CNAA-Community Needs Assessment Approach

The International Conference on Population and Development, Cairo, Egypt held on 5 - 13 September, 1994 recommended that the aim of family planning programme must be to enable couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so and to ensure informed choices and make available a full range of safe and effective methods. The success of population education and family planning programme in a variety of settings demonstrates that informed individuals everywhere can and will act responsibly in the light of their own needs and those of their families and communities. The principle of informed free choice is essential to the long-term success of family planning programmes.

2. Under the Target Oriented approach, the National level targets in respect of different family planning methods were used to be fixed in consultation with the States/Union Territories, keeping in view the long- term demographic goals and past performance levels of the States/Union Territories. These targets, however, became an end in itself and not the means to bring about the expected decline in the birth rates. The target based system followed up to 31st March, 1996, suffered from negligence of the quality of services provided to the people under family welfare programme. The needs of the individual client were not properly met. Thus the numerical method-specific targets provided such type of demographic planning which is against the democratic ethos of the country. Thus, a need arose to introduce decentralised participatory approach with emphasis on clients’ satisfaction and quality of services under Target Free Approach doing away the target-oriented approach.

3. The approach of determining targets was given up after extensive consultation with the States and after making pilot studies in one District of each of the 18 States in 1995-96. In the 4th conference of the Central Council of Health & Family Welfare, the Council placed on record its appreciation of the efforts made by all the State Govts. to implement the Family Welfare programmes on the basis of Target Free Approach with effect from 1996-97. In its 5th conference held in January 1997, the Council urged all States & Uts and Voluntary Organisations to secure the full involvement of the community in the implementation of family welfare programme under Target Free Approach.

4. On the basis of the experience gained during the experimental approach and in pursuance of the decision taken in Conference of State Secretaries (Family Welfare) held on 2nd February, 1996, the Target Free Approach for the family welfare programme was extended all over the country from 1st April 1996, which necessitates the decentralised participatory planning renamed as Community Needs Assessment Approach (CNAA) in 1997-98. Decentalised planning implicates close association of the community and its leading lights and opinion leaders such as village Pradhans, Mahila Swasthya Sanghs, Primary School Teachers, etc. in formulation of the PHC based family welfare and health care plan. Under this approach, plans regarding family welfare services were to be formulated in consultation with the community at the grass root level and expected to lead to improvement in quality of services and client satisfaction matching with ground situation requirements. In this connection, a manual of CNAA on Family Welfare Programme had already been circulated to all the States and Uts to provide guidance in decentralized planning at the level of SC/PHC containing various forms/formats and the guidelines for filling up the same for preparing these.

5. A total of 9 forms were prescribed in the CNAA manual in which the reports were to be made by the ANM for the sub-center, by in-charge medical officer for the PHC/FRU/sub-district Hospital/district hospital to the District Family Welfare Officer and by the District FW Officer to the State Govt. and to the Govt. of India (Department of FW).

These 9 forms are of two types – forms 1 to 5 are Action Plan forms which have to be prepared once in every year prior to the beginning of the financial year by the ANM, In-charge MO PHC/FRU/Sub-district hospital/district hospital, District Medical Officer and the State Action Plan by the State FW Officers. Form No.6 to 9 of the CNAA manual are the monthly reporting forms to be submitted by 15th-25th of the following month by ANM/MPW(Male) for sub-center/Urban Health Post/revamping center to the PHC, by Medical Officer in-charge FRU/CHC/sub divisional Hospital/PPC District Hospital to the District FW Officer and the consolidated monthly report by the District FW Officer to the state FW Department and the Department of FW(Ministry of Health & FW, New Delhi).

5. Forms 4 and 5 relate to district and State Level annual Action Plan which were required to be submitted to the Department of FW, Ministry of Health & FW, Govt. of India, New Delhi through NICNET by 28th of March every year in respect of the following Financial Year. The form 5 which is the Action Plan for the State is the aggregate compilation of the Action Plan submitted by all the districts in the State on Form 4. Besides the above two forms, a consolidated monthly report (form No.9) from district were also to be submitted to Department of Family Welfare, Govt. of India, New Delhi through NICNET by 25th of the following month. During 2003-2004 and 2004-05 (up to Feb. 2005) State Annual Action Plans (Form 5) have been received from 31 and 28 States/Uts respectively. During these two years 342 and 318 District annual Action Plan (Form 4) out of a total of about 595 districts in the country have been received. The monthly report from the district/states is received in the form No. 9 by this Ministry.

6. From the various quarters and the forums apprehensions emerged that the guidelines stipulated in CNAA manual were perhaps not being followed in preparing/formulation of the Annual Plan at various levels in States/Uts. As a result, the implementation of CNAA in its letter and spirit might be suffering. In view of these apprehensions and also to strengthen the MIES as a tool which could fully meet the requirements of phase-II programme of RCH, an expert group was set up under the Chairmanship of Prof. Mari Bhatt with the terms and reference to review the existing reporting arrangements and formats, MIES manual and software; ii) to strengthen monitoring and supervision at the field level iii) to recommend convergence of a unified MIES for the programme.

7. Proposed mechanism as per recommendations of Prof. Mari Bhatt committee:

The role of male health workers in CNAA should be enlarged and properly spelt out.
-Formulation of MIES Cell and States as well as center
-Pilot testing of revised CNAA in one EAG state and one non-EAG state.
-Building/Strengthening institutional mechanisms both for internal and external validation of information to be furnished.
-Internal validation through the supervisory staff of DHO and PHCs
-External validation through PRCs, RETs, local medical colleges and Training centres.
-Strengthening MIES infrastructure at the Centre and in States/Districts
CNAA Cell in M&E Division at Central level headed by a Director with adequate staff and infrastructure to be established.
-Similar Cells are to be constituted at State and District level.
-Requirement of districts and states for Computer hardware and Development of software--provide with HW &SW training of Programme Managers,Statistical Officers on use of MIES for planning and programme management.
-For having check on quality services INDIA CLEN a body under AIIMS is to develop a system jointly with the help of national level medical colleges, PRC, RETs and other state level institutions to monitor the quality of services.



Updates.....

CNAMA- Community Need Assessment and Monitoring Approach..Now CNAA is renamen as ANAMA to give more emphasis on monitoring in National Family Welfare Programmes in INDIA..

To give summary,

We started as TOA- Target Oriented Approach, than
TFA-Target Free Approach, then
CNAA- Community Need Assessment Approach, then
CNAMA-Community Need Assessment and Monitoring Approach.

I think you understood whole progress....