ADMINISTRATIVE STRUCTURE OF
MEDICAL AND HEALTH DEPARTMENT
IN
ANDHRA RADESH
his chapter deals with the Administration of Medical Health in the State of Andhra Pradesh. It studies the
State of Andhra Pradesh. It brings to the origin of the department of health, evolution of the department, the secretariat level organizational set up, organizational structure at Directorate level, staffing pattern, their roles and functions and so on.
The State of Andhra Pradesh has come into being on 1st November 1956, as a result of the States Reorganisation Act. It comprises 23 districts of erstwhile Andhra State and nine districts of Telangana which were part of the erstwhile Hyderabad State.
Andhra Pradesh has an area of 2,76,700 sq.km and a population of 762.10 millions spread over in 27,221 villages, 14 municipal corporations, and 120 municipalities. Andhra Pradesh ranks fifth both in respect of land area and population in the country. According to 2001 census. the densip of population in the State is 277 per sq.km. The literacy rate is 234.45 per cent. Presently there are 23 districts in the State. The State has three natural geographical regions viz., Coastal Andhra, Rayalaseema and Telangana with varying levels of
socio-economic development, cultural patterns and demographic variations.' It is shown in the table 2.1.
According to 2001 Census, the urban population in the State is
208.09 millions. 2
The Government of Andhra Pradesh has the constitutional responsibility to provide health care services to its population living in urban, semi-urban, rural and tribal areas since health is a State subject. In this chapter, the organisational structure and management aspects of health and family welfare in the Government of Andhra Pradesh are discussed.
Administrative Organisation of Medical and Health Services in Andhra Pradesh
Origin of the Department
The department of Public Health has got a long history with the origin in the year 1864. In that year the first Sanitary Commissioner was appointed in the former Madras Presidency, whose duties were chiefly for military requirements and the expenses of the department were met from military Budget. During the course of time, when the civil portion of the commission’s duties increased, the Sanitary Commissioner was transferred to civil side, transferring the expenditure to civil budget.
The vaccination section of the Health Department, which had its origin in the year 1802, was under the control of Superintendent General of Vaccination with a few trained personnel. This branch of vaccination was gradually developed increasing the vaccination staff. The supervision and control of vaccination were under the control of Medical Department as ‘Preventive Medicine’ was not recognized as a distinct branch of profession till 1875. During the year 1875-76, the control of vaccination department was transferred from medical department to Sanity Department,
Registration of Deaths was first attempted in Madras Presidency in the year 1855 in Madras town only. In the year 1865, the first anempt was made to register the mortality of people in other parts of the presidency through the agency of Sanltary Department. From that time, the Registration of Births and Deaths was carried out with varying degrees of success. Finally, in the year 1899, Madras Registration of Births and Deaths Act of 1899, was passed for the entire state and implemented the same in the entire presidency of Madras in a phased manner.’
In order to have trained personnel for vaccination and public health work a certificate course in sanitary inspection was started in the year 1895, till which time, only people with no training in
practical or theoretical sanitation were employed as Sanitary Inspectors for vaccination work,
The spread of cholera and the frequent occurrence of cholera out breaks was a subject of anxiety and hence, the Government sanctioned the creation of a small groups with reserve of Sanitary Inspectors consisting of two batches with ten Sanitary Inspectors in each, for cholera preventive work in the year 1912. The number of groups increased to eight by the year 1922.
As a result of the recommendations of the Public Service Commission and of the introduction of the new Government of India Act 1919, Sanitary and Public Health became a transferred subject under the control of the Minister in-charge of the Local Self Government Department. The title of “Sanitary Commissioner” was changed as “Director of Public Health” (D.P.H) and the Sanitary Department was named as Public Health Department as per G.O.Ms.No.367 PH dated 8.3.1922.
Thus the Public Health Department was born in the year 1922 with Director of Public Health as head of the Department with the following objectives:5
Systematic maintenance of Vital Statistics and Registration of
Births and Deaths
Conduct systematic vaccination
Improve environmental sanitation
Control of local epidemics like Cholera, Small Pox, Plague, Enteric fevers etc., and reduce mortality rates.
Inspect and guide the local authorities to adopt health measure in Municipalities and Panchayats as contemplated in Municipalities Act, Panchayat and Zilla Parishad Acts.
Train sanitary inspectors to perform Public Health Work in
state and local bodies services, and others.
A separate state of Andhra with 11 districts was carved out of the former Madras state (called originally as Madras presidency) in the year 1953. In Andhra state also the department of Public Health was functioning as a distinct department with DPH as head of the department with the above mentioned objectives. A separate department of Medical services with the Director of Medical Services as head of the department was functioning to render medical care facility through hospitals.
Consequent on the reorganization of states in India on linguistic basis in 1956, the Andhra Pradesh State was formed on 1" November 1956 with 11 Districts of Andhra and 9 Districts of former Hyderabad State. In former Hyderabad State, there existed a single
7d
department of medical and health for preventive and curative aspects of medicine with single Director. After the formation of the A.P.State, the Department of Medical and Health as existing under the former Hyderabad State was bifurcated and the Public Health activities and schemes along with the personnel were merged with the public Health Department of the A.P.State under the Director of Public Health. The curative activitles along within the staff mere tagged on to Director of Medical Services.
When India attained independence in 1947, some remarkable recommendations for developing health services in the country was available under Health Survey and Development Committee known as Bhore Committee in 1946. This committee recommended a three tier system of health care delivery, through setting up of primary, secondary and tertiary health units in each district. Health services in the country have been broadly modeled on these recommendations ever since 1952, when Primary Health Centres are set up at Community Development blocks. Over the years efforts have been made to further strengthen health delivery system. with recommendations made by various health committees as follows:
Health Survey and Development Committee, headed by Joseph Bhore in 1946. This committee recommended,
integration of preventive and curative services, at all administrative levels,
short-term plans for establishment of primary health centres,
(e) long-term plan for primary health centres with 75 beds for every 20,000 population, secondary and district hospitals with 2500 beds.
Health survey and planning committee headed by Dr.A.L.Mudaliar in 1962. This committee recommended consolidation of progress made so far, establishment of Regional Directors for 2 or 3 districts, stop further expansion of PHCs until quality of services in the PHCs improve and development of All India Health Services on line with I.A.S.
Dr.Chadah Committee in 1963 recommended Malaria surveillance to be handed over to general health services and monthly operations to be done by Basic Health Worker (BHW) one for every 10000 population with additional responsibility of Vital Statistics and Family Planning.7
Mukherjee Committee in 1966 recommended separate staff for Family Planning Programme stating that the basic health workers not to be utilized for programmes other than Malaria.'
Kartar Singh Committee in 1973 recommended that the present ANMs should be replaced as Multi-purpose Health Workers and the present BHWs, Vaccinators, Family Planning Assistants, Malaria Surveillance Workers are all to be replaced as Multi-Purpose Health Workers (MPHW) Male.
Dr.Srivastava Committee in 1975 recommended the creation of a band of workers from the community itself at the village level to look after the basic health needs of the villagers, treat minor ailments, and refer cases to PHCs for further treatment and diagnosis purposes."
Working group on Health For All headed by Kripa Narain in
1981 identified and set out objectives to health planning, and evolved specific indices and targets for achieving Health For All by 2000 A.D.''
Evolution of the Department
The department of Public Health which was dealing with vital statistics and control of epidemics, environmental sanitation, conduct of fairs and festivals and implementation of P.H.Act in local bodies was further entrusted with more Public Health Programmes like Malaria control, Filaria control, BCG Vaccination Anti-yaws, Family Planning, Maternity and Child Health, etc., in first and second five
year plan periods. During the same time, in the medical department also rapid changes took place extending medical care facilities to rural area with the establishment of Primary Health Centres under the control of Director of Medical Services. As per the recommendations of Bhore committee, the primary health centres were established with a view to cover the rural populatlon for rendering both preventive and curative services involving Local bodies also in Rural Health Programme. During the third five year plan period, consequent on gearing up the Family Planning Programme which was under the control of Public Health and providing more men and materials, the role of primary health centres became more important.
As per the recommendations of Health Survey and Planning Committee and directions of Government of India, the departments of Public Health and Medical Services hitherto functioning separately, were merged in G.O.Ms.No.1285 H dated 29.6.67 at state as well as district level on administrative, technical, and financial grounds for integrated, efficient and expeditious services. The integrated department is called as ‘Medical & Health Department’ with the following staff at Directorate Level. A re-organised setup of the integrated department was ordered in G.O.Ms.No.1500 H dated 1.8.1967 with the following staff pattem' 2
Director of Medical & Health services
Additional Director of Medical & Health Services (former D.P.H.)
Deputy Directors of Medical & Health Services (6)
Professional Education
Medical care
E.S.I.
Family Planning & MCH
Communicable Disease
Assistant Directors of Medical & Health Service
School Health & Nutrition
M.C.H.
Family Planning
Epidemiology
Small Pox
Malaria & Filaria
Leprosy
Health Education
Planning & Evaluation 10.Statistics 11.T.B.Control
At the district les•el also, the Evo departments were merged to streamline the administration, w’here the impact of merger and reorganization was felt more. The former District Medical Officer was re-designated as District Medical & Health Officer and former
Asst. District Medical Officer was re-designated as Deputy District Medical and Health Officer giving them territorial jurisdiction in the district.
Thus, a complete merger of the Public Health department and Medical department took place at State, district and peripheral level from 1.7.1967 to render both curative and preventive service upto village level.
Health being a state subject, several measures for prevention and control of communicable diseases were taken up by the state of Andhra Pradesh Recruitment of doctors, nurses, paramedical technicians, and other medical manpower were taken up on a large scale. Other measures like establishment of hospitals, Primary Health centres, sub-centres and dispensaries were also simultaneously taken up by the Government with an objective of taking up health care delivery system to the doorsteps of the people.
The adverse effects of high population growth on development are well known. The provision of adequate social, economic, and health facilities to the growing population in terms of hospital, housing and education facilities create problems in the allocation of available and limited resources. Increased dependency burden along
with the increased current consumption levels make a drain on
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development resources and create difficulties in the provision of basic amenities like health and housing. Under such circumstances the Andhra Pradesh State Medical and Health Department branded off into 10 different directorates for effective and efficient functioning. Each office caters to some specific aspects of health services without infringing upon the functioning of other offices which are discussed elaborately in the following lines.1 They are:
Directorate of Health
Directorate of Medical Education
Directorate of Family Welfare
Directorate of AIDS control
Directorate of Institute of Preventive Medicine
Directorate of Insurance Medical Services
Directorate of Drug Control Authority
Commissionerate Andhra Pradesh Vaidya Vidhan Parishad (APVVP)
Directorate of Indian System of Medicine and Homeopathy and 10.Autonomous Institutions like A.P.University of Health Sciences and Nizam's Institute of Medical Sciences (NIMS),
and Sri Venkatesw’ara Institute of Medical Sciences (SVIMS). Directorate of Health is headed by‘ Director who is assisted by
Additional Directors, Joint Directors, Depuq Directors and Regional
Directors. This department looks after (a) implementation of national health programmes, (b) supervision of taluk hospitals with less than 30 beds, upgraded Primary health centres, community health centres,
PHCs dispensaries, and mobile medical units, and (c) prevention and control of local endemic and epidemic diseases."
The Directorate of Medical Education is headed by Director and assisted by Additional Director, Joint Director and Deputy Directors. This office is mainly concerned with imparting medical and paramedical education on the recognized standards and also supervision and strengthening of facilities at teaching hospitals and medical colleges."
The Directorate of Family Welfare is headed by a Commissioner. This department pursues execution of centrally sponsored schemes like Family Welfare, Child survival and safe motherhood programmes. This office also looks after the administration and supervision of the World Bank Project under Reproductive and Child Health.'6
Directorate of AIDs control was established in the year 1992-
93. All the blood banks in Government institutions and S.T.D. clinics work under the supervision of this office. Information, education and communication prograammes towards the prevention of the spread of AIDs are routed through this Directorate.' 7
Directorate of Institute of Preventive Medicine has a Director
who controls and supervises the central laboratory and also central
blood bank. This institute manufactures antigens and antisera for Rabies, Cholera, Typhoid, Tetanus Toxoid, Orosol etc.
Directorate of Insurance medical services is responsible for the supervision and administration of ESI hospitals and dispensaries. This office functions under the Ministry of Labour in the State with technical support from the department of health, medical and family welfare in the secretariat."
The implementation of prevention of Food Adulteration Act (P.F.A. Act) 1954 which was a public health subject, was tagged on to Drug control branch. Later on, for effective implementation of
Act and to strengthen the drug control administration, this branch was separated from the Drugs Controller and attached to the Director Institute of Preventive Medicine (D.I.P.M) in the year 1974, both at Directorate level and district level. The Director of I.P.M. has also been designated as State Food (Health) Authority for Andhra Pradesh to implement the prevention of food adulteration act of 1954 (central Act) and the rules there on. So, a separate department on Drugs Control Administration w'as born with a separate Director, Directorate of Drug Control is in-charge of issuing, checking and monitoring of drug licenses and maintenance of drug quality control in the state. This department is headed by a technically qualified and
experienced non-medical person and is assisted by It.Director, deputy director and senior scientific officers."
Secretariat Level Organisational Set-Up
The State Health Administration is headed by a Minister usually of the Cabinet rank. He is the political head of the department. The Secretary to the Government, Department of Health, Medical and Family Welfare belongs to the cadre of Indian Administrative Service (I.A.S.). He is the administrative head for the State Department of Medical and Health Services and works under the Minister for Medical and Health Services. At the Secretariat level, the Secretary to Government is assisted by an Additional Secretary, two Joint Secretaries, two Deputy Secretaries and several Assistant Secretaries. The work and nature of subjects to be dealt with by these officers are approved by the Secretary. These officers are assisted by different sections headed by section officers with the necessary supporting staff. At present, 17 sections are functioning at the Government Secretariat level. Each section comprises of one Section Officer, two Assistant Section Officers, one typist and one attender.
The Health, Medical and Family Welfare Department is a technical department, headed by highly qualified personnel in the
CHARJ' 2.1
Organisational setup ol” Medium und I lculth Services System in the Gt›vcrnnJcnt ‹›l Andhru l*radcsh — 199 I (includin 8 Broad Functional Areas) I tculth medical and ramily Welfare l3cpartmcnt
Minister lor health Medical und I'umily Wc1l re
Secretariat £Jflicers. Stall*(G‹›vt. level Addl.hccrctnrics, J‹›int Secretaries, Deputy Secretaries, A ext. ccrct‹iricr tHlJ Sccli‹›ns
Secretary to Govcmmunt, I Icttlth Medical anu Family Welfare
Minister for Labour
Director of i3irecttir llircctor of’ t’omnir. Ilirector Director Director ' r °*t° r Medical of 1 Icnlth I ’iimily All VVP lPM & Oug Indian "S° i"i tf1C* Education w»1li rood Control Systems of Dd)Dd
Authority Admn. Medicine & Services
Homeopathy
Nizam lnstt. Of Medical Scs. (NIMS)
Univ. of Managing
Health Director,
Sciences APM&H Vijayawada Housing
Infrastructure Oevpt. Corpn.
Medical colleges, Teaching Hospitals, Special Institutions, Nursing Colleges, Dental Colleges, Para Medical Courses
Addl. Directors, P. W.Prog. Dt.Hq. Blood Bank Drug Ayurveda ESI (Spl. Medical Special unit Dy.Directors, Immunisation hospitals PH Inspectors Homeopath7 Hospi- Medical Education for Regl.Directors of services (UIP) taluk Labomtories Drug Unani tals Care) constructio
M&H Services, MCH, ORT, hospitals, water Laboratories Medical ESD n of DMHOs, All ARl, Training spl. Analysis Colleges & Dispen Buildgs & National Health Centres hospitals Food Hospitals -saries, Qrts in the Programmes Adulteration under ISM panel Dept.
Epidemics control Dispensaries
statutory authority Regl. Dy.
for Health SHTO, Directors of
Primary Health ISM &
Centres, sub-centres. Homcopathy
urban health service•
Source: Directorate of Medical and Health Services, A,P. 1991
field of medical sciences and public health. It is of significance to note that at the Secretariat level, all the issues are discussed and decisions taken by non-technical administrators and there is no technical officer with medical or public health qualifications to help the secretariat authorities in technical matters, in taking decisions on issues relating to medical and health care administration.
There is also a system of consultative machinery at the Secretariat level. Usually the consultative committee members are the people’s representatives nominated by the Government to express and share their x•iews «’ith the Minister for Medical and Health Services.
The service deliver point for curative services is the institutional setup, namely hospitals and dispensaries. These medical and health institutions are teaching hospitals and specialist hospitals attached to medical colleges, district headquarters hospitals, taluk hospitals, civil hospitals, dispensaries uhere services are provided both for out-patients and in-patients along with emergency care and referral systems. At the dispensay level only ‘out-patient’ care is provided as they are not equipped u’ith in-patient’ facilities usually. Integrated curative and preventive services are provided in rural areas through the structure of Primary Health Centres and their sub-centres.
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These include institutional as well as community based health care services.
After the formation of Andhra Pradesh, in November, 1956, the department of medical services and the department of public health were amalgamated with effect from 1st July 1967, and the new combined department was termed as Department of Medical and Health Services and the head of the Department was designated as the Director of Medical and Health Services. At the Government level, the Secretariat, the Secretary to the Government and the Minister for Health and Medical Services are the only competent authorities to make and take any policy decisions, to accord administrative or financial sanctions and to approve of any schemes based on the proposals received from the Director, as the Head of the Department.
ORGANISATIONAL STRUCTURE AT DIRECTORATE LEVEL
In fact, the merger of two directories / departments i.e., the ‘Medical Services” Department and ‘Public Health’ Department in 1967, is a major innovatii e step and it could be stated as a very bold step of integrating curatii e and preventive services which other States in the country could emulate. It was during 1973, again reorganization took place and the Directorate of Medical and health Services was bifurcated, paving the way for two directorates, one for
‘Medical Education’ and the other for ‘Public Health’. This was not a vertical split but led to the creation of top level posts. Let us study the structure and composition of the department and functions:
DIRECTOR OF HEALTH
As a head of the department he has to manage various branches of the department with the assistance and cooperation of subordinate officers and staff at different levels viz., Regional level, District level and peripheral level. He is responsible for the implementation of various national and state health programmes (Chart 2.2).
The Director of Health is also ex-officio Chief Registrar of Births and Deaths in the state and ensure proper implementation of the Births and Deaths Registration Act (Central Act 18) 1969 and the A.P.State birth and death registration rules. He is also responsible for proper guidance in all technical, administrative and financial matters to the regional and district level officers. He shall be responsible for proper utilization of the budget voted for the department and proper administration in the department. 21 Being the advisor to the Government in all technical matters he shall render expert advise to the Government in all technical matters. He shall also ensure proper discipline of the staff. The Director of Health is supported by 5
CHART 2.2 : DIRECTOR OF 14 EALTH
Additional Directors each under Communicable diseases, Malaria & Filaria, Leprosy, Planning and Administration. The Chief Accounts Officer also works under the control of Director of Health to provide necessary support in finance and Accounts.
ADDITIONAL DIRECTOR (COMMUNICABLE DISEASES)
He has to assist the Director of Health in matters relating to control of local epidemlCs in the state. He will personally supervise the conduct of major fairs and festivals in the state to avoid outbreak of any epidemics. He is also in-charge for the prevention and control of diseases like, Diarrhoeal diseases, environmental sanitation, Plague, Yaws, guinea worm eradication, goiter control, flurosis, industrial health, and school health.22 He is supported by Joint Directors each under Epidemics, Industrial Health, Health Education and one Deputy Director for Vital Statistics.
Joint Director (Epidemics)
Control of Epidemics: He has to assist the Additional Director (C D) in planning and implementation for control of epidemics, major fairs and festivals and monitoring the reports on epidemics from the districts (Chart 2.3). He is an officer of civil surgeon cadre.'3
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CHAg3" 2.3: ADDITIONAL DIRECTOR (Com. Dis)
Guinea-worm Eradication Programme: The Guinea-worm Eradication Programme is a centrally sponsored scheme, launched in the year 1983-84. The objective of this programme is to eliminate guinea-worm cases in the state by constant monitoring of reports. This disease which was prevalent in 6 districts in the state, namely Kumool, Mahaboobnagar, Kadapa, Anantapur, Prakasani, and West Godavari was brought down to zero incidence.
Joint Director (Health Education) / State Health Education Bureau: He is the programme officer for “Health education” in the cadre of Civil Surgeon. He will work under the administrative control of Additional Director (C.D). He has to plan, organize and guide health education activities relating to all Public Health programmes. The State Health Education Bureau came into existence in the year 1959 as per recommendations of Government of India.24
To help people to achieve health by their own actions and efforts.
To assist people to shoulder responsibility for their community health.
To obtain people’s active participation and support for Public Health programme.
This department is headed by Joint Director (Health Education) and works under the administrative control of the Director of Health. This Bureau has six sections under
Training, headed by a Training Officer
Media Unit, headed by a Technical Offieer
Editorial wing, headed by Sub Editor
Health Museum, headed by Health Educator
Field Study Demonstration Centre, under a Health Education
Officer
Student Health Education Unit headed by a Technical Officer,
Deputy Director (Vital Statistics): He is a non-medical person but a postgraduate in Statistics. He has to look after the subject Vital Statistics, Health Statistics and Medical Statistics. He has to collect compile the Statistical returns relating to Births and Deaths from the entire State and compile the same. He will also assist the Additional Director (C.D.) and the Director of Health in the implementation of Birth and Death Registration Act in the State.2’
Joint Director (Industrial Health): In order to keep pace with the Industrial growth and prevent occupational injuries and sickness, the department has created one Industrial Health cell in the Directorate of Health (G.O.Ms.No.853/h1/dt 21.10.1974). He is responsible for
issue of approvals for industries, factories, and other establishments likely to harm the health of the community. He will work under the technical supervision of the Additional Director (C.D.) and administrative control of the Director, supported by a Health Supervisor. The main functions of this cell are2‘
Directions to industries in the matters of safety and health.
Complement and implement the health provisions of various
acts and rules.
Implement Public Health Act, Air and Water Pollution Act, Cinematography Act, A.P.Gram Panchayat Act and Municipalities Act etc.
Give technical guidance to District Medical and Health Officers, and Municipal Health Officers on Dangerous and Offensive Trade Acts including Health safety measures in cinema halls and so on.
The Joint Director (Industrial health) is also the programme officer for the Iodine Deficiency Disorders control programme also known as Goitre Control programme.'7
The Iodine deficiency Disorders control programme was started in Andhra Pradesh in the year 1987-88 as a 100 per cent centrally sponsored scheme. The main objective of the programme is
96
to promote awareness about Goitre (Iodine deficiency disease) and its prevention among people living in the endemic areas through distribution of iodised salt at subsidized prices and others.
ADDITIONAL DIRECTOR (MALARIA & FILARIA)
National Malaria Eradication Programme: National Malaria Eradication Programme (NMEP) is a centrally sponsored scheme with 50 per cent assistance from the centre (Chart 2.4). The objectives of this programme are:2'
Prevent mortaliq and morbidity due to Malaria and Filaria.
Maintain agricultural and industrial revolution achieved by reducing the incidence of Malaria.
The programme is implemented through out the state with the help of 22 District Malaria units, 6 zonal Malaria units, 275 sub- malaria units, and 10 urban Malaria units.
The National Malaria Eradication and Filaria Control programmes are supervised by the .Additional Director for Malaria and Filaria, who is the State Programme Officer. He will monitor the programme as per the technical guidelipes and the policy of the Director General of Health Services, Govt. of India. He will be under the administrative control of the Director Health and have technical
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CHART 2.4
MALARIA ERADICATION PROGRAMME
and administrative control over the officers and staff working under the programme at zonal, district and peripheral level. He is responsible for the proper and effective implementation and evaluation of the programme in the state. The Additional Director is assisted by 2 Deputy Directors, one for Central Malaria Laboratory and other for Entomology and one Deputy Director at State level and by the zonal officers at regional level and District Malaria officers at district level.
State Level
Deputy Director of Medial and Health Services (Entomology) - Central Malaria Laboratories): He has to assist the Additional Director (Malaria & Filaria) in planning and organizing training programmes for the field staff in laboratory techniques, collection, and compilation of technical data received from the districts and also assist the Additional Director in implementation of the Malaria eradication programme." There are Deputy Director Medical and Health Services (Entomolo ). Gazetted Assistant / Asst. Director (Admn) and others.
Zonal Level
Zonal Officer (Malaria): They are in the cadre of Civil Surgeons with head quarters at (a) Visakhapatnam, (b) Rajahmundry,(c)
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Guntur, (d) Cuddapah, (e) Warangal and (f) Hyderabad, They are the technical supervisory officers at zonal level having 3 to 5 districts under their jurisdiction.” They provide necessary guidance and supervision to the field staff of the District Malaria Organisation in respect of Malaria, Filaria, J.E. and other vector borne diseases.
Assistant Director (Entomology): He works under the administrative control of the zonal officer and provide support to the Malaria Eradication Programme by studying the Entomological component of Malaria programme and also responsible for research studies.
District Level
District Malaria Officers: He is an Entomologist and programme officer for Malaria at the district level. He is the chief executive of the programme at district to plan, organize and implement Malaria Eradication programme. He works under the administrative and technical control of the District Medical and Health Officer and also under technical control of the Zonal officer (Malaria) of the zone.3' There are Assistant Malaria Officers, Sub-Unit Officers (MPHEO) and others.
Urban Malaria Units
The Urban Malaria Control Programme is implemented in some Municipalities and Municipal Corporations mentioned below:
Hyderabad-3, (2) Visakhapatnam, (3) Vijayawada, (4) Guntur, (S) Nalgonda, (6) Khammam, (7) Kumool, (8) Warangal.
The Biologist is in-charge of the urban Malaria units. He is a qualified Entomologist, responsible for planning, organizing and initiating anti-larvel measures in the urban localities. He is assisted by Health Inspector (Multipurpose Health Worker), Superior field
» orker, field u orker, and insect collector in the field to carry out anti- larvel work in the urban cities as per the NMEP guidelines.
National Filaria Control Programme (N.F.C.P)
Deputy Director Medical and Health Services (Entomology): He is in-charge of the Filaria Control programme. He is a senior and qualified Entomologist, and works under the technical and administrative control of the Additional Director (Malaria and Filaria). He »’ill assist him in planning, execution and monitoring the activities under Filaria control through 28 Filaria Control Units in the state. Each Filaria Control unit is manned by (Biologist) Senior Entomologist, or Multi-purpose Health Supervisor. In total 9 senior
Entomologists, 19 multi-purpose health supervisors, 786 and 331
superior field workers and field workers respectively are working under the Filaria Control programme.
In Andhra Pradesh, there are, 2 Survey Units, 4 Filaria Clinics,
1 Detection-cum-Treatment Centre and 1 Filaria Research-cum- Training Centre. Activities comprises of:”
Early detection of Filaria cases through blood collection for suspected cases and;
Treatment for micro-eases detected.
Anti-larval operations in control units.
ADDITIONAL DIRECTOR (LEPROSY ERADICATION PROGRAMME)
National Leprosy Eradication Programme: As part of the overall objective of “Health For All by 2000” Leprosy control programme was converted into Leprosy Eradication and Multi-Drug Therapy was introduced in 2 districts of Srikakulam and Vijayanagaram in the year 1983. Since then the programme is extended and implemented in all the districts in the state (Chart 2.5). At the state level Additional Director is the programme officer assisted by one special officer in the cadre of Joint Director.3’ He is also called state leprosy officer and responsible for the organization, management and supervision of the Leprosy Eradication. The overall objective of the programme is
CHART 2.5
LEPROSY ERADICATION PROGRAMME
Junior Medical Officer Non-Medical Supervisor Non-Medical Assistant DSO
Medical Officer Medical Officer Temp. Hospitalisation ward LCU/MLC, ULC
M.O., S/N, P.T, N.O.
Lab. Technician L.D.Computer
Health Educator
Non-Medical Supervisor Lab Technician
Physio-therapy Technician Non-Medical Assistant L.D.Computer
eradication of leprosy through early diagnosis and detection of leprosy cases, treatment and rehabilitation of treated cases with a specific goal of bringing down the prevalence rate to less than one per 10,000 population by 2003 A.D. and the programme is implemented through District Leprosy Officers in all the districts.
The National Leprosy Eradication Programme is sponsored by the Government of India with 100% central assistance to the State.
National Leprosy Eradication Programme (NLEP) is being run as a vertical programme in the sense that the staff sanctioned for the programme at different levels works exclusively for the Leprosy Eradication programme. The NLEP is supported by the following staff of Joint Director Leprosy, District Leprosy Officers and others.
ADDITIONAL DIRECTOR (PLANNING AND EVALUATION)
He will look after the planning of the department for strengthening the health services under state and central plan programmes.35 Development of the infrastructure, including upgradation of Primary Health Centres, establishment of new primal health centres, construction of buildings, for community health centres, primary health centres, sub-centres and staff quarters etc. He will also look after the plan schemes budget requirements, staff
requirements and drugs and equipments needed for the health care delivery system (Chart 2.6).
CHART 2.6
PLANNING BRANCH
Source: Dr. MCHRD Function Manual
JOINT DIRECTOR (T.B.)
He is in the cadre of Civil Surgeon. He is the programme officer for T.B. control under the administrative control of Director of Health.36 He is responsible for the proper and effective implementation of the T.B.control programme in the state as per the policies and guidelines of Government of India. This programme is implemented through out the state through the District T.B.Centres headed by District T.B.Control officers (Civil Surgeon Specialist).
There is a State T.B.Training and Demonstration Centre (STDC) at Hyderabad functioning as a service unit for twin cities, besides training activities with the following staff(Chart 2.7):
CHART 2.7
DIRECTOR OF HEALTH
Director (Civil Surgeon)
Bacteriologist (Civil Surgeon)
Epidemiologist (Civil Surgeon)
Radiographers
Lab. Technicians
The main objective of this programme is to reduce active T.B.cases in the community by early detection and diagnosis with effective treatment. This programme is implemented in all the districts of the state with the technical supervision by the Joint Director (T.B.Control) under the control of the Director of Health.
District T.B.Centres: The district level centres are managed by District T.B.Officers. He is of the Civil Surgeon cadre with specialization in T.B. and Chest diseases. He will run the centre at District Headquarters and supervise the activities of T.B.clinics attached to the area hospitals in the district and also monitor the cases referred to the clinics by the peripheral units for further examination and treatment.3’ These district units are functioning with the following staff under the supervision of the District T.B.Officer.
Treatment Organiser (male)
Treatment Organiser (female)
Radiographer
Lab. Technician
Lab. Assistant
Statistician
The T.B.control programme is a centrally sponsored scheme with 50 per cent of the expenditure borne by the central government.
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
Directorate Level
Joint Director (NPCB): Joint Director (NPCB) is the state level programme officer for National Programme for Control of Blindness (NPCB) and is the head of the state opthalmological cell. The cell consists of one Deputy Director (MIS), Gazetted Assistant and other ministerial staff. He is responsible for the coordination of manpower deployment and non-plan allocation for the programme implementation and also for the smooth and effective operation of NPCB in the districts. The main operational objective of this programme is to bring down curable blindness from 1.5 per cent prevalence to 0.3 per cent by 2000 A.D. This is a centrally sponsored scheme with 100 per cent assistance."
He will look after the programmes and performances under the Opthalmic cells, mobile ophthalmic units. district mobile units for eye camps etc. He works under the technical and administrative control of the Director of Health and also provides cooperation and coordination with other departments like Medical Education and A.P.Vaidya
Vidhan Parishad for mobilizing the department for organisation of eye operations and camps.
The organization and administrative set up for effective management of the programme at various levels are made through Deputy Director (MIS), Deputy Statistical Officer, Gazetted Assistant and others.
Regional Level
Regional Institute of Ophthalmology: Sarojini Devi Hospital, Hyderabad with a bed strength of 557 beds and 37 Faculty members has been designated as Regional Institute of Ophthalmology. It is one of the Institutes in India recognized by the Government of India for imparting Trainer’s Training in I.O.L. micro surgery.3’
Central Mobile Opthalmic Units: These are attached to and functioning at (a) Regional Eye Hospital, Kumool, (b) Regional Eye Hospital, Warangal, (c) Regional Eye Hospital, Visakhapatnam, and
Government General Hospital, Guntur. These units are provided with equipment and staff for conducting cataract operations by arranging eye camps. The staff under these units are:
Civil Surgeon
Civil Asst. Surgeon
Optometrists
Health Educator
Rehabilitation Assistants
O.T.Nurses
District Level
District Headquarters Hospitals: One post of Opthalmic Civil Surgeon has been created under NPCB in all the District Headquarters hospitals in the State. Thus there are 23 Opthalmic Civil Surgeons in the district hospitals.
District Mobile Units: 23 Mobile units are established in all the districts.
District Programme Manager: District Programme Managers are appointed by the District Collectors who is the chairman of the District Blindness Control Society (DBCS). In each district a district blindness control sociey is formed with the District Collector as Chairman with 20 members both official and non-officials. To coordinate the activities of the programme, a district programme manager was appointed by the District Collector on a consolidated pay. They are mostly retired medical personnel with professional experience. The Distñct Programme Managers are responsible for implementation of various components of the programme at district
level utilizing the grants released by the Government of India directly for this purpose.4’
Peripheral Level
Opthalmic Assistants: 350 PHCs were upgraded in the state by sanctioning one post of Opthalmic Assistant to assist the Medical Officer in conducting refraction, other eye care tests, give advise for cataract operations whenever required and conduct screening for school children for correcting refractive errors and treat minor eye ailments. These PHCs are provided with the required equipment to provide all the above mentioned sen•ices under NPCB.
ADDITIONAL DIRECTOR (ADMINISTRATION)
He is an officer of the Deputy Secretary cadre and is deputed to the Department of Health by the Government to assist the Director in the matters related to Administration and Services. He is assisted in the Directorate by one Deputy Director (Administration) and one Assistant Personnel Officer4l and Chief Accounts Officer.
STATE HEALTH TRANSPORT OFFICER (SHTO)
He is in the cadre of Superintendent Engineer. He works under the administrative control of the Director of Health. He is in-charge of the State Health Transport Organisation (Chart 2.8). He will also
CHART 2,8
STATE HEALTH TRANSPORT ORGANISATION
assist the other departments of Medical and Health as he is responsible for maintenance of all the vehicles under Medical and Health, belonging to Family Welfare, APVVP, Institute of Preventive Medicine, Indian Systems of Medicine and Homeopathy. 4
The State Health Transport Organisation looks after the maintenance and repairs of 1638 vehicles belonging to the Director of Family Welfare, Director of Health, Director of Medical Education. Commissioner of Andhra Pradesh Vaidya Vidhan Parishad, Director of Insurance Medical Services, Director of Indian Medicine and Director of Institute of Preventive Medicine. There are 214 ambulances under different programmes in the fleet of State Health
transport Organisation.
His organization consists of (1) one central workshop at Hyderabad (2) 4 regional workshops at Visakhapatnam, Vijayawada, Cuddapah and Warangal and (3) 20 mobile workshops at district headquarters where there are no regional workshops. He is assisted bj the following technical staff to attend the jobs like repairs, replacements and maintenance of vehicles.
Deputy Transport Officer
Assistant Transport Officers
Assistant Accounts Officer
Assistant Personal Officer
Cost Accountant
Deputy Statistical Officer
Service Engineers
Foremen
Chargemen 10.Skilled Artisans
I I.Junior Technical Assistants 12.Artisans
DISTRICT MEDICAL & HEALTH OFFICER
He is in the cadre of civil surgeon. He is the head of the district health administration. He is under the administrative and technical control of the Director of Health as well as Regional Director concerned (Chart 2.9). He is responsible for the implementation of all National Programmes in the district with the assistance of the district programme officers like, district T.B.Officer, District Leprosy Officer, District Malaria Officer, Additional District Medical and Health Officer etc.43
The posts are e.misting at (1) Utnoor of Adilabad, (2) Paderu of Visakhapatnam district, (3) Rampa Chodavaram of East Godavari district, and (4) Palai’ancha of Khammam district.
Files had to be circulated to both the Doctors for approval
before orders are issued. Only in limited circumstances and situations,
CHART 2.9
DISTRICT MEDICAL & HEALTH OFFICER
the Directors could function independently. Some sections and units were under the control of both the Directors (dual control) not in conformity with the principles of organizational relationship. These were answerable to both the Directors, a paradoxical situation which hampers effective and smooth functioning. Thus the decade of 1970-
80 registered integration, separation, again amalgamation of the department of medical and health services besides creating many posts at different levels of hierarchy giving an impression that it is ‘top-heavy’ administration with marginal utility value with regard to the up-keep and maintenance of people’s health.
The Directorates / Heads of Institutions / Departments are as
follows:
Director of Health Services
Director of Medical Education
Commissioner / Director of Family Welfare
Commissioner, Andhra Pradesh Vaidya Vidhan Parishad
Director of Preventive Medicine and Food Authority
Director of Drug Control Administration
Nizam Institute of Medical Sciences (NIMS), Hyderabad
University of Health Sciences, Vijayawada
Director, Department of Indian Systems of Medicine and
Homeopathy
Medical and Health Housing and Infrastructure Development Corporation
Director of Insurance Medical Services (Employees State Insurance Scheme).
TABLE 2.1
MEDICAL AND HEALTH INSTITUTIONS UNDER DHS, A.P. AS ON 31.03.2004
Source: Director of Health See ices. A.P., Hyderabad (Planning Division).
Andhra Pradesh Vaidya Vidhan Parishad (APVVP)
CHART 2.10 APVVP - ORGANOGRAM
Introduction: Established in the year 1986 under an Act of legislation, Andhra Pradesh Vaidya Vidhan Parishad (APVVP) deals exclusively with the middle level hospitals of bed strengths ranging from 30 to 350. At present the hospitals under the control of APVVP which are referred to as secondary hospitals or first referral hospitals are 228 in number. Out of which, 20 are District Hospitals, 55 are Area Hospitals, 118 are Community Health Centres, 10 are called as Speciality Hospitals and 25 dispensaries“ (Table 2.1). It consists of staff working in the Andhra Pradesh Vaidya Vidhana Parishad (Chan 2.10).
Services: The district hospitals offer treatment in the speciality fields of General Medicine, General Surgery, Orthopaedics, Obstetrics & Gynaecology, Anaesthesiology, Paediatries and Ophthalmology and have bed strength ranging between 200 to 350.
Area hospitals offer treatment in the fields of general medicine, general surgery, obstetrics and gynaecology and paediatrics and have bed strength of 100.
Community health centres have bed strength of either 30 or 50. Out-patient and in-patient services are provided in all the above departments apart from lab and diagnostic services. Services under national health programmes such as National Malaria Eradication Programme, National TB Control Programme, National Programme
for Control of Blindness, Reproductive Child Health and most importantly AIDS control services are also provided at these institutions. The position of key staff, Head Office and at the district level are seen in the table 2.2 and 2.3.
Functions: The main functions of APVVP hospitals in providing effective delivery of health services are,45
Major and minor operation theatres as per standards,
Out-patient department with consultation rooms and diagnostic facilities with reception area
Emergency medical services with theatre faciliy
Delivery suit with all facilities
Wards with attached nursing cubicles
Administration department with stores
Hospital service departments such as generator room, laundry, workshops, garages, mortuary room, staff quarters, patient attendant sheds, cycle stands, canteen, security post and sulabh complex.
Upgraded clinical effectiveness and quality with
Norms for clinical, technical and support services
Quality assessment mechanisms
Skill updating trainings
Better equipment
Expanded capacity
Improved functioning of hospitals by
Effective linkages between different levels of health service
Referral clinical management protocols
Key Staff
TABLE 2.2
POSITION OF KEY STAFF — HEAD OFFICE
TABLE 2.3
POSITION OF STAFF AT THE DISTRICT UNITS
Staff Category San- Filled Vacant
Equipment: Major Equipment like X-Rays, USG, ECG, Endoscope, Defibrillator, Boyles M/C, Autoclave, Theatre & Lab Equipment, Pulse Oxinieter, Operating Microscope, Generators & Air Conditioners have been supplied to all the hospitals, as per the service norms developed to each category of hospital. The equipment malntenance and training centres (4) established in the State looks after maintenance of the equipment, while the primary responsibility of the upkeep of the equipment lie with the user. To maintain the material and equipment, the allocation of budget is necessary (Table 2.4)
TABLE 2.4
POSITION OF APVVP - Budget
(Rs. In Crores)
Drugs & Consumables
An approximate amount of Rs.12 crores, is spent towards drugs and consumables annually. APHMHIDC Hyderabad a State owned corporation procures them based on the hospitals’ indents and disburse through a central drug store located at each of the district headquarters.
Thus there are 228 medical institutions under the administrative and technical control of the APVVP having a bed strength of 16224.46 (Table 2.5)
TABLE 2.5
HOSPITALS AND DISPENSARIES UNDER APVVP
Sources: 1. Government of Andhra Pradesh, The Andhra Pradesh Vaidya Vidhana Parishad Act of 1986 (Act 29 of 1986).
2. Government of Andhra Pradesh, G.O.Ms.No.139, Health, Medical and Family Welfare, (CI), Department Dt: 27.2.1987.
A Commissionerate was constituted under the Act and it functions as a corporate body.
An Overview
The Go› emment of Andhra Pradesh has the constitutional responsibili to provide health care services to its population living in urban, semi-urban, rural and tribal areas since health is a State subject. The history tells that the department of Public Health was
established in 1864 in Madras Presidency whose duties were chiefly for military requirements and the expenses of the department wee met from military budget. Later on it was transferred to civil side. Several developments were made. A certificate course in sanltary inspection was started. The Public Health Department was established in 1922 with Director of Public Health with the objectives of conduct systematic vaccination, improve environmental sanitation. control of local epidemics and so on.
After the formation of the Andhra Pradesh State, the Department of Medical and Health was bifurcated. The curative activities along within staff were tagged on to Director of Medical Services. Several committees — Bhore Committee (1946), Mudaliar Committee (1962), Chadah Committee (1963), Mukherjee Committee (1966), Kartar Singh (1973), Srivastava Committee (1975), Kripa Narain (1981), and so on were constituted to develop the medical services.
The Department of Public Health was constituted to control Malaria, Filaria, BCG Vaccination, Anti-yaws and others. Later on. a complete merger of the Public Health Department and Medical Department took place at state, district and peripheral level from 1967 to render both curative and preventive services upto village levels.
The Andhra Pradesh State Medical and Health Department branded off into 10 different directorates for effective and efficient functioning. Each office caters to some specific aspects of health services without infringing upon the functioning of other offices.
The Medical and Health Organisations are constituted to develop the medical services at the Secretariat level, directorate level, district level and so on. Several functions are also allocated to each levels. Directors are also appointed to these levels with the motive of increasing the services. The Acts, norms, and others are too passed to streamline the role of the directors of the departments. The APVVP
as also constituted. At the district level, the structure and composition and also role of the district Government Hospital, Anantapur is discussed elaborately in the following chapter.
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