Community based monitoring as an accountability tool and related trends of change and improvements in the rural health services in the state of Maharashtra.-Dhananjay Kakade

Community Based Monitoring of Health Services and related trends of change and improvements in the rural health services in the state of Maharashtra

Dr. Dhananjay Kakde- SATHI , Pune

(With Inputs from SATHI team members)

What is community based monitoring of health services?

• At the core of CBM is the act of tracking, recording and reporting the state of public health services in villages, as experienced by the people themselves.

• CBM processes related to NRHM are organised at the village, primary health centre (PHC), block, district and state levels.

• Regular information collection at the community level in the villages

• Processes for regular dialogue between community representatives and health care providers

• Helps to develop community ownership and accountability of Health services

Levels of committees forFeedback & Action

State Planning & Monitoring Committee

District Monitoring &

Planning Committee

Block Monitoring & Planning Committee

PHC Monitoring & Planning

Committee

Village Health, Water supply, Nutrition and

Sanitation Committee

Five Key processes in Community Based Monitoring of Health ServicesProcesses Description

Building people’s capacity to publicly rate health services

Capacity building of VHC and monitoring committee members through trainings

Monitoring by committee members through data gathering and filling report cards at village, PHC, Rural Hospital levels.

The report cards marked health services using 11 indicators, with each rated good, partly satisfactory, or poor. All indicators used a three month recall period

Based on report cards, dialogue with health functionaries

Findings from the report cards were presented in the Public hearings or mass dialogue

Media Coverage Public awareness about the problematic condition of the public health system and the potential of CBM to improve it.

State level conventions and dialogue

Forum where systemic unresolved issues are raised and solved

Tools for community monitoring

• Monitoring booklet forms• Village Health Calendar • Interview format for MO

PHC / CHC• Actual medicine stock taking

at PHC/CHC• Format for Exit interview

(PHC / CHC)• Documentation of testimony

of denial of health care

Filling up of the report card and display

Objective positive impact of CBM in improving health services

• Practice of PHCs prescribing medicine from private shops has largely stopped

• Illegal charging and private practice by certain medical officers has now been checked

• Frequency of visits of ANM and MPWs in villages has led to improved village health services in many villages

• Definite improvement in immunisation coverage in many villages

• Certain sub-centres and mobile units which were not working have now started functioning

CBM has contributed to significant improvements in rural health services

Change after six months of monitoring in villages of Velha block, Pune

October 2008 April 2009

‘Good’ ratings for village level Health services across 220 villages in Maharashtra over 3 phases

303540455055606570

Phase 1 Phase 2 Phase 3

48%

61%

66%

‘Bad’ and ‘Partly satisfactory’ ratings for village level Health services across 220 villages

Partly satisfactory and Bad evaluations over 3 phases

14%

20%23%25%

28%

16%

05

101520

2530

Phase 1 Phase 2 Phase 3

Good evaluation trends over 3 P has es for Immunis ation s ervic es

69 71

90

50

60

70

80

90

100

P has e 1 P has e 2 P has e 3

G ood evaluation trends over 3 P has es for Ang anwadi s ervic es

54

75

87

40

50

60

70

80

90

100

P has e 1 P has e 2 P has e 3

600

700

800

900

1000

1100

Thane district OPDper PHC per month

741 679 869

Thane CBM OPDper PHC per month

721 722 1028

07-08 08-09 09-10

17%

43%

0

10

20

30

40

50

Increase in Thanedistrict PHCs OPD

Increase in ThaneCBM PHCs OPD

Increase in people’s OPD utilisation in PHCs covered by CBM

Increase in people’s inpatient utilisation in PHCs covered by CBM

200

300

400

500

600

700

800

Thane district IPDper PHC annual

324 317 488

Thane CBM IPD perPHC annual

417 446 735

07-08 08-09 09-10

50%

76%

0

10

20

30

40

50

60

70

80

Increase in Thanedistrict PHCs IPD

Increase in ThaneCBM PHCs IPD

From community based monitoring to planning of health services

• Key future strategy for planning of health services would be to use information about local issues/ priorities and resources identified during the community monitoring process.

CBM has given us hope that in context of public health system, the positive

alternative to dominant trend of privatisation is communitisation of

health servicesThank you.