Sunrise Andhra Pradesh 2029 Health and Nutrition Draft Sector Paper Dec 2015 Submitted by

83 Pages·2016·3.98 MB·English

by  Krishna C Deepala

April 2008
A Newsletter from Ernst & Young

Vision – Sunrise Andhra Pradesh 2029
Health and Nutrition

Draft Sector Paper

Dec 2015

Submitted by:
Ernst & Young LLP (EY)

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Health & Nutrition Sector Paper

Contents

Contents ................................................................................................................. 2
List of Tables ........................................................................................................... 3
List of Figures .......................................................................................................... 4
1. Executive Summary ........................................................................................... 8
2. Sector Overview .............................................................................................. 12
3. As-Is Assessment— Comparing with Global and National Indicators ...................... 15
4. Relevant leading practices and emerging trends................................................. 48
5. Key Ideas and Strategy .................................................................................... 53
6. Monitoring and Evaluation ................................................................................ 69
7. Budgetary Plans .............................................................................................. 74
8. Annexure-1 ..................................................................................................... 77

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List of Tables
Table 1: Vital health Indicators comparison Matrix ................................................... 18
Table 2: Demographic Profile Comparison ............................................................... 19
Table 3: Reproductive health and fertility in AP (Marriage and fertility (FY 2015-16) 19
Table 4: Maternal Health Profile of AP ..................................................................... 20
Table 5: Status of MCH Indicators in Andhra Pradesh ............................................... 20
Table 6: Showing status of TB in AP ....................................................................... 27
Table 7: HIV prevalence in AP ................................................................................. 27
Table 8: Health infrastructure in AP(Source: NHM PIP- 2014-15) ........................... 32
Table 9: Accessibility and Availability of health facility (Sources: NHM PIP-2014-15) . 33
Table 10: Human resource in AP (Sources: NHM PIP- 2014-15) ................................. 34
Table 11: Budget for Health & Family Welfare department (All fig. Cr) ....................... 39
Table 12: Budgetary analysis .................................................................................. 40
Table 13: HALE and Health expenditure (% of GDP) ................................................. 41
Table 14: Key Global Health Indicators ................................................................... 41
Table 15: STATE-WISE STATISTICS OF AYURVEDA AS ON 1.4.2010, Ministry of AYUSH
............................................................................................................................. 44
Table 16: medical tourism enablers ......................................................................... 67
Table 17: Key priority Indicators ............................................................................. 70
Table 18: CORE Dashboard indicators tracked by GoAP .......................................... 72
Table 19: Budget estimate for CAPEX ....................................................................... 75
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List of Figures
Figure 1: Showing demand and supply side consideration .......................................... 15
Figure 2: Global comparison - HALE V. Life Expectancy ............................................ 16
Figure 3: AP: IMR / MMR Across State ..................................................................... 21
Figure 4: Showing the diseases diagnosis profile ...................................................... 21
Figure 5: Status of Anaemia in Children and Women ................................................. 22
Figure 6: Trend of Malnutrition across surveys ......................................................... 24
Figure 7: Immunization trend analysis ....................................................................... 25
Figure 8: Comparison of Malaria Status across states ............................................ 26
Figure 9: Showing the trend of HIV cases ................................................................. 28
Figure 10: Showing time trend data of geriatrics ...................................................... 29
Figure 11: Disability status in Andhra Pradesh ......................................................... 30
Figure 12: Disability comparison from India (Source: Census 2011) ........................... 30
Figure 13: Showing 108 Ambulance locations across state ....................................... 31
Figure 14: utilization of NTR scheme ....................................................................... 36
Figure 15: Comparison of AP RTA with India RTA time trend status (Source: India stats)
............................................................................................................................. 38
Figure 16: Speculated growth of HALE in AP ............................................................ 41
Figure 17: Health Expenditure as a share of GDP in India and OECD countries ............ 43
Figure 18: SWOC - Health in AP ............................................................................... 46
Figure 19: Sustainable Health Ecosystem ................................................................ 53
Figure 20: Sunrise Andhra Vision 2029 – Key Strategies Framework ......................... 54
Figure 21: Nutrition - intervention ............................................................................ 56
Figure 22: Emergency response and trauma care system .......................................... 60
Figure 23: Integrated health surveillance system ..................................................... 61
Figure 24: Showing strengthening of information environment through ICT .................. 62
Figure 25: Challenges for growth of Bio-medical Industry .......................................... 65

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List of Abbreviations

AIDS- Acquired Immune Deficiency Syndrome
ALS- Advance Life Support
ANM-Auxiliary Nurses Midwifes
ASHA- Accredited Social Health Activist
AYUSH- Ayurveda Yoga Naturopathy Unani Siddha and homeopathy
BCC- Behavior change communication
BLS- Basic Life Support
BPL- Below Poverty Line
CBR- Crude Birth Rate
CCE- Central Clinical Establishment
CDR- Crude Death Rate
CHC- community Health Centre
CLTS- Community Lead Total Sanitation
CPF – Central Provident Fund
DLHS- District Level House Hold and Family Survey
EU- European Union
EmOC- Emergency Obstetric Care
GoAP – Government of Andhra Pradesh
GDP- Gross Domestic Product
GSDP- Gross State Domestic Product
HALE- Health Adjusted Life Expectancy
HDR- Human develop report
HDI- Human Development Index
HIV- Human Immune Deficiency Virus
ICDS- Integrated Child Development
IMR- Infant Mortality Rate
IPCC- Intergovernmental Panel on Climatic Change
IIPS- International Institute for Population Sciences
IPHS- Indian public health standards
JCI- Joint Commission International
MDG- Millennium Development Goal
MMR – Maternal Mortality Ratio
MoHFW- Ministry of Health and Family Welfare
NCD- Non Communicable Diseases
NHM – National Health Mission
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NICU-Neonatal Intensive Care Unit
NPHCE-National Programme for the Health Care of Elderly
NRHM- National Rural Health Mission
OECD- Organisation for Economic Co-operation and Development
PCD- point of care diagnostic
PEMANDU- Performance Management and Delivery Unit
PHC- Primary Health Care Centre
RGC- Regional Geriatrics Centre
RGI-The Registrar General and Census Commissioner of India
RMHC- The Rural Micro Health Centre
RNTCP- Revised National Tuberculosis Control Programme
SEZ- Special Economic Zone
SRS- Sample Registration System
SWOC – Strength weakness opportunity and strength
TB- Tuberculosis
TFR- Total Fertility Rate
UNDP- United Nations Development Programme
U5M- Under5Mortality
WHPP- The Workplace Health Promotion Programme
WHO – World Health Organisation

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Executive Summary

Health & Nutrition Sector Paper

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1. Executive Summary

1.1 The Health Vision
The state has committed itself to achieve the status of one of 3 best states in the country by 2022
and one of the 3 best states in the world by 2029. This means that emerging as a globally
competitive state by sustaining human development and inclusive growth through better
governance and building a knowledge economy. Towards this vision 2029, the state puts forth its
sectoral strategy through each of its sector papers, such as this paper on ‘health sector’. The
strategies are well aligned to the ongoing Social Sector Mission agenda of the state and lays out
plans to monitor progress beyond the Mission period.
However, in the context of health sector, the ramification of the State’s vision needs to be
elaborated and understood further. Therefore, the State has envisioned building a healthy
society by developing a sustainable ecosystem to universalize quality health and nutritional
services that is accountable, effective, efficient, equitable and technologically appropriate.
While, there are 100 core indicators defined by the WHO and there are many more operational
indicators, the gold standard for holistic and comprehensive evaluation health status
internationally used to rank and compare the countries/states is Human Development Index (HDI)
and the Healthy Adjusted Life Expectancy (HALE). Therefore, the state’s vision for health sector
is defined as achievement of HDI of 0.9 and HALE of 64yrs by 2029.
1.2 The Challenges to the Vision
Historically, Andhra Pradesh (AP) has always led the country by example as regards the health
agenda. It was the first State in the country to formulate and adopt the State Population Policy
in 1997, with a resolve “to improve the standard of living and quality of life”. The Rajiv Arogya
Shri was the first health insurance program adopted by a state to increase access to tertiary care.
Today, the same program has extended and today stands re-christened as ‘NTR Vaidya Seva
Scheme’ (INR 74,000 lakh, ACC. 2013-14) universalizing access to healthcare for all in the state.
Similarly, the state has made significant progress in terms of its maternal health, with a reduction
of MMR from 134 per 100,000 live births in 2007-09 to 92 in 2013.

However, high neonatal mortality despite the increase in institutional deliveries; 63% burden of
anaemia among women and nutritional insufficiency contributing to 80% of infant deaths has
remained a cause of concern. Given the vision 2029 for health, greater challenge for the state is
to leapfrog and gain a HDI of 0.4 points and a HALE of 6years in the next 15years from the
current HDI of 0.485 and HALE of 58years. This becomes additionally contextual in case of AP,
which is witnessing stagnation in its population, thereby seeing a changed demographic profile of
growing number of adult and old age population in an urbanized environment. This potentially has
triggered the emergence of non-communicable and life diseases.
1.3 Key Ideas and Strategy
Cognizant of the demand, the state has planned to focus holistically on adoption and provision of
healthy productive life style that is people centric, irrespective of the ownership/ management
mechanism for delivery of such services. Therefore, the key strategies to realize the Vision 2029
for health and nutrition sector are to concentrate on:
1. Institutional strengthening of Health and Nutrition Services
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