Andhra Pradesh

Vision 2047
Comprehensive Health, Nutrition
and Wellness for All

FEBRUARY 2024

1
AP's health sector is doing well over multiple dimensions (I/II)

• AP significantly better on key RMNCH+A indicators vis-à-vis national average – target to achieve parity
with global benchmarks/SDG targets
– Mortality: MMR (451 for AP vs. 971 for India vs. 32 for Germany), IMR (243 for AP vs. 283 for India vs. 32
for Germany), U-5 MR (273 for AP vs. 323 for India vs. 42 for Germany, France and Australia),
– Nutrition: U-5 wasted (16.1%4 for AP vs. 19.3%4 for India vs. 0.1 for USA2), U-5 stunted (31.2%4 for AP
vs. 35.5%4 for India vs. 2.1%2 for Germany)
Overall and – Anemia: Significant reduction in anemia prevalence between 2020 and 2023 due to implementation of
RMNCH+A comprehensive Anemia Management programme:
– Anemia amongst pregnant women aged 15-49 years: Reduction from 53.7%4 in 2020 to 27%5
in 2023 (vs. India avg. of 52.2%4 and SDG target of 25% by 2030)
– Anemia amongst adolescent girls: Reduction from 60.1%4 in 2020 to 51%5 in 2023 (vs. India avg.
of 59.1%4 and SDG target of 14.2% by 2030)
– Immunization and deliveries: 100% child immunization5 and near-100% institutional
deliveries (99.6%)5

• Better than national avg. disease incidence across select Communicable Diseases
– Tuberculosis incidence significantly lower vis-à -vis national average (1745 vs. 2106 for India) – target to
Disease achieve parity with global benchmark (Australia - 66)
incidence – Vector-borne diseases (e.g., malaria) incidence rate with API<1 and ABER>10 – focus needed
on zero indigenous transmission to eliminate vector-borne diseases in line with GoI target by 20305

Note: RMNCH+A – Reproductive, Maternal, Newborn, Child Health and Adolescents, V-HC – Village Health Centre, R-PHC = Rural Primary Health Centre, U-PHC – Urban Primary Health Centre
1. Special Bulletin on Maternal Mortality in India, 2018-20, SRS Sample Survey, Ministry of Home Affairs, 2020; 2. World Bank; 3. SRS Statistical Report 2020, SRS Sample Survey, Ministry of Home Affairs,
2020; 4. NFHS 2019-21; 5. Department of Health and Family Welfare, Government of Andhra Pradesh; 6. Global TB Report 2022, WHO 2
AP's health sector is doing well over multiple dimensions (II/II)

• Adequate and responsive primary healthcare infra

– Population served per V-HC at 3,000 vs. 5,000 as per IPHS norms, R-PHC at 26,000 vs. 30,000, and U-PHC
Health
at 35,000 vs. 50,0001
infrastructure • Adequate primary and secondary healthcare workforce availability
and – ASHA workers at ~100% of NRHM target and 82% of NUHM target 2
workforce – Adequate availability of specialists in Secondary Health facilities with a vacancy of 5.4% vs. 61%
for India1

• Best-in-class service delivery models with:

– Family Doctor Programme and Medical mobile units launched in rural areas to enable
last mile reach
– Launch of Mahila Master check-ups and NCD–CD Screening 2.0 - 84% population screened with creation
Service of ABHA ID1
delivery and – Village-level health camps with specialist consultation being conducted every six months
financing • Emerging focus on digital healthcare
– AP with 35% of total tele-health consultations in India 3 and digitization of MCH records for
6lakh+ mothers and children in RCH portal3
• High health insurance coverage with >80% households 1 covered compared to national average
of 41%4

Note: RMNCH+A – Reproductive, Maternal, Newborn, Child Health and Adolescents, V-HC – Village Health Centre, R-PHC = Rural Primary Health Centre, U-PHC – Urban Primary Health Centre
1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. State Health Dossier 2021, NHSRC; 3. Socioeconomic Survey 2023, Government of Andhra Pradesh; 4. NFHS-5, 2019-21 3
 Key focus areas identified going forward

• Demographic transition with increasing share of 60+ population – projected to increase to 23% by 2047 vs.
18% for India1
Overall and • Life expectancy at par with national average (70.61 vs. 702 for India)
• Potential to improve overall health outcomes amongst tribal population, for example:
RMNCH+A
– Mortality: MMR (1221 vs. 451 as AP avg. vs. 973 as India avg.), IMR (371 vs. 241 as AP avg. vs. 284 as India avg.)
– Anemia prevalence amongst pregnant women aged 15-49 at 83%1 vs. 27%1 as AP avg. vs. 52.2%5 as India
avg. and amongst adolescent girls at 85%1 vs. 51%1 as AP avg. vs. 59.1%5 as India avg.
• Potential to improve disease incidence for key diseases:
– High NCD deaths (5061 per lakh population vs. 5596 for India) with limited/outdated infra for treatment of
critical and trauma care (e.g., CVDs, Cancers, Trauma) – only 6 CATH labs across 16 GGH's 1
Disease – Higher than average CVD mortality (2411 vs. 1856 for India)
incidence – Higher than average TB incidence rate of 3101 for tribal population (compared to 1741 for overall AP and 2107 as
national avg.)1
• High death rates due to RTA (15.261 vs. 11.568 for India) with limited trauma care facilities and skilled
paramedics

Health • Potential to ramp up health infrastructure in line with norms (population served per R-CHC at 242k vs. 120k
infrastructure, as per IPHS norms)1
workforce and • Shortage of skilled Nursing and Paramedics in emerging areas (like Audiometric, Speech and Hearing,
service Occupational Therapy, Perfusion, MRI etc.)
• Exclusion of out-patient care in existing health insurance schemes (PM-JAY/Aarogyasri)
delivery
Note: NCD – Non-communicable Diseases, CVD – Cardiovascular diseases, GGH – Government General Hospital, RTA – Road Traffic Accident
1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. SRS-based Abridged Life Tables, Ministry of Home Affairs, 2016-2020; 3. Special Bulletin on Maternal Mortality in India, 2018- 4
20, SRS Sample Survey, Ministry of Home Affairs, 2020; 4. SRS Statistical Report 2020, SRS Sample Survey, Ministry of Home Affairs, 2020; 5. NFHS-5, 2019-21; 6. Global Burden of Disease, (IHME, PHFI, ICMR)
2019; 7. Global TB Report 2022, WHO; 8. SDG India Index 3.0, 2020-21
RMNCH+A: AP performing better than national average – potential to
reach global benchmarks

Overall and RMNCH+A

​Select examples
Infant Mortality Rate Under five wasted Percentage of pregnant women
Life Expectancy (years)
(per 1,000 live births) (%age of kids<5 yrs) (15-49) with anemia
84.6 87.0 24 28 19.3 52.2
70.6 70.0 16.1 15.8
27.0 31.4 25.0
6 3 12.0
0.1
​AP1 ​India avg. 2 ​Japan3 ​Monaco3 ​AP4 ​India avg. 4 ​Kerala4 ​Germany3 ​AP5 ​India avg.5 ​Kerala5 ​USA3 ​AP1 ​India ​Kerala5 ​USA3 ​SDG
Avg. 5 target

Maternal Mortality Ratio Under 5 Mortality Rate Under five stunted Percentage of adolescent girls
(Per 1,00,000 live births) (per 1,000 live births) (%age of kids<5 yrs) (15-19) with anemia
97 32 31.2 35.5 51.0 59.1
27
23.4 32.5
45
19 10 14.2
3 4 2.1
​AP1 ​India avg. 6 ​Kerala6 ​Germany3 ​AP4 ​India avg. 4 ​Kerala4 ​Germany3 ​AP1 ​India avg.5 ​Kerala5 ​Germany3 ​AP1 ​India Avg. 5 ​Kerala5 ​SDG target

AP is better than/at par with national avg. - potential to be at par with global benchmarks and achieve SDG targets before
2030

Better than national avg Below national avg. At par with National avg.

1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. SRS-based Abridged Life Tables, Ministry of Home Affairs, 2016-2020; 3. World Bank; 4. SRS Statistical Report 2020,
SRS Sample Survey, Ministry of Home Affairs, 2020; 5. NFHS-5, 2019-21; 6. Special Bulletin on Maternal Mortality in India, 2018-20, SRS Sample Survey, Ministry of Home Affairs, 2020 5
Anemia | Pregnant Women: All districts apart from two tribal districts
with better than national average anemia prevalence

Pregnant women (15-49 years) ​Parvatipuram ​Srikakulum

Bottom-5 districts
​Manyam
who are anemic (%) 75.14
21.07 District Value
AP avg. – 27% ​Alluri Sitharama Raju 33.85 ​Vizianagram Alluri Sitharama Raju 84.08
National avg. – 57% 84.08 19.34 17.91 ​Visakhapatnam Parvathipuram Manyam 75.14
​Eluru ​Kakinada
​NTR 27.93
Eluru 36.9
​ nakapalli
A
​ untur
G 36.9 19.75 Nandyal 35.58
30.88 ​East Godavari
​Palnadu 16.69 20.45 Chittoor 34.16
30.9 23.62 ​Konaseema
​Nandyal 16.48
​West Godavari
15.83 ​Krishna
​Kurnool 32.19 21.08 ​ apatla
B Top-5 districts
35.58
​Prakasam
District Value
​Anantapur 16.93
27.99 27.83 ​Nellore Bapatla 15.83
21.15 ​YSR Krishna 16.48
​Sri Sathyasai 21.38 Better than AP avg.
18.76 ​Tirupati West Godavari 16.69
​Annamayya Worse than AP avg. but Anantapur 16.93
34.16 better than national avg.
Visakhapatnam 17.91
​Chitttoor Worse than national avg.

Source: Department of Health and Family Welfare, Government of Andhra Pradesh 6

Anemia | Adolescent Girls: All districts apart from three with better
than national average anemia prevalence

Adolescent girls (15-19 years) ​Parvatipuram ​Srikakulum

Bottom-5 districts
​Manyam
who are anemic (%) 83.37
59.63 District Value
AP avg. – 51% ​Alluri Sitharama Raju 58.55 ​Vizianagram Alluri Sitharama Raju 85.34
National avg. – 59.1% 85.34 44.78 50.72 ​Visakhapatnam Parvathipuram Manyam 83.37
​Eluru ​Kakinada
​NTR 52.23
Srikakulam 59.63
​ nakapalli
A
​ untur
G 57.01 46.25 Vizianagaram 58.55
58.2 ​East Godavari
​Palnadu 45.99 49.85 NTR 58.2
52.87 55.62 ​Konaseema
​Nandyal 33.07
​West Godavari
48.03 ​Krishna
​Kurnool 42.74 38.7 ​ apatla
B Top-5 districts
49.4
​Prakasam
District Value
​Anantapur 41.13
47.14 53.73 ​Nellore Krishna 33.07
40.71 ​YSR Prakasam 38.7
​Sri Sathyasai 41.76 Better than AP avg.
50.76 ​Tirupati SriSathya Sai 40.71
​Annamayya Worse than AP avg. but Anantapur 41.13
50.58 better than national avg.
Annamayya 41.76
​Chitttoor Worse than national avg.

Source: Department of Health and Family Welfare, Government of Andhra Pradesh 7

Health infra and workforce: Potential for AP to ramp up CHC health
infrastructure and urban healthcare workforce in line with norms

Health infrastructure and workforce

Select examples
Population served/R-PHC Population served/R-CHC

30,000 242,446
26,063
120,000

​AP1 ​IPHS Norms1 ​AP1 ​IPHS Norms1

Population served/U-PHC ASHA workers (% against required)

50,000 99.6 100.0
84.3 81.5
35,745

AP2 Kerala2 AP2 Kerala2

​AP1 ​IPHS Norms1 Rural Urban

Adequate PHCs and rural healthcare workforce – need to ramp up CHCs and urban healthcare workforce

Better than national avg Below national avg. At par with National avg.

1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. State Health Dossiers, 2021, NHSRC 8
Disease Incidence: AP performing well on CD incidence; focus
efforts required on CVD and RTA deaths

Communicable diseases Non-communicable diseases and injuries

​Select examples ​Select examples
HIV incidence
NCD Deaths per 1,00,000 persons
(per 1,000 uninfected population)
0.05 506 559
0.04
304 290
0.01 0.01

​AP1 ​India avg. 2 ​Kerala2 ​Singapore3 ​AP1 ​India Avg. 4 ​Jharkand1 ​France4

CVD mortality rate RTA Death Rate

Tuberculosis incidence
(per 1,00,000 population) (per 1,00,000 population)
210 241 15.3
174 185 11.6
115 133 6.0
68
40 2.7
5
​AP1 ​India avg. 5 ​Kerala1 ​GoI 2025 target1 ​Germany5 ​AP1 India Avg. 6 ​Jharkand
6
​Israel6 ​AP1 ​India Avg. 7 ​Bihar7 ​UK3

​ NCD deaths at par with national average, with select key NCDs
​ Better than national avg., potential to be at par with global leaders
worse than national average
Better than national avg Below national avg. At par with National avg.

9
1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. India HIV Estimates, 2022, NACO, ICMR; 3. World Bank; 4. NCD data Portal, India Profile 2019, WHO; 5. Global TB
Report 2022, WHO; 6. Global Burden of Disease, (IHME, PHFI, ICMR) 2019; 7. SDG India Index 3.0, 2020-21
Vision@2047: Driving tech-enabled, affordable healthcare for all with
enhanced emphasis on nutrition and wellness

Key vision elements

100% health insurance for all with expanded coverage and tech-enabled service delivery

Mission Nutrition for all, with a special emphasis on women and tribal population

Physically and mentally fit population - community-driven mental health and wellness ecosystem

Inclusive and collective care for senior citizens, with geriatric care units established at all HWCs

"Health hub" for India and the world with future-ready healthcare workforce and world-class
research institutions
10
Eleven macro goals to drive “Heath and holistic wellness for all” (I/II)

Vision Current Target Target India Benchmarks

Macro goals
element State 2030 2047 average (State, Global)

Delhi – 75.82, Kerala – 752

Overall Life expectancy (at birth) 70.61 >75 >85 702 Monaco (87), Japan (84.6)3

Maternal Mortality Ratio (per

1,00,000 live births) 454 <15 <10 974 Kerala – 194, Germany (3)3

Infant Mortality Rate (per 1,000

245 <14 <6 285 Kerala – 65, Germany (3)3
live births)
Wellness,
primary and % of pregnant women aged 15-
27%1 <25% <5% 52.2%6 Kerala – 31.4%6
preventive 49 who are anemic
care
% of adolescent aged 15-19 years 51%2 <14% <10% 59.1%6 Kerala – 32.5%6
who are anemic

Suicide Rate (per 1,00,000 Bihar – 0.67, Uttar Pradesh – 3.57, Italy
population) 16.87 <7 <1 12.47 (6.7)3

Note: OOPE – Out-of-pocket expenditure

1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. SRS-based Abridged Life Tables, Ministry of Home Affairs, 2016-2020; 3. World Bank; 4. Special Bulletin on Maternal
Mortality in India, 2018-20, SRS Sample Survey, Ministry of Home Affairs, 2020; 5. SRS Statistical Report 2020, SRS Sample Survey, Ministry of Home Affairs, 2020; 6. NFHS-5, 2019-21; 7.. Accidental 11
Deaths and Suicides in India, 2022, NCRB Report, 2022
Eleven macro goals to drive “Heath and holistic wellness for all” (II/II)

Current Target Target Benchmarks

Vision element Macro goals/metrics India average
State 2030 2047 (State, Global)

R-CHC - R-CHC - 120k

Population served/ R-CHC R-CHC - 170k R-CHC - 120k -
242k1 (as per IPHS norms)

Penetration / number of 121 Geriatric Geriatric

Quality and Geriatric care facilities (At District Care units Care units - -
accessibility of (Geriatric care units) Hospitals) at all CHCs at all HWCs
care
%age of households with usual
Rajasthan (87.8)2
member covered by a health 80.2%1 >90% 100% 41%2 Canada (91%)3, Germany (88%)3
scheme/ insurance

% of NABH accredited
7%1 100% - - -
institutes
World-class and Total number of
future-ready 201 XX XX - WHO recommended: ~5504
epidemiologists in the state
workforce

1. Department of Health and Family Welfare, Government of Andhra Pradesh; 2. NFHS-5, 2019-21; 3. World Bank; 4. WHO Recommended is 0.1 epidemiologist per 10,000 population. Given 5.5 Cr 12
population of Andhra Pradesh estimated in 2047, total recommended number of epidemiologists stands at 550
Seven priority areas across three areas identified for Andhra
Pradesh to focus going ahead
1 2
Current disease burden Future disease burden
(basis current impact on AP population health) (basis global trends and expected AP demographic profile)

Geriatric Care
(23% population expected to be
>60+ years of age by 2047)5
Maternal, Child and NCDs
Adolescent Care (~63% of DALYs2)
(~10-15% of DALYs1)

Pandemic Preparedness
(Increasing focus across the world
in post-COVID era)
Trauma Care Mental Health
(~12% of DALYs ) 2
(Suicide rate3 of 16.8 vs. SDG target
of 3.5)4

3
Tribal welfare: Focus on improving overall health profile for tribal sections

Note: NCDs – Non-Communicable Diseases; DALY – Disability Adjusted Life Year 13

1. India: Health of the Nation's States — The India State-Level Disease Burden Initiative: ICMR, PHFI, and IHME, 2017; 2. Andhra Pradesh Health Dossier, 2021, NHSRSC; 3. Per 1 Lakh population; 4.
Accidental Deaths and Suicides in India, 2022; 5. Department of Health and Family Welfare, Government of Andhra Pradesh
Five thrust areas to drive change across priority areas
A Emphasis on wellness, primary and
preventive care
A
•
1
Designing programs to drive increased focus
on nutrition, mental health and wellness
A
• Developing comprehensive population-
2
based health registry to drive population
health and nutrition outcomes
A
• Institutionalizing universal screening with
3 E
and diagnosis across key focus areas with
efficient referral systems and follow-up
mechanisms
E Institutional reforms
• Setting up AP-State Health Systems
E1
Resource Centre to evaluate system gaps and
strengthen state health systems
E2 Strengthening AP State Institute
• for health needs and setup of medical hubs
for Health and Family Welfare (SIHFW)
for effective capability building and
skill enhancement
B Augmenting accessibility and quality of
A B
care, esp. for Secondary care
•
B1 Increasing penetration of health insurance
via central/state schemes and access to
tertiary health with reduced OOPEs
• Ensuring patient-centric and patient-
B2
responsive care, with incentives tied to
patient feedback
• Ensuring adherence to best-in-class
B3
C
international quality standards
B4 Driving focused R&D with world-class
•
institutions – e.g., CoEs for geriatric care and
new and unknown diseases
D
C Resilient & world-class
healthcare workforce
D Citizen-centric, tech-enabled delivery •
C1 Increasing workforce (incl. specialists)
availability - creation of new positions
• Developing single digitized source of all patient
D1
health records
• Improving workforce quality through
C2
• Integrating portals and health systems for
D2
revamped medical courses and multi-skilling -
seamless data exchange
focus on paramedical courses, geriatric care
D3 Facilitating at-scale adoption of AI/digital
•
technologies (e.g., e-ICU, telemedicine, personalized and specialty nursing
• Ensuring career attractiveness with
C3
medicine) and point of care devices (e.g., handheld
X-rays, portable hemodialysis, HB meters, glucometers) defined career pathways and performance-
•
D4 Developing a robust and preventive public health linked progression
surveillance system 14
A1 Emphasis on wellness, primary and preventive care
Illustration: Mobilization of health workers in Assam to bring behavioral change towards mental health

Program Overview Key features

• Integrated all frontline workers and counsellors into one unified
State Assam
banner – "TEAM POKHILA"
Program name • Teams are sub-divided into three groups – Supervising Team,
POKHILA (meaning Butterfly) District Field Visit Team and Block Team

​Districts • Block Teams formed with following composition – Counsellor,

​Pilot launch in 5 districts – Kamrup, Dibrugarh,
Barpeta, Darrang and Nagaon
Objective
Resolve stigma towards mental and health and
other behavioural changes via community action
Block coordinator, Block community mobilizer, ASHA supervisor
and Multi-Purpose Workers and provide door-to-door
counselling services
• Comprehensive case-wise reports and maintained for follow-
ups and severe cases are referred to the district administration

Focus areas • Members are comprehensively trained in community service,

group therapy, focused psychotherapy, family counselling, role
Mental Health, Pregnancy, SAM/MAM, Teenage
play and field demonstration
marriage, School dropouts

15
B1 Augmenting accessibility and quality of care, esp. for Secondary care
Illustration: Hub and spoke model in Telangana for Diagnostic Services to reduce OOPEs

Program Overview Key features Key outcomes

• 4-tiered hub and spoke model: • >32 Lakh tests,
State Telangana – Central laboratory as master hub worth INR 16 Cr.
– DHs/AHs/U-CHCs as mini hubs delivered in first 12
Program name – PHCs acting as spokes months of operation
Telangana Diagnostics Hub – Basti Dawakhanas acting as
collection centres • INR 12.45 Cr. OOPE
Objective savings for the public
Increase access to wide-range of free-of- • State-of-the-art laboratories installed in
cost diagnostic tests to reduce OOPE District Hospitals with the capacity to • Cost per test
conduct 57 types of biochemistry, drastically reduced to
Partners pathology and microbiology tests INR 10
Completely in-house
• Blood and urine samples collected at
spokes/collection centres and
transported to hubs for analysis

• Reports are generated, validated and

delivered online via SMS
Source: National Health Mission 16
B2 Ensuring patient-centric and patient-responsive care
Illustration: Implementation of value-based health care in Singapore

Vision:
Wherever you go in Singapore, you will get the same quality outcomes in medical treatments

2017 2018 2020

Private providers
Start of roll-out in 2 Roll-out to general Public polyclinics
seek for Bundled care for
tertiary hospitals hospitals and (Hyperlipidemia
implementation ~200 DRGs
for 7 conditions Ministry of Health and Hypertension)
advice

Improvements in Focus on cataract

<12 months and hernia repair

1. DRG – Diagnosis-related Group 17

 B2 Ensuring patient-centric and patient-responsive care
Key Learnings: Learnings across six defined dimensions from Singapore example

Dimension Singapore best practice

Segmented 49 conditions across 9 hospitals are covered with 5 – 6 indicators for each
KPI Set condition area; 50% clinical measures and 50% PROMs1 measured
Especially
strong

Data, IT Outcome indicators are measured through EHR and extraction methods, on a
& Analytics national level on claims basis like eClaims + PROMs via iPads

Stakeholder Jointly defined with clinicians what good care is and which indicators are
engagement required & engaged with public and private providers

Providers/ clinicians can participate in collaborative learning environment by

Incentives
meeting with best practice providers; no punishment of low performers

Definition of internal optimization levers and establishment of integrated

Interventions
practice units for certain population segments

Governance & Cooperation between Ministry of Health and National University Health System
Policy (NUHS) to drive quality initative

1. Patient Reported Outcome Measures 18

B Augmenting accessibility and quality of care
Illustration | Launch of motor bike ambulances in Chhattisgarh to increase access

Program Overview Key features Key outcomes

• 4-stroke motorbikes modified to act as • Improved access to
State Chattisgarh
motorbike ambulances, and fitted with care to 368 villages
side-carriages and functional first aid-kit positively impacting
Program name 1,00,000 people
Sangi Express (meaning Friend) • Patients, including pregnant women and
infants, ferried to the nearest PHC or CHC • 27% institutional
​Districts for basic care. Ambulances also ferry deliveries directly
​Narayanpur, Bijapur, Balrampur, women, newborns and infants to weekly attributable to motor
Kawardha rural markets with government- bike ambulances
supported medical stalls
Objective • Reduction in MMR
Increase last-mile reach of healthcare • Local drivers from same community are from 160 in 2016 to
services by adapting to unique hilly hired and trained in first-aid responder 137 in 2020 (amongst
topography of the district training other factors)

Partners • Dedicated helpline number launched and

distributed via SHGs, frontline workers
UNICEF, SAATHI Samaj Sewa Sanstha
and the local community
19
C1

Why was the ANP program introduced?

ANP cadre was introduced in the 1980s into the NHS in response to an acute
shortage of junior doctors

What are the roles & capabilities of ANPs?

Increasing
• Capabilities of ANPs:
– ANPs are required to have Master's level education in core clinical/ research
workforce areas to the capacity of being able to independently prescribe medication
• Job roles:
availability - – ANPs are employed in a range of primary & secondary care roles

creation of new – Roles are context dependent as they are specifically recruited to & trained for
locally defined roles (e.g., lead nurse, matron, nurse practitioner, nurse
positions specialist)

for health needs What are the key benefits of introducing an ANP cadre?
Illustration: Creation of new • Healthcare access: Reduced patient wait times
cadres – Advanced Nurse • Level of care: ANPs have been able to successfully provide a level of care
Practitioner (ANP) cadre in comparable to junior doctors; Prescribing patterns & patient outcomes of ANPs
are comparable to general physicians in home visits
UK • Cost-effectiveness: Cost of a GP consultation in home visits is on average 60%
higher
• Health systems: Task sharing between cadres could reduce the hierarchical
relationship between physicians & nurses
Source: RCN Advanced Practice Requirements,
The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic revie
w 20
, The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK
D2 Facilitating at-scale adoption of technology for tech-enabled delivery
Illustration: Use of drones to enable last mile access to drugs and diagnostic services

Program Overview Key features

• Use of indigenously-made drone technology to provide drugs,
State Arunachal Pradesh
vaccines, healthcare goods and nutritional supplements to rural
and tribal communities
Program name
Medicine from The Sky (MTFS) • Extended to collection of diagnostics – blood samples, sputum
etc., from patients to nearest available diagnostic centres
​Districts
​East Kameng, Lower Dibang Valley, Lower Subansiri • Local area PHCs/CHCs act as focal point-of-contact as well as
District, Kra Daadi district pick-up and drop-zones

Objective • Heavy involvement of local youth and women who are being
Increase last-mile access to essential services and trained as "Drone Ambassadors"
ensure continuum of care

Partners
WEF, Redwing Labs (execution partner), SAMRIDH
Healthcare Blended Financing Facility (initiative by
USAID and IPE Global)
21
D3

Program Overview

State Himachal Pradesh

Objective Improving early TB case detection while reducing OOPE

Facilitating at-
scale adoption of Partners HPCL

technology for Key features

tech-enabled
• TB Screening of vulnerable population using hand-held X-ray
delivery cameras with low-dose radiation expusre and high-resolution
Illustration: Use of hand- imaging
held X-ray devices
• AI-trained analysis to prevent misreporting and facilitate
quick diagnosis

• Screening team consists of one X-Ray technician and one

ASHA worker

22
Interventions across identified focus
areas

23
Seven priority areas across three areas identified for Andhra
Pradesh to focus going ahead
1 2
Current disease burden Future disease burden
(basis current impact on AP population health) (basis global trends and expected AP demographic profile)

Geriatric Care
(23% population expected to be
>60+ years of age by 2047)5
Maternal, Child and NCDs
Adolescent Care (~63% of DALYs2)
(~10-15% of DALYs1)

Pandemic Preparedness
(Increasing focus across the world
in post-COVID era)
Trauma Care Mental Health
(~12% of DALYs ) 2
(Suicide rate3 of 16.8 vs. SDG target
of 3.5)4

3
Tribal welfare: Focus on improving overall health profile for tribal sections

Note: NCDs – Non-Communicable Diseases; DALY – Disability Adjusted Life Year 24

1. India: Health of the Nation's States — The India State-Level Disease Burden Initiative: ICMR, PHFI, and IHME, 2017; 2. Andhra Pradesh Health Dossier, 2021, NHSRSC; 3. Per 1 Lakh population; 4.
Accidental Deaths and Suicides in India, 2022; 5. Department of Health and Family Welfare, Government of Andhra Pradesh
1 Current disease burden | Disease-specific action plan:
Maternal, Child and Adolescent care

Context Key interventions

With 10-15% contribution to DALYs, child and ​Launch dedicated nutritional and behavioural programs:
maternal malnutrition is still the major risk factor • Mass-scale phygital awareness campaigns on normal deliveries, child
marriage, teenage pregnancies
driving disease burden (11.7% share)1 • Regularization of VHSNDs for prompt care and nutrition exhibitions
• Monitoring mechanisms for anaemia among adolescent girls and
Overall targets pregnant women
• Provision of supplementary nutrition to adolescent girls and pregnant
Current Target Target women
Metric State (2030) (2047) References • Counselling sessions via CHOs, upskilled as "Lifestyle Coaches" for all
Maternal Mortality Rate India (97),
pregnant women and their families
(per 1,00,000 live births) 452 <15 <10 Kerala (19)
​Drive universal screening and surveillance with referral mechanisms
% of pregnant women India (52.2%), • Maternal death reporting and surveillance by MPCDSR portal
aged 15-49 who are 53.7%2 <25% <5% Kerala (31.4%)
anaemic • Strong linkages for early referral of sick and small newborn, and high-
risk pregnancy women
% of adolescent aged India (59%), • Follow-up mechanism at home for post natal mothers by MLHP/ANM
15-19 years who are 60%2 <14% <10% Kerala (32.5%)
anaemic under Family Doctor Program
Infant Mortality Rate 242 <14 <6 India (28), ​Establish NICU and PICU at each District Hospital / Sub-District Hospitals
(per 1,000 live births) Kerala (6)
for increased access
Under 5 mortality rate 272 <16 <8 India (32),
(per 1,000 live births) Kerala (10)
​Introduce a dedicated cadre of mid-wives to promote normal deliveries
% of children under 31.2 2
<10 <5 India (35.5%), and launch a dedicated State Mid-wifery Training Institute under the
5 who are stunted Kerala (23.4%)
ambit of Govt. College of Nursing 25
1. India: Health of the Nation's States — The India State-Level Disease Burden Initiative: ICMR, PHFI, and IHME, 2017; 2. Department of Health and Family Welfare, Government of Andhra Pradesh
1

Maternal, Child Activity

Total funding
required
Funding
available
Additional
funds required
and Adolescent (INR Cr.) (INR Cr.) (INR Cr.)

care: ​Awareness generation

campaigns
X
​X X
​X X
​X

Proposed ​Provision of supplements ​90-100 ​8-10 ​80-90

investment ​Universal screening, ​30-50 ​5-8 ​23-43

requirements till
surveillance and reporting
​Infrastructure enhancement
​XX ​XX ​XX
2030 (NICU and PICU)

​Capacity building and training ​30-50 ​5 ​25-45

T
​ otal 1
​ 50-200 1
​ 8-23 1
​ 32-177

26
1 Current disease burden | Disease-specific action plan: Non-
communicable diseases, with a focus on CVDs and Cancer Care

Context Key interventions

Andhra Pradesh witnessing epidemiological transition with Mandate wellness programs, including yoga in schools and
NCDs accounting for 63.34%1 of DALYs and 68% of total
deaths. Overall objective to reduce premature moribities with colleges along with the creation of jogging tracks, dedicated cycle
two focus areas: tracks, and open gyms in public parks
​CVD, accounting for 17% of total DALYs and 32% of total
deaths. with IHDs contributing 10.6% DALYs share 1
Launch comprehensive annual screening for cancer at
community level
Cancer, accounting for 5.6% of total DALYs1
Develop referral mechanisms with strong linkages to
secondary and tertiary care
Key targets
Strengthen infrastructure at all levels for cardiac and cancer
Metric Current Target Target References care:
State (2030) (2047)
• All DHs and medical colleges with CATH labs and radiation
Premature Deaths due
to NCDs (per 1,00,000 234 <160 <105 India (236), Delhi therapy units by 2030
(178)
population)2 • All AHs and CHCs with e-Cardiology/tele-medicine units and
Premature Deaths due India (99), Delhi day-care cancer centres (incl. chemotherapy units) by 2030
to CVD (per 1,00,000 113 <75 <50 (68)
population) 2 • All PHC/HWC/VHC with emergency cardiac and cancer care
Premature Deaths due services by 2047
to Cancer (per 1,00,000 41 <30 <20 India/Delhi (46),
population)2
2
Jharkhand (28) ​Establish a CoE for NCDs in collaboration with global institutions
27

1. India: Health of the Nation's States — The India State-Level Disease Burden Initiative: ICMR, PHFI, and IHME, 2017; 2. Global Burden of Disease, (IHME, PHFI, ICMR) 2019
1

NCD (CVD and Particulars

Total funding
required
Funding
available
Additional
funds required
(INR Cr.) (INR Cr.) (INR Cr.)
Cancer):
Proposed ​Annual Cancer Screening ​110-130 ​60 ​50-70

investment ​Provision of Drugs and

​50-60 ​30-40 ​20-30
requirements till
Supplements

​Infrastructure enhancement
2030 (CoE, Cath Labs, Day-care centres)
2
​ 00-210 3
​ 0-40 1
​ 70-180

​Wellness activities and

awareness generation ​170-190 ​- ​170-190

​Total ​530-590 ​120-140 ​410-450

28
1 Current disease burden | Disease-specific action plan: Trauma
Care

Context Key interventions

Deaths due to RTA significant in AP (15.25 vs. national ​Strengthen “Road Safety Agency” to audit accidents and
average of 11.5)1, with rural death rate at 44%1 implement corrective actions
compared to 17%1 in urban areas
​Establish dedicated EMTCs with specialized workforce at all
levels for prompt corrective action:
Key targets
• Level-1 EMTC at all state/regional level institutions by 2030
• Level-2 EMTC at all GGH/DH by 2030
Current Target Target • Level-3 EMTC at all AH/sub-DH by 2040
Metric References
State (2030) (2047)
• Level-3 EMTC at all PHCs by 2047
Death rate due to RTA India (11.6), ​Establish Regional Institutes of Paramedical Sciences at
(per 1,00,000 15.261 <10 <5 Bihar (6)
population) Visakhapatnam, Guntur and Kurnool with a minimum capacity of
200 per course

Ideal time and ​Launch dedicated courses in areas such as Perfusion technology,
<75 Kms, <50 Kms, <5 Kms,
distance to reach <75 -- MRI technician, Cath Lab technician, Emergency medical
basic trauma Mins1 <50 Mins <30 Mins technician
care centre
​Upskill all public health cadres in basic trauma care till PHC
level with special emphasis on facilities near national/state
highways 29
1. Department of Health and Family Welfare, Government of Andhra Pradesh
1

Trauma Care: Particulars

Total funding
required
Funding
available
Additional
funds required
Proposed (INR Cr.) (INR Cr.) (INR Cr.)

investment
requirements till
I​nfrastructure enhancement
(​ Regional Institute of Paramedical 1
​ ,000-1,200 -​ 1
​ ,000-1,200
Sciences, EMTCs)

2030
C
​ apacity building and skilling X
​X X
​X X
​X

​Total ​1,000-1,200 ​- ​1,000-1,200

30
1 Current disease burden | Disease-specific action plan: Mental
Health

Context Key interventions

AP's current suicide rate of 16.81 per lakh population
higher than the national avg. of 12.41. However, AP has
launched 2 key efforts to promote mental health: ​De-institutionalization of mental health via community-
• District Mental Health teams for all 26 districts to provide based mental health resolution:
clinical services for 2 days and out-reach services for 6 days • Upskill public health workforce (e.g., ASHA, AAW, CHOs)
• Tele-MANAS services started from two centres to provide in mental health tackling to enable solutioning at grass-
on-call counselling roots level
• Counsellors to be made available in every AH and CHC by
Key targets 2030 and in PHCs and VHCs by 2047
​Expand tele-mental health services using technology to
Current Target Target
Metric
State (2030) (2047)
References connect individuals in remote areas with mental health
professionals
Suicide Rate India (12.4), ​Develop mental health chatbots and AI-powered tools for
(per 1,00,000 16.81 <7 <1 self-screening and initial assessment
Bihar (0.6)
population)

31
1. Accidental Deaths and Suicides in India, 2022, NCRB Report, 2022
1

Mental Health: Total funding Funding Additional

Proposed Particulars required
(INR Cr.)
available
(INR Cr.)
funds required
(INR Cr.)
investment
requirements till
W
​ orkforce enhancement and
capacity build 2
​ 0-40 2
​ 0-40 -​

2030 T
​ echnology advancement in
Mental Health ​400-500 ​- ​400-500
(​ AI, tele-consultations)

​Total ​530-590 ​120-140 ​410-450

32
2 Future disease burden | Disease-specific action plan: Geriatric
care

Context Key interventions

Share of population of 60+ years expected to increase ​Develop state-specific policy for geriatric care with a focus
in AP from 13% in 2023 (vs. 11% in India) to 23% in on strengthening the regional geriatric care centres in line
2047 (vs. 18% in India)1 with the recommendations from National Program for Health

​Ensure dedicated at-home and self-care systems to reduce

Key targets burden on primary infrastructure

​Establish a Centre of Excellence for geriatric medicine in

Current Target Target Vishakhapatnam
Metric References
State (2030) (2047)
​Ensure adequate geriatric facilities with skilled workforce –
Geriatric Geriatric upgrade MRW post in CHCs with Physiotherapists
Geriatric Care 12 1 Care Care
Facilities (At District units units --
(geriatric units) Hospitals) at all at all ​Provide palliative and hospice care in all Secondary Health
CHCs HWCs Hospitals

Note: MRW – Multi-rehabilitation Worker

1. Department of Health and Family Welfare, Government of Andhra Pradesh 33
2

Geriatric Care: Total funding Funding Additional

Proposed Particulars required
(INR Cr.)
available
(INR Cr.)
funds required
(INR Cr.)
investment
requirements till
I​nfrastructure enhancement
(CoE, Geratric Care units, at-home, 1
​ 00-110 7
​ 0-90 2
​ 0-40
self-care systems)

2030 ​Capacity building and

upskilling 3
​ 50-360 3
​ 50-360 -​

​Total ​450-470 ​420-450 ​20-40

34
2 Future disease burden | Disease-specific action plan: Pandemic
preparedness

Context Key interventions

With continuously emerging new pathogens and
increasing risk of zootonic infections, ensuring
pandemic preparedness is on the top of WHO global
agenda to reduce adverse socio-economic impact
Key targets
​Develop measurement framework to assess pandemic preparedness of the
state in line with global indices such as Global Health Security (GHS) Index
​Ensure a steady supply of well-trained specialists, including
epidemiologists, microbiologists and entomologists
​Upskill all public health management cadres (PHMC) in pandemic
preparedness in line with CDC/ICMR guidelines
​Develop a robust, integrated and preventive public health surveillance
system encompassing hazard, exposure and outcome surveillance

Current Target Target ​Launch an "Integrated Control Room" for rapid response and monitoring
Metric References with cross-departmental representation
State (2030) (2047)
​Institutionalize protocol-based pandemic readiness by ensuring
Total number of WHO adequate and upgraded infrastructure:
epidemiologists 201 XX XX recommended
~5502 • Adequate ICU/HDU beds (25% of total beds), convertible wards
• Upgraded diagnostics with buffer capacity and NABL-accredited labs
No. of NABL 81 At all GGH, At all (including establishment of BPHLs at all BPHUs)
DH/SDH
accredited labs (At GGH) and CHCs -- • Building and system designed and equipped as per IC protocols
BPHUs
​Establish a CoE for Infectious Diseases for policy advocacy, research,
innovation and training
35
1. Department of Health and Family Welfare, Government of Andhra Pradesh
2

Pandemic Total funding Funding Additional

Preparedness: Particulars required
(INR Cr.)
available
(INR Cr.)
funds required
(INR Cr.)
Proposed
investment ​Infrastructure enhancement
(CoE, pandemic-ready infra)
5
​ 0-60 -​ 5
​ 0-60

requirements till C
​ apacity building and
upskilling ​XX ​XX ​XX

2030 ​Integrated Surveillance System

and Control room set-up ​XX ​XX ​XX

T
​ otal 5
​ 0-60 -​ 5
​ 0-60

36
3
Tribal Welfare: Overall health profile improvement

Context Key interventions

​Launching phygital awareness generation campaigns and driving
High Maternal and Child Mortality with high community participation in controlling child marriage, teenage pregnancies
prevalence of TB and anemia (particularly sickle cell
anemia) ​Institutionalize universal screening at community level (e.g., for sickle cell
anemia) along with setting up of systematic active case-finding camps
Overall targets saturating all tribal areas
​Infrastructure strengthening across institutions:
Current Target Target
Metric State (2030) (2047) AP average • Each PHC to be converted into 24x7 delivery point as per IPHS along with
provision of family planning services / unmet needs
Maternal Mortality Rate • Each VHC to be strengthened for conducting normal deliveries
(per 1,00,000 live births) 1221 <20 <13 45
• Strengthening NBCCs in every delivery point and providing level–II SNCU
services at CHC level
Infant Mortality Rate 371 <18 <8 24
(per 1,000 live births)
​At-scale adoption of technology to drive increased care:
Under 5 mortality rate
(per 1,000 live births) 39 1
<20 <10 27 • Implementation of e-ICU services in facilities such as NBSU-SNCU-NICU
supported by State Newborn Resource Center (SNRC)
% of pregnant women
aged 15-49 who are 83%1 <30% <7% 27%
anemic ​Enabling optimal access to care and drugs via provision of mobile
ambulances for transportation
% of adolescent aged 15- 85%1 <30% <10% 51%
19 years who are anemic
Provisioning of one health functionary in every habitation to own
TB Incidence Rate 310 1
71 19 174 healthcare outcomes irrespective of population
37
1. Department of HF&W, Government of Andhra Pradesh
3

Total funding Funding Additional

Activity required available funds required
Tribal Welfare: (INR Cr.) (INR Cr.) (INR Cr.)

Proposed ​Awareness generation

campaigns
X
​X X
​X X
​X

investment ​Provision of drugs and

supplements ​XX ​XX ​XX

requirements till ​Universal screening, ​XX ​XX ​XX

2030
surveillance and reporting

​Infrastructure enhancement ​XX ​XX ​XX

​Technology adoption ​XX ​XX ​XX

T
​ otal X
​X X
​X X
​X

38
Roadmap for 2030 and 2047

39
Roadmap 2023–2047: Key interventions and strategic reforms
(I/IV)

2023 2030 2047

Short-term interventions to achieve 2030 goals and ensure readiness for 2047 Long-term interventions for 2030-47

1 Emphasis on wellness, primary and preventive care

• Drive large-scale emphasis on lifestyle, mental health and wellness: • Automated enrolment into disease-
– Build capability of frontline workers (ASHA, Aanganwadi, ANMs, CHO) to function as specific treatment lines basis screening
"Lifestyle Coaches" to tackle mental health, nutrition, and wellness issues and diagnosis
– Mandate wellness programs, such as yoga in schools and colleges and create jogging
tracks, dedicated cycle tracks, open gyms in public parks at all municipalities
– Launch mass-scale phy-gital campaigns to drive increased awareness on key topics
(e.g., normal deliveries, child marriage, teenage pregnancies, anemia etc.)
– Regularize VHSNDs with specific emphasis on adolescent girls and pregnant women
– Launch community-based mental health to tackle issues at grassroots level
• Develop population registry by extending "Family Doctor Programme" to urban areas
leveraging primary teams comprising Medical Officers and frontline workers (e.g., ASHA,
ANM, CHOs, MPHS (M), MPHS (F))
• Institutionalize time-bound universal screening across focus areas (e.g., annual
comprehensive NCD screening with focus on cancer, hyper-tension and diabetes, diagnostic tests Intervention type
such as CBC, LFT, RFT, LP etc., anemia screening and monitoring at private schools and at Policy Institutional
community level) coupled with efficient referral systems and follow-ups
Process Technological

40
Note: ANM – Auxilliary Nurse and Midwife, CHO – Community Health Officer MPHS – Multi-Purpose Health Worker, VHSND – Village Health, Sanitation and Nutrition Days
Roadmap 2023–2047: Key interventions and strategic reforms
(II/IV)

2023 2030 2047

Short-term interventions to achieve 2030 goals and ensure readiness for 2047 Long-term interventions for 2030-47

2 Augmenting accessibility and quality of care, esp. for Secondary care

• Reduce OOPE for families by achieving saturation of national/state schemes, expanding • End-to-end value-based healthcare
coverage (e.g., OPD insurance) and increasing penetration of tertiary-level health with incentives tied to quality of care
facilities via PPP and affordability
• Enhance quality of care by making services responsive to patient feedback (e.g.,
development of Patient Satisfaction Index, digital mechanisms to collect patient feedback,
integration with JAS)
• Ensure 100% compliance to national and international quality standards (e.g., NABH,
NABL (ISO:15189), JCI, NQAS) for existing and new institutions by tying insurance scheme
incentives toquality standards
• Drive enhanced accessibility to world-class facilities and medicines (e.g., upgrading all
District and Area Hospitals to function as day-care cancer units, establishing level-3 EMTC
units at all CHCs, strengthening diagnostics (CT, MRI, Tele-radiology) at all DHs/sub-DHs)
• Drive focused R&D by setting up of key institutions (e.g., CoEs for geriatric care, Intervention type
Entomological Training and Research Laboratory in universities, Opthalmology R&D
Policy Institutional
institutions) in collaboration with global healthcare institutions
Process Technological

41
Roadmap 2023–2047: Key interventions and strategic reforms
(III/IV)

2023 2030 2047

Short-term interventions to achieve 2030 goals and ensure readiness for 2047 Long-term interventions for 2030-47

3 Resilient & world-class healthcare workforce

• Create dedicated cadres to meet rising demand (e.g., Specialty Nursing Cadre, Public Health • Establish medical hubs in all major cities
Management position for doctors) with integrated ecosystem of premier
• Strengthen current training and teaching infrastructure (e.g., establish Regional Institutes medical facilities, research centres and
of Paramedical Sciences at Visakhapatnam, Guntur and Kurnool producing 200 paramedics, educational institutions
augment existing Government College of Nursing with State Mid-wifery Training Institutes)
• Launch dedicated courses in line with current and future state demand (e.g., paramedical
courses such as audiometry, pathology, specialty nursing courses such as Critical Care Nursing,
Trauma Care Nursing and Mental Health courses) with mandatory On-The-Job-Trainings using
innovative methods and simulations
• Provide opportunities to up-skill different public health cadres (e.g., Medical Officers on
Syndromic case management of HIV/AIDS, all cadres on Pandemic Preparedness, mid-wives on
high-risk pregnancy protocols)
• Develop scientific job charts in collaboration with renowned public health/educational Intervention type
institutions for various public health cadres with performance-linked career progression
Policy Institutional

Process Technological

42
Roadmap 2023–2047: Key interventions and strategic reforms
(IV/IV)

2023 2030 2047

Short-term interventions to achieve 2030 goals and ensure readiness for 2047 Long-term interventions for 2030-47

4 Citizen-centric, tech-enabled delivery

• Ensure full digitization of health records with a single source of patient health records • Establishing an integrated and
• Facilitate integration of different portals such as RCH, NACO, U-WIN, e-Hospital, Dr-Care, preventive public health surveillance
NCD etc. to facilitate seamless data exchange across all levels of health facilities system, leveraging multiple linked data
• Enabling at-scale adoption of digital delivery (e.g., tele-medicine, e-ICU) and point-of-care sources
technologies (e.g., hand-held X-rays)

5 Institutional reforms
• Establish Andhra Pradesh State Health Systems Resource Centre at Vishakhapatnam as • -
the apex body for technical support and to strengthen state and district health systems
• Strengthen Andhra Pradesh State Institute for Health and Family Welfare (AP-SIHFW)
identified in Vishakhapatnam with appropriate workforce and infrastructure Intervention type
• Strengthen "Road Safety Agency" with adequate cross-departmental representation to Policy Institutional
audit each accident and implement corrective measures
Process Technological

43
Thank
You!