Health Sector Reforms
in
Karnataka State
By
Dr. H.Sudarshan
Karuna Trust
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
Public Private Partnership
Task Force on Health and Family Welfare
• 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.
Task Force on Health and Family Welfare
Final Report
1.
2.
3.
4.
5.
6.
12 Major Issues of Concern
Corruption
Neglect of Public
Distortions in Primary Health Care
Lack of Focus on Equity
Implementation Gap
Ethical Imperative
Task Force on Health and Family Welfare
Final Report
7.
8.
9.
10.
11.
12.
12 Major Issues of Concern
Human Resource Development
Cultural Gap and Medical Pluralism
From Exclusivism to Partnership
Ignoring the Political Economy of Health
Research
Growing Apathy in the System
Task Force on Health and Family Welfare
Final Report
Contents
1.
2.
3.
4.
5.
6.
7.
8.
Equity in Health Care
Quality of Health Care
Primary Health Care
Secondary and Tertiary Health Care
Public Health
Mental Health and Neurosciences
Nutrition
Women and Child Health
Task Force on Health and Family Welfare
Final Report
Contents
9.
10.
11.
12.
13.
14.
15.
16.
Population Stabilisation
Focus on Special groups
Health Promotion and Advocacy for Health
Human Resources Development for Health
Research in Health
Health Systems Management
Health Financing
Rational Drug Management
Task Force on Health and Family Welfare
Final Report
Contents
17.
18.
19.
20.
21.
22.
23.
24.
25.
Law and Ethics
Indian Systems of Medicine and Homoeopathy
Panchayat Raj and Empowerment of People
Strengthening of Partnership
Multisectorality and Intersectoral Co-ordination
The Karnataka State Integrated Health Policy 2001
Vision 2020
Implementation of the Report
Major Recommendations and Expected Outcome
Task Force on Health and Family Welfare
Final Report
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
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.
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
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
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 Insurance
2. Yashaswini Scheme
3. Arogya Raksha Project
Health Systems Management
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
Re-organization & Re-structuring
of
Karnataka Health & Family
Welfare Department
Health Systems Management
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
CHART NO. 2
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
Public Health
Medical
DMO (DS)
PG in Clinical + Hos Adm
Dist. Med Store
Dist. Maint Unit
Dist. Laboratory
Dist. HMIS Unit
AMO
Taluka Hospital
Programme Officer
Taluk
Taluk Health Officer
(THO)
Community
Health Centre
Medical Officer
PHC
MBBS min.qualification
PGs can also enter
State cadre (KHS)
PG qual. compulsory
Merit cum seniority
District Cadre (ZP Cadre)
Deputy DMO/RMO
DHO
PG in Public Health
CHART NO. 3
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEAVEL, PRIMARY HEALTH CENTRE
Medical Officer
Lady Medical Officer
Staff
Nurse
JHA
(F)
Pharmacist
JHA (M)
Lab Tech
JHA
(F)
JHA
(F)
Sr. HA
(Female)
JHA (M)
Sr. HA
(Male)
JHA
(F)
SDC
JHA
(F)
Driver*
JHA(M)
Aya
JHA
(F)
TBA
VHW
AWW
* Driver for PHCs which have vehicles
CHART NO. 4
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DISTRICT LEVEL
TALUK HEALTH OFFICE
Taluk Health Officer
DPH 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. 7
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STRUCTURE AT DISTRICT HEALTH OFFICES – DHO & DMO
DHO
DMO
District Hospital
District Laboratory
Prog Co-ordinator
DSO
Microbiologist
Pathologist
Biochemist
RCH-PO
Entm
Statis
Mental-PO
CVS-PO
Dt. Maint Unit
Vector -PO
Civil works
Vehicle maintenance
Equipment maint
TB - PO
Opth-PO
Onco-PO
FW - PO
Dt. Medical Store
LEP+STD/HIV
Dt. HMIS Unit
Blindness PO
Nutri
HP- PO
IEC
AMOs
CHART NO. 9
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
DIRECTOR
PUBLIC HEALTH
Add. Director
AIDS
(KSPC)
JD
AIDS
JD
RCH
Add. Director
Health Promotion
Project Director
RCH & PHC
JD
PHC
JD
IEC
JD
Nut
AD (CMD)
State Survey Off
JD-Vect
Borne Dis
DD
KFD
JD
TB
DD
Dis Surv
Chief Acc.
Officer
JD
Leprosy
AD-BMP
Urban PHCs
JD
Vaccine
JD
Lab
CHART NO. 10
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
DIRECTOR
MEDICAL
Addl Director
NCD
Addl Director
Medical
JD
Medical
JD
GMS
JD-Hosp
North
JD-Hosp
South
JD-TrauEme Med
JD
Ophthal
(MINTO)
JD-CVS
& Diabet
JD-Dent
Health
CAO
JD-MH
JD-Onco
(NIMHANS)
(KIDWAI)
CHART NO. 11
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
DIRECTOR
Ext. Aided Projects
DIRECTOR
Procurement & Maint
AD (SPC)
Planning & Monitor
Joint Director
Planning
Secretary PWD
Joint Director
HMIS
DD-Law & Ethics
(Forensic Medicine)
Joint Director
Procurement
JD-Bio-Medical
Equip Maintenance
Superintendent Eng
Civil
Civil Engineering.
Staff
as in KHSDP
CHART NO. 12
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE : PROPOSED
DIRECTORATE OF ISM&H
DIRECTOR
ISM&H
Directorate level
JD
Med Edu
DD
Ayurveda
JD
ISM&H
Admin
Officer
Accounts
Officer
DD
Unani
DD
Homoeo
DD
Nat & Yog
Physician Gr I
District Hospital
Dt. ISM&H Officer
Phy Gr II
Hosp & Disp
Ast Drug
Controll
3 DrugInspectors
Principals
Col & Hosp
Aided
Col & Hos
DD
Pharmacy
Div DDs
?
CHART NO. 13
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE : PROPOSED
STATE INSTITUTE OF HEALTH & FAMILY WELFARE (AUTONOMOUS)
PRINCIPAL
SECRETARY
Governing Board
Joint Director
Training
Director
Selection Post
SIHFW
(Autonomous)
Joint Director
Research
(Social Scientist)
Deputy Director
Course Content
Deputy Director
Training
Commissioner /
DGHS
Directorate
Specialists
Communication
Health Mgt
RCH/NCD
Principals RHFWTC/DTC
ANM Training Centres
CHART NO. 14
DEPARTMENT OF HEALTH & FAMILY WELFARE – ORGANISATIONAL STRUCTURE
DRUG CONTROL DEPARTMENT
DRUGS CONTROLLER
ADDITIONAL DRUGS
CONTROLLER
Drugs Testing Laboratory
Enforcement Division
Head
Quarters
Drugs Price
Control Cell
Bl bank
& Intellig
Dy. Drugs Controller - 8
Asst. Drugs Controller -19
Drugs Inspector
-56
Circle &
Dt. Off
Superintendent (Admn) -1
Superintendent (Lab) -1
Other Technical
-7
Officers
Junior Chemists
-30
Pharmacy Education
Govt.
College of
Pharmacy
Board of
Examining
Authority
Principal & Chairman
-1
Member Secretary
-1
Professor
-6
Asst. Professor
-8
Lectures (Pharmacy Lect) -17
(Non Pharmacy)
-5
CHART NO. 15
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
DEPARTMENT OF MEDICAL EDUCATION
SECRETARY
MEDICAL EDUCATION
Autonomous Teaching
Hospitals/Institutions
Director
Medical Education
DEAN
BMC
*Dir
RIO
AD
Med Edu
DEAN
MMC
Vice Prl
Vice Prl
BMC
MMC
Supr
Hos 1
Supr
Hos 2
Supr
Hos 3
Supr
Hos 4
DEAN
GDC
Supr
Hos 5
Supr
Hos 6
PROFESSORS & HOD BMC / MMC
Supr
Hos 7
Vice Prl
JD
ME
DD (ME)
GDC
DD (DE)
ASSOCIATE PROFESSORS
ASSISTANT PROFESSORS
LECUTRERS
REGISTRARS / TUTORS / DEMONSTRATORS/ RESIDENTS
* Regional Institute Ophthalmology (RIO) could be made into an Autonomous Institution
CHART NO. 8
DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL
Autonom Hosp.
PRINCIPAL
SECRETARY
Commission on
Health
Secretary (ME)
Drug Controller
Commissioner / DGHS
Dir. ISM&H
Autonomous Teaching
Hospital / Institute
SIHFW
Director (ME)
Pop & Health Research
CAO
Finance
CVO
Vigilance
Director
Public Health
Joint Director
Special Groups
Director
Medical
Additional Director
Planning
Director
EAP
Director
Procurement /
Maintenance
Additional Director
N. Karnataka
NGO Cell
Task Force on Health and Family Welfare
Final Report
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.
Good Governance
Karnataka Health Department
by
Dr.H. Sudarshan
Vigilance Director
(Health,Education & Social Welfare)
The Epidemic of Corruption in Health Services
Corruption in Hospitals
a. Corruption in service delivery by the
following:
• Ayaas/ward boys
• Nurses
• Contract workers
• Technicians
•Administrative Staff
• Pharmacist
• Doctors
• Specialists
The Epidemic of Corruption in Health Services
Corruption in Hospitals
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
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
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
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
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.
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
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.
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
THANK YOU