Andhra Pradesh Health Sector Reform: A Narrative Case Study

The State of Andhra Pradesh in India has recently taken several innovative approaches to improve access to healthcare. This report presents the major initiatives, including health insurance and contracting arrangements for health services, and describes underlying motives, challenges, and opportunities associated with the reform.

It is evident that innovative steps have been taken to shape the future health status of the population in Andhra Pradesh. The State Government has the last couple of years taken several new approaches to improve the access to quality health care. International organizations like the World Bank, European Commission and the Department for International Development (DFID) have a history of supporting reform initiatives within the health sector in Andhra Pradesh. But the political support for healthcare reform was anchored when the Chief Minister took a strong interest in initiatives for high impact and encouraged innovative approaches in the health sector reform process, back in 2004. This change of mindset resulted in significant budget allocations, providing the grow ground for the new initiatives and to spur improved services in a short period of time for the many underserved people in the State. The engagement has resulted in contract arrangements where the government has harnessed the private sector for more effective healthcare delivery. Financial protection of the poor has been another motive of the reform, given that healthcare costs have been the main reason for indebtedness, and the outcome is one of the world’s largest health insurance schemes. The Andhra Pradesh Health Sector Reform Programme (APHSRP), with managerial focus for improved efficiency in the work of the government, is yet another initiative which falls under the reform efforts.

This report presents the main reform initiatives and describes underlying motives, challenges and opportunities associated with the reform process. There are gaps that need to be addressed and external support for e.g. impact assessments, are in some cases critical. The aim is to present the health sector reforms and encourage the discussion on how governments together with partners can harness innovation and improve the access to health care.   This report brings forward the health sector reforms in Andhra Pradesh to spur the discussion of health sector reforms as a phenomenon. Other governments can, and should, learn from the extensive and innovative approaches and change of mindset, while the government of Andhra Pradesh would benefit from improved access to information regarding related policy reforms and their affects in other countries.

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