Sunday, October 12, 2008


(Rajiv Arogyasri+EMRI+HMRI+Mobile Clinics).
It is the vision of the Andhra Pradesh government headed by the dynamic and peoples friendly Chief Minister Dr.Y.S.Rajasekhara Reddy to provide of Medicare and insurance cover against contagious and dreaded diseases including heart and kidney ailments to the Below Poverty Line (BPL) families in the state.
Ever since he took over the reigns of the state government, the Chief Minister has been striving relentlessly to ensure that the basic health amenities reached the poorest of the poor in the state irrespective of their caste and creed. The objective is to ensure the BPL families also enjoy the benefits of strides in medical technology and specialty healthcare facilities available in the state.
Early December, yet another health initiative was launched by the Chief Minister to induce reforms in health sector. Titled as the Rajiv Health Mission the program is supported by the DFID (Department of International Development) of the British government.
The mission provided among other benefits to the poorest of poor, funds worth Rs.360 crore for improving the health systems which deliver the health services across the state. It included:
Strengthening service delivery of essential health care,
Improving health sector governance and management
Capacity building and decentralized planning for responsive services catered to SC/ST and other deprived groups.
Building efficient financial management, procurement and monitoring systems.
In the budget for 2008-09 the AP Government has provided for Rs.450 crore for the implementation of the Rajiv Arogya Sri, rural health insurance program proposed to cover the entire State by October 2, 2008.
The Rajiv Arogyasri is the flagship of all health initiatives of the Congress government with a mission to provide quality healthcare to the poor living below poverty line (BPL) in the state by the end of November 2008.
The Government has also increased the plan allocation to Medical and health department to Rs.1315 crore including the Rs.117 crore for the health sector reforms.
They include the innovative programs like EMRI mobile clinics and ambulance service to rural poor to improve hospital deliveries and reduce infant mortality through 108 and Helpline 104 to provide “Fixed Day Health Service“.
In the 2008-09 budget the Government has provided Rs.29 crore for health care in remote and interior areas to set up two ANM training centers and provide additional new buildings for 60 primary health centres.
TheAndhrapradesh state government initially launched Arogyasri, health insurance for all as a pilot project in Mahbubnagar, Srikakulam and Anantpur districts since May 2007 and the same is now being extended to all districts to benefit 1.8 crore families who form around 30 percent of the BPL families living in urban slums and poverty ridden villages of the state.
The unique project provides free Medicare for all, besides insurance cover for critical patients. Other features of the unique health initiative were:
andhrapradesh State government to pay the premium for all Arogyasri card holders.
All BPL families become eligible in both villages and urban slums.
Insurance covers diseases like heart ailments. Nuero surgery, kidney, cancer, burn injuries including surgeries and hospitalization charges.
Several Specialty hospitals chosen to provide benefits for the Arogyasri Card holders.
White ration card with photo will provide eligibility for the scheme
Arogyasri Health care trust formed with CM as honorary Chairman.
A family with wife, husband, children dependant parents.
There is no age bar on eligibility
Any serious ailment of the beneficiary family gets entitlement and relief under insurance cover.
Even motor vehicle accidents are covered
Even kidney transplants- dialysis, radio therapy for cancer patients will be soon brought under the purview of the insurance
Each family could get Medicare including hospitalization expenses coverage worth Rs.Two lakh.
Revolving fund of Rs.FIVE crore created for the operations of the Insurance.
A Call centre set up to assist the BPL families in not only procuring the health cards but also on how to get benefit from it.
Arogyasri Healthcare Trust set up with an IAS officer as its CEO to streamline healthcare for the poor.
TheAndhrapradesh government to form a team of 72,000 Arogyamitra volunteers to guide the beneficiaries in tribal areas about the insurance benefits
The flagship program of the YSR government is now extended to all the districts in a phased manner. The program is slated to benefit all the BPL families in the state holding white ration cards.
Reviewing the program last week the Chief Minister Dr.Y.S.Rajasekhara Reddy said that 1.80 crore Arogyasri health cards will be issued by the end of October, 2008 covering all the BPL families under the scheme.
On December 5th, 2007 the Arogyasri scheme was extended to East Godavari, West Godavari, Chittoor, Nalgonda and Ranga Reddy districts covering 48.23 lakh BPL families comprising a population of 1.68 crore.
As of now the Andhrapradesh State government has brought 23.12 lakh BPL families comprising of 85.33 lakh population under the Rajiv Arogyasri and the premium amount of Rs.60 crore including the service tax @ Rs.330 per family has been paid and service is ensured for the poor in more than 78 corporate hospitals in the state.
As of December 2007 a total of 1,76,918 rural poor were provided medical check ups in 828 health camps and 15,000 were sent to referral hospitals for treatments as part of the scheme. All eligible families are being provided with Rajiv Arogyasree Bhima Health card.
By November 2008 a total of 1.82 crore insurance cards will be issued to cover 6.60 crore people (82 percent of the population) under the purview of the scheme. Such a mass coverage of poor people under a health scheme is unique, anywhere in the world.
The US Health Secretary Michael Levit who visited Hyderabad in the first week of January 08 was given a first hand information of the healthcare services in AP and the unique rural health insurance project which facilitated over 10,000 surgeries and Medicare worth Rs. 52 crore to the rural poor since its launch in five districts.
The AndhraPradesh government has also now become a partner of the EMRI program launched by the Satyam foundation with its unique toll free call number 104 and 108.
Now the EMRI services are available faster on two wheelers to circumvent the traffic jams and availability of ambulances in the vicinity of the requirement. The scheme for mobile hospitals is already in vogue in 92 remote regions and the same is being extended to more and more locations in the state.
EMRI is tied up with 842 private hospitals across Andhra Pradesh to provide medicare free of cost for the first 24 hours of admission of casualties. The tie-up with the EMRI and Arogyasree program was recently launched by the Chief Minister Dr.Y.S.Rajasekhara Reddy. An allocation of Rs.1000 crore is projected for the integrated program.
The AP government has also entered into collaboration with the Satyam Foundation to set up a Health Management and Research Institute to provide online consultation to the rural and urban poor on diseases and availability of services at locations closer to them.
The toll free number of 104 is provided where doctor received the call and heard the needs of the caller and advise him immediate requirements.
Satyam is providing software for management of the system which is made available to public to provide services which include
Information on AIDs/HIV treatment
Information on diseases and their cure
Data on hospitals and specialized institutes for diseases
Info on blood banks, organ banks etc
Availability of life saving drugs at specialized medical shops all over the state.
The Andhra Pradesh government has also launched mobile clinics to serve the rural population who were not in the reach of the hospitals and also to reach Medicare to affected population during famines, droughts, floods and cyclones.
450 mobile clinics have been launched by the government across the state to offer both general medicine and also vaccination for contagious diseases.
Other initiatives:
To begin with the state government initiated steps to regularize supply of drugs and equipments down to all the primary health centers. Secondly it initiated steps to fill up the posts of doctors (1089 posts) 2500 para-medical staff posts at all territorial hospitals. Thirdly it withdrew the user charges payable by patients in government specialty hospitals, slapped by the TDP government.
The AndhraPradesh government has also hiked the allocation for purchase of drugs for free supply in government hospitals from Rs.100 crore of 2003 to Rs.230 crore in 2007.
Every gram panchayat is allocated Rs.10,000 for Medicare including mosquito screening, clean drinking water systems.
The Andhrapradesh government took steps to upgrade the Nizam’s Institute of Medical Sciences and the Sri Venkateswara Institute of Medical Sciences on par with that of the AIIMS. Fifthly, it created 520 primary health centers to provide emergency and maternal, neo-natal care at a cost of Rs.1200 crore besides a brigade of 50,000 health volunteers to take medicare to remote villages.
Little hearts:
One of the milestones in the health sector is the government initiative to provide free heart surgeries for children below 12 years suffering with ailments including holes in the heart. On a massive scale the state government organized for mass scrutiny of such cases at the district level which threw up nearly 10,000 cases .
Since the government hospitals did not have facilities for operating infants on such a large scale, the government enlisted the support of the corporate hospitals to take up the operations. The Care Hospital, Apollo and Kamineni Hospitals have joined shoulder with the state government in this effort to ease the pain of the little hearts caused due to either hereditary deformities or during deliveries at home for lack of proper facilities.
As a right step in this direction the government has initiated steps to promote hospital deliveries of babies and to contain home deliveries to end the menace of heart ailments and also bring down the infant mortality rate in the state.
Since 2004 when it took over the Congress government has completed 5160 little heart surgeries as of October 2006
Andhra Pradesh as bagged the third position in infant mortality ratio (IMR) at 62 per 1000 births and the Nizamabad district has gone a long way in reducing infant mortality rate at 18.62 per 1000.
For the convenience of pregnant women in villages the state government has initiated a unique scheme of providing free conveyance by ambulances upto the hospitals. The scheme popular in districts as - Maatha-Shishu Rakshak - has gone a long way in reducing the infant mortality in the state. The Janani-Suraksha scheme has helped promoting hospital delivery of children with a special cash incentive to pregnant women.
The YSR government transformed the public health scenario by an equitable ratio of private- public partnership to improve the diagnostic services at all government hospital services. Besides filling up majority of vacancies for civil surgeons, specialists and lady doctors the state government also improved the faculties at the teaching hospitals.
More recently it has been involving the private enterprises in managing the diagnostics in government hospitals – setting up of X-rays, blood, urine, stool, cholesterol and ENT tests for a nominal fee. By doing so it has not only reduced the burden on the government but also provided quality service to the patients at a nominal cost. Instead of sending patients for diagnostics, it is providing every facility under the same roof.
Andhra Pradesh government has a focused strategy to tackle the endemic of HIV/AIDS in the population spiced with migrant labor of coastal Andhra districts and the gulf job seekers of telengana districts functioning as carriers of the dreaded social malaise.
The state accounted for almost one million HIV positives with around 6000 fullblooded AIDS patients. The Andhra Pradesh State Aids control Society (APSACS) had drawn up a program to spread awareness of dangers of indiscriminate sex between multi partners and need for use of condoms .
With the help of over 120 NGO’s the APSACS has taken up the awareness program on a war footing to end discriminate against children with HIV in schools and also against women with HIV in work places.
APSACS has also launched an ambitious program to promote HIV testing by all adults in the state to create a data bank. A good beginning was made in the summer session of the Andhra Pradesh Legislative Assembly with nearly 200 MLA’s besides the Chief Minister and the Speaker opting for the HIV test.
The State Government has also mooted steps to make HIV testing mandatory for registration of newly wedded couple in the state .For the first time in the history of the state the congress government has allocated funds to the tune of Rs.100 crore for the HIV/AIDS relief program. The government has also announced setting up of residential-schools-hostels for the benefit of orphan children with HIV.
In association with the Satyam Foundation the state government has also set up a helpline for HIV and AIDS victims for providing counseling and medical support at all corners of the state.
The APPSACS conducted an exhaustive campaign labeled as ASHA to spread awareness of HIV and AIDS among youth, workers and white collared employees. Two rounds of ASHA runs were organized un the state capital and the district towns to popularize safety measures including disposable razors, syringes and also condoms.
To assist the children victimized by the HIV/AID on families the state government has also launched a unique program - BALASAHAYOGA - to help children afflicted by HIV/AIDS in the society.
It is perhaps only in Andhra Pradesh that the benevolence of the Congress Government is felt in real sense. Under the relief fund the health and medical needs of the poor and those residing in remote and interior areas are made possible.
As on date the CMO has processed and sanctioned Rs.226 crore to benefit 73,000 patients and the contribution is made directly to the hospitals treating the poor patients by the state government.