How Telangana Became One of The Best Performing States in Healthcare Sector

From being one of India's most deprived states, to top-performer on the national stage, Telangana has been recognized as one of the best performing states in the healthcare sector by NITI Aayog. Slotted next to Kerala and Tamil Nadu, which are traditionally considered to be top performers when it comes to healthcare, Telangana has managed to revamp its healthcare through various initiatives. Here are some of the programmes undertaken by the state government to provide the best possible healthcare facilities in the state:

- KCR kit scheme: The vision of the state is to significantly reduce, the high toll of maternal and pregnancy wastage which has become a reality with the launch of KCRKIT program in 2017, wherein a multipronged strategy was adopted to ensure safe pregnancy and newborn survival.

- Compensate wage loss during the period of pregnancy and post-delivery

- Accessible, high quality antenatal care and institutional delivery with routine essential obstetric care

- Accessible, high quality emergency obstetric care at the first referral level

- Improve overall maternal and child health care through E-governance of service delivery

Through this scheme the expectant mothers also receive financial assistance of Rs. 12,000 for a male child and Rs. 13,000 for a girl child. Even after birth, the family is taken care of through the KCR Kit - a special care-package of 16 essential health and nutritional items for all expectant mothers. This kit is precious to new parents - especially those who don't have the means to purchase the items themselves. This has helped in tremendously increasing government institutional deliveries from 31% in 2015-16 to 50% in 2019-20 (NFHS).

- Amma Vodi Scheme: Through this initiative, free referral transportation is provided to all pregnant woman to the designated destinations covering ANC check-ups to delivery and postnatal care. Pick-up & drop back services are provided to the mother and child for immunization and services for sick newborn care units or nutrition rehabilitation centres. There are around 300 of ambulances under this scheme that provide services to the expecting women or new mothers of the state.

- Midwifery Initiative: Telangana has been the front-runner in the midwifery initiative launched with the objectives to

- Promote a cadre of trained personnel where there is non-availability of skilled professionals

- Provide autonomy to pregnant women in making their own choice of birthing

- Help in reduction of c-sections by encouraging natural birthing

- Promote respectful maternity care

The trained midwives contribute to 50% of the normal births in the 16 facilities that they are posted. Looking at the successful model in Telangana, the Country has taken all steps to replicate this initiative across all States.

- Kanti Velugu:  Launched in 2018, the programme works towards “Avoidable Blindness Free Telangana”. The state government conducts universal eye screening, covering the entire population of the state under the “Kanti Velugu” initiative. It is known as the world's largest eye screening camp, and has already reached a population of 3.5 crores since 2018.

The objectives of “Kanti Velugu” programme are:

a. To conduct eye screening and vision test for all citizens of the state

b. Provide spectacles free of cost

c. Arrange for surgeries and other treatments free of cost

d. Provide medicines for common eye ailments

e. Educate people on prevention of serious disabling eye diseases.

- Basti Dawakhanas: The initiative was launched by the Greater Hyderabad Municipal Corporation in Telangana in April 2018 with the main aim of strengthening primary health care in the state. It is basically a network of primary healthcare centers that have come up to serve the urban poor. They are easy to access and free of cost. Around 350 Basti Dawakhanas that are present today in the state offer free consultation, medicines and a variety of diagnostic tests. Each of these Basti Dawakhanas has a doctor, ASHA workers, and an auxiliary nurse midwife. According to the state government, the biggest beneficiary of this programme has been Telangana's women.

- Telangana Diagnostics – This initiative launched in 2018 is a free in-house diagnostics service having a Central hub at Institute of Preventive Medicine (IPM) which caters to 350 spokes in and around Hyderabad dt providing 57 tests conducted. Online reports (bi-directional) with SMS sent to the beneficiaries. 20 mini hubs are functional providing Pathological and Radiological services including ECG, X-Ray, Ultrasound with 4 CT scan services.

- ST- Elevation Myocardial Infarction (STEMI): It is a serious type of heart attack which accounts for 17 per cent deaths in Telangana. If untreated promptly in the first hour (‘Golden Hour)  leads to death . The public health facilities are now equipped to tackle STEMI through hub and spoke model. 4 hubs with 38 spokes covering 22 districts are now functional. Alongside, 2 state-of-art cathlabs are established at DH Khammam and Osmania general hospital. Within a short span, 82000 ECGs have been transmitted, diagnosing 3446 critical cases of which 1626 are STEMI cases. Upon identification, a specially trained MO in peripheral spokes administer the life-saving clot-buster drug costing around Rs.40000 under the guidance of hub cardiologist in the golden first hour.

- Electronic Intensive Care Unit (eICU): Works in hub and spoke model connecting peripheral ICUs with the central command centre (CCC) for providing critical care services in the remote areas. NIMS is serving as the Hub and 15 peripheral ICUs including remote tribal areas each having 10 beds will be spokes. This model helped in decreasing referrals to <10%, patient compliance and follow-up rates increased.

- Tele health consultations @ toll-free no 1800-599-12345 are ongoing in 593 PHCs with virtual specialist consultancies available through 630 specialists empanelled

- Arogya Lakshmi Scheme: This scheme takes care of pregnant, lactating women and as well as infants by preventing malnutrition by providing them complete nutrition. The program provides regular, balanced meals and has reached over 19 lakh lactating mothers, over 5 lakh infants and over 25 Lakh pregnant women.

Achievements

According to the government of Telangana, through these various health initiatives, over the years the state has achieved:

- Today in Telangana, the total institutional deliveries are 99.8 per cent (HMIS)

- The state also boasts 100 per cent immunization for infants, children and pregnant women

- The state has also achieved the best outcomes for Maternal Mortality Rates (MMR) and Infant Mortality Rates. According to a special bulletin on Maternal Mortality Rate in India released by Census Commissioner, Ministry of Home Affairs, Telangana is ranked third after Kerala and Maharashtra for having lowest number of maternal deaths. According to the Sample Registration System (SRS), at the time of statehood, the MMR in Telangana was close to 92 and by 2017-19 it has dropped to 56.

- The state achieved 2nd rank in the Country for Sick Newborn Care Units (SNCUs) quality of care index. 35 SNCUs are functional currently.

- 8 SNCUs accredited by National Neonatology Forum (NNF)

- The State has reached category 1, the Elimination phase where States/UTs including their districts reporting an annual parasite incidence (API) rate of less than 1 case per 1000 population at risk.

- State is ranked 1^st in National External Assurance Standards (NQAS) with 126 facilities certified (PHC category) and 2^nd in UPHC category. he National Quality Assurance Standards are broadly arranged under 8 "Areas of Concern"– Service Provision, Patient Rights, Inputs, Support Services, Clinical Care, Infection Control, Quality Management and Outcome.

- Ranked 1st in the country with highest notification of TB cases and ranked 3rd in the country with 87% of TB treatment success rate

- 300 facilities received Kayakalp awards. The aim of this initiative is to improve and promote the cleanliness, hygiene, waste management and infection control practices in public health care facilities and incentivize the exemplary performing facilities.

- Mechanized laundries set-up in 101 secondary care hospitals

- Over 2.2 crore population screened for risk of Non-Communicable Diseases (NCDs) as part of universal screening of population above 30 years of age

- 2.5 crore population registered in village health registry as part of digitalizing of entire state population in a master database for health programs

- 2.2 crores population have a comprehensive health profile of their common communicable and non-communicable diseases done by ASHA in the ASHA disease profile

- 305 labour rooms are standardized

- 23 Maternal and Child Hospitals are being established

- High Dependency Units/Obstetric ICUs cater to high-risk pregnancies by providing high quality intensive care to prevent maternal morbidity and mortality

- One Breast Milk Bank fully functional at Niloufer Hospital and 6 more to be functional in the State

- 2 Lactation management centres are being established and all staff nurses are trained in lactation management counseling to improve early initiation of breastfeeding. The birth companions are also trained and counselled on the importance of immediate and continued breastfeeding

- 8 District Early Intervention Centres (DEIC) are established, 10 more are being setup to identify the “4 Ds” Defects at birth, Diseases of childhood, Deficiencies and Development Delays including Disabilities and early intervention of these conditions

- 57 blood banks and 31 blood storage units functional

- Palliative medicine treats complications and ensures that the life of end stage patients is pain-free, peaceful. 33 Palliative care centres established with 8-10 beds and home care services are offered in a radius of 30-40 kms through Alana vehicles.