KARNATAKA - of Planning Commission

Demography, Health and NutritionPrivate sectorparticipation inprovisioning healthcareservices is stillpredominantly anurban-basedphenomenon. Rural areasmust rely onstate sponsoredhealthcare.survive stubbornly in geographical pockets andspecifi c population groups. Although the maternalmortality rate has declined, it is still unacceptablyhigh for a developed state like Karnataka.Private sector participation in provisioninghealthcare services is still predominantly anurban-based phenomenon. Rural areas must relyon state sponsored healthcare. Here again, it isthe poor who are the single largest constituencyfor public healthcare. It is for these reasons thatthis chapter will focus on public health services inthe state since private sector-managed healthcaredoes not target the sub-populations who are mostat risk and have the least capacity to spend ontheir health needs.PopulationAccording to the 2001 census, since 1951 thepopulation of Karnataka has increased two andBOX 6.1UN Millennium Development Goalsto be achieved by 20151. Reduce infant and under-5 mortality ratesby 2/3rd.2. Reduce maternal mortality rates by threequarters.3. Halt and begin to reverse the spread ofHIV/AIDS.4. Halt and begin to reverse the incidence ofmalaria and other major diseases.BOX 6.2Karnataka State Integrated Health Policy 2004a half times to 52.73 million. It progressivelyincreased between 1951 and 1981 but registereda decline in growth, for the fi rst time, in thedecade 1981–1991 i.e. from 26.75 per cent to21.12. It further declined to 17.5 per cent in thedecade 1991–2001. Two critical demographictrends which are now becoming visible, are anincrease in the size of the working population(15 to 59 years) and a decrease in the below15 population – both of which have signifi cantpolicy implications. The fi rst is a possible increasein joblessness if the economy is unable to provideemployment for this large labour force; thesecond is the greying of the population over thenext 25 years, which will trigger a need for socialsecurity. While Karnataka’s population growthduring the preceding decade is less than all-India(21 per cent), it is higher than the neighbouringstates of Kerala (9.4 per cent), Tamil Nadu(11 per cent) and Andhra Pradesh (13.9 per cent),indicating how imperative it is for Karnataka tosustain this decline in decennial growth.The crude birth rate (CBR), which was 33.7 in1971, declined to 22.0 in 2002 – a decline ofabout 35 per cent. The two neighbouring statesof Andhra Pradesh and Tamil Nadu recorded adecrease of 41 and 42 per cent respectively duringthe same period. The crude death rate (CDR) fell by45 per cent to 7.2 in 2002 from 13.0 in 1971. Thestates of Kerala, Andhra Pradesh and Tamil Nadurecorded a decline in CDR of about 30 per cent, 48per cent and 50 per cent respectively during thisperiod. Across districts, Udupi has the lowest CBR(15.8) and Koppal’s CBR of 28.8 is the highest inBased on the report of the Task Force on Health and Family Welfare (2001), the government formulated aState Integrated Health Policy:1. Providing integrated and comprehensive primary healthcare.2. Providing a credible and sustainable referral system.3. Establishing equity in delivery of quality healthcare.4. Encouraging greater public–private partnership in the provision of quality healthcare in order to betterserve the under-served areas.5. Addressing emerging issues in public health.6. Strengthening health infrastructure.7. Improving access to safe and quality drugs at affordable prices.8. Increasing access to alternative medicine systems.130