National Rural Health Mission NPCC meeting Andhra Pradesh 13 th March 2008

1. National Rural Health MissionNPCC meetingAndhra Pradesh 13th March 2008 Anil Punetha, IAS Commissioner of Family Welfare, EO Secretary to Govt. (HM&FW dept.) and State Mission Director (NRHM) Govt. of Andhra Pradesh

2. AP Profile • Estimated Population as on 1.10.2007 … 837.08 lakhs • 0-5 years children … 93.73 lakhs • Density of population ... 277 per sq km • Sex Ratio (Females/ 1000 males) ... 978 • Literacy Rate • Total … 60.47% • Male … 73.32% • Female … 50.43% • Number of Sub-centres … 12522 • Number PHCs … 1570 • Number 24-hrs MCH Centres … 800 • Community Health Centres … 167 • District Hospital under APVVP … 19 • Area Hospital under APVVP … 58 • Teaching Hospitals … 11

3. Present Scenario • Andhra Pradesh is the fifth largest State in India both in terms of geographical area and population. • As a result of various health policies and National Programs including NRHM there has been considerable improvement in the general health status of the population.

4. Achievements under Key Indicators

5. Infant Mortality Rate

6. Maternal Mortality Rate 1992-93 & 1998-99 – Estimates by IIHFW 2001-03 – SRS (2001-03)

7. Total Fertility Rate

8. Full Immunization

9. Antenatal Care visits

10. Institutional Deliveries

11. Sex Ratio

12. Life Expectancy at Birth (In Years)

13. NRHM Expected outcomes • To achieve a cure rate (TB - DOTS) of – 85% by 2012 • To reduce prevalence rate of Leprosy to – 0.43 per 10,000 by 2012 • To increase Cataract operations to – 6 lakhs per annum by 2012 (AP). • To reduce Malaria Mortality Rate to – 60% by 2012 (No deaths reported in 2006-07) • To reduce Filaria / Microfilaria rate to – 80% by 2012. * SRS (2006) ** SRS (2005) # SRS (2001-03)

14. National Rural Health MissionBefore and After

15. Strengthening of Infrastructure Facilities

16. Strengthening of Staff Position

17. Schemes / Interventions

18. State Government Budgetary allocations

19. Budgetary contribution of State Govt. for NRHM activities (Rupees in lakhs)

20. Budgetary support of the State Govt. to Health Sector (Rupees in lakhs)

21. Progress during 2007-08

22. Progress during 2007-08 (Rupees in lakhs) Note: The expr. under immunization is more than the approval due to inclusion of expr. on JE vaccine (Rs.10.48 crores)

23. Critical Gaps • Lack of adequate infrastructure and vacancies at village and sub-centre level. • Lack of infrastructure and vacancies at PHC level. • Shortage of Specialists in remote, interior and tribal areas. • Lack of adequate institutional neonatal care. • Overload on referral health facilities. • Capacity building regarding preparation of District Health Plans at different levels. • Multiple Channel of reporting causing inconvenience. • Social and cultural practices among tribal and rural population which acts as a barrier in the utilization of health services. • Lack of commitment of community leaders at grass root level.

24. Action Plan for 2008-09

25. Abstract (2008-09) (Rupees in lakhs)

26. RCH Flexible Pool (Rupees in lakhs) Contd..

27. RCH Flexible Pool (Rupees in lakhs) Contd..

28. RCH Flexible Pool (Rupees in lakhs) Contd..

29. RCH Flexible Pool (Rupees in lakhs) Contd..

30. RCH Flexible Pool (Rupees in lakhs) Contd..

31. RCH Flexible Pool (Rupees in lakhs)

32. Mission Flexible Pool (Rupees in lakhs) Contd..

33. Mission Flexible Pool (Rupees in lakhs) Contd..

34. Mission Flexible Pool (Rupees in lakhs)

35. Operating Cost of Immunization Programs (Rupees in lakhs) Contd..

36. Operating Cost of Immunization Programs (Rupees in lakhs)

37. National Disease Control Programme (Rupees in lakhs)

38. Procurement of Drugs • Budget for procurement of identified drugs, Kits and Equipments under RCH-II are not incorporated in the PIP 2008-09, since the GOI will procure and supply to the states. • However, approximate requirement for procurement of identified drugs, Kits and Equipments will be around Rs.2500.00 lakhs for 2008-09.

39. Innovations

40. Rural Emergency Health Transport Scheme • The objective is to provide transport to pregnant women, infants, children and other emergency cases. • A common Toll-free No.108 is provided for 24X7 & 365 days. • Total 502 ambulances are deployed for covering of 1,107 mandals in all over the state. • On an average time taken from call receipt for reaching hospital is 16 min. in Urban and 22 min. in Rural areas. • Total emergencies attended per day is 2,806 (97% are Medical) • In two years, REHTS has saved 20,394 lives by attending to them in the crucial Golden hour

41. Health Information Help Line (104) • It is a unique, innovative scheme implemented for the first time in India. • The main objective of establishment of HIHL is to assist the people particularly in rural & interior areas who are facing difficulties in getting access to a qualified doctor and also getting information on any health problem. • All these services are made available toll free on “104”on 24x7 and 365 days in a year to begin with in three districts viz., Anantapur, Mahabubnagar and Srikakulam. All other districts are taking advantage of this facility through 1056. • The facility was inaugurated on 21st Feb-2007 & today it addresses 14000 calls per day.

42. CUSTOMER DELIGHT Dec- 07 PAST PRESENT

43. CUSTOMER DELIGHTJan08 Performance Trends While 8 out of 13 indicators have shown improvement, the others dropped Drivers of Recent Performance Training issues and Connectivity issues. Actions to be Taken Necessary Corrective measures in concerned areas.

44. CUSTOMER DELIGHTFebruary08 N=600 Performance Trends • CD levels improved in most parameters Drivers of Recent Performance • Improved staff Performance and connectivity measures Actions to be Taken • continued efforts to improve & sustain

45. Rural & Interior area Health Services (Fixed Day Health Service) • Objective • Services for identification, diagnosis, monitoring & treatment, record keeping and referral of risk cases in a habitation is possible through a convergent, comprehensive, regular once-a-month fixed day program. • Services will be provided through a mobile health unit which will physically visit each habitation. • Benefits • Access to the needy at habitation itself, for most of the requirements • Free lab diagnosis and medication for 30% of the population with multiple vulnerabilities • 15% may need to be referred to PHCs/hospitals for further treatment • Alerts to public health officials for any outbreaks and epidemics • Savings to the targeted population in terms of access costs, diagnostics costs and treatment costs (e.g., savings of Rs 1,275 for a pregnant woman) • Diagnosis, treatment and monitoring at habitation for non-communicable / newly emerging diseases (e.g., Diabetes, Hyper-tension, Asthma/COPD) • Impact • Current mortality of MMR, IMR and child mortality can be brought down by 50% within three years • Incidence of communicable diseases can be brought down by 60% through effective community participation and planning

46. Action Taken on Sub-Group comments

47. Sub-Group meeting comments

48. Sub-Group meeting comments

49. Sub-Group meeting comments

50. Sub-Group meeting comments