Implementation Perspectives from The Field in Maharashtra

Dr. Sanjiv Kamble,

Deputy Director, Health servicesMumbai 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.

DetailsTotal No. of

District

Total No. of CBMP under

Districts

1 District 36 13

2 Blocks 355 39

3 PHC 1812 134

4 Villages 43,943 860

5 Population 11,23,74,333 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 NGOSr. District District NGO Sr. Block NGO

1 Amaravati Khoj, Melghat 1 Apeksha Homeo Society2 Osmananbad 2 Halo Medical Foundation

3 Nandurbar Janarth Adivsai Vikas Sanstha

3 Narmada Bachhav Andolan

4 Pune Mahila Sarvagin Vikas Mandal (MASUM)

4 Chaitanya Samajik Sanstha 5 Rachana Society

5 Thane Van Niketan 6 Kashtakari Sanghatana6 Solapur Halo Medical Foundation    

7 Kolhapur Sampada Gramin Vikas (Sangram)

7Social Assoication of Network Voluntary Action Development

8 Aurangabad Marthawada Gramin Vikas Sanstha

9 Nashik Vachan 8 Magmo Welfare Society10 Gadchiroli Amhi Amchya Arogyasathi 9 Indian Institute for Youth Welfare Sanstha 11 Chandrapur YARD Varora 10 Prakruti Mahil Vikas Kendra12 Beed Manavlok Pratishtan 11 Samta Pratishtan

13 Raigad Disha Sanstha 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 from community

• Displayed in poster form 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 ordered regarding 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 providersCall 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.

The idea was executed and now any indoor patient can call the nurse when required.

Better communication between people & providersA CBM volunteer saves life of a woman in high risk

labourIn 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

4861 66

0

20

40

60

80

Phase 1 Phase 2 Phase 3

Good rating over 3 Phases

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