Implementation Perspectives from The Field in Maharashtra Dr. Sanjiv Kamble, Deputy Director, Health services Mumbai division, Maharashtra

Objectives of CBM  To provide regular and systematic information about community needs to guide the planning process appropriately.  To provide feedback according to the locally developed yardsticks.  To enable the community to become equal partner in the health planning process.

Structure of CBMP in Maharashtra Sr. No. Details Total No. of District Total No. of CBMP under Districts 1District3613 2Blocks PHC Villages43, Population11,23,74,33310,91,699

Community Based Monitoring and Planning (CBMP) in Maharashtra Covers 13 districts with formation, orientation and activity of multi- stakeholder committees in 134 PHC areas 39 Blocks Around 860 villages Planned expansion in 2014 to now cover more than 1000 villages, across 18 districts

District and Block NGOs appointed under CBMP Sathi Cehat, State Nodal NGO Sr.DistrictDistrict NGOSr.Block NGO 1AmaravatiKhoj, Melghat1Apeksha Homeo Society 2Osmananbad2Halo Medical Foundation 3Nandurbar Janarth Adivsai Vikas Sanstha 3Narmada Bachhav Andolan 4Pune Mahila Sarvagin Vikas Mandal (MASUM) 4Chaitanya Samajik Sanstha 5Rachana Society 5ThaneVan Niketan6Kashtakari Sanghatana 6SolapurHalo Medical Foundation 7Kolhapur Sampada Gramin Vikas (Sangram) 7 Social Assoication of Network Voluntary Action Development 8Aurangabad Marthawada Gramin Vikas Sanstha 9NashikVachan8Magmo Welfare Society 10GadchiroliAmhi Amchya Arogyasathi9Indian Institute for Youth Welfare Sanstha 11ChandrapurYARD Varora10Prakruti Mahil Vikas Kendra 12BeedManavlok Pratishtan11Samta Pratishtan 13Raigad Disha Sanstha 12Nirmiti Sanstha 13Nirmiti Sarvahara Jan Andolan

Monitoring and Planning Committees State Monitoring & Planning Committee District Monitoring & Planning Committee Block Monitoring & Planning Committee PHC Monitoring & Planning Committee Village Health, Water supply, Nutrition and Sanitation Committee

Samundi Village level data collection in Trimbakeshwar Block Nashik on 24th January, 2012.

Preparation of Village Health Report Cards VHC members and block facilitators collect data regarding health services at village, PHC and Rural Hospital level. Report Cards prepared by them after analyzing data collected from community Displayed in poster form in the village and PHC

Filling report card

VHSC Members Visit to PHC

Awareness Program 45 Villages in Osmanabad District

Gadchiroli District - VHSC Members initiative - Arogya Takarar Peti in the Village

Awareness Poster campaign by VHSC Members in Beed

Public hearings (Jan Sunwai & Jan Samwad) Forum for dialogue and accountability Report cards and cases of denial presented. Health officials respond to issues raised by people. Actions ordered regarding services at village, PHC and Rural hospital levels 450 Public hearings organized so far

Qualitative Improvement due to Jan Sunwai and Jan Samwad Awareness of People increased regarding NHM, guaranteed health services and other entitlements. ANM and MPW village visits improved Outside prescription stopped. Community actively involved to solve difficulties of health providers. Accountability of healthcare functionaries has improved Immunization coverage improved.

Success story of CBMP - How people ‘constructed’ Jamshet Sub-centre In Jamshet village, Thane district, construction of a sub-center was incomplete for over two years Village health committee members discussed the issue in a series of Gram Sabha meetings and in Block monitoring committee meetings A Large group of community members went to the sub-centre to ‘complete’ the construction through ‘Shramdaan’ The sub-center building got completed and is now fully functional with regular deliveries being conducted

People’s suggestions communicated to providers Call bells for patients in Ganjad PHC During a Jan sunwai at Ganjad PHC in Thane district, Subhash shared his experience of being unable to call the nurse while the IV saline drip had run out. People gave a suggestion to install manual call bells on each bed. The idea was executed and now any indoor patient can call the nurse when required.

Better communication between people & providers A CBM volunteer saves life of a woman in high risk labour In Jyutpani village in Dharni block of Amaravati, a severely anemic woman went into labour. The local ANM tried to convince the woman that she should be delivered at the RH but the family refused. Someshwar, the block CBM coordinator was approached by PHC staff, he successfully convinced the relatives that it was a complicated delivery and that the patient should be shifted to the Rural Hospital. The family was convinced and they shifted her in time for a normal safe delivery, a life was saved.

Including community priorities in planning at RKS level Intervention related to proper utilization of RKS funds – example of Nasarapur PHC Installation of several water tanks has solved problem of water shortage and has made laboratory fully functional. Post of sanitation worker was vacant leading to lack of cleanliness; RKS has now appointed sanitation worker. Appropriate board has been installed through RKS funds, showing name of the PHC, helpful for new patients to find. Workshops on ‘Right to Health’ and ‘role of adolescents in the development of village’ are being conducted

Overall trend of ‘Good’ ratings for village level Health services across 220 villages in Maharashtra Disease Surveillance Curative Services at village level Use of untied funds ANC PNC Immunisation Anganwadi PHC Services PHC staff behavior

New initiatives in 2014 Based on communitization of social sector Act in Nagaland, modified process of communitization is being proposed in Maharashtra. Block level grievance redressal cell on pilot basis in Melghat, Amaravati as part of CBMP Regional grievance redressal centres in 8 regions and District level GRS in all 35 districts of Maharashtra Recently Maharashtra state government has issued new amendments in PESA. New committee was formed for developing guidelines for its implementation in Health sector. Toll free number ‘104’ for lodging complaints regarding health services Development of guidelines for PESA areas giving powers to Gram Sabha to monitor Health services in 12 Adivasi predominant districts ‘Kayapalat’ (Facelift) – improving service delivery in Health facilities utilizing voluntary sector funds beyond NHM

Thank You