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Health Sector Reforms in Karnataka State. By Dr. H.Sudarshan Karuna Trust. Public Private Partnership. Partnership with Voluntary Organizations : Entrusting Management of PHCs to Vos and Private Medical Colleges Karuna Trust is managing 15 PHCs

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health sector reforms in karnataka state

Health Sector Reforms inKarnataka State

By

Dr. H.Sudarshan

Karuna Trust

public private partnership
Public Private Partnership

Partnership with Voluntary Organizations:

  • Entrusting Management of PHCs to Vos and Private Medical Colleges
  • Karuna Trust is managing 15 PHCs
  • Goal is to manage one “Good Practicing PHC” in all the 27 Districts
  • Tele Medicine project – Asia Heart Foundation and Karuna trust
  • Tribal ANMs Project
  • Innovations: VHCs, Rehabilitative Services
public private partnership task force on health and family welfare
Public Private PartnershipTask 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.

task force on health and family welfare final report
Task Force on Health and Family WelfareFinal Report

12 Major Issues of Concern

  • Corruption
  • Neglect of Public
  • Distortions in Primary Health Care
  • Lack of Focus on Equity
  • Implementation Gap
  • Ethical Imperative
task force on health and family welfare final report5
Task Force on Health and Family WelfareFinal Report

12 Major Issues of Concern

  • Human Resource Development
  • Cultural Gap and Medical Pluralism
  • From Exclusivism to Partnership
  • Ignoring the Political Economy of Health
  • Research
  • Growing Apathy in the System
task force on health and family welfare final report6
Task Force on Health and Family WelfareFinal Report

Contents

  • Equity in Health Care
  • Quality of Health Care
  • Primary Health Care
  • Secondary and Tertiary Health Care
  • Public Health
  • Mental Health and Neurosciences
  • Nutrition
  • Women and Child Health
task force on health and family welfare final report7
Task Force on Health and Family WelfareFinal Report

Contents

  • Population Stabilisation
  • Focus on Special groups
  • Health Promotion and Advocacy for Health
  • Human Resources Development for Health
  • Research in Health
  • Health Systems Management
  • Health Financing
  • Rational Drug Management
task force on health and family welfare final report8
Task Force on Health and Family WelfareFinal Report

Contents

  • Law and Ethics
  • Indian Systems of Medicine and Homoeopathy
  • Panchayat Raj and Empowerment of People
  • Strengthening of Partnership
  • Multisectorality and Intersectoral Co-ordination
  • The Karnataka State Integrated Health Policy 2001
  • Vision 2020
  • Implementation of the Report
  • Major Recommendations and Expected Outcome
task force on health and family welfare final report9
Task Force on Health and Family WelfareFinal Report

Karnataka State Integrated Health Policy 2001

  • 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
public private partnership10
Public Private Partnership

For Profit – Private Sector

  • Out sourcing of Cleaning, Security and maintenance Services
  • Contracting Private Doctor and Specialists
  • Contracting One Super Specialty Hospital – OPEC Hospital, Raichur.
decentralization
Decentralization
  • Karnataka has Decentralized Democratic System – Panchayat Raj Institutions
  • Involvement of ZP and Taluka Panchayats in Health
  • Decentralization of Administrative and Financial Powers
  • VHCs – IPP9 project
reforms related to human resources
Reforms related to Human Resources
  • Appointment of Staff on Contractual basis
  • Multi-skilling of Health Personnel : CRS course
  • Mandatory Pre-PG rural service
  • Formation of District Cadres
  • Creation of Taluka Health Officers
  • Recruitment and Transfer Policy – transfers by counselling
reforms in health financing
Reforms in Health Financing
  • User Fee Vs Token Fee
  • Establishment of Hospital Committees
  • Granting Autonomy to Hospitals & Health Institutions
  • Health Insurance:
  • KT– UNDP Community Health Insurance
  • Yashaswini Scheme
  • Arogya Raksha Project
health systems management
Health Systems Management

Financial management

  • Optimum utilisation of allocations
  • 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 assets
  • Community Insurance for health
  • Liability Insurance for doctors
  • Test Audit
re organization re structuring of

Re-organization & Re-structuring of

Karnataka Health & Family Welfare Department

health systems management16
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

slide17

CHART NO. 2

DEPARTMENT OF HEALTH & FAMILY WELFARE –

ORGANISATIONAL STRUCTURE: PROPOSED

DISTRICT LEVEL

Public Health

Medical

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

slide18

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

(F)

JHA

(F)

JHA

(F)

JHA

(F)

JHA

(F)

JHA (M)

JHA (M)

JHA (M)

JHA (M)

JHA(M)

JHA(M)

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

Medical Officer

Lady 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

slide19

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

slide20

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

slide21

CHART NO. 9

DEPARTMENT OF HEALTH & FAMILY WELFARE –

ORGANISATIONAL STRUCTURE: PROPOSED

STATE LEVEL

DIRECTOR

PUBLIC HEALTH

Add. Director

AIDS

(KSPC)

Add. Director

Health Promotion

AD (CMD)

State Survey Off

Chief Acc. Officer

Project Director

RCH & PHC

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

slide22

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)

slide23

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

Superintendent Eng

Civil

Joint Director

Procurement

JD-Bio-Medical Equip Maintenance

Joint Director

Planning

Joint Director

HMIS

DD-Law & Ethics

(Forensic Medicine)

Civil Engineering. Staff

as in KHSDP

slide24

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

slide25

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

slide26

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) -1

Other Technical -7

Officers

Junior Chemists -30

Govt. College of Pharmacy

Board of Examining Authority

Principal & Chairman - 1

Member Secretary - 1

Professor - 6

Asst. Professor - 8

Lectures (Pharmacy Lect) -17

(Non Pharmacy) - 5

Dy. Drugs Controller - 8

Asst. Drugs Controller -19

Drugs Inspector -56

slide27

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)

slide28

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

Director

Procurement / Maintenance

CAO

Finance

CVO

Vigilance

Director

Public Health

Director

Medical

Director

EAP

NGO Cell

Additional Director

Planning

Additional Director

N. Karnataka

Joint Director

Special Groups

task force on health and family welfare final report29
Task Force on Health and Family WelfareFinal Report

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.
slide30

Good Governance

Karnataka Health Department

by

Dr.H. Sudarshan

Vigilance Director

(Health,Education & Social Welfare)

slide31

The Epidemic of Corruption in Health Services

Corruption in Hospitals

  • Corruption in service delivery by the following:
slide32

The Epidemic of Corruption in Health Services

Corruption in Hospitals

  • Various forms of Corruption by Doctors and Para Medical Staff:
    • Private practice
    • Nursing Homes (owned by spouses, relatives & business partners)
    • Referrals to Private Hospitals
    • Owning Pharmacies
    • Blood Banks
    • Excess of assets over income
slide33

The Epidemic of Corruption in Health Services

Corruption in Hospitals

  • For the following Services
epidemic of corruption in health services drugs control department
Epidemic of Corruption in Health ServicesDrugs Control Department
  • Lokayukta ride on Drugs control Department – wide spread corruption - mamools
  • Manufacturing License: Inspection of units for fresh & renewal - less than 20%
  • Drugs collected during inspections – Low
  • 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
epidemic of corruption in drugs control department
Epidemic of Corruption in Drugs Control Department
  • Indiscriminate issue of Loan licenses & product permissions to Loan Licensee
  • 50% of the Medical shops do not have qualified pharmacists – hardly 14 prosecutions
  • 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
Corruption in Procurement of Drugs
  • Purchase of Non Essential Drugs – Nemisulide 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.
slide37

The Epidemic of Corruption in Health Services

Corruption in Civil Works: Construction of PHCs, CHCs, Taluka & District Hospitals and Repairs.

Corruption in Administration:at offices of District Health, Directorate & Secretariat for the following

  • Recruitment & Postings,
  • Transfers & Promotions
  • Sanctioning Leave, Medical reimbursement
  • Monitoring Private Practice & Absenteeism
  • Suspension and Reinstating
slide38

The Epidemic of Corruption in Health Services

Corruption in Medical Education

  • Sanctioning New Colleges - Medical, Nursing & ISM&H
  • Increasing seats of Nursing Colleges
  • Admissions
  • Examination: bribes for examiners-Undergraduate & PGs
  • Recruitment of Teaching Staff
  • Registration in KMC.
slide39

Reforms for Good Governance in Health

  • Proactive Lokayukta
  • Consumer Forum
  • Transparency Act
  • Right to Information Bill
  • Training in Health & Hospital management
  • Leadership training
  • HMIS & e-Governance
  • Hospital & Health Committees
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