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KARUNA TRUST |
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2006-2011
Total Management of Essential RCH
& Primary Health Care
through Public Private Partnership
ON FOUNDATIO
40 YEARS
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ACKNOWLEDGEMENT
Karuna Trust deeply acknowledges the guidance and support extended by
Population Foundation of India in executing the Total Management of Essential
Reproductive Child Health and Primary Health Care through Public Private
Partnership consistently for five years from 2006 to 2011.
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Contents
Acknowledgement
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Abbreviations
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1. Executive Summary
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2. Project - At a Glance
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3. Relevance & Context of the Project
4
Relevance of the Project in the Context of the Issue
About Population Foundation of India
4. About Karuna Trust
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a) Public Private Partnership
b) Innovations in PHCs
c) Scaling up
5. Scope of the Project
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6. Project Budget and Expenditure
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7. Project Objectives
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9. Performance
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a) HMIS
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b) Comparison of the Situation before & after Karuna Trust took over
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c) A report of activities
42
10. Advocacy
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11. A Report of End line Evaluation
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12. Annexure
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Annexure I : List of Health Indicators in 6 North Karnataka Districts
Annexure II : Services at PHCs
Annexure III : Karuna Trust Model of PHC Management
Annexure IV : Case Studies
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ABBREVIATIONS
1) AIDS Acquired Immune Deficiency Syndrome
38) NACP National AIDS Control Program
2) ANC Ante Natal Care
3) ANM Auxiliary Nurse Midwifery
4) ARSH Adolescent Reproductive and Sexual Health
5) ASHA Accredited Social Health Activist
6) ARS Arogya Raksha Samithi
7) AYUSH Ayurveda Unani Siddha and Homeopathy
8) AWW Anganwadi Worker
9) BCC Behaviourial Change Communication
10) BCG Bacillus Calmette Guerin
11) CEO Chief Executive Officer
12) DPT Diphtheria Pertussis Tetanus
13) DLC Differential Leukocyte Count
14) DHO District Health Officer
15) EOI Expression of Interest
16) ESR Erythrocyte Sedimentation Rate
17) FRU First Referral Unit
18) GDP Gross Domestic Produce
19) HIV Human Immunodeficiency Virus
20) HMIS Health Management Information System
21) HMPU Herbal Medicine Processing Unit
22) IHMR Institute of Health Management Research
23) ICT Information & Communication Technology
24) IEC Information Education Communication
25) IUD Intra Utrine Device
26) IPD In Patient Department
27) ISRO Indian Space Research Organization
28) KHSDRP Karnataka Health Systems Development
Reforms Project
39) NVBDCP National Vector Borne Disease
Control Program
40) OPD Out Patient Department
41) PHC Primary Health Centre
42) PHCF Public Health Challenge Fund
43) PFI Population Foundation of India
44) PNC Post Natal Care
45) PPP Public Private Partnership
46) PTA Parent Teacher Association
47) RCH Reproductive and Child Health
48) RTI Reproductive Tract Infection
49) RNTCP Revised National Tuberculosis
Control Program
50) SC
Scheduled Caste
51) SHG Self Help Group
52) ST
Scheduled Tribe
53) STI Sexually Transmitted Infection
54) SSI Sight Savers International
55) SBA Skilled Birth Attendant
56) TLC Total Leukocyte Count
57) UNDP United Nations Development Project
58) VGKK Vivekananda Girijana Kalyana Kendra
59) VHSC Village Health & Sanitation Committee
60) VOs Voluntary Organizations
61) VRC Village Resource Centre
62) VSAT Very Small Aperture Terminal
63) WHO World Health Organization
64) ZP
Zilla Panchayat
29) Lab Laboratory
30) LHV Lady Health Visitor
31) MHW Male Health Worker
32) MO Medical Officer
33) MoU Memorandum of Understanding
34) MSI
35) No.
Management Systems International
Number
36) NGO Non Government Organization
37) NRHM National Rural Health Mission
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TOTAL MANAGEMENT OF ESSENTIAL RCH AND PRIMARY
HEALTH CARE THROUGH PUBLIC PRIVATE PARTNERSHIP
PROJECT - AT A GLANCE
Project Partner
Karuna Trust # 686, 16th Main, 39th Cross, 4th ‘T’ Block,
Jayanagar, Bangalore – 560 041 Phone: 91-80-2244 7612
Email: karuna.trust@vsnl.net
Website: www.karunatrust.com
Project Supported By
Population Foundation of India B-28, Qutab Institutional
Area Tara Crescent New Delhi - 110 016 INDIA
Telephone : + 91-11-43894100 Fax : +91-11-43894199
E-mail : info@populationfoundation.in
Website : www.populationfoundation.in
Geographical Coverage
North Karnataka 'C' category Districts – Bagalkot, Bellary,
Bidar, Bijapur, Gulbarga & Raichur
Total Number of PHCs supported
7
Total Population Covered by all 7 PHCs 187904
Year of Commencement of the Project 2006
Year of Conclusion of the Project
2011
Project Budget and Expenditure
Project Period
1st May, 2006 to 30th April, 2011
Project Approved Budget
` 79,74,519/-
Funds released from PFI
` 74,04,400/-
Interest Earned on project Fund
` 68,987/-
Total Fund
` 74,73,387/-
Total Expenditure till September-2011 ` 75,25,808/-
Advance from KT for the project
` 52,421/-
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PHCs and Projects Managed By Karuna Trust under PPP
Jammu & Kashmir
Punjab
H.P
Uttarakhand
Haryana
Rajasthan
UP
Gujarat
Madhya Pradesh
ArunachalPradesh
Bihar
Meghalaya
JK
WB
Manipur
Maharashtra
Orissa
AP
Goa
KA
T.N
Kerala
Bidar
Bijapur
Gulbarga
Belgaum
Bagalkot
Raichur
Dharwad
Koppal
Gadag Bellary
Uttara Kannada
Haveri
Legend
PHCs 62
PFI supported PHCs 7
Vision Centers 12
Mobile Health Clinic 8
Training Center 1
HIV/ADIS -UNICEF-Project 1
MNCH Project 8
CHD Project 2
MANASA-SRTT
F.R.U
Karuna Trust H.O
VGKK
Davangere
Shimoga
Chitradurga
Tumkur
Chikamagalur
Udupi
Hassan
D.K
Kodagu
Tumkur
Kolar
Bangalore
Mandya
Bangalore®
Mysore
Chamarajnagar
Poor Districts
Intermediate Districts
Better District
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EXECUTIVE SUMMARY
Karuna Trust has an interesting beginning in which it was not a planned one .While VGKK
was providing healthcare to tribals through its clinic at Yelandur, it was noticed that several of
them had contracted leprosy through interaction with the non tribal rural population of
Yelandur taluk.
The Management of a PHC in Gumballi, Chamarajnagar district was handed over by the
Ministry of Health and Family Welfare to Karuna Trust in 1996. This set in place a pioneering
example of PPP in Primary Health Care. All National Health Programmers including RCH were
important components of healthcare activities at the PHC and a number of Specialist care
service were integrated with primary care in the PHC at Gumballi.
The impact of the Gumballi PHC as a Model strengthened the concept of PPP and provided
the base for replicating the model. At Present Karuna Trust manages 62 PHCs in 7 states
(Karnataka - 28, Andhra Pradesh -2, Orissa-11, Meghalaya-6, Arunachal Pradesh -11,
Maharastra -1, Manipur - 3 PHCs). Karuna Trust also manages seven Mobile Health Clinics, One
First Referral Unit, Two Citizens Help Desks and One Non Curative Primary Healthcare Service
Project - in Karnataka
PFI is a National non-government organization at the forefront of policy advocacy and
research on population issues in the country. PFI has awarded a grant of ` 79,74,519/- for a 5-
year project from 2006-2011 for “ Total Management of Essential RCH & Primary Health Care
through Public Private Partnership “ in 6 districts of North Karnataka.
The major objectives of the project were to strengthen the existing Government PHCs to
model PHCs, to maximise the utilization of Sub-Centers under the PHC area for delivering
primary RCH & related health care services and to influence and facilitate change for improved
health seeking behaviour in the communities covered by the Model PHCs.
The strategies to achieve these objectives have been through building PPP for effective
primary health care, adequate capacity of service providers at levels for providing primary
health care & strengthening information and communication technology for appropriate and
timely consultation and building of skills. The project's focus areas are the districts with poor
socio-demographic indicators, namely - Bagalkot, Bellary, Bidar, Bijapur, Gulbarga and Raichur.
The activities included complete management of PHC through decentralized planning, human
resources management, supply of generic drugs & vaccines with BIN card management system,
waste management system, quality control etc with many innovations like introducing mental
health, traditional medicine & eye care into primary health care.
This resulted in improvement in health indicators which are better than the State &
National average. The Infant Mortality Rate (IMR) is 19 compared to the National average of 48
per 1000 live births. The Maternal Mortality Rate (MMR) is 81 compared to the National average
of 254 per 1,00,000 live births. All the National Health Programmes are implemented
successfully. These are achieved through 52 capacity building trainings conducted in the project
period. The project ended in April 2011 & the no-cost extension with the balance amount
unspent during the Project Period was extended for 5 months till September 2011.
Although the project concentrated particularly on 7 PHCs in backward areas, the results
and experiences were useful in implementing the similar model in all the PHCs run by the Trust.
The project resulted in strengthening the concept of Public Private Partnership and the capacity
building of the staff through various approaches. Karuna Trust shall take full responsibility of
sustaining the activities conducted in these 5 years.
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RELEVANCE & CONTEXT OF THE PROJECT
Over 30% of rural India and 20% in urban India did not seek treatment due to financial
reasons in 2004, up by 15% since 1995. Nearly 39 million people in India are pushed to poverty
because of ill-health every year. The sharp increase in the prices of drugs has been the main reason
for the rising costs of medical care, which more than tripled between 1993-94 and 2006-07. The
common man spends 72% out-of-pocket expenditure on health care. Of hospital admissions, 47%
in rural India and 31% in urban India were financed by loans and sale of assets. In the Unorganized
Sector, 93% of India's populations are cultivators, agricultural labourers, artisans and workers – all
in the unorganized sector who typically do not have a regular or assured source of income. And
therefore they do not have access to medical insurance1. 88% towns have healthcare facilities
versus 24% villages and 66% medical professionals are in urban areas2. There is an increase in the
absolute number of persons unable to seek healthcare due to financial reasons, about 40% of the
hospitalized having had to borrow money or sell assets and around 24% of all people hospitalized in
India in a single year fall below the poverty line due to hospitalization3. An analysis of financing of
hospitalization shows that a large proportion of people, especially those in the bottom four-
income quintiles borrow money or sell assets to pay for hospitalization4
Karnataka, like other States, follows the national pattern of three-tier health infrastructure
in delivering public health care facilities. At tier I is the District Hospital, tier II is the Taluka Hospital
and Community Health Centers and at tier III are the Primary Health Centers and Sub-Centers.
Health services are provided in urban areas using the tier I health care facilities. Health services in
rural areas are provided using the second and third level facilities. The Department of Health and
Family Welfare under the leadership of Honorable Minister of Health and Family Welfare is in
charge of providing healthcare facilities in the State. The Department of Health and Family Welfare
has following wings:
ŸHealth and Family Welfare Services
ŸDirectorate of Medical Education.
ŸAYUSH
ŸDrug Controller Department
The Directorate of Health and Family Welfare Services provides comprehensive health care
services to the people of the State through its network of 9344 Sub-Centers, 2195 Primary Health
Centers, 177 Community Health Centers, 146 Taluka hospitals and 27 District hospitals, with more
than 50,000 beds.
The health status in Karnataka has improved considerably in the past century. Several gains
have been made in health status of Karnataka. Eradication of smallpox, plague and more recently,
guinea worm infection are some of achievements that testify it. Similarly, the life expectancy at
birth has increased from 37.15 to 61.7 years and from 36.15 to 65.6 years for males and females
1 National Commission for Enterprises
2 National Health Policy 2002
3 National sample Survey carried by Government of India
4 World Bank, 2002
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respectively, between 1951 and 2001. The MMR for Karnataka is 178 per lakh live births while that
for India is 212 per lakh live births (Sample Registration System, 2007-09). The IMR for Karnataka
has declined from as high as 148/1000 live births (in 1951) to 69 (in 1981) and further to 45 in 2008,
41 in 2009 (SRS 2011). The Crude Birth Rate has fallen from 40.8/1000 populations in 1951 to 22.0
in 2000 and further to 19.5 in 2009 (SRS 2011). The total fertility rate from 6.0 children (in 1951) to
2.13 (in 1998-99) and further to 2.0 in 2008. The progress in bringing down Crude Death Rate by
more than two thirds from 25.1 in 1951 to 7.4 in 2008 (SRS 2009) is noteworthy. Public health care
services richly deserve much of the credit for this.
While gains in terms of health status have been made in Karnataka, the continuing large
rural-urban differences remain, exemplified by IMR estimates of 50 for rural areas and 33 for urban
areas (SRS, 2009), inter-district and regional disparities continue to be challenges faced by the
health sector in Karnataka. The five districts of Gulbarga Division (Bidar, Koppal, Gulbarga, Raichur
and Bellary), with Bijapur and Bagalkot districts of Belgaum division continue to lag behind. Under-
nutrition in under-five children and anemia in women continue to remain unacceptably high.
Women's health, mental health and disability care are still relatively neglected. Certain
preventable health problems (anemia, malaria, vaccine preventable diseases and tuberculosis)
remain more prevalent in certain geographical regions or among particular population groups.
Addressing these disparities and inequalities is a priority concern and a daunting task for the
Government.
The National Rural Health Mission launched in 2005 has increased access to and affordability
of health services to rural areas across the country through inter-sectoral convergence, creation of
a cadre of ASHA and utilization of resources through Panchayats, NGOs and community in general.
It also covers existing programs such as those for control of tuberculosis, malaria, leprosy,
blindness, iodine deficiency and filarial through revitalizing Primary and Community Health
Centres and sustained awareness campaigns among the public. The Eleventh Five Year Plan (11th
Plan in brief) estimated at Rs.36, 44,718 crores has shifted to focus to the social sectors, especially
health and education.
However, public spending on health today at 0.94% of India's GDP is among the lowest in the
world. While the Indian Government spends just 19 purchasing power parity dollars on every
person for health, the figure stands at 207 in Thailand, 122 in China, 88 in Sri Lanka, 751 in Maldives
and 60 in Bhutan. On the ground, India is facing a dire shortage of female doctors and women in the
healthcare workforce. Only 6% of Allopathic doctors (1/10,000 population) in rural areas are
women. Overall in India, there are only roughly 14 healthcare workers per 10,000 population as
against the WHO benchmark of 25.4 which has made access to healthcare difficult.
Preventive primary and some part of secondary treatment have to be completely free,
cashless and provided by the Government and funded through taxes, according to the PM's high-
level expert group on universal health coverage.
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About Population Foundation of India
PFI is a National non-government organization at the forefront of policy advocacy and
research on population issues in the country. PFI was established in 1970 by a group of socially
committed industrialists led by Mr. J.R.D. Tata and Dr Bharat Ram. It has kept pace with the times,
facing new challenges and changing perspectives through periodic reviews of its objectives,
processes and achievements to make itself relevant to the people it serves.
PFI collaborates with central, state and local government institutions for effective policy
formulation and planning. It supports governmental and non-governmental organizations in
programmers that focus on RCH, Family Planning, ARSH, HIV/AIDS and Urban Health. The
foundation also works with corporate organizations as part of their Corporate Social Responsibility
(CSR). PFI reaches out to the underserved and the unserved areas in 20 States.
In collaboration with PFI, Karuna Trust aims to strengthen the existing primary health care
services in the PHCs by providing comprehensive primary health care through preventive,
promotive, curative & rehabilitative services to the community for increased and better access to
essential health services in the remote & inaccessible areas.
Core components of Primary Healthcare
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ABOUT KARUNA TRUST
Genesis
Karuna Trust was registered as a Charitable Trust in 1986. The Trust – a sister organization of
the nationally reputed Vivekananda Girijana Kalyana Kendra that works on empowerment and
health of the tribal communities from B.R. Hills in Chamarajanagar district of Karnataka, was
established to respond to the widespread prevalence of leprosy in the Yelandur Taluk of Karnataka.
Karuna Trust has been singularly successful in addressing this problem and the prevalence of
leprosy in Yelandur dropped from 21.4 per 1000 population in 1987 to 0.28 per 1000 in 2005. From
leprosy control, Karuna Trust expanded its mission to address problems of epilepsy, RCH, dental &
eye care, mental health and tuberculosis and further on into the areas of primary healthcare,
livelihood and education with Public Private Partnership initiatives as the focus.
Vision
For a society in which we strive to provide an equitable and integrated model of Healthcare,
Education and Livelihoods by empowering marginalized people to become self-reliant.
Mission
To develop a dedicated, service-minded team that enables holistic development of
marginalized people through innovative replicable models with a passion for excellence.
We believe in community-based, people-oriented, need-based, and culturally acceptable
methods using appropriate technology with minimum cost being factored to the community. Some
of Karuna Trust's innovative programs in primary healthcare include work in the areas of mental
health, telemedicine, mainstreaming of herbal medicine into primary healthcare, setting up of
herbal medicine units and mobile health units, introduction of a community-based model of health
insurance, running a free eye hospital and FRUs and instituting a citizen's help desk in general and
district hospital.
Innovations in Primary Health Care
The 61 PHCs run by Karuna Trust are model centers that incorporate innovative health
approaches towards effective delivery of primary health care.
a) Community Mental Health Program
Under the PPP in Karnataka, 28 PHCs offer access to primary mental health care for the rural
community through the availability of a transit care facility for homeless mentally ill women, a
helpline for the rescue of mentally ill destitute and psychiatric treatment offered in all 28 PHCs. The
program also aims at re-integration of mentally ill people with their families.
b) Telemedicine
Karuna Trust has instituted a telemedicine facility in Gumballi PHC in collaboration with
AIMS, Kochi and Narayana Hrudayalaya, Bangalore. Through the project, ECG reports of patients
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are able to be instantly transmitted from Gumballi PHC to the Narayana Hrudayalaya Hospital in
Bangalore. It is particularly useful as many families live in remote or hilly areas and immediate
diagnosis could be a life-saving factor for them.
c) Herbal Medicine Unit
The HMPU is situated in the campus of the Gumballi PHC. The
reason for this project is to not only encourage the growth of herbal
plants and procure the same for manufacture of herbal medicine,
but to also promote the use of herbal treatment as an alternative
to allopathic medicine for curative and promotive health. Profits
gained from the HMPU are used to fund programs for tribal
development.
d) Mainstreaming of Traditional Medicine in PHCs
The project of mainstreaming use of traditional medicines in PHCs was started as a pilot one-
year Project in 20 PHCs in Karnataka. A part of the project is dedicated to spreading awareness on
the use and efficacy of traditional medicines in schools, SHGs, communities and PHCs through
'Arogya Mithras' (health friends). Herbal demonstration gardens have also been planted in all the
PHCs as well as in rural schools. The project integrates local health traditions with affordable access
to primary health care and thus meets preventive, promotive and curative needs of the
community. The project is proposed to be scaled up in 2 other districts in Karnataka with possible
extension to other States in the country in future.
e) Mobile Dental Unit
Accessible and affordable dental care, once considered beyond the reach of the common
man is now within reach of the poor and needy of Yelandur and T. Narasipura taluks. The unit is fully
equipped and has a dedicated team that visits remote villages in and around the 2 taluks and
provides dental care free of cost. Even complex dental
procedures such as root canal treatment are handled in the unit.
The unit is also equipped with an in-built video system that is
used to educate the public on preventive and curative dental
care. The mobile dental unit is the first of its kind in the country.
f) Community Health Insurance
The community health insurance project initiated in 2006
aimed at covering people living in economically challenged
circumstances. The project, first sponsored by UNDP as a pilot,
was implemented in Chamarajanagar and Belgaum districts in Karnataka and featured low
premium payment (` 22 / person / year), hassle free enrolment policy, immediate claim
settlement, no exclusion policy; coverage for wage loss and 'out-of-pocket' expenses and
additional benefits for patients undergoing surgery. Approximately 6 lakh beneficiaries from 25
PHCs enjoy insurance coverage.
g) Village Resource Centre in collaboration with ISRO
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
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Centre. The organization has one Expert Centre at Mysore and 18 sites for students located in rural
areas in different districts of Karnataka. Through VSAT connectivity at PHCs located in Karnataka
and Arunachal Pradesh, Karuna Trust is able to provide information on diversified areas such as
health, education, geographic information, advice on agriculture, land & water management,
weather patterns, updated information on current market scenarios, disease and livestock,
Government schemes, job opportunities and e-governance related information.
The time assigned to Karuna Trust for this broadcasting is from 2 p.m. to 6 p.m., Monday
through Saturday. The Mysore centre also organizes need-based training programs for different
groups.
h) Health Promotion Project : PHCF – KHSDRP
Karuna Trust has been selected by the Karnataka Health
System Development & Reform Project to provide non-curative
primary health care services in Chamarajanagar district under a
project titled 'Performance-Based Partnership for Providing Non-
Curative Primary Health Care Services'. Karuna Trust will enable
training and community activities that lead to improved
community health (especially in the case of poor or disadvantaged
communities) and ensure that health services provided are utilized
effectively through achieving behaviour change and healthy
practices.
f) Community based eye care-Vision Centre
Karuna Trust has approached SSI to collaborate on a project
that helps to provide eye care services through 12 vision centres at
select PHCs run by Karuna Trust. Through the study, Karuna Trust
hopes to increase the efficiency and effectiveness of vision centers
and secondary eye-care institutions. The project also seeks to
evolve a model of Public Private Partnership to highlight the issue of
primary ophthalmology, in particular, the concept of vision centres
to the agenda of state-level policy makers.
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Public Private Partnership
The Trust has also pioneered and is currently engaged in implementing a successful PPP
model with various state governments for delivering affordable and integrated primary healthcare
services by taking over the day-to-day operations of PHCs.
Having begun the PPP model in the Gumballi PHC in Chamarajanagar district of Karnataka in
1996, Karuna Trust today reaches out to over 1 million people through direct management of 50
PHCs in 7 States of India with a total of 975+ dedicated healthcare professionals. Observing the
successful way in which the organization has been able to turn non-performing, poorly equipped
PHCs in to model centres offering high quality and affordable primary healthcare, other State
Governments have approached Karuna Trust requesting for similar PPP projects with PHCs in their
States. The Trust therefore plans to scale-up the process of the PPP project in other States in the
country.
Under the PPP Karuna Trust has successfully established effective management systems for
successful PHC management in remote areas where human resources were a constraint, socio-
cultural factors, economics and geography were a barrier to care-seeking and where skilled human
resources for health were largely unavailable. A fixed process is followed before taking over of a
PHC. The ZP is responsible in each district for the functioning of PHCs. The DHO identifies a PHC for
PPP. Karuna Trust submits a proposal under the PPP project to the CEO of the ZP with a copy to the
DHO. Following assessment and viability of the project, the DHO and the CEO (ZP) jointly approve
the proposal and forward the same to the Commissioner of Health & Family Welfare Committee of
the concerned State Government. The Government studies the PPP and approves it and an order is
accordingly issued. An agreement for the PPP is drawn up and signed between the DHO and Karuna
Trust. The ZP continues to play an important role in monitoring the functioning of the PHC and has
the authority to discontinue the PPP project if found unsatisfactory and not meeting the standards.
(Such agreements were drawn up for all 7 PFI-supported PHCs between April 2006 and September
2011.)
Public Private Partnership
The National Health Policy of 2000 lists PPP with NGOs as an important, viable strategy for
development. The Public (Government) partners with the Private (both for-profit private sector
and non-profit sector including NGOs, VOs, etc.) on issues of policy formulation, planning,
implementation, monitoring & evaluation, and training & research. PPP is not the same as
privatization, nor is it a contractual scenario. Under the PPP model, both partners are equal
stakeholders and collaborate equally on all aspects of a program.
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Process followed by Karuna Trust under the PPP Model for Primary Health Care
Karuna Trust has put in place a specific procedure for the management of a PHC. This process
begins even before a PHC is taken over for management. The steps involved are:
ŸAdvocacy with the respective State Governments
ŸResponse to the state’s notification for Expression of Interest / direct application to the
Government
ŸIdentification and selection of PHCs that are poorly performing and situated in remote/hard-
to-reach/ hilly/ tribal areas
ŸDialogue with the community and local panchayats to share information about the PPP and
initiate participatory approaches towards running the PHC
ŸApplying to the ZP/State for running the PHC and sharing of the draft Memorandum of
Understanding (MoU) including process & outcome indicators
ŸFinalizing the MoU
ŸRecruitment of eligible local staff and induction training
ŸWithdrawal/redistribution of Government staff within the district, with an option for
continuing at the PHC
ŸFormal takeover of the PHC from the District Health Officer
ŸHandover of infrastructure, land, building, equipment, vehicle and records
ŸPHC continues to function within the district health system and sends reports, with access to
all the schemes and initiatives of the Government
ŸMonthly/quarterly advance financial reimbursement as per MoU
ŸIn-house capacity building of the staff
ŸSubmission of audited financial statements of the PHCs under PPP to the State and sharing of
progress and annual reports at the district level
ŸAssets created with Government funds to remain with the State
ŸAnnual review of process and outcome indicators set out in the MoU
ANM crossing the river with a vaccine carrier
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The uniqueness of Karuna Trust's work in the area of primary healthcare lies in its community-
oriented focus that integrates preventive, promotive, curative and rehabilitative efforts through a
democratic, cultural and participatory approach. Results of Karuna Trust's takeover and
management of PHCs in five States has hugely benefitted target communities in terms of improved
and efficient healthcare services and increased participation in community health programs.
Karuna Trust also engages actively in lobbying and advocacy at both State and National levels.
Through its presence and participation at various district, State and national committees, the Trust
has an opportunity to share its rich experiences and learnings with policy makers, thus paving the
way for affecting change in policy-level decisions on health.
Scaling up
The Karuna Trust Model on PPP is a promising model to improve access to health care in the most
remote and backward districts of India.
The organization plans to scale-up its PPP project through directly managing PHCs in 8 additional
States. As part of scaling-up, a number of capacity building programs and value-based activities will
be conducted for all cadres of staff involved in the project.
Karuna Trust is partnered by PFI, MSI and the MacArthur Foundation in its scaling-up efforts.
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SCOPE OF THE PROJECT
Community and Health Context in the under served Districts of North Karnataka and the need for
Development
Primary Health Centres supported by the State Government are usually located in central
Panchayat villages based on the population that need to be served. The services provided by the
PHCs are not up to the standard because of a gap in service delivery and management systems. The
Government of Karnataka budgets seven lakhs rupees per PHC towards routine running cost. The
State health scheme has set a flat rate of Seventy Five Thousand rupees per annum per PHC for
drugs – a sum insufficient to meet the population needs. The voluntary and private sectors have
been playing a role in public healthcare in the State albeit in an often informal manner. Their wealth
of contribution to health resources would best be combined with the reach of the state system in
order to deliver quality healthcare services at minimum cost, in particular to rural and remote
communities.
Many parts of Karnataka are backward in terms of development, though not of resources.
They are districts having a low composite health index based on the following factors – health
indicators, literacy rate, sex ratio, population percent in 0-6, unmet need for family planning,
percentage of girls married below 18 years, percentage currently using family planning, percentage
coverage of safe delivery, percentage coverage of complete ANC, percent coverage of complete
immunization, percentage of women who squeeze out colostrums and percentage of home
deliveries. Districts like Chamarajanagar, Chitradurga, Koppal, Dharwad, Hassan and Gadag are
some of the more backward districts in the State with low health indices. Koppal district also has a
high prevalence of HIV & AIDS. Others like Belgaum, Uttara Kannada, Davangere, Chikkamagalur
and Kodagu, even though considered as well developed districts have low health indices. Kolar
district, though near to the State capital of Bangalore, is drought-prone with a large SC/ST and
migrant population.
PHCs located in these backward areas have generally recorded under-performance. Staff
members are often not present at the headquarters and the PHCs are poorly equipped and
administered. Services for essential surgeries, primary level dental care and gender-sensitive
primary healthcare are found to be lacking. Implementation of national health programs and care
for chronic diseases is sporadic. Availability of essential drugs to be given free of cost to patients is
undependable. Training and motivation of personnel is low or non-existent. Therefore, there is a
need to develop these PHCs to the highest standards for making essential healthcare universally
accessible to individuals and families in the community. The PHCs selected by Karuna Trust for
development are those located in the most remote and backward talukas. Of the 28 PHCs managed
by Karuna Trust in Karnataka, 7 are supported by PFI, New Delhi, for strengthening components
related to RCH. These are located in 6 districts of North Karnataka – Bagalkot, Bellary, Bidar, Bijapur,
Gulbarga and Raichur.
Please refer Annexure I for list of indicators for each district.
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Karuna Trust-run PHCs supported by PFI from 2006-2011
Sl. Name of the PHC
No.
Taluk
District No. of Villages Population
Covered
1. Sri Ramarangapura (SRR Pura) Hospet
Bellary
13
2. Hudem
Koodligi
Bellary
34
3. Nandikeshwara
Badami
Bagalkot
11
4. Chandrabanda
Raichur
Raichur
26
5. Kohinoor
Basava Kalyan Bidar
17
6. V K Salgar
Alanda
Gulbarga
12
7. Kannur
Bijapur
Bijapur
15
28,543
38,969
20,217
24,631
15,914
17,328
55,255
Total
7
7
6
159
200,857
Community Participation - Participatory Rural Apprasial at Castlerock PHC
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PROJECT BUDGET AND EXPENDITURE
The total budget of ` 79,74,519/- lakhs for 5 years sanctioned by PFI for the project, and
` 74,04,400/- was released upto the project period completion. It includes the No cost extension
period from 1st May, 2011 to 30th September,2011. KT has utilized ` 75, 25,808/- lakhs for the
entire project period.
Under PPP we receive grants for salaries and medicines. But there is no provision for monitoring &
Supervision, Capacity building and new initiatives. This proposal is for covering the additional
costs. The other PHCs are covered by SDTT and MacArthur Foundation (new PHCs)
Project Period
Project Approved Budget
Funds released from PFI
Interest Earned on project Fund
Total Fund
Total Expenditure till September-2011
Advance from KT for the project
1st May, 2006 to 30th April, 2011
` 79,74,519/-
` 74,04,400/-
` 68,987/-
` 74,73,387/-
` 75,25,808/-
` 52421/-
Year Wise Contribution of GoK, PFI and Karuna Trust:
Year
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
Grand Total
%
GOK
KT
PFI
` 49,01,565
` 97,25,114
` 6,89,740 ` 14,33,157
` 22,58,085 ` 11,63,939
` 80,26,755 ` 9,28,728 ` 10,92,805
` 12,79,76,83
` 15,19,59,88
` 26,62,557
` 53,30,96,62
81%
` 4,02,748
` 7,51,353
` 2,53,552
` 52,84,206
8%
` 12,16,266
` 12,47,651
` 13,71,990
` 75,25,808
11%
Grand Total
` 70,24,462
` 1,31,47,138
` 1,00,48,288
` 1,44,16,697
` 1,71,94,992
` 42,88,099
` 6,61,19,676
100%
GOK KT PFI
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PROJECT OBJECTIVES
The overall focus has been on promotive, preventive, curative and rehabilitative care. The
objectives are :
1. To strengthen existing Government PHCs into model PHCs.
Ÿ Strengthening of routine services offered by a PHC including 24-hour emergency services,
quality laboratory services, management of outreach staff (Anganwadi, ANM, LHV, MHW,
ASHA), implementation of National Health Programs and surgical facilities for permanent
contraception.
Ÿ Recruitment and management of personnel, motivation and capacity building, and technical
training (where applicable), gender sensitization workshops from PHC to DHOs and DS levels.
Ÿ Supply of essential, low-cost, generic drugs following rational drug use and strict prescription
policies.
Ÿ Strengthening BIN card system for stocks.
Ÿ Introducing waste disposal system.
Ÿ Strengthen HMIS and evaluation system from PHC to State level to include data on migrating
patients, morbidity data base, disability, epidemiology and population based survey and
OPD/IPD and Partograph records.
Ÿ Family counseling facilities at PHCs and Sub-Centres
2. To maximize utilization of Sub-Centres under the PHC area for delivering primary RCH and
related healthcare services
Ÿ Provide essential drugs including drugs for RTI and STI at Sub-Centre.
Ÿ Maintenance of herbal garden and traditional medicine drug counters in PHCs and Sub-
Centres.
3. To influence and facilitate change for improved health-seeking behaviour in the
communities covered by the model PHCs
Ÿ Activate Village and PHC health committees, SHGs, and school PTAs to get involved in the
monitoring of the PHCs
Ÿ Mass training/ awareness for the community on RCH, HIV, disability, endemic diseases, family
planning, etc., using IEC materials, in particular film media.
Ÿ Integration of health awareness in local events such as celebrations, festivals, special days,
school days, health camps, village jathres, etc
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Major achievements of the project :
1. Strengthening existing Government PHCs into model PHCs
Ÿ 24-hour availability of staff at headquarters.
Ÿ High performance rate: institutional deliveries have increased to 100% over the project period
in 4 PHCs (Kannur, Hudem, Kohinoor & Chandrabanda), with the remaining 3 PHCs having a
institutional delivery rate between 96-100%
Ÿ Quality laboratory services WIDAL, VDRL, HIV, Sugar and HbSAg
Ÿ Mainstreaming of community mental healthcare at PHCs
Ÿ Adolescent health services through Sneha Clinics.
Ÿ Essential obstetric care: increase in early registration of ANC (80%), immunization (100%),
provision of iron supplements, routine lab investigation and HIV testing for all ANC & PNC cases
Ÿ Display of Citizen’s Charter
Ÿ Implementation of proper waste management system through use of colour coded bins and
separate waste segregation system
Ÿ BIN card system for pharmacy
Ÿ Activities of the ANM, LHV, MHW & AWW have been supported and strengthened through
regular monthly meetings
Ÿ Monthly monitored visits by the MO/LHV/Administrators
Ÿ Mainstreaming of traditional medicine by trained Arogya Mithras
Ÿ PHCs are women-friendly and gender-sensitive
2. Maximizing utilization of Sub-Centres under the PHC area for delivery of primary RCH and
related healthcare services
Ÿ 24-hour compulsory headquartered availability of ANM in 37 sub-centres of the PHCs.
Ÿ 100% coverage of ANC/PNC
Ÿ Regular immunization and health & nutrition days conducted in all Sub-Centres.
Ÿ Effective BCC program on importance on and awareness of family planning.
Ÿ All ANMs trained in IUD insertion and propagate use of temporary contraceptive methods
Ÿ Diagnosis and treatment of RTI/STI at Sub-Centres with effective referral to PHCs for further
treatment where necessary
3. Influence and facilitate change for improved health-seeking behaviour in communities
covered by the model PHCs
Ÿ Improved community participation through pro-active involvement of VHSCs, SHGs and
Arogya Raksha Samithis (PHC Health Management Committees), Panchayats and local groups.
Ÿ Creative Health Awareness through Village Resource Centres.
Ÿ Capacity building for VHSC members.
Ÿ IEC programs.
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PERFORMANCE
Patients sitting in the OPD at Chandrabandha PHC
Karuna Trust works with PHCs located in the most backward and remote areas of the State.
The 7 PFI-supported PHCs under the PPP project are also located in backward districts in North
Karnataka. The districts are chosen based on health and development indicators such as literacy
and sex ratio, unmet need for family planning, percentage of home/safe deliveries and
immunization among others.
Prior to taking over of the PHCs from the Government, Karuna Trust availed the service of
IHMR to conduct an initial assessment of the PHCs. According to the assessment, the PHCs lacked
basic facilities. The infrastructure needed repairs, medical drug supplies were either low or
sporadic in supply, some types of medical equipment was not available at the PHCs. Even basic
furniture such as tables and chairs were not available at some PHCs. The external surroundings
were unclean.
On Karuna Trust taking over the management of the PHCs, significant changes were brought
out in the performance of the PHCs.
The performance parameters are broadly enumerated as under :
1. Health indicators in terms of HMIS data
2. Infrastructure and facilities for each PHC
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Performance Indicators
The focus of Karuna Trust's work in PHC management is improvement in maternal and child health
outcomes through provision of better quality, affordable and accessible primary healthcare to local
communities located in remote, inaccessible, tribal and hilly areas.
Early Registration
A pregnant woman enters the RCH system when she gets herself registered for ANC registration in
the first trimester gives an opportunity to screen her anaemia and other health conditions and provide
her the first dose of tetanus. It also increases the likelihood that the woman will choose skilled
attendance at birth .
The national average of women availing ANC in the first trimester in 2008-09 is reported to be 44%.
The performance varies from different PHCs varies from 60% to 79%. 5 PHC's namely Chandrabanda, Hudem, Nandikeshwara,
S R R Pura & V K Salgara have reported more than 70% compared to the national average of 44%.
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Institutional deliveries :
The national average of institutional deliveries in 2008-2009 is reported to be 69%.
The performance in the 7 PFI PHC's ranges from 86% in SRR Pura, 89% in Chandrabanda, 90% in Nandikeshwara,
92% in Hudem, 94% in V K Salgara , 98% in Kohinoor to 100% in Kannur PHC
Still Births :
According to NFHS 3, the number of still births are estimated to be 35 per 1,000 live births.
The performance of 7 PFI supported PHCs is quite good in this regard.
The number of still births are less than the state average.
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Infant Mortality Rate :
According to the NFHS 3, the infant mortality rate is 43 per 1,000 live births. In 7 PFI PHCs IMR is less
than the state average.
Maternal Mortality Rate:
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IMMUNIZATION
BCG Coverage :
According to NFHS 3 report, BCG coverage is around 88%. The 7 PFI PHCs have BCG coverage of
more than 95%, which is above the National average.
BBCCGG CCoovveerraaggee
DPT Coverage:
According to NFHS 3 survey, the DPT coverage is around 74%. The 7 PFI PHCs covers is more than 98%,
which is more than the National average.
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Polio Vaccine Immunization :
According to NFHS 3 survey, the DPT coverage is around 74%. The 7 PFI PHCs coverage is more than
98%, which is more than the National average.
Polio Vaccine Immunization
Measles Coverage :
According to NFHS 3 survey, the DPT coverage is around 72%. In 7 PFI PHCs coverage is more than
95%, which is more than the National average.
Family Planning
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IUD Coverage :
The percentage of IUD insertions in the 7 PFI PHCs ranges from 50% to 85%. The achievement is below
the target.
Sterilizations :
The percentage of sterilizations conducted ranges from 65% to 98%, but the number of male
sterilizations or NSV conducted is low.
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Comparison of the situation in the 7 PFI-supported PHCs
before & after Karuna Trust took over.
V.K. SALGARA PHC
The PHC is located in a remote area in the Alanda taluk of
Gulbarga district. It covers a population of 17,554 and has 3 Sub-
Centres under its jurisdiction. There are 17 staff members attached to
the PHC. Karuna Trust took over the PHC on 8th May 2005 and PFI has
been supporting the PHC since 2006.
PHC BUILDING
Sl. No.
Before taking over
After taking over
1) LAND
Total Area : 4 acres
No specified boundaries for PHC Boundaries were identified
building & compound
Place surrounded by weeds; not The PHC was cleaned up & few trees
maintained adequately
planted around the campus
No fencing around PHC building Fencing work was undertaken
and completed
2) PHC BUILDING &
STAFF QUARTERS
PHC building was not maintained The building was cleaned up and
well - untidy and dirty
re-painted
3) SUB-CENTER
BUILDINGS
The SC building was vacant and
therefore untidy & dirty
The building was cleaned up and
minor repair work was undertaken
The ANM is headquartered in the building
4) EQUIPMENT
Not being maintained well or
serviced regularly
Irregular supply of equipment
KT supplied the PHC with a computer, printer &
tape recorder (for IEC activities) and email services
A new telephone connection was procured
5) COLD CHAIN
EQUIPMENT
Non-functional, mostly
under repair
Cold chain equipment has been made
functional and is checked periodically for problems
6) FURNITURE
Inadequate
KT provided the PHC with basic furniture
consisting of table and chairs
7) STAFF
Number of vacancies & poor
attendance of existing staff
KT filled up all the vacancies
All staff have been headquartered & providing
24-hour health services to the local community
8) ADDITIONAL STAFF Unavailable
KT posted a counselor for the HIV & AIDS
program. A refractionist was also appointed
9) TRAINING
PROGRAMS
Infrequently held
KT has conducted capacity building training
programs that are need-based for all PHC staff on
relevant topics such as RCH/MCH services,
HIV & AIDS, IEC, PHC Management, Planning &
Budgeting (Accounting), Mental Health, Traditional
Medicine, PRA and Biomedical Waste Management
10) MEDICINES &
REAGENTS
Irregular supply
KT supplies essential medicines & other lab
reagents where Govt. supply is delayed
11) WATER &
ELECTRICITY
Poor and irregular supply due to KT undertook minor electrical repair work for the
frequent break-down of
PHC and SC buildings and restored proper water
wiring & related equipment
& electricity supply
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12) WASTE
MANAGEMENT
Not implemented
KT has implemented a waste management system
in the PHC according to KPCB standards and also
obtained a certificate from the Board
INNOVATIONS BY KARUNA TRUST
1. IEC ACTIVITIES &
PRA PROGRAM
2. HEALTH INSURANCE
PROGRAM
KT organized IEC activities in all the Sub-Centre areas with the assistance of its IEC
vehicle. The PRA program has also been conducted in villages.
A health insurance program was launched in the PHC catchment areas
Sl. Name of the SC Distance Building No. of Population Male Female Eligible No. of
No.
From the (Y/N) Villages
Couples ASHAs
PHC
1. V K Salgara
-
2. Kamalanagar
8
3. Belamagi
7
No
1
No
4
Yes
2
5,128
6,406
6,060
2,619 2,509 775 4
3,366 3,040 940 7
3,175 2,885 942 4
Total
7
17,594
9,160 8,434 2,657 15
EMERGENCY KIT AVAILABLE
AT ALL THE PHC's
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4.1 Page 31 |
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CHANDRABANDA PHC
The PHC is located Raichur taluk in Raichur district. It
covers a population of 25,584 with 4 Sub-Centres functioning
under it. Chandrabanda PHC functions with 9 medical staff.
Karuna Trust took over management of the PHC on 27th
January 2006 and PFI has been supporting the PHC from this
date onwards.
Sl.
No.
1. LAND
Total Area: 2 acres
2. PHC BUILDING &
STAFF QUARTERS
Before taking over
Place surrounded by weeds; not
maintained adequately
No fencing around PHC building
Building not maintained regularly
Repair work pending
Dilapidated staff quarters
After taking over
The PHC was cleaned up & few trees
planted around the campus. KT
started a demo garden & nursery for
traditional medicinal herbs & plants
Fencing work was undertaken and
completed
The building was cleaned up and re
painted.All pending repair work was
assessed, undertaken & completed
Staff quarters were renovated and PHC staff
are headquartered in it
Sign boards & the Citizen’s Charter have
been put up
3. SUB-CENTER
BUILDINGS
4. EQUIPMENT
5. COLD CHAIN
EQUIPMENT
6. FURNITURE
7. STAFF
Poorly maintained.
Buildings were vacant
Was not being serviced regularly
Supply was irregular
Available but not fully functional
Inadequate
Many vacancies
Poor attendance
The building was cleaned up
The ANMs are headquartered at the
buildings 4 SC are located in the
government building & 2 SC buildings are
undergoing minor repair
A Village Resource Centre has been set up in
collaboration with ISRO, Bangalore Tele-
conferencing and tele-ECG facilities are now
available at the PHC
KT supplied the PHC with a computer,
printer and tape recorder (for IEC activities)
along with email services. Some essential
equipment was provided by the DHO,
including a baby warming machine
Equipment for preparation of traditional
medicine has been supplied to the PHC
Available & functional – checked for
periodic maintenance
Furniture procured for the PHC
All vacancies have been filled by Karuna
Trust. All staff members are head
quartered and rendering 24-hour health
care service to the local community
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8. ADDITIONAL STAFF Unavailable
9. TRAINING
PROGRAMS
Infrequent
10. MEDICINES &
REAGENTS
11. WATER &
ELECTRICITY
Irregular supply
Equipment under repair
Not fully functional
12. WASTE
MANAGEMENT
Not implemented
KT has trained & posted 1 counselor for the
HIV & AIDS program and 1 Arogya Mithra
for the traditional medicine program
KT has conducted capacity building
training programs that are need-based for
all PHC staff on relevant topics such as RCH
and MCH services, HIV & AIDS, IEC, PHC
Management, Planning & Budgeting
(Accounting), Mental Health, Traditional
Medicine, PRA and Bio-Waste
Management.
KT supplies essential medicines & other lab
reagents where Govt. supply is delayed or
insufficient.
The pump set has been repaired and
running water restored to the PHC
Minor electrical repair was undertaken &
completed Electrical connections in staff
quarters were also repaired & restored to
order
KT has implemented a waste
management system in the PHC according
to KPCB standards and also obtained a
certificate from the Board
INNOVATIONS BY KARUNA TRUST
1. IEC ACTIVITIES &
PRA PROGRAM
KT organized IEC activities in all the SC areas with the assistance of its IEC vehicle
Not fully functional The PRA program has also been conducted in villages
2. HEALTH INSURANCE A health insurance program was launched in the PHC.
PROGRAM
3. TRADITIONAL
MEDICINE
PROGRAM
Use of traditional medicine has also been integrated into the PHCs
Sub-Centres with Population
Sl. Name of the SC
No.
1. Chandrabanda
2. Katlatkur
3. Singnodi
4. Waduatti
Total
Distance Building No. of Population Male
From (Y/N) Villages
the PHC
Female Eligible No. of
Couples ASHAs
0
Yes
4
5,480
2,740 2,740 900
5
8
No
5
6,862
3,456 3,406 1,022 6
8
Yes
6
6,457
3,248 3,209 1,020 5
10
Yes
5
6,785
3,398 3,387 1,146 6
20
25,584
12,842 12,742 4,088 22
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BEFORE
AFTER
CITIZEN CHARTER DISPLAYED AT ALL THE PHCs
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4.4 Page 34 |
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HUDEM PHC
The Hudem PHC is located in Kudligi taluk in Bellary district. It covers a total
population of 39,408 and has 6 sub-centres functioning under it.
Karuna Trust took over this PHC on 01.02.2005, which has a total of 19 staff
functioning from it. PFI has been supporting the Hudem PHC since 2006.
Sl.
No.
Before taking over
1. LAND
Land boundaries were unclear
No fencing around PHC land
Total Area: 3.4 acres Lot of weeds, not adequately
maintained
After taking over
A compound wall was constructed with
funding support from the Zilla Panchayat
KT has started a demo garden & nursery
for traditional medicine on the PHC campus in
which there are currently about 100 plants of 20
different medicinal varieties growing
2. PHC BUILDING &
STAFF QUARTERS
Pending repair work & irregular
maintenance
Windows were broken in
many places
Repair work was undertaken and the building
re-painted
Broken glass panes in windows were replaced
A Citizen’s Charter has been displayed in the PHC
3. SUB-CENTER
BUILDINGS
Poorly maintained
Buildings were vacant/unused
The buildings were cleaned up & renovated
There are now 4 sub-centre buildings
The ANMs are headquartered at the sub-centres
4. EQUIPMENT
Not being serviced regularly
KT equipped the PHC with a computer, printer
& tape recorder (for IEC activities) along with email
connectivity
Village Resource Centres have been set up in
collaboration with ISRO, Bangalore
Tele-conference and Tele-ECG facilities are now
available in the PHC
Irregular supply
Some essential equipment & furniture such as cots,
BP apparatus and so on were procured from the
DHO. KT has supplied the PHC with a centrifuge
machine, laboratory equipment & equipment
needed for preparation of traditional medicine.
5. COLD CHAIN
EQUIPMENT
Available, but not maintained
properly
Available and functional
6. FURNITURE
Inadequate
Essential furniture available at the PHC
7. STAFF
Many vacancies Poor attendance
All vacancies have been filled up by Karuna Trust.
All staff members are headquartered & rendering
24 hour healthcare services to the local
community.
8. ADDITIONAL STAFF Unavailable
Karuna Trust has trained and appointed 1
counselor for the HIV & AIDS program and 1 Arogya
Mithra for the traditional medicine program.
9. TRAINING
PROGRAMS
Infrequent
Karuna Trust has conducted capacity building
training programs that are need-based for all PHC
staff on relevant topics such as RCH and MCH
services, HIV & AIDS, IEC, PHC Management,
Planning & Budgeting (Accounting), Mental
Health, Traditional Medicine, PRA and Bio-Waste
Management.
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10. MEDICINES
& REAGENTS
11. WATER &
ELECTRICITY
Irregular supply
Irregular supply
12. WASTE
MANAGEMENT
Not implemented
KT supplies essential medicines & other lab
reagents where Govt. supply is delayed or in
short supply.
A separate bore well was dug and motor
connection was installed for water supply to the
PHC out of ZP and GP fundsA new transformer
has been installed that monitors electricity
supply to the PHC and the pump house.
KT has implemented a waste management
system in the PHC according to KPCB standards
and also obtained a certificate from the Board
INNOVATIONS BY KARUNA TRUST
1. IEC ACTIVITIES & PRA PROGRAM
KT organized IEC activities in all the sub-centre areas with the
assistance of its IEC vehicle.
2. HEALTH INSURANCE PROGRAM
A health insurance program was launched in the PHC catchment
areas and being run as an on-going program
3. TRADITIONAL MEDICINE PROGRAM Use of traditional medicine has also been integrated into the PHCs
Sub-Centres with Population
Sl. Name of the SC Distance Building No. of Population Male
No.
From the (Y/N) Villages
PHC
1. Hudem
0
2. Thaakanahalli 4
3. Poojarahalli
6
4. Jumbanhally 8
5. Hurihala
15
6. Bhimsandra
35
No
2
3,196
1,605
Yes
4
4,217
2,120
Yes
7
8,078
4,034
Yes
5
6,991
3,495
No
8
6,277
3,204
Yes
12
11,648
5,362
Total
38
40,407
19,820
Female
1,591
2,097
4,044
3,496
3,073
6,286
20,587
No. of
ASHAs
3
4
7
7
5
11
37
The Hudem PHC building – KT has ensured
that it is well-maintained, neat & clean
The demo garden for traditional medicine
at the PHC – more than 20 different varieties of
medicinal plants are grown here
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KANNUR PHC
The Kannur PHC is located in Bijapur taluk in the district of the same name. It
is situated 625 kms. from Bangalore city and 50 kms. from Bijapur taluk proper.
According to Govt. norms, a PHC has to cover a population of 30,000 (or 20,000 in
remote or hilly areas) and manage 5-6 sub-centres.
However, Kannura PHC is ranked with handling the largest PHC populations –
a total of 53,237! The PHC has a staff accompaniment of 25 and has 11 sub-centres under its purview. It
was taken over by Karuna Trust on 20th May 2005. PFI has been supporting the Kannura PHC since 2006
Sl.
No.
Before taking over
After taking over
1. LAND
Total area: 5 acres
No boundaries
Lot of weeds, inadequately
maintained
No Fencing
Land was cleaned up and boundaries identified
Trees were planted around the campus
Landscaping was undertaken and completed
Fencing work was undertaken
2. PHC BUILDING &
STAFF QUARTERS
Pending repair work
Irregular maintenance
Dilapidated staff quarters
The building was cleaned up, repaired & repainted
Staff Quarters were renovated & occupied
3. SUB-CENTER
BUILDINGS
Poorly maintained Buildings The Sub-Centre buildings were cleaned up & repaired
were vacant
The ANMs are headquartered in the building
4. EQUIPMENT
Not maintained properly
Irregular supply
KT equipped the PHC with a computer, printer &
tape recorder (for IEC activities) along with email
connectivity
Equipment for Village Resource Centres were
installed in collaboration with ISRO, Bangalore
Tele-conference and Tele-ECG facilities are now
available in the PHCSome essential equipment was
procured from the DHO
5. COLD CHAIN
EQIPMENT
Available, but not
maintained properly
Available and functional
6. FURNITURE
Inadequate
Essential furniture available at the PHC
7. STAFF
Many vacancies
Poor attendance
All vacancies have been filled up by KTAll staff are
headquartered & rendering 24-hour healthcare
services to the local community
8. ADDITIONAL STAFF Unavailable
KT has trained and appointed 1 counsellor for the HIV
& AIDS program and a Refractionist has also been
appointed
9. TRAINING PROGRAMS Infrequent
KT has conducted capacity building training programs
that are need-based for all PHC staff on relevant topics
such as RCH and MCH services, HIV & AIDS, IEC, PHC
Management, Planning & Budgeting (Accounting),
Mental Health, Traditional Medicine, PRA and Bio-
Waste Management.
10. MEDICINES &
REAGENTS
Irregular supply
KT supplies essential medicines & other lab reagents
where govt. supply is delayed or in short supply
11. WATER & ELECTRICITY Poor and irregular supply
Minor electrical repair was undertaken to ensure
continuous electricity and water supply to the PHC
12. WASTE MANAGEMENT Not implemented
KT has implemented a waste management system in
the PHC according to KPCB standards and also
obtained a certificate from the Board
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INNOVATIONS BY KARUNA TRUST
1. IEC ACTIVITIES & PRA PROGRAM KT organized IEC activities in all the sub-centre areas with the assistance of
its IEC vehicle The PRA program has also been conducted in villages
2. HEALTH INSURANCE PROGRAM A health insurance program was launched in the PHC catchment area and
is running as an on-going program
Sub-Centres with Population
Sl. Name of SC Distance Building No. of Male
No.
from PHC (Y/N) villages
1. Kannura
0
Yes
2. Domnal
12 km Yes
3. Thidagundi 7.5 km Yes
4. Makanapur 5 km
No
5. Gunaki
12 km Yes
6. Minchnal
16 km Yes
7. Arakere
15 km Yes
8. Siddapur
10 km Yes
9. Boothnal
17 km No
10. Jalgeri
43 km Yes
11. Yathnal Y
53 km Yes
Total
3
6372
2
3068
2
2574
3
2242
3
2548
2
2419
2
2847
1
2512
2
3005
2
3062
1
1965
23 32,614
Female Eligible No. of
Couple ASHA
5882 1838 3
2833 885 1
2377 609 1
2070 646 1
2447 698 3
2326 487 2
3123 895 3
2427 740 0
2775 867 3
2836 883 3
1767 552 1
30,863 9,100 21
Kannura PHC before KT took over…
…and after
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KOHINOOR PHC
The Kohinoor PHC is based at Basavakalyan taluk in Bidar district of Karnataka.
Bidar is 120 Kilometers from Andhra Pradesh's capital city, Hyderabad. Kohinoor PHC is
at a distance of 100 Kilometers from Bidar district and 835 Kilometers from Bangalore
city. Kohinoor PHC covers a population of 31,939 and 7 sub-centres come under its
jurisdiction. The PHC has a staff retinue of 20 personnel and is being managed by
Karuna Trust since 20th May 2005. PFI has been supporting the PHC from 2006
Sl.
No.
LAND
Total area :
120x120 ft.
Before taking over
After taking over
Land boundaries were unclear
Lot of weeds, not adequately
maintained
The land was cleaned up & boundaries identified
PHC BUILDING
& STAFF QUARTERS
Pending repair work & irregular The buildings were cleaned up and re-painted
maintenance
Staff quarters was renovated and is occupied by
Dilapidated staff quarters
the PHC staff
SUB-CENTER
BUILDINGS
Poorly maintained
Buildings were vacant/unused
The buildings were cleaned up & renovated
Minor repair work was undertaken & completed
The ANMs are headquartered at the sub-centres
EQUIPMENT
Not being serviced regularly
Irregular supply
KT equipped the PHC with a computer, printer &
tape recorder (for IEC activities) along with
internet connectivity
Equipment for Village Resource Centre was
installed in collaboration with ISRO, Bangalore
Tele-conference and Tele-ECG facilities are now
available in the PHC
COLD CHAIN
EQIPMENT
Not maintained properly
Available and functional
FURNITURE
Inadequate
Essential furniture available at the PHC
STAFF
Many vacancies
Poor attendance
All vacancies have been filled up by KT
All staff are headquartered & rendering 24-hour
healthcare services to the local community
ADDITIONAL STAFF Unavailable
KT has trained and appointed 1 counselor for the
HIV & AIDS program
TRAINING PROGRAMS Infrequent
KT has conducted capacity building training
programs that are need-based for all PHC staff on
relevant topics such as RCH/MCH services, HIV &
AIDS, IEC, PHC Management, Planning &
Budgeting (Accounting), Mental Health,
Traditional Medicine, VRC training (with ISRO),
PRA and Bio Medical Waste Management
MEDICINES &
REAGENTS
Irregular supply
KT supplies essential medicines & other lab
reagents where Government supply is delayed or
in short (not sufficient) supply
WATER & ELECTRICITY Poor and irregular supply
Minor electrical repair work was taken up in all
the buildings to ensure continuous electricity &
water supply
WASTE MANAGEMENT Not implemented
KT has implemented a waste management system
in the PHC according to KPCB standards and also
obtained a certificate from the Board
34
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INNOVATIONS BY KARUNA TRUST
1. IEC ACTIVITIES & PRA PROGRAM
KT organized IEC activities in all the sub-centre areas
with the assistance of its IEC vehicle The PRA program
was also conducted in the villages
2. HEALTH INSURANCE PROGRAM A health insurance program was launched in the PHC
catchment areas
Sl. Name of SC
No.
1. Kohinoor
2. Attur
3. Batgeri
Sub-Centres with Population
Distance
from PHC
0
6 km
8 km
Building
(Y/N)
No
No
Yes
No. of
villages
1
4
5
Male
2541
2052
2785
Female
2559
2070
2809
No. of
ASHAs
5
3
5
PHC Building
Needle Pit
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NANDIKESHWARA PHC
The Nandikeshwara PHC is located in Badami taluk, Bagalkot district. The
PHC is located at a distance of 125 kms. from Bagalkot district and 25 kms. from
Badami taluk. Nandikeshwara caters to a population of 19,280 and management
was taken over by Karuna Trust from 25th January 2006. The PHC has 16 staff and
3 sub-centres functioning under it. PFI has been supporting the PHC since 2006.
Sl.
No.
LAND
Total area : 3 acres
Before taking over
Lot of weeds, not adequately
maintained
PHC BUILDING &
STAFF QUARTERS
SUB-CENTER
BUILDINGS
EQUIPMENT
Pending repair & irregular
maintenance
Dilapidated staff quarters
Poorly maintained
Buildings were vacant
Not being serviced regularly
Irregular supply
COLD CHAIN EQIPMENT Non-functional
Minor repair work pending
FURNITURE
Inadequate
STAFF
Many vacancies
Poor attendance
ADDITIONAL STAFF Unavailable
TRAINING PROGRAMS Infrequent
After taking over
The land was cleaned up
KT has started a demo garden & nursery for
traditional medicine in the PHC campus in which
there are currently about 211 herbal plants
procured from the Forest Department.
KT cleaned up and re-painted the building
Citizen’s Charter & other relevant sign boards
have been displayed at each section in the PHCS
Staff quarters were renovated & are currently
occupied by PHC staff
The buildings were cleaned up & renovated
The ANM is headquartered at each sub-centre
KT equipped the PHC with a computer, printer &
tape recorder (for IEC activities) along with
internet connectivity
Equipment for Village Resource Centres was
installed in collaboration with ISRO, Bangalore
Tele-conference and Tele-ECG facilities are now
available in the PHC
Some essential equipment were procured from
the DHO
Equipment for preparation of traditional
medicine remedies have been supplied by KT
Equipment has been repaired and is functional
Essential furniture available at the PHC
All vacancies have been filled up by KT
All staff are headquartered & rendering 24-hour
healthcare services to the local community.
KT has trained and appointed 1 counselor for the
HIV & AIDS program, 1 Arogya Mithra for the
traditional medicine program & a Refractionist
for the vision center.
KT has conducted capacity building training
programs that are need-based for all PHC staff on
relevant topics such as RCH/MCH services, HIV &
AIDS, IEC, PHC Management, Planning &
Budgeting (Accounting), Mental Health,
Traditional Medicine, PRA and Bio Medical
Waste Management
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Sl.
No.
MEDICINES &
REAGENTS
Before taking over
Irregular supply
WATER & ELECTRICITY Unavailable Under repair
WASTE MANAGEMENT Not implemented
After taking over
KT supplies essential medicines & other lab
reagents where Government supply is delayed or
in short supply (insufficient)
KT repaired the pump set and ensured water
supply Minor electrical repair work on all
buildings was taken up & completed
KT has implemented a waste management
system in the PHC according to KPCB standards
and also obtained a certificate from the Board
INNOVATIONS BY KARUNA TRUST
IEC ACTIVITIES & PRA PROGRAM
KT organised IEC activities in all the sub-centre areas with the assistance
of its IEC vehicle The PRA program are also conducted in the villages
HEALTH INSURANCE PROGRAM
A health insurance program was launched in the PHC catchment areas
TRADITIONAL MEDICINE PROGRAM Use of traditional medicine has also been integrated into the PHCs
Sub-Centres with Population
Sl. Name of the SC
No.
Distance
From the
PHC
Building
(Y/N)
No. of
Villages
1. Nandikeshwara
0
Yes
4
2. Kutaknakeri
2
Yes
4
3. Adagava
3
Yes
3
Total
5
11
No. of
ASHAs
7
6
4
17
PHC Building
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SRI RAMARANGAPURA (SRR PURA) PHC
The SRR Pura PHC is located in Hospet taluk of Bellary district. Bellary has a high
SC/ST population and the PHC caters to remote local communities. It is at a distance of 75
kilometers from Bellary district and 60 kilometers from Hospet taluk. The PHC covers a
population of 20,387 and has 4 sub-centres under its purview. Karuna Trust took over the
PHC on 1st February 2005 and has been managing it ever since. PFI has been supporting the
PHC from 2006.
Sl.
No.
1. LAND
Total area: 2.5 acres
2. PHC BUILDING &
STAFF QUARTERS
Before taking over
After taking over
Land boundaries were unclear
No fencing around PHC land
Lot of weeds, not adequately
maintained
The land was cleaned up, landscaped & trees
were planted
Fencing work was undertaken and completed
KT has started a demo garden & nursery for
traditional medicine plants in the PHC
Building not maintained regularly
Windows were dirty with glass
broken & doors were damaged
Dilapidated staff quarters with
repair work pending
KT cleaned up, repaired and re-painted the
building. Glass was fixed for the windows &
doors repaired
Staff quarters were repaired and renovated
3. SUB-CENTER
BUILDINGS
4. EQUIPMENT
Poorly maintained
Buildings were vacant
Not being serviced regularly
Irregular supply
5. COLD CHAIN
EQIPMENT
6. FURNITURE
7. STAFF
Non-functional & was under
repair
Inadequate
Many vacancies
Poor attendance
8. ADDITIONAL STAFF Unavailable
9. TRAINING
PROGRAMS
Infrequent
10. MEDICINES &
REAGENTS
Irregular supply
The buildings were cleaned up & renovated
There are 4 sub-centre buildings. The ANMs are
headquartered at the sub-centres
KT equipped the PHC with a computer, printer &
tape recorder (for IEC activities) along with
internet connectivity
Some essential equipments were given by the
DHO Equipment for medicinal preparations has
been supplied by KT
KT has repaired the equipment & made it
functional
Office furniture (tables & chairs) supplied by KT
All vacancies have been filled up by KT
All staff are headquartered & rendering 24-hour
healthcare services to the local community
KT has trained and appointed 1 counselor for the
HIV & AIDS program, 1 Arogya Mithra for the
traditional medicine program & a Refractionist
for vision centre.
KT has conducted capacity building training
programs that are need-based for all PHC staff on
relevant topics such as RCH/MCH services, HIV &
AIDS, IEC, PHC Management, Planning &
Budgeting (Accounting), Mental Health,
Traditional Medicine, VRC management (with
ISRO) PRA & Waste Management
KT supplies essential medicines & other lab
reagents where Government supply is delayed or
in short supply (insufficient)
38
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Sl.
No.
11. WATER &
ELECTRICITY
Before taking over
Poor and irregular supply
12. WASTE
MANAGEMENT
Not implemented
After taking over
Water supply to the PHC is provided by the
Gram Panchayat
KT ensured completion of minor electrical repair
& obtaining new connections for all buildings
KT has implemented a waste management
system in the PHC according to KPCB standards
and also obtained a certificate from the Board
INNOVATIONS BY KARUNA TRUST
1. IEC ACTIVITIES & PRA PROGRAM
KT organise IEC activities in all the sub-centre areas with the
assistance of its IEC vehicle The PRA programs were also conducted
in villages
2. HEALTH INSURANCE PROGRAM
A health insurance program was launched in the PHC catchment
areas and is on going program.
3. TRADITIONAL MEDICINE PROGRAM Use of traditional medicines has also been integrated into the PHCs
Sub-Centres with Population
Sl. Name of the SC Distance Building No. of
No.
From the (Y/N) Villages
PHC
No. of
ASHAs
1 S.R.R. Pura
0 kms. Yes
1
2
2 Suggenahalli 4 kms. Yes
4
2
3 Jowcck
8 kms. Yes
6
5
4 Devalapura 10 kms. Yes
2
5
Total
13
14
IEC Programme at Village
PHC Building
Sub Center
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SERVICES PROVIDED AT PHC & SUB-CENTRE
All Karuna Trust-managed PHCs and Sub-Centres offer the following services:
PHC Services
i. 24 hours Emergency/Casualty Services
ii. 6 days OPD service
iii. 4 to 6 functional beds
iv. Ante-natal care and Post natal care
v. 24 hrs labour room and essential Obstetrics facility for both normal and assisted deliveries
vi. Early and safe abortion services
vii. Prevention and management of RTIs/STIs
viii. Essential New Born Care
ix. Routine immunization services
x. Family Planning services
xi. Essential laboratory services
xii. 24 hrs Ambulance Facility, referral for emergencies
xiii. Essential medicines as per terms of the MoU between government and KT
xiv. Participation in and implementation of National and State Programs of Health & Family
Welfare Department including, NRHM, RNTCP, NVBDCP & NACP etc.
xv. Outreach Health Camps
xvi. Implementation of gender sensitive strategies in PHCs
xvii. Strengthening VHSC, ARS and SHGs
xviii. IEC/BCC activities
xix. Monthly visits by OBG surgeon to sub centres
xx. Adolescent health clinic
xxi. Vision care centres
xxii. Community Mental Health Services
xxiii. Records maintenance using HMIS
xxiv. Integrated Counseling and Testing Centre
xxv. Supply of AYUSH drugs.
Lab Services
i. Routine Blood examination
ii. Blood grouping and Rh typing
iii. Blood for MP test, widal test
iv. Stool examination (Physical, chemical and microscopic)
v. Urine examination (Physical, chemical and microscopic)
vi. Urine test for pregnancy confirmation
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vii. Sputum
viii. Blood sugar
ix. Blood for VDRL
x. Rapid tests for pregnancy
xi. Stool examination for ova and cyst
xii. Water testing for portability
xiii. HIV testing
Sub Center Services
i. Maternal & Child Health services like ANC, intranatal care and PNC
ii. Child Health: Essential newborn care, exclusive breastfeeding, immunization, Vitamin A
prophylaxis and prevention of childhood diseases
iii. Family planning and contraception
iv. Adolescent health care
v. School health services
vi. Control of local endemic diseases
vii. Disease surveillance
viii. Water quality monitoring and disinfection
ix. Promotion of sanitation and appropriate garbage disposal
x. Field visits
xi. Community Needs Assessment
xii. Curative services
xiii. Training coordination and monitoring of SBAs and ASHA
xiv. Implementation of National Health Programmes at Sub centre level
xv. Records of vital events
xvi. Records concerning mother, child and eligible couples
xvii. Maintenance of Sub Center Infrastructure
xviii. Proper Biomedical Waste disposal
All the above services are provided free of cost.
ŸPlease refer more information about PHCs in Annexure II, III
IEC Posters displayed at PHC
Women friendly PHC
41
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A REPORT OF ACTIVITIES
1. Capacity Building Program
Capacity building of medical personnel and other staff involved in Karuna Trust's PHCs has
been the focus of all the Trust's work in the area of primary healthcare. Over the 5 years of the
project supported by PFI, Karuna Trust has undertaken relevant capacity building training
programs that address need to improve skill sets, knowledge gaps and functioning of staff in PHCs
and sub-centres.
List of the Training Program
SL Date
1 3-3-06 to 5-3-06
2 07-07-2006
09-07-2006
3 23-07-2006 to
25-07-2006
4 03-08-2006 to
04-08-2006
5 29-9-2006 to
30-9-2006
6 13-10-2006 to
14-10-2006
7 8-11-2006 to
9-11-2006
8 19-11-2006 to
20-11-2006
9 4-12-2006 to
5-12-2006
10 18-12-2006 to
22-12-2006
11 26-12-2006 to
27-12-2006
12 19-1-2007 to
20-1-2007
Number of days
3 Days
3 Days
3 Days
Subject
Training on PHC
management for Doctors
Administrators and
Health Workers
Karuna Trust Capacity
building programme
for PHC staff
PHC management
Participants
Doctors, Administrators
and Health Workers
Administrators
Medical Officers
2 Days
2 Days
2 Days
2 Days
Lab technicians,
Pharmacists etc
District mental health
Programme
Karuna Trust training
for Vaidyamitra’s
Health Insurance
Lab technicians,
Pharmacists etc
Medical Officers
Arogyamitras
Administrators and ANMs
2 Days
2 Days
PHC staff training on
HIV/AIDS
Arogya Mitra Training
MO and ANMs
Arogya Mithra
5 Days
2 Days
2 Days
Training programme for
Medical Officers
Doctors on PHC management
Capacity building Training Administrators
programme for administrators
Training on HIV/AIDS
MO,Counsellers and Lab
Technicians
42
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13 28-3-2007 to
31-3-2007
14 3-4-2007 to
4-4-2007
15 5-4-2007
4 Days
2 Days
1 Day
16 23-4-2007 to
25-4-2007
17 27-4-2007 to
28-4-2007
18 16-6-2007
3 Days
2 Days
1 Day
19 23-6-2007 to
24-6-2007
20 22-7-2007 to
28-7-2007
21 23-8-2007 to
25-8-2007
22 25-8-2007 to
26-8-2007
2 Days
7 Days
3 Days
2 Days
23 15-10-2007
24 17-11-2007
1 Day
1 Day
25 27-12-2007
1 Day
26 28-12-2007 to
30-12-2007
3 Days
Training Programme
on health Insurance
and Micro Finance
PHCs Staff
Training for LHV/BHE
and Sr. Health Instructors
of PHCs
HV/BHE and Sr. Health
Instructors of PHCs
PHC administrators
training on
Annual Plan and Budget
Administrors
Training Programme
on Mental
Health for MOs of PHCs
Medical Officers
Training for Arogya Mitra’s Arogya Mithra
Training programme
for Administrators
on Community
Health Insurance
Administrators
Training on Traditional
Medicines conducted by
FRLHT
Administrators
Rapid assessment and
validation of Traditional
medicine Project – FRLHT
Administrators
Training for MOs and
Administrative officers on
HIV/AIDS
MOs and Administrative
officers on HIV/AIDS
Training Programme
on Accounts and Record
maintenance for
administrative officers
Administrative
Officers, LHV, ANMs
Karuna Trust validation
workshop
Administrative officers
Training programme on
VRC by ISRO for
Administrative officers of
PHCs
Administrative officers
Training Programme
Arogya Mitra’s
on Traditional Medicine for
Arogya Mitra’s
Training on Eye care
PMOs and MO
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27 1-2-2008 to
2-2-2008
2 Days
28 12-2-2008 to
13-2-2008
29 1-4-2008 to
5-4-2008
30 28-5-2008 to
30-5-2008
31 25-6-2008 to
26-6-2008
32 29-6-2008
33 4-7-2008 to
8-7-2008
34 11-11-2008 to
17-11-2008
35 28-1-2009 to
29-1-2009
36 20-9-2009 to
21-9-2009
37 22-9-2009 to
24-9-2009
38 2-11-2009 to
6-11-2009
39 13-11-2009 to
16-11-2009
40 16-11-2009
41 8-12-2009 to
9-12-2009
42 18-12-2009 to
19-12-2009
2 Days
5 Days
3 Days
2 Days
1 Day
5 Days
7 Days
2 Days
2 Days
3 Days
5 Days
4 Days
1 Day
2 Days
2 Days
Training program
conducted
for MOs, LHV and
JrHA under PFI
New innovations at PHC
MOs, LHV and JrHA
PHC staff
Training program PHCs
staff- MOs, Pharmacists MOs, Pharmacists
and Administrative Officers
Training
programme on
community mental health
Medical Officers
Dissemination
PHC staff
workshop on PPP-PFI, MSI
Community
Administrators
based monitoring training
CBM project workshop on PHC staff
Community monitoring
EPT training conducted by
Karuna Trust for PHC staff
Capacity building for JHAs
male and female and LHV
organized by Karuna Trust
JHAs male and female
and LHV
Manasa Project-
Community mental
health training
MO's
SSI project- Training of
PMOAs & MO's
Medical Officers of Karuna
Trust PHCs
PSI project – PHCs staff
training
Administrators and
PHC Staff
EMS training organized
by Karuna Trust
MO's and ANMs
PSI – PHCs staff training
on health education
MHW and Administrators
EMS training for medical MO's and ANMs
officers of PHCs
PSI/SDTT training for
PHCs JHA staffs
PHCs JHA staffs
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43 9.4.2010 to
10.4.2010
44 16.6.2010 to
17.6.2010
45 31.7.2010
2 Days
2 Days
1 Day
46 28.8.2010
47 29.1.2011 to
` 31.1.2011
48 13.2.2011 to
14.2 2011
49 10-6-2001 to
11-6-2011
50 27-5-2011
28-5-2011
1 Day
3 Days
2 Days
2 Days
2 Days
51 15-7-2011 to
16-7-2011
52 10-9-2011 to
11-9-2011
2 Days
2 Days
HIMS training program
for PHC staff
LHV and Administrator
EMS Training Program for MO's
PHC staff
Training program on
management of Mobile
Health Clinic
MO's and ANMs
Training program
for PMOAs
PMOAs
Community Mental Health MOs
Program for
MO's & PHC staff
Community mental health SN, Jr. HA and ANMs
program for
SN, Jr. HA and ANMs
Training for
Administrative officers
on PHC management
Administrators
To understand the
theoretical background
of different lab tests and
also hands-on training in
practical skills in
conducting the tests
Lab technicians
Capacity building for
MHW of PHCs
MHWs
Capacity
ANMs
building training for ANMs
45
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A NOTE ON THE IMPACT OF TRAINING PROGRAMS
Regular training programs on relevant subjects in
the field had a great impact on the overall performance
and functioning of the staff at all levels under the PPP.
Being exposed to new training methods, new topics or
even refresher courses, has helped personnel sharpen
their existing skills, acquire new ones and put these to
the best use when dealing with local communities
accessing primary healthcare facilities.
Some of the benefits of training have been mentioned
below :
Improved knowledge
The knowledge base of those working in PHCs
and Sub-Centres has improved. Training programs also
focus on aspects of healthcare other than medical, such
as nutrition, health & hygiene, sex & sexuality,
adolescent health as well as maternal & child health.
This enables staff to communicate with local
communities on a range of health topics in a clear,
precise and easy-to-understand manner.
Lab Technician training
Upgraded Skills
Many staff such as ANMs or ASHAs would have
undergone skills training in their relevant field when
they took up work in the field. Periodic refresher
training programs organized by Karuna Trust have
helped sharpen their existing skills as well as acquire
new skills in the field of primary health care.
Training for service providers
Capacity Building training for
PHC Medical Officers on EMS
M.H.W Training
ANM Training at TRC, Mysore
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Being in training programs and learning new aspects of work has helped PHC and SC staff implement
the innovative projects in the field that Karuna Trust conceptualizes. Periodic visits to the field by the Karuna
Trust team to solve troubleshooting issues also helps staff address their concerns, solve conflicts/problems
and implement projects in a smooth and effective manner.
Benefits to the local communities
ŸPeriodic supervision, troubleshooting and training programs has been of immense benefit, albeit indirect,
to the local communities with whom Karuna Trust works through its PHCs.
ŸHaving headquartered staff in PHCs rendering 24-hour healthcare services, improved efficiency of
addressing health issues of patients, timely referrals to higher facilities for treatment, provision of
ambulance services in PHCs, caring staff who are courteous and respectful the people who come to the
PHC – all these have a positive impact on local families.
ŸThey access the PHC more frequently for their healthcare needs and visits to private medical facilities is
reduced significantly, saving them time and money.
ŸThere is improvement in overall healthcare due to timely treatment as all medical services, including
laboratory facilities are available at the PHC itself.
VHSC CAPACITY BUILDING
VHSC Capacity Building Program
A VHSC capacity building program was
conducted in April 2011 in 7 PFI-supported PHCs. All
the programs were organized by Karuna Trust and
conducted in the PHCs. The main objective of the
program was to improve the skills of the VHSC
Members in the PHC area. The program was
conducted in 7 PHCs & 150 VHSC members
participated in the program.
CAPACITY BUILDING FOR SHGS
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Role of community in complicated delivery
Village health day program was conducted on
16th of September 2010 in Chandrabanda PHC
campus. Total 120 members participated and also
local Panchyat members were present in the
program. Medical Officer of the PHC Spoke that
family members should take responsibilities and help
pregnant women in taking care of their health.
Pregnant women should register in the PHC and
undergo all routine checkups. She has to go to the
hospital regularly for checkup. Women below 18
years and after the age of 35 and height less than 145
cm face complication during pregnancy. They should
take regular care by the doctors.
2. IEC Activities
The IEC programs are being conducted since May 2011 under the No-Cost Extension Project. The
programs are theme-based and conducted according to the individual needs of the PHCs.
About our IEC team
Karuna trust is having an IEC team in each PHC. All the Health workers have been trained &
experienced in this regard. The IEC teams conduct the health education programmes at the village level.
Methodology
Drama, Street Theatre, Song, Skit, Poster, Video and Audio, Flip Chart, Wall Writing, Pamphlet,
Slogans, one-to-one communication, Family Counseling, Group Discussion, Public Meeting, and Rallies.
Following IEC activities are conducted in the PHC
· Adolescent health education for high school girls.
· Disseminate information on various types of family planning methods for eligible couples.
· Counseling on cafeteria choice of contraception.
· Health Promotional activities on No-scalpel vasectomy.
· Education on Medical Termination of Pregnancy.
· Active male participation in Family planning
· Ensure access to reproductive health services via family planning
· Improving the distribution of family planning information and services to males, adolescents, and
people in rural areas.
· Awareness on HIV among the community
· Using existing education materials such as hand bills, posters
· By involving opinion users , community leaders, and religious leaders for motivate community people
to adopt FP methods.
The team will conduct following IEC activities on the abovementioned themes:
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Rally at SRR Pura PHC
Sneha Clinic at Chandrabanda
IEC Programme at Village
School Health Checkup
Reorientation about the National Health Programs and RCH
PFI supported Chandrabanda PHC organized one day Refresher training program for ASHA and AWs.
The objectives of the training was to refresh their knowledge on various issues of health and keep their
motivation level high for better performance. 70 ASHA and AWs participated in this training program.
World AIDS day
PFI Supported VK Salagar PHC organized HIV/AIDS awareness program on World AIDS day in a college
at VK Salagar. Along with students, the college faculty also participated in program. The program mainly
focused on importance of HIV/AIDS prevention in the country and the role of youngsters in protecting
themselves from the sexually transmitted diseases. A quiz competition was also organized for the students.
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ADVOCACY
Karuna Trust has been making a significant contribution in the area of primary health care in India.
Active participation in the conferences, seminars and committee discussions at District, State and National
levels have enabled Karuna Trust to share its knowledge and success stories and best practices. Karuna Trust
is constantly striving to influence policy decisions both at the State and National levels for the benefit of
marginalized communities .
The Honorary Secretary of Karuna Trust, Dr. H. Sudarshan has been involved in public health, education
and social welfare of marginalized tribal and rural communities for over 30 years. He also holds/has held
positions in the State and National bodies, which has helped Karuna Trust pursue its advocacy mission at
both State and National levels and also influence the Government at the policy level.
For the past 5 years, KT has been working closely with the community it serves by allowing them to
decide the village plan through VHSC. By this, the villagers can decide the best suitable facilities as they are
the part of the village. Introduction of Citizen's charter in the PHC, the use of low cost generic drugs instead
of expensive branded drugs and conducting PRIs was first implemented by KT which are now being followed
in the other Government run PHCs. The involvement of Karnataka State in the first phase of Community
Monitoring project was mainly because of the efforts of Dr. Sudarshan. The concept of Public Private
Partnership was advocated by Dr. Sudarshan, showing the great results achieved by the Gumballi PHC in
Chamarajanagar district which is replicated across Karnataka and other states.
The health indicators and awareness level of PHCs after the intervention by KT with the help of PFI have
drastically improved and most of the PHCs have good ranking in the Taluk and District levels. These PHCs are
converted as Model PHCs which attracts many organizations to send their staff for exposure visits. A
dissemination workshop was also conducted on "Mainstreaming Traditional Medicine into the primary
health care" where the achievements were shown to the higher officials of the Government which led to
implementing the project in 2 districts of Karnataka.
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END LINE EVALUATION REPORT
(Conducted by IHMR)
The Indian Institute of Health Management Research (Society) was established in 1984 with Public
Health and Management at the Core.
The end line evaluation is a collective review of implementation of the project. The data has been
drawn from both primary and secondary sources using a combination of both quantitative and qualitative
methods. A total of 741 currently married women between 15-49 years were selected from 741 households,
which were spread across three base-line surveyed taluks, namely, Koodlagi, Raichur and Alanda of Bellary,
Raichur and Gulbarga districts respectively. A two stage sampling technique was used to select women from
project villages. The secondary data primarily consisted of quarterly and annual progress reports,
monitoring reports, HMIS data, training documents and activity profile of Karuna Trust etc.
OPERATIONAL CHALLENGES AND STRATEGIES
Organizations are bound to face challenges/problems/barriers while implementing large scale
projects. Karuna Trust is no exception to this. In order to capture information on such challenges, in-depth
interviews were conducted with different personnel working at PHC, SC and ground staff of the project.
Apart from this, FGDs which were conducted with VHSC members also brought out few challenges. The
evaluation team also had a detailed discussion with the project team, including Dr. H. Sudarshan, founder
and Hon. Secretary of Karuna Trust, to understand these challenges.
OPERATIONAL CHALLENGES
For analytical purpose, these challenges have been broadly classified into five categories, namely,
human resource, administrative, financial, drugs and supply, infrastructure and others. The same has been
discussed below :
HUMAN RESOURCES
ŸOne of the major problems highlighted both at the organizational and community level was related with
having a MBBS doctor at PHC. Considering the fact that there is already shortage of MBBS doctors and
appointing one in these remotely located PHCs has been one of the greatest challenges for the
organization, just as has been evidenced even in PHCs which are being manned by the government. Out of
the three PHCs covered during the end line survey, Chandrabanda PHC had the AYUSH doctor, who was
appointed by the Karuna Trust itself. At V.K Salagar PHC too, there was an AYUSH doctor but was deputed
from the government side. However, in Hudeyam PHC, there was a government deputed MBBS doctor.
ŸThe personnel (mainly ANMs who are not trained by the organization) working under the project lack
quality skills and commitment.
ADMINISTRATIVE
ŸAnother challenge which was highlighted was related with lack of administrative power delegated to the
organization to control the government deputed doctor at the PHCs. It was mentioned that government
deputed doctor, in general, are reluctant to follow the administrative procedures set out by the
organization, which hampers the project activities.
ŸThe staff working at these PHCs feels insecure in terms of getting permanent appointment for their current
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positions in near future.
FINANCIAL
ŸLong delay in releasing the grants not only hinders implementation of different activities of project but also
the hampers timely distribution of personnel salary working under the project. For instance, Medical
Officer of PHC Chandrabanda reportedly informed that he did not receive salary from last 10 months.
ŸDistrict health authorities also delay the reimbursement of the travel allowance of the project personnel.
ŸProject team also shared that due to resource constrains there are less opportunities for innovation and
their sustenance.
DRUGS AND SUPPLIES
ŸDelay in procurement of drugs at the district and state level hampers the timely disbursement of drugs
to the health facilities, thereby leading to stock out of even essential drugs. For instance, V.K. Salagar
PHC, the IFA tablets were reportedly out of stock since last three to four months.
INFRASTRUCTURE
ŸProject team told that many of the sub-centres under the project PHC are being run from private premises
and not from government building.
OTHERS
ŸProject team reported that due to lack of understanding of PPP model among the communities, which may
be due to higher illiteracy rates, people consider these PHCs as private health facilities and discriminate
between government and organization run PHCs.
ŸAt times, factors, such as tendency to override jurisdiction by local community members, district
authorities and socio-political conditions undermine the NGOs efforts.
ŸCorruption at district health offices was another challenge reported by the organization.
STRATEGIES
Karuna Trust, from time to time, has implemented different strategies to overcome these challenges. Some
of them are as follows :
ŸEstablishing ANM School to overcome the shortage of trained and committed ANMs.
ŸCapacity building and motivation to healthcare staff.
ŸMobilizing local resources.
ŸImprovised Group D post for lab technician.
ŸAddressing community members by the core project team from time to time to create more awareness on
PPP model and address the problematic issues.
ŸPosting of doctors through KPSC with the help of Government.
ŸAppointment of supervisory staff to conduct regular visit.
ŸExposure visits for staff.
ŸTransparency and accountability.
ŸPromoting First Divisional Clerk (FDC) post to a administrator level
All these strategies directly/in-directly influenced the project and had a bearing on different activities
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of the project, which in turn had the influence on the outcome. These influences have been discussed below
for each of the strategy mentioned above :
ŸThe establishment of ANM School has helped the organization in filling up all the vacant ANM positions
with well trained ANMs equipped with quality skills, which in turn had improved the activities pertaining to
RCH and NHPs both at the field and PHC level.
ŸProviding capacity building trainings other than government sponsored to the health personnel has
facilitated them in further improving their skills and motivation, which is apparent in the form of regular
visits by health workers, timely availability of doctors and staff, maintaining quality in delivering health
services, correct collection of HMIS data, record keeping and maintenance, etc.
ŸFrom time to time local leaders, Panchayat Raj Institutions, local NGOs, VHSCs Arogya Raksha Samithis,
local Rotary functionaries, NRIs, etc. has been involved in decision making while implementing the project.
Their active participation and contribution has helped in creating a sense of ownership among them, which
in turn led to the betterment of PHCs both in terms of infrastructure and service delivery.
ŸSince there were no sanctioned posts of Lab technician in Chandrabanda and Kannura PHCs, Karuna Trust
appointed Lab technicians in place of sanctioned post of Group D (which is not very essential), to ensure
that lab services at PHC are being provided without any hassle.
ŸInvolving local leaders and community members in addressing the problematic issues of the PHCs from
time to time by the Monitoring and Evaluation team of Karuna Trust not only helped in building and
strengthening the rapport with the community members but also created more awareness on PPP model.
ŸDue to non availability of MBBS doctors, Karuna Trust had approached Government to provide MBBS
doctors through KPSC. Currently 3 MBBS doctors are posted in PFI funded PHCs (Hudeyam, Kannur).
ŸKaruna Trust had appointed four zonal supervisors for both administrative and technical support as well as
supervision. Out of these four zonal supervisors, two looks after technical aspects while the other two
supervise the administrative functions. This, in turn, had helped the project to do well.
ŸDuring induction trainings, PHC staffs have been taken to model PHCs run under PPP mode to have the first
hand experience of their functioning, which not only inspired them to do their best but also increased their
vision and knowledge.
ŸZero tolerance policy of Karuna Trust towards corruption resulted into the formulation of transparent
framework of implementation. All the services provided at PHCs are totally free. Regular internal and
external audits , display of citizen's charter and drug list, publication of audit report, annual report and
financial report on website, external evaluation by Government and other external agencies further reflect
on better accountability and transparency maintained by the organization.
ŸKaruna Trust has appointed staff possessing qualification with Master in Social Work as administrators. This
has resulted in two fold benefits. These administrators not only look after the clerical work but also overall
HR and financial management, which in turn has led the Medical Officer to concentrate more on clinical
duties rather than administrative under the project.
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Annexure I
LIST OF HEALTH INDICATORS IN 6 NORTH KARNATAKA DISTRICTS WHERE KARUNA TRUST RUNS PHCs SUPPORTED BY PFI
Sl. Indicators
Bagalkot Bellary Bidar Bijapur Gulbarga Raichur
1. Literacy Rate (5-9 years)
19.0
19.9
24.4 21.9
16.3
15.4
2. Total unmet need for family planning
18.7
16.8
21.5 18.7
23.1
16.7
3. Percentage girls married below 18 years
14.4
9.7
9.8
12.9
13.5
15.1
4. Contraceptive prevalence rate
(% current use of family planning)
52.9
55.1
54.2 56.3
47.5
49.3
5. Percentage coverage of safe delivery
62.3
54.9
68.8 71.2
56.0
51.7
6. Percentage coverage of complete ANC
25.7
34.7
38.9 21.8
31.9
18.6
7. Percentage coverage of complete immunization
58.5
65.3
78.7 50.8
64.6
45.2
8. Percentage of women who gave their children colostrums
76.1
78.9
92.5 80.0
84.2
80.3
9. Percentage home delivery
52.0
54.1
34.2 38.1
51.5
57.2
MNCH: A Situational Analysis - District Reports for Bagalkot, Bellary, Bidar, Bijapur, Gulbarga & Raichur; KHPT-Sukshema Project, 2011 (Internal Document)
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SERVICES AT PHCs
Primary Health Centre (PHC)
Ÿ24x7 PHCs with all headquartered staff.
Ÿ24-hour free healthcare to the community the PHC serves.
ŸASHA workers appointed to service healthcare needs of the
community.
ŸAvailability of all essential drugs with BIN card system for drug
dissemination.
ŸAvailability of alternative medicine in the form of traditional
medicine to treat minor illness, thus saving time and money for
local communities accessing the PHC.
ŸCoverage of populations residing in remote, tribal, hilly and
hard-to-reach areas.
ŸImproved infrastructure through availability of toilets, waiting
rooms, water and electricity and clean campus facilities.
ŸComprehensive PHC waste management and waste disposal
system.
ŸEssential obstetric and newborn care.
Ÿ24x7 ambulance services for emergencies.
ŸGender-sensitive primary care.
ŸMainstreaming HIV & AIDS in primary healthcare.
ŸIncrease in institutional deliveries.
ŸReduction in IMR and MMR (in the 28 PHCs in Karnataka, the
IMR has fallen from 21 in 2009-10 to 18 in 2010-11, while the
MMR is 93 in 2010-11 compared with 119 in 2009-10).
ŸTreatment of RTIs and STIs.
ŸCoverage of all National Health programs such as Malaria,
Tuberculosis, Epilepsy, Blindness Control, Mental Health, HIV,
Diabetes Control, Filarial and Goitre Control.
ŸRCH (including safe abortion) and adolescent health services.
ŸLaboratory services.
Sub-Centre (SC)
Sub-Centre (SC)
Ÿ24x7 SCs with all headquartered staff.
ŸAvailability of ANM workers to cater to
the health needs of the community.
ŸRegular immunization for children –
immunization of specific illnesses
falling under the National Health
programs undertaken.
ŸConducting RCH and adolescent health
services (including MTPs) and
programs.
ŸActive referral system of all ANC, out-
patient and emergency cases to the
nearest PHC (under its jurisdiction) or
to the nearest taluk/district hospital.
Ÿ24-hour availability of all essential
drugs and medicines.
Annexure II
Community
ŸStrong community participation
through Village Health & Sanitation
Committees (VHSCs)
ŸInstitution of Arogya Raksha Samithis
(ARS) for improving community health
needs
ŸCommunity planning and monitoring
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KEY ASPECTS OF THE KARUNA TRUST MODEL OF PHC MANAGEMENT
Annual Action & Budget Plan
Annexure III
Human Resource Management
ŸArea-specific planning.
ŸCommunity Needs Assessment (CNA) & Participatory Rural Appraisal
(PRA) approaches.
ŸTotal population survey.
ŸAnalysis of expenditure of the previous year.
ŸFocus on optimum utilization of funds.
ŸRegular weekly & monthly meetings
ŸDistribution of specific job responsibilities among staff
ŸMotivation, appreciation, discipline & team building
ŸPeriodic staff evaluation & appraisal
ŸFrequent orientation and training skills & personality development
ŸMandatory staff stay at headquarters
Ÿ
Land, Buildings, Equipment & Furniture
Drugs, Vaccines, Surgical Items & Chemicals
ŸClear demarcation & maintenance of the PHC campus.
ŸRegular maintenance of the building, equipment & furniture.
ŸPeriodic assessment of infrastructure & repair work undertaken
where necessary.
ŸMaintenance of log registers for vehicle
ŸRegular repair & servicing of vehicle.
ŸRational drug use.
ŸAnnual indenting of essential drugs (from Essential Drug List) based
on annual need, burden of disease, previous year’s indents.
ŸHalf-yearly supply to PHC.
ŸProper storage of drugs BIN card systemReturn of drugs 3 months
before date of expiry.
ŸRational procurement of vaccines & efficient maintenance of cold
chain
ŸFormation of Drugs & Therapeutic Committee to monitor & record
drug toxicity.
Financial Management
ŸDecentralized book-keeping.
ŸMaintenance of cashbook and daily accounts closure system.
ŸSeparate register for donated drugs & equipment.
Monitoring & Evaluation through Health Monitoring &
Information System (HMIS)
ŸReporting in specific formats.
Ÿ3-tier system to check monthly reports
(ANM, Supervisor & Medical Officer)
PHC Management Training Module: A Resource Handbook, Karuna Trust Internal Document
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ŸReceipts & vouchers for all transactions
ŸSpending authorization & limits set for various levels
ŸQuarterly internal audits & annual external audit
ŸPeriodic checking & signing of records by the Medical Officer
Quality Control: Good Quality Primary Healthcare
ŸPeople-friendly PHCs
ŸAll PHCs with IPHS Standards
Ÿ24-hours Emergency, Obstetric and Ambulance services
ŸStandards for labour room, OT maintenance & laboratory facilities
ŸRegular health and immunization camps
ŸMedical & social audits for maternal & infant deaths
ŸFormation of PHC development committees
ŸCitizen’s Charter
ŸMaintenance of complaint/suggestion box in all PHCs
ŸArrangements for waste disposal as per specified government regulations
ŸSuitable network for referrals
ŸProgram-wise evaluation during monthly meetings.
ŸMonitoring activities as per Annual Action Plan
ŸCoordinated efforts to address drawbacks & gaps
ŸManpower, logistics & other infrastructure to match requirements.
ŸRegular supportive supervisory mechanism.
ŸUse of Technology for Better PHC Management
ŸAll PHCs connected through Email
ŸInternet facility available at all PHCs
ŸTie-up with Indian Space Research Organization (ISRO) to establish Village
Resource Centres (VRCs) at all PHCs
ŸHMIS
Program Implementation
ŸAll National Health Programs are implemented and monitored (RCH, RNTCP,
VBDCP, HIV & AIDS, Blindness Control, Leprosy Elimination, Community
Mental Health, STD Control, Water & Sanitation, Diarrhoea Control, School
Health, Cancer Control, Diabetes Control).
ŸImplementation of the programs of NRHM such as Village Health &
Sanitation Committees, ARS.
Innovations in Service Delivery
ŸMainstreaming of traditional medicine into primary healthcare
ŸIntegration of mental healthcare in primary health care
ŸCommunity Health Insurance scheme
ŸEstablishment of Vision Centres
ŸTele-medicine
ŸMobile Health Clinics
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CASE STUDIES
CASE STUDY FROM V.K. SALGARA PHC
Annexure IV
History & Background
Sunitha is 18 years old and the wife of Arun Kumar Hosamani, a tenant farmer in V.K. Salgara, Bijapur
district. Sunitha, who was married off as soon as she finished her SSLC, comes from a poor family and
assists her husband with his agricultural labours. Sunitha and her husband are the sole bread-winners
of the joint family in which they live, and their combined income is ` 30,000 per annum is barely enough
to live on
At 18 and pregnant with her first child (primi), Sunitha was brought to the V.K. Salagara PHC with a
history of 9 months of amenorrhoea. She had undergone all the routine ANC check-ups and medical
investigations. Sunitha was brought to the PHC in a private vehicle on 19th December 2010 by around 2
p.m. noon with complaints of labour pain. The local ASHA in-charge also accompanied her to the
centre.
Intervention at V.K. Salagara PHC
Her case history was taken down and vitals examined, which read
BP
: 110/70mmhg,
PR
: 92/min
FHS
: +++
On further examination CVS, RS and CNS were found to be within normal limits. A per-abdomen
examination was conducted, which showed the following :
Fundal Height was 36 weeks
Longitudinal Lie
FHS: 162/min Regular
Head was engaged
A pelvic examination revealed that Sunitha’s cervix was dilated 4 cms., with a 50% effacement and the
baby’s head at 0 station. Membranes were found to be intact.
Throughout the afternoon, Sunitha’s vitals and the unborn child’s foetal conditions were periodically
examined and duly recorded. A partograph of the case was also maintained. Thus far, Sunitha was
stable and the FHS was within normal limits, with no sign of distress.
Later that afternoon, by about 3.45 p.m. following rupture of membranes, a PV was done and the
results showed a thick greenish liquid which was followed immediately by an indication of foetal
distress (observed due to decreased foetal heart rate). Sunitha developed chills and began to feel
frightened. Her condition was soon stabilized and the staff on duty reassured her and made her feel
comfortable.
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The staff nurse on duty accessing Sunitha’s vitals and constantly monitoring her condition, made a
decision to refer Sunitha to a higher medical facility where there was special OBG care available. Her
relatives were informed about her condition and the probable conditions of the unborn child in their
local language using the simplest of terms so that they could fully understand the situation. Her family
also approved the decision to refer Sunitha to a higher centre for further medical management.
An ambulance attached to the V.K. Salagara PHC (which was bought with PFI’s support) transported
Sunitha to the Government Hospital in Gulbarga by about 4.30 p.m. The staff nurse of the PHC and the
ASHA in-charge also accompanied Sunitha to the hospital to provide support and reassurance to the
frightened 18-year old mother-to-be.
At the time of referral, Sunitha’s condition read as follows :
Vitals
: Stable
Foetal Heart Rate : Variable
Cervix
: Dilated with thick meconium
Intervention at the Government Hospital, Bellary
As soon as Sunitha was admitted at the hospital, she went into labour and the specialist doctor on duty
delivered a female baby weighing 2.5 kgs. with the help of vaccum. As the baby did not cry immediately
after birth, resuscitation was done and the infant shifted to NICU for further care and observation.
Sunitha’s family and relatives were relieved that their daughter and her baby were doing well. Sunitha’s
mother was grateful to the V.K. Salagara PHC, which had referred their daughter in a timely manner and
expressed her happiness at the ambulance service provided by PFI which had transported her daughter
in time and saved her & her baby’s life.
Sunitha’s father summed up the experience in a single sentence: “the ambulance in the V.K. Salagara
PHC helped save my daughter and grandchild; it would have been too late if we had had to wait for
other means of transport.”
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CASE STUDY FROM CHANDRABANDA PHC
Patient name: Huligamma
Age: 19 yrs
Husband name: Yellappa
Education:
Occupation: Cooli
Place: Chandrabanda PHC, Raichur district
History & Background
Chandrabanda PHC is located 12 kms from Raichur city which is one of the 'C' category districts in
Karnataka.
Huligamma wife of Yellappa is a 21 yr old pregnant woman. She & her husband are both daily
wagers & moved to the PHC area in search of work which comes under Arsigere Sub-Center. The
financial condition of the family was not very good & these two were the sole bread winners for the
family of 5 people.
The ANM of the Sub-Centre on her regular visit to the village went to Huligamma's house and came
to know that she had recently moved to the village. Then the ANM registered her for the ANC checkups
and then took the history and the initial physical examination showed that she was in her 3rd trimester
and was in her 34th week & weighing 46 kgs. She was a Primigravida. Her hemoglobin was 8mg% by
paper method so prenatal IFA tablets were given & advised her to take nutritious food. She was then
referred to the PHC for further checkups and investigations. The lab investigation showed that her Hb
was 6gm%. The ANM visited her regularly but still her hemoglobin did not improve because of the short
period.
PHC Intervention
On 25/2/2012 at 10:15 AM, ASHA rushed to the Sub center saying that Huligamma has developed
labour pain. ANM called the 108 ambulance and she was shifted to PHC by 11Am. She being a high risk
pregnancy she was advised to go to FRU/Higher center and due to her financial condition she refused to
go. With the consent and explanation of the risk involved she was admitted and initial examination was
conducted. Her Cervix was 2 to 3cms dilated on admission. She had on and off labor pains with few
contractions initially. Her labour progressed gradually and by 5PM she was 6cm dilated. Partograph was
maintained and recorded accordingly. Staff Nurse had undergone Skill Birth Attendant Training and she
was aware of all risks involved and vigilant for any untoward incidents.
Regular BP, Pulse, contractions and FSH was monitored and recorded. By 9PM her cervix was fully
dilated and she delivered a female baby weighing 3.100gms. Episiotomy was given as she was Primi-
gravida. All the immediate care was given to the newborn. Placenta was delivered in another 10mins.
Unfortunately she developed Post Partum Hemorrhage (PPH). She was immediately treated with 2
ampoules of Oxytocin which was given in NS Drip and 1 ampoule IM and simultaneously her abdomen
was massaged and digital compression was given to the uterus to stop the bleeding. The bleeding was
under control by 10:30PM.
Mother was under observation for another 2hours and then shifted to the PNC ward. Baby was
breast fed within half an hour of delivery and kept warm.
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CASE STUDY FROM HUDEM PHC
Personal Background & History
Lakshmi is aged 11 and lives in Kadekolla village in Kudligi taluk (Bellary
district). She lives with her parents and 5 siblings (1 older sister and 4
brothers). Her father is a daily wage labourer (coolie worker) and the only
bread-winner in the family, whose income is less than Rs.20,000 per
annum.
Lakshmi
Lakshmi, her older sister and a younger brother were born with
congenital blindness. Being poor and uneducated, her family was
unable to provide proper medical attention and in desperation, visited
several temples in hopes of a miracle. Lakshmi herself was a lonely, sad girl
who would try and imagine shapes and sizes, the feel of trees and things
from descriptions of friends and family. She always had so many questions
and wished to go to school like other normal children, but poverty and lack of
financial sources forbade her from fulfilling her heart’s wish. Lakshmi felt surrounded
by the dark and nurtured hopes that one day, she would be able to see.
Intervention at Hudem PHC
The village Lakshmi lived in had a sub-centre,
Bheemasamudra that came under the purview of the
Hudem PHC. The PHC was taken over and managed by
Karuna Trust in 2005 and supported by PFI. A vision
centre was also established to cater to primary eye care
Her older sister & younger brother
are also congenitally blind
concerns as part of the primary healthcare services of
the centre.
A screening camp was conducted by Mr. Thippeswamy,
PMOA of the Hudem PHC in several villages surrounding the PHC and Lakshmi was one of the cases
identified with blindness since birth. Following the camp, the PMOA discussed the cases identified with
the DBSC & DHO of Bellary district. When the DHO made a follow-up visit to the PHC, he was impressed
with the work and assured Karuna Trust that he would extend all help possible to cases of congenital
blindness along with the DBCS and other centres.
Case Referral & Diagnosis at VIMs
Lakshmi’s case was referred for diagnosis and treatment to VIMS Medical College, Bellary by the PMOA.
The DHO was supportive of the case, even to the extent of making arrangements for transportation for
Lakshmi to VIMS. She was given a referral letter from the DBCS Program Officer.
On arrival at VIMS, Lakshmi underwent extensive tests to determine the extent of her blindness. Her
test results read as below :
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Ocular Examination
Eyelid
Cornea
Pupil
Lens
RE
Normal
Normal
RRR
SHMC
LE
Normal
Normal
RRR
SHMC
Investigation
RBS
SAC
BP: 110/70mm of hg
Nil
BE.PATENT
Vision Test
RE
HM Positive
HM Positive
LE
HM Positive
HM Positive
Diagnosis
Both eyes had developmental congenital cataract
Treatment
Advised surgery
SICS with PC IOL Implantation
With Dr. Vijay after surgery
Interventions at Vijayanagara Institute of Medical Science
Following the examination, it was found that Lakshmi only had congenital
cataract, which was fully curable with surgery. A day was scheduled and
surgery carried out on Lakshmi’s left eye by Dr. Vijay M.S (DO DNB), Asst.
Professor of Ophthalmology, VIMS Hospital.
Out Come
The results of the surgery opened up a new world for Lakshmi and was like
a re-birth for her. She was able to see and her whole world changed
dramatically. She was able to enjoy the nature that she loved so dearly.
Lakshmi’s family were also overjoyed at their daughter’s new-found
happiness and expressed their deepest gratitude to VIMS and Karuna Trust
for helping her regain sight.
Lakshmi’s visual acuity for her left eye is 6/36, PH,TO and she has been advised continuous use of
spectacles. Nevertheless, Lakshmi now brims over with
confidence. She wants to study, play with other children
and do something worthwhile in life.
Lakshmi has also been advised surgery in her right eye.
Karuna Trust also plans to get her siblings examined to
see if the vision centre can help them regain sight. The
Trust also plans to network with other local NGOs in the
area to arrange for a way to get Lakshmi educated.
Lakshmi with her family
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Karuna Trust and VGKK team under the leadership of Dr. H. Sudarshan has received the following
recognitions from state National and International bodies :-
1. Rajyothsava State Award, For social work – 1984, Government of Karnataka
2. The Vivekananda Seva Puraskar (National Award)
3. Environment Award (Govt. of Karnataka)
4. Dr. B.R. Ambedkar Centenary Award (Govt. of Karnataka)
5. Karnataka State Award for Best Child Welfare Organization-VGKK
6. Right Livelihood Award (Alternate Nobel Prize)
By Right Livelihood Award Foundation Sweden
7. International Distinguished Physician (American Association of
Physicians of Indian Origin - AAPI)
8. Dr. Pinnamaneni & Seethadevi Foundation Award for Excellence
In Social Work
9. Karnataka Jyothi Award
10. Basava Shree Award
11. Padmashree Award by President of India -
12. Human Rights Award
13. Mahaveer Award
14. Dr. Baba Saheb Ambedkar Award for VGKK (Govt. of Karnataka)
15. Krishnadevaraya Award
16. Devaraj Urs Award (Govt. of Karnataka)
17. Vivekananda Medal (Ramakrishna Mission)
18. The PHFI Outstanding Achievement Award (Public Health Foundation
Of India-PHFI)
19. Sagar Award for Social Service
20. Stood Second in the 'Lifetime Achievement Award, 2009 (BMJ Group)
21. Citizen Extraordinaire Award (Rotary Club of Bangalore)
22. Mahaveer Ahimsa Prashasthi (Mahaveer Seva Sansthan, Mysore)
23. Distinguished Alumnus Award (Bangalore Medical Collage )
24. Swastha Bharat Samman (Zee news )
25. Rama Krishna Mission
: 1984
: 1991
: 1992
: 1992
: 1994
: 1994
: 1995
: 1995
: 1997
: 1997
: 2000
: 2001
: 2001
: 2002
: 2002
: 2003
: 2004
: 2009
: 2009
: 2009
: 2011
: 2011
: 2011
: 2011
: 2012
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The following are the prominent positions Dr. Sudarshan has held in the past and in the present :
Past Membership on State/National Bodies
1. President, Voluntary Health Association of Karnataka (VHAK)
2. Joint Secretary & Vice President, Voluntary Health Association of India (VHAI)
3. Honorary Treasurer, Federation of Voluntary Organizations for Rural Development (FEVORD-K)
4. Member, Executive Committee, National Literacy Mission
5. Senate Member, Bangalore University
6. Member, Steering Group of Planning Commission for SC, ST & BC
7. Member, Working Group for Health & Family Welfare, Ninth Five Year Plan
8. Member, Steering Committee on Health, Tenth & Eleventh Five Year Plan
9. Member, Technology Council, CII, New Delhi
10. Member, Central Selection Committee for National Youth Award
11. Member Executive Committee, National Institute of Rural Development (NIRD), Hyderabad,
Government of India
12. Member, State Wildlife Advisory Board, Department of Forestry, Karnataka
13. Member, Working Group 6 on 'Macro-Economics & Health', Government of Karnataka
14. Chairman, Task Force on Health & Family Welfare, Government of Karnataka
15. Member, Technical Advisory Group (TAG) & Grant-In-Aid Committee (GIAC),
Ministry of Health & Family Welfare, Government of India
16. Member, Executive Committee, CAPART
17. Member, National Standing Committee, Public Cooperation
18. Member, Task Force on Primary Education, Government of Karnataka
19. Vigilance Director, Karnataka Lokayukta (Health, Education & Social Welfare), Government of Karnataka
20. Chairman, Task Force on Public Private Partnership, National Rural Health Mission (NRHM),
Government of India
Present Membership on State/National Bodies
1. Ashoka Fellow, Ashoka Innovators for Public, USA
2. Member, 'Independent Commission on Health in India' (ICHI), VHAI, New Delhi
3. Member, 'National Commission on Population', Government of India
4. Member, Core Group on Health, National Human Rights Commission (NHRC), New Delhi
5. Member, Executive Committee, National Nutrition Mission, Government of India
6. Executive Committee Member, Janasankhya Sthiratha Kosh, Government of India
7. Member, Vision 2020, Government of Karnataka
8. Chairman, Study Group on Delivery of Health Services, Karnataka Knowledge Commission
9. Member, Advisory Group on Community Action (AGCA), NRHM
10. Member, National ASHA Mentoring Group (NAMG), NRHM
11. Member, Suvarna Arogya Suraksha Trust (Vajpayee Arogyashree Health Insurance) and Chairman,
Empanelment & Disciplinary Committee
12. Member, State Health System Resource Centre (SHSRC), Government of Karnataka
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Published by :
KARUNA TRUST
# 686, 16th Main, 39th Cross, 4th 'T' Block, Jayanagar, Bangalore - 560 041.
Phone : 080-2244 7612, Email : karuna.trust@vsnl.net www.karunatrust.com
c Karuna Trust