The Rs.595 crore World Bank assisted Karnataka Health Systems Development Project (KHSDP) has witnessed a slight decline in allocation for healthcare in 2002-2003 due to a reduction in the overall State budget as a result of a tight financial situation. But the share of the resources for the primary and secondary tiers of the healthcare sector and non-salary recurring costs (drugs and supplies etc) has increased substantially since the commencement of the project in 1996-97. The drugs budget for a primary healthcare sector has increased from Rs. 50,000 to Rs.85, 000. The annual drugs budget per bed has increased from Rs. 9,477 in 1996-97 to Rs. 11,989 in 2001-02, while annual maintenance budget has increased from has increased from Rs. 383 to Rs. 2,235 per bed.

In tune with the reforms in the healthcare sector, user charges with exemption for those below the poverty line are being collected in all district hospitals and a range of sub-divisional and community hospitals. The money is retained by the district health committee to be used in hospitals for non-salary recurring expenditure. The total user charges collected increased from Rs. 3 million in 1997-98 to Rs. 24 million in 2001-02. The user charges are used for ambulance maintenance and repair of water and sanitary connections.

According to S Rajashekar, additional administrative officer, KHSDP the Children and Women's hospital in Davangere has accumulated over Rs. 10 lakh from user charges.

The project execution, which is being implemented currently in Bangalore, Belgaum and Mysore divisions is aimed at improving the delivery of healthcare services in 204 secondary has been extended to March 31, 2004 to consolidate the software components in the hospitals.

The number of beds has increased from 13,499 to 19,334 in 183 secondary hospitals during the past five years, an increase of 5,877 beds against the target of 3,825. The number of in-patients increased from 0.6 million to 1.2 million to 23.1 million, said Rajashekar.

According to senior officials in KHSDP, improvement is needed in areas like waste management, software components and contracting out various services. There has been progress in training of doctors, paramedics and nurses, availability of drugs and supplies, referrals to big hospitals, acquiring equipment and timely repair of equipment.

Kagodu Thimmappa, minister for health and family welfare, government of Karnataka said that lack of doctors has affected services in a few districts like Uttara Kannada, Bidar, Chikamagalur, Dakshina Kannada and Bangalore rural and urban districts.

To address the mismatch in skills in the project hospitals, the process of transferring about 350 specialists has been initiated and is expected to be completed by 31 January2003. Disease surveillance units have been formed in all the districts under the project to deal with emergency situations such as outbreak of epidemics. To overcome staff problems the deputy commissioner of the district has been authorised to appoint specialist doctors and paramedical staff on contract whenever necessary.

As many as 6.17 million from the scheduled castes and scheduled tribes people were checked in 44,234 health camps. The improvements have led to increased credibility of service and greater patient satisfaction, informed Rajashekar.

Under the KHSDP software support is given to 47 hospitals being upgraded by the KfW, a German-based funding organisation in the backward areas of Gulbarga district. In addition, waste management systems have been set-up in 136 hospitals.

The execution of the project has led to an increase in the budgetary expenditure for the healthcare sector from Rs. 535 crore in crore in 1996-97 to Rs. 1,110 crore in 2001 and Rs. 1,250 crore in 2001-02 said Rajashekar.