Monday, December 23, 2019

AP needs capital cities as well as mega city: Lok Satta

District governments mooted for decentralised administration

Foundation for Democratic Reforms and Lok Satta Founder Jayaprakash Narayan has in principle welcomed the proposal of Andhra Pradesh government to extend the State capital to three areas .

However he said that the decision to have three capital cities would be only one aspect of governance. The proposal might satisfy people in different regions but it would not lead to decentralisation of administration. True decentralisation would happen only when people need not come to the Chief Minister and the capital city for their work or grievances.

Dr.Narayan in a release said that a capital city would be different from a mega city which could become an economic growth engine. Thus after allocating 2,000 acres for Secretariat, legislature and government offices, remaining thousands of acres could be utilised for developing Amaravathi as a Mega city. It is a fact that mega cities like Hyderabad, Mumbai, Bangalore, Ahmedabad, etc., would have a cluster effect and attract investments for development.

For genuine decentralisation, Chief Minister should delegate his powers to Ministers and officials. Most importantly ‘District Governments’ be set up for integrated development so that for 95% of their requirements, people need not come out of their districts.

He also said panchayats should be extended to include a population of 20,000 to 25,000 for decentralisation of powers and administration. At least one third of State Budget should be allocated for local bodies - panchayats and municipalities. The responsibility of paying salaries of teachers, maintaining primary health centre be entrusted to the local bodies. State Government should only have a supervisory role, he said.

He also suggested that regional councils be set up for Rayalaseema and North Coastal Andhra with MLAs and give them maximum powers. If these regional councils did not deliver, then the State Government should have powers to regulate them.

Courtesy: The Hindu

నార సంచులకు నగిషీలు

బాల్యం నుంచే విలువల్ని బోధించాలి

Thursday, December 12, 2019

Make use of AI and networking to improve public services

దేశ పౌరులుగా ఉండవలసిన హక్కులు, బాధ్యతలపై అవగాహన కలిగి ఉండాలి

మాజీ కేంద్రమంత్రి అశోక్ గజపతిరాజును పరామర్శించిన జేపీ

ప్రజల భాగస్వామ్యంతోనే అవినీతి అంతం

ప్రభుత్వమంటే పెత్తనం కాదు

పోరటతత్వంతోనే సమస్యలు పరిష్కారం

విద్యార్థులు నాయకత్వ లక్షణాలు అలవర్చుకోవాలి

ప్రభుత్వాలు అనవసర ఆర్భాటాలకు పోరాదు

దేశానికి, రాష్ట్రానికి అశోక్ సేవలు అవసరం

విద్యార్థులు బుద్ధిబలంతో సమస్యలు పరిష్కరించుకోవాలి

సాంకేతికతను సమాజ శ్రేయస్సుకు వినియోగించండి

ప్రజలకు సేవలు అందించడమే ప్రభుత్వ లక్ష్యం

సాంకేతిక విజ్ఞానంపై అవగాహన అవసరం

Friday, November 15, 2019

Public health policy is not about money spent but the outcome

‘Average time a doctor spends with patient in India is one minute as against six minutes in Germany’

Hyderabad: India may have made strides in control of communicable diseases, population control, polio and others but its public healthcare, especially primary healthcare, is in bad shape. Public policy on health is not just about amount of money allocated or spent but how it is being implemented and the outcomes, said Jeffrey Hammer, visiting professor in economic development at Woodrow Wilson School, Princeton University. US.

“National Rural Healthcare Mission was touted to be big success on huge sums spent and number of people employed but our research has shown people could not differentiate much between a public health doctor or a village healer or a quack,” he said, at the first public lecture series on ‘Governance in Action’ hosted by Foundation for Democratic Reforms and Administrative Staff College of India on Thursday.

Prof. Hammer’s current research is on quality of medical care in India, determinants of health status and improving service delivery through better accountability. Studies had shown the average time spent by a doctor with a patient is about one minute whereas it was about six minutes in Germany! “We can’t have government interfering into every field but at the same time we cannot think markets are the most efficient,” he observed.

The country had been chasing investments as it would generate jobs but “who would want to come to a place where there is no sewerage system, sanitation is not a priority, pest control is absent, mosquitoes cause havoc and air is polluted — all these have to be provided for by the government,” said Prof. Hammer.

“Health and hygiene issues in India like infant and maternity mortality have been achieved by rich nations at much better rates 100 years ago much before the advancements of medicare like surgical procedures,” he claimed.

Medical insurance could play a role but need regulatory systems yet it was a complicated situation as it was not possible to “second guess happenings in doctor’s room”. Strengthening public healthcare could provide an answer as it could compete with private sector and perhaps drive the costs down due to competition, he felt.

Later, Prof. Lant Prichett, Blavantik School of Government, University of Oxford, spoke on education. These two talks are part of M. Bhoji Reddy & EV Ram Reddi endowment lectures, said FDR general secretary Dr. Jayaprakash Narayan. ASCI chairman K. Padmanabhaiah, also spoke.

Courtesy: The Hindu

మందులు మనవే.. కానీ, అందవు

చదువు చెప్పించలేకపోవడం పాపం

ఉచితంగా విద్య, వైద్యం లభిస్తేనే అభివృద్ధికి బాటలు

Thursday, September 19, 2019

Wednesday, September 18, 2019

Dr.JP's Letter to AP CM Y.S.Jagan on Health Policy

17th September, 2019

Sri Y.S. Jagan Mohan Reddy
Chief Minister of Andhra Pradesh
Andhra Pradesh

Dear Sri Jagan Mohan Reddy garu,  

I am happy to note that your government is committed to improvement of health and medical services in Andhra Pradesh. Initiatives for overhauling of services in government hospitals and transforming government hospitals into model hospitals are steps in the right direction to improve the healthcare system. It is also a right time and opportunity to consider in putting in place a robust, viable, economical, effective universal health care programme across the state with public-private-partnership.
Our public health system has not been able to meet the needs or expectations of our people, causing enormous misery, ill-health and pain, and is driving many people into penury and poverty.  In order to revamp it and make it effective we have to recognize some of its strengths and weaknesses, and we must build on the strengths of the system, remove weaknesses, and create an architecture that can deliver quality care at a modest additional cost. While government spends only about 1% of GDP on healthcare, the people are getting Rs. 4-10 in the form of services for every rupee spent. Therefore, we should spend more, and wisely on public health.
We understand that the main issues in healthcare in Andhra Pradesh or in any other State in India are:
1.    Weak primary health system: Primary Health Center (PHC) and Community Health Centre (CHC) level is critical for family health and for giving patients confidence at first level hospital care for simple interventions. However, there is underutilization of the PHCs or CHCs. There is no credible government facility as first point of contact for family health services.  PHCs are not considered by people as healthcare givers except for limited services like vaccination and family planning. Many doctors are not willing to work at the primary care level and even those who are posted there are generally absent or ineffective. There is no accountability or trust.
2.    Overcrowded and Underfunded Government Hospitals: In the absence of improvement in primary and family healthcare, there is overcrowding in tertiary care government hospitals. In most hospitals, nearly double the numbers of patients are admitted relative to sanctioned bed strength.  Also thousands come as outpatients with simple ailments that should have been addressed by a primary care physician.
3.    Under-paid healthcare personnel: There is misallocation of our health manpower. India is producing about 60,000 doctors every year, and many of them are underemployed. Several MBBS doctors are willing to work for Rs.30-40,000/month in towns and cities.
Given these facts and circumstances, three broad approaches should be considered to radically improve healthcare delivery at a relatively low cost:

1.    Build Primary Care : A network of 10 doctors to provide primary care for 70,000 – 1,00,000 population can be brought into public health system to establish practice in large villages or small towns, within about 10 km radius of the catchment population. Each family will have the freedom to choose the Family Physician (FP) of their liking.  All basic healthcare needs of the family, as well as outpatient care, simple diagnostics and supply of drugs will be met at the FP level. The FP receives from government a capitation fee of, say Rs. 500/ head / year. As the families choose their FP, the doctor who is trusted by people gets paid on the basis of number of people registered with FP. Thus families have a choice, and FPs will have the incentive to serve well and earn the trust of the people. They get free drug supply and vaccines etc. from government. On an average, about 5000 patients can be registered with each FP. The patient will be seen by a hospital at CHC/private nursing home level or at district/tertiary level only on referral by the FP, except in emergencies.
Such a system will be economical and effective in providing quality healthcare at outpatient level. It will give adequate incentive to general practitioners to serve, and people will have choice of FP ensuring accountability.
2.    Broaden Secondary Care: At the secondary level, integration and expansion of Aarogyasri by contracting small private nursing homes with complete choice and competition. The patients should have a choice of going to the CHC or any small private nursing home in which they have confidence.  The CHC as well as private nursing homes will be reimbursed by government on pay-for-service basis applying standard costs and standard services model.
This will give patients choice, create competition among providers, improve quality of care, and meet most of the first level health care needs satisfactorily at a low cost.
3.    Strengthen Tertiary Care: Substantial strengthening of tertiary level district and teaching hospitals where treatment is provided on referral basis. Encouraging private sector participation to acquire and build the infrastructure and lease to the government for a fee. Secondly, enhance the budget for teaching hospitals and district hospitals and increase budget of Centres of excellence and super specialty hospitals
These steps will substantially improve the infrastructure, basic amenities, hygiene and quality of care in tertiary and district hospitals.
The above initiatives can be achieved by increasing in healthcare expenditure by approximately Rs. 2,900 crores/year and would significantly improve care and patient satisfaction. Rs. 2,900 crore is a mere 0.27% of the State’s GSDP. 

We urge you to consider the above model in revamping the healthcare of Andhra Pradesh. We will be happy to interact with the government to present details of this model and work with the officials to make it a success. I am enclosing a brief power point presentation outlining the healthcare reform proposals for your government’s careful consideration

With warm personal regards,

Yours sincerely,

Jayaprakash Narayan
General Secretary

Copy to:
·         Sri Alla Kali Krishna Srinivas — Deputy Chief Minister — Minister of Health, Family Welfare and Medical Education, AP.

·         Dr.K.S.Jawahar Reddy, IAS, Principal Secretary, Health Medical & Family Welfare, AP.

'ప్రతి కుటుంబానికీ ఓ డాక్టర్'.. ఫ్యామిలీ డాక్టర్ వ్యవస్థ పునాదిగా అందరికీ ఆరోగ్యాన్ని అందించే విధానాన్ని తెండి