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

2. STRENGTHS AND ACHIEVEMENTS
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)

3. STRENGTHS & ACHIEVEMENTS
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.

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 (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.

9. IDENTIFICATION OF REGIONAL BACKWARDNESS BASED ON THE AGGREGATE DEVELOPMENT INDEX

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. Primary Health Care
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

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

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. Secondary and Tertiary Care
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.

15. Secondary and Tertiary Care
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.

16. Public Health 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

17. Communicable Diseases
Public Health
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

18. Non Communicable Diseases
Public Health
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

19. Women and Child Health 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

20. Reproductive and Child Health Programme
Women and Child Health
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

21. Focus on Special Groups
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

22. Human Resource Development for Health
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

23. Human Resource Development for Health
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

24. Rational Drug Management
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.

25. Law and Ethics
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.

27. Indian Systems of Medicine and Homoeopathy
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.

28. Panchayat 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.

29. Strengthening Public Private Partnership
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.

30. Multi 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.

31. Health Systems Management
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

32. Health Systems Management
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

33. Taluk CHART NO. 1 DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
Clinical
Stream
Public Health
Stream
Ob&G Paed Gen Surg
Fam Phy
Need based temporary contract appointments
Need based temporary contract appointments
GDMO
AMO
THO
Taluk
Need based on numbers
Inservice PG
Inservice PG
Medical (clinical)
Public Health
MO (PHC)
PHC (MO)
MBBS + PG
MBBS
MBBS

34. District Cadre (ZP Cadre)
CHART NO. 2
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
Medical
Public Health
Dist. Med Store
Dist. Maint Unit
Dist. Laboratory
Dist. HMIS Unit
DMO (DS)
PG in Clinical + Hos Adm
DHO
PG in Public Health
State cadre (KHS)
PG qual. compulsory
Merit cum seniority
District Cadre (ZP Cadre)
Deputy DMO/RMO
Programme Officer
AMO
Taluka Hospital
Taluk Health Officer
(THO)
Taluk
Community
Health Centre
MBBS min.qualification
PGs can also enter
Medical Officer
PHC

35. DEPARTMENT OF HEALTH & FAMILY WELFARE –
Lady Medical Officer
Lady Medical Officer
Medical Officer
Medical Officer
Lady Medical Officer
Medical Officer
Staff Nurse
Staff Nurse
Pharmacist
Pharmacist
Lab Tech
Lab Tech
Sr. HA (Female)
Sr. HA (Female)
Sr. HA
(Male)
Sr. HA
(Male)
SDC
SDC
Driver*
Driver*
Aya
Aya
Staff Nurse
Pharmacist
Lab Tech
Sr. HA (Female)
Sr. HA
(Male)
SDC
Driver*
Aya
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
(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)
TBA
TBA
TBA
VHW
VHW
VHW
AWW
AWW
AWW
* Driver for PHCs which have vehicles
* Driver for PHCs which have vehicles
* Driver for PHCs which have vehicles
CHART NO. 3
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEAVEL, PRIMARY HEALTH CENTRE
Lady Medical Officer
Medical Officer
Staff Nurse
Pharmacist
Lab Tech
Sr. HA (Female)
Sr. HA
(Male)
SDC
Driver*
Aya
JHA
(F)
JHA
(F)
JHA
(F)
JHA
(F)
JHA
(F)
JHA (M)
JHA (M)
JHA
(F)
JHA(M)
TBA
VHW
AWW
* Driver for PHCs which have vehicles

36. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 4
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
TALUK HEALTH OFFICE
Taluk Health Officer
DPH Qualification
BHE's
(Shift from PHC
to Taluk Level)
Refractionists
(Shift from PHC
to Taluk Level)
ASO
(Statistics person must for HMIS)
Senior Health Assistant
(Male & Female)
FDC
Driver

37. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 5
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL, STRUCTURE AT DISTRICT HEALTH OFFICE
DISTRICT
HEALTH OFFICER
Health Officer
Corporation/Municip
Entomologist
Urban Primary Health Centres
Programme
Co-ordinator
District Surveillance Officer
Statistical Officer
RCH
programme officer
Family Welfare
Programme Officer
Vector Borne Dis
Programme Officer
Tuberculosis
programme officer
Lep/HIV/STD
programme officer
Blindness-programme officer
Health Promotion
programme officer
Dt. Nutrition
Officer
IEC
(DHEO)

38. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 6
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STRUCTURE AT DISTRICT MEDICAL OFFICE
District Medical Officer
(DMO)
District Hospital
RMO/DS/Superintendent
Mental Health
Programme officer
(NIMHANS)
CVS / Diabetes
Programme Officer
Ophthalmic
Programme Officer
(MINTO)
Oncology
Programme Officer
(KIDWAI)
Administration
Medical Officers
CHC/Taluk Hosp.

39. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 7
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STRUCTURE AT DISTRICT HEALTH OFFICES – DHO & DMO
DHO
DMO
District Hospital
District Laboratory
Microbiologist
Pathologist
Biochemist
Prog Co-ordinator
DSO
Mental-PO
RCH-PO
Entm
Statis
CVS-PO
Dt. Maint Unit
Civil works
Vehicle maintenance
Equipment maint
Vector -PO
Opth-PO
TB - PO
Onco-PO
FW - PO
Dt. Medical Store
LEP+STD/HIV
AMOs
Dt. HMIS Unit
Blindness PO
Nutri
HP- PO
IEC

40. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 8
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
Autonom Hosp.
PRINCIPAL SECRETARY
Commission on Health
Secretary (ME)
Drug Controller
Autonomous Teaching Hospital / Institute
Commissioner / DGHS
Dir. ISM&H
SIHFW
Director (ME)
Pop & Health Research
CAO
Finance
CVO
Vigilance
Director
Public Health
Director
Medical
Director
EAP
Director
Procurement / Maintenance
NGO Cell
Additional Director
Planning
Additional Director
N. Karnataka
Joint Director
Special Groups

41. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 9
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
DIRECTOR
PUBLIC HEALTH
Add. Director
AIDS
(KSPC)
Project Director
RCH & PHC
Add. Director
Health Promotion
AD (CMD)
State Survey Off
Chief Acc. Officer
AD-BMP
Urban PHCs JD
AIDS JD
RCH JD
PHC JD
IEC JD
Nut
JD-Vect Borne Dis JD TB JD
Leprosy JD
Vaccine JD
Lab DD
KFD DD
Dis Surv

42. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 10
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
DIRECTOR
MEDICAL
Addl Director
NCD
CAO
Addl Director
Medical JD
Medical JD
GMS
JD-Hosp North
JD-Hosp South
JD-Trau-Eme Med JD
Ophthal
(MINTO)
JD-CVS & Diabet
JD-Dent Health
JD-MH
(NIMHANS)
JD-Onco
(KIDWAI)

43. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 11
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
DIRECTOR
Ext. Aided Projects
DIRECTOR
Procurement & Maint
AD (SPC)
Planning & Monitor
Secretary PWD
Joint Director
Planning
Joint Director
HMIS
Joint Director
Procurement
JD-Bio-Medical Equip Maintenance
Superintendent Eng
Civil
DD-Law & Ethics
(Forensic Medicine)
Civil Engineering. Staff
as in KHSDP

44. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 12
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE : PROPOSED
DIRECTORATE OF ISM&H
DIRECTOR
ISM&H
Directorate level JD
Med Edu JD
ISM&H
Admin Officer
Accounts
Officer
Ast Drug
Controll
Principals
Col & Hosp
Aided
Col & Hos DD
Ayurveda DD
Unani DD
Homoeo DD
Nat & Yog
3 Drug-Inspectors DD
Pharmacy
Div DDs ?
Physician Gr I
District Hospital
Dt. ISM&H Officer
Phy Gr II
Hosp & Disp

45. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 13
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE : PROPOSED
STATE INSTITUTE OF HEALTH & FAMILY WELFARE (AUTONOMOUS)
PRINCIPAL SECRETARY
Director Selection Post
SIHFW
(Autonomous)
Commissioner /
DGHS
Governing Board
Directorate
Joint Director
Training
Joint Director
Research
(Social Scientist)
Specialists
Communication
Health Mgt
RCH/NCD
Principals RHFWTC/DTC
ANM Training Centres
Deputy Director
Course Content
Deputy Director
Training

46. DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTURE
CHART NO. 14
DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTURE
DRUG CONTROL DEPARTMENT
DRUGS CONTROLLER
ADDITIONAL DRUGS CONTROLLER
Drugs Testing Laboratory
Pharmacy Education
Enforcement Division
Head Quarters
Drugs Price Control Cell
Bl bank & Intellig
Circle & Dt. Off
Superintendent (Admn) -1
Superintendent (Lab)
Other Technical
Officers
Junior Chemists
Govt. College of Pharmacy
Board of Examining Authority
Principal & Chairman
Member Secretary
Professor
Asst. Professor
Lectures (Pharmacy Lect) -17
(Non Pharmacy)
Dy. Drugs Controller
Asst. Drugs Controller -19
Drugs Inspector

47. DEPARTMENT OF HEALTH & FAMILY WELFARE –
CHART NO. 15
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DEPARTMENT OF MEDICAL EDUCATION
SECRETARY
MEDICAL EDUCATION
Autonomous Teaching
Hospitals/Institutions
Director
Medical Education AD
Med Edu
DEAN
GDC
DEAN
BMC
DEAN
MMC
*Dir
RIO
Vice Prl
BMC
Vice Prl
MMC
Supr
Hos 1
Supr
Hos 2
Supr
Hos 3
Supr
Hos 4
Supr
Hos 5
Supr
Hos 6
Supr
Hos 7 JD ME
Vice Prl
GDC
PROFESSORS & HOD BMC / MMC
ASSOCIATE PROFESSORS
ASSISTANT PROFESSORS
LECUTRERS
REGISTRARS / TUTORS / DEMONSTRATORS/ RESIDENTS
* Regional Institute Ophthalmology (RIO) could be made into an Autonomous Institution
DD (ME)
DD (DE)

48. Financial 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 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

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. Karnataka State Integrated Health Policy
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

51. Vision 2020 Indicators 2001 (Source / Year) 2020 Infant Mortality Rate
58/1000 live births
25/1000 live births
Under – 5 Mortality Rate
69/1000 live births
35/1000 live births
Crude Birth Rate
22.3/1000 population
13/1000 population
Crude Death Rate
7.7/1000 population
6.5/1000 population
Maternal Mortality Rate
195/ 1 lakh live births
90/ 1 lakh live births
Life Expectancy at Birth
Male
61.7 years
70.0 years
Female
65.4 years
75.0 years
Total Fertility Rate
2.13
1.6
Percentage of Institutional Deliveries
51.1 75
Percentage of Safe deliveries
59.2
>95

52. VISION 2020 Indicators 2001 2020 Newborns with Low Birth Weight 35%
10%
Percentage of mothers who received ANC
86.3
100
Percentage of eligible couples protected
59.7
70%
Percentage of children fully immunised 60
>90
Anaemia among children (6-35 months)
70.6%
40.0%
Nutritional Status of children
Severe under nutrition
6.2%
2.0%
Moderate under nutrition
45.4%
25.0%
Mild under nutrition
39.0%
43.0%
Normal
9.4%
30%
Sex (Gender) ratio
964F/1000M
975F/1000M
Sex (Gender) ratio, 0-6 years
949/1000M
970F/1000M

53. Reforms for Good Governance in
Health Services
Proactive Lokayukta – Ombudsman for PRI and active Monitoring – institutionalize the reforms
Vigilance cell in Health Department – Strengthen and Capacity building – Expertise
E-Governance: HMIS – Program and HRM, computerize transfers, recruitment, promotions, e-procurement, Web site for transparency and accountability
Integrity Pact – black listing and debarring
Effective Management and Supervision by Administrators and senior staff – Field visits

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