Community Health Cell Extension Unit, Chennai of SOCHARA

Context

Since the year 2004 the organization has been involved in a number of initiatives broadly under the umbrella of accountability initiatives. These include:
  • In partnership with the National Human Rights Commission (NHRC) of India, CEU facilitated a series of public hearings on the denial of the Right to Health Care all across India.
  • Ever since 2006-2007, CEU has been involved in a number of districts of the state of Karnataka in a campaign on the Right to Primary Health Care – where there is the creation of district level cadre who facilitate the collection of information for a district level public hearing focused on issues of denial and then facilitate concerted follow up activities.
  • As part of the NRHM, CEU is involved in the process of Community Monitoring and Planning (now termed Community Action for Health)in the state of Tamil Nadu. Committees at the village level are formed, oriented, and trained to undertake monitoring of health services / guarantees for their own communities as well as feeding this back to the health system and undertaking planning exercises where the community and the health system sit together to discuss and decide how to improve the situation.
Financial support for all the Community Action for Health activities comes from the government of Tamil Nadu. In addition to the accountability initiatives, CEU has over 30 years experience working in research, policy advocacy and social mobilization initiatives.
Website
www.sochara.org
www.cahtn.in
Area of Work
Karnataka and Tamil Nadu
Contact Person
Rakhal Gaitoinde

Approaches to implementing Community monitoring/ accountability

The organization (CEU) has been developing a conceptual framework to implement community monitoring/accountability under a rights framework approach.  The framework identifies different dimensions or steps in  community monitoring including action plans and system changes. In addition, the CEU approach is  based on the following  principles and aspects:
  • Critical Engagement: Health for all is possible only through a strengthened public health system. With this in mind, all engagement needs to be in the spirit of constructive criticism in an effort to strengthen the public health system, with the public health system itself seen as a major partner in the process.
  • People centric approach: Actions on health and its determinants focuses on the people directly. Local governments, self-help groups, political parties etc., are only secondary areas of engagement based on energy / interest of the people. Within a community, it is also recognized that some groups are more marginalized than others and the approach focus on empowering those groups.
  • Taking a negotiation  paradigm: Bringing about transparency and accountability require communities taking a role of active / equal partners in the governance of the system instead of  a “confrontationist” approach.
  • Ensuring buy-in by health authorities: Taking into account suggestions and perspectives from authorities that might contribute long-term sustainability of community monitoring processes.

Results and Lessons

While there has not been any formal evaluation of the work, through the experience from the project’s team  and the feedback from the various partners it is possible to identify the following results:
  • Increased awareness about services available in the public health system.
  • Increased awareness about health as a human right – this is with regards to a small number of volunteers in each of these committees.
  • Increased accountability at least among the peripheral health staff, in response to a more “aware” community and one that is recording their perceptions on a public document called the Village Health Report Card.
  • Increased willingness of the health department to interact and hear out people.
  • Increased access to the corridors of power by civil society groups.
  • A large group of civil society groups working on the issue of accountability.
In terms of lessons learned, a strength of CEU’s approach is the development of simple tools that are intuitively.  Tools have also been developed in a life cycle approach(school children fill in the school health program assessment, and adolescents fill in the assessment of the adolescent program etc.). In terms of weaknesses and challenges,  the monitoring work is limited  to a few representatives of the community.  Also, the fact that the work is fully funded by the government raises concerns about implementing an independent and critical work.
Finally, there is a need to build in concurrent evaluations, research studies and others, to objectively understanding what is happening in the field.