Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore For National Consultation on Community Action for Health (CAH) October 28-29, 2014, New Delhi Inclusion of Urban Poor in Maternal Health Service Delivery in Bangalore

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore The Community Participation model Formation of Maternity Home Monitoring Committees (MHMCs) by users of maternity homes run by the Bruhat Bengaluru Mahanagra Palike (BBMP) to advocate for improve maternal health service delivery The Study/project  A two-phased three and half year project carried out by Public Affairs Centre with support from the International Budget Partnership (IBP)  Implemented on the ground with three NGO partners located in Bangalore – SPAD, APSA and CFAR.  Process included using of reputed social accountability tools such as Citizen Report Cards (CRCs), Budget Analysis, and Community Score Cards (CSCs) to  collect evidence, and  use the same through a forum to help monitor service delivery  with a joint action agenda by both the staff and the MHMCs Reason for this study  A benchmarking CRC exercise carried out in 2000, with subsequent efforts by NGOs and the BMP to take corrective action  Repeat CRC among Maternity Homes to measure improvement and implement more proactive budgetary and service quality improvement measures Background

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Aimed at assessing, improving and deepening the quality of services provided by these Maternity Homes in Bangalore Phase I objectives  involve the community in demanding for or monitoring the improvement of services in the maternity homes  involve the community for transparency and accountability in budget preparation and expenditures to be able to provide better services to the urban poor women of Bangalore Phase II objectives  carry out budget advocacy for improved access to budget information at the unit level (MH) and improved allocations for ‘Madilu Yojane’  test the replicability of the knowledge product - the draft toolkit  strengthen the community monitoring mechanisms to improve the quality of services in the Maternity Homes. Limited to antenatal, delivery, postnatal, immunization and family planning services provided at the Maternity Homes in Bangalore Objectives

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Implementation framework – the Impact Plan

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Implementation framework – Achievement of Impact

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Process of the formation of MHMCs

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Successful application of social accountability tools to collect, compile and present evidence to advocate for user monitoring of Maternity Homes Volunteering of MHMC members, also user/user representatives, to monitor availability and quality of services in a cooperative manner Successful buy-in from the BBMP Health Department to ensure access by MHMC members into the Maternity Homes for monitoring Creation of space for regular interaction between users and Maternity Home staff (interface meetings held quarterly) Increase in accountability from the Maternity Home staff Increase in engagement between users and Maternity Home staff Entitlement sharing exercises leading to capacity building among MHMC members to share concerns clearly with other stakeholders Key achievements

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Challenge – convincing service providers of the advantages of working with the user community Learning – initial buy-in from senior officials and passing down of appropriate approvals to staff to smoothen interaction processes Challenge – Finding unit-level data to advocate for better budget allocation per MH and implementation of schemes e.g., the Madilu Yojane Learning – Interaction with other programme implementers (e.g., NRHM) to arrive at costs for influencing budget enhancement Challenge – Sustainability of the MHMCs due to lack of ‘official’ recognition Learning – Advocate to include users in official spaces, in this case the Board of Visitors; important to continue external facilitation and support till this is achieved Key challenges and learning

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore Production of report and a maternal health toolkit comprising details of using evidence-based approaches to raise user voice and participation Same set of tools successfully applied in the case of the ESI (Employees’ State Insurance) system for garment workers; also used at the next level – Referral Hospitals leading to formation of RHMCs Lack of financial resources affecting sustainability of the MHMCs and RHMCs Need to take this pilot project forward to all health units – creation of participatory forums OR incorporation of users into existing monitoring mechanisms with adequate capacity-building to demand better services Way forward….possible scale-up?

Meena Nair, Head – PGRG, Public Affairs Centre, Bangalore THANK YOU Our contact details: