Policy Reform in Family Welfare Program of India

Policy Reform in Family Welfare Program of India : Community Mobilization & Community Participation under Reproductive & Child Health Program ------------------------Prasanta Kumar Saha, CStat (UK), Fellow of the Royal Statistical Society, UK.

NEW PLAN MODEL FOR FAMILY WELFARE And RCH PROGRAMME

GENESIS INDIGENIOUS IDEAS: PLANG. COMMISSION. INTERNATIONAL : ICPD ‘ 94

PLAN MODEL: DEFINITION: Decentralized Participatory Planning being activated through Community Needs Assessment Approach (CNAA) for implementing FW / RCH Prog.

Characteristics of Community Participation Model: STANDARD FLEXIBLE SYSTEMATIC SIMPLISTIC GRASSROOT Oriented

CHARACTERISTICS Contd. : BOTTOM-UP PEOPLE’SPLAN PEOPLE’S PARTICIPATION

PRINCIPAL OBJECTIVES : 1. IMPLEMENTATION OF FAMILY WELFARE AND RCH PROG. 2. TO PROVIDE TO PEOPLE BEST QUALITY SERVICES. AND 3. ABOLITION OF EXECUTIVE’S PRECONCEIVED FUNCTIONAL DESIGN.

Preparatory Actions Prior to Introduction of New Model : Abolition of centrally determined method, that is abolition of specific targets for family planning through: l a) Pilot studies in States l b) intimating all the State Secretaries of Health & FW. . l

Preparatory actions contd. l c) discussion in the conference of the State Secretaries of Health & FW. l d) discussion in the Conferences of Central Council of Health & FW who fully endorsed and appreciated the new approach. l e)Visiting of Central team to States.

Steps taken for Operationalisation of New Approach [contd. ] l 1) A manual was distributed to all States in 1996 -97. l 2) Subsequently the same manual was simplified. l 3) Simplifying the relevant Formats. l 4) Revised manual prepared & distributed to all the States. l 5) Discussion in State Secretaries’ conference every year.

Steps taken contd. l Secretary, Deptt. of FW, Govt. of India regularly writing to State Secretaries of Health/FW. l Workshops of District Chief Medical Officers/Officers of State Dte. of Health & FW covering about 300 districts organized in many States.

Steps Continued l National Population Policy 2000: Emphasizing the role of the local body at village level called Panchayat for furthering decentralized planning. l Training to Auxiliary Nurse Midwives [ANM] and Medical Officers [MO] of PHCs. .

MECHANISM OF PREPARATION OF ACTION PLAN – KEY COMPONENT OF NEW APPROACH: Originated at SUB-CENTER[SC] level : Interactions of Auxiliary Nurse Midwives [ANM] with people. l Associating Anganwari Workers/ Women’s Groups at village level called Mahila Swasth Sanghs [MSS] etc and Panchayat. l Checking Consistency of assessment of health care needs by ANMs of the citizens particularly at village level. l Making a meaningful action plan. l The Action plan is to be executed by ANM. l Action Plan Coverage: No selection of clients- it is complete coverage of all clients in a particular village. l l

Key Issues of Community Participation being activated through CNAA: MICROPLANNING l DECISION SUPPORT PLANNING l COMMUNITY PARTICIPATION l CLIENT’S PERSPECTIVE l QUALITY OF CARE. l MICROLEVEL DATABASE l MAINTAINING STANDARD RECORDS/FORMATS. l REGULAR SYSTEM OF M & E OF PRFORMANCE l

BARRIERS l The vertical programme structure inhibiting the setting of priorities according to plans. l Lack of inter-sectoral coordination reducing the effectiveness of plans in the health sector. l Infrastructure getting focussed more than the functions of District & State authorities to meet the unmet felt need of health care of the community. l Apathy of all the implementing authorities.

BARRIERS contd. l Information system not getting due importance by the medical authorities. l Some States need more time l Some reservation on the part of some States

IMPROVED SITUATION l Some encouraging signs emerging : l Process of Panchayati Raj system has started in some States. l Action plans are being done through house-to -house surveys in many districts l In some districts of some States Panchayat workers are maintaining Birth/ Death registers. l However, level of motivation and awareness of Panchayat members needs tremendous improvements.

Improved Situation contd. Panchayat members are being called in PHC level meeting. l ANMs are attending meetings of Gram Panchayat. l Panchayat members are being trained in developmental programmes including health services. l Training on CNAA to ANMs/ MPW(M)s/Medical Officers[MOs] is an on- going program. l

SUMMARY l Quality assessment under CNAA is one of the principal objectives. This objective has been facing lack of sincerity & commitment. l To establish system of direct interactions with the clients, other voluntary agencies’ participation has been considered. l Field Evaluation : existing system of evaluation of quality and status of health care provided by the SCs and PHCs contacting the actual clients is inadequate.

SUMMARY Contd. l Decentralized system of planning model is most viable and cost-effective. l In a developing country like India vast number of people, particularly in rural areas , can expect desired level of services through this model. l Panchayat system, it is expected, will be functioning in this direction within a few years.

References 1. Report of the International Conference on Population and Development, Sept. , 1994, Cairo, Egypt. 2. Annual Reports of the Ministry of Health & Family Welfare, Government of India, New Delhi-1996 -97, 1997 -98, 1998 -99. 3. UNFPA : Technical Report, November, 1999 : “ Planning Population and Development Projects with a Focus on Decentralization and Quality of Care”.

References –contd. l 4. National Population Policy 2000, Department of Family Welfare, Ministry of Health & FW, Govt. of India, New Delhi. l 5. Reproductive and Child Health Program : Schemes for Implementation, October, 1997, Dept. of Family Welfare, Ministry of Health & FW, Govt. of India. l 6. European Commission : ECTA: Situational Analysis, 2001/22, August, 2001: Community Needs Assessment Approach [CNAA] to District Planning.