| Community Monitoring in Health Resources for the Practitioner |
Building Block One: Policy Review for Identifying Health Entitlements and Gaps
The bedrock of community monitoring are the health related entitlements that citizens have. Unfortunately not many among the marginalized are aware of these entitlements. In many cases they are not even aware of the procedures that are necessary to access public services, eg. immunization services, maternal health services etc. Entitlement awareness is the process which is expected to familiarize the marginalised communities to the policy provisions as well as the programmatic procedures which will enable them to access health care services. The process of policy review will help to come up with entitlement related information which can then be converted into written material, become part of the mobilization package tools, and form the basis for community monitoring. The policy review is an essential component of the training curriculum for community mobilisers.
Components of a Policy review – Some of the different components of the policy review are given below:
Converting the Policy Review into educational material – In order to contribute to the process of community monitoring the Policy Review has to be simplified and converted into different kinds of educational material. Simple booklets can be prepared for project staff and for leaders in the community. Leaflets can be prepared for the community at large. Illustrated posters can be prepared and placed in community places.
Components of a Policy review – Some of the different components of the policy review are given below:
- Status of health care services within the public policy framework- According to International Human rights laws to which most countries are signatories, health is a human right ( ICESCR, CEDAW, CRC),and countries have to make provisions for the fulfillment of these rights. Some countries like South Africa have included health as a fundamental right within their constitution. As a part of the policy review it necessary to understand what is the status of health care within the nation public policy framework. Is it a fundamental right or an entitlement? What is the different policies around health care in the country? Is there any provision within public policy for special consideration for marginalized people or special population groups and their health care? Is it equal right for all? What are policy provisions/ laws for case of violation of health care in the country?
- Demographic and health information of the people we are concerned about- What are the key health issues, what is the population, what are the problems faced by them – health issues, social issues economical issues etc. Where are they situated – rural urban, state obligations to meet their demands – health, education, housing sanitation, water etc, Maternal and child health issues in the community, means of livelihood. This information may be available from the Census, Demographic and Health surveys, special surveys conducted by the Government or UN agencies and so on.
- Health System- What is public health care provision system in the country? What is it for rural areas and for urban areas? What are the different levels of health care facilities in the country? What are the provisions for preventive services like immunization of children? What services are available at each level of facilities. What are the services that are supposed to be free? What are the mechanisms for ensuring access to health care services. What is the policy regarding drugs and medicines? Are they free? Is there a system of co-payments?
- Human Resources for Health- Who are the key personnel within the health care system. Who are the health care providers at the each level of facilities, Tasks (role and responsibilities) perform by health professionals of each level.
- Infrastructure- What is basis for allocating health care services – clinic, general practitioner, hospital – how much population are they supposed to be cater to. What are the provisions for emergency care, referral, specialist care. What are the standards for quality of care / services.
- Health Insurance- The criteria, eligibility criteria, what are the benefits, coverage period, how one can get a health insurance card. Is there a feedback and grievance redressal mechanism? National Health Card/insurance: What is the national health card, who gets it, what is the procedure for getting it? What is the coverage available under this card? What happens to them to those who are not covered by this card? How much have those who to pay for health services, uninsured person can avail health services – if yes under what circumstances. Is there any substitute for National health card.
- Health care financing- How is health care related expenditure managed in the country. What is the proportional funds allocated to health? Is there any special fund allocation for marginalized community? What is total fund allocation for health related activities – at the national level and municipal level. What are different component that government cover through funds allocated by them? How is budgeting and funding done for each level?
- Role of Municipality or Local Government- What is the importance of Municipal services in the context of health, eg water supply, sewage collection and disposal, refuse removal, Electricity and gas supply, Municipal health services etc. Who are the responsible authorities, what is the source of funding and so on.
Converting the Policy Review into educational material – In order to contribute to the process of community monitoring the Policy Review has to be simplified and converted into different kinds of educational material. Simple booklets can be prepared for project staff and for leaders in the community. Leaflets can be prepared for the community at large. Illustrated posters can be prepared and placed in community places.
