, Assam and Bihar

  • In FY 2013-14, 15 States / UTs CAH component has been approved

  • AGCA has provided support to Assam, Jammu and Kashmir, Maharashtra, Madhya Pradesh and Uttar Pradesh in developing their state PIP


Way forward role of agca

Way forward – Role of AGCA

Technical Support proposal approved by GOI

National level

  • Revise CAH tools and share with states for adoption

  • Development of RKS guideline and training manual (in consultation with NHSRC and MoHFW)

  • Report on review of  approaches/models on grievance redressal

  • Processes developed for selection of NGOs to support implementation of CAH


Way forward role of agca1

Way forward – Role of AGCA

State Level

  • Support constitution and orientation of State AGCAs

  • Development of state plans – visioning for scale up

  • Orientation of Nodal Officers and state institutions - SHRC, ARC, RRC, SIRD etc

  • Regular mentoring and review


Agca secretariat population foundation of india december 24 2013

Thank You


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