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FLAG B - Logframe
Logical Framework for AP Health Sector Reform Programme
All targets measured from the base-line of 2005-06. Goal level targets are based on the NRHM targets for 2010-11 and are ambitious. Purpose and
outputs are three year targets and are also ambitious. The baseline and purpose level target indicators will be confirmed at the start of the programme
and will be disaggregated for SC, ST, OBCs and women, where appropriate.
Narrative Summary OVIs MOVs Assumptions
Goal : 1.1 Improvement in the key health indicators contributing to NFHS, District RCH GoI and GoAP
To improve the health outcomes in the strategy for 2010-11 surveys and other data commitment to health
status of people in 1. Maternal mortality ratio (per 100,000 live births) reduced available with program sector reforms sustained
Andhra Pradesh - to 75 mangers in the state
especially the poorest %Institutional deliveries increase from 69 to 95
%Deliveries with SBA increase from 91.8 to 95
2. Infant mortality rate (per 1000 lb) reduced from 53 to <20
Neonatal mortality rate (per 1000 lb) reduced from
44.3 to <15
% children with completed immunisation against 7
diseases increased from 46 to 85
% children aged under 3 undernourished decreased
from 37% to X%
3. %TB case detection rate increased from 74 to 82
%TB treatment success rate increased from 84% to
90%
4. Malaria cases per 100,000 reduced from 55 to 30
% Falciparum of all malaria cases reduced
5. HIV prevalence in 15-45 population reduced in urban from
2% to <2% and in rural areas from 1% to <1%
HIV annual new infection rate reduced by 60%
Prevalence rates in STD clinic reduced from 22.8 % to
<22.8%
Narrative Summary OVIs MOVs Assumptions
Purpose: 1.1. Increased utilisation of health services over the project
Increased use of quality period of 3 years by 2009-10 for maternal child health care Baseline drawn up GoAP’s commitment to
health services especially services and reduced burden of communicable disease on disaggregated basis health sector reforms
by the poorest people and (i) institutional deliveries increase from 69 to 86% strategy sustained.
in underserved areas and increase in number of blocks with a HMIS
functional First referral Unit (FRU)1
(ii) complete childhood immunisation increased from National Sample
46 to 78% Survey (NSS)
(iii) Treatment of malaria and regular use of
insecticide treated bed nets results in reduced
malaria cases (per 100,000) reduced from 55 to
40
(iv) DOTS program results in increased TB case
detection from 74% to 80% and TB treatment
success rate increased from 84% to 88%
(v) Use of RTI/STI treatment services and HIV/AIDS
prevention and treatment services increased from
X% to Y%
(vi) Identification and treatment for HIV +ve persons Household survey,
with TB increased from X% to Y% including independent
audits for remote and
The baseline and 3 year targets will be firmed up where they tribal areas
do not exist. All these will be tracked on disaggregated basis
for Below Poverty Line (BPL), SC, ST, and especially in
underserved areas.
1.2. Increase in satisfaction with the health services from Satisfaction survey
1
functional FRU can be defined as a facility with 24 hour availability of blood, gynaecologist and anaesthetist and Operation theatre
Narrative Summary OVIs MOVs Assumptions
baseline for disaggregated population for SC/ST,
underserved areas, and by gender Report on financial
protection schemes
1.3. Financial protection schemes designed and increasingly
accessed by the BPL. (To be modified, once the details of
the proposed financial protection scheme is finalised).
1.1. Convergent health district plans prepared in 18 districts
Output 1: Improved with focus Integrated Tribal Development Agency (ITDA) District Health Plans Disadvantaged groups
access to quality and areas and other underserved areas. Minutes of the Task included and focus
responsive services, 1.2.Operational plan for integrating HIV/AIDS at all levels Force maintained on gender
especially in remote agreed and implemented. and equity.
and interior areas. 1.3. Integrated Disease surveillance and control systems HMIS
implemented.
1.4 Availability of basic services increased by 25 % (tracked Special surveys and
for immunisation, Institutional Deliveries, malaria and TB); studies
agreed norms achieved in underserved areas especially, for
medical and para medical staff, availability of drugs and Reports of Integrated
equipment. Disease surveillance
2.1. Human Resource Management (HRM) policy Mitigation measures on
Output 2 : Governance implemented which includes rationalised district level staff, HR policy adopted by the FRA are implemented
and management of transfer & posting policy, incentives for working in difficult Department, HMIS
health sector area, and training Adequate implementation
strengthened 2.2. PPP framework established which enables private PPP framework capacity built up to
sector contribution to public sector goals and pilot testing of address critical reforms
model FRA implementation
2.3. Progress made as per agreed FRA mitigation plan. report
2.4 Progress made in strengthening Drug Procurements
systems as per agreed action plan M&E reports
Narrative Summary OVIs MOVs Assumptions
2.4. Integrated M&E systems established that produces
reports on NRHM indicators, includes citizens’ feedback on
service standards, and the reports are widely disseminated.
Output 3 3.1. Village and Mandal committees constituted in 30% of Capacity building plans Participatory planning
Institutional remote and interior regions of 18 districts and capacity for village and mandal and accountability
mechanisms for building action plan implemented for them. committees systems established.
community 3.2 Stronger community role in supervision and monitoring of
participation and local health facilities and services. Notes of meetings
systems for 3.3. Evidence of the recommendations/concerns in the
accountability community monitoring reports reflected in the district plans. Special studies
functioning 3.4 Comprehensive communication strategy along with
behavioural studies conducted in year 2 Communication
strategy
Output 4: 4.1. GoAP Department of Health and Family Welfare and MTEF reports Commitment and
Financial management Department of Finance jointly produce MTEF Budgets capacity built up for
system strengthened 4.2 The proportion of resources to primary and secondary Reports by SPIU effective use of financial
health care maintained, as compared to the baseline (see Budget analyses resources
output 4 in milestones 11.2 and 11.3).
4.3 Criteria developed for effective targeting of resources to Criteria for effective
poorest (including underserved areas) agreed, and targeting of resources
resources allocated. to poorest
4.4. Professional finance/accounts and health economics Staffing of Strategy
Narrative Summary OVIs MOVs Assumptions
personnel appointed according to the Financial Systems Performance and
Improvement Plan Implementation Unit
(SPIU).
Activities - Inputs (Estimated)
See Milestones Matrix Output 1= £18 Million (60%)
Output 2, 3, 4 = £20 Million (35%)
TC Support = £2.0 Million (5%)
Total – £40 m -100%
Table 1: Health Goals and Target - AP’s Progress and Challenges 2
HEALTH INDICATOR NFHS II Baseline Intermediate Strategy outcome Status- to achieve MDGs
outcome 2011-12
1998-99 2005-06 2009-10
1. Maternal mortality Ratio (per 341 (2002) 195 - 75 Very challenging
100,000 live births) (SRS 2005)
2. % Institutional Deliveries 50 69 86 95 Very challenging
( NFHS III)
3. % Deliveries with SBA 74 93 95 Challenging
( NFHS III)
4. Infant Mortality Rate (per 1000 66 53 - <20 Very challenging
live births) ( NFHS III)
5. % Children immunized against 7 59 46 78 95 Very challenging
diseases (NFHS III)
6. Couple Protection Rate (CPR) 59.6 68 85 90 Challenging
(NFHS III)
7. Malaria Cases 55 40 30 Challenging
/100,000
8. TB Cases cure and detection 84% cure rate; Maintain 88% cure Maintain cure rate of 90% Challenging
rates 74% case detection rate rate; and 82% case detection
among new smear 80% case detection rate among new smear
positive cases (baseline rate among new positive cases
203 cases) smear positive cases
10. HIV Prevalence in 15-45 years Urban-2% Urban- <2% Urban -<2% Very challenging
population Rural – 1% Rural - < 1% Rural -<1%
STD clinics -22.8% STD Clinics -< 22.8% STD Clinics - <22.8%
11. Annual new HIV infections 5.10 lakh persons Achieve 60% Maintain 60% reduction in Very Challenging
estimated as HIV infected reduction in new new cases.
(NACO) cases
2
These targets have been decided by the GoAP under RCH-2, NRHM and NACP-2, and are ambitious.
