How AP can transform Mother & Child Health

Andhra Pradesh has improved significantly on its maternal and child survival indicators in the last decade: between 2005-06 and 2015-16, survey data indicate that Andhra Pradesh’s infant mortality fell from 54 to 35 deaths per 1000 live births (NFHS 3, NFHS4), and the maternal mortality rate fell from 134 per 100,000 live births in 2008, to 92 in 2012 (Ministry of Health and Family Welfare, NFHS-4, with data for undivided Andhra Pradesh). 
Nevertheless, there is still room for improvement, particularly on several indicators related to access and use of child and maternal health services. Seventy percent of women exclusively breastfeed, 76 percent of women had at least four antenatal care visits during pregnancy, and 65 percent of children are fully vaccinated (NFHS-4). 
This analysis is based on Chief Scholar of the US-India Policy Institute, Abusaleh Shariff’s study. According to him, Andhra Pradesh has made considerable improvements in mother and child health, with 76 percent of pregnant mothers now making at least four antenatal clinic visits. 
The programme Mana Bhavita (started as Maarpu) aims to bring a quick decline in infant and maternal mortality rates and malnutrition, while the Talli-Bidda Express scheme (now called Amma Vodi) focuses on providing safe and hygienic transportation from government facilities to homes for new mothers, babies, and pregnant mothers who go for routine ANC visits. 
The first intervention Dr. Shariff suggests is providing an incentive to each mother of ₹2000, expanding the present-day system. The total cost for Andhra Pradesh is ₹163 crores, with the bulk being cash incentives. (The remainder is increased costs to the health system and private costs to mothers). This could reduce neonatal mortality by 6 per 1000 live births, based on similar programs, saving 804 infant lives in Andhra Pradesh annually. 
The new research uses cost-benefit analysis, which puts bene-fits— including health, social, environmental and economic benefits —into numbers, so policies can be compared. In this case, Dr Shariff estimates the benefits are ₹950 crores annually. Every rupee achieves six rupees of benefits to society, which is a good return on investment. 

The researcher also studies a breastfeeding mass media campaign, using television advertisements and counselling. In Andhra Pradesh, 70 percent of mothers exclusively breastfeed. Based on international evidence, a campaign could increase this to 93 percent, saving nearly 6,000 lives. The policy would have benefits to Andhra Pradesh worth around 8-times the costs. 
By far the most compelling case in the new research paper is for expanding immunisation programs in lagging districts. Just 65 percent of children in Andhra Pradesh are fully vaccinated, so there is a gap to close. 
Additionally, several districts lag behind the state average in terms of percentage of full immunization (East Godavari, Sri PottiSriramulu Nellore, Srikakulam and Vi-zianagaram). The average rate of immunization in these districts is 55%. This intervention targets these districts where 2.2 lakh children are born every year. 
Based on a trial in Rajasthan, Dr Shariff proposes setting up ‘immunization camps’ in the lagging districts, providing lentils and meals worth ₹685 to parents for vaccinating their children. The policy would cost ₹10 crores in Andhra Pradesh and, if it raised the level of fully immunized children to the state average, would save 219 children annually. 
Immunization would generate benefits worth more than ₹30 for every rupee spent, which is a considerable return on investment. New data on costs and benefits closes evidence gaps and helps ensure more good can be done with each rupee. 
Focusing on interventions to further improve mother and child health would help save lives and strongly enhance the overall wellbeing of Andhra Pradesh. 

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