Report on Exposure Trip

Cross-Learning through health committees members exposure trip

Report prepared by Dr. Thomas Keppen M&E Officer Nagaland Health Project,

Directorate of Health & family Welfare

Prepared for

The Nagaland Health Project

TITLE : Cross-Learning through health committee members Exposure trip.

EXECUTIVE SUMMARY:

In the public sector, a Health Sub-centre is the most peripheral and first point of contact between the primary health care system and the community. A Sub-centre provides interface with the community at the grass-root level, providing all the primary health care services. It is the lowest rung of a referral pyramid of health. The purpose of the Health Sub-centre is largely preventive and promotive, but it also provides a basic level of curative care. As per population norms, one Sub-centre is established for every 5000 population in plain areas and for every 3000 population in hilly/tribal/desert areas. The IPHS recommends two ANM and one Health Worker Male for a Sub-centre.

Communitization is a process of the Government and the Community getting into ‘partnership’ working together and sharing responsibilities in the management of Public Institutions and Services in order to make them function optimally and deliver quality services for the overall growth and development of the society.

The functions of Village Health Committees are to take the lead to prevent diseases in the community and promote people’s health through awareness/motivational activities, preventive action, and encourage indigenous/traditional healers in the Community. The Committees are mandated to make assessment of the overall health needs in the village, prepare the annual activity for preventive health care in the village and oversee the implementation of the plan.

Standards are the main drivers for continuous improvements in quality. With the implementation and scale -up of community action for health and nutrition under the Nagaland Health Project, The project aims to strengthen the communitization process in health by investing on selected health committees across Nagaland. In this regard, with an aim to create cross-learning, this exposure visit by L/Longidan HSCMC and Longtsiri VHC was made to their peer health committees to learn from some of the best practices followed by the health committees and also for the SPMU to learn from this exercise and how this process maybe further developed.

INTRODUCTION:

The health committee members of Health Sub-Centre Management Committee L/ Longidan SC and Village Health Committee longtsiri visited Wokha Village sub-centre under Wokha district and Nsunyu Village health committee under Tseminyu block of Kohima district on the 6^th of March 2019, to get a better understanding of the functions and activities of the health committees, this visit was part of the action plan projected by the visiting villages under the community health & nutrition component of the Nagaland Health Project.

The Nagaland Communitization of Public Institutions and services Act 2002, received the assent of the Governor on the 27^th March 2002. Communitization in health envisions Increasing community ownership & community involvement in management of Health service delivery which are linked to structure of Indian Public Health system by the formation of health committees at various levels –village level (VHC) and facility level (SC/PHC/CHC).

The Health Committees through the communitization funds (previously) and now with the NHM untied fund uses these funds to tie over the immediate needs of the facility and health committees. Now this selected health committees with assistance from trained District facilitators and Field demonstrators from the Nagaland Health Project use a participatory planning process to identify problems and challenges in the community. The Committee then uses the one-time grant and subsequent RBF grant to create local solutions to meet the health target indicators.

FOCUS OF THE EXPOSURE TRIP:

The Nagaland Health Project, funded by the World Bank, and implemented by the department of Health & Family Welfare, Nagaland has two project components: 1) Community Action for Health & Nutrition and 2) Health System Development.

The component on Community Action for Health & Nutrition is to support community engagement and community implemented investments intended to impact on Health, Nutrition and Population. The component will support capacity building of various health committees and provide results-based financial resources for the community.

Fund will be allocated for the first time to the above selected villages/facilities only if they meet certain basic criteria called – Pre conditions. Further additional funds may be allocated based on six monthly data of achievement of a few key target health Indicators . Basing on this project design the main focus of this trip, including its objectives and activities are:

Objectives:

Acquire an understanding of the planning and implementation of the communitization process and also the process of the CAHN program from the health committee members, village councils and health staffs at the facility and village levels.
Learn from the experiences and challenges faced in early stages of planning and implementation of the CAHN program from the health centre and village communities.
Observe and learn some good practices shared by health committees and village functionaries in planning and implementation of CAHN.

Activities:

Meeting at the Wokha Village Sub- Centre with the health committee members village council members.
Meeting at the Nsunyu Village Council Hall with the health committee members village council members.
Meeting with DPMU Wokha, SPMU NHP & World Bank staff.
Field visit to observe how participatory planning process is used in the villages to solve problems and challenges and uplift the community.

OVERVIEW OF THE TRIP:

Bhandari is a Block situated in Wokha district in Nagaland. Positioned in rural region of Nagaland, it is one among the 5 blocks of Wokha district. The block has 52 villages. L/Longidan and Longtsiri villages are from this block, Bhandari is located around 25.1 kilometer away from its district head quarter Wokha. Bhandari‘s nearest town/important place is Sarupathar in Assam located at the distance of 12.0 kilometer, and this two villages are located in this Assam and Nagaland border.

It was agreed that the meeting will start at 10 AM at Wokha Village Sub-centre, the health committee members from the two villages had hired two cars and reached the sub-centre on time. The SPMU team along with along with the World Bank staff and a script writer from Dreamz Unlimited started from Kohima early in the morning.

The sub-centre is located on a small hillock overlooking Wokha town, it was a windy and chilly morning, over an impromptu camp-fire outside the sub-centre the sub-centre staffs, the HSCMC members and the village council members were already waiting for us. The DMPU staffs and the BPM from CMO estd Wokha were also in attendance.

The exposure trip was done for two different level of health committees, who have their own specific programs, activities and challenges.

The first meeting at Wokha sub-centre was facilitated by the SPMU, when asked to present their programs and challenges, the Village council chairman from Lio longidan express his happiness on the implementation of the CAHN project and the activities that they have initiated and was hopeful that this cross-learning will help them in better management of their village sub-centre. The HSCMC chairman of the host village explained to the gathering how the health committee along with the village council plan together for the requirements and programs for the sub-centre, how resources were mobilised from the community, and appreciated how the staffs were tirelessly giving their services, he also gave a long list of community contributions made by the villagers. The Village council Chairman and the Village secretary of Wokha village also highlighted on the functioning and community monitoring of the sub-centre.

The Senior Nurse of the facility explained to the gathering how one should take ownership of their assignments, and judiciously use the funds for the community’s welfare, it was observed that the sub-centre has one of the highest numbers of institutional deliveries among the sub-centres, with patients visiting the centre even from Wokha town for consultations and delivery services. When asked to all the health committees what would be their health vision for their village, Sanitation and water security was highlighted as their priority.

After the meeting the visiting committee members were shown around the sub-centre labour room and the dispensing room, many of the visiting committee members were seen clicking pictures of the facilities in the sub-centre, it may be stated that thought the centre was an old building and facilities were at its bare minimum, the centre was impeccably maintained.

The second part of the exposure trip was at Nsunyu village which is about 18 kms from Wokha, this visit has particular relevance for VHC Longtsiri, on how a VHC functions and how inter-alignment with the facility it comes under plays a role in the health planning of a VHC.

The Village council members , the GBs and the VHC of Nsunyu received the visiting team, in-fact they had just completed a program declaring the village “A tobacco free – village” under the initiative of the National Tobacco Control Program of the department of health and family welfare.

During the interaction with the stake-holders at Nsunyu Village, the Chairman of the VHC Nsunyu village explained how they had to surmount many challenges in the initial phase of the committee formation and functioning and that thought they are not yet free from the problems, he expressed his satisfaction how the community are working together to address the issues that confronts them.

The village council secretary explained in detail to the visiting team the concept of CAHN and RBF mechanism and how it has been meticulously designed, it is worth mentioning to note that the Nsunyu VHC has understood the communitization process and has also thoroughly grasp the project concept of community health and nutrition initiated under Nagaland Health Project. He also shared the activities carried out by the VHC, particular mention maybe made on the awareness campaign initiated by the VHC and the impact it is having on the common peoples’ lives. They also shared some innovations in uplifting the livelihood of the woman folks through the project funding, how they are taking care of the aged-people in the village by providing basic toilets.

The VDB secretary of the village also highlighted some of the village initiatives on sanitation where they have provided community toilets, conducts monthly cleanliness drive, addressed water scarcity by providing every household with reservoir for rain water harvesting etc. The visiting team were later taken for a walk around the village to observe the mentioned activities.

The meeting ended with a sumptuous meal prepared by the Nsunyu Village council. This was a first of a kind cross-learning experience in health sector in Nagaland and was highlighted in the news the next day₁. The Exposure trip was facilitated by the SPMU team which included Mr. Achumthung Patton Consultant, Ms. Mengu Sanchu Consultant & Dr. Thomas Keppen M&E Officer, The observer from the World Bank was Dr. Aarushi Bhatnagar.

Point of Interest:

The Health committees either at the sub centre level or VHC level are taking ownership of the health services and issues in the village by actively participating in the planning and execution of health action plans in the villages.
The sub-centre staffs are well-informed of their job responsibilities and are highly motivated. The sense of ownership is well manifested in the programs and activities of the health centre.
The village councils are playing a parental role in providing support and logistic requirements of the health committees.
As envisage in the communitization Act, the village councils are actively supporting the VHCs through social mobilization and encouraging community participation for the various health plans and programs and also conducting community monitoring.
In the Village plans & programs, both Wokha & Nsunyu Village has some health vision for their village which are indirectly supporting the plans & programs of the health committees.

Significant Learning:

There is a very good communication channel between the health committees and the village councils, which is enabling the smooth functioning of the health programs.
Small innovations in the form of providing very low-cost toilets to the elderly and destitute in the village though the committee fund.
Livelihood opportunities have been created through the project fund to the widows and single women folks only in the village through piggery project.
Community taking part in health planning in the villages.

RECOMMENDATIONS:

In order to provide quality care Sub-centres are being prescribed to provide basic primary health care services to the community and achieve and maintain an acceptable standard of quality of care. However as most of our sub-centres are not able to maintain and provide even the basic services, Exposure visit of this kind maybe prescribed, as it is evident from the visit that with a little will and application, the centres can be developed to provide the basic services with the available fund and resources.

The village health committees were not well converse with the communitization concept, developing a few of this performing Health Committees into learning sites in a district or cluster of districts will help in cross-learning. Wokha SC & Nsunyu VHC are well acquainted with the concept of communitization and now with the NHP project design, with subsequent funding, further hand-holding maybe given to this health committees to become full-flagged learning sites.

In future the cross learning may be further developed and standardized, the SPMU may design key structured questions for the visiting health committees to enquire from the learning sites, at the same time an outline of key areas to be addressed by the health committees of the learning sites may be designed.

Bibliography/ References:

1.Nagaland Post: Publish Date: 3/6/2019 11:45:13 AM IST

Annexure 1:

List of Visiting Health Committee members:

A. Lio Longidang HSCMC

Joseph Patton VCC
Samuel Humtso VHC Chairman
Rosena ANM
Easter Co-Chair person
Jonbeni ASHA
Tsenbeni Jami AWW
Mhanyani HSCMC Member.

B. Longtsiri VHC

Manchio Murry VHC Chairman
Jacob Jami VCC
Thungyani ASHA
Likyano AWW
Tsenbemo JamioVHC member

Report on Exposure Trip