SOUTH ASIAN DIALOGUE ON POVERTY AND HEALTH HELD IN BANGALORE 15TH - 18TH NOVEMBER 1999
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- Title
- SOUTH ASIAN DIALOGUE ON POVERTY AND HEALTH HELD IN BANGALORE 15TH - 18TH NOVEMBER 1999
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RF_COM_H_70_SUDHA
TELEPHONE :
OFF :
RES :
2269128
2092390
5471441
Mrs. 9{a.fees Ja-zat
VIDHANA SOUDHA, BANGALORE - 1
minister of state for
medical education
DATED........... 29:2:2000.......
To,
Dr.H.Sudarshan,
Chairman,
Task Force on
Health & Family Welfare,
Government of Karnataka,
Bangalore.
Dear Dr.Sudarshan,
Reg: My suggestions to the Task Force on Health &
Family Welfare.
I congratulate you for accepting the invitation of our Hon’ble
Chief Minister to head the Task Force on Health & Family Welfare. Since,
you are one of the reputed Doctors of our State working for the poor and
tribals in Chamarajanagara Distirct, you are quite aware of the problems
confronting the Health Department.
As regards improvement in the Hospital Administration, I have
few suggestions to make. I have visited number of hospitals in Bangalore,
Mysore, Hubli, Bellary, Belgaum, Mangalore and etc.
There is no
accountability at all levels in the hospitals. It is high time that we should fix
responsibility on every staff member of the Hospital and a code of conduce
should be framed. Disciplinary rules should be simplified to ensure quick
action against erring doctors and officials working in the Hospitals.
All Hospitals should have a Hospital Advisory Committee
instead of the present Board of Visitors with not less than 20 members (NonOfficilas) with powers to take decisions on some matters on the spot and to
interact with patients, doctors and public in general.
This Committee
should have prominent people of that particular area.
TELEPHONE :
OFF :
RES :
2269128
2092390
5471441
Mrs. 9{afees fa-zaC
VIDHANA SOUDHA, BANGALORE - 1
MINISTER OF STATE FOR
MEDICAL EDUCATION
DATED
I suggest that each hospital should have a Hospital Welfare
Fund were funds could be raised by the Hospital Advisory Committee from
the citizens and Corporate bodies including Nationalised Bank where they
have got funds to take up some of the Hospital Projects.
We have to stream-line the present system of Out-patient and
In-Patients departments. Nominal fee should be prescribed at the time of
First registration at the Out-patient Department. Similarly, at the time of
admission as In-patient also some amount of fees should be prescribed. The
amount so collected should be utilized for the improvement of the particular
Hospitals only.
Entry of the visitors should be strictly regulated like private
hospitals.
As regards to Medical Education, a workshop should be
organized by the Task Force at the State and at the Divisional level, wherein
Rajiv Gandhi University of Health Sciences, Medical Colleges of that
particular area, teaching faculty, students and other experts could be invited
to get new ideas to improve the Medical Education.
I wish to draw your attention to the Seminar on Health Care
Industry held recently in Bangalore by the Asian Health Services, which
made very valuable suggestions in Hospital Management. A copy of my
Note sent to the concerned is enclosed for your reference.
I want the Task Force to review the achievements in regard to
various Government of India and externally aided schemes in the Health
-Sector. It is possible to get sufficient funds from various foreign countries in
the'form of grants and loan with nominal interest, if responsibility is fixed
on some officer at the State level who can be provided with sufficient staff
and other powers.
TELEPHONE :
OFF :
RES :
2269128
2092390
5471441
Mrs. 9jgfe.es fazaS
VIDHANA SOUDHA, BANGALORE-1
MINISTER OF STATE FOR
MEDICAL EDUCATION
DATED
In Karnataka, we have large number of eminent personalities, who
have been doing wonderful work in their own field in the Health SectorHoemeopathy, Ayurveda.
Some of these experts are not aware of the
topics that the Task Force has been asked to examine. Therefore,
advertisement through Electronic Media i.e., Udaya T.V. and Doordarshan
be given inviting suggestions.
The Task Force may also formulate special schemes for the
effective implementation of some of the programmes, like Pulse Polio
Programme, Leprosy Eradication, AIDS Awareness, National Control of
Blindness,etc, as there is duplication in the implementation of State and
Central Programmes.
Special Schemes should also be drawn up to get
donations and financial assistance from Corporate Bodies, Phil antropi sts,
and General Public for the construction of Hospital Buildmgs,
Dharmashalas, Blood Bank and other facilities. As in Bangalore City
Corporation Area, we should impose penalty against those indulge in
littering and spoiling the atmosphere of the Hospital.
At the entrance of the each hospital itself, Sign Boards with
detailed description of various Department/Units in Kannada and English
should be displayed to help the people visiting the Hospitals.
Chief Minister Medical Relief Fund should be given to all
hospitals in the State to help the poor patients.
Thanking you.
Yours Sincerely,
(Nafees Fazal)
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VISIT TO TUMKUR DISTRICT HOSPITAL ON THE 21st MONDAY
FEBRUARY BY SWAMI JAPANANDA, MEMBER, TASK FORCE,
HEALTH & FAMILY WELFARE SYSTEM :
MEETING
During the visit there was a meeting organised by C.E.O.
which included DHO, DTO, DLO. DS of Tumkur District.
In the
meeting there was many points which came up to be considered by TASK
FORCE.
All the health officials discussed regarding the improvement
of services rendered by District hospitals PHC, PHU etc.
The highlights
of the meetings are as follows:-
a)
In the entire district there are no lab technicians to work in the
PHCs/PHUs etc.
The district health officer pointed out that 91 lab
technicians are needed immediately.
Regarding the appointment of the
lab technicians we noticed that there are confusions regarding the
appointments of lab technicians.
So even now after getting the G.O.
from the Govt, to appoint lab technicians it has not been carried out.
b)
Many PHCs are not having adequate man power to handle the
patients.
It is unfortunate to know even after repeated requisitions the
Govt, is not able to appoint die necessary staff at PHCs and subcentres.
c)
During the discussions it was noticed that there is no co-
ordination/co-operation amongst the each PFICs and PFIUs.
highlighted during the discussions.
This was
There are many occasions that many
of the PHCs are not sending the regular report as required by DHO office.
d)
It appears that there is lack of organisational monitoring by the
concerned officers.
For example there is one PHC at Venkatapura,
Pavagada Taluk. Tumkur District which has been closed for the last 6
-2-
nionths.
Even though the hospital building is brand new and it did
function for a quite period ot time but, the concerned medical officer has
gone in search of a job to Bangalore.
While going away from the PEIC
lie has not handed over his responsibilities to any one. instead he has also
earned the key of the hospital along with him.
When this incident was
brought to the notice their, answer was not an encouraging answer.
It
shows that there is a lack of information and also there is a lack of
knowledge about their powers i.e. medical officers, DHOs. DS powers.
Nobody knows the capacity and the power which they owe by becoming
incharge of particular departments.
e)
During the discussions we found that many hospitals doesn't have
an}' monitoring system of reporting.
For example some talukas did not
detect tuberculosis, leprosy cases during the entire year.
This was
brought to the notice of the concerned officers.
f)
There was a suggestion by the Chief Executive Officer that to train
the existing health workers to handle the microscope etc. so that the
laboratory work can be managed with the available human resources.
But this subject needs to be discussed thoroughly.
After the meeting we moved to district hospital situated at the centre of
Tumkur.
These are the following observations done by the Task Force
Member.
a)
It was at 4.30 pm we found that there were very less no. of staff
available at the hospital.
Many of them are already left the premises.
-3b)
The entire hospital was not maintained properly.
There were
stincking smell in the corridors and also we observe that the toilets were
not well maintained.
c)
While walking in the corridors we found that burnt cases were kept
out side without adequate covering.
and around of the patients.
There were lot of people moving in
When we asked the officials said there is no
proper maintenance staff to monitor the movements of the visitors in the
hospital premises.
We also found that there was no compound for the
entire hospital.
d)
The beds were not properly maintained and cleaned.
We found
that some lenins were badly kept.
e)
When we visited the blood bank we found that it was some what
cleaned but not up to the standard of maintaining the blood bank.
The
roads to the blood bank and wards are full of bushes and weeds.
f)
It was also found that the operation theatre was locked from inside
and when we enquired with the district surgeon that he was not sure about
the activities of the operation theatre.
It appeal’s that there is no co
ordination amongst the officials and doctors regarding the activities of the
hospitals.
g)
When we entered the casualty’ centre it was not well maintained.
h)
We found that there are the lists of drugs available in the hospital
but it was not displayed.
h)
The Tumkur general hospital which is having 300 beds and
situated in the centre of Tumkur not having 24 hours service of X-
ray. lab facilities.
Even though they have 6 x-ray plants but they
have only one x-ray technician who happens to be rarely found.
-4 -
j)
We also found that there was a vehicle for bringing the specialists
from different parts ot fumkur on call, but we found that these doctors
are staying away from the head quarters which is very difficult to reach
the place immediately.
The official informed that it would be nice that
if these specialists stay nearby to the hospital.
We found that Rs.500/- per day is given to the in-charge officials for the
maintenance of vehicles, generators etc.
He was pleading that this
amount should be raised.
These are the points observed by the Task Force member.
S; o-t - i a laj o'j
Some pointers on what it means to be a
woman in Karnataka
</ The sex ratio is adverse in all districts except Dakshina
Kannada and it has worsened in the eighties
Z 12.3% of women’s deaths are between 15 and 24 against
5.9% for men
W'
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/ Women marry at 20 years, men at 26; 64% of the
marriages between 10 & 14 years are in Bijapur, Belgaum,
Gulbarga and Raichur
✓ The crude birth rate is high over most of north Karnataka
/ Male and female literacy rates diverge by 23 % points;
there is marked difference over most of north Karnataka
/ 33% of girl children are out of school and the dropout rate
for girls is 46% at the primary school level; in Raichur the
dropout rate in lower primary schools for SC and ST girls
g
K
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What equal opportunity means for women
g
/ From 59% in 1959-60, the percentage of vasectomies in T
sterilisations has dropped toJ3.T%yless-than_2%_ofmen
with wives of childbearing age use condoms
/ 1.28 lakhs out of 1.35 crore members of cooperatives are
women; this is less than 0.1%
/ 6 out of 224 members of the Karnataka Legislative
Assembly are women(3 %)
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</ 3 out of 43 ministers Is a woman (7 %)
/ There is only one woman Cabinet minister
/ There is no woman member in any land reforms tribunal
/ There is one woman among 32 High Court judges
/ There is no mention of women in the agricultural policy of
the State although women perform most agricultural
operations
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The truth beyond statistics
</ Girl children are selectively aborted after amniocentesis
U
GLGirls- arc withdiaAvn from schooIs for house andlarni work
■:£, i
few®
Z Women and girls eat less than men and boys and are fed
after them
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Z Dowry is demanded for getting girls married and wives are
harassed and killed for gifts and property
Z Women work more hours than men on unpaid,
unrecognised chores
Z Women are paid less than men for equally arduous work
Z Women’s mobility is controlled by others
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Z Women have much less power than men over their own
lives and over family resources
Z Women are used as fronts by men to comer legal and
monetary benefits -
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There is ample proof of social and
economic discrimination against women
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TO TACKLE THIS,
GO VERNMENT PROGRAMS
SHOULD GO BEYOND
TARGETING THE FAMILY
AND CONSIDER THE
REQUIREMENTS OF WOMEN
Government programs should not be planned
with men alone in mind because
80
EH
/ we are ignoring the needs of half the population
we get an incomplete picture of economic and social
reality with the result that
** conclusions are wrong
** policies poorly formulated and
SOW
** expected results unrealised
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our programs change productive and social relations in
suth a manner that the conditions of women are worsened
TWO MAJOR CHANGES ARE
REQUIRED
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/Women’s concerns must become central in
the developmental strategy of every
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department not just of the Women and
Child Welfare department
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/ This should go beyond routine earmarking
of part of the departmental budget for
“women’s schemes”
T‘Hh±l^kki ihd±^St^H:i2ii±d
IMPROVING WOMEN’S INCOMES
Bi
I
/ Before formulating schemes, we must understand
—the^paiefand-unpaid work women do in the sector
& how decisions are made & tasks allocated eg.in
agri culture, animal hush andry, industry, sericulture
/ On this basis:
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J * training and extension can be organised by
adjusting timings etc:technical training, TRYSEM
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BMWR
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/ ^technology improved: eg.in agriculture,
industry,sericulture
/ * facilities provided at work spots-the entire
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challenge of creches m industrial units, : '-p
construction or agricultural work spots
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INCREASING PRODUCTION AND
IMPROVING PRODUCTIVITY
UBy seeing women as producers, we can:
give
*
</
them legal and real ownership of
assets (productive assets and collateral) C
•/ **
we must take into account the fact that
decisionmaking does not often follow on
formal ownership
/ ^provide access to adequate credit for all
needs-production as well as consumption
/ **
adjust bank timings, procedures and
repayment schedules
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INCOME GENERATION SCHEMES
IMPROVE THEIR DIGNITY AND STATUS
✓ They should pay equal and fair wages
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V They should provide for adequate return and not
treat women’s income as merely a supplement to
family income
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✓ They should provide for movement to higher skills
/ They should train women for leadership positions^
/ They should look at remunerative nontraditional
skills with marketing potential-not just tailoring
and(now) computers
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/ They should improve mobility,skills ofselfdefense,
. &sel frel iancc & dealings with the external world
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WOMEN AND GOVERNMENT HEALTH
PROGRAMS FOR WOMEN MUST BE
TOTALLY REVIEWED LOOKING AT:
V *the role of doctors in selective abortion of
female foetuses
** looking at solutions beyond regulation
V
preventing
*
•/
and treating malnutrition
i
among girl children due to gender bias
Z * advice to adolescent girls regarding
PT
hygiene
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MODIFYING HEALTH PROGRAMS FOR
WOMEN
✓ ALLOUT CAMPAIGN FOR FAMILY
if
✓ Sustained campaign to be launched
Y*
for delaying marriages
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for delaying pregnancies
Y * for nutrition during pregnancies
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Y Complete coverage through trained midwives of
pregnant women
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Y Monitoring and prevention of maternity related
ailments and deaths
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CHILDBEARING MACHINES
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✓ Provide medical support for non-matemity linked
ailments
/ Provide holistic health care for older women
A Sustained campaign to protect innocent women
against men impregnating them with the AIDS
virus
/ Restructure health institutions to provide health
CP .©
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service at PHC level and referral to CHCs and
tai tika level institutions
CAN GOVERNMENT CHANGE
PEOPLE’S ATTITUDES?
*■ W Attitudes cannot be changed by regulation
alone
« A But government can be in the vanguard of
change
/We can induce change at the margin by
three methods:
** training W’ "'"'
** sensitisation
**media
r
TRAINING IS ESSENTIAL FOR
PERSONNEL AND POLICYMAKERS
Mil-
1
</ Programs should be properly prepared
✓ By qualified persons
</ Closely reviewed on the basis of feedback
B ■« ✓ Evaluated
✓ SENSITISATION IS ESSENTIAL FOR
OFFICIALS AND USERS
✓ Programs should be prepared by experts
/ All personnel and policymakers should be trained
I
J Feedback obtained and
A
✓ Programs reviewed
3
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USE OF MEDIA TO CHANGE
ATTITUDES
f:
✓ Government has not fully exploited the media for
/ Many departments have prepared effective
presentations on gender issues eg.on DPEP,
s
I
s
£
/ They should be disseminated on all media-prime
time on TV and radio, through the I&B
department and other methods
A
Util
pit
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i'
/ Effective films made in other languages or by
activist directors should be acquired and widely
shown
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:■■■■<':
■
j HUMAN DEVELOPMENT REPORTS FOR INDIAN
1
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</ The Human Development Index was developed by
Dr. Mahboob ul Haq at the UNDP in 1990
✓ UNDP releases Human Development Reports every
year
..
•
✓ The Central government has not prepared such a
report for the country so far
'L--/ Karnataka is the second State in India to prepare a
Human Development Report; the first was Madhya
Pradesh
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Fhe Human Development Report is different from
the usual Plan and budget documents because:
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it looks only at human development (including
trends in economic growth, per capita income,
employment & poverty) but not at productive
sectors
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it uses official as well as nonofficial studies and
-f it assesses both successes and failures
/ it evaluates not only initiatives taken by the public
sector but also the efforts of individuals and NGOs
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THE HOMAN DEVELOPMENT INDEX IS A BETTER
INDICATOR OF DEVELOPMENT THAN
PER CAPITA INCOME BECAUSE
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/ people are the real wealth of a nation; we need “peoplecentred growth”
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Z enlargement of people’s choices is the objective of growth
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Z the benefits of growth may not reach all segments of the
population
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/ often mass poverty persists even when incomes are rising
due to unequal income and wealth distribution and
dislocations caused by structural changes in the economy
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Z we must also look at other requirements of welfare-a long
and healthy life, access to knowledge and control over
resources to ensure a decent standard of living
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KARNATAKA USES THE UNDP METHODOLOGY FOR
CALCUTAT1NG THE HUMAN DEVELOPMENT INDEX
•nF
/ the HDI is a composite index using three unweighted
variables:
J
—the standard of living is measured by using per capita
income
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■
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—educational attainment is measured by using two
indicators: adult literacy with two-thirds weightage and the
gross enrolment ratio of children in primary schools with
one-third weightage
—health status is measured by using life expectancy at
birth
IX:
CM
UNIQUE FEATURES OF THE KARNATAKA HDR
</ the first HDR prepared by an official inhouse
group
/ the first Statelevel HDR
■/ —to fully use the UNDP methodology
✓ —to calculate district level poverty ratios by
pooling Central and State samples of the NSSO’s
survey of household consumption
/ —to calculate district level Sen’s welfare indices
using Gim coefficients of household consumption
expenditure
/ -to compare HDIs based on per capita income
with those based on Sen’s welfare indices
; KARNATAKA-IN A NUTSHELL
& / Area-191791 sq. kms.
“ / Population-50 million (5.27% of the country)
x ✓ Density-261/sq. km. (India-289/sq. km.)
? / Urbanisation-31% (India-26%)
* ✓ **
WHEN
THE STATE WAS FORMED,
✓ IN HYDERABAD-KARNATAKA
•/ literacy was 8.5% (for females 7%)
»/ enrolment ratio (6 to 11 years) was 27%
/ area and population per secondary school and per
) college were high
/ road length per sq. km. was low
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KARNATAKA, ti^AJOR STATES AND INDIA
53
450
960
62.5
56
44.3
71
453
927
60.3
52.2
39.3
Rank among
major States
4
9
5
6
7
8
9384
9578
6
K arnataka
IM R -97
M MR -92
Sex ratio-91
LEB-91 to 95
Lite racy- 91
Fem ale
literacy -91
Per capita
India
1
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3
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1
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SlSI
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N SD P at
current prices
95-96
0.448
0.423 7
H D 1-9 1 -92
(S h i v k u m ar)
0.388 5
0.41 7
G D I (do)
H u m a n develop ment expenditure ratios:
1 8.74
9
*PER
6
37.92
9________________________________
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«:■
*
*
IB
OfWEKGWOWmtL RMMKOMSS
STTMTE MM® EOTWTS
ill
O
sw
7?
**Karnataka’s international HDI ranking in 1991 is
*
131 against country’s ranking of 134
04
lb Highest ranked district in HDI, Kodagu, is 104 and
if!
#
lowest, Raichur, is 142
s
7
? Karnataka’s international GDI ranking m 1991 is 93 against country’s ranking of 99
* Highest ranked district in GDI, Kodagu, is 65 and
*
lowest, Raichur, is 101
?.-T
Ranking of Districts by Health - Education Index,
Income Index and HDI, 1991
District
Bangalore U r b a n
Bangalore Rural
B e1ga u m
B e 11 a r y
B id a r
B ij a p u r
C 11 i k a m a g a 1 u r
C h itra d u rga
D a k s h i n a Kannada
D h a rw a d
G u 1b a rg a
11 a s s a n
K odagu
1< o 1 a i' __ ____________
M andya
M y so r e
R a ic h u r
S h ini o g a
T u in k u r
U.K annada
Health and
Educa tio n
Index
3
9
8
18
17
14
5
10
1
11
19
6
2
12
14
16
20
6
13
4
Ranking
Income Index
2
10
6
7
20
15
3
12
4
16
11
14
1
19
13
9
18
8
17
5
HDI —
2
8
9
17
18
14
5
10
3
11
19
7
1
15
13
16
20
6
12
4
- ~~
r
-£
■
.•r'jl'Jt'.r
8®
32 ££2$
•
rtr rl- ;'xr: fR-H■ri'-r-rH-W-a.wn Hjirfi-
EH£f
Comparison of HDIs based on Sen’s Welfare
iodeM and GDP 1990-1991
MM1
D IS T R IC T
Bangalore
Bangalore Rural
B eljaum
B ellary
B id a r
B ija p u r
C hikm agalur
C hitradurga
D.Kannada
D barwad
G ulb a r ga
H a ssa n
K odagu
K o la r
M andy a
M y so re
Raicbur
S h ini o g a
Tumkur
U.Kannada
STATE
HDIBASED ON
Sen' s W el fa re Index
GDP
Value
Rank
Value
0.565
2
2
0.601
0.457
8
0.472
8
0.454
9
0.471
10
0.410
17
0.429
17
0.402
18
0.4 14
18
0.430
13
0.443
14
5
0.503
0.524
5
0.447
10
0.471
9
0.565
3
0.592
3
0.444
11
0.459
11
0.387
19
0.401
19
0.460
7
0.473
7
0.584
1
0.630
1
0.430
14
0.443
15
0.428
0.444
15
13
0.426
16
0.440
16
0.372
20
0.383
20
6
0.486
0.467
6
0.456
0.440
12
12
4
4
0.533
0.513
0.470
0.449
Rank
THE GENDER-RELATED
DEVELOPMENT INDEX
/The Gender-related Development Index
measures the divergence in development
levels of men and women in the three areas
selected for the HDI
innnniirniiCTnim
/The GDI is the HDI adjusted downwards
for gender inequality
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Kodag u
Bangalore Urban
D.Kannada
U.Kan nad a
C hikam agalur
Shim oga
Hassan
Bangalore Rural
Belgauin
C hitradurga
Dharw ad
Turn kur
Ma ndy a
Bijapur
Kolar
M ysore
Bellary
Bid ar
Gulbarga
Raich u r
HDl Rank
GDI Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1
3
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4
5
6
7
8
10
9
11
12
15
13
14
16
17
18
19
20
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HD 1 Rank m inus
GDI Rank
0
- 1
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0
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0
- 1
+ 1
0
0
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+ 1
+ 1
0
0
0
0
0
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pd> -J CHn
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R--K-
LIMITATIONS OF THE INDEX
APPROACH
g-
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:
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SB
I
Z —literacy is defined in the census as the ability to read and
write one’s name
Z —unpaid work of women is not counted in per capita
income
Z * indices could have interlinkages leading to distortions in
findings
Z * there are no weights given for the indices
Z * the indices have value only in relation to one another
I
te —eet.
Z * the selection of maxima and minima affects values and
range
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STAFF POSITION OF A.B.C.D GROUP OF THE DEPARTMENT OF HEALTH AND FAMILY WELFARE
8
9
0
0
R em arks
V acant
A fter
R ecruitm en
. 7J
To be
V acant
6
R ecruited
5% C ut in
sanctioned
V acant
Name of the cadre
W orking
SI.
No.
S anctioned
SERVICESINCLUDING K.H.S.D.P., AS ON 30/4/99
___
GROUP 'A'
1
1
2
Director of Health & FWS
services
2 Director of Health & trg
Institution
3 Additional Director
Joint Director
Health Officer Class
1
Senior
6 Surgeons
’7’ T.B Hospital Superintendents
8 Chief Administrative Officer
9 A. Special Officer. Legal Cell
10 Cheif Accounts Office-cumFinancial Advisor
11 SSPL/DCMO/SPL/SMO/GDMO
12 Joint Director (IEC)
13 Deputy Director (Pharmacy)
14 Deputy Director (Transport)
15 Deputy Director (SME)
16 Dental Surgeons
17 Deputy Dental Surgeons
18 Assistant Dental Surgeons
19 Chief Chemist & Public Analyst
9
22
23
24
25
Chief Pharmacists
t g">
Senior chief Chemist & Public
Analyst | <.<')
Health Equipment Officer
Accounts Officer (FW)
Assistant Executive Engineer
Vaccine Institute Belgaum
Sr. Asst. Director (Nursing)
26 Biochemist
27 Senior Entomologist
28 Administrative Officer
29 Deputy Director (Nutrition)
30 Planning Officer
31 Principal (College of Nursing )
32 Professor (College of Nursing)
33 Assistant Professor (College of
Nursing)
3
4
5
|1O
1
1
0
0
0
1
1
0
0
0
0
0
8
19
6
18
2
1
0
2
3
0
0
2
0
144
92
52
(-)6
46
Q
46
1
1
1
1
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
4,788
4,049
739
(-)63
676
573
103
1
1
1
1
1
1
0
1
0
0
1
0
0
0
0
0
2
33
185
1
19
2
21
40
1
14
0
12
145
0
5
0
0
0
0
0
0
□
0
_J±4
0
0
0
0
1
0
0
12
141
0
5
115
0
0
0
0
1
0
0
12
26
0
5
7
4
3
0
3
0
3
2
1
0
1
2
0
0
0
2
0
0
0
2
0
1
1
0
0
0
0
0
1
0
1
0
1
0
1-v )
1
3
4
1
3
4
0
1
1
3
0
0
0
0
0
1
0
0
0
0
0
0
f
0
1
f s-v
'
0
0
1
3
4
0
1
1
3
0
3
4
1
2
1
4
0
0
0
1
1
■ 0
1
t >-x
' S -
. 5
2
3
0
3
0
3
*
S'—y f
1
3
fx-'.
r—— '!
iv-u.,..''"’
\ ......7
V >- J. <■
S-........ -•
■
-
s
9
0
0
0
0
0
0
0
0
1
0
1
3
4
5
6
34 Statistical Officer-I
2
2
0
0
35 Demographer
1
1
0
1
0
1
...__
__ _ _ — -
— — —— -
1
1
5,246
4,266
1
e
35
37
2
Material Manager
Screen Pathologist
of
Adiologist
GJ}OUP ’A’ TOTAL
10
“
----
0
0
0
0
0
980
(-)77
906
(-)3‘
697
226
-Zb-
-- - --
•
ft
7
.
8
55
('-)4
51
O
51
12
o
0
0
0
0
0
R em arks
6
V acant
A fter
R ecruitm en
To be
73
R ecruited
128
V acant
4
5% C ut in
sanctioned
3
Vacant
W orking
Name of the cadre
S anctioned
SI.
No.
9
10
GROUP 'B'
_1
38
2
Lay Secretary/Gazetted Asst.
39
11
5
1
27
7
1
1
12
4
4
0
0
0
12
2
4
0
43 Technical Officer (FSOC)
Assistant Deputy Director (HE &
SH)
45 Technical Officer (Exhibition)
46 Junior Physicists
47 Assistant Entomologist
48 Medical Record Officer
49 Technical Officer (Goitre)
50 Service Engineer
51 Lecturer College of Nursing
52 Principal School of Nursing
53 Nursing Superintendent Grade 1
1
0
1
Ut
0
0
0
1
0
1
0
1
0
1
1
2
28
4
1
20
5
10
1
0
7
1
1
7
1
3
0
2
21
3
0
13
4
7
0
0
0
0
0
0
0
0
0
2
21
3
0
13
4
7
0
2
21
0
0
0
0
0
0
0
0
3
0
13
4
7
51
18
33
0
33
0
33
13
13
9
11
4
2
_L-)1
0
3
2
0
0
3
2
71
36
35
0
35
0
35
24
17
7
0
7
0
7
12
6
6
(-) -I
5
0
5
1
1
2
21
17
22
1
5
0
1
1
0
0
20
11
21
1
0
J-).1 _
0
0
0
0
0
0
0
0
0
10
0
0
0
20
11
21
1
0
0
0
258
0
0
0
20
11
21
0
0
0
0
93
0
0
0
0
0
0
1
0
0
0
165
-A
.,
4
I
I
,
I
0
58 Health Education Officer/Health
• Education Inspector/Health
science Instructor
J
“
|
_39 Graduate Pharmacist
40 Chemist/Food Analyst
41 Assistant Nutrition Officer
42 Scientific Officer
54 Assistant Leprosy Officer
55 Senior Health Supervisor
5G Nursing Superintendent Grade 1
(PH)
57 District Health Education Officer
•i
5
J
59 Social Scientific Editor
60 Assistant Director (Press)
61 Statistical Officer
63 Micro Biologist
64 Clinical Psychologist
65 Entomologist
66 Cold Chain Officer
Statistical Officer Gr.ll
ei’ Communication Officer
63 Clinical Instructor
2
4
I
517
GROUP'B'TOTAL________
2
1
6
1
0
5
2
4
II
249
||
0
0
268
JI______
R ecruited
V acant
A fter
R ecruitm en
1
0
1
0
1
726
41
20
1.219
505
37
16
1,066
221
4
4
153
(■) 2
1JJP
0
0
219
6
4
221
4
153
0
0
0
0
4
153
51
37
14
0
14
0
14
9,590
1,317
81
9,026
933
51
564
384
30
_c-i7
.('-).9
448
377
21
0
0
0
448
377
21
98
93
5
C-)5
0
0
0
V acant
R em arks
V acant
89
To be
5% C u t in
s a n c tio n e d
90
W orking
Name of the cadre
S anctioned
SI.
No.
GROUP 'C
J.V Deputy Health Education Officer
71 Block Health Educator
72 Projection List
_c^v— Jc?
2? I Junior Projectionist
74 I
Lady Health Visitors
75 Nursing Superintendent Gr.ll
(PH)
Junior Health Asst..F.
77 Senior Health Asst.M.
78 Health Superivisor
79 Senior Non Medical Supervisor
80 Junior Non Medical Supervisor
157
112
45
('-) 10
35
0
35
81
5,662
1,231
4,455
938
1,207
293
C:) 63 .
J.-1216
1144
77
242
266
902
0
4,673
4,102
571
0
571
0
571
4
3
1
0
1
0
1
600
480
120
0
120
0
120
354
283
71
0
71
0
71
90
463
2,164
1,520
75
90
31
375
2,170
43
47
0
387
76
0
799 _ J'J 58
1,365
411 U20
1109
44
31
.C-)1.O
44
46
(2)15
26
5
0
I 61
314
C-)18
1,588 p82
('-) 91 .
43
76
741
391
21
29
5
43
jn-t
0
0
.799 0
410 0
0
0
0
0
0
43
76
Junior Health Asst.M
82 Para Medical Worker
83 Staff Nurses
84 Clinical Instructor (College of
Nursing)
85 Senior Staff Nurses
86 Nursing Superintendent Gr.ll
(P.H)
87 Nursing Tutor
88 Sr. Pharmacist
89 Jr. Pharmacist
90 Drivers
Skilled Tradesman
92 Skilled Assistant
93 Asst Statistical Officer
94 Office Superintendents
95 First Dv. Assistant
96 ^-ucoi'id Dv. Assistant
*6
1,5/
i ,526
50 ...(-) «2.
Clerk Cum Typist
98 Stenographers
391
118
287
104
104
99 Stenographer Junior
100 Typists
79
284
17
69
229
12
14
10
6
3
5
3
5
106 Jr. Lab. Technicians
1,884
701
107 Sr. Lab. Technicians
108 X-Ray Technicians
109 Radiographer
110 Refractionist
111 Orlhopist
112 A-.-.l Medical Recored Officer
380
352
51
582
7
1 1
137
271
20
428
7
7
97
101 Lady House Keeper
102 Sr. Librarian Gr. I
103 Librarian Gr. I
104 Librarian Gr. II
105 Library Asst.
2
3
1
L-L60
W.6
0
55
5
1
1
2
2
(±9
0
0
0
0
0
1183
243
81
31
154
0
4
0
0
..(-.) 12...
0
(-)4
0
0
IQ). 32 0
0
8
10
46
1
1
2
2
0
0
0
0
0
0
0
0
1183
243
69
31
83
0
4
281
0
0
0
69
0
0
5
*
*
21
29
5
43
491
*
0
37
•
37
8
10
46
5
1
1
2
2
902
243
69
31
14
._L
......... - • ----------
1
------------------------- ?____________ J
113 Physiotherapist (General )
j_14 Elecjtrjcian
2] 5 Clinical Psychologist
116 P ep tai Mechanic
117 Junior Chemist
118 Cental Hygienist
119 Hhysiotherapist(Leprasy)
120 Dietician______________
121 Social Worker (STD)
122 Mechnic Class 1 (Junior)
123 Occupational Therapist
124 Modeller
125 Artist-Cum-Photographer
126 Artist
12^firaftsman
12^Fhyical Culture Instructor
129 Auto clave Mechnic
130 Pathological Assistant
131 Scientific Assistant
132 Aircondition Operator
133 Superintendent (Technical )
134 Printing Instructor
135 Weaving Instructor
136 Loom Mechanic
137 Health Equipment and Repaired
Supervisor
138 Junior Engineer
139 Sub-Editor
140 Home Science Asst.
141 Orthoptic Technician
142 Optical Mechnic
143 Teacher
144 Speech Pathologist
143 ■peech Therapist
14? Refrigerator Mechanic
147 Reaserch Assistant
148 Needle Work Teacher
149 Electrical Supervisor
150 Dialysis Therapist
151 Medical Record Technicians
152 Psychotric Social worker
153 Equipment Technician
154 Senior Compositer
155 Junior Compositer
156 iCompositer
157 Junior Computer
158 Food Analaysts
159 1 Insect collector
160 lE.C.G, Tech.___________________
161 .Offset Plate maker
162 ISenior Printer
63 iHealth educators
64 literate Attender
65 ■Supcrier Field Worker
GROUP C TOTAL
I
4
3
18
69
5
1
6
7
51
10
11
5
(_-)19
0
0
28
10
11
1
46
1
24
9
11
0
5
4
7
4
1
0
1
5
1
1
—L-)5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11
1
24
9
11
0
5
4
2
38
7
26
8
8
28
5
22
4
0
0
1
0
1
4
1
0
3
1
1
1
1
3
4
1
1
1
0
1
0
0
0
3
0
0
0
0
0
3
1
1
1
2
1
1
1
1
3
1
1
1
1
0
0
1
0
0
0
0
0
0
0
0
1
2
0
1
"i
1
2
38
5
187
1
4
1
1
0
0
27
1
0
0
1
1
0
1
2
11
4
15
1
1
0
48
18
31
24
9
52
14
33
4
5
4
8
4
2
4
2
5
4
39,264
1
3
1
1
187
1
3
0
1
15
1
1
■ .-v
| 31,173 || 8,091 |
51 •
7
4
1
0
1
5
1
1
. 8. 1
51 r0
6
0
0
____ 10 _
*
9
4
11
0
0
0
0
11
0
0
0
5
4
0
0
0
0
0
0
1
11
1
24
9
0
0
5
4
2
0
1
0
1
5
1
1
0
0
3
0
0
0
0
0
0
0
3
0
3
0
3
0
0
(-) 1
0
0
(-) 1
0
0
0
0
0
0
0
2
0
0
1
1
3
1
1
1
2
11
4
187
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
2
0
0
1
1
3
1
1
1
2
11
0
187
0
0
0
0
15
0
15
-
-
-
0
0
0
0
0
0
(-)1
(-) 3
(-)3
(-)1
(-) 2
(-) 1
0
(-)1
1
(-)10
(-) 3
(-) 48
92 7
7, 164 | 2,37.)
'4,791
*
' 7‘
8
9
0
0
0
0
0
0
o
0
0
67
0
1
3
21
71
1
71
90
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
67
0
1
3
21
71
1
71
90
0
728
0
| 1052
R em arks
V acant
A fte r
R ecruitm en
I
6
To be
2
1
1
3
1
1
0
123
0
0
0
0
14126
R ecruited
2
1
1
69
1
2
4
145
71
1
71
90
16787
V acant
4
5% C ut in
sa n ctio n e d
3
V acant
W orking
2
_____
Name of the cadre
S anctioned
SI.
No.
3ROUP 2D)
1
166 Pump Mechanic
JI67 Wireman
J68 Boiler Attender
169 Dark Room Assistant
1/0 Silk Sreen Technician
171 Leather Worker
172 Carpenter
173 Cleaners
<74 Junior Lab. Attender
175 Plumber
176 Cook
177 Wireless Operater
GROUP D’
No. Of posts of Group 'D'
Vacant(Proposed not be filled up)
5
0
0
0
67
0
1
4
22
71
1
71
90
2661’
X
(-)1
(-) 1
0
0
0
0
(-j 439’
(-) 1495
728
F
10
Itli.
GROUP’D’TOTAL
||
17245
I
14258 || 2988 |
1936
| 1052 1
I
PAGE 8
STAFF POSITION GROUP A , B, C, & D OF THE DEPARTMENT OF HEALTH AND FAMILY
WELFARE SERVICES AS ON 30/4/99
ABSTRACT
Category
Sanctioned Working
5% Cut in
sanctioned
Vacant
4
|
5
Vacant
!
To be
Vacant After
Remark
Recruited Recruitment
8
6
7
77
906
689
217
268
10
258
93
165
31,173
8,091
927
7,165
2,373
4,792
17245
14258
2988
1936
1052
0
1052
62,272
49,946
12,327
2,950
9,381
3,155
6,226
1
2
3
GROUP 'A'
5,246
4,266
980
GROUP 'B'
517
249
GROUP ’C
39,264
GROUP 'D'
Total
*
!
9
I
i
G®
> I-
NUTRITION PROGRAMME
.b
. ...
OBJECTIVES;
The major Goal to be achieved under Nutrition is reduction
of severe and Moderate malnutrition of children below 5 years of.
age by 2000 A. D with the following Specific Goals;
1. Control of vitamin 'A' deficiency and its consequences
including blindness.
2. Reduction in the incidence of low birth weight babies.'
3.
Universal consumption of Iodised salt.
‘ ,
Vitamin 'A1 prophylaxis programme;
Vitamin 'A' prophylaxis programme is one of the Nutrition
programmes implemented in the state in order to prei/ent severe
formjof vitamin 'A' deficiency leading to blindness.
A Mega dose of vitamin 'A' concentrate is administered
orally to the children of 9 months to 3 years one Ml of vitamin 'A'
concentrate containing one lakh I.U is given to the children of
9 months along with Measles immunisation and
2 Ml of vi t ami n 1 A '
concentrate containing 2 lakh I.U is given to the children of 1-3
years at 6 monthly intervals.
vitamin 'A' concentrate is supplied^)
by Government of India free of cost. The statements showing the
progress for 97-98> 98-99 and 99-2000 is enclosed herewith
The Integrated Child Development Sex-vices Scheme;
i
This programme is being implemented with the co-ordinated''
efforts of Health 4 F.W.Services of Department of Women & Child (
Development.
A package of services like Immunisation, Supplementary
Nutrition, Health Checkup,
Education,
Referral Services,
Noo-formal pre-school
Nutrition and Health Education are provided .^he beneficiaries
of this programme are 0-6 year children and pregnant of lactating'
Mothers.
Ofid
•
At present 184 projects are being implemented and the Health
Nutrition sectors are being monitored regularly.
The progress
Reports are computerised at the Directorate every month and sent to
Central Technical Committee,
New Delni and other officers concerned.
i:
'■-.'PORT
0 i stri c t
i u;<
^nr; ys \n 97-90 1 1- .6’ 1 ULb’-A.'
'■’.pt les li nl-cti vlt 'A'
ITOphy 1 ax is pr o"r none 1'or 1-3
year children
pr o"r-,inc
T:jrcn t
ichi cvcne nt
•
»
Tr?rr<?t
Achi nvc'jp nt
Ba n? -il ore ( U)
22000
206 60
1 50
5 8000
55601
96
Ban^al ore( R)
38000
2459 1
64
106000
100614
95
GOCCO
119911
19 3
Chi tr n'Jurfin-
G0000
43125
72
Folnr
49000
52OGO
106
135300
10 4 89 3
77
Shi no." a
Tuolojr
4 3000
40 7 07
94
117000
57000.
51 39 4.
90
135000
1 32240
1421 29
113
■'> 105
Be 1/Zauia
95000
94502
157439
75
77000
99
92
209000
Bi j apur
171000
20 3000
93253
20 46 82
54
76
79000
D h a.r w ad
(^Kanmd a
9 3COO
70705
71026
2 5000
19001
Be 11 ary
5 5000
27327
79
52
107000
779 34
8777 8
Did ar
30000
54550
90
7 4000
5 8835
66
Culbaroa
7 5000
39720
53
149000
5 4 59 0
36
Bai chur
69000
57045
84
1 39000
117583
84
Chilmn/Zalur
20000
17301
37
60000
31101
52
1). Fanned a
56000
23569
42
16 8000
56 21 3
33
H asn an
34OC0
25590
75
102000
290 22
28
Bod cV3n
10000
9325
93
300 0b
31280
104 .,
14 a nd y a
36000
52 46 8
39
67000
49
38
10 0000
14 ys ore
17775
25866
155000
22441
14
^atc total 1017000
775696
76 2 4 37 0 00
1705857
70
101
98
82
(
YIAMI H *A
*
REP ORT FOR THR TEAR 98-99 13 a3 FOLLOW
PropbylMx 1* p r og r aratn® for 1-3
Di.t.Hct
Mellos linked Tit ’ A’
rogr
npne
years ohlldren
- _ ________£
Aohlvono
nt
T urge t Achievement
T oT8” t
%
7
Bangalore (U)
22QOO
Bangalore (R) 300 00
Chi tradurra
60000
Koi ar
49OCO
Shino^a
43000
Tumkur
57000
15762
75170
71
92
32 305
49179
54
100
68
Belgaum
81150
7000
Bl j spur
Bh arv&l
U, F anntsd a
Be 11 ary
^daX
^ilbarga
Bal chur
Chicksalur
B, Fanngd a
H &s s an
Kod affu
Mandy a
lya ore
95000
77000
93000
25000
55000
38000
75000
69OQO
20000
56000
34000
10000
36000
67000
> tate Total 1017000
29 352
44336
3250 3
20725
29® 2
50435
955$
95889
15333
4975
77.7
85o4
9
35
03
56O2
80
12,7
52
76,6
8.8
5 0000
106000
60000
135000
117000
135000
2O9OOO
171000
20 3000
79000
107000
74000
1 49000
139000
60000
168000
102000
30000
240 7 4
86 6 88
41.5
81.7
61079
67465
89 306
101
50
112306
83
' 64.3
1 34481
346 87
76236
99651
6 8411
53174
42670
54256
48999
6033
2262
2592
76.3
20.2
37.5
126
64
72
28.6
39
81.6
3.5
3415
1963
10
19.6
24J54
67.6
108000
155000
69560
64.4 ,
50 3207
50.7 2437000
11339 6 5
46.5
2.2
8.6
. . VITA'41 N 'A' RE:PORT FOR THE YEAR 99-2000 IS aS FOLLOWS.(UPTO HCVEMDER-99)
Di strict
He as les linked vlt ' A'
ogr aane
T arget
Prophylaxis programme for 1-3
year children
Achieveme nt
%
Target
Achievement
%
Bangalore C. £
1 12000
Dangalore- (U)
26000
Bangalore ( R)
45000
22515
52
85000
679 59
50377
.
49 397 ’ ' 75
79
81
Chi tradurga
31000
19965
64
62000
Davangere
33000
19850
60
66000
Kolar
57000
Shimoga
Tunkur
43000
46
86000
64433
75
60000
10025
30 2 4 8
50
120000
85914
71
^Belgaun
96000
192000
Bi j apur
41000
82000
BaEalkote
39000
Bharw^i
34000
. 19310
56
68300
59602
8f
0 ad ag
23000
11965
52
■M6000
31122
67
Haveri
■32000
62
64000
33103
51
U. Kanngd a
25000
20035
1 3488
54
50000
61994
Be llary
50000
16638
33
100000
35349
124
35
Did ar
35000
70000
6 ul bang a
76000
152000
Rai chur
40000
21317
Koppal
^Ihl hna/Xalur
29000
6157
i), Kannad a
30000
13561
45
Udupl
21000
114000
78000
'
i
80000
44735
56
58000
9465
16
60000
64798
108
31
42000
26533
63
38
64000
53
21
20000
40000
Hassan
32000
6551
12312
Rod a/Tu
9000
6978
77
1 8000
50730
27176
14 and ya
14 y sore
34000
20541
60
6 8000
49062
79
150
72
56000
25349
45
112000
77996
69
Cham ar aj nag ar
22000
69B2
31
44000
19121
43
State Total
1149000
31 3777
27
229 8000
909 871
•39
■
■ 3
’
The progress of I CDS programme for 97-98, 98-99 & 99 - 20 00
(upto october-99) is as follows;
.1337-98.
a)
b)
Sectoral level Training conducted by 1-IOs;
Quarter
Targe t
Achieveae nt
Percentage
I
5562
41 37
74
II
5562
4291
79
HI
5562
5016
54
IV
5562
4383
79
Anganwadl centres visited by HOs for Health check-un:
Achievement
Quarter
Targe t
I
39855
24627
II
39 85 5
2 5 417
64
HI
IV
39 855
39 85 5
1 7815
2 8 882
44
72
Percentage
s
62
1998-99
Sectoral level Training conducted by HOs;
b)
a)
b)
percentage
Quarter
T arge t
I
5562
5841
69
II
5562
5042
54
HI
5562
2781
50
IV
5562
5580
60
Achievement
Anganwadl centres visited by HOs for Health check-unt
Achievement
Percentage
Quarter
Target
I
39 85 5
2 2 1 27
II
39855
24001
HI
39 8 5 5
2 41 11
61
IV
39 85 5
2 5 4 40
64
55
'
60
1999-2QQQ
Sectoral level Training conducted by HOs;.
Quarter
Targe t
Achievement
Percentage
I
II
5541
5541
2836
2822
51
53
Anganwadl
centres visited by HOs for Health check-unt
Qu ar ter
Targe t
Achievement
Percentage
I
39 85 5
2 4 89 8
62
II
39855 -
24472
61
National Iodine Deficiency Disorders Control Programme,
The National Iodine Deficiency Disorders Control programme
was initiated during 1988-09 in the state Health Directorate
as 1QO% centrally sponsored scheme inorder to control Iodine
Deficiency Disorders.
In the first phase initial surveys were conducted in all
the 20 districts and four districts i.e., Chikkamagalur.,.
Dakshina kannada, Uttara kannada and Rod agu districts were
identified aS erriemic districts having more than 1Q% prevalence
of Goitre.
Implementation of the control programme.
In the second phase the programme was implemented in the
identified four endemic districts through issue of Gazette
Notification banning the s ale of non-iodlsed salt under pFA and
simultaneously arranging for prevision of iodised salt^
-Since
consumption of Iodised salt is the most effective and cheapest
method of preventing Iodine Deficiency Disorders)
The ban
notification is in force in the entire state since August-95^ ^veo
Educational ac ti vi ties/Trai ni ng programme.
In order to create awareness among the community about
jjp
the importance of iodised salt for prevention of Iodine Deficiency
Disorder, intensive Health Education Activities have been takenup
through printing and distribution of education materials like
flip books, Posters, Flash cards, Danglers,
stickers> Plukards
Pamphle ts e tc. ,
Motivation campaign were organised in the endemic districts
inorder to develop interaction between the IDD experts and the
officers concerned with NIDDCP.
District level and taluk level buyers and sellers meet
were also organised in endemic districts to, sort out the problems
of the whole sellers and other merchants of salt.
1132'5 Health functionaries from 27 districts were trained
on IDD Control programme and
also about the me thod ojogy of tes.t-i_ng
iodised salt with the help of field testing kits.
. 2. .
2
During October 96 the state level convention on IDD Was
also held at Bangalore.
In view of the Global IDD day different Health Education
activities were undertaken in the district aS well as in the
state head quarters.
Prevision of Iodised salt,
The Director of Food & Civil .Supplies have been requested
to supply iodised salt through PDS^and aiso to ensure sufficient
quantity of iodised salt in the entire state.
Quality control.
Inorder to monitor the quality of iodised salt supplied at
different level also the district health and F. W. officer have
been requested to collect samples of salt under PFA and also Non PFA
and sent to Public Health Institute, Bangalore for analysis.
Samples of Salt analysed under PFA.
Ye ar
Total
Satisfactory
97-9 8
U
14
9 8-99
36
35
16
Not Satisfactory
—
1
99-2000 16
(upto Nov 99).
Samples of s alt analysed und er Non-PFA,
Y
Iear
No. of Salt
samples analysed
97-98
9 8-99
99-2000
(upto Nov 99)
satisfactory
Notsatisf actory
251
932
171 (68.1%)
83 (31.2%)
385 ( 62 . 8%)
349 (37.2%)
477
278 (58. 3%)
199 (41.7%)
Samples of salt tested with the help of field testing kits by
He alth fu nc ti onari es,
No. of samples 0:r
tes ted
Total
15 PPM
^IOWm
0 PPM
15 PPM
97-9 8
1 2, 59, 466
4,50, 225
3,76,248
4,32,983
(35.8%)
(29.9%)
(34.3%) -
9 8-99
10,19,702
99-2000
5,29,355
4,09,51 1
(40.16%)
2,04, 185
(38.6%)
3,51,369
( 34. 40%)
1,87,6 9 4
(35.4%)
2,58,822
(25. 38%)
1,37,6 7 6
(26%)
(upto Nov 99)
3 MOni tori ng: The DH & FWO have been requested to review this
programme during the monthly meeting and also report new goitre
cases every month.
State level co-ordination committee.
State level co-ordination committee with Health Secretary
as Chairman has been formulated during 1988 for reviewing the
activities of NIDDCP.
So far eight meetings were held.
Co
' -V
VIL.,.3 SUiilJTTED BY ME TO THE TASK. F^RCE COMMITTEE FQd HEALTH PEPA .iTUSJT
b-f 5rAdministration in Health- & Family Welfare Departments :
Since 199^ adunnintra live skill ha a diminished io th in Hail th
liana gem ent A: Medical Care.
Reason t-
D. II. O’ s, Dy. Directo rs, Principals, District Surgeons and
all other equal ent posts are filled up purely on seniority basis
(who have already got time bond promotion).
Ths above posts are occupied by Medical graduates who are in the fag
end of their service and without any administrative exposure.
As a
result of this the ’’inisterial staff will take tire up^hand A- .misguide
the Administration.
Solutions su-posted t-
These posts should be filled up on promotion
base! on merit-cum-seniority.
—
For curative service l-
Clinical post graduation (1)
degree or diploma if there are no
eligible candidate in the I catogory.
For Health Administration A Training - Degree in community Medicine
or if there are no eligible candidate diploma.
By doing as above, it can be ensured fair length
service and it is
(\ .by,.’-1possible to give and equana-te training in the respective field.
The posts of District Surgeons> D. H. 0. 1 s, Dy. Directors) Principals
should be up graded to the level of Joint Directors to maintain
i c <L_
proper
7--
The posts of Divisional Joint Directors should be made equal to
Additional Directors.
This kind of arrangement will
All posts starting from Secretary of Health
clinical P.O. course.-j-e.
Medical Department
should filled on promotion out of Health & Medical professionals
only to avoids
d?-'
I
2
(l)
Techno Administrative
( :')
(■'L’uqli rill I
chilli," o of
«
Buri Ciito i'1 eu
(i) Bring about uniformity & maintain it in this Techno administration
(4) Frequent change of top administration will bring ideas from
previous departments & tries to implement and fail to do so ~
do to wide variation that exists Between departments.
Depa rtmental ft heads have to apprise the Secretary in every asnect,
Pwhich consumes lot of his valuable time. "Whatever may the
l-X.
competition of the Secretory, -we may aquire superficial knowledge
only.
So it is necessary tn have departmental office1- as Heed of
the Department.
.•
Rural Health / in the Z. P.
J
set up
At present District Health Administration has almost Collapsed,
Since 1987.
This is because Health Department at District Level
comes under 2. P.
There is lot of interference in Health Administration
with regard to Transfer, 0.0.3.
i Desciplinary action etc.
District
Health Officer cannot devote much time for Technical work, -
Supervision
f\etc.
of meetings frequent
i-nc—;l-iscuesinn.
This is because of imrnunarable number
-3
of the Officers ttol-Z-P.'s
As a result of this there is no respect for
D.IT.O.'s and there is no desciplance in the Department.
accounts is a
<rrv<~^
■
Purchase of drugs is not on need based.
There is interference in all aspects of administration.
Solution 1-
It is necessary to remove Health Department from Z. P.
set up.
FOOD ADULTSIUTIOM
It is time to review the P.F.A. programme.
rate Ranges between 1to 20A
there is no broad based P.I'.A.
At present adulteration
This is highly aiming.
At present
set up eighteen state Health Department
or in the Municipalities.
3/-
It P.F.A. Act in not implemented in ris-’nt earnestness.
Food
alultcation will course vi. ible public health hazards within a
f ew y sirs f mm 2000.
Su ••restinn >(l)
Officers incharge of District Health Administration, should be
for carrying out P.F.A. Act.
the
For this there must
be one qualified food inspector for each of the Taluk, and the
Taluk MediCal Officer must be made local health authority.
( p)
There must be one Health Officer in all Municipalities having
more than one lakh population.
the duties in
Health Officer must discharge all
the duties of- Local Heal th. Authority.
Health Administration in Municipaltios«
cities.
lio-re than 3O’/o of population of the State live in the
Out of this 20/
*
to 30/t of live in slums.
Health programmes & sanitation is being under taken by local bodies.
In most of the Municipalities there programmes are being implemented
by non technical officers & officials.
Therefore it is necessary
to post one Health Officer with Medical gr duation to each of the
Municipalities having more than one lakh popula lion-and adequate
para medical staff has to be provided.
The Food Inspectors,
Senior Health Inspector, Junior Health Inspector and A.r. M.’g etc.
P O L I C Y i1.
(1)
Stayin'
in the ruspeotlve Ileud Cpia rteru to all Medical
and Para Medical Officers d; Officers must be made
Compulsory by giving adequate, compensation.
The movements
oi each such official has to be watched through Internet
Programme and monitored by Divisional vigilance squad and
action should be initiated against defaulters.
■ . • • 4/-
I
(2)
N. P.A.
4
J
to the extent of l/3 of the Basic Pay has to be
ziven to all admin 1 o(, m I j on oi ficui'n incl nd i >ig bi.lrict
Surgeons,
H. K. 0. 1 s, D. P.O’s, D. D's, Principals, J. D.’s
A. D's etc., to bar then from practice.
(3)
Sural allowance of 1/3 of Basic Pay may be given tn rural
Doctors tn make than to stay in the rural arras.
(4)
It should be made Compulsory tn make their own arrangements
for residential accommodation in the absence of Cnvernment
qua rt ers.
II.
Auditing of Accounts & Material-’is very very inadequate.
It is
necessary to establish Internal Audit team at District &
Divisional level lieudel by A. C. ol
Slate Accounts
Con troll
by the respective Head of the District.
III.
There must be Divisional Vigilance squad heeded by Divisional
level Health Department Officers tn check monitor d: regulate
the working of the department empowering the squad to take
spot action on the defaulters/affenders/irregular, etc.
IV.
All Officers should be equiped with computors for proper record
keeping - easy
to the records including statistics
of staff expenditure ■?-. eouinments etc., through computer
p rn g eamm i n g.
? v $- ■
yr
GOVERNMENT OF KARNATAKA
BASIC MINIMUM SERVICES
DEPARTMENT OF HEALTH AND FAMILY WELFARE SERVICES
BANGALORE
BASIC MINIMUM SERVICES
INTRODUCTION
1.1
A basic health care service is understood to be a new-work of co-ordinated
peripheral and intermediate health units capable of peforming effectively a selected
group of functions essential to the health of an area and assuring the availability of
competent professional and auxiliary personnel to perform these functions.
1.2
The national norm for a sub-centre vary between 3000-5000 population
depending upon terrain and location. Similarly, there should be one Primary Health
Centre for every 30,000 rural population in the plains and one Primary Health Centre
for every 20,000 population in hilly, tribal and backward areas for more effective
coverage. There should also be one Community Health Centre, for every four PHCs,
with 30 beds and specialists in Surgery, Medicine, Gynecology, Paediatrics,with X-Ray
and Laboratory facilities. The District-wise number of Primary Health Centres and
Community Health Centres in the State, is given in Annexure-I.
1.3
According to Section 184 of the Karnataka Panchayat Act, 1993, read with
Schedule 3 of the Act, management of the hospitals and dispensaries, excluding the
hospitals and dispensaries under the management of the Government or any other
Local
Authority,
implementation
of
Maternal
and
Child
Health
Programme,
implementation of Family Welfare Programmes and implementation of Immunisation
and Vaccination Programme are the functions of the Zilla Panchayats.
1.4.
Establishment of new PHCs and CHCs are proposed by the Zilla Panchayats
and sanctioned by the State Government. Sanctions are normally accorded on the
last day of the financial year and many a times the PHCs sanctioned are different from
those proposed by the Zilla Panchayats. A large number of PHCs, which have been
sanctioned in the recent past, are yet to become functional. Buildings are yet to be
constructed and the staff, as per the norms, is yet to be sanctioned to these newly
sanctioned P.H.Cs.
1.5.
Since the Sub-centres and PHCs in the State are much more than as per the
national norms, the emphasis should be on making the already sanctioned Sub-
2
centres and PHCs functional by construction of buildings, sanction of staff, providing
equipment, etc.
PLANNING COMMISSION ON BASIC MINIMUM SERVICES.
2.
2.1.
During discussions with the Planning Commission, it has been pointed out that
taking cognisance of the widening disparities among the States in the availability of
Basic Minimum Services(BMS),the Conference of Chief Ministers in July,1996,
recommended that Additional Central Assistance(ACA) may be provided to the States
for correcting the existing gaps in the provision of seven Basic Minimum Services; that
of these, access to primary health care, safe drinking water and primary education
were given higher priority with the mandate that universal access to these services is
to be achieved by 2000 A.D., that unlike the Minimum Needs Programme, which
provides funds only for rural primary health care, BMS includes primary health care in
urban and rural areas; that in order to ensure that adequate investments are made for
BMS sectors, minimum adequate provision(MAP) was calculated on the basis of
Actual Expenditure for 1995-96 + ACA + 15 per cent of ACA as State’s share, that the
State Government must also ensure their share of 15 per cent for BMS; that failure to
allocate and utilise MAP requirement would result in curtailment of Central Assistance
in the following year; that during the Ninth Plan funds will be ear-marked for urban and
rural primary health care under the name BMS(instead of MNP); that this ear-marked
amount will include BMS allocation from state budget and that since primary health
care is one of the priority areas identified under BMS the State Health Department may
obtain upto 20 per cent of the ACA for BMS for bridging infrastructural gaps in primary
health care.
2.2.
The Planning Commission has, among other things, emphasised the following:
a)
While computing the requirements for primary health care infrastructure for the
growing population, the fact that the population increase has occurred
in and around the already established centres have to be kept in mind. Since
the already established physical infrastructure cannot be shifted, and it will be
difficult to add additional centres to serve the population in geographically
convenient locations, it would be more feasible to increase the number of
functionaries required to cater to the population's need rather than increase the
number of centres.
3:b)
During the Ninth Plan period the States shall restructure the existing sub-
district/taluk hospitals and block level PHCs into functioning CHCs to the extent
possible.
c)
Existing rural hospitals and dispensaries have to be restructured to PHC/Subcentre.
d)
The poorly peforming districts should be identified and essential funds provided
to meet their requirements so that the existing
gap in the health and
demographic indices among these districts could be minimised.
e)
A flexible approach to the recruitment of staff, if necessary on contract basis,
will be adopted to ensure that the programmes do not suffer due to lack of key
personnel.
f)
There is a lack of critical manpower in primary health care institutions.
The
number of sanctioned posts of Male Multipurpose Workers is only half the
number required. This has been cited as one of the major factors responsible
for the suboptimal performance in Malaria and T.B.Control programmes. It is
essential that necessary administrative steps are taken to fill the gap in Male
Multipurpose Workers.
g)
A substantial proportion of specialists posts even in functioning CHCs are
vacant. Hence these CHCs are unable to function as First Referral Units. In
view of serious implications of
this lacuna in the establishment of referral
system, as well as effective provision of health,MCH/ F.P.Care, there is urgent
need to rectify this.
h)
At the moment there is no post of Anaesthetist in the CHCs.
Anaesthetists are vital
Services of
because without an anaesthetist emergency/routine
surgery in CHCs will not be possible. Attempts may be made to provide this
critical manpower.
i)
Services in primary health care facilities are also affected due to lack of
maintenance of equipment/vehicle and inadequate supply of drugs.
3.
CONSTRUCTION OF BUILDINGS FOR SCs, PHCs and CHCs:
District-wise requirement of funds, for providing buildings to these centres, is
shown in Annexure-ll.
4
PR0VIDING
4.
4.1
STAFF TO PHCs AND CHCs AS PER NORMS:
The PHCs sanctioned since 1989-90 and the CHCs have not been provided with
full complement of staff. To make these centres fully functional, the following staff is
required to be sanctioned.
For CHCs
For PHCs
1.
2.
3.
4.
5.
6.
7.
8.
4.2.
Block Health Educator.
Senior Health Assistant(Male)
Senior Health Assistant(Female)
Staff Nurse
Junior Health Assistant(Female)
First Division Assistant
Second Division Assistant
Group 'D
1. Paediatrician
2. Gynecologist
3. Surgeon
4. Dental Surgeon
5. Office Superintendent
6. X-Ray Technician
7. Staff Nurse
8. Pharmacist
9. Typist-cum-Clerk
10. Second Division Assistant
11. X-Ray Attender
12. Lab. Attender
13. Helper for every 3 beds
14. Cook
15. Dhobi
In addition, the post of Anesthetist is also required to be sanctioned to the
CHCs. The recurring expenditure on the staff to be sanctioned, district-wise, is
shown in Annexure-lll.
5.
MALE MULTIPURPOSE WORKERS:
As against the requirement of 8143 male multipurpose workers, there are only
6352 sanctioned posts. Hence, 1791 posts of male multipurpose workers will have to
be sanctioned.
The recurring cost, district-wise, for these posts are shown in
Annexure-IV.
6.
SUPPLY AND MAINTENANCE OF EQUIPMENT, FURNITURE, DRUGS, Etc.
Funds for supply and maintenance of equipment, furniture, drugs, etc., are now
available, to some extent, under the Externally Aided Projects like LP.P.-IX, KHSDP,
5
RCH, etc. However, once these projects are over, adequate funds, for this
purpose,will have to be provided in the budget.
7.
TOTAL ESTIMATED REQUIREMENT OF FUNDS FOR BMS (RURAL).
As of now, the total estimated
requirement of funds for providing the basic
minimum services, in rural areas, is Rs.389.52 crores (including recurring costs of
Rs.85.51 crores ). This amount may be provided over a period of 2-3 years. Since, as
already pointed out earlier, primary health care services are basically in the Zilla
Panchayat sector, the funds required will have to be provided to the Zilla Panchayats.
ANNEXURE-I
•
Si.No.
Name of the District
NO. of existing
Sub Centre
No. of existing PHCs .
No. of existing CHCs
3
4
5
140
286
31
73
57
70
82
97
55
135
65
46
28
29
50
61
105 .
54
41
47
43
96
52
29
71
81
51
64
63
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Bangalore Urban
Bangalore Rural
Chitradurgal
Davangere
J
Kolar
Tumkur
Shimoga .
Belgaum
Bijapur 1
BagalkoteJ
Dharwacfl
Gadag
r
Haver!
Uttara Kannada
Gulbarga
Bellary
Bidar
Raichurl
Koppal J
Myeore
7
Chamarajnagarj
Kodagu
Mandya
Hassan
Chickmagalur
Dakshina Kannada!
Udupi
J
TOTAL
458
375
418
380
598
456
/
596
316
512
264
231
3 78
690
163
376
463
335
708
8143
1676
.
3
11
12
7
13
10 ... •_
9
15
8
10
3
6
11
12
19
9
6
5
9
15
4
7
9____
15
8
7
6
249
. i5cri<'ido.560 009
. -
••
Si
No
Name of the
District
1
2
—
-C ...
ANNEXURE-II
NO.of Amount
No.of PHC
Sub Centre required Buildings
Buildings
to be con
to be
«
structed
constructed
3
1 Bangalore U
2 Bangalore R
88
3 Chitradurga
54
’ ’ "38
4 Davangere
74
5 Kolar
190
6 Tumkur
105
7 Shimoga.
160
8 Belgaum
9 Bijapur
105
10 Bagalkote
63
50
11 Dharwad
12 Gadag
90
13 Haveri
98
14 Uttara Kannada
223
15 Gulbarga
265
16 Bellary
107
17 Bidar
103
170
18 Raichur
19 Koppal
102
20 Mysore
203
21 Chamarajanagar
161
22 Kodagu
66
23 Mandya
170
24 Hassan
259
25 Chikmagalur
220
26 Dakshinna Kannada 27 Udupi
289
TOTAL
’
3453
4
396.00
W&
333.00
855.00
472.50
720.00
472.50
283.50
225.50
405.00
441.00
1003.50
1192.50
481.50
463.50
765.00
459.00
913.80
724.50
297.00
765.00
1165.80
990.00
1300.50
0
*
15538.5
5
Rs. in lakhs
Amount
required
No.of CHC
Buildings
to be con
structed
Amount
required
Total''amount
required (Total cf
Col.No.(4)+(6)+(8)
6
7
8
9
31
25
30
15
28
26
31
16
10
4
10
17
10
59
13
3
9
13
61
558.00
450.00
540.00
270.00
504.00
468.00
558.00
288.00
180.00
72.00
180.00
306.00
180.00
1062.00
234.00
54.00
162.00
234.00
1098.00
18
33
22
2
23
■ 509
1254.00
4
4
3
300.00
300.00
225.00
324.00
594.00
396.00
36.00
414.00
5
3
3
1
4
1
1
4
4
3
2
1
5
2
3
3
4
5
5
2
3
1
375.00
225.00
225.00
75.00
300.00
.00
*
75
75.00
300.00
300.00
225.00
150.00
75.00
375.00
150.00
225.00
225.00
300.00
375.00
375.00
150.00
225.00
75.00
993.00
936.00
603.00
1734.00
1165.50
1803.00
835.50
763.50
372.00
660.00
1047.00
1483.50
2479.50
865.50
592.50
1302.80
843.00
2236.50
949.50
597.00
1464.00
2134.50
1536.00
261.00
1789.50
9162.00
76
5700.00
30400.8b
ANNEXURE—III
Name of the
District
Amount required for
/ the staff to be san
ctioned to PHCs as
per norms
1
2
3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Bangalore U .
Bangalore R
Chitradurga
Davangere
Kolar
Tumkur
Shimoga
Belgaum
Bijapur
Bagalkote
Dharwad
GadacJ
Haveri
Uttara Kannada
Gulbarga
Bellary
Bidar
Raichur
Koppal
Mysore
Chamaraj anagar
Kodagu
Mandya
Hassan
Chickmagalur
Dakshina Kannada
Udupi
62.95
255.65
206.95
243.52
‘ 229.17
320.72
207.16
501.58
241.18
151.22
98.28
99.21
147.92
151.09
346.99
183.59
107.96
164.93
151.87
351.15
141.82
76.40
240.74
298.14
156.84
176.52
■179.91
TOTAL
5494.46
SI
NG
Amount required for
the staff to be san
ctioned to CHCs as
per norms
Rs."in lakhs
Amount required for
the post of Anaesth
etist to be sanctio
ned to CHCs.
Total amount required
per annum as recii~~~inc
expenditure.
5
'' 6
97.10
58.26
58.26
19.42
76.68
19.42
19.42
76.68
76.68
58.26
38.84
19.42
97.10
38.84
58.26
58.26
76.68
97.10
97.10
38.84
58.26
19.42
2.50
8.70
15.95
. 5.80
11.60
11.60
7.25
15.95
10. 15 10.15
4.35
8.70
15.95
13.05
23.20
11.60
7.25
7.25 '
13.05
18.85
4.35
4.35 '
10.15
17.40
5.80
8.70
5.80
65.25
341.03
299.58
307.58
240.77
429.42
272.67
575.79
270.75
239.05
.122.05
127.33
240.55
240.82
42g.45
234.03
134.63
269.28
203.76
428.26
. 204.43
157.43
347.99
412.64
201.48
243.48
205.13
1469.92
279.85
7244.23
4
76.68
76.68
58.26
.
Lx
wCjKrf,
X"
if).if.
»'-cr!'h.d>-550 U()9
___
ANNEXURE~ IV
SI
NO
■ - 1... .
■DISTRICT
Total No. of Male HPWs
Existing No. of
required as per norms
sanctioned post
3
____________ 4_______
Balance No. of posts
to be sanctioned
5
Rs. in lakhs
Recurring expenditure-per
annum for the post in coliNo
6
■’
J
BANGALORE DIVISION
1
B angalore
140
130
10
7.30
2
Bangalore Rural
286
235
51
37.23
3
Chitradurga
18.25
4
Dayangere
5
Ko].ar
6
Shlmoga
1
Tumkur
. !•
132
107
25..
r- <J
326
198
128
<
37S
282
93. .
380
249
131 .
95.63
418
398
20
14.60
. »•
-
.
93.44
'
67.89
TOTAL
BELGA UM DIVISION
8
B agalkot
9
Belgaum
10
Bijapur
11
pparwad
12
G cidcig
13
14
■ -• Ir
r •A
•
161
-
598
• •
295
- .
174
*•
Haver!
Uttara Kannada
121
40
29.20
416
182 ■
132.86
■ 284
ii-
8.CB
125
49
35.77
126
91
35 '
25.55
296
211
85
62.05
280
36 '
26.28
316
r.
TOTAL
pro
"'■1 ".'JJi'IbOKIXo'
<. - ~tr- i.:
. -!. •
si'
\
,
•
Jr.(
•
* -.o, : c. ..a .
•..
• •>.-
D istrjict;
;
2
1
1!
1 .
OS..V,
gulbarga division
15
2 i. ••
26T
Bellary
16
Bidar^-a •
231 .
17
Gulbarga
512
18
Koppalx _
172 _
19
Raichur
i.. i-: .
206 *
•
f‘t I
c
;.C7
I
■■ • L
it f ■.»
PI-..’
i
......
241
er?:
23
... 16.79
L
182
• -
49
35.77i
*-
60
43.80
r.’ •
9
6.57
41
29.93
. 452
c
■> 163
cV-7
’ 165
r’ £
’ t: r
! Xi-
TOTAL
■
/.
MYSORE DIVISION.
20
Chamarajanagara
202
21
Chickmagalur
335 £
22
Dakshina Kannada
456 .
23
HassanS
463 L
24
Kodagua
163 j
25
Mandya2.
. 376
26
Mysore
488
27
Udupi
131
C* i
i ;•.?
305
30
133
94
rr. '
•• (£-
131
69'.:|
o21
V
1
1
j
' 97.09
01
'
50.37'.
1
1-.
1
<
95.63
40.88 i
158
j
115.34 j
187
65
I
47.45 1
6352
1791
i - ••
*P
TOTAL
STZvTE TOTZ.L
8143
__ L
<
8
51.83
21.90'
i
330
252
^71
■’
56
320
r *• r
71
323
332
z ? r
• ” •
1307.43
L'!=-D..(r;
V.Ofiqn
ANNEXURE-IV
Si
No
1
•DISTRICT
2
_
Total No. of Male MPWs
required as per norms
3____
Existing No. of
sanctioned post
4
Balance No. of posts
to be sanctioned
5
Rs. In lakhs
Recurring expenditure-per.
annum for the post in ColiNo.
'
6
■'
•
BANGALORE DIVISION
1
Bangalore
2
Bangalore Rural
3
Chitradurga
4
r-
Ko].ar
6
Shimoga
7
Tumkur
130
10
7.30
235
51
37.23
107
25..
18.25
iJ
198
128
.
282
93. .
67.89
. .
249
131 „
95.63
418
398
20
14.60
161
121
40
29.20
132
.
<
.
375
'
.
-
326
Davangere
5
140
286
380
93.44
_
•
TOTAL
BELG A UM DIVISION
8
9
10
B agalkot
Belgaum
598
416
284
182 •
ii-
132.86
125
49
35.77
91
35 '
25.55
Bij apur
295
11
Pharwad
174
12
Gadag
126
’’
8.CB
13
Have.r.i
296
211
85
62.05
14
Uttara Kannada
..... ■
316
280
36 ’
v:
26.28
• r
TOTAL
pro
—-.r;-. - _r
•
Si?
* p ■’
N
jr-t
*
.->5
District:2
'
~
OE.V.
f. *“• ** -»
■ r-.-
•
X. “
GULBXRGA DIVISION
-
:
.
15
Bell’ary
26T
16
Bidar'A■
231 _
17
Gulbarga
512 ’
18
Koppal_
172
Raichur
206 x
19
f £ r
241
-J
* e'.
. - .
>fe;
23
35.771
6.57
29.93
' ‘ "
182
452
1 fC
49
60
7.r-£
163
*
i-V
9
165
16.79
.
43.80
41
_ . 1- 2
I.-
I
1
TOTAL
1
•
/.
,-r , .
f _t, I
MYSORE DIVISION.
<•
4
:
131
.
71
305
-7?'
30
323
„
133
20
Chamaraj anagara
21
Chickmagalur
335 x
22
Dakshina Kannada
456
23
HassapS .
463 L
-,r
332
24
Kpdagu3
163.)
rr.;£
9<
25
Mandyal.
26
Mysore
488
27
Udupi
202
Zi.
■
__ L
51.83
21.90:
97.09
j
95.63
69
1
50.37-;
56
‘
330
158
’
........ 115.34 j
252
187
65
|
I
47.45 ’
8143
6352
1791
320
,;.r
■
"1
'
STATE’ TOTAL
■’
131
. 376 i
TOTAL'
:
1
40.88' i
1307.43
H -9o
Homan Development
• Fulfilling Basic Human Needs Issues and Concerns
Sanjay Kaul
3/18/0
Human Development in Karnataka 1999
Fulfilling basic human needs - issues and concerns
Human Development in
di Karnataka 1999
Fulfilling Basic Human Needs Issues and Concerns
Sanjay Kaul
Human Development In Karnataka
3/18/00
Where do we stand?
HDI Ranking of Districts
Ah
s
Kodagu : 0.630
h
Tumkur 0.447
> Maharashtra:0.523 (3)
C
Bangalore Urban: 0.601
n
Mandya: 0.444
> Orissa:0.373 (11)
□
Dakshina Kannada: 0.592
s
Bijapur. 0.443
> Punjab: 0.529 (2)
El
Uttara Kannada: 0.533
a
Kolar 0.443
> Rajasthan: 0.356(12)
KJ
Chikmagalur 0.524
a
Mysore: 0.440
> Tamilnadu: 0.438 (8)
B
Shimoga: 0.483
h
Bellary: 0.429
> Uttar Pradesh-0.348 (15)
H
Hassan: 0.473
h
Bidar 0.419
> West Bengal: 0.459 (6)
□
Bangalore Rural: 0.472
n
Gulbarga: 0.388
> INDIA: 0 423
□
Belgaum: 0.471
■
Raichur 0.376
□
□
Chitradurga: 0.466
HDI for major states
> Andhra Pradesh: 0.400 (9)
> Assam: 0.379 (10)
> Bihar. 0.354 (13)
> Gujarat 0.467 (5)
> Haryana: 0.489 (4)
> Karnataka: 0.448 (7)
> Kerala: 0.603 (1)
> Madhya Pradesh: 0 349(14)
Human Development In Karnataka
3/18/00
Dharwad: 0.459
STATE: 0.471
Human Development in Karnataka
The major issues
Key Indicators
> Sex ratio - 960 (1991)
> Infant mortality rate - 51 (1998)
> Maternal mortality rate - 450 (1995)
> Life expectancy at birth - 62.5 (91-95)
> Literacy rate - 56% (1991 census)
> Per capita income - Rs. 2551 (80-81 prices)
> % children in age group 6-14 attending
schools - 65.3 (rural); 82.4 (urban) (1995)
3/ia/oo
Human Development in Karnataka
> Budget allocation - inadequacy and
imbalance in expenditure
> Access and equity
> Quality of services
> Institutional framework
>The way forward
3/18/00
Human Development in Karnataka
3/18/0
Social Sector Allocations
The major sectors
> Health
> Education
> Income, Employment and Poverty
>Housing and sanitation
> Drinking water
3/18/00
Human Deveiocment In Karnataka
Karnataka's Public Expenditure Ratio (PER) is 19%
[PER is revenue expenditure as % of SDP];
Of this, Social Allocation Ratio(SAR) is 39%.
[SAR is revenue expenditure on social services as %
of total revenue expenditure];
Kerala and West Bengal are the only major stales
where SAR has been over 40%.
> Health: 5% of the state budget and 1% of GDP.
> Education: 16% of state budget and 3% of GDP.
> Share of social sectors in plan outlays woefully small.
3/18/00
Access - Health
Imbalance in expenditure
> Resource allocations to distnds governed by recommendations of
State Finance Commission.
> 36% of non-loan gross own revenue receipts are transferred to rural
and local bodies in the ratio of 85:15. This puts a cap on the resource
flow; in a year when tax collections are poor as in the current year
resource transfers are much less than budgeted.
> Non-plan expenditure is committed expendture; districts which for
historical reasons have better infrastructure and have higher ranks in
human development have a greater share in non-plan outlays, which
get protected dunng budget formulation.
> Allocations to distncts are on a predominantly per capita approach. The
relative needs of distncts will have to become tne starting point for
rational and objective decisions on fund allocation.
> Better off distncts must accept the economic interdependence of
regions; faster growth in Raichur will have beneficial spin off effects on
Dakshina Kannada and Raichur too.
3/18/00
Human Development in Karnataka
> Number of PHCs per lakh population is 4.64
against norm of 3.33;
> Government medical institutions per lakh
population is 5.13; total no:2624;
> Number of beds per lakh population is 86;
> Growth rate of institutions since 1960 is over
3%.
> However, uneven growth across districts northern districts relatively poorly served.
3/18/00
3/18/00
Human Development in Kama taka
Human Development In Karnataka
Access- Housing
Access - Education
> The number of primary schools has gone up from 25800 in 1960 to
over 46900. Norms require setting up of a school for every
habitation with a population >200.
> Over 96% of children have a primary school within one kilometre
and over 85% have an upper primaiy school within three kilometres.
> Enrolment in primary schools exceeds 8.2 million.
> Drop-out rates have dedined from 69% in 1950 to 16.5%. In respect
of girls the dedine has been from 73% to 17%
> Overall gross enrolment ratio for dasses I to VI) has gone up from
66 in 1980to92.
> Giris participation has moved up from 44.5 in 1980 to 48 in respect
of dasses I to IV and from 39 to 45 in resped of dasses I to VII.
> And yet...2.6 million children comprising 28% of children in 6-14
age group are out of school.
Human Development in Karnataka
> The housing stock has almost doubled from 4.2
million to 7.9 million between 1961 to 1991.
> Housing stock has increased @ 30% in the last
decade, with the annual growth rate being 3%.
> Housing shortage is 9.8% (0.3 million); does not
include 8% kacha houses.
> Only 34% of households have access to toilets - in
rural areas the position is dismal with only 6.85%
having toilets - in urban areas the percentage is
around 62.5%.
3/18/00
Human Development in Kama taka
3/18/0
Access - Drinking Water
> 67% of rural population have access to safe drinking water of
over 40 Ipcd; 30% have access between 10-40 Ipcd; 3% have
no access or access less than 10 Ipcd;
> 93% of the 205 urban towns have water supply less than
prescribed norms - i.e 135 Ipcd for towns with population in
excess of 1 lakh, 100 Ipcd for towns between 20,000 and 1 lakh;
and 70 Ipcd for towns less than 20,000;
3/18/00
Human Development in Karnataka
>
Growth in incomes is inextricably related to:
>
Earning capacity which is linked to educational and health status.
>
Earning opportunities which is linked to the growth patterns, nature of
employment, productivity and access to credit.
>
State income (NSDP) has increased from Rs 2977 crore to Rs.13047
crore, > 4-fold increase (1980-81 prices). The fastest increase has
been in the tertiary sector - share has increased from 25% to 43%.
>
Pic income has only doubled in real terms from Rs 1273 to Rs 2668.
>
Work force has increased from 15 million to 19 million - I.e @ 2.6% Female work force has increased at a higher rale of 4%
>
Share of females in main workers increased from 25 to 29%.
>
33% of the work force in secondary and tertiary sectors contributed 65%
of the stale income. However, 85% of work force continues to be in
the primary sector.
3/18/00
Quality of Services Literacy &
Primary Education
Quality of Services - Health
Only 38% of live births take place in institutions.
Measles immunisation coverage less than 50%;
Nearly 60% of children with diarrhoea are not given ORS;
54% of children under four are underweight
Bed occupancy in PHCs is as low as 11.9%;Lack of proper integration of
PHCs with higher level facilities;
Many patients go directly to secondary and tertiary level facilities.
Large vacancies aggravated by cumbersome recruitment procedures;
Unauthorised absence and indiscipline in work force symptomatic of deeper
malaise of dissatisfaction with postings and areas of work;
Human resource development neglected;
In the private sector lack of effective regulation of unlicensed and
unregistered practitioners who cheat the public;
In family welfare virtual absence of male participation;
Limited access to poor, women and SC/ST.
3/18/00
Human Development In Karnataka
Human Development in KamaUka
> Literacy programmes not sustained despite good work in the
early years; Rural female literacy in Raichur is a dismal 16.48%.
> Uneven quality of services in pnmary schools - teacher-pupil
ratios vary across districts;
> 2,6 million children out of school engaged in work
> Majority of children do not achieve the prescribed achievement
levels - multi-grade teaching is the norm and teachers are not
equipped to deal with such situations;
> However. DPEP interventions have shown that remarkable
results are possible in a short time with appropriate strategies;
> Lack of community participation - setting up of grama
panchayats by themselves not enough;
> Many primary schools lack adequate classrooms,
3/18/00
Human Development In Karnataka
Quality of Services Secondary &
Higher Education
Quality of services income, employment and
poverty alleviation
> In high schools only 49% have toilets, 37% have laboratories
and 15% have libraries;
> Employment generation programmes have had limited impact no significant shift in work force away from the primary sector
and only marginal increase in labour productivity inspite of 40%
of plan allocations on agriculture and irrigation;
> Only 389 out of nearly 2000 pre-university institutions offer a
science combination;
> Only 60 out of 148 government first grade colleges have their
own buildings;
> Expenditure on libraries only 1.4% as against 15% of the budget
spent on conducting examinations,
> Salaries take away another 67% leaving very little for
infrastructure, training etc.
> Lack of an integrated approach and limitations of organisational
and delivery systems;
> Corruption and lack of transparency in implementation of
schemes has had adverse impact;
> Poverty alleviation requires a multi-dimensional approach;
> Programmes must be designed by involving civil society and
poor people themselves,
> Inspite of large regional variations in poverty levels - from 56%
in Bidar to 16% In Dakshina Kannada - employment and
poverty alleviation programmes have adopted a per capita
rather than a ‘needs-based" approach.
3/18/00
Human Development in Karnataka
3/18/00
Human Development in Kama taka
3/18/0
Quality of services housing and sanitation
> Though there has been impressive growth in the number of dwelling units,
quality of bousing remains a matter of concern;
> In most districts. 70% of houses has one (or at best two) room;
> Only 30.5% houses in rural areas are made of 'pucca' materials - 20% are
•kucha';
> Houses constructed under government programmes do not involve
benefidanes and result in poor quality constnxbon by contractors;
> Only 41% of rural bouses have electricity and onty 7% have toilets; even
when toilets are constructed dearth of water resists in the toilet falling into
disuse;
> in urban areas, the slum population, estimated at over 15% live without
basic amenities - inadequate access to water and virtually no sanitation.
Urban housing projects, both in pubiic and pnvate sectors do not cater to the
urban poor; the so-called LIG bousing can be accessed only by the lower
middle dass;
> Majority of population in Karnataka defecates in open public places;
3/1B/D0
Human Development In Karmtaka
Quality of services water supply
sfi;
> 1/3 of the population does not have access to potable drinking water
even unto the minimum 40lpcd;
> 1300 habitations do not have public sources of water supply;
> In 4500 habitations groundwater is not potable as it contains high levels
of chemicals like fluoride and iron;
> As 97% of water supply schemes depend on ground water supply,
progressive dedtne in the water table raises questions of sustainability;
> Another aspect of sustainability is the management of facilities; local
communities have not been enabled to manage O&M; energy charges
remain unpaid for months together.
> In urban areas the challenge is even greater - ground water has
become contaminated - alternative sources of surface water require
heavy investment - existing distribution systems require major
rehabilitation with almost 40-50% being the distribution losses revenue recovery is negligible and does not even pay for routine O&M.
3/18/00
Institutional Framework basic propositions
The future beckons - Health
Total immunisation coverage needs to be focused on - measles
coverage needs special attention;
> Bureaucratic structures are less flexible and responsive compared to structures
which allow for public partidpation; government structires require to be brought
doser to the people;
> Grassroots organisations have to be promoted and encouraged - both within
government through local bodies and outside through NGOs;
> Increasingly public accountability is getting reduced and non-performers hardly
ever brought to book; lack of transparency characterises implementation of most
government schemes;
> Panchayat Raj has brought in improvements but the decentralised system has yet
to fully mature and become accountable - several instances of local vested
interests and caste considerations undermine the positive impact;
> Government must approach NGOs with trust and confidence recognising that while
they may not provide replicable models of development (on account of the limited
scale in which they operate) they do provide very rewaning learning experiences.
> Self-help groups provide another route to promote grassroots participation and
empowerment specially among women.
3/18/00
Human Development In Karnataka
Health education needs to be taken up in a campaign mode to
combat killer diseases like diarrhoea, and AIDs;
Better nutrition and health indicators for women can radically
improve the health indices for the state;
Health sector reform needs to focus on ensuring a proper
integration and linkages at the three levels;
Uneven development of health infrastructure compounded by a
poor delivery system is a major reason for the poor health
indicators in the Northern districts; a serious problem is to
ensure staff go to less developed areas - perhaps a judicious
combination of incentives and deterrents are required;
3/18/00
The future beckons Education
>
Human Development In Karnataka
Human Development in Karnataka
The future beckons Income and employment
51iuc3 greater attention is required to increase girl participation rates
specially in the Northern districts;
The general level of stagnation in the manufacturing sector has
to be addressed by improving infrastructure and
entrepreneurship;
Universalisation of elementary education will require a multi-pronged
strategy to reach the 2.6 million out-of-school children;
> Major reform in the education sector will have to focus on making the
system child-centred - supervisory mechanisms and 'inspector raj'
culture will have to be dismantled to make way for a system which child
and community friendly;
The concentration of women in poorly-paid jobs as both main
and marginal workers requires to be rectified;
Productivity gains in the primary sector are a pre-condition to
improving income levels In the rural areas;
> Hard decisions to re-deploy teachers where they are needed will need to
be combined with teachers’ training programmes to make them
facilitators and enable them to operate in a multi-grade situation;
While poverty levels have come down, the alarmingly high levels
of urban poverty has received marginal attention and requires to
be immediately tackled.
> Every family must be enabled to demand education as a matter of right;
> At the same time the tempo of literacy campaigns and post-literacy
programmes needs to be stepped up to reach those who have missed
out on schooling.
3/18/00
Human Development In Karnataka
3/18/00
Human Development in Karnataka
3/18/0
The future beckons Housing, sanitation
and drinking water
> Large investments are required in the next decade to meet the
unmet housing needs in both urban and rural areas;
> Sanitation, specially in urban slums needs special focus;
> Rural water supply schemes can be sustainable in the long run
only through community ownership;
> Urban water supply and sanitation systems can become viable
only through realistic and rational fixation of tariff;
> Government strategy requires to consoously promote
awareness on the linkages across water, sanitation, and health.
> If a perceptible dent is to be made in Karnataka's social and
economic indices, improvement in the status of women must
become central to all policy making > The issue of gender cuts across sectors This implies focus on
girls' education; women's health, housing schemes designed
with the involvement of women, and income and employment
strategies to improve the earning capacity of women workers;
> The close interdependence of all the social sectors requires to
be recognised - hence need to promote convergence at the
village and grama panchayat levels;
> Resource allocation must be need based;
> Eventually people not governments must seize the initiative for
development
Human Development in KarruLsU
3/18/00
Human Development n Karnataka
BRIEF NOTE ON THE PROGRAMMES OF THE DEPARTMENT OF
INDIAN SYSTEMS OF MEDICINE AND HOMOEOPATHY.
Indian Systems of Medicine and Homoeopathy is rendering medical relief to the
public in Ayurveda, Unani, Yoga, Nature Cure and Homoeopathy System of Medicines
and regulates Medical Education, Drugs Manufacture and practice of medicine in these
systems.
There are 93 hospitals, 582 dispensaries and 63 colleges functioning in the state.
All tire dispensaries and 55 hospitals (40 Taluk Level, 15 Rural ) are under the
administrative control of Zilla Panchayaths. The remaining hospitals are under the state
sector. Out of 63 colleges 58 are private colleges of which 5 are under grant-in-aid. The
remaining 5 colleges are Government Colleges.
The budgetary provisions and expenditure of the last three years are as follows:97:1996Particulars
State Sector
District Sector
Total
Non-Plan
Expr.
B.E.
1034.15 865.49
580.85 580.85
1615.00 1446.34
(Rupees in lakhs)
Plan
B.E.
Expr.
140.00
110.95
343.00
307.62
483.00
418.57
B.E.
6.00
6.00
C.S.S.
Expr.
6.00
6.00
Non-Plan
B.E.
Expr.
1196.35 1037.07
982.27
982.27
2178.62 2019.34
(Rupees in lakhs)
Plan
B.E.
Expr.
150.00 99.05
311.49 89.89
461.49 188.94
B.E.
6.00
6.00
C.S.S.
Expr.
2.17
2.17
Non-Plan
B.E.
Expr.
1266.12 1052.69
1121.93 1121.93
2388.05 2174.62
(Rupees in lakhs)
Plan ’
B.E.
Expr.
200.00 128.69
247.41 150.36
447.41
279.05
B.E.
6.00
6.00
C.S.S.
Expr.
4.23
- *
4.23.
1997-98:Particulars
State Sector
District Sector
Total
1998-99
Particulars
State Sector
District Sector
Total
1999-2000:-
Particulars
State Sector
District Sector
Total
Non-Plan
Expr.(Oct)
B.E.
1513.43 805.81
1318.97 Not available
2832.40 805.81
(Rupees in lakhs)
Plan
B.E.
Expr(Nov).
270.00 143.70
238.07 118.03
508.07 261.73
B.E.
8.00
C.S.S.
Expr.fNov)
3.51
8.00
3.51
The achievements of the last three years are as follows :-
1996-97:1.
A Divisional Office of Indian Systesm of Medicine and Homoeopathy has been
sanctioned and functioning at Mysore.
2.
A 10 beded Homoeopathy wing has been sanctioned and started functioning at
Mysore.
3.
Three Govt. Ayurvedic Dispensaries have been started.
98:19971.
A Divisional Office of Indian Systems of Medicine and Homoeopathy has been
sanctioned and functioning at Belgaum.
2.
A 15 beded Govt. Ayurvedic Hospital has been sanctioned and functioning at
Raichur.
3.
The bed strength of Taranath HospitafBellaiy has been increased from 85 to 100.
4.
A 10 beded Homoeopathy wing has been sanctioned and functioning at Govt.District
Ayurvedic Hospital, Shimoga.
5.
21 Teaching Posts( Professor: 14, Asst.Professor:02, Lecturer:05)have been
sanctioned to I.S.M.& HColleges.
6.
5 Taluk Level Hospitals, 43 Dispensaries have been sanctioned and functioning
under District Sector Scheme (Z.P)
7.
P.G. Course under 100% CSS has been sanctioned and started at Bellary.
8.
Administrative approval lias been accorded for the construction of Govt.Unani
Medical College with an estimated cost of Rs.75.00 lakhs.
99:19981.
126 posts of Physicians have been selected by KPSC and appointed by
Government..
2. 1 Post of Drugs Inspector(Homoeopathy) has been sanctioned to Directorate of
Indian Systems of Medicine and Homoeopathy.
3. A Divisional Office of Indian Systesm of Medicine and Homoeopathy sanctioned and
functioning at Bangalore and essential staff to Divisional Office,Belgaum have been
created.
4.
The bed strength of Sri.Jayachamarajendra Institute of Indian Medicine (Unani Wing)
has been increased from 75 to 100 and a 10 beded Homoeopathy wing has been
sanctioned to Govt. Ayurvedic Hospital,Bijapur.
5. Two Ladies Hostels have been sanctioned one each at Mysore and
Bellary and constructed.
6. Essential teaching posts (7 posts) have been sanctioned to ISM&H Colleges
DIFFICULTIES FACED BY THE DEPARTMENT;The Department of Indian Systems of Medicine and Homoeopathy was bifurcated
from the Health Department during 1972.
Consequent on the bifurcation of the
department, the developmental activities are on increasing trend. However the budgetary
allocation are not sufficient to improve further. At present there are 18 District Level
Hospitals of ISM&H
functioning. But there are many places including District Level
in the State where ISM&H hospitals and dispensaries donot exist. The department is not
in a position to start such hospitals and dispensaries due to paucity of funds. In this
connection the kind attention is drawn towards the Estimate Committee Report for the
year 1998-99 wherein the Committee has suggested to start District Level Hospitals in
the remaining districts within three years and Taluk Level Hospitals in all the Taluk
places within a period of five years. With a view to implement the suggestions sufficient
budget allocation under State and District Sectors is required. In many hospitals bed
strength could not be increased due to shortage of funds though demands for such
increase is being received.
The department is planing towards establishment of Sanjeevini Vanas at District and
Taluk Levels in co-ordination with the forest department. To implement this scheme,
sufficient budget provision is required.
Blrectot'
iedlclne
Indian Systems qf Med
and Homoeopathy.
Draft for discussion
i 2 1/00
Page I
p-f i n-uc tC ^'1
v £-ca_s_£iuE>^vS
\.oflk
JLeJ'Q->-£2x5J^'
o.-J>
l«_c<Iqz<x£< S'ltO-H
f^uf^XLuJ
Dr. Angadi S M,
Director of the India Systems of Medicine and Homeopathy,
Government of Karnataka
•
•
»
•
•
•
»
•
«
•
•
Covers the systems of Ayurveda, Homeopathy, Naturopathy, Yoga and
Siddha
Three components - Health Services, Medical Education, Drugs Control
63 colleges exists; this is more than any other state; 5 in government sector;
Staff position not sufficient even as per Council guidelines (Sanctioned
3327; 932 vaccant
Examination system uniform; But the question of employability' remains
Practitioners - 15.000 in Aymrveda, 2295 in Integrated system. 75 in
Naturopathy, 591- in Homeopathy
Bed strength utilisation - 75% in Teaching Institutions; 60% in Hospitals
No norms for ISM practitioners to be on PHcs and PHUs; currently clinical
work including National Health programmes and no Public Health Activity
Other Problems include: PInferiority complex (ISM doctors will be left to look
after the Health Care Units
The staff requirement for ONE ISM Dispensary is ONE Doctor and ONE
Group D; can cover 10,000 population; costs Rsl,80,000 per yrear; Doctors
are waiting for appointments
Main defect is in Budgetary allocation less than 1%; Pay scales not on par;
Paucity of funds; No external aid as other projects; Hospitals in 18 districts;
38 taluq level; 20 sub taluq level with a total of 582 dispensaries
Drug Testing Facility only at Ghaziabad need noe centre for the southern
region
CONCERNS discussed during the interaction
1. Employability of the ISM graduate - possible no opportunity
2. Every Medical College, District and Taluq level an ISM wing separte and
integrated down below
3. Add on to .the existing infrastructure; Do not think as replacing
4. Dispensary need to be within 5 km radius otherwise no one utilises; to keep
this in mind; Political sanctions
5. Can manage the patients with Ayurvedic medicines and without
Paracetamol and such other drugs;
6. Evidence based programme being implemented
7. Research needed to incorporate the ISM drugs
8. No Problem with regards to integration (Dr P N Halagi)
9. Drugs / Medicines in ISM - Expiry date variable some more valuable with
ageing, Quality Control is mandated by' in-house quality control BUT
difficult to and costly to monitor
£0. ^a&^agSStosakg^tf^Sax
13.YU i.
Draft tor discussion
Page 2
I 21/00
Dr. P N Halagi,
Director of Health and family Welfare Services,
Government of Karanataka
•
•
•
•
•
•
•
•
•
•
•
No other State in the country has a State policy for health
27 districts, 175Taluqa, 27065 Inhabited Villages in FOUR Revenue
Divisions of Karnataka
Five crore population : 1 crore in 18 cities
Bed Popln ratio: 1: 1139 against the norm of 1:1000
242 CHCs; 1676 PHCs: 583 PHUs and 8143 Subcentres
Regional variation ++++ ( Concentrated more in South than in North)
Doctors are there but not available
State has its own norms: One PHC for 25-30,000; 50 bed Taluq Hospital;
250 Bed district hospital
Single unified post of Director of Health and Family Welafre unlike other
states
25% of Doctors are females
It is better to have family welfare services integrated with the health
services; A new post of Additional Director of Health Services has been
created for Primary Health Care. There is mal distribution of institutions;
more institutions are needed in Northern Karnataka.
CONCERNS discussed during the interaction
1.
2.
3.
4.
5.
6.
7.
8.
Inequitable distribution of Public
Health
Care
Institution +
Mismanagement
Human Resources Development - Reluctance to serve in Rural areas
(ANMs being given Rs 18,000 Interest free loan Taught driving); ANMs
overburdened with work; 583 ParaMedical workers to become JrHA(M)
after the 1 week training; All JrHA trained in Malaria Microscopy; Posts not
filled due to being Non-revenue
Administration and Clinical work of Doctors to go together; concept of
Mother PHCs being implemented for restructuring the PHCs; Foundation
course needed; MBBS doctor can deliver the goods; Need for proper
supervision and accountability; checks and balances to be linked up;
Yearly assessments along with self appraisal / annual confidence report;
Periodic Inservice training; accreditation of Training Programmes; Current
training is Hospital based so need additional training in PHC System
Appointments and transfer issues; Incentive for Rural / Tribal and hilly
areas
Doctors Day akin Teachers day and award for meritorious service; how
about for all category of staff
Co-ordination and integration needed - Directorate headed by IAS / Gen
Administrator , Additional Director technocrat; Taluq Health Officer
established; Additional District Health Officer abolished; Integration
needed between Education, Practice and Service
Dealt tor discussion
0.
10.
11.
12.
13.
14.
15.
16.
17.
Page 3
I '21/00
HMIS system; currently 34 reports are being sent being modified through
N1CNET
Telephone facility being made at PHCs better still selected PHCs to be
24hour PHCs with Wireless facility
Corruption: Need for decentralistaion; KHSDP has documented efficiency
and also methods; Corruption index to be developed; Nursing Homes
develop around Government Hospitals; Most doctors pratcice; allowed to
practice in ONE Nursing Home [why take permision other professions
do not; The policy regulating practice does not succeed] Pay clinic
concept when G-ovemment will pay for the poor But ? poor will be
eliminated in the process
NGO involvement seen in Family Planning, AIDS, Leprosy, Blindness, TB
Rational drugs
500 out of 615 disciplinary cases cleared; Probably a Retired Judge to be
appointed for adjudication
There is a lack of Male multi purpose workers / Health assistants. There is
a severe dearth of Laboratory technicians. This affects all the programmes.
There are PHCs of different kinds with different staff strength; can we have
some uniformity?
Among the major changes required for improvement are
Motivation to work - all categories of stall
Selection and appointments policy, transfer policy
Incentives - Rural allowance / tribal allowance
Yearly performance appraisal for all staff
Training of Doctors
Dr. G V Nagaraj,
Project Director (RCH),
DHFWS, Government of Karnataka
•
•
•
•
•
•
•
•
Traced the historical perspective of RCH programme - Birth Control clinic to
Health of the mother and child - Numbers game untill 1995 when Target
Free Approach implemented; Quality of Life has improved as evidenced by’
CBR, CDR and LE at Birth; Cairo conference made the difference when India
criticised and paradigm shift took place - No more FP but RCH
The triple indicators of CBR, IMR and CPR being very important
High Perinatal mortality’ rate especially in the Northern parts of Karnataka
probably due to Poor Post natal care
Srilankan experience suggests with NO other clinical care ONLY MCH gave
good benfits
The THREE I s - Insitutional Deliveries; IUDs, Immunisation
Dismal performance in Institutional deliveries - poor facilities
Doctor recruitment and Training - need for a foundation course especially
for Contract doctors
Erosion of District level health management
Draft for discussion
•
•
•
•
•
•
•
•
•
•
Page 4
/21/00
Non involvement of Male worker; their role needs to be deifined; separate
head of account not opened continue with old MPW scheme ; so not involved
in Family Welfare programme; currently no candidates available; gender
issues of society also getting reflected
A serious thought to be given to studying systems with No / complete Male
worker
Current allocation is based on Population and also distance allocation model
( 3-4 Km radius) weightage for both
Sharing of Government assets with private practitioners; akin Business
centre
RCH is awareness and skill based
Integration needed at implementation level (micro level); vertical systems at
macro level
Infant Mortality and Perinatal Mortality are high. Maternal Mortality rate is
453 in Karnataka
Insitutional deliveries have to be increased. There are no facilities for
delivery at the PHC (institutional deliveries: Tamil Nadu 72 - 75%; Kerala
90%; Srilanka 94%)
Doctors recruited for service in PHCs have no experiencxe; there is a need
for foundation course
2 years experience in rural service must be made compulsory for selection
for Postgraduate courses
CONCERNS discussed during the interaction
1. Work extraction with Male and Female workers
2. Critical evaluation needed for the Public Private Mix model; the concerns
include - Quackery / paying modalities/ Tax payers money being misutilised
- should amount to abdicating responsibility alternatives have to be thought
of
3. Choice of NGOs is a Policy matter - need to differenciate between Private and
Voluntary- Orgainsations
4. Need to evolve Accountability parameters - either behavouraial and or client
satisfaction
5. Good home delivery vis-a-vis comparable institutional delivery- cannot
promise subcentre delivery of standard
6. Why7 Instituoonal delivery - critical look needed at what the contribution is
for IMR / MMR reduction; critical to differenciate between Insitutional
delivery and home delivery - the benflts are either Direct or collateral
Why shortage / logistics - NO all India solution for all India's problems
a) Problems with IFA machines
b) Bypass Central government but what about re-imbursement
c) Dai Training stopped due to paucity of Funds
ur.A u.x-iz ~?.^TOTX-iTC'Vtr;y-.5-^rTT
—>:, ..■•■•:.xa <!t
Dealt for discussion
Page 5
1 /21/00
Sri Shivasailam,
Project Director (IPP VIII and IX)
DHFWS, Government of Karnataka
CONCERNS expressed and discussed during the interaction
•
•
•
•
•
•
•
•
•
•
•
•
•
Why ANMs are being debased - ANM have a mandate
ANM need to be considered as Institutions by themselves which is being
done by default | number of ANMs = No of Subcentres)
BASIS OF INSTITUTIONAL DELIVERY
IPP 9 - Civil works - 1000 sub centres in 17 districts 270 MO quarters in
100 PHCs -HARDWARE; SOFTWARE - involvement of NGOs (VHAK, SOSVO
, FOVORD (K)) Indicators being monitored is the Outcomes rather than
Activity (MMR / IMR / CPR etc.,
Financial and organisational support; evaluation after 3 years (Mid term and
also Final) by external third party agencies; sustainable NGO Key area, so 3
years
IEC away from posters; Multi media - local message and local level on
campaign mode (Exhibition); service subsequently with local involvement
Looking and involving existing CBOs - Of the 5000 Mahila Swasthya Sanghs
1500 active
IEC - touch screen - Information to impact;
HMIS - via SATCOM - Health pavillions to be visited not by passed; web
based programme based indicators induces transparency
Tribal ANM programme - identify reproductive health needs, train and send
the them to their own Tribal area to serve
Why Doctors are not using the quarters?
Need to combine all IEC components under One Umbrella
85% of Preventive work by Government; corporate involvement could also be
sought
I Dr. M Jaychandra Rao,
i Project Co-ordinator - IPP VIII,
j Bangalore Mahanagara Palike
•
•
•
•
•
•
IPP 8 main aim to decrease the fertility among the Urban poor
5 strategies - Upgrading existing infrastructure, Increasin'^ service delivery,
IEC for demand generation, MIES, Training support
NGO involvement in terms of SHE Clubs ( Social and Environment health
clubs); Link Workers scheme - change agents from community
90% Physical targets met
Specialist services enhanced
Looking at NGOising the facility - handed over certain Centres to IMA, VHAK
mj\xaiXk<L*i'JSv^ I??-
Draft for discussion
•
•
j&Kr^jT^y*Wj*Wfr^
hVy7?Pm
Page 6
1/21/00
Graded user fees to be thought of
Health centres have no mandate to conduct deliveries
CONCERNS discussed during the interaction
Sustainability- of the Centres especially with the existing systems termed as
corrupt
2. Referral network to be properly addressed
3. IPP VIII did not work through the department
1.
| Dr. Murugendrappa,
Additional Director (Primary Health Care),
And Joint Director (Malaria and Filaria)
' DHFWS, Government of Karnataka
•
•
•
•
•
•
»
•
•
•
•
•
•
All the districts of the State have Malaria and it is spreading / it is not just
continuous spread but saltatory and outside also
Involvement of Private Doctors in Notification - improved after made a
Notifiable disease (progress more in Bangalore only)
Continuous monitoring needed; Regional Dy Dir post vaccant
Name to be changed to Vector Borne disease; The district surveillance
officers to be also incharge of Vector Borne disease
The Basic public health qualifications are not required currently for the
posts
1873 Posts of Lab technicians - Most of the posts are vacant. 99% of Lab
Tech do not know Malaria Microscopy; JOC courses Lack infrastructure
15 day Foundation course sponsored by WHO undertaken to train in
Malaria Microscopy
Need based posting not there; under Zilla parishat Lab tech works also as
SDC, FDC ( on grounds of Health)
Vehicle for the newly formed district not there; so hampers movement of the
Officers concerned; Then Centre now state has to supply
Supply of Insecticides no sufficient; 60 5 DDT to be managed for both
Malaria and JE; Schedule need modification
25 posts of Entomologists vaccant; so not able to obtain sensitivity and
species
Intersectoral Coordination intiated but biological control but limited impact
health staff only undertaking the job
?70% Drug Resistance (II)
CONCERNS discussed during the interaction
1. Need for a Public health Training Institute; WHO Country representative
willing to support + Support the existing State Health and Family Welfare
Institute
Dralt for discussion
Page 7
1/21/00
Specialist Cadre and General cadre the Mysore experience - the ongoing and
also tussles in future
3. Orient for 6 months and then post or else to forego promotion
4. Weak Public Health lobby failed to deliver goods
5. Posts not filled up even after drawing attention
6. If one is considering Evidence Based medicine then no Lab tech in PHC is
shame on the system => No scientific basis
7. There is a delay in'Diagnosis and smears collected for number soniy
8. The ISC with fisheries need to be made into an enterprise
9. Can attempt reimbursement if supply not on time
10. There are problems with respect to supply of Insecticide and spraying
schedule.
11. Japanese encephalitis is present in 10-11 districts. Dengue has also become
a problem
2.
Dr. Makapur,
Director - State Institute of Health and Family Welfare, SIHFW
DHFWS, Government of Karnataka
•
•
•
•
•
•
•
•
19 District Training Centres + I SIHFW
Orientation method like in JIPMER
Induction Training for the New Recruits
CMC Vellore is the Nodal agency for Training, SIHFW planning and
coordinating
Problems of Absenteeism abound; No follow up traing
Shortage of faculty so only Certificate courses
Institute is not recognized because of deficiencies of staff
3 month training programme could be intiated
Dr. Jayadevappa,
Joint Director (HET),
DHFWS, Government of Karnataka
-
•
Involved in the training of Block health Educators and supervise the ANM
training (currently stopped because funds not available)
Only Education undertaken; materials given by existing programmes
CONCERNS discussed during the interaction
1. Need to look at the multiplicity of agencies giving Education and training Field Publicity Offcier; Song and Drama Division et al.,.
Draft for discussion
Page 8
1/21/00
Dr. Jangay,
Joint Director (Leprosy),
DHFWS, Government of Karnataka
•
•
•
•
Need to continue with the Vertical programme for another Two years
Formation of the District MDT society initiated
Voluntary- reporting improving
Drugs suppit- more than adequate
CONCERNS discussed during the interaction
1.
Need to look at future sustainability of the infrastructure under the Leprosy
Programme; could the existing infrastructure be utilised for Bums
Rehabilitation
Dr. Ananda Rajashekar,
j Drugs Controller,
Government of Karnataka
•
»
•
•
•
•
•
•
•
•
•
Formed as a separate department in 1962
Consists of 3 wings - Enforcement, Drug testing laboratory, Pharmacy
education
Also Blood Bank Inspectorate; Government Blood banks nor brough before
the committee but same procedure of Inspection applied to all the Blood
banks
The Inspection for granting and review done jointly by Centre and State
government
Majority of Blood Banks in Bangalore
Only storage and usage permitted at peripheral level
Drugs sample can be drawn at all level including Hospitals
The maintenance amount for the Drug Testing Laboratory is sufficient for
only TWO months
There are no spurious drugs in the market only Low or Sub standard drugs
The facilities only for Allopathic systems of Medicine
There exists about 12,500 pharmacists in the state
CONCERNS discussed during the interaction
1. There need to be difference in application in Certiflying Blood Banks as it
concerns the issues and concerns if saving Lives versus implementation of
the rules
StaiiiJUkSjiiC3i»S32S«I<EZSZZiu2JEHES
ee.'36SA.4s>.
Draft for discussion
Page 9
1/21/00
Chief Pharmacist,
On behalf of the Joint Director (GMS),
Government of Karnataka
•
•
•
•
Purchases are only by Tender - Two cover system being adopted, Blister
packs and printed as Government supply
Every drug listed is in The WHO Essential drug list
Joint Inspection by Centre and State while awarding Good Manufacturing
Practices
The IV Fluids unit is being closed down as per Got Order; It is cheaper to
buy than manufacture
! Sri Jyothi Ramalingam,
i Secretary (Medical Education)
I Government of Karnataka
CONCERNS expressed and discussed during the interaction
•
•
•
•
•
•
•
•
•
•
•
•
The essential activities is the Quality of Medical Education in the 18 + 4
Medical College in the state and the Government Hospital Service Delivery
Of the 20 Essentialities Certificate given 3 colleges have got Central Govt
clearance
The districts of Bidar, Raichur, Shivamogga, North Canara, Chikkamagalur,
Hassan, Coorg, Chitradurga, Bagalkote, Haveri, Gadag, Koppa,
Chamarajanagar do not have Medical Colleges
Para from the IX Five year Plan document
Public Health is in the state List and Medical Education is in the concurrent
List
There is very intense pressure on Government to sanction more Medical
College; so there is a ver urgent need to document whether the number of
Medical Colleges are more or less; there is a need to ensure Transparency
and Distribution in the whole process and also to be’need based
There is aCabinet decision not to have any Medical Collge for the next FIVE
years
The Question of a University medical College was given up because the
Central Government removed the bar on the intake of a Medical College.
Instead of investing in a new Medical College it was thought to strengthen
the existing one in Bangalore and increase the number of seats admissible
Corruption in Medical Education - No comments
Attempts are at coding of PG papers; formation of Ethical committees and
Internal quality Assurance committees
The convergence and integration of the department to be undertaken,
vaccanies to be filled up; and those not fully qualified to be paid full salary
and sent for PG with a promise of working for a specified number of year's
Accreditation programmes need to be taken up in full earnestness
Draft for discussion
Page 10
1/21/00
Sri Nayak,
Commissioner of Health and Family Welfare,
Government of Karnataka
CONCERNS expressed and discussed during the interaction
Support needed from the Task Force as it has been set up by the Chief
Minister himself
• Redeployment of Specialists; need for Public Health qualification of
specialist; se ems that the Public health specialist jumps the order and so
the change needed then - the current situation is that the specialist is lost
and the DHO is bad
• The issue of Private Practive and Non practicing Allowance; need to amend
the Conduct rules
• Provision for a Hospital Management Position at Big Hospitals
• Getting Doctors stay in the quarters - System failure and also because not
implementing the conduct rules;
• Transfer Policy also affecting the quality of work; Disciplinary cases pending
for > 20 years
• The kind element of Centrally sponsored schemes not in time - since we
cannot compromise - can we ask for reimbursement later by initially
creating a buffer fund with Government of India concurrence
• If programme exceeds target and does well will the Government of India
reimburse
• Health Spending need to be move away from dispropotionate spending and
allocate 50/50 for Tertiary sector and primary and secondary sectors
• The question of sustainability and maintenance of the externally funded
projects need to be critically looked at
• The strikes by the Doctors - small vocal groups hold to ransom; How are the
complaints are treated and not brushed aside i.e., Prevention modalities
need to be initiated; Levels of consolation exists and must be exhausted
before strikes; need to seriously think about alternative Health care
Personnel-during the strikes
• In this context RGUHS has started the Medical Ethics Cell and
administering the Hippocratic oath
• Human resources Planning need to addressed; Economy orders stopped the
recruitment and prolonged the vaccancy; which is why the external funders
dictate the filling up of vaccancies; Need for Perspective Planning for Human
Resources for the Health care delivery
• There is huge Wastage of Manpower coming to Bangalore for silly reasons
could this be remedied
•
Draft for discussion
Page I I
1/21/00
Sri A Sen Gupta.
Principal Secretary (Health and Family Welfare)
Government of Karnataka
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•
•
•
•
Problem of Quality - Doctors are much more man managers than just
clinicians; they look at 10,000 or 2000 people working with then'.. Do not
blame the individual but the system; raining from bottom with problems
climbing up and with no training. Health Department has the largest
number of Group A employees
High pay is needed but will work for few hundred rupees less if in
Bangalore; why the change in attitude
Seniority and cadre management must be brought in
No promotion if not qualified for the post
Commisioner of health was brough in to bring about co-ordination - poor
support from secretariat to us; data always different; need for a qualification
in Planning. Three reasons seem to be uppermost - Kiiling of the initiative by
either Central Government or external agencies or it is handed down,
Training not considered important; Not Recognising both seniorirr and
merit.
Some one has to do this ; KHSDP is attempting this
Need for some Public health training to all clinicians
Staff not working in Rural areas: as do not come from Rural areas and there
exists no Policy Planning wing. The stick and rod approach needed 2-3 years
of rural service; Couselling at the time of entry with preference to Women,
PWD; No further transfer for futher five years (transfer is not to be viewed as
punishment); permiitng where quarters available and commuting to work
place
For the Quarters of the staff Non-health issues are also important
QUESTION OF TRANSPARENCY in
a) Transfer (? Creating Cadre and sub-cadre for specialist post);
b) PG matrix needed (Currently DHS/DME decide); People do refuse plan
for 2 to 3 years integrate; Integrate HMIS;
c) Decentralise at Director Level the transfers
d) Private Practice is in hundreds; disciplinary enquiries pending some even
since 14 years; No review meetings have been undertaken; also the
problem of Doctors as Government Servants escape through legal
looholes; PHC audit-inspections and honesty both inbome and imposed
to seriously implemented
KHSDP is being integrated with DHFWS;
When Non clinical services are being contracted the Group D are not
targeted and there is no retrenchment
Assets have been created and they cost less than the cost by PWD; so there
is a need for a separate wing for Engineering for Health Serives with quality
assurance from outside
Coordination Psot of the commissioner with commanility of Pupose and
identified roles have been evolved and need to be critically looked at in the
future; a separate role as disciplinary authority and another for manpower
need to be identified
Draft lor discussion
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Page 12
1/21/00
Little thinking seems to have gone into the issue CHCs are created from 1
out of 4 PHCs but what happens to the original PHC; this calls for a G1S and
Political reasearch
Interdicplir.ary committee for alternate systems of Medicine
PHCs are centres of excellence more number of NGOs need to look at it in a
bigger way
GOK looks at the experts to guide and suggest
Need to evolve a Sunset plan for the externally funded projects
Leprosy id the only exception of success of a Vertical Preogramme
DHS to be free of Personnel Management and Technical Capacity to be built
into
The Primary Health Care is outcome of Primary Health Centre and evolved
with Community Needs Assessment
Indian Medical Association, IMA
Dr. Ramesh, President Elect,
Dr. Sheela Bhanumathy, Secretary,
•
•
•
The three objectives of IMA are Safeguard the professional Interest of the
Doctors, Decompartmentalise the system of Health Care Delivery and also
the education system, and finally to involve and participate in the National
Health Programmes, Health Check up camps and Health Education
activities
In view of its activities the IMA which is currently registered as Society will
also register as Trade Union
Currently 20% of the Medical Professional are members of IMA
The concerns discussed and expressed during the interaction
1.
2.
3.
IMA would work in partnership with the Government agencies to deliver
Health care, not in competition
No improvement in the situation to make the Doctors take up Rural service.
The St Johns Medical College experience of 2 years of Rural experience is
useful. The following steps may be considered to promote the Rural
Services - Extra Points to be awarded during the Post graduate counselling
sessions, Improve the general education system so that the Doctors Family
will not suffer, Honour outstanding PHC Medical Officers on special
occassions;
The Rural allowance to be substanial and not token,
consideration in the promotions
The larger question of why incentive only to the Doctors and not the Non
medical Health Workers need to be highlighted and considered.
Alternatively why only MBBS persons to be considered - can we revive /
start a cadre of Rural Doctors. The IMA expressed its serious reservation for
such system saying that much was diluted and this would further dilute
the role of the doctors. The Systems failure regarding doctors staying in the
PHCs need to be looked at.
Draft tor discussion
Page 13
1/21/00
Indicating its willingness to be part of the decentralised machinery of
Panchayatiraj, the IMA despite its concerns would be involved as resource
persons to orient the Memebrs of the panchayatiraj system regarding the
issues and concerns of health
Discusion regarding Quality assurance
IMA as part of the Surveillance system for Health; involve compulsorily in
the monthly meeting of the PHCs
Private Practice of Government Doctors: Do not permit Private Practice;
Sufficient NPA like that of Central Government i.e., 1 /3rd of Basic
No more Private Medical Colleges
Tax relief for all life saving drugs
Need for Infrastructure support
9-
5.
6.
7.
S.
9.
10.
Karnataka Medical Council, KMC
; Dr. Chikkananjappa, President
The concerns discussed and expressed during the interaction
KMC is a quasi judicial body to look at negligence, misbehaviour,
misconduct and moral turpitude of the professionals with MBBS
background
2. Established in 1956 under IMC Act; 6 members by election, 4 from Medical
Colleges and from University ( 2 each); 5 nominated members of which one
is a non-medical person; Last election 5 ‘/z - 6 treats back; Deputy Secretary
has not attended even one single meeting; Council meets once in 2 months
3. No financial punishment only removal from Register; Quackery not possible
to be booked; No jurisdiction over Nursing Homes and Hospitals; Drugs
controller need to be strict to check quackery; Apex body at the District level
need to be formed; organised quackery also need to be tackled. There is no
dearth of qualified medical practitioners; Group pratcice to be encouraged.
4. There is no machinery for re-registration of the Doctors in KMC; Machinery’
will come up if implementation is decided; Funds not a constraint; 150
hours of CME has been laid down as requirement; IMA has taken the
intiative; probably the RGUHS will be the apex body under which all these
could be considered. CME Body exists; In each of the Divisions a identified
medical college according to the specialities they are competent in
(Preclinical, Paraclinical, Clinical, like wise); to conduct CME. Principal,
BMC is the nodal Officer. There is also a need to involve all systems of
Medicine and not just Modem System of Medicine
5. The doctors need to display and or write their registration number at all
times
6. Those registered in other Medical councils need to register again; there can
be no dual registration- they have to surrender the original / earlier
registration;
7. Recommend the concept of SWATHI
8. Raid parties have been formed to check quacks
1.
Draft for discussion
Page 14
1/21/00
Nearly 2 crore rupees has been collected and all the debts cleared; Own land
has been identified- building will come up
10. No more New medical colleges; The medical education need to be need
based and of quality. Nothing bars from permitting to start a Medical college
if prerequisites are fulfilled. Only clause is if it is not needed. There is to be a
medical college for each district. Linguistic minority is betng accorded
special status. The so called deemed Universities are becoming Doomed
Universities
9.
Council of Indian Systems of Medicine and Homeopathy
The concerns discussed and expressed during the interaction
The Council was recognised since 1965, been awarding the BSAM degree
from 1982 onwards; Board then now council
2. The total number of Practitioners are about 16,000 (BSAM - Integrated);
3,000 Traditional Practitioners [2346 - Integrated; 12,800 Ayurveda, 848
Unani, 2 siddha]
3. > 300 sent notices for those not registering; No complaints have been
received; only from IMA. 20-25 of the pratciitoners have been penalised
4. Raiding party need to have a professional representation; Only ISM Council
have powers to lodge Police complaints
5. Quality control under the directorate
6. Good Manufacturing Practices difficult to implement as Finger Printing too
very*
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1.
Dr. Shivaratna Sawadi,
Director of Medical Education,
i Directorate of Medical Education, Government of Karnataka.
The concerns discussed and expressed during the interaction
1. To incorporate Preventive aspects in Medical education. To have more rural
camps involving all specialities
2. To make participation in conference / presenting papers compulsory; need
for monthly monitoring and performance evaluation. There is need to bring
accountability/ surveillance and community orienttaion into Medical college
3. DME is Head Postmaster
4. The research grant of Rs 5 Lakh is already over
5. When even the Best students thinks to pay for passing; there is both hands
needed for clapping
6. There is needed a survey on Medical Manpower requirement
7. Medical Education Cells have been set up
8. The Health Workers can co-ordinate the activities related to Dental health
Draft tor discussion
Page 16
1/21/00
6. Since Drugs supplied / availability is not sufficient ar rhe Health Care
Settings the Doctors take money for providing the medicines.
< ■ Private practice need to be banned upto certain level especially those with
administrative responsibilities; but should be, compensated adequately like
in the Central Government i.e,. 1/3 of the Basic pay
8. Need to Regularise the Contract Doctors, enforce strictly the 7 years of Rural
service, Provide proper quarters, have 3 doctors in even' PHC
9. Can we think about a co-operative Pharmacy to overcome the problems of
no drugs or doctors taking money for drugs?
10. Doctors to be forced to undertake Preventive services; so need for
Administrative and management training at all levels; should forego
promotion if not desirous of taking training
11. Total opposition for inclusion under Panchayatraj Institutions
12. Urgent need for Manual for the different staff - assigning specific job
responsibilities
13. There is a difference of nearly 3-5,000 rupee in the pay scale between
College Teachers and other Government Doctors; need for parity
Dr. Shivananda, President and team
Karanataka Government Medical and Dental Teachers Association
The concerns expressed and discussed during the interaction:
Hygienic Diet for the patients; No free food subside it; a single canteen for all
including doctors and patients
2. Standards drugs needed
3. 24 hours Laboratory' technician needed; not termed as essential service so
not working for 24 hours
4. Building of Dharmashala for the patients attendants
5. All government ministers to compulsorily take treatment at Government
institutions
6. Clear the entrance to Voctoria Hospital and Vanivilas Hospital
7. No basic amenities for the students; need for establisinh proper learning
environment
8. Library- facilities needed
9. Accerditation systems to be introduced
10. Bio-engineering department to take up maintenance of medical equipment
11. Health insurance to all staff ( not ideminity but regualr Health insurance)
12. Facilities of Intercom; computer; photography to all staff; sabatical;
deputation for conferences / seminars
13. Teaching and Training within the departments - HODs to be held
responsible
14. Bribing to pass exams - poor morals and no integrity among the examiners
is the reason; increased with opening up of Private medical colleges
15. Short term bring accountability; Long term select medical students /
teachers with aptitude and No more new medical colleges; Government
training doctors who do not serve in the rural areas
1.
Draft tor discussion
Page 1 7
1/21/00
Implementation of Residency scheme; decentralisation of financial powers;
government doctors do not go to the media with spetacular surgeries when
they it as mater of routine unlike doctors in the private service
17. Nursing education need to be strengthened ; more theory than practice; sad
state of affairs if the system has to rely on Nursing students for care delivery
IS. Need for medical person in the governing council and the ex director
19. Condemnation of article to be after 5 years and the amount recovered to be
used for development instead of waiting for 20 years and then getting very
less money
20. All hospitals to have citizens charter
21. Transport facilites to Bowring Hospital
22. Need to improve the existing colleges than thinking about one more medical
college
23. Need based and selective improvement of Departments
24. Corporation dispensaries also to be included for teaching purposes
25. Research and ethic to receive greater attention
26. Need for PRO/ receptionist in the Hospitals
27. Pay clinic system could be introduced or limited Private pratcie to permitted
16.
Dr. Bhattacharjee,
Director, Population Centre
The concerns expressed and discussed during the interaction:
1.
2.
3.
4.
5.
Population Centre Started under India Population Project 1 to cater to the
research needs; set up in Bangalore as the IPP 1 covered District under the
Bangalore Division. After the project wound upscope expanded and has
taken up the evlaution work of existing programmes; cost being met under
non plan expenditure under Karnataka Civil Service rules and also
undertakes assignments for payment for the different projects
Staff strength is poor; No staff even to collect and collate data; Need to have
such a unit in every district
Unfortunate that the studies undertaken have not resulted in action; No
interface'for such endeavour
The name of the centre should be changed to Centre for Health Studies
Some of the reports undertaken by the Centre was discussed;
Immunisation coverage; Pulse IUD programme; Yellow Card Scheme;
Contraceptive usage; Incentive for FP, etc.,
Draft for discussion
Page IS
1/21/00
Dr. Hemareddy M T
Formerly Director,
Directorate of Health and Family Welfare,
Government of Karnataka
The concerns expressed and discussed during the interaction:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Need for improvement of the PHCs and Subcentres; The goal of each
subcentre to have atleast two beds
Transfer policy
Officials are not visiting the districts
No comprehensive plan before Project formulation
Need for Trauma Care Centre
Need for Health Information system; and tightening of administration
Cadre like IAS for Health and medical services
Transfers after 4 years
Cleared 43,200 files in 5 years 2 months; of these 12,000 is for transfer /
increment
Planning Cell - Budget based Planning and addiction to World bank
Projects; enhanced / increased accessibility to Nirman Bhawan, Delhi;
Perspective planning does not exist; state government does not create
programmes
Dr. Malini,
Principal,
Government Ayurvedic College,
Bangalore
The concerns expressed and discussed during the interaction:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Rural Ayurvedic type of Treatment could be introduced
The ayurvedic teachers will participate in the camps;' No objection to be
along with in the PHCs
Lack of Staff members in the colleges
Lack of timely promotions
40+ collegs exist and no more colleges needed
Poor prospects for the Ayurvedic graduate
Beneras Hindu University experience could be a good model
Reorientation needed
Disparity' in pay scales to be addressed
Need for emphasis on research
Community Needs Assessment Approach for
Family Welfare in Karnataka—
Ramakrishna Reddy
P. Hanumantharayappa
K.M.Sathyanarayana
Background
Karnataka is one of the several progressive states in southern India.
Even before independence it had moved to the forefront of the
national family planning programme by establishing family planning
clinics in Mysore and Bangalore in the 1930s which was the first official
clinics in the country. The contraceptive prevalence rate 12 per cent
in 1971 in the state. — increased to 55 per cent in 1998. The total
fertility rate (TFR) dropped from 4.4 to 2.5 over the same period.
Furthermore, there have been remarkable improvements in maternal
and child health (MCH) indicators, especially in infant, child, and
maternal mortality rates.1
Lately, however, family planning acceptance has remained more or less
constant, and fertility levels have reached a plateau.
There is also an
enormous regional variation in the success of the programme.
For
example, while the divisions of Mysore and Bangalore are performing
better than the state average, Gulbarga and Belgaum are not doing nearly
so well.
Major concerns include the availability of health facilities in
rural areas and the often non-existent health structure in urban areas,
vacant staff positions, and, more importantly, client accessibility to basic
services. Realizing the need for improvement in these areas, the state
has initiated several need-based projects.
In the last five years, these
Sample Registration System, Registrar General of India, 1998 and Population
Research Centre and International Institute for Population Sciences, National Family
Health Survey: Karnataka, Mumbai, 1995.
__ .GNA-Appnwch inJsaciuuka
57
have included the Karnataka Health Systems
The Community Needs Assessment
Development Project, the KfW Project, India
Approach
Population Projects VIII and IX, the Border Cluster
Experimental Phase: 1995-96
Districts Project, and the Reproductive and Child
The state became aware of the CNA approach in
Health (RCH) Services Project.2
January 1995 after receiving a letter from the
Secretary of Family Welfare, GOI. In the absence of
The community needs assessment (CNA) approach,
any guidelines, state officers were not clear on just
formerly known as the target-free approach (TFA),
how to experiment with the new approach but, after
was introduced in 1995 on an experimental basis, in
a series of discussions, decided to try the new
one district in accordance with the mandate of the
approach in one district. The criterion for selecting
Government of India (GOI).
In the following year,
the district was
consistent family planning
In addition, voluntary acceptance of
again based on the decision of GOI, it was extended
performance.
to all districts in the state.
family planning methods was given due consideration.
The way the state has
gone about implementing the new approach from
Mandya was the obvious choice.
1995 till the present and the modifications it has
1995, the Additional Director for Family Welfare
made in the process have been reviewed and
wrote the following to the District Health and Family
documented.
Welfare Officer (DHFWO) in Mandya:
The main objectives of this study are the following:
“In the financial year 1995-96, the GOI is thinking of
(i)
To describe the processes followed to implement
Thus, in March
implementing the target-free approach in one district of
the new system; (ii) To record the opinions of
the state on an experimental basis, and therefore we
personnel at various levels on the new system and
have decided to make your district target free. Emphasis
its implementation; and (iii) To analyze the potential
will be on providing quality services and hence you will
effects of the new system on performance. Sample
have to ensure it You are, therefore, requested to work
data were gathered in Mandya and Hassan districts I
out your performance goals and work accordingly."3
from two primary health centres/community health
centres/ PHCs/CHCs and four sub-centres.
In
There was no further communication from the state
addition, two PHCs that had an important role in
for several months. Neither the state nor the district
executing the new approach were visited.
made
Health
any
effort
to
discuss
guidelines
for
personnel in the selected institutions were
implementing the new approach though they coul^
interviewed using broad guidelines prepared
have done so at monthly state-level meetings.
specifically for this purpose. All correspondence and
Meanwhile, as part of its normal routine, Mandya
other documents available at all levels from the
carried out the eligible couple (EC) survey and
Department of Family Welfare were collected and
updated the eligible couple registers (ECRs), After
Performance data were collected from
conducting this exercise, district and block officers
the Directorate of Family Welfare and from districts
and field workers were informed of the new
as well.
approach in a monthly meeting and in a letter, which
reviewed.
stated the following:
’
Human Development in Karnataka. Planning Department, Government of Karnataka, Bangalore, 1999.
Letter from the Additional Director, Family Welfare, to Mandya district, March 1995.
Review of Implementation ol CNA Approach lor family Welfare in India
58
During the year 1995-96, targets for the family planning
The Government of Tamil Nadu has recently issued
programme have been removed.
However, it is
detailed instructions on the MCH approach to family
required that the workers should perform to the
planning and specific services that will be quantified
levels of last year.”
and monitored. I am sending herewith a copy of the
order issued by the Tamil Nadu government in this
Since the EC survey had already been completed,
regard.
the district statistical officer collated the
emulating.
This is an interesting experiment worth
information and worked out the expected level of
achievement (ELA) for each of the family planning
We propose to conduct a concurrent evaluation of
methods.
The yardstick for monitoring the
programme performance in the target-free districts/
performance of field workers was the previous
areas through Population Research Centres. The
year’s performance and the performance in that
concurrent evaluation will also study the qualitative
particular month.
improvement in services.
1995, the first guidance on the
May I request you to take suitable steps to improve
implementation of the new approach arrived in the
the quality of services in these district/areas and
form of a letter from the Secretary of Family Welfare,
apprise me of the action taken.’”’
||n August
GOI, to the State Secretary. It read as follows:
State officials in Karnataka reviewed the order
“As you are aware, an important decision was taken in
mentioned and decided that the Tamil Nadu
the meeting of the state secretaries in charge of family
approach did not add anything worth considering.
welfare on April 3 and 4 1995, to exempt at least one
The state, therefore, did not inform the district of
district from the contraceptive targets.
its contents nor did it make any effort to understand
the implementation mechanism described therein^
The objective of exempting one district from targets
was to improve the quality of services. To carry this
Overall, family planning performance in Mandya in
message down to the grassroot workers, it would
1995-96 was more or less consistent with 1994-
be necessary to sensitize the district level officers,
95.
Sterilization and IUD acceptance definitely
the PHC Medical Officers (MOs) and the health
increased, but there was a decline in the use of oral
'workers on specific aspects of quality improvement
pills and condoms. It would appear, therefore, that
and the steps to be taken in this regard.
Such
the only effect that the CNA approach had on the
sensitization could be done during (i) monthly
family planning programme was that the district
meetings of district level officers at state headquarters:
worked out its own “targets" for the first_time ever.
(ii)
meetings of PHC MOs at the district level: and
However, it can be inferred that the new approach
(iii)
meetings of male/female health workers at the
was not field-tested in the real sense because the
PHC level. You may identify resource persons for
district did exactly what it had been doing previously
conducting such sensitization of all personnel in the
to work out ELAs.
target-free district/areas.
substantial improvement in MCH indicators as more
In contrast, there was
Letter from the Secretary, Family Welfare. GOI. addressed to the State Secretary of Karnataka, August 1995.
CN/\ zXpproach in Karnataka
59
women received antenatal (AN), natal, and post
natal care.
Immunization coverage for infants
“A draft format for the PHC plan as is being used in
Tamil Nadu, circulated in the February meeting as part
of the agenda notes, may be used.
improved as well.
You may like to
initiate this exercise of involving all health personnel,
Expansion of CNA
village pradhans, primary school teachers, and NGOs
The decision to expand the CNA approach was made
working in each PHC in your state on the basis of this
in a meeting of State Secretaries in New Delhi on
format or with such modification to it as you deem
February I and 2, 1996.
necessary.
Without deliberating on
A detailed format for preparing the PHC/
the experiences of various states in the experimental
FWHC plan is under preparation at our level and could
year and despite strong opposition from many of
be made available before the end of March 1996.
them, GOI announced its plans to extend the
However, the preparation of your FW and health care
approach to all districts in the country.
Since the
plan need not wait for this data format. The performance
new approach had not really been tried out in
of each PHC would need to be evaluated against its own
Karnataka, and the officials present at the meeting
plan by the district health and FW system at the end of
were not aware of the methodology Mandya had used
each quarter to advise them suitably.
during the experimental year, they did not oppose
need to tune the IEC activities in the PHC area and
the government’s decision. In general, however, they
districts to prompt this bottom-up approach of planning
thought that it would be difficult for field workers
and implementation of a sensitive programme like family
with limited academic qualifications to comprehend
welfare.
They would also
the approach and that the process of change from
targets to target-free would require a considerable
All the PHC FW plans would need to be aggregated into
amount of time and a substantial obligation of
the district FW plans and the district FW plans would
resources. GOI insisted that the new approach would
similarly need to be aggregated in the state FW plan. A
improve the quality of services and stated that
timetable for preparation of the plans at various levels
proper guidelines and an implementation manual
may be set. I would suggest that the PHC plans may be
would be prepared and given to all states.
finalized by April 30, 1996, the district plans by May IS,
Subsequently, the Secretary of Family Welfare, GOI,
like to have your state FW plan by the first week ofl
June 1996.
'
1996, and the state plans by May 31,1996. We would .
wrote to all State Secretaries on February 14, 1996,
about the use of the CNA approach in the family
welfare programme. It stated the importance of the
A system of evaluating the performance of each district
new approach, proposed the methodology for
every quarter may be worked out at the state
preparing plans at various levels of the service delivery
level. A similar exercise to evaluate the performance
system, and mentioned that the new approach would
of each state would be carried out at the national
provide an excellent opportunity to make family
level.
welfare in India a truly people’s programme.
entire health and family welfare organization in the
This exercise would need sensitization of the
state with the deputy commissioners/ district
The letter outlined the procedure for preparing plans
magistrates playing a leading role along with the district
in the following manner:
health and FW system in active collaboration with
Review,of". Implementation of CNA /Kpproaclt for I'amily Welfare in India
60
panchayali raj dignitaries, primary school teachers and
requirements.
active NGOs." 5
included 17 questions on antenatal care (ANC),
The GOI data collection format
deliveries, post-natal care, immunization of children,
The state directorate forwarded the Secretary’s letter
acute respiratory infections (ARI), diarrhoea in
to all DHFWOs and asked them to follow the
children, and family planning.
instructions carefully. However, before the February
norms were tagged to these indicators with the
The GOI coverage
letter from GOI reached the districts, the district
exception of those for family planning.
magistrates received a different letter sent directly
were advised to prescribe their own family planning
from the GOI Secretary of Family Welfare dated
norms to arrive at total service requirements. The
The states
March 4, I 996.6 In it, the Secretary discussed
format provided an idea of the magnitude of the task
sensitization workshops, the budget for conducting
of restructuring demand for reproductive and child
The budget for
health (RCH) services and family planning in terms
sensitization was released to the districts on an
of perceived needs instead of as a function of the
average basis without considering the number of
previous year’s performance.
them, and a set of guidelines.
^HCs and had to be collected from the regional
director's office. The state was unaware of the March
The Implementation of the CNA
letter and, surprisingly, none of the districts reported
Approach
it.
On April 4, 1996, the Joint Secretary of Family
Traditionally, data collected annually in the ECRs were
Welfare, GOI, wrote a letter to the State Secretary
to be used for working out MCH and family planning
about the sensitization workshops with a copy of
targets; however, because targets were set by the
the March 4, letter attached.7 The state later
state, this locally gathered information was rarely
corresponded with the regional director and
used. With the introduction of the CNA approach,
determined the exact budget for each district. One-
however, the state expected that ECR data would
day sensitization workshops at the state, district, and
become quite valuable.
block levels were ultimately conducted between July
asked to collect the data and use the GOI-prescribed
and September 1996, for all health personnel,
coverage norms to arrive at the ELA for various
Hence, the districts were
representatives of NGOs, members of panchayati
MCH indicators. These calculations were simplified
raj institutions (PRI), anganwadi workers (AWW),
by uniformly applying a birth rate of 19 per 1,000
and National Swayam Sewika (NSS) volunteers.
population, despite the enormous regional variations
within the state.
The GOI sent a detailed plan of the bottom-up
approach to all states on March 27, 1996.
After
As there were no specified norms from GOI for
reviewing it, Karnataka felt that the districts should
calculating family planning ELA, the state used its own
follow the government's instructions exactly and
methodology. Districts were instructed to calculate
should estimate perceived needs and service
the ELA on the basis of the perceived need or the
Letter from the Secretaiy. Family Welfare, GOI, addressed to the State Secretary in February 1996 and subsequently marked
to the districts March 1996.
1
Letter from the Secretaiy. Family Welfare, GOI, addressed to district collectors/magistrates March 1996.
Letter from the Joint Secretary. Family Welfare, GOI. marking the letter addressed to district collectors/ magistrates to the
State Secretary April 1996.
unmet need. This led to confusion because the ECR
Zilla Panchayats.
Survey Format-HMIS Version 2.0, did not capture
implemented the Panchayati Raj Act, the CEOs had
information on unmet need for family planning but
assumed the role hitherto played by the district
nevertheless the state sent a letter to the districts.
magistrates and were the chairpersons of_the district
(since Karnataka had already
In the absence of a clearly stated methodology, the
health committees where public health and family
districts were informally asked to consider past
welfare came under their purview.
performance while formulating their activity plans.
therefore, included in order to familiarize them with
A few districts considered only the previous year’s
the recent changes in the family welfare programme).
performance while other districts considered the
The session focused on the roles and responsibilities
average of the past three years. Thus, there was no
of the district health committee, the essence of the
uniformity among districts in the preparation of
manual, and the monitoring and compilation of
activity plans. Nevertheless, the state had introduced
progress reports. Also, a detailed plan for training
the new approach, and the
I'he implementation of
die CNA approach in
die first year of the
staff was outlined.
They were,
Trainers at district levels and
activity plans that were prepared
below were identified from among the health officers
by health functionaries were
attending, and a workshop itinerary was prepared.
consolidated
at
the
PHC,
To facilitate training, state officers were assigned to
district, and state levels. A state
districts.
limited to state and
level plan was prepared and
that outlined the concept of CNA and explained the
district officers only.
submitted to GOI by July 1996.
methodology for estimating ELA was circulated to
State
all the participants.
expansion phase was
This resulted in
officials
monitored
. normous confusion as
progress in the preparation of
hey interpreted theTFA
the activity plans.
Thus, the implementation of the CNA approach in
in various ways and
the first year of the expansion phase was limited to
calculated die ELA for
Although the activity plans were
amily planning methods
ready by the end of July 1996,
to suit diemselves.
A 10-page booklet in the local language
orientation
and
state and district officers only.
This resulted in
enormous confusion as they interpreted the TFA in
the
various ways and calculated the ELA for family
translation of the GOI manual]
planning methods to suit themselves. This practice
staff
into the local language had yet to be done. No effort
continued into the next half of the fiscal year until all
was made to do either as a result of a delay in
remaining health professionals and functionaries were
delegating responsibility to officers at the state level.
trained.
In September 1996, the GOI organized a two-day
CNA orientation workshop in New Delhi for state
In the latter part of 1997-98, the state finally began
officers to discuss the various terms and definitions
district and taluka level training and continued it until
used in the manual. Three officers from Karnataka
the end_ofjune 1998. All health personnel, members
participated; on returning to the state, they were
of PRIs, child development officers, and AWWs were
given the task of conducting orientation training for
trained in these workshops, but in fact, the family
all health personnel.
welfare programme for 1997-98 had already been
implemented. The activity plans and progress reports
In November 1996, a 10-day training session was
that had been introduced alongwith the new approach
conducted for state and DHFWO, senior programme
were already operational, and the sub-centres had
officers, and chief executive officers (CEOs) of the
already collected information according to the
Review of Implementation of CNA Approach lor l-.uitily Welfare in India
62
prescribed formats that had been compiled at various
Due to the delay in training of lower-level health staff,
levels to represent PHC, district, and state plans.
the new approach could not be implemented in the
; Training should have preceded implementation, as it
true sense. GOI was unaware of this. As the state
didn’t, the health department had already implemented
submitted activity plans and progress reports to GOI
the CNA approach without understanding the
on time, the government presumed that the new
i
concepts underlying the approach.
approach was working well and that health personnel
;
,
had understood the concept and were implementing
In 1998-99, the districts in which CNA training had
it correctly. This practice of evaluating performance
been completed followed the procedures learned in
solely on the basis of the timely submission of forms
the training sessions while other districts prepared
did not bode well for the transition from targeted to
plans based on the previous year’s methodology.
target-free programmes.
Also around this time, the birth rate previously used
to calculate MCH indicators was revised from 19 to
Experiences in Implementing the CNA
18 per 1,000. This figure once again was uniformly
Approach
applied—irrespective of the actual birth rate of the
Health personnel from the selected districts, PHCs,
district. It is difficult to understand how the state
and sub-centres were interviewed about the CNA
arrived at this figure when the sample registration
approach.
system for those years reported much higher rates.
followed and opinions given are
The general feeling at tl
Due to the variety of methodologies being applied,
summarized below.
district level is that the
The
processes
confusion prevailed especially in the family planning
new approach is a
The general feeling at the district
welcome change from to
level is that the new approach is
down targets as it make
During this time, GOI modified the new approach
a welcome change from top-
field workers more
by revising the formats used to make activity plans
down targets as it makes field
programme.
responsive and
responsible. The
and progress reports. The number of formats was
workers more responsive and
reduced drastically from more than 30 to nine,8 but
responsible.
Karnataka continued using all the old formats to avoid
proposed
further confusion at the field level since the workers
followed along the suggested
were reconciled to them. State officials introduced
guidelines, and it seems to be
the new formats only at the PHC level and above,
working well. Instead of the state
after conducting four regional workshops in
setting ’targets,’ the districts set
Bangalore, Belgaum, Gulbarga and Mysore with
them through a consultative process. The feeling is
financial assistance from UNICEF.
In addition, two
that the approach is more useful than top-down
workshops, one in 1998 and the other in 1999, were
target setting due to_the participation of all staff in
conducted for statistical assistants. MOs and
the process.
statistical assistants then started compiling
targets were removed has given way to a more
information using the newly introduced formats, so
confident approach to programme implementation.
their reports to GOI changed accordingly.
Monitoring at the PHC and sub-centre levels has
The methodology
by
GOI
is
GOI is being followed
along die suggested
guidelines, and it seems,
be working well.
The confusion that prevailed when
become easy.
’
being
methodology proposed I
Letter from the Secretary. Family Welfare, GOI, addressed to the State Secretary January 1998.
The DHFWO of Mandya district explained that
performance has remained more or less the same, but if
despite initial fluctuations, the district has been able
the age and parity of acceptors are analyzed, they have
to maintain its performance levels.
Even though
come down considerably, and this is a positive sign for
acceptance of sterilization has dropped, the decline
the programme. Even now there is no clarity on how the
is insignificant compared to that elsewhere in the state.
ELAs for family planning methods have to be arrived at.
In this context, he stated the following:
Based on past performance, the ELAs are being worked
out. This methodology will not address client needs and
"The interesting aspect in the district is that it is immaterial
hence a methodology that can look into this aspect should
to people what approach the district is following because
be developed and implemented.”
people over here come voluntarily for family planning
services and demand quality services.
Providing quality
They also mentioned that leadership at the local level, '
services is the major concern, and we at the district have
commitment of staff, and close monitoring of the
taken measures to assure this.”
programme were key factors to success and that
their districts had been able to exhibit all of those
This was found to be true because
Having said this, he informed us
characteristics.
that the district has adhered to all
the MOs of PHCs, who were knowledgeable aboiA
instructions received from the
the CNA approach were able to provide direction
GOI
the
to the programme. They had definite time slots for
programme accordingly. Although
reinforcing the concept in monthly meetings, and
there were delays in training staff,
therefore, the supervisory staff and sub-centre
from above. They
efforts have been made to make
functionaries in their PHC areas had a clear
explained that their task
them thoroughly understand the
understanding of what was expected of them.
is now defined by
new approach. The concept of the
the contrary, in PHCs in those districts where the
benchmarks derived
CNA
approach has
been
commitment of the MO was weak, the understanding
from die prevailing bird:
constantly reiterated in monthly
among staff members of the approach and its
rate in their sub-centre
meetings, and that has paid off. All
implementation was also weak.
areas instead of by targets
staff members are aware of CNA
one-time training without constant reinforcement
based on population size.
and have participated in the
would not have much effect. This was demonstrated
preparation of the activity plans
in the PHCs where the MOs lacked proper
The auxiliary nurse
midwives (ANMs)
enthusiastically claimed
that the CNA approach
is better than the one
with targets imposed
and
has
executed
after discussing them with panchayati raj members
On
It was agreed that
understanding.
A
and AWWs. The statistical assistants have played an
important role in the compilation of the forms and
The auxiliary nurse midwives (ANMs) enthusiastically
in monitoring and have been the major link between
claimed that the CNA approach is better than the
the programme officers and the field workers. The
one with targets imposed from above.
DHFWO of Hassan district expressed similar views.
explained that their task is now defined by
They
benchmarks derived from the prevailing birth rate
Regarding family planning performance and the strategy
in their sub-centre areas instead of by targets based
of identifying perceived needs, both DHFWOs agreed:
on population size.
However, regarding the use of
birth rates for calculations, one of the ANMs
“If you see the performance of the past few years and at
remarked:
present, there is nothing wrong in admitting that
Review oi Implementation oi CNA Appioach lot I amil) Wcllaic in huli.i
64
In my area, the birth rate seems to be less than that
because funds were not released on time.
proposed by the district or state.
context, it was difficult to implement something they
By applying this rate,
In this
the workload in my area gets over estimated, and it
were not confident about.
becomes difficult to achieve the ELAs.
In spite of
family planning programme performance had slipped.
complaining about it, the medical officer has not been
The fertility rate that was once comparable with those
able to resolve the problem, and I am told that in the
of the neighbouring states of Andhra Pradesh and
next year, we will try to work out something on the basis
Tamil Nadu had stabilized while the rates of the other
I think some
states had moved closer to or had reached
of which the calculations will be done.
alternative has to be developed or else the present
replacement levels.
approach will end up as a target-driven approach given
therefore, remarked:
Moreover, Karnataka’s
The Additional Director,
in a different way. The pressure to perform still continues
and temporary denial of salary/pecuniary benefits is
“With very little improvement in
In order to maintain the
recommended if the self-determined ELAs are not met.”
performance over the past few
tempo of family plannin:
years, I feel that Karnataka has
acceptance, the state
become the BIMAR.U (sick) state '
must closely monitor th>
Other ANMs endorsed this view as well.
of South India. The state, unlike
age, parity, and
The review team discussed these perceptions from
Andhra Pradesh, lacks political
education levels of
the field with the Additional Director, who is also
will and commitment at all levels,
acceptors ofsterilizatioi
the RCH programme director and has been
and that has resulted in inordinate
and IUDs. Thepressu
associated with the CNA approach since its inception.
delays in decision-making that
The Additional Director said the following:
have hampered the programme
on workers to perforn
remains despite the nr
methodology.
and its performance.”
‘The new approach has a sound methodology and has a
good philosophy associated with it.
Although I was not
Hence, nothing new was attempted except for
convinced in the beginning, I developed a liking after I
sharing the monitoring and activity formats to satisfy
understood the concept of it thoroughly. For a person at
the immediate needs of GOI.
my level it took some time, and you can imagine how much
have since learned how to estimate ELA, yet the state
time and effort are required to change the mind-set of the
still lacks a clear-cut methodology for addressing client
health functionaries at the grassroot level. Proper training
needs. To help solve the problem, birth rates of 19
of functionaries supported by a well-equipped service
and subsequently 18 per 1,000 were used to,
delivery system form the essential ingredients of the
calculate indicators throughout the state in spite of (
programme. The only apprehension I had then, and I still
well-documented regional variations. The technique
have, is that the GOI hurriedly pushed the implementation
of surveying 100 mothers proposed as part of the
j, of the new approach without paying much heed to training
approach was also tried out, but it did not give a
I and strengthening service delivery systems.”
clear indication of client needs.
All health personnel
The state was tasked with the implementation of the
In order to maintain the tempo of family planning
new approach, but it had not readied its resources.
acceptance, the state must closely monitor the age,
In the beginning,
parity, and education levels of acceptors of
state officials did not have a clue about CNA as the
sterilization and IUDs. The pressure on workers to
training of master trainers had not taken place
perform remains despite the new methodology. The
There were delays on all fronts.
CNA Approach in Karnataka
65
The ELAs for each method will be worked
Additional Director was happy that in most regions
need.
of the state acceptance was voluntary, though that
out on the basis of data collected in these ECRs.
is not always the case in the northern part, where
lower levels of acceptance have negatively affected
In the light of these discussions, it can be inferred that
the state average. In regard to lagging performance,
Karnataka did make efforts to help workers understand
the Additional Director was optimistic and said this:
the new concept, but discussions with health
functionaries revealed that the pressure to perform,
“With more efforts by the Department, the state can
especially in sterilization, had actually increased.
surge ahead in the RCH and family planning programmes.
Even though there are regional imbalances in the
Family Planning Performance
northern parts of the state, various innovative projects
Limiting Methods
and schemes have been initiated, but it will take time
The annual acceptance of sterilization steadily
before these districts yield the fruits of the interventions."
increased in Karnataka from 371,535 in 1994-95 to
The state demographer added these comments:
the state actually implemented the CNA approach
395,624 in 1997-98.
However, in 1998-99, when
by training all field workers, acceptance dropped by,
‘The statistical assistants have done an excellent job in
six per cent from the previous year.
carrying the message of the new approach down to the
grassroot level. In the first year, in the absence of proper
Sterilization acceptance in 1998-99 was comparable
training, the responsibility for compiling the GOI forms was
with the level of 1994-95.
entrusted to them. In the subsequent year, they played an
decline in acceptance was marginal because the
active role and were able to impart the necessary working
pressure to achieve ELA in sterilization has been
knowledge to the ANMs. Scrutinizing, compiling and timely
maintained since the introduction of the new
monitoring of activity plans were all done by them.”
approach. The state claims to have taken measures
In other words, the
to closely monitor the age, parity, and education of
When asked about orienting health workers to the
acceptors and notes that there has been a slight drop
newly introduced forms, the state demographer said
in the average age and parity for women.
that Karnataka intends to do so as part of the overdue
officials are confident that if pressure on performance
Furthermore, the concept of unmet
in general and on sterilization in particular is
need will be taught, and the ECRs will be revised to
maintained, the state will be able to achieve better
include questions related to the estimation of unmet
results in the years to come.
RCH training.
Table 1
Expected and Actual Level of Sterilization Performance in Karnataka
from 1994-95 to 1998-99
1994-95
371,535
...
1995-96
1996-97
1997-98
1998-99
381,571
384,056
395,624
371,275
2.7
0.7
3.0
-6.2
Review of Implementation of CNA Approach for Family Well.tre in India
66
State
__
Spacing Methods
better idea of the number of births averted, which
The National Family Health Survey (NFHS) in 1992
can have a considerable impact on reducing fertility.
found that in Karnataka, only one-tenth of modern
contraceptive-users were using a spacing method.
Oral Pills
With over a third of the population in urban areas,
The common practice for setting the ELA for oral
the percentage of spacing-method use to total use
pills is in terms of the number of users. Performance
is quite small.
The state realizes the strong
records at the district and lower levels, however,
potential demand for spacing methods and is
provide information in terms of the number of cycles
making a considerable effort to promote them by
distributed. That number is aggregated at the state
way of rigorous marketing, IEC campaigns, and
level and divided by I 3 cycles to get the number of
Yet the levels as
users. In other words, the calculations are restricted
reported in the service statistics have not increased
to distribution numbers without considering vital
area-specific interventions.
as expected.
The performance in the last five
information on continuation rates.
Oral pill
years in terms of the percentage increase/decrease
acceptance has been similar to that of IUDs except
for each spacing method is summarized in
for the fact that the extent of decline in acceptance
Table 2.
has been smaller. Following the introduction of the
new approach by the state in 1997-98, performance
IUDs
declined marginally; in 1998-99 it dropped by five
Acceptance of IUDs in the last five years has increased
per cent. Overall, however, acceptance increased by
by 13 per cent; however, the pattern of increase
eight per cent during the reference period.
has not been consistent.
In 1994-95, there were
299,504 acceptors; that number rose to 345,937 in
Condoms
1995-96, an increase of over 15 per cent.
In the
The calculation of condom-users is based on a
following year, acceptance increased by another nine
methodology similar to that used for determining
per cent. It then declined by one per cent in 1997-
oral pill-users, and identical problems exist.
98, and by nine per cent in 1998-99. This is a matter
annual number of users is arrived at by dividing the
for concern. Unless the state takes proper measures,
number of condoms distributed by 72. Unlike other
it will be difficult to sustain the present level of use
spacing methods, condom-use in Karnataka has been
The state is now
declining steadily since 1994-95. In that year, there
monitoring retention rates. Those rates will give a
were 395,108 users. In the following year, the total
and to motivate new acceptors.
Table 2
Annual Performance and Percentage Increase/Decrease of Spacing Methods in Karnataka from
1994-95 to 1998-99
•1994-95
1995-96
1996-97
1997-98
1998-99
299,504
345,937
376,247
372,341
337,854
”•
15.5
8.8
-1.0
-9.2
138,232
151,145
157,545
156,494
148,931
•* •
9.3
4.2
-0.7
-4.8
395,108
374,687
358,627
323,021
278,626
AP= Annual Performance; PI/PD= Percentage Increase/Percentage Decrease over the past year
***
-5.2
-4.3
-9.9
-13.7
The
declined by five per cent.
After that, the decline
which was the performance level in 1995-96.
In
was much greater until in 1998-99, condom-use had
1997-98, however, despite a decline in spacing
fallen to 70 per cent of what it was in 1994-95.
method acceptance, the number of sterilization
equivalents rose substantially, due mainly to
\
Sterilization Equivalents
increased sterilization acceptance.
In order to provide a more holistic picture of
programme performance, Karnataka routinely
If the state intends to monitor performance through
reports to GOI on sterilization equivalents as well as
sterilization equivalents, then the quality of data on
on the annual acceptance of each family planning
spacing methods needs to improve.
The number
Sterilization equivalents are calculated by
of regular users, the duration of use, and
combining sterilizations with spacing methods
continuation rates for each spacing method will
according to the following formula, supplied by GOI.
have to be collected and analyzed.
Sterilization Equivalents = Sterilizations + 1/3
monitoring formats will have to be redesigned.
the number of IUD insertions
*
1/8 the number
not, inferences drawn from the existing data will
of condom-users + 1/9 the number of oral pill
be misleading.
method.
To do this,
If
users. The results of this calculation for Karnataka
are shown in Figure I. All spacing method users are
Family planning service statistics clearly indicate a
converted in this way and are added to actual
decline in performance for spacing methods since
sterilization statistics.
The state has placed more
the effective introduction of the CNA approach,
emphasis on both limiting and spacing methods, but
even though the acceptance of IUDs and oral pills
the pressure to increase the number of sterilization
increased over the five-year period. State officials
acceptors is greater.
attributed
some
of
the
decline
to
poor
infrastructure in the northern region of the state
An analysis of sterilization equivalents reveals that
but put the majority of the blame on CNA and the
performance has been reasonably good. Acceptors
confusion that resulted from its introduction. Yet,
increased from 509,000 in 1994-95 to 555,000 in
there is still optimism at the state level because of
In 1998-99, after the introduction of the
various innovative interventions that have been
1997-98.
CNA approach, the number dropped to 532,000,
undertaken.
Fig. 1
Sterilization Equivalents in Karnataka
Performance in Reproductive and
Child Health
The family planning programme suffered from the
CNA approach because there was no clear system
for working out method-specific ELA. This was not
the case for R.CH indicators.
ELA could easily be
calculated by applying the state-determined birth rate
to the GOI coverage norms.
The result was
performance better than the expected levels. In 1999
for instance, the coverage for ANC and child
immunizations including DPT, polio, and measles was
higher than the proposed levels. As a matter of fact.
Review of Implementation of CNA Approach for family \Xchare in India
68
the performance in RCH indicators improved over
indicators, though calculating coverage norms—
the previous year, and the infant mortality rate (IMR)
based on a standardized birth rate lower than the
in 1998 was 58 as compared to the national average
actual one that further ignored regional and district
of 72. Thus, overall performance in RCH seems to
variations—defied the very principles of bottom-up
have improved considerably, but before drawing such
planning.
an inference it is worthwhile to examine the GOI
set at the sub-centre and PHC levels, no effort was
’
'
Furthermore, although RCH ELA were
coverage norms and the birth rate used. The norms
made to use the ECR data, and no thought was given
were generalized at the national level and the birth
to modifying the registers to capture missing
rate which the state used was low. Those two factors
information.
together could have resulted in underestimation of
the ELA, thus, allowing achievement levels of more
In the past five years, the overall number of family
than 100 per cent to be reached.
planning acceptors generally increased, but after the
I-'1 (
___
i_r
state implemented the CNA approach at the field
Conclusion
level, acceptance rates began to
Karnataka has made efforts to implement the CNA
fall.
approach in light of the guidelines provided by GOI.
the rates for spacing methods was
efforts to implement th
Due to a delayed start, however, the approach could
considerable. Although the state
CNA approach in light
not be field-tested in the true sense for over a year
is
and a half.
When the health system was ready to
absorb the new concept and implement it, GOI
modified the existing data collection formats.
The extent of the drop in
monitoring
acceptance
independently and in terms of
sterilization
Karnataka has made
of the guidelines
provided by GOI. Du
equivalents,
to a delayed start,
however, the approach
MOs
continuation rates for oral pills
and assistant statistical officers were reoriented in their
and condoms and retention rates
could not be field-teste<
use, but field workers were not.
for IUDs have to be analyzed.
in the true sense for ovc
The central
a year and a half.
government’s monitoring of the implementation of
the new approach in both the original and revised
The RCH programme begun in
forms consisted solely of logging in the monthly reports
1997 is not yet operational at the field level. The
that the state regularly submitted. Due to this, GOI
concept of the CNA approach must be integrated
failed to understand what was really happening.
into the RCH training package and the ECRs must
be modified to capture unmet need.
The state
Although the state did not impose any targets on
needs to meticulously plan the integration process
the districts, there was no clearly defined system
based on a long-term goal. In the absence of it, the
for setting ELA for family planning methods, sb
state will find it difficult to implement bottom-up
confusion about their calculation was widespread.
planning and to increase performance levels.
There was a system for working out ELA for RCH
CNA Apptujrh in Karnataku
69
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