Karnataka

Primary Health Care

What is comprehensive primary healthcare?

Primary health care is a whole-of-society approach to health and well-being, centred on the needs and preferences of individuals, families and communities in large.  It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing. 

The Alma-Ata definition of Primary Health Care that emphasises the principles of social justice, equity, self-reliance, appropriate technology, decentralization, community involvement, intersectoral collaboration, and affordable cost. Karuna Trust embraces this model of comprehensive primary healthcare for all.

What are its Components?

The WHO defines primary health care based on three components:

• Meeting peoples’ health needs through comprehensive preventive, promotive, curative, rehabilitative, and palliative care throughout the life course.
• Systematically addressing the broader determinants of health (including social, economic, environmental, as well as people’s characteristics and behaviours) through evidence-informed public policies and actions across all sectors; and
• Empowering individuals, families, and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self-carers and care-givers to others.

Robust primary health care is essential to achieving the health-related Sustainable Development Goals (SDGs) and universal health coverage. It will contribute to the attainment of other goals beyond the health goal (SDG3), including those on poverty, hunger, education, gender equality, clean water and sanitation, work and economic growth, reducing inequality and climate action. We, at Karuna Trust are determined to steer India in this direction.

What is PPP? Why do we need Public-Private Partnership (PPP)?

There are multiple challenges to healthcare delivery, especially to remote and inaccessible areas, where PHCs lack basic facilities such as infrastructure, skilled human resources, ready supply of essential medicines and laboratory reagents, despite continued public sector efforts. Lack of political will, inadequate resource allocation, lack of transparency and good governance, poor community participation are some undermining factors in the public health system. Also, there has been an enormous increase in private (for profit) and voluntary (non-profit) health providers, over the past decade.

Recognizing the respective strengths of both public and private sectors and engaging in partnerships is a viable solution to avoid duplication, to enhance resource pooling, to improve quality and to reorient private sector to achieve public health goals.

Karuna Trust is a pioneer in Public- Private Partnership (PPP) model for Health in India. PPP provides immense scope for mutual learning and knowledge sharing. We strongly believe that a good partnership involves optimum participation from all stakeholders throughout the program/ project lifecycle (planning, implementation, monitoring, evaluation, training, research, policy and advocacy) and not merely functioning as contractors for implementation. We attribute our success in PPP to Good governance and zero-tolerance towards corruption.

Karuna trust is managing 14 PHCs in Karnataka. Among them, 10 are rural PHCs and 2 are urban PHC.
In addition, the trust manages 1 PHCs under the CSR program of corporate and 1 are managed in
collaboration with other NGOs.

HEALTH SYSTEM STRENGTHENING

Secondary Health Care

Dental Clinic

Oral diseases constitute one of the major health problems in a developing country like India. It is also one of the most neglected aspects of personal health especially among the lower income groups because of the lack of awareness and affordability.

The Gumballi PHC, Adugodi PHC and Koramangala PHC are well-equipped dental care unit where a full time trained dentist is present. Oral health awareness and health education is done by the field staff at the village level.

Vivekananda Eye Hospital

The Vivekananda Eye Hospital Gumballi PHC has adopted an integrated approach to eye care, and it has been functioning as an independent unit in close coordination with the ANMs and other health workers at the PHC. The staff at the hospital includes a team of visiting consultants from Vittala International Institute of Ophthalmology, a resident ophthalmologist and supporting staff. Weekly eye check-ups done at the facility and camps are also arranged. Around 1000 cataract surgeries are performed every year.

Vision Centers

The Gumballi PHC, Adugodi PHC and Koramangala PHC boast comprehensive eye care facilities, each staffed with a dedicated, fully trained Optometrist. These centers actively promote eye health awareness and provide valuable health education services through their field staff at the grassroots level in the villages.

Vivekananda dialysis center, Gumballi

The Vivekananda Dialysis Centre at Gumballi PHC, which commenced operations on the 18th of August 2023, is equipped with two advanced dialysis machines provided by Rotary Bangalore. Additionally, the center boasts a dedicated ICU bed for critical care, along with three beds equipped with oxygen support. Karuna Trust has made arrangements for an essential infrastructure such as an RO plant, electricity, and water supply to ensure seamless operations.

The center’s capabilities allow for the performance of up to six peritoneum dialysis procedures daily, translating to a capacity to manage approximately 150 cases each month. In its inaugural month, the facility has successfully handled 100 cases, demonstrating its commitment to delivering efficient and comprehensive care to individuals in need of dialysis services, and making a substantial contribution to fulfilling the community’s healthcare requirements.

Manasa Project

The state of homeless people especially the wandering mentally ill in India, is agonising. The problem of homeless mentally ill population is the product of social neglect and the lack of support, coupled with the apathy of the state towards them and their rights. Manasa/ Manasadhamais a response to this felt need and seeks to provide a system to address the physical, mental and emotional needs of these people. Manasa/ Manasadhama strives to establish a comprehensive model for care, support and rehabilitation of the homeless mentally ill population of Mysore. The institution also works towards raising public awareness and changing overall attitude towards homeless mentally ill individuals.

Our field team rescue homeless individuals in and around Mysore, and shelter them in our Transit Care Centre (TCC), where they are provided food, shelter, comprehensive medical care including psychiatric care. Additionally, skill development activities are conducted at TCC such that all the inmates develop adequate capacity to perform basic chores, selfcare and income generation. General Health & HIV program for the inmates has been arranged with the Government Medical College Hospital (K.R.Hospital) at Mysore. Students of Master of Social Work (MSW) and Nursing students from various institutions visit Transit Care Centre, K.C. Layout, Mysore regularly and interact with the inmates and conduct group therapy (games, storytelling, counselling etc.) After full recovery, their families are traced and repatriated.

One Bed ICU in PHCs

With each wave of covid19, realization has dawned on the importance of strengthening the health infrastructure. This does not limit itself to strengthening secondary and tertiary hospitals alone. There is a pressing need to equip the Primary Health care Centres with certain key equipment of ICU facility. This will help the PHCs respond to any emergencies in the future. In addition to this, these centres will be a part of the Tele ICU concept, where the experts can provide their assistance to the remote medical officer at the PHC.

Tertiary Health Care

10 bed ICU in Taluk and District Government Hospital

Karuna Trust in Partnership with E-Governance Foundation has envisaged 10 bedded ICU project by establishing ICU in in remote rural Government hospitals to handle the surge in covid19 cases and to prepare for future emergencies. We are establishing ICUs in 120 Government Hospitals [District and Taluk Level] – 1240 ICU Beds [5-30 beds per Hospital].

Pillars of 10 Bed ICU

Equipment provided to set up a 10 bed ICU

Tele ICU

Tele ICU is being envisaged in all ICU hospitals. The data that is captured at the hospital in which the patient is admitted, and is made visible through the CARE Portal to the specialist doctors supporting in patient care remotely.  This allows the patients in remote and rural areas to avail the services of specialists physically present in Urban Areas.

For more details on 10 bed ICU click here

List of 10 bed ICU

SOCIAL DETERMINANT OF HEALTH

Energy & Environment

Solar Energy Implementation:

Project title: Centre to Promote Delivery of Health Service using Sustainable Energy as a Catalyst

Introduction/Background of the project

This project is done in partnership between Karuna Trust and SELCO Foundation

I. Title of the project: Centre to Promote Delivery of Health Service using Sustainable Energy as a Catalyst

II. Proposed duration of the Project: May 1st, 2018 to April 30th, 2021

III. Target Group: Primary Health Centres managed by Karuna Trust in India

IV. Project Location: Health centres covered will be located in Karnataka, Meghalaya and Arunachal Pradesh. The two training centres: Mysore, Karnataka and Tezu, Arunachal Pradesh.

Goal: To develop and implement decentralised, renewable, sustainable and efficient energy in providing quality primary health care services

Objectives:

1. To establish training centre for health-energy skills training

2. To establish health-energy mobile training, maintenance and supervision units

3. Implementation at health institutions

4. To develop specific Health-Energy Innovations

5. To do advocacy for policy change

Solar Energy Implementation at health institutions:

– Solar energy installations have been designed and implemented at PHC and Sub centre.

Implementation at health institutions :

– Procurement of data logger done, data being monitored

– The Combined Health and Energy Audit has been developed. Sub centres for need assessment has been made using this Health and Energy Audit.

– The Solar installations have been finished.

– The MoU with ARS has been signed for annual maintenance (AMC) of installed solar units.

– Karuna Trust has installed solar panels to power 14 Primary Health Centers (PHCs) and 14 sub centers in Karnataka.

– Data loggers have been procured and utilized to monitor data at various sites, aiding in energy audits.

– The protocol and process for Combined Health and Energy Audits have been developed.

Tribal and Rural Education

1. Vivek Medical Students Scholarship Program

The Vivek Medical students’ Scholarship (VMS) program of Karuna Trust provides scholarships for deserving students who are meritorious and economically backward. Professional education is becoming increasingly expensive and unaffordable, especially for students from poor socio-economic background. Although there are numerous scholarship options, invariably, many deserving students, outside the reservation categories are left out. To meet these unmet needs, this scholarship program is being sponsored by the alumni of BMC and late Dr. Iychettira Saraswaty Subbiah.

The students are selected based on their merit, socio economic condition and other sources of scholarship, either public/private. Students from needy family, irrespective of caste, creed and religion are chosen based on their interest and commitment to serve the poor or commitment to help other students by donating to the same scholarship program once they settle down or start earning.

The scholarship applications are open every year during the month of August and is announced on our website

Students received scholarship

Eligibility criteria

• 1st year MBBS students of Bangalore Medical College and Mysore Medical College, who have secured 85% and above in 2nd year PUC and Entrance exam ranking 2000 and below.
• 2nd, 3rd and 4th year MBBS students who have not availed any scholarship other than VMS during previous years and secured more than 70% in previous university exam.
• Annual income of family 3 lakh and below

For 1st year MBBS Students applying/ Receiving other scholarships and education loan is not a disqualifying criterion for this Scholarship.

Selection Process:

Applications will be scrutinized by our team and shortlisted candidates will be called for an interview. Number of candidates and amount will be decided by Karuna Trust team. All related documents will be verified during the interview.

Timeline of events: 

Contact Details:

Postal Address: Karuna Trust, #686, 16th main 39th cross, 4th T block, Jayanagar, Bangalore 560041

Phone no: 080 22447612

Email ID: karunatrustblr@gmail.com

2. Skill Training and Capacity Building for CPHC and Renewable Energy

Every month, a two-day hands-on training program is conducted at our Mysuru training centre for nurses, ANMs and PHC management staff from all our PHCs. The sessions for nurses and ANMs cover topics from basic hand washing, infection control to active management of third stage of labour, PPH management and new born resuscitation, using mannequins and simulated models. The session for management staff focuses on basics principles of energy, electricity, equipment maintenance and trouble-shooting, audit.

3. Extended Community Health Outreach Program (ECHO)

The collaborative model between Project ECHO and Karuna Trust is successfully addressing the need for specialty care in rural India. This partnership utilizes ECHO’s Telehealth technology, connecting hubs at Karuna Trust’s head office to 19 spokes across Karnataka, the Northeast, and Rajasthan. Challenges, like consultant availability and connectivity issues, have been managed.

In association with ECHO, a medical education-integrated training through virtual-clinic and online sessions for ANM, ASHA workers and PHC management staff. Knowledge-transfer sessions by specialists and best practises to boost workspace productivity are conducted.

Training programs being conducted:

• Antimicrobial Resistance and Stewardship Program
• Community health worker training Program – For ASHAs and ANMs
• PHC Management training Program
• Specialist Training Sessions- Obstetrics and Gynaecology, Dental 

Tribal and Rural Livelihood

Kammasandra Project:

Karuna trust, in collaboration with Sri Ramakrishna Paramahamsa mission and Vivekananda Rural Development & Education Trust, has established an orphanage for destitute children at Kammasandra, Doddabalappura Taluk. The orphanage focuses on nutrition, safe shelter and education of the destitute children in Kammasandra and nearby villages. A total of 13 children are residing and being educated. Dr. V.A Ram, ENT surgeon and family have contributed enormously towards this endeavour.

COVID 19

COVID-19 Response in Karuna Trust PHCs

Supervision and Monitoring of the Covid-19 Response

Karuna Trust under the guidance of our Secretary – Dr Sudarshan and Joint Secretary – Venkat Chekuri is carrying out a robust COVID-19 response through all our health centres. Joint Secretary is personally supervising the functioning of the health centres in the high alert zones. Our supervisory staff visit all the health centres at regular intervals to provide hand-holding, support and guidance to the health staff.

1. Fever/Flu/Influenza Clinics

In line with the Epidemic diseases act, all the Karuna Trust PHCs were enabled to function as fever clinics. Catering a population of about 1.5 million, the PHCs were nodal centres to disseminate appropriate information to the community and enforce infection control measures in the respective areas. Although the Government designated only a few health centres as fever clinics initially, a designated fever/ flu corner was put in place in all the Karuna Trust PHCs. The fever clinics attended to all symptomatic cases and did an early triage for COVID-19. The apprehensions among the community were attended to with extensive IEC and availability of health staff round the clock at the health centres.

2. Community Screening and Health Education

    A. Community Screening

Door to door visits by ASHA worker to identify the suspect cases. It is done with the help of a mobile app. The data from suspected cases will be entered, along with the automatically derived risk score for the patient. Action will be taken depending upon the risk score of patients.

    B. Teleconsultation

Symptoms of COVID-19 are very much like common flu. Treating all these patients under the same roof might accelerate the spread of infection. Also, most physicians could be inaccessible, busy in managing the high risk COVID-19 patient loads due to the pandemic.
We are augmenting the physician with well-informed ASHA and other front-line workers: With the help of the CERNER app, ASHA can categorize suspected cases in three categories viz, High, Moderate, and low risk. She can arrange a teleconsultation session with moderate-risk patients and physician at PHC

    C. Community surveillance

In pandemic such as the COVID-19 community, surveillance is of immense importance and is essential. It will help us to keep the track of confirmed cases, new suspected cases, contacts of suspected and confirmed cases, and migrants/immigrants so that the spread of disease can be curtailed. In Primary health centres managed by Karuna trust, we keep tight surveillance, so the chances of missing potential cases are minimized. Complete line listing of the suspected cases is maintained by the health workers so we can trace any case at any time. Keeping watch on immigrants from other cities, states, or countries. Following-up on their health condition via telephonic calls and providing them awareness and guidelines on proper health and hygiene management for the prevention of potential spread.

3. Testing and Diagnosis –

Point of Care Testing – TrueNAT MicroPCR

Karuna Trust was the first to de-centralize COVID testing to ward levels through our urban primary health centres. The Government has also adopted the same strategy now. Karuna trust with the support from donors established a state-of-the-art TRUENAT testing centre at the Adugodi Fever Clinic health centre. Patients who require RT-PCR testing for COVID from other urban health centres – Adugodi UPHC, Maternity Hospital, Tavarekere UPHC, Maternity Hospital, Nelamaheshwari, Yemaluru were referred to the fever clinic for the same. About 30 to 40 samples were being tested for COVID using TRUENAT. This expedites diagnosis, reduces waiting time and improves triage of cases at the grass-root level, bringing down the burden on tertiary care centres. Subsequently, 8 more urban PHCs were strengthened with TRUENAT MicroPCR testing facility. All the lab technicians were rigorously trained to conduct tests and we were able to issue reports within 4 hours from sample collection. Today, each of these centres conduct close to 20 to 30 tests/day for vulnerable and high-risk patients such as >60yrs, pregnant women, those with comorbidities, severe symptomatic etc.,

Mobile Testing Units:

With the aim of taking healthcare closer to the community in the most remote unreached areas, migratory population and slum dwellers, we have deployed four mobile Micro-PCR testing units. Mobile team including driver and lab technician reach out to the community and perform COVID-19 RTPCR testing. Reports are generated in less than a day and appropriate treatment is initiated by the PHC MO.

4. Home Management (Isolation)

In addition to tracking, tracing, testing, Karuna trust has emphasised on treatment at Primary care level. Our PHCs have taken full responsibility for follow up and management of all home isolated cases. A COVID-19 kit consisting of thermometers, pulse oximeters, sanitizer, masks, all essential medicines such as Vit C, Zinc, Paracetamol etc., where distributed to all positive cases in PHC area. Patients who had a smart phone were added to PHC’s dedicated COVID patients WhatsApp group and their vitals were monitored by PHC staff, including teleconsultation by medical officer. All other patients were visited by ASHAs or ANMs at least once daily and vitals were checked. Oxygen concentrators from the PHC is taken to the house of patients in need and they are administered O2 in the comfort of their home. Medical officer keeps a close watch on such cases and any deviation in vitals is immediately raised to the MO and appropriate referral is initiated.

5. Infrastructure Strengthening

    1. Oxygen concentrators: All Karuna Trust PHCs in Karnataka and Odisha are equipped with 1 Oxygen concentrator each to cater to the immediate needs of the community. This reduces apprehensions among the people and they can readily access O2 from the PHCs until referral to higher centres are arranged. This is also being used for mild to moderate cases to augment recovery and in children for nebulisation

    2. NCD diagnostic kits:

All subcentres have been equipped with a comprehensive NCD diagnostic kit, which  the ANMs and MHWs use for early diagnosis of NCDs among the community and identify high-risk population for COVID-19, target population for vaccination.

    3. DESIGNATED COVID ROOM in all PHCs with Oxygen facility and essential medicines

6. Referral Services and Hospitalisation

Our Health workers identify patients who need hospitalisation and make all necessaryarrangements including ambulance, personnel support etc

7. Vaccination

All the Karuna Trust managed health centres are actively taking part in COVID-19 vaccination. So far, nearly 60,000 beneficiaries have been vaccinated through our PHCs as on 30th Apr 2021

8. Continuum of care – Continuing other primary health care services during the pandemic

Despite ongoing COVID-19 pandemic antenatal care and new born care have not been affected in PHCs managed by Karuna trust. Deliveries and C-section have been conducted at PHCs and maternity homes with adequate precautions.

9. IT Innovations

In addition to preparing our Primary Health Care centres (PHCs) and field staff to handle their specific roles in dealing with the COVID-19 Pandemic, Karuna Trust is working with our technology partners to innovate solutions that will enhance our abilities to deal with the Pandemic. Some of the innovations are:

a. EMR (COVID-19 Symptom tracker) – Cerner

Karuna Trust uses an Electronic Medical Records (EMR) solution to track and manage the functioning of our PHCs. Working with our technology partner Cerner, we have enhanced the EMR to incorporate COVID-19 suspected patient data. This allows for the tracking of this data over an extended period by multiple healthcare providers. The platform now provides a tool to track, as well as effectively manage suspected COVID-19 patients. The EMR implementation has two parts:

A. At the registration: The staff in charge of registration uses the COVID-19 triage questionnaire to separate the patients into two categories:
1. COVID suspected cases: These patients will be marked as red by the symptom tracker and be serviced in a separate high priority queue.
2. General Patients: These are other than COVID suspected cases. These patients will get serviced by ANMs (Auxiliary Nurse Midwife) and receive appropriate treatment or be directed to a physician if required.

B. At the physician: Physician will prioritize the red signalled patients. He or She, will check the patient with the help of COVID-19 symptom tracker, and determine their risk category, and will take further actions based on their risk category.

    b. Covid19 Emergency Supply Chain Management – Logistimo

We have enhanced our medical supply chain management and tracking solution from Logistimo, to incorporate a separate panel for tracking Covid19 emergency supplies, including PPE. The app now helps us know the current status of medicine and PPE stocks of PHCs, and alert us to shortages before they occur, and to where potential stocks are available. A pharmacist at PHCs will update the stock details in a simple mobile app periodically, it will help us to maintain proper supply of all essential medicines and equipment required for COVID-19 preparedness and first-level management.

10. Training, capacity building and Safety of Health Staff and PPE

1. Training of staff:

All the PHC staff are regularly trained on various COVID related topics such as personal protection, infection control, communication strategies for general public, early warning signs, testing, triaging and emergency management. To fight the COVID-19 pandemic it is of immense importance that everyone who is fighting this disease should be updated with the latest relevant knowledge. Including doctors, nurse, pharmacist, lab technician, ANM, ASHA, health worker, ambulance drivers, Group D worker.

2. Safety of Health Staff and PPE

Safety of health staff is of prime importance for Karuna Trust, we have facilitated the supply of all essentials PPE and drugs for the management of COVID 19. We acknowledge our donors who have supported for the immediate response of COVID-19 at health centres by facilitating the procurement of personal protective equipment. ACT grants supported Karuna Trust with N95 masks for all healthcare workers

11. Covid19 Collaboration

11.1 COVID-19 Action Collaborative (#COVIDActionCollab – ACT)

It has come together in response to the COVID-19 pandemic, consisting of expertise in Public health, Medicine, Technology, Sociology, Behavioural science, Financing, Humanitarian emergencies, Procurement and Supply, Designers, and the likes. The Collaborative has developed and promoted the COVID Action Collab framework to support stakeholders to collaborate, coordinate, and integrate COVID-19 Response. Karuna Trust is part of this collaborative and working proactively with the team.

11.2 Global COVID-19 Collaboration

A Global knowledge sharing platform has been created for mutual learning, case presentation, assessing the global scenario of Covid-19 involving experts in infectious disease and public health across the globe, Karuna Trust is a member of the collaboration.

11.3 Covid19 PHC Action Group:

Karuna Trust is a part of this action group that includes various International and National public health experts together formed as a PHC action Group for Covid-19 to facilitate improved preparedness in PHC/community settings, especially in rural areas

12. COVID CARE CENTRES (CCC) AND DEDICATED COVID HEALTH CENTRE (DCHC)

Karuna Trust, with support from donors and partners has established a designated covid health centre in Gonikoppa, Kodagu District, Karnatka, India. It is a free, 24*7, 30 bedded facility with 1 ICU bed, 8 HDU beds and 21 general beds with oxygen support. This centre has dedicated team of doctors, nurses and other staff. Patients receive quality care, all essential medicines, ygeinically cooked food all at no cost. Ambulance services are avilable for pick up and drop, referral to higher centres if required. This effort has been greatly appreciated by the local citizens and media. Work is in progress for establishing similar centres is Yemalur, Gumballi, Adugodi and Thavrekere health centres too.

Gallery and media reports:

III. COVID-19 Status in Karuna Trust Managed Karnataka PHCs as on 30th Apr 2021