Soliga Tribal people Children of Bamboo Veddoid Group of - - PowerPoint PPT Presentation

“Reaching the Unreached” Karuna Trust & Vivekananda Girijana Kalyana Kendra

By

Dr.H.Sudarshan

Secretary VGKK & Karuna Trust Former Chairman, Task Force on Health & Vigilance Director, Karnataka Lokayuktha

Soliga Tribal people

• Children of Bamboo
• Veddoid Group of Aborginals. Pre-

dravidian or early Dravidians

• Shifting Cultivation. Food gathering and

hunting

• Lived in hormony with Nature – Nature

worshipers

B.RHills

B.R Hills

Evolution of Tribal Development

• Started Curative Health Services
• Woophing Cough epidemic – initiated

Community Health

• “I had no pills for poverty” - Land rights

issue – Community Development

• Conservation of Biodiversity and

Livelihood of tribal people – Sustainable Development

Tribal Education

• Started with 6 children in a hut – 1981
• 4 of them have done Post Graduation
• Jadyea has done MSc in Agriculture and

completing his PhD – Asst Professor in Forestry College – President of VGKK

• 2 MSWs & 1 MSc in Botony

Activities - Health

Vivekananda Tribal Health Centre 20-bedded tribal hospital with X ray, laboratory, pharmacy providing free health care to the tribals Caters to over 20000 Soliga tribals and a few other forest-dwelling tribals of Chamarajanagar district Trained tribal youth as health workers, X ray technicians, laboratory technicians and nurses

Activities - Health

Mobile Medical Unit Doctor with a tribal health worker and driver Carries all essential drugs Curative services School and Anganwadi health check-up Community mobilization and social action Emergency care and referral

Activities - Health

Traditional Knowledge

Integration of authenticated and proven traditional practices : Delivery in sitting posture,

Single herbal remedies for routine ailments

Sickle Cell Anemia screening

Screening and documentation of Soliga population with case records

Livelihood security & Biodiversity conservation

• Conservation of Biodiversity and

Livelihoods of Forest Dwelling Tribes can go together.

• Tribal people and VGKK helping

Forest department in fighting against threats to Biodiversity – Granite Quarrying, Poaching & Smuggling..

Women Self Help Groups

• Tribal women Self help Groups
• Micro credit: Money lenders

eliminated.

• Income Generation Activities: Food

processing, Bakery, Weaving, Hand made paper, Herbal Medicines, Dairy, etc.

Community Organisation

• Soliga Abhivriddi Sanghas(SAS): Village,

Taluka, 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.

Gorukana Ecotourism

A Social Enterprise

Empowering communities through conservation tourism

To facilitate the empowerment and sustainable

development of people living in BR Hills, by forging unique partnerships between tourism initiatives, conservation and communities.

The B.R Hills Wildlife Sanctuary

• BRT houses amazing number of animals

including the tiger, leopard, wild dogs, 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.

Karuna Trust

“Our vision is for a society in which we strive to provide an equitable and integrated model of Health care, Education and Livelihoods by empowering marginalized people to be self reliant” “Our Mission is to develop a dedicated service minded team that enables holistic development

• f marginalized people, through innovative,

replicable models, with a passion for excellence”

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

Public Health Challenge : Neglect of Primary Health Care

• Comprehensive Primary Health Care –

Alma Ata Declaration – India a signatory

• Poor Primary Health Care infrastructure
• Non-functional PHCs - Doctor’s not willing

to stay in PHCs, lack of Health workers

• Non availability of Essential drugs
• Poor management of PHCs

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 Privitisation

• Partnership: It is not being “Contractors” for

implementation of Government Programs. Partnership in Ploicy formulation, Planning, Implementation, Monitoring, evaluation, Training & Research

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
• Help Desk at Two District Hospitals.
• FRU in Santhemaranahalli CHC, Chamarjanagar Dt
• District Health Management – Tumkur Dt.
• Arunachal Pradesh – 9 PHCs
• Meghalaya State – 4 PHCs
• Orissa State – 5 PHCs
• Andhra Pradesh – Adilabad – 2 PHCs

Kammasandra PHC

Needle pit Labour room development Drugs, vaccines etc IDP P.H. C

Infant Mortality Rate (IMR) of Gumballi PHC (1996 - 2008)

10 20 30 40 50 60 70 80 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

New Population added a

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 fo govt. staff – option for continuing at

PHC

• Formal takeover of the PHC from DHO

Major achievements

• 100% headquarter stay of all staff in PHC
• All buildings and equipments in place
• Specialist and referral services available
• 24 hour ambulance services
• Women friendly PHC
• Rational drug use / essential drugs available
• Chronic disease prevention and treatment

programme

Innovations

• Tribal ANMs program: Training tribal girls as ANMs and posting

them in the Tribal Sub-centers. One year course for 7th pass not recognized by Nursing Council. Now 18 months course for 10th pass.

• Introducing Mental Health Program including Epilepsy in

Primary Health Care, Low cost management of Epilepsy in PHC.

• Introducing Dental Health & Cancer Control Program in PHC –

ANMs trained to take Pap Smears.

• Integration of Rehabilitation into Primary Health Care in

addition to Preventive, Promotive & Curative health care.

• Addressing Specific problems: Sickle Cell Anemia & Hot Water

Epilepsy.

• Promotion of Traditional Medicine – 20 herbs for Primary

Health Care

• Integration of Ayurveda & Homeopathy (AYUSH).
• Community Health Financing

Telemedicine

• Telemedicine in all PHCs in collaboration

with ISRO, NH and Amrita Inst.

• Tele-health
• Coronary Care Unit at Chamarajanagar

District Hospital with training of MBBS doctors in managing critical cardiac emergencies

Community Health Insurance- T.Narasipur Model

• NGO & Government Collaboration
• Three Levels:
• Community Herbal Gardens - for common

ailments

• SHGs - Micro-credit for out-patient care
• Pre-paid Insurance for Inpatient care -

Hospitalization

Salient Features of Insurance

• Premium Rs.22 ( I Year Rs. 30/-) per

person per year

• Premium costs shared by community, Milk

Co-operatives, SHGs,UNDP and GPs

• No exclusions - all age groups -

Hospitalization due to any illness

• Rs. 50/- paid to patient for daily wages lost

and Rs. 50/- to the hospital for extra drugs per day of hospitalization

Protocol for Emergency care Protocol for Emergency care

Mainstreaming of Traditional Medicine in PHC

• Integration of single herbal remedies for

routine ailments into PHCs

• 3 tier system – Traditional Medicine, ANM

and PHC

• Involvement of SHGs, schools and Mahila

Vaidya Mitras

• Essential Drug List and STG for ISM

PHCs

• To integrate traditional

medicines into PHC

• To make a rapid assessment

and validation of sound local practices.

• To develop a cadre of

Arogya mitras to cater to the preventive, promotive and curative needs of the community

• To advocate for policy on

mainstreaming the traditional medicine into

• fficial primary health care

system.

Mainstreaming Traditional Medicine in to PHC

Mental Health

• 1. Mainstreaming Mental health into

Primary Health Care in collaboration with NIMHANS

• Management of Mental illness including

Epilepsy at PHC level. Training Medical

• fficers and Health workers.
• 2. MANASA – A comprehensive system of

care for homeless mentally ill people

– Transit Centre, Helpline, Rehabilitation and reintegration with families, Reform of Destitute Homes in Bangalore and Mysore

Manasa Mysore

Mainstreaming Eye care in to PHC

• Community Eye Care – Village blindness

registry – VHSC & RKS

• Training MO & PHC Staff, ANMs, MHWs,

ASHAs in Community based eye care.

• Vision Centers in every PHC – Opthalmic

Assistant PMOA and Optician – Vision testing and optical dispensing at PHC

Eye care in primary Health Center Eye care in primary Health Center

Innovations in Primary health care … Innovations in Primary health care …

Eye Hospital

• Infrastructure built at a cost of 35 lakhs.

GoI contributed 17.5 lakhs and KT raised 17.5 lakhs

• Collaborating with Vittala Institute of

Opthalmology for Human resources

• Partnering with DBCS for reimbursement
• f costs – Rs.600/- per case
• KT spends additional Rs.300/- per case

Mainstreaming Communication Disorders in to Primary Health Care

• Collaboration with All India Institute of

Speech and Hearing (AIISH).

• Prevention, Early detection, Aids and

appliances and Surgical correction.

• Pilot in Gumballi PHC, Akkihebbal and

Hullali PHCs

• Scaling up to all the PHCs in Yelandur

(5PHCs), K R Pet (21 PHCs) and Nanjangud (20 PHCs)Talukas.

Promotion of low cost generic drugs and Rational Drug Use

• Stocking and distribution of good quality,

low cost generic drugs – LOCOST & Biocon

• Biocare Pharmacies at Govt. Hospitals
• Promotion of rational drug use
• Essential Drug List and Standard

Treatment Guidelines

• Reforming the Drug Logistic Society

Mainstreaming Non-Communicable Diseases in to Primary Health Care

• Burden of Non-Communicable Diseases is

increasing - 50%

• NRHM is also starting the program
• Cardio-vascular Diseases – Hypertension,

Coronary Artery disease, Congenital heart diseases.

• Diabetes.

ASHA Training

• Training of ASHA’a in 3 tribal Districts
• f Karnataka
• In collaboration with NGOs in the

Districts

• Nearly 3000 ASHAs already training.
• Supervision and Monitoring.

Community Planning & Monitoring

• Pilot of NRHM in 9 States
• Karuna Trust -Nodel 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

Community Participation

CITIZEN HELP DESK

• Providing Information and helping patients about

facilities and services available

• Monitoring the quality of Health care to OPD patients

and IPD patients

• Awareness programs in the areas inhabitated by poor to

build confidence amongst the poor to access services at Public hospitals.

• Establish a link between service providers and users

through regular feedback mechanism

• Transparency and accountability in the delivery of

services

CITIZEN HELP DESK Jayanagar General Hospital

Mobile Health Clinic Mobile Health Clinic

Management of FRU at Santhemaranahally CHC

• CHC building at cost of 1.5 Crores but

FRU not functional – only two doctors.

• Thayi Bhagya Scheme: Chamarajanagr is

also included

• Partnership with FOGSI & PSI
• 3535 deliveries and 448 C-sections done

during 3 Years

F.R.U Santemaranahalli F.R.U Santemaranahalli

PPP in District Health Management

in Collaboration with other Institutions

• Capacity Building for District Health Plan
• Implementation of Health programs
• Monitoring & Supervision
• Health Management Information System
• Community health insurance
• Asha training and Supervision
• Community Action and Monitoring

Integrated Rural Development T.N.Pura Project

• Dr. Nagaraju & Renuka Nagaraju’s (NRI –

Flint Michigan) donation.

• Only 15 Paise reaches the Poor.
• Government spends about 60 Crores – 6

lakhs from KT

• Health, education and Micro-Finance
• Micro finance – 417 Woen Self Help

Groups – 4 Crores turn over

Integrated Rural Development Kammasandra

• Dr. Ram – Plastic Surgeon in Las Vegas
• PHC in Kammasandra
• Primary and High School
• Anganwadi
• Milk Dairy
• Housing and toilets for all the families
• Orphanage – Puttani Gudu

Cost Benefit

• PPP 75% to 90% to 100%
• Cost of Primary Health Care:

Rs.100/- ($2.5) – Range Rs.60 to 150 ($1.5 to 3.5)

• Spend less than Government
• Better Health out comes

Ka Karu runa a Tr Trust st Ar Arunachal nachal Pra Prade desh sh

PPP in Karnataka & Arunachal Pradesh

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)

Then… and Now

• Untidy & dirty
• Dilapidated
• No Electricity
• Inadequate equipments,

infrastructure and medicines

• Health services not

regular

• Staff not staying in HQ
• Clean & Tidy
• Renovated
• Electricity provided
• Adequate equipments,

infrastructure and medicines

• Health services

available 24 X 7

• All the staff staying in

HQ

PHC Bameng

• 380 km. from Itanagar in East Kameng district
• The mud road from Seppa to Bameng is very often

blocked by landslides

Then… …now

PHC Wakka

Wakka PHC, Tirap Dist Wakka PHC staffs

Labour room X-Ray room

PHC Etalin

PHC building Medical officer PHC building Road to Etalin

PHC Jeying

PHC building 2007 PHC staff in front of quarter

Medical officer in front of his quarter

A view of staff quarter

PHC Walong

PHC building Pharmacy Sub centre KIBITHO PHC Staff

Road to PHCs

Road to PHC Bameng Brahmaputra river crossing Road to Dambuk- Anpum Road to Etalin

Road to PHCs

Road to Dambuk & Anpum Road to Dambuk & Anpum Road to Etalin Road to Walong

Training to PHC staff

Training at Military Hospital Exposure visit to Bangalore Exposure visit to Bangalore Staff training at Roing

Scaling Up – 5 states

PHCs managed by Karuna Trust under PPP

State

• No. of PHCs

Population Karnataka 26 5,63,347 Arunachal Pradesh 9 43,197 Orissa 5 81,274 Meghalaya 4 14,300 Andhra Pradesh 2 18,820 Total 48 7,20,938

Karuna Trust – PPP in India

• Karnataka State – 26 PHCs (5 Lakh

population), 7 Mobile Medical Units, one FRU with FOGSI, Help Desk at District Hospitals.

• 2 PHCs through other NGOs – Vivekananda

Foundation & Vemana Trust

• Arunachal Pradesh – 9 PHCs
• Meghalaya State – One CHC & 4 PHCs
• Orissa State – 6 PHCs
• Andhra Pradesh – Adilabad – 2 PHCs
• District Health Management - Tumkur

Scaling up of PPP in Primary Health Scaling up of PPP in Primary Health

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

• 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

• n Health and Family Welfare

• 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

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

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

GOOD GOVERNANCE IN HEALTH

BY

• Dr. H.Sudarshan

Ex-Vigilance Director

Good Governance in Health Care

• Karnataka Lokayukta – Ombudsman

Institution for control of Corruption in Public Sector

• Vigilance Director for Health – Epidemic of

Corruption in Health Sector

• Prevention and control of corruption in

Health Services.

Year Score Rank First Rank Last Rank 1995 2.78 34/41 New Zealand Indonesia 1996 2.63 45/54 New Zealand Nigeria 2000 2.80 69/90 Finland Nigeria 2001 2.70 71/91 Finland Bangladesh 2002 2.70 71/102 Finland Bangladesh 2003 2.80 83/133 Finland Bangladesh 2004 2.80 90/145 Finland Bangladesh & Haiti 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 & Singapore Somalia

• Transparency International India & ORG-MARG

Research Pvt Ltd - An empirical study

• Covered Ten Sectors: Police, Health, Education, PDS,

Land Admn., Judiciary, Taxation, Railways, Telecom.

• Most Corrupt: Police Least Corrupt: Telecom
• Health: Perceived to be 2nd most corrupt sector
• Payment of Money through hospital staff

Money demanded from North 25% - South 38% Doctors: 77% Hospital Staff: 67%

Corruption in India Transparency International India

95

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

Epidemic of Corruption in Drugs Control Department

• 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

• 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 –

Nimesulide Tabs 18% of budget

• IV fluids scam – Bypassing HAL and

buying from PDPL

• Decentralized Corruption in Procurement
• f drugs by Zilla Panchayaths – buying

spurious and substandard drugs from unlicensed manufacturers – excess price.

• Sigma scam – forged documents

Corruption in procurement of Equipment

• Dialysis machine worth 5 lakhs bought for

11.6 lakhs by DME and at 12.6 lakhs by KIMS – Hubli

• Equipment for removing Cholesterol was

bought for 60 lakhs and used only once

• Gulbarga ZP bought X-ray machines in

1992 and they were not installed till 2004.

• Corruption in Indenting, specifications, not

looking at market rate etc.

99

Corruption in Private Health Sector

• Corruption in Procurement of Equipment
• MNCs are also corrupt
• Tax evasion and Unqualified staff
• Poor quality
• Commissions for diagnostics CT, MRI, Lab

Investigations

• Surgeries (Hysterectomies) and procedures

(Angioplasty) which are not indicated

HONGKONG

Independent Commission Against Corruption (ICAC)

Prevention of Corruption

• Peoples Movement: bottom up process –

Peoples forum to prevent and fight corruption.

• Community Monitoring
• Promote Values - Value based education
• Awareness to make use of Right to Information Bill

And Transparency Act

• Whistle Blower’s protection
• Strengthen Consumer Forum
• Electoral Reforms
• Coalition Against Corruption – NGO net work

102

Good Governance

• Mere Technological

Packages can improve the health outcomes marginally

• Good Governance can

provide quantum jump in the health outcomes

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;
• thers are more dead than alive” –

Swami Vivekananda

Thank you

Web:

www.karunatrust.com www.vgkk.org