In India, primary healthcare remains inadequate, fragmented, and subpar in quality, leading to high out-of-pocket health expenditures. Current primary healthcare services in India focus heavily on Reproductive, Maternal, and Child Health and Adolescent Health (RMNCH+A) programs, neglecting the epidemiological and demographic transitions that have occurred in the country.
Currently, cardiovascular diseases, respiratory diseases, and cancers are the top three causes of mortality among young and middle-aged adults in India. India is rapidly becoming urbanized, and multiple challenges that stem out from rapid urbanization such as large-scale migration poses difficulty in the provision of comprehensive primary health care. Hence, there is a need to strengthen the urban primary health care systems to deliver comprehensive primary health care across the care continuum.
We have adopted an implementation research approach to design and implement a comprehensive primary health care model. As a part of this approach, we assess the primary health care situation in a particular geography, identify the gaps, design and implement local context-specific intervention packages, evaluate feasibility and effectiveness of interventions and scale-up in partnership with the local state and district governments. A dedicated formative research with concurrent monitoring approach throughout the implementation of these interventions inform us to refine interventions based on quality evidence.
We are currently implementing a model aimed at strengthening the continuum of care for diabetes and hypertension in an urban setting. We are exploring the role of technology to improve efficiency, quality of health services and promote equitable health services by facilitating access and coverage of services across the continuum of care.
We have adopted a patient-centric approach across the NCD care continuum to bring more patient-centricity in the community outreach, mobilization, communication efforts in addition to improving quality care at the facilities to achieve better treatment outcomes Our current interventions are centered in Mysore City, Karnataka.
We work to design, develop, implement and evaluate comprehensive primary health care models that address critical gaps in the coverage of affordable, accessible and quality primary healthcare services in urban areas. Our patient-centred continuum of care models focus on strengthening the facilities, communities and the health systems for population-level impact.
Increase coverage of affordable, accessible and good quality primary healthcare services in urban areas
Develop an integrated continuum of care model for non-communicable diseases in urban areas
Improve patient-centric care for non-communicable diseases through a community health worker-led model
A decentralization and convergence initiative for rural healthcare
Developing a model for high coverage and quality of NCD services across the prevention to care continuum
Developing a Health entrepreneurship model to improve accessibility of health services in a backward taluka of Karnataka
Developing an incentive-based CHW-led outreach model to improve patient-centric care
Developing a model to reduce costs, morbidity and mortality by increasing CPHC coverage
About the project:
The project aims to improve the coverage and quality of RMNCH+A-focused healthcare services among vulnerable populations in urban areas to enhance maternal and childbirth outcomes. The objectives are to build resilient community structures, promote leadership and encourage active community participation to improve the delivery of healthcare services with a specific focus on reproductive, maternal, newborn, child and adolescent health (RMNCH+A). To achieve these objectives, the project will use a multi-layered approach that combines community strengthening, improving primary healthcare elements outlined in the Ayushman Bharat (AB) program, improving quality of healthcare delivery, and focusing on RMNCH+A services in the selected geography. It will also strengthen the urban healthcare system by promoting convergence between stakeholders.
Geography: Two Urban Primary Health Centres (UPHCs) of Mysuru City
Duration: April 2024 to November 2027
Donor: Health Systems Transformation Platform (HSTP) and supported by Infosys Foundation
Key Activities:
Expected Outcomes:
About the project:
Building on the success of the TB Mukt Bharat initiative, implemented by the Government of India, and the Kshaya Muktha Karnataka by the Government of Karnataka, KHPT has been a key player in urban areas, providing technical support to the state government. Notably, KHPT’s Breaking the Barriers (BTB) project has been instrumental in overcoming the challenges associated with TB elimination in India. In continuation of this, KHPT is now working to demonstrate the development of comprehensive models for TB-free wards in Mysuru city, in collaboration with the National TB program.
The project focuses on urban settings to identify solutions, collaborate with local urban administrative entities, and implement the TB Resilient Ward concept within selected urban geographies. The initiative will strive to enhance healthcare access for vulnerable populations and support the creation of a comprehensive TB Resilient Ward model. Lastly, KHPT will also focus on strengthening urban local bodies (ULBs) and stakeholders and encouraging community engagement and ownership in TB Resilient Wards. ULBs and community groups like the Mahila Arogya Samithi (MAS) will be empowered to engage in the decision-making processes pertinent to urban TB control.
Geography: Three Urban Primary Health Centres (UPHCs) covering nine wards of Mysuru district
Duration: April 2024 – March 2025
Donor: United States Agency for International Development (USAID)
Key Activities:
Expected outcomes
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:
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:
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:
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:
Duration: September 2022 – August 2025
Key Activities:
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:
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:
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.
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 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.
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:
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
“Prathima, a CHW helped me stop alcohol consumption. During BCC, she told me the disadvantages of consuming alcohol for a diabetic patient. Slowly I tried and reduced alcohol consumption and now I am not drinking and feel healthy.”
Basavachari (Diabetic Patient, Hebbal 1st stage, Mysore)
“Being diabetic, I was worried about buying medicines every month. I was surprised to know from the health worker that UPHCs provide medicines free of cost. Now I am collecting medicines from the Government Hospital and it is a big relief for me. I thank the CHW for the information”
Rihan Jhan (Diabetic Patient, Vidyaranyapuram, Mysore)
During a phone call, a CHW-Supervisor found that a diabetic and hypertensive patient was suffering from urinary tract infection. The CHW-S immediately contacted her husband, who works in the government district hospital. An ambulance was arranged to take the patient to the district hospital. As there was no specialist available in the facility on the day, the patient was shifted to a private nursing home. Since the patient didn’t have money to pay for the treatment, the CHW-S and her husband stepped forward and contributed Rs. 10000 to help the patient. The effort put in by CHWs and CHW-Supervisors during the ongoing lockdown to counsel and help patients in need continue to inspire.
