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(A) Communitization of NRHM in Two Dists. Of MP i.e. Maheshwar Block of Dist. Khargone and Nalchha Block of Dist. Dhar, in collaboration with Dist Administration, Dept. of H& FW, Go MP, supported by UNFPA.

Communitization:

Communitization consists of a unique partnership between the government and the community involving transfer of ownership of public resources and assets, control over service delivery, empowerment, decentralization, delegation and building capacity – all with the aim of improving the delivery of public utility systems. It also demands ensuring accountability of government employees posted at the service delivery level to local communities and control of government assets by village committees including the responsibility for maintenance, amelioration and augmentation of assets.

Rationale – The Pilot Project:

Given that NRHM envisions a decentralized planning  process, inter-sectoral convergence at the village level, need based programming and community ownership, the role of PRIs and community based organizations (CBOs) become all the more critical. Now that there are thousands of Gram Sabha Swasth Gram Tadarth Samitis (GSSGTS) and lacs of members across the state, it is really challenging for the government and the civil society to be able to build up their capacities and empower them to take decisions related to planning, implementing, monitoring and evaluating activities, including maintenance of accounts.

It was with this understanding of strengthening the capacities of GSSGTS members so that this committee understands Reproductive health issues and concerns and not only participates in planning and management but also in monitoring of key RCH program interventions at village level that MPVHA, with the support from UNFPA, visualized and piloted the intervention in one Block each of Khargone and Dhar District of Madhya Pradesh.  The Blocks selected were – Maheshwar and Nalchha in District Khargone and Dhar – in Malwa region in western Madhya Pradesh have a large tribal population, mainly Bhil and Bhilala The source of livelihood, mainly for the tribal, is farming and cattle rearing. There is also seasonal migration. Both the Blocks have very poor health indicators, the IMR, MMR and TFR being very high as compared to the districts of the State MPVHA sought to intervene and change all that – the way Health Services were delivered, and the manner in which it was received. The Project specifically sought to build up the capacities of the GSSGTS members.

Objectives:

Improvement in Knowledge and Understanding on reproductive issues impacting RH outcomes of member VHSC
Capacity Building of VHSC on Development of Village Health Plan
Monitoring of RCH services during Village Health &   Nutrition Day (VHND)

Demography:

In all 177 villages were selected i.e. 97 from Maheshwar and 80 Villages from Nalchha Block. The villages were of around 1000 population and with VHSC already constituted. Priority was given to villages that were remote, difficult to reach and those having poor health facilities or within a radius of 10 – 15 Km.

Strategy:

The strategy of the Project was to build the capacity of members of GSSGTSs especially those who were nominated or elected from the community, a-bridge the gap between service seekers and providers, promote community ownership, promote community based monitoring of VHNDs, develop village health plan, empower the community to use the untied fund in a democratic manner, create demand, making health services accessible to poor, marginalized and vulnerable rural population, and promote safe motherhood including population stabilization with special emphasis on youth fertility and promotion of temporary methods –all leading to reduction in Maternal and Infant deaths.

Major Activities and Process Followed:

Half Yearly Reorientation of members of GSSGTS, Continued Support for Functioning of Village Information Center, Reprinting & Development of IEC / Learning Materials, Divisional Level Experience Sharing Workshop, Jan Sanwad and Process Documentation. 

The learning’s and results of the Pilot Project were quite positive. Based on the learning of the pilot project executed into two blocks Khargone and Dhar of Madhya Pradesh MPVHA in collaboration with Department of H&FW and with the support of UNFPA six divisional level experience sharing workshops were conducted in Ujjain, Gwalior, Jabalpur, Sagar, Rewa and Bhopal. The workshops were attended by Divisional Commissioners, Joint Director Health, all the CM&HO’s of the Divisions, all the DPM,s, BPM’s and other health service providers of the Divisions. The learnings of the Pilot Project shared by a group of Resource Persons from both the District comprising BMO’s, ASHA’s, ANM’s, AWW’s, PRI’s and DPM’s those who were actively involved in carry forward the process from the beginning.

Outcomes:

The process of Communitization has increased participation at all levels, ASHAs, as conveners of GSSGTSs, have emerged stronger, equipped and more vocal, Community nominated members of GSSGTSs (non- service providers) have gained knowledge of RH and related issues and about the constitution, A large number (90 – 95 %) of GSSGTSs, in both Maheshwar and Nalchha blocks are fully functional and active – conducting meetings regularly, recording minutes, maintaining accounts, supporting and monitoring VHNDs, participating in Gram Sabha Meetings, issuing demand letters, motivating pregnant women for Institutional delivery, organizing awareness campaigns and health camps, and managing the VIC. They have also learned how to conduct surveys, Updating Suchana Patal etc.; some GSSGTSs, however require periodic support in terms of guidance and motivational inputs, ANMs are visiting regularly to the intervened villages and have developed direct relationship with GSSGTSs, Participation in Gram Sabha, especially of women has increased, Increase in demand through resolutions and letters by the GSSGTS,  members, Trained members are involved in motivating eligible couple to accept Spacing Methods and the couples, having more than 2 children, for accepting sterilization, Utilization of untied fund has gone above 90%. Similarly utilization of Govt Schemes has gone up, Jan Sanwad is appreciated as an effective platform for dialogue and to improve relationship between service providers and the community, more transparency and trust has been built up as there is a village information board (Suchana Patal) in each intervened village.
There is marked increase in, 3 ANC, Institutional deliveries and immunization status. The demand for spacing methods increased in both the block among the eligible couples. There is reduction in Home Deliveries, Reduction in no of maternal and infant deaths in both the Blocks. Community based maternal death surveillance system established and maternal death social audit is being done.

Major Changes:

There is increase in registration before 16 Weeks of pregnancy, Increase in Institutional Delivery Decrease in Home Delivery, Increase in Complete immunization of Children, Decrease in Maternal Deaths. Decrease in Infant Deaths, Increase in utilization of Temporary FP Methods, Empowered GSSGTS and developed Village Health Plan, Increase in utilization of Untied Fund and documentation, Decrease in gaps between service providers and service seekers, all round empowerment of women and the community (Demand letters), Active participation of the community in Population Stabilization.

Learnings:

Communitization (Bhagidari) Vs Community Monitoring (Nigrani)
Jan Sunwai – understood as allegations and complaints Vs Jan Sanwad – positive communication and dialogue.
Management by Objective Approach (MBO) if community and health providers set the objectives together at the grass root level results is better.
Approach of the top officials and management.
Team building at different level.
Ownership at village level.
Education, dialogue, advocacy, services and applied research should go together and should not be one time affairs.
Village Information Center (VICs) is an important platform.
If facilitation is properly done by NGO, planned changes can be brought out.
Recognition of the monitoring done at the grass root level helps both service providers and seekers to come to at common platform.
The clarity on Communitization increases participation at every level.

Our Vision

"To Promote Social Justice through the Provision and Distribution of Holistic Health Care & Empowerment of People, to make Health a Reality for all, with Special Emphasis on the Deprived Section"