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7Th CRM Karnataka State Debreifing

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7Th CRM Karnataka State Debreifing 7th Common Review Mission National dissemination Karnataka State 5th March 2013 Presenter on behalf of the Team : Dr.Raveesh R Mugali Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Mission Team 1. Dr. Manisha Malhotra, DC-MH 1. Dr. P.K.Srivastava, JD, NVBDCP 2. Dr. Raveesh R Mugali, UNICEF 2. Mr. M. K. Chowdhury, US, MoHFW 3. Dr. Raghu, Deputy Advisor,AYUSH 3. Dr. Shashikala, NHSRC 4. Dr. Balaji Naik. R, WHO-RNTCP 4. Dr. S. S. Das, MoHFW 5. Mr. Zacharia George, Planning Commission 5. Sh. Sanjeev Gupta, FMG 6. Dr. Nikhil Utture, Consultant NRHM, MoHFW, 6. Dr. Raghunath Prasad Saini, RCH 7. Ms. Chhaya Pachauli, Prayas CSO 7. Mr. Yogesh Kumar Singh, Planning Commission 2 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Karnataka :districts 7th CRM Haveri Gulbarga 3 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Haveri District Facilities visited Gulbarga District 1. District Hospital: Haveri 1. District Hospital: Gulbarga 2. Taluka hospital: Shiggoan, Byadagi 2. Taluka Hospitals: Jewargi, Sedam 3. PHC 24*7: Tadas, Attigeri, Kaginele 3. CHC: Mudhol, Malkhed, Gundagurti 4. Non FRU CHC: Rattihalli 4. PHC:Mandewal, Jeratgi, Aurad, Mahagaon, A mbalga, Madbool, Kadganchi 5. Ayush Hospital: Shiggoan 5. UHC: New Rahmat nagar, Ghazipura Urban 6. ANM/GNM training center PHC, Gullar Gali (Slum) 7. District Vaccine stores 6. SCs:Khanadal, Kattisangavi, Mandeval, Aurad 8. SCs:2 DH Neeralagi, Kuruba gonda, Attigeri , Sindigi, Madaki, Dhottargaon, Ranjol 9. Schools:4 FRU Attigeri and Tadas 7. ANM Training Centre PHC-9 10. Village: Neeralagi, Tadas, Kuruba 8. District Training Centre and R.F.W.T.C.Regional/State gonda,Ayush- 1Attigeri drug warehouse 9. Regional Drug Warehouse 11. MMU:SCs-11 Sheelavanta Somapura, Shiggoan District,regional AWC:4 10. Villages:Khanadal, Kattisangavi, Mahagaon, 12. Anganwadi center: Devagiri & ANM training Schools:4 Madaki, Neeloor, Chandapur, Sindgicenters, Kansoor 13. SIHFW, Karnataka drug logistics and MMU-1 , Dhottargaon, Bennur K SIHFW warehouse Villages:13 11. Schools: Sindgi, Kadganchi 4 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Service Delivery What sparks? What doesn’t spur? • Infrastructure development • Inadequate provision of Staff (FRUs & 24*7 PHCs Tripled) Quarters • Utilization of Public health • Patient amenities are inadequate facilities has increased over 5 years • Privacy concerns • Wide range of services provided • A Number of deliveries reported • 108 ambulance service adequately in transit utilized • Diet provision for in-patients • AYUSH units co-located in most of • Coverage of all JSSK the facilities entitlements • MMU in PPP mode provides routine medical services to remote areas 5 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Functionalization of 24x7 PHC & FRUs, Karnataka 24* 7PHC FRU 1150 190 988 1001 1018 1018 1050 961 170 898 950 167 166 150 850 151 130 750 142 144 110 650 Tripled 550 107 90 389 450 70 Health infrastructure350 50 200754 2008 2009 2010 2011 2012 2013 33749 Karnataka State Haveri Gulbarga 2599824755 6887 5661 7844 989 1142 1397 Population/PHC Population/SC population/Bed 6 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Human Resources & Training What Inspires? What stands betterment? • Doctors, Nurses, and ANM are • Compliance to key HR adequately trained esp, SBA recommendations trained nurses • Vacant GDMO and Nurses" • Majority of T.H. and D.H do have positions specialist doctors • Training needs assessment & Training plans • ASHAs are available, trained and • motivated Specialists at FRU’s/ TH (Gulbarga) • CPHN training of LHVs at SIHFW is • Placing Nutrition counselor good initiative and M.O. at NRCs 7 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance 8 Compliance to key HR Conditionalities Article 371-J Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance RMNCH+A What needs correction? What is correct ? • Operationalization of Blood • Institutional deliveries – storage units and C-section facility increased to > 90% (70-75% in is needed in CHCs, THs( Gulbarga). pubic health facilities) • Safe abortion services below • Labor room nurses are SBA district level trained, • Orientation on processes for MDR • Partographs are being and quality of Reviews at facilities maintained and at District • Good visibility of Technical • Line listing of severely anemic protocols women • Emergency obstetric drugs were • 3 ANC checkup Gulbarga district (58 %) available in LR • Multiple referrals 9 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Inst deliveries trend change-Haveri MCH report 30000 Deliveries 25000 Home Deliveries Institution Deliveries Madilu Prasuthi 20000 kit arike FRUs 15000 24*7 JSSK PHC ASHA JSY # of deliveries # 10000 incentiv Thayi es Thayi bhagya 5000 bhagya Plus 0 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 10 A snapshot of RMNCH+A progress in Karnataka Maternal Mortality Ratio Child Mortality Rate 300 228 213 E-NMR NMR IMR U5MR 178 200 144 55 60 50 100 50 45 48 47 45 40 37 0 40 41 38 35 2001-03 2004-06 2007-09 2010-12 32 28 28 26 25 25 20 24 24 23 23 Child Sex Ratio (0-4) 20 20 20 19 22 20 20 955 0 960 951 946 946 950 942 2005 2006 2007 2008 2009 2010 2011 2012 940 930 934 925 930 Total Fertility Rate 920 2.5 910 2.2 2.1 2.1 2.0 2.0 2.0 2005 2006 2007 2008 2009 2010 2011 2012 1.9 1.9 2.0 Consistent improvement in health outcome Achieved MDG 4 & 5 1.5 An estimated 1,600 maternal deaths and 41,800 under five deaths annually (Neo-natal deaths 26, 011, Infant 2005 2006 2007 2008 2009 2010 2011 201211 deaths-36,189) Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Percentage contribution of E-NMR to NMR, SRS 2012…highest in Karnataka 12 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance RMNCH+A Could be better Innovations & Improvements • 10- 12% mortality in SNCUs (Early • Prasuthi Araike Programme is popular NMR high in the state (87% of Karnataka has launched many State NMR) initiatives(PrasoothiAraike, Madilu, Th ayiBhagya and ThayiBhagya Plus) • Central oxygen supply which has dramatically increased the • Poor admissions in NRC due to lack institutional deliveries in Public Health facilities. of referrals. • ARSH: Services to adolescents in • IYCF practices needs improvement general OPD • Most women stayed 48 hrs after • Awareness about JSSK delivery at the FRUs entitlements, • Counseling provided by ICTC counselor or at Suraksha clinic . • Greater visibility of JSSK • WIFS initiated in schools • Delay in payment in few facilities • State Innovation- RoP at SNCU 13 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Immunization Strengths Few Concerns • Immunization planned vs held > • Dropout rates 100% • MCV 2 Coverage-48% • Micro planning exists at every • Review of the immunization level programme using HMIS data is • Trained workforce & Increased difficult at all levels community mobilization-ASHA • Less cold space at state Vaccine store, Need of 1 WIC • Incentives for mobilization • Poor reviews at peripheral • Adequate cold chain space at level periphery, Avg population per • Immunization in private sector cold chain point:24000 • Due lists for tracking for 2 • Potential state for new vaccine years introduction 14 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance An example of Inverse care law High number of measles outbreaks in Northern Karnataka MCV2 Coverage less than 20% 15 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance Disease Control RNTCP NLEP • Key RNTCP staff in position. • In the year 2012-13 ,3368 new • Programme reviewed regularly cases of leprosy were detected • State performance is moderate • Treatment success rates of 98% Areas to Improve.. • Shortage of Pediatric TB drugs and • Regular trainings are conducted Isoniazid 100 mg as per PIP • Low paediatric case notification • MCR & RCS available • High default rate • Endemic blocks are identified • Mandatory TB notification from private sector • Vacant positions to be filled up • Nikshay entry needs strengthening 16 Service delivery RMNCH+A Disease control HR and training Community process Inform & Knowledge Finance Medicine & technologyNUHM Governance NVBDCP Malaria, Dengue & Chikungunya • Declining trend in cases Malaria and JE Filarial Elimination • Increasing trend of Dengue cases • Good efforts in Source reduction • State have 8 Filarial endemic • Passive & Active surveillance – ASHAs districts.3 qualified for
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