Envisaging a healthy growth

Published : Sep 10, 2004 00:00 IST

The state-run health care system in Karnataka is striving hard to overcome problems such as regional disparities and regain its former standards. At the same time, health services in the private sector, especially the multi-speciality hospitals, have earned a reputation for themselves.

in Bangalore

THE Princely State of Mysore was a pioneer in basic health care. In 1806, it was perhaps the first State in the country to take up a vaccination drive against small pox. The State administration set up a government hospital in Bangalore in 1846, the first public health unit in Mandya in 1929 and the world's first two birth control clinics in 1930. But after Independence, the State of Karnataka, which churns out around 1,800 doctors every year, has been striving to keep up with those standards, especially in the rural areas.

Karnataka, like any other State, is full of regional, even sub-regional disparities in the matter of development. The health infrastructure in certain regions, most notably the State's capital, Bangalore, and to a lesser extent the coastal towns of Mangalore and Manipal, has developed well but other areas, especially the rural areas where 60 per cent of the population lives and the northern districts, have not received sufficient attention from the government and the private sector.

Overall, the State has a crude birth rate of 22 (for every 1,000 of the population), a crude death rate of 7.2, an infant mortality rate of 55 per 1,000 live births, a maternal mortality rate of 195 per one lakh live births and a total fertility rate (the number of children born to a woman during her reproductive years) of 2.2.

The State's Health and Family Welfare Services has 8,143 sub-centres (that is, one for 5,000 people), 581 Primary Health Units (PHUs), 1,679 Primary Health Centres (PHCs), 19 mobile units, 7,304 maternity annexes, 17 urban PHCs and 110 Community Health Centres. While the doctor-population ratio is 1:10,260, the bed to population ratio is 1:1,220. In a novel scheme to improve services, the government has allowed 14 PHCs to be managed by medical colleges and trusts. At these PHCs, 75 per cent of the staff salary is paid by the government and 25 per cent by the private entrepreneur.

There are 87 Urban Family Welfare Centres, 124 Urban Health Centres and 24 district-level and 149 taluk-level hospitals. There are 51 other hospitals, including super-speciality hospitals, which treat illnesses like cancer, heart ailments and tuberculosis. As part of the World Bank-funded Karnataka Health Systems Project, the State government has over the past seven years strengthened and upgraded at a cost of Rs.624 crores the infrastructure in 204 of its taluk and district hospitals. As a consequence, six government hospitals have won ISO-9002 certification. Under the project, user charges are levied in taluk and district hospitals, non-clinical services in some hospitals have been privatised and 44 primary trauma care centres established to provide emergency services to accident victims.

Treatment is free for those below the poverty line (BPL) for almost all services in the State government hospitals. For specialised treatments such as cardiac surgeries, BPL families can get up to Rs.50,000 from the Chief Minister's Relief Fund. The government has also been sanctioning Rs.50,000 twice a year to each of the district hospitals, which can use the fund to buy from the private sector medical services that are not available with them.

There are around 22,000 practising doctors in the State. Of them, 4,197 are working in the State's health institutions and about 15,000 in the private sector. The total bed strength in government health institutions is 43,479 while their outpatient departments serve 60,000 patients every day. There are nearly 2,000 hospitals in the private sector, which interestingly have as many beds as the state sector.

According to officials, the shortage of doctors and supervisory staff, financial crunch and an ever-increasing population are some of the major reasons for the state sector's inability to provide a more effective health delivery system. The shortage of doctors, especially specialists, and funds forced the government to hand over in April 2002 part of the management of the Rajiv Gandhi Super Speciality Hospital in Raichur to Apollo Hospitals. Under an agreement, the Karnataka government pays for the maintenance cost of Rs.3 crores to Rs.4 crores a year.

As a result of the funds crunch only a half of the State's 8,154 sub-centres have permanent buildings.

Karnataka has slipped from the sixth place to the seventh in the Human Development Index. And on most human development indices, Karnataka is barely above the all-India average.

In a bid to achieve the "Millennium Development Goals", the Congress-Janata Dal (Secular) coalition government has decided to make primary health care (and primary education) the focus of its development effort. Presenting the new government's first Budget, Deputy Chief Minister Siddaramaiah announced an increase in the Plan outlay for the health sector from Rs.333 crores to Rs.377 crores, which would be utilised to improve taluk-level hospitals and the medical infrastructure in impoverished northern Karnataka. The enhanced outlay should partly stabilise the State's falling public health expenditure, which had fallen from 1.02 per cent of the gross state domestic product (GSDP) in 1999 has fallen to 0.7 per cent in 2004. Ideally it should reach 2 per cent of GSDP.

Under the Rs.765-crore World Bank-assisted `Health, Nutrition and Population (HNP) Project' the government hopes to improve and extend the primary health care system. The focus of the five-year programme "is to increase access to health care for the rural poor and the underprivileged, and to strengthen primary health care with community participation".

Says Mohamed Sanaulla, Commissioner, Health and Family Welfare Services: "Our aim is to stabilise and improve facilities. It is a misnomer to say that the services at government hospitals are not good. In fact, our understanding is that, especially in the rural areas, the level of satisfaction among the people is better with the government health service. People are even prepared to pay `unregistered' (bribe) expenses."

IN a bid to ensure effective primary, secondary and tertiary health delivery systems in the State, successive Karnataka governments have implemented a number of measures. The HNP Project seeks to improve the services at the 1,679 PHCs. To be implemented in three districts as a pilot project, this will also aim at increasing public-private participation and introducing an insurance scheme for the common people, with the government subsidising the premiums.

The Rs.30-crore World Bank-aided Integrated Disease Surveillance Project, spread over five years, is designed to gather initially information regarding communicable diseases such as malaria, cholera, gastroenteritis and typhoid. Information on non-communicable diseases like cancer and hypertension, and trauma care will be compiled later. An information technology network has already been established at the taluk and district levels. The information thus gathered from the district, State and national levels will be analysed and utilised for more effective diagnosis, management and prevention of communicable diseases.

The State is also giving shape to the Rs.15-crore European Union-funded Drug Logistics and Warehousing Project, under which 14 warehouses will be set up in the districts. The current system of indenting for packages would be replaced by the indenting for drugs. As part of it telemedicine programme, five private speciality hospitals are being connected via satellite to 25 district and four taluk hospitals. The system is functioning in two hospitals. The private hospitals have offered free consultations. The Indian Space Research Organisation (ISRO) has set up the satellite link at a cost of Rs.35 crores.

Karnataka is also hoping to improve the birth rate, infant mortality and maternal mortality parameters in the State when the Government of India's Reproductive and Child Health-Phase II programme is implemented in 2005. The State government has set up regional diagnostic laboratories in seven districts to conduct sophisticated tests, including CT scans.

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