Transcript of Presented by: Programme Management Unit ASHA; Community Processes & Intersectoral Convergence SHS,...
- Slide 1
- Presented by: Programme Management Unit ASHA; Community
Processes & Intersectoral Convergence SHS, NHM, J&K
Community Based Monitoring & Planning (Proposal for NGO
Involvement)
- Slide 2
- Introduction Panchayats in India are an age-old institution for
governance at village level. States have to encourage all the steps
to devolve greater powers and funds to Panchayati Raj Institutions.
In Jammu and Kashmir, the roots of Panchayati Raj were planted by
Maharaja Hari Singh in 1935 by promulgation of the Jammu and
Kashmir Village Panchayat Raj. A special Department of Panchayati
and Rural Development was created in 1936 to administer the 1935
Regulation which stated, it is expedient to establish in Jammu
& Kashmir State the village panchayats to assist in the
administrative, civil and criminal justice and also to manage the
sanitation and other common concerns of the village.
- Slide 3
- By an amendment in 1941, the list of functions of the 1935
Regulation were widened. By an Act of 1951, the Panchayati Raj
Institutions (PRI) was adopted to be re-established. The Jammu and
Kashmir Government thereafter enacted the Village Panchayati Act in
1958 replacing the 1951 Act. The J&K state has been one of the
pioneering states in the field of decentralized district planning
with the introduction of an innovative initiative of Single Line
Administration in 1976. The underlying objective of this model was
to decentralize the authority with a view to accelerating the pace
of developmental programmes and involve peoples participation in
the process of development. This realization finally led to the
introduction of Jammu & Kashmir Panchayati Raj Act 1989. This
Act provides for a three tier system (village, Block and District
level) for goverence at the grass roots. The institutions
accordingly in J&K are called Halqa Panchayat, Block
Development Council and District Planning and Development Board
respectively.
- Slide 4
- In the Sate of J & K the devolution of powers to the PRIs
pertaining to H & FW Dept. have been executed as in the
following Govt. Order:-
- Slide 5
- In 1992, through the enactment of the 73 rd Constitutional
Amendment, Panchayati Raj Institutions (PRIs) were strengthened as
local government organizations with clear areas of jurisdiction,
adequate power, authority and funds commensurate with
responsibilities. Panchayats have been assigned 29 rural
development activities, including several, which are related to
health and population stabilization. The XI schedule includes
Family Welfare, Health and Sanitation, (including hospitals,
primary health centres, and dispensaries,) and the XII schedule
includes Public Health. Thus the possible realm of influence of the
Panchayats extends over a significant proportion of public health
issues. The Gram Sabha, where empowered has the potential to act as
a community level accountability mechanism to ensure that the
functions of the village Panchayat in the area of public health and
family welfare, actually respond to peoples needs.
- Slide 6
- Increasingly it is being realized that strategies for achieving
low infant, under five and maternal mortality depend on a
functioning continuum of high quality services from community to
secondary and sometimes higher levels of care. In addition
community support for such services comes through behaviour change
to increase utilization as well as demand high quality services. In
the RCH 2 implementation document, specific mention is made of
plans to support PRI (and urban counterparts) in design,
implementation, monitoring of RCH related interventions. This is
also seen as a potential to address the social determinants of
health through engagement with communities and PRI rather than a
biomedical approach in isolation. It is expected that PRI
involvement will increase community understanding of issues of
accountability for quality and reliability of health care services.
Thus there is opportunity for PRI involvement to address the non
technical components of health care seeking, provided all PRI
representatives are exposed to a perspective building exercise on
health within the framework of gender and equity.
- Slide 7
- National Rural Health Mission, designed to integrate health and
family welfare related interventions and address health from a
holistic preventive, promotive and curative viewpoint takes a much
more significant view of PRI engagement. The fulcrum of the NRHM
programme is a social activist (ASHA) at the village level, who
works with the village level resource team in providing preventive
and promotive health care services. It is expected that she will be
supervised and supported by the panchayats. One of the core
strategies of the NRHM is to empower local governments to manage,
control and be accountable for public health services at various
levels.
- Slide 8
- The Village Health, Sanitation & Nutrition Committee
(VHSNC), the standing committee of the Gram Panchayat (GP) is
expected to provide oversight of all NRHM activities at the village
level and supposed to be responsible for developing the Village
Health Plan with the support of the ANM, ASHA, AWW and Self Help
Groups. For this there is an immense need to train and enhance
capacity of Panchayati Raj Institutions (PRIs) to own, control and
manage public health services which though is evolving a lot is
still needed to be done to maximize the function of PRIs. The
Village Health, Sanitation & Nutrition Committee (VHSNC) forms
the link between the Gram Panchayat and the community. The VHNC is
responsible for working with the Gram Panchayat to ensure that the
health plan is in harmony with the overall local plan. It is
anticipated that this committee will prepare a Village Health Plan
and maintain village level data, supervised by the Gram Panchayat.
Engaging the Gram Sabha and other groups in planning and monitoring
the Village Health Plan will presumably enforce transparency and
accountability.
- Slide 9
- Under the NRHM, untied funds of Rs. 10,000 are placed with the
VHSNCs to meet unanticipated expenditures. A Joint account has been
opened with the Sarpanch and ASHAs for operationlization of the
activities planned. So after considering the functioning of VHSNCs
to put in place the gaps identified, a need is felt to undertake
the subsequently mentioned strategy on priority to achieve the
objective of involvement of PRI as per mandate of NRHM.
- Slide 10
- Proposed Community Based Monitoring and Planning (CBMP) Program
in Jammu and Kashmir Update on communitization initiatives The
following initiatives have been taken by the Jammu and Kashmir
State Health Society (SHS) in implementing the communitization
component through the National Health Mission (NHM): 1. Village
Health Sanitation Nutrition Committees (VHSNC) have been formed in
all 6881 villages of the state in 2011-12. 2. Subsequently, VHSNCs
have been re-constituted to include the newly elected members of
the Panchayati Raj Institutions (PRI's) through a government order
in September, 2011. 3. First instalment of village untied funds
(total amount of Rs 3.25 crores) has been released to 5817 VHSNCs
in 2011-12. The second instalment of funds for FY 2012-13 is 1.09
crore to 6881 committees. Total funds released till date is 4.35
Crores.
- Slide 11
- 4. Interaction meetings/Melas with VHSNC members have been
organized at the district and block level to orient them on the
various components of NHM and their roles and responsibilities.
Approx 34000 VHSNC members have been reached through about 350
block and district meetings. But as per new guidelines VHNSC should
have 12-15 member in which case we may have to orient around one
lac members in the reconstituted committee. Constitution of VHSNC:-
Gram Panchayat Members from the village ASHA, AWW, ANM SHG Leader
The PTA/ MTA Secretary Village representative of any Community
based organization working in the village
- Slide 12
- 5. Rogi Kalyan Samities (RKS) have been constituted in health
facilities at the PHC, CHC and district level. The governing body
of these committees are chaired by the local Member of Legislative
Assembly (MLA) and include officials from the departments of
Health, Integrated Child Development Scheme (ICDS), Public Health
Engineering Department (PHED), Education, along with NGO
representatives. 6. SHS has developed a diary which covers various
aspects of NHM, including roles and responsibilities of ASHA and
VHSNC members. This has been printed and distributed to 4000 Gram
Panchayats in the state. 7. SHS has prepared a booklet on
'Guidelines for Devolution of Functions to PRIs in Health'. This
booklet has been distributed to all line departments and PRI
members in the state.
- Slide 13
- Proposed plan for initiating CBMP The State proposes to
initiate Community Based Monitoring and Planning (CBMP) in NHM
State PIP for 201314. In the first year the programme is proposed
to be implemented in six districts (Jammu, erstwhile Doda and
Rajouri in Jammu division; Ganderbal, Anantnag and Budgam in
Kashmir division) covering 19 blocks. The Advisory Group on
Community Action (AGCA) would provide overall guidance and
technical support to the SHS in implementing CBMP programme. The
key program components would include; 1. Formation and
strengthening of State Advisory Group on Community Action (SAGCA)
and State Technical Advisory Group (STAG) to guide the
implementation of CBMP;
- Slide 14
- 2. Adaptation and translation of VHSNC and RKS guidelines,
training manuals and CBMP tools; 3. Formation and orientation of
planning and monitoring committees at the district, block level;
and 4. Identification and orientation of Nodal NGO's to manage the
implementation of CBMP at the district and block level; 5.
Initiating implementation of CBPM in 1123 villages in 19 blocks
covering 14 CHC and 70 PHC across 6 districts. The details of
program scale proposed in Year-1 (2014-15) is enclosed in Annexure
1.
- Slide 15
- Focus Areas The CBMP process would focus on activating and
building capacities of VHSNC, RKS and Panchayat representatives to
monitor and provide feedback on the functioning of public health
services, including inputs for improved planning on issues such as:
a) demand/ need b) coverage and access c) quality of services d)
behaviour and presence of health care personnel at service delivery
points/ health facilities, and e) identify possible denial of care
and negligence. A grievance redressal mechanism will also be put in
place to resolve the issues/ gaps emerging from the CBMP process at
the block and district level.
- Slide 16
- Key programme components The key components outlined above will
be implemented by a team of professionals based in SHS in
partnership with NGOs at the District and Block level. A. State
Level 1. Formation of State Advisory Group on Community Action
(SAGCA) and State Technical Advisory Group (STAG) to guide the
implementation of CBMP A State Advisory Group for Community Action
(SAGCA) will be constituted for providing advisory support to the
state for implementing CBPM. The SAGCA will be chaired by the
Secretary Health and Family Welfare and comprise senior officials
from the State Health Society, Departments of Health and Family
Welfare, Panchayati Raj, Women and Child Development and NGO
representatives. Representatives from the national level AGCA will
also be included as SAGCA members. SAGCA members will be oriented
to the CBMP processes as implemented in the pilot phase and in
other states. Subsequently, meetings will be organized to
strategize and work out a broad plan of action for rolling out the
CBMP programme in the state over the next three years. PFI/AGCA
members will facilitate the orientation and planning exercise.
- Slide 17
- A Technical Assistance Group (TAG) will also be formed to
provide technical support to the process. The STAG will comprise
representatives from NGOs working on health and rights based
approaches. It will also have representatives from the State Health
Society and its meetings will be convened by the Nodal Officer
designated by the MD NHM. The AGCA will support in developing Terms
of Reference (TOR) and conduct orientation of the SAGCA and STAG
members. 2. Identification and orientation of NGOs/ CBOs to manage
the implementation of CBMP; A mapping exercise would be undertaken
to identify potential NGOs/ CBOs with capacities and field presence
to implement the CBMP program. Subsequently, NGOs/ CBOs will be
selected/ nominated through a due diligence process. Existing
Mother NGOs (MNGOs) and Field NGOs (FNGOs) will be given
preference, on the basis of their performance in implementing the
Regional Resource Center (RRC) scheme. The NGOs staff will be
trained by the AGCA with support from the team based at the
SPMU.
- Slide 18
- 3. Adaptation of state level guidelines, training manuals,
formats for VHSNC and RKS members The TAG will adapt the VHSNC and
RKS guidelines, training modules to suit the state context.
Selected MNGOs and ASHA trainers will also be invited contribute to
the process. A sub-group will be formed to work on the details of
the guidelines, modules and tools, including translation of the
manuals into Urdu, Dogri and adapting the Hindi version to make it
easier to understand. 4. Formation and orientation of planning and
monitoring committees at the district, block and PHC level
Orientation meetings will be organized at the district level for
key officials from the Health, ICDS, PHED departments. The meeting
would help in developing an understanding among the stakeholders on
the CBMP program and seeking their support in the implementation
processes.
- Slide 19
- District and Block Level 1. Formation and orientation of DPMC
and BPMC members DPMC and BPMC will be formed 19 blocks across 6
districts. This will be followed by an orientation meeting of the
committee members on the CBPM process, including developing an
understanding on their roles and responsibilities. Subsequently,
meetings of these committees will be organized on a quarterly basis
to discuss and resolve issues emerging from the community
monitoring and planning processes. 2. Orientation of RKS members A
state level notification would be issued to reconstitute/ expand
the membership of the RKS to enable inclusion of PRI members and
NGO/ CBO representatives. Subsequently, structured orientation of
the committee members will be organized.
- Slide 20
- Village level 1. Community meetings would be organized to
generate awareness on NHM entitlements and CBMP process. IEC/ BCC
materials (including wall writings) would be developed and
distributed among the VHSNC members. 2. Training of VHSNC members-
Two rounds of structured trainings would be organized for the VHSNC
members. In the current FY, a) basic orientation one day would be
organized for all VHSNC members at the village level b) followed by
a two day orientation of selected members (around 5 members) will
be organized at the Gram Panchayat/ PHC level. The second round of
training for VHSNC members would be organized in the next FY. In
addition, orientation meetings of the ASHA, ANM and Anganwadi
Workers (AWW) will be organized to develop their understanding on
the roles and responsibilities of VHSNC. This would be done through
their ongoing monthly review meetings organized at the PHC / Block
level. 3. Focus will be organizing VHSNC meetings and introducing
tools for monitoring services at the village and health facility
level. Subsequently, village and facility score cards would be
generated and shared with service providers to facilitate dialogue
and corrective action.
- Slide 21
- Proposed Operational Mechanism and Human Resource Structure A.
State Level The AGCA would provide technical support and guidance
to the SHS team in rolling out the CBMP program. This would
include: 1. Developing the Terms of Reference (TOR) and support in
constituting the State Advisory Group on Community Action (S-AGCA)
and Technical Assistance Group (S-TAG); 2. Developing guidelines,
criteria and processes for selection of NGOs; 3. Co-facilitating
trainings and orientation of implementing partners; 4. Adaptation
of guidelines, training modules for VHSNC and RKS; 5. Adaptation
tools for community enquiry and facility surveys; and 6. Periodic
review and guidance for implementation of the CBMP programme To
manage implementation of the CBMP program a team of professionals
will be hired. This will include a State Project Officer and 2
Divisional Project Officer(one each in Jammu and Kashmir division)
to implement and manage the CBPM component. In addition adequate
secretarial assistance will be provided to these units.
- Slide 22
- B. District Level In each district, an NGO/ CBO will be
identified to implement the program at the district level. Their
role would include: a) formation and strengthening of District
Planning and Monitoring Committees (DPMC), Block Planning and
Monitoring Committee (BPMC) b) facilitate training of VHSNC and RKS
members c) compilation and analysis of community enquiry data and
facility surveys. Each organization would have two (2) staff, a
District Project Officer and a Training Officer. To manage the
finances, costs for a part time Accountant will also be
provided.
- Slide 23
- C. Block Level In each block, an NGO/CBO will be identified to
implement CBMP activities at the village level and block level.
Their role would include: (a) extension / reconstitution of VHSNC
(b) organizing community meetings to raise awareness on NRHM
entitlements (c) training of VHSNC members (d) organizing regular
meetings of VHSNC (e) initiation of community level enquiry to
assess the availability, access and quality of health services. In
each block, a Block Coordinator along with a team of Community
Facilitators (each covering around 7-10 villages) will be in place.
Difficult to reach districts will have 1 facilitator for 7 villages
and plain districts will have 1 facilitator for 10 villages. To
manage the finances, costs for a part time Accountant will also be
provided.
- Slide 24
- Scale up plans The processes initiated in Year-1 (FY 2014-15)
would help the state in developing a robust implementation
mechanism to support the scale up in the next FYs. The details of
the scale up plan in the subsequent would include: Year 2 (FY
2015-16) 1. Covering remaining blocks from the districts covered in
year one plus few more blocks in identified districts, upto a total
48 blocks in year two. 2. Creating a pool of master trainers (from
existing NGOs/ CBOs) to roll out structured training for VHSNC and
RKS members across the 6 districts. 3. Undertaking a mapping
exercise to identify potential NGOs/ CBOs in the blocks to covered
in year two. 4. Selection of NGO/ CBO in the additional districts
(across all blocks). Year 3 (FY 2016-17) Completion of remaining
blocks across the pending districts.
- Slide 25
- District Jammu S NoBlockVHSNCPHCCHC 1Kot Bhalwal10740
2Dansal10630 3Akhnoor9182 4Marh9031 Total394183 Erstwhile District
Doda S NoBlockVHSNCPHCCHC 1Assar (Doda)4120 2Kishtwar
(Kishtwar)8220 3Batote (Ramban)4521 Total16861 Rajouri District S
NoBlockVHSNCPHCCHC 1Sundarbani4231 2Nowshehra6151 Total10382
Details of Programme Scale
- Slide 26
- District Ganderbal S NoBlockVHSNCPHCCHC 1Ganderbal2141
2Laar2530 3Kangan7471 Total120142 District Anantnag S
NoBlockVHSNCPHCCHC 1Achabal3431 2Bijbehera4861 3Mattan5221
Total134113 District Budgam S NoBlockVHSNCPHCCHC 1Beerwah7481
2Magam5021 3Soibugh4021 4Khag4010 Total204133
- Slide 27
- CUMULATIVE TOTAL Districts6 Blocks19 VHSNC1123 PHC70 CHC14 Of
the six districts only Rajouri and Erstwhile Doda being hard to
reach districts, shall have 1 facilitator for 7 villages; rest of
the 4 districts will have 1 facilitator for 10 villages. Budget
Sheet Budget Sheet
- Slide 28