Custodian of Good Health

Praveen Prakash,Praveen Prakash, Commissioner of Health and Family Welfare, Government of Andhra Pradesh, Hyderabad, has walked the extra mile to ensure his state does well in providing healthcare to all. In conversation with Sharmila Das, Elets News  Network (ENN)

Tell us about your vision for the states health department. Tell us about your mandate.

My vision is to have a kind of public health facility that delivers quality medical care to every patient in the state. The posts of specialists in the government hospitals have to be filled. We have made one year rural service mandatory for the students who want to pursue post graduate course. This, we think, will fill the vacuum that exists in certain remote health facilities. We have massive plans for construction of own buildings particularly for Sub Centre and PHCs that are housed in private locations in rural and tribal areas. We also aim to provide free healthcare to all deserving patients, particularly pregnant women and infants.

Health is an area where there is high potential for application of e-Governance initiatives. If assessed and applied in right areas it will bring high benefits to the common man

Tell us about the e-Governance initiatives that are being taken in the healthcare department?

Health is one area which has high potential for application of e-Governance initiatives. If assessed and applied in right areas it will bring high benefits for the common man. We have massive plans to bring IT enabled services in all health facilities in the months to come. In the meantime we are looking on low hanging fruits. We linked the common service centre Mee Seva to enable timely release of birth and death certificates. Biometric attendance system is being implemented in all hospitals to ensure full attendance of all health personnel in the service of the patients. Mother and Child Tracking System (MCTS) and Health Management Information System (HMIS) are two separate web portals designed by Government of India. MCTS has the name based details of pregnant women and new born children. We have designed pre-recorded voice messages to all these pregnant women with specific messages at regular intervals. These messages contribute to the improvement in their health seeking behaviour, antenatal checkups, nutritional advices, utilisation of 108 and 104 services and birth planning to ensure institutional deliveries. HMIS is holder of health facility based performance data. We maintain them and use them for programme monitoring in the state.

According to you what are the main healthcare projects of the state that have been immensely successful and have the potential to be replicated?

We have introduced Rajiv Aarogyasri a health insurance scheme, which covers 23 million below poverty line families in the state. The annual premium for the family is borne by the Government. About 7000 registrations, 1500 pre-authorisations and `30 million in disbursements have become possible everyday, with the implementation of a robust IT tool. IT leads to transparency, and in control of fraudulent and unethical practices. It also ensures quality monitoring, financial planning and health policy planning. So far we have been able to save more than 1.5 million lives. Rajiv Aarogyasri has attracted global attention for enhancing the quality of care delivered to below the poverty line population with patient safety being the underlying theme and for the well-built IT platform. It has become a model for replication in many other states in India.

Another good project is the Emergency Health Transportation System. We forged private partnership for sharing of technology to provide emergency services all over the state. People in the state can call round the clock on a toll free number 108 to get an ambulance at their door step for transporting the patient free of cost to the nearest hospital in the shortest possible time. About 800 ambulances are being fitted with Automatic Vehicle Location Tracking System (AVLTS). About 3200 emergency cases are attended to every day in the state. In past six years we have been able to save 92,948 lives. This Emergency Health Transportation System has attracted global attention and is being replicated in many other states in India.

Third is the Health Information Help Line. The service is run through a toll free number 104 to provide health advice
and counselling to all the needy and deserving people round the clock. On an average 20,000 requests are received per day. Fixed Day Health Services is additional feature. It is to provide basic health services through a van equipped with medical personnel and equipment moving around the villages within a radius of three kms from the PHCs.

What are the main challenges that you face in developing healthcare in the state? What are the solutions for these challenges?

Every day is a challenge while we are working in the healthcare sector. While providing the required infrastructure, managing the availability of human resources as per WHO standards are the major challenges. It cannot be missed to mention the behaviour and attitude of the personnel that makes or breaks the system.

What is your opinion of the medical training that is available in the state?

I would rate the trainings that are going on in the state as Satisfactory. Most of our trainings to the doctors are aimed at providing them with inputs needed to manage the public health programmes.

What steps should be taken to ensure that the government owned healthcare centres, especially in rural areas, are fully manned?

In recent times we have increased the salary structure of the medical professionals. We have increased the serviceable age till 62 years after retirement at 58 years in certain clinical specialties in teaching hospitals. Wherever we find the gap we have delegated the power to the district authorities to fill the gap through contract recruitment. Also we have partnered with private not for profit agencies on an experimental basis to run some of the PHCs in remote and rural areas.

How do you propose to bring down the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR)?

Infant Mortality and Maternal Mortality Rates are important Millennium Development Goals judging from the States progress in Health Care. We are concerned about the State IMR at 46 per 1000 live births and MMR standing at 134 per 1
lakh live births.

We are implementing the Janani Suraksha Yojana. This is a monetary incentive provided to the pregnant women to get supplementary nutrition support. The other programme is Janani Sishu Suraksha Karyakram (JSSK). This scheme is about providing free entitlements to pregnant women and the sick infants for up to 30 days after their birth. Delivery services including caesarean section, diagnostic services, drugs and consumables, diet, blood provision, transport with drop back facility is being provided.

What initiatives are you taking to take care of the essential needs of newborn children?

We are in the process of establishing Sishu Sanjeevani centres in teaching hospitals, district hospitals and area hospitals. These centres will provide essential care newborn children.

Malnutrition is another major problem. According to studies at least 36.5 percent of children below three years are malnourished in the state. Malnutrition in early childhood has serious, long-term consequences and at greater risk of disease and early death. To address this problem we are establishing Akshaya centres in teaching hospitals, district hospitals and area hospitals. Each Akshaya Centre will have trained medical officers, staff nurses and nutritionists, to provide clinical management to children with severe acute malnutrition along with required in-patient treatment and post discharge growth monitoring. The mothers will be provided with wage loss and food during the in-patient care.

In addition to the above we are also establishing the Mother and Child Care Centres in all district hospitals with 150 beds exclusively to cater to the health of the pregnant mother and the new born child. However we continue to focus on the health of the mother and child. Many programmatic steps are being taken to reduce the number of mother and child deaths.

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