HEALTH AND FAMILY WELFARE DEPARTMENT

DEMAND NO. 19

POLICY NOTE 2013-2014

THIRU K.C. VEERAMANI

Minister for Health

GOVERNMENT OF TAMIL NADU 2013

POLICY NOTE ON HEALTH AND FAMILY WELFARE 2013-14 CONTENTS Sl No 1 2 3 4 5 6 7 Chapter Introduction Health Administration Medical Education Medical and Rural Health Services Public Health and Preventive Medicine Family Welfare Medical and Rural Health Services (Employees State
Insurance Hospitals)

14 15 16

Page No 111 17 26 31 55 69 10 16 25 30 54 68 70

17

18 19

20

21 71 86 85 94 22 23 24

8 9 10 11 12 13

Indian Medicine and Homoeopathy Food Safety and Drugs Control Administration Tamil Nadu State Health Transport Department Medical Services Recruitment Board State Health Society Tamil Nadu Health Systems Project

95 - 102 103 - 104

25 105 - 137 138 - 155 26

Tamil Nadu Medical Services Corporation Tamil Nadu State AIDS Control Society Tamil Nadu State Blindness Control Society Revised National Tuberculosis Control Programme National Mental Health Programme National Vector Borne Diseases Control Programmes National Programme for Prevention and Control of Cancer, Diabetes and CardioVascular Diseases National Tobacco Control Programme National Leprosy Eradication Programme Accident And Trauma Care Centres Chief Ministers Comprehensive Health Insurance Scheme Important Acts Education, Training and Research

156 - 163 164 - 173 174 - 177 178 - 181

182 - 188 189 - 198

199 - 200

201 - 202 203 204 - 206 207 - 210

211 - 217 218 - 223

Chapter 1 INTRODUCTION cwh ms ms fhyK fwh fU bra. (Fw 949) The learned physician should ascertain the condition of his patient, the nature of his disease and the season of the year and then proceed with his treatment. 1.1 Government of Tamil Nadu is totally committed to building healthy people, not only by making available quality medicare facilities to everyone in the State, but also by providing medical facilities of the highest order, keeping pace with rapid technological developments in the field of medicine. Government of Tamil Nadu provides preventive and curative care to all through various Hospitals, Dispensaries, and Institutions. State Profile 1.2 Tamil Nadu is one of the best performing states and has consistently strived for ensuring that the citizens are provided with the best possible medical care. It is the seventh most populous State

in the country with a population of 7.21 crore as per 2011 census. The State has 32 districts. For the management of public health services, the State has been divided into 42 Health Unit Districts. Tamil Nadu is also one of the best performing States in terms of implementing Reproductive and Child Health schemes and has already achieved the National Rural Health Mission / Reproductive Child Health goals. The current Infant Mortality Rate of the State is 22 (Sample Registration System 2011), which is well below the national target of 30 per 1000 live births. Against the national target of 100 per lakh live births for the Maternal Mortality Ratio, the State had already achieved a Maternal Mortality Ratio of 97 as per Sample Registration System 2007-2009. Now, as per the State Health Management Information System data collected in 2011-2012, this has gone down further to 73 per lakh live births. The State has also achieved replacement level and the current Total Fertility Rate is 1.7 which is the lowest in the country. The Union Planning Commission and many independent review missions have commended the performance of the State. 1.3 These achievements in macro indicators have been backed by several pioneering

initiatives. With the vision and guidance of Honble Chief Minister, the State has been implementing several landmark initiatives with a view to ensure Universal Health Care. Starting of Tamil Nadu Medical Services Corporation in 1994, initiating maternal and child health initiatives like 24 hour services at Primary Health Centre (PHC), starting of one 30 bedded PHC in each block, providing adequate blood banks, creating facilities for night caesarean, opening neo natal stabilisation and intensive care units and upgrading capacity for comprehensive obstetric and neonatal care, starting birth companion programme, maternal audits, universal immunisation programme, achieving all targets in the national programmes are some among many such landmark initiatives being implemented by the State. In addition to consolidating the initiatives and the programmes which are already being successfully implemented, the state has also launched the menstrual hygiene programme, the modified Chief Ministers Comprehensive Insurance Scheme and is also implementing Dr.Muthulakshmi Reddy Maternity Benefit Scheme with an increased financial assistance. Currently the focus of the State is to provide equal attention to

public health and prevention of diseases. The State is also ensuring these quality facilities for treatment are easily accessible to the people. In addition to the emerging challenges of Non Communicable diseases on one side, the State has also effectively responded to the challenge of vector borne diseases such as dengue which showed an increase in incidence worldwide last year. History 1.4 Our ancient Indian system of Medicine Siddha and Ayurveda are in practice for over thousands of years. Siddha System of Medicine has been recorded to have been practiced by the eighteen Siddhars and that is why it is called Siddhar Maruthuvam. Susrushta and Charaka were the pioneers of Ayurveda. History tells us that there were well organized hospitals even during the days of Buddha and Ashoka. Roots of modern medicine are linked to the advent of the Britishers. It is believed that the first British Hospital was established in 1639 to treat the sick soldiers of the East India Company. The origin of the modern Government Hospital has been traced back to 1644, when it was started as a small hospital which has now grown into the

prestigious General Hospital attached to the Madras Medical College which itself was started in 1835. 1.5 With the growth of the Medical Services, the Civil Medical Service was separated and established under the management of a Head of the Department called as Surgeon General with the Government. That post was subsequently re-designated as Director of Medical Services (DMS) during 1960. Medical Services Department was bifurcated and the Department of Medical Education was formed in the year 1966. Similarly Department of Indian Medicine was established in the year 1976 and the Department of Drugs control in November 1981. The Family Welfare scheme, which was dealt by the Medical Services Department, was separated and an independent Department of Family Welfare was formed in 1983, to look after the Family Welfare Scheme. 1.6 On the Public Health and Preventive Medicine side, the Directorate of Public Health and Preventive Medicine was formed during 1923 with the main objectives of providing Maternal and Child Health care to the rural and urban population and for the

prevention and control of communicable diseases. Lieutenant Colonel A.T.H. Russell was the first Director of Public Health and Preventive Medicine in the Pre-independent era. Public Health Act, 1939 is the legal instrument enacted before independence of the country which empowers the Health Officers to enforce public health law to safeguard the health of the people. This is currently being reviewed and will be amended to reflect the latest felt needs of the Public Health Sector. During 1965, the Primary Health Centres were separated from the Medical Services Department and brought under the Public Health Department. The Public Health and Preventive Medicine Department is functioning with 42 Health Unit Districts each unit under a Deputy Director of Health Services. The State Health Transport Department, which was with the Public Health Department, was separated and a Directorate of Health Transport was formed on 15.07.1981. Current Scenario 1.7 Medical and Health facilities in Tamil Nadu in the Government sector have grown rapidly and the current scenario is given in Table No.1.

Table No.1 - Medical and Health Facilities in Tamil Nadu in the Government Sector
Sl. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Description Medical Colleges Medical College attached hospitals Dental College and Hospital District Headquarters Hospitals Sub District Hospitals Primary Health Centres (PHCs) Health Sub Centres (HSCs) Urban Primary Health Centres (UPHCs) ESI Hospitals (include the ESI Hospital, Chennai - 78) ESI Dispensaries Indian System of Medicine Hospitals Indian System of Medicine Dispensaries No. 18 43 1 30 237 1614 8706 135 8 195 4 1375

1.8 In addition to the above facilities and institutions, Tamil Nadu has a number of maternity homes, dispensaries and health posts run by municipalities and municipal corporations. With the network of primary, secondary and tertiary hospitals and a plethora of cross cutting programmes such as the National Rural Health Mission, Health Systems Project, AIDS Control Society,

Maternal and Child Health initiatives, Indian Medicine and other focused programmes and special initiatives, the department is fully involved in implementing the two pronged strategy of prevention and cure to ensure that the Health needs of the citizens in our state are taken care of.
1.9 The provision for Health and Family

Welfare Department under Demand No.19 for 2013-2014 is Rs.6,511.22 crore as detailed below:(Rs. in crores)
Plan Shared between Centre and State Total Plan and Non- Plan * 6511.22

Non Plan

Demand

Centrally Sponsored

State Plan

19. Health and Family Welfare Department

3610.22

2256.34

637.66

7.00

2901.00

* A sum of Rs.54.59 lakh have also been allotted under Charged head and the total allocation is Rs.6,511.76 crore.

Total

This includes Rs.6265.95 crores on the Revenue Account and Rs.245.28 crores on the Capital Account. The provision on the Revenue Account works out to 5.31% of the total Revenue Expenditure of Rs.1,17,915.81 crores in the Tamil Nadu State Budget for the year 2013 -2014. Note: Apart from the above provision, Rs.249.85 crores has been allocated towards Civil Works being undertaken by Public Works Department under Demand No.39. 1.10 The Directorate wise allocation for 2013-2014 under Demand No.19 Health and Family Welfare is as follows:(Rupees in crores) 1 2 3 4 5 6 Secretariat, Health and Family Welfare Department Directorate of Medical and Rural Health Services Directorate of Medical Education Directorate of Public Health and Preventive Medicine Directorate of Family Welfare Tamil Nadu Food Safety and Drug Administration 7.93 789.65 1775.52 2189.96 175.96 42.99

10 7 8 9 10 Directorate of Indian Medicine and Homoeopathy Tamil Nadu State Health Transport Department Reproductive and Child Health Project Tamil Nadu Health Systems Project Total 169.13 26.71 387.86 945.52 6511.22

Note: Provision towards ESI Scheme Hospitals for Rs.219.86 crore have been made in the Labour and Employment Demand No.32.

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Chapter 2 HEALTH ADMINISTRATION 2.1 The Health and Family Welfare department in the Secretariat is administratively responsible for the following Directorates: Directorate of Medical Education Directorate of Medical and Rural Health Services Directorate of Public Health and Preventive Medicine Directorate of Indian Medicine and Homeopathy Directorate of Family Welfare Directorate of Food Safety and Drugs Control Administration Directorate of State Health Transport Department Medical Services Recruitment Board

Apart from these Directorates, the staff for the Directorate of Medical Services (ESI) under the Labour and Employment department are sent from Health department.

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Other Programmes and Initiatives 2.2 The Directorates are supported by a number of other initiatives which are implemented across the Directorates such as: National Rural Health Mission State Health Society Tamil Nadu Health Systems Project Tamil Nadu State AIDS Control Society Tamil Nadu Blindness Control Society Tamil Nadu Medical Services Corporation Tamil Nadu Medicinal Plant Farms and Herbal Medicine Corporation Limited (TAMPCOL)

Under the State Health Society and through the Directorates several National Programmes such as the Revised National Tuberculosis Programme, National Mental Health Programme, National Vector Borne Diseases Control Programme, Universal Immunization Programme, and School Health Programme among others are implemented. These have been explained in detail in subsequent chapters.

13

Councils 2.3 The following councils are established through various acts to register the qualified medical, nursing and paramedical professionals to regulate their practice in Tamil Nadu. i. ii. iii. iv. v. vi. Tamil Nadu Medical Council Tamil Nadu Dental Council Tamil Nadu Nurses Council Tamil Nadu Pharmacy Council Tamil Nadu Siddha Medical Council (Siddha & Traditional practitioners) Board of Indian Medicine (Ayurveda, Unani and Yoga & Naturopathy) Tamil Nadu Homeopathy Council

vii.

These are all the Statutory Bodies regulated by Government of India and Government of Tamil Nadu. Apart from this, there is also a Government order for constituting a Physiotherapists Council in the State.

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Classification of Hospitals and Dispensaries 2.4 Government of Tamil Nadu provides preventive and curative care to all, through various hospitals, dispensaries, and institutions. The state has a variety of categories of hospitals. The classification of hospitals and dispensaries in the state are as follows: i. StatePublic Medical Institutions: All Medical institutions Allopathy and Indian System of Medicine maintained through State funds and are directly managed by the Government. These form the backbone of the health care. It ranges from the grassroots level8,706 Health Sub Centres catering to an average population of 5,000 to the 1,614 PHCs catering to an average population of 30,000 at the next level. These are followed by secondary and tertiary care hospitals, details of which have already been given in Table No.1 in the first chapter. StateSpecial Medical Institutions: All institutions intended to serve special sections of public such as

ii.

15

Police, State owned corporations / undertakings, Employees State Insurance Medical Institutions etc. iii. Medical Institutions under the Local Bodies: These Medical Institutions are under the management of Municipal Corporations, Municipalities and Panchayat Unions. With the state taking over most of these facilities they are now very few in number especially in rural areas. Conversion of the remaining rural medical institutions to Government medical institutions is under the active consideration of the Government. Private Aided Medical Institutions: Institutions supported / guaranteed by private contribution and receiving Government aid as well. Private Non-Aided Medical Institutions: All hospitals, dispensaries and clinics solely managed by private persons / establishments.

iv.

v.

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Tamil Nadu Dr.M.G.R. Medical University 2.5 The Government of Tamil Nadu established this Medical University in the year 1987 by passing the Tamil Nadu Medical University Act, 1987 (Act No.37/1987). The name was later amended as the Tamil Nadu Dr.M.G.R. Medical University and the University is functioning from July, 1988. This University is relentlessly working to fulfill a number of objectives including improving the standards in medical and para medical education, medical research in addition to making an impact on the progress of Health Care. 2.6 Thus, the Health Administration encompasses the entire gamut of services, facilities extended throughout the State and strives to ensure that both preventive, curative, research and development needs of the State are adequately taken care of. It is also getting constantly upgraded to keep pace with the demands posed by emerging diseases and migratory challenges.

17

Chapter 3 MEDICAL EDUCATION 3.1 The State needs well qualified manpower not only for manning the medical facilities at all levels, but also to address the health related challenges. Medical Education is critical to provision of the crucial human resources to ensure that the State has adequate number of qualified health personnel both in the government and private domain. The Department of Medical Education plays a pivotal role in producing quality medical and Para-medical personnel to cater to the health needs of the State. The department also has a role to play in the establishment and maintenance of well-equipped teaching institutions, which are the premier referral centres with state of the art equipment, technology and research. The Directorate of Medical Education was formed in the year 1966 from the Directorate of Medical Services and is functioning as an independent Directorate. It is managing the Medical Colleges and teaching hospitals attached to them.

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Administrative Structure 3.2 The Director of Medical Education is the head of the directorate. All the Government medical colleges and attached institutions are part of this directorate. These are manned by the Deans and Principals respectively. Deans, Government Medical Colleges and hospitals Director, Government Institute of Rehabilitation Medicine, Chennai Director, Institute of Child Health and Hospital for Children, Chennai Director, Institute of Thoracic Medicine, Chennai Director, Institute of Mental Health and Government Mental Hospital, Chennai Director and Superintendent, Institute of Obstetrics and Gynecology and Government Hospital for Women, Chennai Director and Superintendent, Institute of Social Obstetrics and Kasturba Gandhi Hospital for Women and Children, Chennai Director, Regional Institute of

19

Ophthalmology and Government Ophthalmic Hospital, Chennai Director, King Institute of Preventive Medicine and Research, Guindy, Chennai Principal, Government Dental College and Hospital, Chennai Principal, Government Physiotherapy College, Tiruchirappalli Superintendent, Government TB Sanatorium, Tambaram, Chennai Superintendent, Government TB Hospital, Otteri, Chennai Chief Medical Officers of Peripheral Hospitals attached to Teaching Hospitals Medical Officers of Dispensaries attached to Teaching Hospitals Principals of other colleges

3.3 Currently there are 18 Government Medical Colleges, one Government Dental College, two Pharmacy Colleges (B.Pharm), two Physiotherapy Colleges, four Nursing Colleges (B.Sc.Nursing) along with 23 Schools of Nursing offering Diploma in Nursing and 44 hospitals (including one Dental Hospital) under the control of Directorate of Medical Education. The total

20

number of bed strength in these hospitals is 30,900. The daily average of out-patents is 71,753 and the daily average Inpatients is 25,188. 3.4 Table No.2 shows the intake capacity of the Medical Institutions for Under Graduate and Post Graduate Courses. Table No.2 - Number of seats available in each course in Government sectorUnder graduate and Diploma courses Name of the Course M.B.B.S. B.D.S. B.Sc. Nursing Post Basic ( B.Sc. Nursing) B.Sc. Radio Diagnosis B.Sc. Radiotherapy Bachelor of Physiotherapy B.Pharm Diploma in Nursing Diploma in Pharmacy Paramedical Courses (23 Courses) Number of seats 2145 100 200 90 30 20 50 120 2000 240 5732

3.5 Table No.3 shows the details of the specialties which are available in the

21

colleges in Tamil Nadu for the students to do their post-graduation. Table No.3 - Number of Specialties and intake capacity under the Post Graduate (P.G) courses
Courses P.G. Degree (Medical) P.G. Diploma(Medical) MDS ( Dental) Higher Specialties M.Pharmacy M.Sc. (Nursing) M.Sc. (Medical Physics) M.Phil (Clinical Social Work) M.Sc. (Molecular Virology) Number of Specialties 23 15 8 16 4 5 1 1 1 Total intake Capacity 706 403 35 189 64 65 10 15 21

3.6 In addition, there are private self financing institutions affiliated to the Tamil Nadu Dr.M.G.R. Medical University providing Medical and Para Medical Education in the State. The details of total number of seats available in these private Institutions as well as the seats surrendered for allotment by the Government may be seen from Table No.4 below.

22

Table No.4 - Seats surrendered by Private Self Financing Colleges for allotment by the Government
Number of seats surrendered to Government 838 909 1124 639 5067 33 152 1062

College

No. of Colleges 11 18 31 21 145 1 26 46

Number of seats 1460 1515 1950 1030 7880 50 1520 1630

Medical College Dental College Pharmacy College (B.Pharm) Physiotherapy College (BPT) Nursing College (B.Sc) Occupational Therapy College (BOT) D.Pharm to B.Pharm (Lateral entry 10%) Post Basic B.Sc. (Nursing)

Admission to professional courses in Medicine 3.7 Admission to the Professional Courses in Medicine in the State is made based on the marks obtained in the relevant subjects of the Plus two examinations. The selection to MBBS / Bachelor of Dental Surgery (BDS)/ B.Sc. Nursing / Bachelor of Pharmacy (B.Pharm) as well as Diploma courses in Nursing is done by a Selection

23

Committee under a Single Window System following the rules of reservation in accordance with the policy of the Government. Admission to Post Graduate Diploma, Post Graduate Degree, and Master of Dental Surgery (MDS) and Higher specialties courses is done by the Selection Committee through a common entrance examination followed by counselling duly adopting the rule of reservation. The State has been consistently opposing the National Eligibility and Entrance Test (NEET) and currently the case on this issue is pending in the Supreme Court. The State is taking all steps to ensure that there is no interference in its policy on Medical and Dental college admissions, at Under Graduate and Post Graduate levels. Services 3.8 The hospitals attached to the medical colleges serve as the referral centres where people all over the State are able to access state of art facilities. In addition to providing quality care in all conceivable specialties, the hospitals are backed by excellent diagnostic support and state of art equipments. The hospitals also share their role in implementation of state wide

24

programmes. The geographical spreads of these hospitals have ensured that the primary and the secondary care institutions have adequate tertiary care support anywhere in the state. The medical colleges and the professionals attached to the specialties in each college and hospitals, have competence in providing valuable inputs for treatment protocols for the diseases. Dental Care, Rehabilitation Medicine, Child Health, Thoracic Medicine, Mental Health, Obstetrics and Gynecology and Social Obstetrics, Ophthalmology, Preventive Medicine and Research, Physiotherapy College, TB Sanatorium are among the focus areas where the Directorate has separate institutions. Stem cell research, rare surgeries, accessible tertiary cares are some of the important contributions made by these institutions. These are in addition to all the specialties which are mandatorily provided for in a medical college hospital. The role of these institutions as part of health and family welfare programmes spread across directorates has been separately brought out under the relevant portions of this policy note.

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Multi Super Specialty Hospital 3.9 The Multi Super Specialty Hospital being established by converting the new building in Omandurar Government Estate, Chennai is expected to strengthen tertiary health care in the State by providing better and expert treatment for serious ailments to the economically weaker sections.

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Chapter 4 MEDICAL AND RURAL HEALTH SERVICES 4.1 The Department of Medical and Rural Health Services is being entrusted with the responsibility of rendering medical care services to the public through the NonTeaching Medical Institutions. Through the pursuit of various policies and programmes, the department is aiming to translate the Alma Ata Declaration of Health for All in to reality. 4.2 The Directorate of Medical and Rural Health Services is implementing the curative medical care services through the grid of 30 District Head Quarters Hospitals, 158 Taluk Hospitals, 79 Non-Taluk Hospitals, 19 Dispensaries, 10 Mobile Medical Units, seven Women and Children Hospitals, two T.B. Hospitals / Sanatoriums which are under the control of this Department. The Hospitals under the control of this department are Secondary care Hospitals.The Medical Services Department of the State has implemented a unique Medical monitoring system - Hospital Management Information System and

27

Hospital Management system and is also implementing the following medical programmes:i. Providing extended medical speciality services like Medicine, Surgery, Obstetrics and Gynaecology, Ophthalmology, E.N.T, Venereology, Orthopaedics, Anaesthesiology, Child Health, Comprehensive Emergency Obstetrics and Newborn Care Services(CEmONC) Dental, Psychiatry, Ambulance Services, Laboratory Services, Leprosy, Tuberculosis, Diabetology, Cardiology and Non Communicable Diseases (NCD) Accident and Emergency Services Family Welfare and Maternity Child Health Services and

ii. iii. iv. v. vi.

T.B. Control and Blindness Control Programmes Tamil Nadu Illness Assistance Society Mental Health Programme

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Administrative Structure Director of Medical and Rural Health Services

Joint Director of Health Services

District Head Quarters Hospitals. Taluk Hospitals. Non Taluk Hospitals. Dispensaries. Mobile Medical Units. TB Hospitals / Clinics. Leprosy Hospitals. Family welfare programme in the District. TB control programme in the District.

Deputy Director of Medical and Rural Health Services and Family Welfare Deputy Director of Medical Services (TB) Deputy Director of Medical Services. (Leprosy)

Leprosy control programme.

The leprosy programme has since been integrated with the Department of Public Health and Preventive Medicine.

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4.3 The Director of Medical and Rural Health Services is the Chairman of the Multiple Appropriate Authority for the implementation of PreConception and PreNatal Diagnostic Techniques (Prohibition of Sex Selection) Act 1994.The Director of Medical and Rural Health Services is also the State Appropriate Authority under the Transplantation of Human Organ Act, 1994. The Directorate also looks after the implementation of the following programmes District Mental Health Programme. State Illness Assistance Society. Services 4.4 The Medical services was the basic wing from which the other Directorates ultimately emerged and till this date serves as a very crucial secondary care institution. It is the main link between primary health care and tertiary care. With the implementation of the Health Systems Project and the concurrent improvements in the facilities and quality of care, these institutions have provided much needed relief to both inpatients and out-patients needing higher level of treatment and assistance. On an

30

average about 2 lakh outpatients and 18,000 inpatients get treated every day cumulatively in these institutions and it also provides obstetric and neonatal care in addition to rendering accident and trauma and other needed clinical services. It also has a critical role in all the nationally and state level programmes implemented across directorates which are detailed separately under the relevant headings.

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Chapter 5 PUBLIC HEALTH AND PREVENTIVE MEDICINE 5.1 The Department of Public Health and Preventive Medicine of Tamil Nadu is engaged in protecting and improving the health of people of the State, by immunization, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards, thereby reducing the burden of morbidity, mortality and disability in the State. Administrative Structure Director

Additional Directors, Financial Advisor and Chief Accounts Officer and Joint Directors Deputy Directors of Health Services Block Primary Health Centres, Primary Health Centres and Health Sub-Centres

32

Regional Health and Family welfare Training Institutes, Institute of Vector Control and Zoonoses, Hosur, Water Analysis Laboratories in the King Institute, Guindy, Chennai and Coimbatore.

5.2 The Directorate of Public Health and Preventive Medicine plays an important role in the prevention and control of communicable diseases apart from providing community based maternity and child health services. Under this Directorate, 1,614 Primary Health Centres (PHCs) and 8,706 Health Sub Centres (HSCs) are functioning besides 385 Hospital on Wheels. 5.3 This Directorate is responsible for civil registration and implementing major health programmes such as Reproductive and Child Health Programme, National Rural Health Mission (NRHM) supported programmes, Dr.Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS), National Immunisation Programme, National Family Welfare Programme, National Diarrhoeal Diseases Control Programme (NDDCP), National Vector Borne Diseases Control Programme (NVBDCP), Integrated Disease Surveillance

33

Programme (IDSP), Non-Communicable Diseases Control Programme (NCDCP), National Leprosy Elimination Programme, School Health Programme, National Iodine Deficiency Disorders Control Programme and Tobacco Control Programme. New initiatives Viz., Hospital on Wheels Programme, Menstrual Hygiene Programme, and Telemedicine Services to remote areas, Establishment of Urban Primary Health Centres, Establishment of level-I and II MCH centres and 24x7 Helpline are also being implemented. 5.4 The Directorate of Public Health and Preventive Medicine is also responsible for the implementation of various Public Health Acts such as Tamil Nadu Public Health Act, 1939, Cigarette and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 and Registration of Births and Deaths Act, 1969. Active support is provided by the PHCs for the implementation of Revised National Tuberculosis Control Programme, National AIDS Prevention / Control Programme, National Blindness Control Programme, Integrated Child Development Scheme, Rural Water Sanitation Schemes

34

and other Programmes.

Community

Development

5.5 As brought out in the introductory chapter, due to the health facilities at primary, secondary and tertiary levels and in particular due to the sustained efforts of the network of public health institutions, the performance of the State in various para meters viz., Infant Mortality Rate, Maternal Mortality Ratio, Birth Rate, Total Fertility Rate, control of communicable diseases and elimination of vaccine preventable diseases have significantly improved over the years. Consequently Tamil Nadu has emerged as a pioneering State in the country in providing public health care. Infant Mortality Rate (IMR) 5.6 Children are the fountains of life. Ensuring the survival and healthy development of every child born is the key for the development of any nation. Infant Mortality Rate is the key sensitive indicator of child health in a country. The current level of IMR in Tamil Nadu for the year 2011 is 22 per 1000 live births as per the Sample Registration System survey (2011). The State ranks as the second lowest among the major states in the country.

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5.7 Seventy percent of the infant deaths occur during the neonatal period. Around 30% of infant deaths occur at home. The major causes of Infant deaths are Pneumonia, Hypothermia, Congenital heart diseases and Multiple Congenital anomalies. United Nations Millennium Development Goal is to reduce the IMR by three quarters from 1990 to 2015. Government of Tamil Nadu is committed to reduce Infant Mortality Rate below 13 (No. of infant deaths per year for every 1000 live births) by the year 2017. Table No.5 - Trend of IMR for India and Tamil Nadu

Year

1980

1990

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010 24 47

Tamil Nadu India

93 114

59 80

51 68

49 66

44 64

43 60

41 58

37 58

37 57

35 55

31 53

28 50

Source: Sample Registration System (SRS) Bulletins

2011 22 44

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Trends in IMR in Tamil Nadu

UIP, 1985
127 121 113 110 104 91

CSSM, 1992

RCH, 1997

NRHM, 2005

130.0 115.0 100.0 85.0 70.0 55.0 40.0 25.0 10.0 -5.0

Rural
93 80

Combined
77 81

65 57 54 42 55

Urban

60 53

55 49 38 34 35 31 31 28

39

35

30 25 28 24 26 22

24 22 19
2011

1971

1976

1981

1986

1991

1996

2001

2007

2008

2009

2010

Source: SRS

UIP - Universal Immunisation Programme CSSM - Child Survival and Safety Motherhood RCH - Reproductive and Child Health NRHM - National Rural Health Mission 5.8 To improve maternal and child health care facilities, the following initiatives are being implemented: Antenatal care Immunization of every child

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Establishment of Basic Emergency Obstetric and Newborn Care (BEmONC) Upgraded PHCs at the rate of one per block Establishment of Comprehensive Emergency and Obstetric and Neonatal Care (CEmONC) Centres in select Government Hospitals and Medical College Hospitals Establishment of Newborn Intensive Care Units (NICUs) in selected Government Hospitals and all Govt. Medical College hospitals Establishment of Newborn corners in all PHCs and provision of necessary equipments like warmer, phototherapy units for the Newborn corner Hospital on Wheels in 385 Blocks for providing community based Reproductive and Child Health (RCH) outreach services Establishment Sick Newborn Care Units (SNCU) and training of staff Hiring of Private pediatricians for providing emergency newborn care in all PHCs Establishment of 42 MCH level-II centres (BEmONC) PHCs to provide

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emergency newborn care services (1per HUD) on 24x7 basis Establishment of New born Stabilization Unit (NBSU) in 42 identified MCH Level 2 centres to improve maternal and child care facilities

Apart from the strengthening of 108 ambulance services with neonatal transport support facilities, several training programmes are being imparted viz. Skilled Birth Attendant training for Staff Nurses and VHN/ANM Integrated Management of Newborn and Childhood (IMNCI) training to PHC medical officers Facility based IMNCI training to Medical Officers and Staff nurses Home based newborn care training to Village Health Volunteers in tribal areas Placement of Village Health Link volunteers in 15 high IMR blocks to provide home based new born care Ultra Sonogram training for prenatal screening to UGPHC Medical Officers

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In addition to these, health education to pregnant mothers on exclusive breast feeding, complementary foods, child care practices, danger signs in sick newborns, preventing child marriage (less than 18) and family planning, have helped in reducing IMR. It is proposed to establish Telemedicine Centre in the identified MCH Level-1 Centers (HSCs) in hilly/tribal areas to provide basic health care on 24x7 basis. Provision of free transport, monitoring of every pregnancy and infant through webbased Pregnancy and Infant Cohort Monitoring System, Recording / uploading of Maternal and Child Health data by Village Health Nurses and investigation and audit of every infant death and initiating measures to prevent similar deaths in future have contributed to the significant decline of infant mortality rate in Tamil Nadu. Maternal Mortality Ratio (MMR) 5.9 Maternal mortality represents the most sensitive and key indicator of womens health and status. National Rural Health Missions (NRHM) primary focus is to reduce MMR and prioritizing the resource allocation for the same.

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5.10 Tamil Nadu ranks second lowest in MMR among the major Indian states. In 2011-2012, Tamil Nadu reported 767 maternal deaths (amounting to an MMR of 73 per 100,000 live births). All efforts are being taken to reduce the MMR further with the multipronged approach to achieve the same.

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Steps taken for reduction of MMR 5.11 Detection, investigation and audit of every maternal death, identification of circumstances leading to the death and prevention of similar deaths in future, Dr. Muthulakhsmi Reddy Maternity Benefit Scheme to eligible mothers, establishment of BEmONC centres, establishment of CEmONC centres, establishment of 24x7 delivery centres in all PHCs, establishment of urban PHCs, establishment of birth waiting homes in the foot hills, Birth companion scheme, establishment of Blood Storage centres in PHCs, EMRI 108 ambulance services, Hospital on Wheels in 385 Blocks for RCH outreach services, establishment of 42 MCH level-II centres, Cell phones for VHNs, Telephones for all PHCs to strengthen referral linkages, functioning of PHC Operation Theatres, tracking and transfer of mothers with high risks to higher facilities, admission of mothers with known high risk factors well in advance in CEmONC centres, networking with all CEmONC centres, professional partners and community partners, multiskill training in anesthesia, obstetrics, and ultra-sonogram to PHC medical officers, provision for hiring of the services of

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obstetricians and anesthetists to provide emergency obstetric care, investigation of all maternal deaths by an expert team with two Obstetricians in each Health District (24 to 48 hours death) to identify the avoidable factors and preventing the recurrence of such events are the major contributing factors for the declining maternal mortality ratio. It is proposed to further intensify these efforts. Primary Health Centres (PHCs) 5.12 PHC Infrastructure: A primary health center is established for a population of about 30,000 in plain areas and 20,000 in hill areas. As already mentioned, there are 1,614 Primary Health Centres functioning in Tamil Nadu. While 1,512 PHCs are functioning in Government Buildings, construction of buildings is under progress in respect of 79 Primary Health Centres. 135 Urban PHCs are sanctioned under the control of the Directorate of Public Health and Preventive Medicine to improve availability of Primary Health Care services to the urban poor.

43

Services 5.13 On an average 2.4 lakh outpatients get treated each day in the 1,614 PHCs spread across the state in addition to about 3,250 inpatients per day. PHCs across the state conducted 2.08 lakh deliveries per annum and deliveries in PHCs constitute an average of 13 per PHC / per month of all the institutional deliveries. 24x7 delivery care services with 3 Staff Nurses are provided in all the PHCs. The institutional services offered in the PHCs are being monitored through a web enabled Institutional Services Monitoring Report (ISMR) and feed back is sent to the districts for further improvements. Upgradation of Primary Health Centres 5.14 It is the policy of the Government to provide at least one 30 bedded upgraded Primary Health Centre in each block where there is no such health facility, in a phased manner. Each Upgraded Primary Health Centre has an operation theatre, modern diagnostic equipments like Ultra Sonogram, ECG, Semi Auto Analyzer, X-ray and an ambulance vehicle. Five doctors are posted to the upgraded PHCs. At present 341

44

upgraded Primary Health Centres are functioning in 310 blocks. These facilities will be extended to the uncovered blocks in the coming years. ISO 9001 Certification 5.15 Government have been taking conscious steps to inculcate quality consciousness among the Government Medical institution to constantly improve quality of services. 48 Primary Health Centres in 12 Health Unit Districts have been awarded ISO 9001 certificates. In each of the remaining 30 HUDs, one PHC has been identified for ISO certification. Each of these 30 PHCs have adopted 2 PHCs for quality improvement. It is proposed to grade the PHCs based on quality parameters and performance indicators. Dental health care services in PHCs 5.16 Dental health care services are provided in 266 PHCs to treat dental ailments. The dental services have received good response from the public. The Government has planned to provide dental health care services in all the upgraded and block level PHCs in a phased manner.

45

Health Sub Centres 5.17 A Health Sub Centre (HSC) is established for a population of 5,000 in plain areas and 3,000 in hilly areas. Each centre is manned by a Village Health Nurse. There are 8,706 HSCs in Tamil Nadu. While 6,510 HSCs are functioning in Government Buildings, 2,196 HSCs are functioning in Rented/Rent free Buildings. Buildings for 139 HSCs are under construction at a total cost of Rs.20.91 crores. Under the NRHM, construction and renovation of HSC buildings are being done in a phased manner. It is proposed to increase the number of HSCs based on 2011 census. Services and programmes 5.18 Since the services and programmes in the PHCs are provided at the grass roots level, most of the cross cutting programmes are embedded in the public health side such as the Universal Immunisation, Vector Borne Diseases Control, and School Health Programme. Universal Immunization Programme 5.19 The Universal Immunization Programme was started in 1985 to protect

46

the children from vaccine preventable diseases like diphtheria, pertussis, tetanus, poliomyelitis, tuberculosis and measles. About 11 lakh Children are getting benefit under this programme. A second dose of measles vaccine at the age of 18 months is introduced during the current year in addition to the first dose given at the age of tenth month. In addition, 12 lakh pregnant mothers are immunized every year with Tetanus Toxoid injection for prevention of tetanus infection during delivery. Pentavalent vaccine was introduced in Tamil Nadu from 21st December, 2011. Pentavalent vaccine gives protection against diphtheria, pertussis, tetanus, Hepatitis-B and Haemophilus influenzae-B. The newly added Hib will prevent life threatening pneumonia and meningitis. Tamil Nadu is one of the two states selected by the Government of India for introducing pentavalent vaccination. The main advantages of giving pentavalent vaccination to the children include protection against five life threatening diseases and fewer needle pricks to a child. Pulse Polio Immunization (PPI) 5.20 For the eradication of poliomyelitis, Pulse Polio Immunization campaign was

47

introduced in the year 1995-96, which along with efficient routine immunization coverage has successfully eliminated the dreaded disease from the State. During 2013, two rounds of pulse polio immunization campaigns have been conducted (on 20.01.2013 and 24.02.2013) as part of the nationwide PPI campaign in order to prevent the importation of Polio virus and to sustain the zero polio status. Focus on Migrant Children 5.21 Immunizing the Migrant children is essential to protect these children from polio and also prevent importation of polio. Special initiatives are being taken to cover the children living in temporary settlements and migrant population to protect the children from Vaccine Preventable Diseases. Special polio rounds were conducted on 22.12.2012 and 23.03.2013. Japanese Encephalitis (JE) vaccination 5.22 JE vaccination programme is being implemented in identified endemic districts namely Cuddalore, Villupuram, Virudhunagar, Madurai, Tiruvarur, Tiruchirapalli, Perambalur, Thanjavur and Tiruvannamalai to prevent Japanese

48

Encephalitis especially among children under the age of 15 years. Under the Acute Encephalitis Syndrome (AES)/Japanese Encephalitis (JE) Preventive Scheme of Government of India, it is proposed to take intensive immunization drive during 2013-2014. It is planned to extend JE vaccination coverage to Karur and Pudukkottai districts during the current year. Impact of Immunization Programme 5.23 Due to successful implementation of immunization programme, the State has achieved and is maintaining polio free status since 2004. Neonatal tetanus elimination status has also been certified by World Health Organization in 2006. The incidence of diphtheria, pertussis and tetanus has become epidemiologically insignificant. There is also a significant reduction in the number of measles cases. Dr.Muthulakhsmi Reddy Maternity Benefit Scheme 5.24 The State Government have launched a revised Dr. Muthulakhsmi Reddy Maternity Benefit Scheme from 01.06.2011 by enhancing the maternity benefit to the poor

49

pregnant women mothers from Rs.6,000 to Rs.12,000. The cash assistance is given in three installments on conditional basis and restricted to two deliveries. From 1st October 2012, benefits under the scheme are disbursed directly from Treasury to the bank account of the beneficiaries (ECS mode). On an average, 6 lakh women benefit from the scheme every year. During 2012-2013, Rs.625.51 crore has been disbursed. For the current financial year, Rs. 720 crore has been allocated for this programme. Hospital on Wheels Programme 5.25 385 Mobile Medical Units were upgraded at a cost of Rs.40 crores with necessary additional manpower, laboratory facilities and other diagnostic equipments to provide high quality medical care with focus on Mother and Child Health Services, Communicable and Non-Communicable Diseases covering all the remote villages and hamlets as per the fixed day fixed time plan specific for each block. Fixed tour programme of the scheme is displayed in the health department website. (www.nrhmtn.gov.in) Honble Chief Minister of Tamil Nadu has inspected one prototype vehicle developed for the Hospital

50

on Wheels Programme and approved the same. 86 new vehicles are provided by the Government for this special programme. The fabrication of 195 vehicles has been completed and vehicles have been sent to the field. The fabrication work of the remaining vehicles is on. 385 Laboratory Technicians will be appointed through Medical Services Recruitment Board (MRB) for this programme. The entire field service of this programme is monitored through a Public Private Partnership. Promotion of Menstrual Hygiene 5.26 The Menstrual Hygiene Programme was launched by the Honble Chief Minister on 27.03.2012. Under this scheme, 18 packs of sanitary napkins are being provided to school going and non school going adolescent (10-19 years) girls in rural areas. Three packs are given for two months (At six pads per pack). In every school in the rural areas, the designated teachers are responsible to distribute the sanitary napkins to school students. 5.27 The Village Health Nurses along with Anganwadi Workers are responsible for distribution of the sanitary napkins to the

51

girls who are not covered in the schools. The objective of the scheme is to increase awareness among adolescent girls on menstrual hygiene, build self-esteem and empower girls for greater socialization also to increase access to the use of high quality sanitary napkins apart from ensuring safe disposal of sanitary napkins. Sanitary Napkins to post natal mothers who delivered in Government institutions at the rate of seven packs each (six pads per pack) has commenced in three Health Unit Districts (Poonamallee, Tiruvallur and Kancheepuram) and all the remaining districts will be covered soon. Sanitary Napkins would also be given to each women prison inmate at the rate of 12 pack (six pads per pack) per year and also to women patients in Mental Hospital. School Health Programme 5.28 School Health Programme is implemented in Tamil Nadu to provide comprehensive health care services to all students studying in Government and Government aided schools. Special emphasis is given to heart diseases, eye disorders, nutritional disorders, skin diseases and dental problems. All Thursdays

52

are scheduled as School Health Days. Students in need of higher medical treatment are referred to higher medical institutions and Saturdays are referral days. Two teachers from each school are identified and trained in identifying common illnesses of students for follow up action with the doctors. During the last year, among the school students, 41,84,643 were treated for one or other health problems and 32,669 referred to higher medical institutions for further treatment. Control of Communicable Diseases 5.29 Control of Communicable diseases is one of the foremost activities of the Directorate of Public Health which is carried out in close coordination with the local bodies. They have been described in detail under the relevant programmes. Water Analysis Laboratories 5.30 It is essential to monitor the quality of water throughout the state to keep a tab on water borne diseases. The Water Analysis Laboratories at Chennai and Coimbatore collect and examine water samples from various protected water sources to monitor contamination of drinking water. These

53

laboratories also assist the Tamil Nadu Pollution Control Board in examining samples of Industrial Wastes and conducting field surveys to ensure the prevention and control of environmental and industrial water pollution. Two more water analysis laboratories are being established in Tiruchirapalli and Tirunelveli. Apart from these, Tamil Nadu Water Supply and Drainage Board (TWAD Board) and Chennai Water Supply and Sewerage Board (CWSSB) are also independently undertake water analysis regularly and follow up action is taken. Establishment of District Public Health Laboratories 5.31 Laboratory services are an essential component of disease surveillance, epidemiological surveys and operational research. The District Public Health Laboratories are the backbone of the laboratory network in disease surveillance programmes for the prevention and control of epidemic prone diseases. In view of the emerging and re-emerging communicable diseases, the Government have issued orders to establish District Public Health Laboratories (DPHL) in all the districts in the District Headquarters to augment the disease control programmes. One

54

Microbiologist, One Laboratory Technician and One Cleaner post have been sanctioned on contract basis in these labs to support the disease control activities at the district level.

55

Chapter 6 FAMILY WELFARE 6.1 Government of India launched the National Family Welfare Programme in 1951 with the objective of "reducing the birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the National economy. The Family Welfare Programme in India is recognized as a priority area, and is being implemented as a 100% centrally sponsored programme. The National Family Welfare Programme is being implemented in the state since 1956. The department implements family welfare programmes in coordination with various related departments. Tamil Nadu is considered as a pioneer in the implementation of the family welfare programmes in the country. In view of commendable progress in reducing the birth rate, the focus has shifted from a "Target based approach" to a "Community Needs Assessment Approach where importance is given to meeting the unmet needs for family planning services and improving maternal and child health. This has been achieved due to the strong social and political commitment and a robust

56

administrative setup. The National Family Welfare Programme is being implemented through the following programmes for the fathers and the mothers. Providing permanent family welfare methods like Vasectomy, Tubectomy and Laparoscopic Sterilisation Providing temporary family welfare methods like Copper-T insertion, Oral pill cycles and condoms for spacing between births. Medical Termination of Pregnancy services are also available in government hospitals and approved private nursing homes. Emergency contraception. Administrative Structure Director

Deputy Director of Medical and Rural Health Services and Family Welfare (in the districts) Post Partum Centres in Government Hospitals.

57

Urban Family Welfare Centres Urban Health Posts Rural Family Welfare Centres(PHC) Approved Nursing Homes Voluntary Organisations. Demographic Indicators

6.2 As already mentioned in the introductory chapter of this policy note, Tamil Nadu is the seventh most populous State in India. As per 2011 census, the population of Tamil Nadu is 7.21 crores with decadal growth rate of 15.6 %. It accounts for 6 % of the countrys total population. The demographic scenario of the state for 2011 (SRS) is furnished in Table No.6 below: Table No.6 - Demographic scenario of Tamil Nadu 2011 Sl. No 1 2 Indicators Crude Birth Rate Crude Death Rate Current level 15.9 / 1000 population 7.4 / 1000 population

58

3 4 5 6

Total Fertility Rate (2010) Infant Mortality Rate Maternal Mortality Ratio * Natural Growth Rate

1.7 22 /1000 live births 73 /1,00,000 live births 0.85 %

* Based on the actual maternal deaths occurred in the State-2011 -12. Goals 6.3 The Table No.7 shows the demographic goals fixed to be achieved by 2017. Table No.7 - Demographic goals
Sl. No 1 2 3 4 Indicators Infant Mortality Rate Crude Birth Rate Maternal Mortality Ratio Total Fertility Rate Goals <13 / 1000 live Births 14 / 1000 Population 44/1,00,000 Live Births 1.6

59

5 6

Couple Protection Rate Reduction of Higher Order Births

65 percent <10 percent

Thrust areas and Strategies for achieving the goal 6.4 Out of 10.8 lakh births occurring in the State 9.6 % (2011) of the births are still Higher Order Births (HOB) i.e. one lakh. The unmet needs under spacing methods are 4.1 percent and permanent methods are 4.8%. The male participation under the sterilization programme is less than 1%. Action will be taken to increase the male participation to 10% under Sterilisation Programme. As per SRS 2011, the infant mortality rate was 22 per 1000 live births. Among these infant deaths nearly 75% are neonatal deaths and in coordination with all the other directorates steps would be taken to further reduce it. In this background, the following strategies will be adopted to achieve the goals proposed for the Twelfth Five Year Plan period. i. Area specific approach will be adopted to identify village wise eligible couples with three and above order of living children and motivate them by a block

60

ii.

iii.

iv.

v.

level team to adopt different methods of contraception. At present 372 Operation theatres are functioning in the Primary Health Centres. Steps will be taken to make the remaining Operation theatres in the Primary Health Centres functional in a phased manner. 1,930 private nursing homes have been involved besides the Government institutions to provide family welfare services in the State. The unapproved private nursing homes which satisfy quality standards will be systematically approved to render Family Welfare services. The Self Help Groups, Elected representatives and Non-Government sector will be involved along with the Government to provide better Family Welfare services to the eligible couples. An effort will be made to train at least one MBBS doctor in each upgraded PHC (which has a functioning operating theatre) in tubectomy sterilization, Mini-lap and No Scalpel Vasectomy. These doctors will also be trained in Manual Vacuum Aspiration techniques to provide safe abortion

61

services at the PHC level. Training in Post Partum IUCD insertion has also been started to ensure that high risk mothers are given a reliable form of contraception with their consent. Activities undertaken by the department 6.5 Post Partum Programme: The main objective of the post-partum programme is to motivate the Eligible Couples to adopt any one of Family Welfare methods through education and motivation particularly during Antenatal, Natal and Postnatal period. At present, there are 110 Post-Partum Centres functioning in Government hospitals in Tamil Nadu to improve the health of mothers and children through maternal and child health and Family Welfare Programmes. Nearly 35% of sterilization operations done in the State are performed in these post-partum centres. 6.6 Urban Family Welfare Centres: There are 108 Urban Family Welfare Centres functioning in the state to render Family Welfare services in the small Municipalities of urban areas. These Urban Family Welfare Centres have been classified into three

62

types based on the size of the population it covers. They are rendering outreach services to the urban population. 6.7 Urban Health Posts: A special programme of Urban Revamping Scheme to render outreach services has been launched and is in progress. Under this scheme, 193 Health Posts of type D covering 50,000 populations and above are functioning to provide Family Welfare & Maternal and Child Health services in the urban slum areas. 6.8 Rural Family Welfare Centres: Family Welfare Programme is implemented in the rural areas through the Rural Family Welfare Centres attached to the Primary Health Centres. There are 382 Rural Family Welfare Centres in the State. 372 primary Health Centres are functioning with Operation Theatres to provide Sterilization Services to the Rural People. Nearly 25% of the total sterilization operations done in the State are performed in Primary Health Centres. The spacing methods like Intra uterine contraceptive device insertion, Oral pills and Condom distribution to the eligible couples in the rural areas are supplied through 1,614 Primary Health Centres and 8,706 Health Sub Centres.

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6.9 Medical Termination of Pregnancy Programme: Medical Termination of Pregnancy (MTP) is a health care measure which helps to reduce the maternal morbidity and mortality through the provision of safe abortion services. The strategy for the provision of safe abortion services includes the implementation of simple and safe technologies like Manual Vacuum Aspiration (MVA) Technique which can be performed up to 8 weeks of gestation in any institution with basic facilities. In the State, approximately 60,000 MTPs are performed in the Government and the private institutions annually which include nearly 15,000 MVA performances. To improve the safe abortion services, the Doctors and Staff Nurses working in Government facilities are being given MVA training. 6.10 No Scalpel Vasectomy (NSV): To encourage the participation of male and to propagate the awareness on NSV technique, 192 NSV camps once in two months will be organized in District Head Quarters Hospitals and Taluk Hospitals during the year 2013-2014 and a sum of Rs.67.20 lakh will be allocated for organizing the camps.

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6.11 Information, Education and Communication (IEC): The sustained IEC activities on Family Welfare Programme in the State have improved by creating awareness among the public to adopt Small Family Norm. The National Family Health Survey-3 result reveals that awareness of Family Welfare methods among masses in the State is universal. IEC activities are being geared up through closed circuit T.V. System, Electronic Display, Wall paintings, Press Advertisements and Innovative activities like erection of Hoardings, Conducting Seminars, Workshops and Self Help Groups. 6.12 Participation of Non-Governmental Organizations: 27 Voluntary Organizations and 1,930 approved private Nursing Homes in the State are also extending the Family Welfare services and the contribution as a whole is 34.6%. 6.13 Group Insurance Scheme to Sterilization Acceptors: The Government of India have renewed the family planning insurance scheme in tie up with ICICI Lombard Insurance Company Limited with effect from 1st January 2012 with the following insurance benefits for the family

65

welfare sterilization acceptors and service providers. The benefits may be seen from the Table No.8. Table No.8 - Group Insurance Scheme to Sterilization Acceptors Death following sterilization in hospital or within 7 days from the date of discharge from the hospital Death following sterilization within 8 to 30 days from the date of discharge from the hospital Failure of sterilization leading/non-leading to child birth Cost of treatment upto 60 days arising out of complication from the date of discharge Indemnity insurance per doctor per facility but not more than 4 cases per Doctor in a year

Rs.2 lakh

Rs.50,000

Rs.30,000 Actual cost not exceeding Rs. 25,000 Up to Rs.2 lakh per claim

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6.14 Compensation to Sterilization Acceptors: Compensation for loss of wages to the sterilization acceptors is being implemented in the State as detailed below in Table No.9. Table No.9 - Compensation to sterilization Acceptors Acceptors of male sterilization in public health facilities Acceptors of female sterilization belonging to Below poverty Line and SC / ST in public health facilities Acceptors of female sterilization belonging to Above poverty Line in public health facilities. Rs. 1,100

Rs. 600

Rs. 250

Interpersonal Counselling to Higher Order Birth Mothers in the selected Village Panchayat 6.15 As per the 2011 Delivery Report, the Higher Order Birth (3rd and above order of birth) in the State is 9.6%. It has been identified that the Higher Order Births are more than State average in 17 Districts. As a new initiative, the interpersonal

67

counselling will be organized in 202 Blocks and 30 Health posts where the Higher order Birth is more than 12.5% to create awareness among the mothers about risk related to higher order birth and to reduce the maternal morbidity and mortality and also to reduce the prevalence of more than 2 children to bring about the small family norms and to stabilize the population in Tamil Nadu. The scheme will be implemented at a cost of Rs.23.20 lakh. Training in Laparoscopic Sterilization 6.16 Eight Government Hospitals (Chennai, Coimbatore, Dindigul, Thanjavur, Tiruchirappalli, Tirunelveli and Villupuram) have been identified as training centres for Laparoscopic Sterilisation. During the year 2013-2014, 12 batches of Laparoscopic Training will be conducted in each centre. Totally 96 number of Doctors will be trained along with operation theatre (OT) Nurses and OT Technicians in these training centres and a sum of Rs.47.54 lakh will be allocated for these training.

68

Training in Mini-Lap Tubectomy Sterilization 6.17 The untrained doctors in Mini-Lap Tubectomy Sterilization who are working in Government Hospitals and Urban Health Posts will be trained in this procedure during the year 2013-2014. Totally 100 Doctors will be trained and a sum of Rs.18.25 lakh will be incurred for this training. 6.18 The family welfare department is a critical department and continued thrust in this area would be needed for the State to sustain the gains achieved so far.

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Chapter 7
MEDICAL AND RURAL HEALTH SERVICES (Employees State Insurance Hospitals)

7.1 The Employees State Insurance Scheme (ESIS) of Tamil Nadu has eight hospitals and 195 Dispensaries functioning under the overall control of the Labour and Employment department except for limited administrative purposes of placing the personnel. The ESIS is divided into four regions and each region is placed under a Regional Administrative Officer to manage the ESI Dispensaries in the respective regions. In all the regions, Central Medical Store is functioning to supply the Drugs and Dressing to the ESI Dispensaries. Administrative Structure Director of Medical and Rural Health Services (ESI)
Joint Director

Regional Administrative Medical Officers of Chennai, Coimbatore, Salem and Madurai

Deputy Director

Superintendent, ESI Hospitals

70

The details of the activities have been brought out in the Labour and Employment department policy note.

71

Chapter 8 INDIAN MEDICINE AND HOMEOPATHY 8.1 India has a long tradition of various systems of medicine. Even before the advent of the modern medicine, these Indian Systems of Medicine (ISM) have been offering cost effective and sustainable relief to all the sections of the society from various ailments without any adverse side effects. The Siddha system of medicine illustrates the ancient wisdom and knowledge of the Tamils to the world. Indian systems of medicine are gaining popularity as a reliable health care system relief. 8.2 When there was an outbreak of Dengue fever last year, the traditional medicines played an admirable role in treating the patients affected with Dengue Fever and other similar viral fevers along with the modern medicine as a complementary treatment. Thanks to the Honble Chief Ministers directions, the Government issued instructions to all the Government Hospitals of Modern Medicine in the State to provide the traditional medicines of Pappaya Leaf Juice, Malaivembu leaf juice and Nilavembu Kudineer to the

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in-patients admitted in the Government Hospitals across the State. There has been overwhelming response from the public on these initiatives. 8.3 The Government formed the Department of Indian Medicine and Homeopathy in the year 1970. The Department is responsible for teaching as well as for providing health care in five systems of Indian medicine viz., Siddha, Ayurveda, Unani, Yoga & Naturopathy, and Homeopathy. This Department functions as the nodal Department for the all round development of Indian Systems of Medicine and Homeopathy in the State. Administrative Structure Commissioner/Director Principals of Government Siddha, Ayurveda, Homeopathy, Unani and Yoga and Naturopathy Medical Colleges State Licensing Authority (Indian Medicine) Government Analyst, Drugs Testing Laboratory(Indian Medicine)

73

Superintendent, Govt. Arignar Anna Hospital of Indian System of Medicine, Chennai District Siddha Medical Officers Government Siddha, Ayurveda, Unani, Yoga and Naturopathy and Homeopathy Dispensaries attached to Government Hospitals/PHCs and Siddha wards in Government Hospitals Objectives of the Department

8.4 The Main objectives of the department are: i. ii. Opening of ISM wings/Hospitals at various levels in all the districts Development of educational institutions in Siddha, Ayurveda, Unani, Yoga & Naturopathy and Homoeopathy Encouraging the cultivation of Medicinal Plants, processing and manufacturing of ISM drugs and promoting research and development in ISM

iii.

74

iv.

v. vi.

vii.

viii.

ix.

Making improvements to the existing Government Indian System of Medicine and Homeopathy Medical Colleges and thereby improving the standard of Medical Education in these systems Opening of new Medical Colleges in these systems Encouraging research and development programmes in these systems of Medicines Making arrangements to grow medicinal herbs and manufacturing essential drugs Encouraging the growth of Centre of Excellence in the field of Indian medicine Improving the standard Medical Education in Private sector

Currently the department has a sanctioned strength of 4,990 employees. Medical Treatment 8.5 There are 1,375 total of ISM institutions including the medical colleges in the State provide medical treatment under Indian Systems of Medicine and Homeopathy, with

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an inpatient capacity of 1,210 beds. Details of the institutions under Indian Medicine may be seen from the Table No.10. Table No.10 - Institutions under ISM System Siddha Ayurvedha Unani Homoeopathy Yoga and Naturopathy Total Total 1,047 100 65 107 56 1,375

8.6 The brief details of the various Hospitals/ Wings managed by this department are 350 bedded Hospital attached to Government Siddha Medical College, Palayamkottai, Tirunelveli 310 bedded Hospital attached to Arignar Anna Government Hospital of Indian Medicine, Chennai 50 bedded Hospital attached to Government Homeopathic Medical College, Tirumangalam, Madurai District 25 bedded ward in Government Pentland Hospital, Vellore

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25 bedded Siddha Wards in District Headquarters Hospitals in the Districts of Erode, Nagapattinam, Dindigul, Kancheepuram and Tiruppur 15 bedded Siddha Ward in Medical College Hospital, Thoothukudi 16 bedded Siddha ward in District Headquarters Hospitals in the Districts of Namakkal, Villupuram, Virudhunagar, Tiruvarur, Karur, Sivagangai, Kumbakonam, Tiruchirappalli, Nagercoil and Mettur 15 Bedded ward Siddha at Taluk Hospital,Chidambaram, Cuddalore District 15 bedded ward Siddha at Non-Taluk Hospital, Kadayanallur 15 bedded Siddha Ward in District Headquarters Hospitals in the Districts of Ramanathapuram, Dharmapuri and Cuddalore 100 bedded Ayurveda Hospital attached to Government Ayurveda Medical College, Nagercoil. Medical Education

8.7 Tamil Nadu is the only State in the country where Government Medical Colleges have been established in all the five

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disciplines of Indian systems of Medicine. The total number of Government Medical Colleges of ISM and the number of ISM Private Medical Colleges available in the State for Indian Medicines can be seen from the Table No.11. Table No.11 - Number of Government and Private Medical Colleges of ISM Sl. No. 1 2 3 4 5 Medical System Siddha Ayurveda Unani Homeopathy Yoga & Naturopathy Total No. of colleges Govt. 2 1 1 1 1 6 Private 5 3 -8 4 20

The Government Colleges are as follows Government Siddha Medical College, Palayamkottai, Tirunelveli District Government Siddha Medical College, Anna Hospital Campus, Arumbakkam Government Yoga & Naturopathy Medical College, AAGHIM campus, Arumbakkam Government Homeopathy Medical College, Tirumangalam, Madurai District

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Government Unani Medical College, AAGHIM Campus. Government Ayurveda Medical College, Kottar, Nagercoil, Kanniyakumari District. Paramedical Human Resources 8.8 Indian Medicine and Homeopathy Department is conducting the following para-medical courses: i. ii. Diploma in Nursing Therapy Diploma in Integrated Pharmacy

A new Diploma course in Integrated Pharmacy is being imparted in pharmacy training and manufacturing practices in all the disciplines of Indian Medicine (except Yoga & Naturopathy). In addition, a diploma course in Nursing Therapy is being conducted for all disciplines of Indian Medicine (except Homoeopathy). These two Diploma Courses aimed at promoting Pharmacists and Nursing Therapists are being conducted at Arignar Anna Government Hospital of Indian Medicine, Chennai and Government Siddha Medical College, Palayamkottai, Tirunelveli. Number of seats available in the Government Colleges and the Private Colleges for the

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admission to the Under Graduate (UG) and Post Graduate (PG) Courses of ISM are given in Table No.12. Table No.12 - Number of seats available in the Government Colleges and the Private Colleges
Details of Seats available for admission Government Private Colleges Colleges Total UG PG UG PG 150 50 50 20 26 296 94 ----94 200 160 400 200 -960 --24 --24 444 210 474 220 26 1374

Sl. No. 1. 2. 3. 4. 5.

Discipline

Siddha Ayurveda Homoeopathy Yoga & Naturopathy Unani Total

UG Under Graduate ; PG-Post Graduate

The number of seats sanctioned for Diploma Course in Integrated Pharmacy and for Nursing Therapy available are furnished in Table No.13.

80 Table No.13 - Number of seats sanctioned for Diploma Course in Integrated Pharmacy and for Nursing Therapy
Number of seats Diploma Diploma in in Integrated Nursing Pharmacy Therapy 50 50

Sl. No. 1.

Name of the Institution Arignar Anna Government Hospital of Indian Medicine, Chennai Government Siddha Medical College, Palayamkottai, Tirunelveli Total

Total

100

2.

50

50

100

100

100

200

Co-Location of ISM Wings in Government Health Facilities 8.9 At present ISM facilities are available in 30 District Headquarters Hospitals, 231 Taluk Hospitals and Non-Taluk Hospitals and 954 PHCs (including the 475 wings opened under NRHM). Additionalities under National Rural Health Mission 8.10 NRHM has been separately covered in detail in the chapter 12 under the State

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Health Society. Some of the additionalities under NRHM under the Indian systems of Medicine are briefly described below
No. of NRHM Wings in PHC
Y & N - 51

Homoeo - 57 Siddha - 275

Unani - 40

Ayurveda - 52

A total of four new schemes have been approved under NRHM for this Department at an out lay of Rs.2.46 crore for the year 2012-2013. The total fund allocation for ISM for the fiscal year 2012-2013 from the NRHM flexi-pool was Rs.17.65 crore details of which can be seen in the Table No.14. Table No.14 - Schemes approved for the year 2012-2013 under NRHM
Sl. No. 1. 2. Scheme Details Hiring charges for the Human Resources engaged (on going Scheme) Information Education and Budget (Rs. in crore) 15.19 0.34

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Communication activities (New Scheme) at Rs. 2500 per ISM unit for all 1360 units Training to all VHNs in Yoga and Naturopathy to impart yoga exercise to pregnant women for natural and safe delivery (New Scheme) Provision of Kit Medicine to pregnant mothers during antenatal and postnatal period (New Scheme) through 370 PHC in the first phase Networking the Commissionerate with District Siddha Medical Offices and the Colleges (New Scheme) Total

3.

0.87

4.

1.00

5.

0.25 17.65

State Drug Licensing Authority for Indian Medicine 8.11 Till 28-11-2007, licensing of Indian System of Medicine drugs was with the Department of Drugs Control. Now this is done by the State Licensing Authority (Indian Medicine) with effect from 29.11.2007 as per Drugs and Cosmetics Act, 1940 and Rules, 1945. The District Siddha Medical Officers are the Drug Inspectors for the purpose of implementation of the provisions pertaining to renewal of license, inspection, sampling, and prosecution in respect of Siddha, Ayurveda and Unani drugs.

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Standardisation of ISM Drugs and Strengthening of Drug Testing Laboratory 8.12 Its primary function is to test the quality of the statutory samples lifted and sent by the Drug Inspectors and District Siddha Medical Officers in discharge of their statutory function under section 33G of Drugs and Cosmetics Act 1940. Advanced and modern equipment have been installed in the Laboratory for the purpose of standardization and quality control of the ISM medicines. The results of the test are given in Table No.15. It can be seen that over the years more samples are being lifted for testing. Table No.15 - Results of the test
Total No of Samples tested 203 248 505 1,185 Standard Quality 141 175 330 878 Not of Standard Quality 62 73 175 307

Year 2009-2010 2010-2011 2011-2012 2012-2013

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National Institute of Siddha 8.13 The National Institute of Siddha at Tambaram, Chennai was inaugurated in the year of 2005 with the fund of State and Central Government. The Capital expenditure is shared between Government of India and the Government of Tamil Nadu in the ratio of 60:40 and the Revenue expenditure in the ratio of 75:25 for the project period of 6 years as per the understanding between the Government of India and the State Government. The Institute is imparting quality Post Graduate education in Siddha apart from research activities. Tamil Nadu Medicinal Plant Farms & Herbal Medicine Corporation Ltd., (TAMPCOL) 8.14 TAMPCOL was incorporated in the year 1983. TAMPCOL is currently manufacturing 92 ISM Medicines viz. 58 Siddha medicines, 26 Ayurveda medicines and 8 Unani medicines like chooranam, thailam, vennai, kudineer, parparm, chenduram, lehiyam, tablets, capsules, syrups, etc. Nilavembu Kudineer, an effective Siddha Sastric medicine in preventing and treating viral

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fever including dengue fever has been supplied to all ISM units in the State and TAMPCOL has played a significant role by effecting timely supplies of medicines to all ISM Units. The Corporation has been earning profit consistently. It is pertinent to note that it is supplying medicines to the institutions under the control of Indian Medicine and Homoeopathy Department at very nominal prices in the interest of general public as these medicines are issued to them free of cost by the Government.

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Chapter 9 FOOD SAFETY AND DRUGS CONTROL ADMINISTRATION Food Safety 9.1 To regulate all activities connected to production of food and food related industries, the Food Safety and Standards Act, 2006 was enacted by Government of India after repealing the Prevention of Food Adulteration Act, 1954. This act has come into force in the entire country from 05.08.2011. Under the provisions of this act, Tamil Nadu Food Safety and Drug Administration Department was created in the State. 9.2 At State level, Commissioner of Food Safety Office has been created as the Head office. All 32 revenue districts have Designated Officers under the Act. At the field level, 584 Food Safety officers have been appointed (385 for each block-rural area and 199 for Municipal areas). 9.3 The field officers have the primary responsibility of ensuring safety of food and food related items in their areas of operation. As per this act, all Food Business

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operators have to either take a license or get a registration depending on their annual turnover. Food Business Operators with less than Rs.12 lakh annual turnover have to register themselves with concerned Food Safety Officers. Food Business Operators with greater than Rs. 12 lakh annual turnover have to take license through the Designated Officers. The time for taking license / registration has been extended till 4th February 2014 by the Food Safety and Standards Authority of India. Till March 2013, 29,129 Food Business Operators have taken the license and 2,03,889 Food Business Operators have registered themselves with the Food Safety Department. All the Designated Officers and Food Safety Officers have been given a 5 day training course to familiarize themselves about the provisions of the Food Safety and Standards Act. 9.4 To test the quality of food, there are six Food Analysis Laboratories in Tamil Nadu. They are located at Chennai (Guindy), Thanjavur, Madurai, Tirunelveli (Palayamkottai), Salem and Coimbatore. All six laboratories have been notified as per the act for testing the food related samples.

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Drug control Administration 9.5 The Drugs Control Administration, which was functioning as a separate Department with effect from 26.11.1981 with the Director of Drugs Control as its Head of Department. It is now functioning under the Tamil Nadu Food Safety and Drug Control Administration (TNFS & DA) Department, under the overall administrative control of "Commissioner of Food Safety & Drug Administration." Administrative Structure.
Commissioner of Food Safety and Drug Control Food Safety department Director, Drugs Control State Drugs Testing Laboratory Joint Director

Deputy Directors

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Zonal Assistant Directors Senior Drugs Inspectors / Drug Inspectors

9.6 There are 14 Zonal Offices (5 in the City and 9 in the Moffusil areas) in the State, each headed by an Assistant Director of Drugs Control who is the Licensing Authority for the Grant / Renewal of Sale Licences in the zone. There are three posts of Deputy Director of Drugs Control and one post of Joint Director of Drugs Control. There are 15 Senior Drugs Inspectors and 146 Drug Inspectors in the department. 12 Senior Drugs Inspectors and 140 Drug Inspectors in various Zones and three Senior Drug Inspectors and six Drug Inspectors are positioned in the Office of the Director of Drugs Control, Chennai. The Intelligence Wing, with a Mobile Van, is under the charge of a Deputy Director of Drugs Control and three Drug Inspectors are part of the Intelligence Wing. There is a Legal Adviser to handle legal issues. 9.7 Drugs Control Department, being a statutory body, performs a very important role in supporting healthcare service

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regulations and enhancing the safety of our community. As a statutory body for Drugs Control, the department distinguishes the massive challenges posed by spurious /adulterated /sub standard quality drugs, selling drugs at excess pricing, misleading advertisements by some manufacturers and dealers. The Drugs Control Administration has the prime mandate of enforcement the following enactments for regulating the manufacture, distribution and sale of Drugs and Cosmetics. i. ii. iii. Drugs and Cosmetics Act, 1940 and Rules, 1945 Drugs Prices Control Order, 1995 Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954

The officers of this department are also empowered to act under Narcotic Drugs and Psychotropic Substances Act, 1985. The Director of Drugs Control is the controlling authority and licensing authority for grant and renewal of licences for manufacture (for sale) of Allopathic, Homeopathic medicines and Cosmetics and also the licensing authority for the blood Banks in the state along with the Central Licence Approving

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Authority. For the implementation and the enforcement of Drugs and Cosmetics Act, one Joint Director of Drugs Control, three Deputy Directors of Drugs Control and one Assistant Director of Drugs Control (Administration) are assisting the Director of Drugs Control. Drugs Control Department monitors the quality, safety, efficacy and rational use of drugs at controlled prices, collection and supply of safe blood and blood components, scrutinizing the misleading advertisements to safeguard the interests of the unwary people. It draws samples of Drugs and Cosmetics for the purpose of test or analysis to ascertain its quality, purity and safety. It has a well equipped statutory laboratory, to undertake the analysis. The total manpower available in the Directorate is detailed in Table No.16. Table No.16 i. Manpower details of Drugs Control Administration
Sl. No 1 2 3 Name of the Post Director of Drugs Control Joint Director of Drugs Control Deputy Director of Drugs Control No. of Posts 1 1 3

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4 5 6 7 8 9 10 11 12 13 Assistant Director of Drugs Control Assistant Director of Drugs Control (Administration) Senior Drugs Inspector Drugs Inspectors Legal Adviser Assistant Accounts Officer Ministerial Staff Office Assistant Driver Telephone Operator TOTAL 15 1 15 146 1 1 117 79 4 1 385

ii. Manpower details of Drugs Testing Laboratory

Sl. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Name of the Post Government Analyst Deputy Government Analyst Senior Analyst Junior Analyst Junior Administrative Officer Technician Grade-I Technician Grade-II Electrician Grade-I Plumber Laboratory Attendant Animal Attendant Ministerial Staff Office Assistant Sweeper Sweeper-cum-Watchman TOTAL No. of Posts 1 2 14 38 1 6 4 1 1 7 1 10 5 1 1 93

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Functioning of Mobile Squad and Legal cum Intelligence Wing 9.8 A Mobile Squad with its headquarters at Madurai and a Legal-cum-Intelligence Wing in this Directorate attend to complaints relating to spurious drugs and investigates specific complaints in Southern Region and in Chennai respectively. Apart from this work, the Legal-cum-Intelligence Wing processes legal matters and undertakes special investigations. Drugs Testing Laboratory 9.9 Drugs Testing Laboratory attached to this Department undertakes testing of samples, drawn by the Drugs Inspectors (other than parenteral preparations) from various retail, wholesale Units, manufacturing units and hospitals, private as well as in government sector.

Prosecutions Sanctioned
9.10 Prosecutions have been sanctioned for certain contraventions under Drugs and Cosmetics Act, 1940 and other acts in 301 cases. The details can be seen from Table No.17.

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Table No.17 - Prosecutions for certain contraventions under Drugs and Cosmetics Act, 1940 and other Acts
Sl. No 1 2 3 4 5 Details Spurious/Adulterated drugs for having manufactured and sold Not of standard Quality drugs (manufactured and sold) Other Contraventions under Drugs and Cosmetics Act, 1940 and Rules, 1945 Contraventions under DMR (OA Act) 1954 Drugs Price Control Order, 1995 No. of cases 9 38 229 24 1

Action Taken for Violation under Drugs and Cosmetics Act and Rules 9.11 During 2012-2013, action was initiated against 17 companies under the Drugs and Cosmetics Act / Rules.

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Chapter 10 TAMIL NADU STATE HEALTH TRANSPORT DEPARTMENT 10.1 The State Health Transport Organisation was started with six Mobile Maintenance Units to look after the maintenance of Health Department Vehicles in the year 1959. During the year 1971, Government of India with a substantial financial assistance from UNICEF evolved an all India pattern according to which each state would have a State Health Transport Organisation. From the year 1973, 15 Mobile Maintenance Units started functioning under State Health Transport Organisation. Later, during the year 1981, the above organization was made as a separate department for the effective maintenance of Health and Family Welfare Department vehicles. During the Year 1995, this Department was converted as Tamil Nadu State Police Transport Workshop to maintain the Police Department vehicles. Subsequently due to the persistent demand of the Medical Officers, this Department was again revived and restored back to its original form from 1.1.1997 and is till date functioning successfully to attend to all the

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needs of vehicles.

Health

and

Family

Welfare

10.2 The aim of the State Health Transport Department is to

Reduce the down time of the vehicles which are taken up for repairs Ensure high percentage of fleet utilization of vehicles Provide more fleet for the successful implementation of health programmes Keep more number of vehicles in good running condition and to conduct periodical servicing, maintenance and to undertake all types of repairs Register new vehicles allotted for the various wings of Health and Family Welfare and to distribute them according to the allotment given by the Head of the Departments Suggest the suitability of vehicles to Head of the Departments as per the existing code rules and Government Orders Advice the Unit Officers of Health and Family Welfare Department regarding Fitness Certificate, getting Tax free

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tokens, Transfer of Ownership etc. for the vehicles under their control Propose the vehicles for natural and premature condemnation based on the report of Technical Expert Committee of the Tamil Nadu State Health Transport Department Conduct classes on fleet management, Tamil Nadu Departmental Vehicle Control rules to Medical Officers and other staff at various Health Training Centres Impart Apprenticeship Training to Degree, Diploma and ITI Certificate Holders Supply of Batteries and tyres to the Health and Family Welfare Department Vehicles Administrative Structure Director a. b. c. Regional Workshops (7) District Headquarters Workshops (9) Mobile Vehicle Maintenance Units (29)

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d. e.

Reconditioning and Central Body Repairing Unit (1) Mini Workshops (4)

Table No.18: Sanctioned staff strength of the State Health Transport Department
Sl. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Name of the post Director Deputy Director (Technical) Deputy Director (Administration) Accounts Officer Automobile Engineer Technical Officer Material Manager Workshop Superintendent Assistant Accounts Officer Assistant Engineer General Foreman Ministerial Staff Technical Staff Office Assistant, Sweeper, Watchman and Gardener TOTAL Sanctioned posts
(As on 31.3.2013)

1 1 1 1 1 1 1 7 7 9 10 87 448 94 669

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10.3 This department has made several significant strides as it passed through different phases of its development. At present, seven regional workshops, nine district workshops and twenty nine mobile workshops, four mini workshops and one reconditioning unit are functioning under the administrative control of this directorate. Currently, this department maintains 2,739 vehicles attached to the various Directorates of Health and Family Welfare Department (as detailed below) and a three-tier structure is followed for the proficient maintenance of vehicles.
Table No.19 - Directorate wise Fleets Maintained (as on 31.3.2013)

Sl. No. 1 2 3 4

Name of the Directorate Directorate of Public Health and Preventive Medicine Directorate of Medical and Rural Health Services Directorate of Medical Education Directorate of Family Welfare

No. of vehicles maintained 1,586 347 256 462

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5 6 7 8 9 10

Directorate of Drugs Control Directorate of Indian Medicine and Homoeopathy Tamil Nadu State Health Transport Department Medical Services Recruitment Board Directorate of Food Safety & Drugs Administration State Health Society Total

4 8 53 2 19 2 2,739

Activities of Regional / District / Mobile Workshops in brief 10.4 The seven regional workshops located at Chennai, Salem, Madurai, Coimbatore, Tiruchirappalli, Tirunelveli, Vellore maintain a fleet of about 400 Vehicles each. Nine district workshops at Chengalpattu, Dharmapuri, Virudhunagar, Udhagamandalam, Erode, Thanjavur, Pudukkottai, Nagercoil and Villupuram and 29 mobile workshops that are spread all over the State are functioning to assist the regional

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workshops in maintaining all the vehicles in an effective manner. The mobile workshop, based on their advance tour programme, visits the hospital premises and takes up periodical servicing and executes minor repairs, on the spot. If the nature of repairs in a vehicle is beyond the limits of the mobile workshop, the required major repairs are executed in the nearby regional or district workshop. Functions of the Department 10.5 This department provides trouble free mobility for implementing various health programmes. It also collects data related to the vehicles maintained by it. This department also identifies obsolete vehicles for their condemnation. During the year 2011-2012, 208 Ambulances and 30 Mortuary vehicles were identified and condemned. Further during important Health care programmes like Pulse polio immunization, this Department deputes its staff concerned to the office of the Deputy Director of Health Service to attend to break down vehicles for successful implementation of the programmes.

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Training Programmes 10.6 Apprenticeship training is also being imparted in this Department every year to 45 I.T.I. Certificate holders, 29 Diploma holders and 17 B.E. Graduates sponsored by the different Government authorities. Improvement in the performance 10.7 Several tools and machineries that are required for undertaking complicated repair works have been installed in the Workshops attached to this Department. With these facilities, the down time required to carry out the works have been drastically reduced which in turn has facilitated in the early delivery of vehicles. Computers have also been installed to expedite the activities of all workshops of this Department. The performance of the workshops in terms of fleet utilization, downtime of repairs, inventory control, man-hour utilization and budgetary control has improved. The percentage of fleet in operation which was 72.6% in the year 1981 has progressively improved to 97%.

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Chapter 11 MEDICAL SERVICES RECRUITMENT BOARD (MRB) 11.1 In order to fill up the posts in a speedy manner, the Government has constituted a separate Board namely Medical Services Recruitment Board (MRB) which consists of a Chairman, a Member and a Member Secretary. The MRB is in-charge of direct recruitment (of all posts which are not coming under the purview of Tamil Nadu Public Service Commission) of all Para Medical Staff including Nurses required for the various departments functioning under the Health and Family Welfare Department. 11.2 Medical Services Recruitment Board conducts recruitment by obtaining seniority list from the Employment Exchange, verifies their eligibility and declares results as per seniority and communal rotation. MRB has so far recruited and filled up 18 posts of Physiotherapist Grade II, 63 posts of Skilled Assistant (Fitter Grade II) and 29 posts of ECG Technician. Currently MRB is finalizing the list of eligible candidates for 255 posts of Radiographer.

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11.3 In addition, the Medical Services Recruitment Board has been mandated by the Government to recruit 2,159 temporary posts of Medical Officers including Speciality Medical Officers and Medical Officers (Dental) through open advertisement. Accordingly, the MRB has published notification for recruitment of Medical Officers on 31.03.2013 and is in the process of conducting examination. Similarly, Government has also mandated recruitment of nurses through open advertisement. The recruitment process for the nurses will be initiated by the MRB, after the pending court cases are finalized. 11.4 Medical Services Recruitment Board is striving to improve and quicken the system of recruitment of Health and Family Welfare Department.

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Chapter 12 STATE HEALTH SOCIETY 12.1 The National Rural Health Mission (NRHM) was launched in 2005 to provide accessible, affordable and quality health services even to the poorest and remotest rural regions. The State has established State and District Health Missions. The State Health Society, Tamil Nadu was registered and all the District Health Societies have been registered under Tamil Nadu Societies Registration Act, 1975. Integration of the multiple societies of different national health programmes at State and District levels, as envisaged under the NRHM has also been done. Vision, Goals, Objectives of National Rural Health Mission 12.2 Vision - Healthy People Now and in the Future. 12.3 Goals of the Mission are To provide accessible and affordable health care based on peoples need

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To deliver high quality of services To improve the long term status of the population To improve the management of services and make them accountable to the people

health health health more

12.4 Objectives of the Mission are Reduction in Infant mortality and maternal mortality Universal access to public health services - womens health, child health, drinking water, sanitation and hygiene, nutrition and universal immunization. Prevention and control of communicable and non-communicable diseases Population stabilization Gender and demographic factors Access to integrated comprehensive primary health care Revitalizing local health tradition and mainstreaming ISM Promotion of healthy life styles

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State Health Society 12.5 To achieve the objectives of the mission, the State Government entered into a Memorandum of Understanding (MoU) with the Government of India, stating their agreement to the policy framework of the Mission and the timelines and performance benchmarks against identified activities. The State Health Society, Tamil Nadu was registered under the Tamil Nadu Societies Registration Act on 15.3.2006. Similarly all the District Health Societies have been registered under the Tamil Nadu Societies Registration Act, 1975. The first phase project period was for 7 years upto March 2012. The sharing pattern of the project expenditure in the XI Plan is 85:15 between Government of India and State Government. Government of India has extended the project in the XII plan period with revised funding sharing pattern of 75:25 between GOI and State government. The Programme Implementation Plan (PIP) for the year 2012-2013 has been approved by the National Programme Coordination Committee (NPCC) of NRHM. The components of National Rural Health Mission along with the scheme wise allocation approved by Government of India under PIP

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2012-2013 are given in the Table No.20 below:Table No.20 - Allocation under Programme Implementation Plan 2012-2013
Sl. No. Name of the Programme under NRHM Amount approved (Rs. in Crores)

Scheme: A 1 2 3 RCH Flexible Pool Additionalities under NRHM (Mission Flexible Pool) Immunisation Total Total (A) Scheme: B National Disease Control Programme National Vector Borne Disease Control Programme Revised National Tuberculosis Control Programme National Programme for Control of Blindness National Leprosy Eradication Programme National Iodine Deficiency Disorder Control Programme Integrated Disease Surveillance Project Total (B) 438.55 525.40 15.90 979.85

4 5 6 7 8 9

9.08 17.71 24.47 2.28 0.24 1.10 54.88

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Scheme: C 10 Infrastructure Maintenance(treasury Transfer)(C) Grand Total (A)+(B)+(C) 298.14 1332.87

For the year 2013-2014 it is anticipated that about Rs.1,400 crore will be approved in the PIP. The funds for all the programmes are routed through the State Health Society at the state level and the District Health Society at the district level. This has contributed to the smooth release of funds to reach the field. Sub committees have also been formed at the state level to facilitate coordination and policy planning under the various components. 12.6 A short description of the various important activities taken up under the first two components (RCH and NRHM flexi pool) is given below. The activities carried out under the other components and disease control programmes are discussed in the relevant Department of the Policy Note. Reproductive and Child Health 12.7 The State has been providing a wide range of Reproductive and Child Health

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Services including institutional delivery, emergency obstetric care, safe abortions, family planning services and adolescent health services in the rural areas as well as the small urban towns. There has also been a thrust towards increasing the utilization of primary health centres through improving the atmosphere and service in these centres. Due to these efforts there has been significant fall in the major RCH indicators, viz. MMR and IMR. Maternal Health 12.8 Delivery Care Services in all PHCs 24 x 7 Hours: One of the remarkable achievements after the introduction of the NRHM has been the manifold increase in the number of the deliveries conducted in the PHCs. This has been made possible due to the introduction of 24 x 7 hour delivery services in every PHC by posting 3 staff nurses for rendering round the clock duty. The daily OP attendance and IP attendance have also increased. This intervention has been implemented in all the PHCs and will be continued in 2013-2014 at a total cost of Rs.40.22 crore.

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12.9 Janani Suraksha Yojana: Janani Suraksha Yojana aims to reduce the maternal and infant mortality by focusing on increasing institutional deliveries. This scheme is implemented in urban and rural areas. An amount of Rs.700 in rural and Rs.600 in urban areas is paid to below the poverty line mothers delivering in institutions for the first two live births. In Tamil Nadu, the amount is given to the women after delivery, in addition to the financial assistance under Dr. Muthulakhsmi Reddy Maternity Benefit Scheme of Rs.12,000 per mother. This scheme has a provision of Rs.33.47 crore for the year 2013-2014. 12.10 Janani Sishu Suraksha karyakaram (JSSK): The scheme of Janani Sishu Suraksha Karyakaram entitles every pregnant women and sick neonate with free drugs, diagnostics, and diet for the duration of the stay, free transport from home to facility, inter facility transfer and transport from facility back to home. The scheme aims at reducing out of pocket expenses for pregnant women and sick neonates. 12.11 Mobile Medical Units (MMU): Mobile Medical Units have been provided to

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all the 385 blocks under NRHM and are functioning since February 2009 under the control of the PHC Patient Welfare Societies. Each Mobile Medical Unit visits 40 camp sites in a month as per fixed tour programme and covers all unserved and underserved villages. Each Mobile Medical Unit team consists of a Doctor and a Staff Nurse. Visits of MMU team are linked with the Village Health and Nutrition (VHN) day. These MMUs have now been upgraded as Hospital on Wheels with improved facilities in the vehicle and addition of lab services. The Hospital on wheels project has been launched in all 385 blocks to provide basic medical services at the door step of the remote and far flung villages. 12.12 Provision of Second Medical Officer in PHCs with Single Doctor: 213 PHCs in the State which were Panchayat Union dispensaries and subsequently converted into PHCs had only one Medical Officer. To make them function effectively in line with other PHCs, one more Medical Officer has been placed in 163 PHCs in 2011-2012. The remaining 50 PHCs are covered in the year 2012-2013. Rs.8.26 crore has been budgeted for this activity in 2013-2014.

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12.13 Integration of 402 Integrated Counselling and Testing Centre (ICTC) Established under TANSACS in Block PHC: There are 797 ICTCs spread across Government Medical College hospitals, Government District head quarters hospitals, Taluk head quarters hospitals, Government PHCs, prisons, corporation and municipal health posts, bus terminus, railway stations and private hospitals established by TANSACS (Tamil Nadu State Aids Control Society) out of which 402 ICTC units in the PHCs are funded by NRHM. Rs.11.94 crore has been budgeted for this activity in 2013-2014. 12.14 Provision of feeding and dietary charges for Ante-natal mothers: AN Mothers who stay for undergoing investigation like ultrasound scan etc., in the PHCs are being provided with food during the Ante natal Clinics at the PHCs. To maintain the extra facilities and to meet out the increasing demands of the ante natal mothers attending the PHC, the PHCs are provided with extra amount based on the number of deliveries conducted. This Scheme is under implementation during 2012-2013 with the Budget provision of Rs. 2.44 crore. This scheme has been

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budgeted at a cost of Rs.3.72 crore for implementation during the year 2013-2014. 12.15 Observation of High Risk AN Mothers: Pregnant mothers who have been diagnosed as high risk pregnancy will be admitted, in 30 bedded PHCs, well before expected date of delivery, along with an attender for round the clock monitoring of maternal and foetal well being and timely referral to appropriate higher facility, at a total cost of Rs. 4.25 crore. 12.16 Placement of RMNCH counsellors: 172 Counsellors have been placed in 110 identified post partum centres to provide counselling to mothers, on Reproductive, Maternal, and Neonatal and Child Health Care. The scheme will be continued by further expanding it to 66 more institutions in 2013-2014. 12.17 Provision of specialist services Obstetricians, Anaesthetists for Emergency Obstetric Care (EmOC): The lack of manpower in the FRUs has been managed through hiring of Obstetricians and Anaesthetists for family welfare and emergency obstetric care services. The Government/Private/Retired personnel are

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hired for the above services at PHCs and District hospitals. Caesarean deliveries are also conducted in PHCs by hiring private gynaecologists under RCH. In 2013-2014, an amount of Rs. 6.75 crore has been budgeted to implement this scheme. 12.18 To hire super-specialists and diagnostic services, an amount of Rs.4 crore has been budgeted for the year 2013-2014. Government of India approved short term training courses for 24 weeks in Life Saving Anaesthesia (LSAS) and Emergency Obstetrics Care for medical officers of primary and secondary health care centres. Tamil Nadu is the leader in conducting these courses which are used to meet this specialist gap. So far, 318 Doctors have been trained in LSAS and 52 Doctors have been trained in EmOC. 12.19 Maternal Anaemia Control Programme: The prevention and control of maternal anaemia is a serious concern for the State. Treatment guidelines (protocols) for implementation of moderate and severe anaemia control programme have been introduced during the year 2010-2011 to tackle this problem. This includes deworming for all pregnant women and use

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of injectable iron sucrose for cases of moderate and persistent anaemia. An amount of Rs.3.00 crore has been budgeted in PIP 2013-2014 for the continuation of management of maternal anaemia using the protocol based intervention. 12.20 Gestational Diabetes Control Programme: All PHCs have been supplied with Semi auto analysers. A scheme for early detection of gestational diabetes using the Glucose Challenge Test approach has been functioning at the block PHC level using the semi auto analyzers provided under RCH. The scheme has been extended to all PHCs using the services of trained staff nurses, wherever lab technicians are not available, at a total cost of Rs.16.14 crore. 12.21 Ensuring blood safetyConduction of Community Blood Donation Camps, Establishment of blood storage centres in all Upgraded PHCs: Provision of safe blood at the level of First Referral Units is a priority area for reducing deaths due to post partum haemorrhage which is a major cause of maternal mortality. With the inputs of

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NRHM, 268 CHCs have been provided with blood storage facilities in phased manner till 2012-2013 to enable them to function as First Referral Units. Blood donation camps will continue to be conducted at the rate of two per block. This will facilitate supply of sufficient quantity of all blood types to these blood storage centres. In the year 2013-2014 the budget of Rs.75.87 lakh has been proposed for conduction of blood donation camps and maintenance of blood storage centres. 12.22 Maternal and Child Health (MCH) Centres: 42 Community Health Centres have been identified at the rate of one centre per HUD to function as level II Maternal and Child Health (MCH) centres based on strategic location to offer higher level Maternal and Child Care. These centres are being developed as comprehensive MCH centres to provide the RCH package of Ante natal and post natal care, Emergency Obstetric Care, Safe Abortion Services, Sterilization Services, Adolescent Clinics, Reproductive tract infections/ sexually transmitted infectious disease management, Poison Management services etc., will also be provided at these centres. 31 health sub centres in remote / difficult areas have been

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identified to provide Level - I MCH centres with additional facilities. Child Health 12.23 Comprehensive intervention to reduce neonatal deaths in districts with high IMR: With the support of NRHM, the neonatal care and referral services in the State have been strengthened by establishing Neonatal Intensive Care Units (NICU) in the districts in phased manner.64 Neonatal intensive care units (NICU) have been operationalised. All the Medical College Hospitals and the district head quarters hospitals and 16 identified Sub District Hospitals are providing NICU services. Nine trained staff nurses, three paediatricians / trained Medical Officers are provided to each NICU/district and sub district hospitals to ensure 24x7 care of the neonates in the NICU. Priority has been given for standardized civil work as well as provision of inputs for housekeeping and security services. An amount of Rs.22.15 crore has been proposed in 2013-2014 for funding the recurring expenditure.

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12.24 Essential new born care services at PHCs and new born stabilisation unit (NBSUs) at First Referral Units(FRUs): The Government of India have provided norms (Indian Public Health standards) for Child Care Service Units - New Born Corner (NBC), New Born Stabilization Unit- NBSU and Sick Neonatal Care Unit SNCU. As per the norms, New Born Corner has been established in 1,421 PHCs with necessary inputs from NRHM in terms of equipments and facility based training of health personnel. Provision of equipments to NBCC in 73 new PHCs, 31 identified Level - I MCH centres and 135 new Urban Primary Health centres was completed in the year 2012-2013. For essential new born care services at these Government Institutions an amount of Rs.3.50 crore has been proposed for the year 2013-2014. In 42 level-II MCH centres and 114 FRUs - New born stabilization Units (NBSUs) are established. A recurring cost of Rs.8.34 crore is proposed in the PIP 2013-2014. 12.25 Comprehensive intervention to reduce neonatal deaths in 15 blocks with high IMR: A new strategy has been drawn for enhancing child care services with a focused attention for reduction of neonatal deaths in blocks with high IMR. Paediatrician

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in each centre would be identified to conduct weekly field visit / well baby clinics in the PHCs in the Blocks with high IMR. These clinics will provide an array of diagnostic and preventive care services. Anganwadi workers as Village Health Volunteers will be providing follow up support for high risk babies discharged from NICU in the local setting for home based new born care. The scheme is being implemented as a convergence activity with Integrated Child development Services (ICDS). It is proposed to expand the scheme in 20 more identified high IMR blocks in the PIP 2013-2014. 12.26 Capacity building for Health Care Providers in Prenatal screening to detect foetal anomaly: Under this scheme, Medical Officers of 256 Upgraded PHCs from all districts are provided hands on and online training of prenatal screening to detect foetal abnormalities using ultrasonography. This scheme is being implemented in partnership with the reputed private sector organizations who is specialized in ultrasonography , through a custom designed software for prenatal screening of foetal abnormalities in first, second and third trimester. Continuous audit

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of the images documented by trained Medical Officers and refining their skills for a minimum period of one year from the date of commencement is being done through these reputed organizations. Memorandum of Agreement has been signed and training for all districts has been completed. This training programme is being extended to another 232 centres (78 CEmONC centres and 154 CHCs) for training two doctors/ centre at a cost of Rs.3.27 crore in 2013-2014. 12.27 Establishment of Early Intervention Centres in two Districts (Pilot Project): Cuddalore and Thoothukudi districts have been selected on pilot basis for establishing early intervention Centres, in the allocated four Primary Health Centres per district. The children (0-3 years) identified by active screening with developmental delay / disability etc. will be managed by appropriate Special Educator / Therapist at the Early Intervention Centres. These centres are being provided with therapy equipments and manpower. The NGO Maduram Narayanan Centre has been nominated by the Commissionerate of Differently abled as a mentor for Exceptional

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Children and consultant for this project and MoU has been signed. 12.28 Managing Children with Malnutrition: Considering the high IMR status for the past three years in the districts of Dharmapuri and Perambalur (State HMIS data), the establishment of one Nutrition Rehabilitation centre (NRC) each at the Medical College Hospital at Dharmapuri district and District Head Quarters hospital of Perambalur district for management of children with severe malnutrition has been approved in the last year plan. In the plan for 2013-2014 it has been proposed to continue the scheme at a cost of Rs.63 lakh. 12.29 Strengthening of Infant death audit: The Infant death audit is being conducted in two stages i.e. Verbal autopsy at the district level and Institutional audit in the Medical Institution where the death occurred. Verbal autopsy is being conducted by the Medical Officer in Rural and Urban area within 15 days of occurrence of death. District Infant Death Audit Committee under the Chairmanship of district collector audits selected infant death at district level and take appropriate action to rectify the defects. A facility level committee in all SNCUs is investigating the events leading to

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Neonatal death as this constitutes the major component of IMR. Adolescent Health Programme 12.30 Control of Anaemia: Anaemia is a major concern among adolescent girls as it leads not only to developmental deficiencies but also to increased maternal mortality. Nearly 97% of adolescent girls in the state are anaemic. One of the major focus of the RCH programme is towards adolescent anaemia control. The programme involves distribution of one Iron and Folic Acid (IFA) tablet a week to all adolescent girls, both in school and out of school along with biannual deworming. The IFA and deworming tablet would be distributed through the school for school going girls and through adolescent link workers for non school going girls. School going adolescent boys will be included in the current year and the scheme has been budgeted at a cost of Rs.22.51 crore. 12.31 Modified School Health Programme: On a pilot basis Modified School Health Programme was implemented in six districts of Cuddalore, Dindigul, Kancheepuram,Kanniyakumari, Thoothukudi and Ramanathapuram during 2009-2010

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and four districts of Salem, Dharmapuri, Tiruvannamalai and Tiruvarur during 2010-2011. The Modified School Health Programme has been extended to the remaining 20 districts. The Scheme will be implemented in all the districts in the coming academic year. 30,000 school teachers and 600 health and education department officials have been trained under this programme during 2012-2013. The implementation of the scheme for the year 2013-2014 has been budgeted at a cost of Rs.13.63 crore. 12.32 Urban Health Programme: In the urban areas, especially in smaller urban towns, major lacunae exist in providing urban health services which is further compounded by the ever growing urban population. The National Rural Health Mission seeks to provide effective health care to these areas by establishing urban primary health centre similar to that of rural PHCs. It is proposed to provide uniform basic infrastructure and staff for these Urban Health Centres. With NRHM inputs towards the cost towards the renovation and repairs of Urban Health Centres, rent for Urban Centres, drugs, equipment, furnitures, establishment of Urban Health

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Centres in 135 Municipalities has been ordered. These centres have been brought under the administrative control of the Director of Public Health and Preventive Medicine. It is proposed to cover 25 Town Panchayats with Urban PHCs at a total cost of Rs.23.96 crore in 2013-2014. Urban health programme is also implemented through 14 Medical colleges by adopting one urban heath post from where the medical colleges are getting large number of primary cases for the minor ailments with the view to reduce the case load. These Urban health centres adopted have been provided with necessary equipments and materials. Tribal Health 12.33 Village Health Volunteers Accredited Social Health Activist (VHVASHA) in 12 districts with tribal population: Despite a number of interventions by the State Government, the vulnerable tribal community is still unable to access basic health care. They continue to face a number of social, cultural, and economic constraints. To promote and improve availability of basic health care services to the tribal/ remote and difficult areas, 2,650 VHV - ASHA have been

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selected and placed. The training of VHV in seven modules has been completed in collaboration with the NGO - SOCHARA and two master trainers at the state level. An amount of Rs.3.17 crore has been proposed for performance based incentives to 2,650 VHV in the plan for 2013-2014. 12.34 Establishment of Birth waiting room: Out of the 34 tribal PHCs, 17 foot hill PHCs have been provided with Birth waiting rooms. Antenatal mothers especially the high risk cases are brought to these waiting rooms well in time prior to the expected date of delivery, to stay in a comfortable atmosphere and have access to emergency obstetric care. A scheme for providing diet to the antenatal mothers and one of their attenders in tribal areas for 1 week of stay before the expected date of delivery is being implemented at all tribal PHCs. An amount of Rs.1.48 crore has been budgeted in the Current year to continue the scheme. 12.35 Mobile Medical Unit (MMU) in Tribal Areas: To reach the remotest pockets, mobile medical services for outreach services with 20 MMUs are being provided in 10 districts through NGOs in collaboration with Tamil Nadu Health

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System Project (TNHSP). In order to reach those tribal areas which are inaccessible, supply of new four wheel drive vehicles suitably equipped as ambulances were approved in 24 identified points in tribal / hilly areas under NRHM. The amount proposed for supporting this scheme for outreach services in tribal villages is Rs.5.76 crore. 12.36 Tribal Counsellors in 10 Government Hospitals: Tribal Counsellors have been appointed in 10 Government Hospitals in the Tribal districts. These persons function as health activists in the institution and create awareness on health and its determinants. They motivate the community towards healthy living practices. It is proposed to extend the initiative to another 32 Institutions in 2013-2014. The total budget proposed is Rs.26.50 lakh for 2013-2014. 12.37 Repairs, Renovations and extension of AN wards, PN wards, Labour room, Operation theatre etc. : With surging institutional deliveries, there is an urgent need to provide larger space in the PHCs to accommodate expectant mothers so that they stay in the health

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facility where they deliver for at least 48 hours post delivery. Hence under RCH, essential civil works for the PHC buildings which need repairs, renovation and extension especially to provide facilities for the additional delivery load are being provided. It is proposed to take up extension and renovations to labour rooms, OTs, ante natal wards, post natal wards and area extension to accommodate other specialized MCH care service and other works in the current year also at a cost of Rs.21 crore. Training and Human Resource Development 12.38 Strengthening of Training Centres: In Tamil Nadu, there are six training centres under the Directorate of Public Health and 10 rural health training centres located in the PHCs where the ANM trainees are trained. In view of the increased need for both pre service and inservice training as a result of RCH/ NRHM initiatives, it is required to upgrade the facilities available in these training centres. The facilities in the training centres will be upgraded along with provision of skill labs for training and evaluation of field staff at

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cost of Rs.1.1 crores. 7 new ANM training schools are proposed at a cost of Rs.18 crore. Additionalities under National Rural Health Mission (NRHM) 12.39 Placement of 4,200 Programmers specific VHV-ASHAs (Village Health Volunteers - Accredited Social Health Activist) in non tribal areas: The State has decided to position programmers specific Village Health Volunteers in HBNBC, Leprosy, malaria and blindness control. Since these VHVs will be functioning in the plain areas under the close supervision of the VHNs, the guidelines for their job functions and incentive schemes are being redesigned based on the programme needs which are relevant in these areas. The VHVs will receive training and performance based incentives for the programmes for which they are selected. This scheme will be continued in 2013-2014. 12.40 Patient Welfare Societies: Patient Welfare Societies have been constituted in all the 1,614 PHCs, 18 Medical College Hospitals and their attached institution, 30 District Headquarters Hospitals and 231

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Taluk / Non-Taluk Hospitals. All the societies are registered and functioning effectively. These societies coordinate with health staff for better functioning of the health Institutions by providing patient amenities and bridging service gaps which will definitely facilitate achievement of the objectives of NRHM. An amount of Rs.10 lakh per Medical College Hospital, Rs.5 lakh per District Head Quarters Hospital, and Rs.1 lakh per Medical College attached Institutions and Taluk/Non-Taluk Hospital, and Rs.1 lakh per Primary Health Centre, Rs 1 lakh per urban health centre per annum under this scheme is given every year. An amount of Rs.25.78 crore is proposed in the PIP 2013-2014 towards this scheme. 12.41 Annual Maintenance Grant to PHCs/HSCs/CHCs/DH/SDH/ Urban PHCs /MCH and attached Institutions: An Annual Maintenance Grant of Rs.1 lakh each is allotted to MCH/DH/SDH/PHCs and 30 bedded PHCs and CHCs providing BEmONC and referral services to ensure quality services through functional physical infrastructure. Similarly, an annual maintenance grant of Rs.50,000 for other PHCs and urban PHCs is allotted per annum for provision of water, toilets, their

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use and their maintenance and other activities which has resulted in the better functioning of the health facilities. Annual Maintenance Grant of Rs.10,000/- is also provided per annum for the maintenance of HSCs with own buildings. An amount of Rs.20.39 crore has been proposed for this core activity in the year 2013-2014. 12.42 Untied grants to Health Facilities: Untied funds are given to all health facilities to meet out unexpected, essential and immediate expenses towards day to day maintenance. Flexibility is also given to the patient welfare societies for spending this money based on actual requirement at the field level. An amount of Rs.10,000/- is allotted as untied grant for each Health Sub Centre per annum. An amount of Rs.25,000/- is allotted to each Primary health centre and Urban primary health centre per annum. An amount of Rs Rs.50,000 per annum is allotted to taluk and non-taluk hospitals and Rs.1 Lakh Per annum to district head quarter hospitals. 12.43 Village Health Water Sanitation and Nutrition Committee (VHWSNC): The village is the basic unit for assessing the health needs of the people and for

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developing village specific plans. Village Health and sanitation Committees have been formed in all the village panchayats in Tamil Nadu, with representatives of the Panchayat Raj Institutions, womens groups and other village level officials related to health and determinants of health such as water and sanitation. Similarly village health and water sanitation committees have been formed in town panchayats. Every committee is entitled to an annual untied grant of Rs.10,000/- which will be used for improvement of the health and sanitation of the village. The committee members have already been given training regarding the village health activities. The financial allocation proposed for these committees during 2013-2014 is Rs.15.07 crore. 12.44 Village Health and Nutrition Day (VHN Day): The VHN day is conducted once a month by each VHWSC in one of the Anganwadi Centres in the Panchayat by rotation. During this session, both the VHN and the ICDS Anganwadi worker will offer joint services. A clinical session including Ante Natal Care will be conducted in the forenoon by the VHN and IEC activities will be conducted in the afternoon. The revised strategy for conducting VHN day has

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provided the health system with ample opportunities to interact with the ICDS workers and disseminate/counsel/manage the different substrata of the community based on their varying health needs. The expenditure will be met from the PHC/HSC funds. 12.45 Infrastructure Upgradation in PHCs /FRU: Public Health Infrastructure plays a crucial role in undertaking curative and preventive health care for the total population of the State. In terms of physical infrastructure, a network of sub-health centres, PHCs, CHCs, taluk /non-taluk and District Hospitals exist in the state. To improve the overall health infrastructure, several strengthening activities have been initiated in the State under NRHM. A detailed facility survey has been conducted through Tamil Nadu Health Systems Project for identification of infrastructure gaps in the secondary hospitals, especially in view of the increasing patient load. Up-gradation of the maternity and neonatal care services and provision of support services to improve the overall functioning of the institution have been given priority. Provision of equipment for the increased work load or replacement of old and obsolete equipment including

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major repairs of essential equipment will be taken up as a part of infrastructure strengthening in selected FRUs and DME institutions. Based on the facility survey, the civil works required in FRUs have been taken up in 2012-2013. To strengthen the facilities with equipment, a cost of Rs. 14.72 crore for First Referral Units (FRUs) and Rs. 9.67 crore for tertiary care institutions was budgeted in 2012-2013. The balance amount of Rs.28.73 crore is budgeted in the current year PIP. 12.46 As part of the district planning process, it is evident that there is a continuing need for infrastructure upgradation in the PHCs due to increased utilization of PHC services by the public. In addition to facilities like additional wards, labour rooms and theatres, another major requirement is the construction of staff nurse quarters to house the nurses providing 24x7 care in the PHCs, It was decided in 2011-2012 that PHCs will be selected based on need and infrastructure provided on a case to case basis on the requirements submitted by the districts. The amount proposed for continuing this scheme in PIP 2013-2014 is Rs.21.00 crore.

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12.47 Quality Assurance Cell: A Quality Assurance Cell with 4 wings-Maternal, Child Health, Quality Management and MCTS has been established in the State Health Society to improve the Quality care services of PHCs and closely monitor their services. 12.48 Mainstreaming of AYUSH: Mainstreaming of AYUSH is also one of the strategies envisaged under National Rural Health Mission with an objective to improve outreach and quality of health delivery in rural areas. The use of AYUSH has expanded and gained popularity with the tremendous expansion. AYUSH is an important component of primary health care delivery in the State. 479 clinics have been well established in PHCs across the state. During 2009-10, the AYUSH services were extended to another 300 PHCs and in 201011 to 175 PHCs under NRHM due to the growing demand, bringing the coverage to more than 60% of the PHCs. The amount proposed for the implementation of the scheme in the current year is Rs.37.31 crore which includes a drug budget of Rs.5.24 crore.

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EMRI (Emergency Management Research Institute) 12.49 The Government has signed a MoU with EMRI Hyderabad to provide integrated Emergency Response Management Services bringing together the departments of Health and Family Welfare, Police and Fire Prevention. Emergency Management service is in operation from 15.09.2008 and an Emergency Response Centre has been established at the Government Kasturba Gandhi Hospital for Women and Children, Chennai. The scheme is being continued in 2013-2014. Elderly Clinics 12.50 With the growing prevalence of noncommunicable diseases in the State along with a perceptible increase of elderly in the community, provision of Geriatric services at the gross root level is the felt need of the rural masses. Hence it is proposed to establish Elderly Clinic at each block PHC of the state and the activity is budgeted at a cost of Rs.6.22 crore towards equipments and running services of Physiotherapist.

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Dental Services in the Government Institution 12.51 The Dental Units in rural area will raise the level of dental health awareness and combine prevention with curative treatment among the rural population, with their active participation, to achieve our goal of Caries free children under NRHM. At present 208 PHCs and 22 Taluk/Non taluk Hospitals are providing dental services for three days in a week. This service has been extended to another seven Taluk Hospitals and 58 UG PHCs. It has been proposed to extend the Dental Services to another 133 Upgraded PHCs at a cost of Rs.11.74 crore during 2013-2014, thereby covering 399 PHCs in the State.

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Chapter 13 TAMIL NADU HEALTH SYSTEMS PROJECT 13.1 Tamil Nadu Health Systems Project (TNHSP) is a World Bank assisted project implemented since January 2005. The Project is being implemented in two Phases. The Phase I of the Project was implemented from January 2005 to September 2010 at a total Project cost of Rs. 597.15 crore. As the Project had completed all the activities and spent the money well within the Project period, the additional financing was provided for the project for continuation of successful activities which were accomplished with success in areas such as Maternal and Child Health, Improving Access and Utilization of Health Services by the poor, Remote and Tribal populations in Tamil Nadu, Improving Quality of Health Care and Improving Human Resource planning and capacity. In addition, the additional financing was provided to scale up specific activities in addition which were well performing including (i) the state-wide expansion of the Non-Communicable Disease (NCD)

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prevention and control activities which were piloted in two districts in the state of Tamil Nadu (ii) the state-wide implementation of the Hospital and Health Management Information Systems (HMS & HMIS) in health facilities including tertiary care institutions; and (iii) the expansion of maternal and neonatal health services to the tertiary level. 13.2 The Project interventions are to enhance the overall development impact and effectiveness which is expected to serve as a model for other states in India as they attempt similar health interventions and reforms. The outcome indicators were designed to reflect two types of outcomes expected as a result of additional financing. (i) The consolidation of successful new modalities to reform the provision of Health Care Services and improve health outcomes in Tamil Nadu.

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(ii) State-wide expansion of key services and systems which can serve as models for other states in India. 13.3 The Phase II of the project is being implemented at a total additional financing cost of Rs. 627.74 crore from October 2010 and is expected to close on 30th September 2013. The following are the components and sub-components of the project; Component 1: Increasing access to and utilization of service. This component supportsi. Reducing Maternal/neonatal Mortality by supporting the effective ongoing operations of 80 Comprehensive Emergency Obstetric and New born Care (CEmONC) Centres the construction and equipping of higher maternity referral institutions at eight medical colleges and the design and provision of various IEC materials; Improving Tribal Health through implementation of the Tribal Development Plan in all identified tribal areas in 12 districts in Tamil Nadu in order to increase access to health care among tribal populations and to

ii.

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iii.

strengthen existing primary and secondary services in tribal areas through public-private partnership; and Facilitating use of hospitals by the poor and the disadvantaged through the provision of effective patient counseling services, the provision of ambulances and mortuary vans, strengthening of laboratories and financing housekeeping services at selected Project hospitals. Component 2: Non-Communicable Disease (NCD) Prevention and Control. This component supports

i.

ii.

Health Promotion activities for preventing Non-Communicable diseases through school-based, work placebased and community-based health promotion programs; and NCD Interventions throughout the state of Tamil Nadu covering Prevention, Screening, treatment, and follow-up for cervical & Breast cancer and cardiovascular diseases (Hypertension) and Diabetes Mellitus through Clinic based, Work-place based, School based and Community based interventions. In addition, the component would

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finance the salaries of female NCD staff nurses contracted and placed at primary, secondary and tertiary level facilities, wide spread IEC activities and supervision, monitoring and evaluation of NCD interventions. Component 3: Building Capacity for Health System Oversight and Management. This component supports i. Strengthening Monitoring and Evaluation capacity of the Department of Health and Family Welfare of Tamil Nadu by establishing a computerized Hospital Management System (HMS) in the remaining 222 secondary level hospitals in Tamil Nadu out of the total 270 hospitals as well as extending to selected Medical Colleges (tertiary level hospitals and their attached hospitals; Improving Quality of Care through continuous monitoring of quality of care, the provision, management and training on rational use of drugs for hospital and Primary Health Centre(PHC) staff; and enhancing the capacity for the hospital accreditation process within the Department of

ii.

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iii.

iv.

Health and Family Welfare of Tamil Nadu; Strengthening Health Care Waste Management through extensive training on Infection Control and Waste Management to all health personnel at primary, secondary and tertiary levels of healthcare, and carrying out an impact evaluation of the implementation of the Environment Management Plan; Capacity building for Strategy Development and Implementation by expansion of the Directorate of Medical Services (annexe building), training of doctors and TNHSP staff, supporting the TNHSP Society by financing its operating costs, and supporting the establishment of a data resource center. Component 4: Improving Effectiveness and Efficiency of Public Sector to Deliver Essential Services. This component supports -

i.

Equipment rationalization and strengthening of equipment and pharmaceuticals management through the procurement of essential equipment

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ii.

and strengthening pharmaceutical and equipment procurement, logistics, repair and maintenance system in the Tamil Nadu Medical Services Corporation (TNMSC); and Human Resource Planning and Development by financing additional contractual staff in project hospitals in order to improve overall efficiency and performance. During the year 2013-2014, it is proposed to undertake the following activities. Improvement of Maternal and Child Health 13.4 With a view to improve the maternal and child health, the following activities would be undertaken Improvement of infrastructure to 24 hrs Comprehensive Emergency Obstetric and Newborn Care centres (CEmONC). Provision of equipment for operation theatres and labour wards. Coordination meetings will be conducted with referral units to improve the referral system.

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Follow-up of referred out cases. Conducting review of Maternal Mortality through video conferences. Re-certification of CEmONC centres. Training of Doctors and Nurses on labour ward practices. Fresh frozen plasma will be made available in all CEmONC centres. To establish Maternal ICU in all CEmONC centres. Untied fund of Rs.1.00 lakh per hospital per annum will be provided to each of the CEmONC hospitals for incidental expenditure. Non-communicable Diseases 13.5 Cardio Vascular Diseases Prevention and Control Programme: During the pilot programme conducted in the districts of Virudhunagar and Sivagangai for a period of 30 months during Phase I of the project, more than 12 lakh persons have been screened and of them 77,757 persons have been found to be having hypertension and are now getting regular treatment in Government Hospitals. Due to this, they have been prevented from getting serious diseases like coronary artery disease,

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stroke, chronic renal failure etc. Emphasis is being given for creating awareness in the community on modifiable risk factors leading to cardio vascular diseases. The community is sensitized for life style modification such as changes in food habits such as reduction of oil and salt in the food, to maintain optimum weight for the height, to increase physical activity, encourage walking and cycling, to stop smoking/ not to initiate smoking and stress management. This programme is being implemented as a multi departmental activity involving Education Department for school based activities, Labour and Employment Department for work place based activities, Rural Development Department for community based activities and Municipal Administration Department for involving municipal hospitals and urban population. Currently the programme is being implemented in 16 districts involving 973 Government institutions including Municipal /Primary/ Secondary/Tertiary care medical institutions. During the financial year 2012-2013, out of 29,80,835 patients screened for hypertension 2,29,838 hypertension cases were identified and brought under treatment protocol. These patients will also be monitored during the

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follow-up for hypertension appropriately.

any complications and will be

due to treated

13.6 Prevention and Treatment of Diabetes Mellitus: In all the above 16 districts the patients attending OP above the age of 30 years are also screened for the presence of Diabetes Mellitus. During 2012-2013, out of 13,33,534 patients screened for Diabetes Mellitus 59,583 cases have been identified and brought under the treatment. These patients will also be monitored during the follow-up for any complications due to Diabetes Mellitus and will be treated appropriately. 13.7 Prevention and Treatment of Cancer Cervix: During the Pilot programme which was implemented in Theni and Thanjavur districts more than 4.70 lakh women were screened, of them 20,000 were found positive for Cancer Cervix, and referred to higher institutions for confirmation and further management. Therefore this programme was extended to entire Tamil Nadu. During 2012-2013 in the 1st phase the screening for Cancer cervix was initiated in 16 districts among 973 institutions. Out of 4,35,886 patients

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screened for Cancer Cervix, 19,143 cases were found positive and referred to higher referral institutions for confirmation and treatment. During the financial year 2013-2014, it is planned to implement this programme in the remaining 16 districts. All the women attending the Out Patient Department who are of 30 years and above are to be screened for cancer cervix. 13.8 Prevention and Treatment of Breast Cancer: Under this programme all the women in the age group of 30 years and above attending Out Patient Department are screened for Breast Cancer. Along with the Screening and Treatment program for Cervical Cancer, an early detection, and treatment for Breast Cancer is also being implemented in all districts of Tamil Nadu in a phased manner. In this program all women above the age of 30 years are taught about self breast examination and are subjected to clinical breast examination, in all the Government health facilities. Those women who are found to be having the problem are subjected to further tests and treatment are provided in the tertiary care centres. During 2012-2013 in the 1st phase the screening for Breast Cancer has been initiated in 16 districts among 973 number

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of institutions. Out of 8,87,555 patients screened for breast cancer 8,563 patients were found positive and they were referred to higher referral institutions for confirmation and treatment. During the year 2013-2014 this programme will be implemented in the remaining 16 districts. Health Management Information System (HMIS) 13.9 Health Management Information System provides information based support for the implementation of cutting-edge reforms by the Tamil Nadu Health Systems Project. Apart from Primary Health Centers and Secondary Care Hospitals, this project is envisaged to cover all the Tertiary Care Hospitals including the Medical Colleges and Medical University. This is a combination of Information Technology (IT) and Management Systems, to deliver improved evidence based health care to the public at large. HMIS was started as Pilot project during the year 2008 in five secondary care hospitals. Because of the encouraging results the project was extended to Phase-1 during the year 2009 for thirty six hospitals in five districts. Subsequently Phase-II activity commenced during the year 2010 for two

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Hundred and Twenty Two hospitals. Currently we are in the completing stage of Phase II hospital implementation. Under revised Phase III activities, HMS for 8 Govt. Medical College hospitals (only OP work flow) Management Information System (MIS), College Management System (CMS) and University automation for 17 medical colleges, 47 institutions under the Medical Education Directorate and Tamil Nadu Dr.MGR Medical University have been planned and SRS preparation is in progress. The total budget allocated for the pilot, phase I, II and III is Rs.128.40 crore. As on date, 265 out of 267 hospitals are functioning with HMIS. Provision of Modern Equipment to Government Hospitals 13.10 Tamil Nadu Health Systems Project has provided following modern equipments for the efficient health care delivery to the public Digital X-ray units with PACS, have been provided in 23 Government District Head Quarters Hospitals, and also in 7 Government Medical College Hospitals, at a cost of Rs.31.60 crore.

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Dialysis Machines with Reverse Osmosis plant, have been provided in 16 Government District Head Quarters Hospitals and also in 1 Government Medical College Hospital, at a cost of Rs.2.38 crore. Hepa Filter with AC system, have been provided in 10 Government Secondary Care Hospitals getting prepared for Accreditation by NABH, at a cost of Rs.83.61 lakh. Pulse Oximeter with Adult and Pediatric probe has been provided in 119 Government Secondary Care Hospitals, at a cost of Rs.97.44 lakh. Equipment for CEmONC services in eight Government Medical College Hospitals: Maternity blocks are being constructed in eight Govt. Medical College Hospitals and are nearing completion. Anesthesia machines, Ultrasonograms with color doppler, Echocardiograms with color Doppler, New Born Ventilators etc will be provided to these Hospitals at a cost of Rs.14.59 crore. Mammography Unit will be provided for 30 Government District Head Quarters hospitals at a cost of Rs.6.40 crore.

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Setting up of Hospital Accreditation Cell 13.11 Twelve Government Hospitals are being prepared to obtain certification under National Accreditation Board for Hospitals (NABH), a unit of the Quality Council of India. Of them two hospitals have secured NABH accreditation, and in another hospital the final assessment was over and the result is awaited. In the remaining nine hospitals pre-final assessment is over and the hospitals are being prepared for final assessment. An Accreditation cell is set up to facilitate accreditation of hospitals. The cost involved in the above activity including other quality of care improvement activities is Rs.3.47 crore. Poison Treatment Centres 13.12 Tamil Nadu Health Systems Project has established Poison Treatment Centres in 66 Government Hospitals which save many patients who are brought to the centres due to snake bite and poisoning. During the current year, 35,972 patients were admitted and treated in these centres out of which 35,389 people got cured. These centres play useful role in bringing down the death rate due to poisoning.

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Emergency Ambulance Services 13.13 The 108 ambulance service is under operation in Tamil Nadu through PPP mode by signing an MOU with EMRI, Hyderabad. At present 629 vehicles are in operation with 6,34,364 beneficiaries. Apart from providing emergency services inter facility transfers between secondary care institutions to tertiary care institution for specialty care treatment, patients are being transported through Advanced Life Support (ALS) ambulances irrespective of distance. These ambulances are fitted with life saving equipments. To provide care during transit trained staff nurses are posted. The staff nurses will manage the case in consultation with the physicians at Emergency Response Center in transit. Also to save sick new born babies who require specialty care at tertiary care institutions, specially designed neonatal ambulances with equipment are under operation in Chennai, Kancheepuram, Cuddalore, Dharmapuri, Madurai and Vellore. To provide continuous care during transit, one trained staff nurse is posted in this ambulance. During this financial year Rs.69.64 crore is provided by Government of Tamil Nadu to operationalise this programme. It is planned to induct more

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vehicles into the system so as to make the fleet strength to 714 including 29 neo natal ambulances and 54 four wheel drive vehicles for hilly and coastal areas to cover all the uncovered areas. Tribal Health Development 13.14 The Project has been operating 12 Mobile Out-reach health services in Tribal areas through NGOs during the Phase I of the Project. This programme is extended by addition of eight more teams making a total of 20 teams. During the current year 10,927 number of trips were made to the tribal areas and 2,84,605 persons were treated. Tribal Counsellors 13.15 There are 42 Tribal Counsellors employed in Government Hospitals and Primary Health Centres in the tribal areas to help the tribal people accessing these institutions for treatment. During the current year, 4,29,227 persons were benefitted by this programme. Mortuary Van Services 13.16 The Government is providing Free Hearse (Mortuary) service in all the

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Government Medical Institutions to transport the deceased from Government Medical Institutions to their destination or cremation ground. This programme is being implemented in partnership with Indian Red Cross Society, Tamil Nadu Branch on PPP mode since 2011. At present 132 vehicles are in operation in all the Government Medical College Hospitals, District Head quarters and some of the Taluk hospitals. So far 45,827 number of bodies have been transported to their hometown / cremation ground within the state and adjacent states also. Government has allotted Rs. 18.95 crore during this financial year. It is planned to increase the fleet strength to 180 to cover all the Government Medical institutions during 2013-2014.

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Chapter 14 TAMIL NADU MEDICAL SERVICES CORPORATION 14.1 Tamil Nadu Medical Services Corporation (TNMSC) established in 1994, under the Companies Act, 1956 ensures the availability of drugs and medical supplies to all the Government Medical institutions and Primary Health Centres. TNMSCs role encompasses procurement, storage, distribution and quality control of drugs, medicines, surgical and sutures. It draws up a list of essential drugs, procures and organizes their storage at different points and distributes these to the health facilities. TNMSC maintains drug warehouses throughout the State. The health facilities draw their requirements from the warehouses through an indenting system on a pre-determined schedule. Each facility is given an annual fund allotment for indenting drugs from the warehouse to avoid over drawal of supplies and this is monitored through a pass Book issued to each facility. The system is, however, not rigid as the facilities have the freedom to seek additional allotment at times of emergency. The entire operation of TNMSC is

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computerized and through the computer network it monitors, on a daily basis, drug flows and stocks at all its warehouses. 14.2 Over the years, TNMSC has built a network of warehouses across the State which has helped the State to minimize the out of pocket expenses for the patients visiting the government medical institutions. TNMSC also plays a vital role in procuring and maintaining high-end equipments including CT/MRI Scan Centres at various Government Hospitals and payment wards at Rajiv Gandhi Government General Hospital, Chennai and IOG, Chennai etc. TNMSC has extended the ambit of its operations to the medical facilities in Police, Prisons, Juvenile Homes, Transport Corporations, Veterinary Department and Cooperative Institutions also. TNMSC also established MRI centres in some of the teaching hospitals and CT scan centres in several Government Hospitals providing diagnostic services on payment basis; the charges being at a lower rate than the private investor-owned centres. TNMSC is the agency to procure equipment and accessories to all the Health facilities in the State and to manage maintenance system for major equipments. The major activities

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include procurement, distribution of Drugs.

storage

and

Procurement 14.3 Essential Drugs and Medicines, specialty drugs and surgical and suture items from reputed manufacturers are procured through a transparent tender process. In addition drugs and chemicals for the Animal Husbandry Department are procured by the TNMSC. The Warehousewise requirement of drugs, placing of supply orders and distribution of drugs is monitored online by use of Information Technology. TNMSC is an ISO 9001:2008 Certified Organization. Under the scheme Pudhuyugam, procurement and supply of Beltless napkins for implementation of menstrual hygiene programme for adolescent girls in rural areas is being done. The Government has allotted Rs.55 crore for the scheme under the Public Health head of account. Storage and Distribution 14.4 The Government medical institutions are provided with pass books based on the allotment made by the respective Head of

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Departments to enable the institutions to draw their requirement of drugs and medicines from the warehouses to which they are attached. The Corporation maintains six months physical stock in the warehouses and two months stock in pipeline for ensuring uninterrupted supply of medicines to hospitals. Quality Assurance 14.5 Quality Control is essential to ensure the quality of drugs procured. To ensure the quality of drugs the Quality Control Wing draws samples from each batch of supply and get them tested in empanelled analytical laboratories, selected through transparent tender system. Only the drugs which pass quality tests are issued to Hospitals. The quality control measures are being upgraded to meet the new challenges in the field to improve the quality. Other Activities 14.6 Operation of CT and MRI Scanners and Lithotripsy Machines: A network of 48 CT Scanners including one 128 slice CT Scanner and 2 nos. of 64 slice CT scanners have been established in 41 Centres in

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Government Hospitals. The Corporation is collecting nominal user charges at the rate of Rs.350/- per scan for in-patients and Rs.500 per scan for out-patients with an extra charge of Rs.200 for contrast scan. The Corporation is also maintaining 10 MRI Scanners and providing scanning facility to the public at a nominal charge of Rs.2,500 with an extra charge of Rs.1,500/- for contrast scan. The Corporation is also maintaining two Lithotripsy machines, one each at Rajiv Gandhi Government General Hospital, Chennai and Government Rajaji Hospital, Madurai. A nominal fee of Rs.5,000, Rs.4,500 and Rs.4,000 is fixed for first, second and third sitting respectively for this treatment. TNMSC Limited has now replaced the existing 10 numbers of CT Scanners which are old and also the work of installing eight more CT Scanners in Taluk hospitals is in progress. MRI Scan have been installed in the Medical College Hospitals at Kilpauk, Chennai and Villupuram and are functioning. The installation of two more MRI Scanners at Government Medical College Hospitals at Dharmapuri and Chengalpattu are in advanced stages.

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14.7 Providing logistic support to payment wards: TNMSC is providing logistic support to the pay wards at the following hospitals and acts as Custodian of Funds for these Centres. i. The ISO 9001 certified Liver Transplant Centre in Government Stanley Hospital, Chennai. Maternity Pay ward in IOG, Egmore, Chennai. Maternity Pay ward at Kasturba Gandhi Hospital for Women and Children, Chennai established. Pay wards at Rajiv Gandhi Government General Hospital, Chennai. Master Health Checkup Centre at Rajiv Gandhi Government General Hospital, Chennai.

ii. iii.

iv.

v.

The proposal for handing over these to the respective institutions is under consideration of the Government. 14.8 Regional Diagnostic Centres: The Corporation is also maintaining the Regional Diagnostic Centres at seven Government Headquarters Hospitals at Villupuram, Virudhunagar, Tiruvannamalai, Tiruppur,

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Ramanathapuram, Pudukkottai.

Namakkal

and

14.9 Construction of Warehouses: TNMSC operates modern Drug Warehouses at 25 convenient locations i.e. at the District Headquarters of Tamil Nadu. Action is being initiated to construct five more warehouses at Perambalur, Krishnagiri, Namakkal, Nagapattinam and Tiruppur. 14.10 Purchase and Supply of Medical Equipment: Specialized and high technology medical equipments, required for all the Government Hospitals are procured and supplied by TNMSC based on specific Government Orders. Further, TNMSC is the procurement agency for Tamil Nadu Health Systems Project, aided by World Bank. The World Bank is actively considering engaging TNMSC as an authorized procurement agency in respect of procurement of Drugs and Medicines, Equipment for their projects in other States. 14.11 Consultancy Services: TNMSC is a well known brand name in Drug Logistics and Warehousing for the whole country. Many States in the country are emulating the methodology followed by this

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Corporation. TNMSC has rendered consultancy services for the Health and Family Welfare Department, Government of Andhra Pradesh and Rajasthan. For the State of Madhya Pradesh, TNMSC has rendered consultancy services for two years for the procurement activities both for drugs and mmedicines. The Government of Chattisgarh is requesting to extend the support as is being done for Government of Madhya Pradesh by the TNMSC. The Corporation has been receiving a number of delegates from all over the country and abroad to emulate and replicate the TNMSC model. TNMSC is constantly striving to improve the system and delivery.

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Chapter 15 TAMIL NADU STATE AIDS CONTROL SOCIETY (TANSACS) 15.1 Tamil Nadu has been a front runner in managing (Human Immuno Deficiency Virus) HIV / (Acquired Immuno Deficiency Syndrome) AIDS. State AIDS Project Cell was started in January 1993. This cell was converted as Tamil Nadu State AIDS Control Society (TANSACS) during May 1994. Initially the HIV/AIDS was rising and it reached 1.13% in 2001. With active co-ordination of Government health system and various supporting units like NGOs and CBOs, TANSACS has been able to reduce it to 0.25%. 15.2 Since 2011, TANSACS is working to achieve the aim of Getting to Zero No new infection, No HIV/AIDS related death, No HIV/AIDS related Stigma and Discrimination. TANSACS is funded by National AIDS Control Organisation (NACO) and the fund allocated for 2013-2014 is Rs.75.28 crore.

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The basic components of TANSACS activities are as follows: Prevention of New Infections Care, Support and Treatment Strategic Information Management System

Prevention of New Infections 15.3 A multipronged approach is used to ensure that all sectors of population are covered by access to services and necessary information is provided to prevent HIV infection. The following schemes are being implemented to ensure prevention of new infections. ICTC (Integrated Counselling and Testing Centres) 15.4 ICTC is the initial contact point for HIV/AIDS related services. These centres are located at Medical Colleges / Government Hospitals / Primary Health Centres. A novel approach of Private Public Partnership (PPP) has also been started and many private hospitals are now part of this network. To cover the remote areas, 17 mobile ICTC Vans equipped with all relevant facilities are being utilized in various

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districts. At present, there are 1,471 ICTCs in the State, which provide counseling and testing. PPTCT (Prevention of Parent to Child Transmission) 15.5 One of the major routes of HIV transmission is through Parent-to-Child transmission. This Programme aims to provide prevention, care and treatment intervention to all pregnant couples with a package of services. HIV positive women are given ARV prophylaxis /treatment to reduce the transmission of HIV virus. The new born baby is given ARV prophylaxis. Intensive training has been given to the concerned medical personnel to ensure that this scheme is extended to all mothers. The budgeted expenditure for 2013-2014 for ICTC is Rs.17.25 crore. Sexually Transmitted Infection (STI) Services 15.6 156 designated Sexually Transmitted Infection (STI) / Reproductive Tract Infection (RTI) clinics are functioning under Tamil Nadu State AIDS Control Society including Chennai Corporation AIDS Preventive and Control Society (CAPACS).

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These clinics are branded as "SUGA VAZHVU MAIYAM" (SURAKSHA- Well being clinics) functioning in Government Medical Colleges, Government Headquarters Hospitals & Government Hospitals. Medical Officers, Staff Nurse and Lab Technician from each hospital are trained on STI/RTI treatment, care and follow up and condom promotion & partner treatment. They treat the STI cases using syndromic case management approach using colour coded drug kits. Targeted Intervention 15.7 The targeted intervention is aimed at bringing the behaviour change among specific population groups whose risks of contracting HIV infections is high. In the State, the focus is on Female Sexual Worker (FSW), Men having sex with Men (MSM), (Intravenous Drug Use) IDU, Truckers and Migrants. This programme is implemented through the Non-Governmental Organizations (NGOs) / Community Based Organizations (CBOs). At present 92 NGOs are functioning & approximately 75465 High Risk Group (HRG) population is covered. During the 2013-2014, Rs.14.38 crore has been budgeted for these intervention projects.

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Link Workers Scheme 15.8 This Scheme is implemented in 21 districts, predominantly in rural areas to cover the high risk & vulnerable population. For 2013-2014, Rs.5.68 crore are budgeted for this scheme. Condom Promotion 15.9 Condoms are the most effective means for prevention of HIV infection among high risk and general population. TANSACS provides free condoms to people through NGOs, STI clinics, ICTC / ART Centres and other outreach programmes. During 2012-2013, approximately Rs.4.77 crore of condoms were distributed. Blood Safety 15.10 It is essential to provide adequate, safe & quality blood and blood component supply to meet the need of patients. In the State there are 274 blood banks (85 Government, 9 Central Government, and 180 Private). Apart from these blood banks, there are 253 Blood Storage Centres (Government 196 and Private 57) where only the storage facilities are available. To ensure safe blood,

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Voluntary Blood Donation is promoted and 94% of all collected blood comes from Voluntary donors. To optimally utilize the blood, the use of blood components is being encouraged. There are 86 blood component separation units in the State (15 in Government sector, one Central Government and 70 in Private sector). During the year 2012-2013, 6,92,000 units blood were collected in Tamil Nadu. Information, Education and Communication (IEC) 15.11 To prevent new HIV infections, it is essential that awareness is created among the general population and the high risk group. IEC campaigns aimed at general population are designed to educate the public about the basic details related to various aspects of HIV/AIDS. Among the high risk groups, the awareness campaigns aim for motivating them for behavior change. Various formats of media and various strategies are used to disseminate messages to different audiences to create a demand for using the health services & for following safe practices like condom usage. Mass media is used to provide general messages to the whole population. Television, Radio and Print media is used

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through Advertisements, Talk shows, Long format programmes etc. Two Mobile IEC vans are operated to take the HIV/AIDS related messages to remote areas where other channels may not have adequate reach. These vans utilize Audio-visual aids, pamphlets, posters etc. to provide information. Red Ribbon Club is a major strategy to cover a large number of youth in the State. At present 2,387 Colleges have Red Ribbon Clubs and they work on the aspect of risk perception and behavior change through behavior change communication. Life Skill Education Programme provides information related to HIV/AIDS to the adolescent group. It has been implemented in 10,006 Schools with 18,000 trained teachers and 20,012 Peer Educators. (Two Peer Educators per school). Other IEC activities include Static advertising like hoardings, Bus Panel brandings apart from organization of specific events like Blood Donation Day and World AIDS Day. A large number of Government Departments are being given awareness training to ensure that they are sensitized about all the aspects of HIV/AIDS. For this financial year 2013-2014, an amount of Rs.10.20 crore is allocated for all IEC activities.

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Care, Support & Treatment 15.12 With proper care & treatment, a person with HIV can live a normal life. Towards this, Government provides various facilities to improve the quality of life of people living with HIV/AIDS. The main activities are as follows:Anti-Retro Viral Therapy (ART) 15.13 ART provides medicines to inhibit the replication of HIV Virus and to reduce the chances of other infection. Proper ART regimen significantly improves the quality of life of the person with HIV infection. Free screening facilities for CD4 tests are provided at ART centres & all eligible persons are provided free ART drugs. Counselling Services are also provided before and during the treatment. At present there are 44 ART centres. Apart from the main ART centres, there are 99 Link ART Centres which provide regular medicines to PLHIV. 68,090 persons are taking regular ART medicines through these centres. Community Care centers are short stay home supported by TANSACS which provide treatment for minor opportunistic infections on IP and OP basis, Counselling, outreach for ART adherence

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and home based care for people living with HIVs (PLHIVs). 29 Community Care Centres (CCC) are currently functional in the State which is run by NGO's and CBO's. Strategic Information and Management System (SIMS) 15.14 SIMS is a web based integrated Monitoring and Evaluation Service where all the units of TANSACS report through this system. The data gathered is used for monitoring & taking corrective efforts to streamline the system. To monitor the works of centres located in a district the District AIDS Prevention and Control Unit (DAPCU) functions as a nodal point in the district. There are 29 DAPCUs in the 29 high prevalence districts. Apart from the above mentioned National Aids Control Organisation (NACO) supported programmes, there are some unique initiatives being run in the State for providing Care & Support to PLHIVs. Legal Aid Clinics are run in 16 districts with the help of District Free Legal Aid Authority to provide Legal Counselling for their legal issues. In cases where it is required, free legal service is provided for taking legal recourse to claim their rights. A separate

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Trust has been established for providing assistance to Orphan and Vulnerable Children (Tamil Nadu Trust for Children affected by AIDS). This trust provides nutritional, educational support to infected and affected children. Under Farmers Protection Scheme (Uzhavar Padukappu Thittam), any member of farmer who is on ART medicines with CD4 count below 350 is provided a pension of Rs.1,000 per month. As of 31st March 2013, 2,663 persons were being given this pension.

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Chapter 16 TAMIL NADU STATE BLINDNESS CONTROL SOCIETY (TNSBCS) 16.1 Blindness is a major problem throughout India. National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100% centrally sponsored programme with the goal of achieving a prevalence rate of blindness to 0.3% of population. The four pronged strategy of the programme is: strengthening service delivery developing human resources for eye care promoting outreach activities and public awareness Developing institutional capacity

The implementation of the programme was decentralized in 1994-1995 with formation of District Blindness Control Society in each district of the country. The Society has taken various steps to create awareness among the public regarding the need for the Eye donation. On 01.04.1996, the Tamil Nadu State Blindness Control Society was formed as a separate entity, to give thrust

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to the goal by planning, execution and monitoring at the District level. The Tamil Nadu State Blindness Control Society is functioning under the control of Mission Director, State Health Society, National Rural Health Mission, and Chennai with effect from 01.04.2007. The Project Director is the Secretary of the society for the implementation of the scheme. Every district in the state has one District Blindness Control Society to govern the activities of the National Programme for Control of Blindness. 16.2 For effective implementation and monitoring of the work at District level, a District Blindness Control Society has been formed in all the Districts. The District Blindness Control Society conducts eye camps with the help of Voluntary Organisations and District Mobile Ophthalmic Units, provides financial assistance to Voluntary Organisations for performing Cataract Operations, undertakes propaganda activities under health education programme in the District and monitors the implementation of the Blindness Control Programme in District level as per the directions of Government of India / State Government / State Blindness

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Control Society. District Blindness control Societies are under the Chairmanship of the District Collectors. 16.3 The cataract, being the major cause for the avoidable blindness, was given importance and various infrastructure facilities like base eye wards, dark rooms etc., have been built till 2002 and are now in use. The State has been a pioneer in tackling blindness, particularly arising from cataract. 16.4 During the year 2012-2013, 6,17,581 persons have been done cataract surgery. Government has taken the following measures to increase the cataract surgeries in Government Institutions:i. The District Blindness Control Societies are permitted to hire private Ophthalmic Surgeons to do cataract surgeries in Government Institutions and pay Rs.150 per cataract case The District Blindness Control Society is permitted to hire private staff nurses trained in the field of ophthalmic surgery to assist cataract surgeries in Government Institutions and to pay Rs.50 per cataract case

ii.

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16.5 The following activities will be carried out during 2013-2014:i. ii. Performing cataract operations and fix Intra Ocular Lens (IOL) Screening of school children for detection of refractive error and provide free spectacles to poor children Collection of eyes for transplantation in persons with corneal blindness Providing training to eye surgeons in modern cataract surgery and other specialised procedures Enhancing capacities for eye care services in public sector by providing assistance to hospitals at various levels Development of eye banks and eye donation centres to facilitate collection and processing of donated eyes. Eye bank has been functioning at Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai in co-ordination with Lions International and also at Government Medical College Hospitals at Salem, Coimbatore and Vellore

iii. iv.

v.

vi.

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Chapter 17 REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP) 17.1 Revised National TB Control Programme (RNTCP) is implemented in the State, from the year 1999, in a phased manner. The entire State has been covered under RNTCP since 2002. The Revised National TB Control Programme aims at detecting maximum number of Tuberculosis patients, especially the sputum positive (infectious type) TB patients and curing them by Direct Observation Treatment Short course (DOTS) through DOT Centres. At the State level, State Health Society RNTCP which was formed under the Chairmanship of Secretary to Government (Health) has been merged with the State Health Society and the funding has been brought under the National Rural Health Mission. The Programme is implemented in close coordination with the Directorate of Public Health and Preventive Medicine. In the State, there are 142 TB Units. One TB Unit (TU) is formed for every five lakh population. Each TB Unit is manned by one

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of the PHC Medical Officers in the Unit, who is designated as Medical Officer (TB Control). He is assisted by one (Senior Treatment Supervisor (STS), and one Senior TB Laboratory Supervisor (STLS). For Multi drug resistant TB, four treatment centres are functioning at Government Hospital at Tambaram, Madurai, Vellore and Coimbatore. Designated Microscopy Centres (DMCs) and Specialty Laboratories 17.2 There are 791 Designated Microscopy Centres in the State. One Designated Microscopy Centre (DMC) has been formed for every one lakh population such that there are at least five DMCs functioning in each TB Unit. Each Microscopy Centre has one Laboratory Technician and has been provided with a Binocular Microscope. Distribution of Tuberculosis Drugs 17.3 The required Anti - TB drugs are supplied in Patient Wise Boxes (PWB) by the Central TB Division, New Delhi directly to the Government Medical Store Depot. From Government Medical Store Depot, the Drugs are transferred to the two State Drug Stores

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at Chennai and Tiruchirapalli. From these State Drug Stores, the drugs are distributed to the other districts. For the year 2012-2013 a sum of Rs.7.37 crore was allotted to Tamil Nadu under RNTCP. Government T.B. Sanatorium, Tambaram, Chennai 17.4 This Sanatorium is attached to the Government Stanley Medical College, Chennai. There is a rehabilitation centre called Amrith Nagar Colony attached to this Sanatorium. This centre was established on 25.08.1948 on the following objectives. i. To provide every individual member of the colony with work according to his capacity and to make room for fresh cases in the Sanatorium by transferring convalescent cases to the Colony To admit members into the colony who are non-infectious so that they could live with their families To provide occupations like printing and carpentry to begin with To pay remuneration to the members for work done To make arrangements for recreation and periodical medical examination

ii.

iii. iv. v.

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Amrith Nagar Colony occupies an area of 17.14 acres and situated about half a kilometer away from the TB Sanatorium, Tambaram. The centre is under the supervisory control of the superintendent Government T.B. Sanatorium, Tambaram and advised by an advisory committee for which he is the Secretary.

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Chapter 18 NATIONAL MENTAL HEALTH PROGRAMME Mental Health Care 18.1 The Institute of Mental Health, Chennai is the only Hospital functioning in the state for the treatment of Psychiatric patients. The Hospital has 1,800 beds and the patients from neighboring States are also coming to this Hospital for taking treatment. Besides giving treatment to mentally ill patients, the hospital also provides rehabilitation to the cured persons. The Government of India has permitted the Institution to start a PG Diploma course in Institute of Mental Health as a part of the Man Power Development Scheme under National Mental Health Programme. The existing N.R.Thiagarajar Hospital at Theni is also being converted as a Mental Hospital to take care of the mentally ill patients of the southern districts of Tamil Nadu. A Mental Health Rehabilitation Centre will be established at Erwadi in Ramanathapuram District. 18.2 Government of India has sanctioned a onetime grant under National Mental Health

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Programme for strengthening of psychiatric wings to the following Medical Institutions under the control of the Directorate of Medical Education:i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii. Madras Medical College, Chennai Government Kilpauk Medical College, Chennai Government Stanley Medical College, Chennai Chengalpattu Medical College, Chengalpattu Government Mohan Kumaramangalam Medical College Hospital, Salem Thanjavur Medical College Hospital, Thanjavur Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli Government Thoothukudi Medical College Hospital, Thoothukudi Government Coimbatore Medical College Hospital, Coimbatore Government Kanniyakumari Medical College Hospital, Nagercoil. Government Theni Medical College Hospital, Theni. Government Rajaji Hospital, Madurai.

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District Mental Health Programme 18.3 The District Mental Health Programme is a community based Programme based on the guidelines of National Mental Health Programme fully funded by the Government of India. A sum of Rs. 2.01 crore was allocated during 2012-2013. The aims of the District Mental Health Programme which is under implementation in the state are as follows i. ii. To create awareness regarding Mental Health in the community. To integrate and implement Mental Health Services through all the wings of the Health Department, To facilitate the early detection and treatment of the patient within the community itself. To reduce the stigma attached towards mental illness through change attitude and public education. To treat the rehabilitated mental patients discharged from mental hospital within the community.

iii.

iv.

v.

18.4 The programme is under implementation in the following 16 Districts

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of Tamil Nadu since the year indicated in Table No.21. Table No.21 - Districts implementing the District Mental Health programme
Sl. No 1 2 3 4 Name of the Districts Tiruchirapalli Madurai and Ramanathapuram Theni, Kanniyakumari, Dharmapuri, Erode and Nagapattinam Tiruvallur, Kancheepuram, Chennai, Cuddalore, Tiruvarur, Namakkal, Perambalur and Virudhunagar Year of Implementation 1997 2001 2005-2006 2007-2008

18.5 Implementation of District Mental Health Programme is proposed for the following six more Districts i. ii. iii. iv. v. vi. Coimbatore Pudukkottai Sivagangai Thoothukudi Villupuram Dindigul

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State Mental Health Authority (SMHA) 18.6 In 1994 the State Mental Health Authority - Tamil Nadu (SMHA - TN) was formed as a statutory body under section 4 of the Mental Health Act, 1987. It is functioning under the superintendence, direction and control of the State Government. The Secretary to Government, Health and Family Welfare Department is the Chairman. Seven other official are its members and three non-government experts in the field of psychiatry are its members. The authority is mandated with the responsibility of developing regulating and coordinating mental health services in the State. The office of State Mental Health Authority is functioning in the campus of Institute of Mental Health, Chennai from 01.08.2012. 18.7 The Institute of Mental Health at Chennai is the major Hospital under the Government sector offering all mental health related services. Further the Departments of Psychiatry headed by a senior Psychiatrist are functioning in all the Government run Medical College hospital taking care of teaching psychiatry to the medical students and providing treatment to

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mentally ill patients. Apart from these psychiatry units are being run in all the District headquarters hospital in the State. In so far as private sector is concerned there are a number of Private Mental Health Nursing Homes / Hospitals for which licence is granted by the Director, Institute of Mental Health. 18.8 The State Mental Health Authority provides mental health related services which include:i. Supervising the psychiatric hospitals/ Nursing homes and other Mental Health Services Agencies Advise the State Government on all matters relating to Mental Health Advocate for integration of mental health in general health care and in all social Development sectors.

ii.

iii.

18.9 The SMHA is striving to enhance the role of government in integrating mental health hospitals/ units, private organisations and the society at large thereby taking care of the mentally ill patients. From the societal point of view, State Mental Health

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Authority aims to increase the level of awareness and acceptance of the people towards the mentally ill patients and to provide a platform for harnessing their potential in order to mainstream them in the society.

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Chapter 19 NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMMES Dengue 19.1 Dengue fever is a mosquito borne virus disease. Dengue is reported in more than 107 countries and from almost all the states in India. Dengue is transmitted by Aedes species of mosquitoes. Last year a spurt in incidences of Dengue was seen in Tamil Nadu and due to the swift action taken by the Government, spread of the disease was controlled. Government of India has identified 31 Sentinel Surveillance Hospitals including Medical College Hospitals, Zonal Entomological Teams, Institute of Vector Control and Zoonoses, Hosur, King Institute of Preventive Medicine, Guindy and District Headquarters Hospitals, Cuddalore and Ramanathapuram for diagnosis of Dengue and Chikungunya. This facility has been extended to other Head Quarters Hospitals also by the Government. Elimination of vector breeding places, like artificial containers are critical for control of Aedes mosquito which spreads these diseases. Last year up to December 2012,

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13,204 cases were recorded and 66 deaths reported. Introduction of Indian medicines such as Papaya juice extract, Nilavembu and Malaivembu kudineer had a positive effect on control of Dengue. The disease is now under control and is under surveillance. Malaria 19.2 Malaria remains an important public health issue in few urban and rural areas viz., Chennai, Ramanathapuram, Thoothukudi, Dharmapuri, Krishnagiri, Tiruvannamalai and Kanniyakumari Districts. The total number of positive cases recorded in the State last year (up to December 2012) was 18,869 of which 37.8 percent were reported from rural areas, while 62.2 percent from urban areas. This disease also is now under control and is under surveillance. Japanese Encephalitis 19.3 Japanese Encephalitis (JE) is one of the public health problems in the state. Japanese Encephalitis Control Units at Cuddalore, Villupuram, and Perambalur with Monitoring Unit in Chennai are carrying out Japanese Encephalitis Vector Control

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activities. Districts such as Perambalur, Villupuram, Cuddalore, Tiruvannamalai, Virudhunagar, Tiruchirapalli, Thanjavur, Tiruvarur and Madurai report JE cases. JE vaccination is being carried out in the above said districts under routine immunization and all children at the age of 18 months are being immunized. JE vector monitoring is being carried out regularly in the endemic districts. Fogging operation is being carried out in villages where suspected JE cases are reported. 19.4 Acute Encephalitis Syndrome (AES) Surveillance is being carried out in District Head Quarters Hospitals, Medical College Hospitals and major private hospitals. Serum samples are taken from the AES cases for diagnosis of JE. Lab diagnosis is done in 7 Sentinel Surveillance Hospitals which includes King Institute of Preventive Medicine and six Medical College Hospitals. When JE is confirmed by laboratory diagnosis, necessary symptomatic treatment is given to the patient in Medical College Hospitals. During 2012, 954 AES cases with 72 deaths and 33 JE cases with 5 deaths have been reported. In Tamil Nadu five districts (viz.,) Villupuram, Madurai, Thanjavur, Tiruvarur and Karur have been

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identified as the focus districts under the control of JE/AES programme of Government of India. Acute Encephalitis Syndrome 19.5 Acute Encephalitis Syndrome (AES) is a general description of the clinical presentation of a disease characterized by high fever and altered consciousness, seizures, convulsions etc, mostly in children below 15 years. Acute Encephalitis Syndrome (AES) has a very complex etiology, and JE virus is only one of the many causative agents of encephalitis. Hence AES surveillance is being conducted to pick up all the JE cases. Existing system of Surveillance 19.6 Cases with signs and symptoms of Acute Encephalitis Syndrome are identified in all Government District Head Quarters Hospitals and Government Medical College Hospitals to pick up the JE cases. Serum / CSF is taken from the Acute Encephalitis Syndrome cases and sent to the Sentinel Surveillance Hospital for JE virus detection. There are seven Sentinel Surveillance Hospitals in Tamil Nadu where JE virus is detected by ELISA IgM test kit supplied by

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National Institute of Virology (NIV), Pune. Following are the list of Sentinel Surveillance Hospitals King Institute of Preventive Medicine, Guindy KAP Viswanatham Government Medical College, Tiruchirapalli Government Villupuram Medical College, Villupuram Government Thanjavur Medical College, Thanjavur Government Madurai Medical College, Madurai Government Tirunelveli Medical College, Tirunelveli Government Coimbatore Medical College, Coimbatore

The data for Acute Encephalitis Syndrome / Japanese Encephalitis in Government Hospital and Government Medical College Hospitals are collected by the Deputy Director of Health Services in the respective District and submitted to the state level. Case Management, Prevention and Control measures 19.7 Case Encephalitis management for Acute Syndrome / Japanese

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Encephalitis is done in all Government Hospital and Government Medical College Hospitals. The case which needs tertiary care is referred to Government Medical College Hospitals with Paediatric Intensive Care Unit (PICU) where the case management is done. For the prevention and control of Japanese Encephalitis, initially children in the age group of 1-15 years were given SA 14-14-2 type of JE vaccine in campaign mode. Cuddalore, Villupuram, Virudhunagar, Tiruchirapalli, Tiruvarur, Madurai, Perambalur, Thanjavur and Tiruvannamalai districts were covered by campaign and later included under routine immunization for children in the age group of 16 months. Vector control activities are done by outdoor thermal fogging using technique. Malathion to reduce the JE vector density in all AES/JE reported areas. Villupuram, Thanjavur, Tiruvarur, Karur and Madurai are the priority districts for this disease. Filaria 19.8 The National Filarial Control Programme is under implementation in the State from 1957. The filarial disease control activities are carried out in 43 urban areas. In these urban areas, 25 control Units and

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44 Night Clinics are functioning. Mass Drug Administration programme with Diethyl Carbamazine Citrate (DEC) tablet was started in 1996 in Cuddalore District as a pilot project. Single dose mass DEC drug administration programme is being carried out from 1997-98 in all endemic districts. Diethyl Carbamazine Citrate (DEC) tablets are supplied by the Government of India. The entire operational cost is met by the State Government. Self-care practices training for the Lymphoedema cases and Hydroceletomy for hydrocele cases are organized. 33,947 Lymphatic filariasis cases have been recorded in this state. Morbidity management kits are also issued to these patients for foot care. A sum of Rs.400 per month was given to Grade IV Lymphatic Filaria patients. This has been enhanced to Rs.1,000 per month now. Mass Drug Administration for 2012 was conducted on 29th April, 2012 and 26th August, 2012 with coverage of 94.1% for which Rs.4.00 crore was allotted by Government of India. Chikungunya 19.9 Chikungunya is caused by mosquito borne virus transmitted to humans by Aedes mosquitoes. There is a decline in Chikungunya cases due to the control

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measures taken by the Department. Up to December 2012, 5,356 cases were suspected out of which 514 cases were confirmed and treated. Leptospirosis 19.10 Leptospirosis is one of the serious zoonotic diseases which require timely diagnosis, treatment and control measures. Seven leptospirosis clinics are functioning in Tiruvallur and Madurai districts for diagnosis and treatment. Rapid diagnostic kits have been supplied to these clinics and the nine Zonal Entomological Teams in the state. The Institute of Vector Control and Zoonoses, Hosur is given the responsibility of investigation during outbreaks with specialized Team. A State Level Reference Laboratory is functioning at State Head Quarters to provide laboratory confirmation and training. Up to December 2012, 3,587 cases were recorded of which only one death was confirmed. Vector borne diseases control and epidemic control activities 19.11 Tamil Nadu is one of the top States in most of the health indicators. The State is also at the forefront in eliminating communicable diseases.

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19.12 On this issue, Honble Chief Minister conducted a series of review meetings and issued detailed instructions. Accordingly, at the district level, the District Collectors have been coordinating the control measures by involving all the departments. Some of the important actions implemented based on the decisions of review meetings conducted by the Honble Chief Minister were i. Release of short films and advertisements educating the masses of their role in preventing mosquito breeding Increase in the number of Elisa Test Centres from 31 to 60 Making available adequate cell counters, medicine, blood and blood components Conduct of fever camps Sending medical teams to the districts that reported higher incidence of fever Organizing entomological surveillance report based actions Putting in place 10 persons per block under the Health Department, 20 persons per block through the Rural Development Department and

ii. iii.

iv. v. vi. vii.

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viii. ix.

additional labourers in Town Panchayats/Municipalities and Corporations for identifying and eradicating sources of breeding Providing adequate equipment for vector control Providing traditional medicines and promoting natural healing through Indian Systems of Medicines

19.13 The District Collectors take continuous action to conduct and review and control of these diseases at the field level.

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Chapter 20 NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES AND CARDIOVASCULAR DISEASES 20.1 Most forms of cancer are curable when detected and treated early. Besides Arignar Anna Cancer Institute, Karapettai, Kancheepuram, a Regional cancer centre each at Madurai and Coimbatore have been established to improve the treatment facilities of increasing cancer patients of Southern and Western regions of the State. In the current year, it is proposed to establish regional cancer centres at Thanjavur and Tirunelveli Medical College hospitals at a cost of Rs.30.00 crore. In order to provide specialized and comprehensive cancer care and to provide training and research pertaining to all types of cancer with focus on oral, cervical and breast cancer, Government have identified the following six institutions: i. ii. Government Arignar Anna Memorial Cancer Institute, Kancheepuram Mahatma Gandhi Memorial Government Hospital, Tiruchirapalli

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iii.

iv. v.

vi.

Institute of Non communicable Diseases and Government Royapettah Hospital, Chennai Rajiv Gandhi Government General Hospital, Chennai Institute of Obstetrics and Government Hospital for Women and Children, Chennai Government Thanjavur Medical College Hospital, Thanjavur

20.2 Under National Programme for control of Cancer, Diabetes, Cardio-Vascular Diseases and Stroke provision has been made for purchase of certain modern equipment for Treatment of Cancer. The state is also creating more regional cancer centres.

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Chapter 21 NATIONAL TOBACCO CONTROL PROGRAMME 21.1 The National Tobacco Control Programme is being implemented in Tamil Nadu since 2003. The State Tobacco Control Cell is functioning under the Director of Public Health and Preventive Medicine since 2007. The District Tobacco Control Cell has been formed in all the districts and functions under the supervision of the Deputy Director of Health Services. Under the National Tobacco Control Program, two districts namely Villupuram and Kancheepuram have been selected as pilot districts for implementation of the District Tobacco Control Programme. Government of India has provided financial assistance of Rs.50.67 lakh. So far, 68,376 violators have been fined for a total of Rs.77.46 lakh. Smoke Free Chennai 21.2 The State Tobacco Control Cell has been functioning under the Smoke Free Chennai project under the support of Bloomberg Global Initiatives. Four enforcement vehicles are covering Chennai

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city and other suburban areas to create awareness and enforcement of tobacco control laws. Capacity building workshops have been conducted for various Government and Private sector people in Chennai.

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Chapter 22 NATIONAL LEPROSY ERADICATION PROGRAMME 22.1 National Leprosy Eradication Programme (NLEP) was launched in 1954-1955 with the main thrust in detection and regular treatment of all leprosy patients. Multi Drug Therapy was launched in 1983 in a phased manner and a complete geographical coverage in the State was achieved in 1991. The prevalence rate 118/10,000 population in the year 1983 was brought down to 0.42/10000 population in 2012. The vertical programme had been integrated with General Health Care System during 1997. Out of 385 blocks, 50 blocks are identified as High Endemic areas and focused activities are carried out in these blocks.

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Chapter 23 ACCIDENT AND TRAUMA CARE CENTRES 23.1 The Government has been taking a number of initiatives to reduce the deaths due to traffic accidents. In the multi pronged approach, use of 108 ambulances have reduced the reaction time to about 20 minutes thereby ensuring that the accident victims are attended to. The Transport department has also identified the hot spots and has taken up a number of measures on its part apart from education of the road users. In order to develop a network of Trauma Care Centres along with Golden Quadrilateral of the National Highways and to provide Trauma services for the accident victims, the Government of India have introduced a scheme. The Government of India has released funds for development of network of Accident and Trauma Care Centre in the following institutions: i. ii. iii. Government Vellore Medical College Hospital, Vellore Government Kilpauk Medical College Hospital, Chennai Government Rajaji Hospital, Madurai

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iv. v. vi.

Government Tirunelveli Medical College Hospital, Tirunelveli Government Kanniyakumari Medical College Hospital, Nagercoil Government Mohan Kumaramangalam Medical College Hospital, Salem

Upgradation and Strengthening of Trauma Care Centre 23.2 During the 11th Plan period (2007-2012), the Government of India has upgraded and Strengthened the Trauma Care Centres in certain Government Hospitals located along Golden Quadrilateral, North-South, and EastWest corridors of National Highways. Under the above scheme, the Government of India have released a total amount of Rs.2.75 crore as grants-in-aid for construction of building only for Trauma Care centre in Government District Headquarters Hospitals at Karur, Krishnagiri, Kovilpatti and Dindigul. 23.3 Building work for Trauma Care Centre at Government District Head Quarters Hospitals Krishnagiri, Dindigul and Kovilpatti have been completed and these Trauma

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Care Centres are now functioning. The building work for Trauma Care Centre in Government District Headquarters Hospital, Karur is nearing Completion. These centres are being equipped with necessary infrastructure to ensure quality care.

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Chapter 24 CHIEF MINISTERs COMPREHENSIVE HEALTH INSURANCE SCHEME 24.1 In order to achieve the objective of Universal Health Care to the People of Tamil Nadu, the Government have issued orders for implementation of a New Insurance Scheme, the Chief Ministers Comprehensive Health Insurance Scheme. Families with an income of Rs.72,000 per annum or below are eligible under the new scheme. The sum assured is Rs.1/- lakh per year per family, along with a provision to pay upto Rs.1.50 lakh per year per family for certain specified 77 procedures; Rs.4 lakh coverage is also being provided to each family in 4 years. The new scheme covers 1016 procedures which include 23 important diagnostic procedures and 113 follow up procedures. So far, Rs.1.07 crore smart cards have been distributed in the districts. 24.2 For identifying the beneficiaries under the scheme, new smart cards are being generated by using the existing data base and distributed to the beneficiaries. Additional new enrollment is done through

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District kiosks established in the District Collectorates. As on 31.3.2013, 817 hospitals have been empanelled to provide treatment, including all the Government Medical College Hospitals and the District Head Quarters Hospitals. Till 31st March 2013, 2.96 lakh persons have benefited under the scheme with the approved amount being Rs.623.58 crore. Out of this, 1,04,953 beneficiaries have been treated in Government Hospitals at an insurance coverage of Rs.217.70 crore. 24.3 Surgeries such as Liver Transplantation, Renal Transplantation including post transplant procedure for immunosuppressant therapy, Bone marrow transplantation, Cochlear implantation and stem cell transplantation cost more than Rs.1.50 lakh and range from Rs.3 lakh to Rs.22 lakh. It is not possible for the poor patients to pay the extra cost for the surgery. Hospitals approved under the scheme cannot also be insisted upon to perform the surgeries within the cost of Rs.1.50 lakh. The Honble Chief Minister has, therefore, announced the creation of a Corpus Fund of Rs.10.00 crore to help the needy and poor people, especially children, who have to undergo such costly surgeries. The extra cost of the surgery exceeding the

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eligible amount Rs.1.50 lakh per annum is to be met from this Corpus Fund. The patient who needs to undergo the specialized surgery need not pay any amount from his / her personal sources. The entire cost of specialized surgery will be borne by the Insurance Company upto Rs.1.50 lakh and the remaining amount will be met from the Corpus Fund. All such cases are cleared by an Expert Committee. TAMIL NADU STATE ILLNESS SOCIETY 24.4 Government of India had requested the State Governments to constitute a Revolving Fund for extending financial assistance to the poor with the contribution received both from the Government of India and State Government. Accordingly, the Government of Tamil Nadu have constituted a Revolving Fund by name Tamil Nadu State Illness Assistance Society in the ratio of 2:1 (Two shares by State Government and one share by Government of India) with an initial corpus of Rs.15 crore and have also formed Tamil Nadu State Illness Assistance Society (Registered on 20.03.1998 under Tamil Nadu Societies Registration Act 1975) to administer the fund. The affairs of the Tamil Nadu State Illness Assistance Society is administered by

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the Executive Committee under the Chairmanship of the Secretary to Government, Health and Family Welfare Department and the Director of Medical and Rural Health Services as the Member Secretary. The objective of the scheme is to render financial assistance from Rs.5,000 to Rs.25,000 according to the nature of surgery to Below Poverty Line people. Through this society, there are two patterns of assistance offered Revolving fund fixed to the 14 Government Medical College Hospitals for performance of specified surgeries by paying cost of consumables, which works out to Rs.2.90 crore per annum ii. Revolving fund fixed to the 32 District Collectors for disbursement of Financial Assistance of Rs.25,000 to the individuals / at accredited private hospitals, after the performance of specified surgeries / treatment and after the issuance of Government Order in each case and this revolving fund works out to Rs.3.95 crore per annum. i.

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Chapter 25 IMPORTANT ACTS Pre-conception and Pre-Natal Diagnostic (Prohibition of Sex Selection) Act, 1994 25.1 The female sex ratio declines mainly due to female foeticide, infanticide and neglect of female child from birth. In order to prevent Sex determination, the Government of India has enacted the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994. The object of the Act is to eradicate female foeticide and for maintaining the high level juvenile sex ratio (0-6 years) and male and female ratio. 25.2 For effective implementation of this Act, the State, District and Sub-District level Advisory Committees have already been formed. At State level there is Multi Member Appropriate Authority wherein the Director of Medical and Rural Health Services is the Chairperson, the other members are the Secretary, Guild of Service, Chennai and Deputy Secretary to Government, Law Department. For the District Level, District

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Collector is the District Appropriate Authority. For SubDistrict Level, Revenue Divisional Officer is the Sub-District Appropriate Authority. Under the Act all such organizations involving in the Pre-Natal Diagnostic Techniques should register themselves with the Appropriate Authorities. Offences under the Act such as non-registration and misusing the equipments to disclose the sex of the foetus are punishable as cognizable, non-bailable and non-compoundable offences up to 3 years of imprisonment. The doctors who are found indulging in malpractices are also liable to lose their Registration for Medical Practice. So far 4,978 scan centres have been registered under the Act and cases have been filed against 72 scan centres for the violation of this Act. Judgment had already been delivered in 62 cases and 10 cases are under trial. This Act is implemented very strictly in the Taluks and Districts where the juvenile sex ratio is below the State level of 946 by maintaining constant vigil over the scan centres and MTP centres.

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TRANSPLANTATION OF HUMAN ORGAN ACT, 1994 25.3 The Act has been enacted by the Government of India during the year 1994 to eradicate human organ trade and to promote Cadaver Organ Transplantation programme. The transplantations are being done only in the approved hospitals in Tamil Nadu. The Hospitals which are applying for registration under the Transplantation of Human Organ Act, 1994 are inspected by a team of specialists and the senior member among the team is the convener and co-coordinator of the team. The team inspects the hospitals and furnish the inspection report in the prescribed format. The Director of Medical and Rural Health Services is the State Appropriate Authority for issuing the Registration Certificate based on the inspection report to the Government / Private Hospitals. The Tamil Nadu Government has constituted three Authorization Committee region wise at Chennai, Madurai and Coimbatore for scrutiny of each and every non relative case for approval of organ transplantation.

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25.4 Accordingly, the registered hospitals, region wise submit their application for organ transplantations to the respective Authorization Committee. The donors and the recipients have to appear before the Committee. Each and every case of non relative is verified and approved by Committee for carrying out the transplantations. In the State 72 hospitals are registered under this Act for performing renal, heart, liver, lungs and corneal transplantations. Cadaver Transplant Programme 25.5 In order to curtail human organ trade and to save the lives of patients who are in critical stages of disease by utilizing the organs of brain death patients, the State had initiated this programme during the year 2008. Now, Tamil Nadu ranks top at the national level in the implementation of the Cadaver Transplant Programme. This programme is supported by an Advisory Committee that has been formed to establish formats and procedures, to oversee compliance with procedures, to ensure stability of functioning of the programme and to recommend a coordinating body to institutionalize and

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streamline the programme. Currently 38 Hospitals are involved in this programme. The Rajiv Gandhi Government General Hospital, Chennai and the Stanley Hospital, Chennai are actively involved in the programme. Transplant hospitals in the State have been divided into three zones and organ donations from cadaver arising in a zone are allocated first within that zone as detailed belowNorth Zone South Zone West Zone Chennai and neighbourhood, Vellore Tiruchirapalli, Madurai, Tirunelveli, Nagercoil Coimbatore, Erode, Salem

Up to March 2013, there are 324 donors and 1820 organs were harvested out of which 959 were major organs (Heart, Lungs, Liver and Kidneys). Civil Registration system 25.6 Tamil Nadu has a long tradition of registration of births and deaths. Prior to the introduction of Registration of Births and Deaths Act, 1969 by the Government of India, registration of births and deaths in

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Tamil Nadu was carried out under the provisions of Madras Panchayats Act 1899 in Rural Areas, the Madras Districts Municipalities Act, 1920 in the Municipalities and selected Town Panachayats and the Madras City Municipal Act 1919 in Chennai Corporation. There are 16,046 Registration Units in 32 Revenue Districts including Chennai Urban District. The Registration of Births and Deaths was made compulsory at the place of occurrence. With the introduction and implementation of Tamil Nadu Registration of Birth and Death Rules, 2000 with effect from 1.1.2000 in accordance with the provisions of sec. 30 of The Registration of Births and Deaths Act 18 of 1969. The registration of Birth and Death should be done within 21 days of its occurrence. The Birth and Death Registration system has been computerized in the entire rural and urban areas of Tamil Nadu. In Chennai Corporation, the Birth and Death Certificates are issued online. Tamil Nadu has achieved 98% in birth registration and 91% in death registration during 2010.

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Issue of Free Birth Certificates at PHCs 25.7 Since the implementation of Birth and Death Registration at Primary Health Centre level from 2009 August, 9,80,780 Free Birth Certificates have been issued up to February, 2013 to the beneficiaries in the state. Medical Certification of Cause of Deaths (MCCD) 25.8 The MCCD scheme is a part of Civil Registration System and is the only source which provides cause specific mortality data. The scheme was introduced in seven selected Municipalities and Chennai Corporation during 1969 and later it was extended to all Municipalities and Corporations from 1980. To improve Medical Certification of Cause of Death, regular trainings are given to doctors every year.

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Chapter 26 EDUCATION, TRAINING AND RESEARCH The Tamil Nadu Dr. M.G.R. Medical University 26.1 The details of the University and about medical education have been given in chapters two, three and eight. As mentioned earlier, the Tamil Nadu Dr.M.G.R. Medical University was started to promote academic excellence, research and advancement of knowledge in the field of Medical and Para Medical Education. At present, 328 institutions, conducting various courses in Medicine and allied sciences, are affiliated to this University. The University Library serves as a Regional Medical Library and Medical informatics centre. King Institute of Preventive Medicine and Research 26.2 King Institute of Preventive Medicine was established on 07.11.1899. Started as a Depot for Small pox vaccine by the British Government, it is named after Lieutenant Colonel W.G.King, FMS, and the then

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Sanitary Commissioner to the Madras Presidency. It is unique in its activities production of vaccine and sera, academic activities, diagnostic work (bacterial & viral), certification of schedule -C drugs. The institute is under the administrative control of Directorate of Medical Education since 1966. In the past, during epidemics in Tamil Nadu, King Institute played an important role by way of production and supply of Anti Cholera and Anti Typhoid Vaccines. It was originally designed to serve as a Vaccine Lymph Depot of State. This institute has been developed into a major Public Health Laboratory in the country, manufacturing human vaccines and sera with allied Teaching and Research in the field of Microbiology. The institute has facility for identifying 23 different types of viruses. International Vaccination Centre 26.3 Functioning for the past 40 years, this Centre is one among the 14 centres recognized by the Ministry of Health, Government of India. This centre mainly deals with the inoculation of Yellow Fever vaccine and issue of International Vaccination Certificate to the public

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traveling to Yellow Fever endemic areas. Haj Pilgrims are inoculated with Meningococcal vaccine. Training and Continuing Health Education Programme under Public health 26.4 Continuing education, in-service training and pre-service training programmes are organized for the health officers, medical officers, nurses and other paramedical staff through six regional training centres namely Institute of Public Health, Poonamallee, Health and Family Welfare Training Centres at Egmore, Madurai and Gandhigram, Health Manpower Development Institutes at Villupuram and Salem, Regional Institute of Public Health, Thiruvarankulam and Institute of Vector Control and Zoonoses, Hosur. The institute of Public Health, Poonamallee is recognized as a national collaborative training centre for various programmes organized by the Reproductive and Child Health Programme and the National Rural Health Mission. 26.5 Multi skilling, task shifting training programmes are organized for medical officers in life saving anesthesia and

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obstetrics for a period of six months to improve the availability of specialist services in rural areas particularly in Primary Health Centres. Ultra sonogram training is given to PHC doctors for detection of congenital deformities during pregnancy in coordination with renowned private sector ultra sound agencies. Skill Birth Attendant training, training on integrated management of newborn and childhood illnesses and immunization training are organized for improving the mother and child care services in PHCs. 26.6 The Multi Purpose Health Worker (Male) Training Course is conducted in Medical Colleges and Regional Training Centres. During 2011-2012 three hundred candidates were trained and during 2012-2013, permission has been accorded to train 600 candidates. The Auxiliary Nurse Midwife (ANM) course is being conducted in seven ANM training schools. Three new ANM training schools at Theni, Namakkal and Sivagangai districts are being established in Tamil Nadu with assistance from the Government of India. ANM training has been started during the current year for filling up of the existing vacancies of Village Health Nurses and Auxiliary Nurse Midwives.

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E-Governance in Public Health 26.7 The Directorate of Public Health and Preventive Medicine is actively implementing the e-governance policy of the government. All the PHCs are provided with computers and internet connectivity. Web portals are developed and used for data management at various levels. The List of Web Portals include Pregnancy and Infant Cohort Monitoring and Evaluation (PICME), Dr.Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS), National Anti-Malaria Management Information System (NAMMIS), Specialty Medical Camps, Health Management Information System (HMIS), Communicable and Non-Communicable Diseases data, Civil Registration System (CRS), National Rural Health Mission (NRHM-MIS), Integrated Disease Surveillance Project (IDSP) and Central Plan Scheme Monitoring System (CPSMS). 26.8 In addition regular training is organized for various levels under the institutions under DME and DMS and DPH. The Health Systems project and the National Rural Health Mission also have allocated funds for training.

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The department is taking continuous steps as per saying Health is Wealth and to realize the objectives of the Vision 2023 released by the Honble Chief Minister. K.C.VEERAMANI Minister for Health