Population Foundation of India, March 19, 2014
Advisory Group Members present
- Dr Abhay Shukla
- Dr Abhijit Das
- Mr A R Nanda
- Dr H Sudarshan
- Ms Indu Capoor
- Ms Mirai Chatterjee
- Dr Narendra Gupta
- Ms Poonam Muttreja
- Dr Saraswati Swain
- Dr Thelma Narayan
Representatives from the MoHFW
- Ms Limatula Yaden, Director, NHM, MoHFW
- Dr Rajani Ved, Executive Director (Officiating), NHSRC
Representatives from the AGCA Secretariat
- Dr Sanjay Pandey
- Mr Alok Vajpeyi
- Mr Bijit Roy
- Mr Vijay Jamwal
- Mr Ajay Misra
- Mr Daman Ahuja
- Ms Tripti Chandra
- Ms Seema Upadhyay
- Mr Saurabh Raj
AGCA members who could not attend the meeting and were given leave of absence
- Mr Vijay Aruldas
- Dr Sharad Iyengar
- Dr Shanti Ghosh
- Dr Dileep Mavalankar
- Mr Harsh Mander
- Dr M Prakasamma
- Dr Alok Mukhopadhyay
- Mr Gopi Gopalakrishnan
- Prof Ranjit Roy Chaudhury
Ms Poonam Muttreja welcomed the participants to the Twenty eighth meeting of the AGCA. She said the objectives of the meeting were to discuss (a) progress of activities between November 2013 – March 2014, (b) key findings and recommendations of the Seventh Common Review Mission (CRM), and (c) priorities and strategies for strengthening Community Action for Health (CAH) over the next year.
Ms Muttreja introduced the newly recruited staff to the AGCA Members. They include Mr Vijay Jamwal, Team Leader; Dr Ajay Misra, Programme Manager; Mr Daman Ahuja, Programme Manager; Ms Tripti Chandra, Programme Manager; and Ms Seema Upadhyay, Programme Manager. They shared a brief on their background, experiences from previous assignments and their current role and responsibilities. Members requested the Secretariat to share details on the allocation of states among the team members.
Prior to the discussion on the agenda points, the group had suggested the following:
- Share the report by the Health Task Force constituted by the Government of Karnataka under the chairmanship of Dr H. Sudarshan.
- Share the Report by the Technical Resource Group (TRG) on National Urban Health Mission (NUHM) constituted by the MoHFW under the chairmanship of Mr Harsh Mander.
- Organise an AGCA meeting to specifically deliberate on designing an operational strategy.
- Share the framework on principles and essential components of CAH with the Ministry for circulation to State governments.
- To increase visibility of the AGCA, regular updates on programme initiatives on the CAH website. An e-group forum could be developed to share AGCA’s work with a wider audience.
- A mapping of potential donors could be undertaken to understand their funding priorities and interest in supporting work of the AGCA.
- Ms Muttreja shared that PFI had recently launched a TV series titled Main Kuch Bhi Kar Sakti Hoon focusing on health and women’s rights issues. The TV series has been directed by Mr Feroz Abbas Khan and is being telecast on Doordarshan every Saturday and Sunday between 7.00 pm -7.30 pm. Episodes are uploaded on the youtube channel at http://www.youtube.com/user/mkbksh immediately after broadcast. Additional material and details are available at www.mkbksh.com. Members were requested to give their inputs on how issues on community action could be interwoven into the serial as one of the aspects Main Kuch Bhi Kar Sakti Hoon would like to impact on is the health giving behavior of the health workers at the community level.
Ms Muttreja invited Mr A R Nanda to chair the meeting
Confirmation and Action Taken on the Minutes of the 27th AGCA meeting held on November 19, 2013
The members confirmed the minutes of 27th AGCA Meeting held on November 19, 2013.
Bijit Roy, AGCA Secretariat, shared an update on the Action Taken on the 27th meeting:
|Sl No||Action Points||Responsibility||Action Taken|
|1.||AGCA Sub-Group meeting to be organized between November 26-28, 2013 to finalize the implementation steps and timelines||AGCA Secretariat||
|2.||Share the Odisha State AGCA Terms of Reference and members with the MoHFW||AGCA Secretariat||Shared with the Ministry on December 9, 2013.|
|3.||Undertake a visit to Madhya Pradesh to resolve the programme implementation challenges||Dr Abhay Shukla, Dr Narendra Gupta and Ms Poonam Muttreja||AGCA visit scheduled on January 30, 2014 was postponed as per the request of Dr M Geetha (Mission Director, NHM)
New meeting dates to be finalized
|4.||Facilitate access to the community enquiry data from the pilot phase of community monitoring from Guwahati Dotcom Services||Dr Abhijit Das||Yet to be completed|
|5.||Share a template for CAH activities, which could be included in the State PIP Guidelines||AGCA Secretariat with support from Dr Abhay Shukla||The template was shared with the Ministry on December 9, 2013.
In addition, specific inputs were provided on the State PIP guidelines shared by the Ministry on February 24, 2014
|6.||Organize a working group meeting for piloting CAH in urban areas under NUHM, in consultation with Mr Harsh Mander and NHSRC||AGCA Secretariat with support from AGCA members and NHSRC||Meeting yet to be organized|
|7.||Develop Rogi Kalyan Samiti guidelines and training materials in collaboration with NHSRC.
|AGCA Secretariat with support from AGCA members and NHSRC||RKS guideline development meeting organized by NHSRC in coordination with AGCA on March 14, 2014.|
|8.||AGCA members to visit states in rolling out the technical support processes||AGCA Secretariat with support from AGCA members.||Technical support provided to states in rolling out/scaling up implementation of the CAH component. States include Bihar, Uttar Pradesh, Jharkhand, Jammu and Kashmir, Gujarat, Sikkim, Assam, Maharashtra, Mizoram, Himachal Pradesh and Meghalaya.|
Members discussed the following points:
- (Sl.1) – Gender issues/ concerns should be included in the CAH tools. A small working group could be constituted to review and finalize the tools.
- (Sl.3) – Finalise soon the date for a meeting with the Mission Director, Madhya Pradesh
- (Sl.4) – Dr Abhijit Das shared that the community enquiry data from the pilot phase could not be retrieved from Guwahati Dotcom. He suggested we end further follow up with the agency since the data was also quite old. This was agreed and accepted by the AGCA.
- (Sl.5) – The template shared by the AGCA is being included in the State PIP guidelines. The Ministry, in coordination with NHSRC, is planning to organize a meeting to orient State Nodal Officers on the PIP development processes. AGCA members will be invited to facilitate a session on CAH.
Members suggested the following points regarding the PIP:
Emphasis should be laid on engaging civil society organizations in facilitating CAH processes
- b) the Ministry should urge all states to include the component and allocate adequate financial resources.
- (Sl.7) – Dr H Sudarshan, Dr Sharad Iyengar, Dr Narendra Gupta and Dr Abhay Shukla will provide guidance and support for the development of the RKS Guidelines and training materials.
Update on the Progress of AGCA Activities (November 2013-March 2014)
Bijit Roy made a presentation on the Progress of the AGCA activities between November 2013 – March 2014. The presentation was an update on key processes at the national and state levels, challenges, financial details and plan of action till March end. A copy of the presentation is enclosed for reference in Annexure -A.
The following inputs were provided by the AGCA members:
- There is need to work closely with the NHM team in Meghalaya to increase ownership of the CAH programme. The AGCA should support the state to develop a perspective plan to cover all the villages in the state over the next three years. Specific emphasis should be laid on developing the capacities of the Village Health Sanitation and Nutrition Committees (VHSNC) to play a meaningful role in planning and monitoring health services at the local level.
- The Secretariat will send a copy of all communication to the concerned AGCA members in the state. The Secretariat regretted for not copying emails for Odisha in specific.
Sharing of CAH experiences and priorities from the Seventh Common Review Mission
Ms Limatula Yaden said the Ministry had organized a national dissemination of the Seventh CRM in March, 2014. The CRM report would be disseminated soon.
AGCA members made the following points regarding the implementation of the community processes:
- AGCA members should be invited to participate and provide inputs at state-level CRM briefing/debriefing meetings. The Secretariat will follow up with a letter to the Ministry.
- AGCA members could be included in the ASHA mentoring group at the state level.
- The above two points were agreed upon by the Ministry.
- The group proposed that the Ministry could seek inputs from the AGCA members in reviewing the State PIPs for the CAH component. The members recommended that to avoid conflict of interest, only those members, who are not involved in the implementation in a particular state, should review the PIP of that state. The Secretariat would submit to the Ministry a list of AGCA members with information on the status of their involvement in the state implementation process. The Ministry may take decision on the basis of this list.
- In the last FY PIPs, 22 States/Union Territories had included the CAH component. However, most states limited their focus to visioning exercises and VHSNC/RKS trainings. To make the CAH processes effective, accountability oriented components like community monitoring/community based planning need to be included, with adequate resource allocations. In the PIP review process, these points need to be taken into consideration.
- The group suggested that the Ministry should consider allocation of a certain percentage of the NHM budget to support the implementation of CAH and other accountability initiatives.
- In Odisha, the selection, training and monitoring of ASHAs were not being done as per guidelines. A field assessment of the rollout of Modules 6 and 7 (in particular) should be undertaken.
- In tribal areas in Maharashtra, women are being paid the Janani Suraksha Yojana (JSY) incentives through an account payee cheque. With limited access to bank accounts and banking services, the women are facing huge problems in encashing their cheques. They are being forced to spend time and money to open a bank account to encash their cheques. It was suggested the incentive cash amount be given to women in remote tribal areas through postal money orders.
The following points were made by the Ministry:
- The Ministry has reiterated that the states should ensure transparent processes for the selection of ASHAs, which conform to the guidelines.The performance monitoring mechanisms for assessing ASHAs are now in place in all states. In addition, certification courses for ASHAs through the National Institute of Open School (NIOS) are being initiated.
- The AGCA should suggest a set of conditionalities, along with key monitoring indicators, to be included in the State PIP Guidelines. This would be used as a yardstick to measure the progress in the implementation of the CAH component.
- Under JSY it is not mandatory to make payments through account payee cheques. The states have been given the flexibility to make payments of the JSY incentives through alternative processes, under specific circumstances and the Ministry has issued a directive order in this regard. A copy of the directive would be shared with the AGCA
Update by the Ministry on AGCA’s proposal for extension of the programme for FY 2014-15
Ms Yaden shared that the Ministry has in principle agreed to provide a no-cost extension for continuation of the programme. Subsequently, a decision regarding details on the next FY proposal would be taken.
Discussion on priorities and strategies for strengthening CAH over the next year
- The group suggested that the following points be included as priorities in the next FY
- In Uttar Pradesh, the CAH component is planned to be implemented across 25 high priority districts by
- (a) the Uttar Pradesh Health Systems Strengthening Programme, supported by the World Bank
- (b) Technical Support Unit, supported by the Bill and Melinda Gates Foundation and
- (c) the State Programme Management Unit , supported by NHM. Initial discussions with these programmes have been facilitated by the Secretariat for integration of efforts such as a common State AGCA to guide implementation of state processes, common tools and guidelines, and a structured capacity-building plan for VHSNCs and RKS. The first State AGCA meeting would be organized soon to discuss the operational steps.
- In Bihar, the implementation processes would be simplified and scaled up by leveraging
- (i) existing ASHA /community processes and institutional structures
- (ii) orientating and mentoring PRI members and and existing collectives of Women’s/ Self Help Groups.
- In Maharashtra, the focus would be to
- (i) activate non-functional RKS – emphasise holding of regular meetings and ensuring adequate representation of civil society members in the committee
- (ii) build capacities of PRI members on negotiation and problem-solving skills through events such as Sarpanch Melas
- (iii) interaction meetings of the VHSNCs and ASHAs
- (iv) organize Swasthya Gram Sabhas and (v) involve NGOs to implement CAH on a voluntary basis.
- In Gujarat, the focus would be on strengthening the capacities of the Gram Sanjeevani Samiti(VHSNC) and the Arogya Samiti (RKS) in rural areas. CAH would be initiated in selected towns/ cities under NUHM.
- Specific cost assessment for each CAH model
- CAH processes should include monitoring and planning of social determinants, especially nutrition. Discussions should be initiated for convergence with the Department of Women and Child Development, both at national and state levels.
Discussion on the steps for strengthening coordination in Madhya Pradesh, Rajasthan, Tamil Nadu and Karnataka
The group suggested the following:
- Review programme implementation, especially in states wherein there are specific problems.
- The Ministry could be requested to allocate a specific time during the review meeting of Mission Directors to share CAH programme experiences and challenges.
- Dr Narendra Gupta and Dr Thelma Narayan will share a note regarding implementation delays in Rajasthan and Tamil Nadu. Subsequently, the Secretariat will write to the Ministry to communicate with the State Governments to resolve issues to initiate the implementation process.
- The Secretariat will send a follow up letter to the Mission Director, Karnataka requesting him to involve the AGCA in strengthening CAH processes in the state.
Piloting CAH under NUHM
During the 26th AGCA meeting held at the Ministry in August 2013, Mr Nikunja Dhal, Joint Secretary, MoHFW, had requested the AGCA to pilot the CAH component in selected urban areas.
Dr Sanjay Pandey shared an update on the progress of the community processes component under NUHM:
- Community Processes Technical Resource Group (TRG) report under the chairmanship of Mr Harsh Mander has been finalized.
- The Ministry has recently finalized and circulated the ASHA and Mahila Arogya Samiti (MAS)
- PFI is providing support to selected states in developing their State PIPs. In addition, on request from the Bihar government, a CAH pilot is being initiated in selected slums of Patna district.
AGCA members shared that pilots on CAH were also being implemented in urban areas Gujarat and Maharashtra.
To take the processes forward, the Secretariat would organize a meeting with Mr Nikunja Dhal to discuss on modalities for implementation of CAH under NUHM. Dr Thelma Narayan, Ms Mirai Chatterjee and Dr Abhay Shukla volunteered to participate in the meeting.
Due to paucity of time, two agenda items could not be discussed at length at the meeting – (i) strengthening convergence with the Ministry of Women and Child Development, and (ii) inputs for mapping and review of mechanisms for grievance redressal. It was decided that these items would be discussed at the next AGCA meeting.
The meeting ended with a vote of thanks by Ms Poonam Muttreja.
|Sl No||Action Points||Responsibility|
|1.||Undertake a visit to Madhya Pradesh to resolve the programme implementation challenges||Dr Abhay Shukla, Dr Narendra Gupta, Dr Thelma Narayan and Ms Poonam Muttreja|
|2.||Share the note on programme implementation delays in Rajasthan and Tamil Nadu||Dr Narendra Gupta, Dr Thelma Narayan, AGCA Secretariat|
|4.||Share reports by a) the Karnataka Health Task Force b) NUHM Community Processes TRG with AGCA members||AGCA Secretariat|
|5.||Organize a meeting with the Ministry to discuss the modalities for implementation of CAH under NUHM||AGCA Secretariat|
|6.||Share a note with the Ministry on suggestive conditionalities and monitoring indicators for CAH||AGCA Secretariat|
|7.||Follow up letter to the Mission Director, Karnataka requesting him to involve the AGCA in strengthening the CAH processes in the state||AGCA Secretariat|
|8.||Initiate discussions for convergence with the Ministry of Women and Child Development at the national level.||AGCA Secretariat|
|9.||Share the directive regarding disbursement of JSY incentives with AGCA members||AGCA Secretariat|