Community Monitoring

through Elected Women

Representatives in Bihar

Dr. Aparajita Gogoi, Executive Director, Centre for Development

and Population Activities (CEDPA) India.

Project Pahel: Monitoring by Women Elected Representatives

o To strengthen the voice, participation,

leadership and influence of Elected

Women Representatives (EWRs) to bring

about social change in areas that affect

women particularly family

planning/reproductive health (FP/RH) by

o Participating effectively in PRI and community meetings

o Taking actions to improve reproductive health services

o Addressing health and development issues in their constituencies

The project is supported by The David Lucile and Packard

Foundation

Project coverage

o Pilot stage of this project (2007)300 EWRs 2 blocks in Patna district in

partnership with PRI Department-(BIPARD)

o Scaled up in (Sept. 2010 – March 2015) to 1200 EWRs

o 6 blocks across three districts of Aurangabad, Sitamarhi and Muzzafarpur

o NGO partners-IDF, Dord and Nirdesh

  .Currently there are 120,000 women leaders in Bihar

Profile of EWRs

  83.8%

10.4%5.3%0.4%

First time elect

Elected once

Elected twice

Elected thrice

10%

39%

30%

21% 20-29

30-39

40-49

50 and above

Never went to school

Upto class 6-8th

Upto class 11-12th

Graduate

Others

40%

29%

14%

10%

3%

0%

1%

0%

2%

Project Strategies 

o Capacity development of EWRs (three day trainings on PRI structures/processes, gender and patriarchy and public health delivery system in the context of MH/FP/RH) and follow up mentoring

o Training the EWRs in the use of checklists to monitor services

o Supporting them to take planned, concrete actions based on evidence generated by the women themselves on the availability and quality of MH/FP/RH services

o Mentoring them through collective forums called Mahila Sabhas (informal women’s councils)

Capacity building

Monitoring checklists

Four checklists (based on Indian Public Health Standards and NRHM guidelines):

o Village Health Sanitation and Nutrition Day (VHSND)o Health Sub Centre (HSC)o Primary Health Centre (PHC)o District Hospital (DH)

Administered to look at MH/FP/RH services:o Infrastructureo Personnelo Community participationo Availability of equipment, drugs and other supplieso Provision of serviceso Quality of logistical arrangements

Process 

o Orientation and training on different components of checklists, service provision at various levels, women’s entitlements and the role of stakeholders

o Hand holding support by field animator during the visit to the facility

o Checklists administered in pairs or groups of 3-4

o Observation and verification against available records before entry in checklist

o Debriefing by field animator after facility visit

Process 

o Data analysis and advocacy asks development

o Mobilisation by sharing of health data in PRI meetings and Mahila Sabhas,

o Convening and regularizing VHSNCs

o Convergence meeting with Health officials at district level

o Meetings with Health providers for action

Findings: VHSND level 

Supplies Availability

Foetal stethoscope 8.6%Haemoglobinometer 8.8%Urine testing kit 11.6%SABLA cards 15.9%

Vit-A solution with spoon 18.5%

Counseling protocol chart 22.1%

Measuring tape 23.8%IFA tablets-small/syrup 33.0%BP Apparatus 38.7%Condoms 47.0%Nutrition supplement 48.2%Oral pills 48.2%Weighing machine-baby 55.6%MCH cards 61.5%Growth chart 67.9%

Blank immunization cards 72.0%

ORS packets 76.0%

Weighing machine-adults 80.0%

IFA tablets-large 80.5%Disposable syringes 94.8%

Vaccine carrier with ice packs 95.5%

Tetanus Toxoid (TT) 99.1%

Availability of functional supplies

Provision of ANC services

2-4 hrs 5-6 hrs 7-8 hrs

32%

53%

15%

Duration of VHSND

Immunization

Weight

IFA tablets

Per abd. exam.

BP

Screening for Anaemia

95%

68%

68%

35%

27%

19%

Findings: HSC level 

Availability of functional supplies

Supplies Availability

DDK 9%

Sterlizer instrument 11%

Haemoglobinometer 20%

Urine Test strips 32%

Vit-A syrup 37%

Examination table 40%

Copper T 41%

Condoms 63%

BP apparatus 69%

Contraceptive pills 71%

IFA tablets 74%

Weighing machine 83%

ORS packets 85%

Tetanus Toxoid (TT) vaccine 88%

Disposable syringes 91%

ANC check-up

TT vaccination

Measurement of weight

Measurement of BP

Haemoglobin test

Urine test (Protein)

Urine test (Sugar)

95%

96%

83%

60%

8%

9%

2%

Provision of ANC services

Findings: PHC level 

Electricity supply

Generator/ power back-up

Telephone facility with STD services

Wheel chair/ stretcher

Refrigerator with deep freezer

Oxygen cylinder

Blood storage facility

Blood pressure apparatus

Table for newborn care

Sterilizer instrument *

Referral transport

100%

100%

50%

100%

100%

100%

0%

100%

83%

83%

100%

Antenatal clinics

Deliveries

Tubectomy and vasectomy facility

Internal examination

Treatment for gynaecological disorders

MTP facility

Treatment for anaemia

Urine examination facility

Referral of High risk pregnancies

Registration of eligible couples for FP

100%

100%

100%

83%

67%

50%

83%

100%

100%

100%

Provision of services

Provision of facilities/supplies/equipment

Findings: DH level 

Provision of services

Antenatal clinics

Deliveries

Tubectomy and vasectomy facility

Internal examination

Treatment for gynaecological disorders

MTP facility

Treatment for anaemia

Referal of High Risk Pregnancies

Registration of eligible couples for FP

100%

100%

100%

100%

100%

67%

100%

100%

67%

District/block Level Convergence Meetings

Actions

o EWRs supporting ANMs and ASHAs in organizing VHSND

o EWRs mobilizing beneficiaries to participate in VHSNDs and visit HSCs for health needs

o EWRs working with health workers to ensure equipment, supplies and finding solutions for issues like privacy for ANCs at VHSNDs and HSCs

(Source: Quarterly reports)

Actions

o Irregularity of health workers at Gram Panchayat meetings

o Mukhiya asked to add to Panchayat Samiti bi-monthly meeting agenda the need to ask MOIC to ensure regular supply of contraceptives at the HSCs

o Urged Mukhiyas to follow up on JSY payments

o EWRs met with MLA Sitamarhi to demand for female doctors

(Source: Quarterly reports)

Results: Convergence meetings emerge as a forum for advocacy and engagement

Pramila Devi, a Ward Member from Gorigama Panchayat, raised the issue of non-availability of referral transport fund at the HSC

Raviba Khatoon, Zilla Parishad Member, raised the issue of non-availability of blood at the district Hospital blood bank which was resulting in the patients being referred to other institutions for treatment. She also raised the issue of non-availability of lady doctor at the DH

Reena Devi, Panchayat Samiti Member, raised the issue of appointment of a lady doctor at PHC Runnisaidpur

Mamta Devi, Up-mukhiya of Chanda Panchayat, raised concerns about the non-availability of delivery services at the HSC. She had also demanded proper monitoring of VHSND site by government officials to ensure quality services

EWR voices at convergence meetings:

Results: Convergence meetings emerge as a forum for advocacy and engagement

To ensure quality health services HSCs in Aurangabad will be provided with appropriate equipment

Two ANMs will be appointed at each HSC in Aurangabad

Two ambulances will be made available at each PHC in Aurangabad district

Civil Surgeon has issued an order to the Medical Officer In-Charge of Dumra and Runnisaidpur PHCs and relevant ANMs, to work with the Pahel local NGO partner, Nirdesh for expenditure of the untied funds

Commitments by Health Officials at convergence meetings:

Trends  

o No. of EWRs attending VHSNDs: 21%* (62% are attending an average of 2 VHSND in each quarter

o Number of meetings being attended by EWRs: 61%**

o Raising FP/RH and Girl’s Edu. issues in meetings: 49%*

o No. of EWRs interacting with health providers: 33% *

(45% of them are meeting with at least 2 health providers in each quarter)

* over baseline** Monthly tracking sheets annual data

Challenges and lessons

- High levels of illiteracy of EWRs, barriers of patriarchy – are major challenges in participation of EWRs in PRI meetings, demanding accountability and raising their voice

(Forums like Mahila Sabha provide women space for sharing and solidarity and helps develop their self- esteem and confidence to take the initiative for change and also develop strategies and implement them as a collective)

- Difficult to address the “hard” issues like infrastructure, budgeting processes, appointment of doctors, electricity, running water, etc.

- Lack of technical capacity among EWRs to use the checklists requires for support of the project staff to support the filling in of the checklist

- Data collection and analysis, and communication of findings takes a substantial time resulting in delay in action

Way forward

In Bihar, with PFI to propose to GoB for IVR based monitoring checklists

Toll free

Real time data collection and analysis

Audio learning package also accessible to understand the indicators being collected