Presentation on theme: "Dr. H.Sudarshan Karuna Trust"— Presentation transcript:
1Dr. H.Sudarshan Karuna Trust www.karunatrust.org firstname.lastname@example.org Seminar on the 11th Five Year Plan of Karnataka: Perspectives Issues in health care in Karnataka and recommendationsDr. H.SudarshanKaruna Trust
2STRENGTHS AND ACHIEVEMENTS Among the key States in India, Karnatakais above the national average (HDI rank 7).has a wide network of Health Care InstitutionsStrong political will and concern for healthhas 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 Scienceshas 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)
3STRENGTHS & ACHIEVEMENTS Externally Aided Projects - infrastructure made available; efficient and effective work culture.The Community Mental Health initiative in BellaryPartnership with Voluntary OrganisationsMaking available anti-tubercular drugsBringing out Human Development Report (HDR)Growing sensitivity to Health care needs and addressing the formidable challenges of Equity in Health and Development.
5ProgressIncreased Life expectancy at birth from 26 years in 1947 to 66.3 years for women and 65.1 for men in 1997Institutional deliveries have improved to 66.9% from 38.4 in (NFHS)Decline in crude birth rage from 41.6 to 22.7/1000 population from 1961 to 1997Control to a considerable extent of Vaccine Preventable Diseases such as polio, diphtheria, whooping cough, tetanus and to a smaller extent measles.
6ProgressImproved infrastructure at secondary care and tertiary care through external aidImproved coverage of community mental health services through the District Mental Health ProgramPartnership with Non-profit voluntary oganizations in primary health care and district levelKarnataka State Integrated Health Policy document
7InequityMonitor 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.
9IDENTIFICATION OF REGIONAL BACKWARDNESS BASED ON THE AGGREGATE DEVELOPMENT INDEX
10Quality 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.
11Primary Health CarePrompt filling up of vacancies – essential staff to stay in headquartersConstruction and renovation of PHC Quarters in a definite time frameLady Medical Officers/ Staff Nurse/ Nurse-obstetrician and Nurse-PractitionerMale Health Workers – choicesSpeedy transport for emergencies and mobility for staff
12Primary Health Care Fully functional laboratories Village Health Committees and PHC CommitteesRound the clock ServicesFunctional Referral SystemRe-organisation / restructuring of SCs, PHUs & PHCs
13Urban 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.
14Secondary and Tertiary Care Mismatch of specialists, technicians and equipment.Administrative Medical Officer to be trained in Hospital AdministrationSocial Workers and DharmashalasEquipment Maintenance - reduction in down timeBio – safetyDevelop Emergency Medicine & Trauma Care Centres – good communication system, ambulance services with trained paramedics.
15Secondary and Tertiary Care Integrate District Hospital Lab and District Public Health LabStandardisation and quality systems of labs, Imaging and other diagnostic servicesOne Standardised Blood Bank per districtIncrease voluntary and related blood donation and rational use of blood.
16Public Health Nutrition - children, adolescents, women Water – availability, purification, standards, testingSanitationWaste management – general waste, hazardous waste, biomedical wasteCollection, segregation at source, disposalPollution control – Air, water and soil
17Communicable Diseases Public HealthCommunicable DiseasesVector borne disease control – by vector control bioenvironmental, Chemical only when essential –(Malaria, JE, Filaria, Dengue, KFD)Disease Surveillance –District Surveillance UnitsKFD – Prevention, ELISA Testing – adequate vaccinesTB: early case detection, complete treatment, close monitoring. DTOsVaccine 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 ForceHIV/AIDS and STDs: Integration with general health services, Voluntary Testing in all districts, Continuum of care, Preventive Education
18Non Communicable Diseases Public HealthNon Communicable DiseasesNeed for District Disease Control Programs for: Diabetes; cardiovascular diseases; Rheumatic fever; Respiratory diseases; Cancer; Blindness; Oral health; Mental health; Neurological disorders;Tobacco controlAlcohol and healthDisaster management – health aspectsAccidents – head injuries – helmetsOccupational health
19Women and Child Health Women’s health Gender issues: access to care, privacy, gender segregated data.Empowerment of women for healthViolence – female foeticide, infanticide, domestic violence, sexual abuseChild HealthAdditional birth attendantIndira Gandhi Institute - apex bodyDiarrhoea – Oral Rehydration Therapy, Acute Respiratory InfectionsHealth education, services for adolescents
20Reproductive and Child Health Programme Women and Child HealthReproductive and Child Health ProgrammeCNA approachQuality of FRUs, Emergency Obstetric CareASHA & Dai training and dai kitsPopulation StabilisationUnmet needs to be metQuality of services, regular follow up, choice of contraceptives, safe contraceptivesRaising age at marriage, registration of marriagesSpacingAdolescent life skill educationCommittee on social development and population issues
21Focus on Special Groups Persons with disabilityPrevention, early detection, medical treatment and rehabilitation , CBR approachCoordination with associated departments and agenciesTribal PeopleSurvey of health statusTribal ANMs, flexible normsTraditional healing systemsElderly personsPolicy for the elderlyGeriatric care facilitiesHealth insurance and pensions
22Human Resource Development for Health Moratorium on new Medical, ISM&H, Nursing, Dental, Pharmacy and Physiotherapy collegesRepairs 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 examinationTeacher training, Performance AppraisalNon-teaching staff of Medical College Hospitals to be under the control of Dept. of Medical Education
23Human Resource Development for Health TrainingState Institute of Health & Family Welfare - as an institute of excellence.Regional, District & ANM training centres under SIH&FWResearch in HealthEstablish – Research BoardCentre for Population and Health Research - Upgradation
24Rational Drug Management Optimization of Drug procurement – quantification, proceduresEstablishment of Standard Treatment Guidelines, Essential Drug List and State Formulary.Govt. Medical Stores/District Stores – reorganisationDrugs Control Department –Strengthening for effective supervision.
25Law and EthicsEffective implementation of Human Organ Transplant Act, 1994 and Prenatal Diagnostic Techniques Act, 1994Renew Registration of health professionals every 5 yearsEnact comprehensive law for Private Health Institutions – Promote accreditation.Enact comprehensive Public Health Act.Take effective steps to stop quackery.
27Indian Systems of Medicine and Homoeopathy ISM&H hospitals to be renovated, upgraded and relocated at CHC, Taluka and District Hospitals of Modern SystemAppoint 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.
28Panchayat Raj and Empowerment of People 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.
29Strengthening Public Private Partnership Oversight Role of Health DepartmentGIS Mapping of all the Public & Private Providers.Involving Private General Practitioners in PHCAssociation of Voluntary organisations in formulation, implementation and monitoring of health programmes.Involve VOs in managing PHCs, District Health Management & State Resource CenterSimplification of grant-in-aid rules / procedures.Creation of a NGO cell under the Commissioner to promote partnership between the public, private and voluntary organisations.
30Multi Sectorality & Intersectoral Co-ordination 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.
31Health Systems Management Division on the basis of functional responsibilitiesPublic HealthMedical (Curative)District CadresConstitution of Karnataka Health Services (KHS)Reformulation ofCadre/Recruitment/Structures/Rules
32Health Systems Management Enhancement of internal system for vigilance, disciplineManpower management – Appraisal system, Transfer Policy, filling of key vacanciesPrivate Practice - Two choicesDelegation of powersExternally Aided ProjectsHMIS - GISPlanning and MonitoringCommission on Health
33Taluk CHART NO. 1 DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTURE: PROPOSEDDISTRICT LEVELClinicalStreamPublic HealthStreamOb&G Paed Gen SurgFam PhyNeed based temporary contract appointmentsNeed based temporary contract appointmentsGDMOAMOTHOTalukNeed based on numbersInservice PGInservice PGMedical (clinical)Public HealthMO (PHC)PHC (MO)MBBS + PGMBBSMBBS
34District Cadre (ZP Cadre) CHART NO. 2DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDDISTRICT LEVELMedicalPublic HealthDist. Med StoreDist. Maint UnitDist. LaboratoryDist. HMIS UnitDMO (DS)PG in Clinical + Hos AdmDHOPG in Public HealthState cadre (KHS)PG qual. compulsoryMerit cum seniorityDistrict Cadre (ZP Cadre)Deputy DMO/RMOProgramme OfficerAMOTaluka HospitalTaluk Health Officer(THO)TalukCommunityHealth CentreMBBS min.qualificationPGs can also enterMedical OfficerPHC
35DEPARTMENT OF HEALTH & FAMILY WELFARE – Lady Medical OfficerLady Medical OfficerMedical OfficerMedical OfficerLady Medical OfficerMedical OfficerStaff NurseStaff NursePharmacistPharmacistLab TechLab TechSr. HA (Female)Sr. HA (Female)Sr. HA(Male)Sr. HA(Male)SDCSDCDriver*Driver*AyaAyaStaff NursePharmacistLab TechSr. HA (Female)Sr. HA(Male)SDCDriver*AyaJHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA (M)JHA (M)JHA(F)JHA(F)JHA (M)JHA (M)JHA(F)JHA(F)JHA(M)JHA(M)JHA(F)JHA (M)JHA (M)JHA(M)TBATBATBAVHWVHWVHWAWWAWWAWW* Driver for PHCs which have vehicles* Driver for PHCs which have vehicles* Driver for PHCs which have vehiclesCHART NO. 3DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDDISTRICT LEAVEL, PRIMARY HEALTH CENTRELady Medical OfficerMedical OfficerStaff NursePharmacistLab TechSr. HA (Female)Sr. HA(Male)SDCDriver*AyaJHA(F)JHA(F)JHA(F)JHA(F)JHA(F)JHA (M)JHA (M)JHA(F)JHA(M)TBAVHWAWW* Driver for PHCs which have vehicles
36DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 4DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDDISTRICT LEVELTALUK HEALTH OFFICETaluk Health OfficerDPH QualificationBHE's(Shift from PHCto Taluk Level)Refractionists(Shift from PHCto Taluk Level)ASO(Statistics person must for HMIS)Senior Health Assistant(Male & Female)FDCDriver
37DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 5DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDDISTRICT LEVEL, STRUCTURE AT DISTRICT HEALTH OFFICEDISTRICTHEALTH OFFICERHealth OfficerCorporation/MunicipEntomologistUrban Primary Health CentresProgrammeCo-ordinatorDistrict Surveillance OfficerStatistical OfficerRCHprogramme officerFamily WelfareProgramme OfficerVector Borne DisProgramme OfficerTuberculosisprogramme officerLep/HIV/STDprogramme officerBlindness-programme officerHealth Promotionprogramme officerDt. NutritionOfficerIEC(DHEO)
38DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 6DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDSTRUCTURE AT DISTRICT MEDICAL OFFICEDistrict Medical Officer(DMO)District HospitalRMO/DS/SuperintendentMental HealthProgramme officer(NIMHANS)CVS / DiabetesProgramme OfficerOphthalmicProgramme Officer(MINTO)OncologyProgramme Officer(KIDWAI)AdministrationMedical OfficersCHC/Taluk Hosp.
39DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 7DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDSTRUCTURE AT DISTRICT HEALTH OFFICES – DHO & DMODHODMODistrict HospitalDistrict LaboratoryMicrobiologistPathologistBiochemistProg Co-ordinatorDSOMental-PORCH-POEntmStatisCVS-PODt. Maint UnitCivil worksVehicle maintenanceEquipment maintVector -POOpth-POTB - POOnco-POFW - PODt. Medical StoreLEP+STD/HIVAMOsDt. HMIS UnitBlindness PONutriHP- POIEC
40DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 8DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDSTATE LEVELAutonom Hosp.PRINCIPAL SECRETARYCommission on HealthSecretary (ME)Drug ControllerAutonomous Teaching Hospital / InstituteCommissioner / DGHSDir. ISM&HSIHFWDirector (ME)Pop & Health ResearchCAOFinanceCVOVigilanceDirectorPublic HealthDirectorMedicalDirectorEAPDirectorProcurement / MaintenanceNGO CellAdditional DirectorPlanningAdditional DirectorN. KarnatakaJoint DirectorSpecial Groups
41DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 9DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDSTATE LEVELDIRECTORPUBLIC HEALTHAdd. DirectorAIDS(KSPC)Project DirectorRCH & PHCAdd. DirectorHealth PromotionAD (CMD)State Survey OffChief Acc. OfficerAD-BMPUrban PHCsJDAIDSJDRCHJDPHCJDIECJDNutJD-Vect Borne DisJDTBJDLeprosyJDVaccineJDLabDDKFDDDDis Surv
42DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 10DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDSTATE LEVELDIRECTORMEDICALAddl DirectorNCDCAOAddl DirectorMedicalJDMedicalJDGMSJD-Hosp NorthJD-Hosp SouthJD-Trau-Eme MedJDOphthal(MINTO)JD-CVS & DiabetJD-Dent HealthJD-MH(NIMHANS)JD-Onco(KIDWAI)
43DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 11DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDSTATE LEVELDIRECTORExt. Aided ProjectsDIRECTORProcurement & MaintAD (SPC)Planning & MonitorSecretary PWDJoint DirectorPlanningJoint DirectorHMISJoint DirectorProcurementJD-Bio-Medical Equip MaintenanceSuperintendent EngCivilDD-Law & Ethics(Forensic Medicine)Civil Engineering. Staffas in KHSDP
44DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 12DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE : PROPOSEDDIRECTORATE OF ISM&HDIRECTORISM&HDirectorate levelJDMed EduJDISM&HAdmin OfficerAccountsOfficerAst DrugControllPrincipalsCol & HospAidedCol & HosDDAyurvedaDDUnaniDDHomoeoDDNat & Yog3 Drug-InspectorsDDPharmacyDiv DDs?Physician Gr IDistrict HospitalDt. ISM&H OfficerPhy Gr IIHosp & Disp
45DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 13DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE : PROPOSEDSTATE INSTITUTE OF HEALTH & FAMILY WELFARE (AUTONOMOUS)PRINCIPAL SECRETARYDirector Selection PostSIHFW(Autonomous)Commissioner /DGHSGoverning BoardDirectorateJoint DirectorTrainingJoint DirectorResearch(Social Scientist)SpecialistsCommunicationHealth MgtRCH/NCDPrincipals RHFWTC/DTCANM Training CentresDeputy DirectorCourse ContentDeputy DirectorTraining
46DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTURE CHART NO. 14DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTUREDRUG CONTROL DEPARTMENTDRUGS CONTROLLERADDITIONAL DRUGS CONTROLLERDrugs Testing LaboratoryPharmacy EducationEnforcement DivisionHead QuartersDrugs Price Control CellBl bank & IntelligCircle & Dt. OffSuperintendent (Admn) -1Superintendent (Lab)Other TechnicalOfficersJunior ChemistsGovt. College of PharmacyBoard of Examining AuthorityPrincipal & ChairmanMember SecretaryProfessorAsst. ProfessorLectures (Pharmacy Lect) -17(Non Pharmacy)Dy. Drugs ControllerAsst. Drugs Controller -19Drugs Inspector
47DEPARTMENT OF HEALTH & FAMILY WELFARE – CHART NO. 15DEPARTMENT OF HEALTH & FAMILY WELFARE –ORGANISATIONAL STRUCTURE: PROPOSEDDEPARTMENT OF MEDICAL EDUCATIONSECRETARYMEDICAL EDUCATIONAutonomous TeachingHospitals/InstitutionsDirectorMedical EducationADMed EduDEANGDCDEANBMCDEANMMC*DirRIOVice PrlBMCVice PrlMMCSuprHos 1SuprHos 2SuprHos 3SuprHos 4SuprHos 5SuprHos 6SuprHos 7JDMEVice PrlGDCPROFESSORS & HOD BMC / MMCASSOCIATE PROFESSORSASSISTANT PROFESSORSLECUTRERSREGISTRARS / TUTORS / DEMONSTRATORS/ RESIDENTS* Regional Institute Ophthalmology (RIO) could be made into an Autonomous InstitutionDD (ME)DD (DE)
48Financial Management 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 powersRelease of funds - timely issue of sanctionNo budgetary cuts for Health ServicesAdequacy of funds for maintenance of essential needs – repairs, maintenance and efficient use of assetTest Audit
49Health Insurance Social Security ESI State & Central Yashaswini Health InsuranceCommunity Health Insurance of Karuna TrustUniversal Health Insurance of GOIWorld Bank Assisted Project - KHSDRP
50Karnataka State Integrated Health Policy Vision, Mission & GoalsComprehensive Health Policy which includesHealth PolicyPopulation policyDrug policyNutrition policyEducation for Health Sciences – PolicyBlood banking policyPolicy on Control of Nutritional AnaemiaAIDS Prevention & Control Policy (draft)ISM&H Policy (draft)Pharmaceutical Policy
51Vision 2020 Indicators 2001 (Source / Year) 2020 Infant Mortality Rate 58/1000 live births25/1000 live birthsUnder – 5 Mortality Rate69/1000 live births35/1000 live birthsCrude Birth Rate22.3/1000 population13/1000 populationCrude Death Rate7.7/1000 population6.5/1000 populationMaternal Mortality Rate195/ 1 lakh live births90/ 1 lakh live birthsLife Expectancy at BirthMale61.7 years70.0 yearsFemale65.4 years75.0 yearsTotal Fertility Rate2.131.6Percentage of Institutional Deliveries51.175Percentage of Safe deliveries59.2>95
52VISION 2020 Indicators 2001 2020 Newborns with Low Birth Weight 35% 10%Percentage of mothers who received ANC86.3100Percentage of eligible couples protected59.770%Percentage of children fully immunised60>90Anaemia among children (6-35 months)70.6%40.0%Nutritional Status of childrenSevere under nutrition6.2%2.0%Moderate under nutrition45.4%25.0%Mild under nutrition39.0%43.0%Normal9.4%30%Sex (Gender) ratio964F/1000M975F/1000MSex (Gender) ratio, 0-6 years949/1000M970F/1000M
53Reforms for Good Governance in Health ServicesProactive Lokayukta – Ombudsman for PRI and active Monitoring – institutionalize the reformsVigilance cell in Health Department – Strengthen and Capacity building – ExpertiseE-Governance: HMIS – Program and HRM, computerize transfers, recruitment, promotions, e-procurement, Web site for transparency and accountabilityIntegrity Pact – black listing and debarringEffective Management and Supervision by Administrators and senior staff – Field visits
54Reforms for Good Governance in Health Services Training in Health & Hospital Management – Effective Monitoring of Stay at the HQ, Private practice, absenteeism, Decision Making & Problem solvingLeadership TrainingHealth staff Welfare: Salaries, benefits, non-monetary incentives, grievance reddressal mechanism.Hospital & Health Committees – Citizen’s Charter, Report card systemPublic grievance redressal at various levels