Health and Family Welfare Department

GOVERNMENT OF KARNATAKA

HEALTH AND FAMILY WELFARE DEPARTMENT

ANNUAL REPORT (2018-2019)

HEALTH AND FAMILY WELFARE DEPARTMENT

ANNUAL REPORT (2018-2019)

INDEX PART-I HEALTH AND FAMILY WELFARE DEPARTMENT Sl.No. Subject Page No. 1.1 Organization and Functions of the Department 1-2 1.2 Important National & State Health Programmes 2-44 1.2.1 Immunization Programme 2-6 1.2.2 National Leprosy Eradication Programme 6-9 1.2.3 Revised National Tuberculosis Control Programme 9-14 1.2.4 National Programme for Control of Blindness 14-19 1.2.5 Karnataka State AIDS Prevention Society 20-28 1.2.6 National Vector Borne Diseases Control Programme 28-30 1.2.7 Communicable Diseases (CMD) 30-31 1.2.8 Reproductive and Child Health Programme 32-37 1.2.9 RCH Portal 37 1.2.10 Mother Health 38 1.2.11 Emergency Management and Research Institute (EMRI): 38-43 Pre-Conception and Pre-natal Diagnostic Techniques 1.2.12 Programmes (PC & PNDT) 43-44 1.3 School Health Programme 45-48 1.4 SAKALA Guaranteed services rendered 48-49 1.5 Health Indicators 49 1.6 Health Services 49-51 1.7 National Urban Health Mission 51-58 1.7.1 Quality Assurance 58-65 National Programme for Prevention and Control of 1.7.2 Fluorosis (NPPCF) 65-67 1.8 Citizen Friendly Facilities 68-69 1.9 Regulation of Private Medical Establishments 69-71 1.10 Health Education and Training 71-72 1.11 Mental Health Programme 72-76 Information, Education & Communication (IEC) 1.12 programme 76-77 1.13 State Health Transport Organization 77 1.14 Integrated Disease Surveillance Project (IDSP) 77-79 1.15 Nutrition Programmes 80-82 National Iodine Deficiency, Disorder Control Programme 1.16 (NIDDCP) 82-83 1.17 Karnataka State Drug Logistics and Ware Housing Society 84-86 1.18 State Institute of Health & Family Welfare 86-87 1.19 Public Health Institute 87-89 1.20 Suvarna Arogya Suraksha Trust 89-94 1.21 Food Laboratory 94-104

PART II DRUG CONTROL DEPARTMENT 2.1 Introduction 107-109 2.2 Organization Setup 109-110 2.3 Enforcement Wing 110-113 2.4 Drugs testing Laboratory 113-116 2.5 Pharmacy Education 116-123 2.6 Finance 123-124

PART III AYUSH DEPARTMENT 3.1 Organization Setup 127 3.2 Departmental Brief Note, Staff Position of the Department 128 3.3 Health Sector (Details Of Hospitals & Dispensaries) 128-131

3.4 Government Central Pharmacy & Drug Testing Laboratory) 131 3.5 Ayush Drugs Control 131-132 3.6 Statutory Boards 132 3.7 Ayush Medical Education 132-134 3.8 Herbal Garden Details 134 3.9 The Right To Information Act 2005 135 3.10 Bio Medical Wastage Management 135 3.11 Sakaala Yojane 135 3.12 Ayush Department : Achievements For The Year 2018-19 135 3.13 Proposed Plan For The Year 2019-20 135-136 NATIONAL AYUSH MISSION: Achievement For 2018-19 & 3.14 New Proposal For The Year 2019-20 136-137 NATIONAL HEALTH MISSION Achievement For The Year 3.15 137-138 2018-19 & Intended Programmes For 2019-20 Annexure 3.16 Ayurveda (District and Taluk wise details) 138-142 3.17 Unani System (District and Taluk wise details) 142-143 3.18 Homoeopathy System (District and Taluk wise details) 143-144 Nature Cure And Yoga System (District and Taluk wise 3.19 144 details)

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, 207 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. 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). • 2018- TT Vaccine replace by Td Vaccine.

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. Pulse Polio Programme held on 10th March 2019, the achievement is 102.21 % 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)

2018-19 (in lakhs) Sl No Programme/Method Target Achievement A FAMILY WELFARE 1 Sterilization 4.41 2.8 2 IUCD 2.83 1.26 3 CC Users 4.09 2.28 4 OP Users 2.75 1.43 B IMMUNIZATION S.L Vaccine Target Achievement (%) No 1 TT(PW)-1 1195504 81 2 TT2 and Booster 74 3 Hep-B 1055013 72 4 OPV-0 82 5 OPV-1 104 6 OPV-2 102 7 OPV-3 103 10 BCG 99 11 Penta-1 105

2018-19 (in lakhs) Sl No Programme/Method Target Achievement 12 Penta-2 102 13 Penta-3 103 IPV-1 75 IPV-2 67 Measles & Rubella (MR)- 1st 14 100 Dose 15 JE-1 (10 districts) 336594 98 Fully Immunization (9 to 11 16 1055013 100 month) Measles 2nd dose (More than 17 93 16 months) Japanese Encephalitis (JE) 18 vaccine (more than 16 months of age who received ) Measles & Rubella (MR)- 2nd 19 93 Dose (16-24 months) 20 DPT-Booster 93 21 OPV-Booster 94 DPT-Booster -2 (5 years) 78

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 0.34/10000 population in 2018-19 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 07 districts have prevalence rate 0.50 to 1 (Bidar, Gadag, Raichuru, Chikkaballapura, Uttara Kannada, Chamarajanagar & Koppal) (i.e 10000 population. As on March 2019 there are 2460 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.These 40 taluks include both high endemic and non endemic blocks.

 Under Urban Leprosy Elimination Programme (ULEP) 2018-19, 30 Towns, 3 Medium cities 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 22nd Oct 2018 to 4th Nov 2018 in 1) Bengalurru (Urban), 2) Chitradurga, 3) Chikkaballapura, 4)Chamarajanagar, 5) Davanagere, 6) Kalburgi, 7) Kolar, 8) Tumkuru, 9) Vijayapura, 10) Udupi & 11) BBMP . Totally 211 (PB 122 & MB 89) 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 2018-19, totally 211 (PB 122 & MB 89) cases were detected.Post Exposure Prophylaxis (PEP) treatment will be given to MB Leprosy cases. 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 2018-19- 65 ASHAs per taluk were given Sensitization programme. A total of 14044 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.

2. Capacity building:

For the financial year 2018-19 – MOs 1418 and Health workers 1053 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.

3. 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, 2018-19 (Anti Leprosy fortnight – 30th Jan 19 to Feb 13th 2019):

Sparsh Leprosy Awareness Campaign (SLAC) was conducted successfully from 30-01-2019 to 13-02-2019 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 2018-19 Deformity Deformity Child New Cases Detected PR Cases Cured Gr.II Rate 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 * 2018-19 - 2789 - 0.34 - 2869 - 2.94 82 147

*(Up to March 2019)

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. 66 Reconstructive Surgery Operations done as on 31st March 2019, Rs.8000/- paid (As per Guidelines) incentive for RCS undergone Persons Affected by Leprosy. 3. Micro Cellular Rubber Footwear provided to 4559 Persons Affected by Leprosy ( PALs). 4. 2043 Self care kits provided to foot ulcer cases. 5. 199 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 2018-19:  In the Financial Year 2018-19 , 3 District Leprosy Officer’s & 1 NGO’s review meeting was conducted .  LCDC workshop was conducted on 4th and 5th Oct 2018 at Gandhibhavan, Bengaluru.  Leprosy Case Detection Campaign (LCDC) of state level coordination committee meeting was held under Chairmanship of Commissioner dt: 22- 09-2018.  Sparsh Leprosy Awareness Campaign of state level coordination committee meeting was held under Chairmanship of Additional Chief Secretary dt: 03- 01-2019. 1.2.3 Revised National Tuberculosis control programme (RNTCP): Karnataka state started implementing RNTCP form the year 1997.As per National Strategic Plan 2017-2025 Karnataka state has a target of 118927 TB patients to be notified during 2018,out of which 60927 are expected to be notified from public sector and 58000 from Private sector. State has notified69904TB patients from the public portal and 13286patients notified from the private sector totalling to 83190 TB patients in the year 2018.The annualized Total TB case Notification rate of Karnataka for the year 2018 is 125 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 20/lakh population to

10 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 one round of Active Case finding in the month of July for a period of 15 days from 2nd to 13th July. Active case finding is a special activity focusing vulnerable and hard to reach populations of the state. All districts with a vulnerable population of 1 crore was targeted and 9888855(99%) of the population was screened and 93382(1%) presumptive TB patients were tested with a yield of 2264(2.4%) TB patients Karnataka has the highest number of Medical colleges (56) 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 has diagnosed 2070 Drug resistant TB patients in 2018 using state of art technologies available in IRL Bangalore, KIMS Hubli and RIMS Raichur culture and DST labs. There are 65 CBNAAT machines in the state which diagnoses drug resistant TB within 2 hours. In the year 2018, 1,45,508tests were performed using the existing 65 CBNAAT machines out of which 12462(8.5%)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 2018, 41601(28.5%) 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. Till

11 date 94 patients are started on Bedaquilin and 32 patients are initiated on Delamanid. 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 and previously treated TB patient. Rs 5000 is provided to treatment supporters for treatment completion among Drug Resistant TB patients.In the year 2018 44743 beneficiaries have been paid an amount of Rs 6,86,76,750. 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 prequalified Drug Resistant TB treatment regimens, incentives to patients, private practitioners 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

Financial Management Fund Status (in Crores) 2018-19 Allocation Closing Expenditure till Year (approved Fund Release Balance as per 31st March ROP) UC H-line item 55.0525 Provisional H H Line Item 2018-19 42.2697 (NHM) line item B-Line item 51.2618 24.0622 Total 12.7828 = 79.1147

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 is 1% as per National Survey 2006-07.

1. The Karnataka State Health and Family Welfare 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 Districts Programme Managers (Blindness Control Division) at Districts level as per the Guidelines of NPCB. Government of India releases the funds to the State Society for onward distribution of funds to all Districts Health &Family Welfare Society (Blindness Control Division) based on the Target assigned to each Districts. 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. 40 Eye Banks registered under Human Organs Transplantation Act are functioning in Karnataka including 7 Functioning Government Eye Banks. 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 3,83,497 94.79 2018-19 4,04,563 3,90,630 96.56

Achievement of School Eye Screening Programme No. of Children No. of Children No. Spectacles given Year detected with Screened 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 47,871 2018-19 46,39,151 2,31,958 56,487 EYE BALLS COLLECTION Year Target Achievement % 2013-14 5,600 3,499 62.48% 2014-15 5,600 3,938 70.32% 3,572 2015-16 5,600 63.79%

2016-17 5,600 3,527 62.98% 2017-18 5,600 5914 105.61% 2018-19 5,600 5561 99.30% Financial Progress (Rs. in lakhs) Year Budget Expenditure % Allocation 2014-15 1890.73 1276.47 68% 2015-16 954.00 914.00 96% 2016-17 1959.73 1616.23 82% 2017-18 3230.26 1998.54 62% 2018-19 3002.87 2576.31 (Provisional) 86%

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.

KSAPS is implementing NACP IV funded by National AIDS Control Organization (NACO), New Delhi: Karnataka has been conducting HIV Sentinel Surveillance since 1998. Surveillance is carried out annually by testing for HIV at designated sentinel sites and now the annual frequency of HSS was shifted to biennial (once in two years). The prevalence among antenatal clinic (ANC) attendees as per HSS 2012-13 was 0.53%. This is close to the NFHS-3 estimate of 0.69% in 2006. HIV prevalence among ANC attendees indicates decline in adult HIV prevalence in the state from 1.5% in 2004 to 0.36% in 2014-15. In 2016-17 15th round of HIV Sentinel Surveillance has been conducted at both ANC & HRG sites where HIV prevalence among ANC attendees is 0.38% and HRG FSW is 3.33%, MSM is 5.40% in Karnataka.

Figure 12.7: Declining trend among ANC attendees 2 1.5 1.5 1.3 1.1 1 0.86 0.85 0.69 0.5 0.53 0.360.38 0 2004 2005 2006 2007 2008 2010 2012 2015 2016

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 68,709 Female Sex Workers (FSWs) under targeted interventions and 19,076 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 845 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 1,42,000 destination migrants. 6 truckers TIs cover a population of 87,000 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 472 Stand alone ICTCs and 2703 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% In ICTC for 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. and present FY 2018- 19, ICTCs. 24,73,845 General clients were counseled and tested with positivity rate of 0.73% and 14,23,045Antenatal women were counseled and tested with positivity rate of 0.05% in ICTCs. Table: 12.60. Tested and found Positive in ICTC

General clients ANC Achievement Achievement Year % % % % Target Target Achie Tested Achiev +ve Posit Tested +ve Positi veme ement ivity vity nt 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 2018-19 2225423 2473845 111.16 18143 0.73 1315595 1423045 108.17 776 0.05

3. Care Support & Treatment: During 2018-19, 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 2019 were 337624 out of which, 165445 cases are alive and on ART. The progress of ART centers is given in Table 12.61.

Table 12.61. Cumulative Status report on ART (till March - 2019)

Adult Adult Child Child Indicator TS/TG Total Male Female Male Female Pre ART 161905 155774 808 10459 8678 337624 Registration Ever Started on 125125 123042 565 7628 6195 262555 ART Alive on ART 68734 85734 346 5784 4847 165445 Reported on ART 42808 25417 135 1224 904 70488 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% 2018-19 924006 718162 77% * Note : Source CIMS / SIMS

5. Information Education and Communication : IEC Activities undertaken for the year 2018-19 (April – March 2019) :

 On eve of World Blood Donors Day on 14.6.2018, National Voluntary Blood Donation Day on 1.10.2018 and World AIDS day on 1.12.2018 radio spots on Blood donation and World AIDS Day were broadcast through 3 Pvt FM Channels.

 Telecast of TV spots through Doordarshan in “That antha Heli” for 15 days.  State level Consultation to finalise the model rules of HIV Act held on 27.7.2018

at Hotel Citrine, Seshadripuram, Bengaluru.  One day sensitisation programme for DAPCU Assistants for the implementation of reporting of the activities – 2 batches.

 Joint Working Group meeting with various departments was conducted.  State level Positive speaker training at Davangere was conducted

 Display of messages on HIV/AIDS and Blood donation inside the metro train during Blood Donation Day and World AIDS Day.  ToT on Adolscent Education Program at Divisional level was conducted.

 Telecast of spots inside the train during events.

 Marriage Bureau for PLHIVs was conducted in all 4 Divisions.  Display of messages through LED screens at railway stations.

 Branding inside the train with HIV/AIDS messages.

 Broadcast of spots on various themes of HIV/AIDS issues through All India Radio.

 Day branding through All India Radio on eve of World AIDS Day.

 Branding of BMTC, KSRTC/NW/NEKSRTC buses across the State.

 Totally till Mar 2019, 1,20,921 persons of various departments/Institutions are trained on HIV/AIDS across the State.

PLHIVs Government schemes in Karnataka Sl Name of the scheme As on March 2019 No 1 Anna anthyodaya 36551 2 CABA (Children affected by AIDS) 19038 3 Rajiv Gandhi housing 2540 4 Mythri pension scheme for Transsexual/Transgender 1144 5 Free testing 62462

6 RTE Education ACT 641 7 Chetana Scheme (loan) This scheme for Female sex 2179 workers 8 Higher education and Scholarship 167 9 Dhana Shree yojana 2323 10 Free Legal Service 865

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)

Table 12.63: Blood Safety Indicators (2012-13 to 2018-19)

Indicator 2012-13 2013-14 2014-15 2015-16 2016-17 2017-19 2018-19

Total blood units 844419 6,60,138 6,94,151 7,54,485 7,46,716 7,87,330 collection 856215

Blood units 657612 collected from 4,35,258 4,08,974 5,19,260 5,39,878 5,93,108 VBD 738263

7. Financial Progress: FY – 2018-19

Table 12.64 Programme Component wise expenditure of KSAPS Budget

Targeted 2241.65 1341.64 1772.52 Interventions 83.07 134.01 79.55 Link Worker 135.66 135.66 Scheme

Sexually 118.70 118.70 118.70 100.00 Transmitted

Year 2018-19 (31.03.2019) Total Expenditure Grants Approved by received/a Programme Budget for Expenditure Programme vailable for 2018-19 (in Lakhs) on total the year (in Lakhs) grant 2018-19 (%) (in Lakhs) Infection / Reproductive Tract Infections Services Blood Safety 369.37 369.37 356.92 96.63 Lab Services 66.04 66.04 56.00 84.80 ICTC/HI- 98.88 2116.48 2876.48 2863.61 TB/PPTCT Information, 92.88 Education & 304.97 304.96 283.26 Communication

ART/CCC 1660.00 1745.00 1742.31 98.45 Institutional 104.88 459.02 459.02 553.31 Strengthening

Strategic 70.92 Information 41.03 41.03 29.10 Management System

UNICEF 0 0 0 0

State Fund

2210-06-101-7-15 51.75 2409.70 1944.81 1247.03 Grant in Aid Salary 2210-06-101-7-17 Reimbursement of 100.00 100.00 87.94 84.46 Travel cost to HIV patient 2210-06-101-7-18 44.35 108.00 108.00 71.54 – LWS programme 2210-06-800-0-14- 0.00 TB & HIV patients 0.00 0.00 0.00 nutrition foods Total 10130.62 9660.71 9362.05 83.95

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 Malaria elimination in the State 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:

B/S Deaths Malaria Pf Radical Year Collected & due to Cases Cases Treatment Examined Malaria 2013 8788786 12466 828 12352 0 2014 9805708 14794 1329 14456 2 JANUARY 2015 9631843 12445 1588 12304 0 TO DECEMBER 2016 9823219 10652 1701 10250 0 2017 10257499 7589 1233 7267 0 2018 10732290 5289 787 5289 0 2019 (Jan to 2568830 621 50 621 0 March)

Financial Progress: NRHM:

(in Rs. Lakhs) Year Allocation Expenditure

2014-15 566.00 429.41

2015-16 502.00 556.96

2016-17 470.00 543.77

2017-18 338.53 296.47

2018-19 253.36 201.40 (Provisional)

2019-20 290.10 0.00

Achievements:

1. State is heading towards elimination of Malaria and proposed to achieve the goal by 2025.

2. During 2018, 91 % decline in Malaria is achieved compared to 2006 as per National goal. Action plan proposed during 2019-20: 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 JANUARY 2015 96611 38 1 38 TO DECEMBER 2016 257393 51 5 51 2017 575102 17 2 17 2018 747123 18 0 18 2019 (Jan to march) 12321 1 0 1

Action plan proposed during 2019-20:

 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:

Yearly Mass Drug Administration (MDA) Programme for ELF is implemented in 9 endemic districts of the State with administration of DEC and Albendazole to the eligible population since 2004.

Three districts out of nine endemic districts (DakshinaKananda, UttaraKananda and Udupi) have achieved mf rates less than 1 % & are under Transmission Assessment Survey with stoppage of MDA.

DakshinaKananda, UttaraKananda districts have passed TAS-1 and TAS-2.

Dist of Gulbarga, Yadgir &Bidar are under Mass Drug Administration Districts of Raichur, Bagalkot and Vijayapura are partially under Transmission assessment Survey.

Morbidity management and Hydrocelectomy operation are taken up in all endemic districts, 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%

Year (Date of MDA) % covered 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% 17th August 2017 88.6% 24th September 2018 92.7 %

Financial Progress of funds received by NHM:

(Rs. In Lakhs)

Year Allocation(in Lacks) Expenditure

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 76.56 48.73

2018-19 177.14 112.53 (Provisional)

2019-20 370.64 0.00

Current Status of ELF:

1. Districts of Dakshina Kananda , Uttara Kananda & Udupi have passed Transmission assessment survey-IIand are eligible for TAS III during 2019- 20.

2. Districts of Raichur, Bagalkot and Vijayapura are partially under Transmission assessment Survey. Taluks of Manvi & Sindhanoor of Raichur District, Bilagi & Bagalkote of Bagalkot District and B.Bagewadi & Indi of Vijayapura district have passed 1st TAS. TAS- II will be taken up during 2019.

Action Plan for 2019-20

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 and TAS-II wlll be taken up in the Districts of Dakshina Kananda , Uttara Kananda & Udupi.

VI. Japanese Encephalitis Control Programme Activities for the control of Japanese Encephalitis:

1. Japanese Encephalitis reported in 17 districts- Ramanagar, Kolar, Davangere, Belagaum, Bagalkot, Dharwad, Uttara Kananda, Yadgiri, Ballari, Richur, Koppal, Mysuru, Chamarajnagar, Mandya, Dakshina Kananda, Udupi& Chikmagalur.

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 Deaths Cases

JANUARY 2013 300 0 9 0 TO 2014 133 0 34 0 DECEMBER 2015 382 0 49 1 2016 406 0 11 0 2017 332 0 23 1 2018 380 0 35 5 2019 (Jan to March) 94 0 8 0

JE Vaccination programme:

J.E Vaccination Report 2016-17 to 2017-18 (up to Mar 19)

2017-18 2018-19(April 2018 to March-2019)(Provisional)

2nd S.L Name of the 1st dose 2nd dose Total 1st dose Total Cove rage Target Target dose No District Cove (ELA) Cove Cove (ELA) Cove Cove % % rage % % rage rage rage rage 1 Bellary 55987 55711 99.51 49251 87.97 104962 55075 51036 92.67 46669 84.74 97705

2 Bijapur 52726 48885 92.72 40791 77.36 89676 53795 49829 92.63 45389 84.37 95218

Chik 3 17496 18390 105.11 16430 93.91 34820 17198 16919 98.38 16076 93.47 32995 ballapur Chitra 4 27898 27603 98.94 23641 84.74 51244 26054 25033 96.08 23703 90.98 48736 durga

5 Davangere 37616 36688 97.53 33213 88.29 69901 31976 31566 98.72 26968 84.34 58534

6 Dharwad 34992 33929 96.96 26439 75.56 60368 32575 32640 100.20 30517 93.68 63157

7 Kolar 23781 25696 108.05 23078 97.05 48774 22945 24229 105.60 22141 96.50 46370

8 Koppal 30181 28788 95.39 24419 80.91 53207 30305 28972 95.60 27020 89.16 55992

9 Mandya 21870 22513 102.94 21699 99.22 44212 20555 20383 99.17 20046 97.53 40429

10 Raichur 45927 44063 95.94 39997 87.09 84060 46116 44936 97.44 42033 91.15 86969

Total 348474 342266 98.22 298958 85.79 641224 336593 325543 96.72 300562 89.30 626105

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 2018-19:

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 2019-20:

 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 2019-20 also.

 Workshop and training programme for AES survey and JE control will be taken up in selected districts 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 5.00 2.59 2018-19 9.10 3.62 2019-20 2.00 0.00

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 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

JANUARY TO 2015 5077 9 DECEMBER 2016 6083 8 2017 17844 10 2018 4848 4 2019 till MARCH 497 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 2018-19 301.50 211.34 (Provisional) 2019-20 365.00 0.00

‘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 JANUARY TO 2015 20763 8357 2099 DECEMBER 2016 15666 7925 1528 2017 32831 18663 3511 2018 23772 14677 2951 2019 till MARCH 2772 1849 278

Achievements during:2018-19: 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. 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 2019-20: 1. Emphasis for sub centre based Aedes surveillance and source reduction activities throughout the year through ASHAs.

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.

1.2.7 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 2015 to 2018 (Jan to Dec) &2019 (Jan to Mar)

2015 2016 2017 2018 2019

Diseases/ Programme. Deaths Deaths Deaths Deaths Deaths Attacks Attacks Attacks Attacks Attacks

Gastroenteri 169936 49284 5 147860 12 135125 9 147860 12 tis Cholera 59 2 84 1 59 2 19 3 0 0 Typhoid 53797 0 57112 0 53797 0 90755 22306 0 Viral 5848 1 1224 0 4929 7 5226 4 4929 7 Hepatitis KFD 41 1 32 1 41 1 22 0 296 10 Leptospirosi 568 3 130 0 273 0 503 2 273 0 s H1N1 3565 94 110 0 3565 94 1733 72 1187 14 Handigodu 485 0 495 0 523 9 514 16 523 9 Syndrome Dog Bites 239168 8 258035 13 239168 8 313090 20 83837 3 Snake Bites 11109 104 12182 55 11109 104 10244 62 1580 4

*Handigodu Syndrome disease are old attacks, after 2005 no attacks are reported

Plague Control Programme 2013(Jan to Dec) &2019 (Jan to Mar)

Surveillance 2013 2014 2015 2016 2017 2018 2019

Rodent collection 1088 889 1186 1226 407 40 Survey not yet Sera Collection & 1033 889 1055 1003 287 40 started Examined

REP Survey in 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 206 2. Chikkamagalore District 289

TOTAL CASES UNDERTREATMENT 495 (These are all old

patients under treatment) Kyasanur Forest Disease :

Kyasanur Forest Disease (KFD) is reported from these 7 Districts in Karnataka2016 (Jan to Dec) & 2019 (Jan to Mar)

SI Name of the 2016 2017 2018 2019 NO District Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1 Shimoga 14 1 39 2 18 0 248 10 2 U.Kannada 2 0 6 1 4 0 41 0 3 Belagavi 16 0 1 0 0 0 2 0 4 Chikmagaluru 0 0 0 0 0 0 1 0 5 Kodagu 0 0 0 0 0 0 1 0 6 Mysore 0 0 0 0 0 0 1 0 7 Chamarajnagar 0 0 0 0 0 0 2 0 Total 32 1 46 3 22 0 296 10

H1N1 (Influenza-A) Comparative Statement of H1N1 Samples Tested and Confirmed cases 2013(Jan to Dec) & 2019 (Jan to Mar):

SI Particulars 2013 2014 2015 2016 2017 2018 2019 No 1316 1683 1043 1 Specimen Examined 1870 2349 3494 4600 8 5 5 H1N1 cases 2 122 303 3565 110 3260 1733 1198 confirmed by lab test

4 Reported deaths 19 34 94 0 15 72 14

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 2019-20: 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 prevent the death and reduce the epidemics due to cholera and Gastroenteritis.

5. Supply of Medicine issue and necessary instructions to all districts for controlling of H1N1 in the state.

6. 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)

1.2.8 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).

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).

Child Health Achievements:

1. Karnataka bags award at the 5th National Health Summit on Good and Replicable Practices 2018 in Public Health Care at Kaziranga, Assam, India.

a. 5th National Health Summit on Good and Replicable Practices in Public Health Care was held from 30th October 2018 to 1st November 2018 at Kaziranga, Assam, India.

b. Mission Director, National Health Mission along with state level officials participated in the summit.

c. State was selected for oral presentation on “Health and Wellness Centres” and “Comprehensive Mental Health Care Package” and 3 Posters on “Digital Nerve Center(DiNC)”, “Haemoglobinopathies and Haemophilia care”, “Assisted home care for mentally ill” as good and replicable practices in public health care. d. Sri.Jagat Prakash Nadda, Honourable Union Minister for Health and Family Welfare, Government of India and Sri.SarbanandaSonowal, Honourable Chief Minister of Assam awarded the State of Karnataka at the National Health Summit on Good Replicable Practices in Public Health Care at Kaziranga, Assam.

e. Award for Best Performance was awarded to Karnataka - Highest annual decline in Infant Mortality Rate 2015 Vs 2016among States(India average-4.0%).

2. At present 41 Special Newborn Care Units are functional and 5 more SNCUs are envisaged for the FY 2019-2020. Special Newborn Care Unit of SNR Dist.

Hospital, Kolar has been accredited as a level to Neonatal Unit by National Neonatal Forum-NNF.

3. 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.

4. 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. 5. 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. 22 SNCUs are envisaged for the same in FY 2018-19.

6. 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.

7. 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.

8. 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 (FBNC): 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):41 SNCUs are functioning as on 2016 at all district hospitals& government medical college hospitals and some high performing Taluk hospitals.

d) SNCU Online Monitoring Software: All 40 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 centres 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.

3. Home Based Newborn Care (HBNC): ASHAs visit the neonates at least 6 times in the first 42 days after delivery. 41,423 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 the components (Diarrhoea control and Prevention of Malnutrition) of IMNCI which have been given an additional thrust.

The following additional activities have been approved in ROP 2018-19:

 Strengthening of facility based new born care (FBNC): SNCU& NBSU mentoring by 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.

1.2.9 RCH portal : RCH (Reproductive and Child Health ) portal is a centralized web based application for early identification and tracking of the individual beneficiary throughout the reproductive lifecycle. Application facilitates to ensure timely delivery of full component of antenatal, postnatal & delivery services and tracking of children for complete immunization services. RCH portal has been designed to meet the requirements of the RMNCH program by incorporating additional functionality and features of the MCTS.

RCH portal started in the State from October 2018 and around 89% of Pregnant woman and 89.51% of Children registered in RCH portal during the year 2018-19.

RCH portal helps Beneficiaries in providing Information about desired services, Government Schemes & Benefits, advance information about the due services, Facilitate better interaction with Health Service Provider and Free consultation from Central Helpdesk (Toll Free No)

RCH portal helps Jr.HAF / ASHAs in auto generation of work-plan, Better guidance from senior supervisors, micro planning for Filed Visit, Payment of incentives to the Health Service Providers

RCH portal helps State, District and Taluk Officers in Planning, Decision making, analysis, Better planning for Vaccination Supply & Mgmt, Group /Individual SMS’s to health workers and monitor the High risk cases and LBW cases closely. The RCH portal will be linked with other department applications like for issuance of Birth certificate (Directorate of Economics and Statistics) and to capture services provided by ICDS W&CD department.

1.2.10 Mother Health: JananiSurakshaYojane (JSY):

This is a centrally sponsored scheme under National Health Mission with budget sharing of 60:40 among the national and state Government and is implemented in the state since 2006.

Under this scheme cash assistance to the mother for institutional delivery is Rs. 700 per case whereas in urban areas, cash assistance to the mother is Rs. 600 for institutional delivery. The cash assistance is also available for women delivering at home with an amount of Rs. 500 being given per case. If specialists are not available in Government-run health centers or hospitals, the institution can hire such specialists to manage complications or for caesarean section. Assistance up to Rs.900 per delivery could be utilized by the health institution for hiring services of specialists. The Parity and age limit for JSY payment is removed and JSY cash assistance is paid to all deliveries belonging to BPL/SC/ST through PFMS soon after delivery.

Janani Shishu Suraksha Karyakrama (JSSK) This is a centrally sponsored scheme under maternal health Programme, through National Health Mission with budget sharing of 60:40 among the national and state Government and is implemented in the state since 2010. 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;

Sl.No Programmes 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 1 Janani 383251 411423 425711 396840 282731 325197 SurakshaYojane 2 JSSK Drugs & a. 492403 777433 569476 563863 415056 429874 Consumables b. Diet 405756 387997 382937 450301 355213 231462 c. Diagnostics 447070 342919 353193 476938 422166 358197 d. Blood Transfusion 16339 22950 60982 28979 19904 24360 e. Referral Transport - - 185255 131404 62226 64814

1.2.11 Emergency Management and Research Institute (EMRI):

ArogyaKavacha(108):

“Arogya Kavacha” 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. 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 Centre 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, colour, 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 2018 to March 2019, 1079095 Emergency calls are attended, 945095 emergencies are attended and out of these 333073 pregnant women have utilized the services and 95477 lives are saved.

Janani SurakshaVahini:

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 2018 to March 2019 is 71842.

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 2018 to March 2019 is 109139.

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 a 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 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 2018 to March 2019, 42,196 emergencies are attended by the bike ambulances.

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 centre is situated at IT Park Hubli and Sir. C V Raman Nagar Hospital, with a capacity of 100 seater each. People (Citizens) from any part of the state can avail their service by calling 104. From April 2018 to March 2019, 7390236 calls are received at the call centre out of which 7353152 calls are provided with the different services. At present around 10000 calls per day on an average is being received at both the call centres. Vatsalya Vani: 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 centre 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. 1.2.12 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 Purpose: Prevent Sex detection and selective abortion of female foeticide and increase the sex ratio of females. Objective of the act: The Pre-conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex- Selection) Act, 1994 to provide for the prohibition of sex selection, before or after conception, and for regulation of pre-natal diagnostic techniques for the purpose of detecting genetic abnormalities or metabolic disorders or sex-linked disorders and

44 for the prevention of their misuse for sex determination leading to female foeticide and for matter connected therewith or incidental thereto. Social discrimination against women and a preference to sons have promoted female foeticide in various forms skewing the sex ratio of the country and also in our State towards male. Female foeticide began in early 1990s when ultrasound techniques gained widespread use in India. Pre- Conception & Pre – Natal Diagnostic Techniques (PCPNDT) act was enacted by Parliament of India in 1994 with the intent to prohibit prenatal diagnostic techniques for determination of sex of the foetus leading to female foeticide. Government of Karnataka is strictly enforcing PCPNDT act by taking action against all erring who are conducted sex determination and abortion and by stepping up the awareness regarding the worth of girl child.

Indicators of Sex Ratio:

0-6 Child Sex Ratio (CSR) 2001 Census 946 2011 Census 948

Activities:

 All statutory committees under the act are constituted at State & District level. Under the Chairmanship of District Commissioner who is also District Appropriate Authority, the District Inspection & Monitoring Committee shall inspect all the scanning centres every quarterly.

 A total of 4913 scanning centres are registered of which 4659 are private scanning centres and 254 are government scanning centres. (As per March- 2019 Quarterly report)

 Till date a total of 81 cases have been registered for violating PC & PNDT act, of which 41 cases are penalized for violation 40 cases are pending for judgement.

 BALIKA software is developed for effective reporting of F forms through which all the registered scanning centres must report.

 Under PC & PNDT rules, 2014 to empower the Untrained Registered Medical Practitioners who conduct the scanning are given Competency Based Test and Education in collaboration with Department of Medical Education. A total of 198 doctors have successfully cleared the exams and issued certificates.

 To create awareness among public, effective IEC is publicised through radio and video jingles.  Further to reinforce and strengthen the objectives of the act, Government of Karnataka is conducting Decoy operations to expose the suspects indulging in offence of determining sex and awarding remuneration of Rs.50000 on success of each sting operation.

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.

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

Progress report for the period of 2018-19

Sl. Annual Achieveme Beneficiaries % No. Target nt 1 Health screening of 0-18 years children (Anganwadi and Schools) 1,53,47,733 1,34,46,234 88

During 2018-19, out of an annual target of 15347733,13446234 students enrolled in Anganwadies Centres, Government / Government Aided and Government Residential Schools were screened and 2187 students (April-18 to March-19) 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 & Albendazole tablets given to adolescents under WIFS Program – 2018-19: Target Achievement

IFA (Pink) Procurement is under process

IFA (Blue) 2,05,02,970 1,68,08,983

“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 2018-19 total of 21,46,970 beneficiaries have been distributed with sanitary napkins.

Beneficiaries of HealthProgrammes as on 31.03.2019 Sl.No Programmes 2014- 2015- 2016-17 2017-18 2018-19 15 16 1 Janani 325197 411423 425711 393874 282731 SurakshaYojane 2 Vajpeyi Arogya Shree 939 996 4420 6047 2187 3 Rastriya 945095 Balaswasthya 695061 759434 1036056 1136789 Karyakrama 4 Arogya Kavacha 7831 8358 12288 18664 38160 5 Dialysis 41414 49704 49809 52185 55871 6 Telemedicine 38223 43808 45803 59656 28170 7 Burns Cases 980 948 960 888 913

1.4. SAKAALA Guaranteed services rendered: The Department of Health and Family Welfare had included 08 Citizen Centric Services namely (i) Issue of Disability Certificate (ii) Issue of Wound Certificate-Minor Wound (iii) Issue of Discharge and Sterilization Certificate (iv) Issue of Age Certificate (where specialist opinion is not required) (v) Prasuthi Araike (vi) Madilu Kit (vii) Birth Certificate Issued in Hospital (viii) Birth Certificate Issued Thereafter. The Department had stopped providing the Prasuthi Araike and Madilu Kit services to the citizens of from the 2019-20, and a request to drop these services from SAKALA through letter no. e-H/Sakala Online/17/2019-20 dated 29- 05-2019. Complying with the decision taken during the meeting held on 26-03-2019 under the Chairmanship of Principal Secretary to the Government, Department of Health and Family Welfare, it was decided to include the following services under SAKALA:

i. Registration of Private Medical Establishments (under KPMKE Act)

ii. Renewal of Private Medical Establishments (under KPMKE Act)

iii. Registration of Ultra Sound Scanning Centres / Genetic Counselling Centres / Genetic Laboratories, Genetic Clinic / Imaging Centre (under PC & PNDT Act)

iv. Renewal of Ultra Sound Scanning Centres / Genetic Counselling Centres / Genetic Laboratories, Genetic Clinic / Imaging Centre (under PC & PNDT Act)

A request letter has been sent to the Principal Secretary to the Government, Department of Health and Family Welfare for the approval and Order.

Further, the Department of Health and Family Welfare envisaged that :

 “Birth Certificate Issued Thereafter” is not under the purview of Department of Health and Family Welfare, and is managed by the Department of Economics and Statics through Corporations, Municipalities, Nada Kacheri’s etc.  Inclusion of “Issue of Death Certificate” under the SAKALA services through wide letter no. e-H/Sakala Online/17/2019-20 dated 29-05-2019.

 Initiated the development of a citizen-centric online system for the Issue of Wound Certificate-Minor Wound, Issue of Discharge and Sterilization Certificate and Issue of Age Certificate (where specialist opinion is not required) which may be included under SAKALA upon completion.  The Government of India has developed an online system (www.swavlambancard.gov.in) for the Issue of Disability Certificate through the Department of Empowerment of Persons with Disability, wherein the citizen can apply on-line for the Disability Certificate, and this can be included under SAKALA services.

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. (NFHS-IV) 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 36 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 207 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 2359 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. 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 10,000-12,000 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.

• Involvement of ULBs in planning, implementation and monitoring of the program through existing district Urban Local health societies. Bodies (ULBs ) • 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 other Ministries (Drinking Water, Sanitation, Housing, Coordination 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.

Mobile Medical • To provide comprehensive primary health care at the Units door steps of the community.

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 (BCG, 62.6 59.8 measles, and 3 doses each of polio and DPT) (%) Institutional births (%) 94.3 95.4

Total Cities / towns:

Sl. Cities Sl. Cities Sl. Cities Sl. Cities No no no no 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 2017-18 124.76 106.80 85.60%

3 2018-19 131.79 104.94 79.62% (Provisional)

Physical Progress (gross):

UCHC & Referral UPHC Hospital Sl. Year No. Achieve Target Target Achievement ment

1 2016-17 361 348 8 8

2 2017-18 364 361 9 8

3 2018-19 364 361 9 9

Para-medical staff Doctors on ASHA MAS on contractual contractual (all) Sl. staff (all) Year No. Achie Achiev Achieve Achieve Target veme Target Target Target ement ment ment nt 1 2016-17 3508 2958 4081 2850 492 350 2398 1353 2 2017-18 3329 2672 4071 3478 529 436 2522 2114 3 2018-19 3329 3061 4071 3828 568 477 3171 2588

1.7.1 Quality Assurance:

Quality assurance division under National Health Mission is responsible for maintenance of quality related aspects of all the public health care facilities in the state.

It mainly comprises of Kayakalpa, National Quality Assurance System (NQAS), Swachh Swasth Sarvatra (SSS) and Swachha Pakshika Programmes.

Quality Assurance Programs under NHM, Government of Karnataka

• Kayakalpa • National Quality Assurance System (NQAS)

• Swachh Swasth Sarvatra (SSS)

• Swachha Bharath Abhiyan’s Swachhtheye Seve, Swachha Pakshika Programmes.

Kayakalpa:

 The Swachh Bharat Abhiyan launched by the Prime Minister on 2nd October 2014, focuses on promoting cleanliness in public spaces. Public health care facilities are a major mechanism of social protection to meet the health care needs of large segments of the population. Hence, Hon’ble HFM launched the Awards to Public health Facilities “Kayakalpa” on 15th May, 2015 to give awards to those public health facilities that demonstrate high levels of cleanliness, hygiene and infection control.  Under Kayakalp programme all public health care facilities are quarterly assessed on the themes of Hospital/Facility Upkeep, Sanitation and hygiene, Waste Management, Infection control, Support Services and Hygiene Promotion.

 State and district level Kayakalpa awareness trainings, facility level trainings, periodic quarterly assessments, traversing gaps, conferring awards (Includes team incentives) are other key features of Kayakalpa.

Objectives:

1. To promote cleanliness, hygiene and Infection Control Practices in public Health Care Facilities.

2. To incentivize and recognize such public healthcare facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control.

3. To inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation.

4. To create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes

 As per GoI instructions and new Kayakalpa guidelines separate check lists for DH, TH/CHC & 24*7 PHC, NON 24*7 PHC (including UPHC) are adopted and implemented in 2017-18.

 Kayakalpa Status in 2015-16, 2016-17, 2017-18 to 2018-19:  Karnataka has taken up this initiative and implemented the program in 20 District Hospitals for 2015-16 and awarded 4 Hospitals.

Type of facility Internal Peer External Awards Assessment Assessment Assessment District Hospital 20 13 09 04

 Kayakalpa 2016-17

Type of facility Internal Peer External Awards Assessment Assessment Assessme nt

District Hospital 34 25 19 6

Taluk Hospital/ CHC 345 150 67 23

PHC 2208 529 136 74

Total 2587 704 222 103

 Kayakalpa 2017-18

Type of facility Internal Peer External Awards Assessment Assessment Assessment

District Hospital 39 35 26 18

Taluk Hospital/ CHC 348 193 97 60

PHC (including UPHC) 2280 1023 423 212

Total 2667 1251 546 290

 Kayakalpa 2018-19

Type of facility Internal Peer External Awards Assessment Assessment Assessment

District Hospital 45 43 32 27

Taluk Hospital/CHC & 353 234 147 104 UCHC

PHC( including 2407 1150 602 348 UPHC)

Total 2805 1427 781 479

 Kayakalpa 2018-19 had a total of 2805 public health facilities viz 49 DH, 353 TH/CHC/UCHC 2407 PHC including UPHC competing for the awards in the state. Out of these 1427 facilities viz. 43 DHs, 234 TH/CHC/UCHC and 1150 PHC/UPHCs qualified for Peer Assessment. Subsequently total of 781 facilities viz 32 DH, 147 TH/CHC/UCHC 602 PHC/UPHC qualified for External Assessment as per the Kayakalpa criteria of which a total of 479 facilities viz 27 DH, 104 TH/CHC/UCHC and 348 PHC/UPHCs have qualified for the Kayakalpa Awards 2018-19.

 To carryout External Assessment of DH, TH and CHCs State had conducted State level Kayakalpa External Assessors Training to all State Level Programme Officers, Joint Directors, Deputy Directors, Nodal Officers, Advisors, Consultants of DoHFW including NHM, SIHFW, KSAPS, SAST, KSHSRC, KDLWS, WHO, UNICEF, UNIDO, KHPT and PHI under the chairmanship of MD, NHM. This was followed by constitution of 30 External Assessment teams consisting 3 members in each team and Districts allotment for the external assessment teams were completed using random table method generated on a MS Excel to reduce selection bias.

 To carryout External Assessment of PHC, State conducted Swachh Bharath Abhiyaan Master Level Training to DHOs, DQAU-FWOs, DC-QAs & ACPAs, NUHM DPMU-DPM/CPM and Key person from all the districts. Further the Master trainers from each district trained the External Assessors at district level to carryout External Assessment of PHCs. External assessment teams were formed at district level based on Kayakalpa External Assessment Guideline for PHCs 2018-19 and undertook assessment of PHCs in the neighboring districts.  Kayakalpa External Assessment was carried out from 27.12.2018 and External Assessment teams of both state and district completed Kayakalpa External assessment of all 781 public health facilities using mobile application called GUNAK and submitted their report to State (For DH, TH and CHC) and respective districts (For PHC). SQAU compiled and carried out validation of scores reported by External Assessment teams. Based on Kayakalpa award criteria a total of 479 facilities viz 27 DHs, 104 THs/CHC/UCHCs and 348 PHC/UPHCs have qualified for Kayakalpa Awards 2018-19.

National Quality Assurance System (NQAS)

 National quality assurance system, a comprehensive quality improvement program dedicatedly for public health care facilities in the country was developed as per IPHS standards and “Quality Assurance for Public Health Facilities-2013” was released. NQAS has got accreditation from International Society for Quality in Healthcare (ISQUA).

NQAS - 2016-17  In Karnataka state 20 districts hospitals underwent trainings and regular assessments (Internal assessment & District Quality Assurance Unit assessment) regarding 8 RMNCHA related departments-Labour room, Maternity Ward, Pediatric Ward, Sick Newborn care unit, Intensive care unit, Operation Theatre, Post-Partum Unit, Blood Bank in 2016-17.

 DQAU Assessment of qualified 18 District Level Public Health Hospitals was conducted.

 The above 12 District hospitals underwent state quality assurance committee assessments and were scored as per the new revised criteria for certification.

 Totally 7 district hospitals have secured state certifications and recommended for National Accreditation. 7 District Hospitals achieved state certification:

Tumakuru District Hospital

Vijayapura District Hospital

Koppal District Hospital

Mallegowda District Hospital Chikkmagaluru

Lady Goshan , Dakshina Kannada

Wenlock District Hospital, Dakshina Kannada

S N R District Hospital Kolar

NQAS 2017-18

 91 facilities currently from 30 districts of the state for NQAS implementation in the select 8 RMNCH+A departments.

 In 2017-18, NQAS is being implemented in 91 facilities a DH, TH and UPHC each per district plus Lady Goshen District Hospital from Dakshina Kannada.

 Service Providers trainings at the State level for 30 districts are completed for facilities currently under the program. Facilities undergo periodic quarterly assessments, gap closure activities using the allocations as per administrative approvals 2018-19.

 DQAU assessments of 80 facilities scoring more than 70% in internal assessment is sent

 Similarly State level assessments of 26 facilities qualified where undertaken and the final list of State certified facilities for GoI assessments was sent.

Sl Name of Hospital Facility Type Remarks No. 1 Tumakuru District District Hospital Full certification received GOI Hospital 2 Vijayapura District District Hospital Full certification received GOI Hospital 3 Koppal District District Hospital Full certification received GOI Hospital 4 Wenlock District District Hospital Full certification received GOI Hospital, Dakshina Kannada 5 Megann Hospital District Hospital External Assessment awaited Shivamogga from GoI 6 Lady Goshan , District Hospital External Assessment awaited Dakshina Kannada from GoI 7 S N R District District Hospital External Assessment awaited Hospital Kolar from GoI 8 District Hospital District Hospital External Assessment awaited Hassan from GoI 9 District Hospital District Hospital External Assessment awaited Dharwad from GoI 10 Karwar Teach District Hospital External Assessment awaited Hospital UK from GoI 11 Tarikere Taluk Talluk Hospital State certified Hospital Chikmagaluru 12 Gangavathi Taluk Talluk Hospital State certified Hospital Koppal 13 Srinivaspura Taluk Talluk Hospital State certified Hospital Kolar 14 Sira Taluk Hospital Talluk Hospital State certified Tumkur 15 Nehru Nagar UPHC UPHC External Assessment awaited Dharwad from GoI 16 Bapujinagar UPHC UPHC External Assessment awaited Shivamogga from GoI 17 Darga UPHC UPHC External Assessment awaited Vijayapura from GoI

 NQAS Gap identification and tracking format are introduced as the basis for utilizing the funds for traversing the gaps.

NQAS 2018-19  In 2018-19 NQAS Implementation has been expanded to all facilities in the State excluding UCHC and non 24X7 PHC due to non amiability of NQAS Checklists.  As of now, 17 facilities are state certified of which 4 District Hospitals underwent GoI assessment and have received full certifications, and remaining facilities waiting date for External Assessment from Govt of India. Swachh Swasth Sarvatra (SSS):  Swachh Swasth Sarvatra Programme is a joint initiative of Ministry of Health and Family Welfare and Ministry of Drinking Water and Sanitation launched on 29th December 2016 to achieve high levels of sanitation and hygiene in and around public health care facilities.  In 2017-18, in the first phase in Karnataka the activities are initiated in CHCs in or nearest to the 26 Open Defecation Free (ODF) Blocks and in Gram Panchayaths in or nearest to the Kayakalpa winning PHCs in each of the 30 districts.  Nomination of 30 Kayakalpa 2016-17 award winning PHCs for Swachh Swasth Sarvatra Program to make their respective villages ODF. Training is to be undertaken by MoDWS  Kayakalpa Gap identification and tracking format are introduced as the basis for utilizing the funds of Rs.10L each under SSS for traversing the gaps. Out of 26 SSS Funded CHCs, 3 CHCs where declared as Swachha Ratna CHC in 2017-18  In 2018-19, in the first phase in Karnataka the activities are initiated in CHCs in or nearest to the 44 Open Defecation Free (ODF) Blocks and in Gram Panchayaths in or nearest to the Kayakalpa winning PHCs in each of the 30 districts. Out of which 27 CHCs undergone for Kayakalpa peer Assessment of which 14 CHCs participated for External Assessment finally 10 CHCs declared as Swachha Ratna CHC as well as 8 CHC also declared Swachha Ratna CHC where fund were provided in 2017-18. Hence total 21 CHC declared as Swachha Ratna CHC from the inception of SSS.  Kayakalpa Gap identification and tracking format are introduced as the basis for utilizing the funds of Rs.10L each under SSS for traversing the gaps.

Swachhata Pakshika

 The Ministry Health and Family Welfare Government of India in partnership with State Health Departments and Public Health Institution across the state & UTs celebrated “Swachhata Pakshika/Pakhwada’ (Cleanliness Fortnight) from 01st to 15th April 2018 and 2019 as part of Swachha Bharat Abhiyaan (SBA).

 During this fortnight in the state, the efforts were made amongst others, to inculcate a culture of “Swachhata’ in a way that goals and objectives of ‘Swachh Bharat Abhiyaan’ are met and sustained. The Health Facilities acted as catalyst so that there were visible changes and impact all around.  The end objective of this event were not only to inculcate a culture of ‘Swachhata’ in healthcare staff and induce visible changes in cleanliness level of healthcare facilities but it also generated massive awareness of the importance of Swachhata.

 The 15 days events were planned around themes such as Awareness Drive, Cleanliness Drive and Sustenance Drive devoting 5 days on each of the theme.

“Swacchtheye Seve”

 Swachha Bharat Mission fortnightly campaigns like Swachha Pakshikas- “Swacchateinda Siddi”, “Swacchtheye Seve” was celebrated in 15th September to 2nd October 2018 at all Public Healthcare facility level and community levels Financial Progress 2015-2016 to 2018-19

Year Target (in lakhs) Achieved(in lakhs

2015-16 267.14 96.98

2016-17 1248.85 486.16

2017- 18 2026.51 1108.63

2018-19 2639.35 1305.13

1.7.2 National Programme for Prevention and Control of Fluorosis (NPPCF):

National Programme for Prevention and Control of Fluorosis (NPPCF) was started by Ministry of Health and Family Welfare Services, Government of India during 11th five year plan with the aim to prevent and control Fluorosis in the country.

National Programme for Prevention and Control of Fluorosis was implemented in the Karnataka State as per the guidelines of Government of India from 2010-11 onwards in a phase manner in 19 endemic district for Fluorosis, during the FY 2010-11 in two districts viz, Ballari and Mysore as pilot project. During 2011-12 this was extended to Chikballapura, Davanagere, Tumakuru and Koppal districts.Further this programme was extended to 12 other districts viz, Bengaluru Urban, Chitradurga, Kolar, Ramanagara, Shivamogga, Bagalkote, Vijayapura, Gadag, Raichur, Kalaburgi, Hassan, and Mandya during 2013-14. In the FY 2016-17 Bengaluru Rural district is newly added to this programme.

The National Programme for Prevention and Control of Fluorosis, as a first step towards mitigation of Fluorosis in the State, all the 19 districts PHCs and Sub centers have been stratified based on the incidence of Fluorosis by consumption of more than 1PPM fluoride content in water and has been categorized strata wise accordingly. To achieve the set goals of mitigation of Fluorosis in the State well before the year of 2030, the State has brought out a Strategic frame work for Micro level implementation of activities in villages as per the API classifications. At Present 2,917 RO plants have been established to provide fluoride free drinking water to public through rural drinking water and sanitation department in all 19 endemic districts. Other measures like rain water harvesting, planting of trees, supply of RO purified water to Anganawadi and Schools is also being addressed through co-ordination meetings with other related departments during monthly co-ordination meetings being held under the chairmanship of DC/CEO of ZP.

In Karnataka NPPCF programme is being implemented in 19 Districts of Karnataka. The following activities are being conducted. Physical Progress report of NPPCF Programme for the FY 2018-19

Laboratory Activity

Total No. of Water samples test done for Fluorosis 11,132

Total No. of Water samples found above 1 PPM 3,097

Total No. of Urine samples test done for Fluorosis 35,253

Total no. of Urine samples found above the limit 23,451

Sl. Survey Activity (Community and School Survey) No.

1 Total persons Surveyed for Fluorosis 1,596

2 Total school surveyed 988

3 Confirmed Cases of Dental Fluorosis 14,804

4 Confirmed Cases of Skeletal Fluorosis 6,112

5 Suspect Cases of Non-Skeletal Fluorosis 5,922

Confirmed Cases of Non - Skeletal 6 4,221 Fluorosis

IEC Activities

Articles/ press release in local 1 39 newspaper/ mag

Video spots/ interview with expert on 2 4 local TV

Audio spots/ Q & A session on local 3 16 radio/ community Radio

No. of Locations where posters are put 4 8,687 up

5 No. of Pamphlets / booklets distributed 55,679

6 Seminars 206

7 Nukkad Nataks / Street Plays 34

8 Songs/ Dances 12

9 Wall Paintings 56

Medical Management of Fluorosis

Supplementation ( No of persons) 10,860

Physiotherapy / orthoses 742

No. of beneficiaries provided with mobility aids 349

Provision of safe water

No. of safe water sources made available by PHED 6,424

Financial progress report of NPPCF Programme for the FY 2018-19:

Under National Health Mission, Government of India, for effective implementation of NPPCF Programme in Karnataka State, Rs.366.56 lakhs RoP has been approved for the FY 2018-19. At State Level for IEC activities Rs.29.00 lakhs expenditure was done. At district level for HR component including Consultants and Laboratory technicians and Medical Management (including Treatment, surgery and rehabilitation), Laboratory Diagnostic facilities, Health Education & Publicity and Coordination Meetings Rs. 213.92 lakhs expenditure was done. Total expenditure of NPPCF Programme for the FY 2018-19 is Rs. 242.92 lakhs (66.3%).

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

69 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& 207 Community health centers will be link to all District Hospitals & Government Medical Colleges.

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. And up to the end of May 2019 from all the districts, all the applications were scrutinized and 24532 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 No. of Registration No. District Certificate given

1 Bagalkote 845

2 Bangalore Rural 273

3 Bangalore urban 6138

4 Belgaum 893

5 Bellary 686

6 Bidar 415

7 Bijapur 641

8 Chamarajanagar 163

9 Chikaballapura 220

10 Chikamagalur 289

11 Chitradurga 435

12 Davanagere 981

13 Dakshinakannada 1071

14 Dharwad 1923

15 Gadag 572

16 Gulbarga 761

17 Hassan 453

18 Haveri 574

19 Kodagu 138

20 Kolar 251

21 Koppal 324

22 Mandya 520

23 Mysore 2050

24 Raichur 478

25 Ramanagara 167

26 Shimoga 593

27 Tumkur 769

28 Udupi 1168

29 Uttarakannada 505

30 Yadgiri 236

Grand Total 24532

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. Signature of part-iv confidential reports of Belgaum Division Doctors.

5. Celebration of State level Doctor’s day programme on July 1st Bengaluru at Directors Office.

6. Stalls are opened at Mysore Dasara Exhibition regarding Health Awareness

7. Submission of Nomination received from elected bodies for Arogya Raksha Samithi to Government.

8. Submission of Nomination received online, from Candidates to work Haj as Medical Personnel, to Government.

9. Submission of list of Doctors who are eligible to issue Compulsory Health Certificates to Amarnath Yathries , to Government

10. Submission of Nominations of Departmental of Staffs for various Awards like Sarvothama Award and Florence Nightingale Award 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, the Sustainable Development Goal 3 specifically focuses 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 Mentoring Training” 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 State 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 completed a pilot project of Assisted home care to drop out SMD patients in 3 districts (Ramanagar, BBMP & 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. 818 Faith healers are included for training programmes in the year 2018-19

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. Also taken 10 Talukas under Taluka mental Health Program wherein 1 Psychiatrists and 1 Social Worker are being Recruited.

2018-19 Physical and Financial Progress:

 2018-19 Released Budget 2191.19 Lakhs, Expenditure.1629.48 Lakhs. (74.36%)

 From April 2018 to 31st March 2019, 8,96,732 patients with mental health problems have been treated across the state and 1,98,649 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 884 Out Reach camps and catered to 29,997 patients. The Team under the DMHP have made 6067 Home visits and attended to 5,642 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 18-19, 1,616 Medical officers, 475 Ayush Doctors 4,734 paramedical workers, 490 RBSK/RKSK staff, and 21,816 ASHAs have participated in the training.  Weekly counselling services have been started in 314 centres: 122 colleges, 98 workplaces and 94 urban slums. In all these service nodes, the counsellor on a fixed day during the week provides services of counselling for those in need and also refers to DMHP psychiatrists if required. During 2018 -19, nearly 45,206 persons benefitted: 28,118 beneficiaries in colleges, 8,533 beneficiaries in workplaces and 8,555 in Urban slums.  A total of 7,590 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, 3030 counsellors from Karnataka State Aids Prevention Society (KSAPS) / Women and Child Department (WCD), 6,671 police / prison staff, 818 faith healers / NGOs, 431 elected representatives have been sensitized on signs and symptoms of Mental illness and treatment facilities available within their districts.

 Sensitization of total 2214 staff comprising of Village Rehabilitation Workers (VRWs), Multipurpose Rehabilitation Workers (MRWs), NTCP staff , NCD staff, RNTCP staff , Agricultural Department staff, Horticultural Department staff, Panchayath Raj Officials and Volunteers from village level have been sensitized on features of Mental illness and treatment facilities available.

 26 Schools/PU colleges/Residencial Schools Visited by Social Worker/ Psychologists/ Psychiatric Nurse and 701 Children/ School teachers Sensitized.

 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 18-19 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 1. Printing & distribution of education materials at District level & distributed 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 Health Programme & Schemes.

4. TV spot on various National Health Programmes & Schemes has been telecasted through Doordarshan & private TV channels.

5. Broadcasting and conducting of interviews, Radio jingles and phone in programme in Akashvani, Private FM radio on various Health Programme. 6. Printing & fixing of flex on hoardings on various National Health programmes & Schemes.

7. Wall painting on Immunization Schedule in selected Health & Panchyat Raj institutions and public places.

8. Health information disseminated through LED TVs in Railway station & KSRTC Bus stations.

9. National & International Health days like World Health Day, World Population Day, World Mental Health Day, World TB Day, Anti Leprosy Day & others was coordinated by IEC wing.

10. Panel discussion on various Health programme in AIR and Doordarshan by subject experts.

11. Essay competition on Mental Health program to School students was organized at Taluk & District Level.

12. Debit Competition on Tobacco control programme to technical college students was organized at Taluk & District Level.

13. Press conference, Press meets was conducted by Hon’ble Chief Minister & Hon’ble Health Minister on National Health Events.

14. Press advertisement was given on National Health Events / Days in State, Regional, District & taluka level newspapers. 15. Conducted major exhibition and tablo on special occasion like Dasara, Kannada Rajyotsava & Jatras.

16. Dissemination of Health & FW services messages through Facebook, Twitter, LinkedIn, etc

17. Dissemination of Health message on LED screens in railway coaches.

18. Installation of Standees & display of health messages on various National Health Programmes & Schemes at Metro Stations.

19. Telecasted spots & scrolling messages in cinema theaters & local city cable Network throughout the state. 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 1443. 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 2018-19 is as below as on March 2019:

Total number of Vehicles (Including Ambulance) in Health & Family Welfare Services Department : 1443 1.14. Integrated Disease Surveillance Project (IDSP):

1 IDSP reports are received from Sub centres (S form), Health facilities such as PHC, CHC, GH and DH (P form), Laboratories (L Form). Annual Average reporting percentage is 95%, 91% & 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. Similarly other Municipal Urban Health Facilities of different Districts have been made as reporting units under respective Districts to improve the surveillance activities in the Urban areas.

3 Integrated Health Information Platform (IHIP) for IDSP: Joint Monitoring Mission (JMM) organized by MoHFW and WHO in the year 2015 to review the programme recommended the revamping of information system & IT architecture of the reporting platform under the program. Subsequently, on the request by MoHFW, WHO Country Office-India has designed and developed Integrated Health Information Platform (IHIP) with IDSP.

IHIP is near-real-time. Web-enabled electronic health information system intended to capture village-level case-based disease surveillance data under IDSP. The IT platform shall also enable greater collaboration with other existing disease surveillance program and sectors, with support from WHO in future. All types of surveillance standards, data standards and IT standards are incorporated in IHIP.

IHIP was pre tested in various types of health facilities in two districts in Karnataka and one district of Telangana and the feedback/changes were suggested. Furthermore, IHIP-IT platform is implemented in seven states: Karnataka, Telangana, UttaraPradesh, HimachalPradesh, Kerala, AndraPradesh and Odissa on 26th November 2018 by Secretary to the Health, GoI.

4 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, District Malaria Officer, Reproductive and Child Health Officers, Epidemiologist, Microbiologist, Entomologist, Veterinary Doctors, Physicians, Pediatricians and Food Safety Officers visits the affected area to take preventive measures and for control of Outbreak. A total 192 outbreaks have been reported in the year 2018 in which 168 (88%) have utilized the Laboratory support and 121 (63%) Lab confirmed. 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. The 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. In ROP 2018-19, 5 more DPHLs (Bellary, Dharwad, Chickmagalur, Chikkaballapura and Ramanagara.) have been approved for strengthening. Procurement of equipments and renovation of the identified lab space is in progress.

8. All District Surveillance laboratories except Bangalore Urban& Bangalore

Rural 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 (2018-19):

 Budget grants approved by GOI as per ROP for 2018-19 – Rs. 358.49 lakhs

 Expenditure up to March 228.10 (64%) (PROV.)

1.15. Nutrition Programmes: 1. Vitamin ‘A’ Administration Programme:

This programme is implemented for pre-school children of 9 months to 5 years 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 viz.:

2. Measles Rubella 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 Immunization. Around 10.30 lakh children are target beneficiaries of this programme. This is a routine monthly programme.

Sl Year Target Achievement % No.

1 2018-19 (till August 2018) (Vitamin ‘A’ was not administered due to non availability of Vitamin ‘A’ 1030317 Solution) 339268 33

(ii) Vitamin ‘A’ supplementation programme :

1 This programme is implemented biannually to the children of 1 /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 45.69 lakh children are Target Beneficiaries of this programme during 2018-19.

Sl.No Year Target Achievement %

1 May 2017 4798898 4565356 95

2 November 2017 4738211 4350613 92

3 2018-19 The Vitamin ‘A’ conc was not procured during 2017-18 due to price issue at the centre. Hence the Bi-annual Vitamin ‘A’ Supplementation programme was not implemented. Now issue is cleared and tender is called for procuring Vitamin A conc.

2. Mass Deworming Programme: This programme is implemented Bi-annually during February and August every year. Albendazole tablets are distributed to pre- 1 school children. /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. National Deworming Day is implemented as per GOI Guidelines.

The progress is as follows.

Year Target Achievement %

2018 (February) 4235328 3884512 92

2018 (August) 3965328 3767061 95

2019 (February) 4133000 3964000 96

FINANCIAL PROGRESS

Year Approved Expenditure (Rs. in lakhs) (Rs. in lakhs)

2018-19 160.00 The Vitamin ‘A’ conc was not procured during (Vitamin A) 2017-18 due to price issue at the centre. Hence the Bi-annual Vitamin ‘A’ Supplementation programme was not implemented. Now issue is cleared and tender is called for procuring Vitamin A conc.

Nutrition Rehabilitation Centres (NRCs) in Karnataka: Nutrition Rehabilitation Centres refers to a unit for ‘inpatient, centre 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. The Medical officers visit A.W.Centres and conduct health check up once in two months. The children diagnosed with Mal-Nutrition and other deficiencies are treated suitably. Severely malnourished children are referred to Paediatricians for treatment at Taluka Hospitals/ District Hospitals/ Nutrition Rehabilitation centres.

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 Centres. 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 Counsellors 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.236/- 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.

Taluka Nutrition Rehabilitation Centres (NRCs) : As per the instructions of the Chief Secretary, Government of Karnataka 49 taluka NRCs were established in 26 districts during March 2019. The beneficiaries are provided with treatment along with food. The mother / guardian is paid wage compensation loss of Rs. 259/- per day for 14 days or as long as the child is admitted in the centre. The centre is managed with existing staff.

PHYSICAL PROGRESS of NRC is as follows.

Discharged with Referred Children Admissions target weight (Medical Year followed up gain Transfer)

2018-2019 5415 2406 146 3363

Financial Progress 2018-19

Approved Expenditure Remarks (Rs. in lakhs) (Rs. in lakhs) Nutrition Rehabilitation 40.30 95.88 Budget for Rs. 40.30 was Services approved for 17 NRCs in the (32 NRCs) ROP 2018-19 against the proposal for Rs. 127.84

IEC under 185.79 79.38 Committed Nutrition Programme

Training and Workshop:

1. 4 days SAM TOT training programme was organised from 11th to 14th of February 2019 at Seminar Hall-I, SIHFW, Magadi Road for Paediatrician / Medical Officer, Staff Nurse / ASHA Supervisors and CDPO from WCD Department. 2. A state level work shop on Brain Storming Session was organised under the chairmanship of Additional Chief Secretary and Development Commissioner in coordination with WCD Department on 26-02-2019 at Hotel Capitol, Rajabhavan Road, Bengaluru.

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

National Iodine Deficiency Disorders 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, Uttara Kannada, Kodagu, Chikkamaglur, Bengaluru(U), Bengaluru(R), Shivamogga are recognized to be Endemic Districts.

During 2018-19, 190 Goitre cases reported and put on treatment as per the report sent from the districts.

During 2018-19, IDD Survey is taken up in 10 districts viz., Shivamogga, Hassan, Kodagu, Mysore, Mandya, Dharwad, Davanagere, Ramanagara, Tumkur and Dakshina Kannada 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 2019-20 also.

As per Government of India Guidelines, during the 2018-19 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. PHYSICAL PROGRESS 2018-19

Particulars 2018-19

Goitre Cases 190

Salt samples tested in 8 Endemic districts using Salt Testing kits (STK)

Year Total samples Above 15 PPM Below 15 PPM 0 PPM

33,16,002 3,02,850 1,50,344 2018-19 37,69,196 (87.98%) (8.03%) (3.98%)

Salt samples tested for Iodine content at IDD Laboratory

Year Total Satisfactory Non-Satisfactory

2018-19 9695 8245 (85.04%) 1450 (14.96%)

Urine samples tested for Iodine Excretion at IDD Laboratory

Total Moderate Normal Mild Year Samples (>2 to (>10µg/dl) (>5 to <10µg/dl) tested <4.99µg/dl)

4413 63 2018-19 4476 0 (98.59%) (1.40%)

1.17 Karnataka State Drug Logistics and Warehousing Society: Introduction:

Karnataka State Drug Logistics and Warehousing Society, Bangalore was established with an objective to cater to the needs of Health Institutions coming under the Directorate of Health and Family Welfare Services as well as those Hospitals coming under the control of Directorate of Medical Education and such other programmes coming under Health and Family Welfare Services. Objectives:

Karnataka State Drug Logistics and Warehousing Society, Bangalore is headed by Additional Director. He functions under the Administrative control of the Commissioner, Health & Family Welfare Services and the Director of Health & Family Welfare Services. The requirement of Drugs, Chemicals & other items of all State Sector Hospital, Teaching Hospitals under the Directorate of Medical Education and the Hospitals/Institutions coming under ZP, are procured and supplied in accordance with the budget allotted and the indent of individual Hospitals/Institutions through District Drugs Warehouses. Plan of Action:

1. The erstwhile Government Medical Stores has been restructured into a society and is functioning as Karnataka State Drugs Logistic & Warehousing Society ® which was formed with the financial assistance of the European Commission through Government of India during the year 2003. Presently 26 Dist. Ware Houses catering to the needs of hospitals. Cold Storage Room has been installed in all 26 Dist. Drug Warehouses. As per the indents of the Health Institutions drugs are supplied to them through the Troop Carrier Vehicles of Warehouses. During 2014-15, 6 new Troop Carriers were issued to warehouses.

2. The essential equipment’s and necessary materials were supplied to all the 26 Drug Warehouses, All the warehouses are computerized and internet connection is also provided. Karnataka State Drugs and Logistics Warehousing Society is connected to all Districts. Drug Warehouses, where in data is feed through Warehouse Information System WIS.

3. From 2014-15, Online Drug Inventory Management System, has been followed for Indenting of Drugs from various Health Institutions & Medical Educational Institutions. Drugs and Chemicals are also supplied by this Society to combat Natural calamities like floods, droughts which are supplied as per the directions of the Government from time to time. The Equipments and Furniture required for different health institutions are procured through KDLWS from the year 2011-12.

4. Bio-Medical Equipment Maintenance Outsourcing Cell is under process, This Cell compiles the Equipments information of the state, monitors the repair work and AMC/CMC of the equipments.

5. On 15.04.2015 Chief minister implemented Bike Ambulance Service. This service is used for people injured in accidents. This service treats the injured person before the ambulance the sport.

6. Providing Need Based Drugs to 2800 Health Institutions in the state without Budget ceiling.

7. 171 ICU units established in District and Taluka Hospitals.

8. To provide essential Equipments / Instruments to reduce Neonatal Deaths in the areas where population of SC & ST is more.

9. To purchase and provide Sanitary Pads under Shuchi Programme in the areas where population of SC & ST is more. 10. To provide essential Equipments / Instruments for carrying out eye testing, Identify the disease and to perform surgeries in the areas where population of SC & ST is more. 11. To provide LED Microscopes atleast two for one Taluk, for identifying Tuberculosis cases.

12. Modular OT, Centralized Oxygen System, Dental Consumables,Centralized Sterilization, Service Department has been supplied.

Budget Allocations:

Table 12.69.Budget released KSDLWS, Bangalore for procurement of Drugs and Chemicals and expenditure for the past five years is as follows:

Budget Released (Rs. Expenditure (Rs. In Year In lakhs) lakhs)

2012-13 9375.00 9375.00

2013-14 10,500.00 10,500.00

2014-15 13,349.00 13,349.00

2015-16 15000.00 15000.00

2016-17 16624.38 16624.38

2017-18 17575.00 17575.00

2018-19 15614.29 15614.29

Budget Allocations: Budget released KSDLWS, Bangalore for procurement of Equipment & SDP, SCP & TSP and expenditure for the past five years is as follows:

Budget Released Expenditure Year (Rs. In lakhs) (Rs. In lakhs)

2012-13 3268.09 3268.09

2013-14 2500.00 2500.00

2014-15 2045.00 2045.00

2015-16 2300.00 2300.00

2016-17 2500.00 2500.00

2017-18 3300.00 3300.00

2018-19 3680.00 3680.00

Other Department Programmes:

Drugs, Chemicals diagnostic kits, Lab consumables, Blood Bank Consumables and instruments medical equipment required under National Rural Health Mission, Karnataka Aids Prevention Society are procured and supplied as per their requirements.

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 2018-19

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 2018-19 (Both Physical and Financial) Details regarding achievements for the year 2018-19 upto March -2019 (Both Physical and Financial) enclosed in the Annexure.

Other remarkable achievements for the year

a) 5th batch of CPHN Course for in service LHV’s/ANMs was completed on March- 2019 and 6th Batch started in April -2019.

b) 2nd Batch PGDHP & E Course for in service BHEO’s was completed in June-2018 and 3rd Batch started in July-2018.

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 2018-19 under (NHM)

Details of the No. of persons Sl.No. Batches Achievement Training trained

Maternal Health A sum of Rs. 4141.12 1 276 2337 Trainings lakhs have been incurred as expenditure Child Health out of Rs. 3206.34 2 226 4498 Trainings lakhs released

Family planning 3 131 1098 Trainings

Other Trainings under 4 52 1774 NHM

ASHAs Training for 5 Induction & ASHA 177 5222 Module 6&7

6 ASHA NIOS Training 501 18887

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 analyzed. 2. The samples are analyzed for E. Coli Organisms and Coli Form Organisms which are the indicators for the facial 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 vax Acwy (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:

“Ayushman Bharat-Arogya Karnataka:

A major milestone in 2018-19 is Karnataka’s Stride towards ‘Universal Health Coverage’ to fulfil the mandate delegated to States in the Indian Constitution.

Convergence of Schemes to achieve Universal Health Cover & Uniformity in Service Delivery:

As of 2017, the following seven standalone schemes were operational concurrently in Karnataka:

1. Yeshaswini Scheme

2. Vajpayee Arogyashree Scheme

3. Rajiv Arogyabhagya Scheme 4. Rastriya Swasthya Bhima Yojane (RSBY) including Sr. Citizen Scheme

5. Rastriya Bala Swasthya Karyakram 6. Mukhyamantrigala Santhwana Harish Scheme

7. Indira Suraksha Yojane

In the above seven standalone schemes, there was significant overlap across schemes in terms of scope and coverage, sub optimal utilization of the public health institutions and variations in the treatment rates in private hospitals. The design of some of the schemes resulted in bypassing of the public health system in favour of availing health care services from private health care providers. Such bypassing of the public health system had contributed inadvertently to the weakening of the health system in terms of service delivery and productivity. To counter these problems a single scheme that catered to all the people of the State with all benefits that were scattered in the 7 schemes under a single umbrella was conceptualized. Arogya Karnataka – Synergizing Health Care Spectrum in State

The Universal Health Coverage (UHC) scheme, “Arogya Karnataka” is in implementation since 2.3.2018, with the goal of providing Universal Health Coverage to all residents of the State. The Government of India has come out with a centrally sponsored scheme (CSS) called Ayushman Bharat - National Health Protection Mission later named PMJAY to provide health protection to the poor families in the country. It had a smaller coverage but higher financial assistance.

Since Karnataka already had rolled out “Arogya Karnataka Scheme” an integration of both the schemes “Ayushman Bharat” and “Arogya Karnataka” to achieve operational efficiency was envisaged with Common coverage, scope and implementation modalities under a co-branded name “Ayushman Bharat-Arogya Karnataka”. The integrated scheme called “Ayushman Bharat - Arogya Karnataka” is implemented in an “Assurance Mode”. A MoU by National Health Agency, GoI and State Government was signed on 30/10/2018 and Government Order vide No. HFW/69/CGE/2018 dated 15/11/2018 was issued. Scheme Overview

The patients availing healthcare services are categorized as

 Eligible Patient: Residents of Karnataka State and belongs to “Eligible Household” as defined under the National Food Security Act, 2013

This category shall also includes the beneficiaries listed in the SECC data and the enrolled members of the hitherto existing Rashtriya Swasthya Bhima Yojane.

 General Patient: Residents of Karnataka State but do not come under the definition of “Eligible Household” as defined under the National Food Security Act, 2013, or do not produce the eligible household card.

Cost of treatment to be borne by the Government  “Eligible Patients” : Financial assistance up to Rs.5.00 lakh will be provided for specified simple secondary care, complex secondary health care, tertiary health care and emergency health care, per annum, for a family This will be on family floater basis meaning one or more persons of the family can use the full cover of Rs. 5.00 lakhs. One person can also use the entire Rs.5.00 lakh.  “General Patient”: The benefit limit will be 30% of package rates, with overall annual limit of Rs.1.50 lakh per family, per year on co-payment basis. Enrolment of patients

 One-time enrollment of patients, on an IT portal to be established by SAST as and when they approach any PHI for treatment for the first time or any other enrollment facility as designated from time to time

 For single incident patient can get treatment under the scheme by producing his Aadhar card and PDS card.  A patient approaching an empanelled private hospital in case of emergency without a referral from a PHI can be enrolled at a designated enrollment center or a PHI after stabilization and discharge from hospital AB-ArK Card

 Under the Ayushman Bharat- Arogya Karnataka scheme the enrolment card called AB-ArK Card and the unique AB-Ark ID is generated and provided to the patient at the enrolment center on payment of a fee of Rs.10/-.

 Enrollment cards are also issued in Common service centers, B1, K1 and Seva Sindhu centers on a payment of Rs. 10/- for an A4 Size Health card or Rs. 35/- for plastic card.

The salient features of the integrated scheme are ;

a) Basic Sum Assured is Rs. 5,00,000/- (INR Five lakhs only) per AB-ArK Beneficiary Family Unit, per annum for “Eligible Households” as defined in the National Food Security Act 2013, and RSBY enrolled beneficiaries, or any other coverage as agreed upon by the Government of India and the Government of Karnataka jointly from time to time under “Ayushman Bharat–Arogya Karnataka”. For those that do not come under the “Eligible Household” under the NFSA 2013 or are not enrolled RSBY beneficiaries, the sum assured is 30% of the package rate up to Rs.1.5 lakh per family per annum.

b) Under the integrated scheme, there are 1650 treatment packages. Of these, 291 simple secondary procedures will be limited to PHIs, 254

complex secondary procedures, 900 tertiary procedures, 169 emergency procedures and 36 sub-procedures will be provided.

c) Primary and Simple secondary procedures will be performed in PHIs.

d) Complex secondary procedures and tertiary procedures will be performed in PHIs and empanelled Private hospitals,

e) While complex secondary procedures and tertiary procedures require referral from PHIs, for 169 emergency procedures, patients can directly go to the empanelled hospitals of their choice and avail treatment without referral.

Fund Sharing Pattern a) All the members of 62 lakh beneficiary families enrolled under the Rashtriya Swasthya Bhima Yojane Scheme shall also be “Eligible beneficiaries” of the integrated scheme “Ayushman Bharat-Arogya Karnataka” (AB-ArK) and the expenditure incurred on this is shared between GoI and GoK. GoI will provide funding of 60% of the expenditure incurred for beneficiaries that are in the SECC data 2011 and left over RSBY beneficiaries who were enrolled under the earlier RSBY scheme that came to a close on 31/8/2018 and 40% will be borne by Government of Karnataka.

b) GOK will provide health care for the remaining eligible families and also 19 lakh APL families. These 19 lakh APL families will be eligible for assistance of 30% of the package rates upto Rs. 1.50 lakh per family per year.

c) With the State being 40% of the expenditure incurred for the 62lakh families, in addition to 100% of remaining Eligible families and General Families, the endeavour of the State to reach the vision of Universal Health care for the residents of Karnataka will be sustained.

Performance Status – 2018-19 as of 31st March 2019:

Total Hospitals Empanelled

Hospital Sector No. Empanelled

Government / PHIs 410

Private 403

Total 813

Efforts are on to empanel more hospitals for the benefit of patients across the State. ARKID Cards Issued: 3484749 numbers.

Total Beneficiaries treated: ArK commenced implementation from 1st June 2018. Hence, during the months of April & May 2018, beneficiaries availed treatment

93 under existing schemes. The total budget allocated for the year 2018-19 is Rs. 765 crores.

The total patients / beneficiaries who availed treatment and the total expenditure towards their treatment including number of male and female beneficiaries is given in the following table:

Amount in Beneficiaries Scheme Case Lakhs Male Female VAS 28170 14607.87 16718 11452 RAB 733 335.27 399 334 MSHS 11808 590.52 7085 4723 ARK 50190 23090.81 30332 19858 AB-ARK 26309 9850.72 14153 12156 Admin 576.05 Total 117210 49051.24 68687 48523

Under SDP, SCP and TSP, the treatments availed is as follows:

Category Cases Amount in Lakhs

SDP 28478 11507.27

SCP 21798 9023.85

TSP 7501 3335.97

Total 57777 23867.09

In addition to the above, under RSBY, RBSK and JSS schemes, the following expenditure were also incurred during the year for treatment of Senior Citizens and Children. The details given in the table below:

Amount in Scheme Cases Lakhs

RSBY - Senior Citizen 5537 2904.02

RSBY - General 25971 4224.13 RBSK 1100 511.21

RBSK - Cochlear Implant 54 36.2

JSS - State Govt. 2311 1527.26 Employees Total 34973 9202.82

From April 2019 onwards, the SAST application portal will allow uploading of Preauths and Claims of only AB – ArK and JSS Schemes only.

Organ Transplant Scheme :

Government Order No. HFW 64 FPE 2018, Bangalore, dated 3/2/2018 issued for implementation of Organ Transplant Scheme. A grant of Rs. 30 crore has been earmarked for transplantation of heart, kidney, liver etc. for poor patients for the year 2018-19. The scheme is designed for live related and cadaveric transplant (brain dead).

Government vide letter dated 14/3/2019 has directed to utilize unspent funds from AB-ArK Scheme and maintain separate Accounts for the scheme. Empanelment criteria have been published and SAST is in the process of empanelling both Private and Government hospitals under the scheme.

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 2018-19

Month Total Unsafe/ samples Registration Licensing Samples Misbrand/ for the year Analyzed 2018-19 Received Adulterated

April 1170 2961 353 397 32

May 1313 3089 344 321 30

June 4716 3680 282 301 26

July 3622 4097 369 327 28

August 3107 3882 279 292 38

September 1912 5232 392 298 61

October 1887 6137 264 254 25

November 1624 4340 256 252 32

December 1922 4587 435 437 75

January 1882 5023 340 326 28

February 1858 4968 370 367 53

March 2223 6108 493 388 5

TOTAL 27236 54104 4177 3960 433

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 redesignated and 177 new posts have been created in the Government Order vide No: HFW 317 CGE 2011, dated: 23-08-2012 and for filling up of these posts Executive Orders have been issued.Cadre and recruitment rule has came into existence with effect from 05.01.2017, accordingly 158 Food Safety Officers posts will be filled through KEA (Karnataka Examination Authority).As per the Government of India notification arrangements is being made inducting sub divisional officer in the districted quarter will be placed on in charge arrangement

96 to the post of designated officer as he is facilitated sufficient staff under his control and empowered to execute standing orders at his level which enables him to carry out duties of designated officer and effective enforcement of FSS Act and rules.

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 Rs212.00Lakhs, 212Lakhs was released in three installments from the Directorate of HFW services, out of whichRs 192.23Lakhs was utilized. This budget is used forthe salary of contractual staff, Manual Labours, fuel expenditure and for other office expenditure.

Action Plan for 2018-19:  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 2018-2019 (Up to MARCH- 2019):

Head of Account Released Expenditure Lakhs Lakhs (Rs) ( Rs)

2210-06-107-0-01 1124.00 1220.00

2210-06-001-0-01 FIT 39.74 19.12

2210-06-101-1-02 NMAP 35.32 29.39

2210-06-102-0-02 The Scheme is merged

PUBLIC HEALTH INSTITUTE, SHESHIDRI ROAD, BANGALORE. PERFORMANCE REPORT FOR PUBLIC HEALTH INSTITUTE, SHESHIDRI ROAD, BANGALORE.

PERFORMANCE REPORT FOR THE MONTH OF MAR- 2019.

Sl. SECTIONS OF PHI Total Cumulative total NO. samples no of samples analysed analysed from during the April-2018 to – month of MAR-2019 March 2019 I WATER BACTERIOLOGY Bacteriological analysis of water for 117/107/270 1765/1378/3119 drinking purpose,analysedBorewell/Tapwater/ Others Number found fit for potable purpose. 80/76/204 879/805/2028 Number found unfit for potable 37/31/66 956/751/1360 purpose II DIAGNOSTIC BACTERIOLOGY Bacteriological analysis of water for - 18 1 isolation of V, Cholera No of samples received. Number of sample analysed. 0 18 Number of samples positive for V. 0 0 Cholera. 2 Bacteriological analysis of stool 0 0 sample for isolation of V. Cholera Number of samples negative for V, 0 5 Cholera Number of samples positive for V. 0 0 Cholera 3 Bacteriological analysis of food for Coli 102 538 forms and other specific pathogens,analysed Number of samples found positive 18 40 Number of samples found negative 84 198 III Yellow Fever Vaccination and 492 6749 International Certificate Give IV CHEMICAL EXAMINER’S LABORATORY 1 Number of suspected Norcotics - - samples Tested

Sl. SECTIONS OF PHI Total Cumulative total NO. samples no of samples analysed analysed from during the April-2018 to – month of MAR-2019 March 2019 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 ) 4 Liquor Samples - - Opening balance - - Samples received - - Total - - Samples Analyzed - - No samples found positive / - - substandard Pending - - 5 ACB - - Opening balance 0 0 Samples received 7 103 Total 7 103 Samples Analyzed 6 102 Pending 1 1 V STATE FOOD LABORATORY 1 Opening balance during the month. ( 28 118 under FSSA ) No of food samples received under 61 366 FSSA Total samples 89 896 No of food samples analyzed 70 753 No of samples Found unfit for Analysis 01 2 No of samples Found unsafe 0 13

Sl. SECTIONS OF PHI Total Cumulative total NO. samples no of samples analysed analysed from during the April-2018 to – month of MAR-2019 March 2019 No. of samples misbranded/ 3 19 substandard Closing balance 18 18 2 Opening balance during the month. ( 255 2520 under Non-FSSA ) No of food samples received under Non 884 7132 FSSA Total samples 1139 8931 No of food samples analyzed during 926 6232 the month No of samples Found unfit for analysis 0 1 No of samples found unsafe 23 179 No. of samples found misbranded/ 6 99 substandard. Closing balance 213 213 VII TRAINING SECTION Post Graduate Doctors - - 1 Post Graduate. MD trained/visited - 12 Microbiologist 2 Post Graduate MDS trained/visited - - Microbiologist Under Graduate Doctors - - 3 Doctors MBBS trained/visited 10 108 4 Doctors B D S trained/visited - - Students from other Institution - - 5 Post Graduates - 2 6 Sanitary health inspector - 13 7 Under Graduate - 28 Nursing Student - 0 8 B Sc Nursing - 68 9 General Nursing ( LHV’S ) - 0 10 Senior Lab Technicians - 0 11 Junior Lab Technicians - 2

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Sl. SECTIONS OF PHI Total Cumulative total NO. samples no of samples analysed analysed from during the April-2018 to – month of MAR-2019 March 2019 12 Nodal Officers/DSO/A.O/DO’s - 0 13 F.S.O - 0 14 Excise sub inspectors /BHE - 6 TOTAL 10 227 VIRAL SENTINAL SURVEILLANCE LAB 1 Chickangunya;- No. of samples received 36 493 No. of samples tested 36 493 No of Positives 10 116 No.of equivocal 2 29 2 Dengue:- No of samples received 36 499 No. of samples tested 36 499 No. of Positives 6 105 No.of equivocal 0 27 3 J E: - - No. of samples received - - No. of samples tested - - No. of Positives - -

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Annexure-1 Details of Posts sanctioned in Public Health Institute, Bangalore, Divisional Food Laboratories (Mysore, Belgaum & Gulbarga) and Details of Posts sanctioned under Food Safety and Standard Act (Posts sanctioned in Raichur, Chitradurga, Dharwad and Chikkamagalur Regional Food Laboratories) and Posts as per the C&R Order dated 5/1/2017

Working as Posts Sl. Working on Designation sanctio ned Vacant Remarks No. Strength Deputation under FSSA /In charge

Food Safety 1 1 1 0 0 Encarded to IAS Commissioner

Chief Administrative officer Health & Joint Food FW Services, 2 Safety 1 0 1 1 Bangalore is in Commissioner charge as Joint Food Safety Commissioner

Deputy Commissioner Deputy (Squad) is in 3 Commissioner 1 0 0 1 charge as Deputy (Admin.) FSSA Commissioner (Admin)

Deputy 4 Commissioner 1 1 0 0 (Squad) FSSA

Senior Food Chief Food Analyst is in 5 4 0 4 4 Analyst charge as Chief Food Analyst

Senior Food 6 4 0 4 4 Analyst

Programme officers Health & FW Services, Designated 7 36 0 36 36 Karnataka is in Officers charge as Designated Officers

8 Food Analyst 14 0 12 14

Deputation by 9 Legal Advisor 01 0 0 01 Judiciary Department

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Working as Posts Sl. Working on Designation sanctio ned Vacant Remarks No. Strength Deputation under FSSA /In charge

10 Jr Food Analyst 25 0 7 25

Jr. 11 0 0 0 1 Vacant Microbiologist

Deputation by Sr. Food Safety Health Family 12 34 0 7 34 Officer and Welfare Department

Deputation by Asst. Health Family 13 Administrative 1 1 0 0 and Welfare Officer Department

Deputation/ In charge / by Food Safety 14 210 0 170 210 Health Family Officer and Welfare Department

Deputation by Asst. Statistical Directorate of 15 1 1 0 0 Officer Economics and Statistics

Deputation by 16 Stenographer 0 0 0 1 any Government Department

9 Posts are deputation by Health Family and Welfare First Division 17 40 9 0 31 Department, 20 Assistant Posts are Deputation by any Government Department

Deputation by any Government 18 Group- D 6 0 0 6 Department

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STAFF POSITION OF GAZETTED & NON-GAZETTED EMPLOYEES OF PUBLIC HEALTH INSTITUTE AS ON 01.03.2018

Sl.No DESIGNATION SANCTIONED WORKING VACANT 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 - CHIEF FOOD ANALYST & PUBLIC 1 - 1 7. ANALYST SENIOR FOOD ANALYST & PUBLIC 1 1 - 8. ANALYST 9. FOOD ANALYST 6 4 2 10. JUNIOR FOOD ANALYST 13 5 8 ASSISTANT ADMINISTRATIVE 1 1 - 11. OFFICER SENIOR HEALTH ASSISTANT 1 1 - 12. (NAMP) 13. OFFICE SUPERINTENDENT 2 2 - 14. FIRST DIVISION ASSISTANT 6 6 - 15. SECOND DIVISION ASSISTANT 4 2 2 16. STENOGRAPHER 1 - 1 17. TYPIST 1 - 1 SENIOR MEDICAL LAB. 10 09 1 18. TECHNOLOGIST JUNIOR MEDICAL LAB. 13 12 1 19. TECHNOLOGIST 20. DRIVER 1 1 - 21. LAB. ASSISTANT 26 1 25 22. ELECTRICIAN 1 0 1 23. WATCH MAN 1 - 1 24. GROUP “D” 7 7 - 25. GROUP-D (FIT HEAD) 1 1 - TOTAL 103 58 45

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PART II

DRUGS CONTROL DEPARTMENT

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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.

Drugs Control Department, Palace Road, Bengaluru 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,

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 Narcotics Drugs & Psychotropic Substances Act, 1985in relation to Drugs covered under the Drugs & Cosmetics Act, 1940 & Rules thereunder.

During the financial year 2018-19, a total provision of Rs. 5311.00 (of which Rs. 5154.00 under the State scheme and Rs. 157.00 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 Hubli and the other at Bellary in North Karnataka, are completed through KHSDRP and have already started functioning in respective own buildings. The Department is taking initiatives to get the NABL accreditation in the National level for these two laboratories. 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 01.04.2018 to 31.03.2019, a total of 14613 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.

As announced in the 2013-14 financial year budget, 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.

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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 2018-19 Rs. 600.00 lakhs has been allocated for the construction of ladies hostel in the premises of Government College of Pharamcy and purchase of site for sub office at Raichuru. 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,

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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 31.03.2019.

Number of posts Sanctioned Filled up Vacant Group-A 116 97 19 Group-B 254 160 94 Group-C (Technical) 67 21 46 Group-C (Non-Technical) 238 145 93 Group-D 111 42 69 Grand Total 786 465 321

Note: 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, Group B- 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 ADC’s vacant) under Assistant Drugs Controllers 112 Drugs Inspectors are provided. (83 Drugs Inspectors posts are vacant as on 31.03.2019). 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.

Sl. DDC REGIONAL ADC CIRCLES No. 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.

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Sl. DDC REGIONAL ADC CIRCLES No. OFFICE

Dharwad Circle, Karwar Circle, Haveri Circle, 03 Hubballi GadagCirlce.

Gulbarga Circle, Bidar circle and Bijapur 04 Gulbarga 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 2018-19 (31.03.2019)

Number of manufacturers units in the state

a Drugs Manufacturing units 301

b Loan License Manufacturers 410

c Cosmetic Manufacturing units 67

d Cosmetic Loan License Manufacturing 33 units

e Repacking Units 04

f Approved Laboratories 34

g Blood Banks 216

h Blood storage Centers 254

i Cord Blood Bank (Stem Cells) 05

Total Number of Sales premises in the State 38014

NUMBER OF INSPECTIONS CARRIED OUT

Sales premises 24875

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Manufacturing Premises 171

Blood Banks / Blood storage Centers 201

STATUTORY ACTION TAKEN

Sales Suspension 1184

License Cancellations 786

Manufacturing License Cancellations 30

Stop Production 03

Product permission 04 Cancellations

Suspension of product 02 permission for limited period

Warning letters issued 11

Blood Bank Stop Collection 01

Number of prosecution cases launched under Drugs and Cosmetic Act, 1940 and Drugs (Price 43 Control) order 1995/2013& DMR

Number of cases convicted 48

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 year 2018-19 (1st April 2018 to 31st March 2019).

Legislation Particulars Sl.No. D&C Act D.P.C.O D.M.R 1940 1995/2013 Prosecutions pending at the 01 beginning of the year(i.e. as on 573 36 02 01.04.2018) Prosecutions launched (up to 02 31.03.2019) 43 - - (During 2018-19)

03 Total (as on 31.03.2019) 616 36 02

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Legislation Particulars Sl.No. D&C Act D.P.C.O D.M.R 1940 1995/2013 61 01 00

Prosecutions decided(as on 31.03.2019) 13 - 00 (a) Cases ended in 04 acquittal/discharged (as on 31.03.2019) 48 01 00 (b) Cases ended in Convictions (as on 31.03.2019)

Prosecutions pending as on 05 555 35 02 31.03.2019 Total Number of cases as on 06 592 31.03.2019

2.4 DRUGS TESTING LABORATORY WING:

Drugs Testing Laboratory division is headed by Principal Scientific officer and is assisted by 3 Chief Scientific Officer’s of 3 laboratories. 19 scientific officers are working as government analysts. Out of 113 junior scientific officers this year 31 Junior Scientific Officers(JSO) are recruited and are deputed for 3 months training. 04 JSO posts remained vacant as on 31.03.2019. 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 Hubli and Bellary.

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1. Drugs Testing Laboratory, Bangalore:

(a) Number of samples analyzed 3177

(b) Number of samples found to be Standard quality 2962

(a) Number of (b) Number of samples analyzed, samples found to 3177 be Standard quality, 2962

2.Regional Drugs Testing Laboratory, Hubballi:-

(a) Number of samples analysed 1252

(b) Number of samples found to be Standard quality 1208

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(a) Number of samples (b) Number of analysed, 1252 samples found to be Standard quality, 1208

3. Regional Drugs Testing Laboratory, Bellary:-

(a) Number of samples analysed 1254

(b) Number of samples found to be Standard quality 1172

(a) Number of samples analysed, 1254 (b) Number of samples found to be Standard quality, 1172

Total samples from all the three laboratories for the period 2018-19 Sl. Total No. of Standard Not of Standard DTL/RDTL No. Samples analysed quality Quality 1 Bangalore 3177 2962 215 2 Hubballi 1252 1208 44 3 Bellary 1254 1172 82 4 Total 5683 5342 341

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8000

7000

6000

5000

1 4000 2 3 3000 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.

Government College of Pharmacy, Bangalore

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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 following disciplines are established under the Post-graduate course 1. Pharmaceutics

2. Pharmacology

3. Pharmacognosy 4. Pharmaceutical Chemistry

Details of the candidates for final examinations for the period 2018-19

Month Name of the Course Duration May/June- Appeared Passed 2018

M Pharm (Master’s Degree in First Year 31 31 2 years Pharmacy) Final Year 31 31 First Year 44 32

B Pharm (Degree in Second year 40 37 4 years Pharmacy) Third year 48 43 Final Year 46 42

D Pharm (Diploma in First Year 71 59 2 years Pharmacy) Final Year 48 35

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.

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Details of the students appeared for D Pharm examinations conducted by Board of Examining Authority during the period 01.04.2018 to 31.03.2019.

Number of Students appeared for E.R-91 ER Sl.No. Examination MAY -2018 January – 2019 [D Pharma Annual Examinations] (Annual) (Supplementary) No. of the Students appeared for 1st 13145 7897 D Pharm 1. Number of Students Passed in 1st 3511 1477 D Pharm Number of Students appeared for 6272 2812 Final year D Pharm 2. Number of Students passed in Final 3080 674 year D Pharm

Achievements of Drugs Control Department for the year 2018-19

 An estimated cost of Rs. 40.389 Crores for Strengthening of State Drugs Regulatory System in Karnataka was announced in the 2018-19 budget to be implemented in 2 years. The plan of action comprises purchase of Laboratory equipments, upgradation of laboratories to meet the NABL requirement and to facilitate analysis of more number of Drugs Samples at a faster rate drawn by the enforcement officers and for construction of two (2) sub-office buildings. A grant of Rs. 10 crores was earmarked for the implementation of the scheme during the 2018-19. Laboratory equipments of worth Rs.3.37 Crores are purchased under this scheme.  Enforcement officers, Scientific Officers and Pharmacy College Lecturers took part in the “India Pharma-2019” held at Bangalore. FICCI appreciated the Department for active participation.

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 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 & Certificates for issued for Domestic and International Commerce.

Competent Designated Time Sl. Designated Competent Authority Appellate Service List Officer limit to No. Officer Authority time limit Authority time limit Dispose to Dispose Regional Assistant Additional 15 Grant of 30 Working Deputy 15 Working 1 Drugs Drugs Working License days Drugs days Controller Controller Days Controller Regional Assistant Additional 15 Renewal of 30 Working Deputy 15 Working 2 Drugs Drugs Working License days Drugs days Controller Controller Days Controller Registered Regional Assistant Additional 15 Pharmacist 7Working Deputy 15 Working 3 Drugs Drugs Working Change/ days Drugs days Controller Controller Days Cancellation Controller Competent Regional Assistant Additional 15 Person 7 Working Deputy 15 Working 4 Drugs Drugs Working Change/ days Drugs days Controller Controller Days Cancellation Controller Regional Assistant Additional 15 Changing of 7 Working Deputy 15 Working 5 Drugs Drugs Working Name days Drugs days Controller Controller Days Controller Grant of Fresh Deputy Principal Drug Drugs 6 60 days Secretary 15 days Secretary 15 days Manufacturing Controller HFW HFW license Renewal of Deputy Principal Drug Drugs 7 210 days Secretary 15 days Secretary 15 days Manufacturing Controller HFW HFW license Deputy Principal Issue of WHO Drugs 8 7 days Secretary 15 days Secretary 15 days GMP Certificate Controller HFW HFW Deputy Principal Issue of Free Drugs 9 7 days Secretary 15 days Secretary 15 days Sale certificate Controller HFW HFW Issue of Market Deputy Principal Drugs 10 Standing 7 days Secretary 15 days Secretary 15 days Controller Certificate HFW HFW Issue of GMP Deputy Principal Drugs 11 Certificate as 7 days Secretary 15 days Secretary 15 days Controller per Sch. ‘M’ HFW HFW Issue of No Deputy Principal Drugs 12 Conviction Drugs 7 days 15 days Secretary 15 days Controller Certificate Controller HFW

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Competent Designated Time Sl. Designated Competent Authority Appellate Service List Officer limit to No. Officer Authority time limit Authority time limit Dispose to Dispose Issue of Deputy Principal Production Drugs 13 7 days Secretary 15 days Secretary 15 days capacity Controller HFW HFW certificate Issue of Licence Deputy Principal Drugs 14 Validity Drugs 7 days 15 days Secretary 15 days Controller Certificate. Controller HFW Issue of Deputy Principal Drugs 15 Essentiality 7 days Secretary 15 days Secretary 15 days Controller Certificate 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 Manufacturing Drugs 17 7 days Secretary 15 days Secretary 15 days and Marketing Controller HFW HFW Certificate Issue of Quality Deputy Principal Drugs 18 and Capacity 7 days Secretary 15 days Secretary 15 days Controller Certificate HFW HFW Issue of Deputy Principal Drugs 19 Performance 10 days Secretary 15 days Secretary 15 days Controller Certificate. HFW HFW Issue of Installation / Deputy Principal Drugs 20 Registration / 7 days Secretary 15 days Secretary 15 days Controller Products HFW HFW certificate Issue of Certificate of pharmaceutical Deputy Principal Drugs 21 Products 20 days Secretary 15 days Secretary 15 days Controller (COPP) For the HFW HFW recommended products Issue of Good Deputy Principal Laboratory Drugs 22 7 days Secretary 15 days Secretary 15 days Practice Controller HFW HFW Certificate

 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.

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 Construction of own office buildings at Belagavi and Shivamogga are completed and functioning in the own building. Sites are purchased for the construction of offices at Davanagere and Chitradurga.

 Regional Office, Belgavi

Assistant Drugs Controller Office, Shivamogga.

 Information , Education Communication Programmes: Pharmacovigilance Programme:-

In association with Indian Pharmacopoeia Commission (IPC), Government of India, A workshop on “Interactive Session on Role of Pharm-D/Pharmacy institution to join hands with IPC in order to promote quality and Safety of Medicine was held on 12.10.2018” was conducted for the officers of the Department and Pharmacy Institution faculty and students.

International Day Against Drug Abuse Programme:-

An awareness programme was conducted on the drug abuse on June 26 on the occasion of International Anti Drugs Abuse Day

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in the department auditorium several students from various pharmacy college were invited and participated.

 In the Current year special inspection drive was conducted to detect/prevent misuse of drugs falling under NDPS Act. For the first time 67 cases were detected for various contraventions under Drugs & Cosmetics Act, 1940 & Rules there under and documentary evidences and incriminating materials were recovered.  “Technical Cell” is established in the department for the speedy disposal of the application filed by the manufacturers in order to boost the exports.  The non revenue receipts fee for the issue of certificates for domestic and International Commerce has been revised. This has increased revenue of the Government.

450 product permissions are granted for exports on priority to the manufacturers in the year 2018-19 based on the NOC.

4100 Certificate of Pharmaceutical Products (COPP) is issued to the manufacturers for the registration of their products in various countries in the year 2018-19.

 Product permissions granted to manufacture of Drugs & Cosmetics for sale during 2018-19 are detailed below;

Details Domestic Export Total

Drugs 614 1446 2060

Cosmetics 254 250 504

 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.

 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

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reach the various stock holders like retailers, wholesalers, Doctors and Enforcement Officers to prevent the use of substandard drugs.

 Drugs Testing Laboratory Bangalore has received NABL accreditation.

 Regional Drugs Testing Laboratories, at Hubballi and Bellary are under process of obtaining NABL accreditation.

 For the first time a consensual agreement was made between the Management of Private Pharmacy Colleges and the Government for the government seats in the private colleges in order to encourage the pharmacy course and to ensure that the meritorious students get seats in the private colleges at government fixed fee. Accordingly in the academic year 2018-19, 1212 seats for D-Pharmacy, 1355 seats for B-Pharmacy, 554 seats for M- Pharmacy and 407 seats for Pharm-D are made available for poor and meritorious students.  Conducting of examinations for the D. Pharmacy course is by online transmission of question papers to various examination centers.

 In order to provide quality education for D.Pharmacy students stringent norms are notified and new college applications are scrutinized in the high power committee meeting .

 In 2016-17 budget hon’ble Chief Minister of Karnataka was pleased to sanction of Girls Hostel at GCP, Bangalore. Construction is under progress at cost of Rs. 999.00lakhs.

2.6 FINANCE: Budget Allotment and Expenditure for theyear 2018-2019

(01.04.2018 to 31.03.2019)

State Sector (Rs. in lakhs)

Budget allotment Expenditure for the Sl. BUDGET HEAD for 2018-2019 year 2018-19 (upto 31.03. 2019) No. 1. 2210-06-104-0-01 1679.00 1698.52 Drugs Controller 2. 2210-06-104-0-02 677.00 774.93 Drugs Testing Laboratory 3. 2210-06-104-0-12 Drugs Testing Laboratory , 360.00 298.45 Hubballi 4. 2210-06-104-0-13 Drugs Testing Laboratory, 243.00 248.65 Bellary

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Budget allotment Expenditure for the Sl. BUDGET HEAD for 2018-2019 year 2018-19 (upto 31.03. 2019) No. 5. 2210-06-104-0-15 Strengthening of State Drugs 551.00 336.90 Regulatory System 6. 2210-05-105-1-14 595.00 591.25 Govt. College of Pharmacy 7. 4210-03-105-02-03 600.00 600.00 Drugs Controller - Buildings 8. 4210-04-200-1-05 Sub-Offices construction and 449.00 - other works Total 5154.00 4548.70 (88.25%)

Central Sector (Rs. in lakhs)

Sl. Budget allotment Expenditure for the year BUDGET HEAD No. for 2018-19 2018-19 (31.03. 2019)

2210-05-105-1-15 Central Plan Schemes for Research work in Govt., 1. College of Pharmacy, 157.00 149.44 Bangalore and Development of Post graduate courses

TOTAL: 157.00 149.44

REVENUE RECEIPTS FOR THE YEAR 2018-19 (Rs. in lakhs)

SL. Revenue Receipts for BUDGET HEAD NO. the year 2018-19

0210-04-104-2-01 1. 434.49 Drugs Controller

0210-03-105-0-01 2. Government College of Pharmacy & 612.92 Board of Examining Authority

TOTAL 1047.41

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PART III

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

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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 Deputy Director-(Unani) Chief Chief Planning & Deputy controller Deputy Director-(Hom) Administrative Development Director Deputy Director (NC& Yoga Officer Officer (Pharmacy) Deputy Director (Pharmacy) Asst. Controller of Drugs

Drug Testing Joint Director Planning Officer Laboratrory (M.E)

District AYUSH Drug Officers Inspector Bagnalore, Mysore, Belgaum, Administrative Accounts Kalaburgi Officer Officer Principals Govt/ Aided /Un Aided Prog. Officer: Ayush Medical -CSS Colleges -NHM -IEC

SENIOR MEDICAL OFFICER (AYUSH) MEDICAL OFFICER (AYUSH)

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3.2 Departmental Brief Note, Staff Position of the Department: The Department of AYUSH has the mandate of regulating AYUSH Education and drug enforcement and is also responsible for health service delivery under the Ayush systems. The Department is headed by Commissioner AYUSH, assisted by a Joint Director (Medical Education), one Chief Administrative Officer (KAS Senior Scale), Drug Licensing Authority, one each of Deputy Directors for Ayurveda, Unani, Homoeopathy and Nature Cure &Yoga, a Chief Planning and Development Officer, an Administrative Officer and an Accounts Officer. District AYUSH Officers are incharge of Dist. Hospitals, Taluk Hospitals and Dispensaries under the overall control of the respective Zilla Panchayats.

2018-19 Budget details:

(Rs. In lakhs)

State Sector ZP Sector

Budget Expenditure Budget Expenditure

Non-plan 16644.11 17132.37 14390.83 12166.55

The Staff Position of the Department is as follows: Non-Teaching Teaching Total Sanctioned Filled Vacant S F V S F V Group-A 1113 793 320 203 127 76 1316 920 396 Group-B 76 13 63 126 10 116 202 23 179 Group-C 1196 432 764 - - - 1196 432 764 Group-D 1285 590 695 - - - 1285 590 695 Total 3670 1828 1842 329 137 192 3999 1965 2034

3.3 HEALTH SECTOR (Details of Hospitals & Dispensaries):

At the district level, the department is represented by the District Ayush Officer (DAO), who is under the administrative control of the concerned Zilla Panchayat. The DAO is responsible for day to day functioning of the hospitals and dispensaries in the district, which are the main service delivery arms of the department.

The system wise break up is given here under:

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Sl.No. Systems Government Hospitals No. of dispensaries No. of Hospitals No. of Beds. 01 Ayurveda 115 1821 564 02 Unani 18 392 50 03 Homoeopathy 18 260 43 04 Nature Cure 05 46 05 Yoga 03 15 05 Total 159 2534 662

DISTRICTWISE DISPENSARIES OF AYUSH DEPARTMENT IN STATE AS ON 31-03-2019

Dispensaries

Nature Sl. District Ayurveda Unani Homoeopathy Total Cure

1 Bangalore (U) 10 2 2 - 14 2 Bangalore (R) 6 1 1 - 08 3 Kolar 5 2 - - 07 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 44 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

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Dispensaries

Nature Sl. District Ayurveda Unani Homoeopathy Total Cure

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 50 43 5 662

DISTRICTWISE HOSPITALS OF AYUSH DEPARTMENT IN STATE AS ON 31-03-2019 Hospitals Nature Sl. District Ayurveda Unani Homeopathy Cure Yoga Total 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 Chamaraja 9 nagar 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 Chikka magalur 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

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Hospitals Nature Sl. District Ayurveda Unani Homeopathy Cure Yoga Total No Beds No beds No Beds No Beds No Beds No Beds 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

Ayurveda hospital details at Annexure-1

3.4 GOVERNMENT CENTRAL PHARMACY:

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

DRUG TESTING LABORATORY Is functioning in Bangalore 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 2018-19. 01-04-2018 to 31-03-2019 Sl.No. Types of Drugs Tested Total 1 Legal Sample 182 2 Survey Sample 467 3 Ayurveda Medicines 06 4 Unani Medicines 01 5 Raw Drugs 226 Total 2255 Total Number of Samples tested - 2255

3.5AYUSH DRUGS CONTROL:

Is responsible for regulating manufacture of ASU drugs by companies licensed in the state under the provisions of the Drugs and Cosmetics Act, 1940 and the rules there under.

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There is one Deputy Drug Controller (DDC), one Assistant Drug Controller and one Drug Inspector in the head quarter at Bangalore. The DDC is the ASU drug licensing authority. The Director / Commissioner Ayush is the drug controller for ASU drugs. ASU drug control units are also functioning at Mysore, Belagavi and Kalaburgi.

Details of Licensed manufacturing Units as on 31-03-2019 are as follows:-

No. of No. of Sales Sl. Loan Systems Manufacturing license Whole No Retail license holders. sale

1 Ayurveda 264 203 0 0

2 Unani 0 0 0 0

Total 264 203 0 0

3.6 Statutory Boards:

There are two statutory boards namely the Karnataka Ayurveda and Unani Practitioner’s Board (KAUP) and the Karnataka Board of Homoeopathy Systems of medicine functioning under the department, responsible for registration of practitioners of the respective systems.

Details of registered practitioners as on 31-3-2019

Sl.No Name of System No. of practitioners

01 Ayurveda 39094

02 Unani 2277

03 Naturopathy & Yoga 1080

04 Siddha 10

05 Homoeopathy 13764

TOTAL 56225

3.7 AYUSH MEDICAL EDUCATION :

Department of Ayush regulates admissions to all Ayush colleges in the state.

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The details of Medical Colleges under this department as follows in the state.

Total No. of System Government Unaided Aided colleges Colleges Colleges No. Intake No. Intake No. Intake No. Intake Ayurveda 4 320 3 195 68 4650 75 5165 Unani 1 60 0 0 4 240 5 300 Homoeo 1 100 0 0 13 1110 14 1210 pathy Yoga & 1 60 0 0 6 480 7 540 Nature Cure Total 7 540 3 195 91 6480 101 7215

These AYUSH Medical colleges are affiliated to Rajiv Gandhi University of Health Sciences. Selection of candidates for all these Medical colleges is through a Common Entrance Examination as decided by Government from time to time. Ayurveda Medical Colleges In The Government Sector:

Four Government Ayurveda Medical Colleges are functioning in the State. 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 100 Dravyaguna 07 Ayurvedic Medical Shalakyatantra 07 College, Bangalore. Shalyatantra 07 Panchakarma 07 Roganidhana 06 Rasashastra & Byshajya 06 Kalpana 2 Government 100 Kayachikitsa 07 Ayurvedic Medical Ayurveda samhitha 05 College, Mysore. Siddhantha (CSS) Swastavrutha 05 Panchakarma 05 3 Taranatha 60 Rasashaastra & Byshajya 07 Government Ayurveda Kalpana Medical College, Shalya 04 Bellary. Kayachikitsa 07 Panchakarma 07 4 Government 60 -- - Ayurvedic Medical College, Shimoga. 320 Total 87

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UNANI MEDICAL COLLEGE : There is one Government Unani Medical College is functioning at Bangalore city withan intake capacity of 60 students per Year.

Sl. Name of the College Intake Seats No UG P.G

1 Government Unani Medical College, Bangalore. 60 -

HOMOEOPATHY MEDICAL COLLEGE: There is one Government Homoeopathy Medical College at Bangalore.

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

NATURE CURE & YOGA MEDICAL COLLEGE

There is one Government Nature Cure and Yoga College in Mysore.

Sl. Name of the College Intake Seats No UG P.G

1 Government Nature Cure and Yoga college, 60 - Mysore.

3.8 HERBAL GARDEN DETAILS:

Herbal 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.

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3.9 THE RIGHT TO INFORMATION ACT 2005: Under the Right to Information Act, 2005, 362 applications have been received and 353 applications are disposed up to March-2019. 3.10 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. 3.11 SAKAALA YOJANE: Under the new scheme “SAKAALAYOJANE” AYUSH Department has giving Three Services to public as follows:  Issue of performance certificate and non conviction certificate under the provisions of Drugs and Cosmetics Act.  Grant of license and GMP certificate. (Good Manufacturing practices)  Renewal of License and GMP certificate 3.12 AYUSH DEPARTMENT: ACHIEVEMENTS FOR THE YEAR 2018-19:  In the year 2018-19 through the district around 44.05 lakhs Out- Patients and 2.17 lakhs in Patients were treated in AYUSH system of medicine.  New Unani Dispensary open at Mulabagal Taluk, Kolar Dist.  On June 21st 2018 International Yoga day was celebrated through out the state.  Special Postal Cover was released to mark Ayurveda Day.  In flood affected areas of Kodagu, free medical centres were opened to provide health services to the people.  New post graduate courses were started in Panchakarma, Kayachikitsa, Shalya Tantra and Swastya Vrutha subjects in Mysore and Bellary Government Ayurveda Medical Colleges.  Intake capacity of UG Students was increased from 60 to 100 per year in Government Ayurveda Medical College in Bangalore and Mysore.  Co-location of Ayush Doctors in 116 Taluk General Hospitals. 3.13 PROPOSED PLAN FOR THE YEAR 2019-20  For the overall development and effective implementation of the AYUSH programmes the State Government in association with Government of India is continuing the National Ayush Mission project.

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 It is planned to uplift the Ayush Medical Education institutes by improving the present infrastructure and effective IEC programmes.

 It is planned to continue with IEC programme like Home Remedies, Medical Health Camps, Yoga Training Programmes and Seminars at Taluk and District level.

 It is planned to upgrade Kolar and Karwar Hospitals to 50 bedded combined Ayush Hospitals.  New initiatives like setting up specialty Ayush Clinics in District Hospitals and palliative care centres in PPP mode are being planned. 13.14 NATIONAL AYUSH MISSION:

Achievement for 2018-19:

Human Resources  Continuation of 520 AYUSH Doctors and Paramedical Staff.

 Salary Paid to 320 Staffs working under Centrally Sponsored Scheme of National AYUSH Mission of the Rs. 6.57 crores.  Continuation of SPMU Staff.

 Training of Trainers to Medical Officer about General wellness and prevention of Diabetes Mellitus.  Rs.8.00 Crore grants released for Construction of 50 bed AYUSH Hospital at Gadag and Manglaore.

 Celebrated International days like International day of Yoga, Ayurveda Day, Unani Day, Homeopathy day.

New Proposal for the year 2019-20

Activities under NCD programme proposed by Government Ayurveda research centre Mysore.

Sl. No. Name of the Disease

1 Awareness programme on diabetes

2 Diabetes detection camps

3 Capacity building activities 1.NCD training for PG Scholars 2.NCD training for NGOs 3.NCD training for stake holders

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4 Research projects on 1.Dysilipidemis 2.Stroke(V.A) 3.DiabetesMellitus-Pure Ayurveda

5 Inter Sectoral-Project in collaboration with Karnataka instituted of Diabetology. Diabetes Mellitus integrated module.

The objective of these projects is to enrich and compliment modern diabetic therapy with Ayurvedic approach and drug (Karnataka Kadiradi Kashaya kashaya) to compare the efficacy of integrated approach (Kathaka Kadiradi Kashaya +Allopathic oral hypoglycemic ) with the allopathic approach.

Implementation of the Voluntary Certification Scheme for Traditional Community Healthcare Providers (VCSTCHP) Certification process

 To document, promote and preserve the great healthcare traditions of Karnataka. To assess the gaps in knowledge and skills of the TCHPs against a set of MSC and certify them following international best practices as per ISO 17024 for Personnel Certification.

 Enhanced ability and self confidence of the TCHPs to provide quality health service.

 Strong risk management strategies in case of outbreak of epidemics.

 Enhanced public awareness of the quality service of the TCHPs.  Credibility of the TCHPs with various Government agencies and greater customer trust.

 To assess the gaps in knowledge and skills of the TCHPs against a set of MSC and certify them following international best practices as per ISO 17024 for Personnel Certification.

3.15 NATIONAL HEALTH MISSION:

Achievement for the year 2018-19

 Purchase of AYUSH medicines in the year 2018-19 Rs 574 lakhs was approved for procuring drugs for NHM AYUSH doctors and 116 taluk AYUSH units across state. Supply order has been placed for procurement of Ayurveda, Unani & Homoeopathy drugs. The supply of drugs is under process.  IEC programmes (hoardings) in the year 2018-19 Rs. 9.9 lakhs was approved for hoardings in which two wall mounting panels containing brief note about treatments available in AYUSH system of medicines were made &

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one in DAO office and placed another is at district AYUSH hospital in all the districts.

 IEC Materials in the year 2018-19 Rs 78.9 lakhs was approved for IEC materials wall paintings are painted in public places to create awareness about the specialized treatments available under AYUSH system.

 The procurement of printing of AYUSH IEC Booklets are under progress will be distributed to sub centers/ PHC/ CHC/ Taluk hospitals.  Integration of AYUSH in NCD clinics initiation are taken to provide integrative treatment with Allopathic and Ayurveda system for Hypertension, Diabetes and Arthritis patient in NCD clinics. Intended Programmes for 2019-20

 Purchase of AYUSH medicines in the year 2019-20 under AYUSH programme drugs was proposed for 686 Medical Officers,13 panchakarma units, 116 taluk Ayush units &203 NCD clinics and the activity has been approved.

ANNEXURE-1 3.16 AYURVEDA SYSTEM:

At the state level there are 4 major teaching hospitals which are attached to Government Ayurveda Medical Colleges.

Sl.No Hospitals Details Bed Strength 1 Sri Jayachamarajendra Institute of Indian Medicine, 275 beds Bangalore. 2 Government Ayurveda Medical College and Hospital, 175 beds Mysore. 3 Taranatha Government Ayurveda Medical College and 150 beds Hospital, Bellary. 4 Government Ayurveda Medical College and Hospital, 100 beds Shimoga.

1. (a) Ayurveda hospitals under the state sector at district and taluka levels:

Sl.No Details of Hospitals Beds 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

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Sl.No Details of Hospitals Beds Strength

5 Taluk Govt. Ayurveda Hospital, Kundapura, Udupi Dist. 10 Beds

6 Taluk Govt. Ayurveda Hospital,Channagere, Davanagere 10 Beds Dist.

7 Taluk Govt. Ayurveda Hospital, Devadurga, Raichur Dist. 10 Beds

8 Taluk Govt. Ayurveda Hospital, Kalaghatagi, Dharward 10 Beds Dist.

9 Taluk Govt. Ayurveda Hospital, Mundaragi, Gadag Dist. 10 Beds

10 Taluk Govt. Ayurveda Hospital, Hunagunda, Bagalkote 10 Beds Dist.

11 Taluk Govt. Ayurveda Hospital, Muddebihala, Vijayapura 10 Beds Dist.

12 Taluk Govt. Ayurveda Hospital, Kollegala, Chamarajanagar 10 Beds Dist.

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

21 Taluk Govt. Ayurveda Hospital, Hosadurga, Chitraduraga 10 Beds Dist.

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 10 Beds Dist.

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

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Sl.No Details of Hospitals Beds Strength

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

1. (b) Under the Z.P. sector, Ayurveda hospitals at the district level.

Sl.No Name of the Bed strength There are 115 Hospitals District & 564 Ayurvedic dispensaries functioning 1 Vijayapur 50 Beds in the State. 2 Dharwad 25 Beds 3 Karwar 10 Beds 4 Mandya 25 Beds 5 Hassan 25 Beds 6 Madikeri 10 Beds 7 Tumkur 15 Beds 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

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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

3.17 UNANI SYSTEM: At the state level there is 01 major teaching hospital which is attached to Government Unani Medical College.

Bed Sl. No Hospital Details Strength

1 Government Unani Medical College and Hospital, Bangalore. 100 beds

2. (a) Unani Hospitals under the state sector at district and taluka levels : 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, 10 Beds Chikkabalapura Dist.

2. (b) Under the Z.P. sector Unani hospitals at the district level.

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

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Sl.No Taluk Centre Bed strength

1 Manvi, Raichur Dist. 06 Beds

3.18 HOMOEOPATHY SYSTEM:

At the state level there is 01 major teaching hospital which is attached to Government Homoeopathy Medical College.

Sl. No Hospital Details Bed Strength

1 Government Homoeopathy Medical College and 100 beds Hospital, Bangalore

3. (a) Homoeopathy hospitals under the state sector at district and taluka levels :-

Sl. No Hospital Details Bed Strength 1 Taluk Govt. Homoeopathy Hospital, Sakaleshpura, 10 Beds Hassan Dist. 2 Taluk Govt. Homoeopathy Hospital, Badami, 10 Beds Bagalkote Dist. 3 Taluk Govt. Homoeopathy Hospital, Raibagh, Belgavi 10 Beds Dist. 4 Taluk Govt. Homoeopathy Hospital,Kudlagi, Bellary 10 Beds Dist 5 Govt. Homoeopathy Hospital, Soluru, Ramangara 10 Beds Dist. 6 Govt. Homoeopathy Hospital, Indiranagara, Bangalore 05 Beds (U)

3. (b) Under the Z.P. sector Homoeopathy hospitals at the district level. Sl.No Name of the Bed strength district Place 1 Kalaburgi 15 Beds 2 Mysore 10 Beds There are 18 Hospitals and 43 3 Hassan 10 Beds Homoeopathic 4 Shimoga 10 Beds Dispensaries are functioning in 5 Bellary 10 Beds the state. 6 Vijayapur 10 Beds 7 Kolar 10 Beds 8 Mangalore 10 Beds

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Sl.No Name of the district Place Bed strength

1 Somavarapete, Kodagu Dist. 10 Beds

3.19NATURE CURE AND YOGA SYSTEM:

At the state level there is 01 major teaching hospital which is attached to Government Nature cure and Yoga Medical College.

Sl. Details Bed strength No

1 Govt. Nature cure and Yoga Medical College and 100 Beds Hospital, Mysore

4. (a) Nature cure and Yoga Hospitals under the state sector at district and taluka levels :-

Sl.No Name of the district Place Bed strength

1 Taluk Govt. Nature cure and Yoga Hospital, Gundlupet, 10 Beds Chamarajanagar Dist

2 Taluk Govt. Nature cure and Yoga Hospital, 10 Beds Somavarpet, Kodagu Dist

4. (b) Under the Z.P. sector Nature cure and Yoga hospitals at the district level.

Sl.No Name of the district Place Bed strength

1 Govt. Naturecure Hospital, K.G.Koppal, Mysore 06 Beds Dist

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

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