Karnataka state health profile--

CONTENTS:-
 Health care delivery system of Karnataka
 Demographic
 Population
 Recent initiative taken in healthcare by Karnataka government.
 10th and 11th year plan of health care by central government
 Health care plan by state government
 Comparison between state and central scheme of health care
 Recommendation

Introduction
Strength and achievement of Karnataka:-
Among the key States in India, Karnataka

• is above the national average (HDI rank 7).

• has a wide network of Health Care Institutions
• Strong political will and concern for health
• has committed and dedicated officials and bureaucrats; increasing openness and receptive
bureaucrats and technocrats.
• has several health professional educational institutions and Rajiv Gandhi University of
Health Sciences
• has eradicated of smallpox, plague in humans, and recently guineaworm infestation.
• has made substantial progress in the control of Vaccine Preventable Diseases (Polio,
Diphtheria, Whooping cough, Tetanus, Measles)
• Externally Aided Projects - infrastructure made available; efficient and effective work
culture.
• The Community Mental Health initiative in Bellary
• Partnership with Voluntary Organisations
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 • Making available anti-tubercular drugs
• Bringing out Human Development Report (HDR)
• Growing sensitivity to Health care needs and addressing the formidable challenges of
Equity in Health and Development.

Health care Delivery system of Karnataka:-

 The princely state of Mysore was the first state in India to take up a vaccination drive
against small pox.
 World's first two birth control clinics were set up in Karnataka in the district of Mandya.
 Even though health care in Karnataka's private sector is among world's best, state as a
whole has not been fully successful in providing effective primary health care.
 Apart from capital Bangalore and coastal districts of Udupi and Dakshina Kannada other
parts of the state especially northern districts have not received sufficient attention by
government and private sectors.
 However Karnataka has established a modicum of public health services having a better
record of health care and child care compared to other states of India.
 The state has a birth rate of 2.2%, death rate of 0.72%, an infant mortality rate of 5.5%, a
maternal mortality rate of 0.195% and 2.2 being total fertility rate.
 As of 2004 state's Health and Family Welfare Services had 8,143 sub-centres (one for
5,000 people), 581 Primary Health Units (PHUs), 1,679 Primary Health Centres (PHCs),
19 mobile units, 7,304 maternity annexes, 17 urban PHCs and 110 Community Health
Centres.
 While the doctor-population ratio is 1:10,260, the bed to population ratio is 1:1,220.
 There were 87 Urban Family Welfare Centres, 124 Urban Health Centres and 24 district
level and 149 taluk level hospitals. Six government hospitals in Karnataka have won ISO-
9002 certification.
 During 2004-05 Karnataka slipped from the sixth place to the seventh in the Human
Development Index. During fiscal year 2004-05, only 0.7% of total GSDP was allocated
to health sector.
 Karnataka is one of the states of India most seriously affected by the HIV/AIDS epidemic
and stands fifth on the number of reported AIDS cases in the country.
 The first case of AIDS was detected in the state in 1988. Of the 49 high prevalence
HIV/AIDS districts in India, 10 are in Karnataka. This has caused Karnataka to become
the first state in India to bring in legislation making pre-marital HIV tests compulsory.
 Karnataka is also home to Handigodu Syndrome, a rare and painful osteoarthritis disorder
endemic to the Malnad region of the state.

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Demographic of Karnataka:-
Karnataka having a total population of 52,850,562 is one of the major states in South India.
Kannada is the official language of Karnataka and is spoken as a native language by about
64.75% of the people.

Other linguistic minorities in the state as of 1991 are:-

 Urdu (9.72%),  Malayalam (1.69%),

 Telugu (8.34%),  Tulu (3.38%),

 Marathi (3.95%),  Konkani (1.78%)

 Tamil (3.82%),  Hindi (1.87%).

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 Karnataka is also in the fore-front of population control measures with the world's first two birth
control clinics being setup in the year 1930 in the Mandya district. Karnataka, like any other
State, is full of regional, even sub-regional disparities in the matter of development.

The health infrastructure in certain regions, most notably the State’s capital, Bangalore, and to a
lesser extent the coastal towns of Mangalore and Manipal, has developed well but other areas,
especially the rural areas where 60 per cent of the population lives and the northern districts,
have not received sufficient attention from the government and the private sector.

Overall, the State :-

 crude birth rate of 22 ----for every 1,000 of the population

 a crude death rate of 7.2

 an infant mortality rate of 55/1,000 live births,

 a maternal mortality rate of 195 /100000 live births

 Total fertility rate is 2.2.

The State’s Health and Family Welfare Services:-

 8,143 sub-centres (that is, one for 5,000 people),

 581 Primary Health Units (PHUs),

 1,679 Primary Health Centres (PHCs),

 19 mobile units,

 7,304 maternity annexes,

 17 urban PHCs

 110 Community Health Centres.

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 DEPARTMENT OF HEALTH & FAMILY WELFARE –
ORGANISATIONAL STRUCTURE: PROPOSED
STATE LEVEL

DIRECTOR DIRECTOR
Ext. Aided Projects Procurement & Maint

AD (SPC) Secretary PWD

Planning & Monitor

Joint Director Joint Director Joint Director JD-Bio-Medical Superintendent Eng

Planning HMIS Procurement Equip Maintenance Civil

DD-Law & Ethics Civil Engineering.

(Forensic Medicine) Staff
as in KHSDP

While the doctor-population ratio is 1:10,260, the bed to population ratio is 1:1,220. In a novel
scheme to improve services, the government has allowed 14 PHCs to be managed by medical
colleges and trusts. At these PHCs, 75 per cent of the staff salary is paid by the government and
25 per cent by the private entrepreneur.

There are 87 Urban Family Welfare Centres, 124 Urban Health Centres and 24 district-level and
149 taluk-level hospitals. There are 51 other hospitals, including super-speciality hospitals,
which treat illnesses like cancer, heart ailments and tuberculosis.

NOTE:-As part of the World Bank-funded Karnataka Health Systems Project, the State
government has over the past seven years strengthened and upgraded at a cost of Rs.624 crores
the infrastructure in 204 of its taluk and district hospitals. As a consequence, six government
hospitals have won ISO-9002 certification.

Treatment is free for those below the poverty line (BPL) for almost all services in the State
government hospitals. For specialized treatments such as cardiac surgeries, BPL families can get
up to Rs.50,000 from the Chief Minister’s Relief Fund. The government has also been

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sanctioning Rs.50,000 twice a year to each of the district hospitals, which can use the fund to buy
from the private sector medical services that are not available with them.

In state:-

 There are around 22,000 practicing doctors

 4,197 are working in the State’s health institutions

 About 15,000 in the private sector.

 The total bed strength in government health institutions is 43,479

 While their outpatient departments serve 60,000 patients every day.

 There are nearly 2,000 hospitals in the private sector

According to officials, the shortage of doctors and supervisory staff, financial crunch and an
ever-increasing population are some of the major reasons for the state sector’s inability to
provide a more effective health delivery system. The shortage of doctors, especially specialists,
and funds forced the government to hand over in April 2002 part of the management of the Rajiv
Gandhi Super Speciality Hospital in Raichur to Apollo Hospitals. Under an agreement, the
Karnataka government pays for the maintenance cost of Rs.3 crores to Rs.4 crores a year.

As a result of the funds crunch only a half of the State’s 8,154 sub-centres have permanent
buildings.

Karnataka has slipped from the sixth place to the seventh in the Human Development Index. And
on most human development indices, Karnataka is barely above the all-India average.

Population:-
 According to the 2001 census of India, the total population of Karnataka is 52,850,562.
26,898,918 (50.89%) -- male
25,951,644 (49.11%) -- female.

 There is a decadal increase in population of 17.25% from 1991 to 2001. Population

density is 275.6 per km².
 The sex ratio is 964 females to 1000 males and 33.98% of the people in Karnataka live in
urban areas. The literacy rate is 66.6% with 76% of males and 57% of females being
literate.

As per the 2001 census, the eight largest cities of Karnataka in order of their population are
Bangalore, Hubli-Dharwar, Mysore, Gulbarga, Belgaum, Mangalore, Davanagere and Shimoga.
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The state has one of the largest populations of Anglo-Indians in India. Given below is a
composite table of languages and religions of Karnataka as of census 2001

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 Kannada Other languages Total

Hindu 63.9% 20%1 83.9%

Muslim 1.2% 11%2 12.2% Com

preh ensiv
Christian 1% 0.9%3 1.9%

Other religions 1% 1% 2%

Total 66% 34% 100%

District Population Decadal %age growth 1991 -> 2001

Bangalore Urban 6,537,124 34.80

Bangalore Rural 1,881,514 12.21

Chitradurga 1,517,896 15.05

Davanagere 1,790,952 14.78

Kolar 2,536,069 13.83

Shimoga 1,642,545 12.90

Tumkur 2,584,711 11.87

Bagalkot 1,651,892 18.84

Belgaum 4,214,505 17.40

Bijapur 1,806,918 17.63

Dharwad 1,604,253 16.65

Gadag 971,835 13.14

Haveri 1,439,116 13.29

Uttara Kannada 1,353,644 10.90

Bellary 2,027,140 22.30

Bidar 1,502,373 19.56

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Gulbarga 3,130,922 21.02

Koppal 1,196,089 24.57

e Health Policy which includes

 Health Policy

 Population policy

 Drug policy

 Nutrition policy

 Education for Health Sciences – Policy

 Blood banking policy

 Policy on Control of Nutritional Anaemia

 AIDS Prevention & Control Policy (draft)

 ISM&H Policy (draft)

 Pharmaceutical Policy

Communicable Diseases

• Vector borne disease control – by vector control bioenvironmental, Chemical only

when essential –(Malaria, JE, Filaria, Dengue, KFD)

• Disease Surveillance –District Surveillance Units

• KFD – Prevention, ELISA Testing – adequate vaccines

• TB: early case detection, complete treatment, close monitoring. DTOs

• Vaccine Preventable Diseases – complete coverage with cold chain – Hepatitis B,

vaccine production in collaboration with Animal Husbandry Dept.

• Food & water borne diseases – food inspection, Rapid Action Force

• HIV/AIDS and STDs: Integration with general health services, Voluntary Testing in all
districts, Continuum of care, Preventive Education

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 Vision 2020
Indicators 2001 (Source / Year) 2020

Infant Mortality Rate 58/ 1000 live births 25/ 1000 live births

Under – 5 Mortality Rate 69/ 1000 live births 35/ 1000 live births

Crude Birth Rate 22.3/ 1000 population 13/ 1000 population

Crude Death Rate 7.7/ 1000 population 6.5/ 1000 population

Maternal Mortality Rate 195/ 1 lakh live births 90/ 1 lakh live births

Life Expectancy at Birth

Male 61.7 years 70.0 years

Female 65.4 years 75.0 years

Total Fertility Rate 2.13 1.6

Percentage of Institutional Deliveries 51.1 75

Percentage of Safe deliveries 59.2 >95

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 VISION 2020
Indicators 2001 2020
Newborns with Low Birth Weight 35% 10%
Percentage of mothers who received ANC 86.3 100
Percentage of eligible couples protected 59.7 70%
Percentage of children fully immunised 60 >90
Anaemia among children (6-35 months) 70.6% 40.0%
Nutritional Status of children
Severe under nutrition 6.2% 2.0%
Moderate under nutrition 45.4% 25.0%
Mild under nutrition 39.0% 43.0%
Normal 9.4% 30%
Sex (Gender) ratio 964F/ 1000M 975F/ 1000M
Sex (Gender) ratio, 0-6 years 949/ 1000M 970F/ 1000M

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Non Communicable Diseases

 District Disease Control Programs for: Diabetes; cardiovascular diseases;

Rheumatic fever; Respiratory diseases; Cancer; Blindness; Oral health;
Mental health; Neurological disorders;

• Tobacco control

• Alcohol and health

• Disaster management – health aspects

• Accidents – head injuries – helmets

RECCOMENDATION:-
Reforms for Good Governance in Health Services
 Proactive Lokayukta – Ombudsman for PRI and active Monitoring – institutionalize the
reforms

 Vigilance cell in Health Department – Strengthen and Capacity building – Expertise

 E-Governance: HMIS – Program and HRM, computerize transfers, recruitment,

promotions, e-procurement, Web site for transparency and accountability

 Integrity Pact – black listing and debarring

 Effective Management and Supervision by Administrators and senior staff – Field visits

 Training in Health & Hospital Management – Effective Monitoring of Stay

at the HQ, Private practice, absenteeism, Decision Making & Problem
solving

 Leadership Training

 Health staff Welfare: Salaries, benefits, non-monetary incentives, grievance

reddressal mechanism.

 Hospital & Health Committees – Citizen’s Charter, Report card system

 Public grievance redressal at various levels

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PROGRESS should be required:-
• Increased Life expectancy at birth from 26 years in 1947 to 66.3 years for women and
65.1 for men in 1997

• Institutional deliveries have improved to 66.9% from 38.4 in 1992-93 (NFHS)

• Decline in crude birth rage from 41.6 to 22.7/1000 population from 1961 to 1997

• Control to a considerable extent of Vaccine Preventable Diseases such as polio,

diphtheria, whooping cough, tetanus and to a smaller extent measles.

• Improved infrastructure at secondary care and tertiary care through external aid

• Improved coverage of community mental health services through the District Mental
Health Program

• Partnership with Non-profit voluntary oganizations in primary health care and district
level

• Karnataka State Integrated Health Policy document

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