Innovations in Primary Health Care through Public-Private Partnerships

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Innovations in Primary Health Care through Public-Private Partnerships

India
Project Summary
Elevator Pitch

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The main issue being addressed is primary health care. Only up to 20 % of rural people have access to quality health care that is available 24 hours, accessible and affordable. The sheer size and extent of the Government health care infrastructure make it the most effective delivery mechanism for primary health care. Moreover, partnering with the Government and taking over the complete management of non-performing and remote primary health centres in tribal areas is the basis for this model. The main beneficiaries are rural people. The goal is to provide quality primary health care - curative, preventie, promotive and rehabilitative aspects along with innovations in primary care. Karuna Trust runs 28 PHCs in almost all districts of Karnataka and 9 PHCs in 9 districts of Arunachal Pradesh. All the PHCs in Arunachal are extremely remote and many of them get cut off during various months of the year.

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Your idea
Focus of activity

Healthcare Delivery

Start Year

1986

Positioning in the mosaic of solutions
Main barrier addressed

Limited reach of healthcare infrastructure

Main principle addressed

Adopt market-based models as a scaling-up strategy

Partnership/Networking as a tool for health care delivery may be added to the Principles. This is because the scale and reach of Public-private partnerships necessitates a separate priniciple.

Innovation
Description of health product/service offering:

The main issue being addressed is primary health care. Only up to 20 % of rural people have access to quality health care that is available 24 hours, accessible and affordable. The sheer size and extent of the Government health care infrastructure make it the most effective delivery mechanism for primary health care. Moreover, partnering with the Government and taking over the complete management of non-performing and remote primary health centres in tribal areas is the basis for this model. The main beneficiaries are rural people. The goal is to provide quality primary health care - curative, preventie, promotive and rehabilitative aspects along with innovations in primary care. Karuna Trust runs 28 PHCs in almost all districts of Karnataka and 9 PHCs in 9 districts of Arunachal Pradesh. All the PHCs in Arunachal are extremely remote and many of them get cut off during various months of the year.

Description of innovation:

One apparently small difference that has caused a significant increase in utilization of services is 24 hour PHC and availability of all staff at the Headquarters. This is important because, invariably, doctors in many PHCs attend more like visiting doctors rather than team leaders. The innovations implemented through our PHCs are: 1) Community Health Insurance: A unique, community-based health insurance policy with compensation for wage loss and immediate claim settlement with a low premium rate of Rs. 20/person/annum and no-disease exclusion. This is being implemented in all the PHCs in Karnataka. 2) Mainstreaming of HIV/AIDS in primary care and provision of PHC-VCTCs 3) PHCs are now operating as Village Resource Centres in collaboration with ISRO with Telemedicine, Tele-agriculture and farmer advisories, Wasteland & Watershed mapping and management with additional support for capacity-building and monitoring of PHCs 4) Mainstreaming of Traditional Medicine in Primary care with herbal gardens at PHC and sub-centre level, popularization of single herbal remedies for routine illnesses. 5) Integration of mental health care in PHCs 6) Improved community participation with health committees t village and PHC level 7) Health Management Information Systems in all PHCs in collaboration with IIM, Bangalore 8) Provision and management of essential drugs, implementation of standard treatment guidelines and drugs and therapeutics committee in all PHCs 9) PHC waste management systems 10) Effective management, leadership and team building 11) Emergency obstetric care 12) Early detection and prevention of disability

Operational model:

The model focusses on partnering with the Government. Karuna Trust enters into an MoU with the Government after obtaining clearences from the local leaders and the Zilla Panchayat. The Government staff are withdrawn and we recruit all the staff as per the service guidelines of the Government. The Government pays 75% of the running cost and the rest is to be mobilized by the NGO. Karnataka is one of the first states to begin this scheme for involving NGOs and private medical colleges in running primary health centres. Karuna Trust was the first NGO to be handed over a PHC when in 1996 the Gumballi PHC in CHamarajanagar district was handed over to us after 10 years of work in that area on Leprosy, Tuberculosis and Epilepsy.

Human resources:

The team in Karnataka is headed by a Project Director who is a senior doctor with over 20 years public health experience as a District Health Officer. He is assisted by another medical doctor who is in charge of capacity-building and program implementation. The Arunachal Pradesh team is coordinated by a team of 3 managers headed by a doctor with 2 offices and support staff.

Key operational partnerships:

The crux of this initiative is partnership. The strengths of both the GOvernment and NGO sector is called in to achieve a shared objective. Networking with local NGOs in various PHC areas is key to the initiative. In Arunachal Pradesh, Karuna Trust is closely associated with the Ramakrishna Mission which has been working in that state for many years.

Impact
Financial Sustainability:

<ul><li class="entry-label">Fees charged to clients?: <span class="entry-text">No</span></li><li class="entry-label">How do you assure affordability?: <span class="entry-text">The Government of Karnataka pays 75% of the running cost while the remaining 25% is to be the NGOs contribution. This is just the running cost. The cost for innovations, capacity-building and monitoring/supervision is also borne by the NGO. In Arunachal Pradesh, the Government pays 90% of the running cost.</span></li><li class="entry-label">Earned incomes as a percentage of operating costs: <span class="entry-text"></span></li><li class="entry-label">Other funding sources: <span class="entry-text">Other sources of funding include funding agencies for particular projects, local MPs/MLAs and other philanthropists who are intrested in the betterment of their local PHCs. </span></li><li class="entry-label">Strategy for long-term sustainability: <span class="entry-text">We have shown that the PHCs may be run much more effectively and can be model practicing centres for delivering primary health care and innovations to the rural people, at a cost the community and the Government can afford. </span></li></ul>

Current and Future Impact:

<ul><li class="entry-label">Total number of clients: <span class="entry-text"></span></li><li class="entry-label">Clients in the past year: <span class="entry-text">3,50,000</span></li><li class="entry-label">Percentage of low-income clients: <span class="entry-text">80%</span></li><li class="entry-label">Impact: <span class="entry-text">Acceptance of good NGOs in running primary health centres has increased both among the local leaders and the Government. Increased community participation in health care through participation in PHC and village level health committees Improved performence indicators like decreased maternal and infant mortality rates Improved health seeking behaviour Decreased taboo for mental illnesses</span></li><li class="entry-label">Overall "market": <span class="entry-text">Karuna Trust now has 10 years of experience. Also from 1 PHC in one district of one state, the model is now in place in over 35 PHCs in over 30 districts of 2 states. The model has thus demonstrated replicability, sustainability and scalability. The model may be tried in any developing country.</span></li></ul>

Scaling up strategy:
Stage of the initiative:

<i>Scaling Up</i> stage.

Expansion plan:

We plan to expand to a few more states. The main focus in the next three years is also on consolidating the work in Karnataka and Arunachal Pradesh.

Origin of the initiative:

The initiative was the brainchild of Dr. H Sudarshan who began Karuna Trust in 1986 in response to the huge prevalence of leprosy which was as high as 21.4/10000 population. With sustained community based efforts, leprosy was eliminated and the Trust moved on to address felt needs like Tuberculosis, mental illnesses and Epilepsy. 1996 was the landmark in the history of this initiative when the Gumballi PHC in Yelandur Taluk of Chamarajnagar district of Karnataka, one of the most backward districts was handed over to Karuna Trust. Since then, the sucess of this model has resulted in 9 PHCs in Arunachal Pradesh and 28 PHCs in Karnataka now under total management with Karuna Trust. Dr. Sudarshan's work with the Soliga tribals and in running the rural devlopment work at Karuna Trust ahs been well recognized and he was awarded the Right Livelihood Award in 1996 and the Padmashree in 2000.

Sustainability
Policy change:

Greater encouragement and inculcating a sense of shared achievement in the Government

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