SATHI- Support for Training and Advocacy to Health Initiatives

Context

Community Based Monitoring (CBM) was introduced as an important component of the National Rural Health Mission in India in order to help ensure that health services reach communities for whom they are meant. Development of CBM was an outcome of consistent advocacy efforts taken by members of Jan Swasthya Abhiyan (PHM-India) including SATHI team members.
SATHI has been implementing community based monitoring as part of the national rural health mission since 2007.  However,  in the period 1999-2000, SATHI was also part of  a pioneering initiative for community monitoring of health services in collaboration with the people’s organisation ‘Kashtakari Sanghatana’. This experience was organised in one block of Maharashtra, India.
Maharashtra state is one of the largest states (provinces) in India with population of 110 million. As the State nodal NGO, SATHI is presently involved in facilitating CBM in 13 districts covering about 800 villages. A SATHI team member is also part of the national Advisory Group for Community Action, which facilitates CBM at national level in India.

Community Based Monitoring (India)

Common people are presenting evidence on the shortcomings of public health services. They are working for removing these shortcomings, and are making health services accountable in relation to issues raised by them. We must admit that all this is unprecedented. This is happening because of the process of Community Based Monitoring (CBM) which is bringing about a new awareness about health services. We are showing a glimpse of this process briefly through this film.

Website
www.sathicehat.org

Area of Work
Maharashtra (India)

Contact Person
Abhay Shukla

Approaches to implementing Community monitoring/ accountability

Community based monitoring processes are organized at the village, Primary Health Centre (PHC), block, district and state levels. SATHI as state nodal NGO coordinates the CBM activities across districts in collaboration with the district NGOs (one in each district) and block nodal NGOs (one in each block), working with the State health department. A monitoring committee at each level collates the findings from the level below, monitors the health system at its own level, and passes these results up to the next level one or two times a year. For example, the PHC monitoring committee collects results from the village report cards, monitors services in the PHC, and passes village and PHC information up to the block level monitoring committee.

The main tool for the CBM is “village report cards.  This report is filled by community representatives with active guidance from the nodal NGO/CBO. Information is collected on the following indicators: village level disease surveillance services; maternal and child health services including immunisation, antenatal care and postnatal care; curative services at the village level; child nutrition services; availability of services and quality of care at PHC; utilisation of village untied fund; and adverse outcomes (denial of health care, maternal death, infant death). Once they are filled, the village report cards are displayed in a prominent place in the village and a copy is sent to the PHC level monitoring committee for further dialogue and action.

Similar report cards are filled at Sub-centre, Primary Health Centre and Rural Hospital levels. Community members and block facilitators also fill out these report cards. A designated group of people visit their local PHC and/or rural hospital and mark the following indicators as poor, partly satisfactory or good: Infrastructure (electricity, water, toilet, labour room, laboratory), services (infant delivery services, referral services, indoor services, laboratory services), human resources (MO, ANM, lab technician, driver etc.), and availability of essential drugs (stock of nine high priority essential drugs checked on the parameter of state guideline on minimum availability). They also conduct exit interviews with patients, asking them about indicators including the quality of service, behaviour of providers and whether they experienced any illegal charges or corruption. While report cards are prepared and displayed at local level, overall analysis is mostly done by the State nodal NGO.

In addition to the report cards, the monitoring approach includes public hearings called Jan Sunwais. These hearings are attended by large numbers of local community members, POs, NGOs, government officials and prominent persons from the region. At Jan Sunwais, people are invited to report their experiences of poor health services and denial of care, as well as findings included in the village health report cards. The authorities present are then expected to respond to these testimonies, stating how the problems will be addressed.

Results and Lessons

• Community Based Monitoring (CBM) is  an important aspect of promoting accountability & community led action in the field of health.
• The most important input on what, where and how health services are needed and should be provided or improved, can be given most efficiently by the users of the services themselves.
• CBM places people at the centre of the health care delivery process. CBM has enabled people’s participation in monitoring health resources, facilitates people’s direct dialogue with health officials and ensures accountable as well as transparent practices.