Health Sector Reforms in Karnataka State
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Transcript of Health Sector Reforms in Karnataka State
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Health Sector Reforms in
Karnataka State
By
Dr. H.Sudarshan
Karuna Trust
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Public Private Partnership
Partnership with Voluntary Organizations:• Entrusting Management of PHCs to Vos and
Private Medical Colleges• Karuna Trust is managing 15 PHCs • Goal is to manage one “Good Practicing PHC” in
all the 27 Districts• Tele Medicine project – Asia Heart Foundation
and Karuna trust • Tribal ANMs Project• Innovations: VHCs, Rehabilitative Services
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• The Task Force constituted by the Chief Minister GO No HFW 545 CGM 99, Bangalore dt.14-12-1999
• The terms of reference were to make recommendations
for: Improvement of Public Health; Stabilization of the population; Improve management and administration of the Department; Changes in the education system covering both Clinical
and Public Health.
And to monitor the implementation of the recommendations.
Public Private PartnershipTask Force on Health and Family
Welfare
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12 Major Issues of Concern
1. Corruption
2. Neglect of Public
3. Distortions in Primary Health Care
4. Lack of Focus on Equity
5. Implementation Gap
6. Ethical Imperative
Task Force on Health and Family Welfare
Final Report
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Task Force on Health and Family Welfare
Final Report
12 Major Issues of Concern
7. Human Resource Development
8. Cultural Gap and Medical Pluralism
9. From Exclusivism to Partnership
10. Ignoring the Political Economy of Health
11. Research
12. Growing Apathy in the System
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Task Force on Health and Family Welfare
Final ReportContents
1. Equity in Health Care
2. Quality of Health Care
3. Primary Health Care
4. Secondary and Tertiary Health Care
5. Public Health
6. Mental Health and Neurosciences
7. Nutrition
8. Women and Child Health
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Task Force on Health and Family Welfare
Final ReportContents
9. Population Stabilisation10. Focus on Special groups11. Health Promotion and Advocacy for Health12. Human Resources Development for Health13. Research in Health14. Health Systems Management 15. Health Financing16. Rational Drug Management
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Task Force on Health and Family Welfare
Final ReportContents
17. Law and Ethics18. Indian Systems of Medicine and Homoeopathy19. Panchayat Raj and Empowerment of People20. Strengthening of Partnership21. Multisectorality and Intersectoral Co-ordination22. The Karnataka State Integrated Health Policy 200123. Vision 202024. Implementation of the Report25. Major Recommendations and Expected Outcome
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Karnataka State Integrated Health Policy 2001
• Vision, Mission & Goals• Comprehensive Health Policy which includes
Health Policy Population policy Drug policy Nutrition policy Education for Health Sciences – Policy Blood banking policy Policy on Control of Nutritional Anaemia AIDS Prevention & Control Policy (draft) ISM&H Policy (draft) Pharmaceutical Policy
•
Task Force on Health and Family Welfare
Final Report
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Public Private Partnership
For Profit – Private Sector
• Out sourcing of Cleaning, Security and maintenance Services
• Contracting Private Doctor and Specialists
• Contracting One Super Specialty Hospital – OPEC Hospital, Raichur.
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Decentralization
• Karnataka has Decentralized Democratic System – Panchayat Raj Institutions
• Involvement of ZP and Taluka Panchayats in Health
• Decentralization of Administrative and Financial Powers
• VHCs – IPP9 project
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Reforms related to Human Resources
• Appointment of Staff on Contractual basis
• Multi-skilling of Health Personnel : CRS course
• Mandatory Pre-PG rural service
• Formation of District Cadres
• Creation of Taluka Health Officers
• Recruitment and Transfer Policy – transfers by counselling
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Reforms in Health Financing
• User Fee Vs Token Fee• Establishment of Hospital Committees• Granting Autonomy to Hospitals & Health
Institutions• Health Insurance: 1. KT– UNDP Community Health Insurance2. Yashaswini Scheme3. Arogya Raksha Project
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Financial management• Optimum utilisation of allocations• Delegation of financial powers• Release of funds - timely issue of sanction• No budgetary cuts for Health Services• Adequacy of funds for maintenance of
essential needs – repairs, maintenance and efficient use of assets
• Community Insurance for health• Liability Insurance for doctors• Test Audit
Health Systems Management
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Re-organization & Re-structuring of
Karnataka Health & Family Welfare Department
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Division on the basis of functional responsibilities
Public Health Medical (Curative)
•District Cadres•Constitution of Karnataka Health
Services (KHS)•Reformulation of Cadre/Recruitment/Structures/Rules
Health Systems Management
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State cadre (KHS)PG qual. compulsory Merit cum seniority
Medical Officer PHC
Deputy DMO/RMO
Taluk Health Officer(THO)
AMO Taluka Hospital
DHOPG in Public Health
DMO (DS)PG in Clinical + Hos Adm
Programme Officer
MBBS min.qualificationPGs can also enter
District C
adre (ZP
Cadre)
Taluk
Medical Public Health
Community Health Centre
Dist. Med StoreDist. Maint UnitDist. LaboratoryDist. HMIS Unit
CHART NO. 2
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
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Lady Medical Officer Medical Officer
Staff Nurse
Pharmacist Lab Tech Sr. HA (Female)
Sr. HA(Male)
SDC Driver* Aya
JHA(F)
TBA
VHW
AWW
JHA (M) JHA(F)
JHA(F)
JHA (M) JHA(F)
JHA(F)
JHA(M) JHA(F)
* Driver for PHCs which have vehicles
CHART NO. 3
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEAVEL, PRIMARY HEALTH CENTRE
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Taluk Health OfficerDPH Qualification
Senior Health Assistant(Male & Female)
BHE's(Shift from PHC to Taluk Level)
Refractionists(Shift from PHC to Taluk Level)
ASO(Statistics person must
for HMIS)
FDC Driver
CHART NO. 4
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
TALUK HEALTH OFFICE
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DHO
Prog Co-ordinator
RCH-PO
Vector -PO
TB - PO
FW - PO
LEP+STD/HIV
Blindness PO
HP- PO
Nutri
IEC
DSO
Entm Statis
District Hospital
District Laboratory
MicrobiologistPathologistBiochemist
Dt. Maint UnitCivil works
Vehicle maintenance
Equipment maint
Dt. Medical Store
Dt. HMIS Unit
DMO
Mental-PO
CVS-PO
Opth-PO
Onco-PO
AMOs
CHART NO. 7
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STRUCTURE AT DISTRICT HEALTH OFFICES – DHO & DMO
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DIRECTORPUBLIC HEALTH
Add. DirectorAIDS
(KSPC)
Project DirectorRCH & PHC
Add. DirectorHealth Promotion
AD (CMD)State Survey Off
Chief Acc. Officer
AD-BMPUrban PHCs
JDAIDS
JDRCH
JDPHC
JDIEC
JDNut
JD-Vect Borne Dis
JDTB
JDLeprosy
JDVaccine
JDLab
DDKFD
DDDis Surv
CHART NO. 9
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
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DIRECTORMEDICAL
JDMedical
JDGMS
JD-Hosp North
JD-Hosp South
JD-Trau-Eme Med
JDOphthal(MINTO)
JD-CVS & Diabet
JD-Dent Health
JD-MH(NIMHANS)
JD-Onco(KIDWAI)
Addl DirectorMedical
Addl DirectorNCD CAO
CHART NO. 10
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
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DIRECTORExt. Aided Projects
DIRECTORProcurement & Maint
AD (SPC)Planning & Monitor
Joint DirectorPlanning
Joint DirectorHMIS
Joint DirectorProcurement
JD-Bio-Medical Equip Maintenance
Superintendent EngCivil
DD-Law & Ethics(Forensic Medicine)
Civil Engineering. Staff
as in KHSDP
Secretary PWD
CHART NO. 11
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
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DIRECTORISM&H
Directorate level
JDMed Edu
JDISM&H
Admin Officer
AccountsOfficer
Ast DrugControll
PrincipalsCol & Hosp
DDAyurveda
DDUnani
DDHomoeo
DDNat & Yog
3 Drug-Inspectors
Physician Gr IDistrict Hospital
Dt. ISM&H Officer
Phy Gr IIHosp & Disp
DDPharmacy
Div DDs?
Aided Col & Hos
CHART NO. 12
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE : PROPOSED
DIRECTORATE OF ISM&H
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PRINCIPAL SECRETARY
Governing BoardDirector
Selection PostSIHFW
(Autonomous)
Commissioner /DGHS
Directorate
Joint DirectorTraining
Joint DirectorResearch
(Social Scientist)
SpecialistsCommunication
Health MgtRCH/NCD
Deputy DirectorCourse Content
Deputy DirectorTraining
Principals RHFWTC/DTCANM Training Centres
CHART NO. 13
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE : PROPOSED
STATE INSTITUTE OF HEALTH & FAMILY WELFARE (AUTONOMOUS)
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DRUGS CONTROLLER
ADDITIONAL DRUGS CONTROLLER
Enforcement Division Drugs Testing Laboratory Pharmacy Education
Head Quarters
Drugs Price Control Cell
Bl bank & Intellig
Circle & Dt. Off
Superintendent (Admn) -1Superintendent (Lab) -1Other Technical -7Officers Junior Chemists -30
Govt. College of Pharmacy
Board of Examining Authority
Dy. Drugs Controller - 8Asst. Drugs Controller -19Drugs Inspector -56
Principal & Chairman - 1Member Secretary - 1Professor - 6Asst. Professor - 8Lectures (Pharmacy Lect) -17(Non Pharmacy) - 5
CHART NO. 14
DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTURE
DRUG CONTROL DEPARTMENT
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SECRETARYMEDICAL EDUCATION
DirectorMedical Education
Autonomous TeachingHospitals/Institutions
DEANBMC
DEANMMC
ADMed Edu
DEANGDC
*DirRIO
Vice PrlBMC
Vice PrlMMC
SuprHos 1
SuprHos 2
SuprHos 3
SuprHos 4
SuprHos 5
SuprHos 6
SuprHos 7
JDME
Vice PrlGDC
CHART NO. 15
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DEPARTMENT OF MEDICAL EDUCATION
PROFESSORS & HOD BMC / MMC
ASSOCIATE PROFESSORS
ASSISTANT PROFESSORS
LECUTRERS
REGISTRARS / TUTORS / DEMONSTRATORS/ RESIDENTS
* Regional Institute Ophthalmology (RIO) could be made into an Autonomous Institution
DD (ME) DD (DE)
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Autonom Hosp.
Drug Controller
SIHFW
Pop & Health Research
CAOFinance
CVOVigilance
DirectorPublic Health
DirectorMedical
DirectorEAP
DirectorProcurement / Maintenance
NGO Cell
PRINCIPAL SECRETARY
Commissioner / DGHS
Commission on Health
Dir. ISM&H
Secretary (ME)
Autonomous Teaching Hospital / Institute
Director (ME)
Joint DirectorSpecial Groups
Additional DirectorPlanning
Additional DirectorN. Karnataka
CHART NO. 8
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
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Rational Drug Management
• Optimization of Drug procurement – quantification, procedures
• Establishment of Standard Treatment Guidelines, Essential Drug List and State Formulary.
• Govt. Medical Stores/District Stores – reorganisation
• Drugs Control Department –Strengthening for effective supervision.
Task Force on Health and Family Welfare
Final Report
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Good Governance Karnataka Health Department
byDr.H. Sudarshan
Vigilance Director(Health,Education & Social Welfare)
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The Epidemic of Corruption in Health ServicesCorruption in Hospitals
a. Corruption in service delivery by the following:
• Ayaas/ward boys
• Contract workers
• Technicians
•Administrative Staff
• Nurses
• Pharmacist
• Doctors
• Specialists
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Various forms of Corruption by Doctors and Para Medical Staff:
• Private practice
• Nursing Homes (owned by spouses, relatives &
business partners)
• Referrals to Private Hospitals
• Owning Pharmacies
• Blood Banks
• Excess of assets over income
The Epidemic of Corruption in Health Services
Corruption in Hospitals
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The Epidemic of Corruption in Health Services
Corruption in Hospitals
b. For the following Services
• Admission
• Issuing Medical certificates
• Laboratory
• X-ray, Scanning
• Transporting patients
• Referrals
• Medical & Surgical
emergency services
• Elective Surgeries
• Deliveries
• Postmortem
• Blood Transfusion
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Epidemic of Corruption in Health Services
Drugs Control Department • Lokayukta ride on Drugs control Department –
wide spread corruption - mamools• Manufacturing License: Inspection of units for
fresh & renewal - less than 20%• Drugs collected during inspections – Low• 2268 samples declared “Not of standard Quality”
including 126 spurious drugs – very few prosecutions
• No action initiated on those who supplied spurious drugs to Health department
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Epidemic of Corruption in Drugs Control Department
• Indiscriminate issue of Loan licenses & product permissions to Loan Licensee
• 50% of the Medical shops do not have qualified pharmacists – hardly 14 prosecutions
• Violation of DPCO – people of Karnataka have paid nearly 100 crores in excess
• Complaints given by public & institutions were not attended.
• Trading of blood by Unlicensed Blood Banks & chemists, HIV infected blood sold
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Corruption in Procurement of Drugs
• Purchase of Non Essential Drugs – Nemisulide Tabs 18% of budget
• IV fluids scam – Bypassing HAL and buying from PDPL
• Decentralized Corruption in Procurement of drugs by Zilla Panchayaths – buying spurious and substandard drugs from unlicensed manufacturers – excess price.
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The Epidemic of Corruption in Health Services
Corruption in Civil Works: Construction of PHCs, CHCs,
Taluka & District Hospitals and Repairs.
Corruption in Administration:at offices of District
Health, Directorate & Secretariat for the following
• Recruitment & Postings,
• Transfers & Promotions
• Sanctioning Leave, Medical reimbursement
• Monitoring Private Practice & Absenteeism
• Suspension and Reinstating
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The Epidemic of Corruption in Health Services
Corruption in Medical Education
• Sanctioning New Colleges - Medical, Nursing & ISM&H
• Increasing seats of Nursing Colleges
• Admissions
• Examination: bribes for examiners-Undergraduate & PGs
• Recruitment of Teaching Staff
• Registration in KMC.
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Reforms for Good Governance in Health
• Proactive Lokayukta
• Consumer Forum
• Transparency Act
• Right to Information Bill
• Training in Health & Hospital management
• Leadership training
• HMIS & e-Governance
• Hospital & Health Committees
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