Part I Health and Family Welfare Department

PART I HEALTH AND FAMILY WELFARE DEPARTMENT

1.1. Organisation and functions of the Department:

The Department is headed by the Commissioner of Health & Family Welfare Services and the Director of Health & Family Welfare Services.The Commissioner is the administrative head and Director is the technical head. National Health Mission (NHM) is headed by a Mission Director (NHM). Karnataka State AIDS Prevention Society is headed by project director.

These officers are assisted by Additional Directors, Joint Directors, Deputy Directors & Demographer in implementing and monitoring health programmes. The Chief Administrative Officer and Chief Accounts Officers cum Financial Adviser assist in administrative and financial matters of this Department.

At the District level, District Health and Family Welfare Officer is the head of Public Health Services.Implementation and monitoring of various National & State Health Programmes in all below 100 beds health care service institutions which are under ZillaPanchayat Sector are done by the District Health and Family Welfare Officer. He is assisted by

1. District Reproductive & Child Health Officer 2. District Programme Management Officer 3. District TB Officer 4. District Malaria Officer 5. District Family Welfare Officer 6. District Surveillance Officer 7. District Leprosy Officer (who also oversees Blindness Control Programme).

Above 100 beds healthcare services institutions are under state sector. The District Surgeons of District Hospitals are responsible for providing curative, emergency and promotive services including referral services. Presently 15 District Hospitals are under the control of Health & Family Welfare Department.176 Taluk Health Officers are positioned at Taluk headquarter.They are the implementing authorities of Public Health, National and State Health Programs in their respective Taluks.The Medical Officers of Health at Primary Health Centre Level are responsible for the implementation of various National and State Health Programs including Family Welfare Programme and Maternal and Child Health Services.To provide Primary Health Care throughout the State, a network of 8871 Sub Centres, 2359 Primary Health Centres, 206 Community Health Centres and 146 Taluk Hospitals have been provided.

In order to ensure transparency in transfer of Medical Officers / Staff Govt. has enacted “Karnataka Civil Services (Transfer of Medical Officers and other staff) Act 2011 which has come in to force from 13-05-2011. Necessary Rules have also been framed there under. As per these Rules Medical Officers and other staff is being done once in a year i.e. During April/ May through computerized counselling.

The Department of Health and Family Welfare Services implements various National and State Health programmes of Public Health importance to provide comprehensive Health Care Services to the people of the State through various Health and Medical Institutions. (Department is striving to achieve the goals set by

Central Government in vision 2020). Health Care Services rendered are classified into Curative Services, Health Education and Training and School health services, nutritional services, laboratory services.

Health and Family Welfare department was responsible for implementation of Rural Health component of Minimum Needs Programme, National Health Mission (NHM), National Leprosy Eradication Programme, Revised National Tuberculosis Control Programme, National Programme for Control of Blindness, National Vector Borne Disease Control Programme (NVBDCP), National Guinea Worm Eradication Programme, Prevention and control of Communicable Diseases like Diarrhoea, Kysanur Forest Diseases, National Iodine Deficiency Disorder Control Programme and AIDS Prevention Programme.

1.2. Important National and State Health Programmes:

The Department of Health and Family Welfare Services implements various National and State Health programs of Public Health importance and also provides comprehensive Health Care Services to the people of the State through various Health and Medical Institutions. Progress of implementation of Major Programmes are as follows:

1.2.1. Routine Immunization Programme:

Goals:

• To ensure 100% immunization of all Pregnant Women and children against 10 vaccine preventable diseases • To maintain Polio free status • To achieve Measles Elimination & Rubella Control by year 2020

Objectives:

• To prevent incidence and deaths due to vaccine preventable diseases by providing free vaccines to all eligible beneficiaries in the state • To Maintain highly sensitive surveillance system for early identification and control of all Vaccine preventable diseases

Achievement:

• 2013: Introduction of Pentavalent Vaccine (DPT+Hib+ HepB) • 2014: Appreciation from W.H.O for contribution of state in Polio Eradication • 2015-17: Four Phases of Mission Indradhanush (MI) and Intensified MI • April 25th 2016: Switch from tOPV to bOPV and successful validation • 2016 April : IPV Introduction into RI: Karnataka one of first 8 states to start Fractional dose of IPV in RI (0.1 ml Intra-Dermal) • 2016 October: Transition from outbreak based to case based MR surveillance; Karnataka first state in India • 2017:- Measles – Rubella Vaccination Campaign conducted from 7th February to 19th March • 2018: Special Intensified Mission Indradhanush Programme is running(May, June & July 2018)(excluding Udupi & Dakshina Kannada Districts)

• 2018: Implementation of Mission Indradhanush in Bengaluru Urban, Belagavi, Kalburgi, Davangere, Dharwad, Bellary, Vijayapura, Mysore, Tumkuru, Dakshina Kannada & Shimoga Corporation Districts with Raichuru & Yadgiri Aspiration Districts (July, August & September).

1. Full Immunization of Children (All vaccines to child in first year of life)  Core Health indicator under Chief Minister‟s Dash board- Pratibimba

2. Intensified Mission Indradhanush (IMI)  Prime Minister's review under PRAGATI  To achieve 90% full immunization by 2018

3. To Achieve Measles Elimination and Rubella Control by 2020  State, National and Regional Goal

 The Pulse Polio Programme is being implemented in the State since 1995-96 with the main objective of eradication of Poliomyelitis by 2000 AD. Every year, Polio drops are being administered to the children below the age of five years in two rounds. During 28th January 2018 (1st Round), 104.20% and 11th March 2018 (2nd Round) 103.94% Achieved, children aged less than 5 years for administered oral Polio Vaccine. Presently State is free from Polio. HMIS has reported target and achievement in Family Welfare and immunisation:

Target and Achievement in Family Welfare & Immunization (As per HMIS Reports)

2017-18 (in lakhs) Sl No Programme/Method Target Achievement A FAMILY WELFARE 1 Sterilization 4.62 3.07 2 IUCD 5.6 2.14 3 CC Users 4.65 2.2 4 OP Users 3.14 1.44 B IMMUNIZATION S.L Vaccine Target Achievement (%) No 1 TT(PW)-1 78.08 1258667 2 TT2 and Booster 96.84 3 Hep-B 71.02 4 OPV-0 79.34 5 OPV-1 100.35 6 OPV-2 97.59 1101091 7 OPV-3 99.01 10 BCG 95.17 11 Penta-1 97.59 12 Penta-2 99.01

13 Penta-3 99.56 Measles & Rubella (MR)- 1st 14 91.65 Dose 15 JE-1 (10 districts) 334883 102.65 Fully Immunization ( 9 to 11 16 1101091 95.33 month) Measles 2nd dose (More 17 1101091 81.29 than 16 months) Japanese Encephalitis (JE) 18 vaccine (more than 16 334883 89.54 months of age who received ) Measles & Rubella (MR)- 19 1101091 85.76 2nd Dose (16-24 months) 20 DPT-Booster 1184229 82.77 21 OPV-Booster 1184229 83.33

1.2.2 National Leprosy Eradication Programme:

Introduction:

National Leprosy Control Programme was started in 1955. Tremendous achievement was made in the Programme with regard to accessibility and service delivery with the successful implementation of the Programme. The prevalence rate of leprosy dropped from 40/10000 population in the year 1986 to 0.38/10000 population in 2017-18 Karnataka.

The main objectives under NLEP are:

1. Elimination of leprosy i.e prevalence of less than 1 case per 10000 population in all the Districts of the State. 2. Strengthening Disability Prevention & Medical Rehabilitation of persons affected by leprosy. 3. Reduction in the level of stigma associated with leprosy.

At present 10 districts have prevalence rate 0.50 to 1 (Bidar, Gadag, Chamarajangar, Kalburgi, Dharwad, Raichuru, Chikkaballapur, Kopala, Bellari) and Uttara Kannada where the prevalence rate is >1 (i.e 1.00/10000 population. As on March 2018 there are 2619 Leprosy cases on hand.

Activities under NLEP:

1. Case Detection and Management:

 Special Activity Plan (SAP): Activity is being done in Districts having blocks with ANCDR (Annual New case detection Rate) more than 10 cases per 1 lakh population, as well as in Districts having very Low endemicity.  125(PB 69 and MB 56 cases) cases were detected in the FY 2017-18 in 30 taluks. These 30 taluks include both high endemic and non endemic blocks.

 Under Urban Leprosy Elimination Programme (ULEP) 2017-18, 24 Towns, 6 Medium cities and 1 Mega city have been selected. Activities conducted under ULEP are

a) Survey of Slums, Residential Schools, Hostels, Leprosy Colonies, Mutts running educational institutions, Hard to reach areas, tribal colonies and Monitoring, Supervision & Coordination with NGOs & Other departments.

 Leprosy Case Detection Campaign (LCDC) :

LCDC was conducted during 23rd Oct 2017 to 5th Nov 2017 in Bellari, Chamrajanagara, Uttara Kannada , Raichur and Dharwad. Totally 264 (PB 128 & MB 136) cases were detected.

LCDC is a unique initiative of its kind under NLEP. House to House visit by team encompassing one Accredited Social Health Activists(ASHA) and HWF /HWM, Volunteers ,NGOs ,Persons Affected by Leprosy (PALs) as per micro-plans prepared for local areas for a period of 14 days was organized in the year 2017-18, totally 264 (PB 128 & MB 136) cases were detected.Post Exposure Prophylaxis (PEP) treatment will be given to MB Leprosy cases.

2. ASHA involvement :

New activity (ABSULS –Asha Based surveillance Leprosy suspects) as per Government of India guidelines was rolled out in 2017-18.

For the financial year 2017-18- 65 ASHAs per taluk were given Sensitization programme. A total of 11756 ASHAs were trained. Incentives were paid to ASHAs for case detection (Rs.250/case) & after treatment completion i.e PB 6 months (PB Rs.400/case) & MB (MB Rs.600/-case) 12 months. Also ASHA are being regularly sensitized in ASHA Satcom, and in monthly meeting through DLOs.

3. Capacity building:

For the financial year 2017-18 – MOs 923 and Health workers 1185 persons have been sensitized. Intensified training will be given to Health workers and the Medical Officers to diagnose leprosy cases at the peripheral health centres itself.

RBSK teams are being sensitized to pick up suspected Leprosy cases, validate them and initiate treatment.

4. IEC:

Special Drive to remove stigma surrounding leprosy and prevent discrimination was planned in the form of

Sl. No. of Medium No. districts 1. Mass Media(TV, Radio Press) 31 2. Outdoor Media (Hoardings, Wall Paintings, Banner, Rally) 31 Rural Media (IPC Meeting, School 3. 31 Health Quiz) 4. Advocacy meeting (Meeting with Zilla Parishad, NGOs) 31 5. IEC Activities – State 1

 Sparsh Leprosy Awareness Campaign, 2017-18 (Anti Leprosy fortnight – 30th Jan 18 to Feb 13th 2018):

Sparsh Leprosy Awareness Campaign (SLAC) was conducted successfully from 30-01-2018 to 13-02-2018 at State and District level.

It was a unique and highly commendable initiative which was carried out in Karnataka as per guidelines of Central Leprosy Division (CLD). Previously Anti Leprosy fortnight was carried out depicting pictures of leprosy cases in full blown disease status. This year an approach showing solidarity and statement of Sparsh and oneness with leprosy patients was depicted. The entire Panchayath Raj institution functionaries were involved and the problem/issue of leprosy which initially was looked after by health functionaries, was shared among the local population who are the real stake holders. Awareness of the disease and how to approach the health system was widely propagated.

Physical Target and Achievements for Eradication of Leprosy from 2013-14 to 2017-18 Deformity Deformity Child New Cases Detected PR Cases Cured Rate Gr.II cases cases Year Target Ach % Target Ach % 2013-14 - 3461 - 0.45 - 3295 - 3.72 129 320 2014-15 - 3314 - 0.44 - 3260 - 4.41 146 287 2015-16 - 3065 - 0.40 - 3037 - 3.39 104 209 2016-17 - 2897 - 0.40 - 2710 - 3.52 102 166 2017-18 - 2892 - 0.38 - 2774 - 4.05 117 171 * *(Up to March 2018)

Welfare measures for the Persons Affected by Leprosy:

1. 5% of Group „D‟ Jobs are reserved for the Persons affected by Leprosy during recruitment of Physically handicapped. 2. 67 Reconstructive Surgery Operations done as on 31st March 2018, Rs.8000/- paid (As per Guidelines) incentive for RCS undergone Persons Affected by Leprosy. 3. Micro Cellular Rubber Footwear provided to 4588 Persons Affected by Leprosy ( PALs). 4. 1983 Self care kits provided to foot ulcer cases. 5. 208 Lepra reaction cases treated with supportive drugs. 6. Splints crutches and other needed appliances provided. 7. Prevention of Deformity (POD) camps conducted regularly in all the Taluk level hospital. 8. Medical facilities are being provided to the Persons Affected by Leprosy family member residing in 20 Leprosy colonies in the State. 9. Grant-in Aid is provided by State Govt. for the NGO, hospitals providing treatment to the Persons Affected by Leprosy at the rate Rs.500/bed for adults and Rs,275/bed for children per month.

 Details of special events held in 2017-18:

 In the Financial Year 2017-18 , 4 District Leprosy Officer‟s &2 NGO‟s review meeting was conducted .

 TOT Master trainer training for Nikusth online entry was conducted for State Leprosy Officer & 8 District Leprosy Officers.  LCDC workshop was conducted on 26th and 27th Sept 2017 at SIHFW seminar Hall-I.  Leprosy Case Detection Campaign (LCDC) of state level coordination committee meeting was held under Chairmanship of Commissioner dt: 28- 09-2017.  Nikusth Online reporting training was conducted on dt:21-11-2017 at Magadi Road, PHFI computer Lab to all the District Leprosy Officers and Data entry operator.  Sparsh Leprosy Awareness Campaign of state level coordination committee meeting was held under Chairmanship of Additional Chief Secretary dt: 22- 01-2018.  NLEP reorientation training for all DLOs, PMWs and Dermatologists on Major Hospitals under BBMP wards and Post graduates of dermatology department of Medical college was held on 07-03-2018.

1.2.3 Revised National Tuberculosis control programme (RNTCP):

Karnataka state started implementing RNTCP form the year 1997.Since then every year approximately 6 lakh presumptive TB patients undergo screening and at-least 60,000 TB patients are put on treatment.

As per National Strategic Plan 2017-2025 Karnataka state has a target of 99732 TB patients to be diagnosed in one year of which 59732 are expected to be notified from public sector and 40,000 from Private sector. State has notified 54729 TB patients from the public portal and 12412 patients notified from the private sector totaling to 67141 TB patients in the year 2017.The annualized Total TB case Notification rate of Karnataka is 116 cases/lakh/year.State has ensured private TB notifications from the year 2012 and since then 12,389 health facilities have been registered which has a contribution of 17/lakh population to the Case Notification rate in Karnataka in NIKSHAY portal which is a case based web based reporting system of RNTCP. However only 1727/12389 private health facilities are notifying TB patients. Till date 30754 TB patients have been notified from private sector.

In addition state has conducted three rounds of Active Case finding in the months of January, July and December for a period of 15 days each. Active case finding is a special activity focusing vulnerable and hard to reach populations of the state.Phase 1 picked up 139 TB patients in a targeted population of 11,71,254 covering Bangalore City, Urban and Rural districts. Phase 2 covered a targeted population of 57,50,853 in 11 districts thereby diagnosing 1730 TB patients. Phase 3 ACF covered 75,03,613 targeted population in 20 districts and diagnosed 2379 TB patients.

Karnataka has the highest number of Medical colleges (55) involved in RNTCP and contribute the highest percentage of smear negative and extra pulmonary TB patients every year. This year the state has won the rolling shield for best state involvement of Medical colleges in the recently held zonal task force in Hyderabad. A number of operational research studies are being undertaken by the Medical colleges every year.

State diagnoses around 1000 Drug resistant TB patients every year using state of art technologies available in IRL Bangalore, KIMS Hubli and RIMS Raichur

culture and DST labs.There are 62 CBNAAT machines in the state which diagnoses drug resistant TB within 2 hours. In the year 2017,72919 tests were performed using the existing 34 CBNAAT machines out of which 3968(5%)were referrals from private sector and the test was offered free of cost.

The state stands number one in HIV testing of all TB patients in the country. There are 64 ART centres and all are linked to CBNAAT machines. Every TB symptomatic HIV patient is offered CBNAAT for TB diagnosis. In the year 2017,37318(51%) of total tested on CBNAAT machines were presumptive TB among PLHIV. Overall HIV testing rate is 95% and the state registers 6000 TBHIV patients every year. Every TBHIV patient is offered Fixed Drug Combination drugs and those HIV patients without TB are offered Isoniazid Prophylactic Therapy in order to prevent TB infection among PLHIV.

From October 1st 2017 all patients notified under the programme are given weight band wise Fixed drug combination(FDC) which are WHO prequalified and uninterrupted supply is ensured. From December 1st 2017 all pediatric TB patients are also given weight band wise FDCs. Programme offers shorter MDR TB regimen(9-11months) to all diagnosed MDR and Rifampicin Resistant TB patients. Every district offers pre treatment evaluation and admission facilities for DR TB patients through specialized centres called district DRTB centres. RNTCP is efficient in addressing H mono resistant TB patients through a specialized regimen. Also newer drugs like Bedaquilin and Delamanid are available to the programme under conditional Access and are used to manage patients who are MDR/RR and additionally resistant to Fluroquinolones and/or Second line injectable drugs. These drugs are not available in the private market and cannot be imported.

State has undertaken measures of Direct Beneficiary Transfers to patients both public and privately notified, by transferring Rs 500/month till the completion of treatment. There is a provision of incentivizing private doctors with Rs 1000 for notifying TB patients and treatment supporters have been enlisted under DBT for provision of incentives vizRs 1000 for completion of treatment among new TB patients and Rs 1500 for treatment completion among previously treated TB patient. Rs 5000 is provided to treatment supporters for treatment completion among Drug Resistant TB patients.

The state has adequately supported TB patients both financially and offered social support schemes in certain districts.All the TB patients are linked to Pradhanmantri Jan Dhan Yojana scheme.

In to, RNTCP offers modest diagnostic technologies like CBNAAT and LPA, free quality ensured uninterrupted supply of Fixed drug combinations,facilities to treat Drug resistant TB patients, WHO pre qualified Drug Resistant TB treatment regimens, incentives to patients, privatepractitioners and treatment supporters.

Private establishments are hereby appealed to make use of these state of art diagnostic technologies and treatment facilities and incentives and prevent out of pocket expenditure, thereby grossly reduce catastrophic expenses and provide best TB treatment outcomes. Let us join hands in eliminating Tuberculosis from the country.

World TB Day World TB Day 2018 Slogan - Wanted…“Leaders for a TB free world” You can make history END TB

Burden and impact of TB:

per WHO Global TB report 2016,India accounts for one fourth of the global TB burden and remains the highest TB burden country in the World, i.e. 2.8 million out of 10.4 million incident (new) cases annually. In India, more than 40% of population is infected (prevalence of infection) with Mycobacterium tuberculosis. TB kills an estimated 480,000 Indians every year and more than 1,400 every day.

VISION: TB-Free India with zero deaths, disease and poverty due to tuberculosis

GOAL:To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025.

Unite to End TB: how all stakeholders can be involved?

 TB patients, civil society leaders, and community-based organizations need to be meaningfully and intensively engaged at all levels.  Need special efforts to reach and address TB in vulnerable and disadvantaged groups.These key affected population groups are vulnerable, face barriers in accessing care and deserve more attention for reasons of equity, social justice and human rights  Effective engagement of the private sector on a scale commensurate with their dominant presence in Indian healthcare is crucial to achieve Universal Access to TB Care  Linkage with other National Health Programmes is key to provide comprehensive TB care  Addressing social determinants of TB through intersectoral approach is crucial for TB Control  Different government departments and ministries for providing quality TB services in urban areas.  Involvement of Medical colleges in RNTCP more proactively and meaningfully  We need to align our targets and strategies in line with „End TB Strategy‟ to reach the goals of Sustainable Development Goals (SDGs) Active case finding and Diagnosis Strategy:

1. To achieve universal access to early accurate diagnosis of TB and enhancing case finding efficiency, identification of presumptive TB cases at the first point of care and linking them to the best available diagnostic tests is very important. Passive case finding alone can lead to missed cases or delayed diagnosis. Enhanced outreach activities to detect more TB cases are critical to universal access. Screening for TB has also to be undertaken at every point of contact with health care among key population including clinically and socially vulnerable group of people.

Intensified TB Case Finding activity (ICF) is basically a provider initiated activity with the primary objective of detecting TB cases early by active case finding in targeted groups, Increased coverage can be achieved by focusing on clinically, socially and occupationally vulnerable populations who have greater risk of TB.

„Screening‟ is a dynamic process and the prioritization of vulnerable groups.

A vulnerable group is any group of people in which the prevalence or incidence of TB is significantly higher than in the general population. The recommended vulnerable groups to be considered for intensified case finding may be classified as follows:

Clinical Social Geographical Clients attending HIV Care Settings Prisoners Urban Slums Substance abuse including smokers Occupations with risk of developing TB Hard to reach areas.

Co-morbidities like Diabetes Mellitus, Malignancies, patients on dialysis and on long term immunosuppressant therapy

People in Congregated settings– night shelters, De-addiction centers, Old age homes, Indigenous and tribal populations,

Urban Slums Urban slum dwellers are at higher risk of developing TB due to overcrowding, poor basic health services infrastructure and their health seeking behaviour. Health is not a priority for them and risk of TB transmission is high in slums. Intensified case finding efforts in these areas can include:

• House to house, periodic symptom screening of all the mapped urban slums to actively screen for presumptive TB cases.

Close Contacts of TB Household contact:- A person who shared the same enclosed living space for one or more nights or for frequent or extended periods during the day with the index case. shared an enclosed space, such as a social gathering, workplace or facility, for extended periods in a day with the index case. TBSymptom screening should be done whenever X-ray facility is not available.

Health care workers are at greater risk of getting TB infection and also at a higher risk of getting active disease. Pre placement screening and routine annual screening with Chest radiography of all the health care workers is strongly recommended.

Malnutrition is a strong risk factor for progression from TB infection to disease among children.all malnourished children attend any health facility are screened for TB symptoms with chest X-ray as the screening tool should be undertaken among children with malnourishment.

Screening pregnant women for TB in MCH clinics.

Prisoners screening.when prisoners enter the prisons. Periodic mass screening with chest X-ray. If chest x-ray is not available then symptom screening should be done.

Occupational high risk group Several occupations increase risk for tuberculosis. in stone crushing operations, coal and other mining works, tobacco (bidi rolling) and carpet weaving ,cotton factories , Garments factories etc.

Congregate Settings: People in settings like transit camps, night shelter, old age home, orphanages and de addiction centres may have ill ventilated and unsanitary

environment and hence, at higher risk of developing tuberculosis, don‟t miss to diagnose TB among people who approach health facility for any other illness.

5. TB Co morbidities:TB and HIV Tuberculosis, Single window services:TB and diabetes ,TB and nutrition,TB and tobacco,Exposure to tobacco smoke,TB& Silicosis Occupational high-risk group:

After successful completion of treatment need to be followed up for a period of one year after with follow up examinations at 6th, 12th,18thand 24thmonth.

Karnataka State RNTCP Performance for 2017-18

Confirm TB ed Put on Defau Success Year Suspected diagnos TB Cases treatmen Died Cured lt Rate examined ed TB t Cases Retreat New 2017-18 594123 62455 ment 60423 5% 5% 84% 85% 36242 9824

Financial Management Fund Status (in Corers) 2017-18

Allocation (approved Expenditure till Closing Balance Year Fund Release ROP) 31st March as per UC H-line item 49.22 Provisional H Provisional H H Line Item 2017-18 B-Line item 11.52 line item line item 24.24 Total = 60.73 34.050 13.90

Private participation:

 Number of Non Government organizations- a) State Level: 3. b) District Level: 27.  Private practitioners - a) Nursing Home & Corporate Hospitals: 8570. b) Clinics 2680. c) Laboratories: 927.  Railway Hospital -16  ESI Hospital – 62

Involvement of Medical colleges:

All the 55 Medical colleges are involved under RNTCP.( Govt. 19, Private -36). Core committees has been formed in all Medical colleges to review RNTCP activities. One DMCs & one DOTS Centers is functional in every medical college. Medical colleges were provided one MO, One LT and one TB HV on contractual basis.

IEC/ACSM Activities:

Objectives of the Campaign:

1. To create awareness in the community about TB symptoms, availability of quality TB diagnosis and treatment services and importance of treatment adherence

2. To enhance TB case notification from private health sector and offer public health services to these patients as per „Standards for TB Care in India‟

How does ACSM/IEC campaign benefits?

Advocacy, Communication and Social Mobilization (ACSM) are three distinct concepts that are most effective when used together. ACSM is an important component of the TB control strategy and is necessary to ensure long-term and sustained impact.

To achieve universal access to TB care, it is critical to design and implement issue-based, region and audience specific ACSM initiatives. These will in turn create demand for RNTCP services facilitating early diagnosis and treatment as well as treatment completion. Engagement and forging partnerships with multiple stakeholders including Private healthcare providers, corporates, NGOs, CBOs, other vibrant community groups, local self-governments etc. will result in improved provision of care for TB patients. Major components of the ACSM strategy are:

1. Advocacy for administrative and political commitment will keep TB control high on the health. Policy advocacy informs politicians and administrators Communication aims to favorably change knowledge, attitudes and practices among various groups of people. Audience segmentation and targeted behaviour change interventions will be the key to success. 2. Social mobilization brings together community members and other stakeholders to strengthen community participation, Increase demand for early diagnosis and treatment  Improve referral for case detection and community support for case holding.Combat stigma and discrimination, and empower people affected by TB. Increase capacity of health providers and front line workers to deliver ACSM messages. Mobilize political and administrative commitment, and enhanced resources for TB. Increase ownership by the community  Increase capacity for prioritizing TB in health planning at the grass root level of Panchayati Raj  Increase accountability and prompt notification from private health sector using NIKSHAY platform.  Effective dissemination and practice of „Standards for TB Care India‟ in private health sector.

Specific IEC Strategies in this Campaign:

1. Mass-media Strategies (Channels) under ACSM: The Core channels under this domain are:  Television, Radio, New Papers and Magazines

2.Mid-media Strategies (Channels) under ACSM: It covers specific target populations through Outdoor publicity materials and Folk Arts/Dramas.  Posters, Pamphlets, Brochures, Flip Charts, Wall writings/ Hoardings, Kiosks, Mobile Vans and videos on wheels, Folk dramas-

3. Inter personal communication (IPC) strategies (Channels) under ACSM: IPC tool plays key role among Service providers and TB patients.  Counselling, Home Visits

4. Community dialogue Strategies (Channels) under ACSM: Brainstorming of Key stakeholders and influencers  Seminars and workshops, Public meetings and Gatherings, Working with various groups

5. Active Case Finding outreach activities in Police department and other identified departments of the government.

1.2.4 National Programme for Control of Blindness:

The National Programme for Control of Blindness was started in 1976 as a Centrally Sponsored Scheme to counter the problems of Blindness due to various factors and also to reduce the prevalence of Blindness to 0.3% by 2020. The present prevalence rate of blindness to 0.3% by 2020. The present prevalence rate of blindness is 1% as per National Survey 2006-07.

1. The Karnataka State Health and F.W. Society (Blindness Control Division) is working under National Health Mission (NHM) headed by Mission Director. The State Programme Officer will implement and monitor the programme through a network of District Programme Managers (Blindness Control Division) at District level as per the Guidelines of NPCB. Government of India releases the funds to the State Society for onward distribution of funds to all District Health & F.W. Society (Blindness Control Division) based on the Target assigned to each District.

2. Cataract is the major cause of Blindness. 99% of the Cataract surgeries are IOL inserted surgeries. The patient affected with cataract are treated free of cost in Govt. hospitals and NGO hospitals who have MoU with NPCB. Cataract camps are being conducted on regular basis throughout the state in both the government and voluntary sector.

3. Diabetic Retinopathy, Glaucoma management, Laser Technique, Corneal Transplantation, Vitreo Retinal Surgery, Treatment of Childhood Blindness etc., are also treated under NPCB in order to provide improved eye care services and control the incidence of blindness. The patient affected with any of the above eye diseases will also be treated free of cost in Govt. hospitals and NGO hospitals who have MoU with NPCB.

4. In order to detect refractive errors in school going children, the school teacher having their proximity to the children are trained in primary eye screening. The identified children experiencing difficulties in reading are immediately referred to the Para medical Ophthalmic Officers (PMOOs) for eye screening. The children detected with refractive error are provided free spectacles.

5. 27 Eye Banks registered under Human Organs Transplantation Act and 14 eye donation centres are affiliated to eye banks are functioning in Karnataka including 7 Government Eye Banks at Minto Hospital Bangalore, K.R.Hospital Mysore and District Hospital Belgaum, KIMS Hubli, VIMS Bellary, MIMS Mandya and HIMS Hassan As per the policy of Govt.of India under NPCB eye bank infrastructure is also improved to increase cornea collection and Keratoplasty. Accordingly, 9 Eye Banks have been strengthened under NPCB so far. Incentives are also given to all the eye banks registered under HOTA for collecting eye balls in order to increase the cornea collection.

Physical Target & Achievements:

Cataract Surgeries:

Year Target Achievement % 2013-14 3,54,560 3,62,481 102.23

2014-15 4,04,563 3,63,661 89.89

2015-16 4,04,563 3,74,971 92.69 2016-17 4,04,563 3,66,737 90.65

2017-18 4,04,563 3,92,261 96.96

Achievement of School Eye Screening Programme:

Year No. of Children No. of Children No. Spectacles given Screened detected with to Children Refractive Error 2013-14 32,47,402 32,487 30,161 2014-15 29,05,004 47,003 37,786 2015-16 43,75,400 77,261 38,379 2016-17 41,55,367 1,00,426 45,553 2017-18 44,93,399 1,10,883 47871

EYE BALLS COLLECTION:

Year Target Achievement % 2013-14 5,600 3,499 62.48% 2014-15 5,600 3,938 70.32% 2015-16 5,600 3,572 63.79%

2016-17 5,600 3,527 62.98% 2017-18 5,600 4,547 81.20%

Financial Progress: (Rs. in lakhs) Year Released Expenditure 935.00 2013-14 1250.61 (Including State Share) 1890.73 2014-15 1276.47 (Including State Share) 2015-16 954.00 914.00 2016-17 1959.73 1616.23 2017-18 3230.26 2003.19(Provisional)

1.2.5 Karnataka State AIDS Prevention Society:

Karnataka State AIDS Prevention Society (KSAPS) was registered as a Society on 9th December 1997; it is an autonomous institution and the highest policy-making structure with respect to HIV/AIDS in Karnataka. The Governing council is headed by the Chief Minister and the Vice chairman is the Minister for Health and Family Welfare Services.

The Chairman of Executive Committee is Secretary to Government Health & Family Welfare Department. As per NACO, Karnataka is one of the “High Prevalent States” in India. The other high prevalent states in India are Andhra Pradesh, Mizoram, Maharashtra, Manipur and Nagaland. KSAPS is implementing National AIDS Control Programme (NACP IV). Karnataka has 30 Category “A” districts.

Declining trend among ANC attendees

1.6 1.5 1.4 1.3 1.2 1.1 1

0.8 0.86 0.85 0.69 0.6 0.53 0.4 0.36 0.38 0.2

2004 2005 2006 2007 2008 2010 2012 2015 2017

Karnataka State AIDS Prevention Society Programmes:

1. Targeted Intervention:

Response from Karnataka State AIDS Prevention Society (KSAPS) has been to saturate targeted interventions (TIs) in Karnataka under the thrust area of NACP - IV. i. Core TI (FSW, MSM ,TG & IDU): This saturation currently covers around 69,547 Female Sex Workers (FSWs) under targeted interventions and 20,098 Men who have sex with Men (MSM), 1922 transgender are covered under this programme. This programme is funded by NACO through KSAPS.

2 TIs are implementing Injecting Drug User (IDU) programme of which 1 in Bangalore and 1 in Kolar covering 1,896 IDUs. 2 Opioid Substitution Therapy (OST) centers, 1 in Bangalore and 1 in Kolar covers intravenous drug user population. ii. Bridge TI (Migrant & Truckers):

10 TI projects in Karnataka covers 1,37,000 destination migrants. 6 truckers TIs cover a population of 77,000 long distance male truckers. The Truckers program is implemented at Trans-shipment locations.

2. HIV Counseling & Testing at Integrated Counseling and testing Centre:

In Karnataka Total 470 Stand alone ICTCs and 2433 FICTC centers, are functioning.

During 2014-15, 19, 06,237 General clients were counseled and tested with a positivity rate of 1.39% and 12,32,862 ANCs were counseled and tested with a positivity rate of 0.11% in ICTCs. For the FY 2015-16, 1945282 General clients were counseled and tested with a positivity rate of 1.13% and 12,80,862 ANCs were counseled and tested with a positivity rate of 0.08% in ICTCs. For the FY 2016-17, 19,40,589 General clients were counseled and tested with positivity rate of 1.03% and 13,21,668 Antenatal women were counseled and tested with positivity rate of 0.06% and present FY 2017-18, ICTCs. 22, 20, 292 General clients were counseled and tested with positivity rate of 0.85% and 14,18, 176Antenatal women were counseled and tested with positivity rate of 0.06% in ICTCs.

Tested and found positive in ICTC General clients ANC Achievement (Ach) Achievement (Ach) Year % % Target Target Tested % Ach +ve Positi Tested % Ach +ve Positi vity vity 2013-14 1467137 1664848 113.48 29473 1.77 1292519 1178907 91.21 1445 0.12 2014-15 1540494 1906237 123.74 26509 1.39 1253456 1232862 98.36 1295 0.11 2015-16 1617519 1945282 120.26 21989 1.13 1287757 1280862 99.46 1034 0.08 2016-17 1698395 1940589 114.3 20004 1.03 1287757 1321668 103 856 0.06

2017-18 1973772 2220292 112.49 18862 0.85% 1315595 1418176 74.09. 891 0.06

3. Care Support& Treatment:

During 2017-18, 64 ART centers and 194 Link ART Centers and 104 Link Plus ART Centers have been functioning. The cumulative number of HIV cases registered at ART Centers till March 2018 were 320492 out of which, 155376 cases are alive and on ART. The progress of ART centers is given in Table 12.61.

Cumulative Status report on ART (till March - 2018) Adult Adult Child Child Indicator TS/TG Total Male Female Male Female Pre ART Registration 153213 147745 735 10270 8529 320492 Ever Started on ART 115763 113636 485 7218 5833 242935 Alive on ART 64688 80221 297 5539 4631 155376 Reported on ART 38719 22772 117 1106 816 63530 Death

4. STI (SEXUALLY TRANSMITTED INFECTIONS / REPRODUCTIVE TRACT INFECTIONS):

Major route of transmission of HIV in Karnataka in unprotected sexual intercourse and HIV is primarily considered to be a sexually transmitted infection. A person with STI/RTI is 2 to 9 times prone to get HIV. HIV positive patients with STI are more likely to acquire HIV. Hence, control of STIs contributes significantly

to the reduction in HIV transmission. Up to 40% of HIV transmission can be cut down by treating STI, hence STI control could be considered as the most cost effective programme.

There are 54 DSRCs in Karnataka, The DSRCs are located in all District Hospitals and some Taluka Hospitals.

The reports from these hospitals are as follows:

Year Target Achievement Percentage 2012-13 218737 143950 66% 2013-14 237493 167526 71% 2014-15 248952 193949 78% 2015-16 319996 196882 62% 2016-17 393841 229884 58% 2017-18 397779 259363 65% * Note : Source CIMS / SIMS

5. IEC Activities undertaken for the year 2017-18 (till March 2018):

 Day branding on World Blood Donors Day through All India Radio which includes spots and long format programmes.  Broadcast of 244 spots on Blood Donation through Private Radio Channels.  On eve of World Blood Donors Day, advertisement was published on 14.6.2017 in all 5 leading newspapers.  Printed and supplied IEC materials like folders, posters and booklets on various themes.  2 days State level folk workshop was conducted at Haveri district and around 32 folk troupe attended the workshop.  Rollout of 620 folk shows across the State.  Branding of BMTC, KSRTC, NWKSRTC and NEKSTRC buses across the State.  Wall painting across the State on the message Services, Social Protection, Blood Donation, helpline, etc. • International youth day was organized at district level. • Adolescence Education Programme is going on at the distric level covering 6000 schools on Life skills and HIV/AIDS across the state (100 students in each school). • 1027 Red Ribbon Clubs are formed to create awareness among college students. • Interdepartmental meeting is going on in all 30 districts. • Capacity building for PLHIV at district level is going on in all 30 districts. • 4th Joint Working Group meeting was conducted with Department of Education, Department of Youth, Sports and Empowerment, Department of Higher Education, Department of Public Instructions, Department of Women and Child Welfare and SCERT. • State level positive speaker training conducted at KSAPS on 7th and 8/9/2017. • Panel advocate training will be conducted at district level . • All 64 ART centres Legal Service Clinics are started and 137 cases are registered and 18 cases are solved like property and family issues. • Under Children Affected by AIDS (CABA) scheme the financial support is increased from Rs. 750 to Rs. 1000/-. • State level World AIDS Day was observed at district and State level.

• State level WAD was observed on 7th Dec 2017 at Kolar District. • On eve on WAD and to create awareness to the general population, students different media. • Telecast of spots through Radio and TV and day branding through AIR, publishing of messages in newspaper, branding of buses, folk media, etc. • Screening of spots in cinema theatres across the State. • Telecast of TV spots inside the train. • Printing and fixing of flex on the permanent hoardings across the State. • Printing and fixing of sunboards across the State. Till date totally around 112000 members of different groups are trained.

PLHIVs Government schemes in Karnataka:

Sl. Name of the Benefit To whom Concerned Dept Benefi as on No scheme ciaries 2018 2012 Dec 1 Anna 35 Kgs Ration like HIV infected Food & civil Dept 15063 34786 anthyodaya Rice, wheat, Sugar Family 2 CABA (Children Rs,650 to Rs 750 HIV infected & Women & 8245 17518 affected by affected children Dept AIDS) children 3 Rajiv Gandhi free house for HIV people Rajiv Gandhi rural 640 2344 housing Development corporation 4 Mythri pension Rs. 500/- per TS/TG Dept of Women 250 999 scheme for month development Transsexual/Tra corporation nsgender 5 Free testing HIV people get free HIV people Dept Health & 95000 180002 Testing and family Treatment welfare 6 RTE Education free admissions HIV infected & Dept of Primary 0 622 ACT private schools affected Child Education 7 Chetana Rs. 20,000/- for FSWs Dept of Women 0 1005 Scheme (loan) small business but development This scheme for refundable corporation Female sex workers 8 Higher Rs. 23,000/- per HIV infected Dept of Higher 0 25 education year and affected education and Scholarship children 9 Dhana Shree Under this scheme, This scheme Women 1000 yojana the benefit is for particularly HIV Development PLHIV women Rs. positive women Department 50,000 Loan. Out only of which Rs. 10000/-subsidy and remaining Rs. 40000/- to be paid monthly installment to Women Development dept. 10 Free Legal Free Legal service Infected and Karnataka State 0 137 Service to HIV infected and affected people Legal Authority affected people in Bengaluru ART centres. Lawyers will visit to ART centres every Saturday to solve the legal issues

6. Blood Safety:

State Blood Council was established in Karnataka during 1998-99 to provide adequate and safe blood and blood products at reasonable rates. At present there are 200 registered blood banks in Karnataka of which 66 are supported by NACO. Out of 200 blood banks, 41 are in Governments Sectors (State Govt. - 38, Central Govt.- 3), IRCS blood banks are -9, Voluntary/Charitable blood banks-19 and 131 are in private sector (99 private Hospital Blood Banks & 32 are Private Stand Alone Blood Banks)

Blood Safety Indicators (2010-11 to 2017-18)

2010- 2011- 2012- 2013- 2014- 2016- 2017- Indicator 2015- 11 12 13 14 15 16 17 18

Total blood 6,14,787 5,94,512 6,60,138 6,94,151 7,54,485 7,46,716 7,87,330 units collection 844419

Blood units collected from 3,78,933 3,93,694 4,35,258 4,08,974 5,19,260 5,39,878 5,93,108 657612 VBD

Programme Component wise expenditure of KSAPS Budget

Year 2017-18 (till 31.03.2018) Total Grants Expenditure by Approved Budget received/availa Sl. No. Programme Expenditure Programme on for 2017-18 ble for the year (in Lakhs) total grant (in Lakhs) 2017-18( in (%) Lakhs) Targeted 1 2160.98 1779.65 1668.70 Interventions 70.66 Link Worker 130.08 86.31 1.1 135.66 111.72 Scheme Sexually 94.49 Transmitted 2 Infection / 112.73 110.94 110.43 Reproductive Tract Infections Services 3 Blood Safety 404.79 398.37 266.70 62.87 4 Lab Services 61.62 60.64 37.20 53.45 ICTC/HIV- 99.78 5 1876.36 2261.62 2285.89 TB/PPTCT Information, 50.59 6 Education & 282.04 277.57 161.37 Communication 7 ART/CCC 1551.81 1527.21 1561.34 99.21 Institutional 89.60 8 437.60 430.66 469.38 Strengthening Strategic 63.62 Information 27.53 9 43.40 42.18 Management System 10 UNICEF 0 0 0 0

11 State Fund 2210-06-101-7-15 83.30 11J 493.51 493.51 1021.67 Grant in Aid Salary 2210-06-101-7-17 Reimbursement of 80.44 11© 25.00 25.00 14.85 Travel cost to HIV patient 2210-06-101-7-18 48.55 11¹ 100.00 100.00 81.87 – LWS programme 2210-06-800-0-14- 48.11 11r TB & HIV patients 25.00 25.00 12.40 nutrition foods Total 7695.50 7214.07 7849.41 88.22

1.2.6 National Vector Borne Diseases Control Programme (NVBDCP):

National Vector Borne Disease Control Programme is a programme for prevention and control of vector borne diseases namely Malaria, Filaria, Japanese Encephalitis, Dengue and Chikungunya. Programme is being implemented as per the guidelines of Government of India to achieve the following goals set under National Health Policy 2002.

MALARIA:

The main objectives of malaria control programme are:

I. Goal of reducing mortality due to malaria and other vector borne diseases by 2025. II. To prevent deaths occurring due to Malaria. III. To bring down the Annual Parasite Incidence to less than 1 as State is in pre elimination phase. IV. To encourage Community participation in Malaria Control. V. To maintain the goals achieved.

The main activities include surveillance, fever case detection, blood smear examination and treatment (early detection & complete Treatment). Indoor residual spray, bio-environmental methods and personal protection measures under Integrated Vector Management, Entomological Studies on Vector Behaviour, insecticide susceptibility, social mobilization and capacity building, monitoring and evaluation.

Physical Progress:

Deaths B/S Collected Malaria Pf Radical Year due to & Examined Cases Cases Treatment Malaria 2013 8788786 12466 828 12352 0 2014 9805708 14794 1329 14456 2 2015 9631843 12445 1588 12304 0 2016 9823219 10652 1701 10250 0 2017 10257499 7589 1233 7267 0 2018 (Up to 2537602 938 158 938 0 March)

Financial Progress: NRHM:

(in Rs. Lakhs) Year Allocation Expenditure 2012-13 492.00 318.27 2013-14 392.00 327.73 2014-15 566.00 429.41 2015-16 502.00 556.96 2016-17 470.00 543.77 2017-18 (Provisional upto 338.53 296.47 March.2018)

Achievements: 1. State is heading towards elimination of Malaria and proposed to achieve the goal by 2025. 2. During 2017, 88% decline in Malaria is achieved compared to 2006 as per National goal.

Action plan proposed during 2018-19:

1. Integrated Vector Control strategy will be intensified for Vector borne disease control in the state. 2. Stratification and focus intervention in areas of category 3 and 2 for bringing down to category-1 and 0 as per State Malaria Elimination framework.

Urban Malaria Scheme (UMS):

The main objective of UMS is to control malaria in urban areas by reducing the vector population through recurrent anti-larval measures along with adulticidal measures by indoor space spray. Biological control methods are also given more thrust under the U.M.S. The scheme is being implemented in 8 cities/towns of Bangalore, Bellary, Belgaum, Chikkamagalur, Hospet, Raichur, Hassan and Tumkur through local bodies. National Urban Health Mission has supplemented the programme with infrastructure and specific activities like free diagnostics and microscopic centres.

Physical Achievements:

Year B.S. Total of MPP Total P.F. Total R.T. examined cases cases given 2013 92355 66 0 66

2014 108792 39 4 39 2015 96611 38 1 38 2016 257393 51 5 51 2017 575102 17 2 17 2018(Till 119509 6 0 6 March)

Action plan proposed during 2018-19:

 Implementation of Civic By Laws in Municipality, City Corporation Urban and Local Bodies for control of mosquito Breeding in urban towns with population more than 50000.

II. Elimination of Lymphatic Filariasis programme.:

 Elimination of Lymphatic Filariasis by the year 2020: Mass Drug Administration for ELF is being implemented in Filaria endemic districts of Kalburgi, Bagalkot, Bidar, Yadgir, Raichur, Vijayapura while the districts of D.Kannada, Udupi and Uttarakannada are on the verge of elimination of Filariasis. The Mass Drug Administration is being implemented from 2004 in the State with the assistance of Government of India.

Morbidity management and Hydrocelectomy operation are taken up in all endemic districts and no fresh cases with disease manifestations are reported since last 3 years. MF survey and disease surveillance has also been completed in all 21 non endemic districts to confirmed its non-transmission.

The progress of MDA is as follows:

Percentage of drug coverage: Year(Date of MDA) % covered 5th June 2004 85.22% 11th November 2005 89.88% 28th July 2007 90.33% 15th November 2007 90.66% 15th November 2008 90.92% 14th December 2009 89.30% 10th January 2011 91.84% 23rd January 2012 92.00% 5th March 2013 93.8% 14th December 2014 76.7% 14th December 2015 78.9% 10th August 2016 86.0% 2017 88.6%

Financial Progress of funds received by NRHM: (Rs. In Lakhs) Allocation Year Expenditure (in Lacks) 2012-13 160.00 151.96

2013-14 155.00 12.61 2014-15 198.90 194.29 2015-16 251.87 224.64 2016-17 146.84 113.83 2017-18 (Provisional upto 76.56 45.30 March.2018)

Achievements during: 2017-18:

1. As per the results of the “Transmission assessment survey” in the Udupi districts has completed TAS II successfully and is eligible TAS III during 2018-19, where as TAS III will be taken up Dakshina Kannada & Uttara Kannada Districts during 2019-2020.

Action Plan for 2018-19 1. 15th round of Annual MDA shall be continued in Kalburgi, Yadgiri and Bidar and partially in Bijapur, Raichur and Bagalkote. 2. TAS II will be taken up partially in Bijapur, Raichur and Bagalkot districts

VI. Japanese Encephalitis Control Programme

Activities for the control of Japanese Encephalitis:

1. Japanese Encephalitis reported in 18 districts-Bangalore(U), Bangalore(R), Ramanagar, Chikkaballapur, Tumkur, Shimoga, Vijayapur, Haveri, Yadgiri, Raichur, Koppal, Mysore, Mandya, Hassan, D.Kannada, Udupi, Chikkamagalur, Kodagu and BBMP 2. Epidemiological surveillance of (AES) Acute Encephalitis Syndrome is strengthened 3. Diagnosis, treatment and management of all confirmed cases is being done 4. Outdoor fogging operations for vector control. 5. Intensive health education and personal protection. 6. Vaccination of children in the age group 1 to 15 years 7. Bringing awareness in community regarding self protection.

Physical Achievements:

A E S (Suspected) J E Year A E S Cases Deaths J E Cases Deaths 2013 300 0 9 0 2014 133 0 34 0 2015 382 0 49 1 2016 406 0 11 0 2017 332 0 23 1 2018 (Up to MARCH) 115 0 9 0

JE Vaccination programme:

J.E Vaccination Report 2016-17 to 2017-18 (up to Mar 18) 2016-17 2017-18(up to Mar 2018) Sl. Name of the Total Target 1st dose 2nd dose Total Target 1st dose 2nd dose No District Coverage (ELA) Coverage (ELA) Coverage % Coverage % Coverage % Coverage %

1 Bellary 55987 49035 87.58 36690 65.53 85725 55987 55711 99.51 49251 87.97 104962 2 Bijapur 54510 37257 68.35 24310 44.60 61567 52726 48885 92.72 40791 77.36 89676 3 Chikballapur 17496 17737 101.38 15272 87.29 33009 17496 18390 105.11 16430 93.91 34820 4 Chitradurga 27898 24534 87.94 22672 81.27 47206 27898 27603 98.94 23641 84.74 51244 5 Davangere 37616 29767 79.13 18342 48.76 48109 37616 36688 97.53 33213 88.29 69901 6 Dharwad 34992 26015 74.35 23018 65.78 49033 34992 33929 96.96 26439 75.56 60368 7 Kolar 24964 19778 79.23 18640 74.67 38418 23781 25696 108.05 23078 97.05 48774 8 Koppal 30181 24541 81.31 18557 61.49 43098 30181 28788 95.39 24419 80.91 53207 9 Mandya 22307 20860 93.51 20284 90.93 41144 21870 22513 102.94 21699 99.22 44212 10 Raichur 44615 36960 82.84 25135 56.34 62095 45927 44063 95.94 39997 87.09 84060 Total 350566 286484 81.72 222920 63.59 509404 348474 342266 98.22 298958 85.79 641224

JE Vaccination programme is being carried out in phased manner to cover all JE proven districts. Details of vaccination carried out so far is as follows:

JE Vaccination programme is implemented under the guidance and supervision of Project Director (RCH).

JE Vaccination programme has been done a campaign mode in Bellary, Vijayapura, Chikkaballapura, Chitrdurga, Davanagere, Dharwad, Kolar, Koppal, Mandya and Raichur districts, and the programme is now included under routine immunization programme in these districts.

Achievement during 2017-18 :

1. Regular JE vaccination programme is implemented in 10 districts namely Bellary, Raichur, Kolar, Mandya, Koppal, Dharwad, Vijayapura,Chitradurga, Chikkaballapura and Davanagere Districts,

2. Action Plan 2018-19:

 10 Sentinel Surveillance Laboratories are functioning for diagnosis of JE in the state namely VIMS-Ballary, PHI-Bangalore, Kolar, IGICH- Bangalore, KIMS-Hubli, DSO-Chitradurga, MCVR_Manipal Udupi, NIV- Bangalore, DSU-Bagalkot, DSU-Gulbarga, are conducting sero diagnosis for JE and the same will be continued the year 2018-19 also.  Workshop and training programme for AES survey and JE control will be taken up in all four zones for capacity building.  Intensive IEC activities will be undertaken.

Financial Progress: Budget for JE Vaccination is being release and through NHM - RCH component no separate budget allocated under state sector.

Year Allocation (in Expenditure Lacks) 2012-13 120.00 34.72 2013-14 35.00 7.60 2014-15 17.00 5.45 2015-16 7.00 9.17 2016-17 7.00 6.76 2017-18 (Provisional upto 5.00 2.59 March.2018)

IV. DENGUE FEVER/DHF and CHIKUNGUNYA CONTROL PROGRAMME:

Dengue Fever:

Dengue is a mosquito borne viral disease being transmuted by Aedes mosquitoes and reported in several districts in the State.

Dengue epidemic occurs usually from April to November, i.e. during the pre and post monsoon periods. The main cause for the spread of the disease is due to large scale breeding of Aedes Egypti mosquitoes in domestic and peri-domestic situations in water storage containers like cement water tanks, barrels, earthen pots, tyres, and such other containers which are usually not emptied for a long 24

time in addition to discarded materials like Coconut shells, tyres, plastic materials which collect rain water.

The incidence of Dengue fever in Karnataka :

YEAR Positives DEATHS 2013 6408 12 2014 3358 2 2015 5077 9 2016 6083 8 2017 17844 10 2018 (Up to March) 682 0

Financial Progress:

Allocation under NHM –NVBDCP for Dengue / Chikungunya control.

(Rs. In Lakhs) Year Allocation Expenditure 2012-13 200.00 152.55 2013-14 198.50 159.43 2014-15 370.00 222.57 2015-16 285.00 277.62 2016-17 370.00 325.21 2017-18 76.00 66.43

„Chikungunya:

Chikungunya was first of its kind noticed in Karnataka during 2006 which has widely spread both in Urban and Rural areas through Aedeas Egypt mosquito. Though the disease is not fatal, patients suffer from fever, severe joint pain with prolonged arthritic and arthralgic symptoms. This has greatly affected the lively hood of such patients.

The disease has no specific drugs for treatment, but the treatment is purely symptomatic.

The control activities involve source reduction to prevent mosquito breeding as well as community awareness for proper water storage and solid waste management as in the case of Dengue vector control.

CHIKUNGUNYA INCIDENCE:

No. of Blood Suspected No. of cases Year Samples cases Confirmed collected 2013 5295 2667 864 2014 6962 3309 992 2015 20763 8357 2099 2016 15666 7925 1528 2017 32831 18663 3511 2018 Up to 3735 2315 453 March

Achievements during:2017-18:

1. 33 Sentinel Surveillance Laboratories have been established across the state for diagnosis of Dengue and Chikungunya 2. Blood samples received not only from Government Institutions but also from private sectors and these tests are being tested free of cost 3. The no of blood samples collected and examined in the SSLs during 2017-18 was the highest for the past 5 years and was doubled as compared to previous year. 4. Special emphasis is given for Behavioural Change Communication among the community for Change in water storage practices and solid waste management, to prevent Aedes vector breeding in and around domestic situations through IEC activities.

Action Plan for 2018-19:

1. Emphasis for sub centre based Aedes surveillance and source reduction activities. 2. Urban Aedes surveillance and source elimination programme is given special Thrust by deputing health assistant every first and third Friday 3. Involvement of schools for aedes control in the school premises and spread of messages in the community. 4. Intersectoral coordination for control of Dengue and Chikungunya, will be promoted.

Communicable diseases(CMD):

The Communicable diseases (CMD) wing of this Directorate of Health & F.W.Services is playing vital role not only in controlling the water borne communicable diseases in the state by regular monitoring, issuing appropriate guidelines to the District Health Authorities but also investigating epidemic /outbreaks in the state. Monitoring drinking water quality by collecting water samples with more emphasis in rural sector.

Functions: 1. Issue of guidelines from time to time to District level programme officers regarding the control of communicable diseases. 2. Regular monitors of the diseases by issuing appropriate guidelines to the District Health Authorities 3. Investigation of outbreaks. 4. Supply of KFD vaccines to KFD affected districts. 5. Implementations of instructions issued by Government of India and Government of Karnataka, if any

Programmes undertaken during the year: a. Communicable Disease:

(1) Gastro Enteritis (2) Cholera (3) Typhoid (4) Viral Hepatitis (5) Kyasanur Forest Disease (6) Leptospirosis (7) Anthrax (8) Plague (9) H1N1 (Influenza-A) b. Other Programmes: (1) Handigodu Syndrome (2) Dog bite (3) Snake bite (4) Guinea Worm Eradication Programme 5) Rehabilitation programme of Endosulfan

Progress Achieved year wise 2014 to end of March 2018 2016 2017 2018 2014 2015

Diseases/

Programme

Deaths Deaths Deaths Deaths Deaths

Attacks Attacks Attacks Attacks Attacks

Gastroent 15286 117795 15 147860 12 135125 9 2 38581 0 eritis 9 Cholera 65 1 59 2 84 1 2 0 8 3 Typhoid 49752 2 53797 0 57112 0 90607 23798 0 Viral 4660 5 4929 7 5226 4 5957 4 1325 0 Hepatitis KFD 162 1 41 1 32 1 46 3 16 0 Leptospiro 299 6 273 0 503 2 475 2 55 0 sis H1N1 303 34 3565 94 110 0 3260 15 10 0 Handigodu 523 9 523 9 514 16 498 13 0 0 Syndrome 27563 Dog Bites 227949 9 239168 8 258035 13 7 80748 0 9 Snake 8896 140 11109 104 12182 55 10818 49 1562 11 Bites

Plague Control Programme (2012 end of March-2018)

Surveillance 2012 2013 2014 2015 2016 2017 2018 Rodent collection 1591 1088 889 1186 1226 407 40 Sera Collection & 1516 1033 889 1055 1003 287 40 Examined REP Survey in 22 55 18 24 23 60 6

* Rodent sera samples have been analysis at NICD-Bangalore.

Handigodu Syndrome:

Handigodu Syndrome disease prevalent only in Shimoga and Chikkamagalore Districts. (Cases under treatment)

1. Shimoga District 209 2. Chikkamagalore District 289 TOTAL CASES UNDERTREATMENT 498 (These are all old patients under treatment)

Kyasanur Forest Disease :

Kyasanur Forest Disease (KFD) is reported from these 3 Districts in Karnataka : 1. Shimoga 2.Belagavi 3. Uttara Kannada.

Name of SI 2018 the 2016 2017 NO (End of March) District Cases Deaths Cases Deaths Cases Deaths 1 Shimoga 14 41 39 2 15 0 2 U.Kannada 2 0 6 1 1 0 3 Belagavi 16 0 1 0 0 0 Total 32 41 46 3 16 0

H1N1 (Influenza-A)

Comparative Statement of H1N1 Samples Tested and Confirmed cases (2012 to end of March 2018) SI Particulars 2012 2013 2014 2015 2016 2017 2018 No 1683 1 Specimen Examined 4472 1870 2349 13168 3494 1836 5 H1N1 cases 2 878 122 303 3565 110 3260 10 confirmed by lab test 4 Reported deaths 48 19 34 94 0 15 0

Communicable Diseases Control Programme:

The Directorate has given the responsibilities to the CMD-Section to control and eradicate the communicable diseases. They are,

1. Regular monitoring of the diseases by issuing appropriate guidelines to the District Health Authorities. 2. Investigation of outbreaks/epidemics. 3. Monitoring the drinking water sources by analyzing the water samples and issuing instructions for chlorinating the unfit water sources. 4. Conducting workshops to sensitize the medical and paramedical staff about KFD. 5. Creating awareness about these diseases among the public. 6. Immunization of risk group population in KFD endemic district under KFD control programme 7. To strengthen the passive surveillance activities of communicable diseases. 8. To visit all the district and check the under reporting of communicable diseases from District Hospitals, private Hospitals and peripheral health institutions. 9. All communicable diseases surveillance activities to be activated. 10. To involve all the local bodies for preventing the communicable diseases through the supply of safe drinking water and maintain environmental sanitation.

Plan of action for the year 2018-19:

1. Up gradation of Viral Diagnostic Laboratory at Shimoga. 2. To bring down incidence of KFD by maximum coverage of vaccination in endemic districts. 3. Strengthening of VDL Shimoga with fully function of RTPCR equipment for accurate & speedy diagnosis of KFD cases. 4. To intensify the plague surveillance activities by strengthening the plague control unit at Kolar. 5. To prevent the death and reduce the epidemics due to cholera and Gastroenteritis. 6. Creating the awareness for preventing H1N1. 7. Supply of Medicine issue and necessary instructions to all districts for controlling of H1N1 in the state. 8. Providing medical and financial support to be Endosulfan victims for in priority their health status.

Any notable information to be mentioned in the Performance Budget.

The Communicable Diseases unit is entrusted with the task of not only controlling the waterborne communicable diseases but also preventing these diseases in the form of epidemics and minimizing the morbidity and mortality (Human suffering and deaths)

1.2.7 Reproductive and Child Health Programmes:

The Child Health Programme comprehensively integrates interventions that improve child survival and addresses factors contributing to Infant and Under 5 Mortality. Many initiatives have been taken up to provide preventive, promotive, curative & rehabilitative health care services through evidence-based interventions like Facility Based Newborn Care (SNCU, NBSU, NBCC), Home Based Newborn Care, Janani Shishu Suraksha Karyakrama (JSSK), Child Death Review, Kangaroo Mother Care and Lactation Clinic, Integrated Management of Neonatal & Childhood Illnesses (IMNCI) and Intensified Diarrhoea Control Fortnight (IDCF).

Karnataka Child Mortality Trend (SRS 2016):

 Infant Mortality Rate (IMR) in Karnataka is declining steadily. It is declined from 41 in 2009 to 24 as per Sample Registration System (SRS) 2016.  The Millennium Development Goal (MDG) for Under 5 Mortality Rate has already been achieved in Karnataka. The current Under 5 Mortality Rate is 29 (SRS 2016 data), Under 5 Mortality Rate has been reduced by 19 points since 2009.The current goal is to reduce Under 5 Mortality Rate from 29 to 25 according to Sustainable Development Goal (SDG).  The current Neonatal Mortality Rate (NMR) is 18 (SRS 2016). Current goal is to reduce NMR from 18 to 12 according to Sustainable Development Goal (SDG) 2030.  The current Early Neonatal Mortality Rate is 13 (SRS 2016).

Achievements during 2017-2018:

1. At present 39 Special Newborn Care Units are working and 5 more SNCUs are ready to working. Special Newborn Care Unit of SNR Dist. Hospital, Kolar has been accredited as a level to Neonatal Unit by National Neonatal Forum- NNF. 2. Kangaroo Mother Care wards and lactation clinics were established in all District Hospitals as an adjunct to SNCUs to provide supportive services to low birth weight/ preterm babies to improve survival rate and to increase the early initiation of breast feeding rates respectively. 3. Kangaroo mother care workshop- Training of trainers (TOT) for 210 participants (RCHO, SNCU Paediatrician, SNCU & labour room staff nurses from each district) was conducted to ensure KMC workshop at district level and successful rolling out of KMC wards and practices at district level. 4. Newborn resuscitation skill enhancement corners were established in 13 SNCUs with high birth asphyxia load for capacity building of staff nurses and medical officers involved in new born care services. 5. Evaluation of SNCUs across the state by experts to identify the gaps/ bottlenecks and recommendations to strengthen these units for providing quality new born care.

6. Basic NRP training in association with IAP for 370 participants (staff nurses and medical officers from delivery points, NBSUs and SNCUs) was conducted in 8 districts to improve the essential new born care practices amongst staff nurses. 7. Up gradation of NBSU‟s and SNCU‟s based on the delivery load

The following programmes and activities are being carried out in Karnataka to reduce the U5MR, IMR and NMR in the Child Health section:

1. Facility Based New Born Care

a) New Born Care Corner (NBCC) :1070 NBCC are functioning at all delivery points, as on 2016. Newborn care corners are established in labour rooms &Operation Theatres in all the 24X7 PHCs, CHCs, Taluk Hospitals and District hospitals. b) New Born Stabilization Units (NBSU): 165 NBSUs are functioning as on 2016. NBSUs have been established in all First Referral Units (FRUs) and Taluk Hospitals. c) Special Newborn Care Unit (SNCU):40 SNCUs are functioning as on 2016 at all district hospitals and some high performing Taluk hospitals. d) SNCU Online Monitoring Software: All 39 SNCUs are now integrated with the SNCU Online Monitoring Software at their units. e) Kangaroo Mother Care wards: Kangaroo Mother Care (KMC) ward and Lactation Clinics are being established in all the District Hospitals adjacent to SNCUs to strengthen the supportive care to the newborn. KMC wards are established in all hospitals with SNCUs and health care personals are trained in KMC at state level. Further community KMC will be rolled out in order to increase the survival of low birth weight babies. f) Lactation Clinics:Lactation clinics are established in district hospitals to increase the early initiation of breast feeding and exclusive breastfeeding rates. This will be established at all the delivery points and further existing lactation clinics will be upgraded to lactation management centers and mothers will be supported to store the expressed breast milk. g) Neonatal Transportation:Neonatal ambulances ensemble with intensive care will be provided for four divisions to transfer sick neonates. This will be rolled out to all other districts based on the experience of piloting.

2. Integrated Management of Neonatal & Childhood Illnesses (IMNCI):

IMNCI was first initiated in Raichur in 2005 and expanded in a phased manner to all 31 districts including BBMP as on 2017-18.Integrated Management of Neonatal & Childhood Illnesses (IMNCI) programme is an innovative approach where the field level workers (ANMs &Anganwadi workers) are trained to identify common diseases of early child hood (Pneumonia, Diarrhoea, Measles, Ear Infections, Malaria, Malnutrition, Anaemia) and manage or arrange prompt, timely referral. IMNCI was first initiated in Raichur in 2005 and expanded in a phased manner to include all 30 districts from about 2012.By 2011, with the establishment of FRUs and New Born Stabilization Units, the Facility based IMNCI concept was introduced in addition to the Community based component and Medical Officers and Staff Nurses of all Health facilities have been trained and are implementing the same. Supportive supervision of the programme has been under taken through the Community Medicine Department of the 10 Government Medical Colleges. This supervision was initiated from 2014 onwards. 31

3. Home Based Newborn Care (HBNC):

ASHAs visit the neonates at least 6 times in the first 42 days after delivery. 34238 ASHAs are trained to identify common neonatal illnesses & educate the mothers regarding Breast feeding & care of new born. In case of SNCU graduates and low birth weight babies, additional visits at 3rd, 6th, 9th & 12th month at the incentive of Rs. 50/- per each visit is carried out by ASHA. They are provided with a kit containing essential equipment & drugs to car for the newborn.

Knowledge of ASHAs is being reinforced through the SATCOM facility where the State Officials directly interacted with ASHAs and cleared their doubts. Similarly, Medical Officers and Staff Nurses of PHCs were also oriented regarding RMNCH+A strategies through SATCOM.

4. Janani Shishu Suraksha Karyakrama (JSSK):

Janani Shishu Suraksha Karyakrama (JSSK) was introduced in early 2012 to reduce the out of pocket expenditure of the parents towards the treatment of sick newborn. An amount of Rs. 200/- for Drugs and Consumables, Rs. 100/- for diagnostics and Rs.300/- for Referral Transport was allocated per sick newborn as an indicative unit of calculation. The required amount may be spent with justification. In the year 2013-14, the facility was extended for any sick child below one year of age.

5. Child Death Review (CDR):

Child and infant Death Review have been implemented in all Districts of Karnataka. State and District level Child Death Review committees have been formed and are meeting regularly.Perinatal Death Audit is being done at select districts for the year 2016-2017. This will be extended to all districts in the year 2017- 2018. All reports being sent are being reviewed, validated and feedback given to districts.

Through all these efforts, the State has reduced the Under 5 Mortality to 29 per 1000 live births and Infant Mortality Rate to 24 per 1000 live births as per SRS 2016

6. Newborn Week:

Newborn week is being celebrated in Karnataka since 2016. This is a programme launched by Government of India to highlight care of newborns and to emphasize the importance of improving newborn care. It is celebrated every year in the second week of November. multiple training programmes, awareness activities and IEC activities are carried out in the community and at health care facilities across the state.

7. Intensified Diarrhoea Control fortnight (IDCF):

IDCF programme has been observed throughout the state during 2014-15 and 2015-16 (Last week of July and First week of August). All the grass root level of workers is sensitized regarding the use of ORS and ZINC syrup/tablet. The first week is centered around Diarrhoea control and the second week around Infant and Young Child Feeding Practices(IYCF)activities. Sessions held in schools and Anganwadis to create awareness on the subject. These are two of 32

the components (Diarrhoea control and Prevention of Malnutrition) of IMNCI which have been given an additional thrust.

In PIP 2018-19 following additional activities have been proposed:

 Strengthening of facility based new born care (FBNC): SNCU& NBSU mentoringby team of neonatologist every month for SNCUs & quarterly visits to NBSUs with supportive supervision, onsite training of the health care personnel if required, also check and ensure that standard practices are being implemented with detailed report to the state child health.

 State Resource Centre (SRC) for Newborn Care will be established to build the capacity of health care personnel in newborn care at all the levels of facility based newborn care (SNCU, NBSU & NBCC). The rapid expansion of SNCUs coupled with lack of manpower with requisite skills at the district level and non- availability of state level Centre is creating huge load of capacity building of the service providers for the existing system and facilitators. As per the guidance note issued by GOI and also there was a felt need for development of a Centre that will guide the state for all newborn care related training and developmental activities in FBNC.

 Karnataka Newborn Action Plan (KNAP): The Karnataka Newborn Action Plan (KNAP) will be developed in response to India Newborn Action Plan (INAP) which outlines a targeted strategy for accelerating the reduction of preventable newborn deaths and stillbirths in the state. It will be implemented within the existing RMNCH+A framework adapting the INAP principles (Principles of Integration, Equity, Gender, Quality of Care, Convergence, Accountability, and Partnerships) and pillars of intervention packages (Pre-conception and antenatal care; Care during labour and child birth; Immediate newborn care; Care of healthy newborn; Care of small and sick newborn; and Care beyond newborn survival). Capacity building of Health care personnel at 6 intervention packages.

Mother and Child Tracking System:

A web based Pregnant Women and Child Tracking System introduced aiming to provide pre-natal & postnatal care at the door steps of rural poor. As on May 2018, 68.50 lakhs pregnant women and 48.72 lakhs children have been registered under the system. This programme is greatly appreciated by the Government of India which has asked other States to consult. Besides, taking note of Karnataka‟s pioneer initiative in integrating information Technology in Health Care Delivery. The Rockefeller Foundation of USA has conferred “TOP INNOVATOR CHALLENGE AWARD” in December 2011 for this system

1. Janani Suraksha Yojane (JSY):

This is 100 % Government of India funded Programme, through National Health Mission. The main objective of this scheme is to motivate all BPL, SC and ST Pregnant Women to deliver in Health Institutions, to reduce maternal and infant deaths. In this programme, pregnant women of BPL, SC & ST who deliver in health institutions in rural areas are provided Rs 700 cash incentives, in urban areas; Rs 600 and if they deliver through C-Section in private institutions are provided Rs 1500. If the said category Pregnant Women deliver at their homes, they are also provided Rs 500 cash incentives to meet their post-delivery wage loss.

2. Thayi Bhagya:

This Programme envisages, totally free Maternal & Child Health Care of all categories of Pregnant Women and Mothers in the State, with the core intention of zero Out of Pocket Expenditure to all women for MCH Services. The goals and objectives of this programme are achieved with main focus on equity, and ensuring quality MCH services which are available, accessible and affordable to all sections of the society. In addition to the said services, BPL, SC and ST category Pregnant Women and Mothers are provided incentives in cash and kind to motivate them to avail MCH Services in Government and Private Hospitals, with the sole intention of reducing Maternal & Infant Morbidity and Mortality.

3. Arogya Kavacha(108):

“ArogyaKavacha” 108 Emergency service was started in the state of Karnataka on November 1, 2008, by the Karnataka Health and Family Welfare Department under a Private Public Partnership through an MOU signed with GVK EMRI.

The Role and Mission of „108‟ is to save lives by providing a comprehensive „Emergency Response Service‟ to those in Medical, Police or Fire emergencies, through a single integrated number - 108. We operate 24 x 7 and 365 days of the year with a fleet of 711 well equipped ambulances. The ambulances are manned by a trained Emergency Medical Technician (EMT) and a trained driver (Pilot). This service is available across the length and breadth of Karnataka i.e., all the 30 Districts.

he Ambulances are stationed strategically in all Districts and taluks across Karnataka so they can reach the incident location within the shortest possible time anywhere in the state. The services are operated through a centralized Emergency Response Center located at Bangalore. At present there is one ambulance for every 85000 populations with a total of 711 Ambulances throughout the state.

This service can be utilized by any individual who requires emergency help (Medical, Police, or Fire) irrespective of his economic status, caste, creed, color, ethnicity, gender, and/or literacy levels. The process of calling for an ambulance is simplified to such an extent that a call to the toll-free number „108‟ with details of emergency, the number of people involved and the incident location supported with a landmark; would trigger an ambulance dispatch . This is an absolutely FREE SERVICE starting from the phone call till the point of reaching the hospital.

The medical emergencies can be availed for Accident and Trauma (Vehicular and non vehicular), complaints related to Cardiac, Respiration, Diabetes, pregnancy, Stroke/Convulsions, Suicide attempts Poisoning cases, Assault/Violence, Animal Attacks, Neonatal, Building Collapse, Fire, Burns, hazardous material ingestion etc.,

From April 2017 to March 2018, 1165763 Emergency calls are attended, 1136789 emergencies are attended and out of these 360125 pregnant women have utilized the services and 65692 lives are saved.

4. JananiSurakshaVahini:

Janani Suraksha Vahini Programme was initiated under NHM in 2009-10 to ensure 24/7 round the clock, free referral transport between the facilities for pregnant women and sick neonates/ infants. Out of the existing ambulances of the CHCs/ THs/ DHs one ambulance of each facility was designated as JSV Ambulance. At present there are 180 JSV Ambulances. Drivers are outsourced by District Health Societies from Manpower Agencies by calling tenders as per KTPP Act.

3 drivers (1 Regular and 2 Out sourced) are given to each vehicle to work in 8th hourly shifts. Total number of beneficiaries under JSV from April 2017 to March 2018 is 63915.

5. Nagu-Magu:

To provide Drop Back facility for post postnatal mothers and new born from Government Health Facilities to their residence, 200 drop back vehicles called as “Nagu-Magu” were inaugurated on 5th February 2014. The Nagu-Magu vehicles are deployed one each at the District Hospital and Taluka Level Hospitals. Drivers for Nagu-Magu Vehicle are outsourced by District Health Societies from Manpower Agencies by calling tenders as per KTPP Act.

Total number of beneficiaries under Nagu-Magu from April 2017 to March 2018 is 124852.

6. Bike Ambulances: (First Response Unit):

The Bike Ambulances/ First Response unit (FRU) is inaugurated on 15th of April 2015 by Government of Karnataka. It is the “Platinum Ten Minutes” trauma care initiative aimed at reducing deaths due to road accidents. It is an unique initiative and is the first of its kind to be taken up by the State Government in our Country. The first aid and medical care during the “Platinum Ten Minutes” is paramount to save the life of an accident victim, hence the pioneering attempt to start motorbike ambulance service.

The motorbike ambulance service is another pilot and pioneering initiative to ensure first aid to the victims during the Golden Hour They are useful for negotiating the small streets and heavy traffic in the large urban areas where it would be difficult to move ambulances through crowds. The fleet of high-powered touring motorcycles are available when required to respond to various trauma/medical incidents. The Bike ambulances will be currently deployed in Bangalore (19 Nos), Mangalore (2 Nos), and one each to the corporation areas of Mysore, Kalburgi, Belagavi, Hubli-Dharwad, Davanagere, Tumkur, Vijayapura ,Shimoga and KolarDistricts where heavy traffic congestion and narrow streets would be easily overcome by the agile nature of the bikes. The programme will be implemented through GVK-EMRI who are already experience in providing such services through Arogya Kavacha-108. Riders are paramedics or EMTs who are recruited and trained on managing emergencies. Motorbike ambulance drivers would be fully trained in rendering first aid and would start resuscitation measures to save the victim.

Two-wheelers by virtue of their size could manoeuvre through narrow and busy roads and reach accident spots with ease while they would be followed by a 35

fully equipped four-wheel ambulance for shifting the victim to a nearest hospital for further treatment if necessary.

Bike ambulance is able to respond to a medical emergency much faster than an ambulance or a car in heavy traffic which can increase survival rates for patients suffering cardiac arrest/ accident/ other emergencies.

From April 2017 to March 2018, 58349 emergencies are attended by the bike ambulances.

7. Arogya Vani-104:

The Government of Karnataka has started the Arogya Sahayavani-104 service with the moto of reaching the unreached, to provide all the health care services available in the public sector.

Those patients residing in the remote rural villages, who cannot access the medical doctors in the hospitals, can now contact with the doctors through Arogya Sahayavani-104. “104” is a toll free number through which people can avail consultation for minor ailments, counseling services, information on services available in public Health facilities, directory services (Eye bank, Blood Bank) and grievance redressal (Services, Epidemics, Corruption, Hygiene, Drugs and Diagnostics, ASHA grievances, etc., )

Arogya Sahayavani-104 call center is situated at IT Park Hubli with 100 seater capacity. People (Citizens) from any part of the state can avail their service by calling 104 should the clock throughout the year. From April 2017 to March 2018, 7019933 calls are received at the call center. At present around 20000 calls per day on an average is being received at the call center.

8. VatsalyaVani:

For the first time in India, A Three way call conferencing structure for Mother Child tracking system called “VatsalyaVani” is launched in Karnataka by Hon‟ble Chief Minister Shri. Siddaramaiah on 21st December 2015. This programme is implemented through Arogya Sahayavani-104.

VatsalyaVani call center will offer the below services throughout the state:

1. Monitor all pregnant woman and child through ANC/PNC advice. 2. Promote, protect and maintain the health of the mother and child through advice e.g. nutrition, health & wellbeing. 3. Providing information of various government health programs and schemes and their entitlements 4. Identify and track High Risk Pregnancies and low weight birth babies. 5. Motivate mothers for Institutional Delivery and family planning methods. 6. Arrange and monitor transfer to nearest delivery point through state ambulances. 7. Eliminate home deliveries. 8. Track Immunization status. 9. Prevent dropouts. 10. Ensure complete service delivery.

9. Madilu:

This is one of the four components of Samagra Mathru Aarogya Palane (ThayiBhagya) Scheme, it is being implemented since 2007-08, with 50 % of the budget coming from GoI, through National Health Mission and the remaining 50 % of the budget is being provided by the State Government. In this programme, a kit containing 19 items which are useful to the post-natal women and her infant is being provided to BPL, SC & ST beneficiaries, who deliver in any Government Hospital in the State. This benefit is provided to all deliveries of BPL, SC & ST women in HPD districts (Bagalkote, Bijapur, Ballari, Raichur, Koppal, Raichur, Kalaburagi, Yadagiri, Gadag and Chamarajanagar) and for only two live births in the remaining districts of the State. The line items of the kit are being procured from Karnataka Handloom Development Corporation and the soap items are being procured from Karnataka Soaps and Detergents Ltd. The approximate cost of each kit is Rs. 1380.

10. Prasooti Araike:

This is one of the four components of Samagra Mathru Aarogya Palane (Thayi Bhagya) Scheme, out of which, the three components, Viz., Prasoothi Araike, Thayi Bhagya and Thayi Bhagya Plus are 100 % Government of Karnataka funded schemes. Prasoothi Araike scheme is being implemented from 2007-08 with the objective of providing cash benefits to BPL, SC and ST communities Pregnant Women, to enable them to take nutritious diet during pregnancy and post-natal periodto reduce maternal and infant morbidity and mortality. This scheme is implemented in all the districts of the State, except Kolar and Dharwad.

Beneficiaries of this scheme receive cash incentives of Rs.1000 in two instalments, the 1st instalment is provided to the Pregnant Women during her 4-6 months‟ pregnancy and the 2nd instalment of Rs.1000 is provided immediately after delivery, if the beneficiary delivers in any Government Hospital in the State. The 2nd instalment will include the JSY cash component. From 2014-15, the cash incentives, for the Pregnant Women and Post-natal mothers has been enhanced for SC & ST beneficiaries to Rs. 2000 each.

11. Janani Shishu Suraksha Karyakrama (JSSK):

This is also 100 % Government of India funded Programme, through National Health Mission. The main aim of this programme is to ensure, totally zero out of expenditure to Pregnant Women to avail free delivery services in Government Hospitals. In this Programme five free services are provided in all Government hospitals across the State. The services which are provided free of cost to all pregnant women are; free drugs and consumables, free diagnostics, free blood, free diet and free transport services from home to health institutions and back home. For all Government Hospitals; for providing free delivery services, for each case, Rs. 350 for drugs, (Rs. 1600 for C-Section deliveries), Rs. 200 for diagnostics, Rs. 150 for free diet (Rs. 350 in C-Section Deliveries) and Rs. 250 for referral transport is provided.

1.2.8 Pre-Conception and Pre-natal Diagnostic Techniques Programmes (PC. &PNDT) :

Objective:

Implementation of Pre-Conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994

Objectives of the act: 1) Prevent gender biased sex selective. 2) Ensure survival of Girl child. 3) To ensure mapping of ultrasound machines. 4) To ensure prompt quarterly report by ultrasound manufacturers and dealers. 5) To ensure owners and doctors in imaging centers to follow the act strictly. 6) Formation of committees under law to implement the act. 7) To give health education to people regarding adverse effects of declining sex ratio. Indicators of Sex Ratio:

Sex Ratio at Birth (SRB) NFHS-3 (2005-06) 922 NFHS-4 (2015-16) 910 0-6 Child Sex Ratio (CSR) 2001 Census 946 2011 Census 948

Vijayapura district is identified for Beti Bacho, Beti Padhao programme in Karnataka. As per census in the year 2001, child sex ratio (0- 6 years) was 928 and in the year 2011 improved to 931. Objective is to increase CSR ratio to 939 by 2015-16.

As per HMIS report of November SRB is 974.

SRB (HMIS report)

District 2013-14 2014-15 2015-16 HMIS (SRB as per objective Feb 2017) Vijayapura 919 929 939 970

Activities:  www.pcpndtkar.in State PC&PNDT cell website is initiated, displayed Bare act, Kannada translation, MTP Act, Statutory committee details, Ultrasound machine details mapped against each scanning center and many other details displayed.  State Supervisory Board meeting was conducted on dated 09-01-2017under the chairmanship of Honorable Health Minister and was instructed to all medical professionals to write indications for doing ultrasound for pregnant women in their prescription and District Inspection and Monitoring Committee to inspect periodically all scanning center in the districts.  State Inspection and Monitoring Committee and District Inspection and Monitoring Committee Notification published on 03-06-2016.  On 22-01-2016 panel discussion done on PC&PNDT Act in TV channel to create public awareness against selective sex determination.

 Advertisement for monitory rewards for giving clues on selective sex determination are given in gender sensitive districts.  Online submission of F-Form it is under process in line with Rajasthan Integrated system for Monitoring of PCPNDT Act (IMPACT) software.  Ultrasound machines dealers are issued smartcards to deal with machines.  State Appropriate Authority seized 20 ultrasound machines totally at Bijapur, Bagalkote, Belgaum, Mandya during 2016-17 and cases are filed in the District Magistrate Court. District Appropriate Authority has inspected 1994 Ultrasound scanning centers during 2016-17 (April – 2016 to December-2016).  In the year 2015-16 District & Taluk level workshops have been conducted to give awareness regarding the PC&PNDT Act and adverse effects of declining sex ratio for Anganwadi Workers, ASHAs workers, ANMs and Panchayath raj members with the help judiciary and panel advocates and media. District level workshops on orientation PC&PNDT Act conducted at Chikkaballpur, Chitraduga and Udupi.  In 2015-16 workshops regarding PC&PNDT Act are conducted as below: o On 16-12-2015 and on 11-03-2016 for Ultrasound manufactures about the PC&PNDT Act. o On 11-01-2016 at Bellary District in collaboration with district legal cell authority. o State level workshop was conducted as a part of theNational Girl Child day on 24-01-2016. o On 28-2-2016 at K.L.E. Medical College Bijapur, on 27-3-2016 at Siddratha Medical College Tumkur and on 05-04-2016 at Shree Devaraju Arasu Academy of Higher Education and Research Kolar. o On 9-03-2016 under Beti Bacho,Beti Padhao programme workshop done for doctors, MUSK and IRIA at Bangalore and also for FOGSI /MSOG members at Belgaum on 20-04-2016. o On 06-05-2016, 29-05-2016 PCPNDT workshops conducted to Bangalore and Mysore division DHOs and case workers and Belgaum and Gulbarga division DHOs and case workers respectively.  State level workshop conducted on 26-09-2016 for more than 1400 radiologist and obstetrician, 300 Para medical staff, 100 Advocate and Journalists were given orientation on maintenance of records, national level speakers were invited as guest speakers and which was appreciated by private scanning center owners.  District Appropriate Authorities are given instructions to implement the act in true letter and spirit.  In all districts, on 24-01-2017, the National Girl Child Day will be conducted through the Health Centers, Community Health Centers, Taluk Hospital and District Hospitals, to the mothers who are born to a baby girl.  On 09-03-2017 & 10-03-2017 PCPNDT workshops conducted to Bangalore and Mysore division District Health and Family Welfare officers, District Family Welfare Officers, District Inspection and Monitoring Committee Members and Case Workers respectively.  Www.pcpndtkar.in/index.php/complaints has been permitted to provide 104 telephone number and public complaint against information on female feticide or unauthorized centers.  Rs. 50000 / - has been awarded the prize in the Press Release and the local newspaper on the complaint against the unauthorized scanning center and the complainant against illegal abortions.  Were created all legal committees under the PC & PNTT Act.

 Created District Advisory Committee as per the Government Rule No. HFW.84.FPR.2012 date on 10-03-2017.  Conducted the Workshop to Public Prosecutors and Assistant Public Prosecutors on PC&PNDT Act to Bangalore Rural Division dated on 29-10- 2018.  On 14th, 15th, 16th and 27th November 2017 on PC&PNDT workshops Conducted and Training on Balika Online F-Forms Submission to all Government Scanning Center Doctors respectively.  On 28-11-2017 & 29-11-2017 PC&PNDT workshops conducted and Training on Balika Online F-Forms Submission to All District Health and Family Welfare officers, District Family Welfare Officers, District Advisory Committee Members and PC&PNDT Case Workers respectively.  On 29-11-2017, the NIMC team along with State Appropriate Authority and District Appropriate Authority conducted raids at Ramanagara district scanning centers and issued notice to 2 scanning centers.  On 30-11-2017, the NIMC team along with State Appropriate Authority and District Appropriate Authority conducted raids at Chintamani Taluk in Chikkaballapura District scanning Centers, issued notice to 2 scanning centers and one center has to be Sieged.  On 01-12-2017, the NIMC team along with State Appropriate Authority and District Appropriate Authority conducted raids at Bangalore Urban scanning centers and issued notice to 1 scanning center and Sieged the Documents in One center.  On 16-12-2017, State Appropriate Authority and District Appropriate Authority Tumkur conducted raids at Koaratagere Taluk in Tumkur district scanning centers and issued notice to 2 scanning centers and Sieged 2 Scanning Machines.  On 29-12-2017, State Appropriate Authority and District Appropriate Authority conducted raids at Davanagere district scanning centers, 3 Scanning Machines has to be sieged and issued notice to 1 scanning center.  On 09-01-2018 and 10-01-2018, State Appropriate Authority and District Appropriate Authority conducted raids at Vijayapura district scanning centers, 3 Scanning Machines has to be Sieged, 1 Scanning Center has to be sieged and issued notice to 4 scanning centers.  Conducted the Workshop to Public Prosecutors and Assistant Public Prosecutors on PC&PNDT Act to Bangalore Urban Division dated on 04-02- 2018.  On 08-02-2017, State Appropriate Authority and District Appropriate Authority Bangalore Rural conducted raids at Bangalore Rural District scanning centers and issued notice to 1 scanning center and Sieged 3 Scanning Machines.  On 16-02-2017, State Appropriate Authority and District Appropriate Authority Ramanagara conducted raids at Channapattana and Magadi Taluks in Ramanagara district scanning centers and issued notice to 1 scanning center and 2 Scanning machines has to be voluntary Decommissioned.  On 22-02-2017, State Appropriate Authority and District Appropriate Authority Bangalore Urban conducted raids at Bangalore district scanning centers and issued notice to 1 scanning center, Sieged 1 Scanning Center and 2 Scanning machines has to be voluntary Decommissioned.  On 22-02-2017, State Appropriate Authority and District Appropriate Authority Mandya conducted raids at Mandya scanning centers and issued notice to 2 scanning centers.

1.3. School Health Programme:

Rashtriya Bal Swasthya Karyakram:

School Health Programme has subsumed under Rashtriya Bal Swasthya Karyakram (RBSK). This programme commenced from the year of 2013-14, under this programme 0 to 18 years children are screened for 38 health conditions broadly classified under 4‟D‟s. The screening is conducted by 02 dedicated RBSK Mobile Health Teams constituted in each Taluka consisting of 2 Medical Officers, 1 Staff Nurse and 1 Ophthalmic Assistant/ Pharmacist, the main aim of this programme is to conduct health screening so as to identify children with health conditions and to refer for appropriate timely treatment.

Rashtriya Bal Swasthya Karyakram (RBSK) is implemented in the State in all rural and urban areas children studying in 1st to 12th standard in Government, Government Aided, Government Residential Schools and in Aganwadi Canters. Children in 0-18 years age group are screened annually and children found positive for various heart related condition, Neuro problems, Cleft Lip Palate and others are referred to hospitals empaneled under Suvarna Arogya Suraksha Trust (SAST) for cash less treatment. As per the guidelines, the DHOs are implementing this programme successfully in all taluks.

The activities are as follows: 1. Screening of 0 to 6 weeks children through delivery points and ASHA – HBNC visits. 2. Screening of 6 months to 6 years children at Aganwadi Centres. 3. Screening of 6 to 18 years children (1stto 12thstd.) at Schools and Colleges. 4. Health screening to identify children with 38 Health Conditions, broad classified under 4‟D‟s (Defects at birth, Developmental delays, Diseases and Deficiencies) under the age group 0 to 18 years. 5. Children requiring further management are referred to the nearest health facility. 6. Health Education to Anganwadi workers, Teachers and Students as well as students regarding Personal Hygiene, Environmental Sanitation, Safe drinking water and use of latrines are being taught regularly. 7. The children identified with health conditions are further referred to institution as mentioned below:

Annexures Speciality Referral facilities Annexure-1 Primary Care Treatments PHC/ CHC/ TH/ DH Annexure-2 / Secondary and Tertiary Yeshaswini Trust Empanelled 2(B) Care Services Hospitals (Upto 26-05-2017) Suvarna Arogya Suraksha Trust Empanelled Hospitals Annexure-2(A) Cleft Lip and Palate Love Without Reason Surgeries Facial Deformities INGA Foundation surgeries Annexure-2(C) Club Foot Treatment Club Foot clinics under CURE India

This programme is being implemented in co-ordination with Department of Health and Family Welfare, Women and Child Development, Public Instruction, PU Board and Social Welfare.

Progress report for the period of 2017-18

Sl. Annual Achieveme Beneficiaries % No. Target nt 1 Health screening of 0-18 years 1,53,19,670 1,27,85,173 83.46 children (Anganwadi and Schools)

During 2017-18, out of an annual target of 15319670, 12785173students enrolled in Anganwadies centers, Government and Government Aided schools were screened and 6047students (April-17 to Mar-18) have undergone for different surgeries.

Weekly Iron & Folic Acid Supplementation Program (WIFS) :

Introduction:

Adolescents are the most vulnerable group among the children for Iron deficiency anaemia. During adolescence age, especially for girls, Iron deficiency anaemia results into growth deficiencies. During adolescence, iron deficiency anaemia can result in impaired physical growth, poor cognitive development, reduced physical fitness and work performance and lower concentration on daily tasks. Iron deficiency in adolescent girls influences the entire life cycle.

In order to develop evidence based intervention for prevention and control of adolescent anaemia in India, various studies were commissioned. Findings across these studies reveal that weekly supplementation of 100mg Iron and 500μg Folic acid is effective in decreasing prevalence of anaemia. As adolescent anaemia is a critical public health problem in the country, the Ministry of Health and Family Welfare, Government of India, based on the empirical evidence generated by these scientific studies, has developed Operational Framework for Weekly Iron and Folic Acid Supplementation (WIFS) of adolescent.

Objective:

To reduce the prevalence and severity of nutritional anaemia in adolescent population in the age group 6-19 years for all Government and Government Aided School Children from 1thto 12thstd.

Strategies:

 Weekly once IFA tablets (WIFS) :

- Each IFA – Pink tablet contains 45 mg of Iron with 400 mcg Folic Acid, it is given to children of 5 to 10 years age group weekly once for 52 weeks. - Each IFA – Blue tablet contains 100 mg of Iron with 500 mcg Folic Acid, it is given to children of 11 to 19 years age group weekly once for 52 weeks.  Biannual de-worming (Albendazole 400 mg), six months apart, for control of helminthes infestation.  Information and counselling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.

IFA and Albendazole tablets given to adolescents under WIFS Program

Year Target Achievement 2017-18 79,88,122 51,44,895

“SHUCHI” Yojane:

The Adolescent Reproductive & Sexual Health (ARSH) and the Adolescent Education Programme (AEP) are core components National Health Programmes that address Adolescent Health Girls. Both these programmes include a range of intervention for adolescent girls who are in schools and out of schools.

In our State, menstruation and menstrual practices are clouded by taboos and socio-cultural restrictions for women as well as adolescent girls. Limited access to the products for sanitary hygiene and lack of sanitary facilities could prove to be barriers to resorting to un-hygienic practices to manage menstruation. Some of the practices like use of old cloths as pads by recycling them which offers no protection and endangering menstrual hygiene with long term implications for reproductive health.

Good menstrual hygiene is essential for health & dignity of girls and women. Discussions on menstrual hygiene are important for adolescent girls to clarify existing myths and misconceptions around menstruation. Improving menstrual hygiene is important from the point of view of personal comfort and increased mobility. It also reduces the likelihood of infections resulting from poor hygienic practices during menstrual hygiene. Providing girls with knowledge and skills on maintaining menstrual hygiene improves school attendance among the girls who may not attend the schools on those days are even dropout of school altogether.

Promoting menstrual hygiene can be achieved through:

1. Provision of health education to girls on menstruation and menstrual hygiene. 2. Promoting the availability & use of sanitary products. 3. Enabling safe disposal of sanitary napkins. 4. Increasing community action to improve access to clean toilets with water both in home and in schools.

During the year 2017-18 total of 36,59,532 beneficiaries have been distributed with sanitary napkins.

Beneficiaries of HealthProgrammes as on 31.03.2018

Sl.No Programmes 2014-15 2015-16 2016-17 2017-18 1 Prasuti Araike 246219 45940 64982 98488 2 Madilu 271815 334189 336323 - 3 Thayi Bhagya 37194 17871 16012 22975 4 Janani SurakshaYojane 411423 425711 393874 282731 5 Vajpeyi Arogya Shree 939 996 4420 6047 6 Rastriya Balaswasthya 695061 759434 1036056 1136789 Karyakrama 7 Arogya Kavacha 7831 8358 12288 18664 8 Dialysis 41414 49704 49809 52185 9 Telemedicine 38223 43808 45803 59656 10 Burns Cases 980 948 960 888

1.4. SAKAALA Guaranteed services rendered:

Health & Family Welfare Department has been notified for SAKAALA Service Guarantee to provide Six Services namely Issue of Age Certificate, Wound Certificate, Disability Certificate and Sterilization Certificate with Discharge summary, Prasuthi Aaraike, Madilu Kit distribution. SAKAALA has been up- scaled to the whole State from 02 April 2012, 16,07,546services have been rendered as on 04.06.2018.

1.5. Health Indicators :

1. Reduction in Infant Mortality Rate from 95 in 1971 to 24 (SRS 2016) 2. MMR has been reduced from 213 to 108 (SRS 2014-16) for 1 lakh live births. (SRS 2013) 3. Decrease in total fertility rate from 2.3 in 2003 to 1.8(NFHS-IV) 4. Decline of crude birth rate from 41.6 in 1961 to 17.6 (SRS 2016) 5. Decline of crude death rate from 22.2 in 1961 to 6.7 (SRS 2016)

1.6. Health Services:

Urban Health Services:

The District Hospitals under Health & Family Welfare Department provide curative, referral, counselling and 24x7 emergency delivery services along with preventive, promotive and rehabilitative services. Other Major Hospitals and Teaching Hospitals provide Secondary level Services. The details of Hospitals are as follows:

Hospitals No. of Institutions No. of Beds District Hospitals 15 5795 Other Hospitals under HFW 11 2218 Teaching & Autonomous Hospitals 33 17835 (including Medical Education)

Specialty services in District Hospitals:

Specialty services provided in District Hospitals include General Medicine, Pediatric, ENT, Anesthesia, Blood Bank, Telemedicine, Surgery, Orthopaedic, Skin and STD, Dental, Burn care ward, Obstetrics and Gynaecology, Ophthalmology, Radiology, Psychiatry and Geriatrics. For rendering specialty services in District Hospitals

1. The needs of the patients coming directly as well as those referred from peripheral rural centres and moffusil hospitals are catered. 2. Emergency and Casualty Departments work 24×7. 3. The existing Blood Banks are being strengthened depending on the availability of funds, in all the District Hospitals and all Major Hospitals of the State. AIDS screening facility has been provided in these Hospitals. Blood storage units are being established at all FRUs.

4. Radiology and Dental care services are available in all the District Hospitals, Major Hospitals, Taluk level Hospitals and Community Health Centres. 5. Epidemic Diseases Hospitals are functioning at Bangalore, Mysore and KGF. These Hospitals are meant for treating epidemic diseases like Cholera, Gastroenteritis, Diphtheria, Tetanus, Whooping Cough, Rabies, Measles, Chicken Pox, H1N1 and other infectious diseases.

Taluk Hospitals:

These are hospitals in Taluk headquarters with sanctioned bed strength of minimum 100 beds. It acts as referral hospital for the rural population. Taluk Hospitals are provided with 10 Specialists and one Dental Surgeon supported by 71 paramedical & other staff. There are 146 Taluk Hospitals in the State.

Community Health Centres:

A Community Health Centre (CHC) is the first point of contact between community and specialist doctor. As per guidelines, one CHC is provided for one lakh twenty thousand population in plain areas, and 80,000 to 1 lakh population in hilly areas. It acts as a referral institution for the rural Population. CHCs are 30 bedded hospitals provided with four Specialists i.e., Surgeon, Physician, Gynecologist, Pediatrician and one Dental Surgeon supported by 29 paramedical & other staff. There are 206 Community Health Centres in the State.

Urban Health Centres: The objective is to give primary health services in urban slums and services like antenatal care, postnatal care, referral for institutional deliveries, immunization, services under national programmes like DOES, NMEP, etc. family welfare planning including IUD/NSV.

Rural Health Services: As per minimum needs program (Rural Health), the State is following the National Pattern of Health Infrastructure in rendering Primary Health Care by establishing health institutions viz., Sub Centres, Primary Health Centres and Community Health Centres.

Primary Health Centres (PHC):

It is the first contact point between community and Medical Officer. The PHC provides curative, preventive, promotive, family welfare, rehabilitative and outreach services. In addition to these, PHC implements National and State Health Programs. As per guidelines, one PHC is established for every 30,000 population in plain and for every 20,000 population in Hilly and Tribal areas. It has a Medical Officerwith 7 Para-medical & other staff and has 6 beds for in-patients. There are 2353 PHCs in the State.

Sub Centres:

It is the first point of contact between Primary Health Care System and the Community. One Sub Centre with a Female Health Worker is established for every 5000 population in plain areas and for every 3000 population in Hilly and Tribal areas. Each Sub-centre is supplied drugs worth of Rs.5000/- per annum. There are presently 8871 Sub-Centres in the State. 45

Mobile Medical Clinic:

In order to reach health services to the door steps of the remorse households, a pioneer achieving of “Mobile Medical Units” has been started. These units are literally PHCs on wheels, carrying doctor and paramedical staff as well as medicines and other equipment‟s. So for 62 units are working under NHM operational in the State.

1.7. NATIONAL URBAN HEALTH MISSION:

Introduction:

Due to rapid urbanization the population residing in urban areas has increased by leaps and bounds. The percentage of urban population is 38.57% in the state. Perennial availability of work attracts the poor and marginalized people to migrate to the cities and reside in slums or in temporary sheds made out of flimsy materials devoid of any basic infrastructure facilities. The Center and the State have jointly implemented the National Urban Health Mission as a submission of overall Health Mission in order to provide qualitatively and quantitatively, adequate and credible health services and improve the accessibility of Primary Health Care to the vulnerable and slum population. It was launched during the year 2013-14 and the National inauguration was held in Bangalore on 20th January 2014.

Goals:

Improve the health status of the urban poor and other disadvantaged sections by: - A revamped public health system - Partnerships - Community empowerment - Active involvement of the urban local bodies

Beginning:

 Approved on May 1, 2013 as a sub-mission of the National Health Mission. Target Population: 2.36 Crore urban population (Census 2011)  1 metropolitan city, Bengaluru and 79 cities/ towns with population above 50,000.  Madikeri district Headquarters of Kodagu with a population of between 30,000+

Special focus on:

People living in listed, unlisted slums and other low income neighborhoods All other vulnerable population such as homeless, rag-pickers, street children, rickshaw pullers, beggers, labourers and other temporary migrants

Program Components:

City Planning & Mapping (facility & vulnerability) * Program Management * Training and orientation of service providers

* Human Resources. * Infrastructure development (Construction/ Renovation and up gradation) * Procurement * Outreach services * Regulation and quality assurance * Community Process * Innovation * Urban Malaria * PPP * Monitoring and evaluation * IEC/BCC * ICT initiatives

Human Resource:

ANM:

* One for 10-12,000 population * No provision for sub centres, may be located at the existing health facilities (like urban health posts, UFWCs) till the urban PHCs become functional. * Outreach & Special outreach services at community centres, AWCs * Mobility support provided

ASHA

* One ASHA for 1000-2500 slum population (200-500 slum households). * Existing community workers under other schemes could be utilized

MAS

* Group of 10-12 slum women, with an elected chairperson and treasurer, supported by ASHA * Covering 50-100 slum households * Existing CBOs will be utilized * NUHM would provide untied grants and capacity building support to MAS(Annual grant of 5000/- to MAS every year)

Core Strategies:

• Creation of new facilities Strengthening of • Rationalization and strengthening of the existing urban Infrastructure primary health structures (UFWCs, Urban RCH Centres, Dispensaries and maternity hospitals) • Starting of HEALTH KIOSKs Augmentation of • Engagement of General duty Medical Officers, HR specialists and Paramedical Staff at U-PHCs and U- CHCs (referral hospitals) after GAP analysis. Community • Mahila Arogya Samitis (MAS) and ASHAs in slum areas. Participation ARS committees at all UPHCs and UCHCs headed by elected representatives. Urban Local • Involvement of ULBs in planning, implementation and Bodies (ULBs ) monitoring of the program through existing district health societies.

• Formation of independent implementation unit of Bangalore health and family welfare society because it is a metropolitan city. Inter and Intra Convergence with all National Health Programs and Sectoral • Coordination other Ministries (Drinking Water, Sanitation, Housing, WCD etc)

Capacity building • ULBs/ Medical and Paramedical staff/ASHA, MAS of stakeholders

Use of ICT • For better service delivery, improved surveillance and monitoring, provision of computers and connected

software to all the UPHCs and UCHCs. • Running evening OPD in all the UPHCs by engaging different specialist on need and availability basis in Evening Clinic BBMP area, specialists / MBBS doctors in UPHCs of Rest of Karnataka. They are paid on hourly basis. • To provide comprehensive primary health care at the Mobile Medical door steps of the community. Units

Free diagnostics • Cashless treatment of the Urban poor is the policy, and free drugs principle and core theme.

Service Delivery Mechanism

1) Establishment of Bengaluru City Health & Family Welfare Society (BCH&FWS):

The NUHM activities are implemented through BCH&FWS constituted during 2014-15 but made more functional from 2016-17 onwards. The BBMP has 198 wards which includes the 135 wards of erstwhile BBM and 63 wards coming under Bengaluru District Health & Family Welfare Officer, in so far as provision of health services are concerned. The NUHM implementations in all the 198 wards were brought functionally under the unified command of BCH & FWS headed by the Commissioner, BBMP.

2) Urban Primary Health Centers:

The urban Primary Health Centers were planned at the rate of 1 for 50000 populations in the urban areas to provide comprehensive primary health care to the vulnerable population. The pre-existing dispensaries, health centers, maternity hospitals and urban family welfare centers were functionally upgraded after a GAP analysis as UPHCs and were provided funds for re- furbication, furniture, lab & other equipment‟s and HR including doctors and paramedical staff. Wherever necessary new UPHCs have been functionalized by either hiring the buildings on monthly rate basis or in pre-existing government or BBMP building. 160 UPHCs are made functional in the 198 wards of BBMP which includes 10 new UPHCs started in the 63 out skirt wards and another 10 started in the BMP core area during the year 2016-17. In the Rest of Karnataka there are 79 cities and towns where urban health initiatives have started and totally there are 204 UPHCs made functional in all aspects of the guidelines. Three more UPHCs one in Mandya city of Mandya District, one each in

Chittapura and Aland towns of Gulburga district have been functionalized in the year 2017-18.

3) Service Provided:

 In BBMP each UPHCs have been provided with a semi-auto analyzer, centrifuge, hot air oven and incubator thereby providing the state of the art lab equipment‟s for the service seekers.  Furniture, drinking water and audio visual health education equipment‟s have been provided in all the UPHCs for the benefit of patients and their attendants.  Drugs worth of Rs.1,00,000 per month to the UPHCs in BBMP area for giving free and continuous treatment to all the OPDs for both CDs and NCDs. In other UPHCs of Rest of Karnataka drugs worth of Rs.25000/- to 50000/- per month have been provided depending on their request and need for the same purpose.  Evening OPDs: In all the 361 UPHCs evening specialists OPDs, between 5 to 8 pm, for the benefit of poor and daily wage earners to get quality treatment by specialists have been started and functionalized. The specialists and in some cases generalist doctors have been hired on hourly payment basis.

4) Indira Transit Clinics:

Two Indira Transit Clinics one each in Kempegowda and Yashwanthpura BMTC bus stand in Bengaluru city have been started for the benefit of commuters, footpath, dwellers and other people for primary health care services and emergency services. The clinic have doctor, staff nurse, pharmacist, Lab technician working there and a semi-auto analyser, lab equipment also have been provided. Free drugs will be provided to all the patients.

5) Mobile Medical Units (MMU):

8 Mobile Medical Units are functioning under the NUHM in the state. 6 are in BBMP, 1 in Mysore and another one Mangalore. The MMUs are run through PPP model which provides primary health care and referral services to the slum and vulnerable population living in in-accessible and distant places away from the nearest UPHC. Free medical check-up, lab investigations and drugs are provided from the MMUs.

6) Health KIOSKs:

Health KIOSKs are the smallest health outposts being established in the heart of slums for providing basic MCH care and follow-up as well as service guidance for CDs and NCDs. It is manned by a trained ANM and sufficient MCH and other primary health care drugs. 39 KIOSKs have been functioning with a break-up of 25 for BBMP core area, 5 each for Mysore and Mangalore Cities and 4 for Ullala Town, Dakshina Kannada.

7) Communitization:

a) As a part of communitization, Arogya Raksha Samities (ARS) have been constituted in all 361 UPHCs under the chairmanship of Corporator /

Counselor and an annual untied grant of Rs.1.75 lakhs for each UPHC for local health action.

b) Accredited Social Health Activities (ASHA): have been positioned @ 1 per 1500 to 2000 slum population after selection and nomination by the community for acting as a link between the department and the community in order to improve the service seeking behavior of the community for all their health needs from preferably a government service providers. The ASHAs are trained before their positioning.

c) Mahila Arogya Samithis (MAS): have been constituted for each 50-100 households in the slums and provided Rs.5000/- untied fund grants per annum for taking up MCH health and sanitation activities in the neighborhood, identify gaps and services and help the department to improve the service performance in this regard. They are given one day training and a printed module to sensitize them about the health issues and other related matter.

8) Referral Hospitals / Community Health Centers (CHC): There are 9 Referral / CHCs which have been made optimally functional through provision of the following infrastructure during the year 2017-18.

The break-up of 9 are as follows:

6 Referral Hospitals in BBMP core area (BMP), 2 CHCs in Mysore City and 1 in Ullala town of Dakshina Kannada.

Additional HR of physicians, gynecologists, anesthetists, radiologists and dentists have been provided to all the 6 referral hospitals and 2 CHCs in Mysore after service gap analysis.

A. High-tech labs: 6 high-tech labs have been provided with auto-analysers, x-ray unit, scanning and other equipments on a hub & spoke model, hub being at Siddaiah Referral Hospital. This initiative will go a long way in providing the quality investigation for the Urban Poor and slum dwellers thereby preventing their out of pocket expenditure for these costly investigations. This will also help in attracting more service seekers from slums in view of the free diagnostics, treatment and drugs.

B. Special Neonatal Unit: have been established in Siddaiah Referral Hospital for the benefit of poor and vulnerable population with their neonates thereby facilitating the savings due to seeking services elsewhere. This will also bring down the crowding in tertiary care government institutions and will lead to reduce infant mortality and morbidity.

Karnataka – Key indicators (NFHS-4)

Parameter Total Urban Sex ratio at birth for children born in the last five 922 875 years (females per 1,000 males) Households with any usual member covered by a 28.1 23.4 health scheme or health insurance (%) IMR 28 19 Total fertility rate (children per woman) 1.8 1.7 Unmet need for family planning 10.4 12.6 Full ANC care (%) 70.3 69.5 Mothers who received financial assistance under 19.9 12.5 Janani Suraksha Yojana (JSY) for births delivered in an institution (%) Children age 12-23 months fully immunized 62.6 59.8 (BCG, measles, and 3 doses each of polio and DPT) (%) Institutional births (%) 94.3 95.4

Total Cities / towns approved for the year 2017-18

Sl.no Cities Sl.no Cities Sl.no Cities Sl.no Cities

1 Bagalkote 21 Chintamani 41 Hassan 61 Sindanuru 2 Jamkandi 22 Gowribudnur 42 Arsikere 62 Ramnagara 3 Rabkavi 23 Sidhalagatta 43 Haveri 63 Channapattana 4 Modhol 24 Chikballapur 44 Ranibennur 64 Kanakpura 5 Ilakal 25 Chitradurga 45 Savanur 65 Shimoga 6 Terdal 26 Challakere 46 Madikere 66 Badravathi 7 Doddabalapur 27 Hiriyur 47 Kolar 67 Sagar 8 Hoskote 28 Mangalore 48 Bangarpet 68 Shikaripura 9 Belgaum 29 Puttur 49 Mulbagal 69 Tumkur 10 Gokak 30 Bantwal 50 Robertsonpet 70 Tiptur 11 Nippani 31 Ullal 51 Gangavathi 71 Sira 12 Siriguppa 32 Davangere 52 Koppal 72 Udupi 13 Hospet 33 Harihar 53 Mandya 73 Yadgir 14 Bellary 34 Harapanahalli 54 Mysore 74 Shorapur 15 Bidar 35 Dharwad 55 Nanjangud 75 Shahapur 16 Basavakalyan 36 Gadag 56 Hunsur 76 Banglore urban 17 Bijapur 37 Gulbarga 57 Karwar 77 BBMP 18 Chamrajnagar 38 Sedum 58 Sirsi 78 Aland 19 Kollegal 39 Shahabad 59 Dandeli 79 Chittapura 20 Chikkamagalur 40 Wadi 60 Raichur

Budget Approved and Expenditure:

Budget Budget Sl. Percentage of Year Approved expenditure No. expenditure (in crores) (in crores) 1 2016-17 137.53 103.12 74.98% 2 2017-18 (provisional) 124.76 103.22 82.73%

Physical Progress (gross):

UCHC & Referral UPHC Sl. Hospital Year No. Achievemen Target Achievement Target t 1 2016-17 361 348 8 8 2 2017-18 till date 364 361 9 8

Doctors on Para-medical staff on ASHA MAS Sl. contractual (all) contractual staff (all) Year No. Achieve Targe Achiev Targe Achievem Achieveme Target Target ment t ement t ent nt 1 2016-17 3508 2958 4081 2850 492 350 2398 1353 2 2017-18 3329 2672 4071 3478 529 436 2522 2114

1.8. Citizen friendly facilities

Citizen Help Desk

It is a novel scheme implemented in District Hospitals and Major Hospitals. The objective of the Scheme is to guide and help the patients to get proper and timely need care. There are redactors in patients waiting time and the patient grievances are reduced at the local level. So far, 50 Citizen Help Desk is serving the patients round the clock in order to reach health services.

Dialysis Programme:

Dialysis centres were functioning in 57 centres as on March 2017.The list of centres included 20 District Hospitals, 3 Major Hospitals and 34 Taluk Hospitals. In the Budget speech for FY 2017-18, Honourable Chief Minister announced setting up Dialysis centres at all Taluk Hospitals under PPP mode with fund support from NHM. Accordingly, Under PPP mode, Out of 171 centres proposed ,131 centres have been established for providing dialysis services as on date. In 2013-14 Budget speech, Government announced opening of Dialysis centers in one Taluk of each district. The initiation of implementation of the programme was completed, procurement procedure of equipments and instruments is completed and also the training programme for the concerned programme is also completed. In that 30 Taluk hospitals are Dialysis treatment is provided to patients.

Burns wards:

Burns wards are functional since 2008-09 at 6 District Hospitals in first stage at Gulbarga, Bidar, Bijapura, Bagalkot, Shimoga, Chamarajanagara. In the Second phase during 2009-10 at 6 District Hospitals, Kolar, Tumkur, Karwar, Dharwad ,Hassan and Madikeri, Burns patients are now being treated at District hospitals.

Telemedicine:

Telemedicine facility was started in association with ISRO since 2004. In the First phase they were started in District hospital Chamarajanagar, Mandya, Tumkur, Chitradurga, Shimoga, Karwara, Chikmagalur, Gadag and Taulk hospitals at Maddur, Sagara and Yadgir.Hub centers (Centres from whom expert advice is given) identified are - Jayadeva Institute of Cardiology , ST. John‟s Medical college Hospital, Narayana Hrudayalaya, NIMHANS at Bangalore and JSS Hospital at Myosre.During 2008-09 in 2nd Phase Telemedicine centres were started at District hospitals- Kolar, Madikeri, Belgaum, Bellary, Dharwad, Davangere, Gulbarga, Udupi, Bijapura & GH Lingasagur, Raichur District. Hub centres at Bowring and Lady Curzon hospital, Indira Gandhi child health Institute, Institute of Nephro & Urology centre. ISRO was unable to continue V-SAT Connectivity due failure of V-Sat in September 2010. Later onward functioning through Broad band connectivity.department connectivity established to all the centres along with new centers, they are Wenlock Hospital Mangalore, District hospital Koppal, Haveri & General Hospital Hospete. New hub centres are Kidwai Institute of Oncology, Karnataka Diabetic centre and K.R. hospital, Mysore. 49,704 patients were given expert advice through telemedicine during 2015-16.

In 2013-14 through Keonics with the help of KSWAN connectivity from e- govrnance department connectivity established to all the centres along with new centers, they are Wenlock Hospital Mangalore, District hospital Koppal, Haveri & General Hospital Hospete. New hub centres are Kidwai Institute of Oncology, Karnataka Diabetic centre and K R hospital, Mysore.

Telemedicine at Taluk Hospitals :

As announced in Hon‟ble CM Budgete speech in 2015-16 Telemedicine facilities providing to all Taluk hospitals linking to Medical colleges ( Specialty Hospitals are 3, KIMS Hubballi, BIMS Bidar & BIMS Belgavi) . In that 3 Districts Taluk hospitals (11) (Bidar, Vijayapura & Koppal). This programme is implementing through Keonics and e- governance will provide KSWAN connectivity for all the new Telemedicine centers.

In 2016-17 under NHM PIP approved to extend Telemedicine facility for all 141 Taluk Hospitals& 206 Community health centers will be link to all District Hospitals & Government Medical Colleges.

Specialty Hospitals:

1) Sri Jayadeva Institute of Cardiovascular Sciences for Cardiology Services , Bangalore-560069 2) Kidwai: for Cancer(Oncology) Services , Bangalore-560029

3) Indira Gandhi Institute of Child Health : For Child care(Pediatric, Neonatology)- Bangalore- 4) St. Johns Hospital: Multi Specialty(ENT, Dermatology, Orthopedic, Gynecology, Gastroenterologist, Endocrine, Dental, Ophthalmology, Nephrology/Urology, etc), Emergency and Critical Care, Bangalore - 560034 5) Bowring: Multi Specialty(ENT, Dermatology, Orthopedic, Gynecology, Gastroenterologist, Endocrine, Dental, Ophthalmology, Nephro/Urology, etc), Radiology & Pathology, Bangalore 6) NIMANHS: for Mental Health sciences, Hosur Road, Bangalore-560029 7) Narayana Hrudayalaya, Bangalore for Cardiology Services & Multi Specialty 8) Institute of Nephro Urology, Bangalore for Nephro – Urology Srvices 9) Karnataka Diabetic Center: For Diabetic Services, Bangalore-560069 10) JSS Hospital, Mysore: Multi Specialty services, Mysore-570015 11) KR Hospital, Mysore: Multi Specialty Services, Mysore-570001 12) Sanjay Gandhi Institute of Trauma & Orthopedics, Bangalore.

1.9 Regulation of Private Medical Establishments:

The Karnataka Private Medical Establishment Act, 2007 and Karnataka Private Medical Establishments Rules, 2009 are in force. This legislative aims to regulate, control and monitor Private Medical Establishments in Karnataka for providing quality care according to medical ethics by prescribing service quality. Initially 90 days time was given for the Private Medical Establishments for registering which was extended for applying for Registration in 3-2-2013. The Registration committee at all districts are constituted with the following composition:

1. The Deputy Commissioner of the district. – Chairman 2. District Health and Family Welfare Officer -- Member Secretary 3. President/Secretary, Indian Medical Association of the concerned District- Member 4. District Ayush officer- Member 5. Representative from Ayush association-Member.

Suitable instructions and guidelines have been issued by the Directorate to all Private Medical establishments for registration. 31987 applications are received up to the end of March 2018 from all the districts, all the applications were scrutinized and 26228 Institutions are issued registration certificates. The registration committee have been instructed to complete the registration of all Private Medical Establishments immediately. Status of registration district wise is as follows:

No. of Registered Medical establishments registered under KPME ACT

Sl. Name of the District No. of Registration No. Certificate given 1 Bagalkote 898 2 Bangalore Rural 244 3 Bangalore urban 6541 4 Belgaum 2560 5 Bellary 579 6 Bidar 371 7 Bijapur 96

8 Chamarajanagar 163 9 Chikaballapura 136 10 Chikamagalur 271 11 Chitradurga 434 12 Davanagere 804 13 Dakshinakannada 1870 14 Dharwad 1503 15 Gadag 843 16 Gulbarga 744 17 Hassan 572 18 Haveri 743 19 Kodagu 240 20 Kolar 276 21 Koppal 305 22 Mandya 461 23 Mysore 1789 24 Raichur 451 25 Ramanagara 11 26 Shimoga 663 27 Tumkur 805 28 Udupi 1077 29 Uttarakannada 552 30 Yadgiri 226 Grand Total 26228

1.10 Health Education and Training:

The Health Education and Training Section of this Directorate is organized below programmes mainly responsible for:

1. Arrangements of Medical team and Ambulances to VIP and VVIP‟s. visiting to Karnataka. 2. Deputation of Departmental A& B group Officers and Officials different for Trainings at Administration Training Institute Mysore. Fiscal Policy Institute, Kengeri, Bangalore. 3. Deputation of In-Service Doctor for 12 Months PGDPHM Course at Public Health Management at Indian Institutes of Public Health, Leprosy Hospital, Magadi road, Bangalore. 4. Celebration of State level Doctor‟s day programme on July 1st, of every year. 5. Celebration of World Health day on April 7th of every year. 6. Arranging Exhibition on going Health Programme at Mysore Dasara Exhibition. 7. Nomination of Members for Arogya Raksha Samithi‟s. 8. Deputation of Candidates for Haj Medical Mission every year. 9. Conduct DHO‟s to monthly progress review meeting. 10. Deputation of Doctors to render services to Shabarimalai piligims at Shabarimalai. 11. Departmental Officer‟s and Staff Award Proposals submitted to Government.

1.11 Mental Health Programme:

“Mental health is a state of wellbeing characterized by the absence of mental or behaviour disorder whereby the person has made a satisfactory adjustment as an individual, and to the community, in relation to emotional, personal, social and spiritual aspects of there life”

Non communicable Disorders which also include Mental Health are the leading cause of mortality and morbidity globally as well as in India. As per National Mental Health Survey 2016, the lifetime prevalence of any mental health problem has been estimated to be 13.6% and that for Severe Mental Disorders (SMD) to be 0.9%. Hence management and treatment of mental health conditions, and specifically Severe Mental Disorders (SMD) are required. Mental Health Care needs to be integrated with other public health programs to ensure that patients receive comprehensive care across programs.In this context, theSustainable Development Goal 3 specificallyfocuses on health and wellbeing, and has Mental Health as a key priority.

 Goals

1. Prevention and treatment of mental and neurological disorders and their associated disabilities. 2. Use of mental health technology to improve general health services. 3. Application of mental health principles in total national development to improve quality of life. 4. To reduce the treatment gap by 50% to severe mental disorders which is around 80% now. 5. In patient care for acute mental health problems by dedicating 10 beds at all the district hospitals across Karnataka.

 Objectives 1. To provide sustainable basic mental health services in community and integration of these with other services. 2. Early detection and treatment of mentally ill, substance abuse and childhood disorders in community itself 3. To ensure ease of care givers 4. To take pressure off mental hospitals 5. To reduce stigma 6. To rehabilitate patients within the community

 Strategies

1. Integration of mental health with primary health care through District Mental Health Programme (DMHP). 2. Eradicating stigmatization of mentally ill patients and Protecting their rights through good IEC activities and regulatory institutions like State Mental Health Authority. 3. Diffusion of mental health skills to the periphery of health services 4. Appropriate appointment of tasks 5. Equitable and balanced distribution of resources 6. Integration of basic mental health care with general health services 7. Linkage with community development

 Components of DMHP

1. Training of medical, paramedical personnel and community leaders. 2. Community Mental Health care through existing infrastructure of the health services. 3. Information, Education and Communication (IEC) activities

 Innovations

 Telementoring

1. Virtual Tele -mentoring has bridged the Burgeoning treatment gap persisting in the Health Systems such as minimal HR and Treatment Gaps

2. Karnataka a pioneer of Optimal Utilization of Qualified Psychiatrists for “On – Consultation Tele MentoringTraining” at Primary level for varied ailments through Virtual continuous, effectual and efficacy Training imparted on the discourse of Psychiatric treatment to empower Primary Care Physicians (PCPs).  E-Initiative online format for monitoring DMHP from PHC to National level - Collaboration of GOK with NIMHANS & IIIT B

 Assisted Home Care

1. For Severe Mental Disorder patients, community based interventions have been proved to be beneficial and cost-effective. 2. Sizeable proportion of patients remains out of the treatment. 3. Despite efforts about 30% of patients (living in communities) do have sub-optimal outcomes. 4. so, GOK in collaboration with NIMHANS has started a pilot project of assisted home care to drop out SMD patients in 2 districts (Ramanagar & Bangalore urban)

 Included Faith healers in training programmes

Many mentally ill in developing countries would prefer to go to faith healers so Faith healers across the state are being sensitized how to identify mentally ill and what are the treatment facilities available and how to refer for treatment when in need. 1473 Faith healers are included for training programmes in the year 2017-18

District Mental Health Programme under NHM One of the strategies to address the treatment gap and to facilitate training of all health staff starting from PHC level, for early identification and treatment of mentally ill, District Mental Health Programme (DMHP) under National Mental Health Programme is implemented in all the 30 districts and Bangalore city (BBMP) since the year 2016-17.

2017-18 Physical and Financial Progress

 2017-18 Released Budget 675.500 Lakhs, Expenditure 547.550 Lakhs.  From April 2017 to 31st March 2018, 6,43,224 patients with mental health problems have been treated across the state and 1,11,671 patients being treated at Taluka level itself.  The fixed strategy of Mano-chaitanya (super Tuesday clinics) has been successfully implemented at Taluka level along with 1,711 Out Reach camps. The social workers under the DMHP have made 3,688 Home visits and attended to 6,269 patients during Home visits.  Trainings have been taken up in all districts of the state including BBMP. The focus of training has been to identify and treat mentally ill. During the year 17- 18, 1,673 Medical officers, 873 Ayush Doctors 9,375 paramedical workers, 658 RBSK/RKSK staff, and 23,775 ASHAs have participated in the training.  Weekly counseling services have been started in 216 sites: 101 colleges, 67 workplaces and 48 urban slums. In all these service nodes, the counselor on a fixed day during the week provides services of counseling for those in need and also refers to DMHP psychiatrists if required. During 2017 -18, nearly 31,000 persons benefitted: 17,433 beneficiaries in colleges, 7,480 beneficiaries in workplaces and 5,775 in Urban slums.  A total of 9,379 teachers have been provided sensitization for enhancing their skills in Stress Management, Suicide prevention and Life Skills Education. These teachers in turn would impart these skills to the students.  In addition, 1,648 counselors from Karnataka State Aids Prevention Society (KSAPS) / Women and Child Department (WCD), 6,042 police / prison staff, 1,473 faith healers / NGOs, 1,380 elected representatives have been sensitized on signs and symptoms of Mental illness and treatment facilities available within their districts.  To augment the training and encourage better decision making Tele mentoring of DMHP team (social workers, psychologist and Nurses (both Psychiatric and Community nurse) has been initiated on a regular monthly basis.  Tele-mentoring of PHC doctors has been started as an innovative activity from 28th August 2016.  During 17-18 Mental Health Drugs are being procured from DMHP funds under NHM through KDL&WS.

1.12 INFORMATION EDUCATION COMMUNICATION (IEC) :

IEC activities are being implemented to create awareness in the communities on various service facilities being provided at various levels under NHM. Activities are planned for both at state and district sectors. These activities are meant for procuring human resources, equipment, IEC materials (both printed & electronic), organizing telecasting, broadcasting and issuing guidelines to districts to carryout activities.

Grants received for conducting IEC Activities 2017-18

1. Printing & distribution of education materials to peripheral health institutions on National Health programme like Posters, Folders, Flipbook, Handbills, wall calendar, site-signage and Sun-board for effective interpersonal communication. 2. T.V Spot & Radio jingles are produced and broadcasted & telecasted through Doordarshan, Private TV channel & Radio. 3. Publicity done through bus branding on KSRTC / NWKRTC / NEKRTC / BMTC buses on MH, CH, PCPNDT, RBSK, Tobacco, JSSK, JSSY, Institutional deliveries & Breast feeding & others. 4. Tele film & documentary TV spot on various National Health Programmes & Schemes has been produced & telecasted through Doordarshan & private TV channels. 5. Broadcasting and conducting of interviews, Radio drama, Radio jingles and phone in programme in Akashvani, Community Radio, Private FM radio, on various Health Programme. 6. Printing & fixing of flex on hoardings on various National Health programmes & Schemes. 7. Wall painting on various Health programmes in selected Health & Panchyat Raj institutions and public places. 8. Health information disseminated through LED TVs in Railway station & KSRTC Bus stations. 9. Conducted Divisional level Folk artist workshop to train folk artist in NHM thematic issues in order to incorporate them in there shows and depute them to all the districts to inform the public about all Health programme though there different folk forms. 10. Sensitization programme of adolescent girls and self-help group‟s members on RKSK, RBSK, SUCHI& WIFS was conducted at sub-centre level, schools & colleges. 11. Sensitization programme for Stree Sakthi Members, Elected Panchyat Members was conducted at District & taluk level. 12. National & International Health days like World Health Day, World Population Day, World Mental Health Day, World TB Day, Anti Leprosy Day & others was organized and coordinated by IEC wing. 13. Panel discussion on various Health programme in AIR, Community Radio and Doordarshan by subject experts. 14. Debate / essay competition on different National Health Programme to School & Collages students was organized at Taluk & District Level 15. Press conference, Press meets was conducted by Hon‟ble Chief Minister & Hon‟ble Health Minister on National Health Events. 16. Press advertisement was given on National Health Events / Days in State, Regional, District & taluka level newspapers. 17. Conducted major exhibition and tablo on special occasion like Dasara, Kannada Rajyotsava & Jatras. 59

18. Dissemination of Health & FW services messages through Facebook, Twitter, LinkedIn, etc 19. Dissemination of Health message on LED screens in railway coaches, Bus tickets, Milk packets. 20. Installation of Standees on various National Health Programmes & Schemes at Metro Stations. 21. Telecasted spots & scrolling messages in cinema theaters & local city cable Network throughout the state. 22. Conducted debit, essay, slogan, speaking competition in schools & colleges to create Health awareness among the school children's. 23. Grants utilized for IEC activities under SCP/TSP funds.

1.13 State Health Transport Organisation:

For effective implementation of National Programmes under Health & Family Welfare Services. State Health Transport Organisation is assisting in Technical matter for Vehicle maintenance.

The Department has fleet strength of 1420. In the Department, from PHC Level to State Head Quarters in the different level for implementation of National Programme and to Medical Emergency different types of vehicles are being used. After formation of Zilla Panchayat., respective Vehicles of the District are being maintained under the administrative control of the corresponding Zilla Panchayat.

Fleet strength for the Year 2017-18 is as below as on March 2017:

Total number of Vehicles (Including Ambulance) in Health & Family Welfare Services Department : 1420

1.14. Integrated disease surveillance project (IDSP):

1 IDSP reports are received from Sub centres (S form) PHC (P form) Laboratories (L Form). Weekly Average reporting percentage is 97%, 94% & 90% under „S‟-Syndromic form, „P‟-Presumptive form & „L‟ Laboratory form respectively and is inclusive of private sector. 2 IDSP Portal entry happens from the Taluk level on a weekly basis. BBMP has been made as reporting unit under the Bangalore urban district and has started reporting to ensure Urban Health Surveillance 3 Outbreak reports are entered into the IDSP portal on a weekly basis along with the S, P, L reports by the Districts. Any outbreak/ FIR is reported to the state surveillance unit on the same day and the District Rapid response Team inclusive of District Surveillance Officer, Epidemiologist, Microbiologist, Entomologist, Veterinary Doctors Physicians, Paediatricians and Food Safety Officers visits the affected area to take preventive measures and for control of Outbreak.

Notification was issued regarding H5 outbreak among Chicken at Dasarahalli, Bangalore Urban district on 2nd of January 2018 from Animal Husbandry and Fisheries Department. Central, State & District RRT‟s were activated, additional manpower deputed for the surveillance of community in the infected and surveillance zone, all logistics were in place, strengthened IEC activities. After the culling operations the cullers were quarantined and given chemoprophylaxis under the supervision of Medical Officers. Daily

Surveillance activities were conducted for 10 days after the last day of culling activity. Daily reporting format was shared with the EMR division and nu human cases were reported. 4. The Zoonotic diseases of Public health importance such as Leptospirosis, Scrub typhus, Anthrax, AES/JE, Kyasanur forest disease, Brucellosis, Bird flu and Rabies are in Surveillance. 5. NHM has provided additional staffs such as Epidemiologist, Microbiologist, Entomologist, Veterinary Consultant, Training Consultant, Data Manager, Finance and Procurement consultant and Data entry operator at State level and Epidemiologists, Microbiologists, Data Managers, Lab technicians and Data Entry Operators at district level. 6. Eight Govt. Medical Colleges are identified as Referral labs for laboratory confirmation of epidemic prone outbreaks. 3-4 adjacent districts are attached to each Referral lab for providing laboratory diagnosis. BMCRI- Bangalore, MMCRI-Myosre, BRIMS-Bidar, VIMS-Bellary, SIMS-Shivamoga, BIMS-Belgaum, HIMS-Hassan and KIMS-Hubli are the identified Referral labs. Two lakhs, annual grant is allocated to each referral Labs for procurement of required consumables. The labs are reimbursed for each test based on rates fixed by the State Health Society. The tests being carried out are IgM ELISA testing ( Dengue, Chikungunya, Hepatitis A &E, Leptospira, Measles, Mumps, Chicken Pox) Weil Felix for Rickettsial fever, Rose Bengal agglutination for Brucella, Culture for Enteric Fever, Cholera , other enteropathogens and Diphtheria. 7. 14 District Public Health Laboratories (DPHL) are functional in the district hospitals of Chamarajnagar, Bijapur, Gulbarga, Yadgiri, Chitradurga, Koppal, Davangere, Udupi, Bagalkote, Gadag, Haveri Dakshina Kannada, Kolar and Tumkur for routine hospital based surveillance of communicable disease. Presently these labs are performing culture for all clinical samples and serology (Dengue, Chikungunya, JE, Viral hepatitis etc). GOI is supporting these DPHLs with manpower, equipment and lab consumables. 8. All District Surveillance laboratories except Bangalore Urban, Bangalore Rural, Chikkballapura& Ramanagara are carrying out bacteriological examination of water. H2S media for water quality monitoring and Malaria stain are prepared here and distributed to the peripheral health centres. In order to carry out the water quality testing in above mentioned districts, the lab technologists were trained. The DSOs were asked to identify the Taluk/District level labs for the preparation of the H2S media and distribution of the same to the periphery. 9. Media Scanning and Verification cell functions by sending the media alerts to the Districts by scanning printed media & electronic media and expect the districts to verify the incident and to send the report. 10. Periodic video conferencing with the Districts is made available to discuss the issues pertaining to improvement of the programme. 11. Training programme for Medical Officers, Medical College Doctors Pharmacist, Staff Nurses, Lab technicians, Health assistants (male and female), ASHA‟s, AWW, Panchyat development officers Data Managers & Data Entry Operators have been conducted under IDSP. In order to strengthen the surveillance of zoonotic diseases effectively the Veterinary Doctors of all the District‟s RRTs were trained regarding the zoonotic diseases of public health importance and the Intersectoral coordination

Financial Achievements (2017-18):

 Budget grants approved by GOI as per ROP for 2017-18 – Rs. 512.62 lakhs  Expenditure up to March 413.83 (80%) (PROV.)

1.15. Nutrition Programmes:

1. Vitamin „A‟ Administration Programme:

This programme is implemented for pre-school children of 9 months to 5 years of age. The children are administered Vitamin „A‟ solution orally to prevent Night Blindness, formation of Bitot Spots and other Vitamin „A‟ deficiencies leading to blindness. The Vitamin „A‟ solution necessary for this programme is procured under NHM PIP.

Two programmes are implemented under this programme viz.: i). Measles linked Vitamin „A‟ Programme:

One ml of Vitamin „A‟ solution containing 1 lakh IU is administered orally to the children of 9 months along with Measles Rubella Immunization. Around 10.30 lakh children are target beneficiaries of this programme. This is a routine monthly programme.

Sl. No. Year Target Achievement % 1 2017-18 1030317 1014589 98

(ii) Vitamin „A‟ supplementation programme :

This programme is implemented biannually to the children of 11/2 to 5 years. 2ml. of Concentrated Vitamin „A‟ solution containing 2 lakh IU is administered to the children orally, to improve immunity and reduce morbidity and mortality among pre-school children. Around 57.39 lakh children are Target Beneficiaries of this programme during 2017-18.

Sl.No Year Target Achievement % 1 May 2017 4798898 4565356 95 2 November 2017 4738211 4350613 92

2. Mass Deworming Programme:

Under this programme Albendazole tablets are distributed to pre-school children. 1/2 tablet containing 200mg is given to children of 1 to 2 years. And 1 tablet containing 400mg is given to children of 2 to 5 years of age. Around 57.39 lakh children are Target Beneficiaries of this programme during 2017-18. National Deworming Day is implemented as per GOI Guidelines. The first round for 2018 was implemented on 12-2-2018.

FINANCIAL PROGRESS:

Approved Releases Year (Rs. in (Rs. in Expenditure (Rs. in lakhs) lakhs) lakhs) Albendazole tablets is supplied to all districts and expenditure incurred 2017-18 336.96 336.96 totally. A letter is sent to GOI regarding clarification of price of Vitamin „A‟ bottle.

The progress is as follows:

Year Target Achievement %

2017 (August) 4075256 3628239 90 2018 (February) 4235328 3884512 92

The Medical officers visit A.W.Centres and conduct health check up once in two months. The children diagnosed with Malnutrition and other deficiencies are treated suitably. Severely malnourished children are referred to Paediatricians for treatment at Taluka Hospitals/ District Hospitals/ Nutrition Rehabilitation centres.

Nutrition Rehabilitation Centers (NRCs) in Karnataka:

Nutrition Rehabilitation Centers refers to a unit for „inpatient, centers based‟ care of children with severe malnutrition. Children with Severe Acute Malnutrition (SAM) are usually treated either in facility/hospital based care units without medical complications. Under nutrition is associated with high rates of mortality and morbidity due to common childhood illness including diarrhoea, acute respiratory infections, malaria and measles. To prevent deaths due to severe acute malnutrition (SAM) specialized treatment and prevention interventions are required. In Karnataka there are 32 Nutrition Rehabilitation Centers. 20 are attached to District Hospitals and 12 are attached to Medical Colleges. Usually they are either 20 bed or 10 bed capacity. They should have a trained Medical Officer, Staff Nurses and Diet Counsellor at the Rehabilitation Centre.

Children and mother/care taker will stay for a maximum of 14 days. In addition to providing nutritious food to children, awareness is being created to mothers /care takers on preparation of nutritious food. An amount of Rs.174/- to compensate the loss of wages, Rs. 125/- for food for parents, Rs.125/- for food and Rs. 125/- for drugs for SAM child is being provided.

Meetings and Workshop:

1. A meeting was held on Infant and Young child Nutrition - Bengaluru declaration on 13-4-2018 under the chairmanship of PD (RCH). 2. One day review meeting was held on 6-3-2018 for Strengthening of NRCs at SIHFW Bengaluru

PHYSICAL PROGRESS of NRC is as follows.

Discharged Referred Children Year Admissions with target (Medical followed weight gain Transfer) up 2017-18 4783 2250 55 3167

Financial Progress 2017-18

Approved (Rs. in lakhs) Expenditure (Rs. in lakhs) 32 NRCs 132.53 75.74

1.16. National Iodine Deficiency Disorder Control Programme(NIDDCP):

National Iodine Deficiency Disorder Control Programme (NIDDCP) is implemented in the State to create awareness about usage of Iodized salt in daily diet to prevent Iodine Deficiency Disorders (IDD) like Cretinism, Deafmutism, Dumbness, Physical and Mental Retardation, Goiter, etc. Dakshina Kannada, Bellary, Uttar Kannada, Kodagu, Chikkamaglur, Bengaluru(U), Bengaluru(R), Shivamogga are recognized to be Endemic Districts.

During 2017-18, 163 goitre cases reported and put on treatment as per the report sent from the districts.

During 2017-18, IDD Survey is taken up in 10 districts viz., Koppal, Bidar, Bengaluru Urban, Bengaluru Rural, Chamarajanagar, Uttara Kannada, Bellary, Bagalakote, Bijpaur and Gulbarga through Medical Colleges.

Salt Testing Kits (STK) have been distributed to ASHA workers in 8 Endemic districts to test the Iodine content in salt samples at community/household level and to promote the importance of consumption of Iodized Salt in daily diet and to prevent Iodine Deficiency Disorders. These programmes shall be continued during 2018-19 also. During 2017-18, IEC materials like Posters and Handbills on IDD have been printed and supplied to all the districts and during IDD Week Radio Jingles were broadcasted through All India Radio.

As per Government of India Guidelines, during the 2017-18 October 21st was observed as IDD Day and 21st to 27th of October was observed as IDD week. On this occasion various programmes at School/Community level on IDD such as debate, essay competitions, paintings, quiz competitions, rallies by school students and Health workers conduct group meetings/discussions, workshops, demonstrations have been conducted. The programmes has been oriented towards school children, community, pregnant and lactating women at district level for motivating the importance of consumption of Iodized Salt in daily diet to prevent Iodine Deficiency Disorders.

IDD Co-ordination meeting held in association with Joint Director-Public Health Institute, Joint Commissioner-Food Safety, Assistant Director-Midday Meals Scheme, Programme Officer-State ICDS Cell and UNICEF Consultant on 13th November 2017.

ASHA sensitization on usage of Iodized Salt in daily diet, demonstration of Salt Testing Kits (STK) to detect Iodine content in Salt was done through SATCOM Training.

PHYSICAL PROGRESS 2017-18:

Particulars 2017-18 Goitre Cases 163

Salt samples tested in 8 Endemic districts using Salt Testing kits (STK) Year Total samples Above 15 PPM Below 15 PPM 0 PPM 59,274 2017-18 25,69,162 23,20,776 (90.33%) 18,91,122 (7.36%) (2.31%) Salt samples tested for Iodine content at IDD Laboratory:

Year Total Satisfactory Non-Satisfactory 7271 1605 2017-18 8876 (81.82%) (18.08%)

Urine samples tested for Iodine Excretion at IDD Laboratory :

Total Normal Mild Moderate Year Samples (>10µg/dl) (>5 to <10µg/dl) (>2 to <4.99µg/dl) tested 4682 50 2017-18 4732 0 (98.94%) (1.06%)

1.17 Karnataka State Drug Logistics and Warehousing Society:

Procurement and Logistics :

The erstwhile Government Medical Stores was catering to the needs of Institutions coming under the Directorate of Health & Family Welfare Services as well as the Directorate of Medical Education in the state. The process of purchases, storage and distribution of various Drugs & Chemicals was being carried out by the Government Medical Stores which was more a centralized function.

With an intentions to select, procure, store and distribute various categories of drugs in time to all the Health Institutions in a more scientific approach, thereby to ensure availability of right drug at the right time in the right proportion in the hospitals, Karnataka State Drugs Logistics & Warehousing Society (KSDLWS) was established with the assistance of European Commission to the tune of Rs.15.00 crores in the year 2002. The society was registered under Karnataka Registration Act on 28-3-2003 vide Registration No.172/03-04.

Organisation structure of KSDLWS o Governing Council Committee: Principal Secretary, Health and Family Welfare Services is the Chairman of the Governing Council Committee. o Executive Committee: Commissioner, Health and Family Welfare Services is the Chairman of the Executive Committee.

. Additional Director is the Member Secretary to both committees.  Administration  Procurement of drugs and equipments  Logistics  Quality Control  Finance and Accounts  Warehouse information system

The main objective of the Karnataka Drug Logistics Warehousing Society is to provide good quality Drugs, Chemicals, Equipment and other essential items to various health institutions in the State working under the Directorate of Health & Family Welfare Services as well as Directorate of Medical Education at all times, in accordance with their indents by following (WIS) scientific drug management using Information Technology.

1. To identify the essential drugs and to coordinate with the State Therapeutic Committee in preparing the list of essential drug required by the state to cater to the needs of all Health Institution in the State. 2. Updating, preparation and finalization of tender documents. 3. Managing all aspects of quantification and purchase of Drugs, Chemicals and other items required by the various health institutions, as per Karnataka Transparency in Public Procurement Act 1999. 4. Procurement of equipment are done on the basis of the Indent received from various Health Institutions. 5. Analyzing the efficiency of suppliers on the basis of their performance. 6. Management of funds released to Karnataka Drug Logistics Warehouse Society under various programmes. 7. Management of all existing District Drug Warehouse and to take necessary action to establish District Drug Warehouses in remaining District head quarters. 8. To take appropriate actions on the queries and guidelines as informed by Accountant General, CAG and State accounts department from time to time. 9. Implementation of Directives of Executive Committee as well as the Governing council of Karnataka Drug Logistics Warehouse Society from time to time on various aspects.

In the first phase 14 Drug Warehouses were established with complete infrastructures like computers with internet connectivity, Warehouse operative equipment‟s and manpower and are working smoothly. 13 more District Drug Warehouses with complete infrastructure in order to have better District wise access are constructed by KHSRDP and functioning.

In order to maintain cold chain facility to store certain important drugs and vaccine in each District Drug Warehouse and KDLWS Head Office, walk-in-coolers are established.

Indent processing:

The annual drug indent books showing the list of drugs approved by state therapeutic committee were supplied to the District Health & Family Welfare Officers, District Surgeons, Administrative Medical Officers of the hospitals and

medical officers of Primary Health Centers through the respective District Drug Warehouses for submitting annual indent of the drugs.

Administrative Medical officers of the respective hospitals submitted indent to the District Drug Warehouse of the concerned District as per their budget. The Warehouse In charge of the District Drug Ware House consolidated the drug wise indent of all levels of Hospitals of the District and submit the district indent of drugs to the KDLWS through Ware House Information System (WIS). The KDLWS received the District indents and consolidate the state level requirement of drugs. Final list of Drugs & its quantities were approved by Need Assessment Committee and the tender were floated.

KSDLWS has decided to get the online indents from all health institutions from the year 2015-16.

Steps cycle in KSDLWS:

STEP 1. State Therapeutic committee STEP 2. Publishing of Essential Drugs List STEP 3. Online Indent STEP 4. Need Assessment Committee Meeting STEP 5. Floating of Tender STEP 6. Drug supply to warehouses STEP 7. Distribution of drugs to end user

Under Special Programs:

Supply of essential Drugs to concerned hospitals for treating patients affected by natural calamities and patients affected by Drought and to control epidemic diseases such as ChickunGunya, Dengue fever and GE cases etc:

The Society is also procuring Drugs, Chemicals and other necessary equipments required by the Karnataka State Aids Prevention Society and KHSDRP. The procurement is being done as per World Bank Norms. The society is also procuring Drug and equipments required under RCH and National Health Mission programmes, distributing them by preparing various kits required for different categories of Hospitals.

From 2004 to Mar 2016 we were using WIS (warehouse Information System). In this Software all the transaction were monitored till warehouse level. Now by using “Aushada” iSCMC Software, helps to bring transparency in the supply chain management of drugs in the health and family welfare department. The features of “Aushada” iSCMS Software are as follows:

 Collecting annual and improve from all level of health institutions, with the approval of their concern DHO‟s  helps to monitors and improve supply chain management system of drugs and chemicals to all health institutions.  All Published purchase orders and pipelined supply statsus of drugs can be viewed.  Periodic Indent on monthly basis is raise by health Institutions with approval of their AMO‟s to avoid expiry of drugs in health institution level to prevent stock out of drugs.

 If the particular batch of drugs is declared as NSQ such batch of drugs will be freezed at Warehouse level as well as at Health institution level wherever NSQ drugs stock is available and such NSQ drugs will not be available for further transaction.  Nearing expiry drugs details will be available to all users which helps to transfer the drugs to needy warehouse or Health Institutions before its expiry for consumption.  Helps to centrally monitor the availability of stock at warehouse level and also at health institution level.  OPD statistics IPD statistics drugs consumption pattern will help in analyzing and cross verifying the annual indents submitted by Health Institutions. Physical Achievement:

Along with the existing 14 district warehouses, 13 new warehouses have been made operational during the year 2014-15. Drugs are procured as per the requirements of the health institutions and are being supplied through 27 district drug warehouses. :

Ware house List Sl. Districts Sl. Districts No. No. 1 Kolar 15 Ramanagar 2. Hassan 16. Sirsi 3. Mysore 17. Bangalore Rural 4. Tumkur 18. Bagalkote 5. Belgaum 19. Gadag 6. Bellary 20. Yadgiri 7. Vijayapura 21. Haveri 8. Dharwad 22. Koppal 9. Raichur 23. Chitradurga 10. Shivamoga 24. Madikere 11. Kalburgi 25. Bidar 12. Bangalore Urban 26. Gokak 13. Davanagere 27. Karwar 14. Mangalore

The Proposal as been submitted to the Government Health and Family Welfare Department to Provide budget for constriction of Dist Drug Warehouse in the following 5 district:

Sl. Districts Sl. Districts No. No. 1 Udupi 3. Chamaraja Nagar 2. Mandya 4. Chikka ballapur 5 Chikkamagalore

Disposal Drug Policy:

The Request for Proposal was invited for Safe Disposal of Expired and NSQ drugs accumulated in different Warehouses of Karnataka by following the Common

Biomedical Waste Management Rules 2016 and as per directions of the Karnataka State Pollution Control Board vide Request For Proposal Notification no. KDLWS/CS/02/2016-17 dtd: 05.08.2016.

Around about 492238 kgs of Expired and Not of Standard Drugs was scientifically Disposed by 7 CBMWTF units. The cost of Rs. 6350406.00/- towards scientific Disposal of above said Drugs was paid by this office from the environmental fund.

Quality Analysis :

The following precautionary measures are adopted in the tender conditions in order to provide the Quality Medicines for the patients who visit Government Hospitals for treatment.

1. The bidder who is awarded tender should provide NABL report and analytical report of their own laboratory for every Batch of Drugs along with the consignment at the time of supply 2. Every Batch of Drugs supplied to Warehouses across the State are subjected to Quality Control Test by the Empanelled National Accreditation Board for Testing and Calibration Laboratories (NABL), which are recognized by KSDLWS. 3. In addition to this, samples are drawn randomly by Drug Control Department

The approximate cost required for the destruction of said drugs is about Rs. 6350406.00/-. the Rs. 2.35 crores available in the environmental fund in that the above cost will be provided

Financial Achievements: (a) Health & FW Department: (Rupees in Lakhs) Budget Budget Budget Sl. Targeted for released for Percent Utilised up to Remarks No the year the year age 31.03.2018 2017-18 2017-18 2210-06-001-0-01(NP)-0222 1 18720 18720 18720 100% Purchase of Drugs & Chemicals. 2210-01-104-0-01(P) 2 3300 100% 3300 3300 Equipment & Furniture‟s.

(b) Medical Education : Sl Name of the Hospitals Drugs No. Hospitals under Bangalore Medical College & Research 1 41875245 Institution, Bangalore Pradhana Mantri Swasthya Suraksha Yojana (PMSSY) Super 2 10499369 Speciality Hospital 3 Hassan Institute of Medical Science Hospital, Hassan 42557163 4 Mandya Institute of Medical Science Hospital, Mandya 11341549 5 Bidar Institute of Medical Science Hospital, Bidar 11094731 Total 117368057

Below is a list of District-wise Indenting Institutions of „Vitamin A‟ „Akshara Dasoha‟ program for 2017-18.

Sl District BEO No of Sl No District BEO No of No Office tablet Office tablet 1 Baglkote 6 4131 18 Gadag 6 2229 2 Bangalore Rural 4 1072 19 Kalburgi 8 5675 3 Bangalore Urban 9 4982 20 Hassan 8 1622 4 Belgaum 6 3480 21 Haveri 7 2937 5 Belgaum Chikodi 8 7046 22 Kodagu 3 563 6 Bellary 8 3641 23 Kolar 6 1763 7 Bidar 5 0 24 Koppal 4 2869 8 Vijayapur 7 4739 25 Mandya 8 1997 9 Chamarajangar 5 901 26 Mysore 9 3390 10 Chikkaballapur 6 1486 27 Raichur 5 3598 11 Chikkamaglore 8 0 28 Ramanagar 4 1183 12 Chithradurga 6 2333 29 Shimoga 7 2370 13 Dakshina Kannada 7 2131 30 Tumkur 6 1716 14 Tumkur Davanagere 7 3037 31 4 1285 Madhugiri 15 Dharwad 7 2616 32 Udupi 5 1102 16 Uttar Kannada Uttar 6 1328 33 5 1035 Shirsi Kannada 17 Yadagiri 3 2743 Total 81000

Other Departmental Programs:

Under the “AksharaDasoha” Programme of the Education Department certain drugs like Tab. Albendazole, Iron Tabs and Vitamin „A‟ capsules are procured and supplied to students from class 1 to 7th Standard.

Procurement of Equipments:

KSDLWS has carried out the procurement of equipments, furniture‟s and ICT components for the year 2017-18. The details of the same are shown below:

Sl. IND No Name of the tender Program Est. Value (Cr.) 1 IND- 430 Re-TND (State State/NHM 11.23 Budget) 2 IND – Re-TND (NHM NHM 01.71 429 Budget) 3 IND – Thalassimia NHM 04.40 433 Equipment

1.18.State Institute of Health and Family Welfare:

Salient features of the SIHFW:

1. Works as the State Level Nodal Agency for the training under department of the Health and Family Welfare.

2. Works in formulating state training policy, planning, implementation and monitoring evaluation of the in-service training to Medical and paramedical personal in the department. 3. 19 District Training Centres, 4 Health & Family Welfare Training Centres are working under SIHFW, and helps in dissimilating the trainings to districts and sub district levels.

Training Programmes taken up during 2017-18:

1. Maternal Health Trainings : SBA, SBA Refresher, MVA, RTI/STI, Skill Assessment, IMEP. 2. Child Health Trainings : IMNCI, F-IMNCI, NSSK, IYCF, CDR, FBNC. 3. Family Planning Trainings : Specialized Skill programme in IUCD insertion, MTP, Minilap and Laparoscopic training. 4. PPIUCD training to newly recruited Medical officers & Staff Nurses. 5. ASHA‟s Training in ASHA Module 6&7 and New Kit, IYCF Training. 6. Induction training to newly recruited Medical Officers.

Achievements for 2017-18 (Both Physical and Financial):

Details regarding achievements for the year 2017-18 upto March -2018 (Both Physical and Financial) enclosed in the Annexure.

Other remarkable achievements for the year:

a) 4th batch of CPHN Course for in service LHV‟s/ANMs was completed on September 2017 and 5th Batch started in October -2017. b) 1st Batch PGDHP & E Course for in service BHEO‟s was completed in June- 2017 and 2nd Batch started in July-2017. c) The NBE (National Board of Examination) Govt. of India has allotted 60 seats in various specialties in Karnataka for starting of DNB Courses at 02 General Hospitals & 07 District Hospitals for financial year 2018-19.

Achievements for the year 2017-18 under (NHM) No. of Sl.No. Details of the Training Batches persons Achievement trained 1 Maternal Health Trainings 560 7371 A sum of Rs. 2994.88 lakhs have been 2 Child Health Trainings 303 6163 incurred as expenditure out of 3 Family planning Trainings 159 1375 Rs. 3509.30 lakhs released Other Family planning 4 53 1227 Trainings

Other Trainings under 5 263 4928 NHM ASHAs Training for 6 Induction & ASHA Module 182 10278 6&7

1.19. Public Health Institute

Brief Technical Information

The Public Health Institute is one of the oldest health institution and main food and water laboratory in the State. The following sections are working in this institute. 1. Diagnostic Bacteriology Section. 2. Water Bacteriology Section. 3. Water Chemical Section.

Chemical Examiners Section 1. Yellow Fever Vaccine Section. 2. Training Section. 3. Media Preparation Section. 4. Sentinel Lab under NVBDCP and L3 Laboratory under IDSP. 5. State Food Laboratory Section. Diagnostic Bacteriology Section 1. In the Diagnostic Bacteriology Section stool samples for detection of Vibrio Cholera Organisms, are being received and analyzed and the reports are being sent to the concerned Institutions. 2. Water samples for detection of V Cholera Organisms are being received and analyzed and the reports sent to the concerned Institutions. 3. Food samples are being received from private and government institutions for detection of pathogenic Organisms and analyzed. 4. Swabs are being received from operation theatres from the Government Institutions for detection of Clostridium Tetanus Organisms.

Water Bacteriology Section 1. Water samples from both Government and Private Institutions for bacteriological examination are being received and analysed. 2. The samples are analyzed for E. Coli Organisms and Coli Form Organisms which are the indicators for the faecal contamination of the water.

Water Chemical Section 1. In this section, water samples are received for analysis of dissolved solids, PH, alkalinity, turbidity, total hardness and others chemicals like Iron,

Nitrates, Calcium, Chlorides, Sodium, Potassium, Fluorides, Sulphates for potable purposes.

Chemical Examiner Section 1. Samples are received for analysis of the following 2. Lokayukta trap case Samples. 3. Excise Samples. 4. Narcotic Samples 5. Blood and Urine Samples for the estimation of Alcohol 6. Chemical analysis of Bleaching Powder.

Vaccine Section 1. Yellow fever vaccination is being given to International travelers, who travel to African and South American Countries. This is the only center for Yellow Fever Vaccination in Karnataka State. 2. Menu vaxAcwy (Meningitis Vaccine) is provided to the Hajj Pilgrims (9120 doses given) in Karnataka State.

Training Section 1. Training programmes are being conducted for both Junior and Senior Medical Laboratory technologists of Government Institutions from all over Karnataka in the Diagnostic bacteriology, water bacteriology, media preparation sections. 2. Students from Government and Private Institutions of Both Post graduate and under graduate Medical, Dental, BAMS, Microbiologist, Home Science & Para Medical are visiting for enhancement of Knowledge in the Laboratories.

Media Preparation Section 1. Required media to culture Micro Organisms are prepared and distributed to various sections of this Institution.

Sentinel Lab under NVBDCP and L3 Laboratory under IDSP 1. The Blood samples received for detection of vector borne disease like Chickungunya, Dengue and Japanese encephalitis (J.E) are tested.

1.20 Suvarna Arogya Suraksha Trust:

In order to provide health benefit scheme to BPL families in Karnataka, a Special Purpose Vehicle by name Suvarna Arogya Suraksha Trust was established under the Indian Trust Act of 1882. This objective of Government is implemented by SAST through Vajpayee Arogya Shree Scheme. For implementation of the scheme Trust Board Executive Committee and Empanelment and Disciplinary Committee are constituted.

Activities of the Trust:

Karnataka has achieved many firsts in the domain of health and welfare of its people. Having successfully implemented Vajpayee Arogyashree Scheme in a phased manner, it was an honour that SAST was entrusted to implement Rajiv Arogya Bhagya for APL families, Jyothi Sanjeevini for State Government Employees and their dependants, Rastriya Bala Swastya Karyakrama for children in rural areas and urban slums and in government and aided schools, Mukyamantri Santhwana Harish Scheme for road traffic accident victims in Karnataka.

Vajpayee Arogyashree:

To enable the members of BPL families in Karnataka suffering from catastrophic diseases like Cardio, Cancer, Neurology, Renal, Burns, Polytrauma and Neonatal to access the super speciality health care treatment, Vajpayee Arogya Shree Scheme has been introduced by the State Government stage by stage in the state. Approximately about 99.12 lakh BPL families in the State have now access to Multi Speciality Health Care. Right from diagnosis, hospitalization, treatment / surgery and food will be provided free of cost by the Super Speciality Hospitals. The cost of the same will be borne by the Government through the Trust. The maximum expenditure ceiling per BPL family per year is Rs. 1.50 lakhs with a floating provision of Rs. 50,000/-.

To identify and refer any of the BPL family member suffering from any of the above seven catastrophic diseases, the Trust regularly organizes District and Taluk level Health Camps which is attended by people from near and far off villages. The Trust has empanelled 149 Super speciality Hospitals in the State and 34 Super speciality Hospitals in the border areas of neighbouring state totalling to 196 Network Hospitals covering about 663 different surgical health procedures along with 138 follow-up packages so that BPL families will have the services of quality Standards without any discrimination.

During the Financial Year 2017-18 Government has spent Rs. 31341.88 Lakhs to provide treatment to 59656 BPL beneficiaries of the state under this scheme.

Rajiv Arogya Bhagya:

The Rajiv Arogya Bhagya Scheme is being implemented in the state of Karnataka since 20th January 2015, for tertiary care treatment for APL population. Till now, 196 hospitals are implementing this scheme. For the year 2017-18, a total of 2950 claims amounting to 1411.74 lakhs have been settled of patients treated under the scheme.

Any family having an APL card issued by Food & Civil Supplies Department is eligible for tertiary treatment in any of the empanelled hospitals. The main features of the scheme are:

 General Ward: The treatment is provided on co-payment basis – 70 % is paid by the Government and 30 % is paid by the beneficiary to the hospital under the scheme.  Semi-Private & Private wards: The hospitals declare their package rates for semi private and private ward. SAST pays for 50% of the general ward package and the balance 50% along with the difference amount of the package rate for higher ward is paid by the beneficiary to the Network Hospital as beneficiary share.

 Beneficiary will pay for investigations at charges fixed by SAST. Food and travel charges have to be borne by the beneficiary to hospital.

APL SC/ST beneficiaries - TREATMENT IS FULLY FREE: Only general ward is free. Diagnostic investigations at Network Hospitals and complete treatment charges are paid by the government. In addition, food for the patient and one attendant during hospital stay, is also paid by the government.

RAB Scheme for Journalists: Journalists recognized by Information and Public Relations Department and their family members will be provided with FREE treatment under APL scheme in GENERAL WARD ONLY, as per G.O no.AKK 61 CGE 2015, Bangalore dated: 16.07.2016. The scheme will cover one journalist plus three family members. They can avail treatment by showing their ID card issued by their department and APL card, at network hospitals empanelled under SAST for the RAB scheme. Investigations and food charges are not covered.

ASHA Workers coverage under RAB scheme:

Government will provide FREE TOTAL treatment under tertiary illness for all ASHA workers and their family members having APL card, as per G.O. No. HFW 200 FPR 2016, Bangalore dated: 29.12.2016. The 30% beneficiary share will also be paid by the Health and Family Welfare Department. Treatment is available in GENERAL WARD only. Investigations and food charges are not covered.

A mobile app is available for patients of RAB, to select hospitals for treatment based on rates declared for semi private and private wards. It can be downloaded free from goggle store or from website: www.rajivarogya.com

Jyothi Sanjeevini Scheme:

The Government of Karnataka has approved a Health Assurance Scheme vide Government order No. DPAR/14/SMR/2013 dated 18/08/2014, specially designed for State Government Employees, named “Jyothi Sanjeevini”. The scheme is implemented from 20/01/2015. It is a comprehensive health care, wherein the Scheme provides cashless treatment to all the Government Employees and their family dependents through empanelled Network of Hospitals. Provide quality treatment for catastrophic illnesses for tertiary care. The scheme involving hospitalization, surgery, and other therapies through identified Network Hospitals.

The scheme is implemented in an “Assurance Mode” through Suvarna Arogya Suraksha Trust to the “State Government Employees and their dependents” by a network of “Empanelled Hospitals” with no financial cap. The process of identification and empanelment is a continuous one from “time to time”. Only such of those Network Hospitals who are already empanelled and gets empanelled for “Vajpayee Arogyashree Scheme”, alone are empanelled under “Jyothi Sanjeevini Scheme”. It is “cashless” to the beneficiaries except in following cases;

State Government Employee and their dependent family members are covered under this Scheme. The beneficiary is identified by Karnataka Government Insurance Department‟s Policy Number (KGID) updated in HRMS data base of the Department of Personnel and Administrative Reforms of the Government of Karnataka. The dependant family members of a Government Servant includes as defined under Rule 2(1) of clause (i) (ii) & (iii) of Karnataka Government Servants (Medical Attendant) Rules.

The Government Servants will not be eligible, if the benefits are already availed “in any of the other” Government sponsored health schemes;

Entitlement of Wards :

Sl. Range of Pay Category of Wards entitled 1 UptoRs. 16,000/- per month General Ward 2 Rs. 16,001/- to Rs. 43,200/- per Semi Private Ward month 3 Rs. 43,201/- & above Private Ward

The scheme covers tertiary treatment of 7 broad specialities viz cardiovascular diseases, cancer, renal diseases, neurological diseases, burns, polytrauma and neo-natal cases. It includes “663 procedures” pertaining to seven specialities.

The package includes consultation, diagnostics, procedure cost, food, hospital charges and post hospitalization services up-to 10 days include medicines. Upper limit is fixed for those procedures requiring implants, stents etc., exceeding which the difference of cost will be borne by the beneficiaries. In addition, the scheme covers “138 defined follow-up packages” that include post hospitalization care for a subset of covered procedures, including consultations, diagnostics and drugs.

Where the beneficiary opts for superior wards other than the one for which he/she is entitled. In the aforesaid circumstances, the beneficiaries shall bear the additional cost.

Since inception of the scheme 196 hospitals are empanelled under the scheme. Empanelment is continuous process under the scheme. Beneficiaries can avail the treatment in Network hospitals.

Government has been released Rs. 23.00 crores for the year 2017-18. There are 2146 preauthorizations approved for the year 2017-18. Total 2140 Claims settled for an amount of Rs. 1657.35 Lakhs and paid to the Network Hospitals.

Rastriya Bal Swastya Karyakrama (RBSK):

RBSK Programme under National Rural Health Mission initiated by the Ministry of Health and Family Welfare, therefore, aims at early detection and management of the 4Ds prevalent in children. These are Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities.

All the children of 0-6 years of age in rural areas and urban slums and from 6-18 years of age for the children enrolled in classes 1st to 12th in Govt. and Govt. aided schools are eligible under the scheme.

The inspection is since 01.11.2014 under Suvarna Arogya Suraksha Trust. To begin with we had 2 specialities and 36 procedures, than we added 5 specialities with 116 procedures, now further added 6 specialities 145 procedures. Under this scheme 45 hospitals empanelled.

In the year 2015-16 National Health Mission released 9.20 cr and in 2016- 17. Rs. 10 cr released & in 2017-18 Rs. 18.00 crores releaseed. The money was utilized for the beneficiaries of the scheme.

Beneficiaries Amount Settled( in Sl. No Year No. lacks) 1 2017-18 6048 3434.66

Mukhyamantrigala Santhwana Harish Yojane:

To give immediate and instant Medical Treatment/Relief for the victims of the Road Accidents during "Golden Hour".

A humanitarian scheme from the Government of Karnataka to provide Trauma care to Road Accident victims within the Golden hour.Implemented through Suvarna Arogya Suraksha Trust, an autonomous and registered body under the Health and Family Welfare Department, Karnataka.

Context:

Road traffic accidents are unfortunately a part of our daily lives. Often, it is noticed or reported that persons who meet with any road traffic accidents suffer from complications of injuries or even die because they are unable to receive immediate care and hospitalization.

Statistics:

Karnataka ranks fourth in the country in the number of road accidents with 43694 accidents per year (2014). 56818 were injured, 10444 deaths. In 2013, Karnataka ranked 2nd in the country in terms of road accident injuries and ranked fifth for deaths due to RTAs .

Road Traffic Injuries are responsible for over a third of the world injury burden and resulted in the loss of 76 million Disability Adjusted Life Years (DALYs). To address this grave situation, The Government of Karnataka with support of the World Bank, has taken a pioneering initiative to start the Mukhyamantri Santwana -'Harish' Scheme.

Beneficiaries of MSS :

All the road traffic accident victims, who meet with accidents on the roads of Karnataka, irrespective of BPL/APL status, state or nationality. Benefits of the scheme:

Immediate and instant Medical Treatment for the victims of Road Accidents during Golden Hour (48 hours).Cashless treatment to the road accident victims with a maximum amount of Rs. 25,000/- per victim per episode.

Response to a road accident:

 Any person who is near the accident site can call the 108 or 104 helpline for the ambulance.  EMRI will send the ambulance to the accident site.  The EMT (Emergency Medical Technician) in 108 will shift the victim to the nearest and appropriate level of Hospital based on the severity of the injuries. Private ambulance or any other means of transportation can also be utilised by the public.  The victim will be treated free of cost in the hospital for first 48 hours treatment.  This includes patient with or without a Medico Legal Case.  Government will settle the claim for the hospital for the cost of treatment provided in the first 48 hours.  Treatment cost beyond 48 hours or more than Rs 25000/ will be borne by the beneficiary.

Hospitals providing services under this scheme:

 All government hospitals ( District, Taluka, CHC, PHC)  Medical Colleges and private hospitals empaneled under MSHS scheme.

Services provided under MSS:

 Stabilizing the patient as per the severity of injuries.  Suturing and dressing of wounds – simple and compound  ICU based treatment.  Ward based treatment.  Treatment of fractures, head injuries, spinal injuries, burns.  Blood transfusion.

 25 packages as defined by the Expert Committee ranging from Rs 1000 to maximum of Rs 25000/.

Hospital level features of this scheme include:

 Instant patient registration & approval for treatment through designated phone number through dedicated Mobile Number/MSS online application to get spontaneous unique number. This number which shall be utilized for further reference and correspondence.  Scope for hospitals to provide treatment for Medico-Legal cases with police information report.  Designated Software for hospital empanelment, patient registration & claim processing http://mss.kar.nic.in.  Hospitals are graded as Level 1 (Super-specialty), Level 2 and Level 3 (Primary care), based on the infra-structure, staff and treatment facilities available.

Progress of the scheme:

SAST has empaneled 844 Hospitals across the state under MSHS scheme. Out of which 345 Hospitals are private Hospitals & 499 are public Hospitals. 110694 patients registrations are done under MSHS scheme. During 2017-18 23227 beneficiaries treated and Rs. 1828.17 Lakhs and paid to the Network Hospitals.

Jeeva Rakshak Award :

The road accident survey 2015 reveals Karnataka as the third state in the country with highest number of accidents and fatalities. To ensure effective implementation of the MSHS scheme through active public participation, Gok takes immense pleasure in announcing “JeevaRakshak” award for Good Samaritan individuals who responds and immediately acts by informing to ambulance or by facilitating in transferring the patient to nearby hospital, facilitating in saving the life/ minimise the health problem of the Road Traffic accident victims from the scene of accidents.

The aim of institutionalising this award is to encourage individuals to come forward to proactively help the victims of Road Traffic accidents without delay so that the victims gets treatment during the first 48 hours of the accident. The recognised person will be honoured in a benefitting manner with a Good SAMARITAN- JEEVA- RAKSHAK award.

Selection of Jeeva Rakshak award:

The nominations uploaded will be automatically sorted District wise and the respective District Committee after due evaluation will declare three individuals for the award based on the nature and impact of the assistance provided by them in the sequence of first, second and third awardees. The award is instituted to be given a twice a year. Nominations will be received from January to July and August to December and the awards will be presented on August 15th and January 26th every year. For the first time JeevaRakshak award distributed 20 districts in the state.

District JeevaRakshak award Committee: 1 Deputy Commissioner Chairman

2 Chief Executive Officer, ZP Member

3 Superintendent of Police Member

4 Regional Transport Officer Member

5 Local Philanthropist/Public Figure Member

6 District Health Officer Member Secretary

Rastriya Swasthya Bhima Yojane (RSBY):

Rashtriya Swasthya Bima Yojana is a flagship programme initiated by the Government of India to extend Health Insurance for the BPL families and other GoI identified unorganized category of workers. The Scheme is being implemented jointly by Central and State governments through the Insurance Companies and Third Party Administrator (TPA). The main objective of the scheme is to provide Health insurance facilities to the beneficiaries in Empanelled Hospitals.

The RSBY facilities is extended to the following categories like, MGNREGA, Beedi Workers, Domestic Workers, Licensed Railway Porters-Vendors-Hawkers, Rag Pickers and Weavers & Artisans , Street vendors, SafaiKarmachaires, Construction Workers, Mine workers, Cycle RikshaPullars, Auto Riksha Drivers.

Facilities under RSBY scheme:

1. The beneficiaries having RSBY cards and their family are given free treatment for in patient Rs.30000 per year under the empanelled hospitals of the Scheme. 2. Including surgeries 1516 procedures are given free treatment 3. Free treatment is given for the following 13 specialties; 4. General Medicine, Cardiology, Neurology, ENT, Eye, Orthopedic, Endocrinology, Dental, general surgery, pediatric treatment, Oncology, Gynecology & Maternity 5. For the inpatient in the hospital Rs.100/- is paid as conveyance charges this will not exceeds Rs.1000/- per year 6. All the pre-existing, diseases maternity treatment cost and child born during the policy period will be given free treatment 7. Free treatment is provided in all empanelled hospitals in India.

The following are the development s done after transfer of the scheme from Labourdept to Health and Family Welfare dept from 01.04.2016;

1) The smart card issued in the year 2014-15 (6549509) policy has been extended to 01.04.2016 to 31.03.2017 and free treatment has been provided to beneficiaries. 2) For the purposes of free treatment under the scheme 1104 hospitals ( Govt: 633 Pvt: 471) has been empanelled.

3) During the 2017-18, for 67510 beneficiaries, Rs.122.23crores has been spent towards to free treatment to the beneficiaries. 4) Under the RSBY scheme top up to the Senior citizen is provided up to Rs.150000/- 5) We had 19 review meetings with Insurance companies to analysis the program made 6) We had conducted 8 DGRC meetings as on date at district level 7) Where the decisions not taken at DGRC meeting, under EDC meeting decision has been given 8) Under RSBY scheme several Arogya AbhiyanJathra specially for a SCST has been conducted all over Karnataka in all the remote villages. Exp: Street plays, shows, mike announcement (where SC/ST population is above 40%) 9) Advertisement regarding RSBY scheme has been given time to time 10) A separate call center has been started to answer the calls of RSBY beneficiaries vide; 1800 425 8330 & 18004252646

Indira Suraksha Yojane:

Indira Suraksha Yojane is launched for the benefit of dependent members of the farmers who had committed suicide in draught situation due to financial crisis in Karnataka during the F.Y 2015-16 and 2016-17. The beneficiaries of the scheme are identified, certified by the concerned district Deputy Commissioner & the information shared with SAST. The SAST will issue the required ISY Cards to avail the benefits by the members.The scheme is designed to provide free and quality health care services for catastrophic tertiary and secondary illnesses to the beneficiaries under SAST network hospitals.

Under the scheme Tertiary care treatment are provided with financial cap of Rs.1.5 lakh per family per financial year with buffer amount of Rs.50000/- on certain occasions. The secondary care treatment is provided with financial cap of Rs.30000/-per annum. The package cost includes hospitalization, procedure cost, investigation, Medications, food and transportation charges. The treatment can be availed completely free of cost in general ward only.

The scheme covers Tertiary treatment under 7 broad specialities they are Cardiology, Neurosurgery, Genito-Urinary Surgery, Paediatric Surgery, Polytrauma, Oncology and Burns. Under these specialities there are 663 procedures and 138 defined Follow-up packages. Secondary treatment includes medical treatment, surgical treatment, Dental, ENT, General Surgery, Gynaecology, Ophthalmology, Orthopaedics, Paediatrics, Urology, Endocrine Problems, Neurosurgery packages consisting of 1516 Procedures.

The ISY card holders are beneficiaries of the scheme who can avail Tertiary health care services in any of the empanelled Government or Private Suvana Arogya Suraksha Trust Network hospitals. To accept the beneficiaries of the scheme in the Network hospitals additional MOU is not required. Required ISY formats are available in SAST Website, Scheme specific software has been developed in the System.

The beneficiaries holding ISY card and RSBY smart card can avail secondary health care facilities in any of the 1104 empanelled hospitals [Government Hospitals 633 and Private Hospitals -471]. The ISY card holders without RSBY Smart card can avail secondary health care facilities in any 633 government hospitals only. 81

The dependent member of the farmers who had committed suicide must give the correct & proper information to the officers who come to their door step to collect the information.

 The dependent member must produce individual photograph and ID of all the members.  The BPL card belonging to the farmers who had committed suicide that card with the dependent members names will be considered.  The sons of the farmers who had committed suicide having separate BPL card & living separately will not be considered.  Married daughters living with their husband will not be considered.  The dependent members will be considered on the basis of family tree produced with their married status.  If the young children‟s are mentioned as dependent members, their legal guardians to be identified and produce their photo & ID.

Progress of the Scheme:  Indira Suraksha Scheme details has been Published in SAST website along with specimen of ISY Card  Required software for the scheme has been developed and installed in the system  ISY guidelines are issued to all SAST Divisional Regional consultants, District coordinators, Arogya Mithras and network hospitals.  As per the scheme the beneficiary must be sick to avail the benefits. Till now no beneficiaries has come forward to avail the treatment under the scheme.

Indira Suraksha Yojane Cards Issued

Distribution Of Cards Applica Receive Incomp tion to Sl. d lete District Total make No Docume Inform 2016- 2017- number the nts 2015-16 ation 17 18 of Card cards issued

1 Chamarajanagar 8 5 3 - 8 - 2 Chikkaballapura 18 9 5 2 16 - 2 3 Chikkamagalur 149 56 62 29 147 1 1 4 Chitradurga 50 17 17 13 47 - 3 5 Kodagu 15 6 6 3 15 - 0 6 Tumakuru 106 51 42 13 106 - 0 7 Bagalkote 55 15 25 10 50 - 5 8 Belagavi 159 76 27 2 105 3 51 9 Shivamogga 91 39 31 19 89 2 0 10 Ramanagar 40 31 9 - 40 - - 11 Bangalore Urban 1 1 0 0 1 0 12 Bangalore Rural 5 5 - - 5 - 13 Bellary 25 17 7 - 24 1

Indira Suraksha Yojane Cards Issued

Distribution Of Cards Applica Receive Incomp tion to Sl. d lete District Total make No Docume Inform 2016- 2017- number the nts 2015-16 ation 17 18 of Card cards issued

14 Koppala 38 23 10 5 38 0 15 Vijayapura 46 32 12 - 44 2 0 16 Mysore 121 71 35 - 106 5 10 17 Udupi 8 8 - - 8 - 18 Gadag 34 25 9 - 34 0 19 Yadagiri 83 33 11 3 47 11 25 20 Kalburgi 72 50 20 - 70 0 2 21 Uttar Kannada 16 8 8 - 16 - 22 Mandya 163 85 60 15 160 3 23 Davanagere 30 16 11 - 27 3 24 Haveri 148 58 47 - 105 7 36 25 Bidar 93 46 31 3 80 6 7 26 Raichuru 62 33 12 1 46 0 16 27 Dharawad 109 46 48 15 109 - 0 28 Hasana 146 65 65 12 142 4 0 29 Kolar 14 9 4 1 14 - Dakshina 1 - 1 - 1 - 30 kannada Total 1906 936 618 146 1700 48 158

Till March 2018, no beneficiaries has come forward to avail the treatment under the scheme.

Arogyamitra:

For propogation of applicable scheme benefits and to fully guide and assist the SAST patients to avail tertiary treatment, Arogyamitras have been placed in a prominent place in all THCs, CHCs, District Hospitals, all empanelled Government and private hospitals. For new recruit Arogyamitras, two day orientation training is given and at regular intervals refresher trainings are also held. It is the duty of Arogyamitras to be a friend and guide to SAST patients in getting best treatment and that the patients are looked after well in the hospitals. To ensure that Arogyamitras are always close to the patients and not the hospitals, the services of Arogyamitras are rotated among different empanelled hospitals every six months. Apart from assisting the hospitals in submitting the preauths and claims, Arogyamitras duty is to identify and confirm the beneficiary details, to ensure that the patients have a good experience of the hospital, ensure that at the time of discharge beneficiary is given travel fare, medicines, correct discharge summary and advice on nature of care to be taken and whom to contact in an emergency. 83

The Arogyamitras should daily visit the patients and enquire as to treatment and well-being of the patient as per the recent circular.

Top 10 Hospitals:

In terms of number of cases treated under the scheme during 2017-18, the top 10 hospitals details are given below:

Amount Hospital Name District Cases in lakhs Kidwai Memorial Institute of Oncology Bangalore 5925 1985.65 SJICR Bangalore 4109 3072.86 JAGADGURU SRI SHIVARATHREESHWARA HOSPITAL Mysore 1565 666.7 PATIL NURSING HOME GULBARGA Gulbarga 1554 417.42 SJICR MYSORE Mysore 1513 856.94 KLES Dr Prabhakar Kore Hospital and MRC Belgaum 1382 866.60 Narayana Hrudayalaya Private Limited Bangalore 1336 843.21 INSTITUTE OF NEPHROUROLOGY Bangalore 1265 312.81 FATHER MULLER MEDICAL COLLEGE Dakshina HOSPITAL Kannada 1119 671.33 JUSTICE KS HEGDE CHARITABLE Dakshina HOSPITAL Kannada 1072 674.71

Specialty wise usage:

The details of increase in the number of cases handled specialty wise is given below:

Specialty 2016-17 2017-18 Burns 916 825 Cardiology 8703 12078 Cardiothoracic Surgery 4122 4454 Cardiovascular Surgery 458 334 Genito Urinary Surgery 10077 15326 Medical Oncology 6412 8605 Neuro Surgery 3206 4569 Nuclear Medicine 458 144 Paediatric Surgeries 1832 1160 Polytrauma 458 1644 Radiation Oncology 5038 5697 Surgical Oncology 4122 4820 Total 45803 59656

Age Band details of beneficiaries:

The number of persons treated under each category of age group is given below:

Age Band 2016-17 2017-18 0 - 10 3891 2507 11 - 25 3390 4768 26 - 45 14153 24108 46 - 60 14212 24076 60 & Above 10157 4197 Total 45803 59656

Division wise beneficiaries:

The details of division wise beneficiaries and increase compared to last year is given below:

Division 2016-17 2017-18 Bangalore 13741 17841 Belgaum 9619 12945 Gulbarga 7787 9309 Mysore 14657 19561 Total 45803 59656

From division, the district wise spread of beneficiaries is given below:

Division District 2016-17 2017-18 Bangalore - Rural 586 796 Bangalore - Urban 2834 4095 Chikkaballapur 929 1075 Chitradurga 1328 1797 Bangalore Davangere 1783 2295 Kolar 1146 1466 Ramanagar 1130 1543 Shimoga 1348 2129 Tumkur 2124 2645 Sub-Total 13208 17841 Baglakot 1455 1856 Belgaum 3223 4082 Bijapur 1582 2082 Belgaum Dharwad 804 917 Gadag 688 954 Haveri 1141 1591 Uttara Kannada 1146 1463 Sub-Total 10039 12945

Division District 2016-17 2017-18 Bellary 1517 1701 Bidar 1117 1320 Gulbarga 2011 2721 Gulbarga Koppal 995 1006 Raichur 1383 1472 Yadgiri 918 1089 Sub-Total 7941 9309 Chamarajanagar 1382 1672 Chikkamanaglur 1187 1841 Dakshina Kannada 1436 2096 Hassan 2667 3484 Mysore Kodagu 438 641 Mandya 2537 3564 Mysore 3838 5107 Udupi 1130 1156 Sub-Total 14615 19561 Grand Total 45803 59656

Gender wise beneficiaries who have availed benefit under the VAS scheme is as follows:

Gender 2016-17 2017-18

Female 16947 22393 Male 28856 37263

Total 45803 59656

1.21. Food Laboratory :

1. Suspected food samples are being tested and analyzed as per Food Safety and Standards Act, if the samples are found adulterated, legal procedure will be initiated by the food safety officers as per the provisions of the food safety and standards Act. 2. The State Food Laboratory is strengthened by way of supply of equipments and glassware‟s by the KHSDRP. 3. From 5th August, 2011, Prevention of food Adulteration act repealed and Food Safety and Standards Act came into effect in the Karnataka State. This Act will consolidate various act and orders relating to food, under this Act FSSAI has been established. FSSAI has been created for laying down science based standards for articles of food and to regulate manufacture, storage, distribution, sale and import to ensure availability safe and whole some food for human consumption. The government of Karnataka has notified the authorities and laboratories as per the requirement of food safety and standards Act for implementation.

Action Plan for 2017-18:

1. Construction of New State food laboratory is completed with the assistance of KHSDRP and purchase of equipments is also under progress. 2. Up gradation of the existing Divisional Labs are under process with the assistance of KHSDRP and FSSAI, New Delhi as per FSSAI guidelines. 3. Divisional Food Lab, Belgaum, Gulbarga and Mysore will be strengthened by procuring the required instrument with Central Assistance (FSSAI).

FSSA 2006 Report of Karnataka State during the year 2017-18 Total Unsafe/ samples Month Registration Licensing Samples Misbrand/ Analyzed Received Adulterated April 3216 1096 330 230 12 May 3388 1037 335 262 26 June 3626 1364 366 310 50 July 3542 1216 331 228 30 August 3462 1069 307 243 23 September 3158 1189 316 244 35 October 2942 1202 260 185 28 November 3412 1312 331 235 30 December 2996 1269 319 247 41 January 3282 1246 361 245 29 February 3305 1130 490 328 68 March 3356 1369 549 409 56 TOTAL 39685 14499 4295 3166 428

Food Safety and Standards Regulation:

Food Safety and Standards Act, 2006 came into force from August-5, 2011 in Karnataka State. Which consolidates various Acts & order Food Safety and Standards Act emphasizes on science based standards for articles of food and to regulate their manufacture, storage, distribution, sale and import to ensure availability of safe and wholesome food for human consumption. After the implementation of this Act, all other Food Related Acts have been repelled.

In Karnataka State, the Commissioner, Health & Family Welfare Services, has been additionally designated as Food Safety Commissioner. 238 various posts have been re designated and 177 new posts have been created. Cadre Recruitment rules have been framed and action is being taken to fill up the posts.

The budget of Rs.212.00 Lakhs has been allotted for the year 2017-18 under Head of Account: 2210-06-102-0-02 (Plan) Sub Head: 059. Out of Rs 212.00 Lakhs, 212 Lakhs was released in three installments from the Directorate of HFW services, out of which Rs 192.23Lakhs was utilized. This budget is used for the salary of contractual staff, Manual Labours, fuel expenditure and for other office expenditure.

Action Plan for 2017-18:

 Up gradation of the existing state Lab and Divisional Labs are under process with the assistance of KHSDRP and FSSAI, New Delhi .

 Allocation of Funds and Expenditure for the year 2017-2018 (Up to MARCH-2018):

Head of Account Released Expenditure Remarks Lakhs ( Rs) Lakhs (Rs) 2210-06-107-0-01 986.00 833.17 2210-06-001-0-01 FIT 39..74 20.62 2210-06-101-1-02 35.32 5.93 NMAP 2210-06-102-0-02 212.00 192.23

PUBLIC HEALTH INSTITUTE, SHESHIDRI ROAD, BANGALORE. PERFORMANCE REPORT FOR PUBLIC HEALTH INSTITUTE, SHESHIDRI ROAD, BANGALORE. PERFORMANCE REPORT FOR THE MONTH OF MAR- 2018.

Cumulative Total samples total no of Sl. analysed samples NO SECTIONS OF PHI during the analysed from . month of April-2017 to MAR-2018 – MAR-2018 I WATER BACTERIOLOGY Bacteriological analysis of water for drinking 143/141/27 1805/1239/2 purpose, analysed Borewell/Tapwater/Others 7 205 Number found fit for potable purpose. 68/67/162 727/596/115 0 Number found unfit for potable purpose 75/74/115 173/390/643 II DIAGNOSTIC BACTERIOLOGY Bacteriological analysis of water for isolation of V, - 16 1 Cholera No of samples received. Number of sample analysed. - 16 Number of samples positive for V. Cholera. - - 2 Bacteriological analysis of stool sample for isolation of - 42 V. Cholera Number of samples negative for V, Cholera - 42 Number of samples positive for V. Cholera - - 3 Bacteriological analysis of food for Coli forms and other 61 476 specific pathogens,analysed Number of samples found positive 01 22 Number of samples found negative - III Yellow Fever Vaccination and International Certificate 512 6305 Give IV CHEMICAL EXAMINER‟S LABORATORY - - 1 Number of suspected Norcotics samples Tested - - No. of samples found abnormal - - 2 No of Lokayuktha samples received. - - No. of samples analysed. - - No, samples found positive/Sub standard. - - 3 No. of Blood and Urine samples received for alcohol - - No. of samples analysed. - - No of samples found Positive (As per ISI standard ) - - 88

4 Liquor Samples - - Opening balance - 28 Samples received - 28 Total - 28 Samples Analyzed - - No samples found positive / substandard - - Pending - - 5 ACB - - Opening balance 12 111 Samples received 12 111 Total 12 111 Samples Analyzed - - Pending - - V STATE FOOD LABORATORY - - 1 Opening balance during the month.( under FSSA ) 48 48 No of food samples received under FSSA 91 91 Total samples 139 676 No of food samples analyzed 121 658 No of samples Found unfit for Analysis - 5 No of samples Found unsafe/substandard 6/7 20/14 No. of samples misbranded. 8 38 Closing Balance 18 18 2 Opening balance during the month. ( under Non-FSSA 197 197 ) No of food samples received under Non FSSA 699 896 Total samples 896 1122 No of food samples analyzed during the month 670 8322 No of samples Found unfit for analysis - 9 No of samples found unsafe/substandard. 23/0 65/134 No. of samples found misbranded. 34 473 Closing Balance 226 226 VI TRAINING SECTION - - I Post Graduate Doctors - - 1 Post Graduate. MD trained/visited Microbiologist - 20 2 Post Graduate MDS trained/visited Microbiologist - 5 Under Graduate Doctors - 3 Doctors B A M S trained/visited 9 17 4 Doctors B D S trained/visited - - Students from other Institution - - 5 Post Graduates 28 28 6 Sanitary health inspector - - 7 Under Graduate - 85 Nursing Student - - 8 B Sc Nursing - 72 9 General Nursing ( LHV‟S ) 30 60 10 Senior Lab Technicians - - 11 Junior Lab Technicians - 2 12 Nodal Officers/DSO/A.O/DO‟s - - 13 F.S.O - - 14 Excise sub inspectors - -

VIRAL SENTINAL SURVEILLANCE LAB - - 1 Chickangunya;- - - No. of samples received 25 1446 No. of samples tested 25 1446 No of Positives 3 339 No. of equivocal - - 2 Dengue:- - - No of samples received 38 3241 No. of samples tested 38 3241 No. of Positives 4 1546 No. of equivocal - 44 3 J E: - - No. of samples received - - No. of samples tested - - No. of Positives - -

STAFF POSITION OF GAZETTED & NON-GAZETTED EMPLOYEES OF PUBLIC HEALTH INSTITUTE AS ON 31/03/2018.

Sl.No DESIGNATION SANCT WORK VACANT IONED ING 1. JOINT DIRECTOR (LABS) 1 - 1 2. DEPUTY DIRECTOR (Bacteriology) 1 - 1 3. CHEMICAL EXAMINER 1 1 - 4. ASSSISTANT MICROBIOLOGIST 1 1 - 5. JUNIOR MICROBIOLOGIST 1 1 - 6. TRAINING OFFICER (FIT) 1 1 - 7. CHIEF FOOD ANALYST 1 - 1 8. SENIOR FOOD ANALYST 1 1 - 9. FOOD ANALYST 6 4 2 10. JUNIOR FOOD ANALYST 13 5 8 11. ASSISTANT ADMINISTRATIVE OFFICER 1 1 - 12. SENIOR HEALTH ASSISTANT (NAMP) 1 1 - 13. OFFICE SUPERINTENDENT 2 2 - 14. FIRST DIVISION ASSISTANT 6 6 - 15. SECOND DIVISION ASSISTANT 4 3 1 16. STENOGRAPHER 1 - 1 17. TYPIST 1 - 1 18. SENIOR MEDICAL LAB. TECHNOLOGIST 10 10 - 19. JUNIOR MEDICAL LAB. TECHNOLOGIST 13 12 1 20. DRIVER 1 1 - 21. LAB. ASSISTANT 26 1 25 22. ELECTRICIAN 1 1 - 23. WATCH MAN 1 - 1 24. GROUP “D” 7 7 - 25. GROUP-D (FIT HEAD) 1 1 - TOTAL 103 60 43

STAFF POSITION OF GAZETTED & NON-GAZETTED EMPLOYEES OFFOOD SAFETY AS ON 31/03/2018.

Sl Sanctione Working Category of Posts Vacancy Remarks No d of Posts of posts 1 Commissioner of Food Encadred to IAS 01 01 00 Safety 2 Joint Commissioner of Food In charge 01 01 00 Safety 3 Deputy Commissioner of In charge Food Safety (Administration) 01 01 00 4 Deputy Commissioner of In charge Food Safety (Squad) 01 01 00

5 Chief Food Analyst 04 04 00 In charge

6 Senior Food Analyst 04 04 00 7 Designated Officer Deputation 36 36 00 from Health Department 8 Food Analyst / Assistant Chemical Examiner (Non- 14 12 02 Medical) 9 Legal Advisor 01 0 01 Deputation 10 Junior Food Analyst 25 07 18

11 Junior Microbiologist 01 00 01 Deputation 12 Senior Food Safety Officer Deputation 34 12 34 from Health Department 13 Assistant Administrative Deputation 01 01 00 Officer 14 Food Safety Officer Deputation /Additional 210 197 13 Charge from Health Department 15 Assistant Statistical Officer 01 00 01 Deputation 16 Stenographer 01 00 01 Deputation 17 First Division Assistant Deputation 40 09 31 from Health Department 18 Group- D 06 00 06

Total 382 274 108

PART II

DRUGS CONTROL DEPARTMENT

ANNUAL ADMINISTRATIVE REPORT OF THE DRUGS CONTROL DEPARTMENT KARNATAKA STATE FOR THE YEAR 2017-18

DRUGS CONTROL DEPARTMENT:

2.1 Introduction The State Drugs Control Department is existing since 1956 as an independent department under the control of the Ministry of Health and Family Welfare. It is headed by the state Drugs Controller. The main objective of the Department is to implement the Drugs and Cosmetics Act, 1940 and Rules there under and to ensure the quality of the Drugs and Cosmetics manufactured and marketed in the State in the interest of the public health. By exercising strict control and vigilance on the drugs marketed in the State, the Department eradicates the menace of Spurious and substandard drugs, ensures safety of drugs and their availability on the controlled prices to the public.

The Department has three wings:

1. The Enforcement Wing 2. Drugs Testing Laboratory and 3. The Pharmacy Education.

Drugs Control Department discharges the statutory functions involved in the enforcement of the following enactments:  Drugs & Cosmetics Act, 1940 & rules thereunder  Drugs (Prices Control) Order, 2013(an order issued under the Essential Commodities Act).  Drugs & Magic Remedies (Objectionable Advertisement) Act,1954 & Rules,  Narcotics Drugs & Psychotropic Substances Act, 1985 in relation to Drugs covered under the Drugs & Cosmetics Act, 1940 & Rules thereunder.

During the financial year 2017-18, a total provision of Rs. 4132.85 (of which Rs. 3988.85 under the State scheme and Rs. 144.00 lakhs – under Centrally sponsored schemes) have been allocated for the Department.

The establishment and construction work of laboratory buildings of 2 Regional Drugs Testing Laboratories one at Hubballi and the other at Bellary in North Karnataka, are completed through KHSDRP and have already started functioning in respective own buildings as proposed under the State budget 2008- 09. The Department is taking initiatives to get the NABL accreditation in the National level for these two laboratories as proposed in the State budget 2014-15.

SAKALA:

The Department is providing 22 services under SAKALA Scheme to assure the accomplishment of services to the public within the specified time frame. From 01/04/2017 to 31/03/2018, a total of 13918 applications are disposed.

The licensing activity of the drugs sales establishments is fully computerized and the licensing process is online while the computerization of process of licensing to drug manufacturing units is under progress. The Department has successfully adopted the LMS/FMS software under e-governance for its internal files and letters management. The Department has also successfully implemented e-sampling program for the process of Drug Testing and Analysis in the State Drugs Testing Laboratories as a part of e-governance. The information about the substandard drugs is being published through the Departmental web portal, as soon as it is declared as substandard quality. The information is reflected in the department portal and around 35,000 auto generated SMS alerts will reach the various stakeholders like, retailers, wholesalers, Doctors & enforcement officers to prevent the use of substandard drugs. The information is also published in the Newspapers.

The department has got an allotment of 4.30 acres of land, by the District Commissioner, Gulbarga, for the establishment of a Government College of Pharmacy at Gulbarga, with an estimated cost of Rs. 40.00 crores.

In order to encourage the Pharmacy Education in the State, Admissions through CET has been introduced for the B.Pharma Education.

MOU has been entered with the Karnataka Power Corporation Limited for the construction of a multi storied building of 1,19,000 sq. ft. to the department in department site situated back side of the existing Drugs Control Department. The construction of the building is nearing completion.

In the financial year 2017-18 Rs.465.85 lakhs has been allocated for the construction of the department sub office buildings. The construction of office building at Shivamogga completed.

2.2 Organisation set up:

Drugs controller is the head of the Drugs Control Department. Drugs Controller is assisted by Additional Drugs Controller. Drugs Control Department is organized into enforcement/administration division, Drugs Testing Laboratory and Pharmacy Education division. Organization is as below,

Working strength of the Drugs Control Department of categories Group-A, Group- B, Group-C and Group-D with respect to the sanctioned, filled up and remained vacant posts is as follows as on 31.03.2018.

Number of posts Category Sanctioned Filled up Vacant Group-A 116 101 15 Group-B 254 131 123 Group-C (Technical) 67 21 46 Group-C (Non-Technical) 238 141 97 Group-D 111 44 67 Grand Total 786 438 348

158 posts created by government vide G.O.No. HFW/383/PTD/2012 Dt. 06/01/2015 Group A- Principal-01, Professor-12, Assistant professor-20, GroupB- Lecturers- 42, Gazetted Assistant-01, Group C- Superintendant-02, Junior Engineer-01, First Division Assistant-08, Computer operator-08, Librarian-02, Store keeper-02, Second Division Assistant-08, Typist-08, Lab Technicians(Drugs)- 02, Lab. Technician-10, Group D- Lab. Supervisor-20, Attendor-08, Gardener-02, Animal Supervisor-01.

2.3 Enforcement Wing: Enforcement wing consists of an Additional Drugs Controller assisted by 13 Deputy Drugs Controller, (4 DDC‟s Vacant) Deputy Drugs Controller are assisted by 60 Assistant Drugs Controllers (4 ADCs vacant) under Assistant Drugs Controllers112 Drugs Inspectors are provided. (83 Drugs Inspectors posts are vacant as on 31.03.2018). Enforcement wing is laterally assisted by State Intelligence Branch,6 Drugs Inspectors are working under an Assistant Drugs Controllers at Bengaluru under the supervision of Additional Drugs Controller and 2 drugs Inspectors in each of the 8 regional Deputy Drugs Controller offices under the supervision of the regional Deputy Drugs Controller.Enforcement wing is technically assisted by a System Analyst.Circles are headed by Assistant Drugs Controllers and are functioning under the jurisdiction of each regional offices of Deputy Drugs Controller.

DDC REGIONAL Sl.No. ADC CIRCLES OFFICE Bangalore: Circle-1, Circle-2, Circle-3, Circle- 01 Bengaluru 4, Circle-5, Circle-6, and Bangalore Rural Circle Mysore: Circle-1 & Circle-2, Chamarajanagar 02 Mysore Circle, Kodagu Circle and Mandya Circle. Dharwad Circle, Karwar Circle, Haveri Circle, 03 Hubballi GadagCirlce. Kalburgi Circle, Bidar circle and Bijapur 04 Kalburgi circle Bellary Circle, KoppalCircle,Raichur Circle 05 Bellary and Yadgir Circle 06 Belgaum Belgaum Circle and Bagalkot Circle, ChitradurgaCircle,Davanagere Circle and 07 Davanagere Shimoga Circle Udupi Circle, Mangalore Circle, Hassan Circle 08 Mangalore and Chikkamangalur Circle Tumkur Circle, Chikkaballapur Circle, Kolar 09 Tumkur Circle and Ramanagar Circle

PERFORMANCE OF ENFORCEMENT WING

PARTICULARS 2017-18 (31.03.2018) Number of manufacturers units in the state a Drugs Manufacturing units 296 b Loan License Manufacturers 397 c Cosmetic Manufacturing units 64 d Cosmetic Loan License Manufacturing units 33 e Repacking Units 04 f Approved Laboratories 34 g Blood Banks 207 h Blood storage Centers 236 i Cord Blood Bank (Stem Cells) 05 Total Number of Sales premises in the State 32626 NUMBER OF INSPECTIONS CARRIED OUT Sales premises 26876 Manufacturing Premises 289 Blood Banks / Blood storage Centers 450 STATUTORY ACTION TAKEN Sales Suspension 1342 License Cancellations 654 Manufacturing Show cause notice issued 58 License Cancellations 28 Stop Production 12 Product permission Suspension - Product permissions 02 with drawn/Cancelled Blood Bank License Cancellations - Stop Collection - Show cause notice issued 24 Suspension orders issued 01 Number of prosecution cases launched under Drugs and Cosmetic Act, 1940 and Drugs (Price Control) order 36 1995/2013& DMR Number of cases convicted 88

PROSECUTIONS INSTITUTED

The following are the details pertaining to the prosecutions instituted under Drugs and Cosmetic Act, 1940 and Rules 1945, Drugs (Price Control) Order, 2013. (An order issued under Essential Commodities Act. 1955) and Drugs and Magic Remedies (Objectionable advertisement) Act, 1954 and Rules thereunder, during the year2017-18 (1st April 2017 to 31st March 2018).

Legislation Particulars Sl.No. D&C Act D.P.C.O D.M.R 1940 1995/2013 Prosecutions pending at the beginning 01 625 39 04 of the year(i.e. as on 01.04.2017) Prosecutions launched (up to 02 31.03.2018) 36 - - (During 2017-18) 99

03 Total (as on 31.03.2018) 661 39 04 Prosecutions decided(as on 88 03 02 31.03.2018) (a) Cases ended in 26 - 01 04 acquittal/discharged (as on 31.03.2018) (b) Cases ended in Convictions 62 - 01 (as on 31.03.2018) Prosecutions pending as on 05 573 36 02 31.03.2018 Total Number of cases as on 06 611 31.03.2018

2.4 DRUGS TESTING LABORATORY WING Drugs Testing Laboratory division is headed by Principal Scientific officer and is assisted by 3 Chief Scientific Officer‟sof 3 laboratories. 19 scientific officers are working as government analysts. Out of 113 junior scientific officers 34 posts remained vacant as on 31.03.2018. Chief Scientific Officers are assisted by administrative gazetted assistants.

Drugs Testing Laboratory is provided with Hi-tech equipment‟s and trained technical personnel and is equipped to analysis all types of drugs and cosmetic (except vaccines, sera, blood & blood products). There are three Drugs Testing Laboratories in Karnataka, one in Bangalore and one each as Regional Drugs Testing Laboratories in North Karnataka at Hubballi and Bellary.

1. Drugs Testing Laboratory, Bangalore. (a) Number of samples analyzed 3678 (b) Number of samples found to be Standard quality 3413 (c) Number of samples found to be Not of Standard quality 265

(b) Number of (a) Number of samples found samples to be analyzed, 3678 Standard quality, 3413

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2. Regional Drugs Testing Laboratory, Hubballi (a) Number of samples analysed 1895 (b) Number of samples found to be Standard quality 1833 (c) Number of samples found to be Not of Standard quality 62

(c) Number of samples found to be Not of Standard quality, 62 (a) Number of samples (b) Number of analysed, samples found to 1895 be Standard quality, 1833

3. Regional Drugs Testing Laboratory, Bellary (a) Number of samples analysed 1966 (b) Number of samples found to be Standard quality 1813 (c) Number of samples found to be Not of Standard quality 153

(a) Number of (b) Number of samples analysed, samples found to 1966 be Standard quality, 1813

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Total samplesfrom all the three laboratories for the period 2017-18

Total No. of Standard Not of Standard Sl.No. DTL/RDTL Samples analysed quality Quality 1 Bangalore 3678 3413 265 2 Hubballi 1895 1833 62 3 Bellary 1966 1813 153 4Total 7539 7059 480

8000

7000

6000

5000 1 4000 2

3000 3 4Total 2000

1000

0 DTL/RDTL Total No. of Standard quality Not of Standard Samples analysed Quality

2.5 Pharmacy Education: Administrative control and supervision of Pharmacy Education vests with Drugs Controller. There is one Government College of Pharmacy situated in Bangalore. Board of examination authority is functioning for managing the affairs for conducting examinations for Diploma Courses in Pharmacy.

Pharmacy Education consists of two wings i.e. 1. Government College of Pharmacy at Bangalore. 2. Board of Examining authority at Bangalore (BEA)

Government college of Pharmacy, Bangalore started in the year 1964 under the administrative control of this Department. The Pharmacy education imparted at Diploma, Degree and Post Graduate levels. The Government of India through AICTE is supporting with 100% assistance for the development of Post –graduate courses in Pharmacy.

The following disciplines are established under the Post-graduate course

1. Pharmaceutics 2. Pharmacology

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3. Pharmacognosy 4. Pharmaceutical Chemistry

Details of the candidates for final examinations for the period 2017-18 Month Name of the Course Duration May/June- Appeared Passed 2017 M Pharm (Master‟s Degree in First Year 31 22 2 years Pharmacy) Final Year 29 29 First Year 40 22 B Pharm (Degree in Second year 48 36 4 years Pharmacy) Third year 48 34 Final Year 54 39 D Pharm (Diploma in First Year 75 59 2 years Pharmacy) Final Year 59 43

Board of Examination Authority, Bangalore: The Board of Examining Authority is entrusted with the responsibility of enforcing education regulations stipulated by the Pharmacy Council of India at Diploma level in the State with respect to conduct of examinations at Diploma level for the students admitted in the Government and Private Pharmacy Colleges in the State. The Principal Government College of Pharmacy is functioning as ex-officio Chairman, and the Deputy Drugs Controller on deputation functioning as ex-officio Member Secretary of the Board. There are 143 Private Colleges imparting Diploma in Pharmacy Education and one Government College of Pharmacy in the State. Details of the students appeared for D Pharm examinations conducted by Board of Examining Authority during the period 01/04/2017 to 31/03/2018.

Number of Students appeared for E.R-91 ER Sl.No. Examination April -2017 December – 2017 [D Pharma Annual Examinations] (Annual) (Supplementary)

No. of the Students appeared for 1st 5987 D Pharm 10216 1. Number of Students Passed in 1st 3153 1469 D Pharm Number of Students appeared for 5075 2197 Final year D Pharm 2. Number of Students passed in Final 2658 801 year D Pharm

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Achievements of Drugs Control Department for the year 2017-18

 Under the Karnataka Guarantee of Services to citizens Act-2011. The Drugs Control Department is providing 22services of which 5 services are related to grant and renewal of licenses for sale of Drugs. Grant of Licenses for the establishment of Medical Stores/Chemist & Druggists. 17 services are related to manufacturing of drugs & cosmetics which are included in the current year.

Competent Designated Time Designated Competent Authority Appellate Sl.no. Service List Officer limit to Officer Authority time limit Authority time limit Dispose to Dispose Regional Assistant 30 15 Additional 15 Deputy 1 Grant of License Drugs Working Working Drugs Working Drugs Controller days days Controller Days Controller

Regional Assistant 30 15 Additional 15 Deputy 2 Renewal of License Drugs Working Working Drugs Working Drugs Controller days days Controller Days Controller

Regional Registered Assistant 15 Additional 15 7Working Deputy 3 Pharmacist Drugs Working Drugs Working days Drugs Change/Cancellation Controller days Controller Days Controller

Regional Assistant 15 Additional 15 Competent Person 7 Working Deputy 4 Drugs Working Drugs Working Change/Cancellation days Drugs Controller days Controller Days Controller

Regional Assistant 15 Additional 15 7 Working Deputy 5 Changing of Name Drugs Working Drugs Working days Drugs Controller days Controller Days Controller

Grant of Fresh Drug Deputy Principal Drugs 6 Manufacturing 60 days Secretary 15 days Secretary 15 days Controller license HFW HFW Renewal of Drug Deputy Principal Drugs 7 Manufacturing 210 days Secretary 15 days Secretary 15 days Controller license HFW HFW Deputy Principal Issue of WHO GMP Drugs 8 7 days Secretary 15 days Secretary 15 days Certificate Controller HFW HFW Deputy Principal Issue of Free Sale Drugs 9 7 days Secretary 15 days Secretary 15 days certificate Controller HFW HFW Deputy Principal Issue of Market Drugs 10 7 days Secretary 15 days Secretary 15 days Standing Certificate Controller HFW HFW Issue of GMP Deputy Principal Drugs 11 Certificate as per 7 days Secretary 15 days Secretary 15 days Controller Sch. „M‟ HFW HFW Issue of No Deputy Principal Drugs 12 Conviction Drugs 7 days 15 days Secretary 15 days Controller Certificate Controller HFW Deputy Principal Issue of Production Drugs 13 7 days Secretary 15 days Secretary 15 days capacity certificate Controller HFW HFW Deputy Principal Issue of Licence Drugs 14 Drugs 7 days 15 days Secretary 15 days Validity Certificate. Controller Controller HFW

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Deputy Principal Issue of Essentiality Drugs 15 7 days Secretary 15 days Secretary 15 days Certificate Controller HFW HFW Deputy Principal Issue of Neutral Drugs 16 Drugs 7 days 15 days Secretary 15 days Code Number Controller Controller HFW Issue of Deputy Principal Drugs 17 Manufacturing and 7 days Secretary 15 days Secretary 15 days Controller Marketing Certificate HFW HFW Deputy Principal Issue of Quality and Drugs 18 7 days Secretary 15 days Secretary 15 days Capacity Certificate Controller HFW HFW Deputy Principal Issue of Performance Drugs 19 10 days Secretary 15 days Secretary 15 days Certificate. Controller HFW HFW Issue of Installation Deputy Principal Drugs 20 / Registration / 7 days Secretary 15 days Secretary 15 days Controller Products certificate HFW HFW

Issue of Certificate of pharmaceutical Deputy Principal Drugs 21 Products (COPP) For 20 days Secretary 15 days Secretary 15 days Controller the recommended HFW HFW products

Issue of Good Deputy Principal Drugs 22 Laboratory Practice 7 days Secretary 15 days Secretary 15 days Controller Certificate HFW HFW

 Right to information Act, 2005: Under right to information Act 2005 in Drugs Control Department, Drugs Controller for the State of Karnataka is the public Authority, the Additional Drugs Controller is designated as first Appellate Authority, 41 officers are designated as public information officers in Head office, Regional Deputy Drugs Controller offices, all District Circle offices, Drugs Testing Laboratory Bangalore, Regional drugs testing Laboratories Hubballi and Bellary, Government College of Pharmacy.  Drugs Testing Laboratory Bangalore has received NABL accreditation.  Regional Drugs Testing Laboratories, at Hubballi and Bellary are under process of obtaining NABL accreditation.  Establishing of Government College of Pharmacy in Gulbarga at an estimated cost of Rs. 40.00 crores is under process, 4.30 acres of land is obtained for construction of college.  “Technical Cell” is established in the department for the speedy disposal of the application filed by the manufacturers in order to boost the exports.  Department took part in the “India Pharma-2018” held at Bangalore International Exhibition Centre , a stall was set up to showcase the achievements made by the department and services provided by the

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department in promoting the Medical Devices and Pharmaceutical manufacturing in the state.  The Department has implemented e-sampling system in laboratory. As soon as drug is declared as substandard quality, the information will be reflected in departmental portal and around 35,000 auto generated SMS alerts will reach the various stock holders like retailers, wholesalers, Doctors and Enforcement Officers to prevent the use of substandard drugs.  Construction of own office buildings at Belgavi and Shivamogga are completed.  Department in association with NIC is monitoring the blood bank networking in the name of JeevaSanjeevini at URL https://blood.kar.nic.in/for citizens to access the availability of blood and blood components.

495 product permissions are granted for exports on priority to the manufacturers in the year 2017-18 based on the NOC from DCG(I)

3751 Certificate of Pharmaceutical Products (COPP) are issued to the manufacturers for the registration of their products in various countries in the year 2017-18.

 Conducting of examinations for the D Pharm course is by online transmission of question papers to various examination centers.  In 2016-17 budget honourable Chief Minister of Karnataka was pleased to sanction construction of Ladies Hostel at GCP, Bangalore. Construction is under progressat cost of Rs. 999.00lakhs.  Product permissions granted to manufacture of Drugs & Cosmetics for sale during 2017-18are detailed below;

Details Domestic Export Total Drugs 1311 2228 3539 Cosmetics 197 22 219

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2.6 FINANCE Budget Allotment and Expenditure for theyear 2017-2018 (01.04.2017 to 31.03.2018)

State Sector (Rs. in lakhs)

Sl. Budget allotment Expenditure for the No. BUDGET HEAD for 2017-2018 year 2017-18 (upto 31.03. 2018)

1. 2210-06-104-0-01 1753.00 1490.88 Drugs Controller 2. 2210-06-104-0-02 557.00 525.11 Drugs Testing Laboratory 3. 2210-06-104-0-12 362.00 271.99 Drugs Testing Laboratory , Hubballi 4. 2210-06-104-0-13 316.00 247.55 Drugs Testing Laboratory, Bellary 5. 2210-05-105-1-14 535.00 514.26 Govt. College of Pharmacy 6. 4210-03-105-02-03 465.85 312.79 Drugs Controller - Buildings 7. 4210-04-200-1-04 Government College of Pharmacy. - - North karnataka Total 3988.85 3362.58(84.3%)

Central Sector (Rs. in lakhs)

Sl. Budget Expenditure for the BUDGET HEAD allotment for year 2017-18 (31.03. No. 2017-18 2018) 2210-05-105-1-15 Central Plan Schemes for Research work in Govt., 1. College of Pharmacy, 144.00 168.54 Bangalore and Development of Post graduate courses TOTAL: 144.00 168.54

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REVENUE RECEIPTS FOR THE YEAR 2017-18

(Rs. in lakhs) SL. Revenue Receipts for BUDGET HEAD NO. the year 2017-18 0210-04-104-2-01 1. 462.24 Drugs Controller 0210-03-105-0-01 2. Government College of Pharmacy & 484.42 Board of Examining Authority TOTAL 946.66

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PART III

AYURVEDA, YOGA & NATURE CURE, UNANI, SIDDHA AND HOMOEOPATHY (AYUSH DEPARTMENT)

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AYURVEDA, YOGA & NATURE CURE, UNANI, SIDDHA AND HOMOEOPATHY (AYUSH DEPARTMENT)

3.1. Organisation Set Up

Government of Karnataka Additional Chief Secretary

Health and Family Welfare

COMMISSIONER Health and Family Welfare& AYUSH Services

DIRECTOR Department of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homoeopathy)

Deputy Director-(Ayu) deputy drug Chief Chief Planning & Deputy Deputy Director-(Unani) controller Administrative Development Director Deputy Director-(Hom) Officer (Pharmacy) Officer Deputy Director (NC& Yoga Deputy Director (Pharmacy) Asst. Controller Joint Director of Drugs (M.E) Drug Testing Planning Officer Laboratrory

Administrative Accounts Principals Govt/ Drug Officer Officer Aided /Un Aided District AYUSH Inspector Bagnalore, Ayush Medical Officers Mysore, Belgaum, Colleges Kalaburgi

Prog. Officer: SENIOR MEDICAL OFFICER (AYUSH) -CSS MEDICAL OFFICER (AYUSH) -NHM -IEC

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The Department of AYUSH includes both AYUSH Health & AYUSH Medical Education sectors. This Department is rendering Health care, Medical relief to the public through AYUSH Ayurveda, Yoga and Naturopathy Unani, Homeopathy Medicine Systems. Regulates AYUSH Medical Education, AYUSH Drugs Manufacturing, Research unit & AYUSH Medical practice in the state.

The Director of AYUSH is being assisted by One Joint Director (Medical Education), One Chief Administrative Officer (KAS Scale), Drug Licensing Authority , One each Deputy Directors for Ayurveda, Unani, Homoeopathy and Nature Cure &Yoga, Planning and Development Cell, One Administrative Officer and One Accounts Officer at the Directorate level under the supervision of the Commissioner of Health and Family Welfare and Ayush services. District AYUSH Officers are looking after their Dist. Hospitals, Taluk Hospitals and Dispensaries.

2017-18 Budget details is as follows (Rs. In lakhs)

State Sector ZP Sector Budget Expenditure Budget Expenditure Non-plan 14461.63 13012.74 32871.78 10339.57

The Staff Position of the Department is as follows:

Non-Teaching Teaching Total Sancti Sancti Sanctio Filled Vacant Filled Vacant Filled Vacant oned oned ned Group-A 1074 806 268 329 129 200 1403 935 468 Group-B 46 19 27 - - - 46 19 27 Group-C 1129 451 678 - - - 1129 451 678 Group-D 1650 596 1660 - - - 1650 590 1060 Total 3899 1866 2033 329 129 200 4228 1995 2233

3.2 HEALTH SECTOR:

The Hospitals and Dispensaries which comes under ZP Sector are being monitored by the concerned District‟s District AYUSH Officers. Government Central Pharmacy Bangalore supplies 60% of Medicine (Ayurveda and Unani) to Govt. AYUSH Hospitals and Dispensaries & 40 % of Medicine procured & supplied from Karnataka State Drug Logistics &Warehousing Society, Bangalore and Indian Medicines Pharmaceutical Corporation Limited, (Central Government Enterprise). 100% of Homoeopathic medicines procured and supplied from Central & State Government Enterprises.

The Details of Hospitals with bed strength and dispensaries functioning in this State as on 31-03-2018.

The system wise break up is given here under:

Sl Systems Government Hospitals No. of No. dispensaries No. of No. of Hospitals Beds. 01 Ayurveda 115 1821 564 02 Unani 18 392 49 03 Homoeopathy 18 260 43 04 Nature Cure 05 46 05 05 Yoga 03 15 Total 159 2534 661

DISTRICTWISE DISPENSARIES OF AYUSH DEPARTMENT IN STATE AS ON 31-03-2018 Dispensaries Homoeo Nature Sl. District Ayurveda Unani Total pathy Cure 1 Bangalore (U) 10 2 2 - 14 2 Bangalore (R) 06 01 1 - 08 3 Kolar 5 01 - - 06 4 Tumkur 25 1 1 1 28 5 Shimoga 34 - - - 34 6 Chitradurga 32 - - - 32 7 Davanagere 31 - - 1 32 8 Mysore 30 1 - - 31 9 Chamarajanagar 10 2 - - 12 10 Hassan 53 6 1 - 60 11 Mandya 20 3 - - 23 12 Kodagu 8 - 1 - 9 13 Chikkamagalur 41 1 1 1 42 14 Udupi 14 - - - 14 15 D.Kannada 4 2 1 - 7 16 Belgaum 24 1 6 1 32 17 Dharwad 12 - 1 1 14 18 Gadag 17 - 3 - 20 19 Haveri 9 1 4 - 14 20 Vijayapura 12 - 1 - 13 21 Bagalkote 15 1 - - 16 22 Uttar Kannada 12 - - - 12 23 Kalaburgi 21 8 3 - 32 24 Raichur 12 4 1 - 17 25 Koppala 13 2 1 - 16 26 Bidar 16 5 2 - 23 27 Bellary 64 1 3 - 68 28 Ramanagara 7 1 - - 8 29 Chikkaballapura 4 1 - - 5 30 Yadgiri 3 4 10 - 17 TOTAL 564 49 43 5 661

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DISTRICTWISE HOSPITALS OF AYUSH DEPARTMENT IN STATE AS ON 31-03-2018 Hospitals Nature Ayurveda Unani Homeopathy Cure Yoga Total Sl. District

No Beds No Beds No Beds No Beds No Beds No Beds 1 Bangalore (U) 4 296 2 200 2 105 1 10 1 5 10 616 2 Bangalore (R) 3 26 ------3 26 3 Kolar 2 20 - - 1 10 - - - - 3 30 4 Tumkur 5 46 1 10 ------6 56 5 Shimoga 1 100 2 20 1 10 - - - - 4 130 6 Chitradurga 5 42 ------5 42 7 Davanagere 3 26 ------3 26 8 Mysore 9 333 1 10 1 10 1 6 1 5 13 364 9 Chamarajanagar 3 26 - - - - 1 10 - - 4 36 10 Hassan 6 67 - - 2 20 - - - - 8 87 11 Mandya 5 48 1 10 1 05 - - - - 7 63 12 Kodagu 3 25 - - 2 15 1 10 - - 6 50 13 Chikkamagalur 4 32 ------4 32 14 Udupi 3 30 ------3 30 15 D.Kannada 3 31 - - 1 10 - - - - 4 41 16 Belagavi 6 44 - - 1 10 - - - - 7 54 17 Dharwad 3 45 ------3 45 18 Gadag 4 36 ------4 36 19 Haveri 3 22 ------3 22 20 Vijayapura 3 70 1 10 1 10 - - - - 5 90 21 Bagalkote 5 46 - - 1 10 - - - - 6 56 22 Uttar Kannada 3 26 1 10 ------4 36 23 Kalaburagi 7 58 2 60 1 15 - - - - 10 133 24 Raichur 3 35 2 16 ------5 51 25 Koppala 4 32 ------4 32 26 Bidar 3 31 1 10 ------4 41 27 Bellary 6 184 1 10 2 20 1 10 1 5 11 229 28 Ramanagara 2 16 1 10 1 10 - - - - 4 36 29 Chikkaballapura 1 06 1 10 ------2 16 30 Yadagiri 3 22 1 6 ------4 28 TOTAL : 115 1821 18 392 18 260 5 46 3 15 159 2534

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3.3 AYURVEDA SYSTEM:

In the State Four Ayurveda Medical Colleges with attached Hospitals details are given below. Sl.N Bed Hospitals Details o Strength 1 Sri Jayachamarajendra Institute of Indian Medicine, 275 beds Bangalore. 2 Government Ayurveda Medical College and Hospital, Mysore. 175 beds 3 Taranatha Government Ayurveda Medical College and Hospital, 150 beds Bellary. 4 Government Ayurveda Medical College and Hospital, Shimoga. 100 beds

In State Sector District and Taluk level working Ayurveda Hospitals details are given below:

Sl. Beds Details of Hospitals No Strength 1 Hi-Tech Panchakarma Hospital, Mysore. 100 Beds 2 Taluk Govt. Ayurveda Hospital, Arasikere, Hassan Dist. 10 Beds 3 Taluk Govt. Ayurveda Hospital, H.D.Kote, Mysore Dist. 10 Beds 4 Taluk Govt. Ayurveda Hospital, K.R. Nagar, Mysore Dist. 10 Beds 5 Taluk Govt. Ayurveda Hospital, Kundapura, Udupi Dist. 10 Beds 6 Taluk Govt. Ayurveda Hospital,Channagere, Davanagere Dist. 10 Beds 7 Taluk Govt. Ayurveda Hospital, Devadurga, Raichur Dist. 10 Beds 8 Taluk Govt. Ayurveda Hospital, Kalaghatagi, Dharward Dist. 10 Beds 9 Taluk Govt. Ayurveda Hospital, Mundaragi, Gadag Dist. 10 Beds 10 Taluk Govt. Ayurveda Hospital, Hunagunda, Bagalkote Dist. 10 Beds 11 Taluk Govt. Ayurveda Hospital, Muddebihala, Vijayapura Dist. 10 Beds 12 Taluk Govt. Ayurveda Hospital, Kollegala, Chamarajanagar Dist. 10 Beds 13 Taluk Govt. Ayurveda Hospital, Hoskote, Bangalore (R) 10 Beds 14 District Govt. Ayurveda Hospital, Belagavi. 10 Beds 15 District Govt. Ayurveda Hospital, Udupi. 10 Beds 16 Govt. Ayurveda Hospital, Indiranagara, Bangalore (U) 05 Beds 17 Taluk Govt. Ayurveda Hospital, Anekal, Bangalore (R) 10 Beds 18 Taluk Govt. Ayurveda Hospital, Nelmangala, Bangalore (R) 10 Beds 19 Taluk Govt. Ayurveda Hospital, Maluru, Kolar Dist. 10 Beds 20 Taluk Govt. Ayurveda Hospital, Madugiri, Tumkur Dist. 10 Beds

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21 Taluk Govt. Ayurveda Hospital, Hosadurga, Chitraduraga Dist. 10 Beds 22 Taluk Govt. Ayurveda Hospital, Harihara, Davanagere Dist. 10 Beds 23 Taluk Govt. Ayurveda Hospital, Piriyapattana, Mysore Dist. 10 Beds 24 Taluk Govt. Ayurveda Hospital, Aluru, Hassan Dist. 10 Beds 25 Taluk Govt. Ayurveda Hospital, Srigeri, Chikkamagaluru Dist. 10 Beds 26 Taluk Govt. Ayurveda Hospital, Karkala, Udupi Dist. 10 Beds 27 Taluk Govt. Ayurveda Hospital, Ullala, Mangalore Dist. 10 Beds 28 Taluk Govt. Ayurveda Hospital, Navalgunda, Dharwad Dist. 10 Beds 29 Taluk Govt. Ayurveda Hospital, Naragunda, Gadag Dist. 10 Beds 30 Taluk Govt. Ayurveda Hospital, Byadagi, Haveri Dist. 10 Beds 31 Taluk Govt. Ayurveda Hospital, Sindagi, Vijayapura Dist. 10 Beds 32 Taluk Govt. Ayurveda Hospital, Mudhol, Bagalkote Dist. 10 Beds 33 Taluk Govt. Ayurveda Hospital, Chincholi, Kalaburgi Dist. 10 Beds 34 Taluk Govt. Ayurveda Hospital, Lingasuguru, Raichur Dist. 10 Beds 35 Taluk Govt. Ayurveda Hospital,Yalaburga, Koppal Dist. 10 Beds 36 Taluk Govt. Ayurveda Hospital, Balki, Bidar Dist. 10 Beds 37 Taluk Govt. Ayurveda Hospital, Shahapura, Yadagiri 10 Beds

Ayurveda Hospitals functioning in the district places under Z.P. details are given below. Sl.No Name of the District Bed strength 1 Vijayapur 50 Beds 2 Dharwar 25 Beds 3 Karwar 10 Beds There are 115 4 Mandya 25 Beds Hospitals &564 5 Hassan 25 Beds Ayurvedic 6 Madikeri 10 Beds dispensaries 7 Tumkur 15 Beds functioning in the State. 8 Bidar 15 Beds 9 Raichur 15 Beds 10 Koppal 06 Beds 11 Chamarajanagara 10 Beds 12 Gadag 10 Beds 13 Bagalkot 10 Beds 14 Kalaburgi 10 Beds 15 Mangalore 15 Beds

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Sl.No Name of the Taluks Bed strength 01 Doddabalapura, Bangalore (R) 06 Beds 02 Magadi, Ramanagar Dist. 10 Beds 03 Kanakapur, Ramanagar Dist. 06 Beds 04 Srinivaspura, Kolar Dist. 10 Beds 05 Chithamani, Chikkabalapur Dist. 06 Beds 06 Hiriyuru, Chitradurga Dist. 10 Beds 07 Challakere, Chitradurga Dist. 06 Beds 08 Harapanahalli, Davanagere Dist. 06 Beds 09 Tipaturu, Tumukur Dist. 10 Beds 10 Chikkanayakanahalli, Tumukur Dist. 06 Beds 11 Nanjanagudu, Mysore Dist. 06 Beds 12 Kaduru, Chikkamagalru Dist. 10 Beds 13 Mudigere, Chikkamagalur Dist. 06 Beds 14 Tarikere, Chikkamagalur Dist. 06 Beds 15 Holenarasipura, Hassan Dist. 10 Beds 16 Virajapet, Kodagu Dist. 10 Beds 17 Malavalli, Mandya Dist. 06 Beds 18 Maddur, Mandya Dist. 06 Beds 19 Gundlupet, Chamarajanagar Dist. 06 Beds 20 Savadathi, Belagavi Dist. 06 Beds 21 Bylahongala, Belagavi Dist. 06 Beds 22 Athani, Belagavi Dist. 06 Beds 23 Ramadurga, Belagavi Dist. 06 Beds 24 Huballi, Dharwad Dist. 25 Beds 25 Sirasi, Karwara Dist. 10 Beds 26 Kumata, Karwara Dist. 06 Beds 27 Jamakandi, Bagalkote Dist. 10 Beds 28 Bilagi, Bagalkote Dist. 06 Beds 29 Rona, Gadag Dist 06 Beds 30 Shiggavi, Haveri Dist. 06 Beds 31 Ranibennur, Haveri Dist. 06 Beds 32 Chittapura, Kalaburgi Dist. 10 Beds 33 Afazalpura , Kalburgi Dist. 06 Beds 34 Sedam, Kalburgi Dist. 06 Beds 35 Shahapur, Yadagiri Dist. 06 Beds 36 Gangavathi, Koppal Dist. 10 Beds 37 Basavakalyana, Bidar Dist. 06 Beds 38 Sanduru, Bellary Dist. 06 Beds 39 Hospet, Bellary Dist. 10 Beds 40 Siraguppa, Bellary Dist. 06 Beds 41 Huvinahadagali, Bellary Dist. 06 Beds

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3.4 UNANI SYSTEM:

In the State One Unani Medical College with attached Hospital details are given below:

Sl. Hospital Details Bed No Strength 1 Government Unani Medical College and Hospital, 100 beds Bangalore.

In State Sector District and Taluk level working Unani Hospitals details are given below.

Bed Sl. No Hospital Details Strength 1 Govt. Unani Hospital, Roja-B, Kalaburgi 50 Beds 2 Taluk Govt. Unani Hospital, Alanda, Kalaburgi Dist. 10 Beds 3 Taluk Govt. Unani Hospital, Bhadravathi, Shimoga Dist. 10 Beds 4 Taluk Govt. Unani Hospital, K.R. Pet, Mandya Dist. 10 Beds 5 Taluk Govt. Unani Hospital, Bhatkala, Karwara Dist. 10 Beds 6 Taluk Govt. Unani Hospital, Gowribidanuru, Chikkabalapura 10 Beds Dist.

Under Zilla Panchayath District Unani Hospitals Details given below:

Sl.No Place Bed strength 1 Mysore 10 Beds 2 Kalburgi 50 Beds 3 Bellary 10 Beds 4 Bidar 10 Beds 5 Vijayapur 10 Beds There are 18 6 Shimoga 10 Beds Hospitals and 49 7 Raichur 10 Beds Unani Dispensaries 8 Ramanagar 10 Beds functioning in the 9 Tumkuru 10 Beds State. 10 Yadagiri, Thimmapur Rangampet, 06 Beds

Sl.No Taluk Centre Bed strength 1 Manvi, Raichur Dist. 06 Beds

3.5 HOMOEOPATHY SYSTEM:

In the State One Homoeopathy Medical College with attached Hospital details are given below:

Bed Sl. No Hospital Details Strength 1 Government Homoeopathy Medical College and Hospital, 100 beds Bangalore

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In State Sector District and Taluk level working Homoeopathy Hospitals details are given below: Sl. Hospital Details Bed No Strength 1 Taluk Govt. Homoeopathy Hospital, Sakaleshpura, Hassan 10 Beds Dist. 2 Taluk Govt. Homoeopathy Hospital, Badami, Bagalkote Dist. 10 Beds 3 Taluk Govt. Homoeopathy Hospital, Raibagh, Belgavi Dist. 10 Beds 4 Taluk Govt. Homoeopathy Hospital,Kudlagi, Bellary Dist 10 Beds 5 Govt. Homoeopathy Hospital, Soluru, Ramangara Dist. 10 Beds 6 Govt. Homoeopathy Hospital, Indiranagara, Bangalore (U) 05 Beds

Under Zilla Panchayath District Homoeopathy Hospitals Details given below: Sl.No Name of the district Place Bed strength 1 Kalaburgi 15 Beds 2 Mysore 10 Beds 3 Hassan 10 Beds There are 18 Hospitals and 43 4 Shimoga 10 Beds Homoeopathic 5 Bellary 10 Beds Dispensaries are 6 Vijayapur 10 Beds functioning in the state. 7 Kolar 10 Beds 8 Mangalore 10 Beds

Sl.No Name of the district Place Bed strength 1 Somavarapete, Kodagu Dist. 10 Beds

3.6 NATURE CURE AND YOGA SYSTEM:

In the State One Nature cure and Yoga Medical College with attached Hospital details are given below:

Sl.No Details Bed strength 1 Govt. Nature cure and Yoga Medical College and 100 Beds Hospital, Mysore

In State Sector District and Taluk level working Nature cure and Yoga Hospitals details are given below:

Sl.No Name of the district Place Bed strength 1 Taluk Govt. Nature cure and Yoga Hospital, 10 Beds Gundlupet, Chamarajanagar Dist 2 Taluk Govt. Nature cure and Yoga Hospital, 10 Beds Somavarpet, Kodagu Dist

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Under Zilla Panchayath District Nature cure and Yoga Hospitals Details given below: Sl.No Name of the district Place Bed strength 1 Govt. Naturecure Hospital, 06 Beds K.G.Koppal, Mysore Dist

Two 10 bedded Nature Cure hospitals are functioning in Bangalore and Bellary Ayurveda Teaching Hospitals. Five Nature cure dispensaries functioning in Rural areas.

YOGA:

Yoga wings of 5 beds each have been established in SJIIM, Bangalore, Mysore and Bellary Ayurveda Teaching Hospitals to provide treatment in Yoga therapy.

3.7 GOVERNMENT CENTRAL PHARMACY:

Government Central Pharmacy, Bangalore is manufacturing Ayurveda and Unani medicines, the same are being supplied to all Government AYUSH Hospitals and Dispensaries in the state.

Drug Testing Laboratory:

Is functioning to ensure the quality of AYUSH Raw Drug samples and Medicines.

Statement showing the Details of Samples tested by Drug Testing Laboratory in the year 2017-18.

1-4-2017 to 31-03-2018 Sl.No. Types of Drugs Tested Total 1 Legal Sample 78 2 Survey Sample 783 3 Ayurveda Medicines 55 4 Unani Medicines 20 5 Raw Drugs 88 Total 1024 Total Number of Samples tested - 1024

3.8 AYUSH DRUGS CONTROL:

It regulates manufacturing Units and sale of AYUSH Drugs and Medicines under the provision of The Drugs and Cosmetics Act, 1940 and the rules there under.

Drug licensing unit is attached to the Directorate of AYUSH, Bangalore. Director Ayush is the Chief Drug Controller. There is one Deputy Drug Controller, Assistant Drug Controller and two Drug Inspectors in the unit who are under the control of the Drug Licensing Authority. Government also has sanctioned Ayush Drug Control Unit each at Mysore, Belagavi & Kalburgi Revenue Districts with necessary post.

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The number of licenses issued to manufacture Ayurveda, Unani and Homoeopathy Medicine as on 31-03-2018 are as follows:

No. of No. of Sales Sl. Loan Systems Manufacturing Whole No license Retail license holders. sale 1 Ayurveda 248 177 - - 2 Unani - - - - 3 Homoeopathy 11 - 64 168 Total 259 177 64 168

3.9 BOARDS:

There are two statutory boards namely the Karnataka Ayurveda and Unani Practitioner‟s Board and the Karnataka Board of Homoeopathy System of medicine are functioning under the department. The Registered Medical Practitioners of various systems as on 31-03-2018 are as follows:

Sl.No Name of System No. of practitioners 01 Ayurveda 37742 02 Unani 2122 03 Integrated systems 2435 04 Naturopathy & Yoga 1010 05 Siddha 06 06 Homoeopathy 13408 TOTAL 56723

3.10 ACHIEVEMENTS FOR THE YEAR 2017-18:

 In the year 2017-18 through the district around 69.01 lakhs Out Patients and 0.40 lakhs In Patients were treated in AYUSH system of medicine.  In Mandya District, Madduru Taluk in Halehalli Village 10 Bedded composite hospital of Ayurveda and Homoeopathy was started.  In Kodagu District, Somavarapete Taluk in Kushalanagar 10 Bedded composite hospital of Ayurveda and Homoeopathy was started.  In entire State to improve Physical and Mental health of both teachers and students around 400 teachers were given Yoga training and this teachers their by giving Yoga training in their respective schools.  In Preservation of health the impotents of AYUSH system of medicine and the treatments to create awareness among public availability of this system under IEC in several colleges. All districts Manemaddu health awareness programmes and free AYUSH Arogya camps were conducted.  Under SCSP/TSP Schemes in entire State all districts there is dense populating SC/ST people, their AYUSH Department has conducted several Arogya Shibira camps, Manemaddu programmes and Taluk level seminars.

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Proposed plan for the year 2018-19

 Opening of 10 bedded composite hospital in Chitradurga and Chikkamagaluru.  Allround development of AYUSH system and for the utilization of general public in on effective way the state and central in collaboration with state and central governments National Ayush Mission scheme will be continued.  Improving the infrastructure and providing more facilities and education, information, publicity, through communication, creating awareness in general public about AYUSH system of medicine intended to giving excellent health services to the public.  In Rural places entire state Manemaddu health camps Yoga training programmes, State, District, Taluk level AYUSH seminars and other AYUSH IEC programmes will be conducted.  Under SCSP/TSP programmes, students who are studying in AYUSH Government colleges are provided free Laptops, Medical books, Medical instruments will be provided form AYUSH government colleges, free Medical camps will be organized and medical kits will be distributed.

3.11 AYUSH MEDICAL EDUCATION:

The details of Medical Colleges under this Department as follows: Aided Unaided Total No. of System Government Colleges Colleges Colleges No. Intake No. Intake No. Intake No. Intake Ayurveda 3 150 3 195 66 4220 72 4565 Unani 1 50 0 0 4 240 5 290 Homoeopathy 1 100 0 0 10 850 11 950 Yoga & 1 60 0 0 4 420 5 480 Nature Cure Total 6 360 3 195 84 5730 93 6285

These AYUSH Medical colleges are affiliated to Rajiv Gandhi University of Health Sciences. Selection of candidates for all these Medical colleges will be made transparently through Common Entrance Test (CET). Central Govt. grants are being Utilized for the overall development of these colleges.

3.12 AYURVEDA MEDICAL COLLEGES: Ayurveda Medical Colleges disbursing BAMS (Bachelor of Ayurveda Medicine and Surgery)Degrees for students there are FOUR Government Ayurveda Medical Colleges are functioning in the State.

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The details of the UG & PG seats (subject wise) in Colleges as follows:

Sl. Name of the College Intake Seats No UG P.G 1 Government Ayurvedic 60 Dravyaguna 07 Medical College, Shalakyatantra 07 Bangalore. Shalyatantra 07 Panchakarma 07 Roganidhana 06 Rasashastra & Byshajya 06 Kalpana 2 Government Ayurvedic 50 Kayachikitsa 07 Medical College, Mysore. Ayurveda samhitha 05 Siddhantha (CSS) 3 Taranatha Government 40 Rasashaastra & 07 Ayurveda Medical College, Byshajya Kalpana Bellary. 4 Government Ayurvedic 50 -- - Medical College, Shimoga. 200 Total 59

3.13 UNANI MEDICAL COLLEGES:

Unani Medical Colleges disbursing BUMS (Bachelor of Unani Medicine and Surgery)Degrees for students there is One Government Unani Medical College is functioning at Bangalore city withan intake capacity of 50 students per Year.

Sl.No Name of the College Intake Seats UG P.G 1 Government Unani Medical College, 50 - Bangalore.

3.14 HOMOEOPATHY MEDICAL COLLEGE:

Homoeopathy Medical Colleges disbursing BHMS (Bachelor of Homoeopathy Medicine and Surgery) Degrees for students there is one Government Homoeopathy Medical College is functioning at Bangalore city, recently Govt. increases intake capacity of U.G. Seats from 40 to 100 and Central Council for Homoeopathy given permission to Govt. Homeopathy Medical College, Bangalore to start P.G. Courses in Five subjects details are given below.

Sl. Name of the Intake Seats No College UG P.G subjects Seats 1 Government 100 Materia medica 06 Homeopathy Reparatory 06 Medical College, Homoeopathy Philosophy and 06 Bangalore. Organon Practice of Medicine 06 Pediatrics 04 Total 100 28

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3.15 NATURE CURE & YOGA MEDICAL COLLEGE:

Nature cure and Yoga Medical Colleges disbursing BNYS (Bachelor of Naturopathy and Yoga Surgery)Degrees for students there is one Government Nature Cure and Yoga college is functioning at Mysore city. Intake capacity of 60 students.

Sl. Name of the College Intake Seats No UG P.G 1 Government Nature Cure and Yoga college, 60 - Mysore.

HERB GARDEN:

Herb gardens are being maintained at Bangalore. Mysore and Bellary which are attached to the Ayurveda Medical Colleges. The Medicinal plants required for students demonstration and green herbs required for the hospitals are being grown in these herb gardens. Further “Dhanvantri Vana” has been established in 37 acres of land at Nagadevnahalli near Bangalore University campus for development of herbarium and about 500 varities of Herbs have been raised. Depending upon the basic facilities of the Dispensaries and Hospitals Herbal gardens are being developed across the state. The medicinal plants grown here are distributed to the public.

THE RIGHT TO INFORMATION ACT 2005.

Under the Right to Information Act, 2005, 578 applications have been received and all the applications are disposed upto March-2018.

BIO MEDICAL WASTAGE MANAGEMENT

Under the guidelines of the Karnataka State Pollution Control Board and Hon‟ble Lok Adalath, from 2011-12. AYUSH Department has adopted Bio-Medical wastage management of Government AYUSH Hospitals and Dispensaries in the state.

SAKAALA YOJANE :

Under the new scheme “SAKAALAYOJANE” AYUSH Department has giving Three Services to public as follows:

 Issue of Medical Certificate  Issuing license for opening of Drug stores.  As per THE DRUGS AND CONSMETICS ACT and Rules there under issue of Performance and No Conviction Certificates.

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3.16 Other Activities:

NAM 2017-18 Achievement:

1. Human Resources

 Continuation of 520 AYUSH Doctors and Paramedical Staff.  Salary Paid to 293 Staffs working under Centrally Sponsored Scheme of National AYUSH Mission of the Rs.240.57 lakhs. State Sector  Continuation of 03 Data Entry Operator in NAM.  Continuation of SPMU Staff.  One day Training organized to ASHA Workers about National Nutritional Day.  Rs.3.00 Crore grants released to Construction of 50 bedded AYUSH Hospital at Gadag.  Around Rs.42.012 lakhs of Medicine is distributed to 65 upgraded Hospitals of the NAM.  Rs.16.68 lakhs of grants released to organize the AYUSH Manemaddu Arivu Abhiyana at district level around 900 ASHA/SHG‟s got benefitted.

New Proposal: In Government Ayurveda Medical College Bangalore, Shalakya Department it has been proposed to do Pilot Project on the following for Eye disorders. Details as below:

Sl Name of the Disease No. of Duration Approximate No. Patients Cost 1 Shushkakshipaka (Dry 50 6 Months 2,00,000 Eyes) 2 Krimigranthi 50 6 Months 1,00,000 (Blepharitis) 3 Nakthandhya (Retinitis 50 6 Months 6,00,000 Pigmentosa) 4 Thrithiya Patalagatha 50 6 Months 8,00,000 Timira (Mascular Degeneration) TOTAL 17,00,000 The Initial Essential investigations before and after treatment will be conducted in Minto Eye Hospital for all the above 4 Eye Disoders and Documentation will be done. This has been decided in the expert committee conducted for the purpose of doing Pilot Project .

NHM 2017-18 Achievement

 In the year 2017-18, Hon‟ble Chief Minister announced in his budget speech regarding opening of 116 AYUSH Units across the state out of which 93 units are currently functioning by deploying NHM,AYUSH doctors and actions has been taken for functioning of remaining units.

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 In the year 2017-18 Ayurvedic drugs of about Rs.573.00 Lakhs drugs were procured and distributed to PHC/CHCs across the state.  During the year 2017-18, AYUSH,NHM came up with a new programme called “AYUSH Thayi Suraksha Yojane” for 5000 mothers of SC/ST community in 7 HPDs. Under this programme ANC & PNC Kits which includes drugs especially for mothers. Programme budget was Rs.400.00 lakhs.  During the year 2017-18 under AYUSH,NHM 5 trainings were conducted for AYUSH doctors in the subject “Management Of Lifestyle Disorders and Non Communicable Diseases in Ayurveda/ Homeopathy/ Unani”. The cost of the programme was 15.00 Lakhs.  Orientation Training was conducted for all AYUSH doctors of 7 HPDs regarding usage of ANC/PNC Kits.  Rs.1.00 lakhs budget was released towards Mission Document programme of Mysore Ayurvedic Research Centre.

2018-19 Intended Programmes

 Under NHM, AYUSH programme 686 MO‟s are working, it is estimated that Rs.1.5 lakhs of drugs will be supplied to each doctor to give successful treatment in AYUSH system.  It is planned for planting hoardings at district levels to create awareness about AYUSH programmes to public in the year 2018-19.  During the year 2018-19 it has been planned to open NCD clinics at all PHC/CHC‟s where NHM,AYUSH doctors are in position by displaying broachers and pamphlets about methods of controlling NCDs through AYUSH medicines.

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