1. 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

2. 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.

3. 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

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

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

7. 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

8. 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

9. 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

10. 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

11. Tools and mechanisms for DHP

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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.

18. Thank you!!!!