Health Policy of Andhra Pradesh | APPSC State Specific Preparation Course - APPSC (Andhra Pradesh) PDF Download

Introduction

• Andhra Pradesh is the fifth largest state in India, covering nearly 278,000 square kilometers and accounting for 8.4 percent of India's territory.
• It is 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, about 27,000 villages, and 264 towns.
• Over 75 percent of the land is covered by river basins.
• The economy is largely dependent on agriculture.

Healthcare System in Andhra Pradesh

• Both public and private sectors provide traditional Indian medicine such as Ayurveda and Homoeopathy, but allopathic medicine is dominant.
• The Department of Health, Medical, and Family Welfare (DoHMFW) was established in 1922 to deliver primary and secondary healthcare.

Objectives of DoHMFW

• Provide quality, accessible, equitable, affordable, and guaranteed health services to the poor in rural and urban areas.
• Facilitate, partner, and provide regulatory frameworks for private sector and civil society health services.

Complexity of the Health System

• The health system in Andhra Pradesh involves multiple entities coordinating on health service delivery.

Organizations under the Department of Health, Medical, and Family Welfare

• There are ten organizations working within the department.

Health Sector in Andhra Pradesh

• 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
• Ayurveda, Yoga, Naturopathy, Unani, Siddha (AYUSH)

The Department of Health, Medical & Family Welfare (DoHMFW) in Andhra Pradesh oversees various entities including Sri Venkateswara Institute of Medical Sciences (SVIMS), NTR University of Health Sciences, MNJ Cancer Hospital, and Andhra Pradesh Aromatic Plants Board. The Andhra Pradesh Health Sector Reform Programme has led to the establishment of autonomous bodies like Strategic Planning and Innovation Unit (SPIU) and State Program Management Unit (SPMU) under its jurisdiction.
The public sector health care delivery system in Andhra Pradesh comprises four main types of service units:

• Sub-Centers
• Primary Health Centers
• Community Health Centers
• District Hospitals

Sub-Centers

• Sub-centers serve as the primary point of contact between the community and the healthcare system. They are strategically located, with one sub-center for every 5,000 people in plain areas and one for every 3,000 people in non-plain areas such as hilly and tribal regions. These centers offer a range of essential health services including antenatal and postnatal care, immunization, family planning, and treatment for common illnesses.
• Sub-centers play a crucial role in assessing community health needs and implementing various national health and family welfare programs. They act as the first link in the referral system, connecting individuals to primary health centers for more specialized care when needed.
• Additionally, sub-centers provide free medications for minor ailments like fever, diarrhea, and worm infestations, ensuring accessible healthcare services at the grassroots level.

Primary Health Centers (PHC)

• The primary health center (PHC) occupies a crucial position within the state's three-tier health system, positioned above the sub-center.
• Serving as a fundamental healthcare unit, the PHC delivers comprehensive curative and preventive healthcare services primarily to rural populations, with a strong emphasis on preventive healthcare measures.
• With a strategic placement alongside sub-centers, PHCs aim to ensure more extensive coverage of healthcare services for rural inhabitants.
• The establishment of PHCs follows a standardized approach, with one PHC designated for approximately every 30,000 individuals in plain areas and one for every 20,000 individuals in hilly and tribal regions.
• PHCs serve as the primary point of contact for rural communities seeking healthcare services, often being the initial destination for medical assistance from qualified doctors in the public sector.
• Acting as the initial referral unit, PHCs accept patients directly or upon referral from sub-centers for both curative and preventive healthcare.
• Each PHC typically includes a modest provision of 4 to 6 indoor beds for patient care and functions as a referral hub for up to 6 sub-centers.
• In cases where the services provided at PHCs are insufficient to address patient needs, referrals are made to higher-tier healthcare facilities such as community health centers and public hospitals at the sub-district and district levels.

Community Health Centers (CHC)

• Community health centers (CHCs) serve as First Referral Units (FRUs) and constitute the secondary level of healthcare provision.
• Their primary function is to offer referral healthcare services, accommodating cases referred from primary health centers (PHCs) as well as individuals seeking specialized care directly from the center.
• Each community health center oversees the operations of four primary health centers, thereby maintaining a network of healthcare services.
• The population coverage provided by CHCs is structured, with each center serving approximately 120,000 individuals in plain areas and 80,000 individuals in tribal and hilly regions.
• CHCs are equipped with 30 beds and function as hospitals capable of providing specialized care in various medical disciplines, including surgery, pediatrics, curative medicine, obstetrics, and gynecology.

District Hospitals and Higher Referral Care Units

• The district hospital serves as the primary healthcare facility in the district, offering secondary level healthcare services including curative, preventive, and promotive care.
• It plays a crucial role in implementing health policies and managing health services for a specific geographic area.

Janani Suraksha Yojana Scheme and Sukhibhava Scheme

• Both schemes, sponsored by the Central and State Governments, were initiated on November 1, 2005, and are operational until April 2025.
• Under these schemes, funds are allocated separately to various healthcare institutions such as Teaching Hospitals, District Headquarters Hospitals, and Community Health Centers.

Rajiv Aarogyasri Community Health Insurance Scheme

• The Aarogyasri Scheme, launched in Andhra Pradesh in April 2007, offers financial protection to families below the poverty line, covering medical expenses up to Rs. 2 lakhs annually for hospitalization and surgeries.
• Approximately 330 medical procedures are included in the scheme, which is administered through an Insurance Company selected via a competitive bidding process.
• Its aim is to enhance access to quality healthcare for BPL families, focusing on treatments involving hospitalization, surgeries, and therapies through a specified network of healthcare providers.

Rural Emergency Health Transportation Scheme

• Research conducted in India and other developing nations has consistently demonstrated that the absence of reliable transportation services in rural areas significantly impedes access to healthcare for rural populations. 
• This obstacle is particularly pronounced for pregnant women, other women seeking healthcare, infants, and children. Enhancing the utilization of institutional delivery services and reducing maternal and infant mortality rates can be accomplished by establishing a rural ambulance service.
• This service should prioritize the transportation of pregnant women to hospitals for deliveries and address preventable conditions that contribute to high mortality rates among infants and children. To address these challenges, the proposal for a Rural Emergency Health Transportation Scheme, also referred to as the Rural Ambulance Scheme, aims to be implemented across all districts of the state, excluding highly developed districts. 
• The key features of this proposed scheme include:
  • Provision of ambulance services tailored to rural health emergencies
  • Focus on enhancing access to institutional delivery services for pregnant women
  • Targeting preventable health issues affecting infants and children
  • Implementation in all districts except those well-served by existing infrastructure