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Good Practices in Community Processes Learning from West Champaran District, Bihar

 

 

 

(Bureau report west champaran.)

Community Processes, one of the key components of NHM, has widened the scope for establishing strong linkage between facility and community based health services. Frontline workers mainly ASHA have been engaged at community level to create community awareness and demand generation. ASHA Component of NHM has three key roles: facilitation for health services; community level care including counselling and interpersonal communication for health seeking behaviour; and social mobilization. Performance of ASHA has resulted in significant improvement in the key MNH indicators like institutional delivery, special care to sick and high risk newborns, immunization, child and maternal death review, family planning etc. Today, the ASHA programme has become an integral part of the health system and seen as the backbone of the community level health interventions. Eventually, success of all maternal, newborn and child health programmes in any district is heavily dependent on dedicated services of ASHA. In the light of NHM’s community processes, West Champaran district of Bihar has instituted some systems and procedures as good practices which paved the district to top in many community based health interventions. It is believed that replication of these good practices would equally be beneficial to strengthen community processes in other districts too.
District Profile
West Champaran District was established in the year 1972 with its Headquarters as Bettiah, about 200 kilometer from state capital Patna. Location of the district is between 26°16′ and 27°31′ north latitude and 83°50′ and 85°18′ east longitude. The district is surrounded by hilly region of Nepal in the North, Gopalganj & Purbi  Champaran in the South-East and Uttar Pradesh in the West. Following table is furnished with information on geo-demographic and health infrastructure of the district.
Geo-demography

Total Area
5228 Sq. Kms

Total Population (2011 Census)
4546196

Subdivisions
1. Bettiah
2. Narkatiyaganj
3. Bagaha

No. of   CD   Blocks
18

No. of  Panchayats
315

Health Infrastructure & HR

Sadar Hospital 1, Sub Divisional Hospital 1, RH 2, PHC 18, APHC 34 , HSC 533, Doctors 96, ANM 866, ASHA Facilitator 146

ASHA 3106 Timeline of Community Processes in West Champaran
The following timeline depicts year-wise important events occurred as per evolution of NHM’s community processes. Unlike other districts of the state, there are a few district specific events taken place such as pilot of bi-cycle project of Govt. of India, issuance of ID Cards, mechanisms for meeting of ASHA Facilitators over the period of time.
Year Important Events

2007 Launch of ASHA Programme

2009 Capacity Development of ASHA in 1-4 modules

2010 Deployment of District Community Mobilizer through NHSRC

2011
Deployment of ASHA Facilitators

2013
Capacity Development of ASHA in 5-7 modules

Pilot of ASHA Bi-cycle Project

2014
Introduction of PRAN (Permanent Regular Account Number) by SHSB

2016
Orientation of ASHA Facilitators by UNICEF Bihar on 10 Indicators

 

 

Initiation of ASHA Facilitators’ Meeting by DHS 2017 Issuance of Identity Card to ASHA through RKS linking with Aadhar Instituted mechanism for sub-divisional level monthly meeting of ASHA Facilitators by DHS from June 2017 Key Achievements – contributed by effective Community Processes West Champaran has ascended to the top position in male sterilization among 613 districts of India in the year 2018 (HMIS Report). Remained Top in Bihar for last two years in the application of Mobile Kunji – an innovative and effective IPC/BCC and awareness tool with 28 flash cards covering major health care services. Status of Mobile Kunji coverage in the state remained at 31% while it was 71% in West Champaran district. Maximum number of beneficiaries reached out with effective health messages through Mobile Kunji. Once one of the worst performing districts, West Champaran remained among Top-20 districts for last one year in Full Immunization Coverage. Acquired 8th position in the state for coverage of PPIUCD (HMIS Report).
Survey of Eligible Couple, Pregnant Women, Children of 0-2 year age group, Birth & Death register updated till March 2018 in the entire district of West Champaran. Significant improvement in Community and Facility Follow Up of SNCU discharged babies can be noticed after the orientation to ASHA Facilitator on SNCU held in the month of August 2018 facilitated by UNICEF. Total Community Follow Up of SNCU discharged babies increased from 12.8% (1st January to 31st July 2018) to 28.1% (1st August to 25th October 2018) and Facility Follow Up increased from 4.6% to 7.3% in the corresponding periods. After the orientation on SNCU, ASHA Facilitators guided ASHA of their respective clusters to undertake home visits of SNCU discharged babies as a result scheduled visits have been increasing progressively.
Good Practices in Community Processes
Established systems and procedures for monthly meeting of ASHA Facilitators
West Champaran is the only district in Bihar to initiate monthly review-cum-planning meetings of ASHA Facilitators at sub-divisional level by mobilizing its own resources since last two years. The overall purpose of these meetings is to build capacity of ASHA Facilitators and reinforce their skills, identify operational issues and devise corrective measures in a timely manner to improve the performance of ASHA in community based interventions. Within a span of two years, a mechanism to organize monthly meetings of ASHA Facilitators has been deeply instituted within the system ensuring active participation of all key stakeholders including the Civil Surgeon and DPM at the district level to the MOIC, BCM and BAM at PHC level.
Credit goes to Mr Rajesh Kumar, District Community Mobilizer (DCM) of West Champaran, who has initiated the monthly review-cum-planning meetings of ASHA Facilitators in the year 2016. To institute the mechanism for regular meeting of ASHA Facilitators, the Civil Surgeon was convinced to issue a letter to MOICs with directive to organize regular meetings of ASHA Facilitators by utilizing available fund of Rogi Kalyan Samiti (RKS) and Block Programme Management Unit (BPMU). The procedure to organize monthly meetings of ASHA Facilitators includes the following practices: The sub-divisional level meeting takes place on rotational basis, hosted by the PHC having the venue of meeting. Every month, the Civil Surgeon issues a letter for the meeting with the specified date and venue for PHCs. Usually, one of the district authorities like either the ACMO or the DIO attends every meeting to show ownership of the DHS.
PHCs are directed to organize to and fro transportation facilities for participants by arranging vehicles and the cost of transportation (approx. Rs 6000/-) is met from RKS/BPMU fund of concerned PHCs.
Average expenditure amounting Rs 15000/- to Rs 20000/- towards refreshment is paid by the host PHC utilizing its RKS fund. Representatives of various Development Partners are invited to participate in the meeting Agenda of the meeting includes review of community based programmes, capacity building and orientation on ongoing and priority programmes, information sharing on administrative matters and newer programmes, grievance redressal etc. Capacity building and leadership development of ASHA Facilitators
It has been observed that the meeting of ASHA Facilitators is being used as an excellent platform for continued capacity building and leadership development of ASHA Facilitators. Critical review and planning of community based programmes helps the ASHA Facilitators to guide ASHAs through cluster meeting and field visits for performance improvement. District level officials and representatives from Development Partners facilitate orientation of the ASHA Facilitators on various ongoing and newer programmes mainly associated with ASHA component. So far, the ASHA Facilitators are imparted with knowledge and skills on RI, FP, RCH register, NRC, IAPPD, SNCU (female admission and community follow up of discharged babies) etc. Proactive role of DCM and his team (BCMs) has been a source of inspiration for the ASHA Facilitators. On many occasions it has been observed that the DCM and his team not only guide the ASHA Facilitators on programme front but also reassured them on other aspects like women’s empowerment, personality development and leadership etc. to enhance their motivation. Regular meeting has created an enabling environment for ASHA Facilitators to learn from each other and enhance self confidence. On special occasions, good performing ASHA Facilitators and ASHA have been rewarded and given recognition to boost their spirit. Some noticeable positive changes in them are as follows: ASHA Facilitators possess sound knowledge and skills on important health programmes. A sense of accountability in them is conspicuous with more than 95% average attendance in and active participation in monthly meetings. They have demonstrated leadership skills to guide and support ASHA in their respective clusters during monthly cluster meetings and field visits. None of the ASHA Facilitators ever fail to conduct ASHA cluster meetings. Most of them have pursued higher studies and are viewed as assets to their families and neighbourhood. Strengthened mechanism for recording & reporting DCM has instituted a mechanism to strengthen recording & reporting system by introducing Terms of Reference (TOR) for ASHA and separate registers at ASHA level. The TOR of ASHA Facilitators includes day-wise duty roster for 20 days a month. Every ASHA Facilitator maintains daily dairy to record day-wise duty as specified for 20 days in a month. Besides, each ASHA has separate registers for HBNC, household survey, line listing registers for Eligible Couple, Pregnant Women, Children of 0-2 year age group, Birth & Death register etc.
Grievance redressal mechanism
The concluding session of every monthly meeting holds as grievance redressal session. DCM and his team empathetically listen, record and provide solutions to the grievances of ASHA Facilitators. All such grievances requiring attention of Civil Surgeon and other district officials are brought to their notice for redressal. In this process, grievances related to delay in payment of incentives have resolved and updated. This has boosted the morale of ASHA and instilled high motivation in them.
The good practices of West Champaran district in the community processes have certainly contributed to the overall performance of the district and expected to have similar impact in other districts too, if replicated. The learning from good practices of West Champaran district in community processes should challenge other DCMs to adopt similar methodology to create an enabling environment for the ASHA Facilitators and ASHA of their respective districts.

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