WORKSHOP on “URBAN HEALTH AND PUBLIC HEALTH

DEPARTMENT OF COMMUNITY MEDICINE
YENEPOYA MEDICAL COLLEGE
YENEPOYA UNIVERSITY
WORKSHOP
on
“URBAN HEALTH AND PUBLIC HEALTH
FINANCING & BUDGETING”
15 December 2014 to 18 December 2014
TH
TH
1
INDEX
Sl. No
Contents
Page No
1
Schedule of Workshop
5
2
Summary of Workshop proceeding
7
3
Day 1
12
4
Day 2
19
5
Day 3
30
6
Day 4
33
7
Feedback
35
8
Recommendations
40
9
Delegates
42
2
ACKNOWLEDGEMENT

We are indebted to the Honourable Chancellor of Yenepoya University,
Al- Haj Mr. Yenepoya Abdulla Kunhi for granting us permission to conduct this workshop
& constant support.

We thank Mrs. Tulsi Maddineni, IAS, CEO- Zilla Panchayat and Mr. Gokuldas Nayak,
Commissioner of Mangalore City Corporation for gracing the Inaugural Function of the
workshop by being the Chief Guest and Guest of Honour respectively.

We express our sincere and heartfelt gratitude to the Honorable Vice Chancellor,
Dr.PChandramohanfor his invaluable support, timely advice and encouragement

We express our gratitude to Mr.Farhad Yenepoya, Director of Finance, for financial support
& guidance.

We extend our sincere gratitude to Dr.CV Raghuveer, the Honorable Registrar of Yenepoya
University for his constant guidance and support for every activity conducted by our
Department

We gratefully acknowledge and extend our sincere thanks to our beloved Principal,
Dr. GhulamJheelaniQuadri, for his constant encouragement, invaluable suggestions and
motivation.

Our sincere gratitude and thanks go to our key resource person, Dr. K Suresh, Public Health
Consultant-INCLEN and Retired Senior Programme Officer -UNICEFfor taking time off his
busy schedule and delivering the sessions with great zeal and enthusiasm, thereby mentoring
the delegates of the workshop.

We extend our sincere and heartfelt gratitude to the other resource persons namely,
Dr.LakshmiBhavani, Nutrition Officer, UNICEF and Mr. Derik Ian Joshua, Environment
3
Executive, Department of Quaility and Compliance, Manipal University for enlightening the
delegates on various important aspects pertaining to nutritional challenges in urban health
and environmental sanitation respectively.

It is our duty to thank Mr. MadhuManohar, Environmental Engineer, Mangalore City
Corporation for his timely advice and help.

We thank Dr. Mrs. Rajeshwari Devi HR, District Surgeon and Superintendent, Wenlock
Hospital, Mangalore for gracing the valedictory function of the workshop.

We are ever grateful to the Heads of the Departments of Yenepoya Medical College,
without whose support this workshop wouldn’t have been possible

We acknowledge the support given by Mr.Arun, the transport in-charge of Yenepoya
University.

We thank Mr.RaviKhandige, Manager of Yenepoya Central Kitchen for the food
arrangement

We acknowledge Mr.Latheesh for his cooperation and help in arranging the venue.

Our humble and sincere thanks to the faculty from various Medical Colleges of Mangalore
for gracing this event.

Lastly, it’s the delegates which included Postgraduate Students and Faculty from the States
of Karnataka and Andhra, who have been instrumental in the success of this workshop. We
thank them all for the active participation.
Regards
Dr Abhay S Nirgude
Professor and Head
Department of Community Medicine
Yenepoya Medical College
4
SCHEDULE OF WORKSHOP:
Day 1 – 15.12.2014
Session
F/N
Topic
0830 – 0900
Registration
0900 – 0930
Inauguration
0930 – 1000
Icebreaking and Introduction
1000-1015
Introduction to Urban Health Workshop
1015-1030
Tea break
1030 – 1115
Urban Health Context
Dr K Suresh
1115-1130
Urbanization Trends in India
Dr K Suresh
1130-1215
Urban Poor & Health
Dr K Suresh
Determinants of Urban Health
Dr K Suresh
Dr Abhay Nirgude
1215-1300
1300-1400
A/N
Resource person /
Facilitator
Time
Dr K Suresh
LUNCH BREAK
1400-1500
Urban Governance and Health Challenges
Dr K Suresh
1500-1520
Challenges of Urban Nutrition-
Dr K Suresh
1520-1700
Group work :Urban Health Systems in three categories of
urban India & Presentations
Facilitators
1700 – 1530
Briefing for Field visits
Facilitators
Day 2 – 16.12.2014
Session
F/N
Time
0900-1330
Subject
Field visits
Three teams will visit 3 different urban areas. Each group
will form 4-5 subgroups and collate data on
a) Urban infrastructure in general and health facilities,
b) Visit one urban slum and study the environment and
assess health needs of the poor and present practices
c) Collate information on housing, water & sanitation
situation in one slums
d) Assess PDS, diet in last 24 hours, access to PDS and
nutritional status of few families
e) Visit the health facility (1 Govt. & 1 private) and assess
the services provided.
f) Traffic, Roads and environment pollution
Resource person /
Facilitator
Dr K Suresh
Dr. Abhay
Dr Poonam
Dr Shivalli
Dr. Gururaj
Dr. Varun
Dr. Pracheth
5
A/N
1330-1430
1430-1730
LUNCH BREAK
Share field experiences and Collate the data from
different groups
Dr K Suresh
Facilitators
Day 3 – 17.12.2014
Sessi
on
F/N
A/N
Time
Subject
0900-1000
Urban Health Mission & model plan
1000-1045
Housing / Water and Sanitation Issues of Urban Health
1045-1100
Tea Break
1100-1200
Nutritional Issues of the U. Poor
Challenges of Urban Nutrition
1200-1245
Waste management: Environment Resilience
1245-1315
1315 - 1415
Urban Health policy ,Planning and Roles of stakeholders
LUNCH BREAK
Group work & Presentation on Planning health services
for categories of urban areas
1415-1615
Resource person /
Facilitator
Dr K Suresh
Mr Madhu Manohar
Environmental
Engineer, MCC
Ms Laxmi Bhawani
Nutrition Officer,
UNICEF, Hyderabad
Mr Derrick Ian
Joshua
Manipal University
Dr K Suresh
Facilitators
Day 4 – 18.12.2014
sessi
on
F/N
Time
Subject
0830-1000
Presentation of Urban plans-
Resource person /
Facilitator
Facilitators
1000-1130
Public Health Financing and Budgeting
Dr K Suresh
1130-1200
Open house: Any other issues of Public Health Practice
Concluding Session: Opportunities for Health
Management professionals in Urban Health
Valedictory
Dr K Suresh
1200-1230
1230-1300
Dr K Suresh
6
Workshop funded by Yenepoya University
Karnataka Medical Council (KMC) awarded 6 hours credit
SUMMARY
OF
WORKSHOP PROCEEDINGS
7
Key Resource Persons
Name
Sl. No
Designation
1
Dr Suresh K
Public Health Consultant, Retd. senior programme
officer public health, UNICEF, New Delhi, India
2
Dr Laxmi Bhavani
Nutrition Officer, UNICEF, Hyderabad
3
Dr Derik Ian Joshua
4
Dr Abhay S Nirgude
Environment Executive, Department of Quality and
Compliance, Manipal University
Professor & HOD, Department of Community
Medicine, Yenepoya Medical College, Yenepoya
University,Mangalore
Facilitators
Name
Sl. No
Designation
1
Dr R P Pai
Professor
2
Dr Poonam Naik
Professor
3
Dr Padma Mohan
Associate Professor
4
Dr Akshay K M
Associate Professor
5
Dr Selvaraj I
Associate Professor
6
Dr Siddharudha Shivalli
Assistant Professor
7
Dr Gururaj N
Assistant Professor
8
Dr Varun N
Assistant Professor
9
Dr Pracheth R
Assistant Professor
8
REPORT OF WORKSHOP ON
URBAN HEALTH, PUBLIC HEALTH FINANCING AND BUDGETTING
15-18 DECEMBER 2014
Day 1: 15.12.14
The workshop was inaugurated at 9.30 am in Lecture hall 4, Yenepoya Medical College by
Dr. P Chandramohan, Vice Chancellor, Yenepoya University. Dr C V Raghuveer, Registrar,
Yenepoya University, Mrs Tulsi Maddineni, IAS, CEO, Daksina Kannada Zilla Panchayat, Dr
Moosabba, Principal In charge and Head, Department of Surgery, Dr K Suresh, Chief Resource
Person, Mr Farhad Yenepoya, Director (A&A) and Dr Abhay Nirgude, Professor and Head,
Community Medicine were present. Mrs Tulsi Maddineni gave a motivating talk regarding role
of public health in our country and the importance of addressing urban health in this era. Dr
Abhay Nirgude proposed the vote of thanks to the gathering and encouraged the participants to
make best out of these 3 ½ days’ workshop.
The workshop sessions were conducted in the Department of Community Medicine.
Session 1: Ice breaking and Introduction by Dr K Suresh
A newer method of introducing each other was employed, where each delegate introduces the
other, not only with name and college but futures goals in profession, non professional skills
and expectations from the workshop. This was an opportunity for the delegates to interact with
each other and build a zone of comfort.
Session 2: Introduction
Dr K Suresh gave a brief idea about what are the topics that will be covered along with what is
expected from the delegates to be done.
Session 3: Public health context
It was a very informative session that included components of Urban health and the factors
influencing it. The challenges and future opportunities in urban health
Session 4: urbanisation trends in India
Topics discussed under this urbanisation, urban slum, Population trends.
Session 5: Urban poor and Health
Lessons learnt: Identifying urban poor, CPI index, Living and Housing standards, Socio
Economic Status scales
Session 6: Determinants of Urban health by Dr Abhay Nirgude
9
It was started by a brain storming session on the factors influencing urban health; the lessons
learnt include living conditions of urban population, infrastructure, distributive justice and inter
sectoral approaches.
Post tea break the sessions conducted were on Urban nutrition and urban governance and health
challenges, This session took a hr and more with discussions on Food security, PDS,
Challenges to nutrition, Challenges of Hidden Hunger
Session 7: Briefing about group activity, field visit, all the delegates were divided into three
groups and the facilitators were allotted to each group. The delegates were explained their role
in Field visits and how to collect data in different health domains.
Day 2: 16.12.14
9.00 am - 1.30 pm - Field visits
The participants were divided into three groups for the field visits and were guided by the
facilitators (Faculty from Community Medicine).
The visits consisted to three areas Ullal Town, Kotekar Census town, City Corporation
Mangalore. The delegates were asked to collect data and assess the status in the following
domains:
1.
Visit to Slums
2.
Municipal Administration
3.
Health Facilities in Government and Private setup
4.
Traffic ,Roads and environment Pollution
5.
Nutrition Issues
Session on Urban health Planning and Policy making roles (2.30 pm - 3.30 pm)
Following the tea break, all the delegates shared their experiences from the field and collated
data from different groups with respective health domains.
Discussion of their visits and important finding were noted, which needed to be worked upon
again, this session was extended up to 7.00 pm and all the delegates participated by with their
inputs.
Day 3: 17.12.14
Session started at 8:30 am: Urban Health Mission and Model plan was held, the sample plan
was discussed in detail.
10.00 am - 10.45 am: Nutritional issues of urban poor and challenges of urban nutrition by Dr.
Lakshmi Bhavani, Nutrition Specialist, UNICEF – Karnataka, Andhra Pradesh and Telangana
10
regions. It was followed by an interactive session with madam, with questions on
implementation of programs in Urban area. A unique idea of food basket distribution at
subsidized rates was also discussed. There was discussion on IYCF practices and it was felt
that was need for translational research and the role of community health experts to make a
difference.
11.00 am - 12.00 noon
Session on solid waste management: Environmental resilience by Derrick Joshua, it was an
presentation with emphasis on recycling and re using resources. A case study of Surat city solid
waste management was discussed in detail. It was stated that the most important task in waste
management is segregation of waste
12.00 noon - 1.30 pm Session on Housing/ water and sanitation and Urban health Policy,
planning and roles of stake holders by Dr K Suresh
Afternoon session was exclusively dedicated to collating group data of the field visits and
making power-point presentation. It was followed by presentation by the groups and inputs
from the facilitators. Even though the presentations and discussion on it extended up to 8.00
pm in the evening, all the delegates participated enthusiastically and a wonderful co-ordination
was noted among delegates.
Day 4:18.12.14
The sessions started at 8.00 am on public health financing and Budgeting topics discussed were
role of Government in policy making, Financing and budgeting issues.
10.30 am - 12.00 noon – Presentation by three groups and discussion.
The presentations were made and presented before Dr Rajeshwari and Dr K Suresh, Reviews
and suggestions were given to modify action plan. They appreciated few innovative idea
suggested by delegates and promised to try to implement the same in their work place.
12.00 noon - Concluding session on “Opportunities for health management professionals in
Urban Health” by Dr K Suresh.
Valedictory session
The chief guests were Dr C V Raghuveer, Registrar, Yenepoya University and Dr Rajeshwari
Devi, Medical Superintendent of Wenlock district hospital, Mangalore. Dr Abhay Nirgude
Professor & Head asked the delegates to give feedback on the workshop. Vote of Thanks was
given by Dr Pracheth, Assistant Professor, Department of Community Medicine followed by
Memento distribution to all facilitators and Certificates to the delegates.
11
DAY – 1
15.12.2014
12
1. Inauguration
Date: Dec, 15th 2014
Venue: Fourth Lecture Hall
Chair Persons: Dr.K.Suresh
Guests: Tulusi Madineni, KMC Observer, Mr.Gokul Das Nayak
In House Guests:
a) Vice chancellor: Dr.P.Chandra Mohan
b) Registrar: Dr.C.V.Raghuveer
c) Principal In Charge: Dr.Moosabba
d) Director of F & R: Mr. Farhad yenepoya
e) Prof and HOD: Dr.Abhay Nirugude
32 delegates from 10 different colleges of Karnataka and Andhra Pradesh state participated
in the workshop.
Inaugural Prayer
Inaugural speech by Dr.Moosabba
Dr.Viquar presenting bouquet to Mr.Gokul Das Nayak
Dr.Anupama giving bouquet to Mr.Farhad
13
Dr.S.Preethi presenting bouquet to Vice Chancellor
Lighting the lamp by Mrs.Tulasi Madideni IAS
Dr.Preeti Tiwari presenting bouquet to Registrar
Mrs.Tulasi Madineni IAS giving her Guest speech
Mr GokulDas Nayak, Commissioner giving Guest speech
Vote of thanks by Dr Abhay S Nirgude
14
Date: Dec, 15th 2014
Resource Person: Dr.K.Suresh
Facilitator: Dr.Pracheth.R
Venue: Fifth lecture hall
1) Delegates were divided into four teams
Team A with 8 delegates
Team C with 8 delegates
Team B with 8 delegates
Team D with 8 delegates
15
2)
Ice –Breaking session
Each delegate were allowed to choose another delegate from their group and made them to interact and
know each other, hence forth sharing each other’s personal profile to all others.
Delegates introducing each other in the ice-breaking session
3) Date: Dec, 15th 2014
Resource Persons: Dr.K.Suresh
Title:
a) Urban Health Context
b) Urbanization Trends in India
c) Urban Poor & Health
Venue: Fifth Lecture Hall
Time: 11:00 am – 12:00 pm
In General, the urban health contexts were discussed. The urban population in 2014 accounted for
54% of the total global population, up from 34% in 1960. More than half of the world’s population and
one thirds of India’s population now live in urban areas. In the developing world, where most of the
urbanization is to be observed, a large segment of that growth is into slums. Urbanization trends was
the highlight of this session.The three most urbanized states in that order are Goa, Mizoram and Tamil
Nadu while the three in the least urbanized category are Assam, Bihar and Himachal Pradesh. Our
urban areas contribute as much as 60 per cent of the country’s GDP, and something like 80 per cent of
our tax revenue. One out of every six households in urban India is in a slum with 25 per cent of urban
India living in slums. Five cities namely Visakhapatnam, Jabalpur, Mumbai, Meerut and Vijayawada
have more than 40 % slum households. Karnataka has not been able to achieve much success in
translating its pilot success of water supply in Hubli-Dharwar-Belgaum in all the cities of the state
.Very few Indian cities have adequate sewage treatment facilities. Open defecation-free cities is a key
16
target to be aimed at and achieved by all our cities and this has been appropriately reinforced by the
present government’s mission goal of achieving toilets for all by 2019. Issues regarding urban poor
and health were discussed in this session. Urbanization has been traditionally linked to development
and development with health. Equity, quality of health services and financial-risk protection were the
three prime mover objectives of universal health coverage.
4) Date: Dec, 15th 2014
Resource Persons: Dr.Abhay S Nirgude
Venue: Fifth Lecture Hall
Time: 12:00 pm – 01:00 pm
Urban as a determinant of Health was one of the key areas in the workshop. Human rights legislation
is the backbone of effective global health. Lack of legal recognition of slums means not only the
absence of basic services, such as water, sanitation, garbage removal, health care services, but also the
absence of health surveys and even a census on which to document the extent of the need. The state of
civil society in a community at a given time can influence its ability to protect the health of residents;
promote social cohesion; and counter isolation, stigma, or marginalization. Urban populations present
a different health profile and because the urban environment is markedly different from suburban or
rural ones. Hazardous waste landfill sites, types and concentrations of pollutants, noise exposure- a
common urban problem, poor transportation inhibiting access to employment and health services were
some of the issues discussed. “If there were only one thing I could get done today that would make the
biggest impact in global health, it would be “Urban Health”.
17
5) Lunch break
Venue: Roof top Canteen Yenepoya Medical College & Hospital
Time: 1:00 pm to 2:00 pm
6) Date: Dec, 15th 2014
Resource Persons: Dr.K.Suresh
Title:
Venue: Fifth Lecture Hall
Time: 02:30 pm – 6:00 pm
a) Group work: and briefing for field visit
Briefing about group activity, field visit, all the delegates were divided into three groups and
the facilitators were allotted to each group. The delegates were explained their role in Field visits
and how to collect data in different health domains.
18
Day 2
16.12.2014
19
Field Visit
1) 32 delegates were divided into three teams.
Report of Visit to Wenlock Hospital, IDSP and Mangalore City Corporation
As part of the workshop, we set out to visit centres of Public Health importance on the second
day. We were divided into groups of 3-4 each. Our team was lead by Dr K Suresh, Dr Abhay Nirgude,
Dr Poonam Naik, Dr Shivalli and Dr Gururj. The first visit was to Wenlock Hospital.On the first glance,
it didn’t appear like a government hospital. It was well organized and not so crowded like usual
government hospitals. The reason probably it takes up only referred cases. We first met the Resident
Medical Officer( RMO ) who greeted us warmly. She gave us a quick briefing about the administrative
setup of the hospital. RMO highlighted the need to have greater coordination with Police Dept in
identification unknown dead bodies. We went on to the Infosys wing to meet the Head of Department of
Paediatrics. We were surprised to know that most of the cases came from outside Mangalore. The
hospital had enough staff for carrying out its functions in addition to interns from Manipal Medical
College and the like. The Paediatric services of the hospital are well utilized with majority of cases
presenting with Very Low Birth Weight ( VLBW), Birth asphyxia and Paediatric Surgical problems.
Our next visit was to IDSP.Under the project weekly disease surveillance data on epidemic
prone diseases are being collected from reporting units such as sub centres,primary health centres,
community health centres, hospitals including government and private sector hospitals and medical
colleges.Data is being collected on ‘S’ syndromic; ‘P’ probable; ‘L’ laboratory formats using standard
case definitions. Timely and regular reporting of the IDSP forms were the issues identified during
interaction.
The final visit was to Mangalore City Corporation where we met the Commissioner and
discussed issues related to Water supply, Waste disposal, Sewage system etc. We were told of the latest
additions to their service ie any citizen can register a complaint through the internet or via a helpline
which works 24/7. Environment engineer Mr Madhu explained the about solid waste disposal methods
and sewage treatment plant with tertiary treatment. During interaction it was observed that information
about NVBDCP (Malaria and Dengue cases ) was collected by Mangaluru City corporation. Quantum
of information was more with MCC as compared to IDSP. More coordination required between IDSP
and MCC for mutual information sharing on NVBDCP.
20
Team A visited Wenlock hospital. Members Interacting with Wenlock Hospital Superintendent
Interaction with HOD Paediatrics Dr Baliga
Team A Members with Commissioner MCC
Urban Slum team visiting PDS :- Dr Poonam Naik & Dr Shivalli with delegates
Urban Slum Team visited Bangre PHC
21
Urban Slum team visited Bengare anganwadi
Summary and Experience of Town Ullal visit :- Team B
Team : Dr. MD Shoeeb Akram,
Facilitator : Dr. Prachet R
Dr. Sandhya Rani Jawalkar,
Time : 9.30 am to 1.30 pm
Dr. Preeti Tiwari
Dr. Kanchan
Dr. Eshwari
Dr. Ramya
Dr. Lakshmi
We the group as mentioned above with the facilitator had a visit of a town Ullal on 16 th December 2014,
gave us the opportunity of experiencing and learning of the challenges and issues of the various sectors
involved in the Urban health. The sectors which we have visited are.
1.
2.
3.
4.
5.
6.
Town Municipality council
Primary health center
Anganwadi
Public distribution system
Urban slum
Secondary school
Lessons learned in each sector
1. Town Municipality council
We the team visited Town municipality council and had a discussion with the CEO Mrs. Roopa shetty
about the services provided and issues and challenges faced by the council and found out the following
strengths and weakness.
Strengths
 Provision of gas stove to each household under ADUGE ANILA scheme.

No dustbin policy, Adequate water supply
22

Adequate management of Waste disposal

Charging fine for indiscriminate waste disposal.
Weakness
 People’s representative dominate the decisions
 Poor co-ordination with the health sector
2. Primary health center
The team had a discussion with the Medical officer about the services provided and the
challenges faced at the center and found out that the PHC is a 100 bedded,
24*7 working with 2 doctors posted
strengths






Regular IDSP,AFP reporting
Speciality camps conducted
Sneha clinic ,Mental welfare
clinic, Refractionist weekly
Monthly laparoscopic Family
planning services
2 Immunisation session per week
Bio Medical Waste management
3 times a week
Weakness
 Population of 65,000 catered with 34
functioning Anganwadis.
 Only 2 MO’s for 24 hours, with male
MO on night call
 Training MO
 Improper timing of speciality clinics
 Reduced number of deliveries in
PHC
3. Anganwadi
A total of 34 Anganwadis are present in Ullal town catering a population of 1000 by each. We
visited a Anganwadi under which 48 children’s were taking pre-school education, during our
visit we observed that supplementary nutrition and Vit. A prophylaxis were adequately carried
out and majority of the children’s were adequately nourished (assessed by taking
Anthropometric measurements at the time of visit) and also found that the Anganwadi was
overcrowded, ill-ventilated and ill-lighted with improper pre-school education provided and
growth charts not properly maintained.
4. Public distribution system
During our visit to public distribution system we observed that the workforce and the
procurement and supply of materials were adequate with main focus on cleaning of the ration
before distribution and maintaining monthly records of beneficiaries. Allergic dermatitis was
found to be one of the weakness and misuse of the ration by the beneficiaries to be the threat in
the system
23
5. Urban slums
The team visited 6 homes and the peri -domestic area and observed that there is
Strengths



Municipality water supply
Domestic waste management
Anganwadis and school utilization
Weakness





Vulnerable location
Peridomestic nuisance
Poor housing condition
Indifferent attitude towards cleanliness
Ignorant attitude of health care provider
6. Secondary school
Also we visited secondary school and conducted a FGD with the children on Nutrition and found
that knowledge regarding the junk food and consequences was minimal and type of junk foods
was adequate. Interview of the teacher regarding the challenges and issues in the administrative
part was discussed also learned the need of health education among secondary school children is
a must.
Ullal Team visited Household
Ullal team observing PDS
24
Ullal Team visiting PHC
Team : Dr. Ravindra YM
Ullal team observing traffic signal
Summary and Experience of Town Kottekar visit
Facilitator : Dr. Varun N
Dr. Nirmal
Time : 9.30 am to 1.30 pm
Dr. Sowmya Bhat
Dr. Neelesh M N
Dr. Srinivas Krishna Gouda Patil
Dr. Nama Suman
Dr. Shrivathsa D N
The above mentioned group with the facilitator had a visit of a town Kottekar on 16 th
December 2014, gave us the opportunity of experiencing and learning of the challenges and issues of
the various sectors involved in the Urban health. The sectors which we have visited are.,
1
2
3
4
5
6
Gram Panchayat
Health centers
A. Primary Health Centre
B. Private Hospital
Primary School
Anganwadi
Public distribution system
Traffic
Lessons learned in each sector
1. Gram Panchayat
The team visited Gram Panchayat and had a discussion about the services provided and
issues and challenges faced by the Panchayat and found out the following strengths and
weakness.
Strengths

A well organized and well staffed
25

Houses with Sanitary latrines- 100%.

Licence for upcoming houses

Revenue collection

Insurance schemes

Accountability

Maintaining adequate street lights
Weakness

Less knowledge regarding Health issues

Inadequate water supply.

No sewerage system.

Solid waste – Indiscriminate throwing/burning (Majority).

Poor co-ordination with the health sector
2. Health Centers
A. Primary health center
The team had a discussion with the Medical officer about the services provided and the
challenges faced at the center and found out that the PHC is a 06 beded,
24*7 working with 01 doctor posted
Strengths
 Lab. – Hb%, CBC, Urine routine,
HBsAg, VDRL, Blood grouping, BS,
Leptospirosis, water analysis(H2S
media), UPT test, RBS.
 Referral services- To the Wenlock
hospital, Medical colleges
 MLC services.
 NHP
 Dental clinic, Sneha clinic, Suraksha
clinic, Ophthal checkup,
 Weekly SC clinics,
 Regular IDSP reporting,
 Weekly Immunization sessions
 BMW (Ramke)
 Weekly SC clinics.
 Fish farming – Gambusia (Biological
control of mosquitoes)
Weakness
 Population of 32,700
with only 6 ASHAs.
 Only 1 MO, (also in
charge of another
PHC)
 Not conducting any
deliveries
 No IPD services
 Not conducting any
Family
planning
services
 No Specialty camps
conducted
 No supervisory staff.
26
B. Private Hospital
Also the team visited Private hospital and found
 Emergency services available(OBG, IPD, Trauma care, Paeditrics, Surgery, 25 bedded)
 Yoga and Meditation
 Laboratory facility (– Hb%, CBC, Urine routine, HBsAg, VDRL, Blood grouping, BS,
 Leptospirosis, water analysis(H2S media), UPT test, RBS, Sputum examination)
 Waste management (Ramke)
 Cold chain system- ILR not available (2 domestic fridges)
 Improper reporting (IDSP)
 Sputum examination – Referring positive cases to district hospital
3. Primary school
Also we visited Primary school, salient features are
 Students – 41 (1-5th std),
 Mid day meal Programme
 Ksheera Bhagya yojana
 Alternate day IFA supplementation
 Albendazole twice yearly
 Health checkup yearly for childern
 Safe water supply
 Separate sanitary facility for girls and boys
4. Anganwadi
Also visited a Anganwadi under which 103 children’s were taking pre-school
education, during our visit we observed that supplementary nutrition and Vit. A prophylaxis
were adequately carried out and majority of the children’s were adequately nourished (assessed
by taking Anthropometric measurements at the time of visit) and also found that the anganwadi
was overcrowded, ill-ventilated and ill-lighted with improper pre-school education provided and
growth charts not properly maintained
5. Public distribution system
During our visit to public distribution system we observed that the workforce and the
procurement and supply of materials were adequate with main focus on cleaning of the ration
before distribution and maintaining monthly records of beneficiaries.
27
6. Traffic
Traffic survey conducted in Kotekar Junction ( Mangaluru –Kasargod Road) for 10
minutes and found 35 two wheelers, 103 four wheelers, 30 three wheelers were moving in that
road and most of them were not following traffic rules and two wheeler riders were not wearing
helmets.
Kottekar team in an Anganwadi centre
Kottekar team visiting a Household
2) Lunch Break
Dr Varun N & Dr Padmamohan with Delegates
Kottekar team observing traffic signal
Venue: Roof top Canteen Yenepoya Medical College & Hospital
Time: 1:00 pm to 2:00 pm
28
3) Date: Dec, 16th 2014
Resource Persons: Dr.K.Suresh
Venue: Fifth Lecture Hall
Time: 03:00 pm – 06:00 pm
Topic: Sharing of field experience
Dr.Viquar sharing his team field experience
Team B sharing their field experience
Team D sharing their field experience
Team A sharing their field experience
Team C sharing their field experience
Facilitators who accompanied delegates during visits
29
Day 3
17.12.2014
30
1) Date: Dec, 17th 2014
Resource Persons: Dr.K.Suresh
Venue: Fifth Lecture Hall
Time: 09:00 am – 10:00 am
Title: Urban Health mission and Model plan
Enlightening lecture on NUHM gave thought provoking knowledge on the community link
volunteer (urban Accredited Social Health Activist-ASHA) , establishment of Rogi Kalyan Samiti
(RKS) and Mahila Arogya Samiti (50-100 households) to ensure the participation of community
based institutions ,effective participation of urban local bodies and their capacity building along with
key stakeholders, making special provision for inclusion of the most vulnerable amongst the poor,
development of e-enabled monitoring system.
Government of Delhi will be introducing evening OPDs in Govt. Dispensaries especially in urban
poor areas. Linking other social security funds with insurance fund pool - to increase coverage with
no corresponding increase in premium Free Medicines (Jan Aushadhalaya), Voucher schemes
(Chiranjeevi) .The Maternal Neonatal Child and Reproductive Health (RMNCH+A)program, being
implemented in Meerut city, through Health department U.P, Hence forth Meerut Action Plan was
discussed in detail.
2) Date: Dec, 17th 2014
Resource Persons: Dr.Laxmi Bhawani
Title: Nutritional Issues of the Urban Poor
Venue: Fifth Lecture Hall
Time: 11:00 am – 12:00 pm
31
There was discussion on IYCF practices and it was felt that was need for translational research
and the role of community health experts to make a difference. A unique idea of food basket
distribution at subsidized rates was also discussed
3) Date: Dec, 17th 2014
Tea Break
Time: 11:45 am – 12:00 pm
4) Date: Dec, 17th 2014
Venue: Fifth Lecture Hall
Resource Persons: Mr. Derrick Ian Joshua
Time: 12 pm – 1:00 pm
Title: Waste Management: Environment Resilience
The session started with different types of waste, classification of waste, their effects to human
health and environment and their impacts of waste if not managed properly and micro-level and
macro-level management option. A case study of Surat city solid waste management was
discussed in detail. It was stated that the most important task in waste management is
segregation of waste.
32
5) Date: Dec, 17th 2014
Lunch break
6) Date: Dec, 17th 2014
Resource Persons: Dr.K.Suresh
Venue: Fifth Lecture Hall
Time: 1:30pm to 2:00pm
Venue: Fifth Lecture Hall
Time: 03:00 pm – 06:00 pm
Title: Group Work & Presentation on Planning Health Services
Team B working on their Action plan
Team A working on their Action Plan
33
Team D working on their Action Plan
Team B presenting their action plan
Team C working on their action plan
Dr.Abhishek Prayag presenting his group plan
Dr K Suresh lecture on Urban Health Mission & model plan
34
Day 4
18.12.2014
35
1) Date: Dec, 18th 2014
Resource Persons: Dr.K.Suresh
Venue: Fifth Lecture Hall
Time: 09:00am – 10:00am
Title: Public health Financing and Budgeting
Conducting a health needs assessment, Allocating finance to cost effective operations, Decentralization Flexi-funds, Tying of budgets to desired outputs and outcomes, Utilizing sophisticated and accurate
Information systems (HMIS) were the few principles of Public Health Financing and Budgeting discussed in
this session. Estimated health expenditure in India for 12 th five year plan is expected to be around 47.7 lakh
crore Rupees (7-8% of GDP i.e. 9.3 L. Cr/ year) as “Government of India’s health budget has increased by
three folds over that of 11 plan. 12th five-year plan focuses on improvement of health, education and
sanitation. NHA reveals that 78% of the health budget is contributed by private sector, of which households
alone spend 71.13%. Union Budget 2014-2015- Key Objectives were free drug service and free diagnosis
service to achieve "Health For All", two national institutes of ageing to be set up at AIIMS, New Delhi and
Madras Medical College, a national level research & referral Institute for higher dental studies to be set up.
Twelve new government medical colleges (AIIMS like) to be set up. States' Drug Regulatory & Food
Regulatory Systems to be strengthened by creating new drug testing laboratories & strengthening the 31
existing State labs. Training programs to be skill oriented (skill labs) and its use in the routine work
immediately after be monitored. Micro-insurance like the Yeshasvini scheme be promoted as innovative
strategies to reach to the masses and make healthcare affordable as well."Public-Private-Partnership can be a
good vehicle to provide Health for All.
36
Ullal team presenting their Action Plan
City corporation team presenting action plan
Kottekar team presenting their action Plan
2)
Valedictory function
Venue: Fifth lecture Hall
Time: 12:30pm – 01:00pm
37
Dr.C.V.Raghuveer presenting memento to Dr.K.Suresh
Dr.C.V.Raghuveer presenting Memento to Medical Superintendent of Wenlock Hospital
Dr R.P.Pai receiving award as a facilitator
38
Feedback remarks from the Delegates
Workshop on “URBAN HEALTH AND PUBLIC HEALTH FINANCING AND
BUDGETING” was conducted by Department of Community Medicine” from 15 th to 18th
December 2014. At the end of the workshop feedback was collected from all the delegates.
Feedback was analyzed on the basis of following checklist items.

Learning objective of the sessions met and adequacy of the information delivered in speech
was good.

Clarity of the content was excellent.

New information covered in programme on an average was good.

Practical applicability, implementation of information in public health practice.

Arrangement of the programme as a whole viz. AV aids, punctuality and food arrangements
was excellent.
Sl.
No.
Question
Average
score
(5)
Interpretation
1
Learning objective of the sessions met
4.4
Good
2
Adequacy of the information delivered in speech
was good
4.4
Good
3
Clarity of the content was excellent
4.5
Excellent
4
Newer information covered in programme
4.3
Good
5
Practical applicability and implementation of
information in public health practise
4.5
Excellent
6
Arrangement of the programme as a whole viz.
AV aids, punctuality and food arrangements
4.5
Excellent
39
Recommendations:1. Regional Planning Approach: - While planning of Public health issues Municipal
Corporation must consider peri-urban and adjacent rural area. This includes planning for
solid waste disposal, sewage treatment, water supply, vector control measures and tertiary
health care services.
2. Public Private Partnership Model: - (PPP Model) Wenlock hospital is the good example
of successful public private partnership. In order to provide comprehensive health care
services to urban population more Public Private Partnership models should be developed.
3. Role of Medical colleges: -Dakshinakannada district has seven medical colleges of which 6
are within 30 km radius of Mangaluru city. Success of Wenlock hospital and KMC,
Mangaluru is the best example to further explore the participation other private medical
colleges in delivery of health services in urban areas of dakshina Kannada district.
4. Capacity Building of Public health specialist: - Present workshop enabled the delegates to
understand issues and challenges in urban health. This workshop helped in capacity building
of public health specialist. These expertises should be utilized in implementation of National
urban health mission (NUHM) program in dakshina Kannada district.
5. Improve intersectoral coordination :A. Greater coordination between police department and tertiary care hospitals to
identify unknown/unclaimed dead bodies.
B. Integrated disease surveillance project :- Timely and regular reporting of S,P and L
forms (Online) from all private and government hospitals. Improved coordination
between municipal city corporation and IDSP.
6. Public Private people participation Model (PPPP Model):- It was observed that peoples
representative dominates the decision making process. There is poor community
participation and lack of coordination between health sector and corporation ( at all levels).
PPPP model will ensure good quality holistic health care for all.
7. Solid waste disposal methods: - Solid waste disposal very poorly managed at census town
and urban poor areas.
8. Health Infrastructure at census town and Urban Ullal :-Adequate health facilities should
be made available at these places. Health care services are underutilized at census town and
Urban Ullal with respect to intra-natal services.
40
9. Urban slums:- Urban slums need proper sanitation facilities and an improvement in the
management of solid wastes. There is also a need to improve the housing conditions.
10. Anganwadi: - Sanitation in the Anganwadis needs to be improved. Measures have to be
taken to reduce overcrowding in the Anganawadi Centers. Records of the growth
monitoring were not well maintained and the Anganawadi Workers need to be trained in this
aspect.
11. Public distribution system:- Steps need to be taken to ensure proper documentation. Food
basket distribution which has been recommended by the National Institute of Nutrition,
Hyderabad and successfully implemented in Andhra Pradesh may be introduced. Allergic
dermatitis has been noted in few of the food handlers due to use of Boric acid, measures can
be taken for provision of gloves and mask.
12. Improved public transport services: - There needs to be an overall improvement in the
public transport system, which may reduce the number of individual vehicles on the road
and eventually, minimize traffic congestion. The conditions of the roads need to be made
better.
41
Delegates:
Sl.
No
Name
Dr Suresh K
1
2
Dr Laxmi Bhavani
Designation
Public Health Consultant, Retd. senior
programme officer public health,
UNICEF, New Delhi, India
Institute
Nutrition Officer, UNICEF, Hyderabad
UNICEF, Hyderabad
UNICEF, New Delhi
Dr Derik Ian Joshua
3
4
5
Environment Executive, Department
of Quality and Compliance, Manipal
Manipal University
University
Dr Abhay S Nirgude Professor & HOD, Department of
Community Medicine, Yenepoya
Medical College, Yenepoya University,
Mangalore
Yenepoya University
Dr Anand Bangera
Zonal chairman, K.M.C. C.M.E.
(Honorary Delegate) Accreditation Committee
Dr R P Pai
Professor
Dr Poonam Naik
Professor
Yenepoya University
Yenepoya University
Dr Padma Mohan
Associate Professor
Yenepoya University
Dr Akshay K M
Associate Professor
Yenepoya University
Dr Selvaraj I
Associate Professor
Yenepoya University
Dr.Siddharudha
Shivalli
Assistant Professor
Yenepoya University
Dr Gururaj N
Assistant Professor
Yenepoya University
Dr Varun N
Assistant Professor
Yenepoya University
Dr Pracheth R
Assistant Professor
Yenepoya University
15
Dr Saba Mohammed
Mansoor
PG
AJIMS Mangalore
16
Dr Shwethashree M
PG
AJIMS Mangalore
17
PG
J.N.M.C. Belagavi
18
Dr Abhishek Prayag
Dr Srinivas krishna
GoudaPatilPG
PG
J.N.M.C. Belagavi
19
Dr Eshwari
PG
KMC Manipal
20
Dr Priya Rathi
PG
KMC Manipal
6
7
8
9
10
11
12
13
14
42
21
Dr Narayan V
Professor
F.M.M.C Mangalore
22
Dr Ramya M
PG
KIMS Bangalore
23
PG
KIMS Bangalore
PG
AJIMS Mangalore
25
Dr Lakshmi H
Dr Sajjan
Madappady
Dr Tamal
Chakraborty
PG
26
Dr Pratima Maili
PG
27
Dr Nama Suman
Dr Arun Pulikkottil
Jose
PG
AJIMS Mangalore
S.M.College vijayawada
(A.P)
S.M.College vijayawada
(A.P)
Assistant .Professor
F.M.M.C Mangalore
Assistant .Professor
F.M.M.C Mangalore
30
Dr Sowmya Bhat
Dr Oliver Vincent
D'Souza
Assistant .Professor
F.M.M.C Mangalore
31
Dr Rahul Hegde
PG
KSHEMA
32
Dr Srhrivatsha D N
PG
KSHEMA
33
Dr Shankar S
PG
KMC Manipal
34
PG
KIMS HUBLI
PG
36
Dr Neelesh M N
Dr Sathy Kishore
Chivukula
Dr Sudarshan Pai
PG
KVG Sullia
Yenepoya University
37
Dr Nirmal
PG
Yenepoya University
38
Dr Sandhya Rani J
PG
Yenepoya University
39
Dr Anupama
PG
Yenepoya University
40
Dr Shooeb Akram
PG
Yenepoya University
41
Dr Viquar A
PG
Yenepoya University
42
PG
43
Dr Edmond
Fernandes
Dr Preeti Tiwari
PG
Yenepoya University
44
Dr Preethi Selvaraj
PG
Yenepoya University
45
Dr Ravindra
Mandolikar
24
28
29
35
Yenepoya University
Yenepoya University
PG
43
URBAN HEALTH AND PUBLIC HEALTH FINANCING & BUDGETING
CME-WORKSHOP”
DEPARTMENT OF COMMUNITY MEDICINE
YENEPOYA MEDICAL COLLEGE
YENEPOYA UNIVERSITY
44