National Health MissionMaharashtra

Community Based Monitoring

Community Based Monitoring of Health Services under National Rural Health Mission (NRHM)

Introduction:

The National Rural Health Mission (NRHM) was launched for the period 2005 till 2012 with the goal of improving the availability of and access to quality health care for people, especially for those residing in rural areas, the poor, women, and children. Community Based Monitoring was introduced as important component in order to ensure that the services reach those for whom they are meant. Community Based Monitoring is also seen as an important aspect of promoting accountability & community led action in the field of health. The monitoring process also includes outreach services, public health facilities and the referral system. (Government Resolution No. 1724 Health – 7 A, dated 24th August, 2007 launch in CBM in Maharashtra.)

Objectives:

  • To provide regular and systematic information about community needs, which will be used to guide the planning process appropriately.
  • To provide feedback according to the locally developed yardsticks, as well as on some key indicators.
  • To provide feedback on the status of fulfillment of entitlements, functioning of various levels of the Public health system and service providers, identifying gaps, deficiencies in services and levels of community satisfaction, which can facilitate corrective action in a framework of accountability.
  • To enable the community and community-based organizations to become equal partners in the health planning process. It would increase the community sense of involvement and participation to improve responsive functioning of the public health system.

Implementation Strategies:

Every year project plan sanctioning GOI. The Project implemented activity District, Block and PHC Level. The monitoring process will include outreach services, public health facility and the referral system.

Year 2012-2013 in CBM Program Total 13 Districts :

Pilot Phase Districts – Amravati, Thane, Pune, Osmanabad, Nandurbar.
New 8 Districts – Solapur, Beed, Aurangabad, Nashik Chandrapur, Kolhapur, Gadchiroli, Raigad.
CBM project work is done through NGOs. NGOs in the District & Block has been appointed. Every year, the State Nodal Agency agreement is made with SHS and fund distribution.

NGOs working in the Project :
State Nodal Agency, Sathi Cehat, Pune
Block Nodal NGOs :

District Block Name Block Level NGOs
Amravati Chikhaldara/Chandurbazar Khoj Melghat
Dharni Apeksha Hoemo Society
Achalpur/Aanjangaon Mamta Bahudeshiya Sanstha
Nandurbar Shahada Janarth Adivasi Vikas Sanstha
Akkalkuwa/Taloda Lok Samnvayak Pratishtan
Dhadgaon Narmada Bhachao Andolan
Osmanabad Osmanabad/Kalam Lok Pratishtan
Tuljapur Halo Medical Foundation
Pune Velhe/Bhor Rachana Society
Purandar/Dunda Masum
Khed/Junnar Chaitanya
Thane Dahanu/Mokhada Kashtakari Sanghatna
Murbad/Shahapur Van Niketan
Solapur Akkalkot Halo Medical Foundation
Beed Ambajogai Manavlok Pratisthan
Beed Samata Pratishtan
Aurangabad Vaijapur Marathwada Gramin Vikas Sanstha
Soygaon Abdul Salam Pathan Gramin Vikas Sanstha
Nashik Trambakeshwar Vachan Sanstha
Igatpuri Magmo Welfare Sanstha
Chandrapur Varora YARD, Chandrapur
Chandrapur Prakruti Mahila Vikas Kendra
Kolhapur Ajara Sampada Gramin Vikas (Sangram)
Bhudargad Social Assosication of Network Voluntary Action Development
Gadchiroli Kurkheda Amhi Amchya Arogyasathi
Gadchiroli Indian Institute for Welfare Sanstha
Raigad Sudhagad Nirmiti Sanstha
Mangaon Nirmiti Sarvahara Jan Andolan
Karjat Disha Kendra, Raigad

Structure:

District Blocks PHC Villages Population
Pilot Phase 5 7 39 195 727341
Expansion Areas 14 33 245
New 8 District 8 16 48 240 364358
Total 13 37 120 680 1091699

NGOs Manpower in Project Area:

Level NGOs Post Approved Post Total Filled Post
State Level State Nodal NGO State Coordinator 1 1
Jr. Programme Officer/Field Coordinator 5 5
Administrative Assistant 2 2
Jr. Finance Officer 1 1
Data Analysis 1 1
Accountant/Administrative Support 1 1
Regional Resource Person 5 5
District Level District Nodal NGOs District Coordinator         13 13
Accountant/Administrative Support 13 13
Honorarium for Block Coordination & Facilitation (For new blocks in 13 districts) 6 6
Honorarium for Block Coordination & Facilitation (For expansion within Blocks in 13 Districts) 15 15
Accountant/Administrative Support (Existing Blocks) 28 28
Block Level Block Nodal NGOs Block Coordinator 4 4
Facilitator 35 35
Accountant/Administrative Support 28 28
Total 158 158

Performance of CBM Activity for year 2013-14 (till March, 2014):

Sr. No. Activity Target Progressive No. of Participants
State Level
1. State Level Review and Planning Meetings for 13 Districts 3 3 163
2. CBMP Review with Facilitation by AGCA Members 1 1 16
3. State Level Workshop for Capacity Building of Districts and Block Level Trainers 1 1 33
4. State Culmination and Review Workshop (5+8 Districts) 2 1 Video Conferencing
5. State Level Workshop for Accountants (5+8 Districts) 1 1 74
6. State Monitoring & Planning Committee Meeting 4 1 40
7. State Mentoring Committee Meeting 3 2 23
8. State Level Training to Block Level Grievance Redressal Cell Members 1 0 21
9. Regional Workshops Follow up Meetings, District Events 10 12 1878
10. Regional Level capacity building workshops for PRI Representatives 3 3 76
District Level
1. District Mentoring Committee Meeting 36 17 233
2. District Monitoring & Planning Committee Meeting 39 21 369
3. District Orientation Workshop for Health related activities service providers 26 10 530
4. District Level Review and activity planning meeting 52 45 689
5. District Orientation workshop for various level PRI member 13 6 183
6. Workshop for feedback by civil society organization on status of key health indicators 13 3 222
7. Awareness programmes at village level 190 124 2381
8. VHNSC member visit to health facility 190 67 512
9. Orientation for Block Providers 3 1 15
10. Communication workshop at District Level 13 5 433
11. Monthly Grievance redressal cell meeting at block level in pilot blocks 132 4 40
12. Regional quarterly review meeting with Deputy Director and District Monitoring Committee Members 26 10 204
Block Level
1. Planning workshop at RH/Block level with Monitoring and Planning Committee, PRI Members (Pilot Areas) 39 22 744
2. Orientation Workshop for RKS members at Block Level (for Pilot & Exp. In New and within Blocks) 39 28 752
3. Awareness and Mobilization Programmes at Village Level 1360 1030 45702

Last Fiver Year –
Qualitative improvements due to CBM in Five Districts:

Thane District – improvements in CBM areas:

  • Practice of prescribing medicine from private shops has totally stopped, as some of the required medicines which are not available, are now purchased from the RKS funds.
  • Medical officers now do not charge for giving injections to the patients. Private practice of certain medical officers has now stopped.
  • Utilization of untied funds for purchasing furniture for Anganwadis has stopped in Murbad block, and funds are used for other more relevant health related activities.
  • Based on more accurate recording, there is now no discrepancy between Anganwadi records and independently taken weights regarding weight of malnourished children.
  • In Nandgaon PHC of Jawhar block, a new generator has been installed, earlier there was no electricity supply in the PHC. This issue was raised by the PHC monitoring and Planning Committee in their meetings and this issue was resolved.
  • In Jamsar PHC of Jawhar block, the number of people availing OPD services from PHC has significantly increased based on greater awareness and improvement in services.
  • The laboratory in Jamsar PHC was not in function, now it is functioning twice in a week.

Pune District– improvements in CBM areas:

  • In Parinche village of Purandar block, the Sub centre has now started functioning regularly; earlier it was not functioning properly.
  • At Malshiras PHC of Purandar block, the previous practice of prescribing medicines from private shops has been totally stopped and all medicines are given from the PHC.
  • The number of people availing services from certain PHCs now is approximately twice the number of people before CBM started, in selected three blocks of Pune (i.e. OPD attendance has significantly increased).
  • Health charter has been displayed in every selected PHC of Pune District. Information related to ambulance has been displayed in PHCs.
  • As a significant innovation, adolescent representatives (12-17 yrs. age) have been included in the VHSCs in five villages in Bhor taluka and three villages in Velhe taluka, enabling issues of children and adolescents to be raised and addressed in the meetings.

Nandurbar District – improvements in CBM areas:

  • Bijari sub centre of Dhadgaon block has now started functioning regularly, earlier it was not functioning.
  • In Kusumwada PHC of Shahada block, a board has been displayed regarding availability of medicines in PHC. This was the result of State level discussion on shortage of medicine in Nandurbar District.
  • In Ohwa PHC of Akkalkuwa block, considering as a special case land has been sanctioned and a new PHC building is now under construction.
  • The earlier practice of prescribing medicines from private shops has totally stopped. There is documented improvement in supply of essential medicines in PHCs.
  • Implementation of Janani Suraksha Yojana (JSY) has been improved in existing villages and beneficiaries are getting benefits more regularly.
  • OPD attendance at PHCs has increased in the selected CBM blocks of Nandurbar District.
  • Frequency of visits of ANM and MPWs in villages has led to improved village health services in some villages; there is definite improvement in immunization coverage in these villages.

Amaravati District – improvements in CBM areas:

  • The sub centre under Bihali PHC was not functioning for almost two months. This issue was raised in a Public hearing and now it is functioning.
  • Earlier there was no ambulance for Dhamangaon Gadi PHC of Achalpur block, now an ambulance has been made available there.
  • Earlier ANMs were not staying at the Sub-centre, now there are resident ANMs in Gaurkheda, Kumbhi and Malhar sub-centers of Achalpur block.
  • One mobile unit has been started at Nimdari sub-centre based on demand from the community. In Chourkund village under Harisal PHC, a mobile medical unit has been approved.
  • The number of institutional deliveries has increased in Achalpur block. Preliminary data shows a significant increase in the number of institutional deliveries per month.
  • Sindhi sub-centre now has a residential medical officer as this centre covers a population of around 7000.
  • JSY beneficiaries are being paid the rightful amount of Rs. 700/- rather than the Rs. 500/- they were being paid before.
  • The earlier practice of prescribing medicine from private shops has totally stopped in CBM areas. PHC staff attitude toward patients has significantly improved in Dhulghat railway PHC of Dharni block.

Osmanabad District – improvements in CBM areas:

  • Number of patients availing services from PHC is roughly twice compared to the number of patients before CBM was launched, in Moha PHC of Kalam block and Jagji PHC in Osmanabad block (i.e. OPD attendance has increased). IPD and OPD of Rural Hospital of Kalam block has significantly increased.
  • Indian Public Health Charter has been displayed in every CBM covered PHC of Kalam and Osmanabad block. PHC monitoring and planning committee members had raised this issue in their meetings.
  • In Shiradhon PHC of Kalam block, on the recommendation of PHC committee, a suggestion box for patients has been placed.
  • Names of PHC monitoring and planning committee members have been displayed in selected PHCs of Kalam block and one PHC of Osmanabad block.
  • Interaction between health care providers and community has improved in Massa.  Villagers have taken initiative for giving protection to the ANM, as her quarter is on the periphery of the village.
  • Earlier practice of prescribing medicine from private shops has stopped, as some required medicines are purchased from the RKS funds.
  • Frequency of visits of ANM and MPWs to villages has increased in most villages. Attitude and behavior of PHC staff toward patients has improved in all three selected blocks.

Total District wise Issues –

Sr. No. Issue category Total Issues received Total Issues solved Total issues in progress Pending issues
1 Administrative 50 35 7 8
2 Health Institutions/Construction/ Renovation/ Repair 14 6 4 4
3 Health Services/Treatment/Deliveries/ Immunization 25 20 0 5
4 Medicines 10 6 4 0
5 Ambulance (Transport services) Referral services 14 10 2 2
6 Vacant posts (Medical Officers) 9 0 3 6
7 Vacant posts (Other staff) 9 3 4 2
8 Laboratory/ Other facilities/ Sonography 3 0 1 2
9 Accommodation arrangement issues  7 0 6 01
10 Equipments non functioning  1 0 0 1
11 Patient waiting facilities 2 0 2 0
12 Flying squad 1 1 0 0
13 Officers/employees absenteeism 15 11 1 3
14 Funds availability 15 13 1 1
15 Health Institutions/ facilities (Water/ Hygiene/Food) 11 4 4 2
16 Appointments 0 0 0 0
17 Organizations Visit 2 1 1 0
18 Officers/employees behaviour towards patients 2 2 0 0
19 Others 16 5 8 3
Total 206 118 48 40
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