7 th Common Review Mission National dissemination Karnataka State 5 th March 2013 Presenter on behalf of the Team : Dr.Raveesh R Mugali
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Mission Team 1. Dr. Manisha Malhotra, DC-MH 1. Dr. P.K.Srivastava, JD, NVBDCP 2. Dr. Raveesh R Mugali, UNICEF 2. Mr. M. K. Chowdhury, US, MoHFW 3. Dr. Raghu, Deputy Advisor,AYUSH 3. Dr. Shashikala, NHSRC 4. Dr. Balaji Naik. R, WHO-RNTCP 4. Dr. S. S. Das, MoHFW 5. Mr. Zacharia George, Planning Commission 5. Sh. Sanjeev Gupta, FMG 6. Dr. Raghunath Prasad Saini, RCH 6. Dr. Nikhil Utture, Consultant NRHM, MoHFW, 7. Mr. Yogesh Kumar Singh, Planning 7. Ms. Chhaya Pachauli, Prayas CSO Commission 2
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Karnataka :districts 7 th CRM Haveri Gulbarga 3
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Facilities visited Haveri District Gulbarga District 1. District Hospital: Gulbarga 1. District Hospital: Haveri 2. Taluka Hospitals: Jewargi, Sedam 2. Taluka hospital: Shiggoan, Byadagi 3. CHC: Mudhol, Malkhed, Gundagurti 3. PHC 24*7: Tadas, Attigeri, Kaginele 4. PHC:Mandewal, Jeratgi, Aurad, Mahagaon, A 4. Non FRU CHC: Rattihalli mbalga, Madbool, Kadganchi 5. Ayush Hospital: Shiggoan 5. UHC: New Rahmat nagar, Ghazipura Urban 6. ANM/GNM training center PHC, Gullar Gali (Slum) 7. District Vaccine stores 6. SCs:Khanadal, Kattisangavi, Mandeval, Aurad 8. SCs: Neeralagi, Kuruba gonda, Attigeri 2 DH , Sindigi, Madaki, Dhottargaon, Ranjol 9. Schools: Attigeri and Tadas 4 FRU 7. ANM Training Centre PHC-9 10. Village: Neeralagi, Tadas, Kuruba Regional/State 8. District Training Centre and R.F.W.T.C. Ayush-1 gonda, Attigeri drug warehouse 9. Regional Drug Warehouse SCs-11 District,regional 11. MMU: Sheelavanta Somapura, Shiggoan 10. Villages:Khanadal, Kattisangavi, Mahagaon, AWC:4 & ANM training 12. Anganwadi center: Devagiri Madaki, Neeloor, Chandapur, Sindgi, Kansoor Schools:4 centers 13. SIHFW, Karnataka drug logistics and , Dhottargaon, Bennur K MMU-1 SIHFW warehouse Villages:13 11. Schools: Sindgi, Kadganchi 4
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Service Delivery What sparks? What doesn ’ t spur? • Infrastructure development • Inadequate provision of Staff (FRUs & 24*7 PHCs Tripled) Quarters • Utilization of Public health • Patient amenities are inadequate facilities has increased over 5 • Privacy concerns years • Wide range of services provided • A Number of deliveries reported • 108 ambulance service adequately in transit utilized • Diet provision for in-patients • AYUSH units co-located in most of • Coverage of all JSSK the facilities entitlements • MMU in PPP mode provides routine medical services to remote areas 5
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Functionalization of 24x7 PHC & FRUs, Karnataka 24* 7PHC FRU 1150 190 1018 1018 1001 988 961 1050 170 898 950 150 167 166 850 151 130 144 142 750 110 Tripled 650 90 107 550 389 70 450 Health infrastructure 350 50 54 2007 2008 2009 2010 2011 2012 2013 33749 Karnataka State Haveri Gulbarga 25998 24755 7844 6887 5661 1397 1142 989 6 Population/PHC Population/SC population/Bed
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Human Resources & Training What Inspires? What stands betterment? • • Doctors, Nurses, and ANM are Compliance to key HR adequately trained esp, SBA recommendations trained nurses • Vacant GDMO and Nurses" positions • Majority of T.H. and D.H do have • Training needs assessment & specialist doctors Training plans • ASHAs are available, trained and • Specialists at FRU’s/ TH motivated (Gulbarga) • Placing Nutrition counselor • CPHN training of LHVs at SIHFW is and M.O. at NRCs good initiative 7
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance 8 Compliance to key HR Conditionalities Article 371-J
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance RMNCH+A What needs correction? What is correct ? • Operationalization of Blood • Institutional deliveries – storage units and C-section facility increased to > 90% (70-75% in is needed in CHCs, THs( Gulbarga). pubic health facilities) • Safe abortion services below • Labor room nurses are SBA district level trained, • Orientation on processes for MDR • Partographs are being and quality of Reviews at facilities and at District maintained • Line listing of severely anemic • Good visibility of Technical women protocols • 3 ANC checkup Gulbarga district • Emergency obstetric drugs were (58 %) available in LR • Multiple referrals 9
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Inst deliveries trend change-Haveri MCH report 30000 Deliveries Home Deliveries Institution Deliveries 25000 Madilu Prasuthi 20000 kit arike # of deliveries FRUs 15000 24*7 JSSK JSY PHC ASHA 10000 incentiv Thayi es Thayi bhagya 5000 bhagya Plus 0 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 10
A snapshot of RMNCH+A progress in Karnataka Maternal Mortality Ratio Child Mortality Rate E-NMR NMR IMR U5MR 300 228 213 178 144 200 55 60 50 45 100 50 48 40 47 45 37 0 40 41 38 35 32 2001-03 2004-06 2007-09 2010-12 28 28 26 25 25 24 24 23 20 23 22 20 20 20 20 20 Child Sex Ratio (0-4) 19 0 955 960 951 946 946 2005 2006 2007 2008 2009 2010 2011 2012 942 950 934 940 930 925 930 Total Fertility Rate 920 2.5 910 2.2 2.1 2.1 2.0 2.0 2.0 2005 2006 2007 2008 2009 2010 2011 2012 1.9 1.9 2.0 Consistent improvement in health outcome Achieved MDG 4 & 5 1.5 An estimated 1,600 maternal deaths and 41,800 under 2005 2006 2007 2008 2009 2010 2011 2012 five deaths annually (Neo-natal deaths 26, 011 , Infant 11 deaths-36 ,189)
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Percentage contribution of E-NMR to NMR, SRS 2012…highest in Karnataka 12
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance RMNCH+A Could be better Innovations & Improvements • 10- 12% mortality in SNCUs (Early NMR high in the state (87% of • Prasuthi Araike Programme is popular NMR) Karnataka has launched many State initiatives(PrasoothiAraike, Madilu, Th • Central oxygen supply ayiBhagya and ThayiBhagya Plus) • which has dramatically increased the Poor admissions in NRC due to lack institutional deliveries in Public Health of referrals. facilities. • • ARSH: Services to adolescents in IYCF practices needs improvement general OPD • Awareness about JSSK • Most women stayed 48 hrs after delivery at the FRUs entitlements, • Counseling provided by ICTC • Greater visibility of JSSK counselor or at Suraksha clinic . • WIFS initiated in schools • Delay in payment in few facilities • State Innovation- RoP at SNCU 13
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance Immunization Strengths Few Concerns • • Immunization planned vs held > Dropout rates 100% • MCV 2 Coverage-48% • • Micro planning exists at every Review of the immunization programme using HMIS data is level difficult at all levels • Trained workforce & Increased • Less cold space at state community mobilization-ASHA Vaccine store, Need of 1 WIC • Incentives for mobilization • Poor reviews at peripheral • Adequate cold chain space at level periphery, Avg population per • Immunization in private sector cold chain point:24000 • Due lists for tracking for 2 • Potential state for new vaccine years introduction 14
Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technology NUHM Governance An example of Inverse care law High number of measles outbreaks in Northern Karnataka MCV2 Coverage less than 20% 15
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