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Tuesday, July 6, 2010

Community Monitoring of National Rural Health Mission is essential- reports Advisory Group on Community Action

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Community Monitoring, allocation of realistic funds, and assessment of Human Resource Requirements for the purpose are essential for an effective implementation of programmes under National Rural Health Mission – states the Advisory Group of Community Action.

The group has presented a report to the Union Health and Family Welfare Ministry on the completion of the First Phase of Community Monitoring under NHRM taken up in 9 states on  a pilot basis. The report suggests that - the government should support community action including community monitoring to ensure that it is initiated in the other States also.

But, the review has said that community monitoring should be anchored as a part of the larger communitisation effort of the NRHM and within an existing arrangement in the Health Departments. At present there is no significant convergence with other communitisation processes and there is a need to build this in when the process is called up in the pilot States.

The report goes on to suggest that Accredited Social Health Activist (ASHA) should provide the link between monitoring and planning at the village level as the two processes go together. The process and tools should be simplified to enable its use by the community. Recommending an incremental approach, the report says that the issues to be monitored should be gradually increased to ensure that the capacity of the community is built and there is acceptance from the Health Department also.

The Jan Samwads or public hearings should gradually become community-led processes to enable community involvement and accountability, and the entire process of community monitoring should be a three-year cycle, the review report says.

The first phase
The first phase of community monitoring in 2007 was carried out in Assam, Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh, Orissa, Rajasthan and Tamil Nadu. Three to five districts were selected from each State considering the geographical spread and then three blocks in each district. In each block three primary health centres were identified which covered five villages. The spread covered 1,600 villages and 300 facilities. The 18-month process involved capacity building of planning and monitoring committees at different levels for enquiring into the functioning of different components of the NRHM.

“It was an empowering process for the community because it provided knowledge to them on different entitlements, service standards and service guarantees promised within the NRHM. It also gave an opportunity to discuss the status of health services delivery with healthcare providers and programme managers,” the review reports points out.

The village was the main unit for community monitoring and the tools developed at the national level were adapted and modified at the State level.

The score card had 11 parameters to assess and rate the health situation of the village. The Jan Samvad and sharing of village-level findings of monitoring made a great impact on the mindsets of providers which resulted in better service delivery. At the end of several rounds of monitoring, several villages reported an overall improvement in the services. The issues broadly taken up for monitoring were entitlements under Janani Suraksha Yojana, roles and responsibilities of ASHAs, Indian Public Health Standards for different facilities and citizen's charter.

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