Minutes of the 33rd Meeting of the Advisory Group on Community Action – National Health Mission
Nirman Bhawan, Ministry of Health and Family Welfare, June 3, 2016
Members of Advisory Group on Community Action (AGCA) present
  • Dr Abhay Shukla
  • Mr Gopi Gopalakrishnan
  • Dr H Sudarshan
  • Ms Indu Capoor
  • Ms Mirai Chatterjee
  • Dr M Prakasamma
  • Dr Narendra Gupta
  • Ms Poonam Muttreja
  • Dr Sharad Iyengar
  • Dr Thelma Narayan
  • Dr Vijay Aruldas
Officials of Ministry of Health and Family Welfare (MoHFW) present
  • Mr C K Mishra, Additional Secretary and Mission Director, National Health Mission
  • Mr Manoj Jhalani, Joint Secretary – Policy
  • Ms Limatula Yaden, Director, NHM
  • Ms Neha Aggarwal, Consultant, NHM
Officials of National Health Systems Resource Centre (NHSRC) present
  • Dr Satish Kumar, Senior Advisor, Public Health Planning
  • Mr Manoj Kumar, Consultant, Public Health Planning
Special Invitee
  • Dr Varun Goyal, Public Private Partnership Specialist, SAATHII, Delhi
AGCA Secretariat Staff
  • Mr Bijit Roy
  • Mr Daman Ahuja
  • Mr Smarajit Chakraborty
  • Ms Seema Upadhyay
  • Ms Tripti Chandra
  • Mr Santosh Kumar Mallik
  • Ms Jolly Jose
AGCA members who could not attend the meeting and were given leave of absence
  • Dr Abhijit Das
  • Mr Alok Mukhopadhyay
  • Mr A R Nanda
  • Dr Saraswati Swain
Permanent invitees who could not attend the meeting and were given leave of absence
  • Dr Sanjiv Kumar, Executive Director, NHSRC
  • Dr Rajani Ved, Advisor, Community Processes, NHSRC

Ms Poonam Muttreja welcomed the participants to the 33rd meeting of the Advisory Group on Community Action (AGCA).

The meeting began with the reading of a condolence message in the memory of Prof Ranjit Roy Chaudhury, Member AGCA, who passed away on October 27, 2015.  In homage, the group observed a minute’s silence.

The broad objectives of the meeting are given below:

  • Review progress of the programme ‘Strengthening Community Action for Health under the National Health Mission’ for the period October 2015 – May 2016 and identify priorities for the current Financial Year 2016-17.
  • Discuss the potential role of the AGCA in improving quality of care in family planning.
  • Reflect and identify future directions for the AGCA.

Ms Muttreja thanked the AGCA members for their support and continued guidance to the Secretariat over the last year in strengthening and scaling up implementation of community action for health.  She introduced two new team members – Mr Smarajit Chakraborty who has joined as Programme Manager, AGCA Secretariat and Mr Santosh Kumar Mallik who will support strengthening of Rogi Kalyan Samitis (RKSs) in Delhi.

Based on the positive outcomes of the Regional Consultations held in Kolkata and Delhi in February 2016, Ms Muttreja shared that the AGCA should focus on the following action points:

  • Organize orientation workshops on programme plans and implementation details for the finance staff, in coordination with NHSRC
  • Facilitate cross learning among state nodal officers and nodal organizations on the implementation processes, innovative approaches and in addressing challenges
  • Concentrate on investment in capacity building and mentoring of Panchayati Raj Institution (PRI) members, especially the women representatives
  • Undertake periodic assessments of implementation processes in the field
  • Promote use of mass media for dissemination of information and knowledge on health entitlements and to foster community action.

She highlighted some of the positive developments in states such as Madhya Pradesh, Assam and Rajasthan over the last fiscal year. She acknowledged the contributions made by the AGCA members in the respective states.

She briefed that the reductions that have been made in the AGCA budget for the FY 2016-17, would have implications on the pace and scale of implementation support to the states. The Secretariat has requested the MoHFW to reconsider and approve the proposed costs.

Ms Muttreja shared the following feedback provided by Mr A R Nanda who could not attend the meeting:

  • The AGCA meetings should be organized on a quarterly basis at the PFI office. The Secretariat can subsequently brief the senior MoHFW officials on the issues which need attention/ decisions
  • AGCA meetings can be organized at the MoHFW once a year
  • AGCA’s engagement and its meetings need to primarily focus on broader issues around policy review and quality of care, rather than being confined to issues around implementation of community action for health in the states
  • Members should avoid raising state specific implementation issues at the AGCA meetings.

AGCA members confirmed the minutes of the 32nd AGCA meeting organized on October 1, 2015.

Compliance on Action Points from the 32nd AGCA meeting

Bijit Roy shared an update on the Action Taken on the 32nd AGCA meeting.

Sl. No. Action Points Responsibility Action Taken
1. Suggest processes for empanelment of NGOs for implementing community action for health NHSRC and the AGCA Secretariat
  •  Meeting with the NHSRC organized on April 28, 2016 to discuss details.
  • Draft terms of reference for empanelment of NGOs shared with the MoHFW on May 18, 2016.
2. Work on the decentralized health planning deliverables as detailed in the AGCA sub-group meeting NHSRC and the AGCA Secretariat
  • AGCA’s inputs on the State PIPs shared with the NHSRC team in May 2016.
  • Decentralized health planning initiated in Maharashtra. This will be followed by Karnataka, Rajasthan and Uttar Pradesh.
  • Next AGCA sub-group meeting is planned for July 2016 to deliberate on the operational details.
3. Increase engagement with the Ministry of Rural Development and Panchayati Raj AGCA Secretariat
  • Provided detailed feedback to the Ministry of Rural Development and Panchayati Raj on Health Module for Gram Panchayat Members. Module has been finalized.
  • In Kerala, discussions have been initiated with the Kerala Institute of Local Administration (KILA) to facilitate training of PRI members on community action.
  • In Madhya Pradesh, a session on community action has been included in the regular trainings for PRI members. District Community Mobilizers have been oriented to facilitate the sessions.
4. Share the m-Shakti IVRS experiences with organizations implementing community action for health AGCA Secretariat
  • m-Shakti IVRS experiences shared at the Regional Consultations and with state nodal organizations.
5. Share

a) note and agenda of the Regional Consultations; and

b) note on television and radio spots with the AGCA members and the MoHFW for inputs

AGCA Secretariat
  • Note and agenda of the Regional Consultations shared with the MoHFW. Consultations organized in February 2016 in Kolkata and New Delhi.
  • Note on television and radio spots shared with the MoHFW on November 18, 2015. Inputs received from the AGCA members were incorporated in the note.
Update on the Progress of AGCA Activities

Bijit Roy on behalf of the AGCA Secretariat presented an update on the programme ‘Strengthening Community Action for Health under the National Health Mission’ for the period October 2015 – May 2016. The presentation included an update on the activities undertaken at the national and state levels, tapping new opportunities for expanding the scope of community action and the implementation challenges in the states.  In addition, he shared a brief on the approved activities for the current FY.

The following points were made by the AGCA members:

  • Pilot experiences on decentralized health planning in Maharashtra have been encouraging. A meeting of the AGCA Sub-group should be organized in July 2016 to discuss implementation modalities in Karnataka, Rajasthan and Uttar Pradesh.
  • The AGCA should focus its efforts on initiating community action processes in selected urban areas in states such as Gujarat and Odisha. The capacity building and mentoring of Mahila Arogya Samitis (MASs) now initiated in the states provide a good entry point.
  • Dr Abhay Shukla shared that there has been a recent change in the NHM leadership in Maharashtra. A visit of the AGCA is therefore, necessary to brief the new Mission Director on the Community Based Monitoring and Planning (CBMP) processes and advocate for a continuation of its various ongoing activities through the district and block level nodal organizations; as well as to expedite the selection process for the state nodal organization. Ms Mirai Chatterjee volunteered to visit Maharashtra.
  • There are prolonged delays in finalization/ extension of contracts and transfer of funds to the implementation organizations. This results in low fund utilization. The Secretariat should work more closely with both the Programme and the Finance teams at the state level to ensure effective implementation of the approved programme activities and corresponding budgets.
  • The State Nodal Officers who participate in the National Programme Coordination Committee (NPCC) meetings often do not have detailed clarity on the community action processes, thus being unable to respond to specific queries. The MoHFW should consider involving the AGCA Secretariat in the NPCC meetings, in which the community action for health component is being discussed.
  • There should be greater coordination between the NHSRC and the AGCA Secretariat in the development process and the review of the State PIPs for community action for health component.
  • The AGCA needs to focus on strengthening implementation of community action processes in 5-6 selected states.
  • The AGCA Secretariat should prepare an analysis of the State Programme Implementation Plans (PIPs) for the community action for health component. This includes resources request by the states, resources approved by the MoHFW and its utilization by the states.
  • In addition, an analysis should be undertaken to identify the inhibiting factors/ bottlenecks for states where implementation processes are either stalled or tardy.
Brief on Current Programme Priorities under the NHM

Mr Manoj Jhalani, Joint Secretary Policy, MoHFW made the following points:

  • The AGCA should advocate with key stakeholders to take greater ownership towards strengthening accountability mechanisms and in sustaining community action for health processes at the state level.
  • The 14th Finance Commission has provided ample resources to the Ministry of Panchayati Raj (MoPR) for capacity building of the PRI members. The MoHFW is coordinating with the MoPR to mainstream the health agenda into its capacity building plans. These resources can be leveraged at the state level to strengthen capacities of PRI members on community action.
  • The MoHFW will review the AGCA’s request for reconsideration of the budget reductions for the FY 2016-17.
  • The MoHFW is initiating a ‘Patient Feedback Solution’ to enable citizen centric care. The initiative will be piloted in 60 public and private health facilities across six states – Andhra Pradesh, Delhi, Gujarat, Maharashtra, Rajasthan and Tamil Nadu. The initiative will be launched on August 15, 2016. Initially, feedback will be received on four areas: a) behaviour of service providers; b) out-of-pocket expenditures; c) cleanliness in health facilities; and d) other issues. Clients can provide their feedback on health services through Short Message Service (SMS), Interactive Voice Response System (IVRS) and web application. The client feedback will be compiled and used for strengthening the quality of services in the health facilities. Subsequently, client feedback will feed into the quality certification of health facilities and extension of empanelment of private hospitals, which are funded under the Rashtriya Swasthya Bima Yojana (RSBY) and the Central Government Health Scheme (CGHS). In addition, the findings of the feedback will form a part of the Annual Confidential Report (ACR) of health providers to improve accountability. The AGCA should provide inputs on the initiative.
  • The MoHFW is strengthening the process of grievance redressal through the 104 helpline. In addition, help desks will be operated by NGOs in district hospitals to facilitate easy access to services and negotiate with the Civil Surgeon on client concerns.

The AGCA members noted that:

  • There are wide variations in the community perceptions on health services. People are often reluctant to provide negative feedback on the available services.
  • Sensitivity towards patients is a key concern in public health facilities and should form a part of the client feedback and action process.
  • The findings emerging from the client feedback should feed into the agenda and discussions at the RKS meetings and facilitate a prompt redressal of grievances.

Subsequently, Dr  Varun Goyal, PPP Specialist, SAATHII, Delhi made a presentation on the ‘Patient Feedback Solution – An Initiative towards Patient Centric Care in Public and Private Hospitals’.

Improving Quality of Care in Family Planning - Potential Role for the AGCA

Ms Poonam Muttreja informed that PFI had led a multi-organizational fact-finding visit to Bilaspur district, Chhattisgarh, following the tragic death of 16 young women after a sterilization camp in November 2014. Subsequently, the key recommendations from the findings were shared with the senior MoHFW and State Government officials for improving the quality in family planning services.

An additional affidavit in response to the Writ Petition No. 95/2012 (Devika Biswas Vs Union of India and Others) was recently filed in the Supreme Court of India seeking responses from the Government on improving the quality of family planning services. The MoHFW in its response to the Supreme Court of India has stated that ‘it organizes regular meetings with civil society organizations like PFI (as part of the AGCA) and others represented in the Mission Steering Group (MSG) who raise issues in the forum’.

Ms Muttreja requested members for inputs on whether the AGCA should engage in the monitoring of quality of care in family planning.

The members responded as follows:

  • Both accountability and monitoring the quality of care fall within the mandate of the AGCA. Therefore, this can be taken up under its aegis.
  • There is a need to assess our own capacities should the AGCA be entrusted with the responsibility of coordinating with civil society organizations to monitor improvements in the quality of care in family planning services across the country.
  • Monitoring family planning services involves a great deal of technical and qualitative detailing. It therefore, requires a specific skill set and facilitation experience.
Inputs and Guidance from Mr C K Mishra, Additional Secretary and Mission Director-NHM, MoHFW

Mr C K Mishra made the following points:

  • Community action for health is now a well-accepted and understood concept by the State NHM leadership. The AGCA should now provide the states with guidance and intensive support on the implementation processes. This will greatly enhance state ownership.
  • As demonstrated in Chhattisgarh, there is a need to focus on the institutionalization of communitization processes in the states. This should be reflected in the State PIPs.
  • The AGCA should strategize and deepen its focus on a few selected states in the current year.
  • The AGCA should organize sensitization workshops and seminars to increase the knowledge of the key stakeholders engaged in the community action processes.
  • Sanctioning of funds to the states for communitization initiatives is not an issue. In addition, the implementation of activities should continue as per the approved plan. The states need not wait for the Recording of Proceeding (RoP) approvals for the continuation of activities, each year. A specific directive has been sent to the states regarding this.
  • The MoHFW had received extensive feedback on the draft National Health Policy (NHP). It took almost 4 months to group the feedback. The draft cabinet note has been prepared for seeking approval. The policy should be finalized in the next 3-4 months.
  • The MoHFW will launch the National Health Protection Scheme on April 1, 2017. It is a gap filling arrangement which will provide tertiary health care for selective beneficiaries. The details of beneficiaries to be covered under the scheme are being worked out. The implementation of the RSBY will continue.

The members requested Mr Mishra to consider the following:

  • Sending an advisory to the states to prioritize implementation of community action for health.
  • Representation of the AGCA Secretariat in the NPCC meetings.
Envisioning Future Directions for the AGCA

 Members made the following inputs:

  • AGCA’s engagement and its meetings need to primarily focus on broader issues about policy review and quality of care, rather than being confined to issues around implementation of community action for health in the states.
  • Coordination between the NHRSC and the AGCA should be strengthened to promote integrated approaches for diverse components of community processes – ASHAs, VHSNCs, RKSs and Community Action for Health. The NHSRC and the AGCA should work closely to develop capacities of a pool of state and district level master trainers.
  • The AGCA members need to engage more closely with the State Governments. Participation in the Common Review Mission (CRM) provides a good opportunity. In addition, the AGCA should provide inputs to the MoHFW and the NHSRC on the Terms of Reference (ToR) of the CRM, especially for the communitization components.
  • The AGCA needs to focus on supporting the implementation of community action processes in only a few selected states. Continued engagement with the top leadership is essential to develop and sustain government ownership.
  • The AGCA should explore possibilities and leverage complementary funding for strengthening its work.
  • The AGCA needs to strengthen its engagement and collaboration with the MoPR at the national and state levels. The collaboration can focus on supporting capacity building of PRI members at the Gram Panchayat, Block Panchayat and Zilla Parishad levels, particularly those who are represented in the RKSs.
  • The AGCA should provide support for scaling-up innovative processes on community action such as: a) federation of VHSNCs; b) participatory audit of RKSs; c) decentralized health planning; d) monitoring of public services through the SEWA Shakti Kendra; and the UDAY initiative by Action Research and Training for Health (ARTH), which focus on increasing community awareness on health services provided by the ASHAs.
  • Dr Satish Kumar, NHSRC shared that the MoHFW has launched the National Health Innovation Portal to identify and support the scale up of health innovations. The NHSRC hosts the Secretariat. Innovations on community action should be uploaded on the portal.
  • The community action processes should focus on reaching the unreached and excluded groups and facilitating their access to health services.
Action Points from the 33rd AGCA Meeting
Sl. No. Action Points Responsibility
1. Prepare an analysis of the State PIPs – proposed budget by the states, approval from the MoHFW, and utilization of resources for the community action for health component. AGCA Secretariat
2. Organize the next AGCA Sub-group meeting to discuss modalities for initiating the process of decentralized health planning in Karnataka, Rajasthan and Uttar Pradesh. AGCA Secretariat and the NHSRC
3. MoHFW can consider inviting the AGCA Secretariat to participate in the NPCC meetings, when discussing the community action for health component. MoHFW
4. Share inputs on the Terms of Reference (ToR) of the Common Review Mission (CRM) with NHSRC. AGCA Secretariat
5. Share inputs/suggestions on the Patient Feedback System developed by the MoHFW. AGCA Secretariat