Government of India Policy Reform in Family Welfare Program of India : Community Mobilization

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Government of IndiaPolicy Reform in Family
Welfare Program of India Community
Mobilization Community Participation under
Reproductive Child Health Program--------------
----------------------------------Prasanta
Kumar Saha, CStat (UK), Fellow of the Royal
Statistical Society, UK.
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NEW PLAN MODELFOR FAMILY
WELFARE And RCH PROGRAMME
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GENESISINDIGENIOUS IDEAS PLANG.
COMMISSION.INTERNATIONAL ICPD 94
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PLAN MODEL DEFINITIONDecentralized
Participatory Planning being activated through
Community Needs Assessment Approach (CNAA) for
implementing FW / RCH Prog.
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Characteristics of Community
Participation Model STANDARD
FLEXIBLESYSTEMATIC SIMPLISTIC GRASSROOT
Oriented
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CHARACTERISTICSContd. BOTTOM-UP
PEOPLESPLANPEOPLES PARTICIPATION
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PRINCIPAL OBJECTIVES 1.
IMPLEMENTATION OF FAMILY WELFARE AND RCH PROG.
2. TO PROVIDE TO PEOPLEBEST QUALITY SERVICES.
AND 3. ABOLITION OF
EXECUTIVES PRECONCEIVED FUNCTIONAL DESIGN.
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Preparatory Actions Prior to Introduction
of New Model

• Abolition of centrally determined method, that is
  abolition of specific targets for family planning
• through
• a) Pilot studies in States
• b) intimating all the State Secretaries of Health
  FW..

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Preparatory actions contd.

• c) discussion in the conference of the State
  Secretaries of Health FW.
• d) discussion in the Conferences of Central
  Council of Health FW who fully endorsed and
  appreciated the new approach.
• e)Visiting of Central team to States .

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Steps taken for Operationalisation of
New Approachcontd.

• 1) A manual was distributed to all States in
  1996-97.
• 2) Subsequently the same manual was simplified.
• 3) Simplifying the relevant Formats.
• 4) Revised manual prepared distributed to all
  the States.
• 5) Discussion in State Secretaries conference
  every year.

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Steps taken contd.

• Secretary, Deptt. of FW, Govt. of India regularly
  writing to State Secretaries of Health/FW.
• Workshops of District Chief Medical
  Officers/Officers of State Dte. of Health FW
  covering about 300 districts organized in many
  States.

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Steps Continued

• National Population Policy 2000 Emphasizing the
  role of the local body at village level called
  Panchayat for furthering decentralized planning.
• Training to Auxiliary Nurse Midwives ANM and
  Medical Officers MO of PHCs.
  .

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MECHANISM OF PREPARATION OF ACTION PLAN KEY
COMPONENT OF NEW APPROACH

• Originated at SUB-CENTERSC level
• Interactions of Auxiliary Nurse Midwives ANM
  with people.
• Associating Anganwari Workers/ Womens Groups at
  village level called Mahila Swasth Sanghs MSS
  etc and Panchayat.
• Checking Consistency of assessment of health care
  needs by ANMs of the citizens particularly at
  village level.
• Making a meaningful action plan.
• The Action plan is to be executed by ANM.
• Action Plan Coverage No selection of clients- it
  is complete coverage of all clients in a
  particular village.

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Key Issues of Community Participation being
activated through CNAA

• MICROPLANNING
• DECISION SUPPORT PLANNING
• COMMUNITY PARTICIPATION
• CLIENTS PERSPECTIVE
• QUALITY OF CARE.
• MICROLEVEL DATABASE
• MAINTAINING STANDARD RECORDS/FORMATS.
• REGULAR SYSTEM OF M E OF PRFORMANCE

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BARRIERS

• The vertical programme structure inhibiting the
  setting of priorities according to plans.
• Lack of inter-sectoral coordination reducing the
  effectiveness of plans in the health sector.
• Infrastructure getting focussed more than the
  functions of District State authorities to meet
  the unmet felt need of health care of the
  community.
• Apathy of all the implementing authorities.

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BARRIERS contd.

• Information system not getting due importance
  by the medical authorities.
• Some States need more time
• Some reservation on the part of some States

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IMPROVED SITUATION

• Some encouraging signs emerging
• Process of Panchayati Raj system has started in
  some States.
• Action plans are being done through
  house-to-house surveys in many districts
• In some districts of some States Panchayat
  workers are maintaining Birth/ Death registers.
• However, level of motivation and awareness of
  Panchayat members needs tremendous improvements.

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Improved Situation contd.

• Panchayat members are being called in PHC level
  meeting.
• ANMs are attending meetings of Gram Panchayat.
• Panchayat members are being trained in
  developmental programmes including health
  services.
• Training on CNAA to ANMs/ MPW(M)s/Medical
  OfficersMOs is an on- going program.

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SUMMARY

• Quality assessment under CNAA is one of the
  principal objectives. This objective has been
  facing lack of sincerity commitment.
• To establish system of direct interactions with
  the clients, other voluntary agencies
  participation has been considered.
• Field Evaluation existing system of evaluation
  of quality and status of health care provided by
  the SCs and PHCs contacting the actual clients is
  inadequate.

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SUMMARY Contd.

• Decentralized system of planning model is most
  viable and cost-effective.
• In a developing country like India vast number of
  people, particularly in rural areas , can expect
  desired level of services through this model.
• Panchayat system, it is expected, will be
  functioning in this direction within a few years.

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References References1.
Report of the International Conference on
Population and Development, Sept., 1994, Cairo,
Egypt.2. Annual Reports of the Ministry of
Health Family Welfare, Government of India, New
Delhi-1996-97, 1997-98, 1998-99. 3. UNFPA
Technical Report, November, 1999 Planning
Population and Development Projects with a Focus
on Decentralization and Quality of Care.

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References contd.

• 4. National Population Policy 2000, Department of
  Family Welfare, Ministry of Health FW, Govt. of
  India, New Delhi.
• 5. Reproductive and Child Health Program
  Schemes for Implementation, October, 1997, Dept.
  of Family Welfare, Ministry of Health FW, Govt.
  of India.
• 6. European Commission ECTA Situational
  Analysis, 2001/22, August, 2001 Community Needs
  Assessment Approach CNAA to District Planning.