Community Action for Health Maharashtra Regional Workshop on Community action for health Mumbai, 31st Jan. and 1st Feb. 2017 Presentation by Dr. Sunil Patil Joint Director (Tech.), National Health Mission, Maharashtra 1 1

Community Action for Health in Maharashtra Community Based Monitoring and Planning Village health Nutrition and Sanitation committee Community Action for Health in Maharashtra Decentralized Health Planning Rugna Kalyan Samiti (RKS) Grievance Redressal Mechanism MAS in Urban areas

Community Based Monitoring and Planning process of Health Services

Scale of CBMP process (CBMP) in Maharashtra Under regular project mode covers 14 districts with formation, orientation and activity of multi-stakeholder committees in Over 815 villages 120 PHC areas 35 Blocks Currently the CBMP process with lower intensity generalizable mode is being implemented in 1490 villages and 65 blocks of 23 districts of Maharashtra.

Institutional mechanism for implementation of CBMP Levels of committees for Feedback & Action State Planning & Monitoring Committee District Monitoring & Planning Committee Action Feedback Block Monitoring & Planning Committee PHC Monitoring & Planning Committee Village Health, Water supply, Nutrition and Sanitation Committee

Composition of CBMP committees Public Health officials Elected representatives – Panchayat members Representatives from lower committees and community members CBO / NGO representatives 6

Key processes in Community monitoring - Maharashtra Data gathering and filling report cards Community awareness programmes Meetings of community based monitoring committees Visits by committee members To health facilities

Public hearings (Jan sunwais/Sanvad): a forum for people’s voice 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 Over 550 Public hearings organised so far at PHC, block and district levels

Progress under CBMP FY 2016-17 Sr. No. Name of activities Activities completed 1. State level meetings, workshop 02 2. District level meetings, workshops 16 3. Block level meetings, workshops 20 4. Monbitoring and Planning committee meetings at PHC, CHC 82 5. VHNSC meetings 600 6. Awareness programs at village level 52 7. Data collection at village level 90 DECENTRALIZED HEALTH PLANNING PROCESS 8. Collection of People’s Demands at village level 160 9. District and block level workshops, meetings 46

Resource material produced under CBMP Since last 9 years, Under CBMP process total 116 different Kinds of CBMP publications (brochures, booklets, tools, posters, report cards, policy briefs etc.) which have been disseminated across Maharashtra.

Significant improvements in health services in CBM areas Practice of PHCs prescribing medicine from private shops has largely stopped Illegal charging by certain medical officers has now been checked; challenging corruption Frequency of visits of ANM and MPWs in villages has improved Rude and abusive behaviour stopped Definite improvement in immunisation coverage Non-functional sub-centres, mobile units, lab facilities now started functioning Significant rise in outpatient, inpatient utilisation in CBM areas

Community helps to solve problems of health care providers In Bhongowali PHC in Bhor block of Pune district, the doctor was not staying at the PHC. Raised during Jan Sunwai, he complained that he did not have quarters. A CBM committee member offered to arrange a house for him in the village on the spot. Today doctors are regularly staying at the PHC even at night.

State level recognition by CBMP process to well performing health care providers

Community Based Monitoring and Action of ICDS Expansion CBM concept in other social sector such as Nutrition. SATHI is the state nodal organization for CBMA ICDS in Maharashtra since 2013 with the support of Women and Child Development (WCD) department of Maharashtra. Leading implementation of Community based Monitoring and Action of ICDS in 189 Anganwadis of 9 districts of Maharashtra from 2013.

Strengthening VHNSCs and RKS

RKS and VHSNC Maharashtra developed various strategies to strengthen the functioning of these two important community level committees Formed State level Support group for strengthening RKS and VHSNC comprising of NHM PO, SHSRC consultants, SATHI representatives and State RKS and VHSNC trainers The group will primarily involved in developing and executing strategies for strengthening these committees (Eg: RKS coordinators capacity building workshop, Filed mentoring visits, Small studies to understand the gaps etc.)

GramSabha

Grievance Redressal Mechanism in Maharashtra

State level Grievance Redressal Cell State Grievance Redressal Cell was established in September 2009 at State Level under National Health Mission, Mumbai. The Hon. Commissioner (FW) & Director, NHM is the aultimate authority of the Statel level Grievance Redressal Cell. At State level there is a separate Telephone number (022-22662626) to registered grievances.

Circle level Grievance Redressal Cell At each Circle Level, total 8 Grievance Redressal Cells have been established in the year of 2010-11 under Dy. Director, Health Services, Maharashtra. Each circle level there is a separate Telephone number to registered a grievances. Circle level Grievance Redressal Cell Committee 1) Dy. Director, Health Services, Circle Offices Chairman 2) One Retired Judge or Sr. Press Reporter of the City Member 3) One Representative of NGO 4) Circle Programme Manager Member Secretary

District level Grievance Redressal Cell The State Health Society established Grievance Redressal Committee/ Cell under 35 Districts in the year of 2012-13. The District Programme Manager (DPM) is looking after the all grievances. District level Grievance Redressal Cell Committee 1) Chief Executive Officer, Zilla Parishad Chairman 2) District Health Officer, Zilla Parishad Member 3) Civil Surgeon, Civil Hospital 4) District Programme Manager, Zilla Parishad Member Secretary 5) Administrative Officer, District Health Department, Zilla Parishad Based on recommendation from CBMP, the State Health Society will be established at Block level Grievance Redressal Cell /Committee in 2017-18.

Various sources for collection of grievances at different levels Written applications from complainant Via telephone call (HACC – 104, registered GRC telephone number) Via email

Details of number of complaints under Grievance Redressal Cell at various levels Year No. of Complaints Received No. of Complaints Resolved No. of Complaints in process State 2015-16 300 298 2 2016-17 (till Dec. 16) 44 33 11 Circle 1830 1797 1160 893 267 District 2117 1951 166 1444 1143 301

Plans for scaling up in FY 2017-18 Planning to cover all tribal districts (16 districts) of Maharashtra under CBMP process Generalising community monitoring in voluntary mode in various new districts and regions Strengthening Community Based Planning process under Decentralized Health Planning by using existing spaces/structures such as RKS committee, VHNSC, Gram Sabha Block level federations, grievance redressal facilitation cells, resource units working with youth Decision to organise ‘Arogya Gram Sabhas’ in all villages where services can be reviewed, planning decisions can be taken

Thank you!!!!!!!!!