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Management of Primary Health Centres by Non Government Organisations and Medical Colleges, Karnataka
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Subject Area="Public / private partnership (including NGOs)." Objective="Scope and quality of primary health centre services."
Details for Reform Option "Management of Primary Health Centres by Non Government Organisations and Medical Colleges, Karnataka"
Summary

Background: Although Karnataka has relatively good health indicators and infrastructure, this was found not to be true of remote rural areas. In 1996 two PHCs and their sub-centres were handed over to NGOs by the State Government and after a successful pilot programme, it was decided to extend this reform. Action: In 2002, all PHCs were divided into two categories on the basis of their performance, vacancies, building condition and remoteness. The bottom half were offered to NGOs, trusts and medical colleges to manage. A total of 100 were made available in the first phase. The conditions for management were: (i) The initial period of entrustment was 5 years with a review of its functioning after two years. (ii) The government would reimburse 75% of salary payable to government staff, up to a maximum of INR 1500 per month for water and electricity charges, INR 25,000 per annum for maintenance of buildings and contingency and INR 75,000 per annum for drugs. (iii) The proposals were first verified and approved by the Chief Executing Officer of the concerned Zilla Panchayat or ZP (the District Panchayat) and then put to the selection committee. (iv) The NGO/ medical college would be responsible for implementing all National and State health and family welfare programmes. (v) The agency was to employ its own personnel in accordance with the government staffing norms for the PHC and sub-centre but was free to fix the remuneration of its employees. (vi) The existing assets of the PHC and sub-centres were handed over to the agency which they were to maintain and return to the government at the end of the contract period. Results: Karnataka is the only State where this initiative has run continuously and successfully long term. For example at PHCs under Karuna Trust -Gumballi PHC, Infant Mortality Rate (IMR) has come down from 75.7 in 1997-98 to 23.6 in 2004-05 and Maternal Mortality Rate (MMR) has been nil throughout the period. At Thitimathi PHC, IMR came down from 45.8 in 1997-98 to 14.21 in 2004-05 and here as well there have been no cases of maternal mortality. The RCH and other National Health Programmes are reported to be being implemented with better outcomes. All the staff in PHCs and Sub-centres stay at the head quarters to provide services 24 hours. PHCs under Karuna Trust have also launched various other programmes such as community health insurance; a de-addiction centre; sickle cell anaemia screening programme, and a tribal ANM project.

Cost On an average it costs INR 10 to 12 lakhs per PHC. The Government (ZP) gives 75% of this amount and Karuna Trust spends between INR 1.5 to 2 lakhs per PHC from its own resources.
Place Twenty two PHCs in Karnataka since early 2002. Of these, 14 PHCs in 11 districts are run by Karuna Trust and another 8 PHCs by Medical Colleges and other NGOs.
Time Frame Approximately two to 6 months.
Advantages

Quality: Improved quality of services. Time saving: Enables faster decision making and implementation. Cost saving: Government pays only 75% of staff salaries and a fixed amount for drugs, water and electricity.

Challanges

Possible opposition: Objections from the Panchayati Raj Institutions (PRIs), private practitioners and previously employed government staff were initially faced in some PHCs taken over. Similarly, there could be problems in the relationship between the health authorities and NGO staff leading to payment delays and support in terms of equipment, drugs and training.

Prerequisites

Availability of NGOs and trusts, preferably ones already working in the area who are willing to take on the PHCs.

Who needs to be consulted

Government officials at state and district level, NGOs and Medical Colleges.

Risks

Sustainability

Karuna Trust is planning to have one “Good Practicing PHC” in all the 27 districts of Karnataka. More NGOs and private medical colleges are coming forward to run PHCs. The partnership between the Government and NGOs has been well established and hence appears to be a sustainable model.

Chances of Replication

Variable. Another example of this kind of initiative by SEWA-Rural in Gujarat (see PROD No. 43) ran for more than 15 years before it was returned back to the government in 2000. However, a similar project in Orissa was unsuccessful - largely because the terms of reference were inadequate and the NGO did not have the resources or the ability to run the institutions. The Karnataka experience could be replicated in other states only if there is commitment from both the government and NGOs.

Comments

NGOs and Medical Colleges in Karnataka have been able to take responsibility for just 2-3% of the PHCs, the rest have to be managed by the PRIs (Zilla Panchayats). This is because at present, NGOs do not have the capability to take up more PHCs. Capacity building of NGOs would be necessary to enable them to do so.

Contact

Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. April 2005.

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