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Government of India Policy 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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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.
NEW PLAN MODELFOR FAMILY WELFARE And RCH PROGRAMME
GENESISINDIGENIOUS IDEAS:PLANG. COMMISSION.INTERNATIONAL : ICPD ‘94
PLAN MODEL: DEFINITION:Decentralized Participatory Planning being activated through Community Needs Assessment Approach (CNAA) for implementing FW / RCH Prog.
Characteristics of Community Participation Model: STANDARD FLEXIBLESYSTEMATIC SIMPLISTIC GRASSROOT Oriented
CHARACTERISTICSContd. : BOTTOM-UP PEOPLE’SPLANPEOPLE’S PARTICIPATION
PRINCIPAL OBJECTIVES :1. IMPLEMENTATION OF FAMILY WELFARE AND RCH PROG. 2. TO PROVIDE TO PEOPLEBEST QUALITY SERVICES. AND 3. ABOLITION OF EXECUTIVE’S PRECONCEIVED FUNCTIONAL DESIGN.
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..
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 .
Steps taken for Operationalisation of New Approach[contd.] • 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.
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.
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. .
MECHANISM OF PREPARATION OF ACTION PLAN – KEY COMPONENT OF NEW APPROACH: • Originated at SUB-CENTER[SC] level : • Interactions of Auxiliary Nurse Midwives [ANM] with people. • Associating Anganwari Workers/ Women’s 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.
Key Issues of Community Participation being activated through CNAA: • MICROPLANNING • DECISION SUPPORT PLANNING • COMMUNITY PARTICIPATION • CLIENT’S PERSPECTIVE • QUALITY OF CARE. • MICROLEVEL DATABASE • MAINTAINING STANDARD RECORDS/FORMATS. • REGULAR SYSTEM OF M & E OF PRFORMANCE
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.
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
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.
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 Officers[MOs] is an on- going program.
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.
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.
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”.
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.