1. Participatory Audit and Planning (PAP) Process A tool for monitoring and ensuring “Decentralized planning’’ in utilization of Hospital Management Committee funds at Health facility level of Maharashtra state of India 11

2. What is a Social Audit? A social audit is an ongoing process by which people, final beneficiaries of any scheme, program, policy or law, are empowered to evaluate financial and implementation aspects of any scheme/project. Basic Principles of Social Audit- It ensures- -Transparency in the context of access to information, decision making and implementation -Participation of people especially beneficiaries as well as service providers who are responsible to give answers -Accountability by ensuring immediate actions and answerability from Service providers In India, Social Audit is mostly used as a tool for ensuring bottom- up monitoring and evaluation of Employment Guarantee Scheme.

3. Public Hearings – Jan Sunwais Community Based Monitoring and Planning (CBMP) of Health services process in Maharashtra CBMP is being implemented with joint collaboration between State Government and active Civil Society groups and has shown significant positive changes in delivery and utilization of Health Services as well as community ownership Community awareness programs Data gathering and filling report cards Constitution of Monitoring and Planning Committees at various levels Community awareness programmes Data gathering and filling report cards

4. What is the Participatory Audit and Planning (PAP) Process? PAP is an simple and effective process/tool for Monitoring and Planning of Local Health funds. This process has been evolved based on concept of Social Audit and with the mandate and space created in CBMP process. In India, in each Health Institution, a Multi-stakeholder ‘Health Management Committee’ (HMC) who have given some flexible funds and decision making power, for ‘Patient Welfare’ as well as for strengthening of Health Institution. Including HMC and other various stakeholders like representatives of Monitoring and Planning Committee such as active community members, elected members, Health officials and representatives of Civil Society Organizations, and staff of respective Health institution were involved in PAP process

5. Objectives of Participatory Audit and Planning Process -To ensure decentralized planning of Health Services, focusing on active participation of various stakeholders in decision making of planning and utilization of HMC funds. -To identify gaps in the expenditure of HMC funds and also to evaluate functioning of HMC -To build capacity of Health Management Committee members about their roles and responsibilities.

6. Stages for the Implementation of Participatory Audit and Planning Process 1.Collected and analyed last year’s expenditure of HMC; developed a poster for sharing the findings during the PAP event. 2.Cross checking between verified documentation and physical availability of purchased items through HM Committee funds 3.Followed by dialogue between various stakeholders 4.Follow up of decisions taken taken in the PAP event

7. Key Findings -Lack of clarity to committee members about their roles and responsibilities. -Most of the expenditures were done without prior sanctions from HM Committee. -Irregularities in record keeping related to the expenditure of funds as well as functioning of Committee. -Government officials intervene more in the decision making process as compared to other committee members; Verbal orders for centralized purchase from higher level. -In most of the Health institutions, expenditure were done at the end of financial year which lead to overlook of patient’s needs, formal procedures and committee sanctions etc.

8. Key Successes and Impact At Local level- Now HMC funds are being utilized by considering Community needs; various positive changes have been observed such as provision of sitting arrangement, drinking water, food for patients and their relatives etc. which would definitely contribute in improving delivery of health services and hence its utilization. Increased frequency and regularity in the HMC meetings. A steps towards changing power relationship between Community and Health officials. At state level- State government decided to implement the PAP process in all CBMP blocks. So in present year (2014-15) the PAP process will be implemented in at least 22 CBMP blocks of Maharashtra. State level orientation workshop is planned in June 2015 for district level officials who are appointed and responsible for monitoring and evaluation of HMC

9. Status of Issues Raised During PAP Process Status of issues ThaneRaigadNandurbarTotal Resolved10 (37 %)18 (56%)17 (46%)45 (47%) Unresolved9 (33%)14 (44%)16 (43%)48 (50%) Need regular monitoring 8 (30%)00 4 (11%)12 (13%) Out of273237 96

11. Lessons learnt and Challenges faced during implementation of PAP Lesson Learnt- -Role of Civil Society Organization is very crucial and important for facilitation and coordination. -Multi-stakeholder group for execution as well as who have authority to take decision and action on raised issues. -Dedicated and active community based actors who can raised the issues. -Involvement of elected members are important as they have decision making authority. -Mandate at least in the form orders from higher level officials to field level staff which help during implementation of PAP process -Some action from health officials which helps in maintaining motivation of various stakeholders. -Need basic understanding of accounts, mathematical calculations.

12. Lessons learnt and Challenges faced during implementation of PAP Constraining factors- Lack of accessibility to information. Lack of cooperation and reluctance from Health officials for sharing decision making power. Developing consensus among various stakeholders. Maintaining the motivation of stakeholders especially key decision makers such as elected members. Difficult to ensure immediate and concrete actions from higher level.

13. Presentation by- Dr. Nitin Jadhav and team SATHI, Maharashtra, India Thank you.....!