Community monitoring model in NRHM

Community-based monitoring is a part of National Rural Health Mission but it is not taking place. Lack of delivery of services at the Primary Health Centres has become the reason for apathy among villagers towards the PHCs. Meanwhile, the business of quacks is on rise. People with any serious disease do not go to the PHC. They take the services of private doctors or go directly to the district hospitals. Under this project, to retain the faith of villagers and improve the services of the PHC, community monitoring was planned and implemented.

Ten local grass-roots organisations showing keen interest in the goals and project activities were selected for interventions at the field level. These partners already had rapport built in the areas where the PHCs were located. Community Monitors to keep watch on the presence of the health officials at the duty hours in the PHCs were selected and oriented. Community monitors were mainly youth and did monitoring of the PHCs for 30 days. Since partner organizations were based locally, the monitoring of the monitors could also be done. But these monitors were paid monitors and were able to complete this process. They produced results in terms of tracking absenteeism and other service delivery.

To sustain this process, community meetings were organized in the 10 villages where PHCs are located by the local partner organizations. Organizations utilized their rapport with the representatives of the Panchayati Raj Institutions (PRIs) and community leaders in the area particular. Volunteer monitors were selected from the village to continuously monitor the hospitals and their services and discuss it with Village Health & Sanitation Committee (VHSC). Several interface meetings between the service providers and recipients were also conducted to improve the understanding between demand and supply side of service delivery.

The sustainability of this model depends on two points: first, if government adopts this community-based monitoring model and institutionalises the process and, second, if the RPRI and community jointly take the decision to carry the model forward through its own revenue.

Project Overview

Delivery of various services through welfare schemes involves huge allocation of budget and expenditure in India, but the outcome of the expenditure is not proportionate that leads a big part of the taxpayers’ money in vain. Absenteeism is one major obstacle especially in the area of health and education that hampers the delivery of services. The National Rural Health Mission (NRHM) is in operation for improving the health service delivery in rural areas for which the expenditure is Rs 14000 crore (US$3.02bn) in 2009-10. Whether the services are reaching and resulting in expected outcomes? Whether people are satisfied and if not, what are the obstacles/barriers?

Raising questions is easy but answering is tough. To get some answers, CUTS Centre for Consumer Action, Research & Training (CUTS CART) executed a project in Tonk district of Rajasthan aiming at ensuring service deliveries in PHCs by measuring absenteeism of health officials through community monitoring, assessing the satisfaction of citizens through Citizen Report Card (CRC), reasoning out the factors responsible for such behaviour through interviewing the service providers and conducting evidence-based advocacy for bringing changes.

About CART

Established in 1996, CUTS Centre for Consumer Action, Research & Training (CUTS CART) is a research and advocacy Centre. This Programme Centre was created as a result of diversification of CUTS in order to move ahead with its inherited agenda: consumer protection and education, and to create a more responsible society. Continuous pioneering work in the area of consumer protection found CUTS CART at the forefront of the consumer movement in India and beyond. So far, the Centre has trained over 1200 activists and created 300 independent groups in Rajasthan and elsewhere. Moreover, CUTS CART is credited to have about 1000 organisations in its network.

With the multiplication in the dimensions of a consumer, the Centre found the mandate of stepping in to several other programmatic areas. Currently, CUTS CART is working consistently on seven programmatic areas through consumer perspective. The outline of these programmatic areas is mentioned below:

• Consumer Education & Protection
• Investor Education & Protection
• Good Governance (with focus on accountability and access to information);
• Utility Reforms
• Sustainable Mobility (which includes road safety)
• Women & Child Rights
• Sustainable Development (which includes MDGs, environment, livelihoods etc)

The Centre has formulated its own mission statement and strategies and has got more than 10 affiliations from all over the world due to its continuous interventions in the country and other parts of the world.

Documentary film

The project has produced a ten minute documentary titled ‘Engaging Communities in Health Services' which depicts CUTS CART interventions.

Access the video here.

Training of Trainers: Workshop on Community Score Card
27 October 2010 - 31 October 2010
CUTS Centre for Consumer Action, Research & Training (CART)
Venue: Jaipur, India

CUTS International is organising a five-day workshop, as part of an ongoing project, to produce master trainers with basic skills to conduct a community scorecard. Renowned resource persons will preside over various sessions of the workshop. The medium will be English.
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Note: Readers are encouraged to contact George Cheriyan, Director, CUTS International & Head, CUTS Centre for Consumer Action, Research & Training (CUTS CART), for any queries about the methodology used in this study or for any other points of clarification. He can be contacted at: or