Promoting community participation in effective delivery of public health services

New Delhi: Community Action for Health (CAH) is one of the pillars of the National Health Mission (NHM), which places people at the centre of the process of ensuring that the health needs and rights of the community are being fulfilled. It gives communities an opportunity to participate and provide regular feedback on the progress of the NHM interventions in their areas, thus contributing to strengthening health services and ‘Bringing Public into Public Health.’

The CAH processes are being implemented in 22 states covering 2,02,162 villages across 353 districts – that is nearly 32 percent of villages and 54 percent of the districts in the country.

In this backdrop, the ‘National Consultation on Community Action for Health: Deliberating Pathways for Scaling Up’ was held on January 24th at New Delhi. Organised by the Advisory Group on Community Action (AGCA) on behalf of the Ministry of Health and Family Welfare (MoHFW), the consultation included representatives of the MoHFW, State National Health Mission (NHM) Mission Directors, State Nodal Officers, representatives from civil society organizations, and public health experts.

The participants came together to share promising practices on community action and accountability, identify innovations, key challenges and solutions, and provide recommendations and strategies for the effective scaling up of Community Action for Health (CAH) processes under the National Health Mission.

Ahead of the consultation, Mr Manoj Jhalani, Additional Secretary and Mission Director of the NHM, MoHFW discussed the vision and priorities for CAH. He said, “What began as community monitoring of service delivery through the use of health report cards has now matured into a comprehensive process that combines the review of gaps in service delivery with participatory planning processes to address them.”

A panel discussion on ‘Promising Initiatives on Community Action and Accountability’ included perspectives from Dr. Rajani Ved, Executive Director of the National Health Systems Resource Center (NHSRC), who has led the strengthening of the Accredited Social Health Activist (ASHA) and Village Health Sanitation and Nutrition Committees (VHSNC); Mr P Sampath Kumar, Commissioner and Secretary, Department of Rural Development, Government of Meghalaya, who shared experiences on the Meghalaya Social Audit; Sowmya Kidambi, Director, Society for Social Audit, Transparency and Accountability (SSAT), Department of Rural Development, Government of Telangana, and Nikhil Dey the founder member of Mazdoor Kisan Shakti Sangathan (MKSS). Soochna Evam Rozgar Adhikaar Manch and MKSS spearheaded the Jawabdehi Yatra that demanded accountability and the implementation of the Jawabdehi Kanoon or Accountability Law in Rajasthan.

Setting the context for the day-long consultation, Dr Manohar Agnani, Joint Secretary – Policy, MoHFW said, “Working with the community is the only solution to deliver adequate and quality health services, for planning and monitoring processes, and to properly address the grievances of the people. I would like to request all state mission directors and programme directors to give priority to community action for health”

Ms Poonam Muttreja, Executive Director, Population Foundation of India (PFI) and AGCA Member, while tracing the journey of community action over the past decade said, “The scope and reach of CAH makes it one of the largest community-led accountability initiatives globally. The CAH initiative is also a unique example of a successful collaboration between government and civil society organizations in “bringing the public into public health. To deepen the effectiveness of community action we need a cadre of people in every state to support capacity building. We also need to focus on redressal mechanisms without which community action for health will not lead to real change.” Population Foundation of India hosts the Secretariat of the AGCA, which was constituted by a government order by the MoHFW in 2005, to provide guidance on community processes initiatives particularly related to accountability under the National Rural Health Mission (NRHM).

The event was an opportunity for stakeholders from over 22 states to share their achievements and challenges and highlight efforts of the communities to exercise their right to health and their access to healthcare services and facilities.