Introduction
Community-based Monitoring of health services is a key strategy of National Rural Health Mission (NRHM) to ensure that the services reach those for whom they are meant, especially for those residing in rural areas, the poor, women and children. Community Monitoring is also seen as an important aspect of promoting community led action in the field of health.
Process Adopted
RRC Mamta in collaboration with department of Health and Family Welfare conducted community Monitoring in two districts of Punjab on pilot basis. From each district , two blocks were selected and from each block 3 PHCs were taken . In each PHC 5 villages were selected . In this way 15 villages from block balachour and 13 villages from block sujjon were covered and total 28 villages were taken. In District SBS Nagar selected blocks were Balachour and Sujjon . NGOs were selected to conduct community Monitoring .
Following activities were done:
Activity at CHC level:
- One interview with CHC Medical officer
- Exit interview of 5 patients at CHC level
Observation of CHC using checklist
Activity at PHC level:
- One interview with PHC Medical officer
- Exit interview of 5 patients at PHC level
- Observation of PHC using checklist
Activity at Sub center level:
- Observation of Sub-center using checklist
Activity at Village level
- One group discussion with community members
- One group discussion with women
- One group discussion with marginalized women
- One interview with ASHA
- Interview with five women who have delivered in last three months
Formats used were developed and printed by Department of Health and Family welfare, Government of Punjab. After all the activities enlisted above cumulative report card was developed , which were shared in Jan Samvad.
Public dialogue /Jan Samvad: In district , Jan samvad was held at Mata Vidyawati Bhawan, SBS Nagar .
Officials present
- State Programme Manager : Dr. V.K. Gagneja
- Consultant Community processes: Dr. Monika Pathak
- Civil Surgeon, SBS Nagar: Dr. Dharampal
- District program manager: Ram Singh Thakur
- Community Moblizer: Mr. Gurdeep
- DDPO, SBS Nagar: Mr. Amardeep Singh bains
- Chairperson District Planning and Monitoring committee: Ms. Ravinder Kaur
- Programme officer ICDS: Ms. Anshu Thakur
- CDPO Banga:Ms. Veena Bhagat
- SMO Balachour:Dr. Sunil Thakur
- SMO Sujjon: Dr. Jaspal
- District Mass Media officer: Mr. Iqbal Singh
Panel Members:
- Mr. Didar Singh Chithra, District Beauro Chief, Daily Ajit
- Mr. Manjit Singh, Sarpanch Chika Ladhana
- Dr. Surinder Mohan Retd. Civil Surgeon
- Ms. Raksha Chand
Community Persons present: 135 Persons were present
- PRIs
- Women Panch
- Village women
- ASHA
- ANMs
Following issues needs attension in block sujjon and Balachour:
- Janani Suraksha Yojna
- Disease Surveillance
- Curative services
- Untied fund
- Analysis was done to know the reason of Gap in the services, the details of which are as follows:
- Janani Suraksha Yojna:
- Block Sujjon:All the deliveries were hospital deliveries ( 27 out of 27) so in block sujjon people are aware about benefits of institutional deliveries but large percentage of deliveries are taking place in private hospitals . 40% deliveries are Privatec hospital deliveries which is the cause of concern.
- Block Balachour:High percentage of deliveries were Institutional deliveries ( 30 out of 30) so in block sujjon people are aware about benefits of institutional deliveries but large percentage of deliveries are taking place in private hospitals . 50% deliveries are Private hospital deliveries which is causing this indicator to turn red.
Action Taken:
The major cause of turning JSY issue red is high percentage of private hospital deliveries as no. of gynecologist is less in government hospitals in district SBS Nagar. It was recommended by panel members, community members that more gyaenacologist should be posted in the district hospitals . The proposal was accepted by officials present.
Untied fund:Although community is aware about untied but awareness level is low on utilization of untied fund in most of villages visited untied fund is used for purchasing chairs, durries for anganwadi center. Untied fund is also used for repair of roads or cleaning of streets or pond but there is need to build the capacities of VHSNC members for utilization of untied fund for curative and disease prevention services
Action Taken:
Although people have awareness about untied fund but members of VHSNC requires more capacity building on the issues of utilization of untied fund. It was perceived that continues training should be given to VHSNC members so as to make the fully capable undertake responsibilities of their respective VHSNCs
Disease Surveillance: This issue is red because in most of villages MPHW post is vacant and most of functions are performed by ANM Posted in that area. Birth death are registered by ANM. She visits the community area in case of spread of specific disease.
Action Taken:
There is policy decision that there should no more recruitment of MPHW(M) as there is more need of MPHW(F) . So large no. of females are being recruited to provide services. As female workers are needed to provide services to vulnerable population such as pregnant women , lactating mothers, eligible women and childern
SUB-CENTER REPORT CARD: 6 sub center were covered under the block sujjon , gaps were found because in two subcenters namely Rampur and Khamanchoo , as the post of MPHW is vacant.
In block balachour 5 sub center were covered , gaps were found because in three subcenters namely Bela Thajourall, Kathgarh and Garthella , as the post of MPHW is vacant.
Action Taken:
There is policy decision that there should no more recruitment of MPHW(M) as there is more need of MPHW(F) . So large no. of females are being recruited to provide services. As female workers are needed to provide services to vulnerable population such as pregnant women , lactating mothers, eligible women and childern
PHC/CHC REPORT CARD: Six PHCs were covered under this
- PHC Balachour
- PHC Kathgarh
- PHC Paryalli
- PHC Sujjon
- PHC Behran
- PHC Khatkar Kalan
Two PHCs are working 24×7 and working very effectively some gaps were found in infrastructure in PHC Kathgarh and Paryall
Action Taken:
It was instructed by state Programme Manager Dr. V.K. Gagneja that instruments which are deficient at the PHCs should be purchased immediately from PHC untied fund
Denial of Maternal Health guarantee :
Ms. Babita w/o Sanjeev delivered on 14/8/12 of village sal Kalan at CHC Sujjon was eligible for the benefits of JSY . She even got certified from panchayat but she was denied JSY Benefit.
Action Taken:
Dr. Dharampal , Civil Surgeon , SBS Nagar , instructed S.M.O Dr. Jaspal to immediately give JSY benefit to the affected mother.
Some other Recommendations From community members:
- It was suggested by Mr. didar singh chithra that untied money should be used as seed money and untied money can be further stretched through community related activities . It was also suggested that untied fund should be given according to population of the village
- DDPO, , SBS Nagar: Mr. Amardeep Singh bains suggested that if health department needs buildings for sub centers then they can write department of Rural development and panchayats . so provisions can be made
- It was suggested that ANM can do the resource mapping of the area for referral transport vehicle(Ambulance) from private hospitals , which can be utilized during emergencies
- The community suggested that the help of NGOs/ SHGs /NRI Community can be taken in case of non availability of any kind of medicines
Conclusion: It was felt during the whole activity of community monitoring that there is greater need of community mobilization/awareness about health entitlements and health guarantees and to enable them to do community based planning and monitoring activities . Community members requires hand holding and support to carry out the perceived activities at least for one year
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