Appendix H — Program Atlas
Each sheet to the 8-section template + 4-point QA bar (defined inline in Vol III App H Education, the format-reference sector).
Read this chapter in the interactive reader, or download the full 601-page manifesto (PDF).
The People’s Model
Manifesto v2026
Volume III — Implementation Handbook
Appendix H — Program Atlas
Health sector — sheets H.019–H.036 + H.235 (v1.0)
Each sheet to the 8-section template + 4-point QA bar (defined inline in Vol III App H Education, the format-reference sector).
Problem
Karnataka PHCs are often under-staffed and reactive. Continuous primary care is rare; the same patient sees different providers without a shared record.
Program design
- Family Health Team (doctor + nurses + ASHA + CHW) per defined catchment.
- Continuous-care model: NCD follow-up, maternal and child health, mental health first response.
- Consent-based health record summary on the spine.
- PHC-to-DH referral routing with feedback loop.
Owning agency
Lead: Department of Health & Family Welfare
Backup: National Health Mission Karnataka unit
Funding model
Annual cost band: ₹850–1,100 cr / year (incremental staffing + training)
Source: State Budget Health head; NHM convergence; PMJAY-AB integration.
Payment trigger: Monthly catchment performance + per-PHC outcome data.
KPIs
- • PHCs with operational Family Health Team — baseline: Limited; F: ≥50% in pilot districts; B: ≥90% statewide; C: 100%.
- • Continuous-care patients with up-to-date follow-up — baseline: Patchy; F: Baselined; B: ≥80%; C: ≥95%.
- • PHC utilisation share of total OPD load — baseline: Low; tertiary overload; F: +20%; B: +50%; C: Sustained shift to primary.
Standard risk controls
- • Risk: Doctor vacancy at the PHC. Safeguard: Cadre framework (App F); vacancy itself an audit event; rural-service incentive published.
- • Risk: Record-keeping under-burden of front-line staff. Safeguard: Light-touch digital interface; data-entry as workflow not paperwork; consent-protected (Vol I Ch 6).
- • Risk: Referral failure to district hospitals. Safeguard: Routing dashboard on Mission Control; escalation L0–L4 (Vol I Sec. 3.3).
Dependencies
- • Vol I Ch 2 (spine); Vol II Ch 8 Sec. 8.3 NCD loop.
- • App H sheets H.020 (Supply Chain), H.021 (Trauma), H.024 (NCD), H.035 (Digital Health Record).
Problem
Stockouts of essential drugs and consumables at Karnataka PHCs and DHs cost lives. Procurement and distribution are uneven and frequently opaque.
Program design
- Establish Karnataka State Essential Medicines & Consumables Agency (KSEMCA).
- Pooled procurement under KTPP; QA testing on every batch.
- Distribution to district warehouses → PHC level via real-time stock dashboards.
- Auto-replenishment when stock falls below reorder level.
Owning agency
Lead: Department of Health & Family Welfare (KSEMCA institutionally)
Backup: Karnataka Public Procurement Portal team
Funding model
Annual cost band: ₹1,200–1,600 cr / year (drug + consumables purchase)
Source: State Budget Health head; PMJAY drug reimbursement convergence.
Payment trigger: Per-facility daily stock posting + tender + delivery evidence.
KPIs
- • Stockout days for essential drugs at PHC — baseline: Material; not measured; F: Median ≤7; B: ≤2; C: ≤1.
- • % essential drugs procured through pooled tender — baseline: Variable; F: ≥80%; B: 100%; C: Continuous + price benchmarking.
- • Batch QA failure detection rate — baseline: (new); F: Baselined; published; B: Rising sensitivity; C: Sample audit at parity with national peers.
Standard risk controls
- • Risk: Cartel pricing on common drugs. Safeguard: Bidder-floor (Vol I Sec. 1.7 #6); identical-bid detection (App C RF-T-02); cartel referral.
- • Risk: Last-mile distribution leak. Safeguard: Geo-tag delivery + automated stock-vs-distribution reconciliation; App C RF-E-04.
- • Risk: Expired-stock dumping. Safeguard: FEFO (First-Expiry-First-Out) discipline; expiry-tracking dashboard.
Dependencies
- • Vol I Ch 4 OCDS; Vol III App E (Helmet) as adjacent SOE/manufacturing pattern.
- • App H sheets H.019, H.027 (Hospital Quality), H.032 (Equipment Maintenance Corps).
Problem
Karnataka’s emergency response is uneven across geography; trauma care along major highways and in rural blocks falls below acceptable standards.
Program design
- Dial-112 integration with the operating spine; dispatch dashboard at District Mission Control.
- Trauma centres along NH/SH corridors with stabilisation capability.
- Helmet Programme (Vol III App E) co-funded margin to the Road Safety & Trauma Care Fund.
- Air-ambulance protocol for severe-trauma escalations.
Owning agency
Lead: Department of Health & Family Welfare + Karnataka State Police (for 112 integration)
Backup: Karnataka State Road Transport Corporation (for highway-corridor coordination)
Funding model
Annual cost band: ₹400–600 cr / year
Source: State Budget; Helmet Programme margin (App E); NHM convergence.
Payment trigger: Per-incident response-time data + outcome.
KPIs
- • Median emergency response time (urban / rural) — baseline: Uneven; F: ≤15 / ≤25 min; B: ≤10 / ≤20 min; C: ≤8 / ≤15 min.
- • Trauma centres within 50 km along NH/SH — baseline: Patchy; F: ≥60% corridor coverage; B: ≥90%; C: 100%.
- • Survival rate of severe-trauma cases — baseline: Below peer-state benchmark; F: Baselined; B: At benchmark; C: Above benchmark.
Standard risk controls
- • Risk: Ambulance fleet capture by private aggregators. Safeguard: Open-bidder fleet contracts; rotation; conflict-of-interest register (Vol I Sec. 1.7 #7).
- • Risk: Trauma-centre underutilisation outside emergencies. Safeguard: Dual-purpose design with PHC/DH co-location; performance dashboard.
- • Risk: Hospital-side admission refusal. Safeguard: Mandatory acceptance under EMT protocol; Grievance Justice Authority remedy (Vol I Ch 6).
Dependencies
- • Vol I Ch 5 (Helmet Programme funding); Vol II Ch 9 sheet H.047 (Road Safety Urban Design).
- • App H sheets H.019, H.022 (Cashless), H.027 (Hospital Quality).
Problem
Karnataka’s poor face out-of-pocket medical costs that push families into debt. PMJAY/Ayushman Bharat coverage is uneven and access requires paperwork that crisis families cannot navigate.
Program design
- Auto-eligibility for cashless care on the operating spine.
- Empanelment of state-recognised private hospitals plus all government secondary/tertiary facilities.
- Pre-authorisation streamlined to ≤60 minutes for emergency conditions.
- Real-time disbursement to the hospital; audit trail on Open Ledger.
Owning agency
Lead: Suvarna Arogya Suraksha Trust (SAST)
Backup: Department of Health & Family Welfare
Funding model
Annual cost band: ₹2,500–3,500 cr / year
Source: State Budget; PMJAY central share; Health Insurance pooled fund.
Payment trigger: Treatment authorisation + claim disbursement evidence.
KPIs
- • Eligible household coverage — baseline: Partial; F: ≥85%; B: ≥98%; C: 100% with auto-renewal.
- • Median pre-auth turnaround (emergency) — baseline: Variable; F: ≤60 min; B: ≤30 min; C: ≤15 min.
- • Out-of-pocket spend in covered category — baseline: High; F: Baselined; B: Materially down; C: Near-zero for emergency category.
Standard risk controls
- • Risk: Hospital up-coding or ghost claims. Safeguard: Automated claim-anomaly detection; sample re-audit; vendor blacklist for proven fraud.
- • Risk: Empanelled hospitals refusing service. Safeguard: Mandatory-acceptance clause; Grievance Justice Authority; published refusal patterns trigger empanelment review.
- • Risk: Beneficiary identity fraud. Safeguard: Spine identity + consent-logged access; bank-account-change protocol (App C RF-P-03).
Dependencies
- • Vol I Ch 2 (spine).
- • App H sheets H.019, H.027 (Hospital Quality), H.035 (Digital Health Record).
Problem
Karnataka’s maternal and child outcomes mask wide block-level disparities. Low birthweight, stunting, and anaemia are concentrated in identifiable geographies.
Program design
- Pregnancy-to-Age-2 case file on the operating spine (consent-protected).
- Continuous outreach via ASHA + Anganwadi convergence (sheet H.008).
- Iron, folic acid, ICDS supplementation; Janani Suraksha Yojana integration.
- Block-level dashboards with disaggregated outcome tracking.
Owning agency
Lead: Department of Health & Family Welfare + Department of WCD
Backup: Karnataka State Nutrition Mission
Funding model
Annual cost band: ₹1,400–1,800 cr / year (across MoHFW + WCD heads)
Source: State Budget; NHM + ICDS convergence.
Payment trigger: Per-mother per-child case-file events.
KPIs
- • Low birthweight rate — baseline: Above acceptable threshold; F: Baselined per block; B: Material decline; C: At/below state target.
- • Stunting rate at age 2 — baseline: Above threshold; F: Baselined per block; B: Material decline; C: At/below national target.
- • Institutional delivery rate — baseline: High overall; block gaps; F: ≥97% statewide; gaps published; B: Gaps halved; C: Gaps closed.
Standard risk controls
- • Risk: ASHA workload overload. Safeguard: Workload audit; sheet H.031 cadre strengthening.
- • Risk: Caste/community gatekeeping in outreach. Safeguard: Inclusion audit (sheet H.180); Equity audit on outcomes (sheet H.204).
- • Risk: Surveillance creep on women’s data. Safeguard: Citizen Data Trust review; aggregation-only public reporting.
Dependencies
- • App H sheets H.008 (Anganwadi 2.0), H.019, H.020, H.033 (Nutrition Kitchens).
Problem
Non-communicable diseases now drive much of Karnataka’s adult disease burden. Screening, diagnosis, and follow-up are inconsistent.
Program design
- Population-level NCD screening by Family Health Teams.
- Automatic enrolment of positive screens into the follow-up loop.
- Medication adherence tracked through case file.
- Cancer-specific pathway (oral, breast, cervical) with district referral.
Owning agency
Lead: Department of Health & Family Welfare
Backup: National NCD Programme Karnataka unit
Funding model
Annual cost band: ₹600–800 cr / year
Source: State Budget; NHM-NCD convergence.
Payment trigger: Per-adult screening event + follow-up adherence data.
KPIs
- • Adult screening coverage — baseline: Low; F: ≥50%; B: ≥80%; C: ≥95%.
- • Diagnosed-and-controlled rate (BP, diabetes) — baseline: Variable; F: Baselined; B: Material rise; C: Lead Indian states.
- • Cancer screen-to-diagnosis turnaround — baseline: Slow; F: ≤30 days median; B: ≤14 days; C: ≤7 days.
Standard risk controls
- • Risk: Drug-supply stockouts. Safeguard: Sheet H.020 supply chain; stock dashboard.
- • Risk: Patient drop-off after first screen. Safeguard: Continuous-care model under sheet H.019; CHW outreach.
- • Risk: Over-diagnosis or testing-vendor capture. Safeguard: Test-vendor rotation; concentration-risk audit (App C RF-X-02); peer-review of diagnostic patterns.
Dependencies
- • App H sheets H.019, H.020, H.029 (Diagnostics Access), H.035.
Problem
Mental health in Karnataka is under-resourced. First response after a crisis is rarely available; stigma and access combine to push people out of care.
Program design
- Mental health first-responder training for ASHA + CHW + PHC doctor.
- 112 integration for crisis dispatch.
- Community mental-health programme at the taluk level.
- Tele-mental-health line in Kannada + minority languages.
Owning agency
Lead: Department of Health & Family Welfare (Mental Health cell)
Backup: NIMHANS partnership
Funding model
Annual cost band: ₹200–280 cr / year
Source: State Budget; District Mental Health Programme convergence.
Payment trigger: Per-call response + per-case follow-up data.
KPIs
- • First-response within published time — baseline: (new); F: ≤4 h median; B: ≤2 h; C: ≤1 h.
- • Continuity-of-care visits per active case — baseline: (new); F: Baselined; B: ≥4 per year; C: Risk-targeted with measurable outcomes.
- • Tele-mental-health call answer rate — baseline: (new); F: ≥80%; B: ≥95%; C: ≥98%.
Standard risk controls
- • Risk: Stigma reducing uptake. Safeguard: Confidential pathway; outreach via trusted community channels; communications discipline (Vol II Ch 17).
- • Risk: Burnout of first-responder cadre. Safeguard: Workload caps; peer-support model; cadre supervision rotation.
- • Risk: Mis-routing into criminal-justice pathway. Safeguard: Police-MH joint protocol; Grievance Justice Authority remedy for misuse.
Dependencies
- • App H sheets H.019, H.030 (De-addiction), H.144 (Youth Wellbeing).
Problem
Karnataka’s tele-medicine ecosystem is patchy and uneven; rural residents pay information disadvantages plus travel costs to access specialists.
Program design
- State-operated tele-medicine pathway through PHCs and Panchayat Service Centres.
- Specialist consultation hubs (DH-level) connected to PHC field staff.
- e-Pharmacy with prescription audit + ePrescription standards.
- Quality-of-care evaluation on tele-consultations.
Owning agency
Lead: Department of Health & Family Welfare
Backup: Karnataka State Wide Area Network team (connectivity)
Funding model
Annual cost band: ₹150–220 cr / year
Source: State Budget; NHM convergence.
Payment trigger: Tele-consult event + ePrescription dispensation data.
KPIs
- • Tele-consultations per PHC per month — baseline: (new); F: Baselined; B: Material throughput; C: Routine use of tele-specialist.
- • ePrescription compliance rate — baseline: (new); F: ≥80%; B: ≥95%; C: 100% with audit.
- • Patient satisfaction on tele-consult — baseline: (new); F: Baselined; B: Rising; C: At in-person parity for indicated conditions.
Standard risk controls
- • Risk: Vendor lock-in on tele-platform. Safeguard: Open API; vendor-floor + rotation; data portability mandated.
- • Risk: ePharmacy abuse (over-prescription, antibiotic misuse). Safeguard: Prescription audit; antibiotic-stewardship policy; pharmacist verification.
- • Risk: Connectivity exclusion of low-network blocks. Safeguard: Offline-first design (Vol III Ch 22); assisted access at PSC (sheet H.169).
Dependencies
- • App H sheets H.019, H.029, H.035; Vol II Ch 15 (cybersecurity).
Problem
Karnataka’s public-hospital quality varies; preventable infections and adverse events under-tracked.
Program design
- Karnataka Hospital Quality Index published per facility.
- Infection-control programme with surveillance data feed.
- Adverse-event reporting protected by whistleblower rules.
- Independent third-party hospital audits on a published schedule.
Owning agency
Lead: Department of Health & Family Welfare
Backup: NABH partnership (accreditation as benchmark)
Funding model
Annual cost band: ₹180–250 cr / year
Source: State Budget; NABH-accreditation convergence.
Payment trigger: Per-facility quarterly QI report + audit publication.
KPIs
- • Karnataka Hospital Quality Index — median — baseline: (new); F: Index defined; baseline published; B: Rising; bottom-quartile catching up; C: Parity with national benchmark.
- • Hospital-acquired infection rate — baseline: (new); F: Baselined per facility class; B: Material decline; C: At/below WHO benchmark.
- • Adverse-event reporting rate — baseline: Under-reported; F: Rising reporting volume; B: Stable + falling severe-event rate; C: Mature culture; no chilling effect.
Standard risk controls
- • Risk: Quality data manipulation by facility. Safeguard: Independent third-party audit; rotation of auditors (Vol I Sec. 3.7 #5).
- • Risk: Adverse-event reporting chill. Safeguard: Whistleblower protection; non-punitive reporting policy under Grievance Justice Authority.
- • Risk: Concentration of accreditation panel. Safeguard: Panel rotation; conflict-of-interest register.
Dependencies
- • App H sheets H.019, H.020, H.032.
Problem
Karnataka’s outbreak response is slow when laboratory-to-action loops are weak; vector-borne disease and food-/water-borne outbreaks recur.
Program design
- IDSP-aligned surveillance with automated alerts into District Mission Control.
- Rapid-response field teams per district with published deployment SLA.
- Containment evidence (in aggregate) published on Open Ledger.
- Post-incident learning becomes a Service Registry amendment where needed.
Owning agency
Lead: Department of Health & Family Welfare (Public Health wing)
Backup: Karnataka State Integrated Disease Surveillance Programme
Funding model
Annual cost band: ₹130–180 cr / year
Source: State Budget; IDSP convergence; NCDC partnership.
Payment trigger: Alert triggers + containment-evidence publication.
KPIs
- • Alert-to-deployment median time — baseline: Variable; F: ≤24 h; B: ≤12 h; C: ≤6 h.
- • Containment-success rate (cases within Rt<1 within 14 days) — baseline: (new); F: Baselined per outbreak class; B: Material rise; C: Sustained capability.
- • Surveillance coverage of notifiable diseases — baseline: Partial; F: ≥80%; B: ≥95%; C: 100% with audit.
Standard risk controls
- • Risk: Under-reporting by facility/district. Safeguard: Sample audit; whistleblower protection; published response-time data.
- • Risk: Politicised suppression of outbreak data. Safeguard: Statutory publication requirement under Public Information Charter (sheet H.181); independent CIC route.
- • Risk: Vector-control vendor capture. Safeguard: Open tender; rotation; quality testing on spray chemicals.
Dependencies
- • App H sheets H.019, H.020, H.029.
Problem
Karnataka residents in many blocks lack access to quality diagnostics; samples are couriered slowly and results returned even more slowly.
Program design
- District Diagnostics Hubs with sample-logistics network.
- Quality-controlled labs; in-source where feasible, contracted where not.
- Result-return SLA per test class (publicly published).
- Tele-radiology connection to specialist hubs.
Owning agency
Lead: Department of Health & Family Welfare
Backup: KSEMCA (Hubs as part of supply-chain corridor)
Funding model
Annual cost band: ₹350–500 cr / year
Source: State Budget; PMJAY diagnostics share.
Payment trigger: Per-sample logistics + result-return time evidence.
KPIs
- • Median sample-to-result time (essential tests) — baseline: Slow; F: ≤72 h; B: ≤24 h; C: ≤12 h.
- • Hub coverage at district level — baseline: Partial; F: All districts with at least 1 Hub; B: Hub-per-taluk for high-volume tests; C: Universal in-block access.
- • Diagnostic-error rate (sample re-test) — baseline: (new); F: Baselined; B: Material decline; C: At/below benchmark.
Standard risk controls
- • Risk: Vendor capture on contracted labs. Safeguard: Open bidder-floor; rotation; concentration-risk audit (App C RF-X-02).
- • Risk: Sample integrity loss in transit. Safeguard: Cold-chain compliance audit; geo-tag tracking; lab QA cross-check.
- • Risk: Over-prescription of unnecessary diagnostics. Safeguard: Standard-treatment-guidelines audit; CME for prescribers.
Dependencies
- • App H sheets H.019, H.026 (tele); H.027 (Hospital Quality).
Problem
Substance-use treatment in Karnataka is sparse, stigmatising, and frequently criminalising. Harm-reduction approaches are inconsistently applied.
Program design
- Community-based de-addiction centres at taluk level.
- OST (Opioid Substitution Therapy) availability where indicated.
- Harm-reduction services with confidentiality guarantees.
- Police-MH joint protocol for non-criminal pathways.
Owning agency
Lead: Department of Health & Family Welfare (Mental Health) + Social Welfare
Backup: National Action Plan for Drug Demand Reduction convergence
Funding model
Annual cost band: ₹100–160 cr / year
Source: State Budget; central convergence.
Payment trigger: Per-case enrolment + continuity evidence.
KPIs
- • Treatment-coverage of self-reported users — baseline: Low; F: Baselined per district; B: Rising trajectory; C: Material coverage with non-criminal pathway.
- • Retention in OST at 6 months — baseline: (new); F: Baselined; B: Rising; C: At national/WHO benchmark.
- • Re-arrest rate among diversion-pathway cases — baseline: (new); F: Baselined; B: Material decline; C: Sustained low.
Standard risk controls
- • Risk: Stigma and confidentiality breach. Safeguard: Citizen Data Trust review of data flows; explicit confidentiality protocol.
- • Risk: Re-criminalisation of cases via parallel channel. Safeguard: Police-MH joint protocol with audited compliance; Grievance Justice Authority remedy.
- • Risk: Pharmaceutical diversion of OST. Safeguard: Controlled-dispensing protocol; pharmacy audit.
Dependencies
- • App H sheets H.019, H.025, H.099 (Police behavioural standards).
Problem
Karnataka’s frontline health workers — doctors, nurses, ASHAs, ANMs — face uneven training and patchy career pathways. Cadre vacancy is normalised.
Program design
- Continuous training for all front-line cadres.
- Published career-progression rules with practice-based criteria.
- Mentor cadre separate from inspection cadre (sheet H.002 pattern).
- Rural-service incentive + posting clarity through Transfer & Posting Board (Vol III Ch 20).
Owning agency
Lead: Department of Health & Family Welfare (HRH cell)
Backup: Karnataka State Medical and Nursing Councils
Funding model
Annual cost band: ₹250–350 cr / year
Source: State Budget; NHM training-grant convergence.
Payment trigger: Per-cadre training-event + completion log.
KPIs
- • Vacancy rate — doctor / nurse cadre — baseline: Material; F: Baselined per cadre; B: Vacancy halved; C: ≤5% vacancy.
- • Training hours per worker per year — baseline: Variable; F: ≥30 h annual; B: ≥50 h; C: Practice-based, continuous.
- • Worker retention in rural posting (years) — baseline: Short; F: Baselined; B: Material rise; C: Stable cadre presence in rural blocks.
Standard risk controls
- • Risk: Training-provider capture. Safeguard: Open bidder-floor; rotation; published trainer-performance data.
- • Risk: Rural-service incentive abused. Safeguard: Posting-board audit; bypass-attempt is itself an audit event.
- • Risk: Cadre rivalry undermining team-based care. Safeguard: Joint training; team-KPIs alongside individual.
Dependencies
- • Vol I Ch 5 (Cadre framework); Vol III Ch 20 (Posting Board).
- • App H sheets H.019, H.155 (Cyber workforce as parallel pattern).
Problem
A non-functional ventilator, dialysis machine, X-ray, or ICU monitor in Karnataka’s public hospitals is both a clinical and a fiscal loss; maintenance is too often outsourced and unaccountable.
Program design
- In-house medical equipment maintenance corps in district hospitals.
- Asset Registry per facility with maintenance schedule.
- Vendor service contracts only where in-house cannot, with performance audits.
- Training pathway for biomedical technicians.
Owning agency
Lead: Department of Health & Family Welfare
Backup: Karnataka State Works Corps (biomedical wing)
Funding model
Annual cost band: ₹120–170 cr / year
Source: State Budget; maintenance-first rule (Vol I Sec. 3.4).
Payment trigger: Per-asset uptime + maintenance work-order completion.
KPIs
- • Asset uptime (critical equipment) — baseline: Variable; F: ≥85%; B: ≥95%; C: ≥98%.
- • Mean time to repair (critical equipment) — baseline: Variable; F: ≤72 h; B: ≤24 h; C: ≤12 h.
- • Biomedical technician cadre size — baseline: Sparse; F: Per-district plan; B: Vacancy halved; C: Vacancy ≤5%.
Standard risk controls
- • Risk: Vendor lock-in on equipment that requires proprietary service. Safeguard: Procurement-time open-service requirement (App F Commercial Manager scope).
- • Risk: Asset Registry data drift. Safeguard: Quarterly physical verification audit; geo-tag.
- • Risk: Maintenance fund diversion. Safeguard: Maintenance-first allocation ring-fence (Vol I Sec. 3.4).
Dependencies
- • Vol I Ch 5; App H sheets H.020, H.027.
Problem
Karnataka residents in slums, working homeless populations, and certain age cohorts face nutrition gaps the regular school/anganwadi system does not catch.
Program design
- Community Nutrition Kitchens at ward/cluster level.
- Targeting through Vulnerability Case File (sheet H.166).
- Supply chain on KSEMCA logistics where feasible.
- Independent menu-planning oversight.
Owning agency
Lead: Department of Women & Child Development
Backup: Department of Food & Civil Supplies
Funding model
Annual cost band: ₹280–380 cr / year
Source: State Budget; PMGKAY convergence; private CSR (no editorial influence).
Payment trigger: Daily meals-served data + targeting evidence.
KPIs
- • Meals served to eligible vulnerable population — baseline: (new); F: Baselined per district; B: Rising; targeting accuracy >85%; C: Sustained coverage of identified need.
- • Targeting accuracy (% meals to eligible) — baseline: (new); F: ≥75%; B: ≥85%; C: ≥95%.
- • Food-safety incident rate — baseline: (new); F: Baselined; B: At/below threshold; C: Sustained near-zero.
Standard risk controls
- • Risk: Diversion of food materials. Safeguard: Stock dashboard + sample audit; vendor blacklist for proven diversion.
- • Risk: Vendor-capture in supply contracts. Safeguard: Open bidder-floor; rotation; concentration audit.
- • Risk: Stigma reducing uptake. Safeguard: Confidential access; co-location with other services to reduce singling out.
Dependencies
- • App H sheets H.008, H.166, H.167, H.020.
Problem
Karnataka still records preventable water-borne disease in many blocks; sanitation gaps compound the burden, particularly for women and children.
Program design
- Jal Jeevan Mission convergence with district health surveillance.
- Water-quality testing at source + delivery point; results published.
- Sanitation infrastructure with maintenance-first allocation.
- Behavioural-change communication via CHWs.
Owning agency
Lead: Department of Rural Development & Panchayat Raj (Water) + Urban Local Bodies
Backup: Department of Health (surveillance link)
Funding model
Annual cost band: ₹800–1,100 cr / year (water + sanitation combined)
Source: State Budget; JJM + Swachh Bharat Mission convergence.
Payment trigger: Water-quality test publication + sanitation-asset maintenance evidence.
KPIs
- • Households with tested-safe water access — baseline: Partial; F: ≥85%; B: ≥95%; C: 100% with continuous testing.
- • Water-borne disease incidence — baseline: Variable; F: Baselined per block; B: Material decline; C: At/below national benchmark.
- • Functional household sanitation rate — baseline: Variable; F: ≥85%; B: ≥95%; C: 100% with maintenance.
Standard risk controls
- • Risk: Test-result falsification. Safeguard: Independent sample re-test; published per-source data; whistleblower protection.
- • Risk: Sanitation infra decay (toilet built, not maintained). Safeguard: Maintenance schedule in Asset Registry; Works Corps responsibility.
- • Risk: Behavioural communication captured as propaganda. Safeguard: Vol II Ch 17 sheet H.181 Public Information Charter.
Dependencies
- • App H sheets H.111 (Drinking Water Reliability), H.121 (Rural Sanitation).
Problem
Karnataka residents have fragmented or no portable health record; care is repeatedly re-explained across providers.
Program design
- Consent-based Digital Health Record summary on the spine (Vol I Ch 2 — Citizen Case File subsystem).
- ABHA integration where applicable.
- Resident-controlled access; revocation a single action.
- Provider workflow integration.
Owning agency
Lead: Department of Health & Family Welfare + State Health Authority
Backup: Citizen Data Trust (governance)
Funding model
Annual cost band: ₹100–150 cr / year
Source: State Budget; ABDM (Ayushman Bharat Digital Mission) convergence.
Payment trigger: Per-resident consent + record-update event log.
KPIs
- • Residents with active DHR summary — baseline: Low; F: Baselined; B: ≥80%; C: ≥95% with opt-out only.
- • Inter-provider record-share with consent — baseline: (new); F: Baselined per service; B: Routine on flagship pathways; C: Embedded in care delivery.
- • Privacy-incident rate per million records — baseline: (new); F: Baselined; disclosed; B: Material decline; ≤72h disclosure; C: Near-zero with public audit.
Standard risk controls
- • Risk: Consent-fatigue leading to blanket consents. Safeguard: Granular per-purpose consent; Citizen Data Trust review of consent UX.
- • Risk: Data-broker resale risk. Safeguard: Statutory prohibition; Vol I Ch 6 four tests applied to any analytics use; data-broker blacklist.
- • Risk: Provider non-adoption. Safeguard: Workflow integration; light-touch UX; cadre training (sheet H.031).
Dependencies
- • Vol I Ch 2, Ch 6; Vol II Ch 15.
- • App H sheets H.022, H.024, H.147 (Consent Vault Operating).
Problem
Karnataka residents have limited visibility into the health system serving them — facility quality, drug availability, response times — and grievance routes are unclear.
Program design
- Public-facing Citizen Health Dashboard at facility, block, and district level.
- Grievance pathway on the People’s App integrated with the health-system spine.
- Pattern detection across grievances triggers L4 structural audit.
- Transparent escalation through Grievance Justice Authority.
Owning agency
Lead: Department of Health & Family Welfare
Backup: Karnataka State Information Commission (transparency oversight)
Funding model
Annual cost band: ₹30–50 cr / year (platform + facilitation)
Source: State Budget; convergence with ABDM/ABHA infrastructure.
Payment trigger: Per-grievance disposition + dashboard refresh evidence.
KPIs
- • Grievance resolution within SLA — baseline: (new); F: ≥70%; B: ≥90%; C: ≥95% with appeal pathway.
- • Dashboard usage (sessions per district per month) — baseline: (new); F: Baselined; B: Rising trajectory; C: Embedded as routine reference.
- • L4 pattern audits triggered + closed — baseline: (new); F: Baselined; B: Rising; structural causes addressed; C: Sustained mature feedback loop.
Standard risk controls
- • Risk: Dashboard vanity (pretty, unused). Safeguard: Rating-triggered audit (Vol I Sec. 1.7 #8); independent UX evaluation.
- • Risk: Grievance backlash against complainants. Safeguard: Whistleblower protection extended to patients; Grievance Justice Authority remedy.
- • Risk: Data publication revealing individual care patterns. Safeguard: Aggregation rules; Citizen Data Trust certification.
Dependencies
- • Vol I Ch 6; Vol II Ch 8 Sec. 8.4 sheet alignment.
- • App H sheets H.180 (Inclusion Audit), H.215 (Public Reporting on Equity).
Architecture cross-reference
Architecture cross-reference — sector sheets to architectural sheets
Each program sheet in this sector references the operating architecture defined in Vol I Ch 2 and App H CyberDPI sheets H.230–H.233. Specifically: financial flows from this sector’s programs are published through the Open Ledger (sector-specific data fields per App D) anchored to KSSL (sheet H.230). Time-series outcome data and sector dashboards are published on the Karnataka Open Data Portal (sheet H.233). Personal data flows (where applicable) are governed by the Citizen Consent Ledger (sheet H.232). Security audit and incident response across this sector’s systems falls under the statutory CSOC (sheet H.231).
H.235 — Universal Medical Record System (UMRS)
Problem
Karnataka residents’ health records are fragmented across PHCs, district hospitals, private hospitals, labs, pharmacies, and scheme registers. A treating doctor cannot see a patient’s full history; preventive care programmes target by guesswork; citizens carry paper files between providers. Provider workflow is built around department-level silos, not the patient.
Program design
State-owned centralised Health Records Database. Every public-health interaction writes one record per citizen. Role-based access with treating-relationship scoping. Every access logged + visible to citizen on JANATA. Break-glass emergency override (ER, accident, unconscious patient) with 24-hour citizen notification + quarterly audit. Two AI uses: (a) population analytics on de-identified aggregates — default-on, no individual exposure, drives preventive-programme targeting; (b) individual risk scoring on identified records — opt-in via JANATA, reversible, derived scores deleted within 30 days of revocation. State-only programme parallel to ABDM/ABHA; citizens may hold ABHA separately for inter-state portability.
Owning agency
Lead: Karnataka Health Records Authority (KHRA), new statutory body under the Karnataka Digital Health Records Act (Vol III App I Sec. I.4). Independent board: civil-society members + retired High Court judge as Chair (rotation) + Director of Health Services ex-officio. Department of Health & Family Welfare implements; KHRA governs.
Funding model
CAPEX ~₹3,500 cr over 5 years: ~₹1,500 cr state data-centre + DR site + state-of-the-art security; ~₹800 cr endpoint hardware (2,500+ PHCs / hospitals / labs); ~₹600 cr software development + integration; ~₹350 cr initial AI model training + de-identification standard development; ~₹250 cr independent security + algorithmic audits.
Annual cost band: ₹350–450 cr / year (KHRA secretariat + data-centre operations + ongoing audits) by Year 5.
Source: State Budget Health head; NHM convergence; DPDP-compliance grants where applicable.
Payment trigger: Per-quarter facility-onboarding + audit-pass evidence; per-cycle AI-use registration + algorithmic-audit publication.
KPIs
- • Per-citizen UMRS coverage — baseline: 0%; F: 3-district pilot live (~5%); B: 60% (all govt facilities + Y4 voluntary private onboarding starts); C: 100% of Karnataka-domiciled residents.
- • Access-log completeness — baseline: (new); F: 100% of records carry per-access log; B: same; C: same.
- • Citizen access-log views per month — baseline: 0; F: 10% of citizens viewed log at least once; B: 30%; C: 50%.
- • Break-glass override review compliance — baseline: (new); F: 100% reviewed within 30 days; B: same; C: same.
- • Population AI programme targeting accuracy — baseline: targeting by district demographics; F: AI-targeted at PHC catchment level for 3 preventive programmes; B: 12 programmes; C: 25 programmes statewide.
- • Individual risk scoring opt-in rate — baseline: (new); F: opt-in opens end of Y1; B: 20% of eligible residents opted in; C: 40%.
Standard risk controls
- • Risk: Centralised DB becomes a high-value attack target. Safeguard: state-of-the-art security; air-gapped backup; DR site in different geographic zone; annual external penetration test published; 72-hour breach disclosure (DPDP Act 2023).
- • Risk: Role-based access subverted via privileged accounts. Safeguard: immutable spine log; quarterly access-pattern audit by KHRA; statistically anomalous access auto-flagged for human review.
- • Risk: AI model bias against marginalised groups in preventive-care targeting. Safeguard: annual independent algorithmic audit with disaggregated performance metrics by district / caste / gender; published; correctable.
- • Risk: Commercial misuse of health data. Safeguard: statutory bar on sale, licensing, or advertising use; no insurer / pharma access.
- • Risk: Governance capture of KHRA. Safeguard: civil-society members on board; retired-judiciary Chair; sunset clause if quarterly transparency reports lapse for 2 consecutive quarters.
Dependencies
- • Karnataka Digital Health Records Act passage (Year 1) — Vol III App I Sec. I.4.
- • Data-centre + DR site procurement + endpoint hardware (State Manufacturing Catalog where possible).
- • Integration with state schemes (Suvarna Arogya Suraksha Trust + others); workforce training for Family Health Teams + ASHA workers.
- • Vol I Ch 6 (AI-Use Register, Citizen Data Trust, Grievance Justice Authority); Vol II Ch 8 Sec. 8.8 (UMRS narrative); Vol III App J Sec. J.3 (CAPEX).
H.019 — HEALTH — Family Health Teams (PHC as the default)
H.020 — HEALTH — Essential Drugs & Consumables Supply Chain (TNMSC-style)
H.021 — HEALTH — 24/7 Emergency & Trauma Care Network
H.022 — HEALTH — Cashless Care for the Poor (Simplified)
H.023 — HEALTH — Maternal & Child Health 1000-Day Mission
H.024 — HEALTH — NCD Prevention (Diabetes, BP, Cancer screening)
H.025 — HEALTH — Mental Health First Response
H.026 — HEALTH — Telemedicine + e-Pharmacy (regulated)
H.027 — HEALTH — Hospital Quality & Infection Control
H.028 — HEALTH — Public Health Surveillance & Outbreak Response
H.029 — HEALTH — Diagnostics Access Guarantee
H.030 — HEALTH — Drug De-addiction and Harm Reduction
H.031 — HEALTH — Health Worker Training & Career Path
H.032 — HEALTH — Medical Equipment Maintenance Corps
H.033 — HEALTH — Nutrition Kitchens for Vulnerable Groups
H.034 — HEALTH — Clean Water + Sanitation for Health
H.035 — HEALTH — Digital Health Record with Consent
H.036 — HEALTH — Citizen Health Dashboard & Grievance
← Appendix H — Program Atlas · Appendix H — Program Atlas →
This is a chapter of The People's Model manifesto for Karnataka — published in full for public review. Every claim may be challenged: write to [email protected].