Subject Area="Monitoring, evaluation and quality control."
Objective="Equity, quality and integrity in health care."
Details for Reform Option "Task Force on Health and Family Welfare, Karnataka"
In December 1999 the then Chief Minister of Karnataka set up a 13-member Task Force on Health and Family Welfare headed by the Project Administrator of the Karnataka Health System Development Project (KHSDP), with the aim of improving the public health care system in the State.
The terms of reference for the Task Force were to make recommendations for :
i) Improvement of public health
ii) Stabilisation of the population
iii) Improving management and administration of the Department
iv) Changes in the education system covering both clinical and public health
It was also required to monitor the implementation of the recommendations.
The Task Force formed subgroups and held extensive consultations with the Ministry of Health and Family Welfare and other government directorates, as well as with representatives of:
•National Institutes and premier institutions
•citizens and consumer groups
•voluntary, private and corporate hospitals
In addition, the members interacted with elected State representatives, officials from outside the health sector, the media and guests from within and outside the State. They also visited Primary Health Centres (PHCs), Community Health Centres (CHCs) and District hospitals in all districts of Karnataka, as well as most of the autonomous and teaching hospitals and government medical colleges. Nine research studies were conducted with the help of the KHSDP. (See Documents and Illustrations section below for powerpoint presentation on list of research studies.). This process formed the basis for the report.
The Task Force Interim Report was released in April 2000. (See Documents and Illustrations section below for the recommendations.)
In April 2001 the Task Force submitted its final report identifying 12 major issues of concern and an agenda for action to address each problem. (See Documents and Illustrations section below for the recommendations.) They were in summary:
ii) Neglect of Public Health
iii) Distortions in Primary Healthcare
iv) Lack of focus on equity
v) Implementation Gap
vi) Ethical Imperative
vii) Human resource development neglected
viii) Cultural gap and medical pluralism
ix) From exclusivism to partnership
x) Ignoring the political economy of health
xii) Growing apathy in the system
The report had a very wide mandate but its specific recommendations relate, among others, to:
i) re-organisation of the Directorate with a view to streamlining operations
ii) creation of a separate cadre of public health specialists
iii) mainstreaming of the Indian Systems of Medicine and Homeopathy (ISM&H) doctors for primary health care
iv) creation of an integrated set-up at the State level for planning and monitoring
v) rationalising the job responsibilities of field functionaries
vi) decentralisation of administrative and financial powers
vii) rational use of infrastructure
viii) role of the Panchayat Raj Institutions (PRIs) in the day-to-day management of facilities and services
ix) training, capacity building and skill development.
Implementation of between 50 and 60% of the recommendations has been initiated under the guidance of an implementation committee. The latest documentation of this is in progress.
The Task Force also developed the draft Karnataka State Integrated Health Policy. The Department of Health had wide-ranging discussions on this through a workshop and a series of meetings in-house and with different departments. It was adopted by the higher committee for health and then by the Cabinet in January 2004.
The Karnataka State Integrated Health Policy is comprehensive and includes:
•Education for Health Sciences policy
•Blood banking policy
•Policy on control of nutritional anaemia
•AIDS prevention & control policy (draft)
•ISM&H policy (draft)
It emphasises the role of voluntary and private sectors in public healthcare, with the aim of developing partnerships to provide better care and better use of resources. To curb the problem of spurious drugs, the policy envisages introduction of a rational drug policy by disseminating information on drugs, strengthening the drug control and enforcement machinery, providing adequate staff and modernising drug testing laboratories.
Approximately INR 10 lakhs on research and publication of the Task Force report. The Task force members, including the Chairman who worked full time, contributed their time on an honorary basis.
Detailed examination of issues: Report offers a rare chance to explore flaws, problems, inconsistencies and failures within the health system, and suggests overhaul of entire system.
Provides guidelines: For improvement of all areas, especially vigilance and discipline, human resources management, private practice, delegation of powers, planning and monitoring, financial management, drug procurement.
Reveals rights to health: Explains entitlement of population to basic services provided by government of which many may have been unaware.
Clarifies intersectoral links: Details ways in which health services are strengthened and supported by other sectors.
Provides framework for policy making: In short, it provides a pathway for Health Sector reforms.
Co-operation and approval of State Government, including Chief Minister, Minister for Health and Family Welfare, various Secretaries, Directors and officials of related departments.
Who needs to be consulted
The Task Force has served its purpose and has been dissolved. The “Implementation Committee” to implement the recommendations of the Task Force is now monitoring the implementation process.
Chances of Replication
Good, provided State has government co-operation and approval for Task Force, and has a dedicated team willing to commit time and effort not only to researching the report but to implementing the recommendations.
The Task Force is an example of public-private partnership since 7 out of the 12 members were from NGOs.
Tessa Laughton, Research Consultant, ECTA, New Delhi, May 2005.