‘We are committed to achieving health for all’

TALK TIME

secretary, health and family welfare, Karnatakaev ramana reddy

‘We are committed to achieving health for all’

AN IAS officer of the 1988 batch, Dr EV Ramana Reddy assumed charge as Secretary of the Health and Family Welfare Department, Government of Karnataka, on November 23, 2009. Venugopalan spoke to him about his initiatives in the health sector.

gfiles: Which are the prominent health initiatives taken by your department?

EV Ramana Reddy: We mainly deal with 15-20 national and State health programmes, including the Rural Health Component of the Minimum Needs Programme, Curative Services, National Rural Health Mission, National Leprosy Eradication Programme, National Tuberculosis Control Programme, National Programme for Control of Blindness, National Vector Borne Control Programme, National Guinea Worm Eradication Programme, Prevention & Control of Communicable Diseases like diarrhoeal diseases, Kyasanur forest diseases and so on, Health Education, Training and School Health Services, Nutritional Services, National Iodine Deficiency Disorder Control Programme, Laboratory Services, and so on.

‘The majority of patients coming to government health centres belong to the

below poverty line, SC/ST families. We keep a close watch on health

indicators like infant mortality.’

We have about 8870 sub centres, 2310 primary health centres, 326 CFCs and taluk hospitals and one district hospital. Through all these centres, we serve more than three crore out-patients and around 50 lakh in-patients every year.

The majority of the patients coming to the government health centres belong to the below poverty line, SC/ST families. We keep a close watch on health indicators like Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) and Total Fertility Rate (TFR). At present (as per the 2009 figures), the IMR in the State is 41 per 1000 and it is expected to come down to around 25 by 2015. The MMR, which is now 178, is also expected to come down to 100 by 2015.

Similarly, the TFR is about 2, which is ahead of the target fixed by the Government of India.

gfiles: What schemes have been implemented for the nutrition and health needs of women and children?

EVRR: During the last few years, we have started some new initiatives, including a programme called Tai Bhagya. In addition, we have 3-4 components like MADLU. Under this programme, we give tips to mothers for child care after the delivery. The programme includes about 19 items useful for mother and child. Then we have a scheme, Prasuti Araike, where we give Rs 2000 as cash incentive to pregnant women. The first instalment of Rs 1000 is given during the pregnancy and the second after delivery in any health centre.

This is meant for wage compensation and rotational support for the pregnant mother. Under Tai Bhagya, we empanel certain private hospitals where the BPL women can get treatment during pregnancy and the expense is reimbursed by the State government.

gfiles: What is the criterion for this reimbursement?

EVRR: The government pays Rs 3 lakh for 100 deliveries, including normal and caesarean. We have the very popular health programme, Suvarna Aarogya Chaitanya. It is mainly a school health programme. Every year, during September-October, we cover all the school going children (from Class 1 to 12), even in private schools, for a health check-up. We provide this facility to over 90 lakh students every year. Under this scheme, even a small ailment is taken care of. Even if a child needs any kind of surgery, he/she is sent to a private hospital and the expense is reimbursed by the government.

Under the mobile health scheme, we have 114 units which work in remote areas and are run by different NGOs. The government reimburses the cost of treatment. We have some public-private partnership initiatives also. One is Arogya Bandhu, where we outsource Primary Health Centres to various NGOs and medical colleges. Until now, about 56 such centres are run by private agencies. The government reimburses their expenses. The Arogya Kavacha 108 scheme has also become very popular. Then we have a health insurance programme known as Arogya Shree.

gfiles: Are all these national health programmes?

EVRR: No, these are State programmes. The experiment of 108 emergency medical service is very popular in 10 states. Similarly, like Arogya Shree, Andhra Pradesh and Tamil Nadu also have similar schemes. Under this scheme ailments related to the heart, neurology, cancer, and so on are covered. If any surgery or hospitalization is required, the State government takes care of it. We have implemented a scheme for citizen healthcare also in all the district hospitals.

gfiles: What is done for capacity-building of the health department?

EVRR: The health department has 51,000 employees, including paramedical staff, doctors and specialists. For all of them, we have different training and development programmes. In addition, we impart administrative training in Mysore Institute.

gfiles: What challenges does the department face in implementing the schemes?

EVRR: The biggest challenge is human resources. Human resources have to be improved at any cost if we really intend to provide better health services to the people. If we have sufficient staff, we can do the best in rural areas. The main problem is to find the right human resources (specialists and trained doctors) who can work in rural areas. This is the biggest challenge faced by the department. We have taken many steps to improve the situation. At present, we have more than 600 specialists in rural hospitals.

gfiles: Are they permanent employees or on contract?

EVRR: They are permanent employees and have been recruited by the Karnataka Public Service Commission.

gfiles: Does the department have health management and hospital administration training courses regularly for health managers and hospital administrators?

EVRR: We send 15 medical officers for orientation programmes to training institutes. We send the same number for technical training programmes also. We balance the number of both technical and non-technical staff.

gfiles: What are the steps taken to strengthen the district health system?

EVRR: We have two types of hospitals. Under the State sector, we cover the hospitals with more than 100 beds. All the rural health centres come under zilla panchayats. This is the district-level health set-up. We have a two-tier health set-up in the State – District Health Society and District Health Mission. We have Arogya Samitis also, which have members from local bodies and the elected representatives. We also have Village Health Committees, which are run under the Panchayati Raj policy. A panchayat member is the chairman of this committee.

gfiles: What initiatives have been taken for environmental health?

EVRR: Pollution is a big health hazard. To curb it, we have taken many initiatives at various levels. For the past year, we are concentrating on minimizing these hazards. In taluka and district hospitals, we provide treatment plants for liquid waste and to remove the solid waste there are two types of treatment facilities. We provide essential technical information to each district through the Karnataka Health System Development and Reform Project (KHSDRP), which is a World Bank-aided project. Common treatment facility is also available in Uttar Kannada and other districts. We have tied up all the districts with a common treatment facility for solid waste management. It has been implemented not only in government hospitals but also in private hospitals.

gfiles: How many private hospitals are registered in the State?

EVRR: Under the Private Medical Establishment Act, we have received 23,782 applications and 14,295 have been accepted while 10,864 are under review. About 6,541 applications were rejected.

gfiles: What are the schemes for nutrition and health education?

EVRR: Nutrition of mother and child is taken care of by the Women and Child Department. We are expanding the nutrition intervention net through Integrated Child Development Scheme (ICDS), Universal Immunisation Programme (UIP) and Oral Rehydration Therapy (ORT).

gfiles: What are the schemes for stabilization of population growth?

EVRR: Population stabilization through fertility decline has long been a goal for the State government. Keeping in view the present demographic status and the State’s financial and other capabilities, realistic goals in respect of population control, child health and maternal health will be worked out and necessary programmes will be taken up.

gfiles: Which are the prime diseases in the State and what action is taken by you?

EVRR: We do not find any epidemic-type disease in the State. There are only local diseases like malaria, cholera and so on. For malaria and chikungunya we have taken many initiatives, from village to urban level. We have provided guidance and necessary medicines to each district for prevention of disease. We have selected 68 Primary Health Centres where proper plans and efforts are made to curb disease.

‘In taluka and district hospitals, we provide treatment plants for liquid waste,

and to remove the solid waste there are two types of treatment facilities.’

gfiles: What is the fertility rate in the State?

EVRR: The total fertility rate (TFR) varies from district to district. We have achieved the target of 2 at State level, but in some districts it is low – from 1.5 to 1.08. In Udupi, it is lowest (0.98) and in Yadgir it is about 3. There would be a focus on the entire life cycle of women. It means ensuring adequate nutrition and physical and social conditions for mothers during pregnancy, providing access to health services, implementing measures to prevent female foeticide and infanticide.

gfiles: You appear satisfied with the rural health services. But doctors are still not interested in working in rural areas. Do you have any policy to send doctors to rural health centres?

EVRR: The main problem is human resources. We have amended the service rules of the State. In the sixth year, it will be mandatory for all medical students to serve in rural health centres. The rural health services have now improved.

gfiles: What is the situation with regard to e-governance?

EVRR: We have taken many initiatives, including Health Management Exam System (HMES), Mother and Child Tracking System (MCTS) and Procurement System (PS). Our entire health management system is being computerized. All the pregnancies since January this year have been entered under the MCTS. Since last year, all procurements are done through computers. g