April 2017

NHM: Strengthening Karnataka’s Health System

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Dr Rathan Kelkar
Mission Director, NHM, Government of Karnataka

Based on the state’s specific needs, Karnataka has fine-tuned the priorities set under the National Health Mission (NHM) and the focus extends to delivering services like dialysis, ICU units, and repositioning ambulances every 15-20 km till district and taluka level, says Dr Rathan Kelkar, Mission Director, NHM, Government of Karnataka, in an interview with Sudheer Goutham of Elets News Network (ENN).

What is your mandate as Mission Director of NHM, Government of Karnataka?

My mandate is to implement the vision of National Health Mission (NHM), i.e., universal access to equitable, affordable and quality health care services to each and every citizen. NHM schemes fall under three broad categories- maternal and child health, communicable and non-communicable diseases. All the targets under these categories are supposed to be met in time bound manner. My role is to supervise the implementation of all the schemes to ensure that we reach our targets in coordination with the Department of Health.

Further, there is a need to oversee that health facilities are strengthened as per the requirements in the Programme Implementation Plan (PIP); find out ways and means of working with private sector through innovative projects; and use information technology to the maximum extent possible in ensuring that healthcare is delivered to the door steps of the people.

It is important that decentralised health planning is done properly in the right spirit. For example, Karnataka has recently prepared district health action plans with a bottom up approach. It involves the data collected by Asha workers during their houseto- house survey. The plan was then vetted by all the programme managers above district level and based on that the State Programme Implementation Plan (PIP) for 2017-18 was prepared and sent to the Government of India.

Highlight the government’s priorities under the NHM for the year 2017.

For Government of India, the key priorities under NHM for 2017 include availability of free drugs, diagnostics, dialysis units; focus on NCDs; operationalising the FRUs; strengthening of district hospitals; quality care and kayakalp; patient centric health care and toll free helplines; elimination of malaria by 2027 and filariasis by 2020 and address human resource gaps.

Karnataka has additionally finetuned these priorities based on state’s needs, and the focus extends to delivering services like dialysis, ICU units, and repositioning ambulances every 15-20 km till district and taluka level. Other priorities include reduction of health inequality amongst people, strengthening infrastructure and referral system from PHC up-till multi- speciality level and focus on universal health coverage (UHC) through participation of private sector utilising tools such as telemedicine and e-hospital management.

Healthcare (private hospitals) is increasingly adopting information technology. How do you see NHM in Karnataka taking initiatives in this area?

The state under NHM has embraced IT just like private sector. We already have a number of software (38) pertaining to various programmes. For example, the mother and child tracking system, Health Management Information System (HMIS), Asha software, integrated disease surveillance system software, etc. There are on-going efforts in integrating them on common parameters to support better access, data mining and creation of dashboard, indicators. e-Hospital software (containing 4 modules- OP, IP, Lab as well as billing modules) has been rolled out and piloted in about 7 hospitals. The same would now be extended to 47 institutions including district, taluk hospitals and CHCs. In the next one year we are looking at implementing e-Hospital right down to the PHC level.

Additional efforts in IT include making available tablets to ANMs to capture real time data on ground and rolling out telemedicine and tele-radiology projects. The future plans aim at creating mesh of all the IT-related products which will be interlinked together so that there is no duplications and the data can be harnessed to the extent possible.

The other areas that we are looking at the future include utilising IT facilities through PPP networks. CSR activities in collaboration with organisations like Samsung have already helped in distribution of tablets to ANMs/Ashas. Similarly, BIOCON has started doing pilot in some PHCs using software to ensure that IT is used to the extent possible.We are collaborating with HP through standalone clinics at remote locations which will connect the data back to the control room using information technology at the end point.

Healthcare Infrastructure continues to be a challenge for service delivery in the state. What are the steps being initiated to deal with it?

Healthcare infrastructure continues to be a challenge as population is huge and the resources are limited. Maintaining quality of equipment and buildings right down to the grassroots level presents big challenges.

Some steps to deal with these challenges include strong PPP models and CSR interventions to aid the state. Similarly, looking at IT to overcome physical infrastructure and specialists gaps constraints would be useful. For example, if we can have a technician on ground, the doctor on the other end will be able to prescribe medication and health care access could reach the last mile. Outreach activities through designated camps or thorough extension clinics in the urban as well as rural areas could be other ways of overcoming infrastructure related challenge.

Can you share with us the challenges in NHM’s initiatives? How do you find solutions for these challenges?

Key challenges in NHM’s initiatives include the following:

NHM Schemes are benefit oriented scheme; hence implementation becomes a challenge as it has dependency on various stakeholders including ASHAs, ANMs, DHOs etc. whose coordination remains difficult.

Convergence amongst various stakeholders within the health department also remains an issue as diverse personalities handle different wings within the department and common meeting of minds is needed to overcome challenges & ensure better decision making.

Since health has collaboration with other departments in the state including rural/urban/SC/ST/backward/ education department, constant convergence and coordination amongst them is important.

Some of the ways these can be addressed would be :

Capacity building and training at the level of ASHAs, ANMs, Village Health Nutrition and Sanitation Committees to ensure good preventive and promotive aspects of healthcare. Since these actors know the customary practices within villages, their buy in through increasing their strength and incentive structure can go a long way in health care delivery at grass root level.

The emphasis of health as an investment must be realised at different levels in the state and health schemes must not be taken as routine program but those which remain critical to growth and productivity of individuals of the State. Therefore increasing motivation of staff at all levels remain pivotal and exposure and cross learning from best practices of other States. Coordination with urban department and urban health bodies for implementation of urban health programs must be emphasised to meet the targets under NHM.

Each person in the state must contribute to make society healthy and prosperous and own up the activities delegated to them. Health should be perceived as a personal and individual responsibility to improve life style and avoid practices which are deterrent to individual health.

Leaders must ensure that projects are closely monitored and supervised and implemented in time bound manner. Finally there must be adequate resources that need to be committed to health and also efficient use of available resource by reducing any wasteful and duplication of funds.

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