1. Community Based Monitoring of Health Services and related trends of change and improvements in the rural health services in the state of Maharashtra Dr. 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 providers Helps to develop community ownership and accountability of Health services

3. Levels of committees forFeedback & Action State Planning & Monitoring Committee District Monitoring & Planning Committee Block Monitoring & Planning Committee PHC Monitoring & Planning Committee Village Health, Water supply, Nutrition and Sanitation Committee

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

5. Tools for community monitoring Monitoring booklet forms Village Health Calendar Interview format for MO PHC / CHC Actual medicine stock taking at PHC/CHC Format 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 stopped Illegal charging and private practice by certain medical officers has now been checked Frequency 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 villages Certain sub-centres and mobile units which were not working have now started functioning CBM has contributed to significant improvements in rural health services

9. Change after six months of monitoring in villages of Velha block, Pune October 2008 April 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 utilisation in PHCs covered by CBM

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

15. From community based monitoring to planning of health services Key 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 services Thank you.