Karnataka’s Minister for Health and Family Welfare, UT Khader is known for his progressive outlook. The sunny side of his personality is also underlined by his acts of benevolence like lending his car to ferry accident victims. Recently, he put a stop to the Arogya Bandhu scheme, wherein the government had partnered with NGOs, charitable trusts and private medical colleges to run 52 of its primary health centres (PHCs), as he believes the partnership did not yield desired fruits. In a conversation with M Neelam Kachhap, he talks about his people centric schemes and future plans for the state healthcare department
Why did you decide to do away with the Arogya Bandhu scheme?
Karnataka State recognises the immeasurable value of enhancing the health and well being of its people. Our aim is to provide quality healthcare with equity, which is responsive to the needs of the people, and is guided by principles of transparency, accountability and community participation. This was not being followed by many NGOs and hence we decided to stop the scheme.
How has the state of healthcare delivery changed in Karnataka over time?
Karnataka has got a rich history of healthcare delivery. In comparison to other states, we have done well as we have achieved the MDG to reduce child mortality to 31 per thousand live births and maternal mortality ratio (MMR) to 133. We have an auxiliary nurse midwife (ANM) centre per 10000 population; a primary care centre per 30,000; and a community health centre at 110,000 population. Besides every taluka has a taluka hospital and district has a district hospital, some even have medical colleges.
But our aim is to have super speciality functions at every district. We are working towards that. Going forward, we would like to focus more on preventive healthcare. We do not want to keep increasing hospitals but want to keep our people healthy so that they do not need more hospitals.
I will give you a simple example. We have free BP and sugar check-up facilities at all PHCs but people do not make use of it. They would rather spend an hour at a restaurant eating food that may end up giving them heart problems but people do not want to spare
five minutes for preventive check-ups.
We would like to create awareness about a healthy lifestyle. Focus more on preventive measures than curative measures to build a healthier society.
What measures are you taking in this regard?
Creating awareness is a difficult task. It is not as easy as it looks to convince people to change their lifestyle. However, we have partnered with NGOs to help us in this task. We also use our ANM network to spread awareness to mothers so that they can inculcate healthy habits in the family. We give importance to both allopathy and traditional medicine like ayurveda. It’s the patients’ choice, our job is to make these treatments available.
What measures have you taken to make treatment available and affordable?
We have 176 hospitals in the state where we give treatment free of cost. Karnataka is the only state that provides universal health coverage (UHC) for its people. We have the Vajpayee Arogyasri scheme for below poverty line (BPL) families and Rajiv Arogyasri scheme for the above poverty level (APL) families. The patients are provided free admission, food and travel allowances, medicine, investigation, treatment and other expenses at the hospital. Under the scheme, patients can avail treatment for 449 surgical procedures for polytrauma, cardiac, cancer, renal, burns, neonatal and neurological problems. For BPL families it is completely free of cost and for APL families 70 per cent of the cost is taken care of by the government. And we have also partnered with private hospitals to ensure that the full state is covered. We have provided an Arogya Mitra at all hospitals to help the patients.
Are you facing problems in implementing schemes due to reluctance on the side of private players to partner with the government?
Yes. Initially we faced some problems as the private providers were not ready to give treatment at our cost. But, we have streamlined the process and there is no third party involved. The hospital has to send the bill to us within one month of the treatment given and we release the payment within a week of receiving the bill. Any delay, either on our part or the hospitals’ part, invites penalty. So, now we hope that there will be no complaints from private providers.
What happened to the scheme of opening a dialysis unit in at least one taluka per district?
We are focussed on providing dialysis facility to our people and we will take this scheme forward. However, we have received a setback in terms of shortage of trained manpower. We are speaking to other healthcare providers and will partner with them through the PPP model to help us tide over this shortage. At present, dialysis centres have been set up in 16 district hospitals and two taluk hospitals. During 2013-14, 46315 dialysis cycles were received by the patients whereas during 2014-15, 7831 patients received 54740 dialysis cycles in the dialysis centres set up at government hospitals.
How did the government respond when the emergency medical services under the 108 Arogya Kavacha scheme in the state were disrupted due to emergency medical technicians and drivers going on strike?
The ambulance services under the 108 Arogya Kavacha scheme is run by GVK Emergency Management and Research Institute (GVK EMRI) in Karnataka. We instituted this scheme for the people and not for the drivers. We want discipline and performance but the leaders of the drivers are frequently disrupting services. At present, 153 members of the association who were disrupting services were sacked. We have put KSRTC drivers and even our department drivers on duty so that people do not suffer. Ambulances are running with better performance levels. Earlier the performance level was 86 per cent, now with our drivers it is 96 per cent. At any cost ambulance should reach a patient within 20 minutes.
You had also launched the bike ambulance scheme. Tell us about it.
For the first time in India we launched ‘Platinum 10 minutes’ trauma care initiative with 30 two-wheeler ambulances. Today, we order pizza and it reaches us in 10 minutes, why not medical care. However, some urban areas in Karnataka are so congested that even if an ambulance was available it would get delayed in traffic. Our two wheeler ambulances were launched in April 2015 to resolve this issue and since then they receive almost 12 calls each day.
The bike ambulance rider is a trained paramedic who reaches the accident spot in 10 minutes, gives first aid and starts resuscitation measures to save the victim till the four-wheeler ambulance arrives. We have spent around Rs 2 lakh on each of the bike ambulances. Each bike ambulance is equipped with 40 medical items including the stethoscope, pulse oxymeter, bandages and IV normal saline, apart from 53 basic drugs. This facility is not available in other parts of India or even Asia.
What about utilising Karnataka’s core strength in IT? How many government hospitals have patient management and record software?
We have invested heavily on health IT infrastructure. Last year, we announced a project for massive digitisation of patient information with the help of the National Informatics Centre (NIC). The NIC will execute the e-hospital software in all the hospitals of the state to document and utilise the health information of every patient visiting the government hospitals. Along with this, we have also introduced a system of grant-based supply of medicines that exists hitherto in all government hospitals of the state. Henceforth, supply of essential medicines will be made to all hospitals as per the requirements. For some big primary health centres a set amount may be too little and for a small PHC it may be too much so there is a lot of wastage. This is the reason why we implemented a need-based supply of medicines.
What about the shortage of doctors in government hospitals of Karnataka?
I agree that when I joined office there was shortage of doctors. In fact, in the last 10 years no new appointment had been made. During this time, some doctors left their job while some retired. These vacant posts also added to our problems. Hence, we appointed new doctors on contract basis and are in the process of hiring new doctors through the Karnataka Public Service Commission. Almost 80 per cent of our doctor problem has been resolved.
What is the status of The Karnataka Compulsory Service Training Act?
The Karnataka Compulsory Service Training by Candidates Completed Medical Course Act, 2012, and the Karnataka Compulsory Service Training by Candidates Completed Medical Courses (Counselling, Allotment and Certification) Rules, 2015 will come into force soon. At least, we hope that it does.
It’s not like we are asking the candidates to work in the rural area for free. Every MBBS candidate gets a monthly pay of Rs 39,000 and postgraduates (PGs) or senior residents get Rs 45,000. We have budgeted for this around Rs 280 crores per year. We have notified this, making one-year rural service mandatory for medical students. Besides a penalty ranging between Rs 15 lakhs and Rs 30 lakhs for violation of the rule, it will also cost students their medical degree.
If the stay vacates there will be no doctor shortage in Karnataka. We will be able to provide doctors to not only our state but also other parts of India.
Tell us about the low cost diagnostics initiative.
We have launched a medical imaging and special diagnostic laboratory in Bengaluru and we want to take it to 14 districts across Karnataka.
Traditionally, MRI and CT scans are among the most costly diagnostic services. We decided to have our own MRI and CT machines so that we could provide these facilities at a lesser cost to our people. At our centre these are 60 per cent cheaper than the market rate. And this facility is not only for the inpatients. Any outpatient who requires these services could also avail them. The first of these labs was inaugurated by Governor Vajubhai R Vala at KC General Hospital, Bengaluru in January this year. Apart from CT scan, haematology, biochemistry, microbiology and pathology services will also be available. We are able to do this by implementing a PPP model.
Why did you start a free denture scheme?
We are the first in the country to have an oral health policy. Good oral hygiene is key to good health and wellness. With our Dantha Bhagya scheme we hope to distribute free dentures to those below the poverty line who are more than 60 years old and have lost their teeth. We are also in the process of recruiting dentists and buying equipment for all government hospitals as part of a major push to improve oral hygiene. We will also work on creating awareness about oral health and have oral health check-ups for all school-going children.
Tell us about the accidental insurance scheme?
Karnataka will be the first state in India to provide all its people with a government accidental insurance scheme. The Chief Minister’s Comprehensive Health Insurance Scheme will pay Rs 25,000 for treatment in the first 48 hours of the accident at the empaneled hospital. We have observed that many people do not help accident victims because they are the ones who are asked to pay various fees once they take the victim to the hospital. Sometimes people just leave the victim at the hospital’s door and run away. With this scheme people will be able to avail cashless services at hospitals for trauma injuries and hospitals will not turn their back on patients or refuse to treat patients.
This will be available to any one who meets with an accident in Karnataka. It could be a tourist, a student from another state, a labourer or a worker. No accident victim will be rejected treatment.
Due to some technicalities we have not been able to formally launch the scheme. However, all work has been done in this regards and will launch this soon. We have set aside Rs 73 crores for this and Rs 10 crores have already been released. We presented this in a meeting at Delhi and the scheme was appreciated by Prime Minister Narendra Modi, who mentioned it in his Mann Ki Baat programme.
We have also launched cashless treatment facility (Jyothi Sanjeevini) for all state government employees. Earlier, the state employees would spend out-of-pocket on treatment which would be later reimbursed by the department. This was a very inconvenient and tiresome process. We have streamlined everything and now it is much easier for state employees to seek treatment.
What are you working on next?
We are working on having our own medical equipment maintenance system. We are also planning to have a separate department for this. Keeping equipment functional with minimal ‘down-time’ has been a challenge especially in remote locations. Available evidence indicates that 30-35 per cent of medical equipment is non-functional in different hospitals across the state. For example; if an X-ray machine breaks down there would be a toll free number to call for maintenance and repair. As soon as that call is placed, a timer will start and only stop after the person who placed the call verifies and certifies that the machine is again functional.
Shortage of ventilators is a big problem and we are working on combating this situation by making more ventilators and ICUs available for the people. In the coming months, ICUs with 6-10 beds would be set-up in all district hospitals and ICUs with four to six beds in 25 taluka hospital will be set-up soon. To decongest patient load in government hospital in Bengaluru ICUs will be set-up at the outskirts like Yeshvantpur, Yelahanka and Madiwala. An outlay of Rs 22.37 crores has already been approved.
We have opened Jansanjeevani stores (generic medicines) across all district hospitals. This will be launched officially soon. In Phase-1, 30 stores will be opened with an objective of having at least one such store in each district. Jansanjeevani will have over 1,200 generic drugs and branded medicines including life saving drugs. Only drugs manufactured by well-known companies will be sold here to ensure quality. While 361 generic drugs can be procured under Jan Aushadhi, as many as 748 drugs are available under Jansanjeevani. We did not find the Centre’s model feasible, as drugs for critical illnesses including cancer, aren’t available at a lower cost, so we have partnered with HLL for this. We are also considering the introduction of an insurance scheme offering free medical treatment for secondary care or optional procedures.
Anything else you would like to add?
Although we are doing a lot in healthcare there are a lot of problem areas which need attention. One such area is second opinion. This is an important function in healthcare and we are thinking of having an ombudsman committee to address this.
Also, we would like to bring about a change in some norms regarding cadaver organ donation and transplantation to bring in certain amount of flexibility to offer organs of the deceased person/ brain-dead person. This needs to be accompanied by a massive awareness programme.
The health department is also looking for innovative ideas to solve healthcare problems and people with such ideas should come forward and partner with us.
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