Poised for progress

Telangana, the recently-formed state, is committed towards improving its healthcare scenario and embarking on several measures to improve its health indicators

By BV Mahalakshmi

From insurance to assurance, the Telangana state government led by Chief Minister K Chandrasekhar Rao is focussing on enhancing the rural healthcare system in the newly-formed state. The one-year old Telangana government is the first state to develop a hospital-specific budget, apparently a first among all the state governments. This essentially focuses on infrastructure augmentation and decentralisation of healthcare delivery. The Telangana government has also decided to increase the plan budget from 40 per cent to 56 per cent from the erstwhile united Andhra Pradesh’s allocation of 23 per cent. This move aims to take healthcare to the doorstep of the rural population.

“We believe in decentralisation of healthcare delivery in the state. At present, we have 10 districts, very soon we are planning to create more districts. Once the state forms new districts we will ensure that each district will have state-of-the-art healthcare delivery mechanism in place,” says Rao. The budget allocation costs towards hospitals revamp is about Rs 585 crores besides looking at mobile healthcare delivery which facilitates in reaching to the rural and slum population. The state government is looking at convergence of services and education as part of its improvement practices. As part of a hub-and-spoke model, the government is looking at decentralisation of medical services with ‘brand Hyderabad’ as a focal point.

The state government has now initiated steps to streamline the department and improve the quality of health services in government-run hospitals. “We would ensure that sufficient budget allocations are made to government hospitals,” says Rao. Development of public health sector is crucial as nearly 85 per cent of the state’s population depends on it, he adds further. “My government is determined to revamp the public health sector in Telangana and we are aware that the task is not easy. The government needs support and cooperation from all the stakeholders of healthcare,” he states.

“The Telangana government is committed to offer medical services at par with the private hospitals,” says Dr Laxma Reddy, Minister of Health, Telangana Government. “We realise that the government has to be a facilitator for moving forward as far as all healthcare initiatives are concerned. Going forward, the government will not only encourage more and more investments in the private sector, we are equally keen to ensure that our public healthcare system is also beefed up so that the rural and the downtrodden get the best healthcare facilities,” he adds.

For improving accessibility and availability of healthcare services on population basis, the state government is already drafting proposals for installing one urban primary health centre for every 50,000 population and one community health centre for every two lakh population. One auxiliary nursing midwife (ANM) is proposed for every 10,000 population, one accredited social health activist (ASHA) is proposed for every 1,000 to 2,000 slum population and one Mahila Arogya Samiti for 100-150 households in the state.

As on October 2014, there are 153 corporate hospitals in the state having a total bed strength of 21,891 of which there are 5,473 Aarogyasri beds. There are 73 government hospitals with 14,600 beds and 3,650 Aarogyasri beds. This takes the total strength to 226 hospitals comprising 36,491 general beds and 9,124 Aarogyasri beds. The trend is that Hyderabad is concentrated due to patient migration. “We see a huge migrant population from across 10 districts for treatment and surgeries. Hence, as a first step, we decided to upgrade the existing government hospitals by inclusion of more Aarogyasri beds,” Reddy says.

“Our motto is to ensure healthcare at every doorstep in the rural areas. For this, we must ensure that the public health centres at the base level are strengthened. We need to tackle seasonal diseases like malaria, chikungunya, diarrhoea, hepatitis etc. Obviously, we require good doctors and good supply-chain for medicines so that the rural population can avail the benefits. This includes upgradation of primary healthcare centres. They should also help create awareness among people so that they can take preventive measures. Our goal is to improve rural health,” Rao informs.

Besides, in another significant step to empower citizens with convenient access to healthcare, the Telangana government launched India’s first dedicated healthcare app for the Ministry of Health & Family Welfare, powered by Mahindra Comviva, a global leader in providing mobility solutions. The application was conceptualised by Healthcare Innovation Cell (HIC) of the Ministry of Health. This is the first dedicated app for any Ministry of Health & Family Welfare in India and it is positioned to bring a paradigm shift in the healthcare industry by making healthcare facilities more accessible. It also reflects the government’s commitment to the Digital India Initiative.

There are more than 800 government healthcare centres comprising primary health centres, community health centres, area hospitals, district hospitals and specialised centres in the cities listed by the app. The app will help the ministry to facilitate access to its initiatives, provide public health information, locate health centres and also empower the citizens to track and record their health data through the health tools. The HIC was launched by the Ministry of Health, Medical & Family Welfare with the aim to integrate a multi-disciplinary ecosystem to share and implement relevant innovations and solutions for delivery of healthcare services. The cell actively leverages social media platforms to engage with the community and discuss healthcare innovation for Telangana.

Another initiative by the Telangana government is ‘e-arogyam’, an online e-medicine centre in all the government hospitals. The main aim of this programme is to provide quality healthcare services to poor patients in the rural areas. The health department in Telangana has launched ‘e-arogyam’ centres to provide round the clock healthcare services to the patients in the rural areas. these e-arogyam health centres will be linked with district hospital online to provide 24-hour medical services to the people. The main objective of launching the e-arogyam centres is to cater to the timely needs of the patients. Using this platform the doctors in the district hospitals will be connected online for suggestions and instructions to the healthcare staff in the rural primary healthcare centres (PHCs) and community healthcare centres (CHCs). The first ‘e-arogyam’ online health centre at Jadcherla is launched on a pilot basis. Based on its success, the state government is planning to extend such online facilities to all the 10 districts in a phased manner.

Moving in the direction of better health, its MMR’s compound annual rate of decline (CAD) has been 6.4 per cent – better than the all-India average (5.7 per cent). However, there are areas of concern. The infant mortality rate (IMR) is 41 which is highest among the southern states, full immunisation has decreased from 67.1 per cent to 55.47 per cent.

A flashback into the status of healthcare in the Telangana state goes back to only four doctors in Khammam district in 1950s as the period was more into community-owned knowledge. Says Dr AP Ranga Rao, a veteran healthcare consultant, who moved into medical profession in 1966, affordability and access became more prevalent only when the state government increased the number of medical seats from 30 in 1951 to 2,500 currently from 14 medical colleges. “Medical education saw a lot of transition with commitment levels and business objectives both trying to take centre-stage,” Dr Ranga Rao opines.

“There were a lot of investors making a beeline to the healthcare segment in 1980s which also saw a mushrooming of provider-owned private funds,” he adds. All said, local quacks still rule the roost in the remote villages as 80 per cent them have a better chemistry than the unknown doctor. Is the government trying to upgrade the primary healthcare centres (PHCs) is it a wasteful expenditure? This is still a debatable question for the one-year-old Telangana state holding lot of promises to develop healthcare system across the spread of 10 districts.

A study done by Dr Ranga Rao says that while the costs of care are high, the first attempt by the state government should be to reduce inequity in physical access. Attempts have been made earlier in last decade to bridge the gap and provide universal access through different delivery mechanisms taking advantage of modern technology. The interventions were cheaper, leveraged the skills of not for profit private sector, available contemporary widely accepted technology. The programmes initiated were Aarogyasri, 108, 104 helpline, new training programmes to improve skills of village practitioners and certify them as community paramedics. They gained wider acceptance of community. Presently, the high costs of healthcare are not due to high costs of providers but due to the intent of private sector to make enormous profits in investigations and drugs. They even indulge in malpractices like unnecessary investigations etc. This is worsened by the attitude of government machinery indulging more and more in proposing and executing low priority infrastructure in healthcare to make quick money. The government could debate and discuss means and delivery mechanisms for lowering the costs of investigations and drugs.

About 22 per cent of total population i.e. 77 lakhs of the new state lives in the capital city of Hyderabad and the surrounding Ranga Reddy district. This population has access to primary, secondary and tertiary care round the clock with in a hour and at an easily accessible distance and has required transport systems in place. They are served by 2,400 specialists and 640 super specialists of various categories belonging to both government and private sector in addition to the doctors with basic qualification of MBBS.

However, as Ranga Rao points out, approximately 1.86 crore people, constituting 52 per cent of the total population, are living in 8100 villages. Access to qualified primary healthcare is beyond 5-10 km from the place they reside for 57 lakh population and it is farther than 10 km for 92 lakh population. They have to depend on the services of ANMs in the sub centres for a qualified care. In reality, this 1.86 crore population is dependent on local, uncertified, long-standing village practitioners of allopathic care. They stay within reach of the population and they are one of the community, accountable to the community and accept a deferred payment and payment in kind. Approximately, there is one such practitioner for every 1000 population. 80 per cent of them are matriculate.

Some of the initiatives to be taken up by the Telangana government include:

• Establishment of area hospitals with 100-beds covering an area of 100-125 villages by upgrading the existing hospital or new hospital. At present, there are 54 assembly constituencies where there is a need to either upgrade the existing hospitals or create new hospitals so as to ensure that there are hospital with 100 beds in all constituencies of the state. The estimated cost of this upgradation or establishment of new area hospital is expected to be around Rs 567 crores.
• In order to make most of the medical services available in each district without the need for citizens to approach Hyderabad, it is proposed to create a 1,000-bed district hospital in all district headquarters, except Hyderabad, Warangal, Ranga Reddy, Nizamabad and Khammam by upgrading the district level hospitals. The estimated cost for upgrading the district level hospitals to 1,000 beds capacity is expected to be the order of Rs 700 crores.
• It has been proposed to upgrade MGM Hospital, Warangal, and RIMS Adilabad to 1,000 bed hospitals.
• Singareni Collieries Company has been asked to set up 1,000-bed hospital at Kothagudem and another hospital in Adilabad.
• Upgradation of Osmania General Hospital and Gandhi Hospital to 2,000 beds has been proposed
• Filling up the vacant direct recruitment posts under all categories. It is proposed to create separate recruitment board for the health department.
• Transfers and posting play a vital role in spreading the services to urban, semi-urban and rural areas.
• The provisions of Clinical Establishment Act will be examined so as to collect half-yearly information from all the private hospitals on major medical service parameters such as out-patients, IP, bed strength, major surgeries done and the disease profile of the patients visiting private hospitals.