The Mitanin or the community health worker programme was launched in Chhattisgarh in 2002. Mitanins form one of the crucial components of many of the state’s health programmes. Since the advent of the National Rural Health Mission, Mitanins are paid incentives for several health related tasks that they perform at the community level. In the past, these incentives were paid through the health system. But since September 2012, the state has started paying these incentives through the Gram Panchayats in order to increase the community’s ownership over the Mitanin and to make her accountable to the community that she belongs to and serves
The payments through the Gram Panchayats were started on a pilot basis in Tokapal block of Bastar district in September 2012. This block was chosen because the then District Collector of Bastar was supportive of the idea. The actual process was preceded by a series of meetings with Gram Panchayat representatives, health authorities, health providers, Mitanin trainers and Mitanins. After an implementation phase of four months, the pilot was deemed successful and was gradually up-scaled to cover the entire state from July 2013.
The Process: Based on the tasks done by them every month, Mitanins fill in a claims form in a pre determined format – this details the number of tasks done by them and is validated by the concerned beneficiary from the community who signs on the form to show her agreement with the concerned claim. The form is then cross verified and validated by one of the Panchayat Ward Panchs. This form is then verified by the Mitanin trainer and submitted to the Gram Panchayat office. The disbursements are then made on a pre fixed day by the Sarpanch and the secretary of the Gram Panchayat. Random checks are also made on these forms by Block and District Coordinators to ensure the validity of these claims.
The funds are transferred from the District Health Society’s budget head for Mitanin incentives to the Gram Panchayats through the Block Panchayat office. Each panchayat is given an advance of Rs 15000 which is used for disbursements and refilled based on a utilization certificate submitted by the panchayat.
Outcomes: This author interacted with Mitanins, Sarpanch, and secretaries of Gram Panchayat and programme staff of the Mitanin programme to understand their perspectives on this process and its outcomes. All the Mitanins expressed satisfaction with the process. Earlier they had to earlier make several trips to the block Community Health Centre (CHC) to receive the cheque and then to the bank to deposit it even though the amount they received might be very meagre. Also, they earlier received incentives only for accompanying women for delivery and for complete immunization. Other incentives, like those for preparing a malaria slide, were not given to them. Now, they felt the system of receiving incentives from the panchayat itself saved them the bother of making those multiple trips to the CHC and the banks. It also made people in the community more aware of what they did, and the honorarium they received for it.
Both the Sarpanch and the secretaries felt that the system offered them an opportunity to engage with the Mitanins’ work. The fixed day payment schedule also gave them a space to interact with all Mitanins of the village to learn from them on new schemes and to pass on any information that they wanted to. The District Coordinator informed that while with the earlier system, much of the amount earmarked for Mitanin incentives remained unspent, now the disbursements had actually increased as they were being paid all the incentives they were eligible for, thus making the system more efficient.