SCHEMES AND PROJECTS

1.        Reproductive & Child Health Project (RCH): The ICPD, held at Cairo in 1994 set out the Reproductive & Child Health agenda to be followed by the member countries. India opted to adopt the RCH approach to population stabilization.  RCH is defined as a state where "People have the ability to reproduce & regulate their fertility, women are able to go through pregnancy and child birth safely; the outcome of pregnancies is successful in terms of maternal and infant survival and well being and couples are able to have sexual relations free from fear of pregnancy and of contracting diseases"

The Government of Andhra Pradesh has further defined the core focus areas given the demographic status of the State.  These core areas to be covered as a part of the RCH agenda are: age at marriage, spacing, institutional delivery, nutrition of mothers & children, immunisation, home-based care for diarrhoea & early detection and treatment of Acute Respiratory Infections, small family with male responsibility & RTI / STI management.

The RCH approach is followed across the projects though special funds are allocated for the RCH Programme to cover the entire State.  The districts of Mahaboobnagar & Rangareddy that show poor performance on the demographic indicators have also been covered by special sub-project.

2.        Strategic planning: AP was one of the first States to formulate the State Population Policy. The demographic goals to be achieved by the State by 2020 are clearly outlined in this document. In the vision 2020 which is the charter of the government for its future direction, the demographic indicators and their role in the overall development of the State are reflected thus highlighting the emphasis placed by the Government on health and family welfare.

The demographic goals for AP to be achieved by 2020 are to reduce the Crude Birth Rate from the 1998 figures of 2.23 to 1.3%, the Crude Death Rate from 0.88 to 0.6%, reduce the Natural Growth Rate from 1..35 to 0.7%, reduce the Maternal Mortality Rate from 1.54 to 0.5 per 1000 live births, reduce the Infant Mortality Rate from 66 to 15 per 1000 live births, reduce the Total Fertility Rate from 2.07 to 1.5 per woman and increase the Couple Protection Rate from 60 to 75%.

Elaborate consultative bottom-up planning exercise has been undertaken by the State in translating the goals into objectives, strategies and interventions at the State and the district level. A habitation level planning is also being undertaken to ensure that the goals are translated into action at the periphery.

3.        Round the Clock Women Health Centres: 285 PHCs in rural interior and backward areas have been designated as Round the Clock Women Health Centres.  Maternal & Child care services are being provided round the clock in these institutions.  The ANMs are on turn duty in 3 shifts to attend deliveries 24 hours. Specialist services of Gynecologist and Pediatrician are being provided in these institutions weekly once.  Additional facilities like phone and jeep are also allotted to improve communication and referral system for emergency cases.

4.        Sukhibhava : The percentage of institutional delivery in Andhra Pradesh is close to 50%. Untrained attendants conduct the rest of the deliveries at homes resulting in high levels of MMR (1.54/1000 live births) & IMR (66/1000 live births).

The choice of the home delivery is largely dependent on the economic status of the birthing mother.  Identifying this issue, the Govt. of Andhra Pradesh has designed a scheme called Sukhibhava to support poor women to opt for institutional deliveries.

Under this scheme, women below poverty line residing in rural area are paid Rs.300/- towards transport charges and incidental expenses if they have delivery in any Govt. institution.

5.       Strengthening Midwifery: As over a 50% of the deliveries in the State are conducted at home, it is felt necessary to strengthen the midwifery skills of the personnel who handle the deliveries at home. CIDA has proposed to sponsor a project in the State to strengthening the midwifery skill base of the State.  The project is in the offing.

6.        Intensified Mother and Child Programme: Though there are many projects & programmes aimed at reducing the MMR & IMR, the operation at the cutting edge needs strengthening. The Intensified Mother & Child Programme, as the name suggests, proposes to strengthen & consolidate the existing programmes.

Under this programme an immunisation booth will be setup in each habitation, the coordination of the ANM & the Anganwadi worker (the nutrition worker) will be strengthened & a home-based follow-up for all mother & children will be established.  The critical gaps in logistics & consumables will also plugged.

7.        Bill & Melinda Gates Programme: The B& M G through an NGO called PATH is funding a programme that aims at strengthening the routine immunisation programme by identifying & filling gaps in drugs, consumables & logistics.  Besides this, the programme is also supporting the introduction of Hepatitis-B vaccine in the State.

8.        Aarogyaraksha: Population stabilisation cannot be achieved without maternal wellbeing & child survival.  The decision of couples regarding the optimal size of family is influenced to a large extent by the confidence about child survival.

The Government of Andhra Pradesh understanding this key determinant has designed a scheme called Aarogyaraksha that provides insurance coverage to the acceptors of family planning with 2 children for the whole family for a limited period.  The objective of the programme is to increase the confidence of couples about child survival who desire to have a small family.

This scheme provides health insurance coverage for a period of 5 years to the sterilisation acceptors and their 2 children.  The coverage is to an extent of Rs.20,000/- for a period of 5 years @Rs.4,000/- per annum.  The beneficiaries are provided with facility of inpatient treatment in identified Private Nursing Homes. The scheme also includes accident insurance coverage for the children.

9.        AP Social Marketing Programme: The use of spacing methods in AP (close to 1%) is one of the lowest in the country.  The impact of spacing on reducing the MMR & IMR is well documented & accepted.

In order to increase the use of spacing methods among eligible couples in the State, a project called AP Social Marketing Programme (APSMP) is being implemented.

Besides social marketing of spacing methods, this project is also responsible for social marketing of Oral Rehydration Salts and Iron & Folic Acid tablets.  The project aims at promoting the increase in age at marriage in the State too, as the average age at marriage of the State is 17.7 years for girls which is one of the lowest in the country.

The project has developed well researched communication materials for use by the ANMs in health education & counselling.1000 ANMs in the State are being trained to undertake health education & counselling using the kit on promoting spacing, use of ORS, IFA tablets & increase in age at marriage.  Mass media is being used selectively to reinforce the messages.

Simultaneously, expanding the retailer network is enhancing the availability of the spacing methods in the intervention sites.  A cafeteria approach is being promoted giving the eligible couple sufficient scope for choice. Branded IUD insertion clinics called Vanitha clinics are being established in partnership with private hospitals to expand the access to good quality services.

10.     Andhra Pradesh Urban Slum Health Care Project: While the Primary Health Centres provide primary health care to the rural poor, the urban poor are left out without any such support.  192 Urban Health Centres are therefore setup in 74 municipalities with the objective of providing primary health care to urban poor dwelling in slums. The focus of service delivery is to provide health care to mothers and children dwelling in these slums.

The vast potential of the NGO sector is tapped by contracting 192 NGOs across the State to manage the UHCs.  All the staff of these centres are contracted by the NGO.  The rapport of the NGO with the community provides a firm community-base to the project.

Detailed mechanisms for community participation are built in by empowering the groups to handle maternal & child health emergencies using the referral transport fund and providing for governance of the UHC by the Mahila Aarogya Sanghams (community-based health groups) members.

This Project is being implemented with funding from the World Bank as a part of the India Population Project – VIII.

11.     Skill Development: AP is one of the States where sterilisation services are easily available.  Good quality services are made available through regular training of doctors on new & easier techniques of tubectomy & vasectomy. Besides this, skill development training is also given to the Medical Officers of the PHCs regularly through the State Institute of Health & Family Welfare.

12.     Computerisation: In order to ensure that all eligible mothers & children are receiving the designate services, a name-based follow-up is necessary.  The name-based follow-up becomes unwieldy to manage manually.  The Govt. of Andhra Pradesh therefore decided to computerize the recording & follow-up

The software for the programme is being developed by CMC; a Govt. of India undertaking & the project is being piloted in Suryapet Division of Nalgonda District.  On successful piloting, the computerization would be replicated in other parts of the State.

13.     Sector Reforms: In order to implement the various projects & programmes of the Family Welfare Department effectively, there needs to be reforms with sector wide implications especially in areas of workforce management, decentralisation, rational use of infrastructure, performance based funding options and logistics are warehousing. The process has been initiated by funding & technical assistance from the European Commission.