Arogyashreni – Towards creating a replicable model for community monitoring of Primary Health Centres
Samiksha Kashyap, Ramaswami Balasubramaniam · 2012
Description of the problem The National Rural Health Mission (NRHM) has initiated community based institutions at various levels [1] of the health system, intended to create awareness about health services and empower communities to demand their entitlements. They are also responsible for planning and monitoring public health and sanitation programmes based on local needs. Difficult entry barriers like information and power mismatch between personnel and community representatives, reluctant decentralization mechanisms and the excessive bureaucracy hinder the effectiveness of these committees . Thus, the Karnataka experience towards communitization has unfortunately been ambivalent. Solution model In this context, an innovative community monitoring initiative was devised to address issues like a) Usability of community monitoring, b) Developing a sense of ownership among community representatives about their PHCs [2] , c) Bridging information gaps in community representatives to help articulate local problems and begin to look for their solutions, d) Enhancing demand for health services through community engagement and e) Building a low-cost technology based platform for rapid analysis and dissemination of community monitoring information. The project is implemented in all rural PHCs of Mysore district. Based on a community consultation workshop including doctors, academicians and community representatives, a yes/no type monitoring questionnaire was devised, containing 79 questions covering operational aspects of a PHC. The questionnaire was installed on a toll free IVRS [3] system which can be used by any selected community member to answer the questionnaire for their respective PHC. Selected VHSC and ARS members were oriented to answer the IVRS based questionnaire. Preliminary Results Community representatives responded to the IVRS based monitoring questionnaire for 3 consecutive months. These responses were validated by physical verification and statistical assessment of error. Using this base-line community monitoring database a district-wide ranking of rural PHCs was generated. The ranks were disseminated among the community and the Department of Health and Family Welfare. Although the Medical Officers are apprehensive about the community monitoring their PHCs, they concur with the ranks and positions of individual PHCs. Community representatives are interested in monitoring and working with the PHC staff, provided the suggested changes are visible to them. Preliminary analysis of the community’s responses suggests that presence of good physical infrastructure does not necessarily translate into better service delivery. T Narasipura taluk, has the highest density of PHCs is Mysore district. It also ranks lowest among all taluks in terms of overall utility of the PHCs. In two PHCs, changes brought due to community monitoring has been documented. The District Health Officer is interested in using the community monitoring information as a tool for reviewing PHC progress in NRHM. Discussion This project validates the view that community monitoring can be an authentic tool for measuring performance of PHCs and opens up the possibilities to replicate such experiments in other grassroots government institutions as well. The project demonstrates the use of low-cost technology in minimizing data entry/integration issues that adversely affect usability of existing community monitoring mechanisms. The selection of members of VHSCs and ARS for the project was made with the intention to encourage them to bring improvements wherever they can, in their role as members of such committees. While positive indications of progress exist, it is too early to conclude that this form of monitoring can also bring sustainable improvements in service delivery at PHCs. The community monitoring and ranking system report the situation as is , without blaming anyone for it. This allowed the monitoring process to evolve into a joint assessment, rather than a community led inspection of the PHC. Based on these encouraging outcomes, the project aims to target the planning and implementation of activities to be carried out at the PHC. For this reason, the P&MC members shall participate as respondents to the community monitoring questionnaire. The advocacy activities of the project will be more focussed on need based planning and guaranteeing service delivery in the public health system. [1] Arogya Raksha Samithi (ARS) and Planning and Monitoring Committee (P&MC) are examples of such committees working at the level of Primary Health Centre and the Village Health and Sanitation Committee (VHSC) at the revenue village level. [2] Public Health Centers [3] Interactive Voice Response System