Population Foundation of India, September 11, 2014
Advisory Group on Community Action Members present
- Dr Abhay Shukla
- Dr Abhijit Das
- Mr Alok Mukhopadhyay
- Mr A R Nanda
- Mr Gopi Gopalakrishnan
- Dr H Sudarshan
- Ms Indu Capoor
- Ms Mirai Chatterjee
- Dr Narendra Gupta
- Ms Poonam Muttreja
- Dr Thelma Narayan
- Dr Vijay Aruldas
Representative from the Ministry of Health and Family Welfare (MoHFW)
- Mr Manoj Jhalani, Joint Secretary – Policy, MoHFW
- Dr Sanjeev Kumar, Executive Director, National Health Systems Resource Centre (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
- Ms Jolly Jose
AGCA members who could not attend the meeting and were given leave of absence
- Dr Dileep Mavalankar
- Mr Harsh Mander
- Dr M Prakasamma
- Dr Sharad Iyengar
- Prof Ranjit Roy Chaudhury
- Dr Saraswati Swain
Ms Poonam Muttreja welcomed the participants to the 29th meeting of the Advisory Group on Community Action (AGCA).
The meeting began with Ms Muttreja reading out a condolence message in the memory of Dr Shanti Ghosh, Member AGCA, who passed away on August 16, 2014. The group paid homage to Dr Ghosh by observing silence for a minute. The AGCA members conveyed their heartfelt condolences to her family. A copy of the condolence message is enclosed for reference in Annexure A.
Ms Muttreja shared that the broad objectives of the meeting were to discuss:
- Approval of Community Action for Health (CAH) component of the State Programme Implementation Plans (PIPs) for FY 2014-15;
- National Consultation on CAH; and
- priority areas for Community Action.
Ms Muttreja introduced the new Executive Director of National Health System Resource Centre (NHSRC), Dr Sanjeev Kumar, to the members. Mr A R Nanda briefed Dr Kumar regarding the role of AGCA and its collaboration with NHSRC to strengthen the implementation of the community process components under the National Health Mission (NHM).
Mr A R Nanda chaired the meeting.
Confirmation and Action Taken on the Minutes of the 28th AGCA meeting held on March 19, 2014
The members confirmed the minutes of 28th AGCA Meeting held on March 19, 2014.
Ms Muttreja shared an update on the Action Taken on the 28th meeting:
|Sl No||Action Points||Responsibility||Action Taken|
|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||Ms Poonam Muttreja met Mr Faiz Ahmad Kidwai, State Mission Director, NHM on June 17, 2014. A note regarding strategies to strengthen programme implementation was shared with the State NHM team in August 2014. Subsequently, Mr Vijay Jamwal (AGCA Secretariat) visited Madhya Pradesh on August 18-20 and discussed the detailed support which would be extended by the AGCA.|
|2.||Share the note on programme implementation delays in Rajasthan and Tamil Nadu with MoHFW||Dr Narendra Gupta, Dr Thelma Narayan, AGCA Secretariat||Note regarding the programme implementation delays was shared with the MoHFW on April 7, 2014. Subsequently, a follow up letter was sent on August 25, 2014.|
|3.||Share reports i) the Karnataka Health Task Force ii) NUHM Community Processes Technical Resource Group (TRG)- with AGCA members||AGCA Secretariat||Reports shared with AGCA members on April 3, 2014|
|4.||Organize a meeting with the MoHFW to discuss modalities for the implementation of CAH under the NUHM||AGCA Secretariat||Currently the NUHM team has been involved in start up activities such as developing processes and guidelines for ASHA, Mahila Arogya Samiti (MAS) etc. The proposed meeting would be organised in the next quarter when the guidelines are finalised and shared with the states.|
|5.||Share a note with the the MoHFW on suggestive conditionalities and monitoring indicators for CAH||AGCA Secretariat||Note shared with the MoHFW on April 2, 2014|
|6.||Follow up letter to the Mission Director, Karnataka requesting to involve the AGCA in strengthening the CAH processes in the state||AGCA Secretariat||Letter to State Mission Director NHM sent on August 7, 2014.|
|7.||Initiate discussions for convergence with the Ministry of Women and Child Development (MoW&CD) at the national level||AGCA Secretariat||AGCA team had meetings with Mr Sri Ranjan, Joint Secretary, MoW&CD and Mr Saroj K Adhikar, Assistant Director, Monitoring, Evaluation and Training, to discuss the initiatives of the MoW&CD on community action. CAH materials and tools developed by the AGCA have been shared with the MoW&CD officials.|
|8.||Share directive regarding disbursement of Janani Suraksha Yojana (JSY) incentives with AGCA members||AGCA Secretariat||AGCA team had followed up with MoHFW (Mr Vipin Garg, Consultant), NHSRC and North East-Regional Resource Centre, regarding the directive. However, officials were not able to trace the directive.|
Presentation on the Programme Progress and Challenges
Mr Vijay Jamwal, Team Leader, AGCA Secretariat made a presentation on the Progress of the AGCA activities between April to September, 2014. The presentation focused on an update on the processes at the national and state levels, challenges, support required from the MoHFW and plan of action till December 2014.
The following inputs were provided by the AGCA Members:
- Disbursal of funds from the state governments to nodal organizations in Maharashtra and Bihar is not regular, as a result there are gaps in the programme implementation process. A letter from MoHFW to the State Mission Directors, NHM, in this regard would be of great help.
- Guidance and support was requested from the MoHFW to finalize modalities of AGCA’s collaboration with NHSRC, including an early disbursement of funds to implement the Strengthening Community Action for Health under NHM programme.
- Members shared concerns regarding the prolonged delays to re-initiate implementation of the CAH component in Tamil Nadu and Rajasthan. They requested MoHFW to consider writing to the State Mission Directors to reinitiate the processes.
- The ambit of community action should be extended to cover other social determinants, especially nutrition. A joint meeting could be organised with the MoHFW and Ministry of Women and Child Development (MoW&CD) to explore the support, which the AGCA can provide to initiate monitoring of nutrition entitlements under the Integrated Child Development Services (ICDS). Dr Abhay Shukla, Dr Thelma Narayan, Ms Mirai Chatterjee and Ms Indu Capoor (Member, AGCA) volunteered to participate in the proposed meeting.
- A sub-committee comprising representatives from the NHSRC and the AGCA should be constituted to suggest steps, which allow aggregation and incorporation of village level plans into the District and State Programme Implementation Plans (PIP). The sub-committee will comprise of Dr H Sudarshan, Dr Abhay Shukla, Ms Mirai Chatterjee (Members AGCA), Dr Satish Kumar (NHSRC), Mr Bijit Roy, Mr Vijay Jamwal and Dr Ajay Misra (AGCA Secretariat). Dr Satish Kumar, who will join soon, will coordinate the process on behalf of NHSRC.
- The content and layout of the CAH website have been revised as per the inputs received from the MoHFW. The AGCA team will write to the MOHFW and NHSRC to link it to their websites.
- The AGCA had supported the State NHM teams in Jammu & Kashmir and Himachal Pradesh to develop the CAH component of their State PIP for FY 2014-15. However, the states dropped the component in the PIP finalization stage.
- Three chapters of the Rogi Kalyan Samiti (RKS) training manual have been developed and submitted to NHSRC. The chapters are on a) Monitoring of Hospital Services b) Ensuring Equity and Social Inclusion and c) Public Participation in the RKS. The Secretariat will share the chapters with AGCA members.
The following points were made by Mr Manoj Jhalani, Joint Secretary (Policy), MoHFW:
- The MoHFW has written to the Tamil Nadu State Mission Director NHM to reinitiate implementation of the CAH programme. A copy of the letter would be shared with AGCA members for reference and follow up.
- The MoHFW is in the process of drafting a new Health Policy. The request for suggestions has been uploaded on the NHM website. It was agreed that the AGCA would share its inputs with the MoHFW.
- The Additional Secretary and Mission Director, NHM has written to the State Mission Directors, NHM to ensure integration of the community process structures, which include components such as ASHA, Village Health Sanitation and Nutrition Committee (VHSNC), Rogi Kalyan Samiti (RKS) and CAH. A copy of the letter would be shared with AGCA members for reference.
- To expedite the process of disbursement of funds through NHSRC, a draft MoU should be shared with the MoHFW
- To reduce exigencies, states are being encouraged to develop multi-year Programme Implementation Plans (PIPs). In line with this, state governments can develop a multi- year plan for CAH implementation in partnership with NGOs. The AGCA should share a draft Memorandum of Understanding (MoU), which details the modalities of partnership between NGOs and state governments for CAH implementation. The MoHFW would review the MoU and share it with the states for adoption.
- To ensure continuity, the MoHFW has sent a letter to the State Governments to continue implementation of all on-going activities under NHM, after a vote-on-account of the budget. In addition, states have been provided an advance of 33 percent of their total budget outlay. Mr Jhalani will share a copy the letter with the AGCA members.
Update on the design of the National Consultation on CAH
The Secretariat presented an update on the preparations for the National Consultation on CAH to be organized on October 28-29, 2014 in New Delhi. The concept note and agenda of the consultation is enclosed for reference in Annexure B.
The AGCA members suggested the following points on the agenda for the consultation:
- Inaugural Session: Mr Nikhil Dey (Mazdoor Kisan Shakti Sangathan) could be invited to speak on Significance of Community Action in case Ms Aruna Roy is unable to participate.
- Session 3- CAH in Urban Areas: Representative from Kagad Kach Patra Kashtakari Panchayat, Pune, could be invited to participate in the panel discussion, alongwith Public Affairs Committee and SAHAJ .
- Session 4- Initiatives for Grievance Redressal: Mr Biraj Patnaik/Mr Shekhar Singh from the Right to Food Campaign could be invited make a presentation, along with Society for Social Audit, Accountability and Transparency (SSAAT).
- Session 5- Perspective of development partners on Community Action: Representatives from the Bill and Melinda Gates Foundation, Department for International Development (DFID), John D and Catherine T MacArthur Foundation, Open Society Foundations and United Nations Development Programme (UNDP) could be invited.
- Session 1: Implementation perspectives from the field – Maharashtra and Bihar: A panel discussion with Panchayat Representative, Medical Officer and the State Nodal Officer to share their experiences, learnings and challenges from CAH implementation processes should be included.
The following points were made by Mr Manoj Jhalani, Joint Secretary (Policy), MoHFW:
- Expenses related to the travel and accommodation of the State Mission Directors and Nodal Officers will be borne by the state governments.
Discussion on the MoHFW’s comments on the CAH Tools
Ms Muttreja stated that the MoHFW had shared its comments on CAH tools and the User’s Manual on September 9, 2014. Subsequently, the AGCA team prepared a plan of action to incorporate the suggestions, which is enclosed for reference in Annexure C. Ms Muttreja reiterated the need to simplify the implementation processes, especially the tools, to enable adoption and scaling up of CAH in the states.
The group decided the following:
- Separate manuals will be developed for VHSNC members and Programme Managers.
- The language of the manuals would be further simplified.
- Illustrations will be included, especially in the manual for VHSNC members.
- The section on gradation of CAH tools will be included only in the manual for Programme Managers.
- The section on Core principles of CAH will be moved to the main text in the Programme Manager’s manual.
- A separate note on the public service monitoring tools will be included so as to establish a link with the VHSNC manual.
Discussion on AGCA Membership
Attendance of members at the past AGCA meetings was shared with the group. Subsequently, the group discussed the following issues regarding the membership:
- Dr Narendra Gupta informed that he has resigned from the primary membership of the Aam Aadmi Party. The group requested him to share a copy of his resignation letter.
- It was decided that members should refrain from having any direct political affiliation.
- Members should attend at least one third of the AGCA meetings.
- The Secretariat will send updated attendance list to the members. In addition, a specific email will be sent to members who have not been attending meetings regularly, to inform the group regarding their availability and willingness to participate in the AGCA meetings. The details would simultaneously be shared with the MoHFW.
- The name of Dr Shanti Ghosh will be not be on the list due to her demise.
Due to paucity of time, two agenda items could not be discussed at the meeting (i) Sharing of experiences, learning and challenges in implementation of CAH in urban areas, and (ii) Opportunities to initiate monitoring of nutrition services under the Integrated Child Development Services. The presentation on these sessions will be shared with the group for reference.
The meeting ended with a vote of thanks by Ms Poonam Muttreja.
Action Points from the 29th AGCA Meeting
|Sl. No.||Action Points||Responsibility|
|1.||Revise agenda of the National Consultation on CAH as per suggestions of the MoHFW and AGCA members||AGCA Secretariat|
|2.||Share list of invitees along with a invitation letter with the MoHFW to send out invites for the National Consultation on CAH||AGCA Secretariat|
|3.||Constitute a sub- committee comprising of representatives from NHSRC and AGCA to suggest steps which allow aggregation and incorporation of village level plans into the District and State Programme Implementation Plans (PIP)||NHSRC and AGCA Secretariat|
|4.||Rework the CAH tools and User’s Manual as per the MoHFW comments||AGCA Secretariat|
|5.||Request MOHFW to organize a joint meeting Ministry of Women and Child Development (W&CD) to explore opportunities to initiate monitoring of nutrition services under the Integrated Child Development Services (ICDS) programme.||AGCA Secretariat|
|6.||Share a draft Memorandum of Understanding (MoU) with the MoHFW to finalize modalities of collaboration with NHSRC||AGCA Secretariat|
|7.||Share a draft MoU for partnership between the State Government and NGOs for CAH implementation||AGCA Secretariat|
|8.||Share 3 chapters of the Training Manual for Rogi Kalyan Samiti (RKS) with AGCA members||AGCA Secretariat|
|9.||Provide inputs on the draft Health Policy||AGCA Members and Secretariat|
|10||Request MoHFW to share the letters issued to the State Governments regarding:
|11.||Send a letter to the MoHFW and NHSRC to link CAH webpage to their websites||AGCA Secretariat|
|12.||Send updated attendance list to the AGCA members, alongwith a specific email to members who have not been attending meetings regularly, to inform the group regarding their availability and willingness to participate in the AGCA meetings||AGCA Secretariat|
Condolence Message in Remembrance of Dr Shanti Ghosh (at the 29th AGCA Meeting)
Dr Shanti Ghosh, Member, AGCA passed away on August 16, 2014. She was the member of the AGCA since its inception in 2005.
Dr Ghosh was fondly referred to as the ‘mother of neo-natal care in India’. Her contributions in the field of maternal and child health have led to major policy reforms at various levels. She was the head of the Pediatric Department at Safdarjung Hospital, New Delhi for several years. Subsequently, Dr Ghosh was an Advisor to the Ministry of Health and Family Welfare; Chairperson – Child Survival Group; and Member – Safe Motherhood Group.
Dr Ghosh contributed to many international organizations to list a few a) World Health Organization (WHO) Advisor for Family Health program in Afghanistan and b) Advisor to Food and Agriculture Organization (FAO), World Food Program (WFP), Swedish International Development Agency (SIDA) like Bangladesh and Bhutan.
She had worked with Mahatma Gandhi during India’s freedom struggle. Dr Ghosh was bestowed with many awards for her contributions to the health sector. Authored many books on health, nutrition and child care and published over 150 articles in national and international journals.
The AGCA will remember her enormous contributions, especially in the areas of child health and nutrition.
We express our heartfelt condolences to her family.
National Consultation on Community Action for Health (CAH)
The National Rural Health Mission (NRHM) launched in 2005 and the subsequent National Health Mission-NHM (encompassing NRHM and the National Urban Health Mission), 2013, place substantial emphasis on people’s participation in health. The Mission strategy includes articulation of a strong accountability framework that incorporates three dimensions-Programme Monitoring through a Health Management Information System, Periodic Surveys, and Community Based Monitoring. While there is substantial experience with the first two aspects, implementing the third component i.e. Community Monitoring, country wide, has been a mixed experience.
In 2005, the Ministry of Health and Family Welfare (MoHFW) constituted the Advisory Group on Community Action (AGCA) with a mandate to provide policy guidance and technical support on community action under National Rural Health Mission (NRHM) at the national level. The AGCA comprises eminent civil society representatives and public health experts. Population Foundation of India (PFI) hosts the Secretariat for the AGCA. The AGCA receives funding support from the MoHFW to provide technical assistance to states to initiate and scale up Community Based Monitoring and Planning (CBMP).
Between 2007 and 2009, the AGCA guided implementation of a pilot on CBMP in 36 districts across nine states in India. This pilot phase allowed the demonstration of a variety of approaches to undertake processes for CBMP and standardization of tools and training manuals. The AGCA has since then worked closely with State Governments and MoHFW to enable inclusion of CBMP into state level programmes through Project Implementation Plans (PIPs). As per MoHFW recommendation, CBMP has been re-designated as Community Action for Health (CAH), which was considered being more comprehensive.
Over the last few years, there has been significant learning from the pilots and from the advocacy efforts of the AGCA to support states in implementing the CAH component. Community engagement as a form of accountability has also been demonstrated in other sectors such as poverty alleviation. The AGCA is organizing a national consultation in New Delhi on October 28-29, 2014. The objectives of the consultation include:
- Share key experiences and processes from community action models implemented in sectors such as health, nutrition and livelihoods implemented across a variety of contexts;
- Examine relevance of models of community accountability from other social sectors and its applicability for health.
- Identify critical readiness factors required within the current institutional environment to facilitate effective scaling up of CAH.
- Generate recommendations to strengthen implementation and institutionalization of CAH
Participants in the consultation will include senior government officials from state and national levels, development partners, AGCA members, civil society organisations and public health experts.
The duration of the workshop is for a day and a half. On Day 1, a group of practitioners and experts along with State Nodal Officers- Community Processes (NHM) will present and deliberate on experiences in the implementation of various community action models. The concluding session of the first day will summarize broad experiences, lessons and challenges from the day’s presentations.
State Mission Directors, NHM and development partners will join the participants on Day 2. After a brief session to set the context, a series of panel discussions with state government officials will highlight experiences and way forward on the implementation of the CAH component in the states. The consultation will conclude with a summary of recommendations for future direction and concluding remarks by the Additional Secretary and Mission Director-NHM, MoHFW.
- Increased understanding among policy makers, programme managers and implementers on different community processes and models for enhanced accountability.
- Key challenges and potential solutions identified to facilitate effective scaling up of CAH.
- Greater commitment to make CAH a priority intervention under NHM.
National Consultation on Community Action for Health (CAH)
October 28 and 29, 2014, New Delhi
|Day and Timing||Session Plan|
|9.00- 10.00 A.M.||Registration|
|10.00 – 11.00 A.M.||Inaugural Session
|11.00 -11.15 A.M.||Tea Break|
11.15 – 12.30
Community Action for Health under National Health Mission (NHM) – Experiences from Bihar, Maharashtra and Tamil Nadu, Rajasthan
Chair- Ms Mirai Chatterjee (Member AGCA)
|12.30 – 1.15 P.M.||Session 2:
Community Action through Panchayats
Chair – Dr Sharad Iyengar (Member AGCA)
|1.15 – 2.00 P.M.||Lunch|
|2.00 -3.00 P.M.||Session 3:
Community Action in Urban Areas
Chair- Abhijit Das (AGCA member)
Panel discussion: model outcome and challenges
|3.00 – 3.45 P.M.||Session 4:
|3.45 – 4.00||Tea|
|4.00- 4.30 P.M.||Session 5:
Panel Discussion: Sharing of international experiences on Community Action
Chair- Alok M(Member AGCA)
|4.30 – 5.30 P.M.||Session 6:
Lessons learned, challenges and way forward for Community Action for Health
Chair – Mr. Manoj Jhalani, Joint Secretary (Policy), MoHFW
Summary of the day – Dr Rajani Ved, NHSRC
National Consultation on Community Action for Health (CAH)
October 29, 2014, New Delhi
|9.00- 10.00 A.M.||Registration|
|10.00 – 10.45 A.M.||Context setting
|10.45 to 11.30 A.M.||Session 1:
Panel discussion on implementation experiences, challenges and way forward in pilot states- Madhya Pradesh, Rajasthan, Odisha, Chhattisgarh, Jharkhand (State Mission Directors, NHM)
|11.30 to 11.45 A.M.||Tea|
|11.45 to 12.30 P.M.||Session 2:
Panel discussion on implementation experiences, challenges and way forward in pilot states- Assam, Maharashtra, Tamil Nadu, Karnataka (State Mission Directors, NHM)
|12.30 to 1.15 P.M.||Session 3:
Panel discussion on implementation experiences, challenges and way forward- Bihar, Gujarat, Meghalaya, Punjab, Uttar Pradesh (State Mission Directors, NHM)
Chair- Mr C.K Mishra, Additional Secretary and Mission Director-NHM, MoHFW
1.15 to 1.30
|Followed by lunch|
Action points to revise the CAH tool and User's Manual
|Sl. No.||Comments on Manual||Action to be taken|
|i.||Purpose of the manual is not clear - whether it is a user manual or operational guideline||User manual and Programme Manager's guidelines will be separated|
|ii||The document has wordy introduction and not clear who will do the data collection||Language will be simplified. Illustrations and photographs will be included. The box on page 11 will shifted before section on how to use tool kit.|
|iii||The gradation of the community enquiry process is guidance for the manager; need not be part of the tool kit||The section on gradation of tools will be included in Programme Manager's guideline|
|iv||Planning process- the manual completely ignores what is already given in VHSNC manual||The link with the VHSNC manual will be established for both Programme Manager's guideline and users manual.|
|v||User manual should include illustrations||User manual will include illustrations and flow chart|
|vi||Long list of references||The number of reference will be reduced to one page ( with important references). All references will be given in the website and the link will be given in the document.|
|vii||Core principles need to be upfront in the guidelines||Core principles will be bought upfront in the guidelines|
|viii||Design two separate documents - Guidelines for Programme Managers and User manual.||Two separate documents will be prepared- a) Guidelines for programme managers b) User manual|
|1||Include public service monitoring tool - establish link between the VHSNC manual and the current manual and tools||A separate note on public service monitoring tool will be included in manual and also a link will be established with VHSNC manual|
|2||The service providers as respondents to the facility tools may not elicit true responses||The same questions will be asked to the beneficiaries of the services for cross validation.|
|3||Types of facilities and number of facilities to be taken up for developing report card not mentioned||All facilities in the area will be covered for the report card development|
|4||Subjective questions on issues like cleanliness, patient satisfaction etc can be made more objective asking specific questions||Questions will be redrafted|
|5||Detailed comments on each tools||Will be reviewed|