Communitisation of Health Care Improving Public Services :

the Nagaland Experience Dr.Lichamo Yanthan

Joint Director of Health Nagaland kohima

Strenght.Nagaland . 16 Major Tribes with each Tribe having Unique Customs and traditional practices. One of the best practices is very strong “Bond of Community Feeling “ One has to listen and do for the Community when call for “ (Social Service for Community).This is a traditional existing social structure

Taking advantage of the existing social capital in the state, the process of Communitization of health services was initiated in the year 2002.

Goal: Strengthen Health Service delivery through community participation in planning, implementation and monitoring of different health activities towards development of ownership of health delivery by the community.

Why communitisation?

•Communitization is Partnership’ between Government and Community ‘working together”.•Management of Public Institutions and sharing responsibilities in order to make them function optimally in giving quality services.• For the overall growth and development of the society.

: A new word ! COMMUNITISATION : A new word ! new concept!

A new concept!ew concept!

new concept!

COMMUNITIZATION : Concept! A new word ! • Involves Partnership between Government and Community including

- Transfer of ownership of public resources and assets. - Control over service delivery.

- Decentralization, delegation, empowerment and building capacity.• Based on Triple ‘T’ approach:

- Trust the user community.- Train them to discharge their newfound responsibilities.

- Transfer governmental powers and resources in respect of management.

“In essence Communitization is half way to Privatization in the able hands of the user community” capacity.

Assembly Passed Nagaland Commitization of public Services

and Institution Bill in March 2002.

The first of its kind Legislation in the country.

Role of Health Department• Staff salaries and grant-in-aid for other purposes• Manpower posting in all Health Centres• Training and capacity building of Health

Committees• Technical support, supervision and guidance in

all matters• Continuing capacity building to Health

Committees to sustain Communitization

i. At village level:a. Village health Committee:

3 Village Council Member –MemberSecretary VDB 2 Mahila Swasthya Sang1 Anganwadi Worker,1 dhai, PastorMember Secy - Seniormost Health staff

b. Common Health Sub-centre Committeeii. In towns/urban-based sub-centres

Urban Health Committees were constituted with VHC-like membership to take control and management of all urban-based Health Sub-centres in the state.

Iii. At CHC/PHC levelAt CHC/PHC level Health Centre Managing Committee was constituted with representatives of VHCs and village Councils of all constituent villages and towns falling

within the respective CHC/PHC areas

Sl.No

Health Unit Numbers

1 Sub-centres 396

2 PHC 62

3 CHC 21

PRESENT STATUS OF COMMUNITISED HEALTH UNIT

SUCCESS STORIES:

• Improvement in Health workers attendance Improved

• Availability of Medicines:- with the decentralization policy of the act empowering the health committee for procurement of medicines on need based of the community, the regular availability of medicines is ensured.

• Active community participation• Regular Health committee meeting,• Regular village Health nutrition.• Sense of ownership

Thank You

• 3. Active community participation:- (a). Regular Health committee meeting,(b). Regular village Health nutrition day is conducted in all the

villages where preventive and promotive services are provided viz Health awareness, immunization, antenatal checkup, and general health checkup and pledges undertaken at district conferences to advocate Full antenatal checkup for all pregnant women.

(c). Judicious utilization of funds provided by the government for infrastructure.( Construction of new Sub Centre buildings and R/R of existing buildings).

4. ‘ Sense of ownership’ :- As evident from the following:-

Public institution/facilities in various sectors .

• Underutilized• The attendance and performance of the

functionaries not up to the mark• Recurring expenditure on the items such as

equipments repairs/ and procurement of consumables are rarely incurred

• Resulting in disuse or sub-optimal use of facilities• Public expected the Government to deliver quality

services• Community asset and potentials were not used

Main functions of Health Committees

• Take over ownership and management of Health Centres

• Promote Preventive Health• Popularise/encourage traditional medicine

and its practitioners.

• State Assembly Passed the Nagaland Communitisation of Public Services and Institutions Bill, 2002 In March 2002

• nb• First such legislation in India• NNagaland Assembly passed The nagaland Public

Concept Mooted

Mid 2001 August-December2001

January 2002 January 2002

Concept notediscussed among officials, civil society members

State Cabinet decides to adopt the proposal Legal Basis

Provided throughOrdinance

Community participate in Health care Delivery

• Donation/contribution in cash and kinds from the community for the maintenance of the Health unit building.

• Donation of community land for construction of Sub-centre building.

• Community providing building for Health centre.• Regular conduct of cleanliness drive in the village. • Construction of toilet and waiting shed for the Health unit by

the community.• Construction of approach road.• Construction of fencing.• Provision of water supply.• Community taking up wiring and electrification of Health unit• Maintenance of kitchen garden, orchard etc to generate

income for sustenance’s of health unit.

Challenges in Providing Quality Health Care Services in Nagaland

•Five Decade old Conflict situation•Peace Process violence continues•Fatigued and Confused Systems•Widespread Cynics of Govt.Instits•Social Capital needs to be Explored

PROPOSED EXPENDITURE FOR COMMUNITIZATION ACTIVITIES UNDER THE DEPARTMENT OF HEALTH & FAMILY WELFARE 2011-12.

Sl.No Activities Expenditure (Rs. in lacs)

1Essential Medicine:Sub-centre 310 x Rs. 0.20 = 87 x Rs. 0.25 =PHC 100 x Rs. 0.50 =CHC 21 x Rs. 0.50 =

Rs. 62.00Rs. 21.75Rs. 50.00Rs. 10.50

2Training/ Capacity building:Sub-centre/ VHCPHC/CHC/HCMC

Rs. 19.85Rs. 7.26

3Supervision/ Monitoring:a. State level review meetingb. Nodal officer visit to the districtc. Monitoring by the district level officersd. District level review meetinge. Monitoring/ supervision by the state level officersf. State level publication/ documentation/ evaluationg. District level Health committee conferenceh. Award to the best functioning sub-centre

Rs. 2.00Rs. 1.00Rs. 6.60Rs. 3.30Rs. 30.50Rs. 30.00Rs. 11.00Rs. 2.42

4 Emergency fund to the VHC Rs. 19.855 Inter district exposure trip Rs. 8.25

6 Minor repair/ renovation of the sub-centre Rs. 63.60 7 Mobility support to state / district officers for monitoring and supervision Rs. 150.00

Total Rs. 500.00

( Rupees five hundred lacs ) only

I.SUPPORT BY GOVERNMENT TOWARDS COMMUNITIZATION OVER THE YEARS

• a. Infrastructure development• Sub-centre building constructed….. 101.• Imparting continuous training to VHC/HCMC/stake holders.• Regular allocation of fund for purchased of medicines.• Providing emergency fund to the Health Committee. • Supporting exposure trip of Health Committee Member/stake holders organizing

district conferences for Health Committee Member/stake holders.• Mobility support for district officials/state officials for supportive supervision and

monitoring.• Review meeting for district/state level officials. Impact assessment by the third party by UNICEF• Evaluation Department, Government of Nagaland. • On going documentation of Communitization activity (Audio visual ) by IPR,

Government of Nagaland.

REPORT ON COMMUNITIZATION

Ever since the implementation of Communitization in the state by Nagaland Communitization of Public institution and service act, 27th march 2002 the impact on Rural Health Sectors has been very encouraging. The success story in the Health sector especially at the rural level is manifold viz : in service delivery, availability of medicines, maintenance of Health Unit, access to health facilities and the regularity of Health Staff has been improved with the active participation of the community. At present, all the Rural Health Unit has come under the Communitization Act viz.397 Sub-centres, 100 PHCs, and 21 CHCs, The effort of the department being supplemented by the NRHM has improved tremendously, the health care delivery system in the recent years.

Sub Centre Building donated by community

• a. Donation/contribution in cash and kinds from the community for the maintenance of the Health unit building.

b. Donation of community land for construction of Sub-centre building.C. Community providing building for Health centre.d. Regular conduct of cleanliness drive in the village. e. Construction of toilet and waiting shed for the Health unit by the

community.f.Construction of approach road.g. Construction of fencing.h. Provision of water supply.i. Community taking up wiring and electrification of Health unit.J. Maintenance of kitchen garden, orchard etc to generate income for

sustenance’s of health unit.

6. Improving good health practices:-

a. Behavioral change in seeking timely medical help.b. Segregating rearing of live stocks from house hold.C. Adoption of sanitary toilet.d. Provision of safe drinking water supply.e. Maintenance of cleanliness in and around village.f. Use of bed net.

g. Encouraging result in small family norms.

DIFFICULTIES:

An effective implementation of Communitisation is difficult due to the many hurdles the department of health & family welfare face, some of the difficulties that need to be address urgently are given below:-

(1) Shortage of accommodation for staff:- Many health unit ( Sub-centre) does not have Sub Centre building and accommodation facility for

health workers and with non-availability of house for renting in many of the rural setup, the plight of the healthworkers need to be addressed urgently.

(2) Shortage of Health units as per population norms compounded by the problem of difficulty terrain,

the state is unable to provide uniform health care services to all the villages. (3) Inadequate mobility support for supportive supervision and monitoring activity. (4) Variable responds to behavioral changes towards adopting good health practices from area to area

due to socio-economic and cultural influences requires a concerted effort from all stake holders.