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.
- Health Centres:
- Rural PHC (Health and Wellness Centres):
Karuna Trust manages PHCs, in partnership with Respective State Governments: Karnataka – 26; Arunachal Pradesh- 11; Meghalaya-11; Manipur- 4; Orissa- 8, Tamil Nadu- 1
Karnataka– Kammasandra HWC
North-east – Pictures of Khati Uttarakhand
- Urban Health Centres (HWCs):
The urban poor are a unique demographic, with a dual burden of both communicable and non-communicable diseases. Out of pocket health expenditure is a major impoverishing factor. Karuna Trust Manages 3 Urban Health Centres in Bengaluru – Adugodi UPHC, Adugodi Dispensary and Tavarekere UPHC, catering to a Population of over 2.5 lakhs.
Urban- Adugodi Dispensary
- CSR (Corporate Social Responsibility) Health Centres– Gottikere and Arogyadhama.
The standard features of a model PHC managed by Karuna Trust are:
- Total responsibility of Preventive, Promotive, Curative and Rehabilitative Health Services to the entire population under the PHC area
- 24×7 emergency/casualty services
- Out Patient (OPD) Services and Five to Ten bedded In-Patient (IPD) facility
- 24×7 labour room and Essential Obstetric Care facilities
- Minor operation theatre facilities
- Uninterrupted availability of essential medicines and laboratory tests.
- Management of sub centres attached to the PHC
- Community Participation through strengthening VHSNCs and PHC Committees
- Mobile Medical Units- 3
We have three mobile medical units, functioning in Karnataka, covering a population of over 70,000. Population level screening for communicable and non-communicable diseases, health education, preventive and promotive health services are provided.
- e-Health Centres:
Five e-Health centres (2 rural and 3 urban) are managed by us. These centres are equipped with an electronic medical records facility.
- School health:
Karuna Trust has collaborated with BOSCH, to conduct a comprehensive screening for school children in Bengaluru Urban and Ramanagara districts of Karnataka. In line with the NHM and RBSK guidelines, school children are screened for the 4Ds- Defects, Deficiencies, Diseases and Developmental delays including Disabilities. Additionally, Vision, Dental, ENT examination and follow up treatment are also carried out by our expert team.
- NCD Screening:
India is currently facing an NCD epidemic, with a high burden of NCDs especially among the urban and peri-urban population. Comprehensive NCD Screening for Anaemia, Diabetes, Hypertension, Cardiovascular diseases, Respiratory diseases (COPD), Cancers, Refractive errors and screening for risk factors such as drugs abuse are being done at all our health centres. Further, a mobile NCD unit has been deployed in association with CERNER that exclusively focuses on the urban high-risk pockets. Additionally, in association with Indian Cancer Society, comprehensive cancer screening is being done in Sugganahalli PHC area, where over 1500 individuals have been screened and about 100 cases have been identified.
- Vision centres:
We have five state of the art vision centres equipped with fundoscopy and autorefractors. India is home to one-fourth of the world’s blind population. At least 75% of this blindness are preventable. We, at Karuna Trust are committed to early detection and referral treatment of avoidable causes of blindness such as diabetic retinopathy, cataract, refractive errors and glaucoma.
- Menstrual Hygiene Management (MHM) – The sustainable way!!!
The project envisages ‘Sustainable menstrual hygiene’ as an integral part of the services offered by a Primary Health Centre (PHC). It is a comprehensive intervention, designed for all girls and women from menarche to menopause, covering education, nutrition, health services, menstrual hygiene management products and the freedom to make an informed choice. The project will be implemented and monitored by Karuna Trust in partnership with ‘Green the Red’ and ‘RIM’ NGOs
- Geriatric Care- Samrakshana, Rameshwaram:
The program is directed to provide palliative care and assistance to the natural aging process of the elderly with focus on eye care, dental care, behavioural changes and general health and wellness. A mobile clinic providing dental, siddha and allopathic services have been deployed covering 72 hamlets in Rameshwaram.
Karuna Trust has evolved several innovative approaches in delivering comprehensive primary health care over time, with the support of our partners.
ICT innovations in Primary Health Care:
- E-Supply chain management (Logistimo): A Mobile phone-based application is being used for Supply chain management (SCM) of Vaccines, Emergency and Essential Drugs. The stocks of all essential drugs are monitored real-time and uninterrupted supply is ensured across all our PHCs.
- Drone for supply of essential drugs and vaccines: We have piloted the use of drones to deliver emergency medicines to remote areas which are otherwise difficult to access.
- Electronic Medical Records (EMR): In association with CERNER, we have installed electronic medical record system in all our PHCs. EMR facilitates paper less operation, maintenance of patient records, secure sharing of information for secondary and tertiary care, enhances productivity and completeness of data. In alignment with the National dream of Digital India, we are strongly emphasis digital records in healthcare.
- Electronic Health Records: Our PHCs are equipped with laptops and internet networks to maintain electronic medical and health records of the population.
- Telehealth (ECHO): We have made specialist consultation at PHCs a reality through telehealth sessions using information technology. Gynaecologist, Paediatricians and Dentists from our Urban centres have been providing telehealth services to remote rural PHCs.
- E-partograph: We monitor progress of labour and patient flow across our PHCs, real-time. This allows timely identification of complications, rapid response and referral if necessary, to ensure safe deliveries.
- Tele-ECG: ECG records of patients are shared with specialists who interpret the same and provide a definitive treatment plan through our tele-health platform.
- Integrating Comprehensive Eye Care into Primary Health Care (Vision centres): Providing quality and affordable comprehensive primary eye care services in primary health centres including Vision Centres with spectacle dispensing units.
- Repositioning Family Planning in Primary Health Care in collaboration with Population Foundation of India: The project empowers women and men in Reproductive Rights approach to lead healthy and productive lives, enabling them to regulate their own fertility through acceptable family planning services with emphasis on spacing through temporary methods.
- Cancer screening and Management: In association with Indian Cancer Society, we have been conducting a population level screening for oral, cervical, breast and other cancers. High risk individuals and positive cases are then taken to higher centres for management.
- Integrating Mental Health into Primary Health Care: Mental Health Services in primary care began in Gumballi PHC in 1996 with support from NIMHANS, and it is a practical model of how mental health care and epilepsy control can be mainstreamed into primary health care. Community Mental Health Programme is in place in most of our PHCs.
- Integrating Dental Health to Primary care: Gumballi PHC has a mobile dental clinic equipped with essential equipment to provide dental care in remote villages on designated days. Restorations, tooth extractions, root canal treatments are some of the services provided.
- Mainstreaming Traditional Medicine Ayurveda, Yoga & Homeopathy (AYUSH): We have established herbal gardens at our PHCs with a rich cultivation of indigenous herbs and medicinal plants. Make a rapid assessment and validation of sound local practices and develop a cadre of “Arogya Mitras” who can cater to the preventive, promotive and curative needs of the community.
- Management of Communication disorders in Primary Health Care in collaboration with All India Institute of Speech and Hearing (ALLSH).
- Promotion of generic drugs: Rational Drug usage and promoting low-cost generic drugs has also been an agenda for revamping the supply of all essential drugs.
- PHC Management: To improve the overall health centre management and reduce the burden on the Medical officers, we have appointed a designated HR for PHC Management.
- Skill lab Training: We prioritise skill development for all our staff from MOs to community health workers and PHC Administrators. Periodic trainings are conducted for up-skilling and capacity building of health staff.