A Rapid Evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme- Andhra Pradesh

Size: px
Start display at page:

Download "A Rapid Evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme- Andhra Pradesh"

Transcription

1 A Rapid Evaluation of the Rajiv Aarogyasri Community Health Insurance Scheme- Andhra Pradesh Report Indian Institute of Public Health Hyderabad

2 Indian Institute of Public Health-Hyderabad Public Health Foundation of India C/o Indian Institute of Health & Family Welfare, Opposite Nalanda Junior College, Vengalrao Nagar, Hyderabad, India. Indian Institute of Public Health - Hyderabad

3 Evaluation Team Principal Investigator Dr. Mala Rao, Director Indian Institute of Public Health, Hyderabad Team Leader Dr. Shridhar Kadam, Asstt. Prof. Indian Institute of Public Health, Hyderabad Team Members Dr. Rajan Shukla Dr. Rahul Shidhaye Dr. Srikrishna Sulgodu Ramachandra Dr. Sathyanarayana TN Dr. Anitha CT Dr. M. Sitamma Dr. Veena Shatrugna Dr. Anil Chandran Mr. Souvik Bandyopadhyay Mr. Matthew Sunil George Dr. Vivek Singh Ms. Subhashini Narayanan Ms. Harjeet Sembhi Ms. Aarti Rau Pranav Yajnik, Manoj Kumar Tiwari, Madan Dalvi, Diptesh Mukherjee, Atanu Bhattacharjee, Sunil Bodkhe, Venkateshwar Rao, Kishore Chole, Sameer Bamnote, Amit Dambhare, Dr. Mitesh Shah, Harsha Jagtap, Sweta Khade, Dr. Swaroop Purani, Amol Pande, Dr. Mamta Rani Verma 3

4 Table of Contents Section Title Page No. List of Abbreviations 7 Acknowledgements 8 1 Executive Summary 9 2 Introduction and Background 16 3 Aim of the Evaluation 19 4 Evaluation methods 20 5 Results 25 6 Discussion 43 7 Limitations of the study 64 8 Recommendations 65 9 References 67 Annexure 69 4

5 List of Tables Table No Title Page No 1 Unique diagnoses listed in the RAS dataset for each specialty 21 2 Beneficiaries/lakh BPL population 26 3 Distribution of beneficiaries by district and place of residence 4 Distribution of beneficiaries by Scheduled Castes and Scheduled Tribes Treatments undertaken by medical/surgical specialties 33 6 Distribution of network hospitals by number of treatments 34 7 Distribution of persons hospitalised by type of ailment, India 8 Leading causes of disease burden (DALY) in rural and urban areas of AP

6 List of Figures Fig Title Page 1 Monthly distribution of the beneficiary rate/lakh BPL population by phase 25 2 Distribution of beneficiaries by age 27 3 Distribution of beneficiaries interviewed, by age 27 4 Distribution of beneficiaries by sex 28 5 Distribution of beneficiaries interviewed, by sex 28 6 Educational status of beneficiaries interviewed 29 7 Standard of living index of beneficiaries interviewed 30 8 Occupation of beneficiaries interviewed 30 9 Follow up visits by the beneficiaries to the network hospitals Reasons for out of pocket expenditure by beneficiaries Trends in screening and referrals by health camps and total preauthorisations for treatment 12 Variation in claims paid for selected procedures Distribution of beneficiary satisfaction scores for general services Distribution of beneficiary satisfaction scores for hospital services Perceived status of health following treatment Source of information for beneficiaries WHO framework for analysis of CBHI performance Age distribution of beneficiaries in RAS hospitalisations compared with Scatter plot of beneficiaries/ lakh BPL population/ month by distance from network hospitals 20 Levels of intervention for Coronary Heart Disease Total UK NHS health spending (Wanless Report, 2004) Present structure of health system in Andhra Pradesh Proposed functionally integrated structure of health systems in Andhra Proposed referral system for the RAS

7 List of Abbreviations AHCT : Aarogyasri Health Care Trust AMCO : Aaorgyasri Medical Camp Coordinator APVVP : Andhra Pradesh Vaidya Vidhana Parishad AP : Andhra Pradesh BPL : Below Poverty Line CMRF : Chief Minister s Relief Fund CHI : Community Health Insurance CHIS : Community Health Insurance Scheme CBHI : Community Based Health Insurance Scheme CSDH : Commission on Social Determinants of Health DMHO : District Medical & Health Officer ICD : International Classification of Disease MO : Medical Officer MOU : Memorandum of Understanding NHS : National Health Service, UK NRHM : National Rural Health Mission NSSO : National Sample Survey Organization MS : Medical Superintendent PHC : Primary Health Centre RAMCO : Rajiv Aarogyasri Medical Coordinator RAS : Rajiv Aarogyasri Health Insurance Scheme SEWA : Self Employed Women s Association WHO : World Health Organisation 7

8 Acknowledgements We gratefully acknowledge the support of the leadership of the Ministry of Health and Family Welfare, Andhra Pradesh who commissioned and helped us with the process of the evaluation. We are also grateful to all the staff of the participating hospitals, Aarogyamitras, and beneficiaries in making this evaluation possible. We thank Sri. P.K. Agarwal, Sri. J. Satyanarayana and Sri. L. V. Subrahmanyam Principal Secretaries, Department of Health & Family Welfare, Government of AP for their valuable guidance, encouragement and support. We also thank Dr. Ramesh Chandra, Director Health Services, Dr. P. Venkateswara Rao, Commissioner APVVP and Dr. Sudha Ramana, Director Medical Education for their help with the study. Our special thanks to Sri. A. Babu, Chief Executive Officer Aarogyasri Health Care Trust and his team, who have helped and guided us throughout the course of this evaluation. We acknowledge the Star Health insurance team both at the state and district level for their support to this evaluation. We place on record our appreciation for the co-operation and assistance we received from the Aarogyamitras and all other frontline staff during the survey. We also thank the District Medical & Health Officers, District Coordinators of Health Services, private and government network hospitals, teaching hospitals, Aarogyasri district coordinators and the District Collectors of the districts where the survey was undertaken for their coordination, support and hospitality. Our special thanks to Dr. G. Ramdas and the staff at IIPH-Hyderabad for their administrative support in facilitating the evaluation. Dr. Mala Rao Director, IIPH, Hyderabad 8

9 1.0 Executive Summary Background It is recognized that families living below the poverty line (BPL) are drawn into a vicious cycle of ill health, poverty, indebtedness and bankruptcy. The Rajiv Aarogyasri Community Health Insurance scheme (RAS) was established with the aim of breaking this cycle. Its purpose was to improve access of BPL families to treatment of identified medical and surgical conditions through a network of health care providers. The scheme was extended to all 23 districts in 5 phases starting from April In order to operationalise the scheme a public private partnership was established by a coalition of government agencies, private sector hospitals and a health insurance company. The Aarogyasri Health Care Trust (AHCT) was formed to administer and monitor the RAS. The Indian Institute of Public Health (IIPH), Hyderabad was commissioned by the Government of Andhra Pradesh to undertake an independent evaluation of the RAS. The purpose of the evaluation was to provide insights into the current performance of the scheme, to examine whether it is meeting the overall objectives and to suggest ways by which it may be further strengthened. More specifically, the evaluation was required to answer seven questions posed by the AHCT. Methods For the evaluation, two types of data were used. Patient data were obtained from the Aarogyasri website. Secondly, surveys were conducted by teams in 6 randomly selected districts of AP. Information was collected from beneficiaries, Aarogyamitras, Aarogyasri Medical Camp Coordinators (AMCCOs), Rajiv Aarogyasri Medical Coordinators (RAMCOs), Medical Superintendents (MSs), Medical Officers of Primary Health Centres (MO-PHCs) and health camps. In addition, other key informants from the Aarogyasri Health Care Trust (AHCT) and State Government were interviewed. The evaluation was required to be undertaken in 53 days and the methodology was tailored to ensure completion within this time period. 9

10 Key findings There were 111 beneficiaries per lakh BPL population who had utilised the scheme until the end of September All age groups were represented among the beneficiaries, with children below 14 years and the elderly being represented in equal proportions (13% each). There were almost equal males and females among adult beneficiaries. Approximately half of the beneficiaries interviewed were illiterate and a similar proportion had a low Standard of Living Index (SLI). The unemployed together with unskilled labourers made up nearly half the sample, confirming that the scheme was appropriately benefiting economically poor households. About 7% of the beneficiaries had a high SLI and 42% of households had a middle level SLI. The inclusion of beneficiaries from a higher SLI may be due to the fact that Andhra Pradesh does not follow the method used by govt of India to identify BPL households and more than 70% of households in the State are included in this category. The evaluation revealed that the scheme may exclude the most marginalised population such as the destitute, street dwellers and migrant labourers with no residential address and therefore ineligible for inclusion in the BPL population. Eighty seven percent of the beneficiaries had rural addresses and this was significantly higher than the rural population of AP (73%). 10,947 people from Scheduled Castes (SCs) and Scheduled Tribes (STs) had benefited from the scheme but their numbers were significantly lower than their proportions in the population in the majority of the districts. Cardiac, cancer and neurological interventions made up 65% of all treatments administered by the scheme. Substantial variations were observed in recorded diagnoses and WHO International Classification of Disease codes were not being used. Of the 353 participating hospitals, 30 hospitals located in six cities of AP had undertaken more than 50% of all interventions. It was also observed that with increasing distance to these major cities, the utilization rate of the scheme declined. The analysis of claims paid data showed that there was a wide variation in claims paid for individual medical or surgical procedures conducted under the RAS. The beneficiaries were unanimous that the scheme had transformed their lives. Eighty seven percent of beneficiaries reported improvement following treatment of their condition. The beneficiary satisfaction survey elicited the highest scores for doctors, nurses and cleanliness. The lowest scores were for health camps and information 10

11 provided about the scheme. Most beneficiaries had received information about the scheme from sources other than the health care providers. Nearly 60% beneficiaries incurred a median of Rs out of pocket expenditure with transport, medicine and pre-diagnostic investigations being the major reasons. Thirteen percent of beneficiaries had no follow up visit and 28% had only one follow up visit. The District Medical & Health Officers (DM&HOs), RAMCOs, MSs and PHC MOs applauded the equity of access achieved as a result of the RAS and the opportunity for BPL populations to avail of specialist treatment free of cost. The scheme had also enabled some infrastructure improvements in the hospitals. Negative observations included the absence of a platform to share experiences, the lack of standard treatment protocols and patient treatment pathways, empanelment of area hospitals without appropriate discussion with hospital authorities and lack of appropriate infrastructure and human resources at government hospitals. The majority of RAMCOs, Aarogyamitras and all PHC MOs reported receiving no specific training to help them undertake their tasks. DM&HOs were of the view that, as the RAS was now fully established across the state, districts should be allowed the flexibility to review and modify the scheme in accordance with local needs. Many PHC MOs felt more empowered with the introduction of the scheme to refer patients with serious illness for free treatment. However, Aarogyamitras had no accountability to them, and this undermined the coordination of referral and follow-up. MOs also reported lack of formal referral protocols and feedback about patients following treatment. Health camps initially attracted a good response in terms of engagement of specialists, attendance of patients and raising awareness of the scheme. However, the quality of services had declined over time in terms of specialists attendance, screening and treatment provided. Data on health camps demonstrated a decline in numbers of referrals over time by contrast with a sharp increase in total approvals for treatment during the same period. Many network hospitals have rapidly developed operational processes and infrastructure to engage with the scheme. Nevertheless, problems exist and wide variations in the quality of infrastructure, attitudes and processes were observed by the evaluation team. The average expenditure from the Chief Minister s Relief Fund (CMRF) per beneficiary, prior to the launch of the scheme was Rs 30,440 as compared to Rs. 40,839 in phases 1 and 2 of the scheme. Average spending in the scheme was higher but 11

12 included additional benefits such as cashless transactions, inclusion of emergency interventions, and food and transport costs. Conclusions Both the beneficiaries and providers of care acknowledge the transformational role played by the RAS in improving the access and availability of health care to the poor in AP. The evaluation has demonstrated that the RAS has reduced the financial burden of serious ill health among the BPL population of AP. But all health expenditure is catastrophic for many BPL families. The scheme focuses exclusively on high cost specialist treatment. In summary, eliminating all catastrophic expenditure for health care would require a more comprehensive coverage under the scheme. To investigate the cost effectiveness of the RAS would require more detailed study. However, this rapid evaluation was able to demonstrate that the scheme had efficient mechanisms for revenue collection and risk pooling. The Government of Andhra Pradesh was the financer and the whole BPL population was included in the scheme. The financing in terms of revenue collection was efficient, equitable and progressive. Nevertheless, there is scope to reduce variation in treatment costs through more effective strategic purchasing, which would require a systematic audit of clinical and cost effectiveness of care and the introduction of evidence-based treatment protocols and standard patient treatment pathways. Furthermore, strategic purchasing would have the added benefit of enabling the government to establish a more holistic approach which encompasses the whole spectrum of health needs from health promotion and primary prevention to tertiary and rehabilitative care. To achieve this, technical expertise such as health economics, public health and insurance management needs to become available within the AHCT. For sustainability, the scheme should have an earmarked budget which would eliminate its current dependency on the CMRF which should ideally be a contingency fund for emergencies. Beneficiaries of all ages, both sexes and across all districts are accessing the scheme, but distance from major hospitals may be a barrier. While gender is not a barrier for accessing the scheme among adults, the study cannot comment on the same for children because the information on sex of children was not routinely collected under the scheme. Among SC and ST populations there was a significantly lower level of 12

13 utilisation. Variations in disease distributions, socio-cultural factors, knowledge and belief about modern health care systems and economic barriers related to issues such as distance and pre-diagnostic investigation may be reasons for under-utilisation in the SC and ST populations. This needs to be further investigated. Ways to facilitate access for the most marginalised communities who are not even eligible for inclusion in the BPL population need to be explored. The RAS is a government funded scheme that ensures preferential benefit to vulnerable sections of population by providing targeted care to the BPL group. It fulfils in part an important recommendation of the WHO Commission on Social Determinants of Health to ensure universal access to health care regardless of ability to pay, building on targeted health care programmes for the poor as an important step towards universalism. The RAS has established a public private partnership as the framework to achieve its objectives. The partnership has certainly succeeded in improving access to health care and reducing the burden of health care expenditure on the poor. But public and private sector goals differ and need to be better reconciled. A more effective stewardship role for the AHCT and a greater focus on strategic purchasing is recommended. The RAS was introduced as a separate entity to ensure its rapid establishment and roll out. This has now been achieved. To strengthen its delivery, integration with the main public health delivery system would be essential. However, the main public health delivery system in AP needs to become a more cohesive and coherent system as a prerequisite. AP s health sector reform goals provide a timely incentive to implement a consistent and coordinated whole system offering appropriate health services at primary, secondary and tertiary levels. This evaluation has demonstrated the transformation achieved by the RAS in the health care landscape of AP. For the first time, the BPL population can be confident that they will receive treatment for most types of serious illness without facing a catastrophic financial burden. However, it would be premature to draw conclusions about the long term impact of the RAS on the overall health status of the population of AP at this early stage. Nevertheless, given the commitment and enthusiasm among stakeholders, the further improvements to strengthen the RAS delivery mechanism and to introduce a more balanced approach between prevention and care as highlighted by the evaluation can also be achieved. 13

14 Recommendations 1. Improving the RAS delivery system: Integration of all parts/levels of the health care system to develop a more coherent and cohesive patient centred system needs to be considered. The integration should include a convergence of preventive, promotive and curative services to improve early detection and treatment. Similarly greater involvement of existing district level health committees will strengthen the RAS through improving local monitoring and making the scheme more sensitive to local needs. 2. Strengthening the functioning of the AHCT: The AHCT needs to review core skills which may increase the effectiveness of its planning and delivery functions. It is suggested that the AHCT avails of expertise such as public health, health economics and other social sciences. The decision making processes need to be decentralised and more effectively shared between the State and districts. 3. Increase investment in health promotion and disease prevention: The government needs to review the scope for health promotion and disease prevention. The population would prefer not to suffer road traffic accidents than to be provided state of the art reconstructive treatments in world class trauma centres. A more balanced approach which enables greater investment not only in tertiary care but also in health promotion (e.g., nutrition, tobacco prevention), disease prevention (e.g., obesity) and through tackling the wider determinants of health (e.g., road safety and work place safety) is suggested. 4. Public private partnership: The terms of the partnership need to be reviewed to ensure effective and ethical practice and a better balance in terms of tertiary care provision between public and private sector providers. The participation of the community at large including the beneficiaries will strengthen the effective implementation of PPP. They can substantially contribute to planning, implementation and monitoring of the scheme. A mechanism such as an ombudsman at block, district and State level could be effective in resolving community grievances and giving feedback to government on behalf of the community for more effective partnership. 5. A strategic purchasing framework for the RAS: The government needs to establish a strategic purchasing framework with population health improvement as its goal. This would ensure planning for sustainable and appropriate levels of funding, strengthened quality of care and a balance of investment between prevention and cure and steps needed to achieve health equity across the population. 14

15 6. Improving quality of health care: Standard treatment and screening protocols (e.g., evidence based screening and treatment of cancer) and treatment pathways (e.g., defining where investigations, treatment and follow up are provided) underpinned by systematic evidence based reviews of clinical and cost effectiveness need to replace current practice. The government needs to use a method such as accreditation to improve and standardise high quality care across the system and renewal of empanelment as a lever to stimulate change. 7. Improving access for the most marginalised populations: The AHCT needs to collaborate with other health and social welfare departments to increase utilisation of the scheme by SC and ST populations. Furthermore, it needs to explore how to benefit those individuals who lack a residential address and make up the most marginalised populations. 8. Improving data management: It is recommended that data items essential for monitoring such as complete demographic profiles, referral information, and outcomes are included in future. To make information more comparable and usable, the coding of disease conditions needs to be mandatory using the ICD 10 classification. The AHCT needs to take appropriate measures to maintain confidentiality of individual patient data. 9. Undertaking further evaluation and research: A system as comprehensive as the RAS requires continuous audit and in-built evaluation. Studies to determine precisely which features of the RAS contribute to better outcomes need to be undertaken. A review of international best practice in health insurance and financing schemes would allow better scope for refining the RAS delivery system and to achieve better outcomes. 15

16 2.0 Introduction and Background It is recognised that families living below the poverty line are drawn into a vicious cycle of ill-health, poverty, indebtedness and bankruptcy (NRHM, 2005). When faced with serious ailments they often have to sell their assets or borrow large sums to meet the costs of treatment and hospitalisation. The experience of below poverty line (BPL) families in Andhra Pradesh (AP) is not dissimilar. Many people faced with such a situation have been approaching the government of AP for financial assistance to meet the costs of hospitalisation. For the period to , financial assistance to the tune of crores had been disbursed from the Chief Minister s Relief Fund (CMRF) in order to provide financial assistance to beneficiaries to meet their hospital expenses (Aarogyasri Health Care Trust website). Thus there was a felt need by the AP government to provide assistance to BPL families to meet treatment and care costs related to serious illness. The Rajiv Aarogyasri Community Health Insurance scheme (RAS) was conceptualised as a community health insurance scheme that would address this need in Andhra Pradesh so that BPL families across the state could benefit from it. 2.1 Background The scheme aims to provide much needed help to BPL families for treatment of serious ailments thereby saving them from the debt trap. It has the important additional benefit of bringing advanced surgical and medical treatments within the reach of the poor. The scheme provides financial protection to BPL families up to Rs. 2 lakh in a year for the treatment of serious illness. The scheme is being implemented through the Star Insurance Company, which was selected through a competitive bidding process. The objective of the scheme is to improve access of BPL families to high quality treatment of identified diseases requiring treatment and hospitalisation, through an established network of health care providers. In order to operationalise the scheme a public private partnership was launched by a coalition of Star Health Insurance, the private sector hospitals who are part of the scheme and the state agencies. The Aarogyasri Health Care Trust (AHCT) was set up by the state government in 2006 to implement this scheme, to involve the insurance company as well as to facilitate coordination among all sectors of the government that could help in the implementation, such as the Medical and Health Department, the District Collectors and the Civil Supplies department. 16

17 The beneficiaries of the scheme are the members of BPL families as enumerated and identified by the Rajiv Aarogyasri Health Card/ BPL Ration Card. The definition of BPL families in Andhra Pradesh (Annexe to AP-GO Rt No. 965) differs from that used nationally (Planning commission, 2007). The benefit per family is on a floater basis i.e. the total reimbursement of Rs.1.50 lakh per annum can be availed of individually or collectively by members of the family. An additional sum of Rs 50,000 is provided as a buffer to meet expenses if they exceed the original sum i.e. Rs 1.5 lakh per individual/family. In addition, the costs of cochlear implant surgery with auditory-verbal therapy are reimbursed by the Trust up to a maximum of Rs lakh for each case. The transaction is cashless for procedures included in the scheme. The care is provided free at the point of service and the beneficiary makes no payment to the care provider. The same is the case for diagnostic procedures even if they do not result in the patient undergoing any treatment. Network hospitals, i.e. hospitals that are empanelled (included) by the scheme are expected to conduct at least one free medical camp in a week, thereby taking advanced screening and diagnosis to the patients doorstep. All the Primary Health Centres (PHCs) which are the usual first contact point for the majority of the beneficiaries, Area/District Hospitals and Network Hospitals, are provided with help desks manned by Aarogyamitras responsible for hand-holding patients who are likely to lack the confidence and the knowledge to engage with the care providers. The entire process including all transactions is paperless, real-time and online. 2.2 Initiation of the Scheme The RAS has been initiated in two stages: a) Aarogyasri I, the first stage was launched on the 1 st of April 2007 and b) Aarogyasri II, the second stage was introduced on 17 th July Aarogyasri I included treatment related to diseases of the heart, lung, liver, and pancreas. Renal disease, neurosurgery, congenital malformations, burns, post-burn contracture surgery for functional improvement, prostheses (artificial limbs), cancer treatment (surgery, chemotherapy, radiotherapy), polytrauma (including cases covered under the Motor Vehicles Act) and cochlear implant surgery with auditory-verbal therapy for children below 6 years (costs are reimbursed by the Trust on a case by case basis) are all included. All pre-existing cases of the illness eligible for treatment in the scheme are covered. The RAS was established across 23 districts in 5 phases, the first pilot phase covering only 3 districts, with subsequent 17

18 inclusion of 5 districts in each phase (Table 1 of Annexe 1). The 4 th and 5 th phases were launched together. The second stage of the Aarogyasri scheme was launched on 17th July, At this stage a large number of additional surgical and medical conditions were included. The front end of this stage remains the same as for the first stage and network hospitals, Aarogyamitras, Health Cards etc., remain in place. Pre-authorisation and claim processing for additional conditions and treatments included in Aarogyasri-II are however, undertaken by the Trust directly and funded from the CMRF. With the launch of Aarogyasri II, free treatment of the BPL population for the majority of serious diseases became a reality. The launch of Aarogyasri II occurred in parallel to the extension of the RAS to all districts of AP in 2 further phases (phases 4 and 5). The Aarogyasri Scheme now covers 719 surgical and 144 medical procedures, selected on the basis of the treatment being emergency in nature and life saving, requiring specialist doctors/equipment and not ordinarily available in district level Government Hospitals. Treatment and care included in Aarogyasri I and now the Aarogyasri II scheme complement existing free treatments available in Government hospitals. Put together, they are expected to meet a substantial part of the total health care requirements of the general population. Exclusions from the scheme are extremely high-cost procedures such as hip and knee replacement, bone marrow, heart and liver transplants, gamma-knife procedures in neurosurgery and assisted devices for cardiac failure. 18

19 3.0 Aim of the Evaluation The Indian Institute of Public Health (IIPH), Hyderabad was commissioned by the Government of Andhra Pradesh to undertake an independent evaluation of the RAS. The purpose of the evaluation was to examine the contribution of the scheme to achieving overall health improvement in Andhra Pradesh, provide insights into the current performance of the scheme, to examine whether it is meeting the overall objectives and to suggest ways by which it may be further strengthened. More specifically, the evaluation was required to respond to the following questions posed by the government: 1. Did the scheme succeed in mitigating in the entire state of Andhra Pradesh the duress of poor households from catastrophic expenditure required for treatment of serious ailments? 2. Did the scheme secure in a cost-effective manner quality medical care for the BPL population for serious ailments? 3. Do the age, gender and geographical distribution of beneficiaries of the Aarogyasri scheme and the medical conditions for which treatment has been delivered demonstrate equity of access? 4. Does the scheme address the most important health needs of the BPL families? 5. How is the scheme perceived by the BPL families and the public and private health providers? 6. Does the scheme make effective use of Public Private Partnerships for its effective implementation and in particular the role played by the Trust, the Insurance company, the network hospitals and the district administration? 7. What is the overall impact of the scheme in promoting the health status of the people in AP and in particular of Aarogyamitras, health camps, call centre, cashless OP treatment, diagnosis and treatment in network hospital, follow up treatment, online management of the scheme and the resultant qualitative improvement in the life of the common man? 19

20 4.0 Evaluation Methods The evaluation was undertaken using the following methodology. 4.1 Literature review An extensive literature search for articles and reports of previous health care evaluations was undertaken. WHO, World Bank, Pubmed and Medline databases were used as the primary source for identification of relevant articles. Relevant published information available from independent organisations and institutions was also secured using search engines such as Google. Google scholar was used as the search engine for grey literature published by organisations active in the field of health insurance. The search was carried out using the key words community health insurance, health care evaluation, health insurance for health system improvement, health care financing and health insurance and public private partnership for community health insurance. The search yielded a vast number of articles and reports, but only those most relevant to the key questions were included. Snowballing from references used in these most relevant articles secured additional useful literature. All the articles were accessed through IIPH e- journal services and books from the library at IIPH, Hyderabad. 4.2 Secondary Data Analyses The District Pre-Authorisation Statistics were downloaded for the period from 1/04/07 to 30/09/08. These data included information for all the patients treated under both the AS-I and AS-II phases for the 23 districts of Andhra Pradesh from the Aarogyasri website. The original data that were downloaded contained 27 items of information (Annexe 2) for each of a total number of 1,05,712 pre-authorisations for treatment. A code was then written using the software R in order to merge the data that had been downloaded. Treatments for which there was no information on the surgery date variable were treated as non-surgery/therapy cases and were excluded for the purpose of some analyses. There were such cases. There were 89,699 remaining treatments for which dates of surgery/therapy were available, and these were included in all the analyses. These treatments were undertaken for 71,549 beneficiaries. Claims paid data for 15 treatment codes were made available for analyses. 20

21 The descriptions of treatment packages or disease conditions did not follow any standard classification. There were 32 categories of treatment packages, each with large numbers of unique descriptors of diagnoses (Table 1). These categories were merged into 19 groups based on clinical specialties and are listed in Table 1. The regrouping is described in Annexe 6. CATEGORIES NUMBER OF UNIQUE DIAGNOSES Cancer 9152 Cardiac Critical Care 187 Dermatology 4 Endocrinology 26 ENT 67 Gastroenterology 609 General Medicine 23 General Surgery 2390 Gynaecology 1677 Neurology 9359 Ophthalmology 48 Orthopaedic 916 Paediatric 1680 Plastic Surgery 1351 Poly-Trauma 7289 Pulmonology 119 Renal 4396 Rheumatology 28 Total Table 1: Unique diagnoses listed in the RAS dataset in each specialty category 4.3 Primary data analyses Primary data about the various aspects of the scheme and its utilisation were collected by means of surveys administered to selected representatives of various stakeholders such as the beneficiaries, Aarogyamitras, Aarogyasri Medical Camp Coordinators (AMCCOs), Rajiv Aarogyasri Medical Coordinators (RAMCOs), Medical Superintendents (MSs), Medical Officers of Primary Health Centres (MO-PHCs) and other key informants from the AHCT. 21

22 Sample size calculation for beneficiary interviews Adjusting for design effect and non-response, the minimum sample size that was required for this survey was estimated as 210 beneficiaries. This sample size took into account 95% confidence intervals and 10% precision. Sampling Framework A three stage sampling process was adopted to select the beneficiaries of the Scheme. The stages were: a) selection of districts b) selection of mandals and c) selection of beneficiaries. a) Selection of districts A total of 6 out of the 23 districts were selected for the study. The selection of the districts was undertaken using probability proportional to size (PPS) sampling procedure with number of treatments per 1,00,000 population as the variable for size and stratified for three regions (Table 2 of Annex 1). The list of districts selected, included those in all phases of implementation and from all three regions of Andhra Pradesh, namely Coastal Andhra, Rayalseema and Telangana. The districts selected were as follows: Districts Adilabad Anantapur Mahaboobnagar Prakasam RangaReddy West Godavari Of these 6 districts, Mahaboobnagar and Anantapur were covered under Phase 1 of the RAS, Rangareddy and West Godavari were from Phase 2, Prakasam from Phase 3 and Adilabad from Phase 4 of the Aarogyasri Scheme. b) Selection of Mandals The mandals were selected from each of the 6 districts to cover equal numbers of beneficiaries (12) from each mandal. The selection of mandals from each of the districts was done by listing all the mandals from the districts and the corresponding number of beneficiaries. A PPS sampling procedure was then applied to select 3 mandals from each district. 22

23 The mandals selected are given below: Districts Adilabad Anantapur Mahaboobnagar Prakasam RangaReddy West Godavari Mandals Khanpur, Nirmal, Dilawarpur Anantapur, Dharmavaram (M), Gudibanda Kothakota, Devarkadra, Doulathabad Chimakurthi, Ongole, Donakonda LB Nagar, Shamshabad, Shabad Nidadavole, Palacoderu,Tallapudi c) Selection of Beneficiaries The beneficiaries from each mandal were selected randomly. The list of beneficiaries for each mandal was obtained from the website of the Aarogyasri scheme and was used as the sampling frame. When the selected beneficiary was found to have died (4.6% (10) of the total sample size of 217 patients), he/she was replaced with a beneficiary from a nearby house. Network hospitals visit Using a PPS sampling procedure based on numbers of treatments undertaken, 27 network hospitals (Annexe 3) were selected. One district hospital and one area hospital from each district were randomly selected from the list of network hospitals. Thus 9 Andhra Pradesh Vaidya Vidhan Parishad (APVVP) hospitals, 4 government teaching hospitals and 14 private hospitals were included in the evaluation. A RAMCO, AAMCO, MS and Aarogyamitra from each hospital were interviewed. Visit to PHCs One PHC from each mandal was visited. An MO and Aarogyamitra from each PHC were interviewed. Health Camps One health camp was visited in each of the districts except in Anantapur (where no camp was scheduled during the period of the survey), to observe and record its activities. Data Collection Teams were formed to administer the surveys and to collect data from each of the six districts (Annexe 4). The visiting teams interviewed the beneficiaries and other stakeholders selected for inclusion in the evaluation. The surveys were undertaken over a period of two weeks from 1-12 December Semi-structured questionnaires (Annexe 5) for each of the categories of 23

24 interviewees, viz. RAMCOs, AAMCOs, MSs, Aarogyamitras and beneficiaries were developed to systematise and standardise the process of data collection. The responses were collected and analysed from a sample of 217 beneficiaries. Where beneficiaries were children, both children and accompanying adults were interviewed. Responses to the indicators were scored on a scale of 0 to 5 where - 0= No response or no comments 1= highly dissatisfied 2=dissatisfied 3=neither satisfied nor dissatisfied 4= satisfied 5= highly satisfied 24

25 5.0 Results 5.1 Beneficiaries treated in each phase of the RAS Fig 1 shows the numbers of beneficiaries per lakh BPL population treated (beneficiary rate) per month in the 5 phases of the scheme. Typically, all the phases started with a beneficiary rate of approximately 7 per lakh BPL population except in phase 2 which started with more than 10 beneficiaries per lakh BPL population. Qualitative information from West Godavari district which was included in phase 2, suggested that this district had already screened the population and identified potential beneficiaries for the scheme prior to its launch. This may explain the higher beneficiary rate at the start of phase 2. All the phases demonstrated peaks in July and August 2008 because of the combined effect of launching of Aarogyasri II in addition to the existing Aarogyasri I. Number of beneficiaries per BPL population Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 phase-1 phase-2 phase-3 phase-4 phase-5 Months Fig 1: Monthly distribution of the beneficiary rate per lakh BPL population by phase 25

26 5.2 The distribution of beneficiaries across the districts The population size varies across the districts. Comparison of absolute numbers of beneficiaries from each district would therefore be misleading. Also the scheme was implemented in five phases spread over one and half years. In order to assess equity of distribution of the benefits of the RAS across the districts in a more meaningful way, the beneficiary rate per lakh BPL people treated per month was used for comparison (Table 2). Krishna district recorded the maximum number of beneficiaries per month per lakh BPL population followed by Prakasam and Hyderabad. The minimum number of beneficiaries per month per lakh BPL population was treated in Anantapur. Rank District Beneficiaries Beneficiaries/ lakh BPL population Beneficiaries/ lakh BPL population/ month 1 Krishna Prakasam Hyderabad Guntur Vizianagaram Nellore Karimnagar Warangal Vishakhapatnam West Godavari Kadappa East Godavari Khammam Nizamabad Srikakulam Adilabad Nalgonda Kurnool Medak Ranga Reddy Chittoor Mahaboobnagar Anantapur Table 2: Beneficiaries per lakh BPL population 26

27 5.3 Distribution of beneficiaries by age. The distribution of beneficiaries by age is shown in Figure 2. Beneficiaries aged 60 and above made up 13.4% of the people who had availed of the scheme. Children aged 0 to 14 years made up 13%. The age distribution of beneficiaries who were selected for interview (Figure 3) was similar to that in the main RAS Percentage beneficiaries to to to to and above Age Group Figure 2: Distribution of beneficiaries by age 35 Percentage beneficiaries and above Age groups Figure 3: Distribution of beneficiaries interviewed, by age 27

28 5.4 Distribution of beneficiaries by sex The information on sex of children aged 0-14 yrs is currently not available on the RAS website. There were almost equal male and female beneficiaries with males making up a higher proportion in both the overall RAS (54%) (Fig 4) and in the sample interviewed (52%) (Fig 5). Male Female 46% 54% Figure 4 : Distribution of beneficiaries by sex Male Femal 48% 52% Figure 5: Distribution of beneficiaries interviewed, by sex 28

29 5.5 Distribution of beneficiaries by educational status The educational status of the beneficiaries in the RAS is not recorded. Fig 6 shows that approximately half of the beneficiaries interviewed are illiterate Percentage beneficiaries Illiterate 1 to 4 5 to 9 10 to Not available Education Figure 6: Educational status of beneficiaries interviewed, by years of study 5.6 Distribution of beneficiaries by economic status and employment No measure of economic status is recorded in the RAS. For the purpose of this evaluation, the Standard of Living Index (SLI) which is an indicator of economic status of the beneficiaries (NFHS ) was used. The SLI is calculated based on data related to type of house, toilet facility, access to drinking water, type of fuel used for cooking and possession of household amenities such as telephone, mobile, scooter, car, etc. The SLI calculated for the beneficiaries included in the interview (Fig 7) showed that about half of them have a low SLI, confirming that they belong to economically poor households. About 7% of the beneficiaries belonged to a high socioeconomic class and another 42% belonged to households with middle socioeconomic status. The inclusion of beneficiaries from higher SLI may be due to the fact that Andhra Pradesh does not follow the official poverty ratio of government of India (Planning Commission, 2006) and more than 70% population is considered as BPL. Nearly 30% of the interviewees were unemployed and together with unskilled labourers made up nearly half the sample (Fig 8). There are around 8% beneficiaries who are either 29

30 professionals or belonging to service and sales. This group may represent the high SLI category. 60 Percentage beneficiaries Lower Middle High Standard of living index Figure 7 : Standard of living index of beneficiaries interviewed Percentage beneficiaries Data not available Sales Professional, Technical, Managerial Services Agriculture-employee Skilled Manual Agriculture-self employed Household and Domestic work Unskilled Manual Unemployed Occupation Figure 8: Occupation of beneficiaries interviewed 30

31 5.7 Distribution of beneficiaries across urban and rural areas About 87 percent of the beneficiaries belong to rural areas of Andhra Pradesh (Table 3). The percentage of beneficiaries from rural areas is higher than the rural population (73%) of Andhra Pradesh and this difference is statistically significant. However it was observed during the survey that many urban migrants had rural addresses on their Aarogyasri cards. District Rural Urban Beneficiaries Population z value Beneficiaries Population z value Adilabad Anantapur Chittoor East Godavari Guntur Hyderabad Kadapa Karimnagar Khammam Krishna Kurnool Mahaboobnagar Medak Nalgonda Nellore Nizamabad # # Prakasam Ranga Reddy Srikakulam Vishakhapatnam Vizianagaram Warangal West Godavari AP # - Not statistically significant Table 3: Distribution of beneficiaries by district and place of residence 31

32 5.8 Distribution of beneficiaries among Scheduled Castes and Scheduled Tribes 10,947 people from Scheduled Castes (SCs) and Scheduled Tribes (STs) had already received treatments under the RAS. The proportions of beneficiaries from SCs and STs by district are shown in table 4. The corresponding percentages of SC and ST populations as per the 2001 census are also provided for comparison. In the majority of the districts the proportions of beneficiaries were significantly lower than the proportions of SCs and STs in the total population. This finding is in contrast to the fact that the SC and ST populations have significantly higher morbidities as compared to the general population (Misra, 2003). District Percent Scheduled Caste Percent Scheduled Tribes Beneficiaries Population z value Beneficiaries Population z value Adilabad * * Anantapur * Chittoor * * East Godavari * * Guntur * * Hyderabad * Kadappa * Karimnagar * * Khammam * * Krishna * Kurnool * Mahaboobnagar * * Medak * * Nalgonda * * Nellore * Nizamabad * * Prakasam * Ranga Reddy * * Srikakulam * * Vishakhapatnam * * Vizianagaram * * Warangal * * West Godavari * * AP * * *Statistically significant Table 4: Distribution of Beneficiaries by Scheduled Castes and Scheduled Tribes 32

33 5.9 Distribution of treatments by medical/surgical specialties Table 5 shows that half the treatments were for heart disease and cancer. About two-thirds of all treatments belong to three specialties namely - cardiology, cancer and neurology. Conditions category Frequency Percent Cardiac 23, Cancer 21, Neurology 13, Renal 8, Poly-Trauma 8, General Surgery 4, Gynaecology 2, Paediatrics 2, Plastic surgery 1, Orthopaedics Gastroenterology Critical Care Pulmonology ENT Ophthalmology Rheumatology Endocrinology Dermatology Total 89, Table 5: Treatments undertaken by medical/surgical specialties 33

34 5.10 Distribution of network hospitals by number of treatments Table 6 shows the frequency of treatments undertaken in network hospitals in descending order. The data showed that 30 network hospitals together have carried out more than 50 percent of these interventions. Most of these larger hospitals are located in the cities of Hyderabad, Vijayawada and Visakhapatnam. Thirty nine percent of all treatments were undertaken in Hyderabad. Hospital Freq. Percent Cum. Indo-American Cancer Institute, Hyderabad 4, M.N.J.Hospitals, Hyderabad 2, Sri Venkateswara Institute of Medical Sciences, Tirupati 2, City Cancer Centre, Hyderabad 2, Krishna Institute Of Medical Sciences, Hyderabad 1, Narayana Medical College Hospital, Nellore 1, Care Hospital, Visakhapatnam 1, Aarogyasri Health Scheme Superintendent Osmania Hospital, Hyderabad 1, Manipal Super Speciality Hospital, Vijayawada 1, NIMS Hospital, Hyderabad 1, Bibi Cancer and General Hospital, Hyderabad 1, Lalitha Super Speciality Hospital, Guntur 1, Surya Sri Hospital Private Ltd, Visakhapatnam 1, Seven Hills Hospitals Ltd, Visakhapatnam 1, Vizag Hospitals and Cancer Research, Visakhapatnam 1, Quality Care India Ltd (Care Hospitals, Banjara Hills), Hyderabad 1, Queens NRI Hospitals, Visakhapatnam 1, Bollineni Ramanaiah Memorial Hospital, Rajamundry 1, GSL Medical college and General Hospital, Rajamundry 1, Apollo Hospitals Enterprises Ltd (Jubilee Hills), Hyderabad 1, Yashoda hospitals, Hyderabad 1, Kamineni Hospitals Pvt Ltd, Hyderabad 1, Usha Cardiac Centre Limited, Vijayawada 1, Charithasri Hospital Ltd, Vijayawada 1, Government General Hospital, Kakinada 1, Yashoda Hospital (Malakpet), Hyderabad 1, Mediciti Hospitals, Hyderabad 1, Gandhi Hospital, Hyderabad Samudra Healthcare Enterprises Ltd (Apollo, Kakinada) Quality Care India Ltd (Care Hospital Vijayawada) Table 6: Distribution of Network hospitals by number of treatments 34

INDIA: STATE GOVERNMENT SPONSORED COMMUNITY HEALTH INSURANCE SCHEME

INDIA: STATE GOVERNMENT SPONSORED COMMUNITY HEALTH INSURANCE SCHEME SERIES: SOCIAL SECURITY EXTENSION INITIATIVES IN SOUTH ASIA INDIA: STATE GOVERNMENT SPONSORED COMMUNITY HEALTH INSURANCE SCHEME (ANDHRA PRADESH) EXPANDING ACCESS TO MOST EXPENSIVE HEALTH CARE SERVICES

More information

Health Insurance in India: Rajiv Aarogyasri Health Insurance Scheme in Andhra Pradesh

Health Insurance in India: Rajiv Aarogyasri Health Insurance Scheme in Andhra Pradesh IOSR Journal Of Humanities And Social Science (IOSR-JHSS) Volume 8, Issue 1 (Jan. - Feb. 2013), PP 07-14 e-issn: 2279-0837, p-issn: 2279-0845. www.iosrjournals.org Health Insurance in India: Rajiv Aarogyasri

More information

336 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 24, NO. 6, 2011

336 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 24, NO. 6, 2011 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 24, NO. 6, 2011 335 Addressing healthcare needs of people living below the poverty line: A rapid assessment of the Andhra Pradesh Health Insurance Scheme M. RAO,

More information

Dr. NTR UNIVERSITY OF HEALTH SCIENCES: A.P: VIJAYAWADA - 520 008 MEDICAL COLLEGES for the Academic year 2013-14

Dr. NTR UNIVERSITY OF HEALTH SCIENCES: A.P: VIJAYAWADA - 520 008 MEDICAL COLLEGES for the Academic year 2013-14 Dr. NTR UNIVERSITY OF HEALTH SCIENCES: A.P: VIJAYAWADA - 520 008 MEDICAL COLLEGES for the Academic year 2013-14 Sl. No Name of the College Govt. / Private Siddhartha Medical College, Vijayawada - 520 1

More information

Dr. Ambedkar Medical Aid Scheme (Revised 2013)

Dr. Ambedkar Medical Aid Scheme (Revised 2013) Dr. Ambedkar Medical Aid Scheme (Revised 2013) The scheme is meant to provide medical treatment facility to the patients suffering from serious ailments requiring surgery of Kidney, Heart, Liver, Cancer

More information

GOVERNMENT OF ANDHRA PRADESH ABSTRACT. PUBLIC SERVICES STATE SERVICES Andhra Pradesh Collegiate Education Services Special Rules Issued.

GOVERNMENT OF ANDHRA PRADESH ABSTRACT. PUBLIC SERVICES STATE SERVICES Andhra Pradesh Collegiate Education Services Special Rules Issued. GOVERNMENT OF ANDHRA PRADESH ABSTRACT PUBLIC SERVICES STATE SERVICES Andhra Pradesh Collegiate Education Services Special Rules Issued. HIGEHR EDUCATION (CE.I-1) DEPARTMENT G.O.Ms.No. 47 Dated: 14.05.2007.

More information

Dr.M.Usha Rani, Assoc. Professor, Dept. of Computer Science, SPMVV, Tirupati. musha_rohan@yahoo.com

Dr.M.Usha Rani, Assoc. Professor, Dept. of Computer Science, SPMVV, Tirupati. musha_rohan@yahoo.com Expenditure Analysis Through Data Mining Techniques on NREGS(National Rural Employment Guarantee Scheme) Data of Andhra Pradesh Dr.M.Usha Rani, Assoc. Professor, Dept. of Computer Science, SPMVV, Tirupati.

More information

Prevalence and Factors Affecting the Utilisation of Health Insurance among Families of Rural Karnataka, India

Prevalence and Factors Affecting the Utilisation of Health Insurance among Families of Rural Karnataka, India ISSN: 2347-3215 Volume 2 Number 8 (August-2014) pp. 132-137 www.ijcrar.com Prevalence and Factors Affecting the Utilisation of Health Insurance among Families of Rural Karnataka, India B.Ramakrishna Goud

More information

Terms of Reference Concurrent Monitoring of Mid Day Meal (MDM) in Odisha

Terms of Reference Concurrent Monitoring of Mid Day Meal (MDM) in Odisha Terms of Reference Concurrent Monitoring of Mid Day Meal (MDM) in Odisha 1. Background The Government of India has initiated a number of social welfare flagship schemes to enable improving status of human

More information

Presentation on Crop Insurance by P. Nagarjun Ex. General Manager AIC Technical Consultant / OSD, Department of Agri. Govt. of A.P.

Presentation on Crop Insurance by P. Nagarjun Ex. General Manager AIC Technical Consultant / OSD, Department of Agri. Govt. of A.P. Presentation on Crop Insurance by P. Nagarjun Ex. General Manager AIC Technical Consultant / OSD, Department of Agri. Govt. of A.P. Indian Agriculture Major causes of Damage Drought / Dry Spell Heavy Rains

More information

7.2. Insurance and Investments

7.2. Insurance and Investments Personal Finance and Money Management (Basics of Savings, Loans, Insurance and Investments) ------------------------------------------------------------------------------------ Module 7 Topic-2 ------------------------------------------------------------------------------------

More information

TABLE OF CONTENTS SL CONTENT PAGE NO. 1 INTRODUCTION 1 2 OBJECTIVE OF SCHEME 1 3 BENEFITS OF SCHEME 2 4 ELIGIBILITY OF SCHEME 2 5 INSURANCE COVERAGE

TABLE OF CONTENTS SL CONTENT PAGE NO. 1 INTRODUCTION 1 2 OBJECTIVE OF SCHEME 1 3 BENEFITS OF SCHEME 2 4 ELIGIBILITY OF SCHEME 2 5 INSURANCE COVERAGE TABLE OF CONTENTS SL CONTENT PAGE NO. 1 INTRODUCTION 1 2 OBJECTIVE OF SCHEME 1 3 BENEFITS OF SCHEME 2 4 ELIGIBILITY OF SCHEME 2 5 INSURANCE COVERAGE 3 6 PREMIUM FOR RSBY 3 7 MAJOR STAKE HOLDERS 3 8 ROLES

More information

Information and Health Care A Randomized Experiment in India

Information and Health Care A Randomized Experiment in India Information and Health Care A Randomized Experiment in India Erlend Berg (LSE), Maitreesh Ghatak (LSE), R Manjula (ISEC), D Rajasekhar (ISEC), Sanchari Roy (LSE) iig Workshop, Oxford University 21 March

More information

Important Issues on Ageing in India Recommendations To Planning Commission- Will social improvements for elderly grow by 8 %?

Important Issues on Ageing in India Recommendations To Planning Commission- Will social improvements for elderly grow by 8 %? Important Issues on Ageing in India Recommendations To Planning Commission- Will social improvements for elderly grow by 8 %? HELPAGE INDIA Comparative Demographic Facts 25 21 21 20 % 15 10 8 12 India

More information

A Health and Wellbeing Strategy for Bexley Listening to you, working for you

A Health and Wellbeing Strategy for Bexley Listening to you, working for you A Health and Wellbeing Strategy for Bexley Listening to you, working for you www.bexley.gov.uk Introduction FOREWORD Health and wellbeing is everybody s business, and our joint aim is to improve the health

More information

Quality in and Equality of Access to Healthcare Services

Quality in and Equality of Access to Healthcare Services Quality in and Equality of Access to Healthcare Services Executive Summary European Commission Directorate-General for Employment, Social Affairs and Equal Opportunities Manuscript completed in March 2008

More information

2003 FIRST MINISTERS ACCORD

2003 FIRST MINISTERS ACCORD 2003 FIRST MINISTERS ACCORD ON HEALTH CARE RENEWAL 1 In September 2000, First Ministers agreed on a vision, principles and action plan for health system renewal. Building from this agreement, all governments

More information

Moving Toward Universal Health Coverage R A S H T R I Y A S W A S T H Y A B H I M A Y O J A N A (R S B Y) 1 India

Moving Toward Universal Health Coverage R A S H T R I Y A S W A S T H Y A B H I M A Y O J A N A (R S B Y) 1 India Moving Toward Universal Health Coverage R A S H T R I Y A S W A S T H Y A B H I M A Y O J A N A (R S B Y) 1 India I. Basic Demographic and Health Statistics II. Impetus for Reform III. Summary of RSBY

More information

GOVERNMENT OF ANDHRA PRADESH ANDHRA PRADESH VAIDYA VIDAHANA PARISHAD NOTIFICATION NO - 1/2016,

GOVERNMENT OF ANDHRA PRADESH ANDHRA PRADESH VAIDYA VIDAHANA PARISHAD NOTIFICATION NO - 1/2016, GOVERNMENT OF ANDHRA PRADESH ANDHRA PRADESH VAIDYA VIDAHANA PARISHAD NOTIFICATION NO - 1/2016, RECRUITMENT FOR THE POST OF CIVIL ASSISTANT SURGEON SPECIALIST ON CONTRACT BASIS APPLICATION FORM REGISTRATION

More information

The family physician system reform in small cities in I.R. Iran

The family physician system reform in small cities in I.R. Iran Evaluating Impact: Turning Promises into Evidence The family physician system reform in small cities in I.R. Iran Masoud Abolhallaj, Abbas Vosoogh, Arash Rashidian, Alireza Delavari Cairo, January 2008

More information

Ophthalmic Disability in Prakasham District Of Andhra Pradesh

Ophthalmic Disability in Prakasham District Of Andhra Pradesh International Journal of Pharmaceutical and Medical Research Volume 3 Issue 2 April 2015 Website: www.woarjournals.org/ijpmr ISSN: 2348-0262 Ophthalmic Disability in Prakasham District Of Andhra Pradesh

More information

WHAT S CANCER GOT TO DO WITH FOOD?

WHAT S CANCER GOT TO DO WITH FOOD? For Immediate Release 4 February 2015 WHAT S CANCER GOT TO DO WITH FOOD? Food is a major element in cancer prevention and care. Not only can cancer risk be reduced with a healthy lifestyle; nutritional

More information

Managed Clinical Neuromuscular Networks

Managed Clinical Neuromuscular Networks Managed Clinical Neuromuscular Networks Registered Charity No. 205395 and Scottish Registered Charity No. SC039445 The case for Managed Clinical Neuromuscular Networks 1. Executive summary Muscular Dystrophy

More information

COST OF HEALTH CARE- A STUDY OF UNORGANISED LABOUR IN DELHI. K.S.Nair*

COST OF HEALTH CARE- A STUDY OF UNORGANISED LABOUR IN DELHI. K.S.Nair* Health and Population -Perspectives and Issues: 24 (2): 88-98, 2001 COST OF HEALTH CARE- A STUDY OF UNORGANISED LABOUR IN DELHI K.S.Nair* ABSTRACT The study attempts to estimate the economic burden of

More information

Patient Choice Strategy

Patient Choice Strategy Patient Choice Strategy Page 1 of 14 Contents Page 1 Background 4 2 Putting Patients and the Public at the Heart of Health and 5 Healthcare in West Lancashire 3 Where are we now and where do we need to

More information

National Family Health Survey-3 reported, low fullimmunization coverage rates in Andhra Pradesh, India: who is to be blamed?

National Family Health Survey-3 reported, low fullimmunization coverage rates in Andhra Pradesh, India: who is to be blamed? Journal of Public Health Advance Access published March 15, 2011 Journal of Public Health pp. 1 7 doi:10.1093/pubmed/fdr022 National Family Health Survey-3 reported, low fullimmunization coverage rates

More information

Operational cost for management of leprosy-related complicated ulcer in charitable hospitals

Operational cost for management of leprosy-related complicated ulcer in charitable hospitals Lepr Rev (2015) 86, 283 287 SHORT REPORT Operational cost for management of leprosy-related complicated ulcer in charitable hospitals SRINIVAS GOVINDARAJULU*, VIVEK LAL*, SAMUEL THOMSON SUGUMARAN DAVIDSON*,

More information

National Health Insurance Policy 2013

National Health Insurance Policy 2013 National Health Insurance Policy 2013 1. Background The Interim Constitution of Nepal 2007 provides for free basic health care as a fundamental right of citizens. Accordingly, the Government of Nepal has

More information

Global Strategy on Human Resources for Health: Workforce 2030

Global Strategy on Human Resources for Health: Workforce 2030 Global Strategy on Human Resources for Health: Workforce 2030 Developing a new HRH agenda Buenos Aires, Argentina 31 August - 03 September, 2015 Jim Campbell Director, Health Workforce, WHO Executive Director,

More information

Rashtriya Swasthya Bima Yojana: Pioneering Public-Private Partnership in Health Insurance

Rashtriya Swasthya Bima Yojana: Pioneering Public-Private Partnership in Health Insurance Rashtriya Swasthya Bima Yojana: Pioneering Public-Private Partnership in Health Insurance By: Dr. Rumki Basu Professor of Public Administration Department of Political Science Jamia Millia Islamia New

More information

ASIA-PACIFIC ADVANCED NETWORK 31 st MEETING. U Satyanarayana. Asian Institute of Gastroenterology Hyderabad, India.

ASIA-PACIFIC ADVANCED NETWORK 31 st MEETING. U Satyanarayana. Asian Institute of Gastroenterology Hyderabad, India. ASIA-PACIFIC ADVANCED NETWORK 31 st MEETING 21-25.FEB.201125 2011 HONG KONG Telemedical activity in India SGI 2010 and more U Satyanarayana Asian Institute of Gastroenterology Hyderabad, India. India lives

More information

Profiles and Data Analysis. 5.1 Introduction

Profiles and Data Analysis. 5.1 Introduction Profiles and Data Analysis PROFILES AND DATA ANALYSIS 5.1 Introduction The survey of consumers numbering 617, spread across the three geographical areas, of the state of Kerala, who have given information

More information

Equality, Diversity, Cohesion and Integration Impact Assessment

Equality, Diversity, Cohesion and Integration Impact Assessment Equality, Diversity, Cohesion and Integration Impact Assessment As a public authority we need to ensure that all our strategies, policies, service and functions, both current and proposed have given proper

More information

Reconfiguration of Surgical, Accident and Emergency and Trauma Services in the UK

Reconfiguration of Surgical, Accident and Emergency and Trauma Services in the UK Reconfiguration of Surgical, Accident and Emergency and Trauma Services in the UK K Reconfiguration of Surgical, Accident and Emergency and Trauma Services in the UK Summary Our aim is to provide an excellent

More information

Survey of Nurses. End of life care

Survey of Nurses. End of life care Survey of Nurses 28 End of life care HELPING THE NATION SPEND WISELY The National Audit Office scrutinises public spending on behalf of Parliament. The Comptroller and Auditor General, Tim Burr, is an

More information

Maternal and Child Health Service. Program Standards

Maternal and Child Health Service. Program Standards Maternal and Child Health Service Maternal and Child Health Service Program Standards Contents Terms and definitions 3 1 Introduction 6 1.1 Maternal and Child Health Service: Vision, mission, goals and

More information

PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE

PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE PPP- ROLE OF BUSINESS IN AFRICA S HEALTHCARE THE HYGEIA GROUP S EXPERIENCE FOLA LAOYE MARCH 2006 NIGERIAN HEALTHCARE OVERVIEW ROLE OF PPP IN NIGERIA HYGEIA S RESPONSE TO PPP IN NIGERIA NIGERIAN HEALTHCARE

More information

Northern Ireland Waiting Time Statistics:

Northern Ireland Waiting Time Statistics: Northern Ireland Waiting Time Statistics: Inpatient Waiting Times Quarter Ending September 2014 Reader Information Purpose Authors This publication presents information on waiting times for inpatient treatment

More information

National Assembly for Wales: Health and Social Care Committee

National Assembly for Wales: Health and Social Care Committee 2 Ashtree Court, Woodsy Close Cardiff Gate Business Park Cardiff CF23 8RW Tel: 029 2073 0310 wales@rpharms.com www.rpharms.com 18 th October 2011 Submission to: Call for Evidence: Response from: National

More information

4. ROLE OF PRIVATE SECTOR IN HEALTH CARE IN INDIA CHALLENGES, OPPORTUNITIES & STARTEGIES

4. ROLE OF PRIVATE SECTOR IN HEALTH CARE IN INDIA CHALLENGES, OPPORTUNITIES & STARTEGIES 4. ROLE OF PRIVATE SECTOR IN HEALTH CARE IN INDIA CHALLENGES, OPPORTUNITIES & STARTEGIES * G K Lath Type of Health Care Systems 3 Basic Types Type Finance Sector Delivery Sector Examples I Private Private

More information

Ninety three percent of the workforce in India

Ninety three percent of the workforce in India WIEGO Policy Brief (Social Protection) N o 10 September 2012 Health Insurance in India: The Rashtriya Swasthya Bima Yojana Assessing Access for Informal Workers Kalpana Jain 1 Ninety three percent of the

More information

Healthcare services requiring prior authorisation

Healthcare services requiring prior authorisation Annex 2 Healthcare requiring prior authorisation This list does not include organ transplants and does also not apply to long-term care and the primary purpose of which is to support people in need of

More information

Performance Dashboard Appendix 1 Trust Board - 19th June 2012

Performance Dashboard Appendix 1 Trust Board - 19th June 2012 Performance Dashboard Appendix 1 Trust Board - 19th June 2012 Code Integrated Performance Measure Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Criteria for Traffic

More information

Terms of Reference Baseline Assessment for the employment intensive project for youth in Lower Juba (Dhobley and Afmadow), Somalia

Terms of Reference Baseline Assessment for the employment intensive project for youth in Lower Juba (Dhobley and Afmadow), Somalia Terms of Reference Baseline Assessment for the employment intensive project for youth in Lower Juba (Dhobley and Afmadow), Somalia Organization African Development Solutions www.adesoafrica.org Project

More information

Butler Memorial Hospital Community Health Needs Assessment 2013

Butler Memorial Hospital Community Health Needs Assessment 2013 Butler Memorial Hospital Community Health Needs Assessment 2013 Butler County best represents the community that Butler Memorial Hospital serves. Butler Memorial Hospital (BMH) has conducted community

More information

Role of Self-help Groups in Promoting Inclusion and Rights of Persons with Disabilities

Role of Self-help Groups in Promoting Inclusion and Rights of Persons with Disabilities Role of Self-help Groups in Promoting Inclusion and Rights of Persons with Disabilities *K.P.Kumaran 105 ABSTRACT Aim:This study examined the role of self help groups in addressing some of the problems

More information

NCDs POLICY BRIEF - INDIA

NCDs POLICY BRIEF - INDIA Age group Age group NCDs POLICY BRIEF - INDIA February 2011 The World Bank, South Asia Human Development, Health Nutrition, and Population NON-COMMUNICABLE DISEASES (NCDS) 1 INDIA S NEXT MAJOR HEALTH CHALLENGE

More information

Challenges for. Health Insurers & TPAs. Data enhancement and information sharing in the health insurance sector

Challenges for. Health Insurers & TPAs. Data enhancement and information sharing in the health insurance sector Challenges for Health Insurers & TPAs Data enhancement and information sharing in the health insurance sector Alam Singh Assistant Managing Director Milliman 86 w w w. e h e a l t h o n l i n e. o r g

More information

Selection of Future Medical Practice: Using the Australian Medical Schools Outcomes Database to inform national workforce planning

Selection of Future Medical Practice: Using the Australian Medical Schools Outcomes Database to inform national workforce planning Selection of Future Medical Practice: Using the Australian Medical Schools Outcomes Database to inform national workforce planning Author: David A Kandiah Date: 19 October 2012 I do not have an affiliation

More information

The Way Forward: Strategic clinical networks

The Way Forward: Strategic clinical networks The Way Forward: Strategic clinical networks The Way Forward Strategic clinical networks First published: 26 July 2012 Prepared by NHS Commissioning Board, a special health authority Contents Foreword...

More information

Public Private Partnership to Improve Health of Urban Poor in Agra

Public Private Partnership to Improve Health of Urban Poor in Agra Public Private Partnership to Improve Health of Urban Poor in Agra Introduction Agra, one of the important cities of Uttar Pradesh city is spread over an area of 140 sq. km. along the banks of the river

More information

Objective: Current Position& Profile Summary:

Objective: Current Position& Profile Summary: Dr.Pradhyumansinh Rathod (MHM, B.P.T) Project Officer Medical Services - Gujarat State Project Officer Ability Gujarat (Disability) - Gujarat State Medical Service, Education & Research Dr. Jivraj Mehta

More information

Group Health Insurance Schemes of State Governments

Group Health Insurance Schemes of State Governments 2 nd Prize Winner Dr Vinita Rana, NIA, Pune Group Health Insurance Schemes of State Governments Over the last 50 years India has achieved a lot in terms of health improvement. But still India is way behind

More information

This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project.

This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project. Developed by Acknowlegement This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project. This study has given us a better understanding of the human resource

More information

National Clinical Programmes

National Clinical Programmes National Clinical Programmes Section 3 Background information on the National Clinical Programmes Mission, Vision and Objectives July 2011 V0. 6_ 4 th July, 2011 1 National Clinical Programmes: Mission

More information

DEVELOPMENTS IN THE MEDICAL AND HEALTH INSURANCE SECTOR

DEVELOPMENTS IN THE MEDICAL AND HEALTH INSURANCE SECTOR DEVELOPMENTS IN THE MEDICAL AND HEALTH INSURANCE SECTOR Medical inflation, an increase in the utilisation of medical services and the changing demographics have spawned significant developments in the

More information

Health Insurance for the DISABLED

Health Insurance for the DISABLED Health Insurance for the DISABLED Why is Health Insurance required? fu'kdrtu a d LokLF; chek D; a\ A major component of Social Security that gives: Free Hospitalisation. Pre and post hospitalisation coverage.

More information

HOSPITAL SUBSECTOR ANALYSIS

HOSPITAL SUBSECTOR ANALYSIS HOSPITAL SUBSECTOR ANALYSIS Fourth Health Sector Development Project (RRP MON 41243) A. Introduction 1. The health status of the people of Mongolia has generally improved over the years, and significant

More information

The Victorian Transport Accident Scheme. Heather Evans General Manager, Strategy

The Victorian Transport Accident Scheme. Heather Evans General Manager, Strategy The Victorian Transport Accident Scheme Heather Evans General Manager, Strategy Agenda 1. Overview of the Scheme 2. Recent Performance 3. Key Initiatives Who is the TAC fully funded combined no-fault and

More information

Consultation Response Medical profiling and online medicine: the ethics of 'personalised' healthcare in a consumer age Nuffield Council on Bioethics

Consultation Response Medical profiling and online medicine: the ethics of 'personalised' healthcare in a consumer age Nuffield Council on Bioethics Consultation Response Medical profiling and online medicine: the ethics of 'personalised' healthcare in a consumer age Nuffield Council on Bioethics Response by the Genetic Interest Group Question 1: Health

More information

Care, Fairness & Housing Policy Development Panel 21 November 2005

Care, Fairness & Housing Policy Development Panel 21 November 2005 Agenda Item No: 6 Developing a Corporate Health & Well-being Strategy Head of Environmental Services Summary: This report proposes the development of a health & well-being strategy for the Council, which

More information

REDEFINING POVERTY LINES AND SURVEY OF BPL FAMILIES. ( Rural Areas)

REDEFINING POVERTY LINES AND SURVEY OF BPL FAMILIES. ( Rural Areas) REDEFINING POVERTY LINES AND SURVEY OF BPL FAMILIES Proposal Submitted to Honb le CM ( Rural Areas) 1. 8 th Plan 1992-97 : Ministry of Rural Development, GoI conducts BPL census at the beginning of each

More information

The New Complex Patient. of Diabetes Clinical Programming

The New Complex Patient. of Diabetes Clinical Programming The New Complex Patient as Seen Through the Lens of Diabetes Clinical Programming 1 Valerie Garrett, M.D. Medical Director, Diabetes Center at Mission Health System Nov 6, 2014 Diabetes Health Burden High

More information

National Clinical Effectiveness Committee. Prioritisation and Quality Assurance Processes for National Clinical Audit. June 2015

National Clinical Effectiveness Committee. Prioritisation and Quality Assurance Processes for National Clinical Audit. June 2015 National Clinical Effectiveness Committee Prioritisation and Quality Assurance Processes for National Clinical Audit June 2015 0 P age Table of Contents Glossary of Terms... 2 Purpose of this prioritisation

More information

Dual Diagnosis. Dual Diagnosis Good Practice Guidance, Dept of Health (2002);

Dual Diagnosis. Dual Diagnosis Good Practice Guidance, Dept of Health (2002); Dual Diagnosis Dual Diagnosis is a challenging problem for both mental health and substance misuse services. People with mental health problems, who also suffer from substance misuse are at an increased

More information

Commissioning Policy: Defining the boundaries between NHS and Private Healthcare April 2013 Reference : NHSCB/CP/12

Commissioning Policy: Defining the boundaries between NHS and Private Healthcare April 2013 Reference : NHSCB/CP/12 Commissioning Policy: Defining the boundaries between NHS and Private Healthcare April 2013 Reference : NHSCB/CP/12 NHS Commissioning Board Commissioning Policy: Defining the Boundaries between NHS and

More information

NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST STATEMENT OF PURPOSE

NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST STATEMENT OF PURPOSE NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST STATEMENT OF PURPOSE Legal status of the Trust University Hospitals NHS Trust (NUH) came into being on 1st April 2006 and assumed responsibility for the services

More information

Injury Survey 2008. Commissioned by. Surveillance and Epidemiology Branch Centre for Health Protection Department of Health.

Injury Survey 2008. Commissioned by. Surveillance and Epidemiology Branch Centre for Health Protection Department of Health. Injury Survey 2008 Commissioned by Surveillance and Epidemiology Branch Centre for Health Protection Department of Health September 2010 Copyright of this survey report is held by the Department of Health

More information

Support the innovative use of technology for affordable healthcare in rural India

Support the innovative use of technology for affordable healthcare in rural India Support the innovative use of technology for affordable healthcare in rural India SMART Health India A new model of healthcare for rural India The Challenge: Rural India is home to 750 million people living

More information

TOR - Consultancy Announcement Final Evaluation of the Cash assistance and recovery support project (CARSP)

TOR - Consultancy Announcement Final Evaluation of the Cash assistance and recovery support project (CARSP) TOR - Consultancy Announcement Final Evaluation of the Cash assistance and recovery support project (CARSP) Organization Project Position type Adeso African Development Solutions and ACTED - Agency for

More information

No application should be posted / sent directly to the Secretary, A P Para Medical Board by any candidate and such Applications will be REJECTED.

No application should be posted / sent directly to the Secretary, A P Para Medical Board by any candidate and such Applications will be REJECTED. Room No. 306 of the Directorate of Medical Education Complex, Behind Kendriya Sadan, Koti, Hyderabad -500 001 Phone & Fax:040-24653519 *** Notification No. 76 / APPMB/ Combined Paramedical Suppl Exams

More information

Measuring quality along care pathways

Measuring quality along care pathways Measuring quality along care pathways Sarah Jonas, Clinical Fellow, The King s Fund Veena Raleigh, Senior Fellow, The King s Fund Catherine Foot, Senior Fellow, The King s Fund James Mountford, Director

More information

VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT

VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT Health and Population - Perspectives and Issues 24(2): 80-87, 2001 VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT The rural poor suffer from illness are mainly utilising costly health

More information

Topic Area - Dual Diagnosis

Topic Area - Dual Diagnosis Topic Area - Dual Diagnosis Dual Diagnosis is a challenging problem for both mental health and substance misuse services. People with mental health problems, who also suffer from substance misuse are at

More information

NHS BLOOD AND TRANSPLANT MARCH 2009 RESPONDING EFFECTIVELY TO BLOOD DONOR FEEDBACK

NHS BLOOD AND TRANSPLANT MARCH 2009 RESPONDING EFFECTIVELY TO BLOOD DONOR FEEDBACK 09/26 NHS BLOOD AND TRANSPLANT MARCH 2009 RESPONDING EFFECTIVELY TO BLOOD DONOR FEEDBACK EXECUTIVE SUMMARY From April 2009 an NHS wide common approach to complaint handling comes in to effect. This provides

More information

National Commission for Academic Accreditation & Assessment. Standards for Quality Assurance and Accreditation of Higher Education Programs

National Commission for Academic Accreditation & Assessment. Standards for Quality Assurance and Accreditation of Higher Education Programs National Commission for Academic Accreditation & Assessment Standards for Quality Assurance and Accreditation of Higher Education Programs November 2009 Standards for Quality Assurance and Accreditation

More information

COHESION POLICY: STRATEGIC REPORT 2013

COHESION POLICY: STRATEGIC REPORT 2013 COHESION POLICY: STRATEGIC REPORT 2013 Factsheet: Social inclusion and social infrastructure Cohesion Policy EN Strategic Report 2013 Programme implementation 2007-2013 Factsheet: Social Inclusion and

More information

The Hospital For Sick Children TELEMEDICINE

The Hospital For Sick Children TELEMEDICINE The Hospital For Sick Children Telemedicine Services Clinical Consultations Telemedicine Services Education Sessions Telemedicine Services Administrative / Research Key Professionals Dr. Fraser Golding,

More information

Selfhelpgroups - Default Management and Recoveries: A Study among the Scheduled Caste Women in Andhra Pradesh and Telangana

Selfhelpgroups - Default Management and Recoveries: A Study among the Scheduled Caste Women in Andhra Pradesh and Telangana International Journal of Humanities and Social Science Invention ISSN (Online): 2319 7722, ISSN (Print): 2319 7714 Volume 3 Issue 8 ǁ August. 2014 ǁ PP.58-62 Selfhelpgroups - Default Management and Recoveries:

More information

Physical Disability and Rehabilitation (Physical Therapy, Orthopaedic Workshops, Orthopaedic and Reconstructive Surgery) Policy Paper

Physical Disability and Rehabilitation (Physical Therapy, Orthopaedic Workshops, Orthopaedic and Reconstructive Surgery) Policy Paper Physical Disability and Rehabilitation (Physical Therapy, Orthopaedic Workshops, Orthopaedic and Reconstructive Surgery) Policy Paper Physical Disability and Rehabilitation Advisory working group, Dec

More information

APPENDIX B HONG KONG S CURRENT HEALTHCARE SYSTEM. Introduction

APPENDIX B HONG KONG S CURRENT HEALTHCARE SYSTEM. Introduction APPENDIX B HONG KONG S CURRENT HEALTHCARE SYSTEM Introduction B.1 Over the years, Hong Kong has developed a highly efficient healthcare system and achieved impressive health outcomes for its population.

More information

Regional Centre: Gandhi Medical College, Secundrabad, A. P

Regional Centre: Gandhi Medical College, Secundrabad, A. P Regional Centre: Gandhi Medical College, Secundrabad, A. P S. No. Name of the Colleges (s / s) 1. Dr. M. Narsing Rao / Bhaskar Medical College, Yenkapally Village, Moinabad Mandal, R.R. District, Off:08413-235333,

More information

Progress on the System Sustainability Programme. Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014

Progress on the System Sustainability Programme. Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014 Agenda Item: 9.1 Subject: Presented by: Progress on the System Sustainability Programme Dr Sue Crossman, Chief Officer Submitted to: NHS West Norfolk CCG Governing Body, 31 July 2014 Purpose of Paper:

More information

MEDICAL CERTAINTY WITHIN YOUR REACH

MEDICAL CERTAINTY WITHIN YOUR REACH For sales enquiries, please contact: Phone: 1-855-66-4028 Email: insurance@bestdoctorscanada.com MEDICAL CERTAINTY WITHIN YOUR REACH Best Doctors Canada Insurance Services 145 King Street West Suite 00

More information

Knowledge Management Policy

Knowledge Management Policy Knowledge Management Policy Knowledge Management (KM) envisages capturing, creating, sharing and managing knowledge. KM comprises of three components (i) people who create, share and use knowledge as part

More information

CENTRE FOR DISTANCE EDUCATION ACHARYA NAGARJUNA UNIVERSITY:: NAGARJUNA NAGAR 522 510

CENTRE FOR DISTANCE EDUCATION ACHARYA NAGARJUNA UNIVERSITY:: NAGARJUNA NAGAR 522 510 CENTRE FOR DISTANCE EDUCATION ACHARYA NAGARJUNA UNIVERSITY:: NAGARJUNA NAGAR 522 510 Prof. M. V. RAMKUMAR RATNAM, M.A.,M.Phil., Ph.D. Coordinator (Examinations)(I/C). Dear Learner The following is the

More information

Complaints Annual Report 2014-15. Author: Sarah Housham, Senior Complaints and PALS Officer

Complaints Annual Report 2014-15. Author: Sarah Housham, Senior Complaints and PALS Officer Complaints Annual Report 2014-15 Author: Sarah Housham, Senior Complaints and PALS Officer 1 Rnoh Complaints Annual Report 2014 / 2015 Complaints Handling & the Principles of Remedy Introduction Complaints

More information

National Professional Development Framework for Cancer Nursing in New Zealand

National Professional Development Framework for Cancer Nursing in New Zealand National Professional Development Framework for Cancer Nursing in New Zealand Adapted from: National Cancer Education Project (EdCan). 2008. National Education Framework: Cancer nursing A national professional

More information

WHO Consultation on the Zero Draft Global Mental Health Action Plan 2013-2020 International Diabetes Federation (IDF) Submission

WHO Consultation on the Zero Draft Global Mental Health Action Plan 2013-2020 International Diabetes Federation (IDF) Submission WHO Consultation on the Zero Draft Global Mental Health Action Plan 2013-2020 International Diabetes Federation (IDF) Submission The International Diabetes Federation (IDF), an umbrella organisation of

More information

Awareness of Health Insurance in Andhra Pradesh

Awareness of Health Insurance in Andhra Pradesh International Journal of Scientific and Research Publications, Volume 2, Issue 6, June 202 Awareness of Health Insurance in Andhra Pradesh Jangati Yellaiah Ph.D. Scholar, Department of Economics, Osmania

More information

Standards of proficiency. Occupational therapists

Standards of proficiency. Occupational therapists Standards of proficiency Occupational therapists Contents Foreword 1 Introduction 3 Standards of proficiency 7 Foreword We are pleased to present the Health and Care Professions Council s standards of

More information

Homelessness: A silent killer

Homelessness: A silent killer Homelessness: A silent killer A research briefing on mortality amongst homeless people December 2011 Homelessness: A silent killer 2 Homelessness: A silent killer December 2011 Summary This briefing draws

More information

Partnership working in child protection: improving liaison between acute paediatric and child protection services

Partnership working in child protection: improving liaison between acute paediatric and child protection services At a glance 63 October 2013 Partnership working in child protection: improving liaison between acute paediatric and child protection services Key messages Both in-hospital and communitybased social work

More information

Connection with other policy areas and (How does it fit/support wider early years work and partnerships)

Connection with other policy areas and (How does it fit/support wider early years work and partnerships) Illness such as gastroenteritis and upper respiratory tract infections, along with injuries caused by accidents in the home, are the leading causes of attendances at Accident & Emergency and hospitalisation

More information

Survey to Doctors in England End of Life Care Report prepared for The National Audit Office

Survey to Doctors in England End of Life Care Report prepared for The National Audit Office Survey to Doctors in England End of Life Care Report prepared for The National Audit Office 1 2008, medeconnect Table of Contents 1 SUMMARY OF FINDINGS... 3 2 INTRODUCTION... 5 3 RESEARCH OBJECTIVES AND

More information

Report to: Trust Board Agenda item: 13 Date of Meeting: 25 April 2012

Report to: Trust Board Agenda item: 13 Date of Meeting: 25 April 2012 Report to: Trust Board Agenda item: 13 Date of Meeting: 25 April 2012 Title of Report: Status: Board Sponsor: Author: Appendices HR Quarterly Report For information Lynn Vaughan, Director of Human Resources

More information

CIRCULAR 13 OF 2014: MANAGED CARE ACCREDITATION - FINAL MANAGED HEALTH CARE SERVICES DOCUMENT

CIRCULAR 13 OF 2014: MANAGED CARE ACCREDITATION - FINAL MANAGED HEALTH CARE SERVICES DOCUMENT CIRCULAR Reference: Classification and naming conventions of Managed Health Care Services Contact person: Hannelie Cornelius Accreditation Manager: Administrators & MCOs Tel: (012) 431 0406 Fax: (012)

More information

Children s Services Improvement and Business Support. Service Review 2013/14

Children s Services Improvement and Business Support. Service Review 2013/14 Children s Services Improvement and Business Support Service Review 2013/14 Service Name: Children s Services Improvement and Business Support Service Contact: Richard Williams Date of review: 2013/14

More information

NORTHERN IRELAND WAITING TIME STATISTICS: INPATIENT WAITING TIMES QUARTER ENDING SEPTEMBER 2012

NORTHERN IRELAND WAITING TIME STATISTICS: INPATIENT WAITING TIMES QUARTER ENDING SEPTEMBER 2012 NORTHERN IRELAND WAITING TIME STATISTICS: INPATIENT WAITING TIMES QUARTER ENDING SEPTEMBER 2012 This publication presents information on waiting times for inpatient treatment in Northern Ireland at 30

More information

Health Security for All

Health Security for All Health Security for All A joint partnership between Government of Jharkhand and ILO Sub Regional Office for South Asia, New Delhi Dr. Shivendu Ministry of Health, Family Welfare, Medical Education and

More information