ABOUT US

Health, Medical & Family Welfare Department provides curative and preventive services to the people in the Rural & Urban areas of the State through the following agencies.

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GOALS

 i.                           Every person will have access to responsive basic health care and specialised health care at affordable prices.

ii.                         Women will have safe and successful pregnancies

iii.                        Infant/child mortality due to ailments like ARI and Diarrhea will be reduced drastically.

iv.                       The spread of AIDS will be contained

v.                         Communicable diseases like GE, Malaria and TB will be effectively prevented

vi.                       Families will be small and better spaced

vii.                      Equitable access to quality health care will be ensured

viii.                    Health sector will be equipped to deliver quality services for non-communicable diseases and trauma & injury cases

ix.                       Life expectancy levels will reach 68 years males and 70.6 years for females from current 62 years and 64 years respectively.

x.                         Ensuring equality and access to affordable health care

xi.                       Enhancing technical efficiency of key programs and clinical effectiveness

xii.                      Ensuring micro/macro economic effectiveness in the use of resources

xiii.                    Improving quality of care /consumer satisfaction

xiv.                    Assuring systems for long-term sustainability

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STRATEGIES

a.        Universal access to primary and secondary health care.

b.       Strengthening tertiary care in existing Government Hospitals.

c.        Focus on communicable diseases.

d.       Increasing role for Indian Systems of Medicine.

e.        Strengthening process of institutional development.

f.         Setting up self-supporting health insurance scheme.

g.        Increase community participation.

h.        Establishment of village level health workers and provide trained community health workers in all remote and tribal villages.

i.          Identify one DWCRA group leader in other villages to be trained to deliver basic health services on call basis at a rate to be fixed by the community.

j.         In the urban slums the system of link volunteers, each one catering to the basic health needs of 20 families will be strengthened.

k.       Institute a regular health camp approach where the PHC Medical Officer and his staff will hold camps in a minimum of 2 villages every week so that the population gets health care at their doorstep.

l.          Adopt a base hospital approach on a pilot basis. Base units at mandal level will not only provide for most of the medical interventions but also operate the system of mobile units fanning out to the villages thus delivering basic care at the village level and also ensuring a better referral network.

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STRATEGIES FOR PREVENTION AND CONTROL OF COMMUNICABLE DISEASES

A)  Communicable diseases have to be controlled through serious efforts by Government machinery at field level involving Non-Governmental Organisations (NGOs), Self-Help Groups (SHGs) and community. There has been improvement in tackling communicable diseases, but serious efforts have to be mounted to bring down diseases to minimum level.  This is possible only if Panchayat Raj Bodies and Municipal Bodies take effective steps for controlling mosquito breeding and supply of safe drinking water to the people.  Practical measures have to be worked-out to tackle the diseases.

B) Government has decided to appoint two High Level Expert Committees to suggest measures to control communicable diseases.  A National workshop was conducted whose recommendations are available in regard to measures to be taken to control communicable diseases.  A National Workshop is also organized by Indian Medicine Department to suggest medication and other measures required for supply of Homoeopathy medicines for containing communicable and other diseases.

C)State Level Action Plan  

Action plans are being prepared to tackle diseases like (a) tuberculosis (b) Blindness (c) Leprosy and (d) Filaria.   Respective departments will identify the problem and prepare action plans to reduce the levels of diseases by 20 percent every year.  In the coming 5 years, the diseases should be controlled to the minimum level.  These plans have to be made at the State level and later on District level plans have to be prepared.  With time bound programmes these plans have to be finalized.

D)     Training Programmes

Training programmes are also planned for all levels of staff and Non-government organizations and self-helf groups for prevention and control of communicable diseases.

AIDS Prevention and Control Programme

a) Andhra Pradesh has a population of 7 million people. As of November 2000 the State has reported 6463 HIV infections in Andhra Pradesh, out of which 67 people have AIDS. The prevalence of HIV positive is 28.5% among the attendees of STD Clinic and 2.25% among the attendees of Antenatal clinic.

b)  The State has established 28 STD clinics to diagnose and treat STD patients out of which 20 clinics are strengthened in terms of equipment and provision of medicines. The incidence of STD in the state is showing an upward trend from 17942 cases in 1996, to 22627 cases in 2001 which is more than 25%.

c)  The State Government is committed to bring awareness, knowledge and understanding about HIV/AIDS, prevention and transmission in general population and to bring about desired behavioral change of seeking information on HIV/AIDS and condom use involving NGO’s, electronic and print media, out door publicity.

d)  It is desirable to establish infective disease hospitals for the purpose of admitting HIV patients, who are not accepted socially. The possibility of utilizing the idle capacity available in the existing Government Leprosy and TB Hospitals for treatment of HIV patients by entrusting their management to Non-Governmental Organisations is being explored. Grants-in-aid can be considered to genuine and strong NGOs to run these hospitals for HIV patients.

e)It is proposed to provide the AIDS Testing facilities in all the District Head Quarters Hospitals. Necessary training will be imparted to the staff and posted to the AIDS detection centres.

f)  Training programmes also will be taken up for the Daias and RMPs who can play vital role in educating the community about the HIV and AIDS disease.

g)  Disposable syringes and needles and waste disposal system will be adopted in all the Public Health Institutions as a policy.

Strategy for System Improvements

The following steps were initiated which shall contribute to the overall improvements in the health sector.

1.   PHCs and secondary Hospitals Grading

1.       All Systems of Medicine under one roof Ayurveda, Homoeo & Unani in 64 DH, AH & CHCs.

2.       Master Health check up periodic speciality Medical camps.

3.       Blood Banks in all DH, AH & CHCs on National Highway.

4.       Health Check ups in schools and welfare hostels.

5.       Incentives & Disincentives.

6.       Affiliation for DNB (Family Medicine) in all District Hospitals.

7.       To all advanced diagnostic facility including Telemedicine to all district level through public private participation by taking the help of corporate sector.

8.       Clean & green programmes and horticulture development in all hospitals.

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HEALTH STATUS IN THE STATE

During the last few decades there is a considerable improvement in the health status of the population in the State.  Smallpox was eradicated.  There are no reported cases of Guinea Worm diseases since 1997. The prevalence of Leprosy was reduced from 124 per 10000 population in the year 1983 to 5.6 per 10000 population by October 2000.  Polio cases have gone down from 50 in 1995 to nil cases in the year 2000.  The life expectancy at birth has gone up from 45.6 in 1970 to 62.6 in 1998.  The mortality due to infectious and communicable diseases like Cholera, Gastro-enteritis, Diphtheria, Tetanus etc., has also registered a considerable decline.  The infant mortality rate has gone down from 113 per 1000 live births in 1971 to 66 per 1000 live births in 1998.  The maternal mortality rate has declined from 3.8 in 1993 to 1.54 in 1997-98.  However the sickness in the community is dominated by communicable diseases.  The major sickness continues to be due to Malaria, Tuberculosis, Diarrhoeal diseases and Acute Respiratory diseases followed by malnutrition.

Resource allocation for Health Sector

The state government has consistently increased allocations to the health and family welfare sector.   Allocations to health sector increased from about 560 crore in 1994-95 to 1500 crore rupees in 2000-01.  In other words allocations to the sector, measured at current prices, has been tripled over a period of six years.

State population policy

1.  In the 1951 census, although Andhra Pradesh had almost the same population size (31 million), the difference in population size between the two States has increased to 11 million in the 1991 census: Andhra Pradesh with a population of 66.5 million and Tamilnadu with a population of 55.8 million.  Although Andhra Pradesh has achieved decline in fertility to some extent in recent times, not withstanding low female literacy and high infant and child mortality, the State is not as favourably placed as its neighbouring States in terms of decline in fertility rates.  In fact, Andhra Pradesh has experienced the most rapid population growth amongst the four Southern States during the decade 1981 to 1991.

2.  It is clear then that the State’s programmes and strategies require review, and that there is an imperative need for the development of new policy initiatives in this area of great human and social concern.  Population policy, by definition, is a deliberate effort on the part of Government to bring about a change in the size, structure and distribution of population to a level that helps to improve the standard of living and quality of life of the people.  The policy will specify in clear, measurable and attainable terms the demographic goals to be achieved in a specific period of time as well as the interventions and new initiatives proposed to attain the goals.

3.  In 1994 International Conference on Population and Development articulated linking demographic concerns, including fertility reduction of reproductive health concerns for those affecting women. India was a signatory to this call.  The reproductive health approach must necessarily be integrated into the State’s population.  

4.  Taking congnizance of these facts, it is considered essential that population policy at State level be enunciated, which is in conformity with the overall health and population policy of the country.

5.  Many studies have indicated that high infant and child mortality rates (IMR & CMR) are directly related to higher fertility rates.  About 100 million children in the country, and 7.2 million children in the State, are in the 0.4 age group.  The CMR (1.4 age group) for the State at 22.4 is lower than the country’s (33.4).  Similarly, the IMR (0.1 age group) for the State at 66 per 1000 is also lower than the country’s 72 per 1000, but much higher than Kerala’s which stands at a creditable 13 per 1000.  Infant mortality in Andhra Pradesh has declined in the post-neonatal component, and it is neonatal causes that account for a substantial part of infant mortality in the State.  A study on the burden of disease in Andhra Pradesh reveals that perinatal causes form a significant component of burden of disease.  Interventions relating to antenatal and intra-natal care are obviously inadequate.

6.  Total fertility performance of a woman is linked to three major factors - the age at marriage, the length of marital union and the use of contraception.  Several studies have proved that there is an inverse relationship between the age at marriage and the number of children born to women, the lower the age at marriage, the higher the number of children.  The median age at marriage for females in Andhra Pradesh are 15.1 years, close to Bihar (14.7) and Uttar Pradesh (15.1), which is far from Tamilnadu (18.1 years) and Kerala (19.8 years).  Low age at marriage also influences mortality and morbidity levels of mothers and children.  In Andhra Pradesh, as per the National Family Health Survey 1992, the IMR for children born to mother < 20 years is 88 as compared to 58 for children born to mothers aged 20-29.

                        The population stabilization objectives which form part of the policy statement are

Reduction in the fertility rate through

·         Promotion of use of spacing methods: minimum spacing of 2 years before first birth and 3-5 years between 1^st and 2^nd          births.

·         Promotion of use of terminal methods with concentration on couples with 2 children and above.

·         Increasing the use of male contraceptive methods.

Reduction in MMR through

·         Increase in coverage of pregnant women with tetanus toxoid, IFA tablets and other ante-natal care from the current level of         86% to 100% by 2000 A.D

·         Increase in institutional deliveries (current level 32.9%) and domiciliary deliveries by medical and para medical personnel   and trained traditional birth attendants (current level 27.3%) to 100% by 2000 A.D.

·         Improved referral systems for emergency obstetric care.

·         Increase in accessibility to quality services for medical termination of pregnancies and for treatment of reproductive tract   infections.

Reduction in IMR/CMR through

·         Eradication of polio cases and deaths by 1998.

·         Elimination of neo-natal tetanus by 1998.

·         Elimination of measles deaths by 1998.

·         Sustained universal immunization of children.

·         Reduction in the incidence of diarrhoeal deaths by 75% and in cases by 50% by 2000 A.D.

·         Reduction in the incidence of low birth weight babies from the present level of 33% to 20% by 2000 A.D.

Fertility and Population growth

If the present trend in population growth continues, the Andhra Pradesh Population by 2010 AD will be 10 crores. There has been positive change in the demographic indicators particularly in the Total Fertility Rate (TFR).  The causes for this good performance are the all round efforts made to deliver quality services and to increase health consciousness particularly among the rural women.  The positive trends in Andhra Pradesh on comparing NFHS-2 (1998-99) (National Family Health Survey) with NFHS-2 (1992-93) are as follows:

1.       Crude Birth Rate reduced from 24.1 to 22.3 per 1000

2.       Higher order births reduced from 41.0% to 31.2%

3.       Couple Protection Rate increased from 45.3% to 59.6%

4.       Total Fertility Rate reduced from 2.6 to 2.25 per women.

5.       Women receiving ante-natal care increased from 86.6% to 92.7%

6.       Safe deliveries increased from 49.3% to 65.2%

7.       Infant Mortality Rate declined from 70.4 to 65.8 per 1000 live births

8.       Full immunisation risen from 45% to 58.7%

The Sterilisation Performance (1992-1993 to 1999-2000) has also been commendable.  The state has continued to experience decline in fertility over the past three decades.   The gains in family planning programme have been sustained over the recent years as well.

Primary Health Care

Following table gives an overview of the primary health care facilities in the state.  There is at least one PHC or a hospital in every Mandal. Sub centres are functioning at the rate of one per 5000 population in the plain areas and one per 3000 population in Tribal areas.

Secondary Health Care

Andhra Pradesh has spearheaded development of First Referral Hospital Services in the country.  Setting up of an autonomous organisation set this in motion, namely APVVP, to manage and develop First Referral Services.  APVVP was instrumental in preparation of a comprehensive project for development of middle level hospital services in the state.  Appreciating the approach by A.P., the Government of India recommended other state governments to take up similar projects.  Since then about ten states have started implementing health system projects with World Bank funding.  Today these are referred to as the “Health System Project” states.  Following table gives the present strengths after the improvements taken up in middle level hospital service facilities.

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USER CHARGES

In view of gross increase in the infrastructure facility and felt need for maintenance and sustainability of institutions it has been proposed that the institution should generate resources to deliver continuous health care. Hence a user charges framework to be adopted uniformly at District Hospitals, Area Hospitals and Community Health Centres is developed. The entire amount collected from the user charges shall be remitted to the Hospital Advisory Committee (HAC) Account and will be utilised with prior approval from H.A.C for improvement of hospital services in terms of improvement of sanitation, clean & green programme, Electricity, water & drainage, certain repairs of essential equipment and purchase of essential life saving drugs, whenever, there is shortage. However depending upon the ground reality the HAC is empowered to make suitable changes from the tariff of user charges. The outpatients and In-patients registration charges are uniform to all the patients. In case of diagnostic charges and operation charges the White cardholders are fully exempted from payment. In respect of poor patients not holding white card, the user charges may be exempted at the discretion of the Medical superintendent, if according to his/her assessment the patient is poor for which reasons are recorded.

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