Arogyashreni: towards creating a replicable model for community monitoring of primary health centers in Karnataka, India

Introduction The National Rural Health Mission (NRHM) has initiated community-based institutions at various levels of the health system e.g. Arogya Raksha Samithi (ARS) and Planning and Monitoring Committee (PMC) at Primary Health Center (PHC) level while the Village Health and Sanitation Committee (VHSC) at the revenue village level. These institutions are intended to create awareness about health services, and to empower communities to demand their entitlements. They are also responsible for planning and monitoring of public health and sanitation programs based on local needs. However, some barriers including the asymmetry of information and power among health service personnel and community representatives, inefficient decentralization mechanisms, and excessive bureaucracy hinder the effectiveness of these committees. Thus, the Karnataka experience towards communitization has unfortunately been ambivalent. In this context, an innovative community-based monitoring initiative was devised with objectives of (1) making community-based monitoring operational; (2) developing a sense of ownership among community representatives about their PHCs; (3) bridging information gaps among community representatives to help them articulate local problems and begin to look for their solutions; (4) enhancing demand for health services through community engagement; and (5) building a low-cost technology based platform for rapid analysis and dissemination of information generated through community-based monitoring of health services. Methods This innovative community-based monitoring of health services initiative has been implemented in all rural PHCs of the Mysore district. A questionnaire with closeended questions (yes/no type) was devised through a community consultation attended by medical doctors, academicians, and community representatives. This questionnaire containing 79 questions on various aspects of PHC functioning was then installed on a toll-free Interactive Voice Response System (IVRS). Selected VHSC and ARS members were oriented to answer the IVRS-based questionnaire. Any selected community member could answer the questionnaire for their respective PHC. Responses generated through IVRS-based questionnaire were validated through physical verification and statistical assessment of error. Using this base-line communitybased monitoring database, a district-wide ranking of rural PHCs was carried out. The ranks were disseminated among the community as well as to the Department of Health and Family Welfare.