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Role Played by the Department: -

Role Played by the Department: -
In accordance with the changeovers made in the implementation of health and family welfare services, the implementing strategy is based on the decentralized planning at the level of PHC's to improve the quality of health care. The primary health care is classified into:
1. Medical and Health
2. Indian System of Medicine
3. National Health Programmes
4. Community participation and NGO approach
The services and the facilities are setup with an objective of achieving the goals by 2010 A.D

• Reducing the birth rate to 19

• Death rate to 7

• IMR less than 30

• Couple protection rate to 60%+ by 2000 A.D

• MMR 150/ Lakh 

  Medical & Health: In order to provide the qualitative health services many development works have been undertaken in various schemes like
  · Karnataka health system development project
  · India Population project-IX
  · Zilla panchayat programmes
  National Health Programme: Change over is made from the segregated approach to integrated approach even in the extension services of the national health programmes. Household visits of the field staff either with the weekly or fortnightly programme are made for providing surveillance, education and treatment facilities
  Under family welfare programme, a changeover from the segregated approach to that of integrated approach is made under RCH programme. This means that RCH is equivalent to Family planning + CSSM + prevention of RTI/STD and AIDS + client approach to provide family welfare and health care sevices.
  Health interventions and the services at different level i.e district , taluk, PHC and PHU level lie under the following headings.
  · Prevention and management of unwanted pregnancy- spacing & small family norms
  · Maternal care
  · Pre-natal Services
  · Natal Services
  · Delivery Services
  · Post mortem Services
  · Child survival - Immunization and prophylactic services
  · Management of reproductive tract infection and sexually transmitted diseases, HIV & AIDS
  Community Participation: This is ensured with the training of elected members, teachers, anganwadi workers and even the local N.G.O's. Strategy is target free approach and the health services are being provided according to the local needs of the community
  The health infrastructure and service facilities especially in Uttara Kannada district has thrown light on the regional disparities in the matter of health status. The following tables shows the total bedded strength including private institution the population of institutional Ratio 461 and ANM/ Mid Wife Ratio of Rural 2900

   

  Health institution & Ratios

   

Critical Indicators for RCH Programme as per District Records:

If we look at the critical indicators achieved by the district during last year (Up to December-08), it is quite visible that still lots of things need to be done and focus has to is priority based. Full ANC is % which is all positive sign to achieve overall health of a mother and child,

Immunization status in the district:

 
If we look at the Immunization carried out in karwar it is up to the mark compared to the karnataka strategies.
 Leprosy Scenario:

Karwar district is non-endemic district for Leprosy. Initially Leprosy Programme was implemented by leprosy vertical staff. From 1.04.2003 Leprosy Programme integrated with General Health care staff. At present DLO Office is working as a supervisory Planning and Reporting units for the district. DLO is working with available staff & District Nucleus. 
 Epidemiological situation of Leprosy of Karwar District

Uttara Kannada District & State Integrated Policy:

The “Karnataka State Integrated Health Policy 2004” articulates the state’s long-term vision for the health sector. It states that the mission of the Department of Health and Family Welfare, GOK is to provide quality health care with equity, which is responsive to the needs of the people, and it is guided by the principles of transparency, accountability and community participation.

     Uttara Kannada District & State Health Policy Perspectives and Goals:

• To provide integrated and comprehensive primary health care.

• To establish a credible and sustainable referral system.

• To establish equity in delivery of quality health care.

• To encourage greater public private partnership in provision of quality health care in order to better serve the underserved areas.

• To address emerging issues in public health.

• To strengthen health infrastructure.

• To develop health human resources.

• To improve access to safe and quality drugs at affordable prices.

• To increase access to a system of alternative medicine.

 

Public Health Approach and Primary Health Strategy:
The district recognizes the value of practicing public health and primary health care, for the common good of all citizens. It has committed itself to revitalizing these aspects. Public Health and Primary Health care work in synergy, particularly emphasizing the principles of:

• Inter-sectoral coordination at all levels, specifically at the district and below.

• Community Participation through Panchayat Raj Institutions and other mechanisms and for involvement in decision-making concerning their own health care.

• Equitable distribution of good quality care, and

• Use of appropriate technology for health care.

 
The primary health care strategy does not focus only on the primary level but also on the secondary and tertiary levels.

 Public health recognizes and attempts to address the socio-cultural, socio-economic and demographic factors that affect health status and implementation of health programs.

Uttara Kannada district Health Policy would attempt to ensure adequate availability of personnel with specialization in public health to discharge public health responsibility in the entire district.
Equity in health and health care:
Equity will be a key policy thrust encompassing four main parameters namely, region, disadvantaged groups, scheduled castes and tribes, gender and vulnerable groups (street children, elderly).
Further proof of imbalances/ differences in health indicators of Uttara Kannada district is reflected in the following table.

District	Female Literacy		Girls  Married below 18 years	Currentusers of FP method	Birth order 3 & above	Safe  Delivery		Complete Immunization	Composite  index
U.KANNADA	68.50	15.00		58.59	27.20		86.10	89.90	76.11

 

Quality of care:
The possibility of the early enactment of the Karnataka Health Care Establishment Bill to ensure acceptable standards of care would be considered as an important step in assuring quality of care.

Besides the above, the following important components have been envisaged as part of the State Integrated Health Policy with short /long term interventions, keeping in view the set of goals to be achieved.

• Multi sector ability and inter-sect oral co-ordination.

•  Public, private and voluntary sector partnerships.

• Health financing.

• Health planning.

• Health management and administration.

• Environmental health.

• Nutrition.

• Population stabilization.

• Education for health personnel.

• National Drug Policy.

 

Policy components on priority health problems and issues:
             

• Women’s health.

• Child health.

• Communicable / Infectious Diseases (like T.B, HIV/AIDS and Vector borne diseases).

• Prevention and control of non-communicable diseases.

• Emergency health services

          In conclusion, through the Integrated Health Policy, Uttara Kannada is placing health high on its agenda. “Health is Wealth” will be translated into action by allocating adequate human and financial resources, by good governance and institutional capacity building. The district will play a role of facilitator in harnessing resources, energies and ideas from the private and voluntary sector. It will work towards equity, integrity and quality in health and health care. 

 

CURRENT STATUS & GOALS:

Sl. No.	Goals and its Indicators	Indi-cator Type	Current status	Projected
				2008-2009	2009-2010	2010-2011		2011-2012
1.	Reduction in Maternal Mortality(MMR)	HI	133    SRS  (2001-03)	110	100	85		70
2.	Reduction in Infant Mortality Rate (IMR)	HI	40 (SRS- 2007)	35	30	28		25
3.	Total Fertility Rate (TFR)	HI	1.2  NFHS-3	1.1	1.01	1.00		1.00
4.	Institutional deliveries	HI	93.45% (NHFS-3)                               87.95%  (DLHS-3)	94%	96%	97%		99%
5.	Safe deliveries	HI	86.10%    NFHS-3	88%	90%	95%		100%
6.	Immunization	HI	89.90%   (DLHS 3)	95%	98%	99%		100%
a.	BCG		93.50%	100%	100%	100%		100%
b.	DPT		93.50%	95%	100%	100%		100%
c.	Polio		90.30%	95%	100%	100%		100%
d.	Measles		93.50%	95%	98%	100%		100%
e.	Hepatitis B			90%	100%	100%		100%
7.	Malaria	HI	Reduction of mortality by 50% by 2012
8.	Dengue	HI	Reduction of mortality by 50% by 2012
9.	Filaria	HI	Total elimination by 2012
10.	TB cure rate	HI	83%	85%	90%	92%	95%
11.	Fully functional Sub centers	SDI	333	333	333	333	333
12.	24x7 PHCs	SDI	30(2007-08)	30	30	30	30
12 a	Of which with 2 MBBS doctors			10	20	30	30
12b	With one additional AYUSH Doctor		07	23	23	23	23
13	FRUs	SDI
a.	Functional		10	10	10	10	10
b.	Bed Occupancy rate		<50%	<50%	50%	60%	>75%
14.	Janani Suraksha Vahini	SDI	10	10	10	10	10
15	Arogya Kavacha (108 services) deployment for maternal health	SDI	3	10%	25%	30%	35%
16	IPHS standard	SQI
a.	CHCs		4	N.A	25%	50%	100%
b.	Taluk Hospitals		6	N.A	25%	50%	100%
c.	District Hospitals		1	N.A	25%	50%	100%
17.	Quality Assurance – NABH Accreditations	SQI
a.	CHCs		Nil	Nil	25%	35%	50%
b.	Taluk Hospitals		Nil	Nil	25%	35%	50%
c.	District Hospitals		Nil	Nil	25%	50%	100%
18.	Integration of AYUSH with instns.	SDI
a.	Ayush integration with PHCs		16	20	30	40	77
b.	Ayush  integration with Taluk Hospitals		-	-	4	6	10
c.	Ayush  integration with District Hospitals		-	-	1	1	1
19.	Mobile Medical Units	SDI	5	7	8	9	11
20.	No.of fully functional VHSCs	CLI	1126	1198	1198	1198	1198
21.	ASHA	CLI
a.	Selections(Cumulative)		900	1746	1746	1746	1746
b.	Trained(Cumulative)		Nil	900	1500	1746	1746
c.	Fully functional with drug kits		Nil	900	1500	1746	1746
22	VHNDs	CLI	Hold 2 VHNDs in every Anganwadi every month
23	Gender Equity	CLI	Effectively implement PC PNDT