Suggested outline of the Community based monitoring activity

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Suggested outline of the Community based monitoring activity

We are envisaging an interactive system of monitoring, where more than one level of committee looks into the functioning of each level. The underlying concept is:

The Monitoring committee at each respective level reviews and collates the records coming from all the committees dealing with units immediately below it. This enables it to make an assessment of the situation prevailing in all the units under its purview, and to make a report at its level.
This Monitoring committee also appoints a small sub-team drawn from its NGO and PRI representatives who visit a small sample of units (say one facility or two villages every trimester) under their purview and review the conditions there. This enables the committee to not just rely on reports but to have a first-hand assessment of conditions in their area. For example, the PHC committee representatives would visit 2 villages and conduct FGDs there, in each trimester by rotation. Similarly the Block committee representatives would visit one PHC by rotation in each trimester.
The monitoring committees at PHC / Block / District levels would make an assessment of the functioning of the major Health care facility at their respective level (PHC / CHC / District Hospital). This obviates the need for a separate committee to look into Health care facilities.
The Monitoring committee sends a periodic report (Quarterly for Village, PHC, Block and District levels; Six monthly for State level) to the next higher level committee enabling it to collate the report at that level.

Keeping this in mind, outlined below are a broad suggested framework for activities at various levels, and a complementary suggested framework of organisation of information for the Community based monitoring activity.

Suggested framework of activities according to levels

Level	Agency	Activity (Quarterly for Village, PHC, Block and District levels; Six monthly for State level)
Village	Village Health and Sanitation Committee	Reviews Village Health register, Village health calendar Reviews performance of ANM, MPW, ASHA Sends brief three monthly report to PHC committee
PHC	PHC Monitoring and Planning Committee	Reviews and collates reports from all VHSCs An NGO / PRI sub team conducts FGDs in three sample villages under PHC Visit PHC, review records, discuss with RKS members Send brief three monthly report to Block committee
Block (including CHC)	Block Monitoring and Planning Committee	Reviews and collates reports from all PHCs NGO / PRI sub team visits at least one PHC of the block, conduct interviews with MO and make observations Visit CHC and review records, discuss with RKS members Send brief three monthly report to District committee
District (including District hospital)	District Monitoring and Planning Committee	Reviews and collates reports from all Blocks An NGO / PRI sub team visits at least one CHC of the District, conducts interviews with Incharge, meets Block committee members and RKS members, makes observations c. Visits District hospital and reviews records, discuss with RKS members Send brief three monthly report to State committee
State	State Monitoring and Planning Committee	Reviews and collates reports from all Districts An NGO / PRI sub team visits 3 to 5 Districts, conducts interviews with DHO and District Committee members, makes observations on DH Sends six monthly report to NHM / Union Health Ministry

Suggested framework to organise information

Village level
Main issues for monitoring	ANM / MPW services incl. maternal, infant and child health services at village level; ASHA activities Availability of key services at local health facilities Selected adverse outcomes like maternal death Denial of health care
Reference documents	Village Health Plan Charter of Citizens Health Rights for Sub-centre and PHC NHM schemes ASHA, JSY, Untied fund expenditure etc.
Who	Village Health and Sanitation Committee (incl. ASHA+ ANM +AWW+SHG) Responsibility for facilitating FGDs and interviews in sample villages local CBO / NGO
When	Quarterly
Tools	Standard agenda items for VHSC meeting Village Health register Village Health calendar ANM / MPW records Village FGDs Interviews of ANC/ PNC beneficiaries ASHA interview Protocol for cases of denial of health care

PHC level
Main issues for monitoring	Overview of village level health services Staffing, Supplies and services availability at PHC Quality of care at the PHC from peoples perspective Implementation of the National Health Programmes; State specific health schemes Selected adverse events, denial of health care
Reference documents	PHC Health Plan Charter of Citizens Health Rights for PHC IPHS for PHC NHM schemes ASHA, JSY, Untied fund expenditure etc. Standard Treatment Guidelines Guidelines for National health programmes and Family Planning Insurance Scheme
Who	PHC monitoring and planning committee incl. PRI members, members of selected VHSCs, NGOs / CBOs, PHC RKS members Facilitation by NGO / CBO
When	Quarterly
Tools	Standard agenda items for PHC committee meeting Reports from VHSCs Record of select village FGDs Interview of the MO PHC Exit interview of PHC patients Records of cases of Health care denial related to PHC Interviews of RKS members Objective findings in PHC Adverse outcomes Protocol for cases of denial of health care PHC level Public hearing

Block Level
Main issues for monitoring	Overview of health services (incl. outreach and PHC based services) in the block Staffing, Supplies and services availability at CHC Quality of care at the CHC from peoples perspective Implementation of the National Health Programmes and support by CHC to outreach services; State specific health schemes Selected adverse events, denial of health care
Reference documents	CHC Health Plan Charter of Citizens Health Rights for CHC IPHS for CHC NHM schemes ASHA, JSY, Untied fund expenditure etc. Standard Treatment Guidelines Guidelines for National health programmes and Family Planning Insurance Scheme
Who	CHC monitoring and planning committee incl. PRI members, members of selected PHC committees, NGOs / CBOs CHC RKS members Facilitation by nodal NGO / CBO
When	Quarterly
Tools	Standard agenda items for CHC committee meeting Reports from PHC committees Records of visits to select PHCs Interview of the MO incharge CHC Exit interview of patients Records of cases of Health care denial related to CHC Interviews of CHC RKS members Objective findings in CHC Adverse outcomes Protocol for cases of denial of health care Block level Public hearing

District Level
Main issues for monitoring	Overview of all public health services in the District (except for services provided by municipal bodies), including implementation of all aspects of NHM, State specific health schemes Quality of care at District Hospital and sub-divisional hospitals
Reference documents	District health plan Charter of Citizens Health Rights for District hospital and sub-divisional hospitals IPHS for District hospital NHM schemes ASHA, JSY, Untied fund expenditure etc. Standard Treatment Guidelines Guidelines for National health programmes and Family Planning Insurance Scheme PPP and related regulations District health budgets
Who	District Health Monitoring and planning committee Public Hearing Facilitator team Inputs from DPMU, CMO, Collector, ZP
When	Six -monthly
Tools	Standard agenda items for District committee meeting Reports from the block health committees Records of visits to select sub-divisional hospitals / CHCs Report of the district health mission District Public Hearing District Peoples Rural Health Watch report

State level
Main issues for monitoring	All issues of Rural public health services / NHM in the state including State specific health schemes
Reference documents	State Health Plan, State PIP NHRC recommendations and State Govt. component of NHRC National Action Plan All NHM schemes ASHA, JSY, Untied fund expenditure etc. IPHS and functioning of various level facilities National Health Programmes and Family Planning Insurance Scheme PPP and related regulations State health budget and expenditure
Who	State Health Monitoring and Planning committee State Peoples Rural Health Watch report / citizens report by civil society groups Public meeting of State mission with civil society representatives.
When	Six monthly committee meetings Annual independent reports, public meetings
Tools	Reports from the District Health committees Records of visits to select districts Report of the State Health Mission Reports of District Public Hearings Independent reports

Note: Reports refer to information received by a committee from other bodies; records refer to information collected by the committee itself

PHC level
Main issues for monitoring	Overview of village level health services Staffing, Supplies and services availability at PHC Quality of care at the PHC from peoples perspective Implementation of the National Health Programmes; State specific health schemes Selected adverse events, denial of health care
Reference documents	PHC Health Plan Charter of Citizens Health Rights for PHC IPHS for PHC NHM schemes ASHA, JSY, Untied fund expenditure etc. Standard Treatment Guidelines Guidelines for National health programmes and Family Planning Insurance Scheme
Who	PHC monitoring and planning committee incl. PRI members, members of selected VHSCs, NGOs / CBOs, PHC RKS members Facilitation by NGO / CBO
When	Quarterly
Tools	Standard agenda items for PHC committee meeting Reports from VHSCs Record of select village FGDs Interview of the MO PHC Exit interview of PHC patients Records of cases of Health care denial related to PHC Interviews of RKS members Objective findings in PHC Adverse outcomes Protocol for cases of denial of health care PHC level Public hearing

Block Level
Main issues for monitoring	Overview of health services (incl. outreach and PHC based services) in the block Staffing, Supplies and services availability at CHC Quality of care at the CHC from peoples perspective Implementation of the National Health Programmes and support by CHC to outreach services; State specific health schemes Selected adverse events, denial of health care
Reference documents	CHC Health Plan Charter of Citizens Health Rights for CHC IPHS for CHC NHM schemes ASHA, JSY, Untied fund expenditure etc. Standard Treatment Guidelines Guidelines for National health programmes and Family Planning Insurance Scheme
Who	CHC monitoring and planning committee incl. PRI members, members of selected PHC committees, NGOs / CBOs CHC RKS members Facilitation by nodal NGO / CBO
When	Quarterly
Tools	Standard agenda items for CHC committee meeting Reports from PHC committees Records of visits to select PHCs Interview of the MO incharge CHC Exit interview of patients Records of cases of Health care denial related to CHC Interviews of CHC RKS members Objective findings in CHC Adverse outcomes Protocol for cases of denial of health care Block level Public hearing

District Level
Main issues for monitoring	Overview of all public health services in the District (except for services provided by municipal bodies), including implementation of all aspects of NHM, State specific health schemes Quality of care at District Hospital and sub-divisional hospitals
Reference documents	District health plan Charter of Citizens Health Rights for District hospital and sub-divisional hospitals IPHS for District hospital NHM schemes ASHA, JSY, Untied fund expenditure etc. Standard Treatment Guidelines Guidelines for National health programmes and Family Planning Insurance Scheme PPP and related regulations District health budgets
Who	District Health Monitoring and planning committee Public Hearing Facilitator team Inputs from DPMU, CMO, Collector, ZP
When	Six -monthly
Tools	Standard agenda items for District committee meeting Reports from the block health committees Records of visits to select sub-divisional hospitals / CHCs Report of the district health mission District Public Hearing District Peoples Rural Health Watch report

State level
Main issues for monitoring	All issues of Rural public health services / NHM in the state including State specific health schemes
Reference documents	State Health Plan, State PIP NHRC recommendations and State Govt. component of NHRC National Action Plan All NHM schemes ASHA, JSY, Untied fund expenditure etc. IPHS and functioning of various level facilities National Health Programmes and Family Planning Insurance Scheme PPP and related regulations State health budget and expenditure
Who	State Health Monitoring and Planning committee State Peoples Rural Health Watch report / citizens report by civil society groups Public meeting of State mission with civil society representatives.
When	Six monthly committee meetings Annual independent reports, public meetings
Tools	Reports from the District Health committees Records of visits to select districts Report of the State Health Mission Reports of District Public Hearings Independent reports

Note: Reports refer to information received by a committee from otherittee itself bodies; records refer to information collected by the committee itself

While operationalising this framework, the following mode of functioning may be kept in mind:

The Monitoring committee at each level would review and collate the summary reports coming from the committees dealing with units immediately below it. This enables it to make an assessment of the situation prevailing in all the units under its purview, and to make a report at its level. For example, the District committee would receive and review the reports from all Block committees.
However Monitoring committees would not only rely on reports, but would also directly interact in the field situation and get feedback. Firstly, each committee would appoint a small sub-team drawn from its NGO and PRI representatives who would visit on a quarterly / six monthly basis a small sample of units (say one facility or two villages) under their purview and directly review the conditions there. This enables the committee to not just rely on reports but to also have a first-hand assessment of conditions in their area. For example, the PHC committee representatives would visit two villages and conduct Group discussions there, in each trimester selecting different villages by rotation. Similarly the Block committee representatives would visit one PHC by rotation in each trimester.

Secondly, monitoring committees at PHC, Block and District level would be involved in six-monthly or annual Jan Samvads or Public hearings at their respective levels, where committee members would get direct feedback of the situation including possible presentation of cases of denial of health care. Similarly, it is suggested that the State health mission could conduct an annual public meeting open to all civil society representatives where the State mission report and independent reports would be presented and various aspects of design and implementation of NHM in the state, including State specific health schemes, would be reviewed and discussed enabling corrective action to be taken.

Tools for monitoring: