The health care reforms in Andhra Pradesh, a review of health sector reforms in India, health sector reforms in India began in the 1970s. The Govt. India, establishing the need for HSR specified and in the eighth five year plan. The Eighth Five Year Plan (1992-1997) shows the first plan, the need for economic restructuring, management systems, according to the macro trends of the 1990s. During his time in the health sector was to dismiss the concept of free medical care and people have to pay, though partly for health care (1). The Ninth Plan (1997-2002) emphasized the need for the reaction of the public health care providers, private and voluntary health review and reorganize the population to change the landscape of health care to order to achieve greater efficiency and effectiveness and to introduce health reforms for the population to an optimal support trying to get an affordable price, the Ninth Plan, to increase the participation of volunteers, private organizations and groups employed own to ensure the provision of health services and intersectoral coordination in implementing health programs and health activities, thus promoting Panchayati Raj Institutions (PRI) in planning and monitoring of health programs at local level to achieve greater responsiveness to the health needs of people and greater accountability, intersectoral coordination and the use of local community resources and mental health (2). The Tenth Five Year Plan (2002-2007) played reforms in primary, secondary and tertiary (3). Influence health policy significantly. The objectives, priorities and strategies, changes in commitments are largely determined by political risks. There are demands on health systems. The development of health care is largely the culture, history and rules. The satisfaction of our customers is very high. According to NFHS-2 data, the overwhelming majority of customers are from the services provided by state schemes satisfied. Can the expectations are low, that is, our people are so polite. But on the contrary, we have the report of Transparency International, the leading health system in India is a corrupt system (4) The Government has taken several measures to improve public health institutions and strengthening the infrastructure of primary health care . However, the situation is exacerbated by the severe shortage of resources – in terms of financial, technical and human power, which has led policy makers and program managers at various levels are facing difficult decisions. In this situation, attempts are made to various reform initiatives to ensure that the health of people must be met with a major reform measures introduced to strengthen the draft secondary health system is the World Bank in seven states ( Andhra Pradesh, Karnataka, Punjab, West Bengal, Maharashtra, Orissa and Uttar Pradesh). Projects include the strengthening of the FRU / community health centers and district hospitals to improve the availability of emergency care services to patients in order to reduce overcrowding at the district and tertiary hospitals, the construction sector grew purchase of equipment, availability of ambulances, medicines, improve the quality of services following capacities up gradation in their clinical training, changes in attitudes and behavior of suppliers of health care, reduce disparities in health personnel and facilities, improving hospital management of waste, disease surveillance and response. It is important for the progress and problems in implementing reforms in individual states and appropriately modify the content and pace of implementation to be assessed. Such summary and analysis of all issues is needed to provide insights for policy makers and other stakeholders regarding the various dimensions and consequences of health reform. (5) The Constitution of India, health is a state responsibility. Although the scenario was, many state governments in India on the basis of Health Systems Development Project of World Bank loan for the implementation of health sector reforms (HSR), one of which is the most important Public expenditure on health care rose to extremely low levels observed before. Systems Development Project Health aims to develop strategic management capacity, strengthen performance, accountability and efficiency, and build capacity for implementation. Furthermore, it should improve the quality of clinical services through the renovation and expansion of county, city and sub district hospitals and improve access to services. In all seven states of reform, is approximately 15% of the total project cost is borne by state governments. All project documents note the low level of funding for hospitals in the state reform school. This is due to the lower attributable fraction of total spending allocated to public health, the limited proportion of total health spending going to hospitals, and within this, an unequal distribution of resources for tertiary hospitals. After analyzing the problems of health care, the state governments have agreed to the reform of the terminology, the use of “guarantees” to the “obligations” for various companies. These are: (i) increase the overall size of the health budget, (ii) the imbalance in spending between the secondary and tertiary levels of protection of health, (iii) the operation and maintenance of components current expenditure allocations for the protection of secondary health facilities, (iv) to provide fees for selected services in accounting, and (v) address problems of labor. The Project Development of Health Systems launched in seven states, the need for increased public spending on health recognize and identify as the first political reforms continue. However, these warranties and conditions have not been successful in strengthening health sector budgets in the states implementing HSR. Worse, HSR has not been able to halt the decline in the proportion of spending on health services throughout the spending. The Indian system is particularly complicated due to higher tax revenues for central government control, however, given the primary responsibility for health spending to the states (6). Andhra Pradesh is the first state to go with the HSR. The health care reforms in Andhra Pradesh in the state of Andhra Pradesh was formed on November 1 1956 the reorganization of States under the rules. It is the fifth largest state, covering an area of 2, 76, 754 square miles, with 8 4% of the territory of India and also the fifth most populous country with a population of 75 crores. The state has diverse physiographic features of the high mountains, rolling plains to a coastal town in the delta environment. Andhra Pradesh is administratively into 23 districts, 79 divisions, sales, 1123 mandals parties, about 27,000 villages and 264 towns. AP um 7 economy grew 2% in 2006/07 – the fourth consecutive year of 6% growth. The final list of the poverty rate is 16%, compared with 23% for India. the credit rating of the third-highest among major Indian states, the third best investment climate in the country, and the fourth lowest level of corruption among the Indian states of Andhra Pradesh is the first Indian state to one of several operations banking sector – in Andhra Pradesh received program re – for U.S. business $ 550 million in 1997 – the objective of contributing to the acceleration of state policy and institutional reforms in a wide range of sectors within a common fiscal framework. It is also the only Indian state in the bank three budget support operations – the first in Andhra Pradesh Economic Reform Loan (pearl has paid 1) In March 2002, the pearly second in February 2004 and the third pearl in January 2007 — which seeks to support the national development agenda. (12) In the AP, not regional, social and gender differences. Health outcomes are the worst on castes (16% of the population) and Tribus () 7% of the population, especially in underserved areas in the tribal drought in northern and southern areas threatened, and for women . The effective delivery of quality primary health care is hampered by supply and demand, including poor health and human infrastructure. (15) The history of health care reform in the State of Andhra Pradesh, the project may first remission Health System, a World Bank funded projects the health system is traced in the country. This project, initiated in 1995 to the life of the AP Vaidya Vidhana Parishad (APVVP) applied. Organizations like the World Bank and DFID are supporting the reform process in the state. The Bank supports the project include AP economic restructuring, improving primary health care as one component. (7) The focus of reforms to improve access to health services of good quality, strengthen governance and management in health care, improving institutional mechanisms for popular participation and accountability and strengthening financial management systems. (15) The Government of Andhra Pradesh [GOAP 1999] “Vision 2020″ of a seven-point set of priorities for health reform: universal access to primary health care, promotion of private investment in the tertiary health care, focusing on to save specific programs to promote family planning is focused on improving health standards among disadvantaged groups and backward regions, with emphasis on prevention, improving system efficiency public health and developing public education information and communication (IEC) program for information dissemination on preventive health care. (13) The Andhra Pradesh government is embarking on a major reform of health care to improve health care in the state. DFID has expressed its willingness to pursue these initiatives with a grant of £ 100 million over the next five years (2006-2011) expressed support. The reform initiative will be measures to improve efficiency and accountability of the public health sector, to concentrate Community action focuses on preventive health care and access to quality health care to the poorest segments of the population (14) DFID is up to £ 40 million budget to support the health sector DoHMFW, GOAP, more than 3 years from 2007 to 2010. The sector will be supported to create synergies with the National Rural Health Mission (NRHM), a program of health sector reform in central government for decentralization approach for the poor, improving service delivery ( 15) support the health sector over three years available (2007-08 – 2009 – 10). It aims to increase the use of high-quality medical care, especially the poor and underserved areas. (16) The main conclusions are: a) Improve access to high quality and professional services, especially in remote areas and the interior, b) governance and management of health sector expanded c) Institutional mechanisms for the participation of community and systems of accountability in the operation, financial and management systems to strengthen and improve public health spending. The performance of health care is measured against the * (17) increased efficiency and improved performance of existing programs * Improving efficiency in the allocation of resources, improved access and equity * and * run satisfacfionReforms consumer health progress key reforms are covered by these categories and activities that can be found below, and we consider each in detail (i) the reorganization and restructuring of existing health care center in the state of Andhra Pradesh Vaidya Vidhana Parishad strengthening of relevant institutions and setting standards, improving the provision of drug education in Andhra Pradesh, Health, Medical and Housing Infrastructure Development Corporation (APHM & HIDC) strengthening primary schools health as 24-hour centers, MCH introduction of general obstetrics and neonatology (CEmONC centers) (ii) changes in health-care system is organized, pay and management of the Hospital Advisory Committee / hospital development of all societies and RUF, primary health centers and teaching hospitals to provide free bus passes to pregnant women, prenatal care for Public-Private Partnership (iii) changes in methods of financing the Plan of Sukhibhava (improving care institutional delivery services plan) royalties (IV) of the reforms related to the integration of human resources and duties of officials in planning, implementing and monitoring programs of HM & FW Department (V), with the participation of the community in health care delivery and deployment of Voluntary Health Plan for Women (VI) the reform, the quality of performance indicators for the gradation of primary care health centers performance evaluation hospitals Sekundarstufe 1 Reorganization and restructuring the current health system A) Andhra Pradesh Vaidya Vidhana Parishad, AP, Andhra Pradesh Vaidya Vidhana Parishad has (APVVP) through the adoption of a law in the Legislative Assembly in 1986 (8) This is made with the aim has been created to increase greater emphasis on the development of preventive and curative care, and the necessary links with the appropriate levels to ensure full medical and health services. APVVP is committed to supporting the World Bank in Andhra Pradesh first reference, health systems project (APFRHSP) in 1994 for a period of seven years. This is one of the major projects undertaken by APVVP. Project objectives included the improvement of efficiency in the allocation and use of health resources through policy and institutional changes and improved health system performance by improving the quality, effectiveness and costs of health care health at the first referral level. B) strengthening institutions and establishing basic standards of referral service standards for various categories of hospitals under the administrative control of fixed APVVP creating a hierarchy of hospitals and facilities services. This system of standards and service reference links have been developed with the aim of optimizing the use of resources to avoid duplication and waste of resources flowing to regulate other patients and reduce treatment costs by reducing patient loads to larger hospitals. District Hospital has been dedicated to services in eleven specialties are presented for the 9 civil surgeon specialists, 18-20 Civil Assistant Surgery, 54-84 paramedics and others available. C) to improve the supply of drugs to ensure regular supplies of medicines at all times and in all situations, a system of three sources of drug supply has been launched in hospitals APVVP: (a) the purchase of medicines centralized, in which the Drug manufacturers have been allocated a certain amount to the value of the strength of bed (RS 2000 per bed per quarter), (b)) an emergency supply for medicinal products (Rs 100 per bed per month would be done in any institution, emergency procurement of medicines is (c) drugs that are short and regular contract suppliers have not been available in the office of the district coordinators of the shares of services Health. APFRHSP Under had been years of construction and renovation of 160 hospitals, including 81 community health centers, conducted 58 field hospitals and 21 district hospitals. (10) d) formation of Andhra Pradesh, Health , Medical and Housing Infrastructure Development Corporation (APHM & HIDC), an independent company established in 1987 exclusively for the development of infrastructure for housing and other medical and paramedical personnel and the construction of sub-centers, primary schools health, hospitals, pharmacies, clinics, health centers and other One of the main projects has required APHM & HIDC, the World Bank assisted India Population Project-VIII, initiated to improve medical facilities in urban slums in 74 municipalities. Make e) the strengthening of PHC as 24 hour centers, maternal and child health in a step to facilitate the care of mother and child health at all times, has 470 primary health centers in the most backward areas around the days Mother and Child Health Center (formerly the Women, Health Centers name). A nurse, ANM, and three support staff have been appointed in each center on a contractual basis. Nursing staff were trained to carry out normal deliveries and refer emergencies. Additional services such as telephones and vehicles of primary health centers have provided support to communication and transport for referral of emergencies. Should be conducted two weeks of specialty hospitals obstetrics and pediatrics at the centers to identify a high risk to pregnant women and newborns reference RUF. F) the introduction of general obstetrics and neonatology (CEmONC centers) The State Government has decided to offer 108 centers in each district to CEmONC that pregnant women stay, emergency care that no more than 40 — 50 km to receive specialist ensure dissemination. Training of MBBS doctors in anesthesia, neonatology and blood transfusion has also provided support for this system. 2) changes in the organization of health care, delivery and management training) of the Advisory Committee of the hospital or clinical development for all societies and RUF, primary health centers and teaching hospitals of the Hospital development societies were formed in all tertiary hospitals under the supervision of the Office of Medical Education. (18) and after the implementation of NRHM kalyam Rogi Samithi formed in each of APS to ensure adequate participation of local institutions with the aim of improving the effective and efficient service with the financial flexibility to name. These companies are examples of decentralization. Activities of the Society are the preservation of the hospital (including sanitation and water supply, electricity, building and construction and equipment), the purchase of medicines and medical supplies and equipment. The government has rules and limits for the execution of these works, which are set to be implemented by the company. The “system works,” said a UNICEF team assessed the impact of the RSK in late 2000. The system is not without gaps. After all, it was noted that “control of local bodies RKS still in the hands of a collector and when he is not interested in the health care then it can only be derived (13) b) the provision of free bus ride will pregnant women for ante-natal check UPS (19) The Government of Andhra Pradesh has taken an innovative system for pregnant women in rural areas claim to prenatal care in the hospital following range of primary care or FRU starts. has been combined with State Road Transport Corporation and the free movement of buses used to pass in three visits. The issues with the ANM bus to support pregnant women to their visits. c) Public Private Partnership (20 ) · Management of Urban Health Centers of NGOs under the World Bank Andhra Pradesh Urban Slum Health Care Project (APUSHCP), 192 urban health centers (CHU) have been established in 74 municipalities in 21 districts for 1848 cities slums. After the withdrawal of support by the World Bank, the project has been funded by the government since 2002. The project results show a significant improvement in the coverage of the ANC, institutional deliveries, postnatal care and immunizations the population of the slums. · 108 The government rescue. tied with Satyam Computers for emergency transport, which has proven to offer a very successful program and many states are in the same Gujarath. The goal of 108 ambulances to save lives in emergency situations. An ambulance is for three sandals. ambulances fitted with equipment worth Rs. 17 lakhs for their services, even in emergency situations of life, road and Fire (22) · Rajiv Bhaginis Sree innovative Govt. insurance system for the poor of serious illnesses can not attract the nation to serve as a successful program this time. This program provides financial assistance to BPL families of 2 lakhs per anum for the proposed treatment for serious diseases . It covers the entire state on 2 October 2008 with the Govt. payment of insurance premiums for all beneficiaries. The sum of RS. 450 crores will be provided to implement the plan in 2008/09 (21). 3) Changes in financing methods A) Sukhibhava regime (23) Under this program, a workforce of 300 rupees (Rs 200 and Rs 100 to cover transportation costs for food and incidentals) is a pregnant women who are below the threshold poverty of families who are State hospitals and services APVVP Hospital / University Hospitals / PHC / CHC to provide serv-on. This aid is only granted to women without children or with a live child. b) Royalties: – When users pay their share of significant use in the optimization of spending patterns and a better distribution between organizations and institutions (24). Vandemoortele and Reddy (1996), are based on a comprehensive review of funding for social service users Basic carried out by UNICEF, the point of discouraging other three rates to be financed (1) of the user, cause a steep decline in use of services, especially among the poor, (2) gender bias seasonal and regional economic differences can also complicate the impact of users on equity financing, (supporting amended 3) the ability of user sufficient funding and effective decentralization of government beyond, and (4) Users can finance political support for the goal of universal coverage of basic social services undermined. In 2001, the Commission on Macroeconomics and Health (2001) and the same conclusion that the charges at the end of the arms without essential health care, in 2005, the latest report Millennium Project United Nations Secretary General (2005), entitled “Investing in Development – A Practical Plan to Achieve the Millennium Development Goals to discuss” with the press for the withdrawal of the royalties. The health sector in the India has a reputation for inefficiency and corruption at all levels included. There is very little accountability in the public and private sector. quality standards are virtually nonexistent, as argued published performance measures and reporting honest. A recent study in the field of human resources for health at Harvard University Global Equity Initiative (2004), is the people – but the health of workers – which can produce an efficient health system and provide a good avalanche. ( 25) 4) the reforms associated with the integration of human resources and duties of officials in planning, implementing and monitoring programs of HM & FW Department in the district was formed District Health Coordination Committee (DHCC) for proper planning, implementation and monitoring of all programs or activities of HM & FW Department in the district. The Committee is entrusted with primary responsibility for planning, completion, implementation and monitoring of the Action Plans and District Health institutionwise health plans in a participatory manner with all staff involved, other relevant authorities and NGOs. 5) community involvement in health care provision and delivery of women volunteers from the Health Plan A key component of the National Rural Health Mission is every town in the country offer training with women activists – ‘ASHA or Accredited Social Health Activist. Selected from the same village and accountable to it, the ASHA will be trained to act as an interface between community and the public health system. The following are the key components of Asha (26) A woman, usually a daughter-in-law of a house that has been studied, 7 of class, preferring to SC / ST community was selected as the WHV by the Gram Panchayat Health Committee. The selected WHV has a month of training in health aspects of pregnancy, prenatal care, childbirth and postpartum and newborn care, immunization, diarrhea, acute respiratory infections , first aid and treatment of minor ailments. The training was in Telugu Mahila Pranganams for three weeks and one week in the training of primary health centers provided at field level. Academy of Nursing Studies was designated as the central WHVs training. 6) quality of care reforms to A) Performance indicators for the ranking of PHCs One component of the AP World Bank supports the economic restructuring of the project is to improve primary health care. To improve the quality of primary health care, a performance appraisal system has been developed for primary health centers and the rate of HCC. The assignment was awarded to the A to C, in descending order b) the results of the evaluation of secondary hospitals, a performance evaluation system for hospitals under APVVP second level was added. Indicators for general services (outpatient, hospital, bed-room) emergency services (emergency surgery in -IP emergency, major emergency operations, emergency surgery minor), clinical services are available (the main minor surgery, tubal ligation, supplies) and diagnostic services (X ray, electrocardiogram, laboratory tests and USG) were developed for this purpose. normative goals for each type of hospital (district hospital, hospital, Community Health Center) have been resolved, measured against the performance and the rating assigned. Top of A, while the lowest rating is C (27) Conclusion: – introduction of rights of use and outsourcing of services to the private sector are the main elements of reform in health care. The health reforms are only part of drastic reforms in other key sectors, conducted as part of Andhra Pradesh Economic Restructuring Project (APERP) and the overall impact on the health of people and their access to health care is more dependent on external changes proposed health sector . For example, while exempting the ration card white with a score that is the poor from user charges in public hospitals, aims to reduce drastically the number of white card holders to halve the state. The net effect would reduce the percentage of the population entitled to free treatment. (29) Moreover, the success of 108 Emri services and the overwhelming response by Sree Rajiv Bhaginis regime are examples of successful HSR. As each thing has

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