AP, TS need incremental improvement

The NITI Aayog recently released “Healthy States - Progressive India” report. According to data there is a wide gap between Telangana State and Andhra Pradesh, particularly with regard to performance robustness. This is more glaring when the data is compared to the two regions before and after the bifurcation.

The report states that Telangana fell by one position in the ranking from base year (2014-15) to reference year (2015-16). Telangana scored 54.94 in the base year, but notched up to 55.39 in the reference year. It has seen a 0.45 incremental change, where its overall performance in the base year is ranked at 11th position, but dropped to 12th rank in the reference year 2015-16.

In contrast, Andhra Pradesh notched up one position in the ranking from eighth in the base year to seventh in the reference year and scored to 60.16 in the reference year from the score of 57.75 in the base year with incremental change of 2.41.The index has been prepared by comparing the performance between base and reference years.

According to the report, nine larger States, including the two Telugu-speaking States, have been grouped as achievers with a significant scope for improvement; both Telangana and Andhra Pradesh have also registered positive incremental change.

The health score of Telangana has been increased by 0.45 points over the time period, while Andhra Pradesh has been increased by 2.41 points. In incremental performance, both Telugu states Telangana and Andhra Pradesh have displayed a positive incremental change in index score with 12 and seven ranks respectively.

According to report, among the least improved States in terms of incremental progress, Telangana is the ‘least improved’ and Andhra Pradesh has been categorised as ‘moderately improved’.

They have showed gains in improvement of health outcomes from base to reference year in indicators such as Neo Mortal Rate (NMR) (61.53 to 64.80 per 1000 live births), while Andhra Pradesh (NMR) (6.45 to 61.53 per 1000 live births), in Telangana under U5MR (37 to 34 per 1000 live births) and in Andhra Pradesh U5MR( 26 to 24 per 1000 live births), Total Fertility Rate (TFR) in Telangana and Andhra Pradesh are (6.1 to 5.1) (5.6 to 6.2) respectively, the health index in case of full immunization both Telugu States are shown little improvement, while in Telangana it is (100 to 89.1 percent) and in Andhra Pradesh (97.6 to 91.6).

Institutional deliveries (public and private) can play a substantial role in addressing maternal and infant mortality and morbidity. In respect of institutional deliveries there is much improvement in both Telugu States with (59.2 to 85.4) in Telangana and (53.1 to 87.1) in Andhra Pradesh.

The report also notes Telangana has made notable progress in the proportion of institutional deliveries; but it takes the longest for the state to transfer funds to the implementing agency.

As per the report, Telangana is the slowest, where it takes an average of 287 days for funds from the State treasury to reach the implementing agency.

The report also revealed that Telangana also has a high proportion of vacant specialist positions in district hospitals with 55 percent unfilled.
The State also performed “very poorly” on first trimester Antenatal Care (ANC) registration and the state saw a decline in registration of births by 5.4 percent, while Andhra Pradesh is fared better with 10 percent increase.

It further said that among the smaller states and UTs, less than 25 per cent positions of Auxiliary Nurse Midwife (ANM) were lying vacant at sub-centres, including Telangana (29 per cent) between the base year (2014-15) and reference year (2015-16).

Sex Ratio at Birth (SRB) is an indicator which measures the number of girls born for every 1000 boys in an year reflects the extent to which the number of girl children born by selective abortions. Under this parameter both Telugu States have 918 girl children for 1000 boys both in base year and reference year, it means in both states the SRB is stagnated and lower than seven larger States.

The report advised that there is need for both Telugu States to effectively implement Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act 1994 and take appropriate measures to promote the value of girl child.

According to the National Health Policy 2017 establishes a target of 85 percent above for treatment success rate of TB cases, which was achieved by both Telugu States with 123 percent in Telangana and 145 percent in Andhra Pradesh.

According to the National Family Health Survey (NFHS)-4 data on average out-of-pocket (OOP) expenditure per delivery in public health facility is considered as a proxy indicator for overall OOP expenditure.

As per the report, the average OOP expenditure per delivery in public health facility for Larger States is Rs.3,080, for Smaller States it is Rs. 5,170, and for UTs it is Rs. 2,995. The average OOP expenditure in Telangana is Rs.4020, while in Andhra Pradesh it is Rs.2138.

Given the number of health interventions targeting pregnant women by both States, to ensure free delivery at public health facilities, the Telugu States should aim to reduce the OOP expenditure.

The functioning of 24x7 PHCs is important for providing a basic package of health services to the community and for reducing the workload at higher level facilities, the report stated that Telangana need to substantially increase the number of functional 24x7 PHCs in order to reach the required target and similar to Andhra Pradesh also, noted the report.

It further stated that functioning of CCU is important for the availability of specialized cardiac care services at the district level and for reducing the workload at tertiary level facilities, Telangana was also among the states, which do not have a single district with functional cardiac care unit at public hospitals, while Andhra Pradesh is ahead of Telangana by establishing CCUs in 53.9 percent.

The report, however, mentioned that Telangana has achieved 100 per cent registration of births. However, the report concludes that both Telugu States needs incremental improvement in health parameters.

By Gudipati Rajendera Kumar