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

PEOPLESPLAN

PEOPLES PARTICIPATION
PRINCIPAL OBJECTIVES :
1. IMPLEMENTATION OF FAMILY
WELFARE AND RCH PROG.
2. TO PROVIDE TO PEOPLE
BEST QUALITY SERVICES.
AND
3. ABOLITION OF EXECUTIVES
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:
a) Pilot studies in States

b) intimating all the State

Secretaries of Health & FW..
 Preparatory actions contd.

c) discussion in the conference of the

State Secretaries of Health & FW.
d) discussion in the Conferences of
Central Council of Health & FW
who fully endorsed and appreciated
the new approach.
e)Visiting of Central team to States .
 Steps taken for
Operationalisation of New Approach
[contd.]
1) A manual was distributed to all States in
1996-97.
2) Subsequently the same manual was
simplified.
3) Simplifying the relevant Formats.
4) Revised manual prepared & distributed to
all the States.
5) Discussion in State Secretaries conference
every year.
 Steps taken contd.

Secretary,
Deptt. of FW, Govt. of India
regularly writing to State Secretaries of
Health/FW.
Workshops of District Chief Medical
Officers/Officers of State Dte. of Health
& FW covering about 300 districts
organized in many States.
 Steps Continued
National Population Policy 2000:
Emphasizing the role of the local body
at village level called Panchayat for
furthering decentralized planning.
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.
Associating Anganwari Workers/ Womens Groups
at village level called Mahila Swasth Sanghs [MSS]
etc and Panchayat.
Checking Consistency of assessment of health care
needs by ANMs of the citizens particularly at village
level.
Making a meaningful action plan.
The Action plan is to be executed by ANM.
Action Plan Coverage: No selection of clients- it is
complete coverage of all clients in a particular
village.
Key Issues of Community Participation
being activated through CNAA:
MICROPLANNING
DECISION SUPPORT PLANNING

COMMUNITY PARTICIPATION

CLIENTS PERSPECTIVE

QUALITY OF CARE.

MICROLEVEL DATABASE

MAINTAINING STANDARD
RECORDS/FORMATS.
REGULAR SYSTEM OF M & E OF
PRFORMANCE
 BARRIERS
The vertical programme structure
inhibiting the setting of priorities according
to plans.
Lack of inter-sectoral coordination
reducing the effectiveness of plans in the
health sector.
Infrastructure getting focussed more than
the functions of District & State authorities
to meet the unmet felt need of health care of
the community.
Apathy of all the implementing authorities.
 BARRIERS contd.

Information system not getting

due importance by the medical
authorities.
Some States need more time
Some reservation on the part of
some States
 IMPROVED SITUATION
Some encouraging signs emerging :
Process of Panchayati Raj system has started
in some States.
Action plans are being done through house-
to-house surveys in many districts
In some districts of some States Panchayat
workers are maintaining Birth/ Death
registers.
However, level of motivation and awareness
of Panchayat members needs tremendous
improvements.
 Improved Situation contd.
Panchayat members are being called in
PHC level meeting.
ANMs are attending meetings of Gram
Panchayat.
Panchayat members are being trained
in developmental programmes including
health services.
Training on CNAA to ANMs/
MPW(M)s/Medical Officers[MOs] is an
on- going program.
 SUMMARY
Quality assessment under CNAA is one of
the principal objectives. This objective has
been facing lack of sincerity & commitment.
To establish system of direct interactions
with the clients, other voluntary agencies
participation has been considered.
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.
Decentralized system of planning
model is most viable and cost-effective.
In a developing country like India vast
number of people, particularly in rural
areas , can expect desired level of
services through this model.
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.
4. National Population Policy 2000,
Department of Family Welfare, Ministry of
Health & FW, Govt. of India, New Delhi.

5. Reproductive and Child Health Program :

Schemes for Implementation, October, 1997,
Dept. of Family Welfare, Ministry of Health
& FW, Govt. of India.

6. European Commission : ECTA: Situational

Analysis, 2001/22, August, 2001: Community
Needs Assessment Approach [CNAA] to
District Planning.