Health, health infrastructure and health policy of Andhra Pradesh

Health, health infrastructure and health policy of Andhra Pradesh

Andhra Pradesh is the fifth largest state in India, with an area of nearly 278,000 square kilometers, accounting for 8.4 percent of India’s territory. It is also the fifth most populous state with a population of 76 million. Administratively, the state is divided into 23 districts, 79 revenue divisions, 1,123 mandals (cluster of villages), about 27,000 villages and 264 towns. Over 75 percent of its land is covered by river basin. The economy of the State is largely dependent on agriculture.   Both the public and the private sector provide Indian traditional medicine, e.g. Ayurveda and Homoeopathy. However allopathic medicine is the dominant system of medicine in both sectors.

The Department of Health, Medical and Family Welfare (DoHMFW) was set up in 1922 as the nodal agency for delivery of primary and secondary health care to the people of the State. Primary objectives of DoHMFW are

  • to provide quality, accessible, equitable, affordable and guaranteed health services to the poor, both in rural and urban areas andHealth, health infrastructure and health policy of Andhra Pradesh
  • facilitating, partnering and providing regulatory frameworks for private sector and civil society health services.

The existing health system in Andhra Pradesh is very complex and has multiple entities coordinating with one another on issues related to health service delivery. The Department Health, Medical and Family Welfare consists of ten organizations namely

  • Andhra Pradesh Vaidya Vidhana Parishad,
  • Andhra Pradesh Health Medical Housing and Infrastructure Development Corporation,
  • Andhra Pradesh State AIDS Control Society,
  • Commissionerate of Family Welfare,
  • Directorate of Health Services,
  • Directorate of Medical Education,
  • Institute of Preventive Medicine,
  • Andhra Pradesh Yogadhyana Parishad,
  • Drugs Control Authority and
  • Ayurveda, Yoga, Naturopathy, Unani, Siddha (AYUSH).

The department also oversees the following autonomous bodies: Sri Venkateswara Institute of Medical Sciences (SVIMS), NTR University of Health Sciences, MNJ Cancer Hospital and Andhra Pradesh Aromatic Plants Board. With the inception of the Andhra Pradesh Health Sector Reform Programme, the Strategic Planning and Innovation Unit (SPIU) and State Program Management Unit (SPMU) have become autonomous bodies overseen by the DoHMFW as well.

In the public sector there are four types of service delivery units based on the levels of care provided by these units

  • Sub‐Centers,
  • Primary Health Centers,
  • Community Health Centers and
  • District Hospital

SubCenters: Sub‐center, also known as a sub‐health center, is the first contact point between the primary health care system and the community. As per the government norms, there is one sub‐center for every 5,000 people in plain areas and for every 3,000 people in non‐plain areas, e.g. hilly and tribal areas. It is the most peripheral of the service delivery, with referral system linking it to the primary health center, which caters to 20,000 – 30,000 population. A sub‐center is the most accessible health care center to the community at the grass‐root level and provides all the primary health care services. These health services include: antenatal, natal and postnatal care, immunization, prevention of malnutrition and common childhood diseases, family planning counseling and services. They also provide drugs, free of cost, for minor ailments such as diarrhea, fever, worm infestation etc. The sub‐center also carries out community needs assessment. Added to the above, the government implements several programs, both national health and family welfare related, that are being delivered through these sub‐center workers.

Primary Health Centers (PHC): The primary health center is a rung above the sub‐center in the three‐tier health system in the state. It is a basic health care unit that provides integrated curative and preventive health care to the population primarily in the rural areas, with emphasis on preventive aspects of health care. The primary health center, along with the sub‐centers, are designed to provide more effective coverage to the rural population on the basis of one primary health center for every 30,000 people in plain areas and one for every 20,000 people in hilly and tribal areas. Primary health centers are the main service delivery units of rural health services, often the first main stop for health services from a qualified doctor in the public sector for the sick. These health centers act as the first referral unit to those who are directly reported by or referred from sub‐centers for curative and preventive health care. Every primary health center has 4–6 indoor beds for patients and it acts as a referral unit for 6 sub‐centers. If the services at the primary health center do not meet the needs of the patients, they are referred to community health centers and higher order public hospitals at sub–district and district hospitals.

Community Health Centers (CHC): These are the First Referral Units (FRUs) and form the secondary level of health care provision. The community health centers are designed to provide referral health care for cases from the primary health centers and for those patients in need of specialist care who approach the center directly. There are four primary health centers under each community health center, whereas each community health center caters to approximately 120,000 people in plain areas and 80,000 people in tribal and hilly areas. The community health centers are 30‐bedded hospitals that provide specialist care in surgery and pediatrics, curative medicine, obstetrics and gynecology.

District Hospitals and higher referral care units: The district hospital is the main port of call for the district health system. It functions as a secondary level of health care which provides curative, preventive and promotive healthcare services to the people in the district. It also forms the fundamental basis for implementing various health policies while it delivers healthcare and management of health services for a defined geographic area.

 

Janani Suraksha Yojana Scheme and Sukhibhava Scheme

Janani Suraksha Yojana (JSY) Scheme and Sukhibhava Scheme Sponsored by Both Central and State Governments. These schemes were introduced on 1 November, 2005 and valid Up to April 2025. Janani Suraksha Yojana and Sukhibhava funds are being released (separately under each scheme) by the Commissioner of Family Welfare to all Teaching Hospitals, District Headquarters Hospitals, Area Hospitals, Community Health Centers, Government hospitals.

Rajiv Aarogyasri Community Health Insurance Scheme

Aarogyasri is a unique Community Health Insurance Scheme being implemented in Andhra Pradesh from 1st April, 2007. The scheme provides financial protection to families living below poverty line upto Rs. 2 lakhs in a year for the treatment of serious ailments requiring hospitalization and surgery. Nearly 330 procedures are covered under the scheme. The scheme is being implemented through Insurance Company, selected through a competitive bidding process. The objective of the scheme is to improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries and therapies through an identified network of health care providers.

Rural Emergency Health Transportation Scheme

Many studies in India and in other developing countries have conclusively shown that lack of dependable transportation facilities in the rural areas acts as a serious hindrance in the utilization of healthcare services by the rural poor, particularly for services required by the pregnant and other women as well as infants and children. Substantial improvement in utilization of institutional delivery services, and reduction in maternal and infant mortality rates can be achieved through organization of a rural ambulance service that is focused particularly on pregnant women who have to be transported to hospitals for deliveries, and on infants and children who die in large numbers due to completely avoidable and manageable conditions. Accordingly, it is proposed to organize a Rural Emergency Health Transportation Scheme which will be called briefly as Rural Ambulance Scheme in all the districts of the state (excepting the very well developed districts). The following are the salient features of the proposed Rural Ambulance Scheme.

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