Facility Assessment Report
State Name: Andhra Pradesh
Year: 2022
Year
USAID RISE Project
RISE is a 5-year global project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
and the U.S. Agency for International Development (USAID). Jhpiego is the lead implementation partner
of the USAID-RISE project in India that aims to support and strengthen the states’ response to the impact
of the current and future waves of COVID-19 and emergency respiratory situations across 28 states in
secondary and tertiary care healthcare facilities using a “Hub and Spoke Model”.
Rationale
Suboptimal standardized care provision across the health system: Due to many unknowns
in the treatment of COVID, there was successive recommendation that often contradicted each other.
This created lack of clarity among those providing care and the situation was further complicated due to
a lack of operational planning and coordination resulting in the convergence of patients in tertiary centers.
Lack of knowledge and skills at Secondary/tertiary level facilities and among private
providers: Providers involved in service provision did not have an adequate level of knowledge and
skillset to deliver critical care. The demand surge coupled with the infection of existing providers forced
them out of the pool and caused frequent rotation. The lack of standard treatment of SARS – CoV2
created a lot of confusion on treatment modalities and clinicians rely on a cocktail of drugs often creating
panic and confusion among people with limited capacity to triage, stabilize and manage
suspected/confirmed COVID-19 patients at lower-level health facilities resulted in cases inundating the
tertiary facilities Inadequate support in-state/district for building workforce resilience: With the
pandemic stretching into a second year, the healthcare workforce is overstretched and faces physical and
psychological exhaustion. The workforce has experienced deaths and disease in their cadre and among
family members. Extended work hours further aggravate the need for timely and adequate support.
Status of Critical Care in the State
The State Government extended critical care services through 576 special COVID hospitals with
6147 ICU beds, 23,199 oxygen beds, 16755 general beds, and 2320 ventilator beds across the 26 districts
in the State. This includes Government and private hospitals enlisted under the Government’s Aarogyasri
health insurance scheme, and also a few other private hospitals not covered by the scheme. During the
second wave of COVID, it was estimated that 5% of all positive cases might require ICU-level
hospitalization, which meant that the current level of ICU/HDU bed availability in Andhra Pradesh was at
a level lower than desired.
Introduction
RISE India is driving health system preparedness for current and future respiratory emergencies
aimed at building sustainable, self-reliant, and resilient health systems by delivering comprehensive
planning, implementation, and evaluation support across the 5 key areas of need: 1) COVID
Vaccination: 2) Critical Care, 3) Oxygen Management, 4) Laboratory strengthening, and 5) Biomedical
Waste Management. The hub and spoke facility model form the backbone of the RISE strategic
planning and implementation mandate to achieve health system preparedness. Spoke assessments
help in collecting information on the status of the key areas to inform the project on the next steps.
Objectives of the Second Round of Assessment
The second round of spoke assessments is designed to achieve the following objectives1) To assess health system readiness across the 5 key areas of intervention.
2) To identify changes in key components like HR/equipment/skills and others across the 5 key
areas from the first facility assessment.
3) To identify areas of interventions that need to be advocated for with the facility-in-charge
and State health administration to work towards improved health system readiness.
Methodology
Unlike the first round of assessments, the second round of spoke assessments is being
conducted only in a subset of spoke facilities of all the spokes registered in the state.
1) 50% of ICU spokes identified to conduct the second round in the State following
facilities are selected for the second round of spoke assessments
S. No
District
Spoke facility name
Facility with ICU/
Non-ICU
Date of
Assessment
1
Guntur
GMC,GGH, Guntur
ICU
26th Sep 2022
2
Krishna
DH Machilipatnam
ICU
27th Sep 2022
3
Visakhapatnam
DH Anakapalli
ICU
27th Sep 2022
4
Chittoor
DH Chittoor
ICU
27th Sep 2022
5
Anantapuramu
GGH, Anantapur
ICU
27th Sep 2022
6
Chittoor
DH Madanapalli
ICU
28th Sep 2022
7
Anantapuramu
DH Hindupur
ICU
28th Sep 2022
8
East Godavari
RMC, GGH, Kakinada
ICU
28th Sep 2022
9
Kadapa
RIMS, Medical College Kadapa
ICU
29th Sep 2022
10
West Godavari
DH Tanuku
ICU
29th Sep 2022
11
Vishakapatnam
DH Paderu
ICU
29th Sep 2022
12
Prakasam
RIMS, Medical College Ongole
ICU
29th Sep 2022
13
Nellore
DH Atmakur
ICU
29th Sep 2022
14
Vizianagaram
DH Vizianagaram
ICU
3rd Oct 2022
Human Resources
120%
96%
100%
80%
85%
74%
79%
100%
100% 100% 100%
97%
85%
69%
68%
73%
77%
64%
50%
50%
60%
40%
20%
32%
26%
15%
21%
31%
15%
4%
0%
3%
27%
36%
23%
0%
0%
0%
0%
Trained by State
Require Training
From the above chart, it was observed that human resources from the hub and spoke need training
requirements to upgrade themselves in Critical Care Management, Oxygen Management and Laboratory
strengthening
Especially Medical Officers, Nursing staff, Junior/Senior Residents, Bio-medical engineers, Support staff,
Micro- Biologist, Nursing staff, and Oxygen Technicians need training on BLS and ACLS.
Triage & Bio-Medical Waste Management
All the Hub and Spoke facilities in the State have a Triage and clinical person deputed. The facility
also has an MOU with an external agency and has a clear SOP on BMWM.
Critical Care Services
Avilable Beds
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
8183
5994
5953
4070
794
745
340
150
4070
496
1st
2nd
1st
2nd
1st
2nd
1st
2nd
1st
2nd
Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment
Total number of beds
available in this facility?
Adult ICU
PICU
HDU Beds
Oxygen beds
Compare to 1st and 2nd assessments it was observed a significant increase in beds in the health
facility. Total beds increased by around 37%, PICU beds increased by more than 100%, and oxygen
beds increased by 46%
In the case of Adult ICU beds and HDU beds observed decreasing number due to a decrease in
COVID cases
Ventilators
550
1330
ventilators 1st
Assessment
ventilators 2nd
Assessment
operational
ventilators 2nd
Assessment non
operational
2014
Critical Care Services
First Assessment
120%
100%
80%
60%
40%
20%
0%
100%
93%
100%100%
86%
79%
86%79%
Regarding Ventilators observed a 51%
increase compare to 1st assessment
but 27% of ventilators are nonoperational due to some minor
repairs
Second Assessment
100%100% 93% 93%
All Critical Care Services are made
available at the facilities. During the
second assessment observed a slight
change in Central line insertion and
Arterial line insertion services
unavailable in DH Atmakur, DH
Paderu, and DH Tanuku.
Oxygen Ecosystem Status
120%
100%
100%
97%
100%
80%
60%
48%
40%
19%
18%
16%
20%
0%
17%
8%
0%
4%
PSA Plants
Booster for PSA
LMO Tank
Manifold
Concentrator
Non operational
Increased
Non operational
Increased
Non operational
Increased
Non operational
Increased
Non operational
Increased
Non operational
Increased
0%
Cylinder(Total)
nd
Compare to 1st and 2 assessment observed extraordinary improvement in the oxygen
ecosystem. PSA plants increased by 48%, LMO tanks increased by 18%, and 100% of the facilities’
established manifolds and also Concentrators were also made available in 100% of facilities.
At the same time, it was noticed that some devices are non-operational due to some minor and
technical issues as shown in the above bar chart
COVID-19 Vaccination Status
It was observed only 43% of spoke facilities are having COVID Vaccine services.
Laboratory Status
Out of 14 facilities assessed in 2nd round of
assessment, it was observed that…
67%
70%
60%
50%
33%
40%
30%
20%
9%
10%
0%
0%
RTPCR
TRUENAT
RTPCR &
TRUENAT
CBNAAT
 67% of facilities’ RTPCR testing
Machines/Equipment are available and
operational for COVID-19 testing.
 33% of facilities are having TrueNat
services. Only 3 facilities namely GGH
Guntur, GGH Kurnool, and DH Nandyala
have both RTPCR and TrueNat
 9% of the facilities having both
TrueNat
and
CBNAAT
testing
Machines/Equipment are available
Recommendations
Facilities with more than one PSA plant may provide surplus oxygen to nearby facilities that require
oxygen if a booster for PSA is made available. And facility need not depend on other agencies for
refilling oxygen cylinders.
In some of the facilities like DH Anakapalli, DH Atmakur, DH Hindupur, and DH Vizianagaram RTPCR Testing Equipment is available but it’s non-Operational due to no HR
Human resources from the hub and spoke facility need refresher training to upgrade themselves in
Critical Care Management Oxygen Management and Laboratory strengthening
Due to some technical issues in the “Pranavayu” app oxygen tracking is not working regularly
At DH Anantapur 175 ventilators are non-operational due to some minor repairs and 16 Adult ICU
and 11 PICU beds are non-operational due to the breakdown of side drills
At DH Atmakur specialists are not available for critical care services in the facility
At Hindupur 30 ventilators are non-operational due to some minor repairs and emergency medical
technicians’ requirement is observed in the facility
At DH Machilipatnam Pathologists and Sr/ Jr Resident positions are yet to be filled and two Ambulance
driver positions are vacant.
At Madanapalle 18 ventilators, are non-operational due to some minor repairs and Specialists are not
available for Critical care services in the facility.
At DH Paderu 20 oxygen beds are not in operational mode and also 20 concentrators are nonoperational due to minor repairs.
At Tanuku RT-PCR and Molecular testing Machines/Equipment is not available in the facility. Critical
Care services like Central line insertion, Arterial line insertion, and ABG analysis services are also not
available in the facility lack of specialists. One Ambulance driver position is also vacant.
At Vizianagaram 93 concentrators are non-operational due to minor repairs, which need to be
addressed
At GGH Kakinada, 85 Ventilators are non-operational due to some minor repairs. 80 concentrators
are non-operational due to some minor repairs. The facility needs a centralized OT complex that
needs to be developed in the hospital. Anesthesia equipment is not working properly repairs are
required. The oxygen management and monitoring department needs to be established. One oxygen
plant does not have PESO certification due to this, that plant is not working. Good Cath lab is
available in the facility but it is not used due to there is no specialist in the Cardiology department.
In urology IP males and females are in the same wared, Separate ward for the female is required. The
lift is not working at OT which needs immediate repair
At GGH Kadapa ventilators are non-operational due to some minor sensor problems which can be
repaired. Capacity building of Human resources regularly especially for the staff nurses on BLS and
ACLS
At RIMS Ongole 70 ventilators and 230 beds are non-operational. Newly recruited staff require
training (especially Microbiologists, Lab Technicians, Pathologists, Bio-medical engineers, and support
staff). Pathologists and Sr/Jr Resident positions are yet to be filled. Fire Safety Measures need to be
provided at the PSA Plants and LMO tanks sites also.