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Community Action for Heath Under National Health Mission 2005 - 2023_CAH Final Report_LowResolution |
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CONTENTS
03 F O R E WORD
04 KE Y ACHIEVEMENT S
06 E X E C U T I VE SU MMARY
09 O V E R V IEW OF COMMU NI T Y ACTI ON FOR HEA LTH (CA H)
10 PI L O T PHASE OF CAH
12 S C AL I N G U P CAH
13
Advise on community partnership and ownership under National Health
Mission (NHM)
23
Develop models on community action and provide technical assistance to state
governments for scaling up
32
Provide feedback based on ground realities to inform policy decisions
33 ENABLING FACTORS
35 CHALLENGES AND ADAPTATIONS
37 REFLECTIONS FROM ADVISORY GROUP ON COMMUNITY ACTION (AGCA) MEMBERS
42 ANNEXURE
42
Status of approvals for CAH in NHM Programme Implementation Plans
43
Support provided to the state governments
44
Facilitation structures for CAH implementation
46
List of resource materials developed by the AGCA Secretariat
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FOREWORD
I am both proud and honoured to introduce this report, encapsulating 18 years of dedicated support
by the Advisory Group on Community Action (AGCA) to fortify community action for health (CAH)—a
key pillar of the National Health Mission (NHM). Comprising eminent public health experts, AGCA has
continually guided state governments in fostering community engagement and accountability, in the
planning, provisioning, and monitoring of public health services.
Since 2005, Population Foundation of India has had the distinct privilege of hosting the AGCA secretariat,
as mandated by a government order. Under the guidance of several Ministry of Health and Family Welfare
(MoHFW) officials, the National Health Systems Resource Center (NHSRC), the state NHM leadership, and
CSOs, we have ardently strived to “bring the public into public health.”
This document stands as a testament to the unwavering dedication of countless individuals and groups
who champion community-driven initiatives, thereby paving the way for universal health coverage in
India. The pages that follow spotlight AGCA’s remarkable achievements, underscoring the pivotal role of
community action in transforming the health landscape.
From its inception during the pilot phase, AGCA has embarked on a groundbreaking journey. It has
pioneered innovative approaches, facilitating the adoption and expansion of CAH processes across over
2,30,000 villages, 145 cities, and 450 districts in 25 states, making CAH perhaps the biggest community
action programme in the world. Over the years, the AGCA secretariat has successfully trained over
50,000 health officials as master trainers and facilitators. Throughout this journey, in collaboration with
the NHSRC, the secretariat has crafted extensive resources for states, streamlined implementation,
and fortified capacities within states and districts to navigate the intricate processes of community
engagement. An evaluation of the CAH pilot showed the following outcomes: greater awareness in the
community on health entitlements; improvements in the coverage of immunization and antenatal care
services; increased availability of medicines and laboratory services in health facilities; and reductions in
outside prescriptions and demands for informal payments by the health providers
Amidst shifting policy environments and the diverse needs of individual states, AGCA has consistently
displayed adaptability and resilience. Our knack for blending technical support to local contexts and
evolving demands underscores our dedication to the health and well-being of communities.
Field testimonials and case studies provide an insightful look into the tangible impact of CAH, enlivening
statistics with faces and narratives. These accounts echo sentiments of change, hope, and progress.
My profound gratitude to all AGCA members, who were extremely generous with their time and
provided valuable guidance. I also want to thank the Secretariat team, Principal Secretary- Health, State
NHM Mission Directors, state and district nodal officers, our partners, community leaders, and every
stakeholder involved. Your steadfast commitment and relentless efforts are at the root of a brighter and
healthier future for all.
As we continue this journey, let’s renew our commitment to ensuring that community action remains at
the forefront of health transformation, particularly under the ambitious Ayushman Bharat programme,
spearheaded by the Government of India.
Poonam Muttreja
Executive Director, Population Foundation of India
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KEY ACHIEVEMENTS
Between 2005 and 2023, the Advisory Group on Community Action (AGCA)
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1
Provided technical support to 25
state governments to implement
Community Action for Health (CAH)
processes in 2,30,000 villages
across, 450 districts and 145 cities.
2
Supported the National Health
Systems Resource Centre (NHSRC)
in developing national guidelines,
training manuals and resource
materials for community action
3
Supported 31 state governments
in developing the National Health
Mission (NHM) Programme
Implementation Plan (PIPs) for
community action
4
Provided regular feedback on issues
from the ground which required
policy level attention, including
participation in the Common Review
Mission (CRM)
5
Oriented 4000 Community Health
Officers (CHOs), Medical Officers
(MOs) on communitisation processes
and rolling out Jan Arogya Samitis
(JASs)
6
Organised over 3000 Jan Samwads
to find joint solutions between
community and health officials to
improve delivery of public health
services
7
Organised annual national and
regional consultations, webinars,
cross visits to promote cross
learning and adoption of good
practices among state governments.
8
Trained a pool of over 50,000 state,
district and block NHM staff
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EXECUTIVE SUMMARY
The Ministry of Health and Family Welfare (MoHFW) established the Advisory Group on Community
Action (AGCA), in 2005. It had eminent and experienced public health experts to guide state governments
to ensure accountability in the health system and to make communities aware of their healthcare
entitlements and take active part in the monitoring and planning of health services. The AGCA Secretariat
was hosted at the Population Foundation of India through a government order. The Secretariat
works under the guidance of the AGCA members. Quarterly meetings of the AGCA were organised with
participation from the MOHFW and the National Health Systems Resource Centre (NHSRC). Regular
interactions are also organized to review and plan out technical support to the state governments.
The AGCA has been providing technical support to state governments for the past 18 years to strengthen
community action in the healthcare sector. It has been a vital cog in the country’s public health system,
enabling public participation and ensuring health services are need-based through a blueprint that
effectively implements community-action processes under the NRHM. The AGCA has supported the
NHSRC in developing guidelines, training manuals, community monitoring tools and communication
material.
Between 2007 and 2009, the AGCA guided a pilot in nine states (Assam, Jharkhand, Odisha, Chhattisgarh,
Madhya Pradesh, Rajasthan, Maharashtra, Tamil Nadu, Karnataka) covering 36 districts and 1,620 villages.
The project was externally evaluated and showed very positive outcomes around building trust between
communities and health systems, improved coverage of health service and, support to frontline
health workers to overcome service delivery constraints. The project also effectively implemented local
and need-based planning for special groups/remote areas, appropriate planning and utilisation of
untied funds through Village Health Sanitation and Nutrition Committees (VHSNC), Sub Health Centers
(SHC), Primary Health Centres (PHC) and Community Health Centres (CHC). The pilot resulted in the
deputation of doctors at PHCs, reduced demands for informal payments, timely and full payments
of Janani Suraksha Yojana (JSY) incentives and a significant reduction in outside prescriptions. The
evaluation team recommended state governments develop plans to initiate and scale up community-
action processes, along with simplifying the processes and community monitoring tools.
Continuing its support, the AGCA helped these nine states sustain and scale up their interventions while
expanding the processes to five additional states—Gujarat, Bihar, Uttarakhand, Sikkim, and Manipur.
Efforts were made to expand the state community-process teams leading to the development of over
50,000 trainers and facilitators at the state, district, and block levels. As a result, the community-
action processes were expanded from the initial pilot in nine states to 25 states, 452 districts, and
2,30,000 villages by 2023.
In 2013, when the National Urban Health Mission (NUHM) was launched, the AGCA supported the
activation of Mahila Arogya Samitis (MASs) in selected cities of Odisha. The success of these processes led
to the scaling up of their implementation across seven states and 145 cities.
Since 2007, more than 3,000, Jan Samwads (Public Dialogues) have been organised to enhance
community engagement with health systems. These forums facilitated the public voicing of issues and
fostered a greater understanding of community healthcare challenges among administrators and
policymakers. More importantly, solutions were sought jointly by ‘Bringing the Public into Public
Health’.
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Measures were taken to improve healthcare facilities, service provision, staff responsiveness, and fund
utilization.
At the national level, the AGCA worked closely and supported the National Health Systems Resource
Center (NHSRC) to develop national guidelines and resource materials. Additional resources developed
by the AGCA include guidelines for community-based monitoring, animation videos, and
documentary films.
In line with the MoHFW’s focus on Comprehensive Primary Health Care (CPHC), the AGCA submitted a
proposal on social accountability at Health and Wellness Centres (HWCs). It has been working closely
with the NHSRC to support state governments in rolling out Jan Arogya Samitis (JASs). This includes
facilitating training and orientation for over 3,700 Medical Officers (MOs) and Community Health
Officers (CHOs).
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The AGCA has kept experimenting and nurturing innovative approaches to community action with
state governments, including:
• Strengthening grievance redressal and local planning through Rogi Kalyan Samitis (RKSs) in 119
districts across five states—Bihar, Jharkhand, Uttar Pradesh, Manipur, and Goa
• Partnership between State Social Audit Units (SAUs) and NHM to conduct social audit of health
services in 35 districts across 4 states: Jharkhand, Meghalaya, Uttarakhand, and Kerala
• Community-based monitoring of Health Wellness Centres (HWC) by the Village Health Sanitation and
Nutrition Committees (VHSNCs) in 9 districts across Assam and Bihar
• Community-based monitoring through MASs in 145 cities across 7 states- Odisha, Bihar, Chhattisgarh,
Gujarat, Delhi, Uttarakhand and Kerala
• People’s Health Assemblies in 24 districts of Tamil Nadu
In 2023, AGCA launched the ‘Samwad (Dialogue)’ webinar series to share best practices on community-
action processes with the state and district nodal officers to learn from these webinars and adopt
effective practices in their own contexts. The AGCA has also been providing regular feedback to the
MoHFW, NHSRC and state governments on ground-level issues that need policy-level attention. This is
being done through field visits to states, participation in the CRM and fact-finding missions following a
series of maternal deaths in Barwani, Madhya Pradesh, and sterilisation deaths in Bilaspur, Chhattisgarh.
Thus, the AGCA has contributed significantly to the success of NHM. Its approach of ‘Bringing the Public into
Public Health’ provides a blueprint for making healthcare services transparent, accountable, and inclusive.
The AGCA has championed a systemic shift from a passive receipt of services to an active community-
engagement model, fostering trust and empowerment. By providing a platform for community voices, the
AGCA has ensured that the Indian public health system is shaped ‘of the people, by the people, and for
the people.’ This robustly designed, implemented and evaluated has the potential to drive substantial
improvements in the overall health status of the country.
During a global WHO meeting at Johannesburg, South Africa, senior officials from the international
organisation praised the community action model, which has been led by the MoHFW and taken to
scale across the country. At WHO’s request, the AGCA submitted a case study to the organisation.
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OVERVIEW OF COMMUNITY ACTION FOR HEALTH (CAH)
The National Rural Health Mission (NRHM) was launched in 2005 by the Government of India to provide
equitable, affordable, and quality health services through an accountable framework. Communities
were empowered to monitor and provide feedback on the functioning of health facilities in their areas.
The AGCA was formed in 2005 by the MoHFW to guide community action under the NRHM. The AGCA
Secretariat was hosted at Population Foundation of India through a government order.
Accountability Framework under NHM
COMMUNITY ACTION FOR HEALTH
Community Action for Health (CAH), previously known as Community Based Monitoring and Planning
(CBMP), is a strategy of the National Health Mission (NHM). It places community members, organisations,
and elected representatives at the centre of the health system to ensure their health needs and rights
are met. It empowers communities to participate in monitoring health schemes, promoting equitable,
accessible, and quality health services.
MANDATE OF AGCA
The AGCA comprises eminent and experienced public health experts from across the
country. Its mandate is to
• Advise on developing community partnership and ownership for the NHM
• Provide feedback on ground realities to inform policy decisions
• Develop new models of community action and recommend further adoption/ extension to the
national and state governments
AGCA MEMBERS
• Mr A.R. Nanda, Former Secretary, MoHFW
• Dr Abhay Shukla, SATHI-CEHAT
• Dr Abhijit Das, Centre for Health and Social Justice
• Mr Alok Mukhopadhyay, Voluntary Health Association of India (VHAI)
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• Mr Gopi Gopalakrishnan, World Health Partners
• Dr H. Sudarshan, Karuna Trust
• Ms Indu Capoor, Chetna
• Ms Mirai Chatterjee, Self Employed Women’s’ Association
• Dr Narendra Gupta, Prayas
• Dr M. Prakasamma, Answers
• Ms Poonam Muttreja, Population Foundation of India
• Dr Sharad Iyengar, Action Research and Training for Health
• Dr Thelma Narayan, Sochara
• Dr Vijay Aruldas, Christian Medical College, Vellore
PILOT PHASE COMMUNITY ACTION FOR HEALTH (CAH)
In 2007-09 the AGCA guided the implementation of a pilot on community action for health in 1,620 villages
across 36 districts in nine states.
Key results and findings from the pilot:
1. Village Health Sanitation and Nutrition Committees (VHSNCs) provided a voice
to the community, especially from the excluded and marginalised groups
2. Increased knowledge of health entitlements in the community
3. Health department more responsive in providing services to the community
4. Greater community involvement and support to frontline health workers helped overcome service
delivery constraints, supporting more effective local planning.
5. Enhanced trust and improved interaction between the provider and the community
• Improvements in service delivery –ante natal and post-natal care, immunisation. Provider became
more responsive to community needs.
6. Community-based inputs in planning and action
• Active involvement of panchayat members in planning and functioning of health facilities
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• Local and needs-based planning for special groups/remote areas
• Appropriate planning and utilisation of untied funds at VHSNCs, Primary Health Centres (PHCs), and
Community Health Centres (CHCs)
7. Reduction in out-of-pocket expenditure
• Reduced demands for informal payments
• Timely and full payments of Janani Suraksha
Yojana (JSY) incentives
• Significant reduction in outside prescriptions
States | 09
Districts | 36
Villages | 1620
Map not to scale
“There have been gains from an equity perspective too.
Community monitoring has involved the excluded and the
marginal groups. There was an affirmative approach to
ensure that the Dalits, Scheduled Tribes (ST) and women
were involved. Steps were taken, in many states, to ensure
that women, Dalit and ST members headed the VHSCs.
This is an important gain from the process. Community
monitoring has also enabled a better connect between
the front-line service providers and the community,
in some instances. The community has begun to
appreciate the constraints of the front-line providers”
Excerpts from evaluation report of pilot
EXTERNAL EVALUATION TEAM:
• Maharashtra and Rajasthan: Dr Ashok Dyalchand
• Karnataka: Dr Rajani Ved
• Odisha and Tamil Nadu: Mr S Ramanathan
• Madhya Pradesh: Dr/Ms Renu Khanna
• Assam, Chhattisgarh and Jharkhand: Dr Rajani Ved, NHSRC
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SCALING UP COMMUNITY ACTION FOR HEALTH (CAH)
After the completion of the pilot phase, PFI provided support
to state governments to scale up CAH, using its own resources.
Over the next three years, 21 state governments/Union
Territories included CAH as part of their Programme
Implementation Plan (PIP). In consultation with the MoHFW,
a two-day workshop was organised in 2012 with all the state
nodal officers to develop a detailed plan of action for scaling
up CAH. The plan was presented and approved by Mr Manoj
Jhalani, Joint Secretary-Policy, MoHFW.
AGCA Secretariat Staff
• Mr Bijit Boy
• Ms Seema Upadhyay
• Dr Smarajit Chakraborty
• Dr Daman Ahuja
• Mr Saurabh Raj
• Ms Jolly Jose
STRENGTHENING OF THE AGCA SECRETARIAT
In 2014, the MoHFW approved AGCA’s proposal to provide technical support to state governments to
strengthen the CAH processes. Six experienced staffers were recruited and placed at the Secretariat. The
Secretariat team works in close collaboration with NHSRC and functions under the guidance of the AGCA
members to perform the following:
• Provide technical support to the state governments on community action processes
• Develop and disseminate training material, guidelines, checklists, tools, and communication material
• Feedback to national and state governments on community processes and ground realities
The community action processes are currently being implemented in over 2,30,000 villages, 452 districts
and 145 cities across 24 states/UTs1.
Testimony
As a result of the community action
for health, institutional deliveries have
increased from 50% to 80% and PHC OPDs
have increased by over 20%.
Dr. Rajendra Pindarkar
Taluka Health Officer-Shahada
Nandurbar district of Maharashtra (2015)
1Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Delhi, Goa, Gujarat, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya
Pradesh, Maharashtra, Manipur, Meghalaya, Nagaland, Odisha, Puducherry, Rajasthan, Sikkim, Tamil Nadu, Tripura, Uttar Pradesh,
Uttarakhand.
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SECTION 2: OUTCOMES
In this section the outcomes related to our mandate from the MoHFW are detailed.
MANDATE 1: ADVICE ON COMMUNITY PARTNERSHIP AND
OWNERSHIP UNDER NATIONAL HEALTH MISSION (NHM)
The AGCA worked closely with the National NHSRC to provide technical support to state governments to
strengthen community action. This included:
• Co- facilitating development of PIPs
• Support for upscale CAH processes
• Building capacities and guiding a pool of state and district level mentors and trainers
• Organisation of Jan Samwads (Public Dialogues)
• Supporting allied departments and stakeholders
OUTCOME 1.1. ALLOCATION OF RESOURCES IN PIPS
BY THE STATE GOVERNMENTS (HSS)
The AGCA has worked closely with state NHM teams to co- facilitate development of PIPs for community
action processes. Beginning with 9 states (2007-09), the community action processes were adopted by 31
states and Union Territories. The details are mentioned in the table below. The AGCA team engaged with
the following states to institutionalise processes- Bihar (VHSNC), Gujarat (VHSNC), Karnataka (VHSNC),
Maharashtra (Community Based Monitoring), Odisha (MAS), Sikkim (VHSNC), Uttarakhand (VHSNC) and
Uttar Pradesh (RKS).
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*Pilot states @ States where processes are saturated.
OUTCOME 1.2: SUPPORT TO STATE GOVERNMENTS
FOR SCALING UP IMPLEMENTATION OF CAH
The pilot phase of CAH engaged civil society
organisations (CSO) to support capacity building of
VHSNCs and other community-based monitoring
structures till the state level. The external evaluation
of the pilot phase suggested that community
monitoring must be anchored as a part of the larger
communitisation effort of NRHM. Based on the
feedback, concerted efforts were made to transition
the implementation of CAH processes to state
level institutions, including Community Processes
Resource Center, ASHA Resource Center, State Health
System Resource Center (Chhattisgarh, Maharashtra,
and Karnataka), State Social Audit Units (Jharkhand,
Kerala, Meghalaya and Uttarakhand). This helped
increase state ownership and rationalized costs for
scaling up.
“States should adopt and
scale up community action
for health. There is need to
have an effective grievance
redressal mechanism in the
context of community action
as well as the upcoming
National Health Assurance
Mission.”
Mr C K Mishra,
then Additional Secretary and Mission
Director (NHM), MoHFW, National CAH
Consultation Report, 2014
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The AGCA has adapted its approach based on the policy priorities of NHM. With the launch of the National
Urban Health Mission (NUHM), community monitoring of services through the MASs were piloted in
Bhubaneshwar and Puri cities of Odisha. Subsequently, these processes were scaled up in 145 cities
across 7 states (Bihar, Chhattisgarh, Delhi, Gujarat, Kerala, Odisha and Uttarakhand).
With the launch of the Health and Wellness Centres (HWCs) under Ayushman Bharat, the AGCA supported
Assam in developing a model of community monitoring of Comprehensive Primary Health Care
(CPHC) in 7 aspirational districts in 2017. Learnings from the model have since been adopted by state
governments in Bihar and Kerala. The details are included in the latter section on models of CAH.
The AGCA supported NHSRC to strengthen community processes under the NHM. This includes
support in developing the following resource material.
2Andhra Pradesh, Assam, Bihar, Delhi, Goa, Gujarat, Himachal Pradesh, Jammu and Kashmir, Jharkhand, Karnataka, Kerala, Ladakh,
Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Mizoram, Nagaland, Odisha, Puducherry, Punjab, Rajasthan, Sikkim, Tamil
Nadu, Tripura, Uttar Pradesh, Uttarakhand.
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OUTCOME 1.3: CREATING AND MENTORING A POOL OF
STATE AND DISTRICT LEVEL TRAINERS AND MENTORS
In 2014-2023 (upto May 2023), AGCA team directly built the capacities of over 50,000 NHM staff and
trainers across 27 states2. The significant areas of capacity building included:
• Community action for health through
VHSNCs, MASs and JASs
• Strengthening of RKSs
• Social audit of health services
• Community level initiatives to mitigate
COVID-19
“I feel
empowered
with training I
received and now
I’m not afraid to
ask questions or
speak to health
functionaries in
our village.”
Munwa Devi,
VHSNC member Pakadih
village, Gaya district of
Bihar She accompanied
and helped a woman
to access institutional
delivery services in a
timely manner
Since COVID-19 we have initiated online trainings and mentoring sessions with state NHM teams.
To support the trainers and the programme managers, AGCA developed and disseminated a range of
resource material among state governments for VHSNCs, MASs, RKSs and JASs. The material include
posters, handouts, brochures and videos (detailed in Annexure 4). During COVID-19, the AGCA
developed and circulated guidance notes for VHSNCs, RKSs, MASs and Resident Welfare Associations
(RWAs) on their roles and responsibilities for COVID-19 mitigation.
In addition, AGCA developed and customised training resource material for each state. Assam,
Bihar, Goa, Gujarat, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra,
Meghalaya, Nagaland, Odisha, Punjab, Rajasthan, Sikkim, Uttarakhand, and Uttar Pradesh have adapted
these materials.
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OUTCOME 1.4: ORGANISATION OF JAN SAMWADS
(PUBLIC DIALOGUES)
The process of community monitoring is
followed by compilation of data as score cards
at the village and facility levels. These depict
the performance and gaps. Based on this, Jan
Samwads (Public Dialogues) are organised at
the SHC-HWC, PHC, block, district, and state
levels for the community to amicably voice
their issues and seek redressal. Involving the
community, PRIs, VHSNC members, ASHAs
and health officials, the forum also provides an
opportunity to publicly appreciate the efforts
and concerns of the frontline health workers
and staff. These events helped administrators
and policymakers understand the challenges
faced by the community in accessing health
care and take necessary policy decisions which
were relevant for the entire state. Some of the
indicative outcomes are detailed below as a
case in point:
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Initiation of x-ray service at a Community Health Center
(CHC) Pakribarawan, Nawada district, Bihar
An issue was raised during the Jan Samvaad in December 2021 to initiate x-ray services for
patients, visiting the Community Health Centre (CHC) Pakribarawan. Apparently the High
-Tension (HT) line was not connected to the transformer and the earthing was not proper. The
Electricity Department was directed to provide the necessary support to restore the HT line
of the transformer. Ms. Aruna Devi, the local Member of Legislative Assembly (MLA) played
a significant role in getting this done. The earthing was repaired by RKS fund and finally the
X-Ray machine was inaugurated by the Civil Surgeon, Nawada on October 13th, 2022. The x ray
machine is being operated regularly since then. Approximately 30-40 x-rays are done each day.
The patients are saving INR 300 to 400, per x-ray. This results in a cumulative annual saving of
Rs 200,000. This cost includes x-ray as well as transportation cost of going to Nawada.
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Reflection from clients
When this X-Ray service was not available, we had to pay a lot of money (Rs. 300 -400/-)
but now that the X-Ray service is available at CHC Pakribarawan, we can use the service
free of cost.
Sarita Devi, Dola Pakribarawan
I am very impressed with the x-ray service being started at CHC as we now don’t have to
use private x-ray services.
S.Nawab, Pakribarawan
Grievance Redressal: Experiences from Melghat,
Maharashtra
The community action process is being implemented in Maharashtra since 2007. The need to
institutionalise a redressal mechanism to resolve public grievances became obvious with growing
awareness of rights. Block and district level Grievance Redressal Committees were duly formed. The
Takrar Nivaran Samiti (TNS) or Grievance Redressal Committee in Dharani block, a tribal dominated
area in Amravati district, is one such committee. The block has been in the news for high infant and
child mortality. The TNS members include: the Taluk Health Officer, the Medical Superintendent of
the Sub-district Hospital, a representative from the Integrated Child Development Scheme (ICDS), the
Sabhapati of the Panchayat Samiti, representatives from civil society and the media. The committee
meets every 3 months to discuss and address grievances. The TNS receives grievances from both the
community and the health care providers, and takes cognisance of issues arising from community
monitoring. When a pregnant woman attending the sub-district hospital was found to have a very
low haemoglobin level, the doctors referred her to the Amravati District Hospital, which was about
four hours away from her residence. However, the woman and her husband refused to go there, as
there was no one to take care of their children at home. The doctors sought help from the committee
members. The members convinced the couple to go to the district hospital and arranged to take
care of their children. One of the members regularly followed up with the Civil Surgeon at the District
Hospital. This highlights how a committee can foster community action far beyond mere redressal of
grievances, and ensure better health outcomes.
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OUTCOMES CAPTURED THROUGH COMMON REVIEW MISSION (CRMs)
OUTCOME 1.5: CONTRIBUTIONS TO OTHER
STAKEHOLDERS AND DEVELOPMENT PARTNERS
AGCA over the years has worked with different stakeholders to strengthen community action strategies
in health which include:
SUPPORT DURING COVID-19
Based on the feedback from Mr Vikas Sheel, then Joint Secretary- Policy, MoHFW at the 41st AGCA meeting
on May 7, 2020, the AGCA directed its technical support to state governments focusing on COVID-19. This
included:
• Development and dissemination of guidance notes for PRIs, Village Health Sanitation and Nutrition
Committees (VHSNCs), Rogi Kalyan Samitis (RKSs), Mahila Arogya Samitis (MASs), and Resident Welfare
Associations (RWAs); standard operating procedures (SOPs) for organisation of Village Health Sanitation
and Nutrition Days (VHSNDs) and Urban Health and Nutrition Days (UHNDs).
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• Social and behaviour change communication (SBCC) material around COVID-19 such as videos,
audio clips and posters.
• Undertook a dipstick study to understand the issues around COVID-19 vaccine hesitancy in 37
districts across seven states. A note including findings and recommendations was developed and
shared with MoHFW and the NHSRC. Key communication messages that were identified from the
study were converted into reference book and SBCC materials for frontline health workers in Hindi,
English, Marathi and Oriya.
https://drive.google.com/drive/folders/1e6iC3zaIuJDpuvATJACl-N lPlXIjRdE?usp=sharing
• Facilitated over 100 online training sessions on COVID-19 mitigation for engagement of VHSNCs,
MASs and RKSs in which 5,642 block, district, and state nodal officers participated.
• Facilitated 11 virtual Jan Samwads in Bihar and Rajasthan to enable community interactions and
feedback to health officials during COVID-19
• Documented and disseminated 30 good practices to state governments on community engagement
initiatives during COVID-19.
Mahila Arogya Samities stitch and distribute masks to
slum dwellers in Odisha
Members of Mahila Arogya Samities (MASs) came forward to support the community during the
Covid- 19 pandemic. Among these was the initiative to distribute face masks to slum dwellers
free of cost to those who could not afford them. MAS members of 4 cities: Cuttack, Berhampur,
Koraput and Bhubaneswar in Odisha stitched and distributed face to the needy people in slums.
MAS members purchased cloth for masks from three sources: (i) MAS untied funds, (ii) award
money from the National Urban Health Mission (NUHM) on the best performing MAS based on
their previous year work, and (iii) personal contributions.
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MANDATE 2: DEVELOP MODELS ON COMMUNITY ACTION
AND PROVIDE TECHNICAL ASSISTANCE TO STATE
GOVERNMENTS FOR SCALING UP
The AGCA worked closely with the state governments to incubate models of community action and
supported their scaling up. The models include:
1. Strengthening grievance redressal and local planning through Rogi Kalyan Samitis (RKSs) in 75
districts of Uttar Pradesh
2. Partnership between State Social Audit Units (SAUs) and NHM to conduct social audit of health
services in the states of Jharkhand, Meghalaya, Uttarakhand and Kerala
3. Community based monitoring of HWC services by the VHSNCs and community members in Assam
4. Community based monitoring through Mahila Arogya Samiti (MASs) in Odisha People’s Health
Assemblies in Tamil Nadu
“Comprehensive primary healthcare is not possible minus
active community involvement. The government is very keen
on establishing a Jan Andolan, where people feel the need to
participate in the entire processes of continuum of care and have
their grievances heard.”
Dr Manohar Agnani,
then Joint Secretary, Policy, MoHFW,
Report on the national consultation on CAH,
New Delhi, 2018
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3Agra, Aligarh, Allahabad, Bareilly, Ghaziabad, Gorakhpur, Jhansi, Kanpur Nagar, Lucknow, Moradabad and Varanasi
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’Samwad’: Webinar series to enable cross learning and
scaling up of good practices on community action
The AGCA Secretariat organised ‘Samwad (Dialogue)’ to disseminate good practices on
community action. Through these webinars, state and district nodal officers can learn from
each other’s experiences and adopt good practices within the state.
• The AGCA Secretariat co-facilitated the first webinar with the Odisha NHM team on
‘Formation of JASs at PHCs in Odisha’ on February 3, 2023. Mr Sukanta Mishra, State
Manager Urban Health and Dr Sushanta Kumar Naik, State Consultant Community Processes
made presentations and interacted with the participants. Over 900 participants (state and
district nodal officers and community health officers from 20+ states) attended the webinar.
• The second Samwad on ArdraKeralam Puraskaram: Mobilising Panchayats for Health
was organised on June 6, 2023. Ms K M Seena, Head Social Development, National Health
Mission-Kerala presented the initiative. Over 100 participants from the state NHMs attended
the webinar and viewed it on YouTube.
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MANDATE 3: PROVIDE FEEDBACK BASED ON GROUND
REALITIES TO INFORM POLICY DECISIONS
The AGCA has regularly provided feedback to the MoHFW, National Health Systems Resource Centre
(NHSRC), and state governments on ground-level issues needing attention. This has been done through
field visits to states, interactions with state and district nodal officers, ASHAs, VHSNCs, MASs, JASs, RKSs
and Panchayati Raj Institutions (PRI), as well as by participating in the Common Review Mission (CRM).
Here are a few examples of the feedback that has been provided:
Jan Arogya Samitis (JASs):
• Roll out of JASs: Many states faced challenges in constituting JASs at the PHC level. This was mainly
due to the functioning of existing RKSs. The Odisha NHM issued detailed guidelines on converting
the existing RKSs into JASs. The AGCA identified this initiative and shared the details with other
states. A specific webinar was organised on this initiative in February 2023, wherein nodal officers
from 20 states participated and learned.
• Sikkim constituted JASs in PHCs where RKSs still existed. The AGCA advised state officials to retain
only one committee by dissolving the existing RKSs.
• The Medical Officers (MOs) and Community Health Officers (CHOs) could not form and lead meetings
of the JASs. For this, the AGCA requested states to organise specific orientation sessions on the
constitution of the committee, steps and preparations for organising initial meetings involving
VHSNCs and community outreach, etc. The Secretariat facilitated physical and online training for
CHOs in Bihar, Goa, Gujarat, Jharkhand, Karnataka, and Sikkim.
ASHAs:
• Fixed incentives for ASHAs were increased based on feedback to the Chief Minister of Puducherry
during the 14th CRM, 2021.
• Timely release of ASHAs incentives in Bihar, Jharkhand, Gujarat, Madhya Pradesh, and Rajasthan
(CRM and field visits).
• Space was allocated for ASHA restrooms in Jharkhand, Punjab, and Uttarakhand (CRM and Jan
Samwads).
• Briefing of ASHAs on incentive structure and payments in Uttar Pradesh during the 14th CRM,
2021.
• ASHAs to be compensated for accompanying clients to the health facilities for follow-ups and
treatment of NCDs, Uttar Pradesh 13th CRM, 2019.
• Provide warm jackets and boots for ASHAs in Ladakh for field outreach. This could not be included
in the PIP.
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Others:
• Fixed day family planning services initiated at PHCs and HWCs in Darbhanga and Nawada districts in
Bihar, 2022.
• Deputation of female doctors for OPD at PHCs twice a week in Nawada district of Bihar, 2021.
• ASHA Mentoring Group and State Advisory Group on Community Action in Assam were merged in
Sikkim based on feedback from AGCA in 2015.
• In Gujarat, activities CAH approved under the PIP were not being implemented. This was streamlined
based on feedback from AGCA during the 10th CRM, 2016.
• Patient feedback form to be made simple and illustrated for people with low literacy, Bahraich district,
13th CRM, 2019.
• Submitted plans to the MoHFW on:
• Community-Based Health Planning, 2023
• Social Accountability for HWCs, 2021
• Feedback on Mera Aspatal, 2019
• Inclusion of indicators to monitor the functioning of VHSNCs and RKSs as part of the Health
Management Information System (HMIS), 2018
The AGCA is committed to providing timely and effective feedback on ground-level issues that need
attention. This feedback is essential to ensuring that the health system is responsive to the needs of the
people.
Enabling factors and challenges: Impact on the accountability processes
In pursuing its mandate, AGCA has been able to achieve many milestones in partnership with the state
governments as listed in sections above. Based on our experience, an environment has been created
that encouraged us to surge ahead and innovate. On the other hand, we have been beset by numerous
challenges some of which AGCA was able to overcome but some persisted despite all our efforts.
ENABLING FACTORS IN COMMUNITY ENGAGEMENT
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CHALLENGES AND ADAPTATIONS
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Support and work with NHSRC in making JASs functional and effective
• Provide hands on support to select states where formation of JASs is slow. This can include brain
storming on operational issues related to formation/ re-constitution of JASs, adaptation of guidelines
and drafting of advisories for the districts
• Support development of a capacity building and mentoring plan, including selection and training of
district trainers, development of resources, training of trainers and feedback
• Develop resources and an orientation plan for Medical Officers and Community Health Officers (CHOs)
to operationalise JASs- reorganising the committee, organising meetings, planning health promotion
and outreach
• Co-facilitate state review and reflective exercises to gauge functioning of JASs and provide necessary
support
Facilitate cross learning and scaling of good practices
• Continue to organise webinar series Samwad (Dialogue) to facilitate cross learning and scaling of
good practices among state governments
• Document and disseminate good practices
• Facilitate exposure for state and district officials
Re-initiate community-based health planning (CBHP)
• Develop tools including digital tools and user manuals along with NHSRC and select state officers.
• Pilot the intervention in selected geographies beginning with two states
Continue support to state governments on strengthening functioning of VHSNCs, MASs, RKSs
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REFLECTIONS FROM ADVISORY GROUP ON COMMUNITY
ACTION (AGCA) MEMBERS
The constitution of AGCA to promote communisation and community action in health was a novel thought
taken under the National Rural Health Mission (NRHM) launched in 2005 throughout the country. Its
members were representatives of the voluntary organisations with long experience of working directly
with communities in different parts of the country and also some superannuated medical experts from
different disciplines. The AGCA in its initial years did substantive work and created a framework of
how the public health system could be rooted in the community to get better results from the health
interventions. I became its members from its second meeting wherein I was initially called to discuss a
proposal submitted by Prayas for undertaking a project of community monitoring of health services in
one of the districts of Rajasthan. Though the AGCA resolved not to review and recommend individual
proposals sent to it by the ministry but decided to undertake some pilot projects in different regions of
the country on similar lines. I anchored one such project implemented in four districts of Rajasthan and
demonstrated that it is possible to get a very active community engagement in health promotion through
effective demand and supply of preventive and curative services. What made AGCA distinct was that
though it was a body created by the government, its secretariat was located in a civil society organisation.
This arrangement ensured that meetings held regularly, agenda planned, in-depth discussions take place
in the meetings and provided input to the health ministry based on the discussions. The AGCA was a
platform which provided me the opportunity to dynamically interact with the public health functionaries
from apex to periphery in most parts of the country. In this process while I provided my insight, I gained
a lot. It was a very pleasant experience. The Secretariat of the AGCA based at Population Foundation of
India did a commendable job in keeping the momentum of AGCA even till the end.
Dr Narendra Gupta
Member, AGCA
****
The origins and journey of the AGCA, I believe, date back to the years before the International Conference
on Population and Development (ICPD) at Cairo in 1994. In the early 1980’s when I started working
in public health, there was not much public health to speak of and only family planning programmes.
Whenever people spoke to us at SEWA on health, knowing we are a women’s organisation, they would
say: “Tell them to stop having so many children.” Meanwhile, our SEWA members would say: “We need to
have four to six children so that two or three survive.” There was a wide mismatch in views between the
grassroots and middle-class policy-makers, leave alone community action for health being mainstreamed
in ministries of health in the states and in the centre. The ICPD conference changed all of that and after
the excitement of change that it brought in, we began dialogue and consultations with our Ministry of
Health and Family Welfare (MoHFW). Our officers had played a key role at Cairo and we were eager to see
that the recommendations which India signed on to were implemented at home.
I think working together with the government in the years before and after Cairo led us to the National
Rural Health Mission, along with the political will of the government of the day. This then led to an
understanding that without community action for health, not much change in people’s health status
could be achieved. My recollections are that the AGCA was born out of the “manthan” or churning of
those times, with responsive officers in the MoHFW and a government willing to take some conceptual
leaps and put some faith in the people of our country.
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We started out in 2005, ably led by Mr Amulya Ratna Nanda of Population Foundation of India and former
Health Secretary, MoHFW, with community-based monitoring of NRHM’s programmes and services. We
collectively developed templates and then tested them out in several states. It was not easy---there was
resistance from local officials and others. People in the villages we worked in and in the urban mohallas
did not at first understand how they could play a role, being the recipient of services where no one asked
them anything---from planning to implementation, leave alone monitoring. But we persisted and were
patient and kept keeping on. The evaluation of the pilot phase showed that we had made headway but
had far to go.
Fortunately, the MoHFW was also committed to the AGCA and our team---its members and the Secretariat
at Population Foundation of India, kept going and adding to our knowledge and praxis. We also moved
from monitoring only to several community-based actions including decentralised planning, capacity-
building of local health committees like the VHSNCs and MASs and deeper dialogue with the state and
national health officials. We were invited to participate in the Common Review Missions, train trainers in
state government on community action or what began to be called community action for health. States
engaged actively with our secretariat team and we did much to build capacity wherever and whenever
required. Finally, there were the national level consultations which brought out several strong examples
of community action by the states and by civil society.
What did we learn and what did we contribute? First, in several states, we were able to create awareness
that people are and should be active participants in their own health, by participating in health planning
at the local level, their health committees and in conducting Jan Samwads (Public Dialogues) with
local public health authorities. They learned to ask questions about the government’s services and
entitlements without any fear and hesitation. They learned that health is a right and that they could be
active in demanding, providing and monitoring health services, rather than being passive recipients.
Many of them in several states were not only active on the VHSNCs and MASs but also acted on the social
determinants of health---preventing early marriages, on water and sanitation, ensuring their Aaganwadis
were functioning and providing quality food and more.
Second, there was much mutual learning between the government officials and us. We may not have
always agreed on issues or ways of going about community action, but an open dialogue and discussion
was initiated and continued for fifteen years! The dialogue also led to ear-marked funds for community
action---maybe less than we needed, but a good start in any case.
Third, community action for health is now mainstreamed in government policy documents. While people’s
action for health at the grassroots will take some more time, it is enshrined in the health policies in many
states and at the national level. That is certainly a big step forward. In addition, community action or
citizens’ action is now seen as a core aspect of the long journey towards universal health care.
Fourth, many ideas and workable examples from civil society like methods for social accountability, more
active participation in Gram Sabhas (Village Assemblies) and even running low-cost pharmacies have
been mainstreamed in the government programmes across many states.
Fifth, I believe that AGCA and our action in several states at the grassroots and with policy makers
contributed in some measure, albeit modest, to the deepening of democracy in our country, as people
found voice and representation---especially women, Adivasis, Dalits, informal workers and others who
were central to our efforts. Their agency developed as they took collective action to
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safeguard their own health and obtain the services that are their due. These are but a few of what we
learned in what has been a rich harvest.
Forty years ago, or before, who would have thought that community action for health would be
mainstreamed as much as it has? Many of us are pushing for more, but let us remember where we were
and where we have reached. No doubt we have far to go and we will not rest till universal health care, its
complete and comprehensive architecture, reaches every corner of our land. The AGCA has shown us
that it is the people of our country, especially those who are most vulnerable like women, who will get
us there one day.
Ms Mirai Chatterjee
Member AGCA
****
After 17 years the curtains have come down on the AGCA Secretariat. The AGCA was constituted to
support community participation within the NRHM. One of the first tasks assigned by the then Mission
Director (MD), MoHFW to the AGCA was to draw up the outlines of Community Monitoring, a component
that had been introduced as a vital part of NRHM. The MD NRHM had felt that the AGCA with its
membership drawn from community health practitioners was best suited for this task. Once the outline
was ready the MD asked the members of AGCA whether they would be able to guide the process of
implementation at least in the initial phases, and the AGCA Secretariat was established in the Population
Foundation of India. Since then, the Secretariat has been involved in devising mechanisms and tools for
Community based Planning and Monitoring and supporting different state governments to strengthen
community engagement and participatory planning and monitoring across the country. It has been a
task that has been welcomed enthusiastically by the states, and in these many years, various states have
developed their own capacities to do so. The NRHM and subsequently National Health Mission (NHM)
have been acknowledged as one of the largest initiatives in the world towards achieving Universal Health
Coverage, and the AGCA Secretariat has been a keen partner in strengthening community participation.
It’s experiences over the years forms a treasure trove of valuable lessons, not only for state governments
and Health Departments in India, but in all low resource community settings across the world. It has
been a matter of pride to have been associated with these efforts in a small way, but the lessons remain,
and the practices will also remain forever grounded in the thousands of villages, blocks and districts
across India.
Dr Abhijit Das
Member AGCA
****
The AGCA journey has been enriching in every way. We came together with a passion to serve the nation
country when the NRHM was conceptualised and rolled out. It has been an unusual, one-of-a-kind
collaboration between the government and civil society, characterized by mutual regard, respect and
encouragement. The NRHM provided the vehicle for change, which the government staff at different
levels have taken advantage of.
In Community Action for Health which has been the core of our work, our understanding
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has evolved, become richer and more robust because of the scale of implementation, and the diverse
contexts, socio-political realities and variations in political and other enablers. The consistent focus at the
national level on “communitisation” has provided states the nudge and the AGCA the encouragement to
work on strengthening community processes. That this focus has remained through the changes in the
NHM leadership is a testament to its relevance at the grassroots and to the understanding of the NHM
leadership.
The annual Common Review Missions (CRM) have been a great learning – I have visited Odisha, West
Bengal, Tripura and Mizoram. The enormous efforts put in by the state governments before and after
each CRM is to be complimented. “Communitisation” would not have been possible without the support
of the state functionaries at the grassroots. It has worked well where they encouraged it. Appropriate local
facilitation by civil society has often made a crucial difference. I have been inspired by how communities
have learnt to utilise the space provided to them and have admired the spirit and persistence of the
facilitating civil society groups.
The AGCA secretariat team at Population Foundation of India has been outstanding. It has done an
excellent task of facilitating, working with states, converting ideas to reality, structuring interventions
and persisting in their efforts. Population Foundation of India’s leadership has been crucial. We also
owe a lot to the MoHFW, which enabled the formation and functioning of the AGCA and its work and
has encouraged it through the many changes. The AGCA journey will always remain close to my heart.
I hope that Population Foundation of India will continue to be available as a nodal point for the group
to continue to dialogue. Thank you to my AGCA colleagues too, for your passion, encouragement and
inspiration. May you continue to be blessed in all that you do.
Dr Vijay Aruldas
Member AGCA
****
Community Action for Health, through its institutional mechanisms, facilitated by the public health system
has created practical opportunities to bring in peoples’ voice and participation to improve access to
health care in 2.3 lakh villages across 25 states of India. This intense process includes ASHAs, VHSNCs now
appropriately called Jan Arogya Samiti’s (JAS), people’s charters for health, PRIs, facility level committees
etc. Studies show positive impacts on the functioning and accountability of the health system. Through a
process of constructive engagement by several individuals through the AGCA; a competent Secretariat;
several organisations and networks, community action for health was scaled up, with able leadership
by the MoHFW, consistently over the years. This is a unique effort from a global perspective, and one
hopes that it will continue to grow from strength to strength. Society for Community Health Awareness
Research and Action (SOCHARA) and its predecessor the Community Health Cell has promoted and
adopted a community health approach since 1984, along with many other organisations.
Dr Thelma Narayan
Member AGCA
****
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I have had the privilege of being a member of AGCA from its establishment in 2005 by the National
(Rural) Health Mission, till 2023. I saw the key role of the advisory group comprising senior members
of civil society engaged in the field of health, along with a compact Secretariat hosted by Population
Foundation of India, as facilitating the NHM initiatives to bring about communitization of its key activities,
to strengthen the system’s accountability to the community and in enabling community members to
adopt a role as active participants rather than as mere recipients of health services.
I travelled to support AGCA facilitated activities in the states Himachal Pradesh and Rajasthan and have
taken part in NHM Common Review Missions (CRMs) to Mizoram, Bihar, Punjab and Uttar Pradesh,
focusing on community action for health, among other areas. I found that the AGCA added significant
value to those undertaking NHM activities mainly in the way it encouraged state and district officers to
look at interventions and its impact from the community standpoint, and to consider the possibility that
common people might view health needs and care very differently from planners and implementers. It
achieved this change in perspective by encouraging a collaborative rather than adversarial relationship
with active community voices. The delivery mechanism was necessarily large scale -- through community
institutions like VHSNCs, MASs, Rogi Kalyan Samitis, etc. but it was evident all along, that there was an
effective blend of state health system approaches and a feedback collection and redressal mechanism. I
found the AGCA Secretariat team to have exercised enormous perseverance and creativity in interacting
with a range of state health officials, respecting their competing priorities, while enabling their teams to
reach out to the community. This was especially in evidence during the difficult Covid 19 pandemic times,
when online platforms were utilized on a large scale. With the AGCA Secretariat having been disbanded,
I fervently hope that activities for community action for health continue in spirit and on the ground. The
18-year legacy of partnership between civil society and government would thereby endure and hopefully
seed new initiatives.
Dr Sharad Iyengar
Member AGCA
****
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ANNEXURE 1
STATUS OF APPROVALS FOR CAH IN NHM PROGRAMME IMPLEMENTATION PLANS
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ANNEXURE 2
SUPPORT PROVIDED TO THE STATE GOVERNMENTS
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ANNEXURE 3
FACILITATION STRUCTURES FOR CAH IMPLEMENTATION
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ANNEXURE 4
LIST OF RESOURCE MATERIALS DEVELOPED BY THE AGCA SECRETARIAT
SNo
Particulars
I.Pilot Phase
Community
1.
Entitlement (2007-
2009)
Language
English
Hindi
2.
• Managers’
Manual
English
3.
• Training
Manual
English
Description
Introduction to NRHM, service guarantees scheme
and provision under NRHM, community participation
in NRHM, and Framework for community monitoring.
https://nrhmcommunityaction.org/pilot-phase/
Introduction of NRHM, Community Monitoring
under NRHM, first phase of community monitoring,
implementation of first phase of community
monitoring, organizational responsibility
https://nrhmcommunityaction.org/pilot-phase/
How to conduct state managers’ orientation, and
block providers’ workshop at the state and district
level and how to train different levels committees
https://nrhmcommunityaction.org/pilot-phase/
4.
• Monitoring
Manual
English
What are health rights, health systems in India,
communitization of health services, what is
community monitoring, introduction to NRHM,
frameworks for community monitoring in NRHM,
mobilizing community and formation of VHSCs,
conducting community monitoring at the village and
facility level, compiling village and facility level score
card, sharing the results and conducting Jan Samwad
https://nrhmcommunityaction.org/pilot-phase/
A Report on
the First Phase
5.
of Community
Monitoring under
NRHM (2010)
English
Introduction to NRHM, the process, national
preparatory phase, state implementation phase,
immediate outcomes, review of community
monitoring.
https://nrhmcommunityaction.org/pilot-phase/
The film highlights the potential of Community
Monitoring as a community empowerment tool and
6.
A documentary
film on pilot phase
Reviewing Hopes:
Realizing Rights
(2010)
Hindi with subtitles
in English
democratization process in the context of people’s
right to health. The film contains the experiences and
opinions of various stakeholders associated with the
process at the national, state and grassroots levels.
It also captures the processes, immediate impact of
the process at the field level, lessons learned and
challenges faced.
https://www.youtube.com/watch?v=0D_jZH0uIps
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II.Scale-up Phase
Poster
Strengthening
7.
Community Action
for Health (2014-
2019)
Guidelines and Manuals
8.
User manual on
CAH (2014)
Guidelines for
9.
Programme
Managers’ on CAH
(2014)
10.
Monograph on
CAH (2014)
Posters
11.
Primary Health
Centre (2015)
12. Sub-Health Centre
(2015)
Village Health
13.
Sanitation
and Nutrition
Committee (2015)
Village Health
14.
Nutrition Day
(2015)
English
Hindi
CAH process, accountability framework of NHM, pilot
phase, external evaluation and scale-up phase.
https://nrhmcommunityaction.org/resource-materials/
English
Hindi
English
Hindi
English
Detailing how to conduct community level enquiry using
a set of formats, and in compiling village level report
card and facility report cards.
https://nrhmcommunityaction.org/resource-materials/
The guideline was developed based on the cumulative
experience and understanding of the pilot phase, which
include a comprehensive set of principles of establishing
and strengthening CAH, institutional mechanisms and
processes required for implementation.
https://nrhmcommunityaction.org/resource-materials/
It is a review on CAH undertaken from field visits to
five different projects implementing community action
programmes /projects in health across the country.
https://nrhmcommunityaction.org/resource-materials/
English
Hindi
English
Hindi
English
Hindi
Services available at the PHC
https://nrhmcommunityaction.org/resource-materials/
Services available at the SHC
https://nrhmcommunityaction.org/resource-materials/
About the committee and its main activities
https://nrhmcommunityaction.org/resource-materials/
English
Hindi
Available services for women, children and adolescents
https://nrhmcommunityaction.org/resource-materials/
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15.
Community action
for health (2015)
16
Leaflet on CAH
(2015)
Newsletter on CAH/
Publication
17. Newsletter on CAH
(2015)
Grievance
Redressal
Mechanisms for
18. the health sector in
India – Experiences,
learnings and
challenges (2018)
Rogi Kalyan
Samiti
Posters
Role and
19.
Responsibilities
(2019)
Grievance
20.
Redressal
Mechanisms (2019)
21. Information Boards
(2019)
English
Hindi
English
Hindi
Detailing its six processes
https://nrhmcommunityaction.org/resource-materials/
Brief on CAH and its six steps
https://nrhmcommunityaction.org/resource-materials/
English
English
Detailing messages from the MoHFW and AGCA, updates
from the state and national level, case stories, etc.
https://nrhmcommunityaction.org/resource-materials/
It captures experiences, learnings and challenges on
grievance redressal mechanisms across
India and South East Asia. It details 6 models from
six states including Tamil Nadu, Andhra Pradesh,
Maharashtra, Odisha, Madhya Pradesh and Rajasthan.
https://nrhmcommunityaction.org/resource-materials/
English &
Hindi
English &
Hindi
English &
Hindi
Key roles of RKS members
https://drive.google.com/drive/
folders/1v9YbGtVqRaQO3NTC5Ks65kK1POFP9Cbd
Explains various forums/platforms available for patient
grievance redressal.
https://drive.google.com/drive
folders/1v9YbGtVqRaQO3NTC5Ks65kK1POFP9Cbd
Display of information on RKS for public: (i) composition
of RKS, (ii) works undertaken by RKS, (iii) meetings of the
RKS, (iv) details of grievance redressal committees, (v)
details on income and expenditure, etc.
https://drive.google.com/drive/
folders/1v9YbGtVqRaQO3NTC5Ks65kK1POFP9Cbd
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Reference Manuals/FAQ on RKS
Frequent Answered
22. Questions (FAQ) on
RKS, UP (2019)
Hindi
User Manual on
Rogi Kalyan Samiti
23.
(RKS) for
Urban Primary
Health Centres, UP
(2021)
Hindi
User Manual on
Rogi Kalyan Samiti
24.
(RKS) for district
hospitals and
community health
centres, UP (2023)
Hindi
Innovation Briefs on CAH
Monitoring
health services
25.
at the Health and
Wellness Centres in
Assam (2020)
English and
Hindi
Social audits of
health services
26.
in Jharkhand,
Meghalaya and
Uttarakhand (2020)
English and
Hindi
It details the frequent questions on RKS process
including its objectives, members, role and
responsibilities, untied fund, etc. based on the
experience and lessons learnt from RKS implementation
and scale-up in Uttar Pradesh during 2016-19.
https://drive.google.com/drive/
folders/1v9YbGtVqRaQO3NTC5Ks65kK1POFP9Cbd
The manual comprises an introduction about RKS,
organisation of its committee meetings, registration/
renewal process, format for writing minutes of meetings,
etc. The purpose behind to develop this document was
to orient the role of NUHM officials at the state and
divisional levels in strengthening RKS at the Urban PHC
level, and share the soft copy of the document with
them for their easy reference and understanding.
https://nrhmcommunityaction.org/resource-materials/
The manual comprises an introduction about RKS,
organisation of its committee meetings, registration/
renewal process, format for writing minutes of meetings,
etc. The document is developed for orienting the
government officials at the state and divisional levels to
strengthen the functioning of RKS at the district hospitals
and the community health centres.
https://drive.google.com/drive/
folders/1v9YbGtVqRaQO3NTC5Ks65kK1POFP9Cbd
Processes adopted to strengthen community
mobilization and monitoring of HWCs and how the
community’s feedback led to corrective actions on the
ground.
https://nrhmcommunityaction.org/resource-materials/
Describes how the pilots on social audit increased
community awareness and participation in monitoring
local health services.
https://nrhmcommunityaction.org/resource-materials/
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Rogi Kalyan Samitis
27.
in Uttar Pradesh
(2020)
Briefer on
28. Community Action
for Health (2020)
English and
Hindi
English and
Hindi
Summarizes the processes adopted to strengthen RKS
functioning in Uttar Pradesh, and the impact that has
had on the quality of services clients received at public
health facilities.
https://nrhmcommunityaction.org/resource-materials/
Brief on CAH, processes, brief on AGCA and its members,
coverage and innovations emerged from the states.
https://nrhmcommunityaction.org/resource-materials/
Resource Materials on Jan Arogya Samiti
29.
Brochure (2022
English and
Hindi
Details about JAS, Ayushman Bharat, its office bearers,
members, and its services.
https://drive.google.com/drive/folders/1v__Je2a-
nK7KxJd0FN7GYBKUFPcdZMDf
30.
Posters (2022)
English and
Hindi
(i) JAS at PHC level; (ii) JAS at SHC level
(iii) Roles and Responsibilities; (iv) Utilization of funds
https://drive.google.com/drive/folders/1v__Je2a-
nK7KxJd0FN7GYBKUFPcdZMDf
31.
Animation video
(2022)
English and
Hindi
Detailing about JAS including its members, composition,
role and responsibilities of each member, JAS at the PHC
and at SHC.
https://drive.google.com/drive/folders/1v__Je2a-nK7KxJd
0FN7GYBKUFPcdZMDf?usp=drive_link
32.
Guidance note on
Jan Samwad (2022)
English
Detailing about the processes for organising Jan
Samwads
https://drive.google.com/file/d/1J7v6ev_
mUgfETS5kf7zeKJ9N9T7pLTni/view?usp=drive_link
Reference Manual
33.
for JAS trainers,
Assam (2022)
English
Films/Animation videos
34.
Pag Pag Aage
(2009)
Hindi
It details about organising meetings, establishing
grievance redressal including simplified and illustrated
patient feedback forms, and social accountability
processes
https://drive.google.com/file/d/19Z0-
z4on6ERM2vyqg12YpLse_B0P96Xz/view?usp=drive_link
The film ‘Pag pag aage’ focuses on health entitlements
and services under the National Health Mission (NHM).
The story
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35. Community Action
for Health (2013)
Bringing Public
into Public Health
(2015)
36.
Jan Swasthya ke
Badhte Kadam
We must change
37. this story (maternal
death review)
(2016)
38.
Rogi Kalyan Samiti
(2019)
Hindi
Hindi
English
Hindi and
English
Hindi
revolves around a ward member, who has received
training on health entitlements under NHM, and uses
the platform of the Gram Sabha to generate awareness
on their rights and motivate people to access and
demand the services.
https://www.youtube.com/watch?v=KnjNTUkzTfA&t=19s
The documentary depicts the changes brought about by
the programme – Community Action for Health (CAH)
under the National Rural Health Mission in selected
districts of Bihar. Health sub-centres, which were shut
for years were made functional, service providers
stopped asking for informal payments for medicine and
care, and there were marked improvements in quality of
services.
https://www.youtube.com/watch?v=lETsAn7VpIo&t=7s
The documentary film Bringing Public into Public Health
(Jan Swasthya Ke Badhte Kadam) showcases the models
of Community Action for Health (CAH) in various states.
It summarizes key experiences, challenges and lessons
learnt from various community action processes being
implemented across the country. The film captures the
experiences from the urban areas of Bhubaneswar and
Delhi too.
https://www.youtube.com/watch?v=GFmzyaHkT50 (English)
https://www.youtube.com/watch?v=dNkUUnuNfWY&t=4s (Hindi)
The film We Must Change this Story – Yah Kahani
Hamien Badalni Hi Hogi, developed by the AGCA
Secretariat with support from the State Health Mission
– Madhya Pradesh, illustrates real life case stories of
maternal deaths and near miss cases, which occurred
while seeking treatment from public health facilities in
Madhya Pradesh. The primary objective of the film is
to evoke an emotional response among health service
providers and health managers to make them think,
internalize, reflect and take preventive actions for
averting maternal deaths.
https://www.youtube.com/watch?v=roMehZVbmR0&feature=youtu.be
(Hindi)
https://www.youtube.com/watch?v=z7qkh0_sRm8&feature=youtu.be
(English)
The documentary film on Rogi Kalyan Samiti (RKS)
showcases the processes, outcomes and learnings of
RKS strengthening initiative in Uttar Pradesh. The film is
used as resource material for state, regional and district
level master trainers.
https://www.youtube.com/watch?v=bFcvCSYRE5I
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Animation film
39.
on Village Health
Sanitation and
Nutrition
Committees (2019)
Community
40.
Action for Health:
Innovative
Approaches (2021)
Hindi and
English
The film briefs on the functioning of Village Health
Sanitation and Nutrition Committee (VHSNC). It
summarizes key steps and stages of VHSNC formation
in detail; members of the committee; and the roles and
responsibilities of each VHSNC member towards its
strengthening.
https://youtu.be/6bxqMxxbFys (English)
https://youtu.be/Q6V8ombCoVw (Hindi)
The film showcases the new approaches/innovations
undertaken to deepen the CAH processes in some
selected states, which include: community mobilization
and monitoring of Health and Wellness Centres (HWCs)
in Assam; monitoring and auditing through State Audit
Units (SAUs) in Jharkhand, Meghalaya, and Uttarakhand;
and strengthening Rogi Kalyan Samitis (RKSs) to improve
quality of health services in Uttar Pradesh. Also, film
covers monitoring of Adolescent Reproductive and
Sexual Health (ARSH) services in Bihar; and CAH in urban
cities of Gujarat.
https://www.youtube.com/watch?v=y1u06t4BBG0&t=6s
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