Community Monitoring of Health Services Through Social Audit Unit

Problem Statement

Despite efforts to strengthen VHSNCs to lead community level monitoring of health services, success has been limited, due to, limitations of VHSNCs capacities to undertake structured processes on a periodic basis.

Programme Description

Social Audit unit (SAU) of Rural Development Department was engaged by stateas independent agency to support in identifying issues and concerns of community, health facilities, and health service providers and help in addressing issues. Process was undertaken in 5 districts (one district in each administrative division- Hazaribagh, Deoghar, West Singhbhum, Ranchi and Palamau) spread across all 5 regions in20 blocks and 80 Gram Panchayats. 151 social auditors from five regions were trained on the communitization processes, who subsequently conducted extensive mobilization and discussions with community and VHSNCs for 3 days, followed by village level exercises of community monitoring and 105 public hearings conducted at Gram Panchayat (80), Block (20) and District (5) levels. Actions were taken to resolve problems such as incentives of ASHAs, medicine supplies and out of pocket expenditures by patients. Structures were formed from Panchayat to state, for addressing issues at each level. To build transparency, state engaged local media to report on these issues. State has ensured commitment and rigor at all levels, active participation by senior officials including ministers, facilitated the process. This intervention was undertaken in FY 2018-19 and Rs. 8 Lakh was spent.

Programme Outcomes

Programme processes improved at various levels:

• payments of ASHA incentives were regularised (delays of 6 to 24 months existed prior to the exercise),
• Services in VHNDs expanded to include tests of hemoglobin and urine and counselling on family planning,
• Rest rooms for ASHAs were established in DH and FRUs,
• Utilization of RKS untied grants improved,
• Availability of Pregnancy test kit and Calcium & Iron tablets for ANMs was ensured. Participation of PRI members on health Programmes in their constituencies, synergy between NHM and media, and health department’s commitment for availability and quality of services improved.

Scalability

The state has built upon existing institutional mechanisms in the state and has continued the interventions in FY 2018-19. Plans to scale it up in entire state are underway.

Implementation Partners

Social Audit Unit (SAU) of RD Dept. Govt. of Jharkhand & Advisory Group on Community Action (AGCA) Secretariat. 

Source :  We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019