HR and Health

1. Communitisation of Health Care
Improving Public Services :
the Nagaland Experience
Dr.Lichamo Yanthan
Joint Director of Health
Nagaland kohima

2. Strenght.Nagaland .
16 Major Tribes with each Tribe having Unique
Customs and traditional practices. One of the
best practices is very strong “Bond of
Community Feeling “ One has to listen and do
for the Community when call for “ (Social
Service for Community).This is a traditional
existing social structure

3. Taking advantage of the existing social capital in
the state, the process of Communitization of
health services was initiated in the year 2002.
Goal: Strengthen Health Service delivery
through community participation in
planning, implementation and monitoring of
different health activities towards development
of ownership of health delivery by the
community.

4. Why communitisation?
•Communitization is Partnership’ between
Government and Community ‘working
together”.
•Management of Public Institutions and
sharing responsibilities in order to make them
function optimally in giving quality services.
• For the overall growth and development of
the society.

5. COMMUNITIZATION : Concept! A new word !
• Involves Partnership between Government and Community including
: A new word !
- Transfer of ownership of public resources and assets.
COMMUNITISATION : A new
- Control over service delivery.
- Decentralization, delegation, empowerment and building
word ! new concept!
capacity.
A new concept!
• Based on Triple ‘T’ approach:
- Trust the user community.
ew concept!
- Train them to discharge their newfound responsibilities.
new concept!
-Transfer governmental powers and resources in respect of
management.
“In essence Communitization is half way to Privatization in the
able hands of the user community” capacity.

6. Assembly Passed Nagaland
Commitization of public Services
and Institution Bill in March 2002.
The first of its kind Legislation in the
country.

7. Role of Health Department
• Staff salaries and grant-in-aid for other
purposes
• Manpower posting in all Health Centres
• Training and capacity building of Health
Committees
• Technical support, supervision and guidance in
all matters
• Continuing capacity building to Health
Committees to sustain Communitization

8. i. At village level:
a. Village health Committee:
3 Village Council Member –Member
Secretary VDB 2 Mahila Swasthya Sang
1 Anganwadi Worker,1 dhai, Pastor
Member Secy - Seniormost Health staff
b. Common Health Sub-centre Committee
ii. In towns/urban-based sub-centres
Urban Health Committees were constituted with VHC-like
membership to take control and management of all
urban-based Health Sub-centres in the state.
Iii. At CHC/PHC level
At CHC/PHC level Health Centre Managing Committee
was constituted with representatives of VHCs and village
Councils of all constituent villages and towns falling
within the respective CHC/PHC areas

9. PRESENT STATUS OF COMMUNITISED HEALTH UNIT
Sl.N Health Unit Numbers
o
1 Sub-centres 396
2 PHC 62
3 CHC 21

10. SUCCESS STORIES:
• Improvement in Health workers attendance
Improved
• Availability of Medicines:- with the
decentralization policy of the act empowering the
health committee for procurement of medicines
on need based of the community, the regular
availability of medicines is ensured.
• Active community participation
• Regular Health committee meeting,
• Regular village Health nutrition.
• Sense of ownership

11. Thank You

12. • 3. Active community participation:-
(a). Regular Health committee meeting,
(b). Regular village Health nutrition day is conducted in
all the villages where preventive and promotive services
are provided viz Health
awareness, immunization, antenatal checkup, and general
health checkup and pledges undertaken at district
conferences to advocate Full antenatal checkup for all
pregnant women.
(c). Judicious utilization of funds provided by the
government for infrastructure.( Construction of new Sub
Centre buildings and R/R of existing buildings).
4. ‘ Sense of ownership’ :- As evident from the following:-

13. Public institution/facilities in various sectors .
• Underutilized
• The attendance and performance of the
functionaries not up to the mark
• Recurring expenditure on the items such as
equipments repairs/ and procurement of
consumables are rarely incurred
• Resulting in disuse or sub-optimal use of facilities
• Public expected the Government to deliver
quality services
• Community asset and potentials were not used

14. Main functions of Health Committees
• Take over ownership and management of
Health Centres
• Promote Preventive Health
• Popularise/encourage traditional medicine
and its practitioners.

15. • State Assembly Passed the Nagaland
Communitisation of Public Services and Institutions
Concept note
discussed
State Cabinet
decides to
Bill, 2002 In March 2002
Concept Mooted
among officials,
civil society
adopt the proposal Legal Basis
Provided through
• nb members Ordinance
• First such legislation in India
• NNagaland Assembly passed The nagaland Public
Mid 2001 August-December January 2002 January 2002
2001

16. Community participate in Health care Delivery
• Donation/contribution in cash and kinds from the community
for the maintenance of the Health unit building.
• Donation of community land for construction of Sub-centre
building.
• Community providing building for Health centre.
• Regular conduct of cleanliness drive in the village.
• Construction of toilet and waiting shed for the Health unit by
the community.
• Construction of approach road.
• Construction of fencing.
• Provision of water supply.
• Community taking up wiring and electrification of Health unit
• Maintenance of kitchen garden, orchard etc to generate
income for sustenance’s of health unit.

17. Challenges in Providing Quality Health Care Services
in Nagaland
•Five Decade old Conflict situation
•Peace Process violence continues
•Fatigued and Confused Systems
•Widespread Cynics of Govt.Instits
•Social Capital needs to be Explored

18. PROPOSED EXPENDITURE FOR COMMUNITIZATION ACTIVITIES UNDER THE
DEPARTMENT OF HEALTH & FAMILY WELFARE 2011-12.
Sl.No Activities Expenditure (Rs. in lacs)
Essential Medicine:
1 Sub-centre Rs. 62.00
310 x Rs. 0.20 = Rs. 21.75
87 x Rs. 0.25 = Rs. 50.00
PHC Rs. 10.50
100 x Rs. 0.50 =
CHC
21 x Rs. 0.50 =
Training/ Capacity building:
2 Sub-centre/ VHC Rs. 19.85
PHC/CHC/HCMC Rs. 7.26
Supervision/ Monitoring:
3 a. State level review meeting Rs. 2.00
b. Nodal officer visit to the district Rs. 1.00
c. Monitoring by the district level officers Rs. 6.60
d. District level review meeting Rs. 3.30
e. Monitoring/ supervision by the state level officers Rs. 30.50
f. State level publication/ documentation/ evaluation Rs. 30.00
g. District level Health committee conference Rs. 11.00
h. Award to the best functioning sub-centre Rs. 2.42
4 Emergency fund to the VHC Rs. 19.85
5 Inter district exposure trip Rs. 8.25
6 Minor repair/ renovation of the sub-centre Rs. 63.60
7 Mobility support to state / district officers for monitoring and supervision Rs. 150.00
Total Rs. 500.00
( Rupees five hundred lacs ) only

19. I.SUPPORT BY GOVERNMENT TOWARDS COMMUNITIZATION OVER
THE YEARS
• a. Infrastructure development
• Sub-centre building constructed….. 101.
• Imparting continuous training to VHC/HCMC/stake holders.
• Regular allocation of fund for purchased of medicines.
• Providing emergency fund to the Health Committee.
• Supporting exposure trip of Health Committee Member/stake holders
organizing district conferences for Health Committee Member/stake
holders.
• Mobility support for district officials/state officials for supportive
supervision and monitoring.
• Review meeting for district/state level officials.
Impact assessment by the third party by UNICEF
• Evaluation Department, Government of Nagaland.
• On going documentation of Communitization activity (Audio visual ) by
IPR, Government of Nagaland.

20. REPORT ON COMMUNITIZATION
Ever since the implementation of Communitization
in the state by Nagaland Communitization of Public
institution and service act, 27th march 2002 the impact on
Rural Health Sectors has been very encouraging. The
success story in the Health sector especially at the rural
level is manifold viz : in service delivery, availability of
medicines, maintenance of Health Unit, access to health
facilities and the regularity of Health Staff has been
improved with the active participation of the community.
At present, all the Rural Health Unit has come under the
Communitization Act viz.397 Sub-centres, 100 PHCs, and
21 CHCs, The effort of the department being
supplemented by the NRHM has improved
tremendously, the health care delivery system in the

21. Sub Centre Building donated by community

24. • a. Donation/contribution in cash and kinds from the community for
the maintenance of the Health unit building.
b. Donation of community land for construction of Sub-centre
building.
C. Community providing building for Health centre.
d. Regular conduct of cleanliness drive in the village.
e. Construction of toilet and waiting shed for the Health unit
by the community.
f.Construction of approach road.
g. Construction of fencing.
h. Provision of water supply.
i. Community taking up wiring and electrification of Health
unit.
J. Maintenance of kitchen garden, orchard etc to generate
income for sustenance’s of health unit.

25. 6. Improving good health practices:-
a. Behavioral change in seeking timely medical help.
b. Segregating rearing of live stocks from house hold.
C. Adoption of sanitary toilet.
d. Provision of safe drinking water supply.
e. Maintenance of cleanliness in and around village.
f. Use of bed net.
g. Encouraging result in small family norms.

26. DIFFICULTIES:
An effective implementation of Communitisation is difficult due to the many hurdles
the department of health & family welfare face, some of the difficulties that need to be
address urgently are given below:-
(1) Shortage of accommodation for staff:-
Many health unit ( Sub-centre) does not have Sub Centre building and accommodation
facility for health workers and with non-availability of house for renting in many of the rural
setup, the plight of the healthworkers need to be addressed urgently.
(2) Shortage of Health units as per population norms compounded by the problem of difficulty
terrain, the state is unable to provide uniform health care services to all the villages.
(3) Inadequate mobility support for supportive supervision and monitoring activity.
(4) Variable responds to behavioral changes towards adopting good health practices from area
to area due to socio-economic and cultural influences requires a concerted effort from all
stake holders.