Health sector reforms - Andhra Pradesh :Health sector reforms - Andhra Pradesh By Dr.V.Sudhakaram


Introduction :Introduction formed on 1st November, 1956 fifth largest State accounting for 8.4 % of India’s territory fifth most populous state with a Population of 75 crores the third best investment climate in the country; the fourth-lowest corruption level among Indian states The first state to undergo HSR in India


Financial aspects :Financial aspects AP's economy grew at 7.2% during 2006-07 -- the fourth consecutive year of 6% plus growth. poverty headcount ratio stands at 16%, compared to 23% for India http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:20970681~pagePK:141137~piPK:141127~theSitePK:295584,00.html#Ongoing_projects Public health expenditure 17.5% private exp.82.5% Per capita health exp.Rs.1039.00 Public Rs.182.00and pvt.Rs.857.00 (NHA 2001-02)


Health indicators :Health indicators


Public Health Infrastructure(Source:RHSbulletin,March2007,M/O H&FW,GOI) :Public Health Infrastructure(Source:RHSbulletin,March2007,M/O H&FW,GOI)


Public Health institutions in the statesourse:http://mohfw.nic.in/NRHM/State%20Files/ap.htm#hp :Public Health institutions in the statesourse:http://mohfw.nic.in/NRHM/State%20Files/ap.htm#hp PHC CHC Dist. Hospitals Medical colleges AYUSH hospitals AYUSH dispensaries 1924 481 20 32 20 1096


Why HSR? :Why HSR? In the Indian constitution health is state responsibility The Indian system is complicated ,as the major tax resources are controlled by central Govt. major responsibility was on states. ( http://www.idrc.ca/en/ev-118491-201-1-DO_TOPIC.html.The international development research centre) Many states had to recourse health system project loans from World bank for carrying HSR of which one of the key policies was to raise public spending from the low levels


Go.AP 1999, Vision 2020 seven-point set of priorities for health sector reform: :Go.AP 1999, Vision 2020 seven-point set of priorities for health sector reform: providing universal access to primary healthcare; encouraging private investment in tertiary healthcare; focusing on specific programmes to promote family planning; focusing on improving health levels in disadvantaged groups and backward regions; ensuring a strong prevention focus; enhancing the performance of the public health system; and formulating a state (IEC) programme to broadcast information on preventive healthcare


Reforms underway in health sector :Reforms underway in health sector (I) Reorganization and restructuring of existing government health care system (II) Changes in health system organisation, delivery and Management (III) Changes in financing methods (IV) Reforms related to human resources (V) Involving community in health service delivery and Provision (VI) Reforms to quality of care


Reorganization and restructuring of existing government health care system :Reorganization and restructuring of existing government health care system Establishment of Andhra Pradesh Vaidya Vidhana Parishad Strengthening of referral institutions and fixing of service norms Improvement in drug supplies Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC) Strengthening of PHCs as 24-hour MCH centers Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres


Changes in health system organisation, delivery and Management :Changes in health system organisation, delivery and Management Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals Provision of free travel bus passes to pregnant women for antenatal check ups Public Private Partnership


Public private partnership :Public private partnership Management of Urban Health Centers by NGOs, Under the World Bank assisted Andhra Pradesh Urban Slum Health Care Project (APUSHCP), 192 urban health centers (UHCs) have been established in 74 municipal towns in 21 districts covering 1848 slums.


Changes in financing methods :Changes in financing methods Sukhibhava Scheme User fees


Reforms related to human Resources :Reforms related to human Resources Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department


Involving community in health service delivery and Provision :Involving community in health service delivery and Provision Women Health Volunteers Scheme


Reforms to quality of care http://mohfw.nic.in/NRHM/State%20Files/ap.htm#hp :Reforms to quality of care http://mohfw.nic.in/NRHM/State%20Files/ap.htm#hp Performanceindicators for grading the PHCs Performance rating of secondary hospitals


HSR,The good :HSR,The good Success of 108 Success of Rajiv arogya sree Success of NRHM?


HSR,The bad? :HSR,The bad? HSR has not been able to arrest the decline in the share of health spending within total government spending. The Indian system is especially complicated, as the larger tax resources are controlled by the central government but the major responsibility for health-care spending is bestowed on the states (http://www.idrc.ca/en/ev-118491-201-1-O_TOPIC.html.The international development research centre)


Expenditure on M & PH & FW of Andhra Pradesh http://rbidocs.rbi.org.in/rdocs/Publications/PDFs/74942.pdf (Reserve Bank of India) :Expenditure on M & PH & FW of Andhra Pradesh http://rbidocs.rbi.org.in/rdocs/Publications/PDFs/74942.pdf (Reserve Bank of India)


CAPITAL EXPENDITURE ON MEDICAL AND PUBLIC HEALTH (AS % OF TOTAL EXPENDITURE)(Reserve bank of india,RBI bulletin,various issues) :CAPITAL EXPENDITURE ON MEDICAL AND PUBLIC HEALTH (AS % OF TOTAL EXPENDITURE)(Reserve bank of india,RBI bulletin,various issues)


HSR,The bad :HSR,The bad The Commission on Macroeconomics and Health (2001) also concluded that user fees end up excluding the poor from essential healthservices abandon user fees- Millennium Project’s recent Report to the UN Secretary General (2005) titled “Investing in Development – A Practical Plan to Achieve the Millennium Development Goals”


Who can bring change? :Who can bring change? A recent report on human resources for health brought out by Harvard University’s Global Equity Initiative (2004) argues that it is people – health workers alone – who can produce an effective health system and deliver good health


…..Thank you :…..Thank you