Soliga Tribal people Children of Bamboo Veddoid Group of - PowerPoint PPT Presentation

Mainstreaming Eye care in to PHC • Community Eye Care – Village blindness registry – VHSC & RKS • Training MO & PHC Staff, ANMs, MHWs, ASHAs in Community based eye care. • Vision Centers in every PHC – Opthalmic Assistant PMOA and Optician – Vision testing and optical dispensing at PHC

Innovations in Primary health care … Innovations in Primary health care … Eye care in primary Health Eye care in primary Health Center Center

Eye Hospital • Infrastructure built at a cost of 35 lakhs. GoI contributed 17.5 lakhs and KT raised 17.5 lakhs • Collaborating with Vittala Institute of Opthalmology for Human resources • Partnering with DBCS for reimbursement of costs – Rs.600/- per case • KT spends additional Rs.300/- per case

Mainstreaming Communication Disorders in to Primary Health Care • Collaboration with All India Institute of Speech and Hearing (AIISH). • Prevention, Early detection, Aids and appliances and Surgical correction. • Pilot in Gumballi PHC, Akkihebbal and Hullali PHCs • Scaling up to all the PHCs in Yelandur (5PHCs), K R Pet (21 PHCs) and Nanjangud (20 PHCs)Talukas.

Promotion of low cost generic drugs and Rational Drug Use • Stocking and distribution of good quality, low cost generic drugs – LOCOST & Biocon • Biocare Pharmacies at Govt. Hospitals • Promotion of rational drug use • Essential Drug List and Standard Treatment Guidelines • Reforming the Drug Logistic Society

Mainstreaming Non-Communicable Diseases in to Primary Health Care • Burden of Non-Communicable Diseases is increasing - 50% • NRHM is also starting the program • Cardio-vascular Diseases – Hypertension, Coronary Artery disease, Congenital heart diseases. • Diabetes.

ASHA Training • Training of ASHA’a in 3 tribal Districts of Karnataka • In collaboration with NGOs in the Districts • Nearly 3000 ASHAs already training. • Supervision and Monitoring .

Community Planning & Monitoring • Pilot of NRHM in 9 States • Karuna Trust -Nodel Agency for Karnataka • Implemented in 4 Districts in partnership with local NGOs • 49 PHCs & 562 Villages covered • VHSC & RKS capacity building • Village Health Plan and Report cards

Community Participation

CITIZEN HELP DESK • Providing Information and helping patients about facilities and services available • Monitoring the quality of Health care to OPD patients and IPD patients • Awareness programs in the areas inhabitated by poor to build confidence amongst the poor to access services at Public hospitals. • Establish a link between service providers and users through regular feedback mechanism • Transparency and accountability in the delivery of services

CITIZEN HELP DESK Jayanagar General Hospital

Mobile Health Mobile Health Clinic Clinic

Management of FRU at Santhemaranahally CHC • CHC building at cost of 1.5 Crores but FRU not functional – only two doctors. • Thayi Bhagya Scheme: Chamarajanagr is also included • Partnership with FOGSI & PSI • 3535 deliveries and 448 C-sections done during 3 Years

F.R.U Santemaranahalli F.R.U Santemaranahalli

PPP in District Health Management in Collaboration with other Institutions • Capacity Building for District Health Plan • Implementation of Health programs • Monitoring & Supervision • Health Management Information System • Community health insurance • Asha training and Supervision • Community Action and Monitoring

Integrated Rural Development T.N.Pura Project • Dr. Nagaraju & Renuka Nagaraju’s (NRI – Flint Michigan) donation. • Only 15 Paise reaches the Poor. • Government spends about 60 Crores – 6 lakhs from KT • Health, education and Micro-Finance • Micro finance – 417 Woen Self Help Groups – 4 Crores turn over

Integrated Rural Development Kammasandra • Dr. Ram – Plastic Surgeon in Las Vegas • PHC in Kammasandra • Primary and High School • Anganwadi • Milk Dairy • Housing and toilets for all the families • Orphanage – Puttani Gudu

Cost Benefit • PPP 75% to 90% to 100% • Cost of Primary Health Care: Rs.100/- ($2.5) – Range Rs.60 to 150 ($1.5 to 3.5) • Spend less than Government • Better Health out comes

Ka Karu runa a Tr Trust st Ar Arunachal nachal Pra Prade desh sh

PPP in Karnataka & Arunachal Pradesh

PPP for Primary Health Care in Arunachal Pradesh • Year 2005 • To improve the health facilities in the State • One Primary Health Centre (PHC) in each district of the State will be managed and operated through a selected Non Government Organization (NGO)

Then… and Now • Clean & Tidy • Untidy & dirty • Renovated • Dilapidated • Electricity provided • No Electricity • Adequate equipments, • Inadequate equipments, infrastructure and infrastructure and medicines medicines • Health services • Health services not available 24 X 7 regular • All the staff staying in • Staff not staying in HQ HQ

PHC Bameng • 380 km. from Itanagar in East Kameng district • The mud road from Seppa to Bameng is very often blocked by landslides

Then… …now

PHC Wakka Wakka PHC, Tirap Dist Wakka PHC staffs X-Ray room Labour room

PHC Etalin Medical officer PHC building Road to Etalin PHC building

PHC Jeying PHC staff in front of quarter PHC building 2007 A view of staff quarter Medical officer in front of his quarter

PHC Walong Pharmacy PHC building Sub centre KIBITHO PHC Staff

Road to PHCs Road to PHC Bameng Road to Etalin Brahmaputra river crossing Road to Dambuk- Anpum

Road to PHCs Road to Walong Road to Dambuk & Anpum Road to Dambuk & Anpum Road to Etalin

Training to PHC staff Staff training at Roing Exposure visit to Bangalore Training at Military Hospital Exposure visit to Bangalore

Scaling Up – 5 states

PHCs managed by Karuna Trust under PPP State No. of PHCs Population Karnataka 26 5,63,347 Arunachal Pradesh 9 43,197 Orissa 5 81,274 Meghalaya 4 14,300 Andhra Pradesh 2 18,820 Total 48 7,20,938

Karuna Trust – PPP in India • Karnataka State – 26 PHCs (5 Lakh population), 7 Mobile Medical Units, one FRU with FOGSI, Help Desk at District Hospitals. • 2 PHCs through other NGOs – Vivekananda Foundation & Vemana Trust • Arunachal Pradesh – 9 PHCs • Meghalaya State – One CHC & 4 PHCs • Orissa State – 6 PHCs • Andhra Pradesh – Adilabad – 2 PHCs • District Health Management - Tumkur

Scaling up of PPP in Primary Scaling up of PPP in Primary Health Health

Task Force on Health and Family Welfare Final Report OBJECTIVE AND THE PATH Objective: Achievement of Equity, Quality and Integrity in Health Care The Path:  Revamping the organisation and structure  Capacity Building

Task Force on Health and Family Welfare • The Task Force constituted by the Chief Minister GO No HFW 545 CGM 99, Bangalore dt.14-12-1999 The terms of reference were to make recommendations for: •  Improvement of Public Health;  Stabilization of the population;  Improve management and administration of the Department;  Changes in the education system covering both Clinical and Public Health. And to monitor the implementation of the recommendations.

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 •

Task Force on Health and Family Welfare Final Report 12 Major Issues of Concern 1. Corruption 2. Neglect of Public 3. Distortions in Primary Health Care 4. Lack of Focus on Equity 5. Implementation Gap 6. Ethical Imperative

Task Force on Health and Family Welfare Final Report 12 Major Issues of Concern 7. Human Resource Development 8. Cultural Gap and Medical Pluralism 9. From Exclusivism to Partnership 10. Ignoring the Political Economy of Health 11. Research 12. Growing Apathy in the System

GOOD GOVERNANCE IN HEALTH BY Dr. H.Sudarshan Ex-Vigilance Director

Good Governance in Health Care • Karnataka Lokayukta – Ombudsman Institution for control of Corruption in Public Sector • Vigilance Director for Health – Epidemic of Corruption in Health Sector • Prevention and control of corruption in Health Services.

Year Score Rank First Rank Last Rank 1995 2.78 34/41 New Zealand Indonesia 1996 2.63 45/54 New Zealand Nigeria 2000 2.80 69/90 Finland Nigeria 2001 2.70 71/91 Finland Bangladesh 2002 2.70 71/102 Finland Bangladesh 2003 2.80 83/133 Finland Bangladesh 2004 2.80 90/145 Finland Bangladesh & Haiti 2005 2.90 88/158 Iceland Bangladesh & Chad 2006 3.30 74/163 Iceland Haiti 2007 3.50 72/180 New Zealand Myanmar/Somalia 2008 3.40 85/180 Denmark Somalia 2009 3.40 84/180 New Zealand Somalia 2010 3.30 87/178 Denmark, NZ & Somalia Singapore

Corruption in India Transparency International India • Transparency International India & ORG-MARG Research Pvt Ltd - An empirical study • Covered Ten Sectors: Police, Health, Education, PDS, Land Admn., Judiciary, Taxation, Railways, Telecom. • Most Corrupt: Police Least Corrupt: Telecom • Health: Perceived to be 2nd most corrupt sector • Payment of Money through hospital staff Money demanded from North 25% - South 38% Doctors: 77% Hospital Staff: 67%

The India Corruption Study 2005 by Transparency International India State C. Index Rank State C.Index Rank Kerala 240 1 Delhi 496 11 Him Pradesh 301 2 Tamil Nadu 509 12 Gujarath 417 3 Haryana 516 13 Jharkhand 520 14 Andhra Pradesh 433 4 Assam 542 15 Maharashtra 433 5 Rajasthan 543 16 Chattisgarh 445 6 Karnataka 576 17 Punjab 459 7 M.P. 584 18 West Bengal 461 8 J & K 655 19 Orissa 475 9 Bihar 695 20 Uttar Pradesh 491 10 95

Epidemic of Corruption in Drugs Control Department • 2268 samples declared “Not of standard Quality” including 126 spurious drugs – very few prosecutions • No action initiated on those who supplied spurious drugs to Health department • Violation of DPCO – people of Karnataka have paid nearly 100 crores in excess • Complaints given by public & institutions were not attended. • Trading of blood by Unlicensed Blood Banks & chemists, HIV infected blood sold

Corruption in Procurement of Drugs • Purchase of Non Essential Drugs – Nimesulide Tabs 18% of budget • IV fluids scam – Bypassing HAL and buying from PDPL • Decentralized Corruption in Procurement of drugs by Zilla Panchayaths – buying spurious and substandard drugs from unlicensed manufacturers – excess price. • Sigma scam – forged documents

Corruption in procurement of Equipment • Dialysis machine worth 5 lakhs bought for 11.6 lakhs by DME and at 12.6 lakhs by KIMS – Hubli • Equipment for removing Cholesterol was bought for 60 lakhs and used only once • Gulbarga ZP bought X-ray machines in 1992 and they were not installed till 2004. • Corruption in Indenting, specifications, not looking at market rate etc.

Corruption in Private Health Sector • Corruption in Procurement of Equipment • MNCs are also corrupt • Tax evasion and Unqualified staff • Poor quality • Commissions for diagnostics CT, MRI, Lab Investigations • Surgeries (Hysterectomies) and procedures (Angioplasty) which are not indicated 99

HONGKONG Independent Commission Against Corruption (ICAC)