Community Action for Health in Tamil Nadu

Ameerkhan K

SOCHARA-CEU

On behalf of CAH partners and Makkal Nalavazvu Iyakkam

Structure of the presentation

Back ground Evolution and context of CAH processVision and Major strategies Core activitiesLearnings Major challenges

Back ground of CAH evolution in Tamil NaduJan Swasthya Abhiyan’s Right to Health care campaign – led to

strategies to engage with public health system

NRHM – Identified Communitisation as one of the five pillars

AGCA – Policy framework to Health program – piloted CAH in 9 states

CSO / NGO’s experience – Led to customize the CAH in Tamil Nadu context

Tamil Nadu Government – Supported the pilot and funded the expansion phase

Evolution and context of the model• Piloted from 2007 to 2009 in 225 hamlets with the Government Order

of Tamil Nadu.

• Based on the experience the health system and CSOs jointly wrote a

paper on the model and discussed in the state level multi stake holder

consultation in 2009.

• Identified Tamil Nadu specific priorities - The word “CAH” and

“Village Health Planning Day” took centre stage.

• Expanded the process in terms of coverage and process (from 225 to

3800 villages of 446 Panchayats during 2010 – 2012) with financial

support from the state.

Vision and major strategies

To Strengthen the local democracy through improved community

participation and to enhance understanding of health and ensuring

health for all

To develop platform for constructive dialogue between people and

health system for the evolution of people centred health policies

To build equitable and quality health care accessibility and

deliveries in public health system

Developed by CSO at the state level consultation based on

experiences of pilot phase

Major strategies and activitiesSocial Mobilization –

democratizing the participation

Building critical mass – awareness

and in depth trainings – focused on RTH and public

health system

Community led evidence collection

Community led multi stake

holder health planning

Realizing Health plans through joint action at multiple

levels

Organogram

Following organizational structure was developed based on

the experiences of pilot and expansion phase. The model is

yet to implement

ADVISORY GROUP OF

COMMUNITY ACTION FOR

HEALTH State Nodal implementation

Team State Nodal Organisation

 State Health

Society

REPRESENTATIVES FROM EACH GROUP

District Nodal Implementation

Team 

District Nodal Org

DISTRICT MENTORING COMMITTEE REPRESENTATIVES

FROM EACH GROUP

 

Deputy. Directorate of Public Health

Block Nodal implementation

Team

Panchayat Nodal implementation

Team

 Cluster Nodal

Org 

BLOCK FEDERATION COMMITTEE

REPRESENTATIVES FROM EACH GROUP

 VOLUNTEERS

(1955)

PRI MEMBER

S

REPRESENTATIVES FROM

EACH GROUP

 PRIMARY HEALTH

CENTRES

Directorate of Public Health

Cluster Coord

Pan. Coord

BLK. PHC

PHC

Dt.Coord

Monthly and weekly review participation

Mon

thly

an

d

weekly

revi

ew

p

art

icip

ati

on

Monthly

Quarter

Monthly

Reporting & feedback

Reporting & feedback

Reporting & feedback

ACTION / IMPACT AT MULTIPLE LEVEL

The process triggered community level action – especially in the

health determinants

The data created interest and used by many elected representative

to involved in direct action – especially by the opposition

Policy makers found useful to triangulate and to get nuances

from the field

Action and outcomes

Impact in Peripheral Health Workers service delivery through improvement in Village Health Nurse (VHN) Post Natal Home Visit (42nd day) in 3700 villages

round1 Sept 2011 round2

Jan 2012

round3June2012

0.00

10.00

20.00

30.00

40.00

50.00

60.00

25%n = 2047

36%n = 2128

43%n = 1598

Positive response (%)

Gre

en i

n P

erc

enta

ge

Availability of health care services at village - Percentage of adolescent girls received Iron Folic Acid over two rounds of monitoring in 3700 villages

Green red yellow0.0

10.0

20.0

30.0

40.0

50.0

60.0

32 %n = 798

R1

43 %n = 798

R1

26 %n = 798

R1

44 %n = 1231

R2 39 % n = 1231

R2

17 %n = 1231

R2

Availability of IFA

Resp

onse

in p

erc

enta

ge

Positive response (%) Negative response (%) Partial response (%)

Quality of antenatal care delivery by educating woman on pregnancy related risk factors in 3700 villages

round1 Sept 2011 round2

Jan 2012

round3June2012

0.0

20.0

40.0

60.0

80.0

100.0

55 %n = 2473

68 %n = 2656

75 %n = 2046

educating on danger signs in 3 rounds

Perc

enta

ge o

f gre

en

Positive response (%)

Addressing social determinants of health through village over health water tank cleaning in 3700 villages

round1 Sept 2011

round3June 2012

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

51 %n = 935

30 %n = 935

40 %n = 821

58 %n = 821

Beneficiaries response in 2 rounds

Resp

onse

in P

erc

enta

ge

Negative response (%)

Partial response (%)

Partial response (%)

Equitable health development across communities in monthly village over head water tank cleaning in 3700 villages

General Arunthatiyar Dalit0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

42 %n = 531

43 %n = 76 41 %

n = 338

59 % n = 469

53 %n = 90

58 %n = 380

round1 Sept 2011round3June 2012

Caste groups

Perc

enta

ge o

f Yell

ow

Partial response (%)

Reducing the gap between Antenatal Care Availability – Quality – Education Index using informative monitoring tool in 3700 villages

round1 Sept 2011 round2

Jan 2012

round3June 2012

0.0

20.0

40.0

60.0

80.0

100.0

94 %n = 2539

98 %n = 2684

98 %n = 2063

93 %n = 2540

98 %n = 2687

97 %n = 2063

59 %n = 2540

73 %n = 2671

93 %n = 2063

Quality Availability Education

ANC services in 3 rounds

Perc

enta

ge o

f G

reen

Major impactParticipatory monitoring and planning process led to collective action and

community ownership

A platform created for constructive dialogue among multi stake holder –

preliminary attempts to balancing the power

Created lot of interest and confidence on the public health system –

especially in a highly populist policy state

The culture of questioning spirit and collective demand was strengthened.

At the health system level over the period of time service providers

understood the underlying principles and supported the process

Created evidences that were not available with health system

Emerging IssuesMobilising community and sustaining the community committees at

Panchayat level

PRI does not have any role / control as it is envisaged in NRHM

framework. The overall policy of the state plays major role.

Communitization measures almost nil in Tamil Nadu – including un “tied”

funds utilisation.

Lack of redressal mechanism in public health system impeded the system

level changes through CAH process.

Lack of trust by the policy makers in community participation in health and

in people’s health rights impacted the sustainability.

Way forwardLong term commitment for communitisation process and adequate support

from the government

Need to convert community accountability measures as core component of

the health system – have to go beyond the mercy of the “good officers”

Separating the management of the accountability process from the regular

authorities – Autonomous body ! Which works with but outside of the

health system

Build mechanisms to respond to the need arises from the community action

for health process towards first step of building people centered health

system.

Thank You