Karnataka is a huge southern state with Maharashtra, Andhra Pradesh, Goa, Tamil Nadu and Kerala surrounding the state. Area wise it is the 8th largest state which covers ~6% of total area of India and population wise 9th populous state of India. Population of the state in increasing since last 10 years. Karnataka has rich cultural heritage and have preserved its natural beauty through national parks and sanctuaries.
Karnataka as a state is growing economically, politically and is showing improvement in health status of the people. The state has great potential in achieving the universal health coverage and is improving over the period of time. The major indicators such as Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR), and Under 5 Mortality rate (U5MR) though have shown decline over past few years but the numbers are still high when compared to neighbouring states. Achievements so far could be reduction in total fertility rate (TFR) which has come up to 1.9 (~2) children per couple and almost near to achieve full 100% institutional deliveries. To attain the health of people of the state, many programs and policies have been started and implemented very well at ground level such as Karnataka Public Health Policy (Karnataka Jnana Aayoga), Vajpayee Arogyasri Yojana, Yeshasvini Healthcare Scheme, Karnataka State Integrated Health Policy and a few more. Based on the data available there are few issues which Karnataka as a state needs to tackle though they are already working towards it through various policy implementation.Infant Mortality Rate
The IMR is the indicator for representation of nation’s quality of living, health and socioeconomic condition. According to NFHS4, IMR is 27 deaths whereas under-five mortality is even more i.e. 31 deaths per 1000 live births. When compared to other southern states like Kerala and Tamil Nadu, Karnataka still has high IMR. Within the state, IMR is relatively higher in rural over urban areas this could possibly due to better healthcare service delivery in urban over rural areas.- The causes here for high IMR are many preventable conditions like diarrhoea, respiratory infection, malnutrition and other infections. Secondary causes could be education qualification of the parents, mother’s age at marriage or first delivery, place of living, socioeconomic background. In order to reduce the mortality rates Government of Karnataka (GoK) introduced New Born Care Corner (NBCC), New Born Stabilization Units (NBSU), and Special Newborn Care Unit (SNCU) at district and taluk level hospitals. The Janani Shishu Suraksha Karyakrama (JSSK) program under the National Health Mission (NHM) was started in the state to lessen the out of pocket expenditure by the parents during the treatment of sick infant. – Improper complementary feeding practices could be one of the cause here for high under 5 years mortality rates in case of Karnataka, as the children who receive adequate diet whether breastfed or non-breastfed the % is very low i.e. 5-15% only. – This should be one of the major concerns of the state as it directly associated with quality of life of the people in the state.
Malnutrition is deadly and can harm in many ways than imaginable. It compromises on the growth of future India, doesn’t allow the child to grow to its full potential. It not only affects physiologically but mental and emotional development is hampered. Though the trends are declining and the state is doing well in eradication of Malnutrition but still as per NFHS 4, 36.2 % children under 5 years are stunted, underweight is similar as NFHS 3 showing no improvement and wasting has increased in the states which was 17.6 % during NFHS3 now it has risen upto 26.1 % which is very high. These figures can be indicative of intensity of acute malnutrition which could be due to fever, infection, diarrhoea or loss of appetite which further lead to increased mortality and morbidity rates among children. Damage during this period results in growth faltering which is irreversible.
Improper BF practices is also one of the major concerns in the state of Karnataka as only 56.3% infants are breastfed within one hour of birth and only 54.2% children are exclusively breastfed for 6 months this may lead to undernutrition.
According to NFHS4 data, only 46 % children received age appropriate complementary feeds and this practice has declined from NFHS3 which was 69.7%. This is a serious issue, wherein the programs are there but the implementation part from the GoK is questionable as this is probably because of unawareness among mothers which ultimately harms the health of children in more than one way.
Anaemia in general can be defined as low levels of haemoglobin (Hb) in the blood. Low Hb levels can be dangerous in every age group irrespective of the gender as it affects the productivity of an individual but is matter of concern mainly for the women in reproductive age and pregnancy. Though the rates of anaemia are declining as compared to NFHS 3, but among the southern states Karnataka has high anaemia prevalence among non-pregnant women, pregnant women, and all women age 15-49 years i.e. 44.8 %, 45.4 % and 44.8% respectively. Anaemia cause excessive fatigue and is major threat during pregnancy, it may hamper normal delivery process and growth and survival of the foetus is crucial in this situation. Complications such as low birth weight, respiratory infections at birth, compromised cognitive development of infant, IUGR are associated with Anaemia during pregnancy.
Anaemia in non-pregnant reproductive age women is also vital as it leads to a vicious cycle of malnutrition or survival as anaemic adolescent’s girls would herself have compromised health status, such girls in anaemic state in later life enter the pregnancy further giving birth to anaemic child and thereby continuing this cycle of compromised health.
Improving women’s nutritional status irrespective of the age and marital status becomes important here, in order to reduce this problem especially during pregnancy GoK under the Reproductive and Child health program recommends Iron and folic acid (IFA) tablets during pregnancy. However, again this supplementation is availed only by the mothers who come for ANC during pregnancy which is only 32.8 % (NFHS4). Also mothers who consumed IFA during pregnancy was only 45.2% which is indicative of low consumption of IFA which further leads to Anaemic state and thereby vicious cycle continues.- Severe anaemia is also one of the leading causes for Maternal Mortality which is another major issue in the state.
Unsatisfactory Immunization Coverage
Immunization has become mandatory in India in order to prevent 6 major diseases which are preventable through vaccination i.e. tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. In order to achieve full coverage of these vaccinations National Immunization Programme is implemented in the state under the National Health Policy (NHP). Immunization improves the quality of life of the child and prevent many harmful diseases that would occur in later life.
Immunization coverage has improved in Karnataka but not as good when compared to other southern states like Kerala where the coverage is 85-90% and here it is around 70-75% only accept for BCG (this might be because it is the very first vaccination given after the birth and its given in the hospital while for other vaccinations mother would have to go the centre separately thereby losing out on immunization schedule).
There is not much discrepancy in urban and rural practices given the implementation of immunization program at community level is well in both areas. As per NFHS4, children who are fully immunized (12-23 months) is only 62.6% which really hasn’t improved since NFHS3, here we can think about high possibility of lack of compliance towards child immunization or the cost or absolute negligence on parents part but then here Anganwadi workers or ANM or ASHA worker play an important role.
Vitamin A deficiency is worldwide recognized as major public health issue which affects the vision of the million so children. Along with six important vaccinations mentioned earlier, Vit A is equally important and under the National Programme on Prevention of Blindness, the state administers oral doses of Vit A in children below 5 years age which should be given every 6 months after 9 months of age. Vitamin A supplementation is achieved by only 70-80% of the children.
Elderly population is growing in the state thereby making it a need to provide them with required healthcare facility. Elderly are the ones who are in need of the insurance or affordable healthcare services as they are dependent at this age and not working. But insurance companies they hardly provide policies to the one who needs it the most as they might utilize the policy benefits which is wrong. We as nation have very less expertise in Geriatric healthcare and Karnataka have major problem as training courses on geriatric care is not available. Priority needs to be given to elderly care as population in this group is increasing ever since 1991 i.e. from 57 million to 90 million in 2011. The state is among few of the states in our country to start National Programme for the healthcare of Elderly. GoK also facilitates health security to elderly under the RSBY scheme.
Disparities in Healthcare delivery system
For a healthcare delivery system to achieve full coverage it need to be effective, should be reliable, deliver quality services, affordable and accessible within the available resources and community participation. Karnataka has public, private, organizations where there is public private partnership, there’s alternative medicine practitioner and not for profit organizations.
Though Karnataka state is growing and working towards achieving universal health coverage, access to quality healthcare and equity still exists. Services provided by the government are underutilized by the people. There are 2193 Primary Health Centres (PHC), 325 community health centres, 26 district hospitals but still utilization from these are low, it could be attributable to either quality of care provided or long ques in government hospitals or simply unavailability of human resource.
In order to fill the post of medical officers so that people of the state should not suffer, integration with AYUSH practitioner is one of the steps taken by GoK. Further to reduce the MMR and IMR, GoK have started training MBBS doctors who can be functional during Emergency Obstetric care services. – Regional disparities exist in the state, where in few district coverage is good and in few there is minimal coverage of health service e.g. Raichur and Tumkuru.
Quality of care provided in government hospital is pre conceive and is not changing as patients satisfaction, safety or value for time is not considered leading to increased out of pocket expenditure by utilization of private healthcare services.
Failure to provide quality services has given rise to private sector growth in Karnataka, where in as per DLHS4, 60 and 70% of people preferred treatment from private hospitals for acute and chronic illnesses respectively.
Disparities in provision of health services exist which is affecting the people of Karnataka in a greater way.There are many such public health issues that exists in the state of Karnataka and India. Every region has their own limitations, system and culture due to which implementation of various really good programs is hindered but that is where Government has to take stand and look for innovative ways of implementation through maximum utilization of resources and manpower to achieve universal health coverage, so that no individual is deprived of the healthcare due to lack of monetary support. No infant or mother should die due to unavailability or low quality services. Karnataka has a great potential and is growing but needs to focus on strengthening of their system which is possible through smart planning and implementation of so many great initiatives by government.