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Government of IndiaGovernment of India
Policy Reform in Family Welfare Policy Reform in Family Welfare Program of IndiaProgram of India : :
Community Mobilization & Community Community Mobilization & Community Participation under Reproductive & Participation under Reproductive &
Child Health ProgramChild Health Program------------------------------------------------------------------------------------------------PrasantaPrasanta Kumar Saha, Kumar Saha, CStat (UK), CStat (UK),
Fellow of the Royal Statistical Society, UK.Fellow of the Royal Statistical Society, UK.
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NEW PLAN MODELNEW PLAN MODELFORFOR
FAMILY WELFARE FAMILY WELFARE
And RCH PROGRAMME And RCH PROGRAMME
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GENESISGENESIS
INDIGENIOUS IDEAS:INDIGENIOUS IDEAS:
PLANG. COMMISSION.PLANG. COMMISSION.
INTERNATIONAL : ICPD ‘94INTERNATIONAL : ICPD ‘94
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PLAN MODEL: PLAN MODEL: DEFINITION:DEFINITION:
Decentralized Participatory Decentralized Participatory Planning being activated Planning being activated
through Community Needs through Community Needs Assessment Approach (CNAA) Assessment Approach (CNAA)
for implementing FW / RCH for implementing FW / RCH Prog.Prog.
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Characteristics Characteristics of Community Participation of Community Participation
Model: Model:
STANDARD STANDARD FLEXIBLEFLEXIBLE
SYSTEMATICSYSTEMATIC SIMPLISTIC SIMPLISTIC
GRASSROOT Oriented GRASSROOT Oriented
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CHARACTERISTICSCHARACTERISTICSContd. :Contd. :
BOTTOM-UP BOTTOM-UP
PEOPLE’SPLANPEOPLE’SPLAN
PEOPLE’S PARTICIPATIONPEOPLE’S PARTICIPATION
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PRINCIPAL OBJECTIVES :PRINCIPAL OBJECTIVES :11. . IMPLEMENTATION OF FAMILY IMPLEMENTATION OF FAMILY WELFARE AND RCH PROG. WELFARE AND RCH PROG. 2. 2. TO PROVIDE TO PEOPLETO PROVIDE TO PEOPLEBEST QUALITY SERVICES.BEST QUALITY SERVICES. AND AND 3. 3. ABOLITION OF EXECUTIVE’S ABOLITION OF EXECUTIVE’S
PRECONCEIVED FUNCTIONAL DESIGNPRECONCEIVED FUNCTIONAL DESIGN..
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Preparatory Actions Prior Preparatory Actions Prior to Introduction of New Model :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..
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Preparatory actions contd.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 .
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Steps taken for Steps taken for Operationalisation of New ApproachOperationalisation of New Approach
[contd.][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.
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Steps taken contd.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.
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Steps ContinuedSteps 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. .
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MECHANISM OF PREPARATION OF ACTION PLAN MECHANISM OF PREPARATION OF ACTION PLAN – KEY COMPONENT OF NEW APPROACH:– KEY COMPONENT OF NEW APPROACH:
Originated at SUB-CENTER[SC] level : Interactions of Auxiliary Nurse Midwives [ANM] with people.Associating Anganwari Workers/ Women’s 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.
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Key Issues of Community Participation Key Issues of Community Participation
being activated through CNAA:being activated through CNAA:MICROPLANNINGDECISION SUPPORT PLANNINGCOMMUNITY PARTICIPATIONCLIENT’S PERSPECTIVEQUALITY OF CARE.MICROLEVEL DATABASEMAINTAINING STANDARD RECORDS/FORMATS. REGULAR SYSTEM OF M & E OF PRFORMANCE
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BARRIERSBARRIERS
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.
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BARRIERS contd.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
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IMPROVED SITUATIONIMPROVED 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.
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Improved Situation contd.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.
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SUMMARYSUMMARY
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.
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SUMMARY Contd.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.
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References : References :
ReferencesReferences1. Report of the International Conference on 1. Report of the International Conference on Population and Development, Sept., 1994, Population and Development, Sept., 1994, Cairo, Egypt.Cairo, Egypt.
2. Annual Reports of the Ministry of Health & 2. Annual Reports of the Ministry of Health & Family Welfare, Government of India, New Family Welfare, Government of India, New Delhi-1996-97, 1997-98, 1998-99. Delhi-1996-97, 1997-98, 1998-99. 3. UNFPA : Technical Report, November, 3. UNFPA : Technical Report, November, 1999 : “ Planning Population and 1999 : “ Planning Population and Development Projects with a Focus on Development Projects with a Focus on Decentralization and Quality of Care”. Decentralization and Quality of Care”.
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References –contd.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.