Regional Consultation, New Delhi February 10, 2016 Update on implementation of Community Action for Health under the National Health Mission Regional Consultation, New Delhi February 10, 2016

Accountability Framework National Health Mission (NHM) Three pronged approach External surveys Routine program monitoring Community based monitoring

Advisory Group on Community Action (AGCA) Group of civil society experts constituted by the MoHFW in 2005, with Population Foundation of India (PFI) as the Secretariat Mandate : Advise on developing community partnership and ownership for the Mission Provide feedback based on ground realities to inform policy decisions – community monitoring , Common Review Mission, fact finding missions Develop models on community action

Process Monitoring and information sharing of data on health services Education and awareness generation Community awareness on health entitlements Display of citizen’s charter and service guarantees in health facilities Training of VHSNC, RKS and Planning & Monitoring Committees Monitoring and information sharing of data on health services Collection of information on community experiences of health services Compilation and sharing village and facility report cards Regular meetings of Planning and Monitoring Committees at block, district and state levels to take decisions on issues and gaps Public dialogue Periodic public dialogue (Jan Samwaad) - Engagement with providers based on community evidence Follow up action to resolve issues and gaps Including incorporation into the District and State Programme Implementation Plans (PIPs) A systematic approach was adopted in the implementation of community action. This involved : Structured trainings for VHSC members and block and district planning and monitoring committees Use of folk media and communication materials for dissemination of information on NRHM and its health entitlements Display of citizens charters and minimum service guarantees (including roles and responsibilities of service providers, timings of services) at the village and in health facilities Community enquiries were done through community meetings and information was collected for health facilities through direct observation and exit interviews. This was done at an interval of six months. Multi-stakeholder committees were formed and trained to feed inputs emerging from the community enquiry and facility surveys for planning and corrective actions. Block, District and State Level Jan Samwads (Social audits) were organized to share instances of denial of services and outcomes of the community monitoring process.

AGCAs support Facilitate state level visioning and planning exercises, including development of State PIPs Develop/adapt guidelines, manuals, communication materials documentary films, TV and radio spots, IEC materials on health entitlements, newsletter Develop capacities of state nodal officers and implementation organizations Regular mentoring and guidance to states on programme implementation Undertake programme implementation reviews Documentation and dissemination of best practices community action models, grievance redressal, decentralized health planning

2015-16 – Proposed in 26 States’ & UTs PIP Scaling up 2015-16 – Proposed in 26 States’ & UTs PIP 2015-16 – Approved in 19 states Rajasthan Gujarat Maharashtra Karnatakac Madhya Pradesh Uttar Uttarakhand Orissa Chhattisgarh Bihar Jharkhand Assam Nagaland Manipur Arunachal Pradesh Mizoram Meghalaya Tripura Sikkim Kerala Punjab Delhi Daman & Diu Himachal Pradesh West Bengal Goa Rajasthan Gujarat Maharashtra Karnataka Madhya Pradesh Uttar Uttaranchal Orissa Chhattisgarh Bihar Jharkhand Assam Nagaland Manipur Kerala Arunachal Pradesh Himachal Pradesh Delhi Goa Meghalaya Mizoram Sikkim Tripura Punjab West Bengal The AGCA guided the implementation of a pilot, which was implemented in 9 states, 36 districts and 1600 villages. 26 States and UTs- include 19 approved states, 4 non approved, 2 pending states and one UT (Daman and Diu) not approved. 19 approved states- Arunachal Pradesh, Assam, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Meghalaya, Mizoram, Odisha, Punjab, Sikkim, Tripura, Uttar Pradesh, Uttaranchal, West Bengal, . Approved Approval pended Not approved

Implementation in the States Component included by 25 states News states: Tripura, Himachal Pradesh and West Bengal Approvals as per Record of Proceedings (ROP) – 19 states (Arunachal Pradesh, Assam, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Meghalaya, Mizoram, Odisha, Punjab, Sikkim, Tripura, Uttar Pradesh, Uttaranchal, West Bengal) Budget Proposed: Rupees - 49,84,56,000 Approval: Rupees- 27,70,22,000 (23 % increase*) Approval (FY 2015-16): Rupees - 22,49,11,000 Pending approval states: Rajasthan, Uttar Pradesh, Nagaland and Manipur Rajasthan : Budget Rs.2.17 crore No detailed plan submitted. Nagaland : budget of Rs. 39.51 lakh (covering 2 districts) Manipur: Budget Rs. 15.00 lakh No detailed plan submitted.

Priority areas- going forward Support states in mentoring of VHSNCs to enable community level planning and monitoring Strengthening of RKS as per the MoHFW guidelines in selected states Support states in operationalizing grievance redressal mechanisms Coordinate with the Ministry of Panchayati Raj to build capacities of PRI members on health and its determinants Guide states in contextualizing the implementation mechanisms and scaling up implementation Pending approval states: Rajasthan, Uttar Pradesh, Nagaland and Manipur Rajasthan : Budget Rs.2.17 crore No detailed plan submitted. Nagaland : budget of Rs. 39.51 lakh (covering 2 districts) Manipur: Budget Rs. 15.00 lakh No detailed plan submitted.

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