venkat chekuri hon. joint secretary, vgkk & karuna trustaphrdi/2018/1-jan/hea… · based...
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by
Venkat Chekuri
Hon. Joint Secretary,
VGKK & Karuna Trust
“Reaching Health Care
to the Unreached”
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Equity in Health Care
• We have PET, MRI and we can do heart
transplants
• But we have very few functional laboratories
in PHCs and people do not get treated for hook
worm anemia!
• Health services for SCs and STs
• Out of pocket expenditure for the poor– 70%.
Mostly spent on drugs & diagnostics.
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Health Financing
• 0.9 to 1.6 of GDP – promised 2-3%
• Public vs Private spending 1.2% - 3.3% or
33%– 67% has to be reversed.
• Per capita public spending of Rs 675/- is
inadequate. Primary Health Care (PHC) is less
than Rs. 200/-
• Out of pocket expenditure is 70%
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Quality in Health Care
• Poor quality in both public and private
• IPHS standards
• Accreditation: NABH, ISO, in house Quality
Control Cells (QCC)
• Corruption in public & private sector
• MCI and State Medical Councils
• Quality of Drugs
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‘Reaching the Unreached’
• Started in Veerappan’s area
• Extended to Naxalite & insurgency areas
• Remote, hilly, tribal areas
• No electricity, no telephone connectivity, bad
roads - cut off during rainy season.
• Poor or unavailable public & private facilities
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Vivekananda Girijana Kalyana
Kendra
VISION
A self reliant and empowered tribal society rooted in its culture & tradition, living in harmony with nature.
MISSION
Sustainable development of tribal people through rights based approaches to health, education, livelihood
security and biodiversity conservation.
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B.RHills
B.R. Hills
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Soliga Tribal people
• ‘Children of Bamboo’
• Veddoid group of aborginals. Pre-dravidian or
early-dravidians
• Shifting cultivation, food gathering and
hunting
• Lived in harmony with nature – ‘nature
worshipers’
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Megalithic (800 BC) Burial Sites
B R Hills
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Tribal Health Care
• Comprehensive Primary Health Care:
Preventive Promotive .
Curative Rehabilitative
• Understanding traditional health and
integrating/ building on it.
• Empowering people to manage their health
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Tribal Education
• Started with 6 children in a hut – 1981
• 4 of them have done Post Graduation
• Jadyea has done MSc in Agriculture and
completed his PhD – Asst. Professor in
Forestry College – President of VGKK
• 2 MSWs & 1 MSc in Botany
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Innovations in Education
1. Experiential learning
2. Life skills education
3. Computers in education
4. Value based education
5. Social work curriculum
6. Personality development
7. Environmental education
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Women’s Self Help Groups
• Tribal women self help groups (SHGs) – 24
groups
• Micro credit: money lenders eliminated.
• Income generating activities: food processing,
bakery, weaving, hand made paper, herbal
medicines, dairy (with the help of Vetcare)
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Technology & Resource Centre
• Food processing
• Organic farming
• Conservation, cultivation and commercialisation of
medicinal plants
• Alternate / cost effective rural building
• Sanitation & drinking water
• Rain water & roof water harvesting.
• Income generation & other rural development
activities
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Community Organisation
• Soliga Abhivriddi Sanghas (SAS): village, taluka
and district level.
• Active participation in Panchayat Raj System
• Need based planning done by SAS and submitted to
ZP
• Land alienation and other exploitation stopped
• Taking active role in education of tribal children.
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Gorukana Ecotourism
Empowering Communities
Through Conservation Tourism
To facilitate the empowerment and sustainable development of
people living in B R Hills, by forging unique partnerships
between tourism initiatives, conservation and communities.
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The B.R Hills Wildlife Sanctuary
• BRT houses amazing number of animals including
tiger, leopard, wild dog, elephant, gaur, deer etc.
• Over 220 species of birds including black eagle,
Malabar whistling thrush etc.
• 800 plus species of plants from various families
and shows a close affinity to the Western Ghats.
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Biligiri
Conservation Through Tourism
Care for the
LandCare for the
People
Care for the
Wildlife
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Adventure
Guest
Soligas
BR Hills
Land &
Wildlife
Local economic
development
Skills development
through employment
Health & education
facilities
Benefits:
Benefits:
Memorable
Adventure holiday
Knowledge
acquisition
Environmental and
Social understanding
Maintenance of
biodiversity
Expansion of green
frontiers
Conservation of
Threatened species
Benefits:
The Biligiri Model
Conservation
Tourism
Experience100% eco-friendly wilderness lodge
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Coverage
• Karnataka: Soliga, Jenu Kuruba, Betta Kuruba,
Yeravas,
• Arunachal Pradesh: Nocte, Wancho, Adi , Galo,
Mishimi, Nyshi
• Meghalaya: Khasis, Garos, Jaintias
• Andaman & Nicobar Islands: Great Andamanese,
Jarawas, Schompens, Onges, Sentinels
• Andhra Pradesh: Adilabad – Gonds, Kolams
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Primitive Tribal Groups in
Andaman & Nicobar Islands
• Great Andamanese of Strait Island
• Onges of Little Andaman
• Jarawas of South and Middle Andaman
• Shompens of Great Nicobar
• Sentinelese of Sentinel Islands
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Karuna Trust
• Founded in 1986
• Response to high prevalence of leprosy in
Yelandur- 21.4/1000 in 1987 to 0.2/1000 in
2005
• Community based, people oriented, need
based, culturally acceptable models using
appropriate technology with minimum cost to
the community
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Private Sector
• Private Sector is an important player
• 80% of out patient care, 50% of inpatient care
is by private sector – 90% of preventive and
promotive health care is by public sector
• Involving private sector – purchasing the
services for BPL – Yashaswini, Arogya Shree,
RSBY.
• Regulating/accrediting private sector
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Public Private Partnership
• Public – Government
• Private – For-profit private sector & not-for-profit sector ( NGOs, VOs)
• Privatisation: Partnership with not for private sector is not privatisation
• Partnership: It is not being “contractors” for implementation of Government Programs. Partnership in policy formulation, planning, implementation, monitoring, evaluation, training & research
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Karuna Trust – PPP in India
• Karnataka State:
26 PHCs - one in each District
2 PHCs through other NGOs – Vivekananda Foundation &
Vemana Trust
Eye Hospital – Chamarajanagar Dt.
7 Mobile Medical Units (MMU)
Help Desk at two district hospitals.
FRU in Santhemaranahalli CHC, Chamarjanagar Dt
District Health Management – Tumkur Dt.
• Arunachal Pradesh – 11 PHCs
• Meghalaya State – 11 PHCs
• Manipur – 3 PHCs
• Odisha State – 6 PHCs
• Rajasthan – 12 PHCs
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Comprehensive Primary Health
Care
• Rights based empowerment of people for managing
their health – Right to Health, Reproductive Rights.
• Community based Preventive, Promotive, Curative
and Rehabilitative services
• Mother & Child Health, all National Health
Programs and specific local problems.
• Addressing all other determinants of health – safe
water, sanitation, nutrition, livelhood etc.
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Kammasandra
PHC
Needle pit
Labour room
development
Drugs, vaccines etc
Labour
wardIDP
Emergency Kit
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PPP – The Process
Advocacy with respective state government
Expression of interest / direct application
Identification of PHCs – poor performance, remote / tribal areas
Dialogue with community and PRI members
Applying to ZP / state, sharing draft MoU
Finalising MoU
Recruitment and induction training
Withdrawal of govt. staff – option for continuing at PHC
Formal takeover of the PHC from DHO
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58% 56%62%
77%
93%96%
0%
20%
40%
60%
80%
100%
120%
Percentage (%) of institutional
deliveries in
26 Karnataka PHCs
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Infant Mortality Rate (IMR) in 26
PHCs of Karnataka State
20 20
2221
18
13
11
8.3
0
5
10
15
20
25
2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
Rate
Year
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254
81
0
50
100
150
200
250
300
National Average Karuna Trust PHC's
MMR
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Innovations in Health Care
• Process Innovations : Innovations in Health
care delivery, good governance, community
participation
• Integrating traditional health practices
• ICT innovations: telemedicine, cell phone,
tablets, drones
• Appropriate technology
• Cost effective health care delivery
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Innovations in Primary Health Care
Mental Health Program including epilepsy in PHC, lowcost management of epilepsy in PHC
Introducing Dental Health & Cancer Control Program inPHC – ANMs trained to take Pap Smears etc.
Vision Centers in PHCs
Integration of Rehabilitation (Palliative Care) into PrimaryHealth Care in addition to preventive, promotive & curativehealth care.
Promotion of Traditional Medicine – 20 herbs for PrimaryHealth Care. Integration of Ayurveda & Homeopathy(AYUSH)
Tribal ANMs program: training tribal girls as ANMs andposting them in the tribal sub-centers.
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Innovations in ICT
• Telemedicine/ ECHO
• Logistimo –Supply chain management of drugs– cell
phone
• Sensors for monitoring of Cold Chain
• Drone for delivering emergency drugs
• Empowering health-workers with tablets and android
phone – Dtree, EMC2
• Digitization of health records of 23,000 people at
Gumballi PHC
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ASHA Training
• Training of ASHA’a in 3 tribal Districts of
Karnataka
• In collaboration with NGOs in the Districts
• Nearly 3000 ASHAs already training.
• Supervision and Monitoring.
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Community Health Insurance
• NGO, Government and UNDP
• Women’s self help groups - micro-credit for
out-patient care
• Pre-paid insurance for inpatient care -
hospitalization
• Lowest premium of Rs.30/- (50 cents) per
person per year, 100,000 people.
• National Insurance Company – No exclusions
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Health Insurance/ Health
Assurance
• Karuna Trust – Community Health
Insurance
• RSBY - Labor Department
• Yashashwini – Cooperative Department
• SAST: 1.Vajpayee Arogyashree, 2. Rajiv
Arogyabhagya, 3. Jyothi Sanjeevini, 4.
Mukhyamantrigala Santwana - Harish
Scheme
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Present and Scaling up States
Boisor
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Protocol for Emergency Care
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• To integrate traditional medicines into PHC
• To make a rapid assessment and validation of sound local practices.
• To develop a cadre of ArogyaMitras to cater to the preventive, promotive and curative needs of the community
• To advocate for policy on mainstreaming the traditional medicine into official primary health care system.
Mainstreaming Traditional
Medicine in to PHCs
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Management of Cancers in
Women at PHCs
• Cervical and breast cancers
• Early detection, referrals and after care
• Training Nurses, ANMs and ASHAs in visual
inspection for early detection of cervical cancers.
• Management of STDs and RTIs
• Cryotherapy for premalignant lesions – Train
medical officers.
• Specialist clinics at PHCs
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ASHA Training
• Training of ASHA’a in 3 tribal Districts
of Karnataka
• In collaboration with NGOs in the
Districts
• Nearly 3000 ASHAs already training.
• Supervision and Monitoring.
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Community Planning &
Monitoring
• Pilot of NRHM in 9 States
• Karuna Trust – Nodal agency for Karnataka
• Implemented in 4 districts in partnership with
local NGOs
• 49 PHCs & 562 Villages covered
• VHSC & RKS capacity building
• Village health plan and report cards
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Community
Participation
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Scaling Up – 5 states
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Karuna Trust
Arunachal Pradesh
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PPP for Primary Health Care in
Arunachal Pradesh
• Year 2005
• To improve the health facilities in the state
• One Primary Health Centre (PHC) in each
district of the state will be managed and
operated through a selected non government
organization (NGO)
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PHC Bameng
• 380 km. from Itanagar in East Kameng district
• The mud road from Seppa to Bameng is very
often blocked by landslides
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Then…
…now
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PHC Wakka
Wakka PHC, Tirap Dist
Wakka PHC staffs
Labour roomX-Ray room
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PHC Jeying
PHC building 2007 PHC staff in front of quarter
Medical officer in front of his quarterA view of staff quarter
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Road to PHCs
Road to PHC Bameng
Brahmaputra river crossing Road to Dambuk- Anpum
Road to Etalin
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Brahmaputra Delta
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Road to PHCs
Road to Dambuk & Anpum
Road to Dambuk & Anpum Road to Etalin
Road to Walong
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District Water Quality Management
• Monitoring water quality in Chamarajanagar
and Chikkaballapur districts of Karnataka.
• Flouride, Arsenic, Nitrates and Chlorites.
• Convergence between the Health Department
(Bacteriological Contamination) and RDPR
Department (Chemical contamination).
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Quality in Health Care
• NABH Accreditation for Gumballi PHC
– First PHC to get it other than Gujarat
State.
• Standard Operating Procedures (SOPs)
• 14 PHCs and the FRU accreditation in
process.
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Cost Benefit
• PPP 75% to 90% to 100%
• Cost of Primary Health Care: Per
capita cost Rs.180/- for one year
• Spend less than Government
• Better Health out comes
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Present and Scaling up States
Boisor
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OBJECTIVE AND THE PATH
Objective:
Achievement of Equity, Quality and Integrity in
Health Care
The Path:
Revamping the organisation and structure
Capacity Building
Task Force on Health and Family
Welfare
Final Report
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• 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
Karnataka State Integrated Health
Policy
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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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GOOD GOVERNANCE IN
HEALTH
By
Dr. H. Sudarshan
Ex-Vigilance Director
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Year Score Rank First Rank Last Rank
1995 2.78 34/41 New Zealand Indonesia
2000 2.80 69/90 Finland Nigeria
2005 2.90 88/158 Iceland Bangladesh & Chad
2006 3.30 74/163 Iceland Haiti
2007 3.50 72/180 New Zealand Myanmar/Somalia
2008 3.40 85/180 Denmark Somalia
2009 3.40 84/180 New Zealand Somalia
2010 3.30 87/178 Denmark, NZ Somalia
2011 3.10 95/182 New Zealand Somalia
2012 3.60 94/174 Denmark, Somalia
2013 3.60 94/175 Denmark Somalia & N Korea
2014 3.80 85/174 Denmark Somalia & N Korea
2015 3.80 76/167 Denmark Somalia & N Korea
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85
The India Corruption Study 2005
by Transparency International India
State C. Index Rank
Kerala 240 1
Him Pradesh 301 2
Gujarath 417 3
Andhra Pradesh 433 4
Maharashtra 433 5
Chattisgarh 445 6
Punjab 459 7
West Bengal 461 8
Orissa 475 9
Uttar Pradesh 491 10
State C.Index Rank
Delhi 496 11
Tamil Nadu 509 12
Haryana 516 13
Jharkhand 520 14
Assam 542 15
Rajasthan 543 16
Karnataka 576 17
M.P. 584 18
J & K 655 19
Bihar 695 20
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Reforms for Good Governance in
Health Services
Proactive Lokayukta – Ombudsman for PRI and
active monitoring – institutionalize the reforms
Vigilance cell in Health Department – Strengthen and
capacity building – expertise
E-Governance: HMIS – Program and HRM,
computerize transfers, recruitment, promotions, e-
procurement, web site for transparency and
accountability
Integrity Pact – black listing and debarring
Effective management and supervision by
administrators and senior staff – Field visits
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87
Good Governance
• Mere technological packages can
improve the health outcomes
marginally
• Good governance can provide
quantum jump in the health outcomes
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3 Qualities for a Leader
1. Concern and Empathy for the poor &
marginalized
2. Ability to understand their problem and find
a solution.
3. Will to put in to practice in spite of
insurmountable obstacles
Be & Make – Integrated personality – “Self –
love”, “Self-hatred” & “Love for others”
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Transforming India through Quality
Leadership
• Working as a team – Net working
• Living practitioners of values – Human Resources
for Development
• Inner strength - Moral/ Spiritual
• “My life is my message” – M K Gandhi
• “They alone live who live for others; others are
more dead than alive” – Swami Vivekananda
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MANASA – Care of Homeless,
Mentally Ill WomenThe activities of Manasa are:
1. Rescuing homeless, mentally ill women roaming in the streets
2. Providing psychiatric and other healthcare at Transit Care Centre for 6 to 8 months
3. Rehabilitation and reintegration with the families
The cost of providing the above care is about Rs.50,000/- per
patient X 25 patients
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Cost of Providing Comprehensive
Primary Health CareCost of Comprehensive Primary Health Care:
Per capita cost Rs. 180/- for one year. Rs. 45
lakhs per PHC with 25,000 population.
Government pays 90% of the cost and KT has
to raise 10%+
Supporting Primary Health Care in North East
Arunachal Pradesh, Meghalya and Manipur
10% cost Rs. 4.5 lakhs per PHC x 25 PHCs
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Vivekananda Eye Hospital and
Blindness Control Program
Karuna Trust runs blindness control program for the
poor people of Chamarajanagar District
We identify cataract cases and provide free surgeries
including intraocular lenses.
Annually we conduct about 1000 surgeries
In addition to the what the Govt
provides we need an additional Rs.500/-
per surgery x 1000
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Mobile Dental Unit
Yelandur taluk, Chamarajanagar
Dt., Karnataka
Dental Health care is available only at district
and a few sub-district hospitals.
Karuna Trust runs a model Mobile Dental
Unit to go round the Villages to provide
dental health care.
The mobile unit donated Rotary Club,
Bangalore has dental chair with X-ray.
Cost of running Mobile Dental Unit per
month is about Rs. 30,000/- x 12 months
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Karuna America: Team
Srinivasa Bhat
Secretary
Dr. H Sudarshan
Hon. Chairman
Dr. Surya Prakash
President
Vijay Kotrappa
Treasurer
Majunath Subbarao
Director
Dr. Arvind Halliyal
Director
Dr. Makum L. Ramesh
Director
B.V. Muralidhara
Director
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Tax Exempt 501(c)3
Organization
US 501c-3 Fully Federal and State Tax
Exempt Organization.
Donations are tax exempt
Tax ID#: 47-4565265
21 Silverwood Lane, Pomona, CA
91766
Email: [email protected]
Web site: www.karunaamerica.org
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Partner Organizations
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Potential Partners
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Here's what you need to do.
Login to you Amazon account.
Open another tab/window and go to http://smile.amazon.com
In the search window, on the right side bottom, enter Karuna America.
Select the right organization (from Pomona)
If you are logged in to your Amazon account, it will get redirected and tell you that the selected organization has been added and 0.05% of your purchases will be donated to the organization
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Ways to Give