Early in March this year, the High Court commended the Telangana government’s efforts in controlling the Omicron variant of the Covid pandemic. Some 28,000 beds had been created with oxygen facility in a span of one year. Telangana has been ranked 3rd in the country in the latest NITI Aayog’s Health Index for overall health performance among the larger states. The progress in healthcare for this young State has been on several fronts. Most dramatic perhaps is in the area of maternal health.
As per the Sample Registration Survey (SRS) 2017-19, the decrease in Maternal Mortality Rate (Maternal deaths per 1 lakh live births) has been the highest in the country. From 76 in 2015-17, MMR dropped to 56 in the latest SRS taking the State to the third position in the country just behind Kerala and Maharashtra. Since its inception, the State has also recorded one of the highest rates of increase in deliveries in public health facilities- from 30.5% (NFHS IV) to 50% (NFHS V).
The introduction of the KCRKIT scheme which incentivises women for delivering in public facilities has much to do with the much improved maternal health indicators. A sum of `12,000-`13,000 is transferred online into the bank accounts of women in four tranches. The improvement of infrastructure in labour rooms, introduction of 300 transport vehicles (102) especially for pregnant women, construction of 28 exclusive Maternal and Child Health Hospitals and online tracking of high risk pregnancies (www.kcrkit.telangana.gov.in) have ensured that the State is highly ranked in the country.
To tackle the high rate of C-sections and to ensure presence of skilled personnel in remote areas, the government is creating a cadre of Nurse Practitioner Midwives. Nurses, after 18 months of intensive training as midwives, are transforming labour rooms. Alternate positions of birth, respectful maternity care, birth companion in labour rooms are now part of maternal health care in remote hospitals. In the coming days, Midwife Led Care Units (MLCUs) of Telangana which are being acclaimed by maternal health experts will be a part of every delivery point.
The Infant Mortality Rate (IMR) is 23. The 32 functioning (of the 60 sanctioned) Special New Born Care Units (SNCUs) which cater to the sick newborn children in the State have been ranked Number 2 in the country in the Quality Care Index. Since last year, every child born in a government facility is screened for congenital defects at birth and corrective procedures follow.
Blood test reports online
Every day in Hyderabad, an average of 30,000 blood test reports are sent online through SMS to the personal mobiles of patients. Blood samples are collected in the Primary Health Centres and Basthi Dawakhanas, bar-coded and transported to the central Telanagana (T) Diagnostic Hub at Narayanguda. Here, they are analysed after due verification and internal quality checks in the fully automated machines which are integrated with a bi-directional software. The T Diagnostic Hub which is NABL-accredited has an MOU with AIIMS, New Delhi and CMC, Vellore for EQAS programme. Due to this programme, in the last two years, roughly `150 crore has been saved for the public .
Twenty mini hubs render free imaging services (ECG, Xray and Ultra sound (with Tiffa scan) in the GHMC where patients can walk in with a referral slip. The ‘Telangana Diagnostics App’ in Google Play leads one to the nearest Diagnostic Hub in the twin cities.
The hub and spoke model of T Diagnostic services are already functional in 19 other districts and being expanded to rest of the state The nearly 300 Basthi Dawakhanas (BDs) located within slums across the breadth and length of the Greater Hyderabad have garnered widespread attention and praise. Manned by MBBS doctors, the BDs provide OP, diagnostic and tele-consultation services to the poorest in the city. The XV Finance Commission has recommended that Telangana model of Basthi Dawakhanas be set up in rest of the urban areas in the country.
MBBS/Ayush doctors are being posted at the Sub-Health Centres now called Palle Dawakhanas. Aimed to strengthen primary health care, the Palle Dawakhanas offer an expanded bouquet of preventive and primary healthcare services.
Tele health consultations are ongoing in all the PHCs by 990 empanelled specialists and super-specialists from 19 specialist areas including gynaecology, paediatrics, oncology, nephrology etc. On the tele consultation platform where the PHC facility is networked with all the first referral and tertiary healthcare facilities, a medical officer books an online appointment with the concerned specialist. At the appointed time the specialist/super-specialist video consults with the patient online through the monitors.
At the end of each consultation, an e-prescription is printed out at the spoke facility and patient walks out with medicines in hand. More than 2 lakh consultations have been done so far. A recently concluded study in the state by the TATA TRUST pegs the average saving per tele-consultation for the common man at `1,400.
Telangana currently stands 1st in the country in National Quality Assurance Standards (NQAS) PHC category and 2nd in the UPHC category.The State has witnessed epidemiological transition from Communicable to chronic Non-Communicable diseases (NCDs). NCDs contribute to 62% of the State disease burden.
The communicable diseases are well under control though dengue continues to linger in some endemic especially urban areas Telangana is ranked No.1 in the country with highest notification of TB cases and ranked 3rd in the TB treatment success rate (87%).
10 districts are already certified as malaria free.
After Kerala, Telangana is one State that has Palliative care centres (8-15 beds) in each district to ensure that there is dignity and respect for end-stage patients. Home care services are also offered within a radius of 30-40 kms. An honourable mention was made of the palliative care services in the State in a recent UN meeting on regulatory use of opioids.
Telangana is moving swiftly towards establishing a digital health eco-system. Backed by Aadhaar authenticated population data which serves as a common entry point for all health programmes, the ANM records are completely automated saving two to three hours of time per day for the frontline workers . While a registry of communicable and non-communicable diseases is online, with the formal launching of the e-health profile, the e-health record is to be made available shortly for access across all health facilities. The NDHM standards for the data and the health care system are being worked on.
(The author is a member of the India Administrative Service (IAS) and is currently posted as Secretary, Education. She was formerly Commissioner of Health and MD, NHM in the state of Telangana from 2016-18 and again from 2020-22)
‘BASTHI DAWAKHANAS PRAISEWORTHY’
To tackle the high rate of C-sections and to ensure presence of skilled personnel in remote areas, the government is creating a cadre of Nurse Practitioner Midwives. Nurses, after 18 months of intensive training as midwives, are transforming labour rooms
The nearly 300 Basthi Dawakhanas (BDs) located within slums across the breadth and length of the Greater Hyderabad have garnered widespread attention and praise