• Mr A R Nanda
• Dr H Sudarshan
• Dr Abhay Shukla
• Dr M Prakasamma
• Dr Thelma Narayan
• Ms Poonam Muttreja

Official of Ministry of Health and Family Welfare (MoHFW) present

• Ms Neha Aggarwal, Consultant, NHM

Officials of National Health Systems Resource Centre (NHSRC) present

• Dr Satish Kumar, Senior Advisor, Public Health Planning
• Mr Padam Khanna, Senior Consultant, Public Health Planning
• Dr Manoj Kumar Singh, Consultant, Public Health Planning

AGCA Secretariat Staff

• Mr Bijit Roy
• Mr Daman Ahuja
• Mr Smarajit Chakraborty
• Ms Seema Upadhyay
• Ms Jolly Jose

AGCA members who could not attend the meeting and were given leave of absence

• Dr Abhijit Das
• Dr Vijay Aruldas
• Mr Alok Mukhopadhyay
• Dr Narendra Gupta
• Dr Sharad Iyengar
• Ms Mirai Chatterjee
• Ms Indu Capoor
• Mr Gopi Gopalakrishnan
• 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 34th meeting of the Advisory Group on Community Action (AGCA).

The broad objectives of the meeting were to:

• Share updates on the ‘Strengthening Community Action for Health under the National Health Mission’ grant for the period June-September, 2016 and work priorities till December 2016.
• Discuss the AGCA future strategies.
• Deliberate on the outcomes of the AGCA sub-group meeting on Decentralised Participatory Health Planning and its operationalisation plan.

• The AGCA and the NHSRC should plan a visit to Rajasthan to brief the State Mission Director NHM on reinitiating the CAH processes in the state.
• The MoHFW is currently looking at the utilisation trends of the resources allocated for each component. However, there are prolonged delays in their disbursement from the State NHM to the implementation organisations, which result in a low utilisation of funds. For example in Maharashtra, funds were disbursed to the State Nodal Organisation only in January 2016. The MoHFW could consider sending a directive to states advising a prompt disbursement of funds for the implementation of CAH activities.
• The AGCA Secretariat should organise bi-annual state level meetings to review progress on the approved CAH activities and the corresponding utilisation of funds.
• The AGCA Secretariat and the NHSRC should review and identify all the community process components (from FMR B1 to B15) and try to put them together in the next State PIP.
• The NHSRC organises periodic orientations for the newly inducted Principal Secretaries and State NHM Mission Directors. The AGCA could be invited to present and share their experiences on the CAH processes.
• Innovations on the CAH processes in the states should be documented and presented at the next National Innovations Summit.
• The Secretariat should organise a meeting with the NHSRC to discuss the RKS capacity building roll out plan.
• Dr Abhay Shukla shared that during the State Review in March 2016, it was decided that the process of reselection of the State Nodal NGO would be completed within 45 days. The state has so far shortlisted and interviewed five organisations in August 2016. However, no final decision has been taken. A further delay in the finalisation of the State Nodal NGO would affect the implementation of the approved activities. Dr Shukla requested the Secretariat to write a letter to the State NHM Mission Director to expedite a decision on this matter.
• The Secretariat informed that the Maharashtra State NHM officials have shared that the State Nodal NGO, SATHI, was given a no-cost extension letter by the State NHM two months ago. However, there has been no formal communication from SATHI and no plan either to meet the implementation of the approved activities till date. SATHI should consider sending a formal communication to the State NHM on the sanction of the no-cost extension. Subsequently, a letter could be sent by the AGCA Secretariat to expedite the selection process of the State Nodal NGO.
• The group suggested that the forthcoming regional consultations could be organised in Guwahati and Mumbai.

Screening of television spots on community action for health

Ms Muttreja shared that the AGCA Secretariat with support from Bombay Local Pictures has developed a set of 4 television spots on: i) Health Entitlements in Primary Health Centres (PHCs), ii) Health Entitlements in Sub-Health Centres (SHCs), iii) Services in Village Health and Nutrition Days (VHNDs), and iv) Role of Village Health, Sanitation and Nutrition Committees (VHSNCs).  The spots have three versions – durations of 30 seconds, 60 seconds and a longer 3-minute version, which could be shared on social media and other digital platforms. She mentioned that the radio spots were being finalised and would be shared within the next three weeks. The spots were much appreciated by the group.

The following points were suggested by the AGCA Members:

• The AGCA Secretariat should develop a wider dissemination plan of the spots.
• The spots should be shared with the organisations which are implementing the CAH process and further disseminated in the field through WhatsApp groups.
• The spots could also be shared with health training, medical and academic institutions for a wider dissemination of the messages.

• The AGCA was constituted by an executive order of the MoHFW to function as an autonomous as well as a civil society group, which would provide guidance on the designing and implementation of the communitisation components under the National Rural Health Mission (NRHM). Members of the AGCA and representatives of NHSRC were of the unanimous view that spirit and objectives of the AGCA’s mandate would be best fulfilled if it were independent of day to day functions of policy and programmatic technical support, which are NHSRC’s mandate.
• The Terms of Reference (ToR) of the constitution of the AGCA vide government order number N.37014/3/2005-EAG, dated August 31, 20I5, mentions that the “The Population Foundation of India will provide the necessary Secretariat support to the Advisory Group, with suitable assistance from the Ministry of Health and Family Welfare”. A copy of the government order is enclosed for reference as Annexure C.
• The AGCA has been functioning as an independent think tank providing objective inputs and technical support to the national and state governments on the functioning of the NHM, especially from a community-centric perspective. The AGCA has also coordinated with various civil society actors to strengthen community action for health processes in across 22 states. The NHSRC, is perceived as an institution affiliated totally to the government for funding, reporting, technical assistance and its accountability lies with the government.
• The MoHFW located the AGCA Secretariat in PFI, which is a reputed national level institution and acceptable to the civil society players.
• The capacity building of members of the Village Health, Sanitation and Nutrition Committees (VHSNCs) and Rogi Kalyan Samitis (RKSs) to monitor and demand for quality services requires an intermediary organisation with specific skill sets. The AGCA has been playing this role in the state and hence support from the MoHFW should continue.
• Shifting of the AGCA Secretariat to NHSRC will impact the accountability aspects, which is the foundation for CAH.
• Over the last couple of years, the AGCA has been working closely with the NHSRC team on programmatic issues and specific initiatives, such as Decentralised Participatory Health Planning. In addition, the NHSRC representatives have been regularly participating in the AGCA meetings. The AGCA’s collaboration with the NHSRC on operational issues can be further discussed and strengthened.
• While, certain specific costs such as organising the AGCA Meetings, travel for members to the states can continue to be supported by the MoHFW, PFI should discuss and seek approval from its Governing Board for partial funding of the Secretariat. In addition, there is a need to leverage alternative sources of funding, beyond the government, for long term sustainability.

• The process cannot be viewed as a one-time activity. It needs to be allocated sufficient time and should be inclusive and participatory.
• The convergence with the Department of Panchayati Raj is essential, as it plays an important role in the planning process. Efforts should be made to involve the District Planning Committees in the process.
• The Secretariat has taken an initiative in Assam wherein discussions have been initiated with the State NHM and the State Institute of Rural Development (SIRD) to include participatory health planning in the Gram Panchayat Development Planning (GPDP) process.
• A separate line-item should be included in the State PIPs to identify, prioritise and approve proposals, which have emerged from the decentralised participatory planning process.
• All districts need to make an online submission of the PIPs from the current FY year, which will subsequently be locked. The changes to the District PIPs can be done by the designated nodal officer at the state level.
• The State Programme Managers (SPMs) and the District Programme Managers (DPMs) should be provided training on the decentralised participatory planning process and facilitate its inclusion in the District and State PIPs.
• The participatory planning process may be initiated in the model districts identified by the MoHFW. The list of model districts is enclosed as Annexure F.
• The State Advisory Group on Community Action (SAGCA) and the State Planning and Monitoring Committees (SPMCs) should review the proposals generated through the participatory planning process and facilitate its inclusion into the final State PIPs.
• AGCA Members suggested that the MoHFW and the NHSRC should insist the states to upload the district PIPs and approvals on their website.
• The NHSRC will coordinate with the State NHM teams to organise the state level orientations.
• The next sub- committee meeting will be organised on October 6, 2016.

Response from the NHSRC:

• The proposals will be uploaded as annexures in the district PIPs which cannot be removed or changed at the state level. Till last year, it was mandatory for the states to share the PIPs for the 186 High Priority Districts (HPDs) along with the SPIPs.