The Karnataka Health Vision report has emphasised the need for chalking out district health programmes. Every district health administration should be able to provide comprehensive preventive, promotive, curative, rehabilitative, palliative, laboratory, telemedicine services to its population through implementation of health schemes, stated the report that was released recently.
“Currently, the policies, programmes, action plans, guidelines and directives generally flow from top to bottom, being formulated in national and State capitals and implemented in a district. It is well acknowledged that the involvement of a district team in planning health and welfare activities are generally limited. If local people are not engaged, local data is not available and local implementation does not happen, the impact is likely to be lesser,” stated the report.
Former director of NIMHANS G. Gururaj, who is the chairman of the Vision Group, told The Hindu on Monday that a district is the nucleus of all health, welfare and development programmes. “Developing district programmes covering a population of approximately 2.5 million is possible, feasible, sustainable and manageable from an administrative viewpoint with decentralisation mechanisms. Focussing on a district, and developing that as a hub of implementation activities for completeness, coverage and quality is achievable and advantageous as it helps in improving health of local populations,” Dr. Gururaj said.
Recommendations
“Many programmes implemented at the district level can bring convergence, integration and improved coordination. With a good district management, programmes can be moved further to taluka areas for more focused implementation. Each district has a wide network of health care facilities, district hospital, medical colleges in almost all (except 8) districts, private health care providers, local NGOs, industries and educational institutions and are led by the District Commissioner, CEO – ZP, District Health officer and a District Surgeon. Selective investment can be made by the State in focussed areas for improvement. Developing intersectoral approaches which are scientific, sustainable and cost effective becomes easy in a district based on good quality data,” the report stated.
Besides, capacity building and strengthening of district officials from health, education, transport, police, rural development, municipality, welfare and others is possible and can lead to better planning, implementation and monitoring through intersectoral coordination mechanisms.
“All district training centres can plan and implement human resource development activities as per their needs and at their times with coordination from the State. Local medical colleges can provide support through agreed upon frameworks. Each medical college can be given the responsibility of providing care and services in three primary health centre areas,” the report stated.
“Optimisation and sharing of health manpower (through integrated training programmes for health personnel) can bring greater benefits and can avoid duplication of activities. With decentralisation of activities, personnel can be trained together on health matters and programmes. The possibility of implementing existing rules and regulations is more feasible, sustainable and economical in the long run at a district level,” according to the report.
Surveillance for local epidemics
Citing the example of the District Mental Health Programme (DMHP) in Ballari district by NIMHANS in 1984, Dr. Gururaj said this programme paved the way for the National Mental Health Programme in 700 districts of the country and statewide DMHP (implemented in all districts) by 2020. “The District Road Safety and Injury Prevention programme in Tumakuru in 2014 demonstrated the feasibility of road safety in an Indian district. The Yuvaspandana programme of Karnataka for youth mental health promotion jointly taken up by the State and NIMHANS has been expanded to all 30 districts of the state by 2021,” he said.
“Establishing a strong public health surveillance team in a district can address local epidemics, disasters, communicable diseases, NCDs and injuries by further liasoning with state level agencies and academic institutions. Greater CSR funds can be mobilised for programmes and services in a district for general or focussed activities,” he added.
