National Health Mission Assam

Community Action for Health Assam

Total population: 3.12 Cr. Total ASHA: Total VHSNC: Avg. population cover by ASHA: 1018 Total District Hospital: 25 Total CHC: 151 Total PHC: 1014 Total SC: 4621 *(AS PER RHS REPORT 2014) Assam at a glance

First Phase of CAH  Assam was one among 9 states which was selected for the pilot phase of CAH.  First phase implemented in 3 Districts and 9 blocks in  SMG formed with involvement of experts from government and non government organizations.

 State and district level visioning workshops  Training of master trainers at the state level and NGO functionaries.  Media workshops at the state and district levels  Constitution and trainings of Village Health, Sanitation and Nutrition Committees (VHSNCs) and Planning and Monitoring Committees at the PHC, block and district levels  Collection of data and preparation of report cards at the village, PHC, block and district levels  Organisation of Jan Samwad at the PHC and block levels. Activities under taken during first phase

Sate Nodal NGO (VHAA) District Nodal NGO RVC The ANT GGSS Dhemaji Bongaigaon Kamrup

Second Phase of CAH  A small level scale up was taken up in  It was implemented 5 districts and 34 blocks covering 5678 VHSNC.  Second phase of CAH was implemented with support from VHAA as state Nodal NGO.

Sl.N o DistrictsBPHCsVHSNCs 1Chirang2665 2Dhemaji5709 3Jorhat Cachar Kamrup Total 5 Districts Districts covered during Second Phase of CAH

 Community mobilization through rallies and street plays  Informal meetings with key stakeholders (leaders of CBOs, women leaders and village pradhan) were held to get information on village resource and social mapping, identifying key health problems, map service providers and understand health related expenses  Organising village meetings to share findings, entitlements under NHM and facilitate formation of VHSNCs  Sharing village health service profile with the community  Informing community on NHM/ community monitoring (sharing pamphlets and posters) Focus group discussions, in-depth interview and public meetings. Interviews of both beneficiaries and service providers using specific tools was carried out for data collection. Implementation Strategy

Current Phase of CAH  Community Action for Health (CAH) will be implemented in all districts covering all blocks and 40 selected VHSNCs from each Block.  For purpose of implementation for all 27 districts are clubbed into 6 zones.  Current phase of CAH is implemented with support from VHAA as state Nodal NGO.

Present Status of CAH implementation State Nodal Agency (VHAA) has been selected. Zonal NGOs for zones 3,4,5 & 6 covering 18 districts has been selected. Agreement has been signed between NHM & State Nodal Agency. State Nodal Agency has signed agreements with Zonal NGOs under zones 3,4,5 & 6. State Mentoring Group for ASHA and community processes- meeting held on 11 th January 2016 discussion & finalization of work plan done. Member of MSG and AGCA member attended. The State Nodal Agency has submitted the work plan based on inputs from State Mentoring Group. Action initiated to implement the decision of the SMG meeting. Selection of Zonal NGOs for Zones 1 & 2 covering 9 districts is under way.

Sl NoLevelCoverage Selected NGO/ Organization 1State LevelAll Zones VHAA (Voluntary Health Association of Assam) 2Zone 1 Barak Valley Zone: Dima Hasao, Cachar, Karimganj, Hailakandi (4 districts) Selection Under Process 3Zone 2 Bongaingaon Zone: Bongaingaon, Dhubri, Barpeta, Kokrajhar, Chirang (5 districts) Selection Under Process 4Zone 3 Darrang Zone: Darrang, Goalpara, Udalguri, Nalbari, Baksa (5 districts) RWUAA (Rural Women Upliftment Association of Assam) 5Zone 4 Jorhat Zone: Karbi Anglong, Golaghat, Jorhat, Sonitpur (4 districts) RWUAA (Rural Women Upliftment Association of Assam) 6Zone 5 Dibrugarh Zone: Sivsagar, Dibrugarh, Tinsukia, Dhemaji, Lakhimpur (5 districts) SCORPION 7Zone 6 Kamrup Zone: Kamrup Metro, Kamrup Rural, Morigaon, Nagaon (4 districts) RWUAA (Rural Women Upliftment Association of Assam) Current Phaseof CAH

YearRoP Approval (In Lakhs) under NGO/PPP/Innovation head

VHSNC  Identification of VHSNC  Ensuring & facilitate Bank Account for each VHSNC  Ensuring regular VHSNC meetings  Ensuring presence of VHSNC members in VHND  Handholding in preparation of minutes of VHSNC meeting.  Handhold & Facilitate Maintenance of registers under the VHSNC  Maintenance of VHSNC account & Cash Books  focus to form Model VHSNCs. CAH at Different Levels

Sub Centre  Strengthening of Sub centre functioning with the inclusion of RHP and 2 nd ANM at the sub center.  Ensure support to ANMs by LHV/LHS for better service delivery CAH at Different Levels

Block Level  Convergence meetings with other line departments and stake holder for health promotion & promotion of CAH. CAH at Different Levels

District  More pro active role of district administration to bridge the gap to ensure quality health services.  convergence at the district level with all concerned Line Departments. CAH at Different Levels

Mentoring of VHSNCs at District/Block/SC Levels DPMU District ASHA Nodal Officer (Addl. CM&HO) supported by District Community Mobilizer BPMU Block ASHA Nodal Officer (SDM&HO) supported by Block Community Mobilizer ASHA Supervisor /ANM / AWW / ASHA VHSNC members Facilitati on support by State Nodal Agency and ZNGOS

1. Identification of selected VHSNCs on selected parameters. 2. Meetings: State & District Level:  Orientation on Community Action for Health. 3. Mapping & identification of Trainers for Community Action for Health  VHSNC trainer pool to be used for this activity 4. Development of resource material:  Capacity building of DCM, BCM, NGOs on Community Action for Health.  Planning on Community Action for Health.  Systematic and vigorous IEC activities supported by Material & Content development. 5. Planning & Mentoring Committees:  State Level/District Level/Block Level /Village Level (VHSNCs, Sub centre committees and RKS). Activities initiated under CAH

Tender process took time for which the selection of NGOs was delayed. Identification/verification of relevant NGOs was time consuming and hence delayed Ownership at all level is also seen as a major challenge. Effective convergence at all levels. existing report card format needs modification as per ground reality. Monitor able indicators. The major challenges/bottlenecks faced for implementing CAH activity

Challenges of VHSNC  Formation of VHSNC as per revenue village  Irregular presence of PRI members in the monthly VHSNC meeting  No proper system of reviewing the progress of previous month’s resolution  Delay in release of VHSNC untied fund  Non submission of UCs and SoE of VHSNC fund on regular basis.How ever with the introduction of Rs.150 ASHA incentives for attending VHSNC meeting has yielded result.  Lack of proper monitoring of VHSNC activities The Major challenges of CAH & VHSNC

Way forward  Training of NGO staffs up to block level.  Orientation of the service providers (ANM,LHV/LHS) on CAH activities.  Orientation of the ASHA Supervisor.  Training of the identified VHSNC members.  Preparation of Report Card and Sharing of the same with different stakeholders.  Holding Jan-Sambad at district / block level.

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