1. 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, 97, 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. Under this approach, planning of family welfare services will be
formulated in consultation with the community at the grass root level and it is
expected to lead to improvement in quality of services and client
satisfaction. Besides, monitoring and
evaluation of the performance also require a fresh look at the issues of
quality of care at different levels of the primary health care system. 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. In this connection, a manual of CNAA on
Family Welfare Programme has already been circulated to all the States and Uts
to provide guidance in decentralized planning at the level of SC/PHC.
5. Forms: 5.1 A total of 9 forms are prescribed in the
CNAA manual in which the reports are 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).
5.2 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.
5.3 Form No.6 to
9 of the CNAA manual are the monthly report 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).
5.4 The
guidelines for filling up of all these 9 forms have been detailed in the CNAA
manual. However, it may be pointed out
that forms 4 and 5 which are district and State Level annual Action Plan are
also 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 will also be
submitted to Department of Family Welfare, Govt. of India, New Delhi through
NICNET by 25th of the following month.
6. The success
of the CNAA Approach largely depends upon the preparation of the Annual Action
Plans in the beginning of each year by the concerned State Health & Family
Welfare authorities at various levels starting with the grass root level
workers at periphery to identify and plan the services in different sectors of
Health and Family Planning which are required to be provided during the
year. The preparation of the Annual
Action Plans (Form 4 and Form 5) at district and State levels based on the
assessed Need of the people for Family Welfare Services as one of the most
essential and vital activities in the programme
7. Due to the transitional state of affairs from target oriented approach to target free/Community Needs Assessment Approach – the achievements made by the States during 1996-97 and 1997-98 were less in comparison to the need assessment. However, from 1998-99 the achievements under various Family Programme methods have started showing an upward trend.
8. During
1999-2000 and 2000-01 (upto middle of Nov’2000) State Annual Action Plans (Form
5) have been received from 21 and 18 States/Uts respectively. During these two years, 321 and 320 District
annual Action Plan (Form 4) out of a total of about 569 district in the country
have respectively been received. During
the last two years, the monthly performance statistics from districts (Form-9)
have been received from 302 and 313 (Max. report received during any month of
the year).
9. The previous
Target Free Approach Manual (TFA Manual) has been recast as CNAA manual after
consultations and discussions in Workshops of State/District/Sub-centre level
functionaries. To make the manual fully
understandable by the grass root level workers at periphery, a supplementary
booklet – “Guidelines as a supplement to CNAA Manual”, has also been printed
and circulated to the State. The
process of further simplifying the various formats in the manual is still on.
10. All the
efforts are being made to operationalise and stabilize the information system
as guided by the manual and through NICNET and otherwise. In this regard a series of Workshops,
specially in seven weak States of Rajasthan, Bihar, U.P., Assam, Orissa,
Haryana and Madhya Pradesh with the financial support of WHO, to provide
orientation programme for Distt./Sub-district level health officials in CNAA
are being organized during the biennium 2000-2001.
11. During
2000-01, an amount of Rs.100.00 lakhs and Rs.220.05 lakh have been released to
the States/Uts for the printing of ECRs and the nine (9) Forms of the CNAA
manual with a view to help the operationalisation and implementation of the
CNAA by the States.