Annual Plan -2012-13

2012-2013

ANNUAL PLAN OF KARUNA TRUST FOR THE YEAR

2012-2013

HEALTH PROGRAMMES

A. PRIMARY HEALTH CARE

I. Management of Primary Health Centres under Public Private

Partnership

Two focus areas planned for the year in the management of PHCs.

Improving Quality of PHCs through Accreditation and Quality Certification

Scaling up to increase the number of PHCs in Karnataka and other States

Karnataka: Existing: 29 PHCs including 1 as CSR Initiative of NPCIL in Kaiga

Proposed:

o Proposal submitted to take over 6 PHCs in Karnataka

o At Kaiga, Livelihood Project (Tailoring)

Planned:

o NABH Accreditation is under progress and is in the final stage of

assessment for PHC at Gumballi

o ISO Certification for 13 designated PHCS in Karnataka in partnership

with IHMR

Andhra Pradesh: Existing: 2 PHCs

Proposed:

o Proposal submitted to Govt. of Andhra Pradesh to manage PHCs in

four Districts : East Godavari, West Godavari, Khammam and

Vishakapatnam

o 8 PHCs expected to be handed over in East Godavari District

o 2 in West Godavari District

Orissa: Existing: 10 PHCs

Proposed: One PHC in Pandripada in Kandhmal District

Arunachal Pradesh: Existing: 11 PHCs; Proposed: 2 PHCs

Meghalaya: Existing: 6 PHCs; Proposed: 4 PHCs

Manipur: Existing: 3 PHCs; Proposed: 2 PHCs

Maharashtra: Existing: 1 PHC – will be continued

Proposal submitted to the State Government for PHC management

Madhya Pradesh: 10 PHCs

Mizoram: 10 PHCs

Tripura: 10 PHCs

Kerala: 2 PHCs

J&K: 10 PHCs

Chattisgarh: 10 PHCs

II. Mobile Health Units

Karuna Trust, in collaboration with Karnataka Health System Development and Reforms

Project (KHSDRP), National Rural Health Mission (NRHM) and Nuclear Power Corporation

of India (NPCIL) runs nine Mobile Health Units to cater to the underserved, insurgent and

remote areas in Karnataka and Maharashtra. These are the areas that have remote habitations

and are far from the PHC or have no access to any health facilities

Existing: 7 Mobile Health Units - 5 supported by KHSDRP

2 supported by NRHM

1 Mobile Health Units supported by NPCIL in Tarapur

Proposed: Expression of Interest submitted to KHSDRP for 10 MHUs in Karnataka

III. CSR Initiatives

1. Wienerberger

Health Centre

Wienerberger is a leading producer of clay building materials, was founded in 1819 by Mr.

Alois Miesbach in Vienna (Austria). Wienerberger India was established in Bangalore in the

year 2006. Karuna Trust is managing a Health Clinic at Gottikere village in Karnataka since

2009 which is supported by Wienerberger as part of its CSR initiative.

1 more Primary Health Centre in Yeliyur is proposed for the year (included in the 6 PHC

proposal of Karnataka)

2. Nuclear Power Corporation of India Limited (NPCIL)

NPCIL has initiated to provide healthcare services to the rural India through Health Centres

and Mobile Health Units. Karuna Trust is being engaged as its partner to manage the

services.

Mobile Health Unit

Rajasthan: Proposed: 1 MHU at Rawatbhata

Tamil Nadu: Proposed: 1 Health Centre at Kudankulam

Solid Waste Management

Proposed Solid Waste Management Project at Tarapur, Maharashtra in collaboration with

Hand in Hand for Rs. 5 crores for 5 years

Health/Education/Livelihood

Baseline survey proposal has been submitted to carry out any of the three in Health,

Education and Livelihood sectors and is budgeted for One Crore Rupees per year.

Gujarat: Proposed in Bhavnagar

Uttarakhand: Proposed in Narora

IV. Innovations in Primary Health Care

1. Integrating Mental Health into Primary Health Care

Mental Health has been integrated into primary health care in 27 PHCs of Karnataka.

Psychiatric treatment is being provided to the rural community. This intervention is supported

by Sir Ratan Tata Trust.

The ongoing activities will be continued for this year.

2. Mobile Dental Health

Karuna Trust has taken dental care to the villages & PHCs through Mobile Dental Health

model. It is now accessible to the poor and needy in Yelandur and T. Narasipura Taluks. The

PHC adopted by Karuna Trust at Gumballi has a mobile dental clinic equipped with all the

necessary instruments and a dedicated team that visits remote villages in the range of 800

Kms in and around Yelandur and T. Narasipura Taluks on previously designated days and

treats patients free of cost.

The dental van covers eight PHCs twice a month apart from a tribal clinic at BR Hills and

some tribal villages. During the year the unit has covered a distance of about 2000 Kms

reaching out to 2910 patients spread.

The above activities continue for the current year.

3. Tele Medicine and Communication Technologies for Health Care

ISRO-VSAT Technology

Karuna Trust acts as a facilitating organization to promote and share knowledge on issues of

development, livelihood and education to people living in rural areas through the Village

Resource Centre. The organization has one Resource Centre at Mysore and 18 student sites

located in rural areas in different districts of Karnataka. information.

Task of re-orienting the satellite position has been outsourced by ISRO and due to this

transition, the VSAT connectivity is non functional at present about which Karuna Trust is

following up with the concerned to have the systems in place at the earliest possible time.

Proposed: Telemedicine services in 1 PHC in collaboration with Cisco

Assessment of mHealth Intervention

Harvard Institute for Global Health, South Asia Initiative, has launched a study to assess the

impact of a mHealth intervention on adherence to antenatal care appointments and infant

vaccinations in a population served by NGOs in primary health Centres in rural Karnataka,

India. Secondary aim is to explore possibility of deployment of this technology in other areas

of health care delivery and treatments. Karuna Trust has been selected for this study as we are

extensively serving the rural population.

Necessary training was provided by two students from Harvard Public School, USA. The

project was piloted in 5 PHCs run by Karuna Trust in Karnataka.

There are plans to scale up to 6 more PHCs during the current year at no cost to Karuna Trust

4. Management of Non-communicable Diseases

Hypertension, Cardio-Vascular diseases and Diabetes clinic are held at Gumballi PHC on

second & fourth Sundays of every month. It caters to the people of Yelandur, Kollegal,

Chamarajanagar, Gundlupet Taluks and Mysore rural areas. Consultation is provided by

Senior Radiologist cum Physician, Dr Y.N.I.Anand who has served in the Indian Army.

Medicines are prescribed at no profit and no loss rate.

The services will continue for the current year.

5. Mainstreaming Traditional Medicine (AYUSH)

The integration of traditional medicine into the PHC network is an effective method to

deliver the concept to the people. Karuna Trust has utilized the PHCs it is running in

Karnataka to mainstream traditional medicine, and currently 20 PHCs and five government

Ayurvedic dispensaries are actively offering traditional medicine as an option to its patients.

Training programs have also been conducted for PHC staff in order to orient them to the uses

and value of traditional medicine, as also SHG members, who have been trained in the use of

traditional medicine at the household level for common illnesses.

The program will continue with the above activities for the current year.

6. Emergency Medical Services

Karuna Trust’s initiative is to improve management of emergency cases at Primary

Health Centres (PHCs) in Karnataka. The “Primary Emergency Care” initiative includes

wall posters, an Emergency Toolkit, an Emergency Drug box. Training sessions and

refresher courses are conducted to the health staff. The goal is to decrease morbidity

and mortality at the PHC level by standardizing management of emergency patients

through simple yet effective interventions.

EMS will continue to be operational in all PHCs of Karnataka.

7. Promotion of Quality low-cost generic drugs & Rational drug Use

Karuna Trust stocks and distributes good quality, low cost generic drugs from LOCOST, a

voluntary organization. The contract has been renewed and LOCOST has resumed the drug

supply to the PHCs managed by Karuna Trust.

8. Management of Communication disorders in PHC in collaboration with

AIISH

Evaluation process of rehabilitation and its efficacy for prevention of communication

disorder in three outreach service centres at three PHCs: Akkihabbalu in Mandya, Hullahalli

in Mysore and Gumballi in Chamarajanagar Districts was initiated. The activities of Material

Development, Selection of Volunteers, Orientation and door to door survey activities

continue for the current year at the service centres.

Planned to scale up to three Talukas and 21 PHCs

B. SECONDARY HEALTH CARE

1. Vivekananda Eye Hospital

The Vivekananda Eye Hospital at Gumballi has been offering quality eye care services to the

community free of cost that includes screening, consultation and surgery. Equipped with

modern equipments, the hospital is integrated into the primary health care. The main

activities are:

Screening, examination, evaluation and surgery for blindness due to cataract

Promotion of Vitamin A supplementation through ANMs/male health workers

Strengthening immunization services, particularly measles

Early detection, health education and treatment of chronic diseases like Diabetes

Mellitus through special Sunday clinics

Compulsory annual screening and examination for retinopathy changes for

hypertensive and diabetic patients

Routine out-patient services, emergency eye care and correction of refractive errors

Weekly eye camps

The above mentioned activities continue for the current year with improved quality in

services.

2. First Referral Unit

In partnership with Government of Karnataka and Diwakar Services Trust, Karuna Trust is

managing a First Referral Unit for emergency obstetric care and neonatal services under

Thayi Bhagya scheme in Community Health Centre, Santhemaranahalli, Chamarajanagar.

Proposed: Two more FRUs in Northern Karnataka for the current year.

3. Citizen Help Desk

Citizen Help Desk is one of the innovative schemes which empowers the public with

information and provide guidance of health in Government Hospitals. The main services are:

To improve services at the Government hospitals by educating the staff and public

about facilities and services available; timely feedback to the concerned authorities

regarding staff and drug stock outs

To enhance transparency and accountability in the delivery of services

To empower the public with information from Help Desk and provide guidance

through posters, leaflets and boards

To enhance the productivity of the staff through counselling, confidence building

and motivational sessions

Establish a link between service providers and users through regular feedback

mechanism.

Conduct regular interaction camps in the areas inhabited by poor to build confidence

amongst the poor to access services at Public hospitals.

Existing: 2 Help Desks - Jayanagar General Hospital and Ramanagar District Hospital

Proposed: Expression of Interest submitted for 2 more Citizen Help Desks at Chikkaballapur

District Hospital and Indiranagar General Hospital in Bangalore

4. Innovative Projects

1. Integration of Eye care into Primary Health Care in Karnataka in collaboration

with Sight Savers International

Comprehensive primary eye care services are being provided including Vision Centres with

Spectacle dispensing units. The main components are:

Integration of other infectious diseases with eye care e.g. Diabetes and

hypertension with DR

Reproductive Child Health workers involvement in referring mother and child

suffering from eye disorders to vision centres

Advocacy with state Government authorities for replication/training of DPMs and

Govt. PMOOs in concept of vision centres and integration

Health systems research to understand the impact of integration of primary eye

care with primary health care

The above mentioned activities continue to be provided at 10 designated PHCs in Karnataka

2. Scaling up project in collaboration with John D & Catherine T. MacArthur

Foundation, USA

The specific project objectives include improving access to quality reproductive health

services at primary level through taking up direct management of PHCs along with the

corresponding sub-centres, enabling cross-learning and improved PHC management.

The project began in 2009 with three States under the purview of Scaling-up and during

previous year, four more states were included, bringing the total number of PHCs under the

project to 73.

12 PHCs are planned to be taken over across States to achieve a target of 85 PHCs

3. Manasa Project in collaboration with Sir Ratan Tata Trust

Integrating Mental Health services into primary healthcare has been a practicing model in

Karuna Trust managed PHCs and additional services in mental health domain have been

taken up in collaboration with Sir Ratan Tata Trust.

Manasa Project has been catering to the homeless and mentally ill, predominantly women in

Mysore city and the adjoining areas.

The services include:

Mental Health Help Line

Transit Care Centre

Psychiatric services at Nirashritara Parihara Kendra

Community Mental Health Programme through PHCs

Currently community mental health programme has been integrated into 27 PHCs in

Karnataka.

Small Grant Projects

1. This year, community mental health services have been extended to the peripheries of

Hyderabad city in collaboration with Navajbhai Ratan Tata Trust and IMH.

2. Community Mental Health Programmes in India- Documenting 5 best practices as a

Research Project

4. Repositioning Family Planning in Primary Health Centres in Karnataka in

collaboration with Population Foundation of India

This is a 3-year project aiming to empower eligible couples to lead healthy and productive

lives and exercising the rights to regulate their fertility through acceptable family planning

methods. The objectives include:

Delaying first pregnancy

Promoting spacing between pregnancies among eligible couples

Improving quality of RCH and primary health care programs through quality

accreditations, continuous review and monitoring mechanisms

The project has been launched in 14 designated PHCs, mostly in northern Karnataka.

5. Water Quality Management in collaboration with Government of Karnataka and

Arghyam

Water Quality Management promoted by Karuna Trust is first of its kind where managerial

inputs are provided to the Panchayat Raj Engineering Department and Health departments

that are responsible for water quality. Karuna Trust facilitates management of district

laboratories, awareness programs through IEC, increased communication and convergence

among the departments which in turn contribute to safe drinking water to the community.

This is being piloted in two districts: Chikkaballapur and Chamarajanagar and expected to

start in Tumkur district once the budget is approved which is submitted to RDPR by Karuna

Trust.

6. Sukshema (MNCH) project in collaboration with Karnataka Health Promotion

Trust (KHPT)

Sukshema, the Maternal, Neonatal and Child Health (MNCH) project is a joint venture with

Government of Karnataka, launched in the eight underserved districts of Northern Karnataka.

The districts under the project are Bidar, Gulbarga, Yadgir, Raichur, Bellary, Bijapur,

Bagalkot and Koppal. The objective is to improve MNCH outcomes in rural populations

through the development and adoption of effective operational and health system approaches

within the National Rural Health Mission framework.

Project activities planned by Karuna Trust for the year are Dissemination workshops,

coordinating with KHPT for Trainings and Advocacy.

7. Comprehensive District HIV/AIDS Program (CDHP)

In Karnataka, Koppal is one of the districts supported by UNICEF in partnership with

Samraksha for CDHP Prevention Program, Link Worker’s Scheme. Karuna Trust took over

from Samraksha in 2010 and has been executing the CDHP project for UNICEF in Koppal.

The project will continue with the existing activities for the year.

8. Strengthening Primary Health Care through PPP (SDTT)

SDTT has continuously supported Karuna Trust for the past 3 years by supplementing

Government Funds towards various activities of management support, capacity building,

extra medicines and salary of PHC staff in 12 PHCs of Karnataka.

A new proposal has been submitted to strengthen all the PHCs in Orissa and Arunachal

Pradesh and approval is awaited.

9. Birthing Kits

Janma Birthing kits supplied by AYZH Health and Livelihoods Pvt. Ltd. are subsidized by

Rotary Foundation and distributed to the PHCs managed by Karuna Trust in Karnataka,

Andhra Pradesh, Orissa and Arunachal Pradesh.

Distribution of additional kits is dependent on Rotary Foundation’s plan of subsidised supply.

10. Supply Chain Management

Logistimo enables supply chain management using mobile phones and is offered as Software

as a Service (SaaS) to improve vaccine/medicine in rural areas. This project is funded by the

Bill & Melinda Gates Foundation. Logistimo has evinced interest in partnering with Karuna

Trust. This program comes as no cost to Karuna Trust.

Logistimo has supplied the required model of mobile phones to the Supervisors and

Pharmacists of Karnataka PHCs. Necessary training is being imparted and this program is

planned to be launched during end of July 2012. The program may be extended to PHCs of

other States based on the progress and effectiveness of the program and willingness form

both sided to continue.

C. LIVELIHOOD AND SUSTAINABLE DEVELOPMENT

1. Integrated Rural Development Project at T. Narasipur Project

Community Micro Finance Plan is fully operational through a three-tier

participative democratic organizational setup - Self Help Groups (SHGs) at

grassroots level, cluster of SHGs into Community Development Associations

(CDAs) forming a Federation at the apex level

Traditional Medicinal plants are grown and protected in Yachanahalli, Hegguru,

Alagudu and Karuna Trust Campus and people have received primary health

treatment from these plants. These plants are grown in the backyards of SHGs

members and as well as in Schools.

TB Control and Eradication Programme and Free Eye Camps are being

conducted in the catchment areas of the Government Hospital and PHCs

Community Development and Vocational training programmes are conducted

for the Self Help Group members and unemployed youth

All the above activities will continue for the current year.

2. Integrated Rural Development Project at Yelandur

Secondary Healthcare services are offered through Eye Hospital, First Referral

Unit and Mobile Dental Care

Homeopathy and Herbal medicines are integrated into primary healthcare and

treatment extended to patients

The Pre-University college aims at improved pass percentage from the existing

50% reported during previous year

The ITI Institute has been recognised by Govt. of Karnataka for Grant-in-aid.

Stitching of uniforms for boys and girls is in full progress

All the above activities will continue for the current year.

3. Integrated Rural Development Project at Kammasandra

Putani Gudu caters to the orphan and destitute children by providing them with

free education, hostel facilities, food and healthcare.

Low cost housing, dairy farming, Swasthya Grama Yojana and adoption of

Anganawadis are the activities carried out as part of Livelihood programmes.

All the above activities will continue for the current year.

4. Integrated Rural Development Project at Ghopur, Assam

Focus on strengthening of the existing Self Help Groups with no additional

Groups planned to be formed

Organizing Socio-economic development activities in Ghopur and other parts of

Assam continue as planned

Flood relief activity has been initiated this year to help the flood victims

All the above activities will continue for the current year.

D. RESEARCH AND ADVOCACY

Study of patterns of Antibiotic Dispensing in Pharmacies in Tumkur, Karnataka,

India

Antibiotics are obtained by patients from a variety of sources in India, including government

and private hospitals, pharmacies and unlicensed dispensers. There exists no reliable

quantitative or qualitative description of antibiotic prescribing patterns in Primary Health

Centres (PHCs) in rural areas . This study in Karnataka will fill this gap, using methodology

adapted from a WHO pilot study to examine antibiotic use in Delhi, Mumbai, and Vellore.

The study will operate in the district hospital, Taluka hospitals, PHCs managed by the

government and NGOs, and private retail pharmacies in Tumkur district, Karnataka

Study has been completed by Karuna Trust and analysis is in progress by CDDEP (Centre for

Disease Dynamics, Economics and Policy) after which a final report will be submitted to

Ethical Committee of Institute of Public Health by Karuna Trust.

Health Information Management System

IIM-B has developed a Health Management Information System called Jannarogya for

Karuna Trust. Janaarogya aims to support the improvement of health care systems in

Karnataka by increasing the capacity of health care workers to make decisions based on

accurate information.

E. PROPOSED PROJECTS

1. Smile on Wheels

Smile on Wheels is a national level multi-centric project initiated by SMILE Foundation with

an objective of providing promotive, preventive and curative health services to the

beneficiaries with focus on urban poor.

Karuna Trust has submitted a proposal to serve the people of Yemalur and Doddakenahalli

villages located in Krishnarajapuram Taluk of Bangalore urban district which is

predominantly inhabited by migrants working in the construction industry through a Mobile

Health Clinic.

2. Embrace Baby Warmers

Embrace provides infant warmers known as Thermpods to PHCs and community healthcare

Centres. In partnership with Embrace, Karuna Trust intends to improve maternal and child

healthcare by providing access to Embrace products. Proposal in under progress and is

expected to become operational once the MoU is signed.

3. Cold Chain Management

Energize the Chain, is talking to the Vodafone Foundation and the Karuna Trust, which is

known for its work in providing healthcare to the rural poor. This initiative would include a

controlled experiment to confirm if sites powered by cellphone towers have less vaccine

spoilage. This is easy to check because vials of vaccine can be fitted with labels that darken

on exposure to heat.

Expression of Interest has been submitted by Karuna Trust side to collaborate with Energize.

Initially it was intended to start in 2 PHCs of Karnataka, but now will be extended to the

PHCs in Orissa and Andhra Pradesh.

This is a no cost project to Karuna Trust.

4. Health management of people affected with Handigodu syndrome

Handigodu Syndrome is a rare and painful osteoarthritic disorder endemic to

the Malnad region in the state of Karnataka, India. Also known as Handigodu Joint Disease,

it derives its name from the village of Handigodu in the Sagara taluk of the Shimoga

district of Karnataka where it was first noticed. This disease currently has no cure.

Scientifically it is termed as Endemic Familial Arthritis of Malnad. Apart from Sagara taluk,

the disease has also been reported from the Koppa, Narasimharajapura and Sringeri Taluks of

Chikmagalur districts.

The proposed activities are:

1. Health centre at Sagara taluk with 10 beds facility exclusively providing Ayurvedic

treatment

2. Mobile Health Unit visits all the affected villages 6 days a week providing treatment

3. Village level treatment centres using the exiting building in the villages like

community halls for providing treatment

5. District Nutrition Management Programme with Ashoka

6. Information Technology Intervention

Karuna Trust has been in the Integrated Rural Development sector for over 25 years and the

expansion of services in terms of activities and geography is envisaged in the near future. In

this context, the following areas need attention:

Currently there is no mechanism to store the organizational data in a systematic way

There are over 900 health workers working for Karuna Trust apart from the

employees at the head Office and regional offices. There is no employee database to

store the employee details which is an essential need

Data backup is critical ad currently there is no backup process except for the Tally

backup being taken on an external hard disk

The g-mail Ids are considered as the official mail- ids of Karuna Trust employees and

there is no process to recover the mails in the event of an employee leaving the

Organization

A Management Information System might be required in the near future to manage

the overall activities of Karuna Trust in a more efficient and effective manner

Karuna Trust Website maintenance needs to be outsourced to a professional service

provider whom Karuna Trust has identified and the transition from the existing

servers is in progress

Considering the above factors, IT intervention is crucial to progress towards Process

Orientation thereby reducing person dependency.