Regional Workshop on Community Action for Health Meghalaya Date: 24th & 25th Jan 2017

CONSTITUTION & COMPOSITION OF STATE AGCA/SMG State Advisory Group Community Action was constituted in March 2011. The State felt the need of adding few more members, so it was reconstituted on July 2015 with new members.

3 Districts, 9 Blocks, 27 PHCs, 135 VHSNCs EKH JH WGH FREQUENCY OF THE STATE AGCA/SMG MEETINGS DURING FY 2016-17 SMG meeting was held only on the 1st & 2nd Sept 2016 this FY 2016-17. SCALE OF THE IMPLEMENTATION OF CAH-DISTRICTS, BLOCKS, VHSNCS Pilot Stage (2011-14) 3 Districts, 9 Blocks, 27 PHCs, 135 VHSNCs EKH JH WGH 3 Blocks 3 Blocks 3 Blocks 9PHC 9PHC 9PHC 45Vhsnc 45Vhsnc 45Vhsnc Scale up in few more villages (till date) 5 Districts, 9 Blocks, 27 PHCs, 189 VHSNCs EKH WJH EJH WGH SWGH 3Blocks 2Block 1Blocks 1Block 2Block 9PHCs 6PHCs 3PHCs 3PHCs 6PHCs 63Vhsnc 42Vhsnc 21Vhsnc 21Vhsnc 42Vhsnc

INSTITUTIONAL MECHANISM FOR IMPLEMENTATION OF THE CAH Implemented through Community Process support structure/civil society/mixed – Meghalaya implemented CAH both through the NGOs & Support Structure State level- State Advisory Group on Community Action Cum State Monitoring & Planning Committee (SAGCA)/ State Mentoring Team, State Nodal Officer, State Nodal NGO (VHAM). District level-District Monitoring & Planning Committee Cum District Mentoring Team, District Nodal Officer, District cum Block Nodal NGO, DPMU. Block level- Block & PHC Monitoring & Planning Committee as well as the BPMU. Village level- VHSNC cum Monitoring & Planning Committee Convergence with stakeholders of various line departments like ICDS,PHE etc. is happening at all levels.

APPROACH TO KEY PROCESSES UNDER CAH: Awareness generation on entitlements – Implementing NGOs conduct awareness at the community level along with the district & block teams. Strengthening of VHSNCs including availability of untied fund, training and regular mentoring – Orientation & re-orientation of the VHSNC members, training on the important, roles & responsibility of the members, training on VHAP is another key initiative taken up under this programme. Strengthening of Rogi Kalyan Samiti, Planning and Monitoring Committees or equivalent- Orientation & re-orientation of the (PHC MPC) PHC Monitoring and Planning Committee but more participation is required & regular meeting is under process. Community enquiry- Initially conducted by the NGOs but now community members are taking up the initiative to conduct the enquiry in almost all the implementing area except garo hills district. Jan samwad and follow up action – Are being held at the Block level of the implementing blocks. Issues are being informed to the Concerned department and follow up during the review meeting at different levels.

Mechanisms to address the gaps identified - Gaps are being address at different levels ie PHC, Block & District levels. Some issues are also being address during the Jan Samvad. Grievance redressal mechanisms – Not available Progress under CAH as per approved RoP FY 2016-17 Training of District & Block Team (DPM/DCPC/DHEO/NGO/BPM etc) on strengthening the implementation of CAH programme completed. The state is in the process to train the core members from community level for implementation & strengthening the programme. (this need to be done in consultation with the headman from the community) Renewal of MOU with the implementing NGO completed except with an NGO from Garo Hills District in progress. District workshop cum review meeting is in progress. Strengthening of the community (a continuous process activity) done and in progress at the field level.

RESOURCE MATERIAL PRODUCED UNDER CAH SUCH AS IEC, FILMS, BOOKLETS, MANUALS ETC. Documentary film which has been initiated by the District Nodal Officer, East Khasi Hill is completed and showed in the local news channel. Poster on VHSNC roles & responsibility is initiated in EKH to be followed in JH & WGH. Leaflets on VHSNC roles & responsibility is initiated in EKH to be followed in JH & WGH. Life cycle approach to health care through videography is under progress. SIRD will be involved in capacity building

CASE STUDIES & BEST PRACTICES IN COMMUNITY ACTION People of Khasinda village access health services from the Primary Health Centre located in Shella block, East Khasi Hills district. This centre would earlier refuse to issue birth certificates for newborns. The community, empowered through the community action process, raised the issue with the Deputy Commissioner, who took prompt action. The PHC is now issuing birth certificates. Mawkajut village has 2 ICDS centres, but only one centre had a building where the services of the Anganwadi Centre can be provided. The community people saw the difficulty of the AWW and Helper of the second centre, to provide efficient services to their beneficiaries from their homes. So together the VHSNC in collaboration with the Village Dorbar mobilised and generate funds by themselves and constructed another Building for the new ICDS centre in the year 2016.

CASE STUDIES & BEST PRACTICES IN COMMUNITY ACTION Wapung Pamra PHC of Khliehriat block in East Jaintia Hills of Meghalaya is one of the biggest PHCs in Meghalaya covering a population of 30,770. However, it was not been able to function as a 24x7 PHC due to non-availability of potable water. The Medical Officer in the PHC tried his level best to solve this water problem as the people could not access In-patient Department services in the PHC. He discovered a water source in a hilly terrain with the help of the local people, which was not contaminated by coal mines. But, it was 2 kms away from the PHC. In February 2016, the PHC staff along with the people from the Wapung Shnong village tried to bring this water to the PHC through plastic pipes purchased from RKS and Megha Health Insurance Scheme (MHIS) funds. In March 2016, the members from the VHSNCs of Tuber, Mukhaialong, Wapungskur, Pamrapaithlu, Iongkaluh came together and made the pipelines underground. The district NGO, Mih-Myntdu Socio Cultural Welfare Association (MSCWA), which is mentoring the VHSNCs also joined hands in this noble venture.

PICTURES (COMMUNITY PARTICIPATION/SC/PHC) Community work for laying the pipes to the PHC in progress. A small initiative taken by the Community in Mawkajut in building the ICDS centre in 2016

CASE STUDIES & BEST PRACTICES IN COMMUNITY ACTION Village Health Action Plan 2017-2018 was formulated by Mawryngkneng Block, East Khasi Hills as a model for all blocks in the state.

PICTURES (COMMUNITY PARTICIPATION/SC/PHC) Jan Samvad in progress…

Meeting of State Advisory Group on Community Action for Health State Level Review meeting cum Workshop on Community Action for Health. Group work in Progress Meeting of State Advisory Group on Community Action for Health Community meeting in progress at Teporpara Village, Garo Hills

PHC Level Sharing of Report Card, Diengpasoh PHC. Training on CAH for BAKDIL Staffs, Garo Hills VHSNC meeting, Pyrkan Village, Shella. Data collection at Khliehrangnah Village

STATUS OF FUND UTILISATION IN FY 2016-17 ROP approval – 13.36 lakhs Fund utilization – 7.85 lakhs (59%)

Outcome & Experiences from the process Jan Samvad has enabled people to voice their concern on health matters of the community. Certain health centres were not functioning as required and the DMHO concerned has been informed to address this issue. The community have started taken ownership of health services and facilities within the community. The villagers have started to undergo institutional deliveries and regular ANC checkup. VHSNC members have started to know their roles and responsibilities. Have started understanding that convergence with different departments will help them achieve common health goals.

Concerns & Challenges Coordination and partnership with other line departments. Frequent turn over of trained NGO staffs hampers the programme. Proper documentation at every level. Lack of regular reporting by the NGO from Garo Hills. Mentoring of the VHSNC members so that they can independently take the process of Community enquiry forward. Intersectoral Convergence is weak at the village level, there are several committees but synergy among them needs to be there. Timely disbursal of necessary funds is essential to continue the process – funds excessively delayed are funds denied!

Concerns & Challenges In many hamlets, the participation by women is higher in the VHSNCs. While this is beneficial, it needs to be examined, whether men consider the process as unimportant and whether there is a danger of it being subverted, if, only women continue to manage the process.

Way forward/Future Plan Strengthening few proactive VHSNCs Committees. Once Village Heath Report Card is generated by the community then the critical gaps can be identified and the system can respond to fill the gaps. Awareness about the entitlements. The process of each activity will be well documented. Improvement in reporting & supportive supervision. NGOs to retain skilled manpower. Convergence will be strengthened. Women Village Leaders needs to be trained specially VHSNC women members. Build capacities of the implementing partners and the VHSNCs in CAH. For this we will require technical support from the State NHM/ Nodal agencies.

Way forward/Future Plan Long term commitment for Communitization process and adequate support from the government The State NGO strongly recommends continued support from the MoHFW for the process. The process still needs significant nurturing and direction from MoHFW. There is a need for technical and financial support to ensure that the process continues to be implemented in the pilot districts/blocks/villages as well as initiated in other districts/blocks/villages. CAH has shown significant success in the past 5 years and there is a need to scale it up to other districts to imbibe a sense of empowerment required Scaling Up in 2017-18 The state may plan to scale up in new Blocks of the implementing district.

SAMPLE STRATEGIES Issues identified Block Actions taken Advocacy strategies REMARKS Lack of Water Supply in Nangbah and Wapung Pamra PHC Thadlaskein and Khliehriat Water was tested and sent to PHE MCSWA,VHAM,NHM,DMHO to jointly follow up on the same with PHE MCSWA can find out from the community which is the nearest source of water that can be supplied to the PHC. Then report to the PHE Department . Done Lack of medicines All blocks and PHCs Meeting with the MOs of all the PHCs then DM&HOs of both East and West Jaintia Hills And VHAM have also filed RTI to get the list NHM to bring the matter up with SAGCA and NAGCA

Graph 01: Availability of Infrastructure Graph 02: Availability of Staffs Graph 03: Maternal Health Services Graph 04: Child care & Immunization Services

Graph 05: Maternal Health Services Graph 06: Child Health Services Graph 07: ASHA Support Services

Example of active Community Participation in Chokpot CHC (Non CAH facility/district)

VHSNC INFORMATION BOARD DISTRIBUTED TO ALL THE fACILITIES

THANK YOU