Seminar on the 11th Five Year Plan of Karnataka: Perspectives Issues in health care in Karnataka and recommendations

1. Seminar on the 11th Five Year Plan of Karnataka: PerspectivesIssues in health care in Karnataka and recommendations Dr. H.Sudarshan Karuna Trust www.karunatrust.org ktrust@vsnl.net

2. Among the key States in India, Karnataka is above the national average (HDI rank 7). has a wide network of Health Care Institutions Strong political will and concern for health has committed and dedicated officials and bureaucrats; increasing openness and receptive bureaucrats and technocrats. has several health professional educational institutions and Rajiv Gandhi University of Health Sciences has eradicated of smallpox, plague in humans, and recently guineaworm infestation. has made substantial progress in the control of Vaccine Preventable Diseases (Polio, Diphtheria, Whooping cough, Tetanus, Measles) STRENGTHS AND ACHIEVEMENTS

3. Externally Aided Projects - infrastructure made available; efficient and effective work culture. The Community Mental Health initiative in Bellary Partnership with Voluntary Organisations Making available anti-tubercular drugs Bringing out Human Development Report (HDR) Growing sensitivity to Health care needs and addressing the formidable challenges of Equity in Health and Development. STRENGTHS & ACHIEVEMENTS

4. Health Status of Karnataka

5. Progress Increased Life expectancy at birth from 26 years in 1947 to 66.3 years for women and 65.1 for men in 1997 Institutional deliveries have improved to 66.9% from 38.4 in 1992-93 (NFHS) Decline in crude birth rage from 41.6 to 22.7/1000 population from 1961 to 1997 Control to a considerable extent of Vaccine Preventable Diseases such as polio, diphtheria, whooping cough, tetanus and to a smaller extent measles.

6. Progress Improved infrastructure at secondary care and tertiary care through external aid Improved coverage of community mental health services through the District Mental Health Program Partnership with Non-profit voluntary oganizations in primary health care and district level Karnataka State Integrated Health Policy document

7. Inequity Monitor inequities in health based on social, economic and health care services, disaggregated with respect to age, gender, socio economic status, geographical regions and others. The Health System must improve availability and access to quality health care (particularly primary health care and public health) in the underserved talukas / districts and for the poor and vulnerable population. In the large and undivided districts like Gulbarga and Belgaum the districts should be divided into two and a post of Additional DHO / DMO should be created with Additional team of Programme Officers. An Additional Director should be made responsible for the Northern Districts.

10. Quality of Health Services Effective implementation of the Health Establishment Bill for ensuring proper standards in the private health care system. Have minimum acceptable standards worked out by independent committees for health care institutions at different levels and locations and for public health measures. The Joint Directors, Medical and Public Health, will be designated as the persons in charge of Quality Assurance. The Administrative Medical Officer in charge of each hospital will be responsible for ensuring quality of care in each institution. The professional bodies may be encouraged to have accreditation of their member institutions. The Indian Medical Association, Karnataka State Branch may take the initiative.

11. Prompt filling up of vacancies � essential staff to stay in headquarters Construction and renovation of PHC Quarters in a definite time frame Lady Medical Officers/ Staff Nurse/ Nurse-obstetrician and Nurse-Practitioner Male Health Workers � choices Speedy transport for emergencies and mobility for staff Primary Health Care

12. Fully functional laboratories Village Health Committees and PHC Committees Round the clock Services Functional Referral System Re-organisation / restructuring of SCs, PHUs & PHCs Primary Health Care

13. Urban Primary Health Care Have Urban Primary Health Centres, one for 50,000 population in cities and towns, converting the existing resources such as health centers, urban family welfare centers and maternity homes. While these Urban Primary Health Centres will be the responsibility of the local body (Corporation or Municipality), technical guidance will be provided by the Directorate of Health and Family Welfare Services.

14. Mismatch of specialists, technicians and equipment. Administrative Medical Officer to be trained in Hospital Administration Social Workers and Dharmashalas Equipment Maintenance - reduction in down time Bio � safety Develop Emergency Medicine & Trauma Care Centres � good communication system, ambulance services with trained paramedics. Secondary and Tertiary Care

15. Integrate District Hospital Lab and District Public Health Lab Standardisation and quality systems of labs, Imaging and other diagnostic services One Standardised Blood Bank per district Increase voluntary and related blood donation and rational use of blood. Secondary and Tertiary Care

16. Nutrition - children, adolescents, women Water � availability, purification, standards, testing Sanitation Waste management � general waste, hazardous waste, biomedical waste Collection, segregation at source, disposal Pollution control � Air, water and soil Public Health

17. Communicable Diseases Vector borne disease control � by vector control bioenvironmental, Chemical only when essential �(Malaria, JE, Filaria, Dengue, KFD) Disease Surveillance �District Surveillance Units KFD � Prevention, ELISA Testing � adequate vaccines TB: early case detection, complete treatment, close monitoring. DTOs Vaccine Preventable Diseases � complete coverage with cold chain � Hepatitis B, vaccine production in collaboration with Animal Husbandry Dept. Food & water borne diseases � food inspection, Rapid Action Force HIV/AIDS and STDs: Integration with general health services, Voluntary Testing in all districts, Continuum of care, Preventive Education Public Health

18. Non Communicable Diseases Need for District Disease Control Programs for: Diabetes; cardiovascular diseases; Rheumatic fever; Respiratory diseases; Cancer; Blindness; Oral health; Mental health; Neurological disorders; Tobacco control Alcohol and health Disaster management � health aspects Accidents � head injuries � helmets Occupational health Public Health

19. Women�s health Gender issues: access to care, privacy, gender segregated data. Empowerment of women for health Violence � female foeticide, infanticide, domestic violence, sexual abuse Child Health Additional birth attendant Indira Gandhi Institute - apex body Diarrhoea � Oral Rehydration Therapy, Acute Respiratory Infections Health education, services for adolescents Women and Child Health

20. Reproductive and Child Health Programme CNA approach Quality of FRUs, Emergency Obstetric Care ASHA & Dai training and dai kits Population Stabilisation Unmet needs to be met Quality of services, regular follow up, choice of contraceptives, safe contraceptives Raising age at marriage, registration of marriages Spacing Adolescent life skill education Committee on social development and population issues Women and Child Health

21. Persons with disability Prevention, early detection, medical treatment and rehabilitation , CBR approach Coordination with associated departments and agencies Tribal People Survey of health status Tribal ANMs, flexible norms Traditional healing systems Elderly persons Policy for the elderly Geriatric care facilities Health insurance and pensions Focus on Special Groups

22. Moratorium on new Medical, ISM&H, Nursing, Dental, Pharmacy and Physiotherapy colleges Repairs to colleges, hospitals and hostels. Fill up Vacancies in teaching hospitals. Medical colleges to take up 3 PHCs for training and providing health services. Corruption in examination Teacher training, Performance Appraisal Non-teaching staff of Medical College Hospitals to be under the control of Dept. of Medical Education Human Resource Development for Health

23. Training State Institute of Health & Family Welfare - as an institute of excellence. Regional, District & ANM training centres under SIH&FW Research in Health Establish � Research Board Centre for Population and Health Research - Upgradation Human Resource Development for Health

24. Optimization of Drug procurement � quantification, procedures Establishment of Standard Treatment Guidelines, Essential Drug List and State Formulary. Govt. Medical Stores/District Stores � reorganisation Drugs Control Department �Strengthening for effective supervision. Rational Drug Management

25. Effective implementation of Human Organ Transplant Act, 1994 and Prenatal Diagnostic Techniques Act, 1994 Renew Registration of health professionals every 5 years Enact comprehensive law for Private Health Institutions � Promote accreditation. Enact comprehensive Public Health Act. Take effective steps to stop quackery. Law and Ethics

27. ISM&H hospitals to be renovated, upgraded and relocated at CHC, Taluka and District Hospitals of Modern System Appoint District Level ISM&H Officers. The issue of disparity in stipend/ salary between doctors/ internees of ISM&H and modern medicine should be examined on a priority basis. Upgradation of the Government ISM&H Pharmacy. Indian Systems of Medicine and Homoeopathy

28. Enhance the role of PRI in health management. Formulation of Health component of the District Development Plan. Monitoring of Health activities of ZPs by Commissioner. System to ensure better involvement and co-ordination between health officials and PRI. Panchayat Raj and Empowerment of People

29. Oversight Role of Health Department GIS Mapping of all the Public & Private Providers. Involving Private General Practitioners in PHC Association of Voluntary organisations in formulation, implementation and monitoring of health programmes. Involve VOs in managing PHCs, District Health Management & State Resource Center Simplification of grant-in-aid rules / procedures. Creation of a NGO cell under the Commissioner to promote partnership between the public, private and voluntary organisations. Strengthening Public Private Partnership

30. Establishment of mechanisms for intersectoral co-ordination at all levels. Set up a High Power Committee with Chief Secretary as Chairman for intersectoral co-ordination. Multi Sectorality & Intersectoral Co-ordination

31. Division on the basis of functional responsibilities Public Health Medical (Curative) District Cadres Constitution of Karnataka Health Services (KHS) Reformulation of Cadre/Recruitment/Structures/Rules Health Systems Management

32. Enhancement of internal system for vigilance, discipline Manpower management � Appraisal system, Transfer Policy, filling of key vacancies Private Practice - Two choices Delegation of powers Externally Aided Projects HMIS - GIS Planning and Monitoring Commission on Health Health Systems Management

48. Optimum utilisation of existing allocation Increase in Health Budget from 4% to 7% National Health Accounts and State Health Accounts � SDP 0.9% to 2 -3% Delegation of financial powers Release of funds - timely issue of sanction No budgetary cuts for Health Services Adequacy of funds for maintenance of essential needs � repairs, maintenance and efficient use of asset Test Audit Financial Management

49. Health Insurance Social Security ESI State & Central Yashaswini Health Insurance Community Health Insurance of Karuna Trust Universal Health Insurance of GOI World Bank Assisted Project - KHSDRP

50. Vision, Mission & Goals Comprehensive Health Policy which includes Health Policy Population policy Drug policy Nutrition policy Education for Health Sciences � Policy Blood banking policy Policy on Control of Nutritional Anaemia AIDS Prevention & Control Policy (draft) ISM&H Policy (draft) Pharmaceutical Policy Karnataka State Integrated Health Policy

51. Vision 2020

52. VISION 2020

54. Reforms for Good Governance in Health Services Training in Health & Hospital Management � Effective Monitoring of Stay at the HQ, Private practice, absenteeism, Decision Making & Problem solving Leadership Training Health staff Welfare: Salaries, benefits, non-monetary incentives, grievance reddressal mechanism. Hospital & Health Committees � Citizen�s Charter, Report card system Public grievance redressal at various levels

55. THANK YOU