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 <>

Reduction in the fertility rate through

1. Promotion of use of spacing methods: minimum spacing of 2 years before first birth and 3-5 years between 1st and 2nd births.
2. Promotion of use of terminal methods with concentration on couples with 2 children and above.
3. Increasing the use of male contraceptive methods.

Reduction in MMR through

1. 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
2. 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.
3. Improved referral systems for emergency obstetric care.
4. Increase in accessibility to quality services for medical termination of pregnancies and for treatment of reproductive tract infections.

Reduction in IMR/CMR through

1. Eradication of polio cases and deaths by 1998.
2. Elimination of neo-natal tetanus by 1998.
3. Elimination of measles deaths by 1998.
4. Sustained universal immunization of children.
5. Reduction in the incidence of diarrhoeal deaths by 75% and in cases by 50% by 2000 A.D.
6. 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.

Primary Health Care Facilities
Service Facility	Number
Primary Health Centres	1,386
Sub Centres	10,568
Mobile medical units	45
Urban filaria control units	28
Filaria clinics	4
Filaria survey units	2
District TB Centres	24
Leprosy control units	104

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.

Secondary health care facilities
Service facility	Number
District Hospitals	20
Area Hospitals	56
Community Health Centres	117
Others (MCH)	8
C.D. Hospitals	2
Civil Dispensaries	25
Total	228
Bed Strength
District Hospitals	5250
Area Hospitals	5600
Community Health Centres	4640
Speciality Hospitals	500
C.D. Hospitals	324
All institutions’ beds	16314
Staff
Medical	1900
Nursing	4199
Paramedical	2519
All others	2733
Total	11351

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.