1.

Discuss the key initiatives taken by the Government of

Andhra Pradesh for ensuring healthy lives and promoting
well-being for all at all ages (Sustainable Development Goal 3) ?

The focus areas under the goal are maternal and child
health, reducing communicable and non communicable
diseases, universal access to medicines and vaccines, and
minimizing substance addiction, road traffic injuries and
deaths, and pollution related illnesses. AP has made
significant strides in improving various health indicators.
The Infant Mortality Rate has declined to below the
national average. The MMR, at 74, is much better than the
all-India figure of 122. Out of the total reported deliveries,
99% are institutional and around 94% of the children aged
1-5 years are covered under full Immunization..

Government is committed to provide end to end

cashless health care services to reduce Out- of Pocket
expenses through YSR Aarogyasri to 1.44 crore BPL
families in Empaneled Network Hospitals for 2059
procedures with a limit of Rs. 5 Lakhs per family per
annum. The Govt. will bear the entire expenditure of
treatment and provide financial assistance @ Rs.225/- per
day to the patients who undergo surgeries under Dr. YSR
Aarogyasri for the postoperative recovery period @
Rs.225/- per day subject to a maximum of Rs.5000/- per
month.

As a part of healthcare, the government plans to

implement the Nadu-Nedu programme in the health
sector in a phased manner to improve the infrastructure in
Sub Centres, PHCS and Area Hospitals by spending about
Rs. 12,000 crore to Rs. 13,000 crore on infrastructure,
equipment, diagnostics in the next three years to achieve
the goal and maintain the national-level standards in
government hospitals on par with corporate hospitals.

During 2019-20, Andhra Pradesh has allocated 5.5%

of its expenditure on health, which is higher than the
average expenditure by other states (4.5%).

Through the health initiatives implemented by the

State, the key women and child well being related
indicators like Infant Mortality Rate, Maternal Mortality
Ratio and anemia among Women shall show significant
improvement.

Ban on Liquor:

In order to improve health and hygienic conditions,

prohibition of Liquor will be implemented in (3) phases
and availability of liquor confined to 5-star hotels.
Government reduced the number of liquor shops from
4,380 to 2934. The Government has taken over the retail
trade and entrusted it to the Andhra Pradesh State
Beverages Corporation Ltd. Government also increased
the rates of liquor abnormally and also imposed time
restrictions to keep the poor people away from the
consumption of liquor. As a result, the consumption of
liquor & Beer has come down drastically.

2. Discuss Dr.YSR Aarogyasri Scheme in the state of Andhra

Pradesh ? Discuss the new initiatives taken under the scheme ?

Dr.YSR Aarogyasri Scheme is a `flagship scheme' of

all health initiatives of the state government introduced
with an aim to achieve Universal Health Coverage in the
state. Under Dr. YSR Aarogyasri scheme, the BPL
population of the state holding the white ration card or
BPL card (144.07 lakhs of families according to the data of
Civil Supplies Dept,) are eligible for the benefits. As per
eligibility criteria issued by the government, families with
an annual income up to Rs.5 lakhs are eligible. All the
dependent family members existing in the white ration
card or health card are also eligible. No premium is
collected from the beneficiaries.

The Government will bear the entire expenditure of

treatment as per the scheme guidelines. 1529 network
hospitals are empanelled and 2059 procedures in West
Godavari and 1259 procedures in the remaining 12
districts are covered under the scheme. 143 procedures are
reserved only for Government network hospitals. 138
follow-up procedures are identified for cashless treatment
for one year from the date of discharge. So far, 2,526
health camps have been conducted in tribal areas where
5,96,330 beneficiaries were screened, and 3,730 patients
were referred.

During 2019-20, 4,41,573 patients benefited under YSR

Aarogyasri.

New initiatives

1. The scheme was expanded in other states viz.,

Hyderabad,Bengaluru and Chennai.The Scheme was
successfully launched by the Hon'ble CM on 01.11.2019
with the first approval of pre-authorisations pertaining to
the hospitals in 3 cities viz., Hyderabad, Chennai and
Bengaluru. A total of 130 hospitals are empanelled
covering 716 super specialty procedures (Hyderabad-72,
Bengalur-35 and Chennai-23) 3020patients treated w.e.f
1.11.2019 to 31-03-2020.

2. The scheme was expanded to include new procedures of

treatment cost exceeding Rs.1000/-
 1000 new procedures of exceeding treatment cost
Rs.1000/- are identified for implementation of pilot
project in West Godavari from 01.01.2020. Up to
31.03.2020, 2763 patients have undergone treatment
amounting to Rs.3.91 Cr. in WestGodavari district. 200
new procedures are identified for implementation from
01.01.2020 in the remaining 12districts. Upto31.03.2020,
10,834 patients have undergone treatment amounting to
Rs.22.93 Cr. in the remaining 12 districts.

3. Nearly 67,00,000 Health Cards have been delivered to

the districts for distribution across the state.

4. Expansion of Dr.YSR Aarogyasri scheme for families

whose annual income is up to Rs.5.00 lakhs.

5. Post-operative sustenance allowance for the patients

who undergo surgeries under Dr. YSR Aarogyasri scheme

Government has decided to provide financial

assistance to the patients who undergo surgeries under
Dr.YSRAS for the postoperative recovery period @
Rs.225/- per day subject to a maximum of Rs. 5000/- per
month to the patients who undergo surgery (836
procedures) under Dr.YSR Aarogyasri. From 01.12.2019 to
31.03.2020, 1,05,702 patients have received Postoperative
sustenance allowance amounting to Rs. 72.93cr.
3. Discuss the measures for effective implementation of Dr.YSR
Aarogyasri Scheme in the state of Andhra Pradesh ?

1. To increase awareness by giving wide publicity through

the health camps, network hospitals and other IEC
activities on the existing policies.

2. To design and deploy online modules for transparent

and effective implementation of the scheme.

3. To strengthen the staff (technical and non technical) at

head office and field levels.

4. To appoint the expertise to conduct research and data

analysis.

5. To contemplate and work out the new proposals to

increase the accessibility of treatment to the patients in
rural areas.

6. Inclusion and deletion of procedures.

7. Revision of packages from time to time.

8. Social audit of the scheme.

9. To publish news articles on the success rate of the

scheme
10. Regular medical audit of the claims to find out the
unethical and fraudulent cases and to act against the
erring hospitals.

11. To conduct regular inspection of network hospitals by

the District Coordinators and officials from Head Office.

12. Regular review meetings to obtain inputs and Feedback

for revision of the policies.

4. Discuss the recommendations of the Expert Committee on

Health Reforms, headed by former Union Health Secretary K.
Sujatha Rao to strengthen the public healthcare system in the
state of Andhra Pradesh ?

The State government of Andhra Pradesh constituted an

expert committee (​the eight-member committee​) to
undertake a comprehensive review of the status of
healthcare in the State under the chairmanship of Sujatha
Rao.

The committee reviewed the healthcare programmes

currently in operation, and recommended an integrated
action plan for time-bound implementation of the
Universal Health Care (UHC) services to all citizens of the
State.
The constitution of the committee is said to be a step
towards revitalising the health system to ensure UHC
through the YSR Aarogyasri or Quality Health for All
programmes.​The expert committee suggested over 100
reforms in the medical and health sector in the state.

The Expert Committee on Health Reforms felt the need for

investing ​Rs 10,000 crore ​in the next five years to
improve facilities and increase capacity in teaching
hospitals, medical colleges and district hospitals. The
committee made this recommendation after studying the
model in Gujarat, where the government pumped Rs
15,000 crores.

The committee observed that in both Gujarat and

Tamil Naidu, there is a strong commitment to
strengthening public hospitals to reduce medical
expenditure burden on the poor by providing free
services.

The ​out-of-pocket expenditure on health ​is around

15,711 crore out of which an estimated 8,000 crore alone
was spent on medicines in the State. It was recommended
to the government for providing common medicines at
free of cost and high-cost ones at reduced prices so that
the burden on people can be reduced. The committee
further highlighted the need to fill the vacant posts of
specialists, doctors, paramedic etc in all hospitals
including Community Health Centres (CHC), Area
Hospitals, district hospitals and teaching hospitals across
the State. According to the committee observations, there
are 1005 posts of specialist cadre, 555 posts of General
Medical officers in CHC, 1840 posts of nurses, 1239 posts
of paramedics and 2793 posts of support staff vacant.

Deaths due to injuries, hypertension, heart diseases,

diabetes, cancer and chronic obstructive respiratory
disease (COPD) are dominant, especially in the coastal
districts of East Godavari, West Godavari, Krishna and
Guntur. The members of the committee highlighted that a
large number of people are impoverished due to health
issues. As many as 10 lakh families who are a little above
the poverty line are falling below the poverty line due to
health expenditures.

The committee suggested a ban on private practice by

government doctors but recommended a hike in their
basic salary.There should be a health sub-centre for every
5,000 people; village clinics for every 1,000 population
and a primary health centre for every 30,000 population.
There are about one crore people under the age of 18 years
and the government should focus on their health.

Private doctors in the State are catering to the needs of

85.85% outpatients and the government sector’s share is
just 14.15%.

In neighbouring Odisha, government hospitals are

catering to the needs of 72.25% outpatients and only
27.75% outpatients approach private doctors for
treatment, according to the data of the National Sample
Survey Organisation (NSSO) 71st round.

The Expert Committee on Health Reforms, headed by

former Union Health Secretary K. Sujatha Rao, made a
slew of recommendations to ​increase the share of
public healthcare in A.P. to at least 50% by
establishing Village Health Clinics and issuing
health cards.

Odisha’s achievement

As per the NSSO data, the government health machinery

in the other South Indian States seems to be more efficient
and is catering to the needs of a larger percentage of
outpatients.
In Tamil Nadu, the government hospitals are attending
34.45% outpatients. The percentage of outpatients being
treated in Kerala is 33.65 and Karnataka 21.35. The
achievement of Odisha in this regard is considered
remarkable.

Andhra Pradesh has the dubious distinction of standing

third from the bottom. Haryana, which is in the last place,
caters to only 9.85% outpatients. Bihar, which caters to
13.90% outpatients, stands second from the bottom.

An important recommendation of the expert committee

was revamping the primary healthcare that had been
“dismembered” with several of its functions being
entrusted to the private players.

The committee had urged the government to bring back a

system where services were integrated and the provision of
healthcare from the village level to the medical college
hospital level was seamless. The committee had
recommended establishment of Village Health Clinics
(VHCs) to work in sync with the government flagship
programme (Village Secretariats) of taking governance to
the people.
The VHCs should have trained workers who would
integrate AYUSH with Allopathic medicines to treat minor
ailments, stabilise the very sick and refer them to the
nearest public health and wellness clinic, the committee
had observed.

Health cards

The committee also recommended that every household be

issued a health card with demographic profile and details
of existing vulnerabilities. The objective was to help the
PHC doctors and paramedics to identify those who needed
more attention. In this system, the health centre would be
responsible for the health and well-being of assigned
households.