Title: Improving Community Ownership and Accountability: Experience from Karnataka Theme: Equity Matters: Enhancing Equity and Convergence in MNCH Service Project & Organization: Govt. Of Karnataka and KHPT Presenter: Dr. Narayan, Deputy Director – Community Monitoring, DoHFW, GOK

Rationale Cultural barriers There are various cultural beliefs and practices that prevent women and families to benefit from the bio-medical models of health. Example: Not feeding colostrum to the new born Channelize utilization People, over the years, have developed a certain negative perception of government services and functionaries which is a barrier to access these services. Developing and building a positive perception of all available MNCH services and providers in public health system through effective branding can enhance the utilization. Accountability & responsiveness Although the Village Health and Sanitation & Nutrition Committees (VHSNCs) and Arogya Raksha Samitis (ARSs) have been constituted under the NHM, they have been playing limited roles in improving the performance of the facilities and improving the interaction between facility and the community.

Shaping Demands Empowers villagers to understand the real picture-Myths, Quality, Services, resources available and their rights People question the gaps and find suitable solutions from concerned authorities. Systems under pressure to respond. First move towards transparency Structures strengthened to encourage continuous advocacy and people’s representation at various levels. ARS and PMC Community begins to see the effect regular transparent interface. Encouraged to monitor services effectively. Ownership of available resources.

Community monitoring involves: – Increasing awareness of rights and services – Encouraging involvement of people – motivating them for regular monitoring – building their capacities Community leaders, organizations, people’s movements and panchayat representatives will be encouraged to assist VHSNC members Community Monitoring Process expected to help understand the needs of the community, characteristics of the system, effective services, behaviour of health workers, worker attendance at health centres. Process helps investigate extent of usage of health services by people, understand work ethics of health service workers and can work towards correcting lacunae in the system collaboratively. Carried out once in a month discussions with VHSNC members and FLWs

2. Piloting tools at the sub centre level 3. Train VHSNC members to use tool & facilitate 4. Outcome analysis of community monitoring findings 5. Use findings for participatory planning exercise & Build community action plans 1. Develop Supportive Community Monitoring tools

Considered the learnings gained from VHSC Capacity Building project implemented in the year Reviewed the existing tools and strategies for community involvement. Consultation with FLWs and community representatives Development of simple to use and illiterate friendly job aid- Supportive Community Based Monitoring Tool (SCBMT) Process

Piloting in 2 districts: Piloted with VHSNC members in few districts to understand the planning and monitoring in supportive manner to realize the community participation & ownership Handholding at the village level to support the VHSNC to use the SCBMT Scaling up in 6 districts : Namma Habba (Interactive Intimate Theatre) campaign mode was adopted to capacitate VHSNCs District Resource Persons from the department led the training and handholding VHSNCs In Total, 5413 VHSNCs were capacitated in 8 high priority north Karnataka districts to use the tool

Results: Events for which communities were mobilized by VHSNC

Results: Topics discussed in the last VHSC meeting

Results: Ever attended VHSC meeting The proportion of Non-functionaries attended VHSC meeting has increased from 48% to 97%.

Results: Community Behavior Tracking Survey (CBTS): Increased contact ASHA during ante-natal period Bagalkot & Koppal: Pilot districts Six scale up Districts

“ Together with the frontline health workers we discuss the health concerns of our village, identify the problems and jointly generate solutions.” VHSNC president, Kalaburagi district, Karnataka

Challenges Not to look at the tool for the purpose of documentation, rather use it for planning, monitoring and supporting FLWs Participation of female VHSNC members in the meeting Bringing Community Representative and FLWs is still a challenge Sustainability of handholding VHSNC The link with the Panchayat system missing. Parallel functioning VHSNC though is a responsibility it is perceived as well as functions viewed as power structures or as responsibility.

Way forward 1.Strengthen community monitoring system- Support ASHA and VHSNC members to strengthen the supportive community monitoring and build accountability mechanisms between the VHSNC members, ASHAs and PHC staff 2.Handholding-Create human resource pool to offer mentoring and handholding support for the VHSNC members 3.Planning and facilitating access-Integrate VHSNC activities into the panchayat and develop systems for ongoing interaction and dialogue for the same

Thank You