Press Releases Archive
17th September, 2019
Sri Y.S. Jagan Mohan Reddy
Chief Minister of 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:
- 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.
- 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.
- 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:
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.
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.
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,
- 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.
The following are Dr Jayaprakash Narayan’s responses to a few questions raised on the J&K division.
Q: Should Article 35 A be repealed?
Article370 and Article35A must be repealed.
Article 35A and its variants in other States and regions of India violate the fundamental rights, undermine unity and integrity of the nation, and create impediments to economic growth, investment and job creation. Therefore, repeal of Article 35A and other regulations/provisions all over India restricting rights of all Indians is necessary. It should not be viewed in isolation and the same principle should be applied to all of India. Isolation of regions and communities in the misplaced belief of ‘protecting’ them only stunted economic growth, perpetrated poverty, stifled innovation, retarded cross-fertilisation of cultures and ideas, and weakened unity and integrity of the nation.
Q. Should Article 370 be repealed?
Article370 and Article35A must be repealed.
The provisions of Article 370 were clearly intended to be transitional and temporary. However there are two different sets of issues related to Article 370. Those provisions that spawned legislation like Article 35A are clearly unproductive and dysfunctional in this day and age of global supply chains and disappearing trade barriers. Similarly, the provisions that limit application of fundamental rights in any form, or violate the principles of separation of powers, constitutional checks and balances, universal franchise, democracy and people’s sovereignty expressed through the elected legislatures should be recognised as anachronistic and dysfunctional.
Q. Do you support regional autonomy for Jammu and Ladakh?
Jammu and Ladakh have been seeking regional autonomy. I believe they should have autonomy. The model of autonomy should be discussed: a) it could be regional councils in the pattern of Telangana Regional Council we had until mid-70’s. b) it could be Meghalaya pattern before it became a full-fledged State. I believe similar flexible models should be evolved wherever there are demands/need of that kind. It is best to encourage all stakeholders in a State to hammer out a compromise, and then Parliament must sanctify it as law. If the choice in such cases is between local autonomy and separate statehood, then the contenders will usually agree on a compromise.
Q. What is your view on creation of union territories through unilateral decision making of the Govt?
India is a Union of States. It is a federal country, and a unitary model of a single-tier government at national level making all decisions will be a failure, and will lead to fissiparous tendencies. Therefore conversion of a State into a UT is regressive. Our pattern always has been converting a UT into a State wherever necessary/feasible. A new UT has been created either because of a dispute between States (Chandigarh), or as a transitional measure (North-east, Goa and Pondicherry after decolonisation, Sikkim after voluntary merger with India etc. So far there have been no instances of converting a whole State into UT(s). It is a unitary approach that should be avoided for reasons stated above. And it is unwise to unilaterally impose a solution without taking the stakeholders into confidence and hammering out a negotiated solution. The Union should play a proactive role to reach a solution, but should not bulldoze. NDA under Mr Vajpayee followed this approach before bifurcation of UP, Bihar and MP. That is the federally correct and politically wise approach.
Q. Can you please elaborate on "different model of democratic government". Is J&K, a state with internal and external security complications, ready for it?
Obviously local situations vary in a large and complex country. As long as Union’s constitutional role under Seventh Schedule is intact, and fundamental postulates of democratic and accountable government are adhered to, unity and integrity of India are safe. Union’s meddling in State’s functioning will only make things more complicated and often worse. Regarding different local models, there is no reason why Delhi, through constitutional diktat should decide how the State legislature is elected (our Constitution prescribes an elaborate model as a complete replica of the Union), local governments are structured (73rd and 74th Amendments created over structured, underpowered, largely dysfunctional local governments) or cooperatives are managed(Part 9 B prescribes elaborate mechanisms to manage a coop; at this rate tomorrow somebody will incorporate a chapter in the Constitution on how to run a local club!).
In Kashmir, earlier the Sadar I Riyasat (Governor) was elected by the legislature. Heavens won’t fall if the all States elect Governors just as the President is elected, or if we abolish governors altogether. Until now J&K had a term of six years for its elected legislature. Every State can be allowed to choose the manner of election of executive and legislature, and their term of office within a band, say 3-6 years. There is no reason we should impose by the federal Constitution an inflexible, one-shoe-fits-all approach. No one person has the ability or imagination to anticipate all local needs and contingencies and design a model that fits every situation.
Q. Can we expect to see these new UTs turning into states in the long-term?
I understand that the HM announced that the creation of UTs is only a temporary measure. Parliament has the power to convert a UT into a State. The problem is with conversion of a whole State into UTs. Once we abrogate Article 370, J&K became like any other State, and we should adopt the same constitutional methods and practices. We cannot in the same breath argue for full integration of the State, and at the same time treat it on a different footing; we are actually weakening integration. There are obvious local challenges because of civic unrest; they should be handled the way we handle them anywhere else in India. That is the best guarantor of national integration. Different treatment will only give fodder to other nations to undermine our sovereignty.
Q. Should India be concerned about the reaction of the international community (especially Pakistan, US)?
We are too big a nation to worry all the time about other nations. We should do what is best for our people and our nation. At the same time our own self-interest and global image should be protected. If we are seen as undemocratic or hypocritical, our global influence diminishes. Our actions must therefore reflect our values, and we must take world nations, particularly friendly great powers into confidence, and lucidly explain our stand and actions to the world. Beyond that we should not be guided by wishes of other nations.
Q. Your thoughts on how to resettle Kashmiri Pandits
Legally, the Kashmiri Pandits have all rights and they should be enforced. They have been violently and brutally driven away from their homelands. It is a disgrace and a tragedy that we as a nation did very little to protect the Kashmiri Pandits who are refugees in their own nation. If they go back to their homes, they would have legitimate concerns about their lives and safety in the midst of hostile neighbours. There are probably three options: a) if enough groups wish to go back to their homes and if there is safety in numbers, the government must provide full assistance to them, and provide full protection to their communities as long as it is needed. b). if in their homes there is serious threat to their lives and livelihoods, they must be allowed to choose any location in J&K where they feel safe, and the government at its cost must provide full rehabilitation and fully protect those settlements. c) if some families prefer to permanently settle in other parts of India outside J&K, government must provide full compensation to them for loss of homes, properties and livelihood, and give all assistance needed for resettlement.
Q. What is the way forward for these new UTs?
What happens in the new UTs depends on GoI’s approach to long term solution. The above answers cover some approaches. But we must not forget Jammu region where there has been for long a popular demand for separate statehood/autonomy. That needs to be addressed simultaneously.
The current situation could provide us an opportunity to strengthen unity, promote local flexibility and evolve as a mature federal polity. Let us hope a constructive and healthy debate will facilitate real change for the better.