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

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Improving Health System and Strengthening NRHM through Community Action Experiences, Lessons Learnt, Challenges and Way Forward AGCA Secretariat – PowerPoint PPT presentation

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


1
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

2
Outline
  1. The accountability framework under NRHM
  2. Community action under NRHM process,
    experiences and gains
  3. Challenges
  4. Way forward status of implementation in states

3
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

4
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

5
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

6
CAH - Immediate Outcomes
Community Based Planning and Monitoring
(CBPM) programme in Bihar - India
7
First phase of Community Monitoring (2007-09)
  • 9 States, 36 districts, 1620 villages
  • Assam
  • Chhattisgarh
  • Jharkhand
  • Karnataka
  • Madhya Pradesh
  • Maharashtra
  • Orissa
  • Rajasthan
  • Tamil Nadu

8
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 Citizens 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

9
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

10
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

11
2. Performance of health services improves
-Rajasthan (Sep 2008-Oct 2009)
Number of Villages
Poor
Average
Good
12
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

13
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

14
Key challenges
  • 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

15
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

16
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

17
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

18
  • Thank You
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