PRIMARY HEALTH SECTOR IN A.P.

A.P. :
A POPULATION OF 76.2 million and a population density of 277 per sq. km. (as against the national average of 324). The decadal BIRTHS growth rate of the state is 14.6 percent against 21.5 percent for the COUNTRY.

The state has 23 districts, 1127 blocks and 26,614 villages. The Total Fertility Rate of the State is 2.1; the Infant Mortality Rate is 57, and the Maternal Mortality Ratio is 195 (SRS 2001 - 03) which are lower than the National average.

The Sex Ratio in the State is 978 (as compared to 933 for the country).

The Andhra Pradesh government has launched what it calls the Rajiv Health
Mission, an over-arching health program that was launched in the State on August, 15, 2007 to dedicate three new public services to the people of the state in Public-Private- Partnership mode. These are:
(a) Emergency services through a toll-free line 108;
(b)Health Information Helpline through a caller-free line 104 and
(c) Community Health Insurance for BPL Families.

It can be seen that there are about 8 sub-Centers per PHC and about 9.6 PHCs
per CHC in AP.
That Andhra Pradesh has more than the required number Of Sub-centres (SC) but there is a shortage of more than 65 percent Community Health Centres (CHC). But, even though the number of scs is more than the required number,
We can see that Health Worker (Male) at these Sub centers is almost half of what is required.
The Situation is even worse at CHCS where there is an acute shortage of Physicians (74.8%), Paediatricians (67.6%), and Obstetricians & Gynaecologists (56.3%). The total specialists at the chcs are 66.5 percent less than the minimum number required. This clearly shows that, in addition to setting up of more chcs, more specialists would also have to be recruited for them.

Similarly, there is also a shortage in the no of nurses/midwife (25%),
Laboratory Technicians (17.3%), Radiographers (16.2%), and Pharmacist (5.8%).

World Bank’s World Development Report advocated that nurses and midwives could deliver most of the minimum essential public health and clinical services, with doctors providing clinical supervision and direct care of complex issues and complications. It suggests, as a rule of thumb, that the ratio of nurses to doctors should exceed 2:1 as a minimum with 4:1 or higher considered more satisfactory for cost-effective and quality care.

The Commission of Macroeconomic and Health (2001) also noted that many of the health care interventions provided at community level can be carried out by people other than doctors: by nurses, midwives and other paramedical staff of various degree of training.

The current doctor to nurse ratio of 3:1 and much lower doctor to paramedic ratio is clearly opposed to the conventional global norms, which advocate a doctor:nurse ratio of 1:4.

This is instructive to policies, which are allowing the mushrooming of new medical colleges within the country.

Patient-Doctor Ratio
Health being a State subject, the data in regard to doctor-patient ratio in various State Government Hospitals is not maintained centrally. The doctor-patient ratio, varies from case to case depending upon various factors like the type of disease, nature of specialization, type of patient-care required i.e. indoor/outdoor.
According to the Medical Council of India, the allopathic doctor-population ratio at present works out to 1:1722.

Multipurpose worker (Female)/ANM at Sub Centres & PHCs 13740

• Health Worker (Male) MPW(M) at Sub Centres 6327

• Health Assistants (Female)/LHV at PHCs 1564

• Health Assistants (Male) at PHCs 1814

• Doctor at PHCs 2202

• Obstetricians & Gynaecologists at CHCs 73

• Physicians at CHCs 42

• Paediatricians at CHCs 54

• Total specialists at CHCs 224

• Radiographers 140

• Pharmacist 1637

• Laboratory Technicians 1437