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Karnataka TERRITORIAL HEALTH INEQUALITIES

TACKLING HEALTH ISSUES IN HIGH FOCUS – NORTH KARNATAKA DISTRICTS Date : 04.07.2010 BY S.SELVA KUMAR Mission Director National Rural Health Mission Karnataka. Karnataka TERRITORIAL HEALTH INEQUALITIES.

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Karnataka TERRITORIAL HEALTH INEQUALITIES

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  1. TACKLING HEALTH ISSUES IN HIGH FOCUS –NORTH KARNATAKA DISTRICTS Date : 04.07.2010BY S.SELVA KUMARMission Director National Rural Health MissionKarnataka

  2. Karnataka TERRITORIAL HEALTH INEQUALITIES • Health Indicators are relatively poor in the districts of Bidar, Gulbarga, Bijapur, Bagalkot, Koppal, Raichur, Bellary, Chitradurga, Davangere, Kolar, Chamarajanagar totaling 11 districts. • GOI identified 7 high focus districts. • Bidar, Raichur, Bellary, Davanagere, Chitradurga, Kolar, Chamarajnagara. • Bidar, Raichur, Bellary & Chamarajnagara appear in both the lists. • Resources and Strategies are more focused in these districts.

  3. “OBSTACLES TO HEALTH” SOCIAL DIMENSION SOURCE DLHS-III • Female literacy lowest in Raichur – 35.9% • Percentage of girls marrying before 18 years is highest in Koppal – 44.7% • Unmet need for family planning is highest in Gulbarga – 23.9 % • Percentage of institutional delivery is lowest in Koppal – 24.8%

  4. COMMUNITY DIAGNOSIS OBSTACLES FOR ACHIEVING BETTER HEALTH & DEVELOPMENT MMR & IMR are high and not declining fast enough. Prohibitive out of pocket expenditure. Unregulated fertility, resulting in population explosion. Emerging and reemerging disease burden Service delivery - ineffective and insensitive. Manpower shortage and unmotivated. Weak community involvement inspite of vibrant PRI. Inadequate finance for local health planning and action. Inability to utilize funds. Non-participation of AYUSH and traditional practitioners.

  5. FOCUSED STRATEGIES 1. Service delivery improvement : Infrastructure strengthening & upgradation Civil works Equipments Functionalization of institutions Human resource (additional & otherwise) District specific plans in 7 high focus (GOI) districts 2. Communitization : ASHA VHSC ARS 3. Demand Generation : ThayiBhagya ThayiBhagya+ (State) PrasoothiAraike (State) JSY Madilu 4. Referrals : JananiSurakshaVahini ArogyaKavacha (108) 5. Special programme : Vajpayee Arogyashree Home Based New Born & Child Care (HBNCC) Maternal, neo-natal & child health (MNCH) 6. Difficult area allowance 7. Governance & monitoring : District nodal officers from the state Tool kit for monitoring

  6. SERVICE DELIVERY IMPROVEMENT (Supply side) i.Infrastructure strengthening & upgradation in these focussed Districts State budget has been enhanced considerably through Special Development Plan. World Bank Assisted KHSDRP Assistance under Kfw funding. NRHM infrastructure works

  7. SERVICE DELIVERY IMPROVEMENT … Fwd ii. Functionalization of institutions : Sub centre – 838/2282 (36%) Rent for areas where govt. building is not available PHC – 24x7, All PHCs in Gulbarga division with districts of Bidar, Gulbarga, Raichur, Koppal & Bellary, have been converted into 24x7 to improve the accessibility of services. FRUs – Out of 192 FRUs 76 are situated in high focus districts which is equal to 40%. NICUs – 8 no. are planned in high focused districts. ANM training schools – Apart from govt. run 11 ANMTC, 12/28 (43%) are opened in private sector. Urban health centres – 19/37 (51%) of urban health centres are working in high focus districts. UHCs in Bangarpete, Urigaum of Kolar districts are filling up the gap in health services where BGML has withdrawn.

  8. SERVICE DELIVERY IMPROVEMENT … Fwd iii. Human resource (additional & otherwise) : Doctors Specialists-34/65=52% General Duty Medical Officers (GDMOs) - 5/8=62% Staff Nurse-1335 / 2869 = 47% ANMs i. Against vacancy-410 /973 =42% ii. Additional-750 ANMs in backward districts

  9. 24x7 PHCs 443 OF 961 24x7 PHCS=46% ARE IN HIGH FOCUS DISTRICTS Family friendly with : Clean serviceable toilets Clean environment Seating arrangements Clean and fresh drinking water TV with video for health education Clean and fresh linen A septic delivery room and ward Identified vehicle for mobility during emergency

  10. COMMUNITIZATION ASHA – Around 9000 ASHAs were selected, trained & positioned in 6 ‘C’ and Chamarajnagar districts in the 1st phase itself during 2008-09. All these ASHAs are pro-actively working for the cause of MCH services. As on today 29,688 ASHAs are in the field. ii. VHSC–8,204 / 23, 973 (34%) have been functionalized for creating health awareness in the community. iii. ARS – 799/2,483 (32%) are actively functioning to improve the facilities & services.

  11. DEMAND GENERATION Thayi Bhagya Thayi Bhagya+ Prasoothi Araike JSY Madilu

  12. THAYIBHAGYA SCHEME (PPP MODEL)

  13. PRASUTHI ARAIKE • State initiative from the year 2008-09 • Piloted in 6 ‘C’ & Chamarajnagar district to start with & upscaled to the entire stat. • Intends to provide wage loss compensation and nutritional assistance to SC, ST & BPL pregnant women & mothers • Rs. 2000/- in two instalments • First installment of Rs. 1000/- during last 3 months of pregnancy • Second installment of Rs. 1000/- immediately after delivery in a Govt. hospital only • Full ANC care with 3 ANC checkup, TT immunization and Full consumption of iron tablets is a necessity for getting the benefit • 98,161 (41%) PREGNANT WOMEN AND MOTHERS HAVE RECEIVED THE BENEFIT OUT OF 2,36,277 DURING THE YEAR 2009-10

  14. MADILU • Extremely popular home grown innovation • 19 Items for mother and infant care • For BPL / SC & ST families, 1st two live births • Improved Institutional Deliveries * Safe motherhood * Improved child survival 98187 (40%) BENEFICIARIES OUT OF 247372 ARE FROM HIGH FOCUS DISTRICTS

  15. COMPONENTS OF MADILU KITS (TOTAL 19 ITEMS) Checks Bed Sheet Jamakhana Bed Sheet Towel Sweater, Socks and Cap Rubber Sheets Abdominal Belt Jabla Cotton Diaper Flannel Bed Sheet Child Bed sheet Sanitary pads for mothers Soaps and Detergents Kit Mosquito Net (For 21 Malaria Endemic Districts Only)

  16. REFERRALS Janani Suraksha Vahini – Free ambulance services for shifting complecated delivery cases from one institution to another. Arogya Kavacha (108) - Emergency ambulance services available across the State with toll free number 108. 517 Ambulances are in the field. 42% of the referrals are maternity cases.

  17. SPECIAL PROGRAMMES Vajpayee Arogyashree : Cashless insurance coverage for the BPL families for treatment of chronic & serious diseases. Treatment at accredited specialty and super-specialty hospitals. 402 diseases identified for the service. Pre-existing diseases are covered. Neo-natal medical problems are also covered. 5 members in a BPL family are eligible. Rs.1.5 lakhs medical assistance per annum per family is the upper limit. Diet & transportation charges are re-embursed. Programme is piloted in the districts of BIDAR, GULBARGA, RAICHUR, KOPPAL & BELLARY of Gulbarga division. Shortly going to be extended to districts of Belgaum division, wherein the backward districts of BIJAPURA & BAGALKOTE get covered.

  18. SPEICAL PROGRAMMES ….. Fwd ii. Home Based New Born & Child Care (HBNCC) : Gadchiroli model of residential new born care. Targeted to reduce Neo-natal Mortality & Infant Mortality. Programme implemented in phases. The high focused districts of Bidar, Gulbarga, Raichur, Koppal, Bijapur, Bagalkote & Chamarajnagar are identified for the programme. 16 taluks have been identified for the 1st phase. Master trainers have already been trained in SEARCH, Gadchiroli. Mentor facilitators training will be commenced shortly.

  19. SPEICAL PROGRAMMES …. Fwd iii. Maternal,Neo-natal & Child Health (MNCH): Implemented through Karnataka Health Promotion Trust (KHPT) under liberal assistance from Bill & Melinda Gates foundation. Goal is to improve maternal neo-natal & child health (MNCH) outcomes. Project period is 5 years starting from January 2010. Focus districts are all the 6 ‘C’ category districts. Improvement of service delivery through capacity building of lower and middle level managers. Preparation of meaningful, implementable, need –based & data based district health action plans.

  20. GOVERNANCE & MONITORING District nodal officers from the state : 30 state level officers in the department have been identified as district nodal officers. Visit the districts 3 days in a month as per Pre-fixed calendar. Most senior officers themselves have taken the responsibility of high focused northern districts. ii. Tool kit for monitoring : Review format along with tool kit have been designed, developed for uniformity in monitoring. Structured scoring have been incorporated both in physical & financial progress for uniform & quality monitoring. Creates a sense of competition among the districts to score high and top the list every month.

  21. Governance ……Contd • Video Conferncing with Health Managers (CMO’s , Program Officers of the Districts, Block Health officers, Administrative Medical Officers of CHC’s) through KSWAN network by the Secretary H&FW • Capacity Building program of VHSC and RKS members through identified NGO’s.

  22. Save the Girl Child THANK YOU 22

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