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Community participaion

Community participation

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LESSON PLANSpeaker: Dr. S.Sudharshini

Topic: COMMUNITY PARTICIPATION

Date: 27– 09 – 2011

Day: Tuesday

Time: 02.00 p.m.

Duration: 75 minutes

Method: Socratic Method of Lecture

Audience: Post Graduates And Faculty,

Institute Of Community Medicine,MMC, Chennai.

A-V-Aids: LCD projector

Evaluation: Concurrent and Terminal12/04/2023 2

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OBJECTIVES

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• At the end of the session the audience should be able to:– Define community participation– List the core features of community participation– List the advantages and disadvantages of

community participation.– List the stages of community participation.– List and describe the steps involved in

community participation.– List and describe Participatory Rural Appraisal

technique.

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Session overviewSUB HEADINGS Time break up

(in minutes)

Introduction 8

Definition 8

CORE FEATURES 4

ADVANTAGES OF COMMUNITY PARTICIPATION. 4

STAGES,DEGREE &LADDER OF COMMUNITY PARTICIPATION. 6

DISADVANTAGES OF COMMUNITY PARTICIPATION. 2

COMMUNITY ACTION CYCLE 12

PRA AND ITS TECHNIQUES 15

Community participation in health 15

Total 74

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Source: NVBDCP, New Delhi, India

MALARIA INCIDENCE IN INDIA

NMCP 1953-56

NMEP-1958 UMS MPO-PFCP EMCP-RBM NVBDCP

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Introduction • Development intervention approaches in INDIA over the past

60 years have been very much a ‘supply oriented one way traffic’.

• The limitations of the approaches which we had been following include:

• A top down approach• Target oriented• Non involvement of the people• Vertically controlled sectoral approach without any horizontal coordination

at the micro level.• The dominant development thinking oriented towards greater inputs

(supply) than what people demanded.• Near total absence of self confidence and even self respect.• Lack of appreciation and promotion of indigenous technical knowledge and

resources.• The ever growing recipient attitude.

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THE MAIN CHALLENGE

• Dislodge the strong dependency culture.• Help them regain their self image and self

respect• Create in them a strong sense of public

consciousness to care about and to stand as the sentinel on the community infrastructure.

• Prepare and transform them to realize the need for community led initiatives.

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Key to the challenge

• The basic logic for the success of any intervention in development and work depends on the confidence built and the power given to people to decide and take community initiatives. Consensus is its key.

• The primary factor for promoting consensus and instilling confidence is participation.

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What is a Community A Community is a set of people living together

with common interest”

We all live in a community. There are different things that bind us together. Let us try to identify them.

Occupation Language Territory Beliefs Values Religion Culture

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What is participation?

•Oxford dictionary defines participation as “to have a share in ” or “ to take part in”.

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Definition of community participation

• A process by which individuals and families assume responsibility of their own health and develop their capacity to contribute to development .

• Enables them to become agents for their own development instead of being passive beneficiaries of development aid.

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Definition

• a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change’ (WHO, 2002, p.10).

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A more detailed definition of community participation

Shaping PlanningMobilisin

g and training

Implementing

Evaluating and

monitoring

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CORE FEATURES OF PARTICIPATION

• It is a voluntary involvement of the people• The people who participate influence and

share control over development initiatives, decisions and resources.

• It is a process of involvement of people in different stages of the programme.

• The ultimate aim is to improve the well being of the people who participate.

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Participatory development and participation in development

Participatory development Participation in development

A top down participation in the sense that the management of the project defines where, when and how much the people can participate.

Bottom up participation in the sense that the local people have full control over the processes and the project provides for necessary flexibility.

It is introduced within the predetermined project framework.

Entails genuine efforts to engage in practices which openly and radically encourage people’s participation.

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PARTICIPATION AS A MEAN AND AS AN END

Participation as a mean Participation as an end

It implies use of participation to achieve some predetermined goal or objective

It attempts to empower people to participate in their own development more meaningfully.

An attempt to utilise the existing resource to achieve the objective of programmes or project

An attempt to ensure increased role of people in development initiative.

Emphasis is on achieving the objective and not on the act of participation itself.

The focus is on improving the ability of the people to participate.

Participation is generally short term Participation as an end is viewed as a long term

Participation as a means appears to be a passive form of participation.

Participation as an end is relatively m ore active and dynamic.

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WHY COMMUNITY PARTICIPATION IS IMPORTANT?

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“As an individual I could do nothing. As a group we

could find a way to solve each other’s problems”.

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WHY PARTICIPATION MATTERS???• Providing an open forum for the community to discuss its problems

and find indigenous solutions which may be efficient and economical.

• Making people aware of their needs.

• Results in better decisions

• People are more likely to implement the decisions that they made

themselves rather than the decisions imposed on them.

• Motivation is frequently enhanced by setting up of goals during the

participatory decision making process.

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WHY PARTICIPATION MATTERS???

• Participation improves communication and cooperation.

• Identification and development of the local resources, thereby

generating self reliance among the community.

• To develop local leaders who can further educate and mobilise the

people in the area.

• People may learn new skills through participation; leadership

potential may be identified and developed.

• Higher achievement at a lower cost.

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Stages of participation

Level I.

•Community receives benefits from the service but contributes nothing

Level II

•Some personnel, financial or material contribution from the community ,but not involved in decision making.

Level

III

•Community participates in lower level decision making

Level

IV

•Participation goes beyond lower level decision making to monitoring and policy making

Level V

•program is entirely run by the community ,except for some external financial and technical assistance.

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DEGREES OF COMMUNITY PARTICIPATIONAw

ay fr

om o

wner

ship

and s

ustai

nabili

ty

Tow

ard

owne

rshi

p an

d su

stai

nabi

lityCollective action

Co-learning

Cooperation

Consultation

Compliance

Co-option

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DEGREES OF COMMUNITY PARTICIPATION

• Co-option• Token involvement of local people• Representatives are chosen, but have no real input or

power

• Compliance• Tasks are assigned, with INCENTIVES• Outsiders decide agenda and direct the process

• Consultation• Local opinions are asked• Outsiders analyze and decide on a course of action.

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• Cooperation• Local people work together with outsiders to

determine priorities• Responsibility remains with outsiders for directing the

process

• Co-learning• Local people and outsiders share their knowledge to

create new understanding• Local people and outsiders work together to form

action plans with outsiders facilitation

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Delegated power

placation

consultation

informing

therapy

manipulation

Citizen control

partnershipDegree of citizen power

Degree of tokenism

Non participation

Original Arnstein's ladder of participation

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DISADVANTAGES OF COMMUNITY PARTICIPATION

• Participation does not occur automatically. It is a process. It involves time. Hence it may lead to delayed start of a project.

• In a bottom-up participation process, we have to move along the path decided by the local people. This entails an increased requirement of material as well as human resources.

• Participation leads to decentralization of power. People at the top should be ready and willing to share power with the people.

• Participation sometimes develop dependency syndrome.

• Participation can result in shifting of the burden into the poor.

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Community Action Cycle

Prepare to scale up

Prepare to mobilize Organize the community For action

Evaluate together

Explore the common issue & Set priorities

Act together

Plan together

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How can you build community participationcommunity mobilization

• A process whereby a group of people become aware of a shared concern or common need and decide to take action in order to create shared benefits. (Joint United Nations Programmed on HIV/AIDS)

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Role of Community Mobiliser

A mobiliser is a person who mobilizes, i.e. gets things moving. Social animator. A Catalyst

• Bringing People Together• Building Trust• Encouraging Participation• Facilitating Discussion and Decision-making• Helping Things to Run Smoothly . • Facilitation in community mobilization process

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Some Qualities • Good communication skills• Good facilitation skills• Good listener• Committed• Decision maker• Active• Negotiation skills• Honest• Known to culture and values of society• Well dressed• Catalyst • Conflict resolution.• Management skills

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Community diagnosis

• What are the main problems?• What are the underlying causes?• What are the resources available?• Focus is identification of basic health needs

or health problems of the community (felt need) and the factors contributing to it.

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Action plan

• Steps taken to meet the health needs of the community based on the resources available and the wishes of the people (felt need).

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Participatory Rural Appraisal

• PRA is “a family of approaches and methods to enable local (rural or urban) people to express, share, enhance, and analyze their knowledge of life and conditions, to plan and to act.” (Mascarenhas et al., 1991)

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PRA• Participatory Rural Appraisal is a methodology for

interacting with villagers/community, understanding them and learning from them.

• It shifts the initiative from outsider to villager.• PRA seeks to empower. It empowers the weak, the

powerless and the marginalised, by enabling them to anlyse, discuss and deliberate on their condition.

• Believes in flexibility in choosing methods.• Reversal of learning.

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PRA Techniques / Tools• Village mapping• Transect walks • Mobility mapping• Seasonal Diagram• Matrix scoring and ranking• Trend analysis • Venn Diagram• Daily activity Chart• Force Field Analysis• Causal Impact Diagram• All undertaken by local people.

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Participatory mapping/modelling

• using local materials, villagers draw or model current or historical conditions. This technique is used to show water sheds, forests, farms, houses, hospital or dispensary distance, wealth ranking, household assets, land use patterns, health and welfare conditions and distribution of various resources.

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Transect Walks/Group Walk• The researcher and key informant conduct a

walking tour through the areas of interest to observe, to listen, to identify different zones or conditions, ask relevant questions to identify solutions

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MOBILITY MAPPING

• A map drawn by the people to explore the movement pattern of an individual,a group or a community.

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Seasonal calendar

• Diagram drawn by villagers with locally available materials

• Depicting Local language months, seasons• Festivals/ social events, crops grown• Occupation / income generation • Periods of plenty/ scarcity• Common diseases

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Seasonal calendar

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Daily Activity chart• Daily Activity Clock illustrates the different kinds of activities

carried out in one day.• Time management - Effective utilisation of time

• To look at relative work-loads in different groups.• How is his or her time spent?• Whether the leisure time is spent usefully ?• Period of relaxation, recreation, physical activity, Personal care, rest.• Income generation, productive work, community work • Whether women spend more time in collecting water and

firewood?

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Daily Activity chart

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Venn diagram• To know the individual and institutional linkages

and relationships with the community.• Visual depiction of key institutions, organisations

and individuals active in the community, responsible for taking decisions.

• Degree of contact between them in decision-making• Size of circle – importance• Degree of overlap – Degree of contact

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Venn diagram

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Venn diagram

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FLOW DIAGRAMSCAUSAL AND IMPACT DIAGRAMS

• To identify the causal factors of health problems

• The various impacts of diseases, as perceived by the villagers.

• This also acts a planning and evaluation tool.

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Trend analysis

• Attempts to study people’s account of the past of how things that were closer to them have changed at different points of time.

• A useful tool for monitoring and evaluating a project.

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Pair wise ranking

• Compares pairs of elements, such as the preference for needs, problems, etc.

• Leads to analysis of the decision making rationale.

item A B C D score rank

A _ A C A 2 2

B _ C B 1 3

C _ C 3 1

D _ 0 4

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Impact / Matrix ranking and scoring

• To rank the problems in the community based on the intensity, the need for immediate or late action.

• Helps to prioritise the problems and needs. Effective service

Easy accessibility

Trust Friendly approach

Timely help

Total score

rank

Panchayat

35 35 30 45 15 160 1

School 20 30 30 10 30 120 2

Health centre

15 20 25 30 10 100 3

institution

criterion

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Force field analysis

• Developed by Kurt Lewin• Technique to visually identify and analyse

forces affecting a problem situation so as to plan a positive change.

Kurt Lewin

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Interviewing and dialogues

• Semi structured interview• Focus group discussion• Direct observation

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PROCESS OF COMMUNITY PARTICIPATION IN HEALTH PROGRAMMES

Analysis of the needs and requirements of the people in the community

Designing the primary health program to meet the needs of the people with the involvement of the people.

Educating the people through formal and informal channels to make them aware of the program and utilizing the resources available with them

Kindling and generating interest among people to keep up the momentum through the provision of resources not available locally.

Leaving the program to the care of the people with aided guidance

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Providing aided guidance to handover the programme to the people

Occasional follow up to sort out any problem

Birth of a permanent community managed PHC

Birth of a healthy society

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QUALITATIVE ANALYSIS OF COMMUNITY PARTICIPATION

• How much does the community know about the programme? • How much do they know about the organization carrying out the programme?

• How often do they come face to face with the programme personnel?

• What responsibilities do they carry out on behalf of the programme?

• What kinds of difficulties do they find in undertaking these responsibilities?

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QUALITATIVE ANALYSIS OF COMMUNITY PARTICIPATION

• How satisfied are they with the involvement in the programme and why?

• Do they have any suggestions to improve their participation in the programme?

• Are all sections of the community equally involved in the programme?

• If there is a differential advantage to some group, why does it happen and who gets the preferential advantage?

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OBSTACLES TO COMMUNITY PARTICIPATION

• Absence of confidence and ability of people in the machinery of health administration.

• Unequal domination of power relations in favour of rich and to the disadvantage of the poorer sections of the society.

• Inaccessible services in right quantity and quality

• Rigid bureacratic set up impeding the people to participate.

• Legal hurdles

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OBSTACLES TO COMMUNITY PARTICIPATION

• Inadequate understanding of local talent, abilities and resources.

• Absence of identity with the community among people.

• People’s dependence on GOVERNMENT and not on their self

• Heterogenity of interests

• Resistance to empower people

• Resistance on the part of certain segment of population to participate

• Sustained efforts missing

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Guiding principles to resolve the obstacles

• Channelizing the NGO’s to promote health plans • Effective training of Health personnel in

Appropriate technology• Responsive administration

• Openness in the sense of having wide contact with the people• A sense of justice, fair play and impartiality in dealing with

men and matters.• Sensitivity and responsiveness to the urges, feeling and

aspirations of the common man.• Securing the honour and dignity of the human being ,however

humble s/he might be.• easy accessibilty.• Honesty and integrity in thought and action.

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Guiding principles to resolve the obstacles

• Effective public relations• Spread of awareness about the health activities of

the government with the expectations and aspirations of the people.• Speedy redressal of public grievances through a

systematic and well thought out mechanism.

• Sound health system• Empowerment of the poor• Developing social networks

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The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000.

The Primary Health Care Movement towards Health for All by 2000AD Alma Ata, 1977

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Alma atta declaration

• The Alma Ata Declaration defined PHC as “essential health care based on practical, scientifically sound, and socially acceptable methods and technology

• made universally accessible to individuals and families in the community

• through their full participation and • at a cost that the community and country can afford

to maintain at every stage of their development• in the spirit of self-reliance and self-determination”

(WHO, Alma Ata Declaration VI, 1978, p.1).

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• Emphasis from “Health care for the people”

“Health care by the people” concept of primary health care

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COMMUNITY PARTICIPATION IN INDIA

• The establishment of primary health units at the village level to bring the service as close to the people as possible, cooperation of the people in the health programme, and adequate medical care for all individuals, irrespective of their ability to pay for it, were included in the Bhore Report.

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COMMUNITY PARTICIPATION IN INDIA

• the Community Development Programme launched in 1952, the setting up of one Primary Health Centre (PHC) per Block was accepted by the Central Council of Health in 1953 .

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THE SHRIVASTAVA COMMITTEE: The employment of paraprofessional or semi-professional workers from the community itself as a link between the Sub-Centers and the community to provide simple services was one proposal.

they opted for the Community Health Worker scheme to meet the insufficiency of doctors.

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• The state of National Emergency under Congress rule from 1975 to 1977 with its forcible campaign to control population growth was shortly replaced by community-oriented approaches of the Bharatiya Janata Party (BJP) government.

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THE COMMUNITY HEALTH VOLUNTEER SCHEME

THE NATIONAL PLANNING COMMITTEE 1946. It was planned to train young men from the villages for 9 month in simple curative care and hygiene for primary health service at the village level.

Program was withdrawn in 1951 .voluntary agencies which picked up the idea in the 1960ies and

1970ies, and used auxiliary personnel for the delivery of primary health care.

Successes from the voluntary sector in India received international recognition and together with the China example of “barefoot” doctors served as role models for the Indian government

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THE COMMUNITY HEALTH VOLUNTEER SCHEME

• the Bharatiya Janata Party (BJP) government came to power in 1977, it adopted the approach but changed the length of training to 3 month. Additionally, it was planned to add one doctor per Primary Health Centre for training purposes.

• The implementation progress was slow and further delayed by the reelection of Congress in 1980

• The new government renamed the programme in Community Health Volunteers (CHV)

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SELECTION OF CHV

• The community used to select one of its own members as the community health volunteer or the VHW.

• The most common procedure adopted for selection of VHGs was that Village Panchayats (village self-government councils) recommended two or three names to the primary health centre .

• A final decision made by a committee consisting of Medical Officer, Block Development Officer and the elected chairperson of the Block Panchayat Committee.

• Although the selection was to be made in an open meeting of the total village council, in practice, most often, only a few important village leaders were involved in the selection.

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PROBLEMS ENCOUNTERED BY CHVS• in 1981, the central government had decided to reduce its contribution from

100 to 50 percent of the costs of the scheme and asked the State Government to meet the remainder.

• Later, following the conviction that women should be employed as VHGs, the central government decided to fund the scheme fully once again.

• All this led to employment considerations becoming more important to VHGs than social service and ultimately they were demanding for higher remuneration.

• One of the main issues enveloping the VHGs was their 'medicalization'.Trained for three months, they focused on providing curative services, to the neglect of preventive and promotive tasks.

• The VHGs began to perceive themselves as village medical practitioners, often even demanding further training for this purpose.

• Poor role definition

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THE INTEGRATED CHILD DEVELOPMENT SERVICE SCHEME,1975

The programme is community-based.

A local woman is selected and trained for three month to become the Anganwadi worker.

She then works in the village covering a population of 1000.

In the Anganwadi centre (childcare centre) she prepares and distributes food, maintains growth charts, weighs children and gives non-formal education to the beneficiaries.

The Anganwadi also cooperates with the Primary Health Centre staff for health check up, immunization and referral.

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THE PROBLEMS ENCOUNTERED BY ICDS

• Communication with the health staff of Primary Health Centres was weak.

• The programme was more perceived as a feeding scheme by the communities and demand for health services did not increase.

• The educational efforts fell short to increase health knowledge of mothers, thus, prevention of malnourishment was not achieved.

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COMMUNITY PARTICIPATION IN NATIONAL FAMILY WELFARE PROGRAM-

MAHILA SWASTHYA SANGHS

• CONSTITUTED IN 1990-1991• CONSISTS OF 15 WOMEN , 10 representing the varied

social segments in the community • five functionaries involved in women's welfare

activities at village level such as the Adult Education Instructor, Anganwadi Worker, Primary School Teacher, Mahila Mukhya Sevika and the Dai. Auxiliary Nurse Midwife(ANM) is the Member-Convenor.

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COMMUNITY PARTICIPATION IN NRHM

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VILLAGE HEALTH AND SANITATIONCOMMITTEE (VHSC)

This committee would be formed at the level of therevenue village (more than one such villages may comeunder a single Gram Panchayat).• COMPOSITIONThe Village Health Committee would consist of:

» Gram Panchayat members from the village» ASHA, Anganwadi Sevika, ANM» SHG leader, village representative of any Community based

organisation working in the village, user group representative

• CHAIRPERSON the Panchayat member (preferably woman or SC or ST candidate.)

• CONVENOR ASHA if not Anganwadi Sevika• TRAINING The members would be given orientation training toequip them to provide leadership as well as plan andmonitor the health activities at the village level.

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SOME ROLES OF THE VHSC

Create Public Awareness about the essentials of health programmes, with focus on People’s knowledge of entitlements to enable their involvement in the monitoring

Discuss and develop a Village Health Plan based on an assessment of the village situation and priorities identified by the village community.

Analyze key issues and problems related to village level health and nutrition activities, give feedback on these to relevant functionaries and officials. Present an annual health report of the village in the Gram Sabha.

Participatory Rapid Assessment to ascertain the major health problems and health related issues in the village. Mapping will be done through participatory methods with involvement of all strata of people. The health mapping exercise shall provide quantitative and qualitative data to understand the health profile of the village.

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ROLES OF VHSC Maintenance of a village health register and health information

board/calendar: The health register and board will have information about mandated services, along with services actually rendered to all pregnant women, new born and infants, people suffering from chronic diseases etc. Similarly dates of visit and activities expected to be performed during each visits by health functionaries may be displayed and monitored by means of a Village health calendar

Ensure that the ANM and MPW visit the village on the fixed days and perform the stipulated activity;oversee the work of village health and nutrition functionaries like ANM, MPW and AWW

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PHC Monitoring and PlanningCommittee

• This Committee monitors the functioning of Sub-centres operating under jurisdiction of the PHC and develops PHC health plan after consolidating the village health plans.

Composition• 30% members from PRI (from the PHC coverage area;2 or more sarpanchs of

which at least one is a woman)

• 20% members non-official representatives from VHSC, (under the jurisdiction of the PHC, with annual rotation to enable representation from all the villages)

• 20% members representatives from NGOs / CBOs and People’s organizations working on Community health and health rights in the area covered by the PHC

• 30% members representatives of the Health and Nutrition Care providers, including the Medical Officer – Primary Health Centre and at least one ANM working in the PHC area

• CHAIRPERSON: Panchayat Samiti member,• EXECUTIVE CHAIRPERSON: Medical officer of the PHC,

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BLOCK MONITORING AND PLANNINGCOMMITTEE

• This Committee monitors the progress made at the PHC level health facilities in the block, including CHC and develops annual action plan for the Block after consolidating PHS level health plans.

• COMPOSITION• 30% - representatives of the Block Panchayat Samiti (Adhyaksha/Adhyakshika or

members with at least one woman)• 20% - non-official representatives from the PHC health committees in the block,

with annual rotation to enable representation from all PHCs over time• 20% - from NGOs/CBOs and People’s organizations working on Community

health and health rights in the block, and involved in facilitating monitoring of health services

• 20% - officials such as the BMO, the BDO, selected MO’s from PHCs of the block • 10% - CHC level Rogi Kalyan Samiti• CHAIRPERSON: Block Panchayat Samiti representative,• EXECUTIVE CHAIRPERSON: Block medical officer,• SECRETARY: NGO / CBO representatives

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ROGI KALYAN SAMITI (RKS) /PATIENT WELFARE COMMITTEE/HOSPITAL MANAGEMENT

COMMITTEE (HMC) . This initiative is taken to bring in the community ownership in running of rural

hospitals and health centres, which will in turn make them accountable and responsible.

• BROAD OBJECTIVES OF RKS• Ensure compliance to minimal standard for facility and hospital care

• Ensure accountability of the public health providers to the community

• Upgrade and modernize the health services provided by the hospital

• Supervise the implementation of National Health Program

• Set up a Grievance Mechanism System

• at PHC and CHC will have the mandate to undertake and supervise improvement and maintenance of physical infrastructure. RKS would also develop annual plans to reach the IPHS standards.*

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• RKS would be a registered society.• It may consists of following members

Group of users i.e. people from community Panchayati Raj representatives

NGOs Health professionals

• According to IPHS, it is mandatory for every CHC to have “Rogi Kalyan Samiti” to ensure accountability.

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MICROFILARIA RATE IN INDIA

Source: NVBDCP, New Delhi, India

NFCP 1955 NHP

MDA

NVBDCPELIMINATION-2015

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INDIA’S COMMUNITY PARTICIPATION LAW: THE MODEL NAGARA RAJ BILL, 2008

• The Model Nagara Raj Bill, 2008 (hereinafter ‘the Bill’) is India’s first community participation legislation and creates a new tier of decision making in each municipality called the Area Sabha.

• The Bill is a mandatory reform under the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), which means that the various states in India must enact a community participation law to be eligible for funds under the JNNURM program.

• This is crucial because the Bill has the potential to empower people by ensuring regular citizen participation in decision-making that affects the conditions of their lives.

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Thank you

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REFERENCES1. Participatory rural appraisal ,principles, methods and application ,N.Narayanaswamy,2002. Primary health care management,chapter 3, community participation ,pg 76-101.3. Community participation in local health and sustainable development Approaches and

techniques European Sustainable Development and Health Series: 44. Training Manual On Community Participation, Ms. Bismita Dass 5. Community Participation, How People Power Brings Sustainable Benefits to Communities J.

Norman Reid USDA Rural Development Office of Community Development June 2000 6. Developing a Good Practice Guide to Community Participation, Community Participation

Project ,March 2008, Inner City Organisations Network/North West Inner City Network7. National Rural Health Mission, A Promise of Better Healthcare Service for the Poor, A

summary of Community Entitlements and Mechanisms for Community Participation and Ownership For Community Leaders Prepared for Community Monitoring of NRHM - First Phase

8. E:\community participation\community participation\India’s Community Participation Law The Model Nagara Raj Bill, 2008 Critical Twenties.htm

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