Decentralising Health Planning in Rajasthan

The discourse on governance is intricately intertwined around the role of citizens in influencing the forces that govern their lives. Agency, engagement and participation of citizens make governance inclusive. Inclusive governance implies equal participation of both men and women. The 73rd and 74th Constitutional Amendments have accorded Indian women an opportunity for political representation. Despite such provisions, most face constraints in pursuing a political career, due to various personal, social and institutional reasons. Gendered identities and practices limit their capacities to articulate and act upon their claims and concerns.

With an aim to mainstreaming the issue of gender in the panchayats, and to make these institutions of local governance more gender responsive, PRIA launched 'Strengthening Gender Response of Panchayats in Rajasthan'. The project enabled panchayats to optimally utilise their mandates and institutional resources. Enhanced capacities of members of a CSO network, which are physically proximate and accessible to the panchayats, acted as a sustainable support system in this regard. Public pressure was built to create an enabling environment to address the issues of maternal mortality and sex selection by panchayats.

Objectives

The primary aim was to make the issues of maternal mortality and sex selection priority agendas for panchayats to address. Panchayats were sufficiently supported by a capable CSO network to address these issues more effectively and efficiently.

Geographical spread

State of Rajasthan, India

Key areas/components

1. Establish a pan‐Rajasthan civil society network to work towards educating and advocating gender issues in panchayats (in particular maternal mortality and sex selection). CSOs act as local support groups, always available to panchayats to provide appropriate support on gender and governance issues.
2. Develop appropriate tools and methods to address maternal mortality and sex selection and pilot them to test their efficacy in panchayats.
3. Sensitisation of media on gender issues. Institutional collaborations between the CSO network and local media increased to influence government policies and programmes addressing maternal mortality and sex selection at the panchayat level.
4. Engaging with district and state level institutions to respond to the demands to address maternal mortality and sex selection issues at each level.
5. Influence processes of planning, budgeting and implementation of annual health plans of local governments to make them gender responsive.
6. Capacity building of CSOs.
7. Capacity building workshops for elected representatives.
8. State level advocacy workshops.
9. Document learning materials and case studies.

Outputs

• A network of civil society organisations (CSOs) created in Rajasthan to strengthen the gender agenda in panchayats.
• Training and sensitising 2580 elected representatives, 3154 Village Health, Sanitation and Nutrition Committee (VHSNC) members and 700 community based organizations on the issues of maternal mortality and sex selection.
• Gram sabhas and panchayat meetings have begun to prioritise women's issues (including maternal health and sex selection).
• 8 bed maternity ward constructed in Public Health Units (PHUs) in Etava gram panchayat, Govindgarh district through the gram panchayat's initiative and community contribution.
• Parbatsar block panchayat in Nagaur district initiated the practice of issuing "Badhai Patra" (congratulatory letter) to the parents of a newborn girl child. The practice was replicated by other districts (Sirohi, Sawai Madhopur, Govindgarh and Banswara).
• Ranjitpura gram panchayat, Hanumangarh district by engaging on the issues of maternal health has ensured 100% institutional delivery in coordination with VHSNCs.
• Regular and informed meetings of VHSNCs are being held, followed by proactive initiatives to address health issues at the village level through appropriate utilisation of untied grants.
• Social Justice and Social Welfare Committees (SJSWC) (the standing committee of the panchayat responsible for primary health care) have been activated and regularly interface with VHSNCs. VHNSCs are taking the lead in initiating participatory health planning at the village level in collaboration with SJSWC.
• 70 participatory health plans prepared by VHSNC and SJSWC and owned by the respective gram panchayats. Gram panchayats 'owned' the health plan after discussion and presented the plan (as well as possible implementation from the gram panchayat's own resources) to the gram sabha for discussions and feedback. The gram sabha approved the plan after suitable revision to make it a legitimate participatory health plan of the gram panchayat. This helped institutionalise the demand for health services.
• Some gram panchayats have initiated implementation of some components of the health plan from their own resources (including available resources under various other schemes)
• Panchayats have been linked with the health delivery system. Gram panchayats capacitated to interface with their panchayat samitis and zilla parishads in accessing resources from the government health delivery system such as District Health Society and offices of the Collector, health department and panchayat department.
• Multi stakeholder dialogues organised in each of the 13 intervened districts to encourage convergence and complementation among different actors for implementation of health plans prepared by the panchayats. This also provided an opportunity to catalyze district level environment in favour of collaborations between panchayats and the health department around women's health in particular and primary health in general.
• Assured responses from the supply side: During the multi stakeholder dialogues as well as otherwise, the health department and district administration promised to support implementation of parts of the village health plan by providing resources available under NRHM or other schemes.
• Collaborations between people, panchayats and the government have been initiated at the local level and highlighted at the state level for suitable scaling up and appropriate policy changes for self-sustenance.

Key Lessons Learnt

• Need to create convergence between the panchayati raj department and health departments
• Central schemes must be integrated at the panchayat level to be more effective
• Roles for panchayats and other agencies need to be delineated clearly
• Merge committees for health with the SJSWC
• Make all agencies for health accountable to PRIs
• Make health plans a sub‐plan of the panchayat plan
• Get the gram sabha to approve health plans
• Provide capacity‐building and gender‐sensitisation trainings to panchayat members
• Dovetail NRHM's funds with panchayat resources for health
• Link the VHSNC and SJSWC meetings
• All proceedings related to health should be made transparent
• Create model health sub-centres to promote better health care for women through community participation

Year/period

3 years (Phase I: 2010 – 2011, and Phase II: 2011 – 2013)

Client

UNFPA