Name of the Project:

‘Grama Arogya’ (formerly known as ‘Graama Panchayath Arogya Amrutha Abhiyaana’)

About the project:

Gram Panchayats are the centres of village administration, development, and health and family welfare, with immense potential to provide decentralized services that can improve the health and well-being of their communities. They have the unique ability to gauge the public health requirements of rural areas, expand access to healthcare services, and leverage community networks to meet the needs of the most vulnerable and unreached populations.

KHPT is supporting the Government of Karnataka, namely the Departments of Rural Development and Panchayat Raj (RDPR) and Health and Family Welfare to implement the Grama Arogya, a first-of-its-kind initiative which aims to enhance the capacities of Gram Panchayats to proactively address issues of public health – such as COVID-19, Non-Communicable Diseases, Tuberculosis, mental health and child marriage – through the provision of point-of-care testing devices and capacity building. The Grama Arogya is a novel initiative that will help create a decentralised convergence model for health at the lowest level between both the demand and supply sides for the health of grassroot communities.

Geography: 5,957 Gram Panchayats of 242 Talukas in 31 districts of Karnataka

Duration: August 2021 onwards

Key Activities:

• Early detection and better management of non-communicable diseases
• Community-centred approaches towards TB-Mukt Panchayats
• Improved awareness and practice of menstrual hygiene
• Addressing undernutrition at all stages of life
• Prevention of and reduced incidence of child marriages
• Enabling access to, and destigmatizing, mental healthcare

 Name of the Project:

Comprehensive Primary Health Care (CPHC) model to deliver Universal Health Coverage with a special focus on Reproductive, Maternal, Newborn Child plus Adolescent Health (RMNCH+A) in Bengaluru city, Karnataka, India

About the project:

KHPT is developing an Urban Comprehensive Primary Health Care (CPHC) model at Singasandra Urban Primary Health Centre in Bengaluru city, with the aim of creating a comprehensive service package for pregnant, lactating mothers and children (below 5 years) among identified vulnerable groups including the urban poor, migrants, and persons with pre-existing health conditions.

The project, which is funded by Wipro Cares, aims to identify specific vulnerable groups and assess/explore gaps in critical service delivery among them; to improve access, strengthen referrals, linkages and follow-up of MNCH services within the facility area; and to strengthen the CPHC model in the context of MNCH services.

Geography: Singasandra UPHC,

Duration: August 2021- September 2025

Key Activities:

• Situational assessment and vulnerability mapping in the context of RMNCHA services to identify vulnerable groups and assess gaps in critical MNCH services
• Development and implementation of comprehensive service package to ensure continuum of care for the vulnerable communities
• Training and handholding of facility staff and frontline workers on the importance and delivering essential RMNCHA services to the vulnerable groups on a priority basis
• Establishing a strong network of follow-up, surveillance and data management for identification of the needs of the vulnerable communities, identification of appropriate facilities for referral and to track the status of the beneficiaries
• Facilitation to strengthen community structures to enhance community participation

Name of the Project:

Arogya Sangama – 3 Way Partnership of People, Providers, and Panchayat for Health

About the project:

The Arogya Sangama Project is a tripartite collaboration between the Department of Rural Development and Panchayat Raj (RDPR), Johns Hopkins University (JHU) and KHPT that aims to build the capacity of the Gram Panchayat Task Force (GPTF) to support responsive primary care at the community level, and to develop a sustainable model for convergence and community engagement

Arogya Sangama will leverage the momentum of PRI engagement for mitigating COVID 19 and aim to build capacities of GPTFs to function as a three-way partnership platform (comprising of people, panchayats, and providers) to increase community ownership, grassroots convergence, and social accountability for rural Health and Wellness Centres (HWCs) in Karnataka.

A prototype model will be developed, implemented and tested; and its applicability, adoption and feasibility investigated and detailed.

Geography: Chamarajanagar (Kollegal) and Raichuru (Devadurga) districts

Duration: May 2023- May 2025

Key Activities:

• Support Johns Hopkins Maternal and Child Health Centre India (JHU-MCHI) in conducting HCD workshops and provide on ground anchoring of the project both in terms of implementation and executing evaluation and assessment activities.
• Implement pilot model with GPTF in the service area of the identified HWCs and conduct related activities such as capacity building of GPTFs, service providers, community mobilization campaigns, IEC etc.
• Conduct data collection activities and analysis for exploratory/formative research and implement facility and rapid household survey to map the baseline/end line status of service utilization coverage, quality, and equity in collaboration with JHU-MCHI.
• Support JHU-MCHI in developing an operational framework for RDPR, Government of Karnataka for scale up of the project in the state based on the evidence generated
• Collaborate with RDPR and JHU-MCHI for model dissemination and advocacy support.

Name of the Project:

Setting Up CPHC-ILC to strengthen the capacity of selected UPHCs in delivering CPHC services in Bengaluru and Mysuru city

About the project:

KHPT, in collaboration with the National Health Systems Resource Centre (NHSRC), and the State Health Society, Karnataka develop an Urban Comprehensive Primary Health Care (CPHC) model focused on the poor and vulnerable populations in Bengaluru and Mysuru city of Karnataka.  The project aims to operationalize CPHC-Innovation Learning Centres (CPHC-ILC) in Bengaluru and Mysuru city, identify and establish a few Urban Health and Wellness Centres (UHWCs) in each Urban Primary Health Centre catchment area, through a convergent approach to work with urban local governance structures and other key community stakeholders.

Geography:

• Bengaluru (Singasandra and Roopena Agrahara UPHC area)
•  Mysuru (Kumbarakoppalu, and Vishweshara Nagara UPHC area)

Duration: September 2022 – August 2025

Key Activities:

• Capacity building of FLW and facility staff on population-level risk assessment and optimal delivery of CPHC services
• Convergence and community ownership by establishing a ward committee for addressing the health needs of its population through periodic need/gap assessment, developing a comprehensive health action plan, implementing solutions and monitoring the progress
• Capacitating the Ward committees in epidemic prevention and preparedness and outbreak management
• Identifying strategic locations for UHWC across these UPHC catchment areas as part of UPHC-HWC, which will provide a single interface for health-related services
• Health promotion and community mobilization through innovative awareness activities (My Health, My Responsibility)
• Digital strategies for health service delivery in alignment with Ayushman Digital Health Mission (ABDM)

Name of the Project:

Developing multi-sectoral convergent urban comprehensive primary health care model to achieve sustainable health outcomes and universal health coverage in Bangalore city, Karnataka.

About the project:

KHPT is working with the Department of Health and Family Welfare, Bruhat Bengaluru Mahanagara Palika (BBMP) City Corporation, and community structures to designed a comprehensive approach, addressing disease prevention, health promotion, and healthcare delivery by strengthening existing systems, promoting convergence and improving service delivery operations through innovative urban-centric CPHC approaches.

The project encompasses three key objectives. Firstly, it seeks to identify specific vulnerable groups and assess/explore gaps in critical service delivery among them. Secondly, it aims to build resilient community structures to facilitate active community participation and ownership. Finally, the project places a strong emphasis on health system strengthening to increase coverage and provide quality-assured CPHC services, especially to all mapped vulnerable populations. The project adopts an implementation research approach, incorporating continuous monitoring, evaluation, research, and learning mechanisms at every stage of implementation.

Geography: Gottigere UPHC areas, Bengaluru, Karnataka

Duration: October 2023 onwards

Donor: HCL Foundation

Key Activities:

• Strengthening community engagement through systematic mapping of all households, maintaining household registers and indexing vulnerable populations; forming and activating Urban Local Bodies (Ward committees, Mahila Arogya Samitis, UHSNC, Jan Arogya Samiti)
• Improving uptake of social protection schemes, including registration to PM-JAY-ABAK, and other schemes of the targeted population
• Health Education and Behaviour Change Communication for increasing health literacy at community and individual levels
• Health facility engagement by assessing and addressing current status and barriers to CPHC service delivery, provision of technical support for graded expansion of CPHC services provisioned under the Ayushman Bharat scheme; and skill-based capacity building of health care staff
• Health system strengthening by establishing a referral system, addressing immediate determinants of health, resource mapping, and leveraging exercise; strategies to reduce OOPE through increasing access to Jan Aushadhi Kendras
• Family and individual health book initiative to influence healthy behaviour and compliance, and creating a digital database of the same to strengthen healthcare delivery and care continuum (Ayushman Bharat Digital Mission)

Context

We are implementing this project, funded by the Landmark Group, in an Urban PHC (UPHC) area in Mysuru City focusing on the NCD care continuum. The project consists of two phases; Phase I consists of population level screening of diabetes, hypertension, understanding the levels of risk factors in the population, qualitative research involving diabetics, hypertensive, service providers, and series of consultations with the officials from Government of Karnataka with an aim of developing the continuum of care package. Phase II consists of implementing the intervention package to establish a continuum of care in the UPHC area of Mysuru city.

After the completion of the Phase I period (July 2017- March 2018) of the project, currently Phase II interventions are being implemented.

Implementation

The primary objective of the Phase II project is to develop a model that will result in high coverage and quality of NCD services across the prevention to care continuum. The secondary or sub objectives include the following:

• To attain high coverage of NCD screening, treatment, care and counselling services
• To provide high quality of NCD screening, treatment, care and counselling services
• To improve awareness and healthy behaviours around NCDs in the community intervention strategy

The Phase I evidence across the prevention to care continuum helped to design a comprehensive NCD program.

An established NCD care continuum framework to design interventions across community, facility and larger health systems was utilised. To build an impactful chronic disease control model, a three pronged intervention approach at facility-health services (supply side), at community (demand side) and at a larger embedding health systems for supporting health policies, and supply of resources (staff, diagnostics and drugs) was adopted.

Through the ongoing interventions, we are also stressing upon important facets for NCD control, i.e. quality improvement at facility, health systems (essential diagnostics, medicines, etc.), decision support (adherence to medications, to follow up, communication with specialists), and human resources (staff training, dedicated NCD staff).

This intervention model is an iterative one and will be further evaluated through a series of formative research and impact evaluation during next phases of this project.

Context

Despite the efforts made by the government to improve quality of services and community accountability in the past, health care is still not accessible to many of the urban and rural poor in India. Public health facilities are underprepared and high cost at private facilities limits many access care at time of need.

Adding to the worries, people in remote areas are more challenged as often health care facilities are far from their reach. Delivering technology enabled health care services through local entrepreneurs at the door step with minimal cost could be a game changer in improving the health status of people in remote areas.

We propose to test the feasibility of a health entrepreneur model in improving access to health care in Chincholi, one of the most backward taluka in Karnataka, through a project funded by the Landmark Group.

Implementation

We aim to assess the feasibility and scalability of implementing a health entrepreneurship model that aims to improve accessibility and affordability of health services in a backward taluka of northern Karnataka. We use a pre-post intervention evaluation design within which formative research and process learning are embedded. This approach helps us to identify barriers and design scalable models, implementation of these models in community settings.

Health Entrepreneurs (HEs) are women and men entrepreneurs from the local community who will work towards improving accessibility and affordability of health services in their community.

They offer services, including:

• Screening / diagnostic services (FBS, PPBS, RBS, BP, HB%, HbA1c, renal function tests etc.)

• The sale of health products (Nutrient rich fortified food, sanitary pads etc.)
• Referrals and linkages to higher facilities if tertiary level care is required

The project has extended initial support by procuring health kit and products. It enables HEs to sustain on their own through income generated by selling health and nutritional products, doing blood tests and measuring vital parameters. HEs will receive initial training to learn about basic health care, health care products, entrepreneurship skills, counselling skills, communication skills, doing blood tests, measuring vital parameters like blood pressure and referral to the health facilities. HEs will also receive regular updates about newer effective diagnostic services, health products, nutritional products etc.

Each entrepreneur receives a kit with point of care devices, health products and a tablet to provide health services to their local community. Apart from health education, tablet is also used for promoting new products and ordering new stock. The implementation support team will also use the tablet to monitor the entrepreneurs’ activity.

Context

This project, seeks to implement an innovative community health worker model embedded within the existing urban health system. The focus remains to bring more patient-centricity in the community outreach, mobilization and communication efforts as well as in improving quality care at the facilities to achieve better treatment outcomes. KHPT has designed and is implementing this innovative model in partnership with Government of Karnataka to support, scale and sustain the program over time.

This model uses community health workers (CHW) and community health worker supervisors (CHW-S), integrated into primary care teams, to bring customized care closer to home for diabetic and hypertensive patients and help patients meet treatment goals with timely referrals and effective follow-ups. The community-level efforts are also complemented by strengthening patient-centric counselling and quality care in the facilities.

Geography and Target Population

The proposed pilot will be undertaken in the catchment area of one of the urban primary health centres (UPHCs) covering a population of around 58,000, of which around 3100 were living with diabetes and/or hypertension.

Among all those diagnosed, around 2100 (700 approx. were hypertensive; 600 approx. were diabetics; 800 approx. were both diabetic and hypertensive) are currently available for follow-up in the Kumbarakoppalu UPHC area. Among this group of patients, only 38% has demonstrated optimal disease control (48% for hypertension and 29% for diabetes).

The major reasons for poor control among the rest of the patients can be attributed to irregular follow-up, non-adherence to medicines and to their poor lifestyle. Many are unaware of the risk factors of NCDs and the importance of regular visits to a healthcare facility. We will assess the feasibility and effectiveness of the proposed CHW model to achieve disease control levels to more than 60% during the project period.

Specific objectives of the proposed model:

• To test the feasibility of an incentive-based community health worker model in an urban setting
• To implement patient centric care for improved NCD outcomes for at least 60% of the diagnosed population
• To integrate, embed and sustain the model within the existing urban health system

Implementation model

The implementation model focuses on four core domains such as community outreach, quality of care and referrals, measurement and evaluation, and adoption, and scale with support from the government. A cadre of CHWs will be trained on core competencies pertaining to patient centric care and will be instrumental for patient outreach and mobilisation for care.

Customised Behaviour Change Communication (BCC) based on individual patient risk and health care needs will be delivered by the CHWs at doorstep of the patients. Supportive supervision of CHWs and mentoring for project staff will be an integral part of the model.

Similarly, on the facility front, quality improvement initiatives will be prioritised, regular supply of drugs and consumables will be ensured, in addition to provision of individual counselling and adherence to standards of treatment protocols. Data quality management, regular monitoring, technology led patient tracking and follow-up will all be part of robust measurement domain of the project.

Advocacy with the government and policy bodies at all levels will be inherent and follow a continuous process; they will be key for adoption and scale up of innovations emerging from the project, in addition to ensuring regular supply of drugs and consumables to the health centres.

An implementation research for developing a CPHC model in Mysuru city to reduce costs, morbidity and mortality by increasing the proportion of persons covered by the CPHC