Tag Archives: tumkur

Studying organisational change in Indian district health systems: end of a PhD journey

On 21st April, 2015 I defended my public health PhD dissertation at Universite

Public defence at UCL. Clicking the photo takes you to the ITM public health department's blog on the defence

Public defence at UCL. Clicking the photo takes you to the ITM public health department’s blog on the defence

Catholique de Louvain in Brussels. I sought to understand  organisational change within district health systems in an Indian district. The research was carried out in Tumkur district in southern Karnataka (on which I have blogged a bit). I focused on understanding “change” within a public service bureaucracy like the one we have in Karnataka. Continue reading

Health managers and organisational change in Indian districts

As Indian districts are increasingly finding themselves at the receiving end of new monies flowing in under the National Health Mission, something that

Flyer of panel discussion where the paper was released at the Third Global Symposium on HSR in Cape Town (October 2014)

Flyer of panel discussion where the paper was released at the Third Global Symposium on HSR in Cape Town (October 2014)

everybody were increasingly pushing for, we find ourselves in a strange predicament, the sheer lack of capacity to spend these new resources. As more and more resources become available, our public health services face a curious gap of not knowing how to make the best use of the new resources as well as the powers that the decentralisation process is bringing. Continue reading

Can we count on our counting systems?

A shorter version of this article appeared on BMJ Blogs on October 31, 2013 under the same title.  Co-written with Himabindu G L of IPH, Bangalore.

Much of the material remains unprocessed, or, if processed, unanalysed, or, if analysed, not read, or, if read, not used or acted upon

Robert Chambers

Basic demographic information forms the basis of policy, planning and public

The Registrar General of India promptly responded with this instruction to all states. But since then...

The Registrar General of India promptly responded with this instruction to all states. But since then…

discourse.  The system through which governments record vital events such as births and deaths is the civil registration system. Defined by the United Nations as “the continuous, permanent, compulsory and universal recording of the occurrence and characteristics of vital events”, it forms the basis for identity, citizenship and civil rights. Established perhaps first by Sweden, as early as 1631,  its importance was globally recognised and more countries have worked towards establishment of efficient and comprehensive civil registration systems.

 

Continue reading

Doctor, doctor where are you?

I am rejuvenating a note I had started a few months back on reading an article on doctor availability in rural areas by Krishna Rao in The Hindu a few dasy back.

CN Halli Taluka Hospital in Tumkur district

Chikkanayakanahalli taluka hospital in Chikkanayakanahalli taluka in Tumkur district. Being a taluka hospital, it is supposed to cater to the hospital needs of 219,000 people in this taluka. Continue reading

Follow the leader…

The auditorium at Tumkur was abuzz with expectation. The district and sub-district health officials from the government health services had congregated for a training session organised by Swasthya Karnataka on administrative procedures. The resource person for the day was Dr. P K Srinivasa, the lead consultant to the Government of Karnataka on implementing the National Rural Health Mission. The expectations of the participants was not so much because a senior official from the state was coming. It was because of who the resource person was; in this case, a respected and established clinician, administrator, mentor and leader within the health services.

Dr. Srinivas had started his career as a doctor trained from Karnataka’s oldest medical colleges, Mysore Medical College. He had joined the state health services early and had worked in remote primary health centres as a doctor and later in hospitals. He had risen up the long ladder stretching form a PHC medical officer to the level of a Project Director of Reproductive and Child Services for the State of Karnataka more recently. After retirement, his rich experience would not be wasted; the state continuing his services as a consultant to help implement the most important initiative these days, the NRHM. Among the lively discussions between the participants and him, was one important aspect of leadership – by example.

Dr. Srinivasa spoke of the fundamental nature of organisations; of adopting the values and principles of the leader. While most people are sincere in their work inherently, many others are fence-sitters, as he called them. They adopt the values of their leader. He also quoted from experience. It is critical for government services to produce such leaders, for in adopting these values of service and dedication, not only would they be transforming the way in which they work, but they would be transforming their entire institution.

Such is the case of the district hospital in Tumkur. The district hospital in Tumkur is an ancient one. It is one of the older large hospitals in the state of Karnataka, having been established a year after independence in 1948. By a strange quirk of fate, the then Maharaja of Mysore, Sri Jayachamarajendra Wodeyar, who was to inaugurate the hospital abruptly left the venue, for the day the hospital was inaugurated was the day that Mahatma Gandhi was assassinated. The inauguration stone that marked the occasion today lies within the walls outside the office of the District Surgeon. The hospital caters to over 2 million people in Tumkur district, and what a responsibility to manage a hospital of such a size given such a task….

Dr. Pratap Surya is the District Surgeon, the man who is at the helm of affairs at the hospital. He has indeed a mammoth task on his hands. Being the head of a large 250-bedded hospital that sees over 1000 people a day is no joke. A random sample of the patients reveals the enormous service that the hospital renders – one of the patients from Midagesi, a distant town in the taluka of Pavagada had come in search of the ENT surgeon for the chronic infection afflicting his adolescent son. He was a landless labourer from there, nowhere else to go for him; the bus charge from his place to Tumkur and back, and the wage loss resulting from a loss of one day’s work together added to quite a burden. There was another person from the town of Madhugiri, an old man who had come hoping to improve his vision by getting rid of the haze that had recently developed in his eye, a cataract. The hospital in Tumkur has an ophthalmologist and an ENT surgeon to cater to both of them. I ran into the gynaecologist, Dr. Diwakar in the corridor. He had just finished a caesarean surgery to save the life of a mother and the newborn. In this case, the newborn was positioned transversely in the mother’s uterus, thus not being able to be delivered normally; a classic indication for a caesarean section. If the mother had not reached the hospital in time from the distant village beyond Madhugiri town, the physiological process of childbirth could have been fatal for both the mother and the child. In her case, thankfully, the newly launched service of 108 had promptly brought her in time for the procedure. The woman being from a family that is below poverty line, like almost all of the patients that obtain service at the hospital had undergone the procedure completely free of cost.

The old man from Madhugiri will have his vision soon. The ophthalmologist scheduled his surgery for the upcoming batch. The ENT surgeon, who single-handedly manages the entire department will soon see the adolescent boy from Midigesi, in time for him and his father to catch the evening bus back home; he cant miss another day of daily wage. The taluka of Madhugiri could rest easy, avoiding its tryst with yet another maternal mortality, thanks to 108 and the gynaecologist at Tumkur. This was yet another routine day in the government hospital in Tumkur.

Yet, it is not automatically so. A lot of effort has gone into managing the hospital. It is but easy to target government hospitals for their poor quality of care and negligence. Easier still to say “privatise”. But, when one sees the segment of people who these hospitals cater to, we understand the importance of strengthening them; and it is not for lack of effort by the local staff that these ills plague the government system. People like the present District Surgeon, Dr. Pratap Surya are the foot soldiers of health care to the masses. Neglect and carelessness in the leader could easily have a cascading effect on the staff. But, Dr. Pratap Surya, by sending the right signals of integrity, service-mindedness and discipline – he leads by example.

Of course, there are problems. Why do poor people have to travel for such a long distance for an ENT consultation? Why wasnt the mother with a transverse lie diagnosed well in advance, so that she need not have come at the nick of time to the district hospital? Moreover, why aren’t such services available at the sub-district level itself? Why is the district hospital so overcrowded?

Thankfully, the launching of the NRHM holds promise. The priority accorded to maternal and child health and the resulting strengthening of referral units to prevent infant and maternal mortality, upgradation of neo-natal ICU’s in Tumkur district hospital, and of course the leadership by example provided by people like Dr. Pratap Surya, one can see encouraging signs of improvement. Let us hope that the efforts of several people within the system like the district surgeon or Dr. Srinivas and many others among the Tumkur district health team will result in better quality service to the poor.