Community Based Monitoring & Planning
(Proposal for NGO Involvement)
Presented by:
Programme Management Unit
ASHA; Community Processes & Intersectoral Convergence
SHS, NHM, J&K
Introduction
 Panchayats in India are an age-old institution for governance at
village level.
 States have to encourage all the steps to devolve greater powers
and funds to Panchayati Raj Institutions.
 In Jammu and Kashmir, the roots of Panchayati Raj were planted
by Maharaja Hari Singh in 1935 by promulgation of the Jammu
and KashmirVillage Panchayat Raj.
 A special Department of Panchayati and Rural Development was
created in 1936 to administer the 1935 Regulation which
stated, “it is expedient to establish in Jammu & Kashmir State the village
panchayats to assist in the administrative, civil and criminal justice and
also to manage the sanitation and other common concerns of the village”.
 By an amendment in 1941, the list of functions of the 1935 Regulation
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were widened.
By an Act of 1951, the Panchayati Raj Institutions (PRI) was adopted to
be re-established. The Jammu and Kashmir Government thereafter
enacted theVillage Panchayati Act in 1958 replacing the 1951 Act.
The J&K state has been one of the pioneering states in the field of
decentralized district planning with the introduction of an innovative
initiative of “Single Line Administration” in 1976.
The underlying objective of this model was to decentralize the authority
with a view to accelerating the pace of developmental programmes and
involve people’s participation in the process of development. This
realization finally led to the introduction of Jammu & Kashmir
Panchayati Raj Act 1989.
This Act provides for a three tier system (village, Block and District
level) for goverence at the grass roots. The institutions accordingly in
J&K are called Halqa Panchayat, Block Development Council and
District Planning and Development Board respectively.
 In the Sate of J & K the devolution of powers to the PRIs
pertaining to H & FW Dept. have been executed as in the
following Govt. Order:-
 In 1992, through the enactment of the 73rd Constitutional Amendment,
Panchayati Raj Institutions (PRIs) were strengthened as local
government organizations with clear areas of jurisdiction, adequate
power, authority and funds commensurate with responsibilities.
 Panchayats have been assigned 29 rural development activities, including
several, which are related to health and population stabilization.
 The XI schedule includes Family Welfare, Health and Sanitation,
(including hospitals, primary health centres, and dispensaries,) and the
XII schedule includes Public Health. Thus the possible realm of
influence of the Panchayats extends over a significant proportion of
public health issues.
 The Gram Sabha, where empowered has the potential to act as a
community level accountability mechanism to ensure that the functions
of the village Panchayat in the area of public health and family welfare,
actually respond to people’s needs.
 Increasingly it is being realized that strategies for achieving low infant,
under five and maternal mortality depend on a functioning continuum of
high quality services from community to secondary and sometimes
higher levels of care. In addition community support for such services
comes through behaviour change to increase utilization as well as demand
high quality services.
 In the RCH 2 implementation document, specific mention is made of
plans to support PRI (and urban counterparts) in design,
implementation, monitoring of RCH related interventions. This is also
seen as a potential to address the social determinants of health through
engagement with communities and PRI rather than a biomedical
approach in isolation. It is expected that PRI involvement will increase
community understanding of issues of accountability for quality and
reliability of health care services.
 Thus there is opportunity for PRI involvement to address the non
technical components of health care seeking, provided all PRI
representatives are exposed to a perspective building exercise on health
within the framework of gender and equity.
 National Rural Health Mission, designed to integrate health and
family welfare related interventions and address health from a
holistic preventive, promotive and curative viewpoint takes a much
more significant view of PRI engagement.
 The fulcrum of the NRHM programme is a social activist (ASHA)
at the village level, who works with the village level resource team
in providing preventive and promotive health care services. It is
expected that she will be supervised and supported by the
panchayats.
 One of the core strategies of the NRHM is to empower local
governments to manage, control and be accountable for public
health services at various levels.
 The Village Health, Sanitation & Nutrition Committee (VHSNC), the
standing committee of the Gram Panchayat (GP) is expected to provide
oversight of all NRHM activities at the village level and supposed to be
responsible for developing the Village Health Plan with the support of the
ANM, ASHA, AWW and Self Help Groups. For this there is an immense
need to train and enhance capacity of Panchayati Raj Institutions (PRIs) to
own, control and manage public health services which though is evolving
a lot is still needed to be done to maximize the function of PRIs.
 The Village Health, Sanitation & Nutrition Committee (VHSNC) forms
the link between the Gram Panchayat and the community. The VHNC is
responsible for working with the Gram Panchayat to ensure that the
health plan is in harmony with the overall local plan. It is anticipated that
this committee will prepare a Village Health Plan and maintain village
level data, supervised by the Gram Panchayat.
 Engaging the Gram Sabha and other groups in planning and monitoring
the Village Health Plan will presumably enforce transparency and
accountability.
 Under the NRHM, untied funds of Rs. 10,000 are placed with the
VHSNCs to meet unanticipated expenditures. A Joint account has
been opened with the Sarpanch and ASHAs for operationlization of
the activities planned.
 So after considering the functioning of VHSNCs to put in place the
gaps identified, a need is felt to undertake the subsequently
mentioned strategy on priority to achieve the objective of
involvement of PRI as per mandate of NRHM.
Proposed Community Based Monitoring and Planning (CBMP)
Program in Jammu and Kashmir
Update on communitization initiatives
 The following initiatives have been taken by the Jammu and Kashmir
State Health Society (SHS) in implementing the communitization
component through the National Health Mission (NHM):
Village Health Sanitation Nutrition Committees (VHSNC) have been
formed in all 6881 villages of the state in 2011-12.
2. Subsequently, VHSNCs have been re-constituted to include the newly
elected members of the Panchayati Raj Institutions (PRI's) through a
government order in September, 2011.
3. First instalment of village untied funds (total amount of Rs 3.25
crores) has been released to 5817 VHSNCs in 2011-12. The second
instalment of funds for FY 2012-13 is 1.09 crore to 6881
committees.Total funds released till date is 4.35 Crores.
1.
Interaction meetings/Melas with VHSNC members have been
organized at the district and block level to orient them on the
various components of NHM and their roles and responsibilities.
Approx 34000 VHSNC members have been reached through
about 350 block and district meetings. But as per new guidelines
VHNSC should have 12-15 member in which case we may have
to orient around one lac members in the reconstituted
committee.
Constitution of VHSNC:-
4.
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Gram Panchayat Members from the village
ASHA, AWW, ANM
SHG Leader
The PTA/ MTA Secretary
Village representative of any Community based organization
working in the village
Rogi Kalyan Samities (RKS) have been constituted in health
facilities at the PHC, CHC and district level. The governing body
of these committees are chaired by the local Member of Legislative
Assembly (MLA) and include officials from the departments of
Health, Integrated Child Development Scheme (ICDS), Public
Health Engineering Department (PHED), Education, along with
NGO representatives.
6. SHS has developed a diary which covers various aspects of NHM,
including roles and responsibilities of ASHA and VHSNC members.
This has been printed and distributed to 4000 Gram Panchayats in
the state.
7. SHS has prepared a booklet on 'Guidelines for Devolution of
Functions to PRIs in Health'. This booklet has been distributed to
all line departments and PRI members in the state.
5.
Proposed plan for initiating CBMP
 The State proposes to initiate Community Based Monitoring and
Planning (CBMP) in NHM State PIP for 2013–14. In the first year
the programme is proposed to be implemented in six districts
(Jammu, erstwhile Doda and Rajouri in Jammu division; Ganderbal,
Anantnag and Budgam in Kashmir division) covering 19 blocks. The
Advisory Group on Community Action (AGCA) would provide
overall guidance and technical support to the SHS in implementing
CBMP programme.
 The key program components would include;
1. Formation and strengthening of State Advisory Group on
Community Action (SAGCA) and State Technical Advisory Group
(STAG) to guide the implementation of CBMP;
Adaptation and translation of VHSNC and RKS guidelines,
training manuals and CBMP tools;
3. Formation and orientation of planning and monitoring
committees at the district, block level; and
4. Identification and orientation of Nodal NGO's to manage the
implementation of CBMP at the district and block level;
5. Initiating implementation of CBPM in 1123 villages in 19 blocks
covering 14 CHC and 70 PHC across 6 districts. The details of
program scale proposed in Year-1 (2014-15) is enclosed in
Annexure 1.
2.
Focus Areas
 The CBMP process would focus on activating and building
capacities of VHSNC, RKS and Panchayat representatives to
monitor and provide feedback on the functioning of public health
services, including inputs for improved planning on issues such as:
a) demand/ need
b) coverage and access
c) quality of services
d) behaviour and presence of health care personnel at service
delivery points/ health facilities, and
e) identify possible denial of care and negligence.
 A grievance redressal mechanism will also be put in place to
resolve the issues/ gaps emerging from the CBMP process at the
block and district level.
Key programme components
 The key components outlined above will be implemented by a team of
professionals based in SHS in partnership with NGOs at the District and
Block level.
A. State Level
1. Formation of State Advisory Group on Community Action (SAGCA) and State
Technical Advisory Group (STAG) to guide the implementation of CBMP
A State Advisory Group for Community Action (SAGCA) will be
constituted for providing advisory support to the state for
implementing CBPM. The SAGCA will be chaired by the Secretary
Health and Family Welfare and comprise senior officials from the State
Health Society, Departments of Health and Family Welfare, Panchayati
Raj, Women and Child Development and NGO representatives.
Representatives from the national level AGCA will also be included as
SAGCA members. SAGCA members will be oriented to the CBMP
processes as implemented in the pilot phase and in other states.
Subsequently, meetings will be organized to strategize and work out a
broad plan of action for rolling out the CBMP programme in the state
over the next three years. PFI/AGCA members will facilitate the
orientation and planning exercise.
A Technical Assistance Group (TAG) will also be formed to provide
technical support to the process. The STAG will comprise representatives
from NGOs working on health and rights based approaches. It will also
have representatives from the State Health Society and its meetings will
be convened by the Nodal Officer designated by the MD NHM. The
AGCA will support in developing Terms of Reference (TOR) and
conduct orientation of the SAGCA and STAG members.
2. Identification and orientation of NGOs/ CBOs to manage the implementation
of CBMP;
A mapping exercise would be undertaken to identify potential NGOs/
CBOs with capacities and field presence to implement the CBMP
program. Subsequently, NGOs/ CBOs will be selected/ nominated
through a due diligence process. Existing Mother NGOs (MNGOs) and
Field NGOs (FNGOs) will be given preference, on the basis of their
performance in implementing the Regional Resource Center (RRC)
scheme. The NGOs staff will be trained by the AGCA with support from
the team based at the SPMU.
Adaptation of state level guidelines, training manuals, formats for VHSNC
and RKS members
The TAG will adapt the VHSNC and RKS guidelines, training
modules to suit the state context. Selected MNGOs and ASHA
trainers will also be invited contribute to the process. A sub-group
will be formed to work on the details of the guidelines, modules
and tools, including translation of the manuals into Urdu, Dogri
and adapting the Hindi version to make it easier to understand.
4. Formation and orientation of planning and monitoring committees at the
district, block and PHC level
Orientation meetings will be organized at the district level for key
officials from the Health, ICDS, PHED departments. The meeting
would help in developing an understanding among the stakeholders
on the CBMP program and seeking their support in the
implementation processes.
3.
 District and Block Level
1.
Formation and orientation of DPMC and BPMC members
DPMC and BPMC will be formed 19 blocks across 6 districts. This
will be followed by an orientation meeting of the committee members
on the CBPM process, including developing an understanding on their
roles and responsibilities. Subsequently, meetings of these committees
will be organized on a quarterly basis to discuss and resolve issues
emerging from the community monitoring and planning processes.
2.
Orientation of RKS members
A state level notification would be issued to reconstitute/ expand the
membership of the RKS to enable inclusion of PRI members and
NGO/ CBO representatives. Subsequently, structured orientation of
the committee members will be organized.
 Village level
1. Community meetings would be organized to generate awareness on NHM
2.
3.
entitlements and CBMP process. IEC/ BCC materials (including wall
writings) would be developed and distributed among the VHSNC
members.
Training of VHSNC members- Two rounds of structured trainings would
be organized for the VHSNC members. In the current FY, a) basic
orientation one day would be organized for all VHSNC members at the
village level b) followed by a two day orientation of selected members
(around 5 members) will be organized at the Gram Panchayat/ PHC
level. The second round of training for VHSNC members would be
organized in the next FY.
In addition, orientation meetings of the ASHA, ANM and Anganwadi
Workers (AWW) will be organized to develop their understanding on the
roles and responsibilities of VHSNC. This would be done through their
ongoing monthly review meetings organized at the PHC / Block level.
Focus will be organizing VHSNC meetings and introducing tools for
monitoring services at the village and health facility level. Subsequently,
village and facility score cards would be generated and shared with service
providers to facilitate dialogue and corrective action.
Proposed Operational Mechanism and Human Resource Structure
A. State Level
 The AGCA would provide technical support and guidance to the SHS team
in rolling out the CBMP program.This would include:
1.
2.
3.
4.
5.
6.
Developing the Terms of Reference (TOR) and support in constituting the
State Advisory Group on Community Action (S-AGCA) and Technical
Assistance Group (S-TAG);
Developing guidelines, criteria and processes for selection of NGOs;
Co-facilitating trainings and orientation of implementing partners;
Adaptation of guidelines, training modules for VHSNC and RKS;
Adaptation tools for community enquiry and facility surveys; and
Periodic review and guidance for implementation of the CBMP programme
 To manage implementation of the CBMP program a team of professionals
will be hired. This will include a State Project Officer and 2 Divisional
Project Officer(one each in Jammu and Kashmir division) to implement
and manage the CBPM component. In addition adequate secretarial
assistance will be provided to these units.
B. District Level
 In each district, an NGO/ CBO will be identified to implement
the program at the district level.Their role would include:
a) formation and strengthening of District Planning and
Monitoring Committees (DPMC), Block Planning and
Monitoring Committee (BPMC)
b) facilitate training ofVHSNC and RKS members
c) compilation and analysis of community enquiry data and
facility surveys.
 Each organization would have two (2) staff, a District Project
Officer and a Training Officer.
 To manage the finances, costs for a part time Accountant will also
be provided.
C. Block Level
 In each block, an NGO/CBO will be identified to implement CBMP
activities at the village level and block level.Their role would include:
(a) extension / reconstitution ofVHSNC
(b) organizing community meetings to raise awareness on NRHM
entitlements
(c) training of VHSNC members
(d) organizing regular meetings ofVHSNC
(e) initiation of community level enquiry to assess the availability, access
and quality of health services.
 In each block, a Block Coordinator along with a team of Community
Facilitators (each covering around 7-10 villages) will be in place.
Difficult to reach districts will have 1 facilitator for 7 villages and plain
districts will have 1 facilitator for 10 villages.
 To manage the finances, costs for a part time Accountant will also be
provided.
Scale up plans
 The processes initiated in Year-1 (FY 2014-15) would help the state in
developing a robust implementation mechanism to support the scale up in
the next FYs. The details of the scale up plan in the subsequent would
include:
 Year 2 (FY 2015-16)
1. Covering remaining blocks from the districts covered in year one plus
few more blocks in identified districts, upto a total 48 blocks in year two.
2. Creating a pool of master trainers (from existing NGOs/ CBOs) to roll
out structured training for VHSNC and RKS members across the 6
districts.
3. Undertaking a mapping exercise to identify potential NGOs/ CBOs in
the blocks to covered in year two.
4. Selection of NGO/ CBO in the additional districts (across all blocks).
 Year 3 (FY 2016-17)
Completion of remaining blocks across the pending districts.
Details of Programme Scale
District Jammu
S No
1
2
3
Block
Kot Bhalwal
Dansal
Akhnoor
VHSNC
107
106
91
PHC
4
3
8
CHC
0
0
2
4
Marh
90
3
1
Total
Erstwhile District Doda
394
18
3
VHSNC
PHC
CHC
41
82
45
168
2
2
2
6
0
0
1
1
VHSNC
42
61
103
PHC
3
5
8
CHC
1
1
2
S No
Block
1
2
3
Assar (Doda)
Kishtwar (Kishtwar)
Batote (Ramban)
Total
Rajouri District
S No
1
2
Block
Sundarbani
Nowshehra
Total
District Ganderbal
S No
1
2
3
Block
Ganderbal
Laar
Kangan
Total
District Anantnag
VHSNC
21
25
74
120
PHC
4
3
7
14
CHC
1
0
1
2
Block
Achabal
Bijbehera
Mattan
Total
VHSNC
34
48
52
134
PHC
3
6
2
11
CHC
1
1
1
3
S No
Block
VHSNC
PHC
CHC
1
Beerwah
74
8
1
2
Magam
50
2
1
3
Soibugh
40
2
1
4
Khag
40
1
0
Total
204
13
3
S No
1
2
3
District Budgam
CUMULATIVE TOTAL
Districts
6
Blocks
19
VHSNC
1123
PHC
70
CHC
14
 Of the six districts only Rajouri and Erstwhile Doda being hard
to reach districts, shall have 1 facilitator for 7 villages; rest of the 4
districts will have 1 facilitator for 10 villages.
Budget Sheet