REVIEW OF HMRI 104 SERVICES IN THE STATE OF ANDHRA PRADESH
NHSRC RESEARCH REPORT – 2011
The Mobile Medical Unit (MMU) approach to reach out to the people in difficult and inaccessible areas is one of the key strategies under NRHM. In the nation as a whole there are around 1787 MMU’s that were introduced under NRHM. Their main objective was to reach a minimum package of outreach and clinical services to remote and difficult to reach areas. The HMRI however was a major variant of this theme. This model has also received considerable international and corporate attention as a possible way forward to reorganise delivery of primary health care. HMRI also has projected itself as experimenting or piloting such an alternative approach to the delivery of primary health care. A study of this model is particularly important as it is a major innovation effort that many states have considered for replication.
In 2010, the Government of Andhra Pradesh was rethinking the HMRI approach. Its main concerns were related to the programme outcomes, cost effectiveness and its impact on the public health system. The Government of Andhra Pradesh was initiating a comprehensive reform of primary health care delivery systems around the concept of Community Health and Nutrition Clusters (CHNC’s) in all districts. This would require at the CHNC level, integration of the services of FDHS with the CHNC’s to increase the access and effectiveness of primary and preventive services in the state. It was in this context that Government of Andhra Pradesh requested the National Health Systems Resource Centre, New Delhi to, undertake a study of the HMRI 104 services to look at both its effectiveness and the best way forward for integration.
The study was designed as a case study of the HMRI which used an analysis of documents, key informant interviews, and a limited sample survey in three districts to describe the programme and comment on the main objectives. The study was done in two stages. In the first stage a description of the programme and its processes using key informant interviews and secondary data was undertaken. In the second stage data collection was carried out from a sample of villages and FDHS vans in three selected districts of Andhra Pradesh (Anathapur, Warangal, and Visakhapatnam). For data collection we used a structured questionnaire for a sample of rural households, for a sample of beneficiaries of FDHS services based on exit interviews, and a sample of 6 different primary providers of health care- PHC Medical Officers, private practitioners, RMPs, ANMs, Anganwadi workers and ASHAs- from the sampled villages where the households had been interviewed. Phase two sample sizes were limited- the findings being used mainly to validate the findings regarding the basic processes and mechanisms of HMRI as described in phase I, and by such an analysis of context and mechanisms arrive at some broad conclusions about possible effectiveness in terms of health outcomes and its impact on public health systems.