An experience from implementing Decentralized Participatory Health Planning (DPHP) process in Maharashtra A process of conversion of people’s demand into budget proposals (PIP) Presented by Dr. Nitin Jadhav SATHI- Support for Advocacy and Training to Health Initiatives

Obstacles faced while working in context of PIP- The government’s process of preparing the PIP is often completed in very short time due to certain larger constraints. There are very few spaces in this PIP process for community members to present their health needs and for them to be incorporated in the PIP. The current PIP framework is complicated and allows limited flexibility, hence it needs to be modified and simplified to enable greater participatory inputs. The local Health officers and providers have not been oriented about the importance of ensuring participatory and community based processes while preparing the PIP.

Proposed Scale of DHP process District Block PHC PHC PHC Village Village Village Total 260 villages, All PHCs covered under 26 blocks from 14 CBMP districst

People’s health priorities have been received from ... 205 Villages 77 PHC 30 Blocks 14 Districts

Level wise analysis of people’s priorities discussed from 14 districts Total 1860 issues raised from 205 villages

Top 5 health priorities emerged from community mobilization process at various levels   Village level SC level PHC/PHU level RH/SDH level HR vacancies & gaps 31 38 95 76 Availability of facilities & services 136 160 Staff attendance &/ stay at HQ 47 70 Outreach services 176 51 Referral 28 Malnutrition related care & quality of care 32 Additional facility 26 Water/sanitation and Cleanliness 34 Building Construction and Repairs 63 Equipments related 29 Medicine related 91

Other than health, priorities expressed by community during meetings from 205 villages Water facilities in village Sanitation system in village ICDS services Kitchen facility/ THR (packet food distributed in anganwadi) Roads and accessibility & transport system

Priorities/needs can be resolved through Analysis of priorities from 6 districts after district & block level consultation meetings   Priorities/needs can be resolved through Name of District Policy/ Systemic district level action PIP RKS CBMP Total Issues raised Amravati 31 51 42 3 127 Aurangabad 25 2 16 45 Beed 67 34 40 11 155 Osmanabad 12 9 4 1 26 Pune 89 92 50 8 250 Solapur 18 37 233 206 161 22 640

Some of examples of people’s health priorities to be included in PIP Facilities & services in health institutions (Sonography, x-ray, caesarean delivery, hot water & water facility in in institution premises, sanitation & waste management etc) 65 Additional facility (Maherghar, dharmashala, kitchen shed) 20 Building Construction/ Repairs (New constructions and repairs in health institutions) Equipments related (Nebuliser, BP aparatus , weighing machine in SCs) Diet/ Food facility (Food facility for admitted patient, delivery patent along with one relative) 11 Medicine related (BP, Diabetes, Asthma medicines, Test Kits for ASHA) 14

Tools and mechanisms for DHP

Proposed stakeholders Step- 1: Community mobilization for identification of community priorities/needs Activity Proposed stakeholders Meetings with VHNSC and community with participation of active community members, marginalised people and women VHNSC committee Community especially marginalized community groups and women Tools and techniques-  - Awareness materials such as poster, slide show, flex posters about PHP process. - Gram Sabha, discussion guide on health planning, micro-planning techniques such as PRA etc. Minimum 5 prioritized needs about Village and sub centre level health services PHC related health services RH/SDH related health services

Proposed stakeholders Step-2: Compilation, categorization and prioritization of community priorities/needs Proposed stakeholders Activity Members of RKS committee Members of Monitoring & Planning committee Medical Officer and staff of PHC RH superintendent and staff of RH level Joint meeting between RKS committee and Monitoring & Planning committee in each selected PHC and RH Tools and techniques- Template for categorization and prioritization of people’s health priorities. Issues which can be resolved through dialogue or through CBMP. Issues which require budget/funds (RKS or PIP). Systemic or policy level issues which can be resolved at state or district level. Catogorization

Proposed stakeholders Step- 3 : Compilation of community needs at block level and development of budget proposals based on prioritized community needs Proposed stakeholders Activity Chairperson and active, interested members of RKS committee from each selected PHC and RH THO office and block accountant Medical officers and RH superintendent District NHM cell especially DPM, DAM Block level workshop for various stakeholders. Tools and techniques- Template for formulation of budget proposals. List of potential sources of funds. Criteria for scrutiny of budget proposals. - To orient and understand about DHP to RKS committee - To discuss and finalize action plan related to community needs which can be resolved through PIP budget.

Step- 4: Finalization of budget proposal at district level Activity Proposed stakeholders Multi-stakholder district level meeting including DPDC/District Monitoring and Planning committee Members of District Planning and Development Committee DHO and CS DPM and DAM Tools and techniques- - District level PIP preparation guidelines and budget template - To scrutinize and give final approval to devloped budget proposals - To discuss and develop plan of action for intervening in the next year’s PIP preparatiom process

Proposed stakeholders Step- 5: State level review of included community needs based proposals in district PIP Activity State AGCA meeting for reviewing budget proposals and addressing policy and systemic level issues Proposed stakeholders MD, NHM, Maharashtra Members of State Mentoring Committee NHM senior officials SPM and SAM Representatives of SHSRC CBMP implementing State nodal organization Tools and Techniques- Criteria for scrutiny of budget proposals. State level PIP preparation guidelines and budget template

Enabling factors Investing adequate time and giving priority to DPHP process by district and state level Health officials. Investing adequate resources for effective implementation of DPHP process. Engaging external force/agency like community based active groups, Civil Society Organizations for facilitating and coordinating community mobilization processes.

Thank you!!!!