Community based monitoring of health services in rural Maharashtra involves regular information collection in villages to track public health services. Village committees provide feedback to higher committees at the primary health center, block, district, and state levels. The process aims to develop community ownership over health services. Key monitoring processes include using booklets, health calendars, interviews, and medicine stock checks. Report cards are filled and displayed. Objective impacts found include stopping illegal charges, improved immunization coverage, and increased health center utilization. Overall, community based monitoring has contributed to significant improvements in rural health services.

1. Community Based Monitoring of Health Services and related trends of change and improvements in the rural health services in the state of MaharashtraDr. DhananjayKakde- SATHI , Pune(With Inputs from SATHI team members)

2. What is community based monitoring of health services? At the core of CBM is the act of tracking, recording and reporting the state of public health services in villages, as experienced by the people themselves.CBM processes related to NRHM are organised at the village, primary health centre (PHC), block, district and state levels.Regular information collection at the community level in the villages Processes for regular dialogue between community representatives and health care providersHelps to develop community ownership and accountability of Health services

3. Levels of committees forFeedback & Action State Planning & Monitoring CommitteeDistrict Monitoring & Planning CommitteeBlock Monitoring & Planning CommitteePHC Monitoring & Planning CommitteeVillage Health, Water supply, Nutrition and Sanitation Committee

4. Five Key processes in Community Based Monitoring of Health Services

5. Tools for community monitoringMonitoring booklet formsVillage Health Calendar Interview format for MO PHC / CHCActual medicine stock taking at PHC/CHCFormat for Exit interview (PHC / CHC)Documentation of testimony of denial of health care

6. Filling up of the report card and display

7. Objective positive impact of CBM in improving health services

8. Practice of PHCs prescribing medicine from private shops has largely stoppedIllegal charging and private practice by certain medical officers has now been checkedFrequency of visits of ANM and MPWs in villages has led to improved village health services in many villages Definite improvement in immunisation coverage in many villagesCertain sub-centres and mobile units which were not working have now started functioningCBM has contributed to significant improvements in rural health services

9. Change after six months of monitoring in villages of Velha block, PuneOctober 2008April 2009

10. ‘Good’ ratings for village level Health services across 220 villages in Maharashtra over 3 phases

11. ‘Bad’ and ‘Partly satisfactory’ ratings for village level Health services across 220 villages

13. Increase in people’s OPD utilisationin PHCs covered by CBM

14. Increase in people’s inpatient utilisationin PHCs covered by CBM

15. From community based monitoring to planning of health servicesKey future strategy for planning of health services would be to use information about local issues/ priorities and resources identified during the community monitoring process.

16. CBM has given us hope that in context of public health system, the positive alternative to dominant trend of privatisation is communitisation of health servicesThank you.