‘Social Audit’ as a process is now well known in India, especially in the context of the National Rural Employment Guarantee Act. Today, social audit has provided a platform for ensuring accountability and transparency in the Employment Guarantee scheme. This process provides a space for dialogue between beneficiaries and service providers.The word “Audit” has its origins from a Latin word ‘’Audire’’, which means ‘to hear’. In ancient Greece, the word ‘audire’ was used in the context of the process of ‘hearing of accounts’. It was usually associated with cross checking of different financial documents by authorities, declaring and sharing the findings of the financial expense, work accomplished and gaps in the implementation of the programs openly with the community.
Today, the ‘Audit’ process has become immensely technical and ‘expert limited. Take for example, the financial audit of Rogi Kalyan Samitis funds conducted by the state government. The financial audits are carried out by appointing Chartered Accountants. Although financial audits might bring in accountability, where government officials are accountable to their superiors, one sees a lacuna within the financial auditing mechanism as there is often no system to receiving feedback from beneficiaries.Keeping this context in mind, the ‘Participatory Audit and Planning (PAP) process of RKS funds’ has taken the core essence of social audit and created a space for Community Based Monitoring Planning Process. The Participatory Audit and Planning process was conducted in a total of nine health institutions of Nandurbar, Thane and Raigad districts of Maharashtra, during December 2014 to March 2015.
Objectives of the PAP Process
- To ensure decentralized planning of Health Services, focusing on active participation of various stakeholders such as elected members, Health providers and Civil Society Organizations in decision making of planning and utilization of Health Management Committee (HMC) funds.
- Identify gaps in the expenditure of HMC funds and also to evaluate functioning of HMC.
- Build the capacity of Health Management Committee members on their roles and responsibilities. In the PAP process, various stakeholders such as representatives of Rogi Kalyan Samiti, Monitoring and Planning Committee, active community members, elected members, health officials and representatives of civil society organizations, and staff of respective health institutions were involved.
Based on the above mentioned objectives, the following steps were taken in conducting the PAP process-
Preparatory Phase-
To understand the pattern of expenditure of RKS funds, a representative of Civil Society Organizations collected information for the financial year 2013-14, from the Health institution. The analysis of the financial audit was to assess the components that incurred the maximum financial spending. Based on the findings, a poster has been developed and is displayed in the premises of the Health Institution pro-viding the details of financial statements
Examples of pattern of expenditure
– In three Health institutions, maximum HMC funds were utilized for printing logos, photocopying of case papers and stationary during the year 2013-14.
– In the sub-district hospital of Thane district, maximum funds were utilized to purchase electrical equipment and building maintenance.
– In Khandas Primary Health Centre of Karjat block of Raigad district, maximum HMC funds were utilized towards building water facility and on payment of internet and telephone bills.
Actual Participatory Audit and Planning (PAP) event
– A meeting was organized in the premises of the Health institution with participation of RKS members, Monitoring and Planning committee members under CBMP process; District and State level Health officials and representatives of Civil Society Organizations. The PAP event began with an orientation to RKS members about their roles and responsibilities. This was followed by a presentation of poster and sharing pattern of last year’s RKS funds expenditure. All the participants were involved in the examination of financial documents and records that included books of accounts, vouchers, supportive documents, and proceedings of RKS meetings etc. After the examination of financial documents, the participants took a tour of the health institutions in each ward. They interacted with patients and staff of the institution. This activity helped in cross-checking the verified financial records and physical availability of purchased items through RKS funds.
Examples of the gaps that emerged and resolved during PAP event
– In one of the PHCs, the existing constitution of the RKS committee was not as per guidelines such as no representation of elected members and Civil Society Organization. Hence, it was suggested that the committee be reconstituted. Within fifteen days of the audit, with the initiative of the accountant of the facility and the CSO representative, the committee was reconstituted. In one of the PHCs, the expenses incurred from RKS funds were for the repair of television, subscriber recharge for dish TV. However during an inspection it was found that there was no television in the facility. The team conducting the PAP found out that the television was under repair. Further, villagers shared that they had never seen a television in the PHC. The investigation revealed that the television was placed in the ward boy’s house. During the meeting he was asked to return the television to the facility. The very next day of the audit, one of the villagers informed a representative of SATHI that the television was returned and now placed in the facility.
– In Son Primary Health Centre (PHC) in Dhadgaon block, Nandurbar district, Rs. 33,705 was spent on purchase of equipment such as microscope, centrifuge machine, slides, test tubes etc. for the PHC. This was the HMC fund for the previous years. As per the process, any purchase that requires a large sum of money, quotations from vendors must be sought first, and then the acquisition and pur-chase is made. However, in this case, the equipment was purchased in March 2013, while the quotations were invited in April 2014. Dialogue between various stakeholders-
The PAP event concluded with a meeting where all issues and findings were discussed and decisions were taken. This was an essential step to consolidate the process and take it to its logical conclusion.
The planning of the RKS funds for the year 2014-15 was done taking into consideration the findings, recommendations and physical verification of items purchased through RKS funds.
Examples of decisions taken during a dialogue between various stakeholders
– A Community Health Center had purchased a fridge and cooler that was placed in the in staff quarters at the time of the committee’s visit. A district level official recommended that the items must be immediately placed in the CHC. The items were returned to the hospital. A decision was taken to utilize the current RKS funds to fix mosquito nets on all the windows of the health centre and replacement of a leaking water tank in the hospital.
– In one Health Institution, curtains for doors and windows were fixed.
Earlier the curtains were put up only in the doctors’ cabin. The doors of other wards like General Ward, Women’s Ward, did not have any curtains. This issue was discussed and curtains which were purchased through RKS funds were put up on the doors of all wards
About the author
Dr. Nitin Jadhav is working with SATHI (Support for Advocacy and Training to Health Initiatives), Maharashtra, India which is mainly involved in advocacy for ensuring accountability in Public Health System of Maharashtra. He works as a State Coordinator; Community based Monitoring and Planning (CbMP) process under NRHM, Maharashtra, India