Community Based Monitoring under National Rural Health Mission (NRHM) at Village Level in the State of Maharashtra, India.

Background: Government of India, under National Rural Health Mission has established Village Health Sanitation Nutrition Committees (VHSNCs) and appointed Accredited Social Health Activists (ASHAs) in all the villages. Government of India also started Community Based Monitoring (CBM) project through Non-Governmental Organizations (NGOs). State of Maharashtra was one of the nine states selected for implementation of the pilot project. Objectives: To assess the effect of training and implementation of CBM on Knowledge, Attitude and Practices of VHSNC members including ASHAs. Design: It is a descriptive study using comparison group. Settings: The study was carried out in 90 villages, 45 each from study and comparison group, in the State of Maharashtra, India. Interventions: The study was conducted with the help of the Community Medicine Departments from nearby Medical Colleges. From each village one ASHA and three members of VHSNC were interviewed. An assessment instrument was developed having some parameters. Based upon responses to each parameter, a scoring system was also developed. Then comprehensive score was calculated for each respondent. Main Variable: Comprehensive score obtained by the interviewed individual was studied. Results: Only 41% ASHAs and 28% VHSNC members were trained in CBM by the concerned NGOs. The Mean score of ASHAs’ was 7.52. The mean score was 6.55 for trained members of VHSNC and 5.00 for un-trained members. Discussion: The interviewed members were lacking in core areas. The members are not ready to take ownership and to monitor services. Conclusions: The training and implementation of CBM did not have any difference in awareness and active participation of ASHAs. This may be due to improper coverage of training. The training helped VHSNC members in improving score but actual implementation of project did not improve the score.