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.