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CAH Briefer 3 Rogi Kalyan Samities_English |
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Secretariat
Advisory Group on Community Action
COMMUNITY ACTION
FOR HEALTH
Bringing public into public health
Improving governance and management
of public health facilities: Rogi Kalyan
Samitis in Uttar Pradesh drive the change
#3
UTTAR PRADESH
Piloting and scaling an
intervention to strengthen
RKS functioning
Piloted in 27 facilities of
1 district (FY2016–17)
Scaled to an additional 168 facilities
in 10 more districts (FY2018–19)
Scaled to an additional 315 facilities
in 20 more districts (FY2019–20)
45% of all RKSs in Uttar Pradesh
(510 of 1,132 RKSs) are currently
covered by the intervention in 31 districts
The National Health Mission (NHM) implementation framework regards creation
of a health system responsive to the needs of citizens and building a broad-based
inclusive partnership as key goals crucial to the attainment of national health goals.
It is to these ends that MoHFW developed and disseminated the National Rogi Kalyan
Samiti (RKS)/Patient Welfare Committee Guidelines to states in 2015. RKSs have
been formed in public health facilities across the country with the mandate to ensure
compliance to minimal standards for hospital care, adherence to protocols of
treatment and accountability of health providers to the community. These committees,
comprising representatives from Panchayat Raj Institutions (PRIs), NGOs, local
elected representatives, health facility staff and government officials of other
departments like Public Health Engineering Department (PHED), Social Welfare, etc.,
serve as a group of trustees for the health facility and manage its affairs.
Given RKSs’ crucial role, NHM’s Advisory Group on Community Action (AGCA)
piloted and subsequently scaled up an intervention in Uttar Pradesh to strengthen
RKS functioning.
This brief summarizes the processes adopted to strengthen RKS functioning in
Uttar Pradesh and the impact that has had on the quality of services clients receive
at public health facilities.
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THE UTTAR PRADESH PILOT
Strengthening Rogi Kalyan Samitis to ensure
health care stays responsive to people’s needs
CONTEXT
Uttar Pradesh has constituted RKSs at district
hospitals, Community Health Centres (CHCs) and
Urban Primary Health Centres (UPHCs) across the
state. However, general lack of awareness about roles
and responsibilities of RKS members, irregular
meetings of RKS committees and absence of a patient-
centric approach in fund utilization have limited their
effectiveness and functioning. Population Foundation
of India, which hosts the AGCA secretariat, has given
technical assistance to the Uttar Pradesh State
Programme Management Unit (SPMU) for an
intervention to strengthen RKS functioning.
INTERVENTION
The overarching aim of the intervention is to improve
provider responsiveness and provision of quality
maternal and reproductive health services in public
health facilities through active involvement of RKSs.
Pilot in Lucknow district
The pilot was initiated in Lucknow district in 2016 with
the support of an external donor.1 It covered 27 public
health facilities in Lucknow, including 10 district
hospitals, 9 CHCs and 8 Urban Community Health
Centres (UCHCs). PFI and SPMU together developed a
curriculum to build the capacity of RKS members,
conducted trainings and provided handholding support.
District officials and RKS members were oriented on
RKS roles, responsibilities and governance processes.
Sustained mentoring support was provided to RKSs to
strengthen their functioning, with focus on four key
aspects: 1) regular meetings of RKS Governing Body
Committee and Executive Committee, 2) regular
monitoring of services and corrective actions, 3)
preparation of annual plans for RKS fund utilization based
on client needs, and 4) establishment of grievance
redressal mechanisms to improve client satisfaction.
Scaling up in 30 districts
Based on encouraging outcomes from the Lucknow
pilot, the state government has scaled up, in a phased
manner, the intervention to an additional 483 facilities
in 30 districts. The Population Foundation of India team
is supporting the SPMU for the scale up. The training
curriculum developed for the Lucknow pilot has been
updated for RKS trainings. Resource materials, such as
information, education and communication (IEC)
materials for display; a booklet on frequently asked
questions (FAQs) about RKS and its functioning; and a
documentary film to orient RKS members, have been
developed and are being disseminated. In addition, a
web-based Management Information System (MIS),
which was developed during the pilot and is in use at
all 27 health facilities in Lucknow, is being deployed at
health facilities in the 30 districts to enable reporting on
RKS functioning. Further, a pool of 86 regional- and
district-level mentors has been trained to orient and
mentor RKSs. As of December 31, 2019, the mentors
had oriented 2,456 district officials and RKS members.
Like in the pilot district, RKSs across the 30 districts
are being actively mentored to strengthen RKS
functioning. The effort is helping RKSs institutionalize
regular meetings of RKS committees; monitor health
care services and take corrective actions; ascertain
client needs and accordingly make provisions in annual
RKS fund utilization plans; and put grievance redressal
mechanisms (feedback box, register, helpdesk) in place
to register clients’ complaints/suggestions for
addressing them.
The RKS initiative in Uttar Pradesh was presented at the National Consultation on
Community Action for Health in March 2019, which Advisory Group on Community Action
(AGCA) organises annually on behalf of the MoHFW. Based on the experience from Uttar
Pradesh, the AGCA secretariat supported state NHMs of Goa, Jharkhand, Odisha and
Sikkim in building state trainers’ and facility in-charges’ capacities on RKS, covering a total
of 32 districts.
1 John D and Catherine T MacArthur Foundation
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IMPACT
Strengthening of RKS has improved public health
facilities’ responsiveness to people’s health needs. The
impact of the intervention is evident at multiple levels:
• Improved functioning of RKS committees: Meetings
of RKS Governing Body Committee and Executive
Committee are now being organized more regularly,
unlike in the past.
• Better hospital amenities and ambience: Improved
RKS functioning and collection of client feedback have
significantly impacted hospital services and amenities.
Change is evident in enhanced patient conveniences,
such as seating space, air-conditioning of maternity
wards and labour rooms, drinking water facility and
toilets; purchase of new equipment; prompt purchase
of emergency medicines during stock-outs; and
installation of CCTVs, among others.
• Improved quality of services: Hospitals in the
intervention districts are reporting improved service
delivery practices, such as making privacy
arrangements in labour rooms, swab culture test for
labour rooms and operation theatres, recording of
vaccinations in the child immunization card,
maintenance of a referral register and follow-up of
referred cases, safe disposal of needles, and improved
disposal of hospital waste.
• Robust grievance redressal mechanisms: Hospitals
are recording client feedback through strategically
located suggestion/complaint boxes, registers and
feedback forms. The feedback is being actively
addressed. This has led to improved basic amenities
in public hospitals, for example, conversion of one
toilet to men’s toilet at Urban Community Health
Center (UCHC) Indiranagar in Lucknow and
installation of lights in dark areas of Lucknow’s Lok
Bandhu Raj Narayan Hospital.
OUTCOMES AT A GLANCE
Data from the pilot district and select hospitals
in the 10 first-phase scale up districts shows
significant improvements.
75% RKSs organised RKS Executive Committee
meetings on a monthly basis
95% health facilities are seeking client feedback
through suggestion/complaint boxes and registers
71% facilities have constituted a grievance
redressal committee to discuss client feedback
60% facilities have completed their financial
audit for FY2018–19
STAKEHOLDERS SPEAK
“RKS provides us clear direction and flexibility to use the
available funds for the benefit of patients.”
Dr. Sandeep Kumar Singh, Medical Superintendent
and RKS member, CHC-Itaunja, Lucknow
“My daughter-in-law delivered her third child at this
hospital (CHC-Itaunja) yesterday! Her other two children
were also born in this hospital. The services being
provided now are far better than during her last delivery
three years ago. The hospital is cleaner, staff is better
behaved, quality of food is good, and we have spent
absolutely nothing from our pocket! We’re happy!”
Patient attendant, CHC-Itaunja, Lucknow
“We have learnt to view the hospital and its facilities from
the patient’s perspective. We take note of the gaps and
make them part of the RKS meeting agenda.”
Dr. Rashmi Gupta, Medical Superintendent and
RKS member, UCHC-Indiranagar, Lucknow
“Earlier when I accompanied a client to this hospital, the
atmosphere was such that I felt like an ill person myself…
but now the conveniences and ambience here has totally
changed and makes one feel good.”
ASHA, Lok Bandhu Raj Narayan Hospital, Lucknow
“Just a few months back, I was brought to this hospital
(Urban CHC-Aishbagh) by a hospital ambulance and was
admitted. Heavy bleeding during my third month of
pregnancy had made my condition critical. Once here, I was
immediately given one unit of blood and put on treatment. I
gradually recovered fully with the good treatment and care
given at this hospital. I want every patient to receive the
kind of service I have received!”
Patient, Urban CHC-Aishbagh, Lucknow
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ROGI KALYAN SAMITI: IMPROVING
HEALTH FACILITY IS IMPACTING LIVES
The RKS at Veerangana Jhalkari
Bai Women Hospital in Lucknow
has received training and
mentoring support from
Population Foundation of India
and SPMU since 2017. This has
resulted in improved RKS
functioning, with regular RKS
Executive Committee meetings
where patient needs and issues
are discussed for decision making.
The RKS’s patient-centric focus
saw the hospital utilize 100% of the
untied fund allocated for FY2018–
19. Several new amenities have
been added, including an air-
conditioner and new chairs and
benches for patients and attendants;
a public address system for
announcements; and improved
quality of food for in-patients. The
RKS has also purchased modern
medical equipment, including a
fetal monitor to continuously
record heartbeat, a non-stress test
machine, and a new infusion pump
for the Special Care Newborn Unit.
These positive changes have been
made possible by making RKS
members aware of their roles and
responsibilities and equipped with
the knowledge and skills to take
decisions for patient benefit.
“ In our RKS meeting, we decided on how we could utilize
the available funds for facility improvement. Our effort to
fill the identified gaps helped us get a good score in
Kayakalp assessment 2018–19. Our hospital stood
second in Lucknow and sixth in Uttar Pradesh!”
Dr Sudha Verma, Chief Medical Superintendent and
RKS Executive Committee Chairperson, Veerangana
Jhalkari Bai Women Hospital, Lucknow
LESSONS LEARNED
• Adoption of systematic processes and transparency
enables participation. Civil Surgeons and Medical
Officers are making efforts to organise RKS meetings
in a structured manner — sending prior notice on the
meeting date, sharing the agenda and proceedings of
the previous meeting, etc. This has increased
participation of members in meetings, including of
elected representatives and officials from the
departments of education, women and child
development, revenue and administration.
• To be effective, trainings/orientations must be followed-
up by regular reinforcement and mentoring. PFI held
regular follow-up interactions with Civil Surgeons,
Medical Officers and hospital managers, developing in
them a comprehensive understanding of RKS roles and
responsibilities along with ownership and confidence to
organise regular RKS meetings, monitor health services
and plan utilisation of funds based on local priorities.
• Ownership by state leadership and their continuous
mentoring of facility staff is crucial. The Uttar Pradesh
state health leadership is driving the process
through regular review meetings on RKS functioning.
Chief Medical Officers and district/block program
managers are regularly following-up with the
in-charges of facilities. This has helped institutionalize
the processes for organising RKS meetings, grievance
redressal and patient-centric utilisation of RKS funds.
THE WAY FORWARD
In a decentralised ecosystem like India’s, RKSs can
strengthen local decision making about health services
significantly. The Government of Uttar Pradesh has
decided to scale up the intervention in a phased manner
to all 75 districts of the state by the year 2023. The
intervention’s positive outcomes in Uttar Pradesh hold
encouraging lessons for other state governments. As
the Pradhan Mantri Jan Arogya Yojana (PMJAY)
component of Ayushman Bharat rolls out, it is crucial
that RKSs be at the forefront to ensure patient
engagement and empowerment.
Secretariat
Advisory Group on Community Action
B-28, Qutab Institutional Area, New Delhi – 110016
T: +91 11 43894 100; +91 11 43894 199
www.nrhmcommunityaction.org | www.populationfoundation.in