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CBMP Poster - Strenthening NRHM Through Community Action |
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Overview
Community Based Monitoring and Planning (CBMP) of
health services is a key strategy of the National Rural
Health Mission (NRHM) which places people at the centre
of the process. It enables the community to ensure that
their health needs and rights are being fulfilled. It allows
them to actively and regularly monitor the progress of
the NRHM interventions in their areas.
Brief on AGCA
The Advisory Group on Community Action (AGCA)
is a group of civil society experts constituted by
the Ministry of Health and Family Welfare (MoHFW)
to advise on community action under NRHM.
Population Foundation of India (PFI) is the Secretariat
of the AGCA.
Accountability Framework of NRHM
Internal Monitoring
Community
Monitoring
Health System
(Providers & Managers)
Community
Monitoring Process
Panchayati Raj
Institutions
Periodic Surveys
and Studies
Community
(CBOs & NGOs)
Objectives of Community Monitoring
• Provide regular and systematic information about community needs
• Provide feedback according to locally developed parameters
• Provide feedback on the status of fulfillment of entitlements, functioning of various
levels of the public health system, identify gaps/deficiencies in services and levels
of community satisfaction
• Increase responsiveness of the public health system
What is • Demand / need
monitored ? • Coverage
• Access
• Quality
• Effectiveness
• Behaviour and presence of health care personnel
• Possible denial of care and negligence
IMPLEMENTATION OF THE FIRST PHASE
PHASE I – SPREAD
• Assam
• Chhattisgarh
• Jharkhand
• Madhya Pradesh
• Maharashtra
• Odisha
• Rajasthan
• Tamil Nadu
• Karnataka
COMMUNITY
MONITORING PROCESS
Orientation of stakeholders
& strengthening of
District /Block NGOs
Mobilisation of
the community
Formation & strengthening of
VHSC/PHC/Block/
District Committees
Community level
enquiries & facility surveys
Sharing of reports & planning
VILLAGE LEVEL REPORT CARD
Village Name
Block Name
District Name
Sl. no.
1
2
3
4
5
6
7
8
9
10
11
Lebeda
Muribahal
Bolangir (Odisha)
Issue
Maternal Health Guarantees
Janani Suraksha Yojana
Child Health
Disease surveillance
Curative services
Untied funds
Quality of care
Community perceptions of ASHA
ASHA’s functioning
Equity index
Adverse outcome or experience reports
Year: 2008-09
Quarter: II
Score
50
42
87
50
96
25
75
100
83
100
100
PERFORMANCE OF HEALTH SERVICES IMPROVES -RAJASTHAN SEP 2008-OCT 2009
The graphs below, illustrate the changes in community perceptions of health services in four districts of Rajasthan over two rounds of data collection between September 2008 and
October 2009. As clearly visible, the number of villages in red, signifying poor services, has reduced substantially with more villages in yellow (average) and green (good) in the second
round of data collection across all four districts.
DISTRICT JODHPUR
30
26
25 23
20
18
15
15
10
05
2
00
FIRST ROUND
4
SECOND ROUND
DISTRICT UDAIPUR
30
26
25 23
20
18
15
15
10
05
2
00
FIRST ROUND
4
SECOND ROUND
DISTRICT CHITTORGARH
50
45 44
40
35
30
25
20
15
10
05
10
00
FIRST ROUND
24
16
5
SECOND ROUND
DISTRICT ALWAR
40 36
35
30
25
20
15
9
10
05 0
36
8
1
FIRST ROUND
SECOND ROUND
POOR
AVERAGE
GOOD
EXTERNAL EVALUATION OF FIRST PHASE:
FINDINGS AND RECOMMENDATIONS
KEY RESULTS
INCREASE IN INSTITUTIONAL DELIVERIES IN THANE DISTRICT
MAHARASHTRA (2007-08 AND 2009-10)
30
25
20
15
10
48
05
00
District PHC Average
101
CBMP PHCs
An analysis of the service
records of primary health
centres across Thane district
in Maharashtra reveals that
the average increase in
institutional deliveries in the
CBMP PHCs is substantially
higher than the average of all
district PHCs.
1. Report card preparation and tools help in increasing awareness in the
community on NRHM provisions and their health entitlements.
2. Public sharing provides an opportunity for dialogue, paving the way
for corrective action and planning.
3. Post sharing – follow up and departmental action leads to
reinforcement of the process.
4. Strengthen mechanisms for grievance redressal to resolve issues
emerging from community monitoring process.
5. Community monitoring needs to be linked to village level planning –
village plans should then feed into the block and district health action
plans.
6. Focus on mentoring of PRI and VHSC members.
7. Strengthen inter-departmental coordination, esp. ICDS, Primary
Education and PHED.
1. 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 behaviour
2. 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
3. Reduction in out of pocket expenditure
• Reducing demands for informal payments
• Ensuring timely and full payments of Janani Suraksha Yojana (JSY)
• Significant reduction on outside prescription
ASHAs in Jharkhand discuss village health plans
Advisory Group on Community Action
Secretariat
Population Foundation of India
B-28, Qutab Institutional Area
New Delhi - 110 016 India
Tel: +91 11 438 94100 Fax: +91 11 438 94199
info@populationfoundation.in www.populationfoundation.in