Since its launch in 2005, CBM has been an accountability mechanism in the Indian government’s NRHM. CBM of health services is a key strategy of the NRHM to ensure that the services reach those for whom they are meant, especially for those residing in rural areas, the poor, women and children. Community monitoring is also seen as an important aspect of promoting community led action in the NRHM. The national implementation of CBM follows an extensive pilot project in nine of India’s 22 states from May 2007 onwards. Village Health and Sanitation Committees (VHSCs) are composed of

• (a) members of local government (Gram Panchayat),
• (b) community health workers (Accredited Social Health Activists (ASHAs))
• (c) outreach functionaries of the public health system (Auxiliary Nurse Midwives (ANMs), Multi-Purpose Workers (MPWs), and preschool/nutrition workers (Anganwadi workers)) and
• (d) representatives from community groups.

VHSCs meet to monitor and plan public health services at the village level. Separate committees are constructed to monitor public health services at the primary health centre (PHC), Block and District levels. Some members of the VHSC are included in the PHC monitoring committee just as some members of the PHC monitoring committee are part of the Block monitoring committee, and so on up the levels. The adoption of a comprehensive framework for CBM and planning at various levels under NRHM places people at the centre of the process of regularly assessing whether the health needs and rights of the community are being fulfilled.

Including CBM as an officially recognized component of the Indian government’s NRHM followed several years of advocacy by health rights organizations to develop a model of community accountability of health services particularly in the states of Maharashtra and Madhya Pradesh.

Much of the initial work to develop an Indian model of CBM was driven by the Advisory Group of Community Action (AGCA), a group of experts specially constituted by the union health ministry to provide technical and other inputs on how to implement NRHM programmes wherever community action was envisaged. The health advocacy non-governmental organization SATHI-CEHAT, in collaboration with many local community-based people’s organizations, also played a key role in coordinating pilot CBM projects.

The 1999 to 2000 project in Maharashtra “Empowering the rural poor for better health” was co-ordinated by SATHI-CEHAT with support from the Union Ministry of Health. This project led to the development of Jan Sunwais and village health calendars/registers, two tools for social audits of health services that were later included in the NRHM model.

... continue reading (Jan Sunwais)