sanitation and health care in Karnataka
Health care
Good health services are those which deliver effective, safe, quality, individual and population based health interventions to those who need them, as and when required, with optimal use of resources, at a cost that the individual and community can afford.
Similar to the rest of the nation, Karnataka has a mix of health service providers; private, public and not for profit institutions, practitioners of AYUSH systems and local health practitioners. The health outcomes in Karnataka still lag behind neighbouring States like Kerala and Tamil Nadu. For example, the Maternal Mortality Ratio reported by the Sample Registration Survey (2010-12) for Karnataka is 144 per 100,000 live births (and 133 in 2015). Although this represents close to a 20% reduction in two years, it continues to be the highest among the four southern States.
HUMAN RESOURCES FOR HEALTH
Karnataka has the highest number of medical colleges and third highest number of doctors trained in the country. Despite this increase in the number of doctors, it is unclear as to how many of these doctors are entering the public sector, how many are going to the private sector, and how many leave the State/Country. There is a dire need to recruit and retain doctors and health workers within the State, and especially within government services through improvements in recruitment and retention of the health workforce.
Drug procurement in Karnataka
Karnataka started the Karnataka Drug Logistics & Warehousing Society (KDLWS) in 2002, which is responsible for the procurement and supply of medicines to the government health system in the State. This scheme has resulted in improved availability of drugs in the government sector compared to the previous system which was the provision of drugs through Government medical stores. The current system procures drugs through a process of e-bidding with quality control of the medicines as a part of the procurement process.
HEALTH GOVERNANCE
Leadership and governance involves ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, provision of appropriate regulations and incentives, attention to system-design, and accountability. Karnataka was one of the first States in the country to adopt a State-level health policy in 2004. This policy aimed at “improving access to good quality healthcare” and would “endeavor 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”. However, even in the current scenario the effective implementation of the principles of accountability and transparency remain a problem in the health sector within the country and the State. According to the Karnataka Lokayukta, 25% of the health budget in the State is lost to corruption at various levels in the health system. They also identified several instances of corruption from areas including recruitment, transfers ,promotions and so on. Some reforms, for example, the introduction of the Karnataka State Drugs Logistics Society, have improved the procurement and stocks of essential drugs in the peripheral health facilities.
Universal HealthCare
The State of Karnataka is committed to ensuring quality healthcare services that are affordable and accessible, to all people living in the State. The government‟s focus is on improving the health status and reducing health inequities by expanding access to social safety networks and promoting affordable primary, secondary and tertiary care services for every household. For the poor and vulnerable, existing safety nets will be further improved and consolidated to ensure wider access to public healthcare services.
Strengthen primary healthcare
Primary healthcare is the foundation of the State‟s health system. Universal access to good quality comprehensive primary healthcare services is a pre-requisite for achieving health for all. The State shall invest in strengthening primary health centres for integrated care with compassion spanning curative and rehabilitative services, preventive healthcare and health promotion. In view of mal-distribution of primary health centers, the State shall rationalize services as per norms and guidelines. Specific recommendations for strengthening primary healthcare are listed in Part 2. Communitisation of health is an important aspect.
Sanitation in Karnataka
The population living in urban slums in Karnataka has increased from 14.02 lakh to 32.91 lakh in a decade. This is a rise from 7.8 per cent of the total urban population to 13.9 per cent now. Bengaluru district has 21.94 per cent of the total slum population, and every fifth person in the Bruhat Bengaluru Mahanagara Palike (BBMP) limits lives in a slum. An analysis of the 2011 Census data shows that Bengaluru is followed by Bellary and Dharwad, which have 6.09 per cent and 6.21 per cent share of the total urban population in slums, respectively. Udupi, Dakshina Kannada and Kodagu reported less than 1 per cent of the population in slums.
Solid Waste Management
Municipal Solid Waste Management is one of the basic functions of the Municipalities. Rapid urbanization, heterogeneous nature of waste, lack of awareness among the public and various other stake holders, lack of appropriate infrastructure, disintegrated & unscientific approach of waste management has made the waste management into an unmanageable situation.
There are totally 277 Urban Local Bodies (ULBs) in the State including BBMP. and recently upgraded 59 ULBs. Excluding BBMP, 217 ULBs generates 5020 tons of municipal solid waste and it is estimated that 59 new ULBs generate about 480 tons of MSW every day. Until 8th April 2016, all the ULBs were following Municipal Solid waste (Management & Handling) Rules, 2000 (MSW Rules) notified by MoEF for Municipal Solid Waste Management (MSWM) in their limits. Recently the Ministry of Environment, Forest and Climate Change has notified Solid Waste Management Rules, 2016 on 8th April 2016. As per the MSW Rules, all the ULBs are responsible for development of necessary infrastructure for collection, storage, segregation, transportation, processing and disposal of municipal solid wastes.
City Sanitation Plan (CSP)
MoUD, GoI has formulated National Urban Sanitation Policy, 2008 (NUSP) for the purpose of safe handling and disposal of liquid & solid wastes. Under NUSP, each city has to prepare CSPs which includes components such as construction of toilets (individual / community / public), Septage management, UGD and sewage treatment plants (STPs), solid waste management, storm water drains, drinking water etc. As per NUSP, 2008, the CSPs for 30 cities of the State has been entrusted to CMAK and the work is under progress.
Swachch bharat abhiyan
Several cities from Karnataka have emerged at the top of the Swachh Bharat index, with Mysuru topping the charts.
A survey of 476 cities during 2014-15 showed Mysuru on top of the charts, and three other Karnataka cities — Hassan, Mandya and Bengaluru — figuring in the list of top 10. West Bengal did well, too, with 25 cities and towns from the state finding place in the top 100, according the survey commissioned by the ministry of urban development.
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