Implementation Perspectives from The Field in Maharashtra

Dr. Sanjiv Kamble, Deputy Director, Health services Mumbai division, Maharashtra

Objectives of CBM

 To provide regular and systematic information about community needs to guide the planning process appropriately .

 To provide feedback according to the locally developed yardsticks.

 To enable the community to become equal partner in the health planning process.

Structure of CBMP in Maharashtra

Sr. No.

1 2 3 4 5

Details

District Blocks PHC Villages Population

Total No. of District

36 355 1812 43,943 11,23,74,333

Total No. of CBMP under Districts 13 39 134 860 10,91,699

Community Based Monitoring and Planning (CBMP) in Maharashtra

• • •

Covers 13 districts with formation, orientation and activity of multi stakeholder committees in 134 PHC areas 39 Blocks Around 860 villages

Planned expansion in 2014 to now cover more than 1000 villages, across 18 districts

District and Block NGOs appointed under CBMP

Sathi Cehat, State Nodal NGO Sr.

District District NGO

1 2 3 4 5 6 7 8 9 Amaravati Osmananbad Khoj, Melghat Nandurbar Pune Thane Solapur Kolhapur Aurangabad Nashik 10 Gadchiroli 11 Chandrapur 12 Beed 13 Raigad Janarth Adivsai Vikas Sanstha Mahila Sarvagin Vikas Mandal (MASUM) Van Niketan Halo Medical Foundation Sampada Gramin Vikas (Sangram) Marthawada Gramin Vikas Sanstha Vachan Amhi Amchya Arogyasathi YARD Varora Manavlok Pratishtan Disha Sanstha

Sr.

1 2

Block NGO

Apeksha Homeo Society Halo Medical Foundation 3 4 5 6 7 Narmada Bachhav Andolan Chaitanya Samajik Sanstha Rachana Society Kashtakari Sanghatana Social Assoication of Network Voluntary Action Development 8 9 Magmo Welfare Society Indian Institute for Youth Welfare Sanstha 10 Prakruti Mahil Vikas Kendra 11 Samta Pratishtan 12 Nirmiti Sanstha 13 Nirmiti Sarvahara Jan Andolan

Monitoring and Planning Committees

State Monitoring & Planning Committee District Monitoring & Planning Committee Block Monitoring & Planning Committee PHC Monitoring & Planning Committee Village Health, Water supply, Nutrition and Sanitation Committee

Samundi Village level data collection in Trimbakeshwar Block Nashik on 24th January, 2012.

Preparation of Village Health Report Cards

• • • VHC members and block facilitators

collect data

regarding health services at village, PHC and Rural Hospital level.

Report Cards

prepared by them after analyzing data collected community from

Displayed form in poster

in the village and PHC

Filling report card

VHSC Members Visit to PHC

Awareness Program 45 Villages in Osmanabad District

Gadchiroli District - VHSC Members initiative - Arogya Takarar Peti in the Village

Awareness Poster campaign by VHSC Members in Beed

Public hearings (Jan Sunwai & Jan Samwad) Forum for dialogue and accountability

• • • • Report cards and cases of denial presented.

Health officials respond to issues raised by people.

Actions regarding ordered services at village, PHC and Rural hospital levels

450 Public hearings organized

so far

Qualitative Improvement due to Jan Sunwai and Jan Samwad

• Awareness of People increased regarding NHM, guaranteed health services and other entitlements.

• ANM and MPW village visits improved • Outside prescription stopped.

• Community actively involved to solve difficulties of health providers.

• Accountability of healthcare functionaries has improved • Immunization coverage improved.

Success story of CBMP -

How people ‘constructed’ Jamshet Sub-centre 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 now fully functional with regular deliveries being conducted

People’s suggestions communicated to providers

Call bells for patients in Ganjad PHC

During a Jan sunwai at Ganjad PHC in Thane district, Subhash shared his experience of being unable to call the nurse while the IV saline drip had run out.

People gave a suggestion to install manual call bells on each bed. The idea was executed and now any indoor patient can call the nurse when required.

Better communication between people & providers

A CBM volunteer saves life of a woman in high risk labour In Jyutpani village in Dharni block of Amaravati, a severely anemic woman went into labour. The local ANM tried to convince the woman that she should be delivered at the RH but the family refused. Someshwar, the block CBM coordinator was approached by PHC staff, he successfully convinced the relatives that it was a complicated delivery and that the patient should be shifted to the Rural Hospital. The family was convinced and they shifted her in time for a normal safe delivery, a life was saved.

Including community priorities in planning at RKS level Intervention related to proper utilization of RKS funds – example of Nasarapur PHC

Installation of several water tanks has solved problem of

•

water shortage and has made laboratory fully functional.

Post of sanitation worker was vacant leading to lack of

•

cleanliness; RKS has now appointed sanitation worker.

Appropriate board has been installed through RKS funds, showing name of the PHC, helpful for new patients to find.

•

Workshops on ‘Right to Health’ and ‘role of adolescents in

the development of village’ are being conducted

Overall trend of ‘Good’ ratings for village level Health services across 220 villages in Maharashtra

• Disease Surveillance • Curative Services at village level • Use of untied funds • ANC • PNC • Immunisation • Anganwadi • PHC Services • PHC staff behavior 80 60 40 20 0

Good rating over 3 Phases

48 Phase 1 61 Phase 2 66 Phase 3

• • • • • • •

New initiatives in 2014

Based on communitization of social sector Act in Nagaland, modified process of communitization is being proposed in Maharashtra.

Block level grievance redressal cell on pilot basis in Melghat, Amaravati as part of CBMP Regional grievance redressal centres in 8 regions and District level GRS in all 35 districts of Maharashtra Recently Maharashtra state government has issued new amendments in PESA. New committee was formed for developing guidelines for its implementation in Health sector.

Toll free number ‘104’ for lodging complaints regarding health services Development of guidelines for PESA areas giving powers to Gram Sabha to monitor Health services in 12 Adivasi predominant districts ‘Kayapalat’ (Facelift) – improving service delivery in Health facilities utilizing voluntary sector funds beyond NHM

Thank You