Social Audit Standard (SAS) 200
Promoting health care including mental healthcare, sanitation and making available safe drinking water
(SAS 200 should be read in conjunction with the “Preface to the Social Audit Standards” and
“Framework for the Social Audit Standards”, issued by the ICAI)
SECTION I – INTRODUCTION
Objective and Scope
1.10 This Social Audit Standard relates to the thematic area of “Promoting health care including mental healthcare, sanitation and making available safe drinking water”. The Standard aims to provide the Social Auditor with the necessary guidance in relation to independent impact assessment engagement of Social Enterprises engaged in promoting health care including mental healthcare, sanitation and making available safe drinking water available and the audit steps and procedures that should be applied while conducting the social impact assessment. The Standard sets out the minimum requirements to be followed while conducting impact assessment. Laws or regulations may establish additional requirements which should be followed as applicable.
SECTION II – PROCESS OF SOCIAL AUDIT
Data Collection
1.20 The stakeholders that may be approached for obtaining data may include:
> Direct beneficiaries
> Immediate family members of the direct beneficiaries
> Contractors/workers providing various facilities and services
> Medical institutions including management personnel of hospitals and medical professionals
> Funding entities, Government (at block, district, state and national levels as relevant) and related institutions
> Monitoring agency
> Key program officials of the entity etc.
The overall activity of conducting survey and collecting sample data should be reviewed in terms of the following factors to assess relevance and reliability:
> designed by in-house team or external specialized agency
> conducted by in-house team or external specialized agency
> number of days taken
> number of teams formed
> number of manpower deployed
> number of villages/districts covered
> total distance (km) covered
Desk Review
1.30 The Social Auditor should conduct a desk review of existing documents to gain further insight into the evaluation procedure and impact assessment. Such documents, in relation to promoting health care including mental healthcare, sanitation and making available safe drinking water, may include the following:
- Cash subsidy/assistance provided
- Establishing healthcare institutions
- Conducting health camps along with pre and post health check-ups being conducted
- Subsidised health treatments provided e.g. Ayushman Bharat Yojana, Mahatma Jyotiba Phule Jan Arogya Yojana (in the state of Maharashtra) etc.
- Vaccination and immunization drives conducted
- Reduction of hardships of patients with special needs and patients with chronic needs
- Accessibility for differently abled people
- Mortality rate inclusive of maternal mortality rate
- Intensive education and awareness campaigns conducted
- Construction of sanitation and hygiene facilities
- Construction and maintenance of water purification/RO plants, digging of borewells, underground water pipelines, supplying drinking water through water tankers
- Feedback form from beneficiaries
- Memorandum of Understanding (MOU) between the entity and the implementing agencies/sponsors/contractors/suppliers/ funding entities/other related institutions
- Helpline facilities provided
- Photographs of various programmes/events
- All the above should be disaggregated as far as possible by gender and specifically cover inclusion of marginalised groups – SC, ST, minorities, elderly, LGBTQIA, persons with chronic illness and differently abled persons. This is critical for estimating inequality and changes in inequality.
Inspection and Personal Interviews
1.40 Besides desk review, the social auditor should also consider conducting physical inspection and personal interviews to get a first hand assessment of impact.
Evaluation Questions
1.50 The social auditor should review the evaluation questions addressed through Questionnaires, In-depth Interviews and Focused Group Discussions to assess the responses received from various stakeholders and to understand what has changed. This would help the Social Auditor in forming his views on the following aspects:
- Did the target people receive the benefit?
- Did the standard of living improve?
- Did the life expectancy increase?
- Was there a reduction in number of patients?
- Was there any improvement in infrastructure facilities provided?
- Was there was any reduction in substance abuse?
- Was the health-care provided efficient?
- Were sufficient clean water and sanitation facilities provided?
- Were the facilities accessible to all irrespective of their socio or economic status or religion and to what extent are they being used?
Such questions, in relation to promoting health care including mental healthcare, sanitation and making available safe drinking water, may cover the following aspects:
(a) Composition of the participants:
- Were the program objectives found to be consistent with the composition of the beneficiaries?
(b) Quality of benefits provided and Socio-economic factors
- How was the quality of services provided?
- Were the participants satisfied with the services that they received?
- How was the quality of engagement with beneficiaries?
- Are beneficiaries better informed about their rights, entitlements, and the policies and schemes that affect them viz. Ayushman Bharat Yojana, LaQshya’ programme (Labour Room Quality Improvement Initiative), National Health Mission, National Mental Health Programme, National Tobacco Control Programme (NTCP), Mahatma Jyotiba Phule Jan Arogya Yojana (in the state of Maharashtra) etc.?
- Have the services enhanced beneficiary’s standard of living, health and sanitation facilities and safe drinking water?
- Have the services reduced mortality rates and improved life expectancy?
- Were the helpline facilities provided beneficial and effective?
- Was there an alleviation of patient misery and their hardships?
- Improve accessibility of health care.
- Suggestions from beneficiaries for improvement of the programs
(c) Suggestions/Feedback
- What were the constraints or challenges faced in providing the services/programs?
Key Metrics for Evaluation of Project/Program
1.60 The Social Auditor should review the project/program documents to frame the evaluation criteria for assessing impact. Such key metrics may be collated from base-line, mid-line (monthly / quarterly) and end-line assessment (if available), respectively at the beginning, middle and end of the reporting period / project / program to effectively understand and evaluate impact.
- The baseline measurement is done to establish the starting point in any project/program, which is then used to measure what actually changed due to the intervention of the entity.
- Assess the past performance trend of the entity.
- Assess the highlights and key achievements during the reporting period. The evaluation of the project/program information would facilitate the Social Auditor to assess:
- What would have happened in the absence of the intervention?
- How much the project contributed to the changes that are evidenced?
- How much unintended negative impacts happened due to the intervention?
Assessment of Evaluation Criteria (Illustrative Key Performance Indicators)
1.70 The Social Auditor should identify the quantitative and qualitative evaluation criteria or the key performance indicators against which the impact has to be assessed.
Such criteria in relation to promoting health care including mental healthcare, sanitation and making available safe drinking water may include any of the following aspects:
| S. No | Evaluation Criteria |
| (A) | Quantitative Criteria |
| Promoting health care including mental health care and sanitation | |
| 1 | Number and amount spent on medical institutions created |
| 2 | Number and amount spent on key equipment’s |
| 3 | Number and amount spent on medical staff e.g. nurses, doctors, surgeons, etc. |
| 4 | Number of beds created |
| 5 | Number of patients treated with categorization of illness/ disease treated |
| 6 | Number of free reports tested as a form of preventive health check-up |
| 7 | Ratio of patients treated to doctors |
| 8 | Number of health camps conducted with patient strength and categorization of services provided |
| 9 | Number of people vaccinated/ immunized through vaccination/ immunization drives along with categorisation of type of vaccine e.g. Polio, Tuberculosis, Hepatitis B, any other pandemic, etc. and with bifurcation of age groups |
| 10 | Details of reduced illness/ patients admitted |
| 11 | Census chart data of reduction in mortality rate including maternal mortality |
| 12 | Number of patients treated due to emergencies |
| 13 | Reduced cases of substance abuse |
| 14 | Historical data and current analysis of patients infected, treated, recovered out of epidemics and other communicable diseases |
| 15 | Number of institutional deliveries out of the total deliveries reported |
| 16 | Details of intensive education and awareness campaigns conducted e.g. frequency, coverage, target audience |
| 17 | Treatment cost incurred with all the categorizations listed above |
| 18 | Number and amount spent on sanitation facilities created and improved along with geographical details |
| 19 | Number of individual household toilets constructed against target (Swachh Bharat Mission – Gramin (SBM(G)) |
| 20 | Number of schools with separate toilet facility for girls |
| 21 | Number of industries (17 category of highly polluting industries/grossly polluting/red category of industries) complying with waste water treatment as per Central Pollution Control Board (CPCB) norms |
| 22 | Details of ground water withdrawal against availability |
| 23 | Number of times helpline facilities was utilised and treatment obtained by such callers |
| 24 | Percentage of households with any usual members covered by any health scheme or health insurance |
| Making available safe drinking water | |
| 1 | Number and amount spent on construction and maintenance of water purification plants and RO plants |
| 2 | Number and amount spent on borewells dug, underground water pipelines laid, drinking water supplied through water tankers |
| 3 | Number of beneficiaries getting safe and adequate drinking water Piped Water Supply (PWS) |
| 4 | Generation and consumption of safe drinking water (in litres) |
| (B) | Qualitative Criteria |
| 1 | Improvement in Economic conditions – Increased standard of living may be used to assess the improvement in economic conditions |
| 2 | Improvement in Health conditions
The following indicators may be used to assess the same:
|
SECTION III – ASSESSMENT OF CHALLENGES, AND LIMITATIONS
Challenges / Areas for improvement
1.80 The Social Auditor should identify the challenges faced by the stakeholders and the areas for improvement based on the suggestions and feedback received from them, which might have an influence on the impact assessment. Some of the examples of commonly faced issues in relation to promoting health care including mental healthcare, sanitation and making available safe drinking water may include the following:
- Social discrimination and exclusion
- Insufficient number of medical institutions, medical equipments and medical professionals
- Lack of training on usage of medical equipments
- Resistance to change
- Access to medical facilities
- Unavailability of adequate funds among non-profit entities for availing support services from ecosystem entities
- Lack of awareness of rights, entitlements, schemes and entities working to provide these access
Any significant issues observed during the assessment, that may influence the user of the impact assessment in decision making, should be highlighted by the social Auditor in the social audit report.
Limitations of the assessment
1.90 The Social Auditor should identify the inherent limitations of the evaluation process which might have an influence on the impact assessment. Some of the examples in relation to promoting health care including mental healthcare, sanitation and making available safe drinking water may include the following:
- Cases of no-response in case the questionnaire is not administered in person
- Some of the questions being skipped by the respondents and remaining unanswered
- Non-availability of respondents after completion of the services provided
- Change in contact details of respondents due to which they could not be contacted
Any significant limitations observed during the assessment, that may influence the user of the Impact assessment in decision making, should be highlighted by the Social Auditor in the social audit report.
SECTION IV – APPENDIX
Taxonomic classification of areas and sub-areas for Social Objectives
(relating to Promoting health care including mental healthcare, sanitation and making
available safe drinking water)
|
Sr. No. |
Areas | Sub-areas |
| 2 | Promoting health care including mental healthcare, sanitation and making available safe drinking water | Reduction of Maternal Mortality Ratio |
| End preventable deaths of newborns and children under 5 years of age | ||
| End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases | ||
| Reduction in premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being | ||
| Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol | ||
| Reduction in deaths and injuries from road traffic accidents | ||
| Ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes | ||
| Attainment of universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines |
||
| Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control | ||
| Increase health financing and the recruitment, development, training and retention of the health workforce | ||
| Achieving universal and equitable access to safe and affordable drinking water for all | ||
| Achieving access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations | ||
| Improving water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse | ||
| Implementation of integrated water resources management at all levels |
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