Swasth Panchayat Scheme: Handholding Panchayats for Improving ...

Swasth Panchayat Scheme: Handholding Panchayats for Improving HealthPlacing health into Panchayat's agenda and Village Level Health Planning have been majornational priorities for last some years. The general problem in this area is the inability ofcurrent PR structures to identify their actual role in health, to locate the loopholes and to planfor better health status of their constituency. What thus the solution we found is that thePanchayats should be presented a true image of health issues in their area in front of themwhich are otherwise unseen. Towards this, an innovative approach has been developed by theState Health Resource Centre and the same is implemented statewide. This is around a healthcenteredon human development index called SWASTH PANCHAYAT INDEX.26 indicators have been adopted for the first year. Initially it was felt that the number ofindicators chosen is on the higher side, but later we found that to ensure convergence ofvarious health determinants, this would be the minimum. The status on each indicators arecollected at the hamlet level by community health workers called Mitanins (equivalent toASHA under NRHM in the state- the programme is operational for last 3 years in the state withmore than sixty thousand Mitanins) together with women's groups and the PR representativesof the locality. This data has been consolidated later at GP and block levels. To park the actualfocus on hamlet level was because one can compare the status of all hamlets- even thosePanchayats with good segregate status are having one or two hamlets with very weakperformance in many indicators, where they should focus. Also to note that we have not movedbeyond the block level so far for many reasons- the major reason is the homogeneity of a blockas an area in terms of geography, culture and the development outreach and the more youextend your area, the weak is the comparability among Panchayats.Once the actual status on each indicator has been worked out, the next step is giving score oneach indicator and on aggregate. This will make many of the invisible health issues visible. Toreach the score on each indicators, status on each indicators are compared with best possiblestatus as well as the minimum expected level of achievement in the development block - i.e.,how far the para/village/GP is able to move from the minimum level towards the maximumlevel of the block is the score of it on each issue (the minimum/maximum goalposts are set forspecific block, according to the overall status of the block). Best Panchayats will be identifiedwith some criteria not only on aggregate scores, but on the better performance in hamlet(s)which is backward in terms of reach, population groups etc. By this, not only the betterPanchayats are focused, but one can also identify the weaker Panchayats and focus on them toimprove the situation. This ranking actually will provide a health related development databaseof the area where planning can be initiated to improve on each indicator.Currently twelve issues on health services (including the active role of GP bodies-Mitaninslocalcommunity etc in health), four issues on right to food, three issues on water andsanitation, one issue related to school education level are taken. More issues will be added incoming year(s). Six negative health outcomes like malnutrition, LBW, marriages before age,less spacing between children, neonatal deaths, outbreak of WBD has also been added in theindicators- score on this 6 will be subtracted from the aggregate. So far, more than hamletwisedata of 3500 GPs in 70 blocks have been compiled and the first indexing as well as block levelranking of Panchayats done accordingly. Towards this, computer software has been developedwhich will give the scores as well as Panchayat Ranking once the actual status of all

Panchayats in a block is entered. Next step in these blocks/panchayats is to initiate healthplanning process based on this data.Before we initiated the status assessment, massive mobilisation of PRIs have been done in theform of 'Sarpanch/panch Sammelans' (Events in honour of PRI heads) and then village levelorientation was done of active women groups, youth groups and other active individuals withinthe GPs other than the Mitanins in all these blocks/panchayats.One more major point to make is about the Chief Minister's special scheme called SWASTHPANCHAYAT PRATIYOGITA (Healthy Panchayat Competition). This is helping us towardsensuring active role and participation of Panchayats in looking at their health status as part ofthe scheme. We have got an allocation of INR 79 lacs from the state budget from this towardsgiving awards of INR 10000 to the GP ranking top and INR 5000 to the GP performing next inall 146 development blocks. Rest of the allocation shall be used to provide special allocationsfor those GPs emerging as weak as well as for successful implementation of the scheme. Toimplement this scheme so as to award best Panchayats on 26 January 2007, we are going for acampaign approach to collect and validate data on each indicators of all GPs of the state in thecoming December.To say something on the exact impact of the programme, this has developed a different outlookon health at the Panchayat level and almost all Panchayats are into health planning now. Manyof the key health issues that were not addressed seriously earlier at the Panchayat level havenow been started to be attended by our elected representatives wherever this initiative hastaken place. One more major achievement is the working together of number of departments atthe district level. We are into the processes of ensuring this at the state level also. However, theexact impact can be presented after one or two years where we shall be having the baseline aswell as current status of health in these Panchayats.We are sure that this initiative has a potential to leverage change in local governancecountrywide, not only in health. Of course we should supplement it with the practical as wellas technical inputs that are needed to initiate plan as well as implementation at each stage.