Hon’ble Chief Minister has always stressed on Real Time Governance and we have strived to bring forward the same in the Health Department as well and Information Technology becomes very important enabler in this scenario, says Dr Poonam Malakondaiah, Special Chief Secretary, Health, Medical & Family Welfare Department & Mission Director, National Health Mission, Government of Andhra Pradesh, in conversation with Gopi Krishna Arora of Elets News Network (ENN).
Q What is your strategy to deliver promotive, preventive, curative and rehabilitative public health services to the rural as well as urban population?
The Health Medical and Family Welfare (HM&FW) Department’s strategy is derived from the Hon’ble CM’s vision to make Andhra Pradesh the healthiest State in the country. He has stressed only on the curative but preventive aspects of healthcare and has included the concept of emotional well-being as key to achieve this vision of timely, accessible and affordable healthcare.
Accordingly our strategy is to strengthen the Public Health facilities with latest medical technology and best practices, rope in Private Public Partnership to scale up efficient delivery and ensure universal health coverage through programmes like NTR Vaidya Seva and Arogyaraksha. Underlying all this is the unitisation of latest information technology and data science to integrate all the information and take focused actions, real time, to bridge any gaps in delivery whether urban, rural or tribal.
Q Affordability and accessibility of healthcare services has become a serious concern for the vast majority of the population. How the department is planning to tackle this?
The Government has undertaken several innovative steps to make healthcare delivery accessible to every citizen of the State. We have a vast network of public health facilities which comprise 13 Teaching Hospitals, District Hospitals, Area Hospitals, Community Health Centres, Primary Health Centres (PHCs) and sub-centres that cater to the public across the care continuum.
In addition, flagship programs like the Chandranna Sanchara Chiktsa have mobile medical medical units that deliver primary healthcare services at the doorstep of the rural areas. In the urban areas, we have started the e-UPHCs to provide the same to all the BPL families that also have a free specialist teleconsultation consultation.
Through the PPP programmes like NTR Vaidya Pariksha, Free Dialysis Programme, e Aushadhi and Mukhya Mantri Eye Kendrams, the public is benefiting from lab services, medicines etc that has decreased the out of pocket expenditure in the State by crores of rupees over the last one year.
Q What are the challenges involved in ensuring equitable access for all citizens to affordable, accountable and appropriate, assured quality health services?
The main challenges are lack of real time data to continuously monitor the efficiency of the several programmes, feedback loop to take corrections and also lack of awareness among the public to effectively utilise all the benefits that the government has offered to the public. However, we have taken several steps that help us address these challenges by creating a Knowledge Command Centre that synthesises all this data in the real time and helps take focused actions and create awareness. This is the first time in the country that such a thing is being done. The world’s largest healthcare IT and Analytics firm Cerner is our partner in this initiative.
Q There are many programmes such as immunisation, population stabilisation, reducing infant mortality and maternal mortality. Where do you utilise the funds most?
Govt utilises the funds mostly for Reproductive & Child Health activities to reduce Infant Mortality Ratio (IMR) and Maternal Mortality Ratio (MMR).
Q What are the major initiatives taken up by the State Government to improve healthcare infrastructure especially in rural areas?
One of the major initiatives has been on making healthcare accessible to the tribal areas. For this, we have taken various steps, some of them I have just shared. Also, we have partnered with the Tata Trusts to improve the cancer care being delivered in the State. We are in the process of setting up new cancer centres in partnership with them that will not only bring quality care but affordable specialised treatment to both urban and rural areas. Our programmes like Talli bidda express and feeder ambulances have received tremendous positive response from the rural areas.
Q What are the government’s priorities under the NHM for the coming year?
The Government’s priority is to reduce the Infant and Maternal Mortality rates by 50% in the next year.
Q India’s healthcare system consists of a mix of public and private sector providers of health services. What are the challenges and opportunities involved in PPP model for health domain?
Through various PPP programs we are delivering various key health services. This has both challenges and opportunities but I can proudly say that we have seen very good outcomes and success with our PPP programmes. Lack of efficient monitoring mechanisms can lead to degeneration of quality of services. Also, the PPP models should be supportive of the business goals of the partner organisation too, failing which the partner might not be able to sustain the service level leading to public dissatisfaction.
The Department has successfully ensured that we have the right contractual, IT and financial elements in the PPP programmess that make the PPP program a win-win situation for the Government, the private partners and, more importantly the public. The proof of this is highly satisfactory scores of 90% and above that we achieve in many of these programmes in the Real Time Citizen feedback.
Q Andhra Pradesh is operating various healthcare programmes in collaboration with service providers and knowledge partners on PPP mode. Tell us about that programmes.
In the state of Andhra Pradesh, Health services are also being provided in PPP mode to ensure better delivery with quality by the service providers. Reputed National & International institutions are the Technology Partners to give technical inputs to enrich the programs. The senior state level health officers are working as Nodal officers for effective monitoring on the implementation of the programme.
Services being delivered in this mode are Talli Bidda Express, NTR Vaidya Pariksha Free Diagnostic Laboratory Services, Tele-Radiology X Ray Services, Tele-Radiology CT Scan, NTR Baby Kit, National Free Dialysis, Chandranna Sanchara Chikitsa, Mukyamanthri Aarogya Kendralu, Mukyamanthri e – Eye Kendram, Biomedical Equipment Maintenance Service, Hospital Sanitation, Security, Pest & Rodent Control, CHC Sanitation services, Hospital Linen & Laundry Services, Mahaprasthanam.
The technology partners associated with these programs are George Institute for Global Health, New Delhi, International academy of Environment & Public Health (Sulabh), New Delhi, Post Graduate Institute of Medical education & research, Chandigarh, Tata institute of Social Science, Mumbai, World Health Organization, New Delhi, Council of Scientific 7 industrial Research, Chandigarh, Quality Council of India – National Accreditation Board, New Delhi, The Energy Research Institute, New Delhi, All India Institute of Medical Science, New Delhi and Administrative staff College of India, Hyderabad.
Q Recently, NITI Aayog appreciated several practices being followed by Andra Pradesh in healthcare system, terming them as the best in the country. Tell us about e- procurement system of Andhra Pradesh.
e-Procurement of APMSIDC Indents are received from HODs i.e, Commissioner of Health and Family Welfare, Director of Public Health, Commissioner of APVVP, AYUSH, Directors of RIMS and District Collectors etc. Today, all tenders are invited through e procurement. These tenders are invited from manufacturers or authorised dealers. Emails are sent to prospective bidders and manufacturers identified through websites requesting to participate in the bid for more competition.
Also, pre-bid meeting is conducted with all prospective bidders on their queries and during this meet all the queries are discussed by presenting on the screen, and suggestions and clarifications are discussed.
As per the outcome of the pre-bid meeting, amendment will be issued duly safeguarding the requirement and ensuring more participation.
Once the tender is received, technical evaluation is conducted and evaluation reports are published on the website for bidders’ objections. Thereafter, the objections received on the technical evaluation reports are discussed in the note file and accordingly financial bids of the responsive bidders are opened.
The details of technical and financial bids are placed before BFC for its decision. BFC will be chaired by the Special Chief Secretary, and Commissioner of Health & Family Welfare, Director of Public Health, Director of Medical Education, Commissioner of Andhra Pradesh Vaidya Vidhana Parishad (APVVP), Secretary, Finance Department along with Managing Director, Andhra Pradesh Medical Service & Infrastructure Development Corporation (APMSIDC) as members.
‘All the documents uploaded by all bidders are visible on e-procurement website along with price quoted by the bidders.
Q Andhra Pradesh is the first State to declare the Universal Health Coverage. Tell us about its implementation challenges and current status.
Dr NTR Vaidya Seva Trust is committed to providing quality healthcare services by implementing various health schemes that suit different sections of the society viz, Dr NTR Vaidya Seva scheme for the BPL families, Employees Health Scheme (EHS) for the Employees/Pensioners along with their dependents, Working Journalists Health Scheme (WJHS) for the accredited journalists and their dependent family members, Amaravati Residents Health Scheme for the families located in the 29 villages of Amaravati. These schemes would cover about 90% of the population of AP; and hence the Aarogya Raksha Health Scheme has been introduced to cover the balance population. Thus, under this scheme any citizen of Andhra Pradesh can enrol by paying a meagre premium of Rs 1,200 per year per family member.
While the NTR Vaidya Seva Scheme and Amaravati Residents Health Scheme cover 1044 procedures with a cap of Rs. 2.5 lakhs per family per year; the EHS and WJHS schemes cover 1,885 procedures with a cap of Rs 2 lakh per session; the Aarogya Raksha cover 1,044 procedures with a cap of Rs 2 lakh per family member per year. The above services are extended to the beneficiaries in nearly 1,000 empanelled hospitals of both Government and Private corporate hospitals.
Though, nothing in particular has to be stated under the head of challenges that are being faced in the implementation of the above Health Schemes, it may faintly be mentioned that the implementation of the Aarogya Raksha needs wider publicity among the public to achieve its goal in toto.
Q Could you tell us about the Health Management Information System (HMIS) application software and other such IT initiatives taken up to improve health care systems?
Hon’ble CM has emphasised on Real Time Governance and we have strived to bring forward the same in the Health Department as well and Information Technology becomes very important enabler in this scenario.
There are currently 19 different data sources, both public and private that the department is synthesizing data from. The Realtime analytics that emerge from this from our Knowledge Command Centre are then disseminated through internal communication apps like Kazila to all stakeholders including District Administration, Hospitals and Private Partners.
The Core Dashboard of the CM is constantly updated with real time statuses of all the initiatives. Additionally, upon the guidance of the Hon’ble CM, we have created comprehensive mobile based apps like ANM Digi that we have provided to our ANMs to relieve them of the administrative burden and help then focus on clinical work. We are also planning on deploying Electronic Health records in all public health facilities in a phased manner. It will allow citizens to access their records within no time and with convenience.
Q What all projects are being initiated in therecent times for better health services?
Some of the upcoming programmes are in the maternal and child health areas. The Rashtriya Bal Swasthya Karyakram screening programme is about to be launched which will preventively screen 80 lakhs children for health issues. We are also working aggressively to reduce the Infant and Maternal Mortality rates through a programmatic approach, the details of which we will be sharing soon.