Why AP Shouldn’t Miss The Healthcare Bus

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Despite being just one year-old, Andhra Pradesh has made significant progress in sectors like Energy, Industries, Investments and Infrastructure.

However, the new state still seems to be trailing behind in human development indices and is yet to see sunrise in the social sector.

According to the SRS report of 2012, (united) Andhra Pradesh’s maternal mortality rate (MMR) stands at 110 per 1,00,000 live births against an MMR of 66 in Kerala. Meanwhile, infant mortality rate per 1,000 live births in AP stood at 41 and under 5 years kids’ mortality rate was at 43.  Clearly, Andhra Pradesh is way behind its southern counterparts and is unlikely to achieve the Millennium Development Goal (MDG) of reduction in IMR and MMR by this year end.

The United Nation’s MDGs state that India has to reduce Infant Mortality Rate to 28 and Maternal Mortality Ratio MMR to 109 by 2015. India’s current IMR stands at 41 while MMR at 190. While the target looks plausible at least to achieve it in the next two years, one cannot underestimate the percentage net contribution of the states which shape India’s IMR/MMR figures.

This means states play a key role in determining the country’s health. Given that Andhra Pradesh is a new state, it can focus on restructuring the entire public healthcare system that will ensure quality and affordable healthcare for all, by considering the changing dynamics of lifestyles and its effect on the field of medicine.

Previous Successes

(United) Andhra Pradesh has had the credit of being the first state in the country to formulate and adopt the State Population Policy in 1997, following which the Government of India formulated the National Population Policy in 2000.

The 1997 Policy Document said this “would bring about a change in the size, structure and distribution of population to improve the standard of living and quality of life”. Fertility reduction, thereby leading to population stabilization through family planning paved the way for the success of this program.

For instance: Women Self-help Groups, the strongest rural force of Andhra Pradesh, were actively involved in creating awareness about the importance of education, informing communities about the perils of early marriages and focused on empowering women by making them financially independent. Safe motherhood, encouraging institutional deliveries and child care, adopting pro-women, pro-children practices were imparted to communities from district-level to mandal and village-level.

This led to a massive decline in the Total Fertility Rate (TFR) from 2.6% as per National Family Health Survey-1 (NFHS-1) (1992-93) to 1.8% as per NFHS – 3 (2005-06). The reduction in total fertility rate also showed an impact on bringing down IMR and MMR due to drop in the number of pregnancies and of people making informed, safe choices.

However, in the last 10 years, apart from the budget allocation for health being slashed, the state’s basic primary healthcare systems and infrastructure has crumbled.

Primary Healthcare a Primary Concern

With Andhra Pradesh aiming to shape itself as a futuristic state, it is imperative that the state government does not neglect basic primary healthcare and makes considerable budget allocations to the sector every year.

One way to deal with this would be by upgrading infrastructure, releasing budget in a timely manner, standardizing diagnostic procedures, strict regulatory mechanisms, building rural clinics, and developing streamlined health IT systems, and improving efficiency through 1.5 lakh field workers including ASHA, ANMs and Anganwadi workers and SHG women in Andhra Pradesh.

Rural-urban divide through skewed development methods has put healthcare in shambles. For instance: Despite the presence of government-run Public Health Centres, Referral Units and Community Health Centres in rural areas, there is paucity of medicines, trained/specialized doctors and parademics. This compels the rural population to travel to urban centres where healthcare costs are high and mostly, unaffordable for rural people.

In 2012, Andhra Pradesh spent only 39% of the total health expenditure allotted to the sector. It is unfortunate that despite meager allocations, spending on public health wasn’t optimal.

Meanwhile, India’s total health spending accounted for only 4.0% of GDP in India in 2012, less than half the OECD average of 9.3%, according to an OECD report. Health spending as a share of GDP among OECD countries is highest in the United States, which spent 16.9% of its GDP on health in 2012.

Huge Out-of-pocket Spending

The lack of effective payment mechanisms has also led to rapid rise in healthcare costs in India. For instance: The public sector is the main source of health funding in nearly all OECD countries. But, in India, only 33% of health spending is funded by public sources, a much lower share than the average of 72% in OECD countries.

This implies that “out-of pocket costs” are exorbitantly high in India, accounting for 60% of health spending in India, higher than in any other OECD country.

Not only does this demand for effective payment system but also in designing an integrated healthcare policy system which provides safety net to the entire population in the form of insurance.

According to a World Bank report, only 5% of Indians are covered by health insurance policies. Such a low figure has resulted in a nascent health insurance market which is only available for the urban, middle and high-income populations.

This underlines the huge potential for health insurance in India. While there are regulatory mechanisms through which the government monitors insurance services, it could also recommend insurance companies to study the target group and customize policies based on a local survey. This level of attention to detail will deepen micro-insurance penetration, covering health and life. Andhra Pradesh can tap into this opportunity.

Given that India is the third largest exports of pharmaceutical products in the world, it stands the advantage of making medicines available and affordable to all. About 80% of the industry is driven by low-cost generic drugs.

Educating People on Changing Lifestyle

It is laudable that the government now has a Health and Nutrition Tracker System and also formed a State Medical Advisory Board with experts from the field. There is also a constant emphasis on shifting to a system of preventive healthcare than sticking to curative one.

This requires educating people/counseling them on how lifestyle changes can help us prevent cardiac problems, diabetes, Ashtma and BP. According to official data, East Godavari, West Godavari, Krishna and Guntur districts have a high highest number of people with BP, Ashtma and Diabetes.

It will, of course, take huge efforts from the government’s side to establish this need for change. Most people view healthy diets as being monotonous, unpalatable or unsatisfying. “Lack of time” is frequently mentioned for not following nutritional advice, particularly by the young and well-educated across the globe. Lack of willpower and motivation is the most common barrier.

That apart, the government should also focus on ensuring access to clean drinking water, toilets and sanitation. According to the World Health Organisation (WHO), if we continue at the same pace without addressing this problem, close to 2.4 billion people will be without improved sanitation in 2015.

Addressing Skill Gap, Need for R&D

On the other hand, Andhra Pradesh boasts of having been the birthplace of some of the world’s greatest doctors. However, despite being one of the first states to focus on the need for medical education, the state has not been able to able to address the skill gap in the field.

From poor quality education where its students lack field experience due to the lack of an ecosystem that mandates practical experience to the lack of proper facilities and faculty in colleges, there is a dire need to restructure curriculum and upgrade ourselves based on the changes in the field. We also need to create awareness on the plethora of opportunities for students in the field, not restricting it to just doctors/nurses.

There is also a need to focus on Research & Development in all colleges which is completely missing. This requires competitive grants from the Universities and constant support to researchers who can break new ground by publishing their works. Research on life sciences, bio-pharma, medical devices, etc is required.

One way to bolster R&D is through collaborations with foreign universities. The reason John Hopkins School of Public Health or Harvard Medical School are well-known is because of the holistic ecosystem they create for their students. So, if Andhra Pradesh decides to go for these collaborations, it is imperative to take a bottom-up approach than focus on the piece-meal model.

Since the government is aiming to be better than Singapore and has the chance to be since it is focusing on building systems from scratch, it should not forget how Singapore also ranks as the country with the most efficient healthcare systems in the world.




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