राष्ट्रीय स्वास्थ्य मिशन
National Health Mission
As mentioned in section I, it will be essential to involve Community based organisations and NGOs at all levels (in addition to Panchayat representatives and public health officials) to effectively operationalise the process of Community based monitoring. These civil society organisations would have three kinds of roles in this process firstly, as members of monitoring committees; secondly as resource groups for capacity building and facilitation; and thirdly as agencies helping to carry out independent collection of information.
In their first role, social organisations working in close, regular contact with communities on health related issues, especially from a rights-based perspective, would be able to present in various monitoring committees the community concerns, experiences and suggestions regarding improving public health system functioning. In their second role, NGOs with experience of capacity building could conduct orientation of committee members about the process of Community based monitoring including the roles of members. All three types of members Panchayat representatives, civil society organisations and health system functionaries would benefit from such capacity building. In their third role, NGOs and CBOs could contribute to the collection of information relevant to the monitoring process at all levels from the village to state level. In these processes, an element of community mobilisation may be involved.
NGOs and CBOs could be given responsibility for overall facilitation of the initial process of committee formation and capacity building at District and Block levels, including peripheral committees at PHC and village levels.
It is suggested that orientation of Community Monitoring committee members at different levels would be conducted by NGO facilitators in the pilot phase. In the subsequent phases, joint teams of NGO and Health department facilitators could be involved. Based on national model material, training modules and materials for orientation of Community Monitoring committee members would be adapted and published at state level and used for this capacity building process.
Teams for Community based information generation Specific teams would dialogue with communities and would collect and process community-based information. These teams could be sub-groups drawn from the larger Monitoring committee at specific levels, but could also include some persons from beyond the Monitoring committee. Formation of such teams should be encouraged especially at the PHC and Block levels. Each team should include members from one or more facilitating NGOs and PRI members, and could also include representatives from among the Health care providers. Such teams should undergo a short orientation exercise before they undertake the community monitoring exercise.
In order to do a round of Community Monitoring exercise at the PHC level, this team could choose a couple of villages in each three-monthly period. Village level meetings should be organized (preferably with the women) in these villages. These meetings would identify the villagers experiences at the different health care facilities, adverse outcomes, services and so on as mentioned in section -II. Records of the village meeting should include details of villagers experiences and perceptions. Separate case studies could be carried out by the Block Level monitoring committee, concerning individuals who have had adverse outcomes or faced serious problems in accessing health care services.
Similarly teams at various levels can conduct facility level monitoring through a facility survey and exit interviews. All this information collection could be based on Checklists for Monitoring prepared on the basis on the various frameworks for Community Monitoring outlined in previous section.
In order to screen civil society organizations for their capacity to partner in community monitoring activities, and to participate in monitoring committees at various levels, a simple questionnaire may be developed. Such organisations may include Community Based Organisations (including self-help groups and peoples organisations) as well as NGOs working at the respective level, with documented activity in the area since at least three years. In addition to other questions about the organization, the following issues may be included in the questionnaire.
| Activity Profile | Community Mobilisation | Womens Empowerment Activities | Rights based Activities |
|---|---|---|---|
| A1- Income Generation | C1- Self Help Groups | W1- Village level womens groups | R1- Right to Healthcare |
| A2 - Environment / Natural Resource Mgmt | C2- Village Level Committees | W2 Womens leadership development and training | R2- Right to Food |
| A3 - Education | C3- Federations | W3 Women and PRI | R3- Right to Information |
| A4- Health | C4- Community Leadership training | R4- Right to Employment | |
| C5- Work with PRIs | R5- Livelihood rights e.g. rights related to Forest, Land, Wages, Displacement etc. (specify) | ||
| C6 Village based organisation and mobilisation on specific issues |
On the basis of their responses to their questionnaire the following screening table may be used and any organization that has at least one entry in all the four aspects (with brief report of the activity carried out in that aspect) may be considered as having qualified. Any organisation with demonstrated experience of monitoring Public services, organising public dialogues or public hearings should be given priority to participate in the Community Monitoring committees.
| Name of CSO | Activity Profile | Community Mobilisation Activities | Womens Empowerment Activities | Rights based Activities | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A1 | A2 | A3 | A4 | C1 | C2 | C3 | C4 | C5 | W1 | W2 | W3 | R1 | R2 | R3 | |
It may be pointed out here that a diversity of civil society networks and organisations involved in promotion of Health rights and monitoring must be involved at various levels, including the state level, right from the initiation of this process. Facilitation at the state level should not be contracted out completely to any single NGO since this may constrict wider participation in the process. It should also be kept in mind that civil society involvement in monitoring should not be focussed only on mother NGOs which are often deeply involved in implementation and who may not always be the most objective monitors of work which they themselves are involved in implementing. Particularly for the Community monitoring process in NHM, it is imperative that the idea is not confined to just leave it to mother NGOs but rather that organisations with experience of rights based activities and accountability enforcing activities be given adequate space and responsibility at all levels. Similarly, during the implementation phase in districts, a diversity of civil society organisations must be involved, including at the block and district levels, to ensure wide participation in the monitoring process. The process of selecting civil society organisations to be involved in monitoring committees at all levels could be facilitated by the mentoring team of the respective level, with guidance from the mentoring team of the higher level. For example, the district mentoring team could suggest the names of civil society organisations to be involved in the District monitoring committee, with inputs from the state mentoring team as relevant. This should be a participatory process including various civil society networks and organisations. It should not be limited to NGOs, and should also definitely involve Community based organisations and peoples organisations.
