Gaps and Gains: Citizen s Reports on Health Programmes Implementation in India

Transcription

1 Gaps and Gains: Citizen s Reports on Health Programmes Implementation in India Organized by Centre for Health and Social Justice and School of Public Health, SRM University, Chennai With support from UNFPA 16 th September 2011, Indian Social Institute, Lodhi Road, New Delhi-17 Organized by CHSJ, SRM and UNFPA Page 1

2 Content 1. Introduction a. Background of the workshop b. Role of each research 2. Introduction to the workshop a. Welcome address b. Objectives and agenda c. Inaugural and keynote address 3. Sharing of research a. NRHM and access to health services among socially excluded communities b. Improving access and quality of health services c. Increasing communitisation d. Interface/linkages of ASHS with community and services 4. Next steps and way forward 5. Annexure 1. Agenda 2. RAHP study partners 3. Key findings of the research 4. Participants list Organized by CHSJ, SRM and UNFPA Page 2

3 Introduction Background of the workshop The Centre for Health and Social Justice (CHSJ) has been facilitating a process of annual feedback on the National Rural Health Mission (NRHM). CHSJ has prepared two citizen s reports on the NRHM (2006 and 2007) and a set of Rapid Appraisal Studies (2009) and these have been shared at National Stakeholders Consultation which have been attended by bilateral organizations, UN agencies, Civil Society Organisations from across the country as well as the Government, and very well received. It has been acknowledged by the Government that such independent feedback is important and essential for understanding the process of implementation and for mid course corrections. Continuing the process, for the year , CHSJ with support from UNFPA and in collaboration with the SRM University, Chennai conducted a Capacity Building programme aiming to build capacity in the civil society sector (NGOs) in India so that they are better equipped to conduct rapid assessment of the implementation of different components of NRHM in different parts of the country (RAHP II). A total of 15 civil society organizations (NGOs) from different states were selected on basis of their interest and some experience in public health issues and capacity to undertake the documentation. Two researchers from each organization were given training in Rapid assessment methodology in two residential Programmes organized at Chennai and New Delhi. Fifteen studies conducted in 8 states of the country through this programme were shared in this workshop Gaps and Gains: Citizen s Reports on Health Programmes Implementation in India on 16 th September 2011 (See Annexure 1 for Agenda). These studies have examined different aspects of NRHM, including health system strengthening, women s experiences of receiving reproductive health services, maternal mortality and so on. The main objective of the workshop is to bring the grassroots realities of public health programme implementation across the country. Apart from sharing the findings, the meeting also focussed on identifying implementation bottlenecks and recommending actions for streamlining desired processes. The meeting was attended by key functionaries from Ministry of Health and Family Welfare, (government of India) Civil Society Organisations and Networks, public Health experts, academicians, UN organisations involved in providing technical support to MoHFW, international organisations, donors and Foundations involved in supporting health activities and media personnel. (See annexure 4) Research Areas These studies by 15 organisations (see Annexure 3) had explored different aspects of programme implementation of Health programs in India, especially with regard to NRHM. These researches had included the issue access to health service delivery by marginalised communities to improving access and quality of health services. These studies also explored the extent of convergence at the level of VHND and ASHA functioning, reason behind maternal deaths and costs, consequences of institutional delivery among poor communities and the nature of post natal care. Theme NRHM and access to health services among socially excluded communities Study Topics NRHM: Do tribal matter? Costs and consequences of utilizing maternal health care: findings from two districts of India Caste to be Inclusive- Under NACO Mapping Perception of SC/ST PLHAs in Accessing & Utilization HIV prevention, care and support services in Andhra Pradesh Organisation Name SVYM, Maysore CHSJ, Delhi SAKSHI, Secunderabad Organized by CHSJ, SRM and UNFPA Page 3

4 Improving access and quality of health services Increasing communitisation Interface/linkages of ASHA with Community and services Awaiting Change: Determinants of utilization of Maternal Health Services among SCs and Muslims in Patna District, Bihar Status and utilization of Maternal Health Services among Migrant families in Rajasthan Exploring Utilization of Health Care Services from 24X7 PHCs in West Bengal Beyond Delivery: Assessing Post Partum Care and Complications in District Mirzapur, Uttar Pradesh Continuing Concerns: An Assessment of Quality of Care and Consequences of Sterilization in Bundi District of Rajasthan in An Assessment of the status of Public Health Facility centre of District Sheikhpura as per IPHS Maternal Death Audit for Action towards making every Pregnancy Safer in Jharkhand Assessment of level of involvement of Village Health and Sanitation Committee with focus on Utilization of Untied Fund, Baran district of Rajasthan Understanding services, convergence & community participation at (VHND)in Bankura District of West Bengal An attempt hardly begun: Communitisation of Health Services among Dalit communities Assessment of functioning of ASHA SAHYOGINI under intersectoral coordination of DWCD & DHFW in Jhunjhunu District of Rajasthan CHARM, Patna JATAN, Udaipur CINI, Pailan SAHAYOG, Lucknow MANJARI, Bundi BVHA, Patna NEEDS, Deoghar CHEERS, Kota IMAN, Kolkota PARA, Hyderabad SRKPS, Jhunjunu Working together: Convergence and coordination related to ASHA functioning in Chhindwara district, Madhya Pradesh MPVS, Bhopal There are four studies from Rajasthan, two from Bihar, one each from Uttar Pradesh and Jharkhand, Assam, Madhya Pradesh, Karnataka and Orissa, Two from West Bengal and Andhra Pradesh. Organized by CHSJ, SRM and UNFPA Page 4

5 Session 1: Introduction The introductory session was attended by Dr Abhijit Das, Director, CHSJ; Prof Satish, Dean, SPH- SRM University, Ms Frederika Meijer, Country Representative, UNFPA and Mr. P.K. Pradhan, Mission Director, NRHM who was the Chief Guest. Welcome address Dr. Abhijit Das, Director, Centre for Health and Social Justice In the welcome address, Dr. Das provided a brief overview of the purpose of the meeting and various studies conducted under the Programme of Rapid Assessment. He spoke about involving the individuals working at the grassroots as their participation towards the study involved great passion and hard work. He also mentioned that the purpose of conducting studies to find the situation of health programmes was not to find out follies but to provide recommendations for making situations better. Dr. Das emphasized about making two percent budgetary provisions for evaluations to be conducted by NGOs under the NRHM in order to give timely feedback to the Government during the course of any programme for improving the services. He also added that none of the studies were conducted by professional researchers or academicians but by practitioners and activist who are engaged in improving health and lives of the poor and marginalized people, in securing their human rights. These studies were conducted systematically and with rigour so that they can bring evidence. Many of the studies revealed gaps and it is not surprising because the issues were complex. He also asked to consider these studies done by NGOs as sources of evidence based feedback for improving health programme delivery. About the Rapid Assessment of Public Health Programme (RAHP) initiative Prof. Satish, Dean, School of Public Health, SRM University, Chennai Prof. Satish mentioned that RAHP is an initiative of partnership and collaboration of an NGO, an academic institution and UNFPA. Through this initiative eighteen NGOs were trained to conduct the research and in the end we have fifteen studies that have been completed through this process. He had explained the phase wise processes of RAHP. The first phase included partner selection to trainings and study topic selection. In second phase training, the partners were trained on data collection, data management and data analysis and in the third phase, the NGOs were given training on report writing. There were mentors assigned for each of the organisations. During the study period, mentors were also visited the organisation and helped in data collection process. For field level guidance, the mentors were continuously in touch with the organisation on phone and s. He also said that they are privileged to provide academic inputs to civil society organizations and NGOs to conduct health research and was great learning exercise for an academic institution like SRM. It was entirely a different experience for an academic institution like SRM to work with NGOs where all feedback is given in the form of activism and advocacy. He felt that there was still a long way to go on writing the study reports by the NGOs. Inaugural Address Ms. Frederika Meijer, Country Representative, UNFPA She mentioned in her inaugural address that it would be a great honour to her and UNFPA to hear the perspectives and ground realties from grassroots people. She expected that the national dissemination workshop would provide valuable inputs to successful implementation of NRHM. She said that presently meetings are being held at Planning Commission and they are looking for feedback from the field. We all know the NRHM has made good progress but more progress is needed. She emphasized that programmes like RAHP are strong pillars of assessment of NRHM and it would help to bring good amount of data and evidences. She encouraged conducting such kind of research studies for quick feedback on health programmes. Organized by CHSJ, SRM and UNFPA Page 5

6 She appreciated the initiative of CHSJ and its work and it is one of the most influential NGOs in the field of public health. She congratulated CHSJ for their initiative such as RAHP which reflects pro-poor marginalized efforts and skills. Address by Chief Guest Mr. P K Pradhan, Mission Director, National Rural Health Mission Mr. P K Padhan, in his address gave a brief background on NRHM. He also mentioned that the presentation of national dissemination will provide NRHM a very useful insight for better implementation. He said that NRHM has a special focus on issues of Maternal and Child Health (MCH) by improving infrastructure, adding human resources and greater community participation through Village Health and Sanitation Committee (VHSC) and Rogi Kalyan Samiti (RKS). He said that there had been improvements in health status of the people but this varied among the states. Also he acknowledged that in the most remote and hilly areas the progress of NRHM is still very low. In tribal belt, desert areas, hilly areas and remote areas, the progress is still limited he said. He mentioned that there is a need to develop an institutional mechanism, where the participation of communities is much stronger. He mentioned about recently published Annual Health Survey and variations in findings across nine states of India. The report shows very interesting figures and striking variations in nine states. In Uttarakhand, the Pitthoragarh district (one of the remote districts) has very low IMR compared to Haridwar, where accessibility is very good, has high IMR. There is need to identify the areas where the variations is very high in case of IMR, MMR, etc. and address it through a better micro planning. Mr Pradhan said there is a need to involve the civil society organisations in a more structured manner to find out the gaps and helpful insights of health programmes. Capacity building of NGOs is needed and this can be done through a network of NGOs, and academic institutions. Following the inaugural session, parallel sessions were conducted to present the study findings. A chair and a rapporteur provided inputs after each presentation and questions were raised from the audience. The key findings of the presentations are annexed (Annexure 3) and discussions are described below. Session 2: NRHM and access to services among socially excluded communities Chair- A R Nanda; Rapporteur- Joe Varghese Presentation 1: NRHM: Do tribal women matter? Bindu Balasubramaniam and Shanthi G, SVYM, Mysore The presentation was done by Dr Bindu. It was said that if the researchers were thinking of publishing their study report they should work more on qualitative aspects as the sample was too small for quantitative generalization. Being tribal was not the only reason for denial of entitlements but other factors could also contribute toward this which should have been explored by the researcher. If cash incentives are not given on time than what is the purpose of these incentives, has the community development officer had taken any process for this? Organized by CHSJ, SRM and UNFPA Page 6

7 Presentation 2: Costs and consequences of utilising maternal; health care: from two districts in India Moumita Ghosh, Deepti Morang, Sunita Singh, Centre for Health and Social Justice, New Delhi The presentation was done by Moumita. In the context of maternal health care what was the total cost incurred by the women who had undergone institutional delivery. What were the coping mechanisms adopted by families of pregnant women who did not have the required money for emergency. The answer provided was that the families gathered the required amount of money was mobilised from family savings and taking loan on interest Presentation 3: Mapping Perception of SC/ST PLHAs in accessing and utilization HIV prevention, care and support services in Andhra Pradesh D.Leslie Martin and Ch.Isaac, SAKSHI Human Rights Watch, Hyderabad The presentation was done by Leslie. What is the percentage of total SC/ST population and what is the percentage of HIV positive people in both the study districts? What are the causes of denial of services to HIV+ patients. Presentation 4: Awaiting Change: Determinants of utilization of maternal health services among SCs and Muslims in Patna district, Bihar Anamika Priya and Arman Suhail, CHARM Patna The presentation was done by Arman. The voices from the community have not come out well in this study so the researcher needs to capture the community s voice in a more elaborate manner. The community monitoring aspect needs to be included in the study for looking at accountability measure of government. Presentation 5: Status of utilisation of maternal health services among migrant families in Rajasthan Ranveer Singh and Vinita Paliwal, Jatan Sansthan, Rajsamand The presentation was done by Vinita. Whether the situation of accessing maternal health services differs in case of nuclear and joint families. It could have been much more interesting if the study looked at this aspect also. Organized by CHSJ, SRM and UNFPA Page 7

8 From the presentation it was not clear for how long the husbands or male members had been migrated from the area. The clarification given was most families migrated in cyclical manner. What is the impact on women s health when the male members had migrated for a longer duration? What is the role of in laws on the women health? How do they have collected the migration data since it is a continuous process? Do they have any mechanism to trace the migrant male members? Points from the Chair of the session The study of SVYM could have looked into maternal mortality issue. The study of CHSJ is a very complex issue and it needs more refining and further scrutiny on the subject. SAKSHI and CHARM needs to include some case studies and that they should ask UNFPA for funding to collect the case studies. The studies needs to include more dimension of health issues of marginalised section and more qualitative data and case studies could further strengthen the studies. Session 3: Improving access and quality of health services Chaired by Dr. Vandana Prasad and Rapporteur: Jashodhara Dasgupta Presentation 1: Exploring Utilization of Health Care Services FROM 24X7 PHCs of West Bengal Jaydeep Sengupta and Sudipa Das Mukherjee, CINI The presentation was done by Jaydeep. There is neglect from government side on sub centres. There is no mention about labour room and baby room in the study Issue of privatisation can be seen from the study Sub centres can be 24x7 waiting home and 24x7 PHC must have ambulance Grievance redressal mechanisms should be developed. Feedback boxes should be available at health centres Trainings and skill building should be given to the service providers, lack of trainings and skills affect the work quality. Presentation 2: Beyond Delivery: Assessing Post Partum Care and Complications in District Mirzapur, Uttar Pradesh Y K Sandhya and Saim, SAHAYOG The presentation was done by Sandhya. Is it not clear with whom the FGD was done, why and where The study did not include harmful practices of post partum care and child care practices Heavy bleeding is found in 25% women, which is very important findings of the study Organized by CHSJ, SRM and UNFPA Page 8

9 Did the CHC studied shown as FRU in the district record? Presentation 3: An Assessment of Quality of Care and Consequences of Sterilization in Bundi District of Rajasthan in Swarup Pal and Bajrang Singh, MANJARI The presentation was done by Swarup. What is the level of coordination between ASHA, ANM and AWW because there is a target of sterilisation among these three service providers. Did the ASHA, AWW and ANM provide information on other contraceptive methods? If not then obviously women will go for sterilisation. Only 13 percent women were provided information on other contraceptive methods. Was there any case where woman was pregnant still the sterilisation was done? There was failure of screening if the pregnant women were sterilised not failure of sterilisation. Presentation 4: An Assessment of the status of Public Health Facility centre as per IPHS of District Sheikhpura, Bihar Devika Biswas and Vivekanand Ojha, BVHA, Patna The presentation was done by Vivekenand. None of the facility centres are upto the IPHS standard, did the researcher tried to look at other key points on facility or service delivery? The major findings were not clear in the presentation. Presentation 5: Maternal Death Audit for Action towards making every Pregnancy Safer in Jharkhand Tanmoy Saha and Amitabh Gautam The presentation was done by Tanmoy. Are the community solutions included in the study really solutions given by community? It looks more like solutions from the researcher. Out of the total death cases occurred, three were in the private hospital. Did the study tried to look at public private partnership? Because the public sector hospitals were equally bad. Why the study only talked about institutional delivery? Then the dai should not know or trained for emergency care, the important thing is that dai should know the referral system for emergency care. What are the parameters taken for services denial in the study? Session recommendations from the chair and rapporteur Organized by CHSJ, SRM and UNFPA Page 9

10 Basic EMOC must be there in all PHCs - telephone and transport more skill building in staff grievance redressal required - also a trust deficit. Block level need some level of specialists. Post-partum care will need more facilities for 48 hour stay including electricity and water/toilets. Need APHCs to become more functional. All managers of facilities should get a manual about IPHS. VHND must go beyond an Immunization day + mass campaigns on reasons of maternal health Need to promote temporary methods instead of only sterilization. Need to strengthen reporting of sterilization failures and complications no data on whether they are getting compensation. Need better data through computerization. Not enough IEC need more information on the insurance claiming behind the discharge certificates. The frontline providers also need more skill-building and more knowledge on Sterilization and post partum complications. Community follow-up needs to be institutionalized. Need to emphasize in ASHA training for early detection of maternal complications and may need to give an incentive. Health system does not have understanding of the need for post partum care [No data on postnatal care on PHC walls] - need a policy and protocol. Informal private providers are preferred and seen as giving better care. Community practices have beneficial components need to be mainstreamed. Session 4: Increasing communitization Chaired by Prof. Satish, Rapporteur: Dr. Anant Bhan Presentation 1: Assessment of level of involvement of Village Health and Sanitation Committee with focus on Utilization of Untied Fund, Baran district of Rajasthan Vikram Raghav and Arvind Pandey, Cheers, Baran The presentation was done by Vikram. NGOs should be involved in assessment process of Village Health and Sanitation Committee works under the provision of NRHM. There is no provision of trainings and capacity building process of VHSC members for functioning their work. Ngo could also mentor the VHSC member and we could send this kind of recommendation to the concerned government. Presentation 2: Understanding services, convergence & community participation at (VHND)in Bankura District of West Bengal Rupasri Ray Barman, IMAN, Kolkata The presentation was done by Rupashri. Organized by CHSJ, SRM and UNFPA Page 10

11 There were no discussion points on this presentation. Presentation 3: An attempt hardly begun: Communitisation of Health Services among Dalit communities Penki Chittababu and Sesha, Para, Hyderabad The presentation was done by Thomas Pallithanam. In the study findings, it was mentioned that the VHSC members were not aware that they are part of VHSC so what is the procedure of selecting them. Any information on how these committees are going to share the funds. What is the quality of training if at all provided to the VHSC members? Communitisation is still not comprehensive or effective. For outreach to be truly effective, it needs to get closer to community and be sensitive to community needs. Health functionaries key to effective community mobilisation but often reduced to being the main and only actors in the process. Capacity building of VHSCs outstanding need- link to accountability mechanisms. VHSCs often seen to exclude the disadvantaged (Dalits/women etc). Need to go beyond processes to outcomes and focus on rationale of communitisation. Communitisation happening but the devil lies in the details. Need for strong mentoring structures. Local NGO and CBO based research can help in unraveling the field realities and making midcourse corrections. Session 5: Interface/linkages of ASHA with community and services Chaired by Dr. Kabir Seikh, Rapporteur: Dr. Leila Celeb Varkey Presentation 1: Assessment of functioning of ASHA SAHYOGINI under intersectoral coordination of DWCD & DHFW in Jhunjhunu District of Rajasthan Sishir Kumar, SRKPS, Jhunjhunu The presentation was done by Shishir. Is there any change in behaviour or working style of ASHA after incentive based target oriented work was given to them. Organized by CHSJ, SRM and UNFPA Page 11

12 If there is a situation occurred where ASHA/Sahyogini brought one pregnant case to a hospital and there is no facility available for C-section operation then what they do. Presentation 2: Working together: Convergence and coordination related to ASHA functioning in Chhindwara district, Madhya Pradesh Prathyush and Kavita Jham, MPVS, Chhindwara The presentation was done by Prathyush. The study did not mention the VHSC s role in the study. What was their role and how do they help ASHA to provide the health services? There was no information on influence of ANMs on ASHA. Session recommendations from the chair In qualitative research the quality should be improved in looking at deviant case analysis. We usually look at majority then we also should look at minority trend. In this kind of research the reflectivity of organisation that has done the research should also include or present within the context of research. Session 6. Next Step and Way Forward Panelist: Dr. Syeda Hameed, Member, Planning Commission; Ms. Frederika Meijer, Country Representative, UNFPA; Dr. Abhijit Das, CHSJ; Prof Satish, Dean SRM; and all rapporteurs At the end of the presentations, plenary was held where all the rapporteurs presented the key findings of the studies and the suggestions that came up during discussions. This gave Dr Hameed, Member of Planning Commission an idea about the studies and gaps in health program interventions that needs to be addressed through future planning. Once the presentations by rapporteurs were over, Dr. Das expressed his gratitude to SRM University and UNFPA for their support and cooperation for successfully conducting the research studies. He said that their support had helped strengthening the capacities of the grassroots level organistaions and able to provide the decentralising feedback from all parts of the country. Frederika Meijer, Country Representative, UNFPA, expressed her thanks for being part of National Dissemination workshop. She said that it was great to hear evidences based research from different parts of the country. She said that the community voices are clearly put forward by these studies and added that the NGOs capacities needs to be strengthened further to take these research to the next level. She emphasized that there is a need to put forward the recommendations of the study findings for better implementation of health programmes in the country. The day ended with vote of thanks from Shelley, Program Manager, CHSJ, to all those who made this meeting successful. Organized by CHSJ, SRM and UNFPA Page 12

13 Annexure 1: Gaps and Gains: Citizen's Reports on Health Programmes Implementation in India th September 2011 Venue: Indian Social Institute,10, Institutional Area, Behind Sai Baba Mandir, Lodhi Road,New Delhi- 17 Registration : 9.30 am onwards Inaugural Session 1. Introductory Session (Plenary) Welcome Address and Introductory remarks: Dr. Abhijit Das 2. About the RAHP initiative: Prof Satish SRM University 3. Inaugural address by UNFPA 4. Chief Guest Address TEA Chair: Ms. Frederika Meijer, Country Representative, UNFPA Chief Guest: Mr. P.K. Pradhan, M.D. NRHM Session Name Time Session Details Presentation by Chair Rappor teur 2. NRHM and Access to services among Socially excluded communities (Parallel session 1a) (5 presentation * 15 min) (45 min discussion) 1. NRHM: Do tribal women matter? 2. Costs and consequences of utilising maternal health care: from two districts in India 3. Caste to be Inclusive- Under NACO Mapping Perception of SC/ST PLHAs in Accessing & Utilization HIV prevention, care and support services in Andhra Pradesh 4. Awaiting Change: Determinants of utilization of Maternal Health Services among SCs and Muslims in Patna District, Bihar 5. Status and utilization of Maternal Health Services among Migrant families in Rajasthan SVYM, Mysore CHSJ, Delhi SAKSHI, Secunderabad CHARM, Patna JATAN, Udaipur Mr A. R. Nanda Dr Joe Varghes e Organized by CHSJ, SRM and UNFPA Page 13

14 3.Improving access and quality of health services (Parallel session 1b) (5 presentation * 15 min) (45 min discussion) 1. Exploring Utilization of Health Care Services from 24X7 PHCs in West Bengal 2. Beyond Delivery: Assessing Post Partum Care and Complications in District Mirzapur, Uttar Pradesh 3. Continuing Concerns: An Assessment of Quality of Care and Consequences of Sterilization in Bundi District of Rajasthan in An Assessment of the status of Public Health Facility centre of District Sheikhpura as per IPHS 5. Maternal Death Audit for Action towards making every Pregnancy Safer in Jharkhand CINI, Pailan SAHAYOG, Lucknow MANJARI, Bundi BVHA, Patna NEEDS, Deogha Dr Vandana Prasad Ms Jashodh ara Dasgupt a Lunch 4. Increasing Communitisat ion (Parallel session 2a) (3presentation * 10 min) (15 mins for discussion) 1. Assessment of level of involvement of Village Health and Sanitation Committee with focus on Utilization of Untied Fund, Baran district of Rajasthan 2. Understanding services, convergence & community participation at (VHND)in Bankura District of West Bengal 3. An attempt hardly begun: Communitisation of Health Services among Dalit communities CHEERS, Kota IMAN, Kolkota PARA, Hyderabad Dr. Satish Dr. Anant Bhan 5. Interface/lin kages of ASHA with Community and services (Parallel session 2b) (2 presentation * 15 min) (15mins for discussion 1. Assessment of functioning of ASHA SAHYOGINI under intersectoral coordination of DWCD & DHFW in Jhunjhunu District of Rajasthan 2. Working together: Convergence and coordination related to ASHA functioning in Chhindwara district, Madhya Pradesh SRKPS, Jhunjunu MPVS, Bhopal Dr. Kabir Seikh Dr Leila Celeb Varkey 6. Next step and closing of the conference Presentation by Rapporteurs and way forward for inclusion in 12 th Planning Process By Rapporteurs Syeda Hameed, Member, Planning Commission (Plenary) VOTE OF THANKS Tea Organized by CHSJ, SRM and UNFPA Page 14

15 Annexure 2. RAHP Study partners Name of study Continuing Concerns: An Assessment of Quality of Care and Consequences of Sterilization in Bundi District of Rajasthan in Beyond Delivery: Assessing Post Partum Care and Complications in District Mirzapur, Uttar Pradesh Maternal Death Audit for Action towards making every Pregnancy Safer in Jharkhand Exploring Utilization of Health Care Services from 24X7 PHCs in West Bengal An Assessment of the status of Public Health Facility centre as per IPHS of District Sheikhpura, Bihar Do Tribal Women Matter: A Study of Forest Based Tribal Women of Heggadadevanakote Taluk in Mysore District Status and utilization of Maternal Health Services among Migrant families in Rajasthan Awaiting Change: Determinants of Utilization of Maternal Health Services among SCs and Muslims in Patna District, Bihar Costs and consequences of utilizing maternal health care: from two districts in India Caste to be Inclusive- Under NACO Mapping Perception of SC/ST PLHAs in Accessing & Utilization HIV prevention, care and support services in Andhra Pradesh Assessment of level of involvement of Village Health and Sanitation Committee with focus on Utilization of Untied Fund, Baran district of Rajasthan Understanding services, convergence & community participation at (VHND)in Bankura District of West Bengal An attempt hardly begun: Communitisation of Health Services among Dalit communities Assessment of functioning of ASHA SAHYOGINI under intersectoral coordination of DWCD & DHFW in Jhunjhunu District of Rajasthan Working together: Convergence and coordination related to ASHA functioning in Chhindwara district, Madhya Pradesh Study partner Manjari, Rajasthan SAHAYOG, Uttar Pradesh NEEDS, Jharkhand CINI-RRC, West Bengal BVHA, Bihar SVYM, Karnataka Jatan Sansthan, Rajasthan CHARM, Bihar CHSJ, New Delhi SAKSHI, Andhra Pradesh CHEERS, Rajasthan IMAN, West Bengal PARA, Andhra Pradesh SRKPS, Rajasthan MPVS Madhya Pradesh Organized by CHSJ, SRM and UNFPA Page 15