When people made rural health mission work

NEW DELHI - These stories may have gone unnoticed, but in the nooks and crannies of India, rural people desperate for better healthcare are finally making the National Rural Health Mission (NRHM) work through a community monitoring programme.

For instance, an Anganwadi worker in a remote village of Orissa who used to charge Rs.50 to make a card for pregnant women to avail themselves of monetary benefits under the Janani Suraksha Yojna - a service that is supposed to be free - was taken to task by local people and made to stop the illegal practice.

Another community from a village in Rajasthan nominated Rukhsana Begum, an auxiliary nurse midwife (ANM) of their area, for the Excellent Service Performance Award.

Such public responses were made possible through the Community-based Monitoring of Health Services - an initiative that began in March 2007 under the NRHM, which has otherwise been dogged by allegations of corruption and come under criticism in its five years of existence for failing to achieve the desired results.

In collaboration with the NGOs Population Foundation of India (PFI) and Center for Health and Social Justice — that served as its national coordinators - as well as state level NGOs, it has empowered people to voice their concerns.

“It is basically training the people to demand their rights,” said Tarun Sen, head of the health system support unit of PFI.

“This is the closest we could ever get to know why we could not deliver under NRHM even after five years,” said Sen, who was formerly associated with the health ministry.

The monitoring programme, which is backed by the health ministry, covered over 1,620 villages in 36 districts of nine states. The pilot phase ended in March 2009.

The programme covered the nine states of Assam, Jharkhand, Rajasthan, Tamil Nadu, Chhattisgarh, Karnataka, Madhya Pradesh, Maharashtra and Orissa in the first stage that ended in March 2009.

With monitoring groups at all levels, the programme through its various tools like ‘Jan Samwad’, or public hearings, mainly focused on spreading awareness among villagers about their rights and establishing two-way communication between the people and healthcare providers.

‘Jan Samwad’ proved to be an effective way of taking public concerns to the authorities.

“A primary health centre (PHC) in one of the districts was without a doctor. Even the compounder posted there did not come regularly. It was a malaria endemic district and with the help of Jan Samwad, the chief medical and health officer of the area came to the PHC for three months and monitored the vaccination process,” Sen said.

“In fact, we have seen cases where the district or state level officers are not aware of some particular disease or deaths in the area because no record is maintained. At such places Jan Samwad becomes an effective platform for taking the concerns to the authorities,” he said.

The community-based monitoring programme is one of the key strategies of the NRHM. It is to ensure that the services reach those for whom they are meant, especially for those in rural areas and the poor, women and children.

The records with the PFI are full of case studies. Five of the nine surveyed states have large tribal population and the situation is worse for them.

“In Madhya Pradesh, Baiga tribals had not received their BPL (below poverty line) cards under which they were supposed to avail themselves of benefits of free healthcare. The matter was brought to the notice of the health officials and they got their cards,” Sen added.

Under the Deen Dayal Antyodaya Upchar Yojana, BPL card holders get free medical checkups and treatment up to Rs.20,000.

“Significant improvement has been seen, but it’s just the first step,” Sen said.

“The process of economic change is very fast, but social changes come slowly; this is where the efforts have to be made,” he added.

NRHM is a national effort aimed at ensuring effective healthcare through a range of interventions at individual, household, community and most critically at the health system levels. The scheme was lauched on April 12, 2005.