DISPARATIES IN HEALTH AND HEALTH CARE SERVICES

Item

Title: DISPARATIES IN HEALTH AND HEALTH
CARE SERVICES
extracted text: u
Donated by Dr. C M Francis in Feb. 2010

DISPARATIES IN HEALTH AND HEALTH
CARE SERVICES
KARNATAKA

**

A

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AS MOHAMMAD
ST. JOHN’S MEDICAL COLLEGE
BANGALORE 560 034

STUDY ON DISPARITIES IN HEALTH AND HEALTH CARE SERVICES:

Health Care is only one contributor to health. It can make a difference of life or
death. Equitable availability of Health Care is a major^/alue a society places on
social cohesion and solidarity. Equity to access to health and health care is one of
the corner stones of the principles of primary health care (PHC) defined at the Alma

Ata Conference in 1978.

“Equity means that peoples needs, rather their social privileges, guide the
distribution of opportunities for well being.

In virtually every society in the world,

social privileges is reflected by differences in socio economic status, gender,

geographical location, ethnic/religious differences and age, other dimensions also
can be important. Pursuing equity in health and health care means trying to reduce

avoidable gaps in health status and health services between groups with different
level of social privilege. ”

Karnataka State with 27 Administrative Districts has 527.34 lakhs population as per
the 2001 Census. State has overall effective literacy rate 67.04%, for males 76.29%

and for females 57.45%.

Overall sex ratio has been 964, sex ratio for 0-6

populations is 949. It varies from 924 in Belgaum to 977 in Kodagu.

The state of

Karnataka ranks 131 on Human Development Index scale at Global level. It has

33.16% of the population below poverty level and 2 out of every 5 children with
malnutrition. It has been observed that there exist disparities in health and health

care facilities in between:

♦ Regions:- North & South Karnataka

♦ Districts : 27 Districts
♦

Disadvantaged:- Lower class and Caste

♦ Vulnerable groups: Age and sex.

This is unnecessary and unjust.

Such issues should no longer be curiosities for

mere speculation but demands close attention at the earliest for policy review and
implementation.

The districts belonging to erstwhile Bombay Presidency, Hyderabad-Karnataka, Old

Mysore, Kodagu and Madras Presidency have different levels of development.
Within a region again there are inter-district, inter-taluk and inter-village disparities.
Districts in Hyderabad-Karnataka region have the lowest HDI while district Kodagu,

Bangalore Urban, Dakshina Kannada, Uttar Kannada and Chikkamagalur had the

higher HDI.

However, developmental disparities within Karnataka are a part of its historical
legacy. The new areas added to the princely state of Mysore in 1956 to form the

united state of Karnataka were at different levels in the most areas of economic and
social development.

Before independence old Mysore enjoyed the reputation of

being one of the progressive regions of the country. Basic health services were a
priority of the princely state of Mysore. In 1806 it was perhaps the first state in the
country to take the vaccination against small pox. A Government hospital was the

first public health unit opened in Mandya in 1929. The state head established public

health units as the principal units for basic health care and undertaking extensive
measure to control communicable diseases like malaria well before independence.

In contrast to old Mysore considered as Karnataka’s South Block, the northern

region covering seven districts of Bombay-Karnataka or Belgaum division and five
districts of Hyderabad-Karnataka or Gulbarga division had made little progress

particularly in social sectors such as, drinking water, health and roads before the

state’s reorganization. Once again within the northern region Hyderabad-Karnataka
was more backward than Bombay-Karnataka due to alleged neglect under the

Nizam rule.

Health is a state subject, and it is the responsibility of Government to ensure an
equitable distribution of minimum and adequate health care that is accessible to the
whole population.

Considering the inadequacies in terms of infrastructure and

relatively poor health indicators, there is a need to understand the disparities in the
health and health care services in the state.

OBJECTIVES:

The goal of this study is to highlight the extent of disparities that exist in health and
health care facilities between districts in the state and within the districts and to

suggest steps to be taken to reduce these disparities.

The objectives of the study therefore include:

1. To determine the disparities in Health determinants.
2. To determine the disparities in Health status
3. To determine the disparities in Health Care resources allocation.

4. To determine the disparities in Health Care utilization.
5. To determine the most disadvantaged districts in Karnataka in order to evolve
and initiate more focussed projects in these districts.

METHODOLOGY
Given the constraints of time available only quantitative data that is available from
the following secondary sources on various characteristics was collected.

1.

Multi Indicator Cluster Survey - 1998 - UNICEF

2.

Rapid Household survey under RCH project, Karnataka State - 1999

3.

Human Development Report, Karnataka State - 1999

4.

Directorate of Health and Family Welfare Services,
Govt, of Karnataka Sept.2000

5.

ICDS - Women and Child Development Department Report - Nov. 2000

6.

Census of India 1991, Karnataka State District Profile 1991.

7.

Rural Development Panchayati Raj Department, Statement on Below Poverty

Line Families, Govt, of Karnataka

Data was checked for its quality and quantity and regional disparities were

assessed on the basis of available data on indicators in following essential

categories:

> Health Determinants
> Health Status
> Health Resource Allocation

> Health Care Utilization indicators and
> Over all indicators

Each

indicator in the

above-mentioned

algebraically added for each district.

categories was

standardized

and

The total was re-standardized and a

composite index as Standardized “Z” Score was obtained for each district, which
gives the relative position of the districts on the scale in Karnataka State.

It has been observed in many studies that lower class and caste suffer with

disproportionate burden of diseases and mortality. Different types of morbidity and
mortality have different patterns with respect to the age, sex and social class. So to
assess the equity with respect to these characteristics, it is necessary to get the
primary data in disaggregated form at various levels right from taluk to state level.

However, disparities in health on the basis of class, caste, age, sex and the religion
could not be assessed, as data does not exist in disaggregated form for districts of

Karnataka.

DISPARITIES IN HEALTH DETERMINANTS OF DISTRICTS IN KARNATAKA

r

r
!
Bidar

)

Belgaum

Dharwad

J__ _

fI

' ra-

\

i
!
Haverl

Shirks. ■'

\

THE BETTER OFF DISTRICTS (T)"
THE INTERMIDIATE DISTRICT (14)
THE WORSE OFF DISTRICTS
(7)

I_____________

.--

Chrtndurga

udupj

Chikamagalur

c

Tumkir

r

Hassan

*3

Mandya

Mysore

Chama rajanagar

J Bangalore

FINDINGS - A

DISTRICTS

Edn15+

HHP

Cwater

Bangalore Urban
Bangalore Rural
Bagalkot
Bellary
Belgaum
Bijapur .
Bidar
Chamrajnagar
Chitradurga
Chikkamagalur
Davengere
Bakshina Kannada
Dharwad
Gadag
Gulbarga
Hassan
Haveri
Kodagu
Kolar
Koppal
Mandya
Mysore
Raichur
Shimoga
Tumkur
Uttar Kannada
Udupi

73.3
41.8
48.2
40.8
46 8
48.2
37.5
41.5
49.8

82.7
38.4
19 4

97.2
98
100
84.1
73.7
94.7
90.3
96
96.8
88
98.6
98.6
99.9
.67.9
63.1
86 8
99
84.5
93.3
83
95.5
95.9
76.6:
94.8
99
97.1
98

55.3
49
71
53.5
53.5
33:2
50.1
53.5
64.4
43.2
32
39.9
41 5
32
56.2
47.2
62.2
71

30 6
46.1
19.4
70.6
35.8

45.1
32.8
36.9
30.1
29.1
29.1
55.6
192

29.1
36.3
55.3
17.4

41.5
35 8

:: 17 4
35.6
45.3

34.1
30.1

ELC98 ACCIatrin ABPL TOTAL
INDEX
79.4
90
85
2.80
96.3
26.4
66
0.55
53
-1.12
51 4
5
: 12.3
55
-1.21
■57.5
18
77
-0.23
66.7
-1.14
51 4
58
60
60.5
-0.30
12.3
64
20
-0.29
67.1
0.14
59
30
72.5
0.37
74.4
40.5
72
0.24
69.6
36.3
66
1.35
69
73.4
78
0.26
75.4
39
61
-1 05
75.4
6 .
55
-1.22
66
54.5
15
-0 02
79
14
78.3
75.4
69
0.19
16
0.47
56.5
44
82
0 37
35 2
61
80.9
^^■-.73
54.3
iOl
0.30
19
70
85.9
69
44
0.12
67.1
-1.71
57
54.3
20
0.48
68
78.9
31.8
0.39
69
77.5
19
0.78
70
38
79.4
1.20
60
79
69
■

Most of Northern Karnataka Districts (Bagalkote, Bijapur, Bellary, Gadag,

Gulbarga, Koppal, Raichur, Belgaum, Bidar) and Chamrajnagar from south of
Karnataka are poor in health determinants.

Disparities in Health Determinants have been assessed on:

Edn15+: Percentage of Literate in 15+ age group. It varies among the district from

32% in Raichur and Koppal to 73.3% in Bangalore Urban.
Karnataka District falls below the state average.

Most of the North

Surprisingly Mysore, Mandya,

Bangalore Rural also has 15+Education below the state average.

HPP: Percentage of Houses in which both wall and roof are made of permanent

Materials. This varies from 17.4% in Koppal and Raichur to 82.7% in Bangalore
Urban.

Districts like Bagalkot, Bellary, Bijapur, Dakshina Kannada, Dharwad,

Gadag, Hassan, Haveri, Koppal, Raichur and Udupi have the percentage of Pucca

House below the state average.

Cwater Percentage of households with access of clean water.

Districts Bellary,

Belgaum, Gadag, Bulbarga, Kodagu, Koppal, Raichur have the below state average.
However, Bagalkot has 100% households with access of clean water.

Elc98: Percentage of households with Electricity taken as one of the amenities

available in household varies from 51.4% in Bagalkote District to 96.3% in

Bangalore Rural District.

Most of the north districts and Kodagu in South falls

below the state average.

ACCIatrin: Percentage of households with Latrine. All Districts of state, percentage

of household with access to latrine is very poor except Bangalore Urban, Dakshina
Kannada and Udupi.

Bijapur District has only 3.1% households with access to

latrine while Bangalore urban has 90% households with access to Latrine.

ABPL: Percentage of families above poverty line - as per BPL census for 9lh Plan.

Percentage of households in all northern districts of Karnataka, Chamrajnagar,
Chitradurga, Dharwad and Kolar Districts falls bellow the state average.

It is an established fact that environment has direct impact on those living in it.

Good housing, availability of safe water and sanitation facilities have positive fact on
health which has been measured in the present study by HPP, Cwater, Elc98 and

ACCIatrin.

Studies have also indicated that education to some extent compensates the effect of

poverty on health irrespective of availability of health facilities and in this study the
literacy has been assessed by Edn15+.

Economic status determines the purchasing power, standard of living, quality of life

and the pattern of disease in the community. This aspect has been assessed by
ABPL i.e., families above the poverty line as per the BPL census for 9th Plan.

DISPARITIES IN HEALTH STATUS OF
DISTRICTS IN KARNATAKA

/

4
Bijapur

Bagalkot
Belqaum

Gadag
Dharwad

■

□ THE BETTER OFF DISTRICTS
(7)
□ THE INTERMIDIATE DISTRICTS (14)
the worse off districts
(7)

A

c

Uttara Kannada

e

Havari

y

Davanagere

/V- J

!
Tumku

E3SIIIIS
Udupi

\

1

Chikamagalur

Tumkur

?

__

Hassan

Jingalore fIB] Bangakxe

_

DaksiHna Kannada

Mandya

Kodagu

Mysore

J-

Jb /

r^^marejanir '

'

11

FINDINGS -B

DISPARITIES IN HEALTH STATUS OF DISTRICTS IN KARNATAKA STATE

Bangalore Urban

67

%Normal
under 5
45.34

Bangalore Rural
Bagalkot
Bellary
Belgaum
Bijapur
Bidar
Chamrajnagar
Chitradurga
Chikkamagalur
Davengere
Dakshina Kannada
Dharwad
Gadag
Gulbarga
Hassan
Haver!
Kodagu
Kolar
Koppal
Mandya
Mysore
Raichur
Shimoga
Tumkur
Uttar Kannada
Udupi

67
88
119
69
88
85
89
104
75
104
46
95
95
86
78
95
66
100
80
84
89
80
88
102
69
46

44.83
34.56
26.51
40.37
36.41
28941
44.5
39.58
47.11
34.61
51.59
41.21
33.07
34.3
48.64
35.42
54.61
41.84
29.08
49.28
40.68
29.71
39.25
47.37
45.22
55.41

DISTRICTS

•

U5 MR

API
Malaria
1.06

Pt. Prev
TB
1.88

0.21
3.3
: 3.71
1.09
4.95
1.05
0 12
2.14
0.41
0.12
2.58
0.28
0 39
372
1.12
0.15
0.1

1.88
1.37

2.19
■376
6.55
0.64
9.05
0.12
1.62
0.13
0.56

17^H
1.67
1 37
2.08
1.66
1.81
1.6
1.52
1.34
1.19
1.19
1.46
1.55
1.19
0.94
2.12
1.32
1.68
1.66
1.32
1.03
1.17
0.86
1.34

Incident TOTAL
DIARR INDEX
0.05
5.8
10.1
7.1
17.1
9.4
73
4
4.9
8.9
15.3
11
4.3
20.9
14.1
16.2
12.5
14.5
16
12.5
14.1
8.5
5.5
20
13 1
10.9
11.9
1.1

0.26
-0.53
-1.87

-6.19
-0.47
-0.89
0.52
-1.00
0.09
-0.27
1.16
-0.05
-0.43
-074
0.00
0.07
2.11
-1.05
-0.68
-0.18
-0 34
-0.71
0.77
-0.11
1.68
2.76

U5MR which is available only for 1991 has been extra polated for newly formed
districts as they have been part of old districts.

© Health status of Kodagu, UK, Udupi, DK, Chamrajnagar and Shimoga was found
to be good and most of the North Hyderabad-Karnataka region districts have
poor Health status.
Due to low API for malaria, low point prevalence of TB and low incidence of
diarrhoea, Chamrajnagar has shown better health status.

Disparities in Health Status have been assessed on

U5MR: Under five Mortality Rate - probability of dying in between birth and age 5,
expressed as number of deaths among children under the age of five per 1000 live

births. Districts Bellary, Chitradurga, Davangere, Kolar, Tumkur have higher U5MR.

Districts Bagalkote, Bijapur, Chamrajnagar, Dharwar, Gadag, Haveri, Mysore and
Shimoga also have U5MR above the state level.

%Normal: Percentage under five children whose nutritional status is within normal
limits based on weight for age. Two out of every five children in state suffered with

malnutrition. Bellary district as low as 26.51% normal children compare to Udupi
with 55.4% children

the normal nutritional status.

District Bagalkote, Bellary,

Bijapur, Bidar, Davangere, Gadag, Gulbarga, Haveri, Koppal and Raichur have high

percentage of under five children with malnutrition.

API MALARIA: Annual Parasite Incidence of malaria, which is number of confirmed
cases of malaria per 1000 population under surveillance. API malaria varies from

0.12 in Chamrajnagar, Shimoga and Davengere as high as 9.05 in Raichur and 6.55
in Mandya. All northern districts, Bangalore urban, Chitradurga, Dakshina Kannada,
Hassan , Kolar, and Tumkur also have higher API malaria.

Pt.Prv.TB:

Point Prevalence of Tuberculosis includes pulmonary and extra

pulmonary tuberculosis cases per 1000 population. Pt. Tuberculosis varies from

0.86 in Uttar Kannada to 2.12 in Kolar. Bangalore Urban, Bangalore Rural, Bellary,

Belgaum, Bidar, Chamrajnagar, Chitradurga, Chikkamagalur, Davengere, Hassan,
Kolar, Mandya and Mysore districts also have the higher prevalence of Tuberculosis
Incident diarrhoea: Percentage of children below the age of five reporting current
diarrhoea or diarrhoea during the last two weeks. Incidence of diarrhoea during last

weeks varies from 1.1% in Udupi to 20% under fives in Raichur and 20.9% in
Dharwad. Under five in 5 out of 27 districts in state have the diarrhoea incidence
more than 10%.

Disparities in health status means the denial of the highest possible level of

physical, psychological and social well being that biological limitations permit.
As no single indicator can adequately describe the situation it is desirable to
concentrate on limited number of specific indicators.

Child health indicators are

more sensitive to Socio-economic differentials, and investment in child health has
long term impact on equity. Therefore under-five mortality, incidence of diarrhoea

and percentage of normal children have been used for assessing the health status.

These indicators also reflect the nutritional health and health knowledge of mother,
availability of maternal and child services including prenatal care, income and food
availability in the family, the availability of clean water and safe sanitation and
overall safety of the child’s environment.

These measures are also sensitive

measures of the gap in health status that are generally judged to be avoidable,

unnecessary and unfair.
Other indicators of health status included are API malaria and point prevalence rate
of tuberculosis including extra pulmonary TB, which are the leading causes of

deaths among communicable diseases.

DISPARITIES IN GOVERNMENT
PRIMARY HEALTH CARE FACILITIES IN
DISTRICTS OF KARNATAKA

Bldar

Gulbarga
Bljapur

3 THE BETTER OFF DISTRICTS
(7)
□ THE INTERMIDIATE DISTRICTS (14)
£3 THE WORSE OFF DISTRICTS
(7)
Haveri

Tumkui

Udupi
Tumkur

Kolar

\
,

Qakshina Kannada

i lore

Mandya

Chamarajanagar

i

FINDINGS - 0

DISPARITIES IN GOVT. PRIMARY HEALTH CARE FACILITIES IN DISTRICTS OF
KARNATAKA STATE
PHC/LAKH
MOW/LAKH PARA/10,000
POPULATION POPULATION POPULATION
2.59
3.31
2.01
Bangalore Urban
5.27
6.62
3.33
Bangalore Rural
3.02
2.20
3.03
Bagalkot
2.42
3.48
. 5:05
Bellary
2.74
4.93
3.62
Belgaum
3.51
3.80
5.11
Bijapur
3.61
6.80
3.78
Bidar
2.85
5.86
4.60
Chamrajnagar
4.81
7.84
5.58
Chitradurga
4.89
10.62
7.69
Chikkamagalur
2.71
6.02
5.44
Davengere
3.62
4.95
3 72
Dakshina Kannada
2.53
2.58
1.97
Dharwad
3.25
5.16
3.61
Gadag
3.23
5.72
4.34
Gulbarga
3.95
9.09
7.29
Hassan
3.28
5.68
4.77
Haveri
7.60
10.55
5.90
Kodagu
3.34
6.14
463
Kolar
2.72
5.47
3.91
Koppal
3.46
8.41
5.59
Mandya
4.46
8.28
5 79
Mysore
2.34
4.70
3.23
Raichur
4.27
7 64
5.30
Shimoga
3.33
6.88
5.14
Tumkur
5.20
8.40
5.57
Uttar Kannada
3.02
5.24
5.71
Udupi__________

DISTRICTS

©

TOTAL
INDEX
-1.55
0.16
-1.30
-0 88
-0.76
-0.44
-0.12
-0.30
0.93
2.01
-0.09
-0.45
-1:68
-0.56
-0.27
1.34
-0.15
2.38
-0.09
-0.60
0.60
0.95
-1,03
0.65
0.17
1.15
-0.06

Kodabu. Chikkamagalur, Hassan, UK, Mysore Chitradurga and Shimoga had

good Primary Health Care Facilities
©

Many North Karnataka districts and even Bangalore Urban lack in Primary

Health Care facilities.

1

Disparities in Health Care Facilities have been assessed on

PHC: Number of Primary Health Care Centres per lakh population. Chikkamagalur

district has the highest number of PHC per lakh population. 11 out of 27 districts of
state, i.e. Bangalore Urban, Bagalkot, Belgaum, Bijapur, Bidar, Dharwad, Dakshina

Kannada, Gadag, Gulbarga, Koppal and Raichur lag behind in Govt. Primary Health

Care institutions.

MOW: Medical Officers working per lakh population. Chikkamagalur district has the

highest number of medical officers per lakh population while Bagalkote has the least
number of medical officers per lakh population. District Bangalore urban, Bellary,
Belgaum, Bijapur, Davengere, Dakshina Kannada, Dharwad, Gadag, Gulbarga,
Haveri, Koppal, Raichur and Udupi also have the less number of medical officers
per lakh population.

Para: Para Medical (Staff Nurse, BHE, Lab. Techn., ANM and Male workers)
working per 10000 population. 16 out of 27 districts have less para medical worker

per 10000 population.

Kodagu has the highest para medical workers per 10,000

population and Bangalore Urban has the least number of PMWs per 10,000

population.

These indicators refer to how resources actually are allocated. Primary health care

provided by network of PHC and sub-centres with community participation is first
level of contact between the individual and health system.

Majority of prevailing

health complaints and problems can be satisfactorily dealt with at this level.

These indicators reflect the distribution of Government health care resources in
different districts of the state and of the provision of health care. The purpose of

health services is to improve the health status of people.

OH

I O 0

Disparities in health care means that health care resources are not allocated

according to needs, health services are not received according to the need.
Disparities in health care implies not ensuring high standard of real (not only

theoretical) access, quality and acceptability in health services for all. Real access
requires active efforts to remove range of important obstacles - financial,
geographical or physical, or other logistic barriers or a perception of low quality of
services that prevent certain groups from receiving the services available to others.

DISPARITIES IN UTILIZATION OF HEALTH SERVICES
IN DISTRICTS OF KARNATAKA

J
£j

Bijapur

Baga.„r.

SO .

Gadag

Dharwad

[3 THE BETTER OFF DISTRICTS
(6)
□ THE INTERMIDIATE DISTRICTS (15)
THE WORSE OFF DISTRICTS
(7)
Haveri

Davanagera
Chftradurga

Shimog

.

Tumkui
■A

k

Chikamagalur

Tumkur

Kolar

Hassan

/ Bangalore ( /

%
Mandya

Mysore

Cha ma rajana gar

4

/

FINDINGS: D

DISPARITIES IN UTILIZATION PATTERN OF HEALTH SERVICES IN DISTRICTS
OF KARNATAKA
DISTRICTS

Immunization ANC3

TT2

Safe DEL.

CFPU

86.9
80.7
42 3
63.9
68
94
61.8

85.8
85.9
80.7
79.4
142.1
83 9
72.4
43.4
75.1
93.4
75.9
94.5
80.1
78.3
35.9
38.3
84.2
85.6
94 3
68.5
37.6
83.3
52.9
72.3
92.1
84.9
93.9

92.9
77.6
45.3
46.6
63.1
60 4
58.3
57.8
90.7
97.5
61.3
91.5
80.4
56.2
53.5
75
60.6
85.4
78 2
48.9
73.3
77.5

60.1
63
47.1
50.4
61.8
47.1
50.6
65.4
59.9
71.4
59.9
63.7
61.2
61.2
39 2
75.1
61.2
70.6
57.1
45.4
71.7
65.4
•45'.4:
69.3
61.3
66
63.7

Bangalore Urban
Bangalore Rural
Bagalkot
Bellary
Belgaum
Bijapur

Bidar
Chamrajnagar
Chitradurga
Chikkamagalur
Davengere
Dakshina Kannada
Dharwad
Gadag
Gulbarga
Hassan
Haveri
Kodagu
Kolar
Koppal
Mandya
Mysore
Raichur
Shimoga
Tumkur
Uttar Kannada
Udupi

77.7
83.7
53.2
52.6
64.8
53.2
50.3
92.7
88.4
83.5
88.4
86.0
74.8
74.8
25.3
92.8
74.8
94.8
90.6
37.2
88
92.7
37.2
92 9
88
89.9
86

70.3
94.9
91.6
92.2
89.1
72
66 5
41.9
75.1
80.5
83.6
56.1
35

80.2
83 3
70.5
90 9
67.6
81.2
85.9

:s9.i
83.9
77.8
88.6
89.5

TOTAL
INDEX
0.75
0.56
-1.44
-1.02
-0.72
-0.35
-0.98
-0.31
0.82
1.38
0.32
1.08
0.23
-0.27
-2.48 !
0.24
0.10
1.07
0.22
-1.91
0.13
0.74
0.92
0.45
0.89
0.99

Most of North Karnataka Districts have poor utilization pattern of existing

Health services

Disparities in Utilization of Health Services have been assessed on

Immunization: Percentage of 12-23 months children completely immunized with
BCG, DPT-3/OPV-3 and Measles.

Immunization coverage varies from 92.9% in

Shimoga to 25.3% in Gulbarga. All districts in North Karnataka had immunization
coverage below the expected level.

ANC3: Percentage of pregnant women who have received 3 or more ANC visits
received during recent pregnancy. Coverage ANC3 varies from 35% in Koppal to

94.9% in Chitradurga. All the in North Karnataka districts have the coverage below
the expected level. Districts Tumkur with 67.6%, and Kolar 56.1% also have low

ANC3 coverage.
TT2: Percentage of ANC received TT2/Booster during recent pregnancy.

TT2

coverage varies from 35.9% in Gulbarga to 94.5% in Dakshina Kannada. Districts
Belgaum, Chamrajnagar, Hassan, Raichur have also shown the very low level
coverage of TT2.
Safe Del.: Percentage of deliveries conducted by Trained Health personnel during
the most recent delivery. Safe delivery coverage varies 48.9% in Koppal to 92.9%

in Bangalore Urban.

Districts Bagalkot, Bellary, Bidar, Bijapur, Chamrajnagar,

Gadag, Gulbarga and Raichur also have a low coverage of Safe Delivery.
CFPU: Percentage of current users of any Family Planning methods Utilization of

Primary Health Services included the utilization of Public and Private health

services. CFPU also varies from 39.2% in Gulbarga to 69.3% in Shimoga. Districts
Bagalkot, Gulbarga, Belgaum, Bidar, Gadag, Koppal, Raichur and Kolar also have

low current users of Family Planning.
Utilization of services is expressed as the proportion of people in need of a service
who actually receive it in given period. A relationship exists between utilization of

health care services and health needs and status.

Health care utilization is also

affected by factors such as availability and accessibility of health services and the

attitude of an individual towards his health and the health care system.

Utilization of public health services is often inequitable with the higher quality, more
expensive services disproportionately used by more privileged segments of society.

III

DISPARITIES IN HEALTH & HEALTHCARE
FACILITIES IN KARNATAKA

a

Belgaum

V Uttara Kannada
Haveri

t

□ THE BETTER OFF DISTRICTS
(7)
□ THE INTERMIDIATE DISTRICTS (14)
THE WORSE OFF DISTRICTS
(7)
Davanagerv

4........... ..........

r
\

Chrtmdurga

c
Tumkui

Udupi

y\

r

n. /X-ZK
;

Tumkur

r^-—J

1

Kolar

}
Hassan

- A/

Bangalore
ingaloi

\

j

Mandya

Kodagu

Mysore

Chamarajanagar

FINDINGS - E
DISTRIBUTION OF DISTRICTS ON THE BASIS OF VARIOUS
CHARACTERISTICS OF KARNATAKA STATE:
DISTRICTS
Bangalore Urban
Bangalore Rural
Bagalkot
Beliary
Belgaum
Bijapur
Bidar
Chamrajnagar
Chitradurga
Chikkamagalur
Davengere
Dakshina Kannada
Dharwad
Gadag
Gulbarga .
Hassan
Haver!
Kodagu
Kolar
Koppal
Mandya
Mysore
Raichur
Shimoga
Tumkur
Uttar Kannada
Udupi

HEALTH
DET.
2.80
0.55
-1.12
-T21

-6.23
'-1.14
-0.30
-0.29
0.14
0.37
0.24
1.35
0.26
-1.05
-1.22
-0.02
0.19
0.47
0 37
-1.7.3
0.30
0.12
-1:71:
0.48
0.39
0.78
1.20

HEALTH
UTILIZ.
0.75
0.56
-1.44

-1.02
-0.72
-035<;
-0.98
-0.31
0.82
1.38
0.32
1.08
0.23
-0.27
-2 48
0.24
0.10
1.07
0.22
-1.91
0.13
0.74

■#40-.
0.92
0.45
0.89
0.99

HEALTH HEALTH
FACILITY STATUS
0.05
-1.55
0.26
0.16
-0.53
-1 30
-0 88
-1.87
-0.76
-0.19
-0 47 <
-0.44
.0.12
-0.89
-0.30
0.52
0.93
-1.00
2.01
0.09
-0.27
-0.09
-0.45
1.16
-1.68
-0.05
-0.43
-0.56
-0.27
-0.74
0 00
1.34
0.07
-0.15
2.38
2.11
-0 09
-1 05
-068
-0 60
0.60
-0.18
-0.34
0.95
-1.03
-0.71
0.65
0.77
-0.11
0.17
1.68
1.15
-0.06
2.76

TOTAL

0.92
0.54
-1.42
-1.53
-0.57
-079
-O
8^.
u.o

-0.18
0.31
1.20
0.13
1.06
-0.20
-0.71
-1.58
0.45
0.13
1.80
-0 07
-1.64
0.27
O.^3
-1.56
0.93
0.35
1.41
1.15

Complete Hyderabad-Karnataka region including districts of Bidar, Gulbarga,

Raichur, Koppal, Bellary, Bijapur and Bagalkot lack in Health Determinants,

Health Status and Health Utilization including availability of Government
Primary Health Care services.
Districts like Belgaum, Gadag also have negative indices but at low level.

®

Chamaraja nagar district has negative value of indices except on health
status. This may be due to few indicators on health status have been taken

from Mysore.
®

Dharwad and Bangalore Urban were also lacking in Government Primary

Health Care services.
©

Kodagu, UK, Chikkamagalur, Udupi, DK, Shimoga and Bangalore Urban

districts have good Health Determinants, Health Status, and Health Utilization
of existing Health Services.

. i

LAST 7 DISTRICTS ON THE BASIS OF VARIOUS INDICES
OVERALL

HEALTH DET

Koppal (95)

Koppal(96)

HEALTH
STATUS
Bellary(97)

HEALTH
UTILIZATION
Gulbarga (99)

GOVT HEALTH
PRIMARY
Dharwad (95)

Gulbarga (94)

Raichur (96)

Kolar (85)

Koppal (97)

Bangalore (U)
(94)

Raichur (94)

Gulbarga (89)

Chitradurga

Bagalkot (93)

Bagalkot (90)

(84)______
Bellary (94)

Bellary (89)

Bidar (81)

Raichur (92)

Raichur (85)

Bagalkot (94)

Bijapur (87)

Gulbaga (77)

Bellary (85)

Bellary (81)

Bidar (79)

Bagalkot (87)

Raichur (76)

Bidar (84)

Belgaum (78)

Bijapur (79)

Gadag (85)

Koppal (75)

Belgaum (76)

Koppal (73)

Figure in brackets indicates the position on 100 point scale

TOP 7 DISTRICTS ON THE BASIS OF VARIOUS INDICES
OVERALL

Kodagu (4)
Uttar Kannada (8)
Chikkamagalur

HEALTH DET.

HEALTH
STATUS
Bangalore (U)(1) Udupi (1)

HEALTH
UTILIZATION
Chikkamagalur (8)

GOVT HEALTH
PRIMARY
Kodagu (1)

Dakshina
Kannada (9)
Udupi (12)

Dakshina Kannada

Chikkamagalur (2)

(14)____________

(12__________
Udupi (13)

Dakshina
Kannada(15)
Shimoga (18)

Uttara
Kannada (22)
Bangalore (R)
29)_________
Shimoga (32)

Bangalore-U(18)

Kodagu (32)

Kodagu (2)

Uttar Kannada
(5)_________
Dakshina
Kannada (12)
Shimoga (22)
Chamrainaqar
(30)________
Bangalore-R

Kodagu (14)

Hassan (9)

Udupi (16)

Uttar Kannada (13)

Bhimoga (18)

Mysore (17)

Uttar Kannada (19)

Chitradurga (18)

Bangalore U (23)

Shimoga (26)

(40)________
Figure in brackets indicates the position on 100 point scale

©However, disparities in health on class, caste, age, sex and the religion could not

be assessed, as data does not exist in disintegrated form for districts of Karnataka.

Relationship in between Health Status and Health Determinants among the
Districts of Karnataka State:

HEALTH
STATUS
LOW

LOW

HEALTH DETERMINANTS
HIGH
IMODERATE

CHITRADURGA
KOLAR

BELLARY
GULBARGA
KOPPAL

BIDAR

RAICHUR
MODERATE

DAVANGERE
BELGAUM
CHIKKAMAGALUR
DHARWAD,
HASSAN, HAVERI
MANDYA, MYSORE
TUMKUR

BAGALKOT
BIJAPUR
GADAG

HIGH

CH AMARAJ NAG AR

BANGALORE (U)

DAKSHINA KANNADA
UTTAR KANNADA
UDUPI, KODAGU
SHIMOGA,
BANGALORE (R)

Observed Agreement 19/27 - 70.4%
Kappa Coefficient: 0.532,

P = 0.000059

It is obvious from the above table that the districts with the low value on health

determinants have low health status and districts with high value of health
determinants have the high value of health status with an agreement of 70.4% and
Kappa Coefficient 0.532, which is significant.

Relationship in between Health Status and Primary Health Care Facilities
among the Districts of Karnataka State:

HEALTH
STATUS

LOW

PRIMARY HEALTH CARE FACILITIES
HIGH
MODERATE

LOW

BELLARY
KOPPAL, RAICHUR

GULBARGA
KOLAR
BIDAR

CHITRADURGA

MODERATE

BAGALKOT
BANGALORE (U)
BELGAUM
DHARWAD

BIJAPUR
DAVANGERE,
GADAG, HAVERI
MANDYA,TUMKUR

CHIKKAMAGALUR
HASSAN
MYSORE

DAKSHINA
KANNADA

KODAGU
UTTAR KANNADA
SHiMOGA

HIGH

UDUPi,
BANGALORE (R)
CHAM RAJ NAG AR
Observed Agreement 12/27 - 44 44%

Kappa Coefficient: 0.1234,

P = 0.1862

Government Primary Health Care services and health status are not very much
related with observed agreement of 44.44% and Kappa Coefficient 0.1234 which is
not significant. This may be due to the utilization and availability of private health

services.
Chitradurga district has low Health status even though it has good Government

Primary Health Care services.

Relationship between Health Status and Utilization of Primary Health Care
services among the Districts of Karnataka State:

HEALTH
STATUS
LOW

MODERATE

UTILIZATION OF PRIMARY HEALTH SERVICES
HIGH
MODERATE
LOW

BELLARY,
GULBARGA, BIDAR
KOPPAL, RAICHUR

KOLAR
CHITRADURGA

BAGALKOT
BELGAUM

BIJAPUR
DHARWAD,
DAVANGERE
HASSAN, HAVERI
MANDYA.GADAG

BANGALORE (U)
CHIKKAMAGALUR

TUMKUR, MYSORE
BANGALORE (R)
CHAM RAJ N AGAR

HIGH

DAKSHiNA KANNADA
UTTAR KANNADA
UDUPI, KODAGU
SHIMOGA

Observed Agreement 19/27 - 70.4%

Kappa Coefficient: 0.532,

p = 0.000059

All districts with high health status continue to use Primary Health Care services and
the districts with low health status have low utilization of primary health care

services. The above table, observed agreement and kappa coefficient denotes that
the health status is more related to the utilisation rather than the availability of

services.

Relationship in between Primary Health Care Facilities and Health Facilities
Utilization among the Districts of Karnataka State

HEALTH
FACILITIES
UTILIZATION
LOW

LOW

PRIMARY HEALTH CARE FACILITIES
HIGH
MODERATE

GULBARGA
BIDAR

BELLARY
BAGALKOT
BELGAUM
RAICHUR
KOPPAL

BANGALORE (R)
BIJAPUR
CHAM RAJ NAGAR
DAVANGERE,
GADAG, HAVERI
MANDYA.KOLAR
TUMKUR

MODERATE
DHARWAD

HIGH

BANGALORE (U)

DAKSHINA
KANNADA
UDUPI

HASSAN
CHITRADURGA
MYSORE

CHIKKAMAGALUR
KODAGU
UTTAR KANNADA
SHIMOGA

Observed Agreement 18/27 - 66.7%
Kappa Coefficient: 0.474,

P = 0.00031

It is clear from the above table the relationship between Primary Health Care
utilisation and Primary Health Care facilities is significant where observed

agreement is 66.7% and Kappa Coefficient is 0.474. This shows the availability of

health services leads to utilization of the health services.

In case of Bangalore Urban though the availability of government primary health
care facilities is low, the utilization of health services is high. This may be due to

availability of health care services in the private sector.

ti-o-SQ-

Conclusion:
From the findings it is clear that the Hyderabad - Karnataka region (Bidar, Gulbarga,

Raichur, Koppal and Bellary), Bijapur and Bagalkote lack on all indicators in the

essential categories.

The utilization of health services, availability of functional

government primary health care services holds the key to overcome the disparities.
Utilization of government health care services had been very poor through out the

North Karnataka. This may be due to lack of physical accessibility of services or

non-availability of functional government primary health care services.

As reported in the study on “Redressal of Regional Imbalances in Development,
there exists excellent network of good roads in south block of Karnataka as

compared to north block of Karnataka. This is an important factor to improve the

accessibility to primary care services.

The bad roads and poor public transport

badly affects the accessibility of primary health cares services.

Supportive supervision by medical officers and DHO to field staff will enhance the
efficiency and effectiveness of staff.

The equity in Health requires equity in the distribution of the determinants,
availability of primary health care services and the utilization of health care services.

There exists a good relationship in between the Health determinants and Health

status with Kappa Coefficient 0.532, p<0.001. Districts have shown the observed

agreement of 70.4%. The districts, which have a high Z score of Health
determinants, have a high score on health status.

The observed agreement on Government Primary Health Care facilities and Health
status had been 44.4% with Kappa Coefficient 0.1234, p = 0.1862. This shows that

in some of the districts health status has been very poor though Government
Primary Health Care services were satisfactorily available. In addition, utilization
and availability of private health care facilities was also satisfactory.

The relationship in between health status and utilization of Primary Health Care
services is fairly good with Kappa Coefficient 0.532, p<0.0001. All the districts with
good health status continued to use Primary Health care services. It seems that

accessibility to Health care services has been good in the districts with high health

status.

The observed agreement in between Primary Health care facilities and utilization of
health facility has been of 66.7% with Kappa Coefficient 0.474, p<0.001. Primary

Health Care facilities have been made use of in the districts with moderate and high
availability of Primary Health care facilities.

The map enclosed indicates the districts, which require top priority (red), moderate
attention (yellow) and districts where existing facilities, utilization and health status

must be maintained at an acceptable level (green).

RECOMMENDATIONS

•

Environment Sanitation including availability of clean water, housing and access
to latrine and amenities like electricity should be improved in entire Hyderabad-

Karnataka region, Bijapur, Bagalkote, Gadag, Hassan and Haveri districts. For
this scheme like Nirmal Karnataka Program under Rural Development and

Panchayat Raj should be implemented with creating awareness on sanitation

and provision of facilities simultaneously.
•

Literacy Status 15+ should be improved in Hyderabad-Karnataka region, Bijapur,
Bagalkote, Chamrajnagar, Mandya and Bangalore Rural districts.

•

Efforts to be made to improve the economic status of household in HyderabadKarnataka region, Bijapur, Bagalkote, Chamrajnagar, Chitradurga, Dharwad,

Gadag and Kolar districts.
•

Nutrition status of under five should be improved in entire Hyderabad-Karnataka
region, Bijapur, Bagalkote, Davengere, Gadag and Haveri District.

•

Malaria incidence to be reduced in Hyderabad-Karnataka region, Bijapur,

Bagalkote, Chitradurga, Dakshina Kannada, Hassan, Kolar and Mandya districts
by implementing National Anti Malaria Program aggressively.

•

Prevalence of TB should reduced in Hyderabad-Karnataka region, Bijapur,
Bagalkote Chamrajnagar, Chitradurga, Kolar, Mandya, Mysore and Bangalore

Urban and Rural districts by extending RNTCP to these districts on priority basis.

•

Primary Health Care facilities to be improved in Hyderabad-Karnataka region,

Bijapur, Bagalkote Bangalore Urban, Dharwad and Gadag districts.

•

More than establishing new primary health care facilities the utilization of existing
primary health care services should be encouraged.

This could be done by

making existing primary health care facilities functional in real sense through

monitoring of availability of staff including MOH and drugs.
***************************

Il
ANNEXURE-1

I.

HEALTH DETERMINANTS INDICATOR

a.
b.

c.
d.

II.

HEALTH STATUS INDICATORS

a.

b.
c.
d.
e.
f.
g.

III.

IV.

Prevalence and level of poverty * -1998
Educational levels * -1991
Adequate sanitation and Safe water coverage * -1998
Housing * -1991

Under five year mortality rate * -1991
Nutrition of children * - Nov. 2000
Maternal mortality ratio: Not Available
Life expectancy at birth: Not Available
Incidence & Prevalence of relevant infectious diseases * -1999
Infant mortality ratio: Not Available
Child mortality (1-4 years) : Not Available

HEALTH CARE RESOURCES ALLOCATION INDICATORS

a.

Per capita distribution of qualified personnel in selected categories
eg., medical officers: physician, obstetrician, paediatrician, surgeons &
paramedical workers. * - Sept. 2000

b.

Per capita distribution of services facilities at Primary, Secondary and
Tertiary levels. * -1999

h.

Per capita distribution of total health allocation and expenditure on
personnel and supplies as well as facilities: Not Available

HEALTH CARE UTILIZATION INDICATORS

a.
b.

c.
d.

Immunization coverage * -1998
Antenatal Coverage * -1998
Percentage of births attended by qualified attendant * -1998
Current use of contraception * -1998

* Indicators used in the present report

4

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