Communitybased Monitoring CBM in Health

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Community-based Monitoring (CBM) in Health
Public Health Forum- Seminar1
Institute of Public Health

• Dr. Upendra Bhojani
• Dr. N. Devadasan

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Setting the stage for CBM

• 73rd and 74th amendments to the constitution of
  India (April 1993)
• Practice of CBM approach, locally (mainly by
  NGOs) and internationally
• Governments recent attempts for CBM in other
  sectors e.g. Education
• NRHM- Government institutionalizing CBM in health
  on a larger scale

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Methodology

• Web search
• Books, Journals, Reports etc.

• Interviews
• Field visits

Case studies

• Location/Duration
• Coverage
• Objectives
• Stakeholders
• Background

• Design
• Indicators
• Role of stakeholders
• Evaluation
• Lessons

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What is CBM?

• a process where concerned citizens, government
  agencies, industry, academia, community groups
  and local institutions collaborate to monitor,
  track, and respond to issues of common community
  concern
• -EMAN, Canada
• Monitoring and evaluation of community
  development by an interested community, so that
  the community can make independent choices about
  its own development World Bank (SA)

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Common themes

• Involvement of community as a principal
  stakeholder
• Collecting, analyzing, reporting and responding
  to information
• Information around the issues of common community
  concern
• To empower community

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Some examples of CBM in health

• NRHM proposed CBM pilots in eight states
• Swasth Plus-Community monitoring Project,
  Karnataka
• Peoples Health Management Information System
  Project, Orissa
• Prayas, Orissa
• Rural Poverty Reduction Project (Monitoring of
  Health Services), Andhra Pradesh etc

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NRHM-CBM
Advisory Group on Community Action
Union Ministry
State health monitoring and planning committee
State mentoring group/State nodal NGO
District health monitoring and planning committee
District mentoring group/Dist. nodal NGO
Block health monitoring and planning committee
Block mentoring group/Block nodal NGO
PHC health monitoring and planning committee
Village health and sanitation committee
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Swasth-Plus PHMIS
20 HHs
20 HHs
Village
NHL
NHL
VDMC
SHGs/PRIs
VDMC Rep.
GP level monthly meeting
Community members PRI members
Health WCD staff
NGO rep.
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Benefits of CBM

• Partnerships/coalitions
• Community
• Sensitization
• Knowledge
• Capacity
• Government
• Capacity
• Social capital

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Prerequisites for CBM

• Mobilizing the community
• Orienting the community to work as complementing
  partner
• Orienting the service providers (government)
  towards CBM process (Knowledge and attitudinal
  factors)
• Setting the agreed objectives for CBM

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Usual stakeholders

• Implementers
• Mostly NGOs
• Service providers
• Mainly Government / Private
• Monitors
• Community/PRIs/SHGs
• Donors
• Government/Development partners

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Approaches to CBM
Census
Dialogue
Community Representatives

• Service Providers
• (Governments)

Community
Data
Data sharing action planning
Analysis
NGO
NGO
NGO
NGO
Study sample
Dialogue
Service Providers (Governments)
Community
NGO/Implementing partner
Data sharing action planning
Data
Analysis
Community
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Role of stakeholders

• NGO
• Getting all the stakeholders on board
• Engaging and organizing community
• Orienting community workers service providers
• Designing the program through consultations
• Arranging facilitating dialogues
• Technical and administrative assistance
• Capacity building
• Government
• Support and cooperation
• Acceptance and responsiveness
• Integration and institutionalization

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Role of stakeholders

• Community
• Support and cooperation
• Monitoring
• Complementing providers
• Initiatives and ownership
• Donor (Government/Development partner)
• Effective and timely disbursement of funds
• Sustained coordination with implementer
• Technical assistance

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Indicators

• Simple and few
• Community consultation
• Health status
• Births, Deaths, Malnourished children, risk
  pregnancies etc.
• Health service delivery
• ANC received by pregnant women
• Immunization status of infants
• Availability of doctor and medicines at health
  facility etc.

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Analysis

• Community/communityfacilitator
• Data- Simplified/demystified
• E.g., PHMIS Project, BABIES model

• some other stakeholder (Mainly facilitating NGO
  or Donor)
• Complex statistical analysis
• Results sharing with community

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PHMIS Project (Orissa)
Births
Deaths
Gram Panchayat
Village
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CARE Project (Tanzania)
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Challenges

• To motivate and organize community
• To create functional partnership/coalition
  between community and governments
• Sustained investment in capacity building
• Integration and institutionalization of CBM
• Scaling up of CBM initiatives
• Can network help?

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Thanks