community based monitoring as an accountability tool and related trends of change and improvements...
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Community Based Monitoring of Health Services and related trends of change and improvements in the rural health services in the state of Maharashtra
Dr. Dhananjay Kakde- SATHI , Pune
(With Inputs from SATHI team members)
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What is community based monitoring of health services?
• At the core of CBM is the act of tracking, recording and reporting the state of public health services in villages, as experienced by the people themselves.
• CBM processes related to NRHM are organised at the village, primary health centre (PHC), block, district and state levels.
• Regular information collection at the community level in the villages
• Processes for regular dialogue between community representatives and health care providers
• Helps to develop community ownership and accountability of Health services
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Levels of committees forFeedback & Action
State Planning & Monitoring Committee
District Monitoring &
Planning Committee
Block Monitoring & Planning Committee
PHC Monitoring & Planning
Committee
Village Health, Water supply, Nutrition and
Sanitation Committee
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Five Key processes in Community Based Monitoring of Health ServicesProcesses Description
Building people’s capacity to publicly rate health services
Capacity building of VHC and monitoring committee members through trainings
Monitoring by committee members through data gathering and filling report cards at village, PHC, Rural Hospital levels.
The report cards marked health services using 11 indicators, with each rated good, partly satisfactory, or poor. All indicators used a three month recall period
Based on report cards, dialogue with health functionaries
Findings from the report cards were presented in the Public hearings or mass dialogue
Media Coverage Public awareness about the problematic condition of the public health system and the potential of CBM to improve it.
State level conventions and dialogue
Forum where systemic unresolved issues are raised and solved
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Tools for community monitoring
• Monitoring booklet forms• Village Health Calendar • Interview format for MO
PHC / CHC• Actual medicine stock taking
at PHC/CHC• Format for Exit interview
(PHC / CHC)• Documentation of testimony
of denial of health care
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Filling up of the report card and display
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Objective positive impact of CBM in improving health services
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• Practice of PHCs prescribing medicine from private shops has largely stopped
• Illegal charging and private practice by certain medical officers has now been checked
• Frequency of visits of ANM and MPWs in villages has led to improved village health services in many villages
• Definite improvement in immunisation coverage in many villages
• Certain sub-centres and mobile units which were not working have now started functioning
CBM has contributed to significant improvements in rural health services
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Change after six months of monitoring in villages of Velha block, Pune
October 2008 April 2009
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‘Good’ ratings for village level Health services across 220 villages in Maharashtra over 3 phases
303540455055606570
Phase 1 Phase 2 Phase 3
48%
61%
66%
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‘Bad’ and ‘Partly satisfactory’ ratings for village level Health services across 220 villages
Partly satisfactory and Bad evaluations over 3 phases
14%
20%23%25%
28%
16%
05
101520
2530
Phase 1 Phase 2 Phase 3
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Good evaluation trends over 3 P has es for Immunis ation s ervic es
69 71
90
50
60
70
80
90
100
P has e 1 P has e 2 P has e 3
G ood evaluation trends over 3 P has es for Ang anwadi s ervic es
54
75
87
40
50
60
70
80
90
100
P has e 1 P has e 2 P has e 3
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600
700
800
900
1000
1100
Thane district OPDper PHC per month
741 679 869
Thane CBM OPDper PHC per month
721 722 1028
07-08 08-09 09-10
17%
43%
0
10
20
30
40
50
Increase in Thanedistrict PHCs OPD
Increase in ThaneCBM PHCs OPD
Increase in people’s OPD utilisation in PHCs covered by CBM
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Increase in people’s inpatient utilisation in PHCs covered by CBM
200
300
400
500
600
700
800
Thane district IPDper PHC annual
324 317 488
Thane CBM IPD perPHC annual
417 446 735
07-08 08-09 09-10
50%
76%
0
10
20
30
40
50
60
70
80
Increase in Thanedistrict PHCs IPD
Increase in ThaneCBM PHCs IPD
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From community based monitoring to planning of health services
• Key future strategy for planning of health services would be to use information about local issues/ priorities and resources identified during the community monitoring process.
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CBM has given us hope that in context of public health system, the positive
alternative to dominant trend of privatisation is communitisation of
health servicesThank you.