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Round the Clock Primary Health Centres, Andhra Pradesh
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Subject Area="Access to service and coverage." Objective="Scope and quality of primary health centre services."
Details for Reform Option "Round the Clock Primary Health Centres, Andhra Pradesh"

Background: The 1998-99, National Family Health Survey 2 (NFHS) for Andhra Pradesh showed that non-institutional deliveries constituted 50% of all deliveries. Only 30% of the non-institutional deliveries were attended by a doctor or other health professional. Since all pregnant women are at risk of complications, they need to have access to obstetric care. Therefore, encouraging institutional deliveries conducted under the overall supervision of trained health professionals is essential to ensure better health of the mother and child. The infant mortality rate for Andhra Pradesh for the five-year period immediately preceding the survey is estimated to have been 65 per 1000 live births. This means that 7 out of every 100 children did not survive until their first birthday. Action: (i) 470 Primary Health Centres (PHCs) were converted into Round the Clock Women Health Centres – providing 24 hour services for normal deliveries – from 1996 in Andhra Pradesh. (ii) These PHCs have one additional ANM employed on contract basis. She is given an incentive to be available for 24 hours and is assisted by a helper. (iii) Specialist clinics are held at the PHC for women and children on a fixed day. Gynaecologists and paediatricians are hired from private or public sector to conduct these clinics. They identify and refer high-risk cases of pregnancy and childhood illnesses. (iv) These PHCs have better facilities for communications and transport - a labour room with essential medicines and equipment and a telephone facility for prompt communication. Vehicle for quick referral is also made available on a hire basis at the PHC. (v) Traditional Birth Attendants (TBAs) or Anganwadi Workers (AWWs) are given INR 50 as an incentive for motivating pregnant women to go for institutional deliveries. Results: There was a 6-fold increase in institutional deliveries in Andhra Pradesh during 2002-03. Institutional deliveries increased at the district level by two to 6 times during the same period. (See Table 1 in Documents and Illustrations.)

Cost Additional cost of converting a PHC into a round-the-clock PHC: INR 471,600 (€8,489) per year (as per budget submitted to Government of India). Therefore, every additional institutional delivery required INR 3,103 . (Table showing unit cost as pre the additional budget for year for Round the Clock PHC given below.)
Place 470 PHCs in Andhra Pradesh. Initiated in 1996.
Time Frame Around six months.

Flexible and comprehensive: It is a flexible programme and targets remote areas where private services are not available. The package contains staff recruitment, infrastructure development and communication and transportation. Saves lives: Early detection and referral of at-risk mothers and children through frequent specialist clinics can reduce the number of deaths. Widens service reach: Regular clinics help increase the use of other services provided by the PHC.


Cost: Round-the-clock PHCs require additional financial resources. Needs infrastructure: It requires some basic infrastructure like roads, telecommunication and electricity. Staff availability: It requires availability of specialists on a regular basis.


It is important to empower the implementing organisation and maintain the management system including the key stakeholders. It is important to provide greater autonomy for management and supervision, adequate staffing and strengthening management procedures. It is important to pay attention to quality by development of technical norms, referral mechanism, clinical and management training programs and the development of performance indicators.

Who needs to be consulted

Commissioner of Family Welfare at state level and District Medical & Health Officers at district level.



Good if state government gives commitment and financial investment in Reproductive Child Healthcare (RCH) is flexible enough to include innovative programmes. It is sustainable if adequate budgetary allocations are made for recurrent expenditures.

Chances of Replication

It is replicable if at the district level, a strong, autonomous implementing agency and an effective monitoring system are in place. It also would require adequate and long-term financial commitment in order to sustain in resource-poor areas. It has been replicated in 450 PHCs and it is planned to increase it to 600 PHCs (March 2004).




Submitted By

Sara Joseph, Researcher, ECTA, New Delhi, September 2004.

Status Active
Reference Files
Table 1.doc District wise increase in Institutional Deliveries
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