RF_COM_H_92_A_SUDHA.pdf

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RF_COM_H_92_A_SUDHA

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Maternal Health I'.iititlviiient ( ainpai^n

N(/fe on Survey litiplenieiilurs
Purpose The purpose of the survey is to quickly grasp key issues relating, to NRI M and JSY
^services, in relation with all deliveries that took place in a hamlet where the population iis
ij^^redominantlv from a sociallv excluded group.
o

- • ■ •


~
The survey instrument is simple so please read it carefully and familiarise yourself with all


the questions.



The lirsi level of analysis of (he survey instrument has to be the district/ block. We have
provided you tally sheets, leading to rhe preparation of district report cards.
The survey formats can be later forwarded to State headquarters.


The primary purpose ol the questionnaire is not to answer research questions but to enable
district level groups to understand to what extent arc NKl IM and .IS Y ser\ ices arc reaching
(he socially excluded groups in their district.

Who is going to he surveyed - 1 he survey is going to coverall women who delivered in a 6J^jonth period (ending one and half months prior to the start of survey period)- April I to
T^Tptembcr 30, 2007 . I his w ill include all women who survived and those who have not. and
children who were born, living or not. It is anticipated that 25 hamlets of roughly I ()()()
^ll^pulaiion each arc going to be surveyed in each block, and two blocks surveyed in ?ach
375) deliveries w ill be covered in
'^Otrict. This will mean roughlv 25,()0() * 30/ lOOO * 0/12

®ch block.

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g^^mple - All deliveries in a specified time period in the designated hamlets where sociallv
^^pluded communities arc in the majority. This will include women who normally li /c (here
!

|||M not those who arc visiting. The delivery mav have taken place outside the village.
■^^EASK IDENTIFY AND VISIT ALL HOUSEHOLDS' WHERE A WOMAN <VHO

Formally

lives /lived
WO SEPTEMBER 3(1, 20(17.

St
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there

had a delvery

dhrinc

; period

WHO

Xpril

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Identify the hamlets in the block in which the survey is to be conducted.

»

deaths, still births, neonatal deaths etc) took place between April 1,20(17 And

i

- Task ol’district level group
Mark out all (he households among the above where deliveries (including maljernal
September 3(1, 20(17 ( Take support of local women's group)

i5-

£

I

As an alternative use a hamlet/ mohalla based key informant approach to pick up recent
deliveries (Key informants will list the deliveries)
Make a hamlet wise list ol all these families, women's name and husbands name

Ws. Conduct survey with the women. H; women are unavailable talk to mother in law, sister
in law; husband, father in law, brother in law etc.

|

Il there is a grievous denial ol rights and adverse outcome record a detailed ca-;e study

^W'7. Collate data
Prepare block and district report card.

-A

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Preparation (b\ field researcher I

Please read the questionnaire carefully before you start the survex. Become familiar with
all the questions ol the questionnaire before you proceed for the interviews.



Make a list of all accredited JSY centres for the Block
private pro\ iders and NGO providers.

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including all government and
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I he interview
met view- must
ijkc place in the home of thc
musi lake
the respondent.
l irsi iexplain the purpose of the interview io the respondent before starling the interview.
i ake their permission before staring the interview

After filling in the basic information about the woman (or other respondent in .
u,
use (he
women is dead) and the place and provider at delivery - ask the remaining questions'

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I tsten to the respondent carefully and (ill in the answers for concrete service g
larantees
and ,IS\ . 'i on may need to crosscheck these answcrs.with the respondent whet
you fill the
Y"

*
form.
v
Similarly when you mark your answers Lor the adverse outcomes / denial ofca
c confirm
your responses with the respondent.
\ou are required to pul a lick on ihe correct response and/or fill in (he blanks.
'on may
also make a note ol any relevant inIbrmaiion dial is not indicated in the form. I Icase tick
ihe lorm in a wax lhal ii is clear which option is beine licked

Answer all the questions

i
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pome dclinitions to know before going for Iteldwork:
|iiom to interview: .4// women in the hamlet that delivered in past 6 months

i.e.

hciween
| April / and September 30, AND whose six months ended 6 weeks before the inn
rview.
| / lease tnlervtew women from excluded groups as well as women from non-exd tded
| S' "“l^ Ihe hamlet. Interview mother-in-law. sister-in-law or husband etc wh\
can
| provide details o/pregnancy and delivery if the woman has not survived.
fate of Dehve.y - li e are uyiny to fmdotit whether the delivery took place at home or al a
. ■ asc, edited mstitmion so please mark the option accordingly. Use th - list of ISY
accredited private providers while compiling die data. Write the name o'the fhcilitv
U known, csp. ill case of private provider.
'^Kpme / Private Informal / fiovemmqni Hospital SHC/PHC7CHC / Private Form tl (

SY)/

Private 1'ormal (Non- JSY) on the way/ other

||||rovider at delivery - H c are trying to ftnd whether <
.....
any nurse ANM ar formal provider was
present during the delivery. Please mark all providers who
.........f were involved
•■gxclauxc nc.ghlx.ur I'BA (dai) / ANM • Nurse/ Doctor formal / Doctor informal J
ASIIA /
husband other
delivery
'^yudnal delivery I )cli very takes place
horn the birth canal w ithout anv use of drm -s or
medicines
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< ( ^/i/ic^ed Jcliven - Delivery takes place from birth canal with the
use of medicines or
v
, nCeds lor Hc 'cler,ed lt"- ^Perl ( formal or informal | support
........... ..
I ( oe.vo/ Operotmn - Dcltvery takes place alter the abdomen is eut open by surgery.
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a/)/)i axmiaic Jo/c if exaa dale is ihk known

f,Concrete Scry ice Guarantees
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m Un. ... .......flaw wil|, „ „

/a
balloon pump. Stethoscope ts also used alomr w Uh the cuff
■gM.\ A/. .Hill.. IS//. 1 are local health staff (hat provide adv ise or preliminary health
.'
. '
. ------ care to the
pregnant women or1young mothers
about their health practices,
nutrition.
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information about health care services available and counsel (hem about"

.

various
it
heallh.colldltlolls
"«*1 to be taken care of / danger signs when they need'io
(Q?
consult a doctor.
.»g(Wm(a// registers a pregnancy in the village and provides suppletnemarv diet to 111
pregnaiu
and laclaimg women
^ A/does a three atite-nuial checkups that includes taking blood pressure, weiuht. abdomen
cxammaitoti. giving 1 | mj. etc. lor the pregnant women and gives advisl for

uismutional and sate delivery practices. She visits (he women at her hottie within
the next lew days ol her delivery, lor health check-up of the mother and child and
piovidc necessary advice.
K7/.4 works as a link worker between the women and ANM or AWW. She takes care of the
hea th needs ol the women and accordingly counsels her to make sure sh • utilizes
the heahh services adequatelx . She also accompanies the women to the h.ispital '
during her delivery.
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9 teiani Suraksha Yojna -

'I ^4 is a go\ ernmem scheme under which

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women arc provided monetary benefits immediate I,
ly (or soon
altcrl alter her delivery. The moiK\ is given by a health stall ol a govcrnmeni health
.i
ecu (re
or hospital, and in some places, b\ u private health institute accredited b\ the
government
for the purpose of JSY.
im/if (a know n the health care services and the hene/iis ofthe vc/7.
'c/ue arc accessible (a (he
^tdn^ the services
'thentonev. ‘

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or

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ady erse outcome

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d^y ij 'he woman or the child suffered son c adverse
^^^hcallh event, dur mg or after pregnancy, delivery or abortion.

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Maternal death (death during or within 6 weeks ol'delivery)
I leavx Bleedmg - (during pregnancx

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labour or soon aher delivery/ abortion)

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High fever soon after delivery or abortion
Prolonged labour (more than one whole day )
1‘aiiv Neonatal death (death within a week after birth)
Neonatal death (death within a month after birth)
Still birth tbah\ born dead, did not ever breath)
f fi Any adverse experience or denial of sen ice
PT He//// la know' nhoiii i/ic experiences afxvamen when they approach health care Jar their
dclivcrw

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?'gif the adx crsc outcomes or adverse experiences arc very severe or go beyond the options
'^indicated in this form, and the researcher feels that it must be documented in detail as a case■Mtudx of health rights \ iolalion or denial of health care services - please document i

as a case-

fctudx (in a formal provided separately).
'•W:
Instructions for C ollating the Survey and preparing Block/Distriet Report Report Cards
force two types ol collation formats and one formal for preparing Block/ District Report Cards
ijovided for your use. The two kinds of collation formats are the Village Collation Ip'ormat and
fc Block/Distriet Collation Format. Separate collation formats are to be filled for General
Eatceorx. OBC category and Rxcluded Groups for each village. Specimens arc provided for
Rose as well.

1 1.
-I

geps lor Collation
r I. Collect all the forms lor one village in one place. Provide each form with a number

I

which could be like UP/Az7At/V/\VI = Meaning State Name - UP; District NameAzamgarh: Block Name - Atraulia; V - Village Name and Wl - number for the
woman.
After numbering the forms please separate into three piles - General; OBC': end

y

B

I excluded
.

Collate each category of form on a .separate collation sheet. Strike one mark tor each
answer from the form. Pul live markers into each column to help in totaling Liter.
Put the forms from one village together into one pile
Add the totals from the the three village files into the appropriate column of tie Block /
District Collation sheet. The name of the different villages can be pul in the place VI:

a.
s

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B

F-

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SB

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'lit

ft
•W'

V2 V3 etc.
l ake the totals for each collation sheet of Village VI and w rite it down in the
appropriate column - GeneraL OBC. I 'xcliided under that village name
When you have Finished writing down the totals for each village in the appropriate
column Illi the total column in this manner. Add the appropriate column fora iv issue
across villages to fill the answer in the same column in the total column eg. U you are
counting women who have received BP check up in a particular block then add the
(icncral category of VI. V2. V3. V4... and write the total under General in th 2 Total.
Similarly adtl BP check up forOBC in VI. V2. V3. .. and write the total unde OBC
catcgorx in the l otal for BP. Finally atld Fxcludcd category number in Villages VL

V2. V3 ... and write the total under Exl for BP check. Complete each row in the
collation sheet in this manner referring to the three different village forms lor each
village.
N. Once the Block District Collation Sheet is completely filled you arc readv io complete
the Block District Report Card. Fill the llrst few lines of the report card from the
district total data. For filling the Numbers Column of the table take the appropriate
figure from the Block/ District Collation Sheet.
9. Calculating percentages : For calculating percentages we will calculate for any
particular issue eg. BP or Institutional delivery for that category of woman

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No of women on one issue ( eg. BP check / Institutional Delivery > Ironi any caicgor\ (eg OBC X 100
I otal number oI women of (hat category ( eg. OBC)
10. Interpreting the Block/District report Card - The Block/District report card allows the
comparison of experiences of women across different categories - viz. Cent ral. OBC
and Socially I 'xcluded. The comparison of percentages for the different groups on any
one issue will enable the researchers to compare the experiences of women across
categories. Thus we can say what is the percentage of women going for institutional
delivery among General category compared to women from Excluded Groups. Or
Number of women facing harassment in OBC groups compared to women from
Excluded Groups. Our hypothesis is that a larger percentage of women from Excluded
Groups will not be gelling services and will be facing harassment and extortion
compared to general category women.

S||.Vishing vou all the best for the Survey and completing the District Report Card !

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J IniqucH)Maternal Health Entitlement Campaign
hitcrviev w ith Woman w ho has delivered hehviecu April 1 and September 30, 2007
(Woman who is a usual resident of the hamlet. woman may not have survived)

I

Name of the Women
Husbands/ Father/ Head of Household's name-

Village-

I

Hamlet

,-Jlf woman is not alive) Name of the respondent / Relation with woman-

yr ■ ’

.................

| ^Social Group - General ZOBC7SC7 ST7 Muslim / NT / Primitive Tribes/Othcr
............................

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/^Economic status - BPL/APL
£

SWhere did you deliver?

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Place - Home / Private I nformal i Government Hospital SI IC/PHC/CHC / Pri’ ale
formal, on the way/ other
Name of the Facility if known -

I

. 2||Who eondqcted the delivery?
.//CyfC ■

Provider at delivery - Relative / neighbour / TBA (dai) / ANM / Nurse/ Doctor Formal /
Doctor
ASHA / husband / other
other........
I )octor informal / ASHA./
(Please mark all involved)
A.

-- ?

V\ hat w as the nature of delivery?

Vaginal delivery/ Complicated delivery / small Operation / Caesar Operation
of Delivery (il not know;n approximate to the1 neares't month):.......................

Y|!pr cross checking whether she belongs to the group we arc interested in)
||g|ex id' the child (from present delivery) ni.,|c / fctll.,|e

!

"iSifconcictc Service Guarantees
ANM examine your BP al least once prior to your delivery?

Yes/ NO

2. Did ANM/AWW give you red tablets for improving your blood levels?

Yes/ NO

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advise you to go to SHC/ PHC or CHC for delivery?

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S-

!

Yes/ NO

Did the ASI1A pro\ ide any advice during your pregnancy?

Yes/ NO

Has ANM visited you at least once after your delivery?

Yes/ NO

Sr- Did you icccivc icgular diet from AW W during your pregnancy?

i

Yes/ NO

I



6. ./diKUii Surakslia Yujua
I llf t|lc woman had an institutional delivery (sec Q I above)] Did the ASHA accompany you'.No / Yes
III lhe woman had an institutional delivery (see O 1 above)] I lave you received a lovvance ot

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|<v 14(1(1/- after delivery in government health lacilitN or other government recogi ised institute

i

lor the purpo

H

If you had he»me delivery did you receive Rs.500/-

3.

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No / Full / Part (Rs ...

.

...)

- No / l ull /1 ail (Rs

)

*

to z\NM or in the Pt K7 Cl IC to gel this allowance?
4. Did you have to pay any amount
-Yes / NO

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5. If \cs How much money?

wI

0

100

101 -250
251 - 500

501 and above (

)

Did vou face an\ harassment in gelling lhe inonc>

w 0

Yes / NO

V . , ’■

,4/zr adverse outcoriie of delivery? (Please lick the nylu answer)

i


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1 Maternal death (death within 6 weeks of delivery) - Yes / NO
2. Heavy Bleeding (during pregnancy / labour or soon after delivery/ abortion) - Yes /
NO
3. I ligh fc\ cr soon alter delivery or abortion - Yes / NO
4. Prolonged labour (more than one whole day I - Yes / N()
5. Early Neonatal death (death within a week alter birth) - Yes / NO

6. Neonatal death (death within a month after birth) - Yes / NO
7. Still birth (baby born dead) - Yes / NO
8. Any other - Specify

•4

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7
Artv adverse experience or denial of service

1. Refused treatment al a government (recognised) health centre ?

Yes/ NO

2. Referred from a government (recognised) health centre to another institutio t but
without providing referral notes/sheet

3.

Yes/ NO

Referred from a government health centre to another institution but withou
Yes/ NO

ambulance

support

4.

w

W.
WM'-

1 hrassmenl or Abusive behaviour by the staff at government (recognised) I ospital

Yes/ \!(|)
?. Government (recognised j Health provider asked for money for providing
Services Yes/ NO

5 a.) If yes how much money -0
101

250

251

500

100

501 and above (

)

5 h.) f low much money did you have io spend for
Medicines

Supplies -

■<

1 ravel expenses
Fees to provider -..

Wf

Any other expenses
Iolal for Delivery..

6. Any other experience?
Specil'y

O-

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' aternal Health Entitlement Campaign

Village- I lamlel Collation Sheet

State -

District
Handel -

Village -

| Question

1

S o c i id (...’ i o ti p -

5

5

5

Total Number of Women
B P L I -I in i ly....

5

Place of Delivery
Government facility

{govt- recognized)
_Hoiiie .
Provideiyat delivery
ANM / Norse/Doctor Fo rm a I
UX51!111 c <dj)eli5 ery

|

X

—.

I Complicated
L9p_cmtion (Small)
! Operati<»n (Caesar)

x-... —■

Concrete Service
Guarant
----------------------ees
' BP takeirduring pregnancy
Got iron folic acid tablets
AN M! A W W/ ASH A advised /
■ referred to govt, institution for
i deliverx
---- ------- ——~—
ASHA pix)vided advice
, _A.Xb I x i-sited after deliver
Supplementary diet from
._AA\AV---------- ---------------------1—..............—.

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4
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________

-

accompanied for deliven
Received full rSY^dFFice’of... ~!
j Rs. 140(1i—
_______________

I. .

i l or home delivery receivel<s?500
P(|ll amount
l or home deliver} receive Rs. 500 ■'
j Pai‘l Aj^ount _
l.

Paid any ainouiittoANNd or~in the~~

L J’.y

lojzet this a I Iowan ce?
"
0 - 100
I0l'""250
251- 500
r______________ ________________ _ _________

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?0l and above

! Faced any harassment in getting
! the money?
Any adverse outcome
Maternal death
Heavy Bj££djn^
""J
Jfever soon after deliven F
, Prolonged labor
! Early Neo natal death
I Neo natal death________ ———
j Stillbirth
.
~
) Any other infant health adverse
i opt come
■ Any other maternal health
L 3.c !_Y? rse (.hi tc0 m e

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F"

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Refused treatment at a
government lieu 111ycen te r
Referred without providing
j referral sheet
f Referred without providing
; ambulance support
i Abusi ve beha\ iour of staff al
j government hospital
Health provider asked monev
I for providing services
0-100
101-250 "
251-500
above
501 * and
I——— 1
1
——
..
l—r,

. ...................................... ........................... !

,-----------■ ,,, , ............. t

| Total Money Spent for Delivers

i'

Upto 1000
1001- 2500

r-----

2501- 5000
5001 10000
10001 and above

: Any other denial

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4-------------

Any other issue in the village-

Name of women facing serious denial of services -

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Maternal Health Entitlement Campaign
Village.' Hamlet Collation Sheet
State \ illagc -

District
Dam let -

Questiwj_ __ ____ _______ _
fotal
on-lt-n_ _____
_BPL famih___ __
_____ —
_______
Tjace of D^iivery
| Oovemment facility _
~PiTvate (govt, recogpj£^1
_______________
[Home
Provider at delivery
ANM i N urse/ I^opipLlA--—____*r Nature of Delivery
! Norma]__________

Soeial Group - O
5

5

z4

- ----

r Coin plicated

Tipsratlon (Srnall)

(Jpcration (Caesar)____ ______ I____
Concrete Service Cyuarantee^
"BP~taken during pregnancy
"cToTTron folic acid tablets_________
AYNM/ AWW/ ASH/CadVised /
referred to govt, institution loi

: delhery_________________________
AAS 11 A pro v ideci ad\ ice
ANM visited after deliyvr
-LSiipplgountary diet from---------■ AWW________________

5

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.— T—

— ■■■

*

'" ■ •" ■.................................................... ..............

■■

.....................................

'

Jaiiiini Suraksha Yojna______ _
ASi-i/X accompanied for delix ery
Received till IJSY allowance of

___________ J.

j deceived pari allowance
I F;or home delix ery receive Rs.500 i
l ull amount
;
I or home delivery receixe Rs.500
- Part Ainojunl________________ j
Paid any amount to ANM or in the .
i l’_l l(’ CHC to get this alloxvance?_J
" O’- JOO ____ __ ________
;

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.......

"To I - 250
”7 ” _
~ 251 '-~500 '____ _J’
___

501 and above___________
r Faced any harassment in gelling
; the ninne/’
Any adverse outcome
1 Maiern<.iT_deadi___ ___
I leax y Bleeding
High lex er soon after delivery i
| Pro!onged labor______________ j

-.... -4------

| Early Neo natal death__________
Neo natal death______________
| Stil 1 birth

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i Any other infant health adverse I

: onleome_ _____________
: Anx other maternal health
adx erse outcome-------- -------

______

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wninir ‘ l^ied^cn'ifec^
_

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Refused treatment al a
government health center__
Referred without providing
referral sheet_
Referred without providing
ambulance support
Abusive behaviour of staff al
goyernmenl hospitai_____
Health provider asked money
for providing services
__O-_IO2
To I -250
""" 251 500__________ \

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501 and above
Total Money Spent for Delivery

TipiTiooo

1001- 2500
”2501 L5000_

“Toi)T£T]
10001 and above
Anv other denial

Any other issue in the village-

Nlame of women facing serious denial of services -

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..............

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District
l-lainlet -

State -

Village -

sc..... 7„._ ______-..
_ 5r ' 2
~.....!... Miislhn

Social Group - E

5

5

5

Qtiesfion___
__
Total Suinberof ^Tunen

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Maternal Health Entitlement ( ampaign
Village/ Hamlet Collation Sheet

1----

_____________ ---- H.

\J)^T_____________

Other______ ____________
BPL family
PI a ce of Delivery
(jovgrnment facility

i

I.....

I^rix ate (govt. rec^ni^lL
Jkime__________________
Pr<n ider at delivery
.
”"a NM / Nurse/ Doctor Formal ^ £
Nature of Delivery___________
i Normal__________________________

^Complicated

L

OperatioH (Small)
;
Operation (Caesar)i
Concrete Service Guarantees
13P taken during pregnancy
|

Goli i on foI ic ac id tabIets

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■-^-~- - —- 77^.-

yssisgssgi
referred to govt, institution loi
delivery____________________

r ASHA provided advice
^ANM visited after deliver...
^Supplementary diet from
■ AWW
J an a in S t intksha

ojua

_ ___ _

”7\SI-IA accompanied for d^livei?
^Received full JSY allowance of
j Rs. 1400/- ________________ L
^Received part allowance_______]_
For home delivery receive Rs.500
! ~ full amount_________________
[For home delivery receive Rs.500
i - Part Amount
L
[’"Paid any amount to ANM or in the |


PHC/ CHC tojtet this allowance? j
'~“~0- 100____ L_____________I

I

101 ~ 250___ 2_____ r

25l’- 500__ ______ ___J_
501 and above_________
■ Faced any harassment in getting
j the money?
______ ______ L
[Any adverse outcome________
Maternal death______________
! Heavy Bleeding ~___________
I High fever soon after ddhjcry
i Prolonged labor
..,7j Iu
' Neo natal death

I

Z
Stillbirth

Any other infant health adverse
outcome
1 Any other maternal health

i adverse outcome
1 Denied Services
; Refused treatment at a
I go^rnment health center
Referred without providing

referral sheet
Referred without providing

ambulance support
Abusive behaviour of staff at
government hospital
Health provider asked money
pro\ iding services
o'-iot? ’ ...
101- 250" •......
I
“72
251- 500
r----------501 and above
i Total Money Spent for Delivery

'

r

Upto 1000
1001- 2500
2501 - 5000
5001 - 10000
10001 and above

' An\ other denial

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State Block/ District

Question

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~ ■'TaSToBC
------1--- - ——

SC _____________
I sf2_______
ST

.... .

Maternal Health Entitlement Campaign
Block / District Collation Sheet
District
Social Group -

Village-^ ise totals

!4_

"
. ...... .........
;_V2... ........
I. XI.
■ I. XL Gen out
I XI 4"(}V|7 y’<

Gen i OH(.

.4

Muslim______________

- ” i........

Ip7'
ST___ \__________
I 1)NT

V4^
RXI..

—4. -

____________

Otiier_______________
BPL family__________
Place of Delivery_____
Government facility
Private (govt.
recognized)
_______

Hoine______________ 1
l;>rovider at deliver)7

ANM / Nurse/ Doctor

LfNature________
ofJ)elivery
Normal
Complicated_________
(operation (Small)_____
Operation (Caesar)
^^oiKmetF^ervice Guarantees______

-I-----

—r

±42

-~r~

..

preunancx_______
___ I
(ioi iron folic acid tablets
I AN M? AWW/ ASH a '
; advised / referred to
i govt, institution for
delivery
___
ASHA provided advice i
' ANM visited after
. deliver___________
! Supplementary diet
' from AW
J a it an i Suraksha 3 ‘?Inn
■ ASHA accompanied for
. delivery____________
Received full JSY
allowance of Rs. 1400/- [
Received part
allowance______
I For home delivers
receive Rs.500 - Full
amount________
i l or home delivery
I receive Rs.500 - Part
! Amount___________
! Paid any amount to
i ANM or in the PHC7
I CHC to get this
I allowance?
F—

.. ~l

'

f—
I__
i__

ss

0- 100
101 251 - 500

I

!

1..... .
I

......

4H

r !

■i...... -

i.

----------:- —^“—-——Til: -

-jysKSSBrawsaMawswrasw^

___ ■ ' .

4;4

'e
: Faced an\ harassment in
uelline the |212’]e2Li „
LAny adverse outcome
; Matenwl death
j Heavy Bleeding
High lex er soon after
_delj\ery____
Pro Ioiiged I a bo r
Earlx Neo natal death
_Neo natal death
!

I..

_.J.

---

StiTf birth~
Any other infant health
adverse outcome
(Types)
Anx other maternal
health adverse
j outcome (Types)
Duiied Services
j Refused treatment al a
goxernment health
center____________
Referred xvithout
providing referral sheet
Referred without
providing ambulance
support____________
I Abusive behaviour of
^staJJAtl-gox^e-r-n-n^M----; hospital ____



r““—2F'■■■■""'

i Health provider asked
money for providing
services

I
i

b'-"T6ij" _ ___

LJ

-------r- -[•■"■
!

T

I____ i

“ K)T “ 25([ ____

s.

25'r'"5^0____



Tool'--2500

"

5001~-10000
1000 i and above

.. ------- -- f

’ll) I and abo^____ _
Total Moik \ Spent for
Deli \ e rx _____________Upto 1000_______ _

TsTjj '- 500Q

-

_

Any Other Denials (types)

I

V.

11
'■

Block / District level Report ( ord

Name of Stale Name of District

S

Name of Block
I oial number of hamlets surveyed
l olal number of women covered in the survey

i

l olal number of women from General CategoryTotal number of women from OBC Toial number of women from Excluded categories

i

Social Exclusion laced b\ women Covered in the sur\c\
SCSTMuslim(. )lher-

*

I

II

PT-

NT-

w Economic Exclusion faced by women Covered in the survey (BPE families) -.31 :•

’ll-r

: General
\ \o

!

(5bc
%aue

No

Excluded
No ’

\ '^age

Total Number of

i

^K-womcn surveye d

JIIb pi .

I
ifi

^^Kv^cnien who had an :
^^^inslilulional delivery
;^^®7omen who ha\ c
jJ/Tecci\ cd support
-Q froin ANM Nurse
7-4'Doclor Formal
1

i

I

i

a Adv ersc Outcomes

IITMalcrnal death

cSWomcn with hea\ \

” ’i

\

afeleeding_______ I

i

i..



^feyomen with High

I
!|l

II

c

.i^ttever soon al ter
1 Be livery
pvomen with
Prolonged labor

i

gtTlTBirth^
||



Early Neo natal
Heaths ( 7 da\s)

I
i

J

■!

i
__ t_

■>agc

:r

I


Neo-natal death ( 2S
;
da\sl ________
(.Oncretc Service (.uarantees
Women receiving BP
examinations horn
. ANM________________
------____
i-----W omen receiving iron s
(ablets from ANM/
= AW W |
Women referred by
I \NM to SubC'etre.
H’lfCorCIICIbr
! delivery
[
! W omen who received I
j advice from ASHA
; W omen visited h\
fe [ ANM alter delivery
j Women received
I supplementary diet j

• from AWW____

i

T
i

‘ uHtitution al delivery |
||| i W'omen receiving lull j
.ISY allowance for
i n s l i 1111 i o i u iJ_(Ie Io ei >
_______receiving
______ ,
Z; Women
WZ. Rs.500'- for home
delivery
WAanen who paid lk»
^Sift-gcl this allowance
I
i^rflTW omen and her
family who faced
‘^■^fcharassmenl in gelling
I
‘J^l.-thc monev

I

d...

a

i

I

i

i thout pro vid i ng

^^K^ eria^ s.heel __

-

J
■ 1

^KiV omen refused
Hpfgatment al a
IlIBgo vern men I hea 11 h
^MKeiUci'___________
^BVomcn referred

i

—J

1—

J _

i W omen accompanied

i

I

•i

—I—

H I by \SIIA lor

|||||^Womcn referred
without providing
^^ambulance support

-r-

i

’ ,1 aluuij Suraksha Vojna.

,

i

t

•■- - v. TV"-•



i

i Women lacing

■ abusive behaviour
: of stafl'al
j government hospiiul ]
j Women whom
| health provider
’V”''
asked for mone\jj----------------------------------------------; Health provider
g- j asked J'or money
i
&? i Health provider
:’s
•S®’ i asked -- Rs 250
■.^:

I
I

r

—-r- !

4-----

4

•—;----------------------------4

i lolal Expenses
Wl | 2500

w
-feW -

•j

ifete

t
f
b
?y

1

II
■'

■-

Rs j

i

1

.L

w

r^.
fP’UiL

f'F

'^“"eofVilh.ge
^■neol the \Vllinj„

8

f

n,.,6
-Age l-ducational Status -

.0

Marriage Status Vears Married

Munbt

Male —

I
1

i

lhe inicmew.
laR'-Pcrmiss on for

0 W|,„, 1W,V..
I . ..... "»

.

n,“J '

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"ep. toe pr^

"s

ll Possible)

,lot c;fvernni[ll(

|| ^'"^gap between

^A^spunse?

tew

prawa" »'J Ml, St.cl(„,g.,

limes were «v«providcKWmac|

• «‘«>K1S„IC adviK

u, it

d,d ll increase •> i

. . <,0;
,?v7s,ct,uesicd'"G-'h'-’start of the

.

|
I

Ileali,iprm.

H IKKible
.
IX.ssib/e to comply uith (hi
noC.b
1 -1-• Ullh Ibis advice^ lnx . <•

'



j

,

I

W'<>A *“«> Wlw W4S Jr
'lou"«J

...aa(„„.x,iv

I

.. 41'

1>
I
iI

*
Bchaviom ol the service (Providers?

An, rclta, U, M,.; w„t ha)w„C(|

1

i|Ktc w<s a reiiwa| jf

Any demand lor money ?

Total costs involved? l-or what purposes ?


t

What ««S .l.e J™.™,,,, reeling when going ,|,r„„gll ,Ik experie„ee?

I

Wluu is ihe Jonilnani feeling ahem ,|K proNei„

I

Any documents'.’
;>•
Willing to share her si ory ai the sharing?

• ■

Yes ' No

i
|

I

May be

•&
';zf;

I )ate

1

Case recorded by

Will go bin not share story

Will Uoi

or Can not go.

C ertificaies and documents seen (copied)
1 ype of Case - (l-'ill I .atcij -

I

Denial of health care through

IJ

II

S-'
IF
'T

i

i.
4'!

.......... ...

w

■w

1>


... ............... .

.........

- ■«



I

A state wise activity update from August to December

Maharashtra
Publications/Materials:
Brochure
Brochure on Community based Monitoring under NRHM in Marathi
< Community based monitoring
Guidebook on
posters
Four
... ........ .. °n gUaranteed Services at village, PHC and Rural Hospitals and patients
rights designed

State level coordination:
The second State Mentoring Team meeting was held on 8'" August 07 to discuss and

JiXXXT

°f

for M’n,,>ring

«

MoU between State Nodal NGO and five District Nodal NGOs was signed and fllst
installment was transferred to the five District Nodal NGOs in September 07

AiSS

'eVe' Training °f TrainerS (T°T) WaS held in Pune between 7th to 11th

District level activities:
The formation of District Mentoring Committees, selection of P.H.Cs and Villages has
been completed in the selected five districts.
8;
of
District
Mentoring Committees were held in all pilot districts in which the
Meetings
District eve workshops and the trainings of block facilitators were planned
District level workshops in the selected districts were held as follows Osmanabad - 10" October, 2007
Pune- 15"' October, 2007
Amravati - 18"' October, 2007
Nandurbar- 18"' October, 2007
Thane- 15"' November, 2007
Press releases were circulated on launching of CbM activity during the District leVel
workshop in Pune, resulting in coverage by newspapers.

Reports
State workshop report is recieved
ToT report is awaited.
Ger
District workshop reports are awaited
Block training reports awaited.
co­
Progress Report (Aug-Oct ’07) recieved

Madhya Pradesh
Publications/Materials
"" Secmtarilt81316

US‘n8 materials that has been deve'oped by National

IntSitaternOdK1 agen?Jy proposed t0 come-up with Kala Jatha for comiknity
mobilization but couldn’t do so due to lack of funds
I
Y
State level coordination:
rhe Madhya Pradesh state level Training of the Trainers (ToT)
was held in
Bhopal between 16-20th August 2007
MoU between State Nodal NGO and five District Nodal NGOs was signed and first
installment was transferred to the five District Nodal NGOs iin September 07
District level Activities:
The following activities have taken place in selected districts
Selection of District coordinator, Block Coordinator, Village facilitator
o Selection of Block, PHC, Villages
8
o District Mentoring Group
o Block Mentoring Group
o Village committees
District level workshops in the selected districts were held as follows o Chhindwada - 30 1 to 3 Is' October, 2007
o Guna - 25"’ September, 2007
o Sidhi- 27th to 28th October, 2007
o Bhind - 23rd to 24tl' November, 2007
o Badwani - 18th October, 2007
Reports
State Workshop & ToT reports have been received
Progress Report (Aug-Oct ’07) received.

Orissa
Publications/Materials:
Publication of Community Entitlement under NRHM (briefing kit) in Oriva
or
Brochure on “What is community Monitoring” in Oriya
or
Block level activities under NRHM in Oriya
District level activities under NRHM in Oriya
State level coordination:
On^Sub ^UgUStttt0 °Ct0ber three mentoring group meeting have taken place
One Sub committee meeting took place in September
P

Orissa State level Training of Trainers (ToT) was held in Bhubaneswar
between 1 1th to 13th October 2007
The civil society meeting took place on Dec 26th to discuss the progress made so far and
to workout the future plan of action
District level activities:
<3^
District level workshops in the selected districts were held as follows o ~
Bolangir-31st October 07
o Kendrapara - 811’ November 07
o Mayurbhanj - 30th October 07
o Nawarangapur- 12th November 07
Reports:
State workshop & ToT report is received
All district workshop reports are received.
Progress Report (Aug-Oct ’07) received.
Mentoring group meeting report (Aug-Oct’ 07) received

Chhattisgarh
Publications/Material:
So far the state is using materials that has been developed by National
Secretariat
Mentoring group members are in process of coming up with street play for
community mobilization that will be finalized by Jan 10th 2008
State level coordination:
Ihe first State Mentoring Team meeting was held on 28th November 07 to discuss and
tinalise the ToT
GF
The state ToT took place from December 16th to 20th 2007
C^=
Second mentoring group meeting took place on Dec 19lh to look into the process
of the Community Monitoring in the state as well as to review the ToT
District level activities:
The selection of block level NGOs have been done
The tentative dates for the district level workshops are from Jan 15 ’08 onwards
Reports;
State workshop report - received
ToT report awaited
cgr
Mentoring group meeting minutes - received
Progress report - awaited

Rajasthan
Publications/Materials
Four posters are in process, are gone for field test soon will be sent for printing
State level Activities
1st state mentoring group meeting was held on 5th October 2007.
The five day state level ToT was held from 4-8th October 2007 in Jaipur.
District level Activities:
C^=District Workshops have been organized in three of the four districts
o Alwar on 2nd Nov ‘07
o Chittorgarh on 6th Nov ‘07
o Jodhpur on 24th Sept ‘07
o Udaipur on Dec 22nd ‘07
Alwar
Al war district had its block facilitator’s training from Dec 6th to 88th ‘07.
district block facilitator’s training took place from Dec 19th to 21 j Uq ?
Jodhpur distiict
Chittorgarh district block facilitator’s training is going on Dec 26lh to 28111“07
Reports
State workshop report and State ToT report have been received.
Al war, Jodhpur and Chittorgarh District Workshop Reports- received
(ST
Pi ogress Report and a checklist of the activities from April to December 2007
have been received.

Assam
Publications/Materials
No work on this front has begun.
State level Activities
State mentoring group meeting was held on 9th October 2007.
16761 WOrkshop was held in Guwahati from 10-11th
2Oo7°'day
The MoU is being processed.
District level Activities:
The district level processes have not started.
Reports
State Workshop report is awaited.

October

Jharkhand

Publications/Materials:
The translation of the materials is not done yet
State level Activities:
The GO has been issued with CINI as the nodal agency and the nances of the
state mentoring group members
The first state mentoring group meeting was held on
5th November 2007 in

Ranchi.

OF

The MoU is being processed.

District level Activities:
The district level processes have not been started
Reports
Mentoring Group meeting minutes are awaited.

Tamil Nadu
Publications/Materials:
The state has not begun to translate the materials.
or
Translation of tools into Tamil - completed
Tools submitted to NRHM
directiorate - feed back got - incorporated
----------T1

1

i

...

___________

*

State level Activities
The GO was issued after a long wait.
OF
A three day workshop cum ToT was organized from December 3-5th 2007
MoU has been signed with PFI
District level Activities:
District level workshops in the selected districts were held as follows o Kanyakumari on Dec 13 th
o Perambulur on Dec 21st and 22'nd ‘07 district
o Vellore on Dec 22nd and 23rd
o Dharmapuri on Dec 26th and Dec 27th
o Thiruvallur on Dec 26th and Dec 27th
Block level workshops as follows;
o Kanyakumari on Dec 19th, 2011' and 21st
L07
o Perambulur on Dec 27"’, 28th and 29th ‘
07
o Vellore on Dec 30th, 3Is and Jan 5th
o Dharmapuri on Dec 28"', 29"' and 30lh
fc07
o Thiruvallur on Dec 29th, 30th and 31st ‘
07
Reports
state level
A brief summary of
OI the
‘eVel workshop
mC.State
W°rksh0p Cum ToT has been received
The district level workshop reports are awaited

The block facilitator training report is awaited
Future plan in brief:

Ch°psbe 0,er by D“31” - e“ept
- The village level activities - start in Jan and first round finish by 12th Jan
ge committee formation and orientation - finished by end Jan
y
First round of monitoring - Feb
Analysis and coming up with village level plans - March

Karnataka
State level Activities
Two meetings with the civil society members on
how to implement the project in
the state.
The state is waiting for the next installment of funds to start its activities.
Reports
The minutes of the meetings have been received.

Feedback on Implemented Handbook for Community Monitoring


.

Each state could add the state level fi
gures of existing physical infrastructure and
manpower in chapter 2.
enTof chapter^Itha^db nC“nity monitoring Process mentioned at the
oi chapter 5 the handbook needs to give more details on a) orientation
ung of members of the community monitoring and planning groups and
b) onentafon ofserv.ee providers abour eoormurrity monitoring

infXta” tom WSC o' “"’"J1"*

has b^ZSZXe^

f°miMiOn °f VHSC CO"M

Pour 17 under section IV Information of social exclusion and main heakh
p oblems could also include ranking the health problems in order of severity in
addition to the order of commonness as it would help to highlight the
mortahty/morbidity causes in the area.
g 8
• Chapter 8 could include some details on orientation of VHSC members and
service providers. Under the themes in table 1, maternal health seZ to have
aXdd d°Ut’t7 h C°Uld b£ add£d With Child health ' discussion with women
nd added in the corresponding format as well. Also, while ASHA communitv
Oftern nSd1S lnChfed’11 W°Uld be 80°d t0 include immunity perceptions of
other providers and services at the PHC from discussions with women

°f AWWS
.

aiS° be “ “

■"

The facility checklists appear to have left out the availability of essential drues
(mcludmg availability of a list of the same). A question or two to find out PPP
P
17k A Wthin the facillties and its imPact could also be added1?
I wouid be useful to include a list of acronyms and maybe a glossary of terms in
e beginning as a reference. For instance in the facility checklist fo/sub-centres
n er service availability is an acronym AGE that is unfamiliar (unless it is a ’

Xb “prZly RW “”der ,ha'iS ‘Reft,Tal fOr RT iS aVailaUe “

SC’

Workshops and Trainings
J/'National Workshop: 3 days
\X^tate Workshop: 2 days
District Workshop: Iday
^/^State ToT: 5 days
xX Block Facilitator’s Training: 3days
1 VHSrLTVel SerT.e Provider’s Tra™ng: 1 day
vHSC Training: 3 days
w committee Orientation: 2 days
9 n,1 C|
9^ Block P&M committee Orientation: 2 days
0. District P&M committee Orientation: 2days

National Workshop on C
Community Monitoring in NRHM
19th to 21st July 2007
Objectives:

1' ±“X““em“s "d ,’ecfamsms for —?

2. Develop operational protocols for capacity buildino

community monitoring
b on community mobilisation and
3. Develop efficient adminstrative and financial systems, including reporting
mechanisms for effective implementation of the project
°
Duration ; Three days
Venue: Caserina Hall, India Habitat Centre (19th & 20th July)
Jac II Hall, India Habitat Centre (21st July)
Workshop schedule:
Day 1
Welcome
Introduction
Expectations and objectives
----- ——_______ ______________ Tea
1 raining for community empowerment in the
health arena : An overview
Provision of equitable, quality health services for
the poor: Principles and practice
--------------------- ------------------Lunch
Community Ownership - Community
Mobilisation - Community monitoring
______________________
_______ __________
_________Tea
Community participation and community
monitoring mechanisms in NRHM
——;____
________ Day 2
*—
Review of Day 1
Introduction to the Community Monitoring
project
Tea
____ ________________
Roles and responsibilities of State Nodal
Oiganisation, District and Field level partners
and Resource persons
____ ________ _____ _____Lunch
Documenting and reporting mechanisms and

10.00
10.15
10.45

Small Group
discussion
Case study and
discussion
Film show and
discussion

11.15
11.30

12.30
1.30
2.30

Discussion

4.00
4.15

Representative of

10.00
10.30

GOI

Member A GCA

11.45
12.00

1.30
2.30

1

processes
Financial systems
——7_______

_

Tea
_____ Day 3

-----Review of Day 2
Developing protocols foT^pacity building TOT and other training

---------- ------ ---------------Tea
Developing protocols for Mobilising
communities and formation of community
monitoring groups
_______ _____ Lunch

Developing tools for community monitoring

Developing a follow up plan
Valedictory

3.30

Mr Ramaseshan

3.45

Discussion in
small groups on
draft training
| designs

10.30

Discussion in
small groups on
draft protocols
Discussion in
small groups on
draft protocols
Tea

10.00

11.15

fl 2.30
1.30
2.30

4.00
4.15
5.00

2

Agenda for State level Workshop
To be organised by: State mentoring team and State Health Mission

Objectives:
NRHM
Cipantstab°ut.the community monitoring process under
NRHM that is going to be implemented in the state

a' differe"' teTOte'the '-"-I





To finalise districts, blocks, civil society facilitating organizations
I o outline a workplan for the state

Participants.
• State Mission officials,
• District health officials
• PRI representatives from selected districts,
\

S0C'ety or9an'za^ons (from these districts)
NRHM Gol and AGCA representatives

Proposed/Tentative Agenda:
Session One : Introduction to the Workshop
Welcome Context and Objectives by Convenor State Mentoring Group
• Round of Introduction
p
• Inaugural address - State Mission Director, Chairperson of State
Mentoring Group.
sh
T
W'H deSCribe b™',he Pr°sress of NRHM In the state
„d
of NRHMthe sfate

°f^unlty monitoring tn the overall oontevt

Session Two - Introduction to Community Monitoring
• Presentation: Community Monitoring in NRHM (common powerpoint)
resentation : Progress of the Community Monitoring Project in different
states and activities undertaken in the state so far (to be prepared by the

o



Discussion and Q/A (Identify Moderator)

Session Three - District Level Activities
• Reading of the relevant section of the Manual in small groups facilitated/
moderated by members of the State Mentoring Groups^the puXse of


understanding the process of implementation in detail
,nhtah±i °f understandin9 and clarification of any issues that may remain
hi Liit? plenary

gession Four - Finalising the selection of Districts, Blocks and the conrprnprl
civil society facilitating organizations.
concerned
------------ggssion Five - Strategising for Community Monitoring in small qrouns
Thematic groups can be organised around the following themes which will
themlhe ,mplementatlon manual and Prepare a detailed work plan for their
BI°Ck leVe‘ Community Planning and Monitoring

Commixes 6

Mobilising the Village Level Planning and Monitoring Committees
• Engaging with the District and Block Health machinery
• Developing a District and Block training strategy
( ne mg notes for each group will be prepared based on NRHM
mplementation Framework and Manual of Community Monitoring)
Session Six - Finalising Community Monitoring workplan for the state


Discussion 6

PlanS Prepared in 9rouPs in the earlier session.



Finalising the workplans

gession Seven-Sharing responsibilities for implementing the next set of
activities and setting a monitoring mechanism
Session Eight - Valedictory,
Outcomes
Detail district level workplans will be prepared for community mobilisation
and for formation of Monitoring groups at all levels
An?!
°f ,activites at the state and district levs will be prepared
An followup plan with responsibilities will be prepared

00*^4 H

Orientation on
Community Monitoring for Selected NGOs under NRHM, Orissa
Programme Schedule
Venue: SIHFW, Bhubaneswar

Date: 14th July 2007
Date and Timings

Session

09.30 AM to 10.00 AM

Registration
1 naugural Session (Mission Director will preside)

10.00 AM to 10.10 AM

Welcome & Introduction to Participants by Mr S Das, Nodal Officer
AGCM, Orissa

10.10 AM to 10.25 AM

Self Introduction by Participants

10.25 AM to 10.40 AM

Address by Mrs. Usha Padhi, IAS, Director, W&CD, Government of
Orissa and Member AGCM

10.40 AM to 10.55 AM

Presidential address by Mr. S. K. Lohani, IAS, Mission Director, NRHM,
Orissa

10.55 AM to 11.00 AM

Vote of thanks by Prof S Swain, Co-chairperson, AGCM, Orissa

11.00 AM to 11.15 AM

Tea Break

11.15 AM to 11.45 AM

Salient Features & Space for Communitisation under NRHM
To be facilitated by Mr. Sudarsan Das
To be Chaired by Prof (Dr.) Saraswati Swain

11.45 AM to 01.00 PM

The Concept of Community Monitoring under NRHM
A. Why community monitoring
B. Objectives
C. Civil society & partnership
D. The first phase
To be facilitated by Dr. Almas Ali & Ms. Sunita Singh
To be Chaired by Prof (Dr.) Sashimani Panda

01.00 PM to 1.30 PM

Open Discussion

01.30 PM to 2.30 PM

Lunch Break

02.30 PM to 3.00 PM

Processes & Preparation of Action Plan
To be facilitated by Ms. Sashiprabha Bindhani, Mr. Basudev Panda & Dr
M. K. Mohanty
To be Chaired by Dr. Almas Ali

3.00 PM to 4.00 PM

Group Discussion
To be facilitated by
Group-I: Mayurbhanj
Ms. Sashiprava Bindhani
Mr. Sudarsan Das
Group-ll: Kendrapada
Prof (Dr.) Sashimani Panda
Dr. Krishna Pattnaik
Group-Ill: Bolangir
Mr. Gouranga Mohapatra
Ms. Sneha Mishra

4.00 PM to 4.40 PM

Group-IV: Nawarangpur
Mr. Basudev Panda
Ms. Usharani Behera
Group Presentation by NGOs

4.40 PM to 5.00 PM

To be Chaired by Ms. Sneha Mishra
Discussion on Group Presentation

5.00 PM to 5.05 PM

Vote of thanks by Usha Rani Behera

State Level Workshop on
Community Monitoring on NRHM, Orissa
Programme Schedule
Venue: Hotel New Marion, Bhubaneswar

Date: 24th July 2007
Timings

Sessions

09.30 AM to 10.00 AM

Registration

Inaugural Session (Mission Director will preside)
10.00 AM to 10.10 AM

Welcome & Introduction of Guests by Sri. S Das, Nodal Officer AGCM, Orissa

10.10 AM to 10.15 AM

Inauguration of the Workshop by lighting the lamp by Mrs. Pramila Mallick, Hon’ble Minister,
W&CD, GoO

10.15 AM to 10.25 AM

Address by Guest of Honor, Sri. Chinmoy Basu, IAS, Principal Secretary,, H & FW, GoO on

10.25 AM to 10.35 AM

Address by Guest of Honor, Sri. Raghunath Mohanty, Hon’ble Minister, Panchayatiraj, GoO

10.35 AM to 10.45 AM

Address by Chief Guest Mrs. Pramila Mallick, Hon’ble Minister, W&CD, GoO

NRHM in Orissa

10.45 AM to 10.55 AM

Presidential address by Sri. S. K. Lohani, IAS, Mission Director, NRHM, Orissa

10.55 AM to 11.00 AM

Vote of thanks by Prof. Saraswati Swain, Co-chairperson, AGCM, Orissa

11.00 AM to 11.15 AM

Tea Break

11.15 AM to 11.30 AM

Self Introduction

Technical Session-1: NRHM & Community Monitoring
To be Chaired by Ms. Usha Padhi, IAS, Director, W& CD, GoO
11.30 AM to 11.45 AM

Presentation on NRHM & Community Monitoring by Dr. Almas Ali, member AGCM, Orissa

11.45 AM to 12.00

Open Discussion

12.00

to 12.15 PM

12.15 PM to 1.00 PM

Presentation on Community Monitoring in Orissa: Process & Progress by Mr. Sudarsan Das
Sharing of views by concerned districts (Collectors/CDMOs)

Technical Session-ll: Process & Activities at different level
To be Chaired by Dr. Usha Pattnaik, Director, HS, GoO
1.00 PM to 1.45 PM

Presentation on activities at

1.45 PM to 2.45 PM

Village- Sri. Basudev Panda
PHC-Ms. Sashiprava Bindhani
Block-Mr. Gouranga Mohapatra
District-Dr. Manmath K. Mohanty
Lunch

2.45 PM to 3.15 PM

Group Discussion (District Wise)

3.15 PM to 4.15 PM

Chaired by Respective Collectors/CDMOs/DSWOs
Facilitated by respective group leaders___________
Presentation on Plan of Action by districts

4.15 PM to 4.45 PM

Chaired by Prof. (Dr.) B. C. Dash, Director, SIHFW
(15 Minutes each presentation)_________________
Open Discussion

4.45 PM to 5.00 PM

Summing up by Dr. Krishna Pattnaik

5.00 PM to 5.05 PM

Vote of thanks by Usha Rani Behera

M.P. State level workshop on C
Community Monitoring
Schedule
Day- 1 - 29/ 05/ 07
Date and
Session
Timings
10.00Registration
10.30 Am
10.30. AM
Inauguration and Introduction

to 11.30
i. Welcome note - Dr. Ajay Khare (5 min)
am
ii. Inaugural Address and Role of State Health Department in
Community based monitoring - Dr. Yogiraj Sharma (20 Min)
in. Detailed presentation on Community Based Monitoring in the
National Rural Health Mission - Framework, Methodology of Pilot
Phase, Service Guarantees and community Monitoring, Shared
ownership of the programme - Dr. Abhay Shukla - (25 Min)
iv. Presidential address Pro Udai Jain, Ex Vice Chancellor Rewa
University (10 Min)

11.30 to

Tea Break

11.45 to
1.30 PM

Ajbroad outline of the ambit and scope of community monitoring at

11.45

A. Village level (15 min)
i Formation and composition of Village Health Committees, ii.
Members of the village health committees, and activities of Village
Health committees hi. Tools for monitoring, and Powers of the
Village Health Committee, Ms. Belu George
B. PHC level (15 min)
Formation, constitution and composition of PHC committee. Power
of the committee, Yardsticks for monitoring and tools for
monitoring at the PHC level- Dr. Shailendra Patne
C. Block Level ( CHC) ( 15 Min)
i. Formation, constitution and composition of PHC committee.
Power of the committee, Yardsticks for monitoring and tools for
monitoring at the CHC level- Dr. Sunil Nandeshwar
D. District Level (15 Min)
i. Role and Responsibility, Formation, constitution and composition
of PHC committee. Power of the committee, Yardsticks for
monitoring and tools for monitoring at the CHC level- Dr. Rahul
Sharma
E. State level Committee. (15 Min)
Role and Responsibility, Formation, constitution and composition
of State committee. Power of the committc e, Yardsticks for
monitoring and tools for monitoring at the State level. State
mentoring team and the State level monitoring team - Distinction
between Roles and Responsibility - Dr. Ajay Khare.
Open Discussion (30 min)

1.30 to
2.30
2.30-3.45

Facilitator

Dr. Ajay Khare

Mode of
Presentation
Power Point
Presentation By
Dr. Abhay Shukla

Presided by
Prof Udai Jain
Ex V.C.
Rewa University

Shri. Atul
Kulshreshtha

Power point
presentations

Chair Person
Dr Yogi Raj
Sharma Director
NRHM

Lunch Break
Specific activities related to community monitoring
i. Jan Samvad /Jan Sunwai- Amulya Nidhi (20 min)
K;Dk^m<(Torate<) Commun’ty mon'toring experiences- Dhananjay
iv. Peoples Rural Health Watch in Madhya Pradesh - Dr Aiav
Khare ( 20 min)
J y
v. Open Discussion- 15 min

Shri. Rajiv Kumar
Chairperson
Dr.I.C.Tiwari,
Ex.Advisor (Health)
Planning
Commission
Govt, of India

Power point
presentation

3.45 to
4.30

4. 30 to
4.45
4.45 to
5.15
5. 15 to
5. 30

Role of Panchayat in the process of community monitoring :
Pilot community Monitoring Process in the State and the role of
the Panchayat Raj institutions- Mrs Leena Singh(30 Min)
Discussion (15 Min)
Tea Break



10.30 to
1.00

1.00. to
2.00
2.00 to
4.00

4.00 to
4.15
4.15 to
5.00

Training and Capacity building at each level of Community Based
Monitoring. Preparations of manuals and orientation materials for
all committee members
- Dr. Abhay Shukla_______
Summary and review of 1st day - Dhananjay

Broad Schedule of activities, List of resource persons required for
S^a?in|9 at|VTOTUS leVelS °f COmmunity based monitoring, Plan
Dr Ajay Khare and Dr, Dhananjay kakde
Preparation of District plan - Group Activity

a.
-------e‘‘

Selection
of blocks.
b. Planning for the District level workshop
c. Planning for the training of block level facilitators.
d. Plan for formation of the village level, PHC level, block level
and district level monitoring committees.
e. IHow suggested tools and methods for monitoring (incl. Jan
Sunwai) at various levels would be used?
f.
District specific issues.
Other relevant issues coming out of the discussion
Presentation of district plans- Group presentation.
15 minutes each district presentation, followed by clarification for 5
min.

Tea break
~

Power Point

Facilitator

Mode of
Presentation
Power Point

Ms Sudeepa Das

Overall facilitationMs. Asha Mishra
Resource team
members.

Mr.S.R.Azad
Chairperson
Dr.I.C.Tiwari,
Ex.Advisor (Health)
Planning
Commission
Govt, of India

Flip chart or
power point

- ------------------------- ----------- -------------■Rw"' p“hBy“,s in

Facilitation and Vote of Thanks
Mr S R Azad

Ms. Asha Mishra
Chair person
CMO

“-----

Lunch

Cone lading Session

Power Point
presentation

- -----------

Day- 2 : 30/ 05/07
I Date
Session
10.00 to
10.30

Ms. Asha Mishra
Chair person
CMO

«»'

Day 1
s
Activity

Managers Orientation workshop
‘ 2 DAYS’
Time

Facilitator

Mode

Registration

10.00 AM10.30AM

State Nodal NGO

2

Inauguration

10.30- 11.00 AM

Health Dept, officials
Panchayat Dept
officials
AGCA members
State Nodal NGO

Register,
Registration form
Materiel
distribution_____
About NRHM
and Community
Monitoring
Commitment of
state health and
Panchayat Dept.

3
3

Breakfast
NRHM and
Community
Monitoring

11.00- 11.15AM
11.15-12.00
Noon

AGCA members
Resource persons

4

Organogram of
CM and role of
different stake
holders

12.00-01.45 PM

Resource person

5

Composition,
1.45-2.30 PM
Role of various
committees (
AGCA,
Mentoring
Group, State
District,
Block, PHC
and village)
Lunch_______ 2.30-3.15PM
Composition,
3.15-4.00 PM

6
7

No
1

Resource Person

Resource person

Power point
presentation on
Right to health
care, CM in
NRHM and its
importance
followed by
discussion_____
Structure of CM
frame work from
AGCA to
villages. Role of
Stake holders.
Power point
presentation
Followed by
discussion
Power Point
presentation
Followed by
Discussion

Power Point

8

9

Role of various
committees(
AGCA,
Mentoring
Group, State
District,
Block, PHC
and village
Role of stake
4.00 PM- 4.45PM
holders
Open
discussion

Resource person

Power point
presentation
Followed by
discussion
Discussion

4.45-5.30 PM

Resource person

Time

Facilitator

Mode

Recap

9.30- 10.00AM

Resource person

Organization of
Jan Samvad /
recording of
Positive and
negative
experience_____
Selection of
District, block,
PHC, villages( if
possible)_____
Tea Break

10.00- 10.45

Resource Person

Individual
reporting
Experience
sharing

10.4511.30AM

Facilitator in each group

Day 2
s Activity

No
1

presentation
Followed by
discussion

11.30-



11.45 AM
H.45- 12.15PM

Group facilitator

12.15-01.30PM

Resource Person

Lunch
Budget

01.30-2.30PM
02.30- 3.15PM

Resource person

Time frame
Concluding
Session

3.15-4.00PM
TOO- 4.30PM

Presentation of
group discussion
I Introduction of
tools

Group
discussion as
per districts

Flip charts /
Power point
Distribution of
tools and
explanation

Power point
presentation
Resource Person_____
Power Point
Govt, officials
Reporting of
AGCA members, Nodal two days
NGO
activity /
I
participants
___________

i

I

presentation

Participants

No

1. Director, Health Dept / Nodal officer
2. AGCA members
3. Mentoring group members (Approx)

1
2
5

Resource group members
(Approx)
CMOs of selected districts
State officials of Panchayat and Social Welfare Dept
Zila Pachayat Chairperson / Chairperson of
Health sub committee of selected Districts
8. Representative of state Nodal NGO
9. District Nodal NGO coordinators

5

4.
5.
6.
7.

Total Participants Approx

Suggestions

1.
2

30-35

1. It is better to decide about resource persons and inform them
regarding their sessions for their preparation.
2. All material like flip chart, sketch pen, CDs should be arranged
before organizing workshop
3. for group discussion responsibility should be given to resource
persons as per number and requirement of groups.
4. Health Department and Panchayat department should be contacted
and participation ensured.
5. After workshop all power point presentation should be given to all
participants in CD.

Suggestive Schedule for District workshop
Sidhi
First Day : 27.10.07
SNo

____ Time_____
10-10.30 AM
T0.30- 11.00AM

Topic
Registration
Inauguration

4

11.00-11.15AM
Tl.15-12.00PM

5

12.00-1.00PM

6

1.00-1.30PM

Tea
~NRHM and
Community
Monitoring of
Health Services
Formation and
composition of
various
committees
Discussion

7
8

1.30- 2.30PM
2.30- 3.15PM

9

3.15-4.00PM

10

3.45-5.00PM

r

2

2

Role and
Responsibility
of committees
Role and
responsibility
of stake holders
District plan

Facilitators
Chairman Zila
Panchayat,
Collector,
CMO, Mr Arun
Tyagi
Dr Ajay Khare

Mr VN
Tripathi
Mr VN
Tripathi
Mr Amit Singh
Mr Bhaskar
Mr Bhaskar

Second Day:28.10.07
S No
1
2

Time_______ ______ Topic
Facilitators
To.00-10.30AM
Recap of
Mr Prakash
previous day
10.30-11.15 AM
Village health
Dr Ajay Khare
and sanitation
committee
11.15-11.30AM
_______Tea_____
H.30-12.15PM
Work to be
Mr VN
done by VHSC
Tripathi
12.15-1.00PM
Discussion
Mr Bhaskar
1.00-2.00PM
_____ Lunch
2.00-2.15PM
Formation of
Mr Prakash
PHC & Block
Monitoring
Committee
2.15-3.00PM
Jan Sunwai and
Mr Bhaskar
recording of
adverse
experience
3.00.3.45
Discussion
Mr Bhaskar
3.45-4.00PM
______ Tea_____
4.00-5PM
Discussion and Mr Arun Tyagi
finalization of
District plan j

State TOT
5 Days
1st Day
SNo
1

Activity
Registration

2

Inauguration

Time
10.0010.30AM

Facilitator
NodarNGO~
representative

10.30-

AGCA
members.
Health ,
Panchayatand
Social
Development,
State Nodal
NGO

H.00AM

Tea break
4
5

10

J______ r

Ice breaking and
expectation

NRHM and community
monitoring process.
Right to health care,
NHRC process etc
Experience sharing of
CM in other states

11.3011.45AM
11.4512.15PM
12.15- 1.00PM

Resource
Person

1-00- 2.00PM

Resource
Person

Lunch
2.00- 3.00PM
Film show on CM
Joo ^TZJpn T
Tea break
ta T^Toopm
Discussion on film show too ^Toop KT
and experience sharing of
| participants

Process of community
i monitoring, difference
i between CM and other
| monitoring

Resource
Person

5.00- 5.30PM

Mode
Register entry,
Registration
certificate
Other material
distribution
NRHM, State
Govt
involvement,
PAnchayat
Dept role etc.
Speeches

Cards,
introduction of
partner etc
Powerpoint
presentation
Followed by
discussion
Experience
sharing and
Discussion

Film Show

LCD

Resource
Person to
coordinate

Participants
opinion about
denial to health
care and their
experience
Power Point or
discussion

Resource
Person

|

Day 2

4
5

6

2
8

9

SNo
1

Activity
Recap

2

Composition
and role of
District
Mentoring
Committee,
Block
Mentoring
Committee,
PHC, Block,
District CM
Committee
Tea Break

Time
oaojo

'.Tsa 'm

10.15-11AM

11.00-11.45AM
11.45-12.00
Noon_____
TZOCM 2.45PM

Facilitator
Resource
Person
Resource
Person

Mode
Individual
sharing
Power Point
presentation
and discussion

Resource
Person

Power Point
presentation
and discussion

Role and
Resource
Responsibility
Person
of State Nodal
NGO, District
Nodal NGO,
Block NGO,
Block
Facilitators,
Role and
12.45- 1.30PM Resource
responsibility
person from
of Health Dept
health Dept
Discussion on
need emerging
from districts
Lunch
1.30- 2.30PM
Role and
230^ 3.15PM
Resource
Responsibility
Person from
ofPRI,
Panchayat or
strengths and
PRI activist
weakness and
need to involve
them
Formation and
3.15-4.00PM
Resource
functioning of
Person
Village Health
and Sanitation
Committee,
role and
| responsibility

Power Point
presentation
and discussion

Power Point
presentation
and discussion

Power Point or
discussion

Power Point
followed by
discussion

10
1I
___

Tea break
Open
Discussion

4.00-4.15 PM
4JS530Pivr

Resource
person

Discussion

S No
1

Activity
Recap

2

Organisation of Jan
Samvad / Jan Sunwai

3

p

Village Level data
collection. Tools and
their filling
Tea Break
Tools applicable at PHC.
CHC and district level
Under standing of tools
and filling

8

11
12

Lunch
Reporting process
VHSC - PHC- CHCDist. - State -AGCA
Reporting of data

Time

AM

Facilitator
Resource
Person
Resource
Person

10.45-11.15
AM

Resource
Person

11.15-11.45
AM
TE45^~12?30
PM

Resource
Person

’mcTioo
AM

12.30- 1.30 PM

Resource
persons in each
group

1-30- 2.30PM

Mode
Individual
sharing
Power Point
presentation
and discussion
Explanation
and filling of
tools

Explanation
and filling of
tools
Participants
will be divided
in 4 or 5 groups
where tools will
be given to
understand and
fill it

130^ITrpM

Resource
Person

Formats to be
explained

TT5^4X)(rPM

Group
discussion

Group
discussion

Resource
Person
Group activity

Power point

Fea Break
4.00-4.15PM
Recording of positive and t Is Toopm adverse experiences
Group formation for field 5.00- 5.30PM
visit

4 groups to be
formed
1. Village data
collection
which will also
visit
Anganwadi,
ASHA,
VHSC,ANM
2. FGD etc
3. PHC

4th Day

rsTTr
i

2

Activity
Field Visit
1. Village team

Time

Too-1.00PM

Facilitator
Resource
Person

2. Focussed Group
discussion with SHG/
SC/ ST/ Women ( may
have discussion with one
group and explore
situation______
3. PHC visit

10.00- 1.00PM

Resource
Person

10.00- 1.00PM

Resource
Person

4

4.CHC visit

10.00- 1.00PM

Resource
Person

_5
6

Lunch
Group discussion and
presentation of reports
Report cards should be
filled up and presented

1.00-2.00PM
100- 5.00PM

•>

Resource
Person

I Mode
Will see all
records of
Anganwadi,
ASHA, ANM,
VHSC
Impact of
schemes,
positive or
adverse
experience
recording
PHC in charge
interview, Visit
of PHC and
observation,
interview with
OPD and
admitted
patients if any
CHC in charge
interview. Visit
of CHC and
observation,
interview with
OPD and
admitted
patients.
Group
discussion it
will be better if
PHO, CHC,
ANM and
Anganwadi
worker, ASHA
etc are present
in the meeting

5th Day_______

S No
1
2

3
4

Preparation of district
activity plan

5

Financial Management
and fund flow
Lunch
Responsibility
distribution among
mentoring group and
resource persons_____
Open discussion plan to
giving information to
community
Concluding program

6
7

8
9

Activity_____
Recap of previous day
and explaining the
queries
District activity plan
Various trainings,
schedules

Time
930-10.75AM

Facilitator
Group
discussion

Mode
Group
discussion

10.30-11.15
AM

Resource
Person

Power point

Resource
Persons in each
group

Participants
will be
planning as per
district
Presentation
and discussion

11.15- 11.30
AM_______
Tl 30 — 1230
PM
12.30- 1.30PM
1-30- 2.30PM
230-3.15PM

Resource
person
Resource
Person

Discussion

3.15- 4.00 PM

Resource
Person

Individual
opinion sharing

4.00-4.30 PM

Dept of health.
Panchayat,
Nodal NGO,
A GCA member

Speeches

___

Suggestions
i. It is better to decide about resource persons and inform them

legal ding their sessions for their preparation.

2. All material like flip chart, sketch pen, CDs should be arranged

8
before organizing workshop
for group discussion responsibility should be given to resource
pei sons as per number and requirement of groups.
4.
ealth Department and Panchayat department should be contacted
and participation ensured.

5'
6.

st cd '

cFh™dOf phc

P°“t I,rese“i°" “ be

vFage should be decide earlier and in

•» •”

PHC, CIJC be informed for cooperation. Ask them to be
vith you during report presentation. It will not only have their

better involvement but it will also give experience of their reaction
to giound realities to your participants.

Participants:
Participant

1. State Officials of Health Department,
Panchayat Department
2. Mentoring Group members
3. Resource persons
4. CMOs / DPMs of selected district:
s or some other in
charge for CM in that district.
5. AGCA members
6. State Nodal NGO
7. District coordinators
S. Block Coordinators^ x Number of districts)
Total number may be 30- 35.

No.

2
5
5
2
2

State TOT
Draft Schedule
Day 1 Dated 16.08.07

Time
10.00-10.30AM'
10.30-11.15 AM-

Subject_________
Mode
Facilitator
Registration_____
Individual Reg.
Mr Johnson
Introduction &
Self introduction
Dr Ajay Khare
Inauguration_____ and guests speech
11.15-11.30AM _ Tea Break
11.30-12.30PM
1TRHM &
Presentation
Dr Abhay Sahukla
Community
Monitoring
12.30-2.00PM
Role and
Presentation and
Dr Dhananjay
responsibility of
group discussion
various committees
State, District,
Bloch, PHC and
Village__________
2.00-3.00PM
Lunch_____
100-4.15 PM
Role and
Presentation
Ms Asha Mishra
responsibility of
various committees
State, District,
Bloch, PHC and
Village_____
4.15-4.30PM
Tea break______
4.30-6.00PM
| Film Show
Note Comments
Day 2 Dated 17.08.07
Time
Subject_____
9.30- 10.00AM
Recap of previous
day_____
10.00-11.15 AM
Role of Stake
holders State,
District Nodal
NGO, Block
facilitator/
committee
H.15-11.30AM
Tea Break______
H.30- 12.30PM
Presentation of
group discussion
12.30-2.00PM
Presentation of
CBM Experiences
2.00-3.00PM

Lunch

Mode
Individual response

Facilitator
Mr Rajeev Kumar

Group Discussion

Mr Rajeev Kumar,
Mr S R Azad, Ms
Belu, Dr Ajay
Khare, Dr
Dhananjay. Mr
Amulya Nidhi

Group facilitator

Ms Indu Capoor

Maharashtra,
Rajasthan & Gujrat

Dr Narendra
Ms Indu Capoor
Dr Dhananjay

3.00-4.30
4.30-4.45Pm
4?45- 6.00PM

Role of Health Dept
Need emerging
from Districts
Tea Break
Discussion on
indicators, Tools
CHC, PHC ,
Patients interview
Village group
discussion etc

Day 3 Dated 18.08.07
Field Visit
Time
Subject________

'Foo

T0JF2.00 PM’

2.00-3.00 PM
~T00^5.00
F.00-8.00

Visit to Barasia
~CHC
PHC
Sub Centre
V illage-Anganwadi,
ASHA, Group
Discussion
Lunch
Group Discussion
Site Seeing

Dr Yogi Raj Sharma

Dr.K.M.Ojha

Group Discussion

Dr Ajay Khare
Mr Belu George
Dr Dhananjay
Dr Narendra Gupta
Dr Rahul Sharma
Mr Amulya Nidhi

Mode

Facilitator

Interview
Group Discussion

Dr Ajay Khare
Mr Anil Sharma
Dr Rakesh Verma

Open discussion

Dr Abhay Shukla

Mode
Group discussion

Facilitator
Group facilitators

Day 4 19.08.07
Time
F30- 11.00AM

11.00.11.15AM
Fl. 15- 12.30PM’

12.30-2.00PM

2.00-3.00
3.00-4.15PM
4.15-4.30PM

Subject
Formation of
committee and
training needs
Tea Break______
Training skills and
practical problems
and strategy to over
come them
Preparation of
report card at
Village and PHC
level
Lunch
Preparation of
report card at CHC
and District level
Tea Break

Presentation and
discussion
Group activity

Group activity

4.30-6.OOPM

Discussion on Film
show and
experiences on
CBM

Open discussion

Dr Ajay Khare

Day 5 Dated 20.007___________
Time_______
9.30-10.15AM

Subject__________ Mode________
Recap of previous
Group leader
day____________
presentation
10.15 AM- 11.30AM Role and
Presentation and
responsibility of
group discussion
Panchayat________
11.30-11.45AM
Tea Break________
11.45-12.30PM
Planning for district Group discussion
activities_________
12.30- 2.00PM
Fund flow________
2.00 - 3.00PM
Presentation of
Presentation
district activities
Feeding information
back to community
3.00-4.15PM
Responsibility of
Open discussion
Resource persons
4.15-4.30PM
Tea Break________
4.30-5.30PM
Concluding program Speeches and
presentation

Facilitator______
Mr Rajeev Kumar
Mr Shayam Bohre

Group facilitators
Ms Asha Mishra

Ms Belu George
Dr Ajay Khare

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Block Facilitator’s Training
Participants: Block facilitator’s, block coordinator’s

Programme
Day 1
10-1030

Context Setting
Introductions 1030-11'15

Tea
Expectations setting 1130^15
■Understandin g health services system 1215-T300
—- ,-------------- -----------------------------------Lunch
Universal access and Social exclusion 1345-1445
Understanding Barriers to health 1445-1530

Inlrodt^rU^^ ,(Entitlem^ts?l^^
Jntrgduction to Community Monitoring (Movie Show)1800-1845
----------------------------------------------------------Tea
------------------------- --------- -----------Day 2
Review of Day 1 0900-093Q
Community Monitoring in NRHM (ProjectRameworkj~ 0930-

~j~ gQ

123CM 300

Lunch

60 mins

30 mins
90 mins

————————
Tea______
-5—-——____________ __________Day 3
Review of Day 2 0900-0930
J^entg^^
card and score cards 0930-1000
Jan Samvad 1000-1100
~
------------------

^valuation of the Workshop
Valedictory 1300-1330

30 mins
45 mins

——~

;______ ____ _________Lunch
Practising the tools and formation of report card & score ca?d at
village level & collation of the score card at PHC and block 1400-

__ _____________ ____ _________

45 mins
45 mins

45 mins
45 mins

"J” QQ

Tea
Community Mobilization~'l045^TTl5
Community Monitoring tooIs 1115-1245
Communication skills 1^45-1315

30 mins
45 mins

60 mins
45 mins

Tea
Understanding Rights 1545-1630
What is a Rights based approach 1630-1715
_____________________ ___________

Time

"-------------

A

Outcomes
1. Increase knowledge about NRHM, especially on entitlements and
mechanisms for community participation and ownership
2.
evelop an understanding on community monitoring within a
framework of health rights
3. Develop skills in applying tools for community monitoring
4. Zrogramme3^10"
imp,ementin9 the community monitoring

Day 1
Session 1: Introductions (45 minutes)
Objectives of the session

This session will give participants an opportunity to know each other.
Process

Guidelines for facilitator
An easy and conventional way of conducting

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E<esinMUCe

introductions is as follows:

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PerS0" she " he

^en will,

=S?E~:2-~E£S~. ""

Session 2: Expectation setting (45 minutes)
Objectives of the session
This session will list out training objectives and clarify the scope of the training
Process

PartlclPantsJo write their expectations from the workshop in a
smal ch f S ok
a oS T.! tosponses on the wall or on a board. Similar expectations can be
grouped. Read the list of expectations when it is complete. After this exercise facilitator
ooin^n hhlCh f Th"9 theSe exPectations are g°ing to be met and which ones are not
going to be met. This session should conclude by explaining the learning objectives of
^he workshop preferably through a single slide in a power point presentation (See ppt

Session 3: Understanding health services system of the state (45 minutes)
Objective of the session
m76 Claray t0 part,iciPants yarding the structure and functions of the

Pa“pants""kno”,he n,,ance8 of ,he ens,y
Process
The facilitator makes a power point presentation on
the health services system in the
country. See ppt BFT-2

Session 4: Understanding Universal Access (60 minutes)
Objective of the session

°f‘h6 ®ession Participants will be able to better understand the various levels
social stratification existing in the society and how such stratification and social
exclusion would limit universal access to health.
Process

The session includes an exercise called Power walk (See details below) After the
SiT,S
b!ains,orm “ 'h°» sooial exclusion can aS se™ oped
access? Facilitator concludes the discussion with a definition of universal access

Guidelines for facilitator
1. Facilitator should have prepared cards with names of different cateoories of
population The names of population categories written on the card are •
I nbal man
• Tribal Woman

• Physically challenged woman
• Female Vegetable seller
• Landless daily wage earner - male
• Mother of 3 daughters
• Father of three daughters
• Rickshaw driver - male
• Shop owner (male)
• Male Bank Officer
• Street beggar - female
• Widow (housewife)
• Widower
• male sex worker
• female sex worker
• transgender (Hijra)
• school teacher (woman)
• school teacher (man)
• Business Person (man)
• Business person (woman)
• domestic servant (female)
• domestic servant (male)
• Doctor
• PLHIV
• agriculture laborer (female)
• agriculture laborer (male)
• Illiterate manual worker (male)
• illiterate manual worker (female)
• adolescent school going girl
• Adolescent school drop out girl etc.

3 Zr5!?Tnt'°ned in the card a"d should act as instructed by the Sator

th'1'<;iPtant dl®a9'ees t0.the statement she/he should remain whereve^ thev^re Read
The staSntVto^teadLTlre^10^3'115

t0

Understand and ^en'respond.

can read daily news paper every day morning
I can negotiate with my partner for doing safe
sex
I can complete my school education
I will be received at a hospital/clinic with r-----respect and dignity
I can purchase a contraceptive whenever I want
I have passed class X?

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'n my 3

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0' beiri»

be able ,o ’PPraaPl a doctor

^nmssotete with m, partner with regard to the number of children I would like

am tired and did not feel like doing the housework I would be able to let it be
am hungry and nobody else in the house had eaten I will be able to eat?

mvMrf r'6 nOt 'n thS m°Od f°r S6X ' W0U'd be able t0 avo'd having sex with

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i

statements and participants taking their positions, participants
will be askAH t9 h 1 f
win be asked to disclose their identities and look at where they are and also explain to
others why they remained where they are or why they have moved ahead What are the
factors which do not let them take a step forward?
5^ After this participants could go back to their seats and share their further thouohts in
L?° e 9r°uP r®9ardln9 various levels of social stratification existing in society and
would lead to social exclusion and marginalization and finally restrictinq their
access to health services, information and commodities.
9
access 'tatOr Sh°Uld C°nclude the discussion by providing a definition on universal
Universal access can be defined as a situation in which the services of an
°n reacbes the poor’ marginalized, socially excluded and underserved
groups living within defined geographical/ administrative boundary

Session 5: Understanding Barriers to Health (45 minutes)
Objectives of the session

Process
1. Participants are divided in to 4 groups

Discussion points (30 minutes)

available

--——9-





List number of barriers on health

kind which emerges EX's^h "S »f

^ion in turn- en. bamer of each

- .nd ever

FeSngs-07"1

Personal and
community level

reSp°nSeS °f the 9rouPs

the following format

Health system level barriers

Provider attitudes and
behaviour

barriers

Guidelines for facilitator

It is better to take a case study related to barriers to health in the area where the
trainees belong to.
While listing out barriers, it is important to see that the analysis of barriers is not
confining to general issues like ‘poverty’, ‘illiteracy’ etc. only. The analysis should use an
onion peel approach’ by which the specific barriers to health are identified. An example1
P
of barriers identified through this approach is as follows:

Personal level

Lack of knowledge
Consequences of un
protected sex
Signs of pregnancy
Availability of Services

Vulnerability:
Economic
Lack of Education
Migrants - No support
systems
Family responsibility

Health Systems level

Community level

Attitudes of service providers who
scold patients
Untrained Providers
Not sensitive / No rights based
understanding
Rude behaviors
Lack of medicines
Services do not reach poor
Bureaucratic systems
Unregulated private practitioners
Referrals from Health centre to
tertiary level ineffective

Early marriage
Too many children
Children too soon
Lack of male
involvement
Housework in
pregnancy
Stigma - sin/marriage of
siblings reputation
Poverty
Migration
Lack of civic amenities

refiJina tothP liSnfh t0 ident.ify
ri9hts that are being violated at different levels
e ring to the list of barriers. List down the barriers and rights. (15 minutes)

Barrier

Right

' Adapted from a audit report prepared by Family Planning Association of India

6. Ask the participants to define what they mean L,
„ ‘right’ (Plenary discussion).
by a
Consolidate the participant’s definitions into an acceptable definition of rights.
(15 minutes)
7. The facilitator can go into the next session on rights and right’s based approach.
Module 3: (90 minutes)

Session 6: Understanding Rights (45 minutes)
Objectives of the session
At the end of this session, participants will be able to know what rights are, from where
rights are coming from and how human rights are integrally related to community
monitoring and finally how important it is to realize rights to achieve development.
Process
Power point presentation, followed by discussion (See a power point presentation DPTd)

Session 7: What is a ‘Rights based Approach’ (45 minutes)
Objectives of the session

This session will demonstrate and explain the meaning of rights based approach
Process
The session should start with Killer Pool exercise for which all the participants should
stand in a circle. The facilitator stands on a chair and asks participants to assume that
the space in front of them is a pool. Facilitator throws pile of balls made of props of
paper into the ‘pool’ and tells the participants that the balls represent babies and the
participants should save the babies from dying in the pool at any cost. Facilitator shouts'
Quick, babies are drowning”. Facilitator keeps throwing the balls very fast. The
participants usually bend down to pick up balls of paper from the ‘pool’. The activity may
c°ntinue for about 1-2 minute and then facilitator suddenly stops the exercise and asks
why the participants did not stop the facilitator from throwing the babies in to the pool by
AnJm/T h's/hehr h^d- ,(ln some cases one Participant might try to grab facilitator’s hand
and try to stop him/her from throwing any more babies in to the pool. In this case
hT t0 ®xplain why he did 30 Obviously this participant is the most
enlightened of them all as he could move ahead from ‘rights awareness’ to ‘rights based
action ). In many developing countries, ‘‘with limited resources, and in the face of urgent
situations many individuals and organizations get caught up - understandably - in
rescuing the drowning babies’ without looking up to see who is throwing them in the
river in the first place”! All participants now go back to their seats to continue the
discussion and the facilitator concludes the discussion by highlighting the need to
Proceed further from mere knowledge of rights to right based action on the basis of a
rights based approach.

Talking points for facilitator

The rationale of community monitoring lies in adopting rights based approaches as it
raises questions about responsibilities and accountability of development agencies.
Rights based action2 includes:









researching and mapping, making
Identifying what rights are not realised
visible ...
Identifying why, they are not realised
Identifying who or which institution bears responsibility
Identifying what the responsibility consists of
Identifying the constraints and obstacles to meeting responsibilities .. Capacity ..
legislative, resources, attitude, .... ?
Identifying how best to change ... what strengths can be reinforced, how will all
involved
participate, what additional needs to be done, or done differently, who with ?

See Implementors Manual and the ppt DFT-3 for a discussion on rights based approach

Module 4: Understanding the concept of community monitoring
Session 1: The characteristics of community monitoring (45 minutes)

Objectives of the session

This session will clarify the need, advantages, objectives and actors of community
monitoring. It will also give participants an opportunity to see how a pioneering attempt
on Social Audit was held with people’s participation within the framework of
inclusiveness and accountability.
Process
The session should begin with screening of a documentary film of a social audit. This is
about a social audit conducted by an NGO social movement named MKSS in India After
screening the movie participants will be asked to share what they feel about the movie.
rom the feed back of participants and through brainstorming, the facilitator will be able
to explain the characteristics and advantages of community monitoring.

The discussion can be summed up by a power point presentation. (See ppt DFT-4)

2 Courtsey: Doortje Braeken, IPPF

V

Tentative Agenda for 4a G meeting
llth-12th January 2008
ISI, Bangalore
Objectives
1. To review the progress of the Community Monitoring processes in each state (
2. To review project timelines/budget based on progress and funding disbursements
3. To review and finalise the broad framework of community monitoring processes as
outlined in the Implementors Handbook
4. To review and finalise the capacity building framework for community monitoring
5. To discuss tasks of TAG vis a vis decentralised planning and community action.

Day 1
Session
Welcome and Context________________________________
Introductions_______________________________________
Review of progress (4 states)
(Statewise presentation (5-7mts each state)_______________
Tea_______________________________________________
Review of progress (5 states)
(Statewise presentation (5-7mts each state)_______________
Review of timelines/budget____________________________
Lunch_____________________________________________
Review of community monitoring framework_____________
Tea_______________________________________________
Review of capacity building framework__________________
Group work on finalizing community monitoring and capacity
building frameworks
Day 2
Presentations of group work_____________________
Tea_____________________________ ___________
Role of TAG vis a vis community planning and action
Any other matter

Tinje
0900-09 0
0910-0940
0940-1040
1040-1100
1100-12Q0
1200-1300
1300-1400
1400-1600
1600-1615
1615-1730

0900-1100
1100-1115
1115-1300
1300-1460

National Secretariat- Status Report
to December' 2b()~'



Tasks
| Material for Awareness Generation

Status
'!
containing the PD] and print-ready 1
versiona oi
ol all
all the
pamphlets.
the posters,
posters, pamphl
briefing kit and manual was sent !
o all the 1
states.
i
• Six type of posters designed by Nat See j
Ii
were dispatched to MP. MaJwrasiit-a.
I
Orissa. Jharkhand. Chattisgarh an[l
Rajasthan
live types of pamphlets Village
health
committee, untied fund to
sub cen
--...ire.
- —
Pile . Health and Nutrition day. at d
NRHM-Know your rights and denhand
your rights
i Model ( •urriculum lor I minings and ’
• Implementor’s Handbook in I nglish
i U orkshops
• Implementor’s Handbook in Hindi
Hanslation ol monitoring tools into hindi
• I ranslaiion of village health report card
into I lindi
• Design lor block facilitator's trainine
| Developing 1 ools
• Community Mobilisation protocols
I
finalized
• Communi tv Monitoring protocols
Unalized
.__
I
Documentation Formats
i Prepared monthly state reporting formal
I National secretariat is constantly in touch with
I state nodal agencies and has collected acti\ itv
J reports.
Assist AGCA members and State
Regular contaci maintained with concernec
; NRIIM directorates for Slate N(i()
i
A( j ( A members and stale contact persons.
i
[ networks tm State preparatory- Phase , Multiple field \ isils made to each slate
i
on
j Website
community
based I
Materials to be unloaded on the website sent to
i monitoring of processes and access to the Ministry
[ services under NRI IM
7

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leehnieal support to Stale Nodal
Organisations

L_.

i Being provided on a regular basis through visits
telephone and email- providing materials
i
information.
] Also constant support has been given as
Jjesource person lor l oT: workshops and -muons j

I

pzzzzz--------

Preparation of Mol Is for the second
.installment

finalisation of accounts of first
[ installment
, Disbursal of grants
| Quarterly reporting

j activities.
Finalised and being executed

Done

j Ongoing

Challenges;
1) I he process of mutual communication is not vet been set-up



Dithculty to keep timeline in absence of timely financial disbursement.

2

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Evidence on Community and System
Strengthening Approaches for
improved health and nutrition
State Consultation on
Community Mobilization
Bhopal, August 11, 2010

1

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iw L Laxmikant Palo
Senior Technical Advisor
The Vistaar Project
New Delhi

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An Overview
r-' -

• Purpose and
Objectives
• Evidence Review *
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Approach
• Project Strategy
• Progress and
Lessons

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Project Purpose

To assist the Government of India

and State Governments of Uttar Pradesh and
Jharkhand
in taking knowledge to practice
to improve maternal, newborn, and child
health and nutritional status

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Purpose of Evidence Review


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• Foster knowledge sharing on interventions
• Facilitate consensus and collaboration around
evidence based approaches
• Generate recommendations and action
• Identify capacity building areas and
approaches

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Evidence Review Process on VHCs
Sending

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summary
results
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of theme

k Identification
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4j Interventions
t°Review

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Selection Process
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Interventions identified for initial review

_____________________________________________________________________________ ~

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Interventions had monitoring and/or
evaluation information available & accessible
,

|

-------------

Interventions meet the project team's criteria
for the evidence review:
showed evidence of outcome or impact results
__

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Lessons Learned
• Community orientation to the role of VHCs takes time
• Community representation in the VHCs is crucial
• Civil society participation and support to VHCs is
essential
• Village ownership of the VHC and the Village Health
Plan is very important
• Involvement in implementation and monitoring of the
Village Health Plan
• Linking the VHC with Government systems and services

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Guiding Principles for TA Design

• Based on Evidence
Reviews
• Working within the
system at scale


Cross Cutting-Costing,
Equity and Gender

• Considered replicability
aspect

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• To improve nutritional
status of pregnant and
lactating women and
adolescent girls
• To improve nutritional
status of children
specially children under
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Capacity Building
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3

vistaar
0a0e to PraCl>cB

5

■MMI■H■■■■■
Key Project nutrition strategic'
_ ...

• Enhance IPC skills of frontline workers
• Promote Community mobilization
• Enhance the knowledge and skills of mid-level
managers
• Strengthen supportive supervision skills
• Promote inter-sectoral coordination
• Improve Nutrition monitoring
• Mainstream equity, gender and inclusion perspective
__ 91^ y

(g) USAID

C viSBW

'•'O’T>»AMBIC*NKO«X

to Prue*6®

Interpersonal
Co m m u n i ca t i o n / H o u s e h o I d
M.

.



Point of home visit



Planned follow-up visit

.

• Training on nutrition IPC

|

I-





Onsite counseling session observation ar
feedback



Record keeping! visit #1 and follow-up
visits)



Review at the sector meeting



Counseling tools (Guidebook and flip book)

(t)USAID
'°a0a lo PradK*

6

OU



d Counsegw^^M
. Learned
| -

• Need for quality counseling training and onsite support
to frontline providers
• It needs to be sustained by supportive supervision,
motivation and monitoring
• Need for a supportive environment (family and
community)
• Adoption of behaviors should be from feasible to ideal
• Services and products must be accessible
• It should be timely, as per their need and planned
follow-up

©USAID

3^

vistaar /
to Prieto*

Challenges in Household
• Counseling is not considered an essential service
• Inadequate knowledge and skills of service providers
• Home visits are not happening as per the client's
preferred time
• Inadequate timely onsite support
• Inadequate mobility support to supervisors
• Lack of active involvement of family and community
• Less engagement of Panchayat

©USAID

•%o vistaar v
^efoPfaOJc0

7

-

Evidence indicates that VHND is an excellent available platform
for the community to access a range of MNCHN services on
an assured basis

vistaar F
to PracW*

Technical Assistance Strategies for
• Orientation of frontline workers on VHND guidelines &
clarification of roles
• Joint (HFW &WCD) district level micro planning for
VHND incorporating unreached villages
• Enhancing community awareness on VHND
• Institutionalizing mechanisms for regular and
structured observation and supervision
• Convergence with other development departments
• Improving allocation and use of funds for VHND

(SjUSAID

g-V1
vistaar F
,ea0t to PradW’

I

8

Im

ss c

>



Build on Government priorities



Sensitize district officials and assist them in orienting
frontline workers on the guidelines

Develop the Microplan jointly and share it with frontline
workers
• Regular review and use of monitoring data is important
• VHND should be a standing agenda item for the District
Health Society review meetings
• PRI and Education Department can play a greater role

(D USAID

MOMTWAfWKANHOM

vistaar 7
^•toPrtdis*

5*

Challenges in VHND Strengthening
• Frontline workers not aware of
the guidelines and their roles in
VHNDs
• Lack of convergence between
WCD & HFW Departments
• Lack of tools & mechanism for
structured observation and
monitoring of VHNDs
• Lack of community awareness
• Lack of necessary equipment and
supplies

©USAID
'eaot to PraCic*

9

Thank You!

10

ai

8/10/2010

The Ekjut Initiative
Dr. P.K.Tripathy & Dr. Nirmala Nair

State level consultation on
'Community Mobilization:
foundation for better health and nutrition
outcomes’
at Bhopal on 11th August 2010
organized by - MP TAST (with DFID support)

WORK of

STANDS ON 3 PILLARS
I Toother, building healthier communities;

1

8/10/2010

TRIAL STATES


Jharkhand & Orissa (- 66 million pop)

40 7O in J&O live below the poverty line!
63 7O of women cannot read

JHARKHAND ORISSA

INDIA

NMR (per 1000 livebirths)2

49

45

39

MMR (per 100,000 livebirths) 2

371

358

301

l.NFHS-3 (2003 data). India, 2. Indian Sample Registration System (2001-2003), 2006. World Bank, 2007.

INCLUSION CRITERIA & TIMELINE
STUDY PARTICIPANTS:
All women of reproductive age (15-49):
• Residing in the project area
• Who gave birth between 31st July 2005 - 30th July 2008
•Who gave consent for involvement in the project

BASELINt
Nov 04-Jul 05

AR)
Aug 05-Jul 06

••EAR?.
Aug 06-Jul 07

YEAR?
Aug 07-Jul 08

PROSPECTIVE SURVEILLANCE OF BIRTHS & DEATHS TO WRA

3

8/10/2010

THE TRIAL DESIGN

36 dusters of ~ 6330 pop
Total population: 228,186
18

Intervention dusters

■'

Control Clusters

Women s groups + PLA

Keo,

iiiiiiiLim iiummii
Control Cluster

^InterventionCluster

SURVEILLANCE SYSTEM
Select one key informant '
per 250 households

ay;±;n
d

to women of rep oductive age

. Interviewer visits informant monthly to
collect list of identifications

ini

Interviewer verifies identifications
and pays informant ■ d i


i i





t



after delivery

. ? ;

4

8/10/2010

The approach SIS

Women’s Group intervention
CONTROL CLUSTERS

EXISTING GROUPS = 20}

INTERVENTION CLUSTERS

EKJUT WOMEN'S GROUPS =244

5

8/10/2010

4 Phases of intervention

Phase 2
Planning
solutions together

Phase4
Evaluating together

MEETING CYCLES
(first 2 phases)
: Identifying & prioritizing problems with the
help of picture cards
6th to 9th Meetings : Planning strategies to solve the problems
through story telling and bridge game

1st to 5th Meetings

Si

6

8/10/2010

r

Community Meeting -1

r

Phases 3 & 4
Phase 3-

Implementation of Strategies - 9 meetings
Cluster level Community Meeting

Cluster level community meeting
Phase 4Evaluation of impact - 2 Meetings

7

8/10/2010

Evidence of impact

• A cRCT is the most rigorous way of measuring
effectiveness of an intervention
• Ekjut trial published in The Lancet in March’10
Tripathy, P et al. The Lancet 2010,375:1182-1192
Effect of participatory intervention with women's groups on birth outcomes and
maternal depression in Jharkhand and Orissa, India: a cluster randomised controlled
trial.

BASELINE RESULTS

• NMR: 58 per 1000 live births
• MMR: 510 per 100,000 live births
• 40% of women did not have any ANC
• 15% had 4+ ANC visits
• 85% of deliveries took place at home

8

8/10/2010

IMPACT ON NEONATAL MORTALITY
70
0

60

a
u



50

■= -Q

o=

40

.....

E

ra
ra

Control

30

u

Intervention

20

z

10
0
Year 1

Year 2

Year3

NMR- Seasonal Variations
90

80
70
60 -i
50
40
30
20

10

—Intervention —Control

9

8/10/2010

I

IMPACT ON NEONATAL MORTALITY
r-

!

§

1

co

S-

• s

s-

w*

o.

s

8o

dl

e e
e

e

50
100
Baseline NMR per 1000 livebirths

• Control clusters

Ek|ut trial

e

150

S Intervention clusters

NMR district

10

8/10/2010

IMPACTON NEONATAL MORTALITY

Bl

YEARS 1-3:

32% reduction in NMR

s1

;;

OR: 0.68 (95% 0:0.58-0.78)

M

TW 1

YEARS 2-3:
,



IB

4

45% reduction in NMR
OR: 0.55 (95% 0:0.46-0.66)

PERINATAL MORTALITY RATE

1

32% reduction

PNMR/YEAR

Yl

Y2

Y3

Intervention

67-5

57.3

47-6

Control

65.2

75

73-5

OR: 0.68
(95% Cl: 0.56-0.79)
Years 2& 3

STILLBIRTH RATE
SBR/YEAR

Yl

Y2

Y3

Years 2&3:

Intervention

3°-9

34-7

26.6

OR: 1.01

Control

30.1

31-9

28.6

(95% Cl: 0.80-1.28)

11

8/10/2010

HOME CARE PRACTICES
Intervention

Cord tied with boiled thread

N(%)
8084______
3291 (40.6)
2594 (32.1)
2088 (25.8)
2559 (31.7)

Infants alive at 1 month

8807

Home deliveries
Birth attendant washed hands
Safe delivery kit used
Plastic sheet used

Exclusive breastfeeding at 6 weeks 7022 (79.7)

Control
N (%)
7034
1583 (22.5)
1284(18.2)
560 (8)
786 (11.2)

OR years 2&3
(95% Cl)

2.50 (1.35-4.62)
2.28 (1.27-4.09)
2.98 (1.84-4.81)
4.33 (2.06-9.11)

8119
__________
5611 (69.1) 1.74(1.03-2.94)

CARE SEEKING
Intervention

Control

9468
3001 (31.6)
945 (10)

8867
3621 (41)
922 (10.4)

0.68 (0.37-1.24)
0.80 (0.39-1.65)

Any of 3 infant illnesses
(cough, fever, diarrhea)

1739 (19.7)

2388 (29.4)

0.61 (0.35-1.06)

Visited facility in case of infant
illness

940 (54)

1050 (44)

1.55 (0.79-3.04)

All births__________________
3+ANC visits________________
Visited facility in case of illness in
pregnancy

OR years 2&3
(95% Cl)

12

8/10/2010

r

CARE SEEKING-lntervention
90
80
70
60

50 440 430
20

10

0 +
AnyANC

3plusANC

Iron

TTInj

Institution Formalprov
Delivery

AnyPNC

H BL SY1 OY2 EY3 ■ Y4

MATERNAL DEPRESSION (YEAR 3)
57% REDUCTION

IN MODERATE
DEPRESSION

Intervention

Control

N(%)

N(%)

Mothers

3120

2963

No/mild depression (10-15)

2962 (94.9)

2665 (90)

2.33(1.25-4.38)

Moderate depression (16-30)

154(4.9)

293 (9.9)

0.43 (0.23-0.80)

Severe depression (31-50)

4 (0.2)

5(0.1)

0.70 (0.15-3.31)

Adjusted OR (95% Cl)

13

8/10/2010

AGENCY

• Care seeking

i

• Visiting a provider
unaccompanied

CM -

• Coing to the shops
unaccompanied

I

• Expenditurefor daily
necessities
• Less frequent expenditure
• Expenditure on expensive
items

NEONATAL MORTALITY TREND:
Marginalisation (intervention are;
80
70
«■

^Most

t 60

33% decline

marginalized

<v

a 50
| 40
•■■►Less

£ 30
Q.

marginalized

73% decline

| 20

10
0
Baseline

Y1

Y2

Y3

14

8/10/2010

Support from within the system Attendance at Ekjut WG meetings
80
r w
73 M

ro £

oi +-«
JZ o

U_

60

(V

g W)

E

40

o C

20

a™
O £

0

'c

12
a. o
u
O

lib

Sahiya/ASHA

AWW

ANM

■WS% ®SK% ®KJR%

Replication taken into consideration
during design
• Women’s groups (SHGs) are an untapped available
resource - facilitation through local women at each
site
• The trial covered 2 states and 3 districts, spread
over 20,000 sq km with several different
indigenous groups
• 3 district teams managed independently
• Concomitant process evaluation explaining the
context, method, implementation and mechanism

15

8/10/2010

Replication taken into consideration
during design
• User friendly facilitator’s manual for universal
application
• Picture cards developed with visual literacy in
mind
• Replication in 8 districts - only supportive
supervision and TOT

1

Scaling up
• Ethical scale up: intervention extended to ex­
control areas
• Quantitative scale up : extended to 5 new
districts
• Functional scale up: working beyond newborn
period to include Under-5 and combating
malnutrition
• ‘'Political” scale up: dissemination workshops,
engaging with media, ministries, funders and
intermediary agencies, etc.
Source: Uvin and Miller (1996)

16

8/10/2010

A

egg;

UT TAB FKAOtSN \

3 Old districts
5 New districts
Total Population=
599 289

[

1

Scaling up

• Community mobilization plan for Orissa
• Proposed study - with ASHAs as facilitators
• Dissemination meetings at district, state,
national & international level
• Local, National & International media
coverage

17

8/10/2010

I

Has it been scaled up successfully?
ex- intervention clusters - post-trial - holding the
gains of improvement from year 3
Scale up in ex- control clusters • Raw data analysis for the first year shows a 25 %
reduction in NMR already
• Lag period for improvement reduced from about 1
year to 4months
• Moderate Postnatal depression rates fell sharply
from 10.1% to 6.8% after intervention was started

Cumulative number of lives saved compared to baseline NMR (58)
210 ■

No Ekjut women's groups
No Ekjut women's groups (baseline intervention arm)

160 ■

Ekjut women's groups running

110 •

60 -

10 ■

-40
NovOS

MayOS

NovOS

May 06

Nov 06

May 07

Nov 07

May 08

Nov 08

May 09

18

8/10/2010

210 •
No Ekjut women's groups

160 -



No Ekjut women's groups (baseline intervention arm)
Ekjut women's groups running

110 ■

Slope of WG arm
becomes different from
control

60 ■

Slope of control arm
breaks winter pattern

10 ■

-40
[ NovOS [MayOS

NovOS

May 06

Nov 06

May 07

Nov 07

MayOS

NovOS

May 09

COST-EFFECTIVENESS
Cost per newborn life saved Cost per life year saved
EKJUT (INDIA)
MIRA (NEPAL)
PROJAH NMO
(BANGLADESH)

US$ 910

US$33*

(US$ 1308 with H£S)

($48 with HSS)

US$3442

US$111*

(US$ 4397 with HSS)

($142 with HSS)

US$ 2995 including HSS costs

* The World Bank - interventions <$127 per DALY are the most cost-effective.

Note: Trial covered a large , dispersed area over 20,000 Sq kms in 3 districts,
therefore cost of 3 district teams was necessitated

19

8/10/2010

1

KEY MESSAGES
Community mobilization through women’s groups
1. Empowerecl community groups can
effecti^^^^BpiSMght to access

a n d«m bmifas fttptf®g£

bl isedy ices

2. CorfimO^ty^^Htaat^erttPsygh^men’s
group<i-n(^si£rt^|^
equitabt^gdviijraeaase decision making
Ca^iT^O^^i^iTi^R mortality settings
3. Major contrioution was by women in both
highly cost-effective

NMR

80
70
60
50
cn

S 40
Z

30
20

10
0
2

3

5

6

8

20

8/10/2010

NMR
80 -

70 4
60
50

40 '

: ill I LI I I
30 ■

..mH

SI



12345678

Can empowered Women’s groups help
improve nutritional status among
children 7
■.<

__________________________

3.

'fl

..

-



'■■f.-:

21

8/10/2010

Community based intervention in combating
malnutrition­
south Bihar( Now Jharkhand )'93 - '95
Nutrition

Care during illness
& Management
of infections

Caring practices
promotion

Im

Community based intervention in combating
malnutrition_________ South BiharfJharkhand )'93 - '95
Impact of health education with regard to child feeding and rearing
practices
90
80
70
60
50
40

-

II

11

30 -|
20 ■■••I

A
x Z X
Z
X z

10 0 -

Z’

H Jan-93

1
.. ,

z

....

i ■I
4^







z ZZ

Dec-95

22

8/10/2010

Community based intervention in combating
malnutrition________ South BiharQharkhand )'93 - '95

Nutritional status (1-3 Years in %)

Nutritional status (3-5 Years in %)

40
50
30

40

20

30
20

10
0
Normal

Normal

Mild
Malnutrition

■ Percentage % (Jan 93)

I

Moderate
Malnutrition

Severe
Malnutrition

□ Percentage %(Dec-95)

an
Mild
Malnutrition

■ Percentage % (Jan 93)

Moderate
Malnutrition

fc.

Severe
Malnutrition

□ Percentage %( Dec-95)

Community Mobilization: foundation for
better health and nutrition outcomes’
5Q Nutritionalstatus(3-5 Years In X)

) ■ Q l_ B I 1 ■-r.

Nutrition

0

Normal

MUd
Modarata
Savara
Malnutrttlm Malnutrition MalnulrfUon

■ Pareantaaa M pan N)

O Pananuta M Oac^S)

Care during illness
Caring practices

& Management
of infections
Addressing inequities

promotion
Improved Agency

Improved self-efficacy
100

-SO

160

J 40

* /

•O'

-£>

No/mild

Moderate

23

8/10/2010

Personal Experience
in Collective Action
Belieb of Cod/Benefrt for
Joining collective Action
Perception of Acceptability of
collective Action

Inclusion of

Intention for

Local Values A

Collect Action

Culture

(Outcome)

■GETTING------------- I
Penonal
Networks
(Pred. Fecit)

Relation to power

j Structural)
uffftnXoR^ 1

Prior Ext.1
Support

IGANIZEDP-----------1
Legal *utui
I

*=J

tte^CC MMUNITY

tkipatory
r-mgt

STATUS

:hange

>R(
GROWTH

cvety'

Iners “Retreat"to
w+ Problem-solve
(MAE)
live

• Progress toward!

aodhl

----------------

self-rehanca
x Knowledge)

LINKAGES
Govt.AExfl

Knledge
Shar'g with m'
(Membership)

INDIVIDUAL
STATUS r—
CHANGE ®

Agencies

24

4

8/10/2010

Tripathy, P et al. Effect of participatory intervention with women's groups on
birth outcomes and maternal depression in Jharkhand and Orissa, India: a
cluster randomised controlled trial.

The Lancet 2010,375:1182-1192
Improving Newborn Survival in Low-Income Countries: Community-Based
Approaches and Lessons from South Asia
Nirmala Nairl, Prasanta Tripathyl, Audrey Prost2, Anthony Costello2, David
Osrin2* . PLoS Med 7(4): 61000246. doi:10.1371/
journal.pmed.l000246Barnett S, Nair N, Tripathy PK, Borghi J, Rath S, Costello
A.
A prospective key informant surveillance system to measure maternal
mortality-fi ndings from indigenous populations in Jharkhand and Orissa,
India. BMC Pregnancy Childbirth 2008; 8: 6.
http://www.biomedcentral.eom/1471-2393/8/6/prepub
Website: www.ekiutindia.org

25

<2 o

SHRC ,CG

2009

Mita lAzliAzS becokvtLkvg Nbcrses
Ajouruvey from
c-ommiziA/Lty health voliziAzteers to health providers
Back ground and Rational - In Chhattisgarh more than 59000 Mitanins are serving as community health
volunteers (CHVs) in their hamlets for last 6 years. During this period their competence (knowledge and skill) has
been enhanced on child health, maternal health, first contact curative care, local herbal remedies, local health
planning, management of neonatal and childhood illnesses, home based neonatal care, infant and young child
feeding practices, women empowerment, behavior change communication etc. Their work has shown a visible
impact like reduction in infant mortality and gains in key behaviors' viz. early and exclusive breastfeeding,
complementary feeding etc. It has been found that almost 2500 CHVs have passed 10th/12th class.
In contrast to this effective community mobilization, our state is facing a great paucity in the availability of staff
nurses, ANMs, GNMs. On the one hand state capacity is less in developing the new ANMs, GNMs etc. and on the
other hand the available nurses are more interested to go outside the state or to join private institutions. Taking
this availability of qualified community health volunteers and lack of nurses in the state, as part of NRHM
architectural correction of health system, functional provision has been made in NRHM state PIP 2009-10 to give
chances and priority to MITANIN-CHV to become staff nurse/GNM/ANM through admission to courses in
government and private colleges. State government has taken an important decision that not only CHV, but also
Mitanin trainers and district resource persons of the Mitanin Program will be sponsored for the courses of staff
nurse/ANM/GNM.
Process- In Aug 09 a state level motivation drive has been organized to mobilize all the 12th passed class (biology
group) Mitanins to appear for a written test organized by a group of private nursing colleges affiliated to
department of medical education, government of Chhattisgarh. More than 125 Mitanins has appeared in this exam
and 55 Mitanins has exhibited their caliber as successful participant. State Health Resource Centre (SHRC) has
facilitated the whole process of listing, motivating, screening, counseling and providing admission list to colleges,
in close coordination with department of medical education and NRHM State Program Management Unit.
The commencement of a new journey- As a result of the above process, 24 Mitanins, 10 Mitanin trainers
and 4 district resource persons of Mitanin program have finally made it to the 4 year course of B.Sc. Nursing
through SHRC and NRHM. For each Mitanin Nursing Student NRHM CG will support a yearly amount of sixty five
thousand rupees to pay for of their food, hostel charges^ text books & uniform etc.
Currently their study has started and a new era commenced among the saga of community health volunteers in
Chhattisgarh. Continuous hard work of last six years is blooming now. At the same time a lesson also learned that
close hand holding will be required to support these Mitanins to complete their four year course timely and
successfully. SHRC is instrumental in hand holding them, which currently includes managing their key problem of
lack of proficiency English language (which is medium of instruction in all colleges). We are arranging special
private tuition for Mitanin Students.
What next- Now the state is planning to facilitate more CHV to take up courses of ANM/GNM in the coming Jan
2010 with NRHM funding supports. More than 2500 skilled and experienced CHVs will get opportunity to get
sponsorship for these courses through NRHM and realize their dreams come true.

State Health Resource Centre, Chhattisgarh

8/10/2010

■■r J
rv>.

w

"

I

y ZOOZ-to Mav omn
X;

)
;<-

..



.

I

,..

'■

.

.

Experience Sharing on Mitanin Program run by Govt of
Chhattisgarh in technical support of SHRC

Presentation Structure

?

program j

. ■< a

"'"TJ

1

8/10/2010

Part l.How program designed (study
of best practices as well as failure etc)

Chhattisgarh 2001 Background-Gaps in Health
Service Provisions
Demand Side Gaps:





Poor awareness at community level.
Poor utilization of health services at SHC/PHC/CHC
level.
Need for behavior changes.
Need for greater community participation.

Supply Side Gaps:







Poor infrastructure.
Human Resource/ Manpower (only 60 pediatricians in
state).
Governance Issues.
Skills, capacities and Motivation.
Drugs, Supplies and Equipments.
Weak Referral arrangements.

Other Critical
issues:
• ANMs Workload
and limitations in
expanding with
MPW force.
• Limited coverage of
Anganbadi centre,
large number of
neighborhood
villages left out.
• Limited
connectivity Weaker linkages of
Panchayats with
health system.

2

8/10/2010

Three Days State level consultation Jan 2002
Participants
• Health Department
officials
• Civil Societies
• NGO's
• Leading health
activists.
• European
Commission
representative and
Action Aid

Results
• Agreed 15 point Health
Sector Reform agenda with
role of civil society partners.
• Decision for a State Wide

community health
volunteers program

Basic exercise- Successful NGO
experiences
Some
pioneers
in CHW
program






Jamkhed
SEWA-Gujarat
RUHSA- Vellore
SEARCHGadchiroli
RAHAChhattisgarh etc

Learning's from pioneer CHW programs

• Referral linkages,
• Duration of project,
• active support and training
throughout the program.
• women as health providers
especially at the community

3

8/10/2010

Basic exercise- Learning's from past
failure esp. Govt large scale programs
Community health
worker (1977)
Community health
volunteer (1977)
Village health guide
(1983)
Malaria Link
Volunteers
Jan Swasthya
Rakshak (Madhya
Pradesh 1996)

-CHWs were largely men.
-Selection was left on the
Panchayat head or to the
ANM.
-There was no continuous
learning and support
provided to the CHW?
-Many CHWs become less
qualified practitioners
(quacks?)

Important gradients- Ready to start
• Supportive Political
Leadership (Indira Swasthya
Mitanin program).

• Great Administrative
Support (New state).
• Full Financial
Support- MOU between state and
European Commission under State Investment
Program .

• State-Civil
partnership {SHRC
formed(MOU between State government
and Action Aid), partner ship in piloting
blocks with local NGOs}lt continued in all
phases and levels.

• Technical
preparedness

Based

on past learning and current health
indicators.

• Need of the State a
community health volunteer Program in form of
Health Sector Reform.

4

8/10/2010

Mitanin Program Designed and Implemented
1. Improve health education and health awareness
2. Improve utilization of existing public health care
services.
3.Promote local measures of immediate
relief to health problems of weaker
sections of society- curative and preventive.

Mitanin
-ASHA

****************************
4.Organize community ^especially women and
weaker sections on health and health related issues.

Institutions

5. Sensitize Panchayats

(the local self-governing
institutions) and build up its capabilities in planning and placing
health on PanchayaCs agenda.

4

Part 2.Program implementation
Across in state l.How and
2. what worked in Mitanin program

5

8/10/2010

Scaling Up across Sate-Piloting and
phase wise Implementation
• May 2002 in 16 pilot block in partnership
with NGO.
• Till March 2003 in 64 blocks, phase -I,
• Till March 2004 in rest 66 blocks - phase -II
Implementation done by Health Department in
technical support of SHRC. Now the program
implemented through DHS under NRHM.

How - role of SHRC
• Module and all training material
development (design, approval,
production).
• Conducting training offi.e. TOT) state
trainers/district trainers/block trainers.
• Support in Mitanin training through
District Nodal Officer (Mitanin Program)
• Monitoring of the program at all level.

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What worked in Mitanin Program

1.Important feature of
design
2. Key Strategies
3. Key operational activities
4.Monitoring strategy

What worked in Mitanin Program
1. What's in a name?

Shakespeare

But if it is to
be owned by the community, the NAME surely creates ownership. So the Mitanin()means
more than a friend, emerged in Chhattisgarh

2. Not a LINK worker but Health
Activist

Mitanin-ASHA (nearer to community)

3. Approach adopted for Community
Participation- Empowering the community to plan and work for their
development.

4. Important ground work selection process & social
MOBILIZATION(kalajatha

, community

group

meeting

, grampanchayat

INVOLVEMENT, MITANIN SELECTION)

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What worked in Mitanin Program
5. Continuous Training's Strategy Camp based training, On-the-job
training,Combating Key Challenges Related to Transmission Loss at Various Levels.

6. Adopted Modular Approach for Training- covering
Chhattisgarh need based subjects, till now coveredl.public health/child health, Z.health resources, 3. women health, 4. National programs(Malaria),
5 First contact curative care-Drug kit, 6. National programs(leprosy and TB), 7.good governance
(micro planning-Swasthaya Panchayat Yojana) S.social security/food security, 9. Local harbal
Remedies (AYUSH) 10. Home Based Neonatal Care, Integrated Management of Neonatal and
Childhood Illnesses, 11. Village health planning, 12 Infant and Young Child Feeding,
13.Counseling (Behavior Chang Communication Kit)
In process 14. Malaria and leprosy 15. TB
and HIV/AIDS.

7. State government and civil society partnership at an
level- state, district, block, sector, implementation of program in 28 blocks in NGO partnership.

8. A Mentoring cascade of 3650 local trainers
across state- In each block 20 Mitanin (ASHA) trainers and 3 block coordinators, and
a district coordinator on an average 5 blocks

SCdl6 at all leVel-State government and civil society partnership and A
I

Mentoring cascade of 3650 local trainers across state

1

/
1

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What worked in Mitanin Program
9. Just Process monitoring (Action by Mitanins)
Mitanin visits every newborn family on first day. Now visiting every
neonatal on 1/3/7/14/21/28 days as per IMNCI protocol. Also do
convey some HBNC skills to family members.
Every pregnant woman's family is met in the last month, the birth is
planned-JSY.
Every child with diarrhea, ARI, Fever is visited for appropriate home
care through Mitanin Drug Kit on first day and referred If required.
Ensuring herbal remedy if required. Mitanins are DOTS providers.
Attends the Immunization Day, supports in key activities output, ex.
immunisation of left/drop outs, THR, weighing etc.
Visits every malnourished child in her hamlet - for counseling on
preventive, curative care and feeding practices.
Holds a hamlet level women health committee meeting every
month. Addressing the problem through WHC of Para on social
security issues.
Leading VHSCs as convener as well as joint signatory. Provide
Support to Local Bodies in health planning.

What worked in Mitanin Program
10. "Action Formulas" for action since conception of the programFour contacts. Six messages for child nutrition, seven messages for newborn etc.

11. No reporting, only mentoring- reports are generated by
Mitanins trainers and block coordinators.

12. Regular strengthening processes-monthly hamietievei
meeting, cluster meeting, two block level meetings of Mitanins trainers every month,
Block coordinators monthly district level meeting, monthly state level training of
district coordinators, monthly state level meeting of CMHOs.

13. Books design ““ it were useful in training, daily reading by Mitanins and her
family members used for family counselling.

14. Continuous Technical, Financial, political,
administrative. Media support- SHRC provides continuous
technical support, Initially funded by European commission till 7th round than managed by
NRHM till now, all ruling party supported the program, continuous Media support etc.

15. Volunteerism- all 60000 Mitanins are volunteer, Incentive started in late 2007.

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What worked in Mitanin Program
10. "Action Formulas" for action since conception of the programFour contacts, Six messages for child nutrition, seven messages for newborn etc.

11. No reporting, only mentoring- reports are generated by
Mitanins trainers and block coordinators.

IZ.Regular strengthening processes- monthly hamlet level
meeting, cluster meeting, two block level meetings of Mitanins trainers every month,
Block coordinators monthly district level meeting, monthly state level training of
district coordinators, monthly state level meeting of CMHOs.

13. Books design “ it were useful in training, daily reading by Mitanins and her
family members used for family counselling.

14. Continuous Technical, Financial, political,
administrative, Media support- SHRC provides continuous
technical support. Initially funded by European commission till 7th round than managed by
NRHM till now, all ruling party supported the program, continuous Media support etc.

15. Volunteerism- all 60000 Mitanins are volunteer. Incentive started in late 2007.

What worked in Mitanin Program
16.KEY STRATEGIES for Mitanins Motivation
Solidarity And Sustainability
• Mitanins mutual sharing through newsletter
• Refilling of vacant places of MITANINS, MT, DRPs,
• Development of Mukhyamantri Mitanin Welfare
KOSH.
• Strengthening the referral practice - through
Mitanin Help Desk.
• Providing career opportunity in health sectorANM,GNM etc.
• Empowering them as community leader- VHSCs
convener. Promoting Mitanins for PRI member

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Part 3. State level Implementation Cost
of the program

Yearly Cost- Mitanin Program


S.No

i

Essential activities

?











s



;■'?

Yearly training cost for 60000 Milanins for average

Yearly Fund required
8Cr

_______________ 8da*s_______________
2

Training cost for TOT of 3500 MT/Blofk
coordinators for 10 days

3

Compensation to 3000 MTs @1800 per Month for
12 month

2.1 Cr

_____
6.48 Cr

__ ___
4

Compensation to 300 Block coordinators @4200
1.43 Cr
_________________ Per month_________________
_

5

Contingency cost for monthly meeting at block /
district and social mobilisation-

1.5 Cr

6

Cost of printing Material etc

0.5 Cr

App. Yearly cost

20 Cr

7

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Part 4.lmpact of the program

Impact
• Advocacy-Policy formulation- A national level community
health worker initiative named as ASHA (Accredited Social Health Activist) program has been
introduces in more then 18 states of India in April 2006.

• Health sector Reform -true demand generation resulted in to-Primary
health care improved with better services. In all 60000 hamlets of state community health volunteers
are extending the first contact curative care for fever, cold, pneumonia, diarrhea etc.

• Technical Human Resource “ 60000 women community health
volunteer, who are trained on preventive and curative aspect of health -Health right. Child health and
maternal health. First contact curative care, local herbal remedies, National health programsVBDCP,RNTCP,NLEPetc.,Counseling skill and Nutrition, Food security, Micro health planning etc.

• Micro level Planning- 60000 hamlets level information on 32 HDI collected,
analyzed and used at village level health planning since last 4 years.

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Impact
• Women Empowerment/Social Capital 60000 women community health volunteers leading the 60000 women health committees and 19000
village health and sanitation committees, which are addressing effectively the issues like- deforestation,
anti liquor movement, public distribution system, employment guarantee scheme, maternity benefit
scheme etc.

• Governance • improving health supply system/ more then 2000 Mitanins are
PRI representative like Janapad Sadasya, Sarpanch, Ranch etc in current election
2010/improving the quality of the services under different programs- PDS/MDM/NREGA/ICDS
services etc.

• Improvement in health indicators- Please see
NFHS lll/SRS data. State has received Country level 4th JRD TATA award in Jan 2009 based on 14
indicators etc.

Thank you

to everyone
here, and to the
60,000 MitaninsASHAs
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