Maternal mortality in Andhra Pradesh cording to the above bulletin. Moreover, the re- quirement is itself below the optimum—2,739 nurse-midwives for 1,924 PHCs—i.e. less than two nurse-midwives per PHC (Table 4). This indicates that adequate staff positions were not created for their round-the-clock functioning. This has been further highlighted in the case study of Medak district later in the paper. • The Andhra Pradesh Vaidya Vidhan Parishad (APVVP) was established in 1986 under an act of legislation with the objective of strengthening the secondary-level health system. The APVVP deals exclusively with hospitals of bed-strengths rang- ing from 30 to 350 which are referred to as sec- ondary hospitals or first-level referral hospitals. At present, there are 288 hospitals under the con- Prakasamma M ing schools, and dental colleges in the state. There are 35 teaching hospitals with a total bed- strength of 13,606. Half of these beds are in six large general hospitals. The Osmania General Hospital in Hyderabad and the Gandhi Hospital in Secunderabad together serve more than 5,000 outpatients and about 300 emergency patients daily. In 1986, a university of health sciences was established at Vijayawada—(later named NTR University of Health Sciences)—and all uni- versity-level institutions of allopathic and Indian systems of medicine, dentistry, and nursing were brought under its academic control. • The Commissionerate of Family Welfare imple- ments all family-planning activities, including the national Reproductive and Child Health Table 4. Primary health infrastructure and key health personnel in Andhra Pradesh, 2006 Particulars Required In position Shortfall % of shortfall Subcentres 11,699 12,522 - - Primary Health Centres 1,924 1,570 354 18.40 Multipurpose workers (female)/ANMs 14,092 13,740 352 2.50 Health Assistants (female)/LHVs at PHCs 1,570 1,564 6 0.38 Doctor at PHCs 1,570 2,202 - - Nurse/midwives (staff nurses) 2,739 2,053 686 25.05 ANMs=Auxiliary Nurse Midwives; LHVs=Lady Health Visitors; PHCs=Primary Health Centres trol of APVVP, of which 23 are district hospitals, 58 are area hospitals, and 167 are CHCs. The aver- age bed-strength is 200-350 in the district hospi- tals, 100 in the area hospitals, and 30-50 in the CHCs. Besides, there are 10 specialty hospitals and 25 dispensaries. The CHCs are the First Referral Units (FRUs) at the periphery. These are expect- ed to provide round-the-clock comprehensive obstetric and neonatal services, including emer- gency management. Table 5 shows that there is an acute shortage of all categories of service pro- viders at this level according to reports obtained from the Government of Andhra Pradesh. • The Directorate of Medical Education is the ad- ministrative authority for functioning of medi- cal colleges, attached teaching hospitals, nurs- (RCH) programmes and the National Rural Health Mission through the primary health fa- cilities. The department also has the responsi- bility for in-service training of field-level health and family welfare workers, such as ANMs and male health workers. Healthcare awareness and use of maternal services in Andhra Pradesh Health awareness and use of maternal healthcare services have shown a shift in the last two decades. There is a clear move from home to institutions and from traditional to professional providers for both antenatal and delivery care as indicated in Figure 2 and 3. During 1992-2005 (NFHS 1, NFHS 2, and NFHS 3), antenatal care from health professionals, especially doctors, increased, and the percentage Table 5. Health facilities and care providers in Community Health Centres, 2007 Particulars Required In position Shortfall % of shortfall Community Health Centres 481 167 314 65.28 Obstetricians and gynaecologists 167 73 94 56.29 Physicians 167 42 125 74.85 Paediatricians 167 54 113 67.66 Source of data: Reports obtained from the Andhra Pradesh Vaidya Vidhan Parishad, Government of Andhra Pradesh 224 JHPN