Community
Monitoring
through Elected
Women
Representatives
in Bihar
Dr. Aparajita Gogoi, Executive
Director, Centre for Development
and Population Activities (CEDPA)
India.
Project Pahel: Monitoring by Women
Elected Representatives
o
To strengthen the voice, participation,
leadership and influence of Elected
Women Representatives (EWRs) to bring
about social change in areas that affect
women particularly family
planning/reproductive health (FP/RH) by
o
o
o
Participating effectively in PRI and
community meetings
Taking actions to improve
reproductive health services
Addressing health and development
issues in their constituencies
The project is supported by
The David Lucile and Packard
Foundation
Project coverage
o
o
o
o
Pilot stage of this project (2007)
300 EWRs
2 blocks in Patna district
in
partnership with
PRI Department(BIPARD)
Scaled up in (Sept. 2010 – March
2015) to 1200 EWRs
6 blocks across three districts of
Aurangabad, Sitamarhi and
Muzzafarpur
NGO partners-IDF, Dord and Nirdesh
Currently there are 120,000 women leaders in Bihar
.
Profile of EWRs
10.4%
First time elect
5.3% 0.4%
Elected once
Elected twice
Elected thrice
83.8%
21%
20-29
10%
30-39
39%
Others
30%
2%
Post Graduate
0%
Graduate
1%
Attended college but… 0%
Upto class 11-12th
Upto class 9-10th
Upto class 6-8th
Upto class 1-5th
Never went to school
3%
10%
14%
29%
40%
40-49
50 and
above
Project Strategies
o
o
o
o
Capacity development of EWRs
(three day trainings on PRI
structures/processes, gender and
patriarchy
and
public
health
delivery system in the context of
MH/FP/RH)
and
follow
up
mentoring
Training the EWRs in the use of
checklists to monitor services
Supporting
them
to
take
planned, concrete actions based
on evidence generated by the
women
themselves
on
the
availability
and
quality
of
MH/FP/RH services
Mentoring
them
through
collective forums called Mahila
Sabhas
(informal
women’s
councils)
Capacity building
Monitoring checklists
Four checklists (based on Indian Public Health Standards
and NRHM guidelines):
o
o
o
o
Village Health Sanitation and Nutrition Day (VHSND)
Health Sub Centre (HSC)
Primary Health Centre (PHC)
District Hospital (DH)
Administered to look at MH/FP/RH services:
o
Infrastructure
o
Personnel
o
Community participation
o
Availability of equipment, drugs and other supplies
o
Provision of services
o
Quality of logistical arrangements
Process
o
o
o
o
o
Orientation
components
at various
and the role
and training on different
of checklists, service provision
levels, women’s entitlements
of stakeholders
Hand holding support by field animator
during the visit to the facility
Checklists administered in pairs or groups
of 3-4
Observation and verification against
available records before entry in checklist
Debriefing by field animator after facility
visit
Process
o
o
o
o
o
Data analysis
development
and
advocacy
asks
Mobilisation by sharing of health data
in PRI meetings and Mahila Sabhas,
Convening and regularizing VHSNCs
Convergence meeting with Health
officials at district level
Meetings with Health providers for
action
Findings: VHSND level
Supplies
Availability
Foetal stethoscope
Haemoglobinometer
Urine testing kit
SABLA cards
8.6%
8.8%
11.6%
15.9%
Vit-A solution with spoon
18.5%
Counseling protocol chart
22.1%
Measuring tape
IFA tablets-small/syrup
BP Apparatus
Condoms
Nutrition supplement
Oral pills
Weighing machine-baby
MCH cards
Growth chart
23.8%
33.0%
38.7%
47.0%
48.2%
48.2%
55.6%
61.5%
67.9%
Blank immunization cards
72.0%
ORS packets
76.0%
Weighing machine-adults
80.0%
IFA tablets-large
Disposable syringes
80.5%
94.8%
Vaccine carrier with ice packs
95.5%
Tetanus Toxoid (TT)
99.1%
Availability of functional supplies
19%
Screening for Anaemia
27%
BP
35%
Per abd. exam.
68%
IFA tablets
68%
Weight
95%
Immunization
Provision of ANC services
53%
32%
15%
2-4 hrs
5-6 hrs
Duration of VHSND
7-8 hrs
Findings: HSC level
Supplies
DDK
Availability
9%
Sterlizer instrument
11%
Haemoglobinometer
20%
Urine Test strips
32%
Vit-A syrup
37%
Examination table
40%
Copper T
41%
Condoms
63%
Measurement of weight
BP apparatus
69%
TT vaccination
96%
Contraceptive pills
71%
74%
ANC check-up
95%
IFA tablets
Weighing machine
83%
ORS packets
85%
Tetanus Toxoid (TT) vaccine
88%
Disposable syringes
91%
Availability of functional supplies
Urine test (Sugar)
2%
Urine test (Protein)
9%
Haemoglobin test
8%
Measurement of BP
60%
Provision of ANC services
83%
Findings: PHC level
100%
Referral transport
Sterilizer instrument *
83%
Table for newborn care
83%
100%
Blood pressure apparatus
Blood storage facility
0%
Oxygen cylinder
100%
Refrigerator with deep freezer
100%
Wheel chair/ stretcher
100%
Telephone facility with STD services
50%
Generator/ power back-up
100%
Electricity supply
100%
Registration of eligible couples for FP
100%
Referral of High risk pregnancies
100%
100%
Urine examination facility
83%
Treatment for anaemia
MTP facility
Treatment for gynaecological disorders
Internal examination
Provision of facilities/
supplies/equipment
Provision of services
50%
67%
83%
Tubectomy and vasectomy facility
100%
Deliveries
100%
Antenatal clinics
100%
Findings: DH level
Registration of eligible couples for
FP
67%
Referal of High Risk Pregnancies
100%
Treatment for anaemia
100%
MTP facility
Treatment for gynaecological
disorders
Internal examination
67%
100%
100%
Tubectomy and vasectomy facility
100%
Deliveries
100%
Antenatal clinics
100%
Provision of services
District/block Level Convergence Meetings
Actions
o
o
o
EWRs supporting ANMs and ASHAs
in organizing VHSND
EWRs mobilizing beneficiaries to
participate in VHSNDs and visit
HSCs for health needs
EWRs working with health workers
to ensure equipment, supplies and
finding solutions for issues like
privacy for ANCs at VHSNDs and
HSCs
(Source: Quarterly reports)
Actions
o
o
o
o
Irregularity of health workers at
Gram Panchayat meetings
Mukhiya asked to add to
Panchayat Samiti bi-monthly
meeting agenda the need to ask
MOIC to ensure regular supply
of contraceptives at the HSCs
Urged Mukhiyas to follow up on
JSY payments
EWRs met with MLA Sitamarhi to
demand for female doctors
(Source: Quarterly reports)
Results: Convergence meetings emerge
as a forum for advocacy and engagement
EWR voices at convergence meetings:
Raviba Khatoon, Zilla Parishad Member, raised the issue of nonavailability of blood at the district Hospital blood bank which was
resulting in the patients being referred to other institutions for
treatment. She also raised the issue of non-availability of lady doctor at
the DH
Pramila
Devi,
a
Ward
Member
from
Gorigama
Panchayat, raised the issue
of non-availability of referral
transport fund at the HSC
Reena Devi, Panchayat
Samiti Member, raised the
issue of appointment of a
lady doctor at PHC
Runnisaidpur
Mamta Devi, Up-mukhiya of Chanda Panchayat, raised concerns about
the non-availability of delivery services at the HSC. She had also
demanded proper monitoring of VHSND site by government officials to
ensure quality services
Results: Convergence meetings emerge
as a forum for advocacy and engagement
Commitments by Health Officials at convergence meetings:
Two ANMs will be appointed
at each HSC in Aurangabad
To ensure quality health
services
HSCs
in
Aurangabad will be provided
with appropriate equipment
Two ambulances will be
made available at each PHC
in Aurangabad district
Civil Surgeon has issued
an order to the Medical
Officer In-Charge of
Dumra and Runnisaidpur
PHCs and relevant ANMs,
to work with the Pahel
local NGO partner, Nirdesh
for expenditure of the
untied funds
Trends
o
No. of EWRs attending VHSNDs:
21%*
(62% are attending an average of 2 VHSND in each quarter
o
Number of meetings being attended by EWRs:
61%**
o
Raising FP/RH and Girl’s Edu. issues in meetings:
o
No. of EWRs interacting with health providers:
49%*
33% *
(45% of them are meeting with at least 2 health providers in each
quarter)
* over baseline
** Monthly tracking sheets annual data
Challenges and lessons
- High levels of illiteracy of EWRs, barriers of patriarchy – are
major challenges in participation of EWRs in PRI meetings,
demanding accountability and raising their voice
(Forums like Mahila Sabha provide women space for sharing and
solidarity and helps develop their self- esteem and confidence to
take the initiative for change and also develop strategies and
implement them as a collective)
- Difficult to address the “hard” issues like infrastructure,
budgeting processes, appointment of doctors, electricity, running
water, etc.
- Lack of technical capacity among EWRs to use the checklists
requires for support of the project staff to support the filling in of
the checklist
- Data collection and analysis, and communication of findings
takes a substantial time resulting in delay in action
Way forward
In Bihar, with PFI to
propose to GoB for IVR
based monitoring
checklists
 Toll free
 Real time data
collection and analysis
 Audio learning package
also accessible to
understand the
indicators being
collected