Health and Nutrition

Executive Summary

Vision 2029-Sector papers


Reproductive and Child Health
Metrics Andhra Pradesh Best Performing State India
IMR 35 12(Kerala) 40
MMR 92 61(Kerala) 174
Full Immunization (%) 65.3 82.5(Kerala) 65.3%
Anaemia in pregnant women (%) 52.9 34.6(Kerala) 55%
Anaemia in children (%) 58.6% 48.5% 66%
Sex Ratio 1020 1084 940
Data Sources: SRS 2013, NFHS 4


Disease Burden
Metrics Andhra Pradesh Best Performing State India
Birth Rate 14.7 17.4 (Kerala) 19.3
Death Rate 7.3 6.2 (Maharastra) 7.3
TB 1,07,293 23,439 (Kerala) 2.2million
Malaria Cases 21,220 1,509 (Kerala) 9.7million
HIV(adult) 0.75 0.12 (Kerala) 0.27
Diabetes at NCD Clinics 35,461 13,435 (Kerala) --
Estimated Cancer cases 35,347 13,816 (Kerala) 2.5million
Data Sources: SRS 2013, RNTCP 2013, NVBDCP 2014-15, ICMR Report

In order to emerge as the most developed state by 2029, Andhra Pradesh has to ensure inclusive growth and sustainable development through better governance and by making a knowledge economy. The health vision for the state categorically mentions developing a sustainable ecosystem by universalizing quality health and nutritional services in an accountable, efficient, effective, equitable and technologically appropriate way. On the basis of international benchmarking, the evaluation system deemed best suited for measuring the health status for AP are HDI and HALE. The Sector paper identifies the health challenges that limit the state from achieving a HDI of 0.9 and HALE of 64 years, both from the demand and supply side. Alongside this, the Sector Paper presents key interventions and strategies for every challenge mentioned and align it with a detailed implementation roadmap. The baseline figures, key indicators, targets for achieving the health vision is also mentioned in the Sector Paper.

As-is Assessment

AP is amongst the states with low HDI value. Health is a major factor to be considered in improving the HDI value for the state. Some of the both demand and supply side considerations of the Health sector for the state are as follows;

  • The Total Fertility Rate and Sex Ratio for AP is better than the national average but the sex-ratio for ages between 0-5 years has been diminishing between 2001 and 2011.
  • MMR in AP is below the national level but it is far below the best performing states of Kerala and Tamil Nadu. Significant progress has been made with respect to institutional deliveries and emergency care but there still remains an inclination for emergency care and the preference of private institutions in place of the government hospitals. The IMR rates are also lower than the benchmark states and most of the neonatal and infant mortality are caused by neo-natal jaundice, low birth weight, etc.
  • Andhra Pradesh has high malnutrition levels that endanger the state with very high rates of stunting, wasting in children. Malnutrition contributes to one-third of child deaths and in case of survival, it leads to falling educational quotient, work potential along with physical and mental retardation.
  • The rate of immunization in children is not very impressive in AP with a national rank of 21st in immunization. The situation is worse in urban AP where the proportions of immunized children are lesser than in rural parts of the state.
  • Amongst vector borne diseases. The incidence of malaria is growing at5-7% annually and few districts have also reported dengue outbreaks.
  • AP has one the highest Tuberculosis prevalence in the country; with rate of prevalence being twice in rural areas as compared to urban areas. Pediatric tuberculosis is also on the rise in the state. Malnourishment results in a weaker immune system thereby making children more susceptible to this disease.
  • AP is the 4th highest HIV prevalent state in the country and sexual transmission is responsible for majority of disease transmission followed by parent to child transmission, injection use and others.
  • There is an emerging health threat from NCDs as well. The proportion of deaths caused by NCDs in India amounted to 5.8 million in 2014.
  • AP has a progressively ageing population. The dual challenges of coping with degenerative diseases in old age and equipping them enough to look after themselves requires strategies and interventions in this aspect.
  • Although there is adequate health infrastructure in AP but it remains under-utilized due to lack of skilled health professionals. There is a pressing need for skilled professionals for NCD management.
  • The state lacks adequate number of educational institutions providing quality education to healthcare professionals.
  • There is a need to improve coverage of the Health Insurance scheme and reduce the out-of-pocket expenditure of people.
  • AP needs a comprehensive data management system for the health sector to avail real time data and reduce discrepancies involved in human interface.

STRATEGIES :

(1) Institutional strengthening of health and nutritional services

  • Streamlining medical education, training and capacity building
  • Public health and hospital service management
  • Creating facilities of home based care, urban health centers and improve the human resources in PHCs, CHCs, ABVVP hospitals.

(2) Policy reform

  • Creating ecosystem for public health reform and restructuring
  • Incentivizing private sector

(3) Community participation in health and nutrition

  • Running awareness campaigns about diseases, their impact & prevention measures
  • Focus on children, adolescents & women

(4) HR reform and career Development

  • Rationalisation of cadre restructuring
  • Vertical and horizontal growth

(5) Quality Assurance and monitoring & evaluation

  • Integrated diseases surveillance and decision support system for service providers
  • IT enabled services for citizens

(6) Co-Creating clinical excellence through better partnerships

  • Smart cities and villages
  • Technology and innovation

KEY TARGETS:

Vision KPI Baseline 2019 2022 2029
Infant Mortality Rate (Per 1000 live births) 14.7   17.4 (Kerala) 19.3
Maternal Mortality Rate (Per lakh live births) 7.3   6.2 (Maharastra) 7.3
Malnutrition rate (%) ( children under 5 yrs) 1,07,293   23,439 (Kerala) 2.2million
- Stunted 21,220   1,509 (Kerala) 9.7million
- Stunted 0.75   0.12 (Kerala) 0.27
- Underweight 35,461   13,435 (Kerala) --
Anaemia among Women aged 15-49 Years (%) 60   - -
Anaemia among Women aged 15-49 Years (%) 65.3 70 80 95
 


Feedback

6/4/2017

Sanjay Gupta

Among the nutrition and health outcomes, the most important is Infant Mortality Rate (IMR). It reflects the health status, socio-economic development and the quality of life of a Country/State/Region. In this respect Andhra Pradesh has still much to achieve. The IMR has reduced from 63 (per 1000 live birth) (SRS-1997) to 41 (SRS-2013) as against the All India decline from 71 (SRS-1997) to 42 (SRS-2013). Moreover, the IMR of the State is much higher than the IMR of Karnataka (32), Tamil Nadu (21), Kerala (12) as per SRS-2013. On the nutrition front, the State has therefore introduced initiatives of Anna Amrutha Hastham (AAH) to reduce incidence of Low Birth Weight; Special care and Supervised feeding for Severely Underweight (SUW)/ Severe Acute malnutrition (SAM) / Moderate Acute Malnutrition (MAM) children under 5 years; Maarpu for making concerted efforts for convergence with allied departments and SHGs and community, apart from making efforts to improve the service delivery.