Activating Spaces, Scaling Up Voices: Community-based Monitoring of Health Services in Maharashtra, India
From 2007 onwards, the Indian government’s National Health Mission supported civil society networks to carry out large-scale, participatory monitoring to improve health service access and quality under the Community-Based Monitoring and Planning (CBMP) program. In the state of Maharashtra, this social accountability initiative created networks both within society and with service providers. It reached many regions across a very large state and endured more than a decade and a half, despite constraints and uncertain government funding. Civil society networks developed under the program retained autonomy and reinvented themselves during the Covid-19 pandemic to enable citizens access to health services.
The CBMP program in Maharashtra supported statewide civil society networks to enable active citizen participation in health oversight committees. It began with an intensive period of promoting grassroots awareness about health service entitlements. It was rooted in a broad network of diverse community-based and civil society organizations engaged with socially excluded communities, led by Support for Advocacy and Training to Health Initiatives (SATHI). The program involved processes of state-society collaboration that were especially intensive in the early years and then ebbed and flowed, before experiencing a revival during the pandemic response.
The CBMP network combined many social accountability tools into a multi-level strategy, using community assessments of health services and local meetings with clinic staff to inform problem-solving efforts at local, district and state levels of the health system. This government-funded civil society initiative worked with local officials to convene public dialogues and to activate previously-dormant official local, multistakeholder oversight bodies, animated by a parallel network of autonomous monitoring committees active at multiple levels of the health system. The CBMP reached approximately 1000 villages in 17 districts across the state, operating at multiple levels by escalating problem-solving advocacy from lower to higher levels of the health system when needed.
This study presents SATHI’s analysis of CBMP’s strategy and institutional dynamics, and documents its lasting effects on two participatory oversight institutions: Village Health, Nutrition and Sanitation Committees (VHNSCs)—part of local government—and Rogi Kalyan Samitis (Patient Welfare Committees)—part of the health system.
