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Communitisation of Payment of Mitanin Incentives in Chhattisgarh

Communitisation of Payment of Mitanin Incentives in Chhattisgarh. JP Misra Executive Director, State Health Resource Centre, Chhattisgarh August 2013. Mitanin Programme - Introduction. Mitanins are Community Health Volunteers, Programme started by Govt. of Chhattisgarh in 2002

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Communitisation of Payment of Mitanin Incentives in Chhattisgarh

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  1. Communitisation of Payment of Mitanin Incentives in Chhattisgarh JP Misra Executive Director, State Health Resource Centre, Chhattisgarh August 2013

  2. Mitanin Programme - Introduction • Mitanins are Community Health Volunteers, Programme started by Govt. of Chhattisgarh in 2002 • There are now more than 66,000 Mitanins covering all rural habitations of the state. • Mitanin is selected by local community of the concerned habitation. • Mitanins have received 17 rounds of training and provide health and nutrition education, linkage with health services and awareness on entitlements. They focus on preventive and promotional aspects of health and also provide curative services for common illnesses. • Mitanin Programme is credited with improving breastfeeding, immunisation coverage etc. and consequently for the sharp decline achieved by the state in its rural Infant Mortality Rate (highest decline in the country). • A recent Independent Study shows a major contribution of Mitanins in reducing Child Malnutrition rate in Chhattisgarh.

  3. Context - Incentives for Mitanins • ASHA programme launched by GoI under National Rural Health Mission in 2006 • Cash incentives introduced for specific tasks • ASHA is seen as the key component meant for Community Participation in NRHM • Decentralised planning and Linking Panchayats with Health sector are amongst the stated objectives of NRHM • NRHM implementation framework (2005) required incentives to ASHA to be routed through Gram Panchayats. However, the actual practice has been to ignore this design element and incentives have been paid by Health department directly. • Incentives are centrally planned and paid. Panchayats and community completely left out of the process

  4. Problems caused due to introduction of Incentives paid directly by the health department • It changed the accountability structure and weakened the link between Mitanin and the community • Mitanins did not receive many of the incentives and faced harassment while receiving the rest • It diluted their role as Activists

  5. Situational Analysis in 2012 Mitanin Incentives Payment: • Mitanin in Chhattisgarh looks at average population of around 300 • Around 450 Mitanins per block, around 90 Mitanins per PHC • She was earning average between Rs.100 to Rs.200 per month • Payment of Incentives related to JSY was less irregular but involved more than 1 trip for 50% cases, travel costs were high • Payment of incentives for Full Immunisation, VHND mobilisation, HBNC, Family Planning, DOTS, Malaria slides, Leprosy referrals etc. was poor • As a result, only 30% of the sanctioned budget for incentives was getting spent

  6. Situational Analysis in 2012 Mitanin – Panchayat Relationship • Mitanin selection is ratified by Gram Sabha • Panchayat representatives trained along with Mitanins in 3 modules of Training – Malaria, Health Planning, VHSNC • Swasth Panchayat Yojana since 2006 to involve Panchayats in Health • VHSNC headed jointly by Panch and Mitanin • Active local health monitoring and planning in VHSNCs with participation of PRIs • Mitanin SammanDiwas celebrated each year in which PRIs felicitate Mitanins in each Gram Panchayat • Around 2,500 Mitanins are also elected members of PRIs • Mitanins supported by Facilitators and full support structure for more than 10 years

  7. Objectives of Panchayat based Payment System • To improve delivery of incentives to Mitanins • To increase involvement of Gram Panchayats in health sector • To restore and promote greater Community ownership of Mitanins

  8. Pilot in 2012 • On Orders of the State Health Society, Chhattisgarh piloted payments to Mitanins through Gram Panchayats in one block (Tokapal in Bastar district) from August 2012 • The results of the pilot were very encouraging • Mitanins were able to get their due and saved on travel • Average payment increased four times • Gram Panchayats showed enthusiasm in discharging their new responsibility • A Public Hearing organised to record experience of Mitanins and PRIs • No false claims found • Evaluated and recommended by State Review Mission, SHRC and District Collector • State Health Society discussed this in February 2013 and decided to implement across the state

  9. Panchayat based payment system • District Health Society gives advance to Janpad Panchayat • Janpad Panchayat releases Rs.15,000 as advance to each Gram Panchayat • Gram Panchayat makes cash payments to Mitanins on declared monthly Payment Day in an open meeting • Mitanin gets paid based on the Claim Form presented by her • Claim form records each task done by Mitanin during the month, verified by the concerned beneficiary and the Ward Panch • Utilisation Certificates issued by Gram Panchayats consolidated by Block Panchayats and given to District Health Society, based on which the funds are replenished

  10. Expansion and Results • From April 2013, PRI based payments started in 35 blocks • From July 2013, expanded all 146 blocks across the state • All the sanctioned incentives are now getting paid • The average payment to Mitanin per month has increased from Rs.105 in 2012-13 to Rs.534 in April 2013. In July it became nearly Rs.650. • This increase is partly due to incentives like Home Based Newborn Care, Family Planning, Full Immunisation, Birth spacing etc. now getting paid and partly due to a couple of new incentives. • Additional facilitation, monitoring and documentation organised with help of Mitanin Support Structure. • State Government has now decided to give 50% top-up to incentives from state budget. • Now, a Mitanin looking after a population of around 300 will be able to earn around Rs.800-1000 per month. • The PRI based process will be evaluated by TISS as a part of Mitanin Evaluation 2013.

  11. Further Recommendations • The accounting can be made easier by budgeting for the incentives in one place rather than fragmenting them across vertical health programmes. • In addition to the current tasks incentivised by NRHM, Gram Panchayats should be allowed and encouraged to design their own incentives for Mitanins (within certain limits). • Based on the successful experience of placing Mitanins with Panchayats, the accountability structure for ANMs and Anganwadi Workers can also be changed to give the central role to Panchayats.

  12. THANK YOU For Your Attention

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