1. Community Action on Health ChhattisgarhChhattisgarh

2. In order to strengthen community participation in health 1.Village Health Sanitation and Nutrition Committees (VHSNCs): aprox.19000 2.Community Based Monitoring (CBM): In all 146 blocks 3.Swasth Panchayat Yojna

3. Structure of Mitanin (ASHA) Cascade LevelUnitState At Hamlet level1 Mitanin in approx. 200 to 300 populationTotal 66220 At Cluster level1 Mitanin Trainer on 20 MitaninsTotal 3150 At Block level1 Block Coordinator on 10 Mitanin Trainer so 2 BC in each block Total 292 1 another block coordinator on each block which is called SPS specially for VHP Total 176 At District Level1 District Coordinator on average 4 blocksTotal 35 At State Level1 SPC (Lead-Community Process) 8 Programme Coordinator (Training, SPY, VHSNC, CBM, Mitanin Incentive, Fulwari, MHD, MKK, Study & Research work) 3 Programme Associate at field level Total 12

4. LevelComponent At Village levelGap identification and Village Health Planning & Action At Cluster levelCluster meeting of avg 10 VHSNCs At Block levelPublic Dialogue (Jan-Samvad) At District LevelGiven reward to top 3 Panchayats of each block At State LevelCommunity Monitoring Report Key processes and components of community intervention

5. Process of Village Health Planning 1.Gap Identification: Identify the gap through - Village Monitoring Register based on 27 indicator Monthly monitoring of deaths Identify the weak hamlet 2.Identify the possible cause 3.Find the solution 4.Responsibility taken 5.Time limit 6.Review

6. 1.1 Village Monitoring Register The indicators include aspects : 1. Access to Local Health Services – Whether monthly immunization session conducted by ANM – Whether BP measurement done in ANC by ANM – Whether drugs provided free of cost by ANM – Whether anti-malarial drugs available with Mitanin – Whether referral transport available – No. of non-institutional deliveries – No. of families not using mosquito bed-nets

7. Indicators contd… 2. Health Status: Morbidity: – No. of Cases of Diarrhea – No. of Cases of Fever/malaria Malnutrition: – No. of malnourished children in 0-3 year age group Violence: – No. of cases of domestic violence against women

8. Indicators contd… 3. Access to food security, water, sanitation, education – No. of non-functional hand-pumps in village – No. of schools without functional toilet – No. of girls (6-18 years) out of school – Whether teachers in Government schools taught regularly – Whether subsidized food-grain entitlements given by Public Distribution System (PDS) – Whether NREGA wages paid in time – No. of children not accessing ICDS – Whether ICDS provided both pulses & vegetables all days for 3-6 yr olds – Did ICDS provide weekly Rations for under-3 yr olds each week – Did Mid-day school meal provide both pulses & vegetables all days for 3-6 yr olds

9. Compilation of Village Monitoring Register At state level we have compiled data of one month on 27 indicators from 17615 VHSNCs Generate ranking of each Panchayat based on their score Share it with block and district level officers Given the cash reward to top three Panchayats (12000, 8000, 5000) of each block

10. Collector giving Reward to Sarpanch at Bastar District

11. Collector giving Reward to Sarpanch at Bemetara District

12. Reward for Sukma District

13. 1.2 Death Register at VHSNC Level For each death, VHSNC also tries to record the probable cause of death as reported by the community. The death register has following structure: 74279 rural deaths were recorded by VHSNCs in year 2014 Name of the person Father' s / Husba nd's name AgeCasteGende r Name of Village Pancha yat Date of Deat h Communit y Reported Probable Cause of Death Pregna nt wome n (Yes/ No)

14. Reporting Causes No. Of Deaths ReportedPercentage Fever/Malaria 39625.3% Neonatal causes (asphyxia/sepsis etc) 32624.4% T.B. 17952.4% Pneumonia 11991.6% Jaundice 16422.2% Diarrhea 9491.3% Maternal causes 3260.4% Low-birth weight/Malnutrition 10461.4% Accidents 37225.0% Suicide 27283.7% Snake-bite 5850.8% Murder 3360.5% Dog bite 1180.2% Convulsion4850.7% Old age & others 5212470.2% Total 74279100% Causes of Deaths Reported by village community

15. 2. Village Health Planning and Action After identify the gaps to act upon through their planning. The Village Health Register identifies the gaps as well as the habitation where a specific gap is more prominent. The Village Health Register has the following structure: 75% villages doing the village health planning. IssueName of the hamlet where the issue exist Possible cause identified by villagers Possible solution sought by Villagers Person responsible to get the work done Date of work to be done Review (in next meeting)

16. Sample VHP

17. 3. Cluster Meetings of VHSNCs 1.Each cluster consist of avg 10 VHSNCs (10 to 15 cluster per block) 2.Share their learning and to solve the common problems 3.Its facilitated by Block Coordinator 4.It is happening in 145 blocks

18. VHSNC – Cluster meeting

19. 4. Public Dialogue (Jan Samwad) at block level 1.Listing of village wise issues like status of health care services, ICDS and PDS services, water, sanitation, education etc 2.Compilation of issues at block level 3.Prepare a memorandum and present at the time of public dialogue 4.Memorandum gives to the govt officers 5.District and block level officers (Collector, CMHO, BMO, CEO) and Elected representative (MLA, Sansad) are answer and accept the memorandum 6.The whole process is facilitated by SPS (Block Coordinator) 7.Around 140 out of 146 blocks had organized public dialogue in year 2014-15

20. Public Dialogue (Jan Samwad)

27. 5. Community Monitoring Report Compilation of Village Health Monitoring Registers Compilation of Death report Collection of Community Feedback on Health Services (Interview of Mitanin, Mother and PRI for SHC and PHC) Exit Interviews of patients from CHCs and District Hospitals (OPD & IPD) Report on Jan Samwad (Public dialogue) events

28. Community Monitoring Report

29. Outcomes 13000 villages out of 20000 are keeping monitoring and death register at VHSNC level 75% Villages done the Village Health Planning More than 1000 VHSNC clusters active, meetings regular in around 85% of them Public dialogue (Jan Samwad) done in 140 out of 146 blocks in 2014-15 CBM Report has created awareness on critical health gaps Verbal autopsy of Maternal & Child death has provided evidence on causes of deaths which were not reported in regular systems

30. Outcomes A large no. of problems getting addressed at the local level Some of systemic problems addressed through Jan Samwad Community in form of VHSNC have gained capacity to assess gaps and act on them, even demand action from relevant authorities on certain items Large coverage and Cost-effective due to involvement of ASHA Support Structure

31. Thanks