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Karuna Trust’s experiences in Managing PHCs in Arunachal & Meghalaya

Karuna Trust’s experiences in Managing PHCs in Arunachal & Meghalaya. Management of Health Centres in Remote Areas Under Public Private Partnership (PPP) Program. Anup Sarmah Coordinator, North East. Map showing Arunachal & Meghalaya. Arunachal Pradesh. Meghalaya. Karuna Trust.

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Karuna Trust’s experiences in Managing PHCs in Arunachal & Meghalaya

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  1. Karuna Trust’s experiences in Managing PHCs in Arunachal & Meghalaya Management of Health Centres in Remote Areas Under Public Private Partnership (PPP) Program Anup Sarmah Coordinator, North East

  2. Map showing Arunachal & Meghalaya Arunachal Pradesh Meghalaya

  3. Karuna Trust Started in 1986 by Dr H Sudarshan in B.R Hills, Karnataka Five states in India, 46 PHCs, 200+ SCs, Population covered- 720,938 More than 1300 Medical and paramedical staff Rural Development activities- 500+ SHGs, cooperative societies Herbal medicine processing industry, Central Food Processing Units, Vocational Training centre, Telemedicine, Community Health insurance, mental health program in PHCs Started Leprosy Control program with Karnataka Govt. of Karnataka in 1987. From 21.4/1000 in 1987 to 0.28 per 1000 population in 2005. In 1996, Karuna Trust proposed a partnership with the Government to adopt and run a Primary Health Center (PHC) in Yelandur taluk, Gumballi. This marked the beginning of a public-private partnership in running PHCs in India.

  4. IMR at Gumballi PHC, Karnataka New population added

  5. Karuna Trust – PPP in India Karnataka State – 26 PHCs (5 Lakh population), 7 Mobile Medical Units, one FRU, Help Desk at District Hospitals. 2 PHCs through other NGOs – Vivekananda Foundation & Vemana Trust Arunachal Pradesh – 9 PHCs ( 2005) Meghalaya State – 3 PHCs (2009) Orissa State – 5 PHCs Andhra Pradesh – Adilabad – 2 PHCs

  6. Public Private Partnership (PPP) • Public – Government • Private – For Profit Private Sector & Not for Profit Sector ( NGOs, VOs) • Partnership: Both the parties work together towards a common purpose. Partnership is in Policy formulation, Planning, Implementation, Monitoring, evaluation, Training & Research. • PPP is not the same as privatisation, neither does it mean that the not for profit sector (eg. NGOs) functions as contractors who implement government schemes.

  7. Key Actors in PPP • National Govt.- approval, Budget • State Govt.- Guidelines, logistics, vaccines • Karuna Trust- Implementation • PRIs( Panchayat)- Local Governance • 3 tier monitoring system- NGO( Coordinator, supervisor, MO), Local governance (PRI) and State Govt.

  8. Models/Options for PPP • Model I : KT directly implementing • Model II : Partnership with local NGO & Government. • Model III: KT playing the role of facilitator and partnership between local NGO and Govt.

  9. Partnership Process • Identification & selection of PHCs • Response to EOI. • Dialogue with community and local PRIs • Shortlisting of NGOs • Government Order: Signing MOU with Director of Health • Handing over of PHC & SCs by DMO to Karuna Trust • 90% of budget from state Govt, 10 % contribution from NGOs • Duration : Initial three years – Renewal every year • Land, buildings and equipment are handed over to NGO. Assets created from govt. funds will remain with the govt. • Government staff withdrawn from the PHC, NGOs appoint their own staff. • Monthly reports to the district and DHS office • Submission of audit report to Govt. to review of performance.

  10. Community participation Preventive Curative Appropriate Health Technology Primary Health Care Equitable Distribution Multi sectoral Approach Promotive Rehabilitative Karuna Trust’s Primary Health Care Model

  11. SERVICES PROVIDED IN PHCs • All Staff stay in PHC/SC premises • 24 hours Emergency/Casualty Services. • OPD service. Home based care at the time of necessity • 5 to 13 Bed inpatient facility. • 24 hrs labour Room and Essential Obstetrics facility. • New borne care corner • Minor Operation Theatre facility. • 24 hrs Ambulance facility, referral for emergencies • RI, ANC/PNC, family planning services, RTI/STI • Availability of essential medicines and Lab. test free of cost. • Implementation of National Health Programs including NRHM. • Organizing village health camp/out reach camp • Door to door house visit by ANMs • Weekly SC visit by MO • Alternate power backup • Vision centres • Emergency Medical Services • Community Participation

  12. Innovations • Total population count, name based tracking system, • Emergency Medical Service (EMS) • Staff training and motivation • Exposure visit to Karnataka PHCs • Vision centres in PHCs • Innovation in ASHA training • Promotion of Traditional Medicine – 20 herbs for Primary Health Care. Herbal garden in PHCs • Promotion of Generic drugs and Rational drug use • Promoting institutional delivery by adopting various methods • Students Health volunteers • Effective IEC • Opium deaddiction

  13. Manpower position in Arunachal & Meghalaya

  14. Deliveries in PHCs

  15. Performance in Malaria control

  16. Malaria positive cases in Sangram PHC

  17. VHND year wise comparison

  18. Outreach Health camp year wise

  19. Asset Creation from PPP fund • Purchased 8 new Ambulance • Purchased 9 motorcycles • X Ray machine in 3 PHCs • Generator in all nine PHCs • Solar light in all PHCs

  20. Assets creation contd…. Labour room development RCC water tank, Anpum X ray Building in one PHC Repairs & maintenance Tiles in ward room in PHCs Labour room in all SCs Staff Quarter in Jeying PHC

  21. Indoor care facility • Total 75 beds for inpatient • Diet facility for inpatient • Kitchen building in 4 PHCs • Vegetable Gardens in all PHC • Referral service for inpatients

  22. Drugs, vaccines etc: • Promotion of generic drugs. • Annual/6 month indenting of Essential drugs • Proper storage, Bin card system. • Stock register updated monthly. • Return the drugs 3 months before • the expiry date • Cold chain for vaccines

  23. Untidy & dirty Dilapidated No Electricity Inadequate equipments, infrastructure and medicines Health services not regular No cold chain, no routine immunization, No IPD facility No ambulance Poor coverage of NHPs No outreach programs No Laboratory Cleaned-up Renovated Alternative arrangement Adequate equipments, infrastructure and medicines Health services available 24 X 7 Cold chain in PHCs, RI regular, outreach sessions regular 5-13 beds facility with Diet Good referral service Better coverage of NHPs. Regular Outreach programs Full fledged Lab as per PHC norms Then….… &………. Now

  24. Then….. • ……Now PHC Building

  25. Then….. Now…... Pharmacy in 2005 Pharmacy in 2006

  26. Kibithu Subcentre, 2008 Kibithu Subcentre, 2006

  27. Then………… Now…….. PHC Building, Mawlong Meghalaya

  28. Then………… Now…….. Pharmacy, Mawlong PHC Meghalaya

  29. Arunachal Pradesh- Challenge for Health workers

  30. Crossing the river Dibang to reach Bizari SC

  31. Towards PHC Dambuk

  32. Crossing the tributaries of Lohit river

  33. Connecting India’s last village KAHO

  34. Life at own risk, crossing river Lohit

  35. Towards Etalin PHC

  36. Etalin PHC Road

  37. Awareness/IEC

  38. Student Health Volunteer launching

  39. PRI Training in 8 districts, 421 PRIs, 120 villages

  40. Financing PPP in Arunachal (per PHC) Karuna Trust share 10% = 3,00,837 Govt. share 90% = 27,07,535

  41. GRANT RECEIVED (December,2005 to March 2010

  42. SWOT analysis of the Project • Strength is synergy which achieved by merging of efforts from both Karuna Trust and the state government • Weakness of the project is primarily scarcity of medical and paramedical professionals, unequal opportunities available with respect to government job security and inadequate budget for some expenditures • Opportunities of the project can be counted as largest population in remote hilly region are being covered under the project in Arunachal Pradesh. Karuna Trust is providing direct health services for 55000 population through its nine PHCs and 23 SCs. • Threat to the project can be the shortage of manpower (doctors), delay in fund release and regular recruitment of NGO staff by the state Govt.

  43. Constraints we are facing • Geographical location of health centres • Long delays in releasing the Grants, 3-4 months • Less opportunity for innovations due to resource constraints • Shortage of MBBS doctors and turn over, community preference for Allopathic doctors • No budget for Monitoring & supervision and Training • Lack of understanding regarding PPP model- illiteracy • Unrealistic expectations among community members owing to lack of awareness regarding a PHC’s limitations such as cardiac surgery, orthopedics, etc. • Discrimination between Government run PHCs & NGO run PHCs • Lack of physical security for staff – underground militants in some districts of Arunachal • Lack of security among staff regarding their future in the PHC in terms of permanency of their appointment • Sometimes, tendency to override jurisdiction by local community member, Dist. authorities and socio-political condition discourage our efforts

  44. Suggestion for improvement of PPP • Extend the PPP for another 4 years for good outcomes in the health care delivery system • Deputation of Medical officers on contractual basis to NGO run PHCs • Modified budget for better capacity building of PHC staff and monitoring of PHCs • Unconditional (100%) grant to NGOs • Timely release of fund • To make PHCs of IPHS standards – adequate infrastructure

  45. Thank You

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