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.
The provision for Monitoring and Planning Committees has been made at Primary Health Centre (PHC), Block, District and State levels. The adoption of a comprehensive framework for community-based monitoring and planning at various levels under NRHM, places people at the centre of the process of regularly assessing whether the health needs and rights of the community are being fulfilled.
Community monitoring is to review the progress to ensure that the work is moving towards the decided purpose, and the purpose has not shifted, nor has the work got derailed in any way. Such a review can help to identify obstacles in the work, so that appropriate changes can be made to cross the obstacles.
Processes
- Orientation of stakeholders & Strengthening of District /Block NGO’s
Orientation of Stakeholders is done by means of State Workshop, District Workshop, Block Providers Orientation Workshop and Media Orientation Workshop, where a shared understanding of the community monitoring process under NRHM is developed and a resolve to work together is taken.
Strengthening of District/Block NGO’s
There is capacity building by way of State Managers Workshop & Block Facilitator’s Training, of the district and block NGOs to understand the administrative and financial set-up of this program and also the various activities envisaged under this program. - Mobilization of community
What is the Need?
The block facilitator will be familiarised with the village health services.
It will aid in the compilation of baseline information to compare after the community monitoring process
Objective of community mobilization: - To make the communities aware of their health related entitlement within NRHM.
- To have a shared understanding of the health issues of the community.
- To facilitate the formation or expansion of the Village Health and Sanitation Committee.
- Building ownership about public health service.
- Developing awareness about determinants of health.
Village Health Services Profile
It is an outcome of the mobilisation process. It should be used by the block facilitators and the VHSC members to familiarise themselves before they start with the monitoring process. It will help in comparing the changes that will be brought about after the community monitoring process.
It is an outcome of the mobilisation process. It should be used by the block facilitators and the VHSC members to familiarise themselves before they start with the monitoring process. It will help in comparing the changes that will be brought about after the community monitoring process.
- Formation & Strengthening of VHSC/PHC/Block/District Committees
There is formation or expansion of committees at village, PHC, block and district levels
Strengthening of Committees
Once the committees are formed there are trainings at each level for the monitoring exercise that the members will undertake. - Community Level Enquiry
The monitoring committee members conduct the first round of monitoring by conducting beneficiary interviews, provider interviews, exit interviews, focus group discussions and observations. At the end of the first round of community monitoring a report card and a cumulative report card is generated at each level. The village report card consists of the issue and their status by means of traffic lights. Green suggests good performing village, yellow suggests there is a cause for concern and Red suggests that the village is performing bad.
After the village report cards have been formed for each village, they are collated by the PHC, block, district and state level monitoring and planning committees. So according to the color code for each issue in each of the village health report card, the greens, yellows and reds are added at each level.
The facility score card is a snapshot of the status of the health facility in the village/block/district. The color codes display the facility’s level of performance. Green stands for good performance, Yellow stands for Cause for concern and Red stands for poor performance.
After the facility score cards have been formed for each facility, they are collated by the PHC, block, district and state level monitoring and planning committees. So according to the color code for each issue in each of the facility score card, the greens, yellows and reds are added at each level. - Sharing of Reports & Planning
Village Sharing Meeting - Village Score Card and key findings of the Community Monitoring exercise
- Adverse experiences and adverse outcome
- To improve service delivery & not fault finding with health care service providers
- To discuss key problems & suggest action points
Jan Samvad (Public Dialogue)
- Conducted at Block and PHC level
- Presentation of Cumulative Village Report Card & Facility Report Card
- Presentation of Denial of Care / Adverse Outcomes
- Discussion on implementation of outreach services, improving Facility level service utilization & support to denial of care/adverse outcome cases
