Index

Sl. Page
CHAPTER
No. No
1 Introduction 1-31
2 History 32-36
3 Health Administration 37-42
4 Medical Education 43-59
5 Medical and Rural Health 60-70
Services
6 Public Health and Preventive 71-91
Medicine
7 Family Welfare Programme 92-107
8 Medical and Rural Health 108-109
Services (Employees' State
Insurance Scheme)
9 Indian Medicine and 110-130
Homoeopathy
10 Food Safety and Drugs 131-145
Administration
11 Tamil Nadu State Health 146-150
Transport Department
12 Human Resources and Medical 151-156
Services Recruitment Board

i
13 Tamil Nadu Medical Services 157-165
Corporation Limited
14 Tamil Nadu Urban Health Care 166-169
Project
15 Tamil Nadu Health Systems 170-172
Reforms Project
16 Tamil Nadu State AIDS Control 173-190
Society
17 National Health Mission – Tamil 191-291
Nadu
18 Chief Minister’s Comprehensive 292-300
Health Insurance Scheme
19 ‘108’ Emergency Care Services 301-310
20 Communicable Diseases 311-333
21 Revised National Tuberclosis 334-342
Control Programme
22 National Tobacco Control 343-346
Programme
23 The Tamil Nadu Dr.M.G.R 347-355
Medical University
24 Certain Important Acts 356-367
25 Research and Training 368-377

ii
 Chapter – 1

INTRODUCTION

c‰wh‹ msΫ ÃâasΫ fhyK«

f‰wh‹ fU¢ braš – FwŸ 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 committed to

build a healthy society not only by providing
quality medicare facilities throughout the State
but also by ensuring medical services of the
highest order, keeping pace with rapid
technological developments in the field of
medicine. A vibrant health policy that ensures
prevention of diseases, easy accessibility of
services, availability of doctors and para medical
human resources and qualitative treatment is
the mandate of the Government. The focus of
this Government is to transform the society into
a healthy one.

1
1.2 Tamil Nadu has emerged as a model State
in the country in providing health care services.
It has already achieved the Millennium
Development Goals (MDG) and also Sustainable
Development Goals (SDG) set by the United
Nations Organization (UNO), far ahead than
most other Indian States. A significant
reduction in Infant Mortality Rate (IMR) from 24
per thousand live births in 2010 to 16 in 2017 as
per Sample Registration System (SRS) Data
2017 against the National IMR of 33, substantial
reduction in Crude Birth Rate (CBR) over the
same period and also reduction of Maternal
Mortality Ratio (MMR) from 90 per one lakh live
births in 2010-2012 to 66 in 2014-2016 as per
SRS Data 2014-2016 are indicative of the
robust policy frame work and also sincere efforts
of this Government to improve the health profile
of the State. Tamil Nadu has received award
from the Government of India for the reduction
of MMR to 66 per one lakh live births well ahead
of the time set by the SDG of 70 per one lakh
live births by 2030 in MMR. While Institutional
delivery in Tamil Nadu is almost 100 percent,
65% of the deliveries take place in Government
Medical Institutions.

2
1.3 Tamil Nadu is recognized as one of the best
performing States in the Health Sector. The
primary, secondary and tertiary health care
delivery systems are being strengthened utilizing
the financial resources from the National Health
Mission, Tamil Nadu Urban Health Care Project
funded by the Japan International Cooperation
Agency (JICA), besides State funding in such a
way that health care is delivered efficiently to all
the people in the State.

1.4 Government of Tamil Nadu has introduced

several landmark schemes such as starting of
Tamil Nadu Medical Services Corporation
(TNMSC), Tamil Nadu State AIDS Control
Society (TNSACS), Transplant Authority of Tamil
Nadu (TRANSTAN) on the one hand and
implementation of pioneering schemes at the
State level such as Dr.Muthulakshmi Reddy
Maternity Benefit Scheme, Chief Minister’s
Comprehensive Health Insurance Scheme,
Menstrual Hygiene Programme, Birth Companion
Programme, Amma Baby Care Kit, Amma
Arogya Thittam, Amma Whole Body Check-up,
Amma Magaperu Sanjeevi among others.
Ensuring access to the Comprehensive

3
Emergency Obstetric and Newborn Care
(CEmONC) Centres, Neonatal Intensive Care
Units (NICU), Blood Banks and Blood Storage
Centres have been pivotal to the improvement in
maternal and child health. Many novel schemes
such as TNMSC, Maternal Death Audit, Birth
Companion Programme have been replicated in
many other States. Tamil Nadu has been
adjudged as the best State in the country in
terms of deceased organ transplantation and
also has the distinction of bagging four
consecutive Best State Award for the years from
2015 to 2018.

1.5 The Government has brought the Tamil

Nadu Clinical Establishment (Regulations)
Amendment Act, 2018 and the Tamil Nadu
Clinical Establishment (Regulation) Rules, 2018
to implement the Tamil Nadu Clinical
Establishment (Regulation) Act, 1997 for
registration and regulation of all clinical
establishments in the State and to prescribe the
minimum standards of facilities and services to
be provided by them. This is a milestone in the
health sector. As per the Act and the rules

4
made thereunder, all the Clinical establishments
in the State will have to be registered.

Today, Tamil Nadu is viewed as the

ultimate health care destination in India and it
attracts medical tourism not only from other
States of the country but also from the other
countries around the World.

State Profile

1.6 Tamil Nadu is the seventh most populous

State in the country with a population of 7.21
crore as per 2011 census with Decadal Growth
Rate of 15.6%. The State has 33 Revenue
Districts. For the management of public health
services, the State has been divided into 42
Health Unit Districts in addition to Chennai
Corporation. Tamil Nadu is one of the best
performing States in terms of implementing
Reproductive and Child Health schemes and has
already achieved the National Health Mission /
Reproductive Child Health goals. The department
has staff strength of over one lakh persons
serving for an average of 6.5 lakh out-patients
and 70,000 in-patients per day. Niti Aayog and
many independent review missions have
commended the performance of the State.

5
 Current Scenario

1.7 Medical and Health facilities in Tamil Nadu

have grown rapidly. The details of Government
Medical and Health Facilities in Tamil Nadu is
given below:

Sl.
Description Units
No.
1 Government Medical Colleges 24
Hospitals attached with the
2 50
Medical Colleges
Tamil Nadu Government Multi
3 1
Super Speciality Hospital
Tamil Nadu Government Dental
4 1
College and Hospital
5 District Headquarters Hospitals 29
6 Taluk and Non-Taluk Hospitals 273
7 Primary Health Centres (PHCs) 1,806
8 Health Sub Centres (HSCs) 8,713
Urban Primary Health Centres
9 (UPHCs) including Chennai 460
Corporation
New Community Health Centres
10 15
(CHCs) being established under

6
Sl.
Description Units
No.
NHM in Chennai Corporation
Employees’ State Insurance (ESI)
11 10
Hospitals
12 ESI Dispensaries 216
Indian System of Medicine
13 1,534
Hospitals and Dispensaries

With the network of primary, secondary, tertiary

care hospitals and a plethora of cross cutting
programmes such as the National Health
Mission, AIDS Control Society, Maternal and
Child Health initiatives, Indian Medicine, 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. The State has a
robust public private partnership by which the
people are able to access the best of the
services in the Government and private sector
through the landmark Chief Minister’s
Comprehensive Health Insurance Scheme
(CMCHIS), free of cost. The World Bank has

7
come forward to provide funding support of
Rs.1,999.902 crore for implementing Tamil Nadu
Health Systems Reforms Programme to improve
the access of the poor and disadvantaged to the
Government health facilities and Programme
Agreement with the World Bank has been signed
on 4.6.2019 and implementation is under
progress.

1.8 The schemes of the Government are

described in detail in the rest of the Chapters of
the Policy Note, while a summary of few
significant achievements are narrated below:

Significant Achievements in the Health

Sector during the last Eight Years

Health Indicators

 Infant Mortality Rate (IMR) which was

24 in 2010 has been reduced to 16 per
1,000 live births in 2017 as per SRS data
2017 against the National IMR of 33. This
Government has received a sum of
Rs.489.40 crore during the period from
2012-2013 to 2014-2015 as incentive from

8
 the Government of India for reducing the
IMR.

 Maternal Mortality Ratio (MMR) was 90

in 2010-2012 and this has been reduced to
66 per one lakh live births as per latest SRS
data 2014-2016. Now, it is further reduced
to 60 as per 2018 State Health Management
Information System Data. The current MMR
of India is 130.

 Total Fertility Rate (TFR) is 1.6. The

target of 12th Five Year Plan has already
been achieved by the Government. This is
the lowest in the country against the India’s
status of 2.3. The above lowest rate is
maintained by the State for the last three
years.

State Schemes

 Chief Minister’s Comprehensive Health

Insurance Scheme, one of the flagship
schemes of the Government, was introduced
in 2012 for providing treatment to the public
in the Government and private sector
hospitals. Smart Cards were issued to 1.58

9
crore families, whose annual income is less
than Rs.72,000. After successful
implementation for five years, the scheme is
continued from 11.01.2017, through the
United India Insurance Company Limited,
which is a public sector company.
Treatment is provided for 1,027 medical &
surgical procedures, 154 specialized
procedures, 154 follow up procedures, 38
standalone diagnostic procedures and 8
High end procedures. 977 hospitals
including all the Government Medical
Colleges Hospitals and the District
Headquarters Hospitals are empanelled to
provide treatment under this scheme.
Migrants including construction workers who
reside in the State for more than six months
are included and orphans as defined by the
State Government are given Insurance
Card. So far, 35.25 lakh persons have got
benefitted for Rs.6,027 crore from
11.01.2012 under this scheme. Patients got
treated in Government hospitals at a cost of
Rs.2,163 crore.

10
  A Corpus Fund has been created with the
Government contribution of Rs.35 crore and
contribution from insurance receipts in
Government Hospitals to meet the
expenditure towards eight specialized high
end surgeries requiring amount higher than
Rs.2 lakh and so far, 7,588 beneficiaries
have been benefitted and the total approved
amount is Rs.563.02 crore.

 Dr.Muthulakshmi Reddy Maternity

Benefit Scheme (MRMBS) and Amma
Maternity Nutrition Kit: Tamil Nadu is the
only State in India implementing
Dr.Muthulakshmi Reddy Maternity Benefit
Scheme, providing financial assistance of
Rs.12,000 since 2011 to pregnant mothers
compensating for the loss of wages during
pregnancy and to meet the expenses on
nutrition diet. Financial assistance of
Rs.12,000 hitherto has been increased to
Rs.18,000 with effect from 1stApril, 2018.
Under the scheme, two Amma Maternity
Nutrition Kits are given comprising of iron
tonic, and nutrition supplement to reduce
Anaemia amongst pregnant women and

11
 improve the birth weight of infants. Hon’ble
Chief Minister inaugurated the distribution of
Nutritious kits to the pregnant mothers on
04.03.2019. During the last 8 years, 53.78
lakh pregnant and delivered mothers received
the financial assistance of Rs.5,233.17 crore.

 Menstrual Hygiene Programme has been

introduced to promote hygiene among the
adolescent girls. Under this scheme,
priceless sanitary napkins are distributed
annually to around 32.79 lakh adolescent
girls at an annual cost of Rs.61 crores.

 Hospital on Wheels Programme are

functioning with 416 teams. Every month
40 camps are conducted in each block. Over
10.53 crore persons have availed benefits
from 15.10 lakh camps conducted so far.
The scheme is under implementation from
2011-2012 onwards in all the 385 Blocks
with modern Medical and Lab Investigation
facilities.

 Amma Baby Care Kit containing 16 items

at a cost of Rs.1,000/- per kit has been
provided to the mothers of about 6.7 lakh

12
 children born annually in the Government
Hospitals for improving the hygiene of the
post-natal mothers and newborn babies and
the scheme has been inaugurated by
Hon’ble Chief Minister on 08.09.2015. Under
this scheme, 17,70,393 delivered mothers
have been given these kits up to March
2019.

 Amma Arokiya Thittam, provides an

opportunity for people aged above 30 years
living in rural areas to have access to basic
health checkup on annual basis in a nearby
health facility. 25 parameters are screened
under this program in 501 PHCs including
urban areas. 49.14 lakh people have been
screened up to March 2019

 Amma Whole Body Health Check-up

and Amma Women Special Check-up is
being implemented since 01.03.2016 in
Government General Hospital, Chennai in
the first phase. So far, 33,631 persons have
undergone this whole body health check-up.
This programme has been extended to
Tamil Nadu Government Multi Super

13
 Speciality Hospital, Omandurar Estate,
Chennai and has been inaugurated on
08.06.2018 by Hon’ble Chief Minister. So
far, 6,323 persons undergone the medical
check-up. This programme is being
extended to the Government Medical
College Hospitals at Coimbatore, Madurai
and Tirunelveli.

 “104” Health Helpline cum

Telemedicine Service was introduced on
30.12.2013 for providing free access to
health information, health guidance and
grievance redressal. 35.24 lakh calls were
received from the public till March 2019 and
health information provided.

 Breast Milk Banks have been started in 25

Government Medical College Hospitals and
District Headquarters Hospitals. Separate
feeding rooms have been established in 352
Bus stands and Terminals to enable the
feeding mothers to breast feed their new
born child in a safe enclosed room.

14
 Schemes under National Health Mission

 Rashtriya Bal Swasthya Karyakram

(RBSK) is a child health screening and
early intervention service with the aim to
screen all children from 0-18 years for four
diseases namely defects at births, disorders,
deficiencies and development delays
including disabilities. 770 mobile health
teams in rural blocks, 15 mobile health
teams in Chennai Corporation and 12
mobile health teams in other corporations
are screening the children in the
Anganwadis, Government and Government
aided schools.

Under RBSK, during the year 2018-

2019, 1.21 crore children were screened in
schools and Anganwadi centres. 6,44,175
children were identified with disease
conditions and 5,19,288 children were
referred and treatment provided at
secondary and tertiary care institutions.
From April 2015 to March- 2019, 16,380
children have been identified for surgeries

15
 and of which 13,894 children have been
managed surgically.

 108 Ambulance Services: 108 ambulance

service is successfully being operated in
Tamil Nadu through a single Toll free
number and the services are available on
24x7 basis free of cost to the public. 940
ambulances are in operation under the 108
emergency ambulance service and since
2011-2012, 74.09 lakh people availed the
services including 18.61 lakh pregnant
mothers. First time in the Government
sector in India, Neonatal Emergency
Ambulance services have been introduced
to reduce neonatal mortality. 76 Four
Wheel Drive Ambulances are in operation in
difficult terrains. First Responder Bike
Ambulance Service has been introduced
with 41 two wheelers on 08.02.2016 and
has been extended to other areas.

 Reduction of Response Time of

Ambulances: Dynamic allocation of
ambulances has been done by the 108
Ambulance Services after which there has

16
 been a significant reduction in average
response time of the State from 15.04
minutes in 2017 to 13.48 minutes in 2018.
The average response time in the city has
decreased further from 11 minutes to 8.36
minutes.

 102 – Drop Back Service Janani Sishu

Suraksha Karyakram (JSSK) Scheme is
implemented under which all delivered
mothers in Government Medical Institutions
and treated sick infants get free drop back
service. To provide 100% free drop back
service, a pilot project at the Institute of
Obstetrics and Gynaecology and Hospital for
Women and Children, Chennai was
introduced through Indian Red Cross
Society. The scheme has been extended to
all other districts now. This service can be
utilized by dialling the Toll Free
Number ‘102’.

 Adyar Cancer Institute has been designated

as State Level Apex Centre for treating of
cancer patients and is being upgraded as
Centre of Excellence at a cost of Rs.120

17
 crore. Four Regional Cancer Centres are
being established at Madurai, Thanjavur,
Coimbatore and Tirunelveli at a total cost of
Rs.58.69 crore.

 Emergency Care and Recovery Centres

with 50 beds established at 10 districts
catering to the needs of wandering
mentally-ill, rescued through retrieval
st
vehicles. Tamil Nadu is the 1 State to have
dedicated retrieval vehicles for mentally-ill
to rescue them to the hospitals.

 Mera Aspataal (My Hospital) is an

initiative to capture patient feedback for the
services received at the hospital through
user-friendly multiple channels such as
Short Message Service (SMS), Outbound
Dialling (OBD), mobile application and web
portal. In this regard Tamil Nadu is the
leading State in Patient Satisfaction Index.

 Early detection of Haemoglobinopathies:

Tamil Nadu is the first among the South
Indian States to implement program for like
Sickle Cell Anaemia, Thalassemia among the
tribal population. The timely identification

18
 and genetic counseling will prevent the
transmission of the carrier from parent to
children which breaks the propagation of the
disease.

 Non-Communicable Diseases - Our State

has been implementing the Non-
Communicable Diseases Intervention
Programme since 2013-2014 in all the
districts. This is the first of its kind to be
implemented on such a large scale in India.
It is under implementation in all the districts
in Tamil Nadu involving 2,602 Government
health facilities across Primary / Secondary /
Tertiary and municipal levels of health care.
Under the programme, screening, treatment
and follow-up services are provided for
Hypertension, Diabetes Mellitus, Cervical and
Breast cancer to all individuals aged 30 years
and above who are attending any
Government Health facility in the State.

 Medical Services Recruitment Board, a

first of its kind in India has been established
exclusively for the Health Department in the
State to recruit medical and para-medical

19
 personnel. As on 31.03.2019, 26,777
personnel in the category of Assistant
Surgeon, Nurse, Physiotherapist,
Radiographer, Pharmacist, Village Health
Nurses have been recruited.

 In the past eight years, 254 new PHCs have

been established at a total cost of
Rs.221.30 crore and 165 PHCs have been
upgraded with 30 beds, Ultra Sonogram,
operation theatre facility, etc., at a cost of
Rs.190.37 crore. Maternity and Child Health
centres have been established in 42 PHCs at
a cost of Rs.19.45 crore. Under National
Urban Health Mission (NUHM) 40 new urban
PHCs in Chennai Corporation and 37 new
urban PHCs in the other Corporations and
Municipalities have been established.
Besides this, 52 Taluk Hospitals have been
started by upgrading Non Taluk Hospitals
and the existing Upgraded Primary Health
Centres at a cost of Rs.93.96 crore.

20
 Medical Education

 Increase of 1,350 additional M.B.B.S.

Seats: Six new Government Medical
Colleges were started in Sivagangai,
Tiruvannamalai, “B” Block of Omandurar
Government Estate, Chennai, Pudukkottai,
ESIC Hospital - Coimbatore and Karur with
an annual intake of 700 students. Apart
from this, 650 additional MBBS seats were
increased in the existing nine Government
Medical Colleges, i.e. Chengalpattu Medical
College, Chengalpattu, Kilpauk Medical
College, Chennai, Madras Medical College,
Chennai, Stanley Medical College, Chennai,
Thoothukudi Medical College, Thoothukudi,
KAP Viswanatham Medical College,
Tiruchirapalli, Government Mohan
Kumaramangalam Medical College,
Salem,Madurai Medical College, Madurai and
Tirunelveli Medical College,Tirunelveli.
Besides this, 40 MBBS seats in IRT
Perundurai Medical College has been
increased from the academic year 2017-18.
Totally, 1,350 MBBS seats were increased
during the last eight years.

21
 Increase of Post Graduate seats: During
the last eight years, 1,213 Post Graduate
medical seats were increased in the
Government Medical Colleges. This includes
conversion of 393 Post Graduate Diploma
seats as Post Graduate Degree Medical
seats and 4 DNB seats

 Super Speciality facility with Trauma Care

Centre in the Government Medical Colleges
at Madurai, Thanjavur and Tirunelveli at a
cost of Rs.150 crore each under ‘Pradhan
Mantri Swasthya Suraksha Yojana’
(PMSSY) were inaugurated by Hon’ble Prime
Minister of India on 4th January, 2019.

 To improve the services in secondary care

hospitals, DNB courses were initiated.
Presently 40 accredited DNB seats approved
in 10 Secondary Care hospitals and
2 Medical college hospitals. Tamil Nadu is
one among the 2 States which got
accredited for 5 Emergency Medicine seats
in Government Headquarters Hospital,
Erode, Government Medical College,
Pudukottai and Government Medical

22
 College, Omandurar Government Estate,
Chennai .

1.9 Some of the best practices recognised by

the Government of India are as follows:

i. Cadaveric Organ Transplantation: Our

State has been always cited as a model for
other States due to the systems put in
place under this programme. For the past
four years, Tamil Nadu has bagged the
‘Best State Award’ nationally under this
category.

ii. Public Health Cadre: In Tamil Nadu,

there is a separate Public Health Cadre
with a separate directorate, budget and
legal support. This has helped to improve
preventive and promotive public health
activities in the State in addition to the
management of primary care services.

iii. Tamil Nadu Medical Services

Corporation (TNMSC) is the ‘State of
Art’ nodal agency in the State, started in
1995, for the procurement of drugs,

23
 equipment and supplies for all public
health facilities. This has ensured
availability of essential drugs. During the
visit, Common Review Mission (CRM) team
observed that there is no out of pocket
expenditure on drugs and diagnostics.
Similar to the TNMSC, Tamil Nadu
Medicinal Plants and Herbal Medicine
Corporation Limited (TAMPCOL) acts
as drug manufacturing, procurement and
supply agency for AYUSH medicines.

iv. Congenital Foetal Abnormality

Detection: To monitor congenital
abnormality in foetus, Medical Officers use
advanced Ultrasonogram machines across
CHCs.

v. Birth Companion Programme: The

State has introduced this new Programme
since 2004, to allow one family member as
birth companion in the labour room. This
has had positive impact on increasing
institutional deliveries in public facilities.

24
vi. Maternity Picnic & Bangle Ceremony:
This helps in reducing gap between service
providers and the community and builds
more trust and confidence in availing
services from public institutions. It is
organised by the Village Health Nurses and
Auxiliary Nurse Midwives under the
guidance of Medical Officer.
vii. Well Functional and Co-located AYUSH
services are provided across most
facilities in the State.
viii. Mortuary Van Services: Tamil Nadu
Health System Project has provided
mortuary vans in all district hospitals for
helping the deceased to reach home or to
the place of funeral, free of cost with the
assistance of the Red Cross Society. Very
good utilization of the mortuary vans was
observed by the Common Review Mission
(CRM) team.
ix. Awards for District Collectors: Based
on the performance under National Health
Mission (NHM), every year three District
Collectors are given awards encouraging
their involvement in health sector.

25
1.10 Awards Won / Secured at all India
Level in the last Eight Years

i. Winner of National e-governance

award-Gold 2011-2012 under category
of “Exemplary use of ICT based solutions”
received from Government of India, at
Bhubaneswar for Health Management
Information System.

ii. 1st prize – Award for Child Survival

given by Government of India (among Non
Empowered Action Group States) at the
event “National Summit on Best Practices
in Public Health Care System” – July 3-5,
2013.

iii. 1st prize – Award for Infant Survival

given by Government of India (among Non
EAG States) at the event “National
Summit on Best Practices in Public Health
Care System” – July 3-5, 2013.

iv. South Asia and Asia Pacific Manthan

Juror’s Award for the year 2013 received
from Digital Inclusion for Development,
New Delhi for Health Management
Information System.

26
 v. e-India Award given by e-health
publication in co-ordination of Government
of Andhra Pradesh for the year 2012 and
2013 for the best use of Information and
Communication Technology (ICT) in the
Chief Minister’s Comprehensive Health
Insurance Scheme in the form of
certificate.
vi. e-India Award for the year 2013-2014
received from e-lets, Thiruvananthapuram for
Health Management Information System.
vii. Award for Making India Polio Free
from World Health Organisation – 2014
viii. South Asia and Asia Pacific Manthan
Special Mention Award for the year
2014 received from Digital Inclusion for
Development, New Delhi for Health
Management Information System.
ix. South Asia-E-health Summit Award in
the form of certificate for 2014 for
Innovation in quality of service delivery
from the ITC Post Uttar Pradesh (Private
Organization).
x. Tamil Nadu was awarded first place for
having highest reduction of Infant

27
 Mortality Rate among larger States in
2015.

xi. Tamil Nadu was awarded Gold Medal for

best performing State for scaling up
cervical cancer screening early
detection and treatment by Common
Wealth Association for Public
Administration and Management (CAPAM)
in Malaysia in 2016.

xii. Tamil Nadu was awarded for Exemplary

Contribution in Post Partum
Sterilization Programme at National
Family Planning Summit (2016), New
Delhi

xiii. Tamil Nadu was awarded first place for

having lowest out of pocket
expenditure incurred in public hospitals
for deliveries and child birth among larger
States at National Summit on Good,
Replicable Practices and Innovations
in Public Health Systems in India at
Tirupathi (2016).

28
xiv. Tamil Nadu was awarded first place for
maximum improvement in IPD - In
Patient Services in Public Health
Institutions among larger States at
National Summit on Good, Replicable
Practices and Innovations in Public
Health Systems in India at Tirupathi
(2016).

xv. National Award for best performance in

the country in terms of Deceased Organ
Transplantation for the years 2015,
2016, 2017 and 2018.

xvi. Tamil Nadu received the Award from the

Hon’ble Union Health Minister on
29.06.2018 for reducing the Maternal
Mortality Ratio in Tamil Nadu.

xvii. Tamil Nadu received the Express Public

Award on 05.10.2018 from the Indian
Express Group for the best
implementation of Reproductive and Child
Health Scheme in Tamil Nadu.

29
 Budget

1.11 The Government of Tamil Nadu is

increasing the budget to the health sector every
year substantially. Rs.12,563.83 crore have
been provided in the budget for 2019-2020. The
directorate wise allocation for 2019-2020 under
Demand No.19, Health and Family Welfare is as
follows:

Amount
Sl.
Name of the Office (Rs. in
No.
crore)
Health and Family Welfare
1 12.55
Department, Secretariat
Directorate of Medical and
2 1,393.34
Rural Health Services
Directorate of Medical
3 3,537.75
Education
Directorate of Public Health
4 3,317.01
and Preventive Medicine
Directorate of Family
5 180.36
Welfare
Tamil Nadu Food Safety
6 79.73
and Drugs Administration

30
 Directorate of Indian
7 Medicine and 312.37
Homoeopathy
Tamil Nadu State Health
8 30.05
Transport Department
Reproductive and Child
9 1,952.79
Health Project
Tamil Nadu Health
10 1,747.88
Systems Project
Total 12,563.83

NOTE:
i. Apart from the above provision, Rs.391.34
crore has been allocated towards civil works
being undertaken by Public Works
Department under Demand No.39.
ii. Provision towards ESI scheme hospitals for
Rs.535.53 crore has been made in the
Labour and Employment department
Demand No.32.
1.12 As stated earlier, the introductory chapter
has tried to capture a snapshot of the activities
of the department which have been elaborated
in detail in other chapters.

31
 Chapter - 2

HISTORY

2.1 Tamil Nadu has rich history in health sector

like other sectors. Our ancient Indian System of
Medicine ‘Siddha’ and ‘Ayurveda’ are in practice
for over thousands of years. Eighteen siddhars
were supposed to have contributed to the
development of siddha medicine. Sashrutha and
Charaka were the pioneers of Ayurveda. Roots
of modern medicine are linked to the advent of
Britishers.

Origins:

 1639 - The first British hospital is believed

to have been established to treat the sick
soldiers of the East India Company.

 1644 - The origin of the modern hospital

(the present Government General Hospital
attached to the Madras Medical College)

 1835 - The first Medical College in the State

viz., The Madras Medical College was
inaugurated

32
 1883 - Dental Department was started in
the Government Hospital

 1885 - The Kasturba Gandhi Hospital (KGH-

Gosha Hospital) was started at Triplicane

 1923 - Directorate of Public Health and

Preventive Medicine

 1954 - Adyar Cancer Institute was started

 1966 - Department of Medical Education

was formed

 1970 - Department of Indian Medicine was

formed

 1981 - Department of Drugs Control was

formed

 1981 - The State Health Transport

Department was formed

 1983 - Department of Family Welfare was

formed

 1986 – State and District Blindness Control

Societies was formed

33
  1994 - Tamil Nadu Medical Services
Corporation was formed

 1994 - Tamil Nadu State AIDS Control

Society was formed

 1999 – Directorate of Medical and Rural

Health Services (ESI) was formed.

 2002 - The Revised National Tuberculosis

Control Programme was launched

 2005 – State Health Society was formed

 2008- Deceased Organ Transplant

Programme was launched

 2011- Food Safety Department was formed

 2013- Government of India launched Urban

Health Mission

 2016- Transplant Authority of Tamil Nadu

(TRANSTAN) was formed.

Distinctions:

 Tamil Nadu has not only the largest

number of Government Medical colleges

34
 but also was one of the pioneers in
starting them

 Madras Medical College has the distinction

of being the second oldest Medical College
in India

 The Eye Hospital, Egmore, attached to the

Madras Medical College is the second
oldest eye hospital in the world

 At present, The Institute of Mental Health

is the second largest Institute in India,
offering mental health services to the
population of Tamil Nadu

 Madras Medical College was also the first

Medical College in the world to admit a
lady student, Mary Ann Dacomb Scharlieb
in 1878

 Charles Donovan in the year 1903 had the

distinction of independently discovering
the parasite Leishmania Donovani in
Madras Medical College (which causes
Kala-azar disease) along with William Boog
Leishman from Netley, England

35
 Dr.Muthulakshmi Reddy was the first
Indian woman to graduate in 1912 from
this college

The department thus has a rich history of

traditional directorates which continue to
expand and function with vibrance, effective
societies for focussed activities, apart from
effective and experienced human resources to
carry forward the rich tradition of the
department.

36
 Chapter - 3

HEALTH ADMINISTRATION

3.1 The following Directorates and Board are

functioning under the administrative control of
the Health and Family Welfare department :

 Directorate of Medical Education -

responsible for providing tertiary care and
medical education.

 Directorate of Medical and Rural Health

Services - responsible for providing
secondary care and regulations as
appropriate authority.

 Directorate of Public Health and Preventive

Medicine - responsible for providing
preventive and public health.

 Directorate of Indian Medicine and

Homoeopathy - responsible for providing
AYUSH (Ayurveda, Yoga & Naturopathy,
Unani, Siddha and Homoeopathy) services.

 Directorate of Family Welfare - focusing on

family planning related initiatives.

37
  Directorate of Food Safety and Drugs
Control - focusing on food safety and
standards and also on drug regulation and
licensing as per the respective Central Acts
and Administration through two different
wings respectively.

 Directorate of State Health Transport -

responsible for maintenance and upkeep of
the vehicles of the various Directorates
under Health and Family Welfare
Department.

 Medical Services Recruitment Board -

focusing on the recruitment of personnel for
the various cadres in the health sector in a
speedy and transparent manner.

Apart from these Directorates, the Health

Department also provides staff to the
Directorate of Medical and Rural Health Services
(ESI) under the Labour and Employment
Department.

38
 Other Programmes and Initiatives

3.2 To ensure focused, speedy and

decentralized implementation a number of
initiatives across the Directorates such as
National Health Mission - State Health Society,
Tamil Nadu State AIDS Control Society, Tamil
Nadu Blindness Control Society, 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.

3.3 While the Tamil Nadu Health Systems

Project has come to a close in 2015-2016, the
State has embarked on a new project for
strengthening the Urban Health Care with the
assistance of Japan International Co-operation
Agency (JICA) at a cost of Rs.1,634 crore. Tamil
Nadu has also got approval for the Tamil Nadu
Health Systems Reforms Project at a total
project cost of Rs.2,857 crores supported by
the World Bank. These missions, programmes
and projects have been explained in detail in
subsequent chapters.

39
 Councils

3.4 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. Tamil Nadu Medical Council

ii. Tamil Nadu Dental Council

iii. Tamil Nadu Nurses and Midwives

Council

iv. Tamil Nadu Pharmacy Council

v. Tamil Nadu Siddha Medical Council

(Siddha and Traditional Practitioners)

vi. Board of Indian Medicine (Ayurveda,

Unani and Yoga and Naturopathy)

vii. Tamil Nadu Homoeopathy Council

These are all the Statutory Bodies regulated by

Government of India and Government of Tamil
Nadu. Apart from these Councils, there is a
Government order for constituting a
Physiotherapists Council in the State. Recently,

40
Government have nominated President, Vice
President and other Members to the council so
as to make it functional.

Classification of Hospitals and Dispensaries

3.5 A broad classification of hospitals and

dispensaries in the State are as follows:

i. State–Public Medical Institutions: All

Medical institutions – Allopathy and Indian
System of Medicine maintained through
State funds are directly managed by the
Government. These form the backbone of
the health care. It ranges from the
grassroot level - 8,713 Health Sub Centres
catering to an average population of
5,000 to the 1,806 PHCs catering to an
average population of 30,000 at the next
level. Above the primary health care
institutions, there are secondary and
tertiary care hospitals in the State. In
addition, 460 Urban Primary Health Centres
across the Urban areas in the State
including Chennai Corporation and 15
Community Health care centres in Chennai
Corporation are also functional.

41
ii. State–Special Medical Institutions:
Institutions intended to serve special
sections of public such as Police, State
owned Corporations / Undertakings,
Employees State Insurance Medical
Institutions, etc. which include 10 ESI
Hospitals and 216 ESI dispensaries.

iii. Medical Institutions under the Local

Bodies: Medical Institutions are under the
management of Municipal Corporations,
Municipalities and Panchayat Unions are
covered under this classification. Urban
Primary Health Care Centres have now been
started to cater to the primary health care
of the rapidly expanding urban population.

iv. Private Aided Medical Institutions:

Institutions supported / guaranteed by
private contribution and receiving
Government aid as well.

v. Private Non-Aided Medical Institutions:

All hospitals, dispensaries and clinics solely
managed by private persons /
establishments.

42
 Chapter - 4

MEDICAL EDUCATION

4.1 The Directorate of Medical Education has

been functioning as an independent Directorate,
from July 1966 on bifurcation from the
Directorate of Medical and Rural Health services,
Chennai. The prime objectives of the directorate
are the development of teaching, training and
research programmes in the medical field,
administration of Government medical colleges,
teaching hospitals and various medical
institutions. Further under the control of the
Directorate of Medical Education, Selection
Committee is functioning for admission of
students to the various Medical, Dental, Para
Medical and Nursing courses. While the
Directorate of Public Health and Preventive
Medicine is providing primary level health care
services and the Directorate of Medical and Rural
Health services, secondary level health care
services, the Directorate of Medical Education
plays a vital role in providing tertiary care
facilities to the public, through the Government
Medical College hospitals.

43
 ADMINISTRATIVE STRUCTURE

4.2 At present, there are 24 Government

Medical colleges, one Government Dental
College, two Government Pharmacy Colleges
(B.Pharm), two Government Physiotheraphy
Colleges and five Government College of Nursing
along with 24 School of Nursing (16 in
Government Medical Colleges and 8 in District
Headquarters Hospitals). The Government have
ordered for taking over of the Institute of Road
Transport (IRT) Perundurai Medical College and
Hospital and School of Nursing, hitherto run by
the IRT by the Health and Family Welfare
department from the academic year 2019-2020.
The Director of Medical Education is the head of
the directorate and is responsible for the
administration of the Government Medical
colleges and the tertiary care hospitals and
Super Speciality hospitals which are headed by
the Deans of the Government Medical colleges
and Directors of the Medical Institutions.

4.3 The current total bed strength in the

Government Medical College Hospitals and allied
institutions is around 37,650 and an average of

44
86,655 out-patients attend these hospitals per
day and 32,394 persons are treated as in-
patients per day.

4.4 The Directorate of Medical Education plays a

vital role in providing quality education in the
field of Medical, Para–Medical, Nursing and
Pharmacy. The intake capacity of the
Government medical institutions for Under
Graduate and Diploma courses are furnished
hereunder:

Sl. Number
Name of the Course
No. of Seats*
1 M.B.B.S 3,350
2 B.D.S 100
3 B.Sc Nursing 250
4 Post Basic (B.Sc. Nursing) 90
5 B.Sc Radiology and Imaging 160
Technology
6 B.Sc Radio Therapy
Technology 20
7 Bachelor of 70
Physiotherapy(B.P.T)
8 Bachelor of Cardio 40
Pulmonary Perfusion
Technology

45
 Sl. Number
Name of the Course
No. of Seats*
9 B.Pharm and B.Pharm 118
(Lateral Entry) (108+ 10)
10 Bachelor of Audio and 25
Speech Language Pathology
11 Bachelor of Optometry 60
12 Para Medical courses 7,876
(25 Courses)
13 B.Sc Cardiac Technology 49
14 B.Sc Critical Care 80
Technology
15 B.Sc Dialysis Technology 105
16 B.Sc Operation Theatre and 170
Anaesthesia Technology
17 B.Sc Physician Assistant 120
18 B.Sc Respiratory Therapy 40
19 Diploma in Nursing 2,000
20 Diploma in Pharmacy 240
21 B.Sc Accident and 130
Emergency Care Technology
22 B.Sc Medical Laboratory 120
Technology
23 Bachelor of Occupational 10
Therapy(B.O.T)

(*These are subject to respective Council approval for

annual admission and vary from year to year).

46
4.5 The details of Post Graduate and Speciality
Courses available in the Government Medical
institutions in Tamil Nadu are as follows:

Total
Sl. Number of
Courses intake
No. Specialities
capacity
1 P.G. Degree 19 334
(Medical Super
Specialities) DM /
MCH
2. P.G. Diploma 1 3
(Medical)
3. M.D.S 8 42
4 P.G. Degree 24 1,758
(Medical Broad
Specialities) MD /
MS *
5 P.G. Diplomate of 1 4
National Board
(DNB)
6 M.Pharmacy 4 58
7 M.Sc (Nursing) 5 65

47
 Total
Sl. Number of
Courses intake
No. Specialities
capacity
8 M.Phil (Clinical 1 15
Social Work)
9 MSc (Molecular 1 21
Virology)
10 M.Phil (Clinical 1 8
Psychology)

* Inclusive of 393 Medical Diploma seats

converted as P.G. Degree (M.D/M.S) seats as
per MCI Amendment Notification dated
12.07.2018.

4.6 Besides the Government Institutions, the

private medical / paramedical self–financing
institutions affiliated to Tamil Nadu Dr.M.G.R
Medical University have surrendered the
following seats for allotment by the
Government:

48
 Sl. No. of Number of
College
No. Colleges Seats*
Medical
1 14 1,850
College
Dental
2 19 1,842
College

3. B.Sc Nursing 163 5,921

4 B-Pharm 51 2,242

B-Pharm
5 (Lateral 33 180
Entry)

6 B.P.T 30 1,625

7. B.O.T 4 225

Post Basic
8. 49 1,050
B.Sc Nursing
(* The number of seats will vary annually subject to
the approval of the respective Council)

49
4.7 Admission policy in Medicine and
opposition to National Eligibility cum
Entrance Test (NEET) :

The Government of Tamil Nadu has been

consistently opposing NEET for admission to
Medical and Post Graduate Medical Courses. The
Government of India has made amendments to
the Indian Medial Council Act, 1956 and Dentists
Act, 1948 by incorporating section 10(D) to
mandate NEET for admission to all medical and
dental courses throughout India. In order to
protect the rights of the State in medical
admission and to sustain the existing admission
policy in the State of Tamil Nadu, two bills viz.
L.A Bill No:7 of 2017-Tamil Nadu Admission to
MBBS and BDS courses Act, 2017 and L.A Bill
No:8 of 2017-Tamil Nadu Admission to Post
Graduate courses in Medicine and Dentistry Act,
2017 were unanimously passed in the floor of
Tamil Nadu Legislative Assembly. With the
approval of the Hon’ble Governor, the
Government of Tamil Nadu forwarded the said
two bills to Government of India for obtaining
assent of the Hon’ble President of India under
Articles 254(2) of the Constitution of India. As

50
the assent of the Hon’ble President of India was
withheld, the Government took a policy decision
to allocate 85% of State quota MBBS / BDS
seats to students who have studied in Tamil
Nadu State Board and to allocate the remaining
15% of seats to the students who studied in
other boards and the same was incorporated in
the prospectus for admission to MBBS/BDS
course 2017-18 session through an executive
order. But the said order was challenged before
the court of law. All legal measures to protect
the above said policy have been taken by the
Government of Tamil Nadu for the interest /
welfare of students of Tamil Nadu. This
Government order was quashed by the Hon’ble
High Court of Madras in W.P.No.16341 of 2017
and others, orders dated 14.07.2017. Against
the above orders of the Hon’ble Court, the
Government had filed a writ appeal (W.A.No.838
of 2017) before the Division Bench of Hon’ble
High Court of Madras. In its orders dated
31.07.2017, the Hon’ble High Court of Madras
has dismissed the writ appeal filed by the
Government and upheld the orders of the Single
Judge of the Hon’ble Court. Further, the
Government had filed a SLP (SLP(C) No.20240-

51
20256 of 2017) before the Hon’ble Supreme
Court of India. In its orders dated 11.08.2017,
the Hon’ble Supreme Court of India has
dismissed the SLP filed by the Government and
upheld the orders of the Hon’ble High Court of
Madras. Finally, based on the directives of
Supreme Court of India, dated: 22.08.2017
pronounced in W.P.(C) No.711 of 2017, the
admission to MBBS and BDS courses from the
year 2017-2018 are made based on NEET
marks, adopting existing Rules of Reservation in
Tamil Nadu.

In its order dated 18.07.2013 in T.C.(C)

No.98 of 2012, the First bench of Hon’ble
Supreme Court of India ordered with 2:1
majority held that the Medical Council of India is
not empowered under the 1956 Act to actually
conduct the NEET. The Government of India has
been requested not to review the order of the
Hon’ble Supreme Court of India dated
18.07.2013 in T.C.(C) No.98 of 2012. The
Medical Council of India has filed Review
Petitions (Civil) No.2159 – 2268 of 2013 before
the Supreme Court of India against the above
judgement. In its order dated 11.04.2016, the

52
Hon’ble Supreme Court Bench has allowed the
maintainability of the Review Petition and
recalled the earlier judgement of the Supreme
Court delivered on 18.07.2013 and directed that
the case will be heard afresh. Hence, the
Government of Tamil Nadu will continue to
oppose NEET as a matter of policy and also
through all legal means.

4.8 New Government Medical Colleges and

increase of Under Graduate and Post
Graduate medical seats:

Six new Government Medical Colleges

have been established at Sivagangai,
Thiruvannamalai, Omandurar Government
Estate, Chennai, ESIC Hospital Coimbatore,
Pudukottai and Karur, during the last eight
years. On account of strenuous initiatives taken
by the State Government, totally 1,350 MBBS
seats have been increased in the last eight
years. At present, there are 3,350 MBBS seats in
the Government Medical Colleges. The details of
increase of MBBS seats are furnished below:-

53
 No of
Name of the
Sl. MBBS
Government Medical
No. seats
College
increased
New Medical Colleges
1 Government Sivagangai 100
Medical College, Sivagangai

2. Government 100
Thiruvannamalai Medical
College, Thiruvannamalai

3. Government Medical 100

College “ Block B”
Omandurar Government
Estate, Chennai

4. Government Medical 100

College and ESIC Hospital,
Coimbatore

5. Government Medical 150

College, Pudukottai

6 Government Karur Medical 150

College, Karur

54
Increase of Seats in Existing Government
Medical College
7. Government Kilpauk 50
Medical College, Chennai
8 Government Chengalpattu 50
Medical College,
Chengalpattu
9. Government Stanley 100
Medical College, Chennai
Madras Medical College,
10. 85
Chennai
Government Mohan
11. Kumaramangalam Medical 25
College, Salem
12. Government KAP 50
Viswanatham Medical
College, Thiruchirappalli
13 Government Thoothukudi 50
Medical College,
Thoothukudi
14 IRT Perundurai Medical 40
College, Erode
15 Madurai Medical College, 100
Madurai

55
 16 Tirunelveli Medical College, 100
Tirunelveli
Total 1,350

For establishing the new Government Medical

College at Karur, the Government have already
issued orders for an annual intake of 150 MBBS,
students and Government have sanctioned a
sum of Rs.269.59 crore for the construction of
buildings for College / Hospital. The permission
of the Medical Council of India / Government of
India has been obtained for opening this college
and admission of the students from the
academic year 2019-2020.

4.9 Amma Master Health Checkup and

Amma Women Special Master Health
Checkup

Amma Master Health checkup and Amma

Women Special Master Health Checkup are
functioning in the Government General Hospital,
Chennai, since 01-3-2016. The following
package of tests are done in the above Schemes
with the cost package as tabulated below:-

56
 Package -1 Package-II Package-III
(Rs.1,000) (Rs.2,000) (Rs.3,000)
complete
hemogram, Package 1 + Package II +
ESR, Urine Echocardiogram, Digital
analyser PSA, thyroid Mammogram,
Blood sugar Profile and Dexa Scan,
F&PP urea, HbA1C Bone profile
Creatinine, Uric (Vitamine D,
Acid Calcium,
Phosphorous
Lipid profiles
and PTH)
Total
Cholesterol,
HDL, LDL,
Triglycerides
Total
Cholesterol /
HDL ratio
Liver Function
Test
Serum billirubin
(total and
direct) AST,
ALT, SAP Total
protein and
albumin.

57
HbsAg
Blood grouping
and typing
ECG
X – ray Chest
USG abdomen
Pap smear

Since, public response to Amma Master health

Checkup and Amma Women Special Master
Health Checkup is exemplary, this health
checkup programme has been extended to the
Tamil Nadu Government Multi Super Speciality
Hospital, Omandurar Government Estate,
Chennai and the same is functioning well since
08-06-2018. In order to provide the Amma
Master health Checkup and Amma Women
Special Master Health Checkup to the people of
southern districts, Government granted
permission to start these two programmes in the
Government Medical College hospitals of
Coimbatore, Madurai and Tirunelveli at a cost of
Rs.10 crore to each hospital (total cost Rs.30
crore).

58
 In addition to the existing packages under
Amma Master Health Checkup, an additional
package viz Amma Platinum Plus (Package-
IV[Rs.4,000]) has been launched at Tamil
Nadu Government Multi Super Speciality
Hospital, Omandurar, Chennai which includes all
the tests in Package III+ Vision Testing,
Glaucoma Testing, Refractory errors testing,
retinal testing, colour vision testing, Treadmill,
lung function testing.

59
 Chapter -5

MEDICAL AND RURAL HEALTH SERVICES

5.1 The Directorate of Medical and Rural Health

Services is providing medical care services
through the following grid of hospitals:-

Sl.
TYPES OF HOSPITAL Number
NO.
1 District Headquarters 29
Hospital
2 Taluk Hospital 206
3 Non- Taluk Hospital 67
4 Women and Children 7
Hospital
5 Dispensaries 11
6 Tuberculosis Hospital 2
7 Leprosy Hospital 7
8 Rehabilitation Institution 1
cum Hospital

The Taluk Hospitals and Non-Taluk Hospitals are

the First Referral Units in the chain of medical

60
services, the District Headquarters Hospitals are
the second referral units. Maternal and Child
Health has been strengthened by providing
Comprehensive Emergency Obstetrics and
Newborn Care (CEmONC) units in 104
Government Hospitals, including all District
Headquarters Hospitals and Newborn
Stabilization Units (NBSUs) in 110 hospitals and
Sick New Born Care Units (SNCUs) in 49
hospitals under the Directorate of Medical and
Rural Health Services. This Directorate is
providing multifarious specialty medical care to
the public for the past 95 years.

5.2 Further the medical services like Medicine,

Surgery, Obstetrics and Gynaecology,
Ophthalmology, E.N.T, Venerology,
Orthopaedics, Anaesthesiology, Child Health,
Dental, Psychiatry, Ambulance Services,
Laboratory Services, Leprosy, Tuberculosis,
Diabetology, Cardiology and Non-Communicable
Disease (NCD) are available in Secondary Care
Hospitals. This Directorate is also responsible
for offering the Accident and Emergency
Services, Family Welfare and Maternity and Child

61
Health, T.B. Control Programme, Blindness
Control Programme, Deafness control
Programme and District Mental Health
Programme.

5.3 The Directorate of Medical and Rural

Health Services has introduced unique
monitoring system both in the Directorate as
well as at district level. Hospital Management
Information System (HMIS) is being
implemented at the Directorate level and
Hospital Management System is being
implemented at the secondary level. The
information regarding the services offered like
Laboratory Services, Nursing, Diet etc., are
being shared by the District level with the
Directorate, digitally.

62
5.4 ADMINISTRATIVE STRUCTURE

DIRECTOR OF MEDICAL AND RURAL

HEALTH SERVICES

ADDITIONAL DIRECTOR OF MEDICAL AND

RURAL HEALTH SERVICES (MEDICAL)-
(PLANNING AND DEVELOPMENT)-(INSPECTION)-
(TB)-(LEPROSY)-(ADMINISTRATION)
JOINT DIRECTOR OF MEDICAL AND RURAL
HEALTH SERVICES – (MEDICAL) (CEmONC)
(ACT) (NCD)(TB)

FINANCIAL CONTROLLER

 District Headquarters
Hospitals
 Taluk Hospitals
 Non-Taluk Hospitals
Joint Director of
 Dispensaries
Health Services
 Women and Children
Hospital
 TB Hospitals / Clinics
 Leprosy Hospitals

63
Deputy Director
of Medical and
`Family Welfare
Rural Health
Programme in the District
Services and
Family Welfare

Deputy Director
TB Control Programme in
of Medical
the District
Services (TB)

Deputy Director
of Medical Leprosy Control
Services Programme
(Leprosy)

64
 Ongoing Developmental Activities

5.5. In order to facilitate better health care and

to increase efficiency of the Health Services
delivered at the secondary care institutions, the
Government created the following six additional
posts:

 One post of Pharmacist additionally to the

Government Hospital, Panruti in Cuddalore
District

 One Electrician Grade-II post for the office

of the Director of Medical and Rural Health
Services.

 Two posts of Assistant Surgeon to the

Government Hospital, Kayalpattinam in
Thoothukudi District and

 Two Pharmacist posts to the Government

Headquarters Hospital, Karaikudi in
Sivagangai District.

65
5.6. Fire safety arrangements and ramp
facilities in the District and Taluk / Non -
Taluk Hospitals:

It has been decided to provide fire safety

arrangements and ramp facilities to all
Government Hospitals. Accordingly, Government
sanctioned Rs.29.71 crores for providing these
facilities to the 158 hospitals, where at present,
these facilities are not available. These works
are underway.

5.7 Establishment of a 50 bedded

Government Non-Taluk Hospital at Emerald
in The Nilgiris District:-

50 bedded Government Hospital building at

Emerald,The Nilgiris district is coming under the
Ithalur Village Panchayat of Kundah Taluk and
will cater to around 20,000 population belonging
to Ithalur and Mulligoor Village Panchayat and
Bikkatty Town Panchayat. Kota and Toda tribes
of Kundah will be benefitted. The Government
Hospital is coming up on an outlay of Rs.18.99
crores. The upcoming Government Hospital is
situated 20 Kms away from the District Head
Quarters Hospital.

66
5.8 Patient Amenities in the Government
Hospitals:-

To improve the patient amenities in

Government Hospitals, Rs.2.97 crores has been
sanctioned for the purchase of 2,287 set of cots,
pillow, and mattresses.

5.9 Infrastructure Strengthening:

In order to strengthen the District and

Taluk / Non-Taluk Hospitals with additional
facilities, the following buildings and equipments
have been sanctioned to the secondary care
Hospitals:

Buildings:-

 Operation Theatre with 12 bedded Post

Operative Ward in Government Hospital,
Paramathivelur in Namakkal district at a
cost of Rs.1.32 crores and Accident and
Emergency Ward at a cost of Rs.3.15
crores.

 Strengthening of Maternal and Child

Health wings in District Headquarters
Hospitals at Kumbakonam,

67
 Ramanathapuram, Virudhunagar,
Kancheepuram and Ooty and Taluk
Hospitals at Tirupattur and Jayamkondam
at a total cost of Rs.127 crores.

 Upgradation of District Headquarters

Hospital, Cheyyar with additional facilities,
equipments, and staff at a cost of
Rs.12.71 crores.

 Additional wards and equipments to the

Government Hospital, Thiruparankundram,
Madurai District at a cost of Rs.3.22
crores.

Equipments:

 Equipments have been provided to the

Maternal and Child Health wing of the
District Headquarters Hospitals at
Cuddalore and Tiruppur at a cost of Rs.2
crores.

 As on date 40 CT scan machines have

been supplied and are operational. In
addition, CT Scan equipments have been
sanctioned to the Government Hospitals at
Virudhachalam in Cuddalore District, Melur

68
 in Madurai District, Omalur in Salem
District, Aranthangi in Pudukkottai District
and Udumalpet in Coimbatore District, at a
total cost of Rs.8.75 crores.

 9 MRI scan machines have been

sanctioned to the Government District
Headquarters Hospitals. In addition a sum
Rs.6 crores was sanctioned to each of the
Government Head Quarters hospitals at
Tiruppur and Krishnagiri.

5.10 Pain and Palliative Care Units:

Pain and Palliative Care Units were

sanctioned to the 8 District Headquarters
Hospitals at Ariyalur, Pennagaram,
Nagappattinam, Udhagamandalam, Perambalur,
Karaikudi, Periyakulam and Virudhunagar, at a
total cost of Rs.1.20 crores and they have been
put to use.

5.11 Other Programmes and

Responsibilities:

This Directorate is responsible for

implementing the Revised National Tuberculosis
Programme, District Mental Health Programme,

69
Accident and Trauma Care and important Acts
such as Pre-Conception and Pre-Natal Diagnostic
Techniques (Prohibition and Sex Selection) Act,
1994, Human Organ Transplantation Act, 1994,
Tamil Nadu Clinical Establishment Act, 1997.

This directorate is the link between the

primary care under the Public Health wing and
tertiary care under the Medical Education
Directorate, providing necessary health services
within the district itself, in Taluks and District
Headquarters.

70
 Chapter - 6

PUBLIC HEALTH AND PREVENTIVE

MEDICINE

‘Public Health and Preventive Medicine organizes

the efforts of the society to promote Health and
Well being for all through Community Based
Approach’

6.1 Health systems with strong Primary Health

Care is essential to achieve Universal Health
Coverage and health related Sustainable
Development Goals of United Nations. Tamil
Nadu has the distinction of having been the first
State to have a separate Directorate exclusively
for Public Health and Primary Care.

Functions of Public Health include

prevention and control of diseases and their
progression through promotion of healthy
lifestyles and healthy habits, promotion of
healthy and hygienic environment including safe
water and food, health education and
community mobilization, empowering the
society, particularly women to make healthy
decisions, preventive measures including

71
immunization, surveillance and monitoring,
organizing high quality community based health
services and conduct of camps and campaigns
like Pulse Polio Immunization, Vitamin A
administration for children below five years and
deworming.

The Directorate of Public Health and

Preventive Medicine of Tamil Nadu, formed
during 1923, is engaged in the above said
context to reduce the burden of morbidity,
mortality and disability in the State.

6.2 The following institutions function

under this directorate:

 Health Sub Centres

 Primary Health Centres in Rural areas

 Primary Health Centres in Urban areas

 Community Health Centres and Upgraded

Primary Health Centres

 Regional Entomological Teams

 National Filaria Control Units

72
 Research cum Action Projects

 Filaria and Malaria Clinics

 Leptospirosis Clinics

 Japanese Encephalitis Control Units

 Water Analysis Laboratories in Guindy King

Institute campus, Chennai, Coimbatore,
Tiruchirapalli and Tirunelveli

 State and District Public Health Laboratories

 Institute of Public Health, Poonamallee

 Health and Family Welfare Training Centres

Chennai, Egmore and Madurai

 Health Manpower Development Institutes,

Salem and Villupuram

 Regional Institute of Public Health,

Thiruvarankulam

 Institute of Vector Control and Zoonoses,

Hosur

 Health Visitor Training School, Triplicane

 ANM Training Schools

73
6.3 Administrative Structure

DIRECTOR

Additional Directors

Joint Directors (Programmes)

 Financial Advisor and Chief Accounts

Officer
 Personnel Officer and Joint Director
(Financial and Human Resource
Management and Administration)

 Deputy Directors of Health Services

 Regional Entomologists
 Principals of Regional Training Centres
and ANM Schools
 Health Officers

 Block Medical Officers,

 Medical Officers
 Institutional and Field Health
Functionaries
 Village Health Nurses
 Health Inspectors

74
6.4 Across the State, the department has a
primary health care network of 1,806 Primary
Health Centres (PHCs) in rural areas including
422 Upgraded PHCs, 460 Primary Health Centres
in urban areas including Greater Chennai
Corporation and 8,713 Health Sub Centres
(HSCs) to achieve Health for All.

Tamil Nadu has planned to achieve the

health indicators on par with developed nations
by 2023 focusing on the components such as
maternal anaemia, neo-natal mortality rate and
low birth weight. Preventable causes of infant
deaths are to be eliminated completely by
appropriate interventions to achieve the goals.
Government of Tamil Nadu aims to bring down
Infant Mortality Rate(IMR) to less than 10 by the
year 2023.

6.5 Initiatives for reduction of IMR and

MMR:

Timely provision of high-quality

emergency obstetric care and routine obstetric
and newborn care are the key strategies for
reduction of maternal and neonatal morbidity
and mortality.

75
6.6 Along with schemes under the National
Health Mission, State specific land mark
initiatives are given below.

 Dr.Muthulakshmi Reddy Maternity Benefit

Scheme
 Comprehensive Emergency Obstetric and
Newborn Care (CEmONC) Services
 Strengthening of Basic Emergency
Obstetric and Newborn Care (BEmONC)
Services
 Birth Companion Programme
 24x7 delivery care services in all Primary
Health Centres
 Birth Waiting Rooms
 Accessible blood bank and Storage Centres
 Menstrual Hygiene Programme
 Amma Baby Care Kits
 Amma Mahapperu Sanjeevini
 Two nutrition kits for the pregnant women

76
6.7 Primary Health Care (PHC)

Primary Health Care (PHC) is essential

health care made universally available and
accessible to individuals in a community,
particularly to the people below poverty line.

The Primary Health Care infrastructure in

the rural areas consists of a three-tier system
namely Health Sub Centre, Primary Health
Centre and Community Health Centre.

6.8 Health Sub Centre (HSC)

The Health Sub Centre is the peripheral

and first contact point between the public
healthcare system and the community. One HSC
is established for a population of 5000 in plain
areas and 3000 in hilly areas. Each HSC is
manned by one Auxiliary Nurse Midwife (ANM)
known as Village Health Nurse (VHN) in Tamil
Nadu and one Male Health Worker for every
three HSCs. The average geographical area
covered by a HSC is about 13.49 sq.kms.

8,713 HSCs are functioning in Tamil Nadu.

HSCs are the hub for delivering Maternal and
Child Health (MCH) and Family Welfare (FW)

77
services to the people in the rural areas. HSCs
are supported by Primary Health Centres (PHC),
Community Health Centres (CHC), Hospital on
Wheels (HoW) and School Health Teams.

6.9 Primary Health Centres

Primary Health Centre (PHC) in rural area is

established for a population of about 30,000 in
plain areas and 20,000 in hilly areas. Tamil Nadu
has 1,806 PHCs in rural areas and 460 PHCs in
Urban Areas including Chennai Corporation to
cater to the needs of poor. The average
geographical area covered by a PHC is about
86.29 sq.kms.

6.10 Community Health Centres (Upgraded

Primary Health Centres)

All the 385 blocks in the State have atleast

one Upgraded Primary Health Centre with 30
beds, operation theatre, modern diagnostic
equipments like Ultra Sonogram, ECG, Semi
Auto Analyzer, cell counter, X-Ray and an
ambulance. 422 PHCs are functioning as
Upgraded PHCs. Five doctors are posted to UG
PHCs to provide 24x7 medical services in rural
areas.

78
 Dental health care services are provided in
341 block level and selected Upgraded PHCs to
treat dental ailments. The Government have
planned to provide dental health care services in
all the upgraded and block level PHCs in a
phased manner.

6.11 The Services provided by a Primary

Health Centre :

1. Outpatient, inpatient services, antenatal

care, delivery care and postnatal care,
and family welfare services

2. Treatment of infectious diseases like

diarrhoea, fever and other infectious
diseases

3. Community Based Maternal and Child

Health Services

4. Prevention and Control of Communicable

Diseases

5. Screening of Non-Communicable Diseases

namely diabetes, hypertension and cancer
and follow up

79
6. School Health Services - early
identification and early treatment of 4Ds –
Birth Defects, Delay in Development,
Deficiency and other Diseases. This early
intervention helps to improve the quality
of life and longevity of the life of the child.

7. Implementation of Various National Health

Programmes like

a. Reproductive and Child Health

Programme

b. Universal Immunization Programme

c. National Family Welfare Programme

d. National Anaemia Control

Programme

e. National Iodine Deficiency Disorder

Control Programme

f. National Water and Sanitation

Programme

g. National Vector Borne Diseases

Control Programme

80
h. National Diarrhoeal Diseases Control
Programme

i. National Tuberculosis Control

Programme

j. National Leprosy Eradication

Programme

k. National AIDS Control Programme

l. Integrated Disease Surveillance

Programme

m. National Blindness Control

Programme

n. National Programme for Prevention

and Control of Fluorosis

o. National Programme for Prevention

and Control of Deafness

p. National Vitamin A Deficiency

Disorder Control Programme

q. National Tobacco Control Programme

r. National Rural Health Mission

Programmes

81
 8. Camps and Campaigns

a. Intensified Pulse Polio Immunisation

camp

b. Mission Indradanush Campaign for

improving immunization coverage

c. Intensified Diarrhoea Control

d. National Deworming Program

e. Vitamin ‘A’ campaign

f. Speciality Medical Camps in rural

areas

g. Fever treatment camps

h. School Health Camps

i. Health education and awareness

campaigns

6.12 Universal Health Coverage (UHC)

UHC seeks to universalise access to

essential assured health services to improve
coverage and quality of institutional and
outreach services with home visits towards

82
achieving health goals under Sustainable
Development Goals (SDG). 985 Health Sub
Centres are upgraded as Health and Wellness
Centres with one additional Village Health Nurse
under National Health Mission to provide the
following twelve services.

6.13 Health and Wellness Services under

UHC

1. Care in pregnancy and child-birth.

2. Neonatal and infant health care services

3. Childhood and adolescent health care

services.

4. Family planning, Contraceptive Services

and all RCH services

5. Management of Common Communicable

diseases: National Health Programmes

6. General Out-patient care for acute simple

illnesses and minor ailments

7. Screening and Management of Non-

Communicable diseases

83
 8. Screening and Basic management of
Mental health ailments

9. Care for Common Ophthalmic and ENT

problems

10. Basic Dental health care

11. Geriatric and palliative health care

services

12. Trauma Care and Emergency Medical

services

6.14 Hospital on Wheels Programme :

Reaching the Unreached is one of the

Public Health Care strategies to take health care
to the doorsteps of the people especially those
working in unorganized sectors like Quarries,
brick kilns and other temporary settlements. 416
Mobile Medical Units with laboratory facilities
and other diagnostic equipment provide high
quality medical care, cover the remote villages
and hamlets as per the fixed day, fixed time
plan specific for each block in a camp mode.
Information Boards about the day and time of
visit are permanently displayed at the camp site.

84
In Municipal Corporations 10 MMUs are
functioning to cater to the needs of urban poor.
With the support of the Labour Welfare
Department, 50 Mobile Medical Units will be
functioning exclusively for construction workers
across the state. Role of Hospital on Wheels is
crucial during disasters like floods, cyclones and
fever outbreaks.

The performance of MMUs in the past eight

years is given below:

Camps
Year Beneficiaries
Conducted
2011-12 1,32,159 60,92,057
2012-13 1,84,098 1,06,99,782
2013-14 1,83,095 1,04,57,225
2014-15 1,87,615 1,19,52,880
2015-16 2,03,998 1,47,47,873
2016-17 2,05,452 1,65,23,783
2017-18 2,05,871 1,70,25,652
2018-19 2,08,229 1,78,14,418
Total 15,10,517 10,53,13,670

85
6.15 Dr.Muthulakhsmi Reddy Maternity
Benefit Scheme:

The financial assistance given under the

scheme to improve the health and nutrition
status of poor pregnant mothers, has been
enhanced from Rs.12,000 to Rs.18,000 per
beneficiary with effect from 1st April 2018. Under
Government of India’s scheme “Pradhan Mantri
Matru Vandana Yojana” financial assistance of
Rs.5,000 is given for first pregnancy. This is
combined with the State scheme. An amount of
Rs.4,000 from this assistance is used for
providing two “Amma Maternity Nutrition
Kits” during third and fourth month comprising
of iron tonic and nutrition supplements to reduce
anaemia amongst the pregnant women and
improve birth weights of infants.

Under the State scheme in order to promote

family planning, financial assistance is given to
higher order birth mothers who adopt
permanent family planning methods. Migrant
mothers are also given this benefit. On an
average, 6.5 lakh women benefit from the
scheme every year.

86
 Performance under the Scheme

Amount Disbursed
No. of
Year to Beneficiaries
Beneficiaries
(Rs. in crore)
2011–12 515.11 6,73,093
2012-13 639.54 6,70,313
2013–14 652.16 6,63,623
2014-15 658.75 6,65,240
2015-16 621.77 6,35,225
2016-17 609.37 6,49,904
2017-18 640.68 7,14,718
2018-19 895.79 7,06,792
TOTAL 5233.17 53,78,908

6.16 Deworming:

Under this initiative, children in the age

group of 1-19 years are given deworming
medicine (Tablet Albendazole) through schools
and Anganwadi centres.

87
6.17 Amma Baby Care Kit:

The visionary and pioneering scheme was

announced in the floor of the Assembly on
12.08.2014 by the former Hon'ble Chief Minister
and was launched on 08.09.2015. This
innovative initiative is being implemented with
the objective of improving the hygiene of the
postnatal mothers and the newborn baby and
inculcating hygienic practices among the
mothers for self and baby care. The Amma Baby
Care kit contains 16 items viz. baby towel, baby
dress, baby bed, baby protective net, baby
napkin, baby oil, baby shampoo, baby soap,
baby soap box, baby nail clipper, baby rattle,
baby toy, liquid hand wash, bathing soap,
sowbagya sundilehiyam and a kit bag to
securely keep all the items. Under this scheme,
upto March 2019, 17,70,393 delivered mothers
have been given these kits for their babies.

6.18 Amma Arokiya Thittam:

Amma Arokiya Thittam provides an

opportunity for people aged above 30 years
living in rural areas to have access to basic
health checkup on annual basis in a nearby

88
health facility. 25 parameters are screened
under this program in 501 PHCs including urban
areas. 49.14 lakh people have been screened
upto March 2019, since the launch of the
scheme in March 2016. People identified with
any kind of Non-Communicable Disease during
the screening are treated at the Primary Health
Centres / Government Hospitals / Medical
College Hospitals / Empanelled Hospitals free of
cost as applicable under CMCHIS. The scheme is
now extended to the urban areas through the
selected urban PHCs.

6.19 The Menstrual Hygiene Programme:

High quality sanitary napkins are provided

to adolescent girls in rural areas without any
cost under this scheme. This programme was
launched on 27.03.2012. Designated teachers
are responsible for distributing the sanitary
napkins in schools. Village Health Nurses along
with Anganwadi Workers are responsible for
distributing the sanitary napkins to the girls who
are not covered in the schools. Under this
scheme, 18 packs of sanitary napkins (six pads
per pack) in a year, at the rate of three packs

89
for two months for each adolescent girl (10-19
years) are provided. Sanitary Napkins are also
given to Post Natal mothers who deliver in
Government institutions at the rate of seven
packs each (six pads per pack). Additionally,
Sanitary Napkins are being given to each women
prison inmate and to female inpatients in the
Institute of Mental Health, Chennai at the rate of
18 packs (six pads per pack) in a year.

6.20 National Iodine Deficiency Disorders

Control Programme (NIDDCP)

Iodine is an essential micro nutrient

required daily at 100-150 microgram for normal
growth and development. Deficiency of iodine
may cause Goitre, low I.Q., Neuromuscular
weakness, Endemic cretinism, Still birth,
Hypothyroidism, Defect in vision, hearing and
speech, Spasticity, Intrauterine death and
Mental retardation.

6.21 The State is focusing on the supply of

iodized salt in place of common salt and
assessing the extent of Iodine Deficiency
Disorders and the impact of iodized salt,
Laboratory monitoring of iodized salt and urinary

90
iodine excretion and Health education and
publicity. The provisions of the Food Safety and
Standards Act, 2006 and Rules, 2011 are being
effectively utilized to ensure compliance.

6.22 Grievance Redressal:

2,580 Closed User Group (CUG) mobile

connections have been distributed to all the
Nodal Officers and District Level Officers in the
Health Department for the Real Time Grievance
Redressal related to Health care service.

6.23 Facilities for Lactating Mothers:

Babies who are breastfed are generally

healthier and achieve optimal growth and
development compared to those who are fed
formula milk. Infants who are not breastfed are
at an increased risk of illness that can
compromise their growth and raise the risk of
death or disability. Breastfed babies receive
protection from illness through the mother’s
milk. With the objective of providing privacy for
travelling mothers, breastfeeding rooms are
provided in 352 bus stands / terminus, since
03.08.2015.

91
 Chapter - 7

FAMILY WELFARE PROGRAMME

7.1 Tamil Nadu is considered as a pioneer in the

implementation of the Family Welfare
Programmes in the country. Family Welfare
Programme is being implemented since 1956 as
people’s programme in the State with 100%
central assistance. The objective of the
programme is to reduce the birth rate to the
extent necessary to stabilize the population at a
consistent level. Family Welfare services are
provided through the Government health
facilities as well as through the approved private
facilities to the eligible couples to stabilize the
population of the State. In view of
commendable progress in reducing the birth
rate, the focus has been shifted from a "Target
based approach" to "Community Needs
Assessment Approach” where importance is
given to meet the unmet needs for family
planning services and improving the Maternal
and Child Health services.

92
7.2 Administrative Structure:

DIRECTOR

Joint Director

Deputy Director

Chief Accounts Officer

Deputy Directors of Medical and Rural Health

Services and Family Welfare (in all Districts)

7.3 Demographic Indicators:

Tamil Nadu is the seventh most populous

State in India. As per 2011 census, the
population of Tamil Nadu was 7.21 crore with
decadal growth rate of 15.6%. It accounts for
6% of the country’s total population. The
demographic scenario of the State (SRS) is
furnished below:

93
Sl.
Indicators Current level
No.
14.9/1000
1 Crude Birth Rate (2017)
population
Crude Death Rate 6.7/1000
2
(2017) population
Total Fertility Rate
3 1.6
(2016)
Infant Mortality Rate 16.0/1000 live
4
(2017) births
Maternal Mortality Ratio 60/1,00,000
5
(2016-17 State HMIS) live births
Natural Growth Rate
6 0.83%
(2017)

Source: Sample Registration System (SRS) –

2017.

7.4 Performance in Family Welfare

Outcomes

7.4.1 Crude Birth Rate (CBR):

Crude Birth Rate is the number of live

births per 1,000 Population in a year. The
current level of Crude Birth Rate (CBR) in Tamil
Nadu is 14.9 per 1,000 populations as per the
Sample Registration Survey - 2017. The State

94
ranks as the second lowest among the major
States in the country.

Trends in Crude Birth Rate

7.4.2 Total Fertility Rate (TFR): Total Fertility

Rate is the average number of children born to a
woman in her reproductive age. The current
level of Total Fertility Rate in Tamil Nadu is 1.6
as per the Sample Registration Survey-2016.
The State ranks lowest among the major States
in the country and below the National level of
2.3. Tamil Nadu is consistently maintaining the
TFR as 1.6 for the past three years.

95
7.4.3 Higher Order Births:

Three and above order of births are

termed as Higher Order Births. The Higher Order
Birth rate in Tamil Nadu was 7.2% in 2018. In
order to reduce Maternal and infant mortality
among Higher Order Birth delivered mothers,
120 blocks with more than 10.5% Higher Order
Birth rate have been identified and the list of
eligible mothers has been prepared through
Village Health Nurses. These mothers are given
counselling to accept sterilization in the
Government health facilities. Special sterilization
drives are being conducted in these 120 blocks.

Trends in Higher Order Births:

Higher Order Births %

40

20

96
7.5 Family Welfare Services available in the
State: The following permanent and temporary
methods of family welfare services are provided
free of cost to the eligible couples in all the
Government health facilities.

Permanent Methods

For Male Conventional Vasectomy and No

Scalpel Vasectomy (NSV)
For Puerperal Sterilization (Tubectomy),
Female Mini-Lap and Laparoscopic Sterilization

Temporary spacing methods

Intra Uterine Copper ‘T’ 380A (10 years)

Contraceptive and 375 (5 years)
Device (IUCD)
Oral Mala N (hormonal) and
contraceptive Chhaya (non – hormonal)
Pills (OP) (Centchroman Pills)
Injectable Antara -Depot Medroxy
contraceptive Progestrone Acetate (DMPA)
Contraceptive Nirodh
Condoms
Emergency E- Pills
Contraception

97
 Medical Termination of Pregnancy:

 Manual Vacuum Aspiration (MVA)

 Medical Method of Abortion (MMA)

Facilities providing family welfare

services

The Family Welfare Services are provided in the

following Centres:

Sl. No. of
Centres
No. Centres
1 Primary Health Centres 1,421
2 Community Health Centres (Block) 385
3 Urban Primary Health Centres 460
4 Health Sub-Centres 8,713
Rural Family Welfare Centres 382
5
attached with PHC/CHC
6 Post Partum Centres 110
7 Urban Family Welfare Centres 108
8 Voluntary Organisations 27
9 Approved Private Nursing Homes 2,462

98
7.6 Schemes implemented under the
Family Welfare Programme

7.6.1 Male sterilization:

It is an ongoing programme implemented

in the State. Special awareness campaigns are
conducted towards participation of males to
accept No Scalpel Vasectomy (NSV). 385 Camps
were conducted in the year 2018-2019. It is
proposed to conduct NSV camps in all the 385
Blocks in the State during the year 2019-2020 at
a cost of Rs.38.5 lakhs.

7.6.2 Female Sterilization:

In Tamil Nadu, 22 Medical College

Hospitals, 31 Government Head Quarters
Hospitals, 223 Government hospitals, 376
Primary Health Centres, 26 Health Posts in
Municipal Corporations and 2,462 approved
private nursing homes are providing female
sterilization services. Apart from providing
sterilization to delivered mothers, the interval
sterilization is also provided to eligible mothers.

99
7.6.3 Post Partum Intrauterine
Contraceptive Device (PPIUCD)

Copper-T inserted to delivered mothers

within 48 hours, is called post partum
intrauterine contraceptive device insertion. The
doctors and staff nurses are trained to insert
IUCD during post partum period. Mothers with
one child are counselled and IUCD is inserted
immediately after delivery. Mothers who have
two or more children and not fit for Tubectomy
will be counselled to accept the PPIUCD insertion
immediately after delivery. In the year 2018-
2019 total number of PPIUCD inserted were 2.01
Lakhs. It is proposed to insert 2.4 lakhs PPIUCD
during the year 2019-2020. A sum of Rs.150/-
is paid to service providers per case as incentive
and Rs.300/- is paid to the acceptors for
accepting PPIUCD.

7.6.4 Injectable contraceptives: Depot

Medroxy Progestrone Acetate
(DMPA) - Antara:

Injectable contraceptive services are

provided to the acceptors through trained
doctors and Staff Nurses in all Government

100
health facilities up to Primary Health Centre
level. These contraceptive services can be
availed by the eligible mothers once in three
months in the Government health facilities. In
the year 2018-2019 total of ANTARA
performance was 39,058 (mothers). It has been
proposed to impart training on this contraceptive
method to Doctors, Staff Nurses / LHV / ANM
during the year 2019-2020 at a total cost of
Rs.58.56 lakhs.

7.6.5 Centchroman pills (Chhaya):

Centchroman is a new non hormonal

contraceptive pill in the name of Chhaya
introduced in all Government health facilities to
benefit more women. It is a safe spacing method
for both breast feeding and non-breast feeding
mothers. The Chhaya performance for the year
2018-2019 was 75,331 (Mothers).

7.6.6 Medical Termination of Pregnancy

(MTP) Programme:

Annually 63,000 MTPs are performed in

the Government and private institutions, out of
which 21,932 MTPs are performed by Manual

101
Vacuum Aspiration (MVA) technique. In order to
provide safe abortion services to the needy
mothers, the Doctors and Staff Nurses of PHCs
and Government Hospitals are imparted training
on MVA technique for safe abortion practices. In
the year 2018-2019 total number of 52 lady
Doctors was trained under MVA technique. It has
been proposed to train 300 doctors under the
MVA technique during 2019-2020 at a cost of
Rs.26.24 lakhs.

7.6.7 Safe abortion practices in all

Government health facilities:

In order to strengthen the safe abortion

practices in rural and urban areas, all the
Government facilities have been made as static
centres for providing safe abortion services. This
will curtail the maternal deaths due to abortion
done by quacks. It will also help in preventing
sex selective abortion.

7.7 Strengthening of temporary Family

Welfare methods in Tribal Areas:

The tribals practice non-medical methods

and unsafe abortion techniques to avoid

102
pregnancy which leads to maternal
complications and maternal mortality. To avoid
these practices, Home Delivery of Contraception
(HDC) through ASHA/Anganwadi Workers has
been initiated to strengthen the practice of
temporary methods among the tribal people.
The temporary methods of OP, E-pill,
centchroman pills, Nirodh and Pregnancy Test
Kit (PTK) are being popularized through special
campaign in the tribal areas.

7.8 Family Planning Logistic Management

Information System (FP-LMIS)
Training:

Government of India has developed a web

portal FP-LMIS to upload and monitor the supply
chain of Family Welfare contraceptives from
National level to ASHA level through web based,
Mobile based and SMS based services. State
Level training was imparted to all the District
level officials in 32 Districts and District Level
training for Block level staff is going on.

103
7.9 Information, Education and
Communication Activities:

To create awareness among eligible

couples to accept permanent and temporary
family planning methods the following IEC
activities are being conducted:

i. World Population Day is celebrated every

year on 11th July, in State, District and
Block levels to sensitize population crisis,
emphasizing small family, gender equality,
spacing and increasing the age of
marriage.
ii. No Scalpel Vasectomy (NSV) week is
celebrated throughout the State once in a
year among community and factory
employees for male participation under
small family norms
iii. Family Welfare dramas are conducted at
Block level emphasizing small family,
gender equality, spacing and increasing
the age of marriage.
iv. Advertisements through FM rainbow radio
stations are broadcasted.

104
 v. Hoardings displaying Family Planning
methods are exhibited in Trade fair
Exhibitions.
vi. Hoardings displaying Family Welfare
methods are erected in Government
Headquarters Hospitals and Government
Medical College Hospitals
7.10 Family Planning Indemnity Scheme
(FPIS):

The Government of India introduced the

Family Planning Indemnity Scheme with effect
from 1st April, 2013 with the following insurance
benefits for the family welfare sterilization
acceptors and service providers:

Death following sterilization

in hospital or within 7 days
Rs.2,00,000
from the date of discharge
from the hospital
Death following sterilization
within 8 to 30 days from the
Rs.50,000
date of discharge from the
hospital
Failure of sterilization
leading/not-leading to child Rs.30,000
birth

105
Cost of treatment up to 60
Actual cost not
days arising out of
exceeding
complication from the date
Rs.25,000
of discharge
Indemnity insurance per
Up to Rs.2.00
doctor per facility but not
lakhs per case of
more than 4 cases per
litigation
Doctor in a year

7.11 State and District Quality Assurance

Committees:

These committees review the deaths,

failures and complications arising out of
sterilization and recommend for the payment of
insurance claims and also give suggestions for
improvement of the quality of the services.

7.12 Compensation to Sterilization

Acceptors:

Compensation for loss of wages to the

sterilization acceptors is paid in the State as
detailed below:

106
Acceptors of male sterilization in Rs.1,100
public health facilities
Acceptors of female sterilization Rs.600
belonging to below poverty line
and SC / ST in public health
facilities
Acceptors of female sterilization Rs.250
belonging to above poverty line
in public health facilities

In Tamil Nadu annually about 3 lakh

sterilizations are performed in the Government
health facilities and private medical institutions.
Tamil Nadu Government encourages
participation of approved private nursing homes
in providing family welfare services. The family
welfare programme is implemented successfully
to improve the quality of family welfare services
and also to improve the spacing between births
thereby contributing to the reduction of IMR and
MMR in the State.

107
 Chapter - 8

MEDICAL AND RURAL HEALTH SERVICES

(Employees’ State Insurance Scheme)

8.1 The Employees’ State Insurance

Scheme of Tamil Nadu is a statutory body
functioning under ESI Corporation, New Delhi.
It has 10 ESI Hospitals and 216 ESI
Dispensaries functioning under it. ESI Medical
College at Coimbatore has been added to the
Government Medical Colleges functioning under
Government of Tamil Nadu.

8.2 The administration of ESI Dispensaries

in this State is done by 4 Regional
Administrative Medical Officers (ESIS)
functioning at Chennai, Coimbatore, Madurai and
Salem.

8.3 The two ESI Hospitals at K.K. Nagar,

Chennai and Tirunelveli are under the direct
control of the ESI Corporation, New Delhi. The
ESI Hospital, Coimbatore attached to
Government Medical College is under the control
of the Director of Medical Education and the
remaining 7 ESI Hospitals are under the control

108
of the Director of Medical and Rural Health
Services (ESIS), Tamil Nadu.

8.4 All the 4 regions have Central Medical

Stores (ESIS) to supply drugs and dressings to
various ESI Dispensaries. The administrative
control of all the personnel comes under the
Director (ESIS), Joint Director (ESIS) and
Deputy Director (ESIS) functioning from
Chennai. In addition to the 4 Regional
Administrative Medical Officers (ESIS), there are
7 Medical Superintendents for 7 State run ESI
Hospitals viz. Chennai-Ayanavaram, Madurai,
Sivakasi, Tiruchirappalli, Salem, Vellore and
Hosur.

8.5 The ESI Dispensaries provide primary

care and ESI Hospitals provide secondary and
tertiary care to the insured persons and their
family members. The details of the activities of
this Department have been brought out in the
Labour and Employment Department Policy
Note.

109
 Chapter - 9

INDIAN MEDICINE AND HOMOEOPATHY

9.1 The Indian Systems of Medicine

(ISM) are ethnic to our country. The Siddha,
Ayurveda and Yoga & Naturopathy Systems of
Medicine have been popular modes of health
care in this country from the dawn of civilization.
Most of the medicines administered under the
Indian Systems are prepared from herbal plants
grown widely in rural areas. These systems have
therefore remained a reliable and economical
form of treatment available locally.The axiomatic
saying in Tamil “cznt kUªJ kUªnj czΔ
rightly depicts the significance of the herbs in
our daily food cycle from the time immemorial.
The ISM&H synonymous with AYUSH operates
on the principle that prevention is better than
cure. The Siddha system is the proud
contribution of our Tamil ancestors to the world.
It is the unique health care system widely
practiced across the world wherever Tamils
reside. Further, these Indian Systems of
Medicine provide relief even for chronic ailments.
The world is witnessing a resurgence of

110
traditional systems of medicine due to the
holistic approach to health followed by these
treatments. The estimate of World Health
Organization reveals that 70% of world
population depends on such ethnic system of
health care specific to the geographies across
the globe. Hence with an avowed intention of
taking the benefits of these systems to the
doorsteps of the public, the Department of
Indian Medicine and Homoeopathy has been
rendering its service since 1970.

Administrative Structure

9.2 The Government of Tamil Nadu established

the “Department of Indian Medicine and
Homoeopathy’’ which came into existence in
1970, is responsible for teaching as well as for
providing health care in five systems of Indian
Medicine viz., Siddha, Ayurveda, Unani,
Homoeopathy, Yoga & Naturopathy. The
Administrative structure of the Department is as
follows:

111
 COMMISSIONER / DIRECTOR

 Joint Director
 Joint Director (Ex- Officio)
 Chief Scientific Officer / Director, Research
and Development Wing
 Principals of Government Siddha, Ayurveda,
Unani and Yoga & Naturopathy, and
Homoeopathy Medical Colleges
 State Licensing Authority (Indian Medicine)
 Government Analyst, Drugs Testing
Laboratory (Indian Medicine)
 Superintendent, Arignar Anna Government
Hospital of Indian Medicine, Chennai
 District Siddha Medical Officers

Government Siddha, Ayurveda, Unani, Yoga &

Naturopathy, and Homoeopathy Dispensaries
attached to Government Hospitals/ PHCs and ISM
wards in Government Hospitals

112
9.3 The main objectives of the department are:

 Bringing Indian system of Medicine into

the mainstream to give holistic health care
and taking the benefits of traditional
systems to the public by opening ISM
wings / Hospitals at various levels in all
the districts.

 Improvement of educational institutions in

Siddha, Ayurveda, Unani, Yoga &
Naturopathy and Homoeopathy to provide
students with all the necessary
infrastructure for gaining systematic
knowledge in the respective system

 Encouraging the processing and

manufacture of ISM&H drugs and promote
research and development activities in
ISM&H

 Developing the existing Government

Indian Systems of Medicine and
Homoeopathy Medical Colleges and to
improve the standard of Medical Education
in these systems

 Opening of new Medical Colleges in these

systems

113
  Encouraging the growth of Centre of
Excellence in the field of Indian medicine

 Regulation of Drug Manufacturing and

Quality Control of Indian System of
Medicine to ensure availability of quality
drugs to public.

 Establishing life style clinics in Yoga &

Naturopathy in all Government Hospitals

ISM Medical treatment

9.4 Details of Government institutions

under Indian Medicine and Homoeopathy are as
follows

No. of medical
System
institutions
Siddha 1,079

Ayurvedha 103

Unani 66
Yoga & Naturopathy 177
Homoeopathy 109
Total 1,534

114
 ISM Medical Education

9.5 Under the control of Indian Medicine and

Homoeopathy Department, Under Graduate
degree courses (BSMS / BAMS / BNYS / BUMS /
BHMS) in the systems of Siddha, Ayurveda,
Yoga & Naturopathy, Unani, Homoeopathy and
Post Graduate degree courses [M.D (S), M.D (H)
and M.D (Y&N)] in the systems of Siddha,
Homoeopathy, Yoga & Naturopathy are being
imparted in the respective 6 Government
Colleges and 27 Private Colleges as follows:

No. of No. of
Sl. Medical
Government Private
No System
Colleges Colleges
1 Siddha 2 7
2 Ayurveda 1 4

3 Unani 1 0

4 Yoga &
1 7
Naturopathy
5 Homoeopathy 1 9
Total 6 27

115
The details of Government Medical Colleges
functioning under Indian Medicine and
Homoeopathy department are as follows:

 Government Siddha Medical College and

Hospital, Palayamkottai, Tirunelveli District

 Government Siddha Medical College,

Arignar Anna Government Hospital of
Indian Medicine (AAGHIM) campus,
Arumbakkam, Chennai

 Government Yoga & Naturopathy Medical

College, AAGHIM campus, Arumbakkam,
Chennai

 Government Homoeopathy Medical College

and Hospital, Tirumangalam, Madurai
District

 Government Unani Medical College,

AAGHIM Campus, Arumbakkam, Chennai

 Government Ayurveda Medical College and

Hospital, Kottar, Nagercoil, Kanniyakumari
District

9.6 Tamil Nadu has the unique credit of

being the only State in the country where

116
 Government Medical Colleges have been
established in all the disciplines of Indian
Systems of Medicine and Homoeopathy. Number
of seats available in the Government Colleges
and the Private Colleges for admission to the
Under Graduate (UG) and Post Graduate (PG)
Courses of ISM&H are given as under:

Details of seats available

Sl. for admission
Discipline
No. Government Private
UG PG UG PG
1. Siddha 160 94 370 --
2. Ayurveda 60 -- 190 --
3. Unani 60 -- -- --
4. Yoga &
60 15 550 --
Naturopathy
5. Homoeopathy 50 -- 660 30
Total 390 109 1,770 30

Main Streaming of Indian System of

Medicine and Homoeopathy Wings in
Government Medical Institutions

117
 9.7 Under the policy of main streaming, at
present Indian System of Medicine and
Homoeopathy treatment facilities are made
available in Allopathy Medical College Hospitals,
Multi Super Speciality Hospital, District
Headquarters Hospitals, Taluk and Non-Taluk
Hospitals and Primary Health Centres (including
475 wings funded under National Rural Health
Mission) and 72 AYUSH Wellness Clinics as
shown below:-

REGULAR
Homoeopathy

Naturopathy
Ayurveda

Yoga &
Siddha

Unani

Colleges Total

2 1 1 1 1 6
Major
3 2 1 1 1 8
Hospital
Medical
College 15 3 2 9 25 54
Hospital

118
 Multi Super
Speciality
- - - - 1 1
Hospital.
(Omandurar)
District Head 31 4 3 20 30 88
Quarters
Hospital
Taluk 191 2 - 8 31 232
Hospital
Non Taluk 58 2 4 - - 64
Hospital
406 25 14 6 2 453
PHC

Regular 13 6 - 5 1 25
Dispensary
Tribal 7 - - - - 7
Dispensary
Mobile 1 - - - - 1
Dispensary
Rural 45 3 - - - 48
Dispensary
Total 772 48 25 50 92 987

119
 NRHM

Taluk 4 - 1 - - 5
Hospital
271 52 39 57 20 439
PHC

Y&N - - - - 29 29
Maternity
Clinic (PHC)
Y&N - - - - 2 2
Maternity
Clinic (Taluk
Hospital)
Total 275 52 40 57 51 475

AYUSH WELLNESS CLINICS

Hospitals - - - - 2 2
under DME
Taluk 4 - - 1 30 35
Hospital
Non Taluk 2 - 1 - - 3
Hospital

120
 26 3 - 1 - 30
PHC

Regular - - - - 2 2
Dispensary
32 3 1 2 34 72
Total

GRAND 1,079 103 66 109 177 1,534

TOTAL

Paramedical courses

9.8 Two Diploma Courses (viz.) Diploma in

Integrated Pharmacy and Diploma in Nursing
Therapy are being conducted at Arignar Anna
Government Siddha Medical College, Chennai
and Government Siddha Medical College,
Palayamkottai, Tirunelveli. The courses are of
two and half year duration and aim at promoting
the availability of institutionally qualified
Pharmacists and Nursing Therapists under this
system of medicine. The number of seats
sanctioned for Diploma Course in Integrated
Pharmacy and for Nursing Therapy are as follows

121
 Number of seats

Integrated
Diploma in

Diploma in
Pharmacy

Therapy
Nursing
Name of the
Sl. Total
Institution
No.

Government
1. Siddha
Medical 50 50 100
College,
Chennai
Government
2. Siddha
Medical
50 50 100
College,
Palayamkottai,
Tirunelveli

Total 100 100 200

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 State Drug Licensing Authority for Indian
Medicine

9.9 The office of the State Licensing

Authority (IM) has started its functioning in
Chennai from 29.11.2007 to ensure quality,
efficacy and safety of Ayurveda, Siddha and
Unani Drugs. The Indian system of Medicines are
licensed by the State Licensing Authority (Indian
Medicine) as per the Drugs and Cosmetics Act,
1940 and Rules, 1945. The State Licensing
Authority is the authority for the grant and
renewal of a license for manufacture and sale of
Ayurveda, Siddha and Unani (ASU) drugs and
also approving authority for institutions for
carrying out tests on Ayurveda, Siddha and
Unani drugs and raw materials used in their
manufacture.The District Siddha Medical Officers
of this department are appointed as Drug
Inspectors as per the provisions of Drugs and
Cosmetics Act, 1940 and Rules, 1945. As per
section 22 and Rule 162 of Drugs and Cosmetics
Act, 1940 and Rules, 1945, the Drugs Inspectors
have power to inspect the premises not less
than twice a year, take statutory samples and to
initiate prosecution against the erring
manufacturers.

123
Standardization of ISM Drugs and
Strengthening of State Drug Testing
Laboratory

9.10 The primary function of Drug Testing

laboratory (IM) is to test the quality of statutory
samples lifted and sent by the Drug Inspector
(IM) in discharging of their statutory function
under Section 33G of Drugs and Cosmetics Act,
1940. The Laboratory has been conferred with
the statutory status. Advanced and modern
equipment have been installed in the laboratory
for the purpose of Standardization and quality
control of ISM Medicine. Government Analyst,
Drug Testing laboratory (IM) Tamil Nadu has
been notified as Government Analyst for
Andaman Nicobar (Union Territory) to discharge
the statutory duties as per Section 33F(2) of
Drugs & Cosmetics Act, 1940.

The Arignar Anna Government Hospital of

Indian Medicine

9.11 The Arignar Anna Government

Hospital of Indian Medicine, Chennai was started
in the year 1970. The hospital functions with a
bed strength of 310. Treatment under all the

124
systems of Indian Medicine and Homoeopathy
(i.e Siddha, Ayurveda, Unani, Homoeopathy and
Yoga & Naturopathy) are offered to the general
public to take treatment of their choice. During
the year 2018 the hospital has treated 4,50,944
out-patients and 54,107 in-patients. A fully
automated analyser has been purchased for the
use in Bio-Chemistry laboratory at a cost of
Rs.8,55,500/- to provide better laboratory
services to the patients. A sum of Rs.56.25
Lakh has been allotted under the State Annual
Action Plan (SAAP) for the renovation of
out-patient buildings of this hospital. The
medicines required for the treatment of patients
under Siddha, Ayurveda, Unani are being
prepared in the pharmacy adjoining the hospital.
For the period from 01.01.2018 to 31.12.2018
an approximate quantity of 3,541 kg of
Nilavembu Kudineer powder has been processed
and distributed to the dispensaries in and
around Chennai. Moreover, Dengue awareness
camps have been conducted in and around
Chennai to prevent the spread of Viral and
Dengue Fevers. 437Kg of Nilavembu Powder has
been distributed to the public in the form of
Nilavembu Kudineer in this campus.

125
 Tamil Nadu Medicinal Plant Farms and
Herbal Medicine Corporation Limited
(TAMPCOL)

9.12 Tamil Nadu Medicinal Plant Farms

and Herbal Medicine Corporation Limited
(TAMPCOL) was started on 27th September 1983
with the main objective of manufacturing and
supplying Siddha, Ayurveda and Unani
medicines. The registered office functions at
Anna Hospital campus, Arumbakkam, Chennai
and its factory, functioning at SIDCO
Pharmaceutical campus, Alathur near
Thiruporur, Kancheepuram district, is involved in
manufacturing of 124 medicines out of which 77
are Siddha medicines, 39 are Ayurveda
medicines and 8 are Unani medicines. These
medicines are supplied to all institutions
functioning under the Commissionerate of Indian
Medicine and Homoeopathy, besides other
Government Institutions and TAMPCOL’s own
sales outlets. TAMPCOL as a Nodal Agency,
procures and supplies medicines, machinery and
equipments to the institutions functioning in this
department. During 2018-2019, the corporation
has extended a rate rebate of 25% with effect

126
from 28.09.2018 for all Government supplies,
which is effecting a savings to the tune of
Rs.150.00 lakh. During the year 2018-2019 the
Corporation supplied 11 medicines under Amma
Magapperu Sanjeevi Kit for pregnant women and
under Amma Baby Care Kit, Sowbhagya Sunti
Lehiyam supply was continued. For the year
2018-2019 medicine supply was effected to the
tune of Rs.2.76 crore to the Tamil Nadu
Livestock Development Agency. The above
manufacturing and supply activities will be
continued in 2019-2020. TAMPCOL will continue
its role in production and uninterrupted supply of
Nilavembu Kudineer and Kabasura Kudineer in
coming financial years also, for the distribution
of the same to Hospitals coming under the ambit
of Indian System of Medicines, AYUSH
Institutions, Corporation / Municipality
dispensaries to prevent dengue and Swine flu
outbreak.

The corporation has three sales counters

at Chennai, Palayamkottai and Nagercoil.
Tampcol proposes to establish one more sales
counter in the Girivalam route at
Thiruvannamalai. A free medical consultancy

127
clinic is being operated at the corporate office
building of the corporation with doctors from all
streams of Indian System of Medicines namely
Siddha, Ayurveda, Unani and Yoga &
Naturopathy on rotation basis.

The corporation is in the process of

revamping its existing packaging practice for
better dispensation of medicines in order to
retain the efficiency and hygiene, besides
making TAMPCOL’s product presence felt in the
market. The corporation has recently renovated
its buildings located inside the factory premises.
Besides, improvised machineries worth Rs.77.49
lakh have been purchased for increased
productivity and reducing factory production
lead times.

The corporation has initiated the process

of establishing an additional production unit in
the campus of Pudukottai District Head Quarters
Hospital. Further it is also proposed to construct
a three storeyed building with each floor
admeasuring 3,000 sq. ft to expand the business
activities at the land purchased at SIDCO
Pharmaceutical Complex at Alathur. With the

128
aim of tapping the global market, the
Corporation’s renowned commercial product viz.
Herbal Hair Tonic has been made available in the
e-commerce site viz. Amazon. The process of
re-launching one more commercial product
called “Vigorous” in the market is underway.

9.13 Other Activities:

 International Institute of Yoga &

Naturopathy Medical Sciences to be
established in Chengalpet, Kancheepuram
District in 50 acres of land at a cost of Rs.
92 Crore.

 Siddha, Yoga & Naturopathy integrated

AYUSH Hospital with 50 beds is being
established at Theni and Thiruvannamalai.

 Awareness programme and distribution of

Nilavembu Kudineer and Dengue and
Chikunkunniya prevention activities will
continue to be carried out.

 A special treatment for weight reduction is

conducted in the hospital attached to
Government Yoga & Naturopathy Medical
College, Chennai, by means of natural

129
 foods, natural herbal treatment, mud bath
therapy, hot steam bath therapy, plantain
leaf bath etc.

State AYUSH Society

9.14 “State AYUSH Society – Tamil Nadu” is

formed to implement the schemes sanctioned to
the State under the National AYUSH Mission.
The schemes are implemented by the Society,
out of the funds received from the Government
based on the sharing pattern in the ratio of
60:40. For the year 2018-2019, schemes were
approved for an amount of Rs.27.82 crore in the
State Annual Action Plan (SAAP) and
supplementary SAAP for Rs.12.85 crore totalling
Rs.40.67 crore, have been approved

130
 Chapter - 10

FOOD SAFETY AND DRUG DMINISTRATION

10.1 The Food Safety and Standards Act,

2006 is being implemented in the entire country
with effect from 05.08.2011 by repealing the
Prevention of Food Adulteration Act, 1954 and
other seven related food laws. Tamil Nadu Food
Safety and Drug Administration Department was
formed with effect from 22.12.2011.

10.2 The department is headed by the

Commissioner of Food Safety, assisted by the
Director and Additional Commissioner of Food
Safety, other supportive staff at state level and
32 designated officers at the district level and
584 Food Safety Officers (385 for Blocks and
199 for Urban) to implement the new Act. Six
Food Laboratories are functioning at Chennai,
Thanjavur, Madurai, Salem, Coimbatore and
Palayamkottai for testing of food samples.

Licensing and Registration Certificate

10.3 As per the Food Safety and

Standards Act, License or Registration Certificate
is being issued to the food business operators

131
whose annual income is more than Rs.12 lakh
through Designated Officer and to the food
business operators whose annual income is less
than Rs.12 lakh through Food Safety Officers.

Enforcement activities

10.4 Periodical inspections are made by

Designated Officers / Food Safety Officers at
various manufacturing, transport, storage and
retail outlets. Regular surveillance of food
products is also done by Food Safety Officers
and wherever required, food samples are lifted
for analysis and based on the analysis report,
legal action are taken.

Prohibition of food products with tobacco &

nicotine

10.5 Tobacco use is the foremost cause of

cancer disease and prevention globally as well as
in India. To prevent various types of cancer
caused by consumption of smokeless tobacco,
the manufacture, transport, storage, distribution
and sale of Gutkha, Panmasala and any other
food product containing tobacco or nicotine as
ingredient has been prohibited in Tamil Nadu

132
and necessary Gazette Notification has been
issued with effect from 23.05.2013. District
Level Surveillance Committee under the
Chairmanship of District Collector with District
Superintendent of Police, District Revenue
Officer, District Excise Officer, Deputy Director of
Health Services, Regional Transport Officer,
Chief Education Officer, District Social Welfare
Officer, Commissioner for Municipalities /
Corporations and Designated Officer of Food
Safety Department as Members has been
formed to enforce the ban order and monitor its
implementation in every district. The ban order
is extended every year and the latest notification
extending the ban for a period of one year was
issued on 23.05.2019. From June 2013 to May
2019, total tonnes of 736.98 (7, 36,980 Kg) of
Gutkha and Panmasala to the value of Rs.24.34
crore were seized and destroyed.

Complaint Redressal

10.6 The department has created a

consumer complaint redressal system to make
complaints on unsafe, substandard and
mislabled food products using a separate e-mail

133
address unnavupukar@gmail.com and a
whatsapp mobile number 9444042322. Any
complaint received is acted upon within 24 / 48
hours and feedback sent to the complainant.

Milk and Milk Products

10.7 To strengthen continuous monitoring

and prevent adulteration of milk and milk
products, 1357 samples were lifted during the
year 2018-2019, legal action initiated in 177
cases. Electronic Milk Adulteration Tester (EMAT)
is being used for Surveillance and creating
awareness on quality of milk brought by
consumers in the districts.

Packaged Drinking Water

10.8 Regular inspection of packaged

drinking water units are being done by the Food
Safety Officers to ensure the provision of safe
and quality packaged drinking water. During the
year 2018-2019, 69 samples were lifted and
legal action initiated in 76 cases.

134
 Safe and Nutritious Food at School
(SNF@School)

10.9 SNF@schools is a nation-wide

campaign launched by Food Safety Standard
Authority of India to inculcate the habit of eating
safe and eating right among school children.
‘Catch them young’ is the approach to change
behaviours and habits among children and for
taking the message of food safety to their
homes.

DRUGS CONTROL ADMINISTRATION

10.10 The Drugs Control Department

functions as a separate department with
Director of Drugs Control as Head of the
Department under the Administrative control of
“Commissioner of Food Safety and Drugs
Administration”.

135
 Administrative Structure

Commissioner of Food Safety and Drug

Administration

Food Safety Drugs Control

Department Department

Director

State Drugs
Joint
Testing
Director
Laboratory

Deputy Directors

Zonal Assistant
Directors

Senior Drug Inspectors

Drugs Inspectors

136
 10.11 The Drugs Control Administration
has the prime mandate of enforcement of the
following enactments, all being Central Acts for
regulating the manufacture, distribution and sale
of drugs and cosmetics:

(i) Drugs and Cosmetics Act, 1940, Drugs and

Cosmetics Rules, 1945 and Medical
Devices Rules, 2017.

(ii) Drugs Price Control Order, 2013.

(iii) The Drugs and Magic Remedies

(Objectionable Advertisement) Act,
1954 and Rules, 1955.

The Officers of this Department are also

empowered to act under the Narcotic Drugs and
Psychotropic Substances Act, 1985.

10.12 The Director of Drugs Control is the

controlling authority and licensing authority for
grant of licenses for manufacture (for sale) of
Allopathic, Homeopathic Medicines and
Cosmetics and the approvals are issued after the
Joint Inspection of the officers of the State and
Central Governments. He is the Licensing
Authority for Blood Banks in Tamil Nadu along

137
with the Central License Approving Authority of
the Government of India.

10.13 Drugs Control Department monitors

 The quality, safety, efficacy and availability

of drugs at right prices.

 The quality and safety of cosmetics.

 The misleading advertisements with respect

to Drugs and Magic remedies.

 Collection and supply of safe blood and

blood components.

10.14 The sanctioned staff strength of the

Department in the enforcement and
Testing Laboratory is given below:-

ENFORCEMENT

SL. NO. OF
NAME OF THE POST
NO. POSTS
1 Director of Drugs Control 01
2 Joint Director of Drugs Control 01
3 Deputy Director of Drugs
03
Control

138
SL. NO. OF
NAME OF THE POST
NO. POSTS
4 Assistant Director of Drugs
15
Control

5 Assistant Director of Drugs

Control 01
(Administration)

6 Senior Drugs Inspector 15

7 Drugs Inspector 146

8 Legal Adviser 01

9 Assistant Accounts Officer 01

10 Ministerial Staff 117

11 Office Assistant 79

12 Driver 04

13 Telephone Operator 01

TOTAL 385

139
 Drugs Testing Laboratory

SL. NO. OF
NAME OF THE POST
NO. POSTS
1 Government Analyst 01
2 Deputy Government 02
Analyst
3 Senior Analyst 14
4 Junior Analyst 38
5 Junior Administrative 01
Officer
6 Technician Grade – I 06
7 Technician Grade – II 04
8 Electrician Grade – I 01
9 Plumber 01
10 Laboratory Attendant 07
11 Animal Attendant 01
12 Ministerial Staff 10
13 Office Assistant 05
14 Sweeper 01
15 Sweeper-cum-Watchman 01
TOTAL 93

140
10.15 Functioning of Legal cum Intelligence
Wing and Mobile Squad:

A Legal cum Intelligence Wing with a mobile

squad is functioning in the Directorate to attend
the complaints relating to drugs and cosmetics.
It processes legal matters and undertakes
special investigations including interstate
investigations in association with the Drugs
Control department of other States.

10.16 Drugs Testing Laboratory:

Drugs Testing Laboratory attached to this

Department undertakes testing of samples
drawn by the Drugs Inspectors (other than
parenteral drugs) from various retail, wholesale
units, manufacturing units and hospitals of
private and Government sector. The analysis of
parenteral drugs are undertaken by the Drugs
testing lab situated at the King Institute of
Preventive Medicine, Chennai.

141
10.17 Number of Licensed Premises as on
31.03.2019

Sales Manufacturing
Licenses Licenses

Blood Storage
Blood Banks

Centers
Homeopathic
Wholesale

Cosmetics
Allopathic
Licences

Licences
Retail

Drug

Drug
38,499 15,522 543 9 170 300 521

10.18 Number of Inspections during

2018-2019

No. of
Details
Inspections
Sales Premises 55,170

Manufacturing Premises 1,195

Hospitals and Medical Stores 2,169

Blood Bank 1,148

142
10.19 Details of Samples drawn, tested and
reported as Not of Standard Quality
Drugs during 2018-2019

Total No. of Samples drawn 8,988

No. of Samples Tested 10,750

No. of Samples declared as Not of
304
Standard Quality

10.20 No. of Sales Licences Suspended

during 2018-2019

Total No. of Retail Licence 30

suspended
Total No. of Wholesale Licence 34
suspended
Total No. of Licence 64
suspended

143
10.21 Prosecution for certain
contraventions under Drugs and
Cosmetics Act, 1940 Drugs Price
Control Order during 2018-2019 and
Drugs and Magic Remedies
(Objectionable Advertisement) Act,
1954 during 2018-2019

Sl.
Details No. of cases
No.

1 For the manufacture Our State – 2

of Spurious drugs Other States – 4
Total – 6

2 For the manufacture Our State – 22

of Not of Standard Other States – 74
quality drugs Total – 96

3 For the sale of drugs 138

without supervision
of Pharmacist

4 For the sale of drugs 259

without prescription
of Registered
Medical Practitioner

5 For the 04
stocking/sale of
date expired drugs

144
 Sl.
Details No. of cases
No.

6 Contraventions 378
under Drugs and
Cosmetics Act, 1940
and Rules, 1945

7 Contraventions 5
under DMR (OA)
Act, 1954

8 No. of Sanctions 2
issued under Drugs
Price Control Order,
2013

This Directorate has conducted surprise raids all

over the state to check the sale of abortion pills
without valid prescription and legal actions have
been initiated against 51 dealers for having sold
abortion pills without valid prescription under
the provisions of Drugs and Cosmetics Act, 1940
and Rules, 1945.

145
 Chapter 11

Tamil Nadu State Health Transport

Department

11.1 Tamil Nadu State Health Transport

Department is the Department in charge for the
maintenance of all the vehicles attached to
various Directorates of Health and Family
Welfare department plays an important role in
providing trouble free logistic support and
mobility for execution of various health care
programmes.

11.2 Main functions of the department:

i) To economically maintain a healthy fleet

of vehicles by carrying out regular service
and repairs.

ii) To deliver all the vehicles admitted for

repairs at the earliest with minimum
downtime and to also ensure that no
vehicle – irrespective of the magnitude of
required mechanical and body repairs, is
retained for more than 30 days.

146
iii) To provide professional assistance in the
tender evaluation made during the
purchase of new vehicles and while
awarding fabrication work in ambulance
vehicles. To test and appraise the
fabrication work executed in the
ambulance and hearse vehicles.
iv) To use a computerized data base
program to regularly assess, monitor and
review the performance of each workshop
attached to this department, to ensure
comprehensive evaluation of the units
and to identify and focus on the areas of
improvement. To act as a repository for
all data related to vehicles.
v) To make right recommendations to the
concerned, on a regular and timely basis
for replacement of aged and worn out
vehicles and to thereafter quickly dispose
the condemned, vehicles through e-
auction.
vi) To provide complete solutions to all the
problems encountered by the Medical
Officers with regard to repairs,
maintenance and operation of vehicles
and to guide vehicle record maintenance.

147
11.3 Fleet Maintained:

This department through 7 regional

workshops, 9 district workshops, 29 mobile
workshops, 4 mini workshops and 1 recondition
unit functioning under its administrative control,
maintains a total diversified fleet of 2,730
vehicles attached to various directorates of
Health and Family Welfare department.

11.4 Special initiatives:

11.4.1 Grievance Redressal Programme:

A grievance redressal programme named

HICORP, an acronym for Health department
vehicles Information and Complaint Redressal
Programme is being implemented by this
department. This acts as an one stop solution
for the medical officers as well as the drivers in
the maintenance and operation of vehicles. The
helpline number to which SMS has to be sent to
resolve the grievances is 94896 21111. This is
the first of its kind 24/7 free of cost grievance
redressal programme run by a vehicle
maintenance department.

148
11.4.2 Vehicle Management Database
Program

A vehicle management database program

has been designed and developed by this
department using in-house resources and
manpower. The activities of workshops, stores
and technical sections of the directorate have
been computerized using this program. The
performance of each regional / district workshop
attached to this department is evaluated every
month, using this program and to encourage
healthy competition, ranks are awarded to each
workshop.

11.4.3 Minimum detention period of

Hospital on Wheel vehicles:

Hospital on wheel vehicles equipped with

laboratory facilities and medical equipment, are
utilized by Primary Health Centres to regularly
conduct medical camps in remote areas and also
during natural calamities to prevent epidemics.
Considering the importance attached to its
utility, special emphasis and priority is accorded
to the repairs and maintenance of these
vehicles. When these type of vehicles are

149
admitted in the workshops, the progress and
repairs in each and every vehicle is monitored at
different levels to ensure that all repairs
including body and engine works are completed
at the earliest and the vehicles delivered within
twenty days.

11.4.4 Condemnation and quick disposal of

aged vehicles:

This department takes all the initiatives in

identifying, aged vehicles that are uneconomical
to maintain and for its early condemnation and
disposal. Various stages involved in the
condemnation of a vehicle like preparation of
Expert Committee reports, cancellation of
registration numbers by the registering
authority, preparation of Condemnation Board
reports and disposal of condemned vehicles
through e-auction are now taken care and
handled by this department thus relieving the
medical officers from such vehicle related
arduous work and enabling them to focus on
public health activities.

150
 Chapter -12

HUMAN RESOURCES AND MEDICAL

SERVICES RECRUITMENT BOARD

12.1 Human Resources are the backbone

of any organisation. Medical Services
Recruitment Board (MRB) plays a crucial role in
contributing human resources required for
achieving the objectives of health and Family
Welfare department. With more than 10
directorates under the control of Health and
Family Welfare Department, MRB undertakes
recruitment for over 200 categories of post
existing in various Government medical
institutions throughout the State.

12.2 Formation of Medical Services

Recruitment Board:

MRB was formed in 2012 exclusively for

the Health and Family Welfare Department with
the objective to carry out all direct recruitments
in order to fill up vacancies to various categories
of posts. The MRB conducts recruitment through
a fair procedure by way of open advertisement
in the newspapers and receives applications

151
online. In its endeavour to provide qualified
personnel, MRB conducts direct recruitment for
Doctors, Nurses and Para Medical posts through
written examination and following weightage
method depending on the category of posts,
following communal rotation and rule of
reservation in force.

12.3 The Medical Services Recruitment

Board has recruited the candidates for the
following categories of posts till 31.03.2019 from
date of inception.

No. of
Sl.
Name of the Post candidates
No.
selected
Assistant Surgeon 9,344
1.
(General)
Assistant Surgeon 1,943
2.
(Speciality)
Personnel for Tamil Nadu 72
3. Government Multi Super
Speciality Hospital
Assistant Dental Surgeon 59
4.
(General)
Assistant Dental Surgeon 67
5.
(Speciality)

152
 No. of
Sl.
Name of the Post candidates
No.
selected
Assistant Surgeon 1,151
6. (General) (Special
Qualifying Examination)
Assistant Medical Officer 101
7.
(Siddha)
Assistant Medical Officer 4
8.
(Homoeopathy)
Assistant Medical Officer 1
9.
(Ayurveda)
Assistant Medical Officer / 73
Lecturer
10.
Grade-II (Yoga &
Naturopathy)
11. Nurses 9,533
Senior Lecturer in 2
12.
Optometry
13. Pharmacist 974
14. Pharmacist (Siddha) 148
15. Pharmacist (Ayurveda) 38
16. Pharmacist (Unani) 20
17. Pharmacist (Homoeopathy) 23

153
 No. of
Sl.
Name of the Post candidates
No.
selected
18. Village Health Nurse 1,323
19. Lab. Technician Grade III 890
20. Radiographer 285
21. Fitter Grade II 60
22. Physiotherapist Grade-II 48
23. ECG Technician 29
24. Therapeutic Assistant 114
25. Prosthetic craftsman 33
26. EEG / EMG Technician 12
27. Audiometrician 14
28. Occupational Therapist 18
29. Dark Room Assistant 227
30. Plaster Technician Grade-II 87
Heart Lung Hypothermia 7
31.
Machine Technician
32. Anaesthesia Technician 77
TOTAL 26,777

154
 12.4 Out of 26,777 candidates recruited
by Medical Services Recruitment Board since its
inception,3,220 candidates have been recruited
from 01.04.2018 and 31.03.2019. Now, the
recruitment process is under way for filling up of
3,948 vacancies in the following nine Medical
and Paramedical categories :

Sl. No. of
Name of the post
No. posts
1. Nurses 2,345
Nurses in Sick Newborn 520
2.
Care Unit
3. Pharmacist 353
4. Lab Technician Grade-II 524
5. ECG Technician 9
6. Physiotherapist Grade - II 77
7. Radiotherapy Technician 25
8. Prosthetic Craftsman 50
9. Ophthalmic Assistant 45
TOTAL 3,948

155
 12.5 ‘Walk-in’ Selection for
Specialities: MRB is recruiting Assistant
Surgeon (Speciality) through “Walk-in” selection
process following the communal rotation and
rule of reservation in force, in order to utilise the
services of various speciality doctors to provide
better treatment for the public.

12.6 Medical Services Recruitment Board

also conducts a special qualifying examination
for the temporarily appointed Assistant Surgeon
(Speciality) by way of ‘walk-in’ selection process
and non-service Post Graduate who are in
service to regularise their services in the Tamil
Nadu Medical service.

156
 CHAPTER – 13

TAMIL NADU MEDICAL SERVICES

CORPORATION LIMITED

13.1 Tamil Nadu Medical Services

Corporation Limited (TNMSC) was formed in the
year 1994-1995, as a fully owned Government
Company under Companies Act, 1956. TNMSC is
an ISO 9001:2015 Certified Organization.
Procurement, storage, testing and distribution of
drugs and medicines, surgical consumables and
sutures to all Government Medical Institutions in
the State is a core activity of this Corporation.
Procurement of sanitary napkins, baby care and
nutritional kits are also undertaken by this
Corporation now, besides finalization of rate
contracts for larvicides and insecticides.

The Corporation has also established a

drug sale counter at Kilpauk Medical College,
Chennai for certain specific drugs. Drugs and
medicines for veterinary Institutions are also
procured and distributed by this Corporation in
the same manner. Procurement of equipment
and their maintenance for the Government

157
hospitals, providing diagnostics services such as
CT, MRI scans, Lithotripsy in the Government
Medical Institutions under user charges,
extending logistics support to pay wards are the
other activities undertaken by this Corporation.

In addition, finalization of rate contracts

for medical instruments and appliances,
agencies for providing services such as
housekeeping, dietary, establishing diagnostics
services such as PET CT scan, MRI scan under
PPP mode and laboratory services and fixing
agencies for collection and disposal of biomedical
waste from the Government Medical Institutions
are also entrusted to this Corporation.

Involvement and empowerment of the

stakeholders in the process of procurement,
adopting prompt payment and strict penalty to
the suppliers, ensuring transparency in the
procurement process are the fundamental
policy, consistently followed by this Corporation
with which it won the appreciation worldwide.

158
13.2 Procurement and Distribution of
Drugs:

TNMSC is a role model in drug logistics

system related to procurement, testing and
distribution of drugs, medicines, surgical
consumables and sutures. Annual rate contract
tenders are finalized for both essential drugs and
speciality drugs through procurement from
multiple suppliers at competitive rates by
following the most transparent procedures as
per the provisions of The Tamil Nadu
Transparency in Tenders Act and Rules. 315
essential drugs, around 366 surgical
consumables and sutures, 538 speciality drugs
are procured every year by this Corporation. The
essential drug list and speciality drug list are
finalized annually through a drug committee
comprising of the Directors of Medical Education,
Medical and Rural Health Services, Public Health
and Preventive Medicine, Drug Control besides
specialists from the Government Medical
Institutions prior to floating tenders. The size
and packing standards of drugs are ensured as
per the standards specified in the tender without
any alteration/substitution by the suppliers.

159
 The procurement and stocking quantity of
drugs and medicines at the warehouses are on
dynamic mode, depending on consumption
pattern while ensuring a minimum stock level of
3 months requirement. The Government Medical
Institutions are collecting the required drugs and
consumables from the district drug warehouses
located all over the State through pass books
issued for the value allotted by the Directorates.
The corporation also procures 225 veterinary
drugs annually for the Animal Husbandry
Department.

13.3 Quality Assurance System:

Each and every batch of the drugs

procured are tested through Empanelled
laboratories before being issued to Institutions.
In addition, periodic retesting of the stock at
Warehouses and at Institutions through the Drug
Control Department ensures efficacy of the stock
at all levels. Empanelled laboratories which are
having National Accreditation Board for Testing
and Calibration Laboratories (NABL) accreditation
are finalized through annual rate contract.
A stringent procedure of the following steps is

160
adopted by this Corporation to ensure strict
quality testing.

Steps Adopted

Taking samples of new batch of drugs received

at Warehouses

Elimination of common batch at Head Office

Removing the identification of the name of the

drug and suppliers

Assigning separate code number to each sample

sent to the empanelled laboratory for testing.

The selection of particular lab for sending the

samples for testing is done by a random
selection method through software.The batches
that are failed in the testing at empanelled
laboratory are retested in Government Analytical
Laboratory to ensure statutory provisions before
rejection.

161
13.4 Supply Chain Management:

The supply chain is managed through

district drug warehouses, online indents from
the institutions and pass book system. Inter
Warehouse transfers prior to additional purchase
and monitoring of district wise/ state wide stock
through the IT network are in place to avoid
both nil stock and over stocked situations.
Government Medical Institutions in the district
are attached to the respective District Drug
Warehouses for receiving their requirement of
drugs periodically and the drugs are delivered to
the institutions through the transport contractors
and the cost of transport is met by the
Corporation.

13.5 Information Technology (IT) System:

Besides monitoring the inventory and

payments through the IT enabled system, the
stakeholders and suppliers are provided with
username and password to view their
transactions and posting of specific information
through the website. Real time SMS to all the
vendors, stakeholders, linking of CT and MRI
scan centres with Head Office for better

162
monitoring of the performance, installing CCTV
at the warehouse and scan centres are also done
to improve monitoring.

13.6 Consultancy Services:

Consultancy services are provided by the

Corporation to the needy states who intend to
replicate the drug logistics system followed by
TNMSC besides extending the services of
procurement and supply of drugs to other States
on need basis.

13.7 OTHER SERVICE ACTIVITIES

CT Scanners:

TNMSC is operating 91 CT scanners in 76

centres in various Government Medical
Institutions spread all over the State with user
charge collection of Rs.500/- per scan plus
Rs.300/- for contrast and Rs.3,000/- per scan
for 64 slice CT scanner and 128 slice CT
scanner.

MRI Scanners:

28 MRI scanners at 27 centres in

Government Medical Institutions are operated by

163
the Corporation with user charge collection of
Rs.2,500/- plus Rs.1,500/- for contrast.
Teleradiology services for Online Reporting of
CT, MRI scans has also been established to
ensure quick reporting for benefit of patients.
The CT and MRI scan services are free for all
families covered under Chief Minister’s
Comprehensive Health Insurance Scheme
(CMCHIS).

Lithotripsy machines:

Four Lithotripsy machines are also

operated with user charge collection of
Rs.4,000/- to Rs.5,000/- per sitting depending
upon number of sittings.

Cath Labs, Linear Accelerator, Cobalt

Therapy unit:

The Corporation is planning to take over

the operation of 11 cathlabs installed in the year
2017-2018 and 6 cathlabs in the year
2018-2019, 9 Linear Accelerators with CT
stimulators and 15 cobalt therapy units being
established in the year 2018-2019 in various
Government Medical Institutions across the
State.

164
13.8 Providing logistic support to payment
wards:

TNMSC Ltd. is providing logistic support as

custodian of funds, to the pay wards at GI Bleed
and Hepato Biliary Centre in Government
Stanley Hospital, Chennai, Maternity wards at
Institute of Obstetrics and Gynaecology(IOG)
and Kasturba Gandhi Hospital Chennai, pay
wards at Rajiv Gandhi Government General
Hospital, Chennai.

165
 Chapter – 14

TAMIL NADU URBAN HEALTH CARE

PROJECT

14.1 Project Objectives: The objectives

of the project are to improve the quality of
health services in urban areas thereby improving
the health status of people in Tamil Nadu
through

i. Strengthening the capacity of the key

hospitals with up-gradation of the facility
and equipment and

ii. Strengthening the capacity of human

resources with the focus on Non
Communicable Diseases.

This Project will focus on

i. Improving the treatment of Non

Communicable Diseases by providing
advanced treatment for Cardio-vascular
diseases, Cancer, Chronic respiratory
diseases and Diabetes.

ii. Improving the existing hospital

infrastructure by replacing and recasting

166
 physically deteriorated and functionally out
dated existing buildings with a
comprehensively designed model “Central
Diagnosis Block”, the project aims to solve
problems which the existing hospital
campus has been facing to improve the
patient safety and effective hospital
management based on a long term Master
Plan.

iii. The project intends to use advanced

Japanese medical technology to create
hybrid operation theatre systems for
imaging and intervention. The project also
aims to construct international standard
operation theatres (OT), intensive care
units with ‘State of Art’ facilities, and
includes operation and maintenance of
those facilities.

Tamil Nadu Urban Health Care Project has an

outlay of Rs.1,634 crore under the Japan
International Co-operation Agency (JICA)
assistance. The formal agreement for the project
was signed by Government of India and JICA on
31st March, 2016. The Project cost of Rs.1,634

167
crore includes JICA loan component of Rs.1,388
crore (85%) and State share of Rs.245.6 crore
(15%). The loan is for a period of 40 years with
a grace period of 10 years at an interest rate of
0.3 percent. The project will be implemented
over a period of seven years.

The project component includes-

i. Upgrading tertiary care hospitals with

facilities and equipment.

ii. Strengthening referral hospitals with

equipment.

iii. Strengthening secondary care hospitals

with facilities and medical equipment.

iv. Strengthening Hospital Management.

v. Strengthening Primary health Care in Non

Communicable diseases.

14.2 Locations: The project will be

implemented in 17 cities and cover 21 facilities.
Under this project, the Government Medical
College Hospitals located at Madurai, Kilpauk at
Chennai, Coimbatore, Salem, Vellore, Thanjavur,
Tirunelveli, Pudukottai, Tiruchirapalli,

168
Thoothukudi and Kanyakumari are included.
Further, six district hospitals of Erode, Tiruppur,
Cuddalore, Dindigul, Krishnagiri and Periyakulam
and four secondary care hospitals at Avadi,
Ammapettai at Salem, Velampalayam at
Tiruppur and Kandiyaperi at Tirunelveli will also
be strengthened.

14.3 Progress of Project Activities: The

Project Management Unit has been established.
A consultant firm has been hired to work out the
drawings, estimate the cost for the buildings,
survey the equipments requirement and prepare
the equipment specification. The construction
work and procurement of equipments will
commence in this financial year.

169
 Chapter-15

Tamil Nadu Health System Reform

Programme

15.1 Government of Tamil Nadu has

pioneered and implemented the Tamil Nadu
Health System Project (TNHSP) at a cost of Rs.
1300 Crore supported by World Bank from the
year 2005 to 2015 and significant results have
been achieved through this project. In
continuation, the Government of Tamil Nadu has
decided to implement Tamil Nadu Health System
Reform Programme (TNHSRP) supported by
World Bank to improve the health system in
Tamil Nadu and the Agreement was signed on
04.06.2019.

15.2 The total project cost is INR

2857.003 crore (USD 410 million). Out of this
INR 1999.902 crore (USD 287 million) is the
World Bank component and INR 857.101 crore
(USD 123 million) is the Government of Tamil
Nadu component. The project period is for 5
years.

170
 15.3 The objectives of the Project are to
improve quality of care, strengthen management
of non-communicable diseases including trauma
and mental health, and reduce inequities in
reproductive and child health services in Tamil
Nadu.

15.4 The Project will be implemented

across the State with interventions in all Medical
College Hospitals, Taluk / Non-Taluk Hospitals,
and Primary Health Centres. To achieve the
above results, the activities include:

(i) Interventions for screening, diagnosis,

treatment and management of non
communicable diseases such as
hypertension, diabetes mellitus, cervical
and breast cancers including population-
based screening efforts to reach
maximum population.

(ii) Improved mental health programme.

(iii) Reduction of deaths due to road traffic

accidents – improvements to 108
Emergency Ambulance Services –
strengthening of Emergency

171
 Departments in the Trauma Care
Centres.

(iv) Strengthening of Maternal and Child

Health programme especially in the high
priority districts.

By implementing this project it is expected

that the health care systems in Tamil Nadu will
reach a stage comparable to that of developed
countries.

172
 Chapter -16

TAMIL NADU STATE AIDS CONTROL

SOCIETY

16.1 Tamil Nadu was the first State in the

country to set up an AIDS control Society way
back in the year 1994 and set an example for
other States to follow.

16.2 TANSACS executes National AIDS

Control Program (NACP), which is currently in its
fourth phase, implemented as a fully funded
project through NACO. TANSACS works under
the vision released by National AIDS Control
Organization (NACO) through the National
Strategic Plan on HIV/AIDS and Sexually
Transmitted Infection (STI), 2017-24 towards
ending AIDS as a public health threat by 2030.
The district level program is monitored by the
District AIDS Prevention Control Units (DAPCU).

16.3 The Program components of

TANSACS: 1) intensifying and consolidating the
prevention services with a focus on High Risk
Groups (HRG) and vulnerable groups 2)
expanding the information, education and

173
communication (IEC) services 3) provision of
comprehensive care, support and treatment
services 4) strengthening institutional capacity
and strategic information management systems.

16.4 HIV Prevalence in Tamil Nadu:

HIV Prevalence Trend

1
HIV Prevalence (%)

0.8 0.83
0.6
0.4 0.35
0.27
0.2
0
2003 2008 2017
Year

16.5 The unique initiatives of TANSACS:

 Tamil Nadu Trust For Children Affected

With Hiv/Aids (known as OVC Trust),

 Transgender Welfare Society with the help

of the Social Welfare Development.

 Supply Chain Management system (SCM)

for drugs and kits

174
  Extensive data analysis and evidence-
based block level intensive interventions to
enhance the treatment.

16.6 Integrated Counselling and Testing

Centres (ICTC):

 During 2018-2019, the HIV counselling

and testing services had been given to
34,57,183 Nos. of General clients and
12,52,871 Nos. of Antenatal Mothers
(ANC)

 There are 2,618 centres that offer

counselling and testing services.

o 377 Stand Alone ICTC’s in Government

Medical College Hospitals, District Head
Quarters Hospitals and Government
Hospitals functions with the support of
NACO.

o 403 SA-ICTC’s, 1,555 Facility

Integrated counselling and testing
centers functioning in Block Primary
Health Centres, additional PHC’s and
Community Health Centers under the

175
 support of the National Health Mission
(NHM).

o 188 ICTC’s under Public Private

Partnership (PPP) to strengthen
Elimination of Mother to Child
Transmission (EMTCT) coverage.

o 15 Mobile ICTC Vans in Coimbatore,

Dindigul, Dharmapuri, Erode,
Kanyakumari, Krishnagiri, The Nilgiris,
Namakkal, Salem, Sivagangai, Theni,
Tiruvannamalai, Tiruchirapalli,
Virudhunagar and Vellore districts to
extend counselling and testing services
to the remote and inaccessible areas.

o 80 numbers of counselling and testing

facilities have been established with the
help of NGO’s for Community Based
Screening (CBS)

176
16.7 Elimination of Mother to Child
transmission of HIV and Syphilis
(EMTCT)

 The Government of TamilNadu is

committed to eliminate HIV and Syphilis
amongst newborns through universal
screening of pregnant women for HIV and
Syphilis as an essential component of the
Antenatal Care (ANC) service package.

 The Elimination of Mother to child

Transmission (EMTCT) services are being
implemented in close collaboration with
Maternal and Child Health (MCH)
programme of the National Health Mission
(NHM) to scale up prevention and care
interventions among the ante-natal
mothers through primary prevention,
family planning, voluntary counselling,
confidential testing, lifelong Anti-
Retroviral Therapy (ART) and counselling
on infant feeding practices.

 “Early Infant Diagnosis (EID)” programme

is implemented in the State through
ICTC’s.

177
  Under EMTCT new regimen (ARV
prophylaxis), all babies born to HIV
positive mothers are initiated with
Nevirapine syrup upto 6 or 12 weeks from
birth.

 All identified HIV positive mothers and

infected infants are being provided with
lifelong ART and follow-up counselling
services.

16.8 EMTCT Achiever’s Award 2018

 Tamil Nadu State AIDS Control Society

(TANSACS) has received EMTCT
Achiever’s Award 2018 during the
National workshop held at National AIDS
Control Organization (NACO)

16.9 Sexually Transmitted Infection /

Reproductive Tract Infection
(STI/RTI) Services:

Designated STI/RTI Clinics:

 TANSACS has established 216 DSRCs in

Government Medical College Hospitals,
District Head Quarters Hospitals and

178
 Government Hospitals as Suga Vazhvu
Maiyam.

 It follows Syndromic Case Management

System through colour coded drug kits and
all out patient attendees are screened for
Syphilis and HIV.

 Once in three months, all High Risk Groups

are screened for STI and tested for
syphilis.

 One trained STI Counsellor working in the

Designated STI/RTI Clinic for counselling
on STI/RTI and HIV-transmission,
Prevention, Partner Treatment, Risk
Reduction and Condom Promotion.

 As a routine practice, the Medical Officers

are being trained on Syndromic Case
Management by TANSACS at regional
levels.

 Data related to DSRC are being reported

at SIMS & SCM routinely.

179
16.10 Targeted intervention:

 The Targeted Intervention (TI) is being

implemented through the Non-
Governmental Organization (NGO) /
Community Based Organization (CBO).

 The Targeted Intervention (TI) aims to

bring behavioural changes among high
risk groups (HRGs) namely, Female Sex
Workers (FSW), Men who have Sex with
Men (MSM), Injecting Drug Users (IDU),
Truckers, Migrants and Transgender (TG)
in the State, who are at risk of contracting
HIV infection.

 In Tamil Nadu, 85 NGOs/CBOs are

functioning covering the needs of HIV
testing and counselling services for HRG’s
across the State.

16.11 Link Workers Scheme

 Link Workers Scheme (LWS) is

implemented in 15 districts to provide
prevention to care continuum of services
to rural based High Risk Groups,

180
 vulnerable population and bridge
population (Truckers/Migrants).

 In each of these districts, 100 villages are

selected based on the epidemiological
profile and HIV related services were
provided through ICTCs in the nearby
area.

16.12 Community Based HIV Screening

 Community Based Screening for HIV is

being implemented for attaining the Global
goal of ending HIV/AIDS by 2030.
TANSACS is conducting CBS through TI
and LWS NGOs/CBOs through training,
guiding and establishing counselling and
testing services on the field for better
community participation.

16.13 HIV & TB intervention in all type of

Prisons, Swadhar and Ujjawala
homes

 Tamil Nadu State AIDS Control Society has

entered into MoU on September 2018 with
Prison Department, Social Defence
Department and Social Welfare

181
 Department for implementing HIV & TB
intervention in Prisons, Swadhar and
Ujjawala Homes to provide HIV, TB, STI,
Viral hepatitis infection related services.

 In continuation, TANSACS is regularly

screening all inmates of Prisons, Swadhar
and Ujjawala Homes of Tamil Nadu and
positive clients are being treated and given
regular follow-up services.

16.14 Condom Promotion

 As condoms are the most effective tool for

prevention of HIV and STI infection among
high risk and the general population, free
condoms are being distributed to people
through STI clinics, ICTC, ART Centres and
other outreach programmes implemented
by NGOs/CBOs through Targeted
Interventions and Link Workers Scheme.

16.15 Blood Safety:

 In order to meet out the requirements of

Blood and Blood Components for the
needy patients, there are 297 Blood Banks
out of which 89 State Government Blood

182
 Banks, 9 Central Government Blood Banks
and 199 Private Blood Banks are
functioning in Tamil Nadu. In addition to
these Blood Banks, 527 Blood Storage
Centres (Government 383 and Private
144) are also functioning to provide
adequate, safe and quality blood and blood
components. Voluntary Non-remunerative
Blood Donation camps are organized
throughout the State with the help of
Colleges, Institutions and other charity
groups and 94% of total blood needs are
matched through these camps. Out of 89
Government Blood Banks, 38 Government
Blood Banks are equipped with Blood
Component Separation Units.

16.16 Information, Education and

Communication (IEC):

 Information, Education and

Communication (IEC) are one of the
components of the National AIDS Control
Programme (NACP).

183
  TANSACS creates awareness and provides
information through Website, Mobile App,
FM Radio, Television, Newspapers,
Hoardings, Wall Painting, Posters,
Pamphlets, Social Media and Outdoor
events.

 Mobile IEC vans create awareness

campaigns and promotion of IEC, demand
generation for testing services among the
general population.

 Active IEC campaigns have resulted in the

reduction of stigma and discrimination
attached to HIV/AIDS.

16.17 Greater Involvement for the People

Living with HIV/AIDS (GIPA):

TANSACS has involved the People Living

with HIV / AIDS (PLHIVs) and Community
Based Organizations (CBOs) as one of the
partners in implementing the programme
at the district level and the same is also
being monitored by them as follows:-

 ensuring service facilities at the grass root

level.

184
  planning the programme at District level
related to prevention to Care continuum of
services.

 Tamil Nadu State AIDS Control Society

(TANSACS) Governing / Executive and
Grievances Redressal Committee as
members.

16.18 Hello + Helpline-1800 419 1800:

 To enlighten the callers with required

information about HIV/AIDS and STI.

 To clear doubts about HIV/AIDS and STI.

 To clear the myths, misconceptions

pertaining to HIV/AIDS and STI.

 To share the callers on the available

informations on service centres in the
respective district.

16.19 Legal Aid Clinic (LAC):

 In association with Tamil Nadu State Legal

Services Authority (TNSLSA), this Legal
Aid Clinic (LAC) is implemented in all
districts.

185
  ART senior counsellors attend the legal
and non-legal issues of People Living with
HIV/AIDS (PLHIVs) and High Risk Groups
(HRGs).

16.20 Red Ribbon Club (RRC):

 As a pioneer in the nation, TANSACS

established Red Ribbon Clubs (RRC) in the
year 2005 to create awareness and to
raise the risk perception and behavioural
changes among the youth.

 2,179 Red Ribbon Clubs are functioning in

Arts and Science, Polytechnic, Engineering,
Medical, B.Ed., Colleges and Teacher
Training Institutions in the State.

16.21 Care, Support and Treatment:

 Life-long free Care, Support and

Treatment services to HIV Positive people
is provided through ART centers attached
to Government health facilities.

 Routine investigations, CD 4 tests and viral

load testing are performed at these
centres. ARV drugs, opportunistic

186
 infection drugs, various counselling
services, referral and linkage services are
rendered through ART centres.

 Currently, around 1,18,000 PLHIVs are

taking free treatment through 55 ART
centers. In addition, 174 Link ART centers
act as drug dispensing units closer to their
homes.

 Apart from this, 31 Care and Support

Centers provide services like tracking of
treatment defaulters, psycho-social
support and linkage to various benefit
schemes.

16.22 Monitoring and Evaluation:

(i) Strategic Information and

Management System (SIMS):

SIMS is an integrated web-based reporting

system, used for data management and decision
making with monthly reporting from all the
programme components comprising ICTC, TI,
Blood Banks, STI/RTI, IEC, Laboratories and
DAPCU. TANSACS receives all the reports
through this system.

187
(ii) PLHIV – ART Linkage System (PALS):

PALS line list is a reporting cum tracking

tool which collects, retains and updates
individualized details of all HIV Positive clients
(Pregnant women & General clients).

Each SA-ICTC or ART centre shall maintain

their respective HIV positive line list which will
contain all the details of the HIV positive clients
tested at their centers or have registered at their
centre for ICTC/ART services.

(iii) HIV Sentinel Surveillance (HSS):

 HIV Sentinel Surveillance (HSS) is carried

out biennially all over the country to study
the disease prevalence from pregnant
women and High Risk Groups (HRGs).

 In Tamil Nadu for the year 2018-19, the

prisons are newly included in the HIV
Sentinel Surveillance.

 HSS is being conducted at 71 ANC sites, 3

prison sites and 44 HRG sites are carried
out from 1st January 2019.

188
(iv) District AIDS Prevention and Control
Unit (DAPCU):

 To ensure effective planning of the HIV

program activities in accordance with the
epidemiological profile of the district and
to establish proper linkages with the NHM
and programs implemented by other allied
departments, NGOs/CBOs and to work in
close coordination with the district
administration, 29 Districts AIDS
Prevention and Control Units (DAPCU) are
in function covering entire Tamil Nadu.

 Out of 29 DAPCUs, the NACO, New Delhi is

supporting financial assistance to 27
DAPCUs, rest of 2 DAPCUs namely Ariyalur
and Tiruppur districts are being supported
by the State Government of Tamilnadu.

16.23 INTEGRATING SOCIAL BENEFITS:

“Tamilnadu Trust for Children Affected

by AIDS”: -The Government of Tamil
Nadu has established trust by providing a
corpus fund of Rs.9.5 crore for financial
assistance to the Orphan and Vulnerable

189
 Children and to support their nutritional
and educational needs.

 During the financial year (2018-2019),

Rs.94.80 lakhs accrued interest amount
was distributed to 3,736 children directly
into their bank accounts via DAPCU.

 A monthly pension amount of Rs.1,000/- is

being provided under the Hon’ble Chief
Minister’s Uzhavar Pathukappu Thittam’ to
8100 PLHIVs holding farmers card. This
scheme is further extended to the children
of infected farmers.

 Free bus passes are issued to PLHIVs to

attend ART centres every month.

 Top priority is given to PLHIVs to access

the various schemes as furnished below:

i. Widow Pension

ii. Old Age Pension Schemes

iii. Antyodaya Anna Yojana (AAY) Scheme

iv. Hon’ble Chief Minister’s Solar Powered

Green House Scheme.

190
 Chapter -17

National Health Mission – Tamil Nadu

17.1 The National Rural Health Mission (NRHM),

Tamil Nadu was constituted in April 2005 with a
goal to provide accessible, affordable and quality
health care to the rural population in the State,
especially the vulnerable group. The National
Urban Health Mission (NUHM) was launched as a
sub-mission in 2013 to provide primary health
care services for the Urban poor. As an unified
mission, NRHM and NUHM are now functioning
as ‘National Health Mission’(NHM), The various
health societies including National Leprosy
Eradication Programme, Tuberculosis Control
Programme, Blindness Control Programme etc.
have been integrated to pool the resources
available for effective implementation of various
programmes under ‘State Health Society’.

The key features to achieve the goal of

NHM include creation of a fully functional public
health delivery system which is accountable to
the community, human resources management,
community involvement, decentralization,
rigorous monitoring & evaluation against

191
standards, convergence of health related
programs at the level of villages and flexible
financing for improving the health indicators of
the State.

The NHM funding between the Central and

State Governments is currently in the ratio of
60:40. The successful implementation of various
innovative initiatives of the State Government
along with the initiatives of National Health
Mission has resulted in a vast expansion of
activities and overall improvement of all health
indicators in the State.

The focus areas under NHM include:

 Reproductive and Child Health

Programme.

 Family Welfare Programme.

 Tuberculosis Control Programme

 Tamil Nadu Accident and Emergency

Care Initiative (TAEI)

 Non-Communicable Diseases
Programme

192
  Universal Health Coverage Programme

 Tribal Health Programme

 Vector Borne Disease Control

Programme

 Integrated Disease Control Programme.

 National Blindness Control Programme.

 National Leprosy Eradication

Programme

 Indian System of Medicine and

Homoeopathy.

17.2 While Tamil Nadu has already achieved the

Millennium Development Goals - 2015 set by the
United Nation and the National targets far ahead
of most other States, it is also striving to
achieve the Sustainable Development Goals
(SDG) by the year 2030.

17.3 The report on India; Health of Nation

States, The India State-Level Disease Burden
Initiative, 2017 reveals that for every 100
deaths occurring in Tamil Nadu, 69.2% of the
mortality is due to Non-Communicable Diseases

193
(NCD), including deaths due to Cardio Vascular
Diseases (CVDs), self-harm injuries and
transport accidents.

For the prevention and control of NCDs,

the implementation of Universal Health
Coverage Programme, Population Based
Screening of NCDs, Community Based Palliative
Care Program are some of the key focus area
with a futuristic vision.

The Government has initiated various

suicide prevention strategies, such as tele-
counselling for suicide attempt survivors through
psychologists placed in the 104 Health Helpline
Centres and Community Based Screening for
depression.

In the area of injuries and transport

accidents, the work of the Tamil Nadu Accident
and Emergency Care Initiative (TAEI) has
expanded its activities to cover setting up of
exclusive Emergency Departments across the
State, provision of additional Human Resources
(HR) and establishment of a Multi-Disciplinary
Critical Care Units (MDCCU).

194
 MATERNAL HEALTH

17.4.1 Reproductive, Maternal, Newborn,

Child Health and Adolescent Health
(RMNCH+A) Services:

RMNCH+A services mainly focuses on

Reproductive, Maternal, Newborn, Child Health
and Adolescent Health (RMNCH+A) services
including institutional delivery, emergency
obstetric care, safe abortions, family planning
services and adolescent health services in the
State.

17.4.2 Janani Suraksha Yojana:

Janani Suraksha Yojana aims at reducing

out-of-pocket expenses during delivery. This
scheme entitles women for accessing Maternal
and Child Health services with a financial
assistance of Rs.700/- and Rs.600/- in rural and
urban areas respectively. During the year 2018-
2019, under this scheme 4,19,743 pregnant
women have benefitted through Direct Bank
Transfer / e-Payment.

195
17.4.3 Janani Sishu Suraksha Karyakram
(JSSK):

Under JSSK programme, there is an

entitlement of free drugs, free referral transport,
diagnostics including diet during the duration of
stay at Government Health facilities for every
pregnant women and sick neonate up to one
year of age. About, 5,63,732 mothers have
benefitted in the year 2018-2019, with free
drugs, diet and consumables. About, 3,64,269
pregnant mothers have been transferred from
home to health facility (including inter facility
transfer) and 2,71,765 delivered mothers have
been dropped back from health facility to home.

17.4.4 Comprehensive Emergency

Obstetrics and Neonatal Care
Centres (CEmONC):

Tamil Nadu is the only State having 65

percent of institutional deliveries occurring in
Government health facilities. Also, analysis of
Government institutional delivery data shows
there is a clear shift of mother’s preference
towards higher facility with 24x7 LSCS, Blood

196
bank, SNCU services which will ensure safe
delivery and care of the New born. Having this
fore thought, Government of Tamil Nadu has
established 126 CEmONC centers in Medical
College Hospitals, District Hospitals and well
performing Taluk/ Non–taluk Hospitals.
Strengthening of the CEmONC centers with
additional infrastructure, Human Resources,
Equipment and Blood Bank facilities has resulted
in reduction of maternal mortality rate 60 per 1
lakh live birth in the year 2018-2019 (HMIS,
2018). NHM plays a key role in support of
CEmONC centers by allocating Rs.20 Crores for
District Hospitals and Rs.12 Crores for upgrading
CEmONC services in Medical College Hospitals.
CEmONC operational cost is provided to these
institutions, which helps to meet out any
contingency in the upkeep of equipment,
consumables, essential drugs, etc. This is
evidenced by lowest Out-of-pocket Expenditure
for normal deliveries in Public Health facilities
among all States in India as per NSSO 71st
Survey.

197
CEmONC Performance: From 2014 -2015 to
2018-2019

2014-15

2015-16

2016-17

2017-18

2018-19
Details

Total
Maternal 2,79,571 4,59,587 5,73,954 4,95,360 6,26,324
Admission
Deliveries 1,70,879 2,78,124 3,21,622 3,14,408 3,47,656
LSCS 90,113 1,45,351 1,68,282 1,61,396 1,84,295
Blood
Trans-
52,083 1,22,273 1,23,981 1,20,542 1,24,705
fusion for
OG cases
Scan for
3,02,545 4,93,013 5,30,476 5,08,301 6,23,046
OG Cases
Neonatal
1,03,344 1,40,525 1,28,085 1,19,316 1,34,554
Admissions

‘LaQshya’ initiative has been taken up at all

levels of care to improve the quality and
standard of care in labour wards and in
operation theatres. This initiative will improve
the quality of care for delivering mothers and

198
will further reduce maternal deaths. Modified
Emergency Obstetric Warning System (MEOWS)
has been introduced in Government Hospitals for
early definitive management or timely referral to
higher centre. This reduces the delay in referral
of pregnant women there by reducing maternal
deaths.

17.4.5 Provision of Specialist Services

(Hiring of Specialists for MCH Care):

In order to bridge the gap in paucity of

human resources, retired / private specialist
(Obstetricians, Pediatricians and Anesthetist) are
being hired to provide MCH services in the
primary and secondary care institutions. During
the year 2018-2019, about 62,976 deliveries
were performed by hiring specialists in the
State.

17.4.6 Anaemia Mukt Bharat Scheme;

Control of Anaemia among children
and mothers:

It has been observed that, 44% of

pregnant women and 56% of lactating mother
are anaemic in Tamil Nadu as per NFHS 4 survey

199
reports. Ministry of Health and Family Welfare,
under Anaemia Mukt Bharat Scheme has
targeted to reduce the prevalence of Anaemia by
3 % per year between 2018 to 2022. Both
prophylactic and therapeutic dose of Iron and
Folic acid tablets are being provided to the
antenatal mothers. The detailed guideline for
Iron and Folic acid tablets supplementation for
lactating mothers for 180 days has been issued.
During the year 2018-2019, 10,38,589 antenatal
mothers provided with Iron and Folic acid
tablets. 1,59,446 pregnant mothers diagnosed
with maternal anaemia provided with Injection
Iron Sucrose. During 2018-2019, 16,64,870
children in the age group of 6 to 9 years
provided with Pink Iron and Folic Acid tablets
under Junior Weekly Iron and Folic Acid
Supplementation (WIFS) programme.

17.4.7 Control of Gestational Diabetes:

In order to control the maternal and

newborn complications of Gestational Diabetes,
pregnant mothers have been tested with
Glucose Challenge Test, diagnosed and treated.
11,05,157 Glucogse Challenge Tests for

200
pregnant mothers have been tested during the
year
2018-2019, of which 15,075 mothers have been
diagnosed as positive for Gestational Diabetes
Mellitus.

17.4.8 Blood Bank and Blood Storage

Services:

NHM provides budgetary support to

TANSACS for Blood Transfusion Services. For the
year 2019-2020, Rs 375 lakhs have been
approved for provision of blood bags to the
Blood Banks and also salary support to 403 ICTC
Counselors and 403 Lab Technicians.

17.4.9 Maternal and Child Health Centres

(MCHCs):

The 42 Community Health Centres have

been identified at 1 per Health Unit District to
function as Level-II MCHCs. These centres are
being strengthened with additional inputs to
provide Emergency Obstetric Care and Safe
Abortion Services, New Born Stabilization
services and poison management etc.

201
17.4.10 Feeding and Dietary Charges:

Under this scheme, antenatal mothers and

postnatal mothers are being provided with
necessary diet at the PHCs while coming for
antenatal check-up and delivery. Post Natal diet
is also being provided to mothers delivered in
secondary and tertiary care health institutions.
During the year 2018-2019, 6,30,904 antenatal
mothers and 4,89,190 postnatal mothers were
provided with diet in Government health
facilities.

17.4.11 High Risk Mother Observation:

High risk camps are conducted at the rate

of one camp per block per month to identify high
risk mothers and referring them to higher
facilities in time. They are shifted to the nearby
District Headquarters Hospital or Medical College
Hospital at the onset of labour pain or
immediately on the onset of the complication.
During the year 2018-2019, 32,978 High Risk
mothers have benefitted under this scheme at
385 High Risk Observation Centres.

202
17.4.12 Training for Medical officers:

a. Life Saving Anesthetic Skills:

In order to provide skilled man power for

safe confinement, 24 weeks intensive training
programme are being provided to 48 MBBS
Medical Officers per year in Life Saving
Anaesthetic Skills including Training in Obstetric
Anesthesia and in Cardio-pulmonary/ cerebral
resuscitation in 11 Government Medical College
Institutions. So far, 618 MBBS Medical Officers
undergone this training. About, 70,129
Caesarean sections and 2,96,646 other surgeries
(from 2007 to March- 2019) were performed by
these trained anesthetists.

b. Emergency Obstetric Care Training

(EMOC):

In order to reduce the burden on the

Obstetricians in the Secondary Government
Hospitals, a 25-week intensive training
programmein 5 Government Medical College
Institutions is being provided to 12 MBBS
Medical Officers per year for managing high risk
mothers. Till date, 136 MBBS Medical Officers

203
have been trained. 8,748 Caesarean sections
and 27,515 other surgeries (from 2007 to
March- 2019) were performed by these trained
EMOC doctors.

17.4.13 Interventions to reduce Higher

Order Birth (HOB):

Tamil Nadu has already achieved

replacement level in Total Fertility Rate (TFR) of
1.6. However, Higher Order Birth (HOB)
amounting for 7.2% of total births contributes to
25.4% of maternal deaths. From April 2018 to
March 2019, in 120 HOB blocks, 20,277 mothers
have undergone permanent sterilization, 7,351
mothers have undergone Intra Uterine
Contraceptive Device (IUCD) insertion, 2,719
mothers were given Injectable Contraceptives
(Antara) and 2,412 mothers were given Oral
Contraceptive Pills (Chhaya). Totally, 32,759
mothers have been benefitted. Abortion
techniques such as Medical Method of Abortion
(MMA) and Manual Vacuum Aspiration (MVA) is
made available across the State from Block PHC
onwards. This results in reduction of illegal
abortion and associated deaths.

204
17.4.14 Pre-Conception and Pre-Natal
Diagnostic Techniques (PCPNDT)
(Prohibition of Sex Selection) Act
1994:

The PCPNDT Act is strictly implemented to

maintain sex ratio at birth uniformly in all
districts. Stringent punishments are being
imposed on deviant scan centers. Valid Scan
Centre licenses are mandatory even for
Government institutions including PHC, CHC, GH
and Medical College Hospitals. Under this act, till
now 6,835 scan centres have been registered in
our State. Periodical review is carried out for
assessing the progress and trends in sex ratio at
birth. Till date, 140 cases have been filed
against scan centers for violating the PCPNDT
Act and out of which, judgment delivered for
119 cases and 21 cases are still under trial.

17.4.15 Maternal Mortality Ratio:

The Government is keen on promoting the

health of pregnant mothers. Tamil Nadu is the
only State in India implementing Dr.
Muthulakshmi Reddy Maternal Benefit Scheme,
providing financial assistance of Rs.12,000 since

205
2011 to pregnant mothers compensating for the
loss of wages during pregnancy. This has now
been increased to Rs. 18,000 including two
nutrition kits worth Rs. 4,000 have been
introduced. As per SDG Goal, MMR should be
brought to less than 70 per 1 lakh live births by
the year 2030. However, Tamil Nadu has already
reached the SDG Goal for the year 2030 in
2014-2016 itself by reaching the figure of 66 per
one lakh live births compared to 130 for India.
As per the HMIS data, currently MMR is 60 per
lakh (HMIS 2018-2019). The graph showing
significant decline in MMR is mentioned below:

206
 Special strategies to tackle key issues
contributing to Maternal Death

Sl. Name of the

Problem Special strategy
No. Activity

1 7.2% of 120 HOB block Additional

HOB strategy sterilization
contributes camps,
to 25.4% interval IUCD
of Maternal promotion,
deaths Injectable
contraceptive

2 6% of total Reintroduction Inj.

maternal of Inj. Benzathine
deaths is Benzathine Penicillin is
contributed Penicillin for made available
by heart Rheumatic from Block
disease heart disease PHCs for
complica- identified Rheumatic
ting children heart disease
mothers through RBSK identified
upto 18 years children once
in every three
weeks through
RBSK upto 18
years of age.

207
Sl. Name of the
Problem Special strategy
No. Activity

3 5% of total To bring More than 30

deliveries mothers more years
of mothers than 30 years Antenatal
more than also as high mothers are
30 years risk category booked as high
risk mother
contribute
and regular
to 21% of
follow up is
maternal being done
deaths

4 One in four 1. Promotion of Strict

maternal Post-Partum monitoring and
Intrauterine
deaths are supervision for
Contracep-
antenatal, tive implementa-
of which Device(PPIU tion of the
6% is due CD) upto above
to sepsis PHC level activities in
caused by 2. Provision of the field level
faulty MVA is being done
services
abortion by JDHS and
upto Block
methods PHCs level DDHS.
involving
PHC doctors

208
Sl. Name of the
Problem Special strategy
No. Activity

3. Provision of
MMA drugs
& injectable
contracep-
tives upto
Block PHCs
level
4. Antara, an
Injectable
contracep-
tive and
New Oral
Contracep-
tive pill
named
Chhaya
have been
recently
introduced.

209
Sl. Name of the
Problem Special strategy
No. Activity

5. Door step
delivery of
contracep-
tives
through
ASHAs/
VHNs
6. Strong legal
action
against
untrained
quacks

5 Registered 1. Pre- 1. Revamped

Visitors, registration PICME 2.0
Migrant of Visitor is rolled out
mothers mother for the
and through entire state
Unregister PICME where there
ed mothers is a
tracking provision
for Visitor

210
Sl. Name of the
Problem Special strategy
No. Activity

2. Civil mother
Registration registration
System in Common
(CRS) - Service
PICME 2.0 Centre /
linkage Online /
102 Call
Centre for
self-
registration
similar to
pre-
registration
of
Antenatal
mothers.
Hence,
registration
and
tracking of
Visitor
mother has
improved

211
Sl. Name of the
Problem Special strategy
No. Activity

2. It is now
made
mandatory
that all
antenatal
mothers
are to be
registered
in PICME
2.0 for
getting
birth
certificate
of the child.

212
 Strengthening of the ongoing programs

Causes of
Sl.
Maternal Ongoing Scheme
No.
Mortality
1 Anaemia i. Annual deworming,
Control Weekly Iron and Folic
Acid Supplementation
(WIFS) tablets for all
adolescent girls to
prevent anaemia,
since they are the
future mothers
ii. Oral Iron and Folic
Acid (IFA) to Antenatal
and Post-natal
mothers, Iron sucrose
injections are provided
at all PHCs
iii. Blood transfusions for
severely anaemic
mothers through 289
functional Blood
Storage centres at
CHCs/SDH.

213
 Causes of
Sl.
Maternal Ongoing Scheme
No.
Mortality
iv. 770 Voluntary Blood
donation camps are
held in all 385 blocks
twice a year.
v. Supplementary
feeding through ICDS.
vi. Amma Nutrition Kit
introduced for all
Antenatal mothers
rd
during 3 and 5th
month of gestation
under Dr.MRMBS
scheme
2 Hypertension i. Early identification at
complicating sub centre level itself
pregnancy with high risk mother’s
follow-up and
prescription of Tablet-
Labetalol to decrease
Blood Pressure.
ii. Standard Protocols to
identify and treat

214
 Causes of
Sl.
Maternal Ongoing Scheme
No.
Mortality
hypertension during
pregnancy through
injection-Magnesium
Sulphate adopted from
PHC level itself
iii. Functional 75 Obstetric
HDUs (High
Dependency Unit) with
facilities to treat any
complications arising
due to hypertension
complicating
pregnancy.
3 Post-Partum i. Continuous care of the
Hemorrhage delivered mothers so
that early post partum
hemorrhage can be
identified and
replacement done
immediately.

ii. Availability of Anti-

215
 Causes of
Sl.
Maternal Ongoing Scheme
No.
Mortality
Shock Garments and
Misoprostol tablet
available even at
PHCs.
4 Sepsis i. Running water supply
and promotion of
simple hand washing
techniques is ensured
at all delivery points.
ii. Amma Baby Care kit
provided to all new
born babies to prevent
sepsis.
iii. Revised Treatment
protocols with Higher
Antibiotics.
iv. Disinfection and
fumigation of labour
rooms

216
 Causes of
Sl.
Maternal Ongoing Scheme
No.
Mortality
5 Heart i. Early identification and
Disease corrective surgeries
complicating during school health
pregnancy visits / adolescent
period through RBSK
programme.
ii. Early corrective
surgeries done free of
cost through Chief
Minister’s
Comprehensive Health
Insurance Scheme in
private empanelled
hospitals and in
tertiary care
institutions.
iii. Early identification and
referral for mothers
with heart disease for
follow up and safe
delivery of such
mothers in apex
tertiary care
institutions.

217
 Causes of
Sl.
Maternal Ongoing Scheme
No.
Mortality
6 Maternal i. Tamil Nadu is the first
death audit State to have a
Government order for
implementation of
Maternal Death Audit
at district level
ii. Maternal death audit is
done at four levels;
1)Community based
audit by PHC team
2)Special Maternal Death
Audit at District level
3)District Level Audit by
the District Collector
4)State Level Audit by
MD, NHM / MCH
Commissioner every
month through Video
Conference.

218
 CHILD HEALTH

17.5.1 New born baby care services:

The Infant Mortality Rate (IMR) often

serves as a key development indicator, reflecting
the combined effects of health interventions and
the socio-cultural environment. The IMR of Tamil
Nadu is second only to Kerala. As per SRS report
2017, the IMR has reduced from 17 to 16 per
1,000 live births.

219
Trend of IMR for India and Tamil Nadu

Year India Tamil Nadu

1980 114 93
1990 80 59
2000 68 51
2001 66 49
2002 63 44
2003 60 43
2004 58 41
2005 58 37
2006 57 37
2007 55 35
2008 53 31
2009 50 28
2010 47 24
2011 44 22
2012 42 21
2013 40 21
2014 39 20
2015 37 19
2016 34 17
2017 33 16

Source: Sample Registration System (SRS)

Bulletins (2017)

220
 Interventions to reduce neonatal mortality
rate is ensured through focus on New Born Care
from perinatal to immediate post-natal care is
given below;

 Special New Born Care Units (SNCU):

Quality new born care is provided through

a dedicated network of 73 Special New Born
Care Units established at Medical College
hospitals / District Head Quarters Hospitals /
Taluk & Non-Taluk Hospitals with additional
equipment, cutting edge technology
(BIPAP/CPAP) and standardized protocols.

 Newborn Stabilization Units:

156 Newborn stabilization units

established at secondary and Primary health
care level

 Home based Young care (HBYC) at the

community level is implemented through
VHN, ASHA’s and Anganwadi workers.

Due to the effective implementation of the

above protocols, there is a drastic reduction in
the neonatal mortality rate from 39 (SRS 2001)
to 12 (SRS 2017) thereby achieving the SDG
Goal.

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17.5.2 Community based newborn baby
care:

Sick newborns discharged from SNCU are

being followed up by VHN/AWW /ASHA till the
baby’s first birthday. Awareness generation to
identify early danger signals in newborns,
promotion of exclusive breast feeding and
improving infant and young child feeding
practices are being done continuously by the
field staff and in campaign mode during Poshan
Abhiyaan sessions (Nutrition Month in
September), Poshan Pakhwada (Nutrition
Fortnight in March) and Village Health and
Nutrition days.

17.5.3 Nutrition Rehabilitation Centres:

Under-nutrition remains a significant cause

of morbidity and mortality in children under five
years of age. Nutrition Rehabilitation Center
(NRC) is a health facility where children with
Severe Acute Malnutrition (SAM) are admitted
and managed. This has been scaled up from 2
NRCs initially to 6 NRCs. During the year 2018-
2019, 691 children treated in these NRCs.

222
17.5.4 Infant Death Audit:

The conduct of Infant Death Audit helps to

find out the causes and the specific
circumstances that led to Infant Death. The
current system of conduct of Infant Death Audit
at the districts by District Collector and periodic
review by the Expert Committee at the State
through Video Conference has provided valuable
learning’s for reduction of Infant Mortality in the
State.

17.5.5 Rashtriya Bal Swasthya Karyakram:

Rashtriya Bal Swasthya Karyakram

(RBSK), is an innovative and ambitious initiative,
which envisages Child Health Screening and
Early Interventions for care, support and
treatment. The programme aims at early
detection and management of a set of 30 health
conditions prevalent in children less than 18
years of age. Children in the age group from
birth to eighteen years including the newborn
and those attending Anganwadi Centres and
Government / Government-aided schools are
benefitted through this programme. Children
who require surgical intervention like corrective

223
surgeries for Congenital Heart Diseases, Cleft
Lip, Cleft Palate, Club Foot, Congenital Cataract,
Cochlear implantation for congenital deafness
and treatment for Autism disorders are covered
under the Chief Minister’s Comprehensive Health
Insurance Scheme (CMCHIS).

At present, there are 805 RBSK teams in

the State, 770 in rural areas and 35 RBSK teams
in urban areas. GPS has been installed in all 805
RBSK vehicles and daily movement of the
vehicles as per tour plan is being monitored at
the State and district level. To ensure the
continuum of care for the children screened by
the RBSK team with treatment at the District
Early Intervention Centres, a mobile based
application is used.

During the year 2018-2019, about, 1.21

Crores children screened in schools and
Anganwadi centres. 6,44,175 children identified
with disease conditions and 5,19,288 children
were referred and treatment provided for the
same at secondary and tertiary care institutions.
Till date, 16,380 children (from April 2015 to
March-2019) identified for surgeries and of

224
which 13,894 children managed surgically.
Under Kannoli Kappom Thittam (KKT), children
in 12,888 schools screened and of which
1,78,413 children identified with refractive
errors and provided with free spectacles.

17.5.6 District Early Intervention Centre

(DEIC):

DEIC are functioning at 34 facilities (13

District Headquarters Hospitals and 21 Medical
College Hospitals) aiming at early detection and
intervention so as to minimize disabilities of the
children diagnosed with health conditions. DEIC
has the required facilities for providing social,
educational, vocational and economic
rehabilitation services provided by a 12-member
team headed by a dedicated DEIC Pediatrician.
All 34 DEIC facilities have been empanelled
under CMCHIS. During the year 2018-2019,
1,82,038 children managed in 34 DEICs.

17.5.7 Block Early Intervention Centres

(BEIC):

The children diagnosed with disease

conditions (Developmental delay / Neuro

225
muscular disorder) and managed at DEICs,
require daily interventions, but unable to reach
the DEICs regularly due to distance and other
reasons such as loss of wages for the parents.
Hence, an early intervention centre is being
established at block level to continue the
intervention services. One BEIC per Health Unit
District, i.e 42 centers established in
coordination with School Education Department.
The Specialists from DEIC will be visiting the
BEICs once in 15 days for monitoring and
supportive supervision. This ensures continuum
of care and increased accessibility and good
follow up.

17.6.1 Rashtriya Kishor Swasthya

Karyakram (RKSK):

In order to respond to the needs of

adolescent health and development in a holistic
manner, Rashtriya Kishor Swasthya Karyakram
is functioning since January 2014 with six
strategic priorities namely nutrition, sexual and
reproductive health, Non Communicable
Diseases, substance misuse, injuries to violence
and mental health. This activity is being

226
implemented in Tamil Nadu covering overall of
8,447 villages in 19 districts, with
implementation through Village Health Nutrition
and Sanitation Committee (VHSNC). Peer
educators in these 19 districts selected @ 4 per
Village Panchayat / Town Panchayat (VHSNC)
and trained on adolescent health.

Presently, 33,788 peer educators are

functioning in the State. During the year
2018-2019, in 432 Adolescent Friendly Health
Clinics (AFHCS), 3,03,882 adolescents have
benefitted with clinical services and counseling
services.

17.6.2 Weekly Iron Folic Acid

Supplementation (WIFS):

This programme involves distribution of

one Iron and Folic Acid (IFA) tablet once a week
to all adolescent girls and boys (10 to 19 years
of age), both in school and out of school along
with bi-annual de-worming (February and
August every year). During the year 2018-2019,
48,80,758 adolescents received weekly IFA
tablets and deworming Albendazole tablets.

227
 TRIBAL HEALTH

17.7.1 Tribal Health Services of Accredited

Social Health Activists (ASHAs) in
Tribal areas:

To augment the services of VHN, 2650

ASHAs are engaged in tribal / hilly / remote and
difficult PHC area. Since, the ASHAs are from the
same tribal community, they motivate the tribal
mothers for antenatal checkups in Health Sub-
Centres and Primary Health Centres, which
results in promoting institutional safe delivery.

17.7.2 Birth waiting room in 17 tribal PHCs:

Though four-wheeler 108 Emergency

Ambulance services are available in the hilly
terrain areas, the long and arduous journey for
the pregnant tribal mothers for safe confinement
warrants her to be admitted in the Birth Waiting
Rooms (BWR) of the PHCs well in advance, i.e.
two weeks before the Expected Date of Delivery
for safe delivery under institutional care. Now,
BWR has been established in 17 foothills of 16
districts with provision of free nutritious meal for
antenatal mother & her companion during their

228
entire period of stay. If referral to a CEmONC
centre is required, it is being done well in
advance. During the year 2018-2019, 2,851
mothers have utilized the Birth Waiting Rooms.

17.7.3 Tribal Mobile Outreach Services:

To augment the Mobile Outreach Services

in tribal areas additional 20 Mobile Medical Units
are being operationalized through NGOs in tribal
blocks of 13 districts. This mobile outreach team
with one Medical Officer / Staff Nurse / Lab
Technician conducts Minor Ailment Clinic,
Antenatal screening, Non-Communicable Disease
screening, lab tests and distributes free drugs.
In addition to above treatment, the team
screens 10th & 12th standard tribal & non-tribal
children and drop-outs above the age of 14 for
Haemoglobinopathy traits. During the year
2018-19, about, 3,15,000 out-patients have
been treated in tribal villages by 20 Mobile
Medical Units.

17.7.4 Referral Services in Tribal Districts:

To reach inaccessible tribal areas, the

State has a well-established Emergency Referral

229
Transport System established through TN-EMRI
with four wheeler drive vehicles suitably
equipped as ambulances at 76 identified points
in tribal / hilly areas.

17.7.5 Tribal Counselors:

Tribal Counselors have been placed in the

10 Government Hospitals in the tribal districts.
These counselors function as health activists in
the institution who create awareness on health
and its determinants. They motivate the
community towards healthy living practices.

17.7.6 Haemoglobinopathies:

Tamil Nadu is the first State among the

South-Indian States to implement this program
for early detection of Haemoglobinopathies like
Sickle Cell anaemia, Thalassemia among the
tribal population. The timely identification and
genetic counseling will prevent the transmission
of the carrier from parent to children which
breaks the propagation of the disease. NHM
along with line departments has implemented
screening of Haemoglobinopathies (Sickle Cell
Anaemia & Thalassemia) in adolescent children

230
studying in 10th, 12th standard and unmarried
school dropouts above the age of 14 in 30
selected tribal blocks in 13 Districts since
November 2017. The programme is being
implemented at a cost of Rs 216.00 lakhs in
Dharmapuri, Salem, Krishnagiri, Namakkal,
Nilgiris, Coimbatore, Tiruvannamalai,
Villupuram, Vellore, Tiruchirapalli, Dindigul,
Erode and Kanyakumari districts. During the
year 2018-2019, 10,042 children screened for
the disease with a positivity rate of 8.7%. It is
now planned to extend the programme to screen
antenatal mothers also. With the successful
implementation of the programme, the incidence
of genetic trait will be reduced and the future
generations will become free from
Haemoglobinopathies.

17.7.7 Establishment of Day Care

Centres for Haemophilia &
Haemoglobinopathies patients in 5
Government Medical College
Hospitals of Tamil Nadu:

The prevalence of inherited bleeding

disorders like Haemophilia A & B, in India is 0.9

231
per 1 lakh population. (Source: Indian Journal of
Medical Research). Five Regional Day Care
Centres for treatment of these children with
blood transfusions and Chelation therapy is
being established at Institute of Child Health and
Hospital for Children, Chennai-8 (Nodal Centre),
Government Mohan Kumaramangalam Medical
College Hospital,Salem, Government Medical
College Hospital, Dharmapuri, Government
Rajaji Hospital, Madurai and Government
Medical College Hospital, Theni.

17.8 Infrastructure Strengthening:

Infrastructure of the health institutions

plays a key role in delivering effective services
to public. Since, its advent, NHM extends crucial
support for primary, secondary and tertiary
health care. In order to execute the construction
works (new & renovations) effectively, timely
and in a patient-friendly manner as well as to
meet the requirements of health institutions,
exclusive divisions under Public Works Division
(PWD) named as “PWD: Medical Works Division”
had been established. From the year 2005 till
March 2019, 444 PHCs, 315 Upgraded Primary

232
Health Centers (UGPHCs), 628 First Referral
Units (FRUs), and 27 Maternal and Child Health
(MCH) wings under NHM and 66 buildings for
Training centers have been constructed. This
includes 8 MCH buildings and Upgradation of 3
CemONC centres which are under construction
at a cost of Rs.134.50 Crores. Thus, effective
strengthening of infrastructure in health
institutions enables the provision of quality
health care services to common public in
Government health facilities.

17.9 Untied Funds:

Flexi pool funds are available with the in

charge Medical Officer for completion of minor
civil work, minor repair works of equipment,
consumables, and upkeep of facilities and
improvement of patient amenities. This reduces
the Out Of Pocket Expenditure (OOPE) of the
poor people approaching the public health
facilities and improves the patient satisfaction.
This provision is available across all Government
Health facilities.

233
17.10 Village Health, Water Sanitation and
Nutrition Committee (VHSNC):

For ensuring community participation,

effective communication and for prevention of
diseases, VHSNC is constituted with VHN, Local
Panchayat President and representative of SHGs.
Every VHSNC is entitled to an annual untied
grant of Rs. 10,000. This fund is jointly operated
by Panchayat President and VHN. There are
about 15,015 VHSNCs in Tamil Nadu which
proactively monitors the access of healthcare
services and schemes to the marginalized
sections of the village. It plays the role as a
forum for grievance re-dressal on community
level issues related to health, nutrition and
sanitation.

17.11 Mobile Medical Units (MMUs):

Tamil Nadu is the only State having nearly

2,270 PHCs in rural and urban areas. To ensure
the concept of follow up NCD patients, high risk
mothers, TB & Leprosy cases, RBSK operated
cases and NCD drug distribution, 416 Mobile
Medical Units with GPS have been introduced
with a Fixed Tour Program (FTP) to 40 villages

234
per month. The camps are being conducted in
Anganwadi centres / Health Sub-Centres
(HSCs). The Fixed Tour Programme of the MMU
unit is being hosted in the district website.
During the year 2018 –2019, about, 1.78 Crores
beneficiaries have benefitted in 2,08,229 camps
from these 416 Mobile Medical Units.

17.12 DNB Programme in District Hospitals:

District hospitals are on par with tertiary

care hospitals in terms of service delivery.
However, qualified human resources are a major
constraint in secondary care hospitals. To
improve the services in secondary care
hospitals, DNB courses were initiated. Presently,
40 accredited DNB seats approved in 10
Secondary Care hospitals and 2 Medical college
hospitals. Tamil Nadu one among the 2 states
which got accredited with 5 Emergency Medicine
seats in Government Pudukottai Medical College
Hospital, Government Omandurar Medical
College Hospital and Government Headquarters
Hospital, Erode.

235
17.13.1 Oral Health Care Services in PHCs:

Oral diseases are a major public health

problem and their burden is on the rise in Tamil
Nadu. To address this issue, NHM initiated
preventive and curative oral health services by
supporting and establishing 389 dental units
across the State. These dental units are set up
with dental equipment, drugs and consumables
with the support of dentists and dental
assistants providing general and specialty dental
services across the state.

17.13.2 Oral Pre-Cancer Screening

Programme:

Oral Cancer ranks among the top three

types of cancer in India. “Oral Pre-Cancer
Screening Programme” was launched in August
2016 for early identification and intervention of
patients with pre-cancer lesions and conditions.
From August 2016 to March 2019, about,
53,81,457 persons screened, out of which
16,106 were suspected for lesions and of which
217 were diagnosed with cancer.

236
17.14 Dialysis Program:

Among the Non-Communicable Diseases,

the End Stage Renal Disease (ESRD) continues
to be a rising burden for the State. Health
policies focusing on intervention and allocation
of more resources for the management of ESRD
patients are imperative in Tamil Nadu.
Strengthening of district hospitals has been a
key priority so that people can receive affordable
and accessible dialysis treatment. A total of 755
dialysis machines are installed in secondary and
tertiary health care settings across the state.
During the year 2018-2019, about, 2,66,963
cycles have been done and 3,988 patients have
undergone dialysis.

17.15 National Quality Assurance

Standards (NQAS) Programme in
Government Health Facilities:

NQAS programme is being implemented in

secondary care and primary care facilities to
improve the quality of healthcare services in
Government Facilities. Every Hospital to get
certified under NQAS will be assessed at three
levels on NQAS checklists i.e. Internal

237
Assessment, State Assessment and National
Level External Assessment. During the year
2018-2019, the State has achieved NQAS
National certification for 13 District Headquarters
Hospitals (highest in the country), 5 Community
Health Centres and 11 Primary Health Centres.

17.16 Mera Aspataal:

Mera Aspataal (My Hospital) is an initiative

to capture patient feedback for the services
received at the hospital through user-friendly
multiple channels such as Short Message Service
(SMS), Outbound Dialling (OBD) mobile
application and web portal. Parameters on which
the patient satisfaction is measured are Staff
behavior, Cleanliness, Cost of treatment, Quality
of treatment and other reasons. Under this
programme, 31 District Headquarters Hospitals
have been registered in the state. “Mera
Aspataal” will help the government to take
appropriate decisions for enhancing the quality
of healthcare delivery across public facilities.
Tamil Nadu is the leading state in Patient
Satisfaction Index.

238
17.17 Kayakalp Award Scheme (Cleanliness
Drive and Award) undertaken in
Public Health Facilities:

Kayakalp Award Scheme which

demonstrates high levels of cleanliness, hygiene
and infection control being implemented in
District Hospitals, Taluk & Non-Taluk Hospitals,
Community Health Centres and Primary Health
Centres across the State.

In 2018-19, Kayakalp award programme

activity implemented in all hospitals in the state
and following facilities were awarded as below:

1. Under the Directorate of Medical and Rural

Health Services, Government
Headquarters Hospital (GHQH),
Pennagaram (1st prize Rs.50 lakh),
Government Headquarters Hospital
nd
(GHQH), Usilampatti (2 prize Rs.20 lakh)
and 22 Government Headquarters
Hospitals (GHQHs) (Commendation Award
Rs.3 lakhs each) have been awarded
Kayakalp awards.

239
2. Government Hospital, Pallapatti (1st prize
Rs.15 lakh), Government Hospital,
nd
Aravakurichi (2 prize Rs.10 lakh) and 70
Government Hospitals (including Taluk and
Non-Taluk Hospitals) received
Commendation award of Rs.1 lakh each.

3. Under the Directorate of Public Health and

Preventive Medicine, Community Health
Center – Morappur received 1st prize Rs.15
lakhs, Community Health Center –
Andakulam received 2nd prize Rs.10 lakhs
and 154 Community Health Centers
received Commendation award of Rs.1
lakh each.

4. Further, 31 Primary Health Centres

received 1st prize Rs.2 lakhs in each of 31
Districts and 187 PHCs received
Commendation award of Rs. 50,000 each.

5. During the year 2018-2019, 27 Urban

Primary Health Centres (UPHCs) in Rest of
Tamil Nadu, 21 UPHCs and 5 Urban
Community Health Centres (UCHCs) of
Greater Chennai Corporation (GCC) were
awarded with cash prize of Rs. 70.00 lakhs
and Rs.68.50 lakhs respectively.

240
17.18 Labour Room and Maternity
Operation Theatre Quality
Improvement initiative (LaQshya):

LaQshya Certification aims at improving

the quality of care to the pregnant mothers in
Labour Rooms and Maternity Operation
Theatres. 188 Government Health Institutions
including Medical College Hospitals, Government
Hospitals and Upgraded Primary Health Centres
have been identified for implementation of
LaQshya process in the State.

In 2018-2019, 13 Secondary Care

Government Hospitals have achieved LaQshya
National Certification.

National Urban Health Mission

17.19.1 National Urban Health Mission

(NUHM):

The goal of National Urban Health Mission

is to “improve the health status of the urban
population in general, particularly of the poor
and other disadvantaged sections, by facilitating
equitable access to quality healthcare through a
revamped public health system, partnerships,

241
community based mechanism with the active
involvement of the urban local bodies”.As per
2011 census, 59 lakhs (17% of the urban
population) live in urban slums.

According to the GOI guidelines,

Government of Tamil Nadu have established 71
new Urban Primary Health Centres(UPHCs) and
strengthened 349 existing Urban Primary Health
Centres (total of 420 UPHCs) in 12 Corporations
including Greater Chennai Corporation and 75
Municipalities having more than 50,000
population.

Abstract
Sl. GCC & Rest Of Tamil No. of
No. Nadu UPHCs
Greater Chennai
1 140
Corporation
Rest Of TN –
2 154
Corporations
3 Rest Of TN-Districts 126
Total 420

242
NUHM endeavors to achieve its goal through
the following approach:

 Need-based city specific urban health care

system to meet the diverse health care
needs of the urban poor and other
vulnerable sections.

 Partnership with community and local

bodies for a more proactive involvement in
planning, implementation, and monitoring
of health activities.

 Ensuring the availability of resources for

providing essential primary health care to
urban poor.

In addition to providing comprehensive

primary health care services, NUHM provides
special services namely,

1. Special Outreach Camp (SOC)

2. Urban Health Nutrition Days (UHNDs)
3. Urban Rashtriya Bal SwasthyaKaryakram
(RBSK)
4. Urban Polyclinics
5. Urban Mobile Medical Units (MMU)

243
1. Special Outreach Camp (SOC):

Outreach camps conducted in UPHC

service area especially hard to reach vulnerable
areas (such as slums, migrant hamlets). 8,821
camps conducted during the year 2018-2019
and 13,11,449 individuals have benefited from
these camps.

2. Urban Health Nutrition Day (UHN Day):

UHN days are conducted by Urban Health

Nurse @ 1 UHN day/UHN/month. 18,093 UHN
days have conducted and 3,66,779 Adolescent
girls and mothers during 2018-2019 have
benefited.

3. Urban Rashtriya Bal Swasthya

Karyakram(RBSK):

Under this programme, children in the age

group from birth to eighteen years including the
newborn are screened for 4 D’ such as Defects
at birth, Deficiencies, Diseases and
Developmental delays including disabilities by a
total of 35 teams, 20 teams in Salem, Madurai,
Coimbatore, Tiruppur, Tiruchirappalli,
Tirunelveli, Vellore and Dindigul Corporations

244
and 15 teams in Greater Chennai Corporation.
During 2018-2019, 5,47,661 children screened
in schools and Anganwadi centres, and 69,758
children were identified with disease conditions
and 44,491 children referred to secondary and
tertiary care institutions.

4. Urban Polyclinics:

To provide comprehensive specialty care

to the urban poor, the concept of “Polyclinic –
Specialist Outpatient Clinic” implemented in 96
UPHCs as evening OP from 4.30 to 8.30 pm in a
full-fledged manner. In these centres, specialty
services such as General Medicine, Paediatric
Medicine, Dental, Ophthalmology, ENT,
Obstetrics and Gynecology, Dermatology,
Psychiatry, Orthopedics and Physiotherapy
services are provided on specific days. During
the year 2018-19, 3,40,188 individuals benefited
from this specialty clinic and the same is being
monitored by a web-based application.

5. Urban Mobile Medical Units:

10 units have been approved by

Government of India under NUHM (5 for Greater

245
Chennai Corporation and 1 each for Coimbatore,
Madurai, Tiruchirappalli, Tiruppur and Salem
corporations) to reach the unreached population
of the slum, migrant population and the workers
of unorganized sector at a total cost of Rs.270
lakhs.

17.19.2 National Quality Assurance

Standard (NQAS) Programme:

NQAS programme was launched in

January 2015 with the aim to improve the
quality of healthcare services in Public Health
Facilities. During the year, 2018-2019, 119
facilities have completed their internal
assessment and 40 facilities have scored 70% in
the assessment. Based on the analysis, further
steps will be taken and a target of 5% of
facilities (UPHCs) has been fixed for undergoing
National Certification for the forthcoming year.

17.19.3 Universal Health Coverage (UHC)

Programme in Urban Health:

Universal Health Coverage (UHC) is being

expanded into urban area by transforming the
UPHC to Health and Wellness Centre. Till date,

246
214 UPHC in Rest of Tamil Nadu has been
branded as Health Wellness Centres and 12 set
of Comprehensive Primary Health Care Services
under UHC are being provided.

17.20 Mental Health Program:

According to the report on Mental Health

Survey, 2016 by National institute of Mental
Health and Neuro sciences (NIMHANS), mental
illness including Self-harm is the 3rd leading
cause of Disability Adjusted Life Years (DALYs)
lost and depressive disorders as the 13th leading
cause of DALYs lost in the State of Tamil Nadu,
which contributes to a total of 6.8% of total
DALYs lost in 2016. It should also be noted that
25% of suicide and violence related deaths
happen in 15- 39 years’ age group contributing
to the top 10 causes of death by age group
among both sexes in 2016.

District Mental Health Programme (DMHP)

is implemented in all 32 District Headquarters
Hospitals and in all Medical College Hospitals.
The services provided are Out-patient and In-
patient Services, Awareness campaign and
Training.

247
 In order to improve the field activities, an
additional psychiatrist engaged to carry out the
Outreach activities and conduct Satellite clinics
so as to increase detection, treatment and follow
up of cases in the community. During April 2018
to March 2019, 6,65,386 patients managed
under DMHP.

The Institute of Mental Health, Chennai, is

the State Nodal Centre for implementing the
District Mental Health Programme. The State has
constituted a State Mental Health Authority
(SMHA), as per G.O.(Ms) No.178 H&FW
(EAP I-2) Dept., dated. 14.05.2018

Functions of SMHA:

 Mental Health Review Board are being

established to cover all the districts to
enhance monitoring of mental health
institutions

 Registration of mental health professionals

and health facilities including those
implementing the DMHP.

248
  To monitor admission, treatment and
discharge of mentally-ill patients as
stipulated in the act.

 To advise on improvement of mental

health services.

In order to address this alarming rise in mental

health issues, the following special initiatives
have been taken;
1. Institutional Screening for mental health
disorders is being done by utilizing the
services of trained NCD Staff Nurses in all
the health care facilities in the State.
2. Community Based Screening for mental
health disorders have been incorporated
into the Population Based Screening
Program for NCDs by Women Health
Volunteers / ASHAs through an incentive
model.
3. Follow up of all suicide attempted victims
with mental health counselling at least with
one visit in the nearby PHC by the Satellite
Clinic

249
 4. Ensuring free drug availability up to PHC
level for which Rs.4 lakhs have been allotted
for all 32 districts for procurement of mental
health drugs.
5. Utilization of services of RBSK medical
Officers for early identification of mental
diseases among school children.
6. Provision of counselling services for suicide
attempted victims by a trained Psychologist
from Institute of Mental Health, Chennai.
7. De-addiction centres have been established
in Cuddalore, Kancheepuram and Tiruppur.

Performance
(April 2018 - March 2019)

No of OP No of IP
Total
cases cases
5,137 1,021 6,158

8. Self-harm cases reported through Tamil

Nadu Accident and Emergency Care
Initiative (TAEI) Centres will be counselled
for a period of 18 months with the consent
of the patient.

250
 Performance
(October 2018 - March 2019)

Number Total
of Self- Number of
harm cases
Sl.
Institutions cases counselled
No.
reported with
in TAEI consent
App forms
1 Government 32,125 8,723
Medical College
Hospitals
2 District 23,315 8,676
Headquarters
Hospitals
3 Taluk& Non- 10,885 4,303
Taluk Hospitals
Total 66,325 21,702

9. Establishment of Emergency Care and

Recovery Centres with 50 beds cater to the
needs of wandering mentally-ill. The centre
provides treatment, shelter rehabilitation,
vocational training and reintegration

251
 services through NGO’s in 7 districts of
Vellore, Villupuram, Theni, Tiruvannamalai,
Tiruppur, Chennai, Pudukkottai,
Dharmapuri, Karur and Tirunelveli.

Performance of ECRC (October 2018 to

March 2019)

Total No of
Total No of patients
patients re-united
admitted at ECRC
with family
277 109

10. Mentally ill patients are shifted through

Retrieval Vehicles for mentally-ill (1 per
district).

Performance of
Retrieval Vehicles for mentally-ill
(October 2018 to March 2019)
Total No of patients shifted through
201
Retrieval Vehicles for mentally-ill

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 11. Linkage of DMHP with NGOs in 10 districts
namely The Nilgiris, Thiruvallur,
Coimbatore, Thanjavur, Trichy, Perambalur,
Kancheepuram, Cuddalore, Thiruvanamalai
and Villupuram. The role of NGO includes;

 To perform door-door survey to screen

mental ill patients.

 Capacity building.

 To create awareness about mental illness

in the community.

 To enhance social entitlement for mentally

ill patients.

12. For providing quality mental health services

State Mental Health Policy is to be published
shortly by Government of Tamil Nadu.

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 New Initiatives 2019-2020

ESSENTIAL DIAGNOSTICS SERVICES

SYSTEM (EDSS)

17.21 The Government of Tamil Nadu is

already providing free drugs at all levels through
TNMSC. To reduce the Out-of-pocket
expenditure for the poor, it is not only necessary
to ensure availability of free drugs but also
ensure free diagnostic services to them. This
year, the key focus area is to establish the
Essential Diagnostics Services System across the
state with a sole aim to provide quick, prompt
and hassle-free laboratory services. Hence, it is
planned to strengthen all the laboratories across
the state by ensuring the availability of an
appropriate ‘Assured Diagnostic Test Menu’ at
each level of health care delivery through a Hub
& Spoke Model along with a well-equipped
Laboratory Information and Management
System (LIMS), at a budget of Rs. 273.14 Crores
over 3 years. This system will ensure a quality &
evidence based diagnosis at the shortest
possible time for appropriate treatment for the
patients.

254
17.22 Health IT Program of the State:

The State has conceptualized a robust IT

platform with population as denominator to
establish a continuum of care from community
to referral units. As a first step, Health IT
standards were drafted and 3 modules namely
Master Registry Module, OP Module and Drug
inventory module were developed using these
standards. About, 6.7 Crores of member
information in electronic form from Public
Distribution System (e-PDS) has been used as a
baseline and the data is updated from HSC to
State level through Master Registry Module.

17.23 Tamil Nadu State Mental Healthcare

Policy and Implementation
Framework:

Tamil Nadu has already implemented the

District Mental Health Programme in all districts.
Now, along the lines of the National Mental
Health Policy of India, 2014, Rights of Persons
with Disabilities Act, 2016 and Mental Healthcare
Act, 2017, National Health Mission, Tamil Nadu
has drafted the “State Mental Healthcare Policy
and Implementation Framework” in consultation

255
with various stakeholders with the following
vision;

“To promote mental health, prevent mental

illness, enable recovery from mental illness,
promote de-stigmatization and desegregation,
and ensure socio-economic inclusion of persons
affected by mental illness by providing
accessible, affordable and quality health and
social care to all persons through their lifespan,
within a rights based framework”

This policy also aspires to achieve the following

two targets in Tamil Nadu;

1. Coverage of Mental Health Services to be

increased by 20% by 2025

2. Suicide Rate to be reduced by 10% by

2025

Upon approval of the policy, necessary efforts

will be initiated to improve mental healthcare in
the State of Tamil Nadu in order to achieve the
above targets.

256
17.24 Tamil Nadu State Palliative Care
Policy:

Palliative care aims to improve the quality

of life of the patients suffering with chronic life
threatening illnesses like cancer, stroke, etc. For
this, National Programme for Palliative Care has
been implemented in all districts of Tamil Nadu
with provision of institution and community-
based services. However, to provide a holistic
approach to the programme and to integrate
community and institutional care, National
Health Mission, Tamil Nadu in consultation with
various experts in the field of palliative care has
drafted Tamil Nadu State Palliative Care Policy.
Upon approval of the policy, necessary efforts
and strategies will be implemented to ensure
quality of life of patients and care givers and
better survival index of those suffering from life
threatening illness and requiring palliative care
services.

17.25 Strategic Document for TB-Free

Tamil Nadu by 2025:

The Revised National Tuberculosis Control

Programme (RNTCP) was started in the year

257
1997 and is being implemented throughout the
state of Tamil Nadu since the year 2002. The
programme is being implemented considering
the key objectives as laid out by Government
with both diagnosis and treatment at free of cost
for all patients.

Now, the State has drafted the Strategic

Document for TB-Free Tamil Nadu by 2025,
which clearly spells out key strategies to achieve
"TB-Free Tamil Nadu by 2025." The strategies
are aimed at achieving the notification rates for
each year from 2019 based on the projections,
to move towards TB elimination levels by 2025.
They have been developed based on the four
principles of the National Strategic Plan (NSP)
2017-2025 namely, ‘Detect-Treat-Prevent -
Build’. Tamil Nadu, by implementing the key
strategies as per Strategic Document will be
able to achieve the goal of 'TB-free by 2025’.

Health Management Information System

(HMIS)

17.26 The use of Information Technology

in health services will definitely improve the
quality of health care services provided to the

258
patients at the hospitals. The Government of
Tamil Nadu implemented Health Management
Information system (HMIS) in the Government
hospitals of the State to improve the quality of
health care services. The implementation of
HMIS has three components;

1. Hospital Management System (HMS):

This is used to help in day to day hospital
functions in 311 Hospitals (263 Secondary
Care & 48 Tertiary Care). The software
helps in registration of patients, prescription
of drugs, distribution of diet and other
hospital functions. This is one of the world’s
largest medical databases in the world.

2. Management Information System

(MIS): This is used for Monitoring and
Administrative purposes in 2267 Primary
Health Centres (PHC’s) (1806 Rural PHCs
and 460 Urban PHCs) and 309 Secondary
Care hospitals (31 Head Quarters Hospitals,
204 Taluk Hospitals & 74 Non Taluk
Hospitals) and all Government Medical
College Hospitals.

259
3. College Management System (CMS)
and University automation system
(UAS): This is used by all Government
Medical College Hospitals and TN Dr MGR
Medical University for admission, allocation
of registration number, hall ticket, mark
sheet preparation, publication of results,
award of certificates to allotment of seat in
Convocation Hall for all students under the
University Automation System.

17.27.1 Tamil Nadu State Blindness Control

Society

The Government of India, in order to reduce the

prevention of preventable blindness from 1.4%
to 0.3% among population, launched the
National Programme for Control of Blindness
(NPCB) in the year 1976, as a 100% centrally
sponsored programme. The implementation of
the said programme was subsequently
decentralized in 1994-95 with formation of
District Blindness Control Society in each District
of the State. In Tamil Nadu, Tamil Nadu State
Blindness Control Society (TNSBCS) was formed
on 01.04.1996 as a separate entity to give

260
thrust to the goal by planning, execution and
monitoring at the District Level.

17.27.2 The TNSBCS is represented by

the District Blindness Control Society (DBCS) in
all districts of Tamil Nadu, where the Collector of
the District is the Chair person and the
programme is executed by the District
Programme Manager (DPM), a Senior
Ophthalmologist from the District Head Quarters
Hospital or Government Medical College
Hospital, as the case may be. The Tamil Nadu
State Blindness Control Society has been
brought under the control of the Mission
Director, National Health Mission since
01.04.2007 and is a part of Non-Communicable
Diseases programme.

17.27.3 The Cataract being the main

reason for avoidable blindness, accounts for
more than 60% of blindness. Under NPCB, the
cataract operations are done at free of cost both
in Government hospitals and private hospitals
through NGOs and a grant-in-aid of Rs.2,000/-
per operation is allowed to NGOs with effect
from 01.04.2018.

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 17.27.4 The development of strong
eye-care facility supported by well-trained
doctors is the necessity to fight the avoidable
blindness. Therefore, districts are being chosen
every year to build a dedicated eye ward, at a
cost of Rs. One Crore and there are 4 such
facilities across the State. Recently, a dedicated
Eye block has been built to in Government
Hospital, Vaniyambadi of Vellore District and
Virudhachalam of Cuddalore District. Regular
trainings to Ophthalmic Surgeon in various sub-
specialties are also given using latest techniques
in various centres established in Government
and NGO sectors.

17.27.5 Achievements in the year

2018-2019
a. 3,33,203 persons were operated for cataract
conditions
b. A pilot project under assistance of Queen
Elizabeth Trust and Indian Institute of Public
Health, Hyderabad to screen complication of
Diabetes such as Diabetic Retinopathy
initiated at Block PHC level in Tirunelveli

262
 District and also extended to 3 more districts
of Vellore, Cuddalore and Salem.
c. A project to screen for Retinopathy of
Prematurity disease in new born children
commenced in 73 Special New Born Care
Units.
d. New Eye Banks started and functioning in
Thanjavur, Tiruchirappalli and Cuddalore.
e. Tamil Nadu stands first in Eye Donation in
India with more than 11,000 eye donations
per year under Hospital Cornea Retrieval
Programme.
f. During 2018-19, equipment for eye units
were supplied to Government health facilities
at a cost of Rs.4.68 Crores.
g. Comprehensive Hi-tech Computerized eye
clinic is to be started in all Medical Colleges &
District Head Quarters Hospital (in 54 Places)
at a cost of Rs.357.85 Lakhs.
h. New Eye Operation Theatre and ward is being
constructed in 5 district and taluk hospitals
namely Tiruppur, Palani, Tiruchendur,
Tindivanam and Cuddalore.

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 NON-COMMUNICABLE DISEASE
PREVENTION, CONTROL AND TREATMENT

17.28.1 Non-Communicable Diseases

(NCD) are on the rise and emerging as leading
cause of morbidity and mortality in the
community. NCDs pose a challenge in both
urban and rural areas due to changing life style
pattern which is associated with NCD related risk
factors.

The Global Burden of Diseases (GBD)

report 2016 alerts that the NCDs constitute
69.2 % of the mortality from various diseases in
Tamil Nadu with Cardiovascular diseases alone
constituting 36.1 % of the mortality. With regard
to the Disability adjusted life Years (DALYs),
65.3 % is due to NCDs of which the major cause
is Cardio Vascular Diseases.

Hence, the State of Tamil Nadu took up

the flagship program to address NCDs under the
erstwhile Tamil Nadu Health Systems Project
(TNHSP). The Non-Communicable Diseases
Intervention Programme supported by TNHSP,

264
was the first of its kind on a very large scale in
India, across in 2,516 Government health
facilities in the Primary / Secondary / Tertiary
levels of health care. Under the programme,
screening, treatment and follow-up services are
provided for Hypertension, Diabetes Mellitus,
Cervical and Breast Cancer to all individuals
aged 30 years and above attending any
Government Health facility in the State. In case
of Hypertension and Diabetes Mellitus, besides
the regular drug treatment and follow-up, the
focus is on counseling individuals on ‘Life Style
Modification’. With closure of the World Bank
supported TNHSP on 15 September, 2015, the
Non Communicable Diseases intervention
program is continued and sustained under
National Health Mission (NHM) through the
National Programme for Prevention and Control
of Cancer, Diabetes, Cardiovascular Diseases
and Stroke (NPCDCS) in 2,600 health facilities in
the State.

265
17.28.2 Performance under Facility
Based or Opportunistic
Screening for NCDs

17.28.2.1 Cardio Vascular Diseases (CVD)

Prevention and Control
Programme:

During July, 2012 to April 2019,

6,35,19,388 individuals were screened for
hypertension and 54,50,646 were found to be
positive. Those identified with hypertension are
put on treatment and follow-up. To augment the
follow up services, Intensive Care Units (ICUs) in
29 District Headquarter Hospitals and two
Medical College Hospitals have been
strengthened under NPCDCS.

17.28.2.2 Prevention and Treatment of

Diabetes Mellitus:

Among 5,14,59,143 individuals screened

for Diabetes Mellitus during the period from July
2012 to April 2019, 22,37,596 patients detected
to be positive. The patients identified with
diabetes are put on treatment and followed up.

266
17.28.2.3 Prevention and Treatment of
Cervical Cancer
From July 2012 to April 2019, VIA
Screening test for Cervical cancer was
performed for 2,02,27,193 women and among
them 5,53,467 women were detected positive.
The women found to be positive in the screening
test are being followed up.
17.28.2.4 Prevention and Treatment of
Breast Cancer
From July 2012 to April 2019, 2,49,41,368
women were screened with Clinical Breast
Examination (CBE). Among the women
screened, 2,54,776 were detected with any
abnormality or lump in the breast. The CBE
positive women referred to higher institutions for
further evaluation and follow-up as per the
protocol.
17.29 Strengthening of Cancer Care at
State and District Level

Adyar Cancer Institute in Chennai is functioning

as State Level Higher Treatment Centre for
Cancer. Four Regional Cancer Centres are being
established in Government Rajaji Hospital
Madurai, Government Coimbatore Medical

267
College Hospital, Government Tirunelveli Medical
College Hospital and Government Thanjavur
Medical College Hospital at a total cost of Rs.60
Crores. Under strengthening of cancer care
activities, replacement of 10 Old Cobalt-60 units
with new Cobalt-60 units, supply of 4 new
Cobalt-60 units and supply of high end 9 Linear
Accelerator units to Government health
institutions is under process.

17.30 District Level Day Care

Chemotherapy Centres

Day care chemotherapy centres are

functional in District Headquarter Hospital in all
districts except in Tiruvannamalai, Karur and
Pudukkottai which are functional in Government
Medical College Hospitals.

The treatment decision for the confirmed

cancer patients will be decided in tumour board
at tertiary care hospital and the first chemo
cycle also would be given there. Then, the
follow-up or maintenance chemotherapy which
involves more cycles will be given at District
Headquarters hospital under supervision of one
physician and staff nurse in each district trained

268
in Day Care Chemotherapy. This will amply
benefit cancer patients who find it most
inconvenient to report to the same tertiary care
institution for the maintenance chemotherapy
and also incur lot of Out-of-Pocket Expenditure
(OOPE) or get lost to follow-up in the absence of
such programme.

17.31 Free Pathology Services

The people in certain districts opt for tests in

private pathology laboratories incurring heavy
Out-of-pocket Expenditure (OOPE) and also face
inordinate delay in receiving reports from the
Government Medical colleges in the
neighbouring districts. Hence, under the ‘Free
Pathology Service’ initiative, histo-pathology
laboratories are being established in district
headquarter hospitals of Cuddalore, Dindigul,
Nilgiris, Nagapattinam, Namakkal, Perambalur,
Ramanathapuram, Tiruppur, Tiruvallur and
Virudhunagar, where there are no medical
colleges.

269
17.32 Population based NCD Screening
and Follow up

Under NPCDCS program, Population based

NCD screening is another specific intervention
implemented in Tamil Nadu. The key person
responsible for this is a field functionary who is
an Accredited Social Health Activist
(ASHA) /Women Health Volunteer (WHV)/
Anganwadi worker (AWW) vested with
responsibility to make house–to-house visits and
carry out enumeration, create awareness on
NCDs and risk factors, screen for hypertension
using a digital blood pressure apparatus and for
Diabetes Mellitus by a Glucometer for all those
aged 30 years and above. The field functionary
is being paid performance based incentives for
her field level activities.

The individuals aged 30 years and above

suspected with hypertension / diabetes at the
household level get referred to the nearest PHC
for confirmation and further follow up. Women in
addition are motivated to attend nearest PHC for
Cervical and Breast cancer screening. The field
level functionaries will also do house to house

270
enquiry of symptoms of Oral cancer, TB, Leprosy
and Mental Health. Besides the survey, the field
functionary also carries out a risk assessment
using Community Based Assessment Checklist
(CBAC) for those in 18-29 years’ age group.

Population based NCD screening is

currently under way in 5 districts (Pudukottai,
Perambalur, Krishnagiri, Karur &
Ramanathapuram) and 3 Corporations
(Tirunelveli, Coimbatore and Chennai) by
involving Women Health Volunteers identified
through Tamil Nadu Corporation for
Development of Women (TNCDW)

From May 2018 to April 2019, out of the

10.6 Lakhs (45%) families enumerated in these
districts, 26 Lakhs (58.9%) were screened for
Hypertension and 25.6 Lakhs (55.7%) for
Diabetes. Among those screened, 2.3 Lakhs
(9.1%) and 1.8 Lakhs (7.9%) were suspected
for Hypertension and Diabetes respectively and
referred to PHCs for confirmation and treatment.
The field functionaries have referred 2.4 Lakhs
(11%) women for screening of cervical cancer
and 2.3 Lakhs (10%) for screening of Breast

271
cancer at the PHCs. A total of 32,840 (0.8%)
individuals were referred for screening of Oral
Cancer.

Currently from March 2019, the program is

up-scaled and integrated with the Health &
Wellness Centres (HWCs) in the State in 35 UHC
blocks covering 834 HSCs by involving 708
WHVs and 126 existing ASHAs. The program will
also be up-scaled to the entire aspirational
district of Virudhunagar by involving 205 more
WHVs and to all the remaining 8 Corporations.

17.33 Universal Health Coverage: Health

and Wellness Centres

Universal Health Coverage (UHC) project

has been piloted successfully in 3 pilot blocks of
Veppur, Shoolagiri and Viralimalai in 3 Health
Unit Districts (HUDs) of Perambalur, Krishnagiri
and Pudukottai respectively covering 67 HSCs
and 17 PHCs (including block PHCs) since 2016.
In 2017-2018, the program was up-scaled to all
remaining HUDs at a total cost of 2474.07 lakhs.

UHC aims to provide equitable, affordable

and quality health services. The full spectrum

272
includes health promotion, prevention and
treatment, rehabilitation and palliative care. The
Sub-Centre strengthening is the pillar for the
UHC program.

In the year (2018-2019), it was proposed

to transform 985 Health Sub-Centres, 716
Additional PHCs and 214 Urban PHCs into
Health& Wellness Centres (HWCs) at a cost of
Rs. 9,357.47 lakhs (rural & urban) and the work
is in progress.

The program is being implemented

through the State Programme Management Unit
(SPMU), Universal Health Coverage (UHC) &
Maternal Child Health (MCH) established at the
Directorate of Public Health and Preventive
Medicine.

The HWCs will provide a set of 12

comprehensive services including Preventive,
Promotive, curative Rehabilitative and Palliative
care.

The primary level activities in the proposed

HWC will be led by the team of a Mid-Level
Health Provider (MLHP) after completion of a 6
months’ certificate course on community

273
healthcare through the Tamil Nadu Dr. M.G.R.
Medical University. Village Health Nurses (VHNs)
will be the Mid-level healthcare provider (MLHP)
at HSC level and Staff Nurses (SNs)/Auxiliary
Nurse Midwives (ANMs) will be the healthcare
provider at PHC level between 4 pm and 9 am
under the supervisory control of the PHC Medical
Officer.

The HWCs could be the window of

opportunity for strengthening the primary health
care systems in context of Tamil Nadu.

17.34 National Program for Palliative Care

(NPPC)

Palliative care primarily aims to relieve

suffering and improve quality of life of adults
and children affected by life-threatening and life-
limiting illness. This involves inclusion of their
family members as a part of care giving
services.

Potential beneficiaries of the program

include patients suffering from cancer, Cardiac
Failure, COPD, Chronic Kidney Disease, mental
retardation, hemiplegia, paraplegia, congenital

274
mental and physical disabilities, Alzheimer’s,
Parkinson’s, chronic disability in the elderly etc.
For children, the major disease categories which
require palliative care include cancer, HIV,
progressive non-malignant conditions, congenital
anomalies etc. It is estimated that 7% of the
population of Tamil Nadu require palliative care.
The Palliative Care Services with a two pronged
approach of Institutional and Community Based
Services is being implemented in Tamil Nadu as
detailed below:

In the Phase I (2016-2017), palliative care

services have been established at eight District
Headquarter Hospitals of Cuddalore, Dindigul,
Tiruvallur, Krishnagiri, Ramanathapuram,
Thoothukudi, Tiruppur and Namakkal and two
Medical College Hospitals of Thiruvarur,
Tiruvannamalai by placing a trained palliative
care doctor and staff nurses. More than 3,800
patients have already benefitted from this
service at these institutions from September
2017 to March 2019.

In Phase II, it has been up scaled to next

10 District Head Quarters Hospitals of

275
Kanchipuram, Coimbatore, Villupuram, Vellore,
Thanjavur, Erode, Trichy, Salem, Tirunelveli and
Kanyakumari. From August 2018 to March 2019,
1,690 patients have been benefitted.

In Phase III (2018-2019), the program

has been implemented in rest of the 12 districts
at 8 Government District Head Quarters
Hospitals of Ariyalur, Dharmapuri,
Nagapattinam, Nilgiris, Perambalur, Sivagangai,
Theni, Virudhunagar and 4 Government Medical
College Hospitals of Karur, Pudukkottai &
Madurai (Thoppur, Thoracic Medicine),
Government Royapettah Hospital in Chennai
District. Oral Morphine is made available in all
the districts of Tamil Nadu.

Further, Community Based Palliative Care

Services are being implemented at block level in
phased manner to provide home-care services.
Trained staff nurse designated as ‘Community
Palliative Care Nurse’ at 1 per block are
providing Palliative care nursing services to
those who are bed-ridden and approaching last
days of their life in home setting. This service
would reduce the physical difficulties of the

276
severely debilitated patients in accessing a
health care facility. Presently, 140 staff nurses
are trained in Community Based Palliative Care
Services

From June 2018 up to April 2019,

Community Based Palliative Care Services have
been implemented in 113 blocks in 25 HUDs
with 29,034 beneficiaries across the state.

17.35 NCD Mobile App:

An NCD mobile app has been developed

with the help of National Informatics Centre
(NIC) to upload the data to improve the quality
of NCD screening for Diabetes, Hypertension,
Cervical and Breast Cancer. 2,832 NCD staff
nurses in the state have been provided with a
tablet computer.

17.36 Health Technology Assessment:

Health Technology Assessment (HTA) is a

method to evaluate cost effectiveness of various
health technologies such as devices, medicines,
vaccines and help health systems for making
evidence based policy decision. Now, a Health
Technology Assessment is being conducted in

277
Tamil Nadu on the screening of Type 2 Diabetes
and Hypertension by ICMR – National Institute
of Research in Tuberculosis (NIRT) with NHM,
TN.

17.37 Occupational Health Services for

Unorganized sector workers

According to International Labour

Organization (ILO), in every 15 seconds, a
worker dies from a work-related accident or
disease. In India, formal Occupational Health
Services are available for the Organized Sector
employees which are only 10% of the total
workforce. The health care needs of the
remaining 90% of workforce in un-organized
sector are largely unattended.

In Tamil Nadu, the un-organized sector

workforce is 93% of the total workforce (Census
2011). They suffer from various occupation-
induced diseases like Silicosis, Asbestosis,
Deafness, Irritant Dermatitis, Spondylosis etc.
apart from several work-related illnesses. Most
workers do not seek medical treatment from a
health facility as they cannot afford to sacrifice a
day’s wages. Since most of the occupation-

278
induced diseases result in irreversible damage,
timely screening, prevention and early treatment
is the way forward.

Since October 2018, National Health Mission,

Tamil Nadu along with Directorate of Public
Health and Preventive Medicine has initiated
Occupational Health Services through its Mobile
Medical Units (MMUs) in 64 blocks in the State
across 32 districts. The MMUs visit the
unorganized sector areas, and screen for 5
major disorders namely Respiratory, Auditory,
Ocular, Skin and Musculoskeletal disease and
refer to district level hospital apart from
providing primary care onsite whenever
necessary. From October 2018 to March 2019,
55,965 un-organized sector workers were
screened, of whom 4,251 workers were referred
to district level hospital for further investigations
and treatment.

As per G.O.(Ms) No.65, Labour and Employment

(I2) Department, dated; 30.05.2019,
Government have issued orders for procurement
of 50 Mobile Health Clinics for providing
Occupational Health Services for construction

279
workers. This activity is funded by Department
of Labour and Employment and implemented
through NHM-TN.

Geriatric Care

17.38 The epidemiological and

demographic transition as a byproduct of
significant achievements in vital health
indicators has made Tamil Nadu an ‘Ageing
Society’ in which 10.4% of its population is
above 60 years of age against the national
average of 8.6% (Census 2011); thus becoming
the third state in India with highest share of
elderly. The elderly suffers from various
degenerative disorders that render them
dependent and vulnerable.

To cater to the health care needs of this

significant and increasing group, Government of
Tamil Nadu through National Health Mission,
Tamil Nadu has already taken initiatives by
establishing elderly-friendly healthcare facilities
at various levels of care under National Program
for Health Care of Elderly (NPHCE).

280
17.39 Institutions providing Elderly Care
at various levels under NPHCE:

1. National Centre for Ageing, Chennai:

A joint venture of Government of India

and Government of Tamil Nadu, this 200 bedded
institute is of national importance and currently
under development at King Institute of
Preventive Medicine, Guindy, Chennai spreading
over 8.64 acres of land at an estimated total
cost of Rs.126.87 Crores.

2. Regional Geriatric Centre (RGC),

Rajiv Gandhi Government General
Hospital, Chennai

The Department of Geriatric Medicine,

Rajiv Gandhi Government General Hospital,
Chennai would serve as the Regional Geriatric
Centre and provides tertiary level of care,
training of health professionals and research.

3. District Level Hospitals:

Government of Tamil Nadu has approved

the establishment of Geriatric units in 18
Government Medical College Hospitals of

281
Coimbatore, Salem, Trichy, Madurai, Tirunelveli,
Thanjavur, Vellore, Villupuram, Dharmapuri,
Kanchipuram (Chingelpet), Kanniyakumari,
Karur, Pudukkottai, Sivagangai, Theni,
Thiruvarur, Thoothukudi, Thiruvannamalai and
13 Government District Headquarters Hospitals
of Ariyalur, Cuddalore, Dindigul, Erode,
Krishnagiri, Namakkal, Nagapattinam, Ramnad,
Tiruvallur, Tiruppur, Perambalur, Virudunagar
and The Nilgiris with required man power.

The following facilities are made available in

each district level hospital under NPHCE:
1. Exclusive ‘Geriatric OP’ for elderly patients on
all days of the week.
2. Separate ‘Q’ for elderly at OP Ticket issue
counter, Pharmacy, Laboratory and
Radiology.
3. Twenty bedded elderly-friendly ward with
anti-skid floor, side-rails and western toilets
with adjacent grab bars.
4. Physiotherapy unit for elderly patients.
5. Intensive-Care facilities- Four ICU cots and
One Ventilator reserved for elderly.

282
 The details of elderly patients that have
availed services from April 2018 – March 2019
under NPHCE is presented in the table below:

Number of Elderly persons attended 7,30,826

Geriatric OPD
Number of Elderly persons admitted 39,220
in geriatric wards
Number of Elderly persons given 80,338
rehabilitation services
Number of Laboratory tests 9,50,416
performed for the elderly

17.40 Tamil Nadu Accident and Emergency

Care Initiative

Introduction

The Government of Tamil Nadu has

recognized the alarmingly rise in morbidity and
mortality due to emergency conditions and has
been implementing the Tamil Nadu Accident and
Emergency Care Initiative (TAEI) with the aim of
strengthening Emergency Care Services in the
State across all levels of health care.

283
17.40.1 Aim of TAEI

To establish a sustainable model of Emergency

Care Service Delivery in the State.

Objectives of TAEI

i. To reduce the trauma morbidity and

mortality in the State by half by the
year 2023.

ii. To reduce the Myocardial Infarction

related morbidity and mortality by 1/3rd
by the year 2023.

284
 iii. To reduce Burn Injury related morbidity
and mortality by 1/3rd by the year
2023.

iv. To reduce the Self-harm and Poison

related morbidity and mortality by half
by 2/3rd by the year 2023.

v. To reduce the Cerebro-vascular

accidents morbidity and mortality by
1 rd
/3 by the year 2023.

vi. To reduce the Pediatric Emergency

related morbidity and mortality by half
by the year 2023.

17.40.2 Key Concepts of TAEI

TAEI introduces a few key concepts and

paradigm shifts in patient care in Tamil Nadu
Emergency Care System. The patient care
demarcated into various clearly defined stages
and steps with fixed time norms, easy to
implement protocols and guidelines, check lists
and standardization of registers.

Emergency Department (ED) is being

created in all hospitals, by reorganizing the

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existing casualty with Emergency Room (ER),
Multi-Disciplinary Critical Care Units (MDCCU),
Emergency Operation Theater, CT / MRI Scan,
Mobile X-ray facilities in the ER premises.

The TAEI-ER model incorporates key

features like concept of Triage, Pre-arrival
intimation, Hospital Call out protocols, Trauma
Nurse Coordinator in all shifts, Resuscitation
bay, Red, Yellow and Green zones, Protocol
based treatment, Focused Assessment with
Sonography in Trauma machine (E-Fast), Point
of Care Testing (POCT), Uniform for all health
care work force and e MLC.

Critical Case Review under TAEI Critical

Case Review has been planned like the maternal
death audit to improve the quality of care in ER.

Currently, App Based Reporting is being

carried out in all TAEI centres and data
pertaining to trauma cases are being collected
on a real time basis. Fourteen Trauma Care
fields are displayed in dash board everyday at
6pm, to get a clear picture on burden of trauma
in the State. Efforts towards Trauma Care

286
Registry and the Injury Surveillance Centre are
being taken up.

17.41. Achievements of TAEI from 2017 to

2019

i. 80 TAEI centers have been established

across the State which includes 25
Government Medical College hospitals and
its allied hospitals, 31 District
Headquarters Hospitals and 24
Government Taluk hospitals located in
Strategic locations along the highways.

ii. Under “Stroke Care and Rapid Intervention

with Plasminogen activator and
Thrombectomy” (SCRIPT), the mapping of
Hub and Spokes has been done,
designating all 23 Government Medical
colleges as Hubs and 55 Government
District Headquarter, Taluk & Non-Taluk
hospitals. Installation of CT Scan facility
completed in all Hub hospitals.

iii. Under TAEI Myocardial Infarction Program,

geographical mapping has been
completed, designating hospitals with Cath

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 Labs as Hubs and hospitals capable of
thrombolysing as Spokes. Currently there
are 18 hubs and 154 spokes identified.
Networking within the MI clusters is being
carried out through protocol based
management and STEMI alerts are given
through Pre-arrival Intimation to the linked
Hub hospital.

iv. New Cath labs are being installed in 9

Medical College Hospitals under the TAEI
MI program. At present, these Cath Labs
are offering office hour Primary PCI to the
patients presenting with STEMI. Round the
clock Primary PCI has been initiated in
Rajiv Gandhi Government General
Hospital, Chennai and soon the other Hub
hospitals will start functioning as round the
Clock hubs.

v. In order to ensure effective

implementation of the TAEI Skill Grading
training, ‘hands on’ sessions and skill
stations for the ED health care workers
have been planned at the 5 Regional
Training Centers (RTC). They are:

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 1. Government General Hospital,
(RGGGH) Chennai.

2. Government Rajaji Hospital, Madurai.

3. Government Mohan Kumaramangalam

Medical College Hospital, Salem.

4. Government Vellore Medical College

Hospital, Vellore.

5. Government Head Quarters Hospital,

Cuddalore

vi. Achievements in training :

a. In TAEI ED Training, a total of 484

nurses, 367 doctors and 575 first
responders trained in ED Skills and
Management.

b. Under SCRIPT program, 150 doctors,

60 nurses and 23 technicians trained
at Rajiv Gandhi Government General
Hospital, Chennai from all the Hubs and
Spokes.

c. Under TAEI Myocardial Infarction(MI)

program, Trainer of Trainer (TOT)

289
 completed for 60 doctors and 20 Nurses
in the State. The MI Kit training
provided to 10 doctors and 30
Emergency Management Technicians.
Regional level trainings at each Hub
hospitals has been planned.

d. In Pediatric Emergency Management

(PREM) Protocols, a total of 11 doctors
and 29 nurses trained across the State,
for a period of 1-3 months of posting at
ICH ED.

vii. Reduction of response time of

Ambulances;

Dynamic allocation of ambulances has

been done by the 108 EMRI Ambulance
Services after which there has been a
significant reduction in average response
time of the State from 15.04 minutes in
2017 to 13.48 minutes in 2018. The
average response time in the city has
decreased further from 11 minutes to 8.36
minutes.

290
viii. In the year 2018-19, Government General
Hospital Chennai, Government Vellore
Medical College Hospital, Government
Krishnagiri District Headquarters Hospital
and Government Kancheepuram District
Headquarters hospital were awarded at
State Level for their Excellence in
organizing and functioning of the
Emergency Services under Tamil Nadu
Accident and Emergency Care Initiative
program.

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 CHAPTER - 18

CHIEF MINISTER’S COMPREHENSIVE

HEALTH INSURANCE SCHEME

18.1 Government of Tamil Nadu with the

objective of ensuring universal health coverage
is implementing the Chief Minister’s
Comprehensive Health Insurance Scheme
(CMCHIS) since 11.01.2012. The scheme covers
1.58 crore families whose annual income is less
than Rs.72,000. In view of the enormous public
benefit due to the successful implementation of
the scheme for five years, the scheme was
continued further for five years starting from
11.01.2017. The Government of Tamil Nadu has
integrated the Government of India’s Pradhan
Mantri Jan Aarogya Yojana(PMJAY) along with
CMCHIS in the State from 23.9.2018. United
India Insurance Company Limited is
implementing the scheme.

292
18.2 The salient features of CMCHIS
being continued from 11.01.2017
are as follows:-

 Sum insured – After integration with

PMJAY all the beneficiary families will get
enhanced coverage upto Rs.5.00 lakh per
year / per family.
 Procedures –1,027 medical and surgical
treatment procedures, 154 specialized
procedures, 154 follow up procedures, 38
standalone diagnostic procedures, 424
PMJAY procedures and 8 high end
procedures are covered under this scheme
 Migrant labourers certified by Labour
Department who reside for more than six
months in the State are included under the
scheme.
 Orphans as defined by the State
Government are also covered under the
scheme.
 CMCHIS health insurance card is used for
claims processing and the same can be
downloaded and printed from CMCHIS
website.
 The Aadhaar linking with CMCHIS is being
carried out.

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  The scheme mandates NABH entry-level
accreditation/NQAS for all empanelled
hospitals including the Government
Hospitals.
 Minimal Electronic Health Record are
available for beneficiaries from website.
 At present, 977 hospitals (244
Government Hospitals and 733 Private
Hospitals) are empanelled under the
scheme.
18.3 Grievance Redressal:

There is a well established grievance

redressal mechanism, including online tracking
and SMS acknowledgement. Public can also
contact 24 x 7 toll free No.1800 425 3993 for
any details of the scheme and to register
complaints. A State and District Monitoring and
Grievance Committee are available to redress
grievances.

18.4 Performance :

Since 11.01.2012 to 31.03.2019, 34.76

lakhs beneficiaries have availed of treatment
worth Rs.5,800.35 crores. Of these 15.34 lakh
patients got treated in Government hospitals at

294
a cost of Rs.2,129.78 crores. (including
diagnostic procedures)

18.5 Speciality wise authorization issued

for surgery are given in the table below:

Speciality wise authorization issued

(11.01.2012 to 31.03.2019)

Sl. No. of Amount

Speciality
No. claims Rs. in lakh.
1 Nephrology 5,87,903 49,090.38
Medical
2 4,05,722 21,461.90
Oncology
3 ENT 1,64,567 21,775.06
Genitourinary
4 1,58,914 35,798.10
Surgery
5 General Surgery 1,54,305 32,602.63
Orthopedic
6 1,46,289 34,859.32
Trauma
Cardiothoracic
7 1,32,154 1,09,763.06
Surgeries
8 Neonatology 1,27,482 19,032.50
Radiation
9 1,13,191 25,869.57
Oncology

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Sl. No. of Amount
Speciality
No. claims Rs. in lakh.
Ophthalmology
10 1,10,810 13,575.05
Surgeries
Gynaecology
11 Obstetric 96,959 18,130.95
Surgery
12 General Medicine 89,876 14,003.30
13 Hepatology 76,020 5,607.52
14 Cardiology 68,355 18,556.24
15 Neurosurgery 57,736 22,815.87
16 Neurology 56,015 9,647.30
Surgical
17 51,702 13,156.93
Oncology
18 Plastic Surgery 49,050 10,664.46
Paediatric
19 46,572 5,586.94
Intensive Care
20 Replacement 38,715 26,263.53
Vascular
21 34,239 8,798.41
Surgeries
Interventional
22 32,391 21,780.83
Cardiology

296
Sl. No. of Amount
Speciality
No. claims Rs. in lakh.
Surgical Gastro
23 14,221 5,305.60
Enterology
24 Pulmonlogy 14,212 2,519.11
Paediatric
25 13,861 3,773.85
Surgeries
26 Gastroenterology 12,545 2,295.93
Follow Up
27 11,118 198.98
Procedures
28 Spine 11,087 3,963.82
Interventional
29 9,137 4,064.96
Radiology
30 Paediatrics 7,988 877.75
31 Rheumatology 6,970 610.15
32 Poly Trauma 5,544 1,052.25
33 Hematology 4,413 942.67
34 Dermatology 3,431 413.46
35 Psychiatry 3,421 204.75
36 OFMS 2,723 320.92

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Sl. No. of Amount
Speciality
No. claims Rs. in lakh.
37 Endocrinology 2,427 389.68
38 PMR 1,142 708.53
39 Transplantation 448 673.39
Thoracic
40 324 33.04
Medicine
Endocrine
41 255 55.93
Surgery
42 Chest Surgery 246 95.65
43 Bariatric Surgery 107 180.04
44 STEMI 77 10.93
Infectious
45 Diseases - 7 0.70
General Medicine
46 Diagnostics 7,58,926 16,301.39
TOTAL 36,83,597 5,83,833.33

18.6 A corpus fund has been created by

Government to mete out high cost procedures
like Liver Transplantation, Renal Transplantation,
Heart and Lung transplantation including post
transplantation Immunosuppressant Therapy,

298
Bone Marrow Transplantation, Cochlear
Implantation, Auditory Brain Stem Implantation
and Stem Cell Transplantation. All the
beneficiaries for such high-end procedures are
approved by an Expert Committee. To recoup
the corpus fund, 27% of the insurance claims
earned by the Government Hospitals under the
scheme are transferred to the Corpus Fund.

18.7 So far, 7,588 beneficiaries (as on

31.03.2019) have been approved for these high
end surgeries from the Corpus Fund as per the
following details:

Nature of Number of
Sl.
Surgical beneficiaries Amount
No
procedure authorized
Liver
1 456 95,41,00,000
Transplantation
Renal
2 2,473 95,65,85,860
Transplantation
Cochlear 277,60,98,800
3 3,770
Implantation
Bone Marrow
Transplantation
780 69,56,72,368
4 and Stem Cell
Transplantation

299
 Heart
5 77 16,27,50,000
transplantation
Heart and Lung
6 12 3,79,50,000
transplantation
Lung
7 5 1,97,50,000
transplantation
Auditory Brain
8 Stem 15 2,73,61,800
Implantation
TOTAL 7,588 563,02,68,828

18.8 Medical Camps and Special Medical

Camps:

From January 2012 to March 2019, 42,181

health camps and 1,086 mega health camps
were conducted and about 64,36,394 persons
were screened in both Government and Private
empanelled hospitals.

18.9 Integration of Pradhan Mantri Jan

Arogya Yojana (PMJAY) with the
ongoing CMCHIS:

Under PMJAY Government of India pays

60% of the premium for 77.70 lakh families
based on Socio Economic and Caste Census
(SECC) data.

300
 Chapter - 19
108- Emergency Ambulance Services
19.1 “108” Ambulance Service is being
operated in Tamil Nadu through a single Toll
Free number and the services are available
24x7 free to the public. This program is
implemented through a Public Private
Partnership between Government of Tamil Nadu
and GVK EMRI. Each ambulance with a Pilot
(driver) has one fully trained Emergency Medical
Technician (EMT) who provides pre-hospital care
to the patient.
19.2 Ambulance Deployment:
Within the districts of the State, based on
criteria like population, accident prone areas,
hilly terrain and remote areas which are difficult
to reach, the 108 ambulances are stationed.
Presently, 940 ambulances are in operation
covering all the districts providing Basic Life
Support (BLS), Advanced Life Support (ALS) and
Neo natal care. There are 76 four wheel drive
(4WD) ambulances for difficult terrain and hilly
areas and 41 First Responders (Bike Ambulance)
for densely populated areas.

301
19.3 District Wise Distribution of
Ambulances:

Ambulances
Neo- FR
Districts ALS BLS 4WD Total
natal Bikes
Ariyalur 1 16 1 0 18 0
Chennai 2 35 4 1 42 13
Coimbatore 2 31 2 4 39 3
Cuddalore 3 33 2 0 38 1
Dharmapuri 0 17 2 4 23 0
Dindigul 2 20 2 5 29 1
Erode 1 22 2 7 32 1
Kancheepuram 5 54 2 0 61 3
Kanyakumari 1 9 2 1 13 0
Karur 1 14 1 0 16 0
Krishnagiri 1 16 2 7 26 1
Madurai 3 25 3 0 31 2
Nagapattinam 2 17 2 1 22 0
Namakkal 1 18 2 3 24 0
Perambalur 1 10 1 1 13 0
Pudukottai 2 20 2 0 24 1

302
 Ambulances
Neo- FR
Districts ALS BLS 4WD Total
natal Bikes
Ramanathapuram 2 18 2 0 22 0
Salem 3 27 2 6 38 2
Sivagangai 2 15 2 0 19 1
Thanjavur 1 22 1 0 24 2
The Nilgiris 2 6 1 20 29 0
Theni 1 13 2 3 19 1
Thiruvallur 1 41 2 0 45 1
Thiruvannamalai 2 29 2 4 37 1
Thiruvarur 1 15 1 0 17 0
Thoothukudi 2 15 3 0 20 0
Tiruchirappalli 2 25 2 2 31 2
Tirunelveli 3 26 2 0 31 1
Tiruppur 2 19 2 0 23 1
Vellore 2 45 4 5 56 1
Villupuram 3 47 3 2 55 2
Virudhunagar 2 15 2 0 19 0
Total 60 735 65 76 936 41
V.V.I.P Convoy 04 940

303
19.4 Categories of Medical Emergencies:

Type of Emergencies Percentage

Pregnancy related 24.97
Road traffic accident 18.83
Acute abdominal pain 8.95
Cardiac related 6.05
Poisoning 4.95
Respiratory 4.66
Injured in assault 3.50
Epilepsy 2.86
Neonatal 1.41
Suicide 0.47
Others 23.35
Total 100.00

19.5 Highlights for the year 2018-2019

 81,642 lives in very critical condition were

saved

 88.8 % of cases admitted at Government

Hospitals

304
  62,562 Medical emergencies attended in
tribal areas

 21,518 Neonatal cases were handled

19.6 Beneficiaries details and other details

under this Service

2014- 2015- 2016- 2017- 2018-

Parameters
2015 2016 2017 2018 2019

Total
(A+B+C) 8,85,452 9,57,991 10,50,998 12,87,445 13,01,546
Beneficiaries

(A) Pregnant
2,33,109 2,32,408 2,40,827 3,22,868 3,24,932
Mothers

(B)RTA 1,80,578 1,91,988 2,19,310 2,28,549 2,45,049

(C) Other
4,71,765 5,33,595 5,90,861 7,36,028 7,31,565
Emergency

Tribal
26,910 31,935 45,103 64,457 62,562
related

Total neo
natal cases 20,376 21,788 20,584 20,343 21,518
transported

Critical lives
84,170 78,311 97,845 72,344 81,642
saved

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19.7 Neonatal Ambulances:

For the first time in the Country, neonatal

emergencies were brought under the purview of
public EMS in Tamil Nadu in June, 2011. These
ambulances are exclusively available for
handling emergencies of Newborn babies
(0-28 days) who need to be transferred from a
Primary / Secondary care hospital to a Tertiary
care hospital having Neonatal Intensive Care
units (NICU). These ambulances are equipped
with life saving equipments like Transport
Incubator and Syringe Pump to handle
emergencies. In addition, for transit care
specially trained Emergency Medical Technicians
are available. 21,518 babies have utilized this
specialty service last year. Currently 65
ambulances are in operation in all the districts.

19.8 Four Wheel Drive:

Four Wheel Drive ambulances were

introduced for Hilly / Difficult terrain areas where
the normal ambulances cannot travel or take a
long time to reach the emergency site. At
present 76 vehicles are in operation.

306
19.9 Bike Ambulance Service:

Bike Ambulances help in reducing

response time to reach the patient in congested
areas and help in providing first-aid services
instantly till arrival of the regular ambulance.
The First Aid Kit is comprehensive, portable and
easy to handle at scene. It contains stand for
portable oxygen cylinder, blinkers, revolving
lights and siren. Other accessories such as
safety knee guards, helmets, gloves, mobile,
GPS and headsets are stocked. So far 38,095
numbers of cases are transported through this
service since launch.

19.10 Source of Funding and Expenditure:

The 108 Ambulance Service is funded by

the State Government and NHM provides 20% of
the operational cost based on the number of
Ambulances. NHM also provides Rs.250/- per
case for Antenatal, Neonatal and Tribal cases.
The expenditure for the year 2018-2019 is
Rs.194.19 crore.

307
19.11 Monitoring:

At the District level, the District Monitoring

Committee headed by the District Collector
reviews the performance of the 108 ambulance
service and at the State level performance is
reviewed by Secretary, Health and Family
Welfare and the Project Director, TNHSP. The
State level Advisory Committee headed by the
Chief Secretary to Government also reviews the
performance once in 6 months. Apart from this,
the programme officers and field level
functionaries periodically inspect the ambulances
and provide suggestions for improvements.

19.12 Emergency Care Centre (ECC)

Emergency critical care centres have been

established in Tambaram, Padiyanallur,
Injambakkam and Mahabalipuram to stabilize
the cases, in case of long distance travel in
highways. At these centres, the road traffic
victims are stabilized and referred to Medical
College Hospital for expert management. This
three bedded centre has the management
facility with advance life saving equipments like
ventilator, defibrillator with multi Para monitor,

308
essential life saving medicines with 4 emergency
care trained Medical Officers and Nurses who
work on shift basis. So far, 4,427 cases in
Tambaram centre, 4,030 cases in Padiyanallur
centre, 3,216 cases in Injambakkam and 1,139
cases in Mahabalipuram centre have been
stabilized. Also under road safety Management
Cell (RSMC), work is in progress for
establishment of similar ECC in 10 Government
Hospitals situated in the National Highways and
5 Mobile Trauma care Units.

19.13 Free Hearse Service:

The Indian Red Cross Society is running

the programme under the MOU with Tamil Nadu
Health System Project. Under this programme
the deceased are transported to the place of
funeral or home free of cost irrespective of the
distance within the State. The attenders of the
deceased or the Chief Medical Officer of the
Government hospital can contact the Central
Response Centre by dialling 155377 which is
functioning round the clock. This service also
renders support during major accidents, natural
calamities and disasters by transporting the

309
deceased to the Government Hospitals for
autopsy and then to their destination. So far,
6,35,569 cases have been transported through
this service since launch. The cases requiring
transportation beyond 300 kms are arranged
through railways. Presently, the number of
vehicles is 153 which will be increased to 180
this year.

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 Chapter - 20

COMMUNICABLE DISEASES

20.1 Tamil Nadu is the front runner in

prevention, control and treatment of
communicable diseases. Promotion of
environmental sanitation, immunization and
early identification and treatment of cases are
the key strategies followed. Infectious diseases
are mainly transmitted through water, food, air,
fomites and vectors like mosquitoes. Integrated
Disease Surveillance Programme (IDSP)
monitors the occurrence of communicable
diseases on 24x7 basis. Occurrence of infectious
diseases are notified to the concerned local
bodies, PHCs for organizing control measures.
Cases from neighbouring states are also notified
through IDSP. State level, district level and
block level Rapid Response Teams are formed to
organise control measures on war footing.

20.2 Vaccine Preventable Diseases:

Vaccines for Vaccine Preventable Diseases

(VPDs) namely Diphtheria, Pertussis, Tetanus,
Poliomyelitis, Tuberculosis, Hepatitis B,

311
Haemophilus Influenzae B, Measles, Rubella and
Japanese Encephalitis and Rota viral diarrhea
are provided under the Universal Immunisation
Programme in Tamil Nadu. Expanded
Programme of Immunisation was launched in
1978. The programme was renamed as
Universal Immunisation Programme in 1985.

20.3 Annually, around 12 lakh pregnant

mothers are immunized with Tetanus diphtheria
(Td vaccine) injection for prevention of
diphtheria and Tetanus infection during delivery.

20.4 Pulse Polio Immunization (PPI)

Sustained immunization coverage and

Pulse Polio Immunization campaigns conducted
from the year 1995-96 have successfully
eliminated the dreaded disease from the State.
The state is polio free since 2004. During 2019,
one round of pulse polio immunization campaign
was conducted on 10.03.2019. The World Health
Organisation certified the eradication of Polio
virus type-2 signifying a milestone in eradication
of Poliomyelitis and type-3 is under certification.
As an endgame strategic step, Government
introduced bivalent OPV and injectable polio

312
vaccine in the immunization schedule. Vaccine
Preventable Diseases surveillance including
Acute Flaccid Paralysis surveillance is carried out
to monitor the occurrence of Vaccine
Preventable Diseases.

20.5 Japanese Encephalitis Vaccination

Japanese Encephalitis (JE) is transmitted

by Culex mosquitoes breeding in rice fields and
similar water collections. Children below 15
years of age are commonly affected by JE. In
Cuddalore, Villupuram, Virudhunagar, Madurai,
Tiruvarur, Tiruchirapalli, Perambalur, Ariyalur,
Thanjavur, Tiruvannamalai, Pudukottai, Karur
and Tiruvallur districts JE vaccine is
administered.

20.6 Special Mission Indradhanush

The Ministry of Health and Family Welfare

(MoHFW) Government of India, launched Special
Intensified Mission Indradhanush to cover the
left-out children for immunization. Under this
special initiative all the districts in Tamil Nadu
are covered in four phases.

313
20.7 Measles-Rubella Vaccine

Measles–Rubella (MR) vaccination was

started from 6th February 2017. In the
campaign, over 1.7 crore targeted children
between 9 completed months and 15 years were
vaccinated irrespective of previous immunization
status or history of measles/rubella disease. MR
vaccine is a safe vaccine.

20.8 Rota Virus vaccine

Diarrhoeal diseases are the leading cause

for childhood mortality globally as well as in
India. Hon’ble Chief Minister launched the
introduction of Rota virus vaccination
programme in Salem on 17.09.2017. Three
doses are administered at the age of 6 weeks,
10 weeks and 14 weeks.

20.9 National Vector Borne Disease Control

Malaria, filaria, dengue, chikungunya and

Japanese encephalitis are the major
communicable diseases under the National
Vector Borne Diseases Control.

314
20.10 Dengue

Dengue viral infection transmitted by

Aedes mosquitoes is the most rapidly spreading
mosquito borne viral disease of mankind with
30-fold increase in global incidence in the last
five decades. It is a major public health concern
throughout the tropical and sub-tropical regions
of the world. Almost half of the world’s
population lives in countries where dengue is
endemic.

The Public Health department, in

coordination with the local bodies and other
departments regularly undertake elimination of
vector breeding places, like artificial containers,
where fresh water can stagnate, such as broken
utensils, discarded tyres, plastic waste cups and
broken bottles which are critical for the control
of Aedes mosquitoes and spread of dengue
fever. Laboratory Testing facilities are available
in 125 centres in the State. The State which had
reported 23,294 dengue cases in 2017 was
reduced to 4,486 with 13 deaths in 2018.
During the current year, from January to June,
1,101 cases with zero death are reported. Daily

315
surveillance is carried out and now the disease is
fully under control.

20.11 Chikungunya

Chikungunya is caused by a virus and

transmitted to humans by Aedes mosquitoes.
There is a decline in Chikungunya cases due to
the control measures taken by the Government.
The prevention and control measures against
Chikungunya are carried out in an integrated
manner with the Dengue control measures. 282
cases were reported during 2018 and in the
current year from January to June, 154 cases
have been reported.

20.12 Malaria

Though in the recent years, Dengue has

been the main Public Health concern, Malaria
also continues to remain a public health issue.
Malaria is a parasitic disease caused by parasites
known as Plasmodium vivax (P.vivax),
Plasmodium falciparum (P.falciparum),
Plasmodium malariae (P.malariae) and
Plasmodium ovale (P.ovale). It is transmitted by
the infective bite of Anopheles mosquito.

316
Humans get affected after 10 to 14 days of
being bitten by an infective mosquito. The two
types of parasites of human malaria, P. vivax,
and P. falciparum, are commonly reported from
India. Infection with P.falciparum is the
complicated form of Malaria. The National
Malaria Control Programme (NMCP) is
implemented in the State from 1953 and the
programme has been expanded in the following
years and now Tamil Nadu is well on the road of
Malaria Elimination by 2022. India aims to
eliminate malaria by 2027.

Though the number of cases has shown a

steady decline, still it is reported in few urban
and rural areas in Tamil Nadu viz., Chennai,
Ramanathapuram, Thoothukudi, Dharmapuri
and Kanniyakumari Districts. Two rounds of
Indoor Residual Spray are being carried out
during June and September of every year in
Malaria endemic villages to prevent Malaria
transmission due to monsoon. The total number
of positive cases recorded last year in the State
was 3,787. In the current year from January to
June 681 malaria cases have been reported.

317
20.13 Filaria

Lymphatic filariasis is transmitted by Culex

mosquitoes breeding in dirty water. National
Filarial Control Programme is under
implementation in the State from 1957 with
control activities n o w being carried out in 43
urban areas. 25 Control Units and 44 Night
Clinics are presently functioning. 25,545
Lymphatic filariasis cases have been recorded in
this State. Morbidity Management kits are also
issued to these patients for foot care.
Transmission Assessment Survey had been
completed in all the 20 Filaria endemic districts.
Government is providing financial assistance to
the Grade IV Filaria patients at the rate of
Rs.1,000/- per month. 8,023 patients have been
benefitted by this scheme at a total expenditure
of Rs.9.62 crore.

20.14 Integrated Approach to Mosquito

Borne Diseases Control
The following measures are taken to control
fever which is transmitted by mosquitoes.
 Daily fever surveillance

318
 Entomological surveillance to find out the
vector density and initiate necessary
control measures.
 Monitoring of dengue virus infection in
Aedes mosquitoes and JE virus in Culex
mosquitoes.
 Comprehensive measures for mosquito
control, water quality improvement and
environmental sanitation are carried out
by local bodies with the technical support
of public health department.
 Health education through schools/
colleges, short films screened in cinema
theatres, miking, distribution of pamphlets
 Medical camps for treating fever cases.
 State level officials from Public Health
Department, Municipal Administration,
Rural Development and Panchayat Raj
inspect various districts and monitor the
daily fever situation and control measures.

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20.15 Coordination with Neighboring States
Inter-state meetings in border districts,
sharing of information on the occurrence of
cases and organizing control measures.
24 Hours Control Room:
24x7 Control Room is functioning in the
Office of Directorate of Public Health and
Preventive Medicine to monitor the occurrence of
infectious diseases reported by public, media
and other sources. Public can get the necessary
information from this control room by dialling to
044-24350496, 044-24334811 and Mobile
No.94443 40496 and 87544 48477.
20.16 Acute Encephalitis Syndrome
Acute Encephalitis Syndrome (AES) is
caused by various micro organisms. AES
Surveillance information is collected from all
major government and private hospitals on daily
basis. After the reported incidence of Nipah virus
infection in Kerala during May 2018 and 2019
and, Tamil Nadu Government has stepped up
AES surveillance especially in the border districts
through the Public Health Department along with
Animal Husbandry and Forest Departments.

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20.17 Leptospirosis

Leptospirosis is one of the serious zoonotic

diseases which require timely diagnosis,
treatment and control measures. A State Level
Reference Laboratory is functioning at State
Headquarters to provide laboratory confirmation
and training. Leptospirosis testing facilities are
also available in all District Public Health
Laboratories and TANUVAS, Madhavaram,
Chennai. 693 cases were recorded in the year
2018. During the current year, from January to
June, 335 cases are reported.

20.18 A H1N1 Disease (Swine Flu)

Influenza Like Illness (ILI) surveillance is

carried out on daily basis through IDSP. Swine
Flu is one of the types of Influenza fever spreads
through airborne route and hands. Apart from
awareness and focus on hand washing, the
Public Health Department has stocked adequate
quantity of Cap. Oseltamivir. All the health care
personnel involved in swine flu control
operations are immunized annually.

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20.19 National Leprosy Eradication
Programme

The National Leprosy Eradication

Programme (NLEP) is a centrally sponsored
Health Scheme of the Ministry of Health and
Family Welfare, Government of India. While the
NLEP strategies and plans are formulated
centrally, the programme is implemented by the
States / UTs. Leprosy is a chronic infectious
disease caused by Mycobacterium leprae. It
usually affects the skin and peripheral nerves,
but has a wide range of clinical
manifestations. The disease is characterized by
long incubation period generally five to seven
years and is classified as pauci-bacillary or
multi-bacillary, depending on the bacillary load.
Leprosy was a leading cause of permanent
physical disability. Timely diagnosis and
treatment of cases, before nerve damage has
occurred, is the most effective way of
preventing disability due to leprosy.

20.20 Milestones in NLEP

 1955 –Launch of National Leprosy Control

Programme (NLCP)

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  1983 –Launch of National Leprosy
Eradication Programme

 1983 - Introduction of Multidrug therapy

(MDT) in Phases

 2005 - Elimination of Leprosy at National

Level

 2012 - Special action plan for 209 high

endemic districts in 16 States/UTs

20.21 In Tamil Nadu National Leprosy

Eradication Programme (NLEP) was launched
during the year 1983. The main objective of this
scheme is to identify the cases early and cure
them completely with Multi-Drug Therapy
(MDT). The prevalence rate of Leprosy in 1983
was 118 per 10,000 population. In 2005, the
prevalence of leprosy was declined to less than
one per 10,000 population and the State
achieved leprosy elimination status. The
prevalence rate is 0.39 per 10,000 population as
on March 2019.

Re-constructive Surgery has been done to

116 patients in 2018-2019 and special varieties
of footwears were given to 10,047 patients.

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12,719 persons with ulcers were given Self-Care
kits. At present, 7,327 persons affected with
Leprosy are receiving pension of Rs.1,000/- per
month other than those already availing the
pensions under the Old Aged Pensions Scheme.

20.22 Epidemic Control Activities at the

State and District Level :

The State level Epidemic Monitoring

Committee and the Public health disease
surveillance unit, coordinates with all
departments and the stakeholders for effective
monitoring and control. At the district level, the
committee functions under District Collectors.
The District Collector holds regular reviews to
ensure the prevention and control of
communicable diseases at the field level to
reduce its spread and contain epidemic
outbreak. They are involved in prevention of the
other public health challenges like outbreak of
acute diarrhoeal diseases by taking effective
steps such as – ensuring regular cleaning of
water tanks, testing samples, preventing sewage
contamination and effective solid waste
management practices etc. Sustained anti-larval

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measures, improving environmental sanitation
and public hygiene in districts through effective
coordination with the local bodies, other line
departments and involving the communities
have been the cornerstone in the effective
prevention and control strategy adopted by the
State against communicable diseases.

20.23 Integrated Disease Surveillance

Programme (IDSP):

Integrated Disease Surveillance Programme

(IDSP) was launched as a Project with World
Bank assistance in November 2004 to detect and
respond to disease outbreaks quickly. The
project was further extended upto March 2012.
Currently, IDSP is implemented as a Programme
by NHM with Government of India support.
Surveillance units were established in the State
and District level that are reporting to the
Central Surveillance Unit (CSU) functioning in
the National Centre for Disease Control, New
Delhi.

 Weekly disease surveillance data on

epidemic prone communicable diseases
are collected from reporting units such as

325
 Health Sub Centres (HSCs), Primary
Health Centres (PHCs), Community Health
Centres(CHCs), Hospitals including
Government and Private Sector Hospitals
and Medical Colleges. The data are
collected on ‘S’ syndromic; ‘P’ probable
and ‘L’ laboratory formats using standard
case definitions. Early Warning Signal
(EWS) is generated whenever there is
rising trend of illnesses or any clustering of
cases from Government and Private
Institutions. EWS is sent to the periphery
for the early intervention and control of
any eventual outbreak.

 Government of India had launched

Integrated Health Information Platform
replacing the IDSP program from the year
2019. The Integrated Health Information
Platform (IHIP) is a web-enabled electronic
information system that is embedded with
all applicable Government of India's
e-Governance standards, Information
Technology (IT), data & metadata
standards to provide State-of-the-Art
single operating picture with geospatial
information for managing disease

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 outbreaks and related resources.

20.24 Surveillance of Epidemic Prone

Infectious Diseases – Communicable
Disease Surveillance Portal (CDSP)

 A Web based surveillance on epidemic

prone infectious disease notification
System in 12 Corporations of Tamil Nadu
(Communicable Disease Surveillance Portal
- CDSP) was established in 2018 under
Tamil Nadu Innovative Initiatives. The
objective of the project is to simplify and
automate with near real time data
collection on disease information and to
give automated alerts and communicate
the same for necessary public health
action using Geographic Information
System. This has the potential to be
expanded to all the districts of Tamil Nadu.
The IHIP and CDSP will synergize and
strengthen the dynamic disease
surveillance in Tamil Nadu.

327
20.25 District Public Health Laboratories
(DPHL) under IDSP

Laboratory services are an essential

component of disease surveillance,
epidemiological surveys and operational
research. The DPHL are the backbone of the
laboratory network in Integrated Disease
Surveillance Program (IDSP) for the prevention
and control of epidemic prone diseases. The
laboratory has an important role in improving
the quality of health by rendering appropriate
diagnosis thereby decreasing the morbidity and
mortality in the community. 31 District
laboratories and one state laboratory at the
Directorate of Public Health and Preventive
Medicine, Chennai are presently functioning.

20.26 International Health Regulations

(2005)

The IHR (2005) aims to prevent, protect

against, control and respond to the international
spread of disease while avoiding unnecessary
interference with international traffic and trade.
The IHR (2005) are also designed to reduce the
risk of disease spread at international airports,

328
ports and ground crossings. The IHR (2005)
establish a set of rules to support the global
outbreak alert and response system and to
require countries to improve international
surveillance and reporting mechanisms for public
health events and to strengthen their national
surveillance and response capacities. This makes
the IHR (2005) central to ensuring global public
health security. The IHR (2005) is an
international law which helps the countries to
work together to save lives and livelihoods
caused by the international spread of diseases
and other health risk and came into effect since
15thJune 2007 and are binding on 194 countries
across the Globe, covering all WHO Member
States / Countries including India. The IHR
(2005) require Countries to notify WHO of all
events that may constitute a public health
emergency of international concern and to
respond to requests for verification of
information regarding such events. This enables
WHO to ensure appropriate technical
collaboration for effective prevention of such
emergencies or containment of outbreaks and,
under certain defined circumstances, inform

329
other States of the public health risks, where
action is necessary on their part.

20.27 Specific Diseases under the IHR

(2005)

Under the IHR (2005), all cases of these four

diseases must be automatically notified to WHO.

i. Smallpox,
ii. Poliomyelitis due to wild-type poliovirus,
iii. SARS and
iv. Cases of human influenza caused by a new
subtype.

Vaccination against Yellow Fever is required for

any traveller leaving an area where the WHO
has determined that a risk of Yellow Fever
transmission is present. In Tamil Nadu, two
international vaccination centres have been
established one at King Institute of Preventive
Medicine and Research, Guindy, Chennai which
functions on Tuesday and Friday and another at
Port Health Organization, Chennai which
functions on Monday and Wednesday. Airport
and Seaport screening for the international

330
travelers are regularly being done to monitor the
spread of diseases notified by WHO as Public
Health Emergency of International concern.
Regular mosquito control measures are also
being undertaken in the Airport and Seaport to
prevent and control the spread of vector borne
diseases.

20.28 Community Hygiene and Sanitation

Campaign

An effective interdepartmental coordination

between the relevant stakeholders has also been
put in place to nip the spread of communicable
diseases in the bud along with equal emphasis
on creating awareness on personal and
community hygiene practices. In this campaign,
the main areas of thrust are

 Hand washing / Hand Hygiene

 Respiratory Hygiene
 Personal/Reproductive Hygiene
 Deworming
 Environmental Sanitation – solid and liquid
waste management
 Effective inter-departmental coordination

331
  Encouraging stakeholder participation to
make it into a public movement
20.29 Hygiene is the most important
component in the prevention and control of
diseases spread through Air / Fomite, Water,
Food, Vector and Zoonotic causes. Simple
messages are spread through these campaigns
on the need to wash hands regularly to prevent
diseases like Swine Flu, keep the surrounding
environment clean to prevent breeding of
mosquitoes and to prevent mosquito borne
diseases.

20.30 Water Analysis Laboratories - Water

Quality Monitoring:

The Water Analysis Laboratories,

established in Chennai, Coimbatore,
Tiruchirapalli and Tirunelveli collect and examine
water samples from various protected water
sources to control pollution and contamination of
drinking water. These 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.

332
Additionally, the local bodies, TWAD and
CMWSSB also independently do such testing at
their levels also.

20.31 One Health Initiative

Tamil Nadu is the first State in India which

started adopting the “One Health Initiative”.
Under this, human, animal and environmental
health are discussed under one umbrella with a
view to share disease intelligence especially on
Zoonotic and Vector Borne issues. It would
gradually be expanded to research to
supplement the efforts in respective fields.

333
 Chapter - 21
REVISED NATIONAL TUBERCULOSIS
CONTROL PROGRAMME
21.1 The Revised National Tuberculosis
Control Programme (RNTCP) was started in the
year 1997 and is implemented throughout the
State of Tamil Nadu since the year 2002. With
RNTCP both diagnosis and treatment has
become free of cost for all patients and there is
no waiting period for patients seeking treatment
and TB drugs now. The programme has come up
with a National Strategic Plan 2017-2025 to
leverage its full potential and to propose
transformational changes in the TB care service
delivery. Tamil Nadu is the first State to
implement nutritional support through Direct
Benefit Transfer (DBT) under Nikshay Poshan
Yojana (NPY) in the country from April 2018.

334
 The objectives of the RNTCP are:
Baseline Target
Objectives
2015 2020 2023 2025
To reduce estimated
TB Incidence rate
217 142 77 44
(per 100,000
population)
To reduce estimated
mortality due to TB
32 15 6 3
(per 100,000
population)
To achieve zero
catastrophic cost for
35% 0% 0% 0%
affected families due
to TB

21.2 The RNTCP aims at diagnosing and

caring for TB cases both in the public as well as
in the private sector. The Drug Sensitive TB
(DSTB) is treated using Fixed Drug
Combinations (FDCs) through Directly Observed
Treatment (DOT) strategy which could be
institutional, community based, family DOT or
ICT based depending on the patient preferences.
There are provisions to make RNTCP FDCs
available to private providers, if the patients and
provider prefer the same. The Programmatic
Management of Drug Resistant TB (PMDT) is

335
being implemented in the State since 2009, also
aims at early diagnosis of Drug resistance TB
cases and treating them with appropriate
regimen.

21.3 The infrastructure and the facilities

available in the State under the programme are
as follows:

State TB Training &

Demonstration Centre 1
(STDC)
District TB Centres
35
(DTCs)
TB Units (TU) 461
Designated Microscopy
1,984
Centres (DMCs)
Intermediate Reference 2
Laboratory (IRL) (Chennai, Madurai)
Culture & Drug 2
Sensitivity (C&DST) Labs (Trichy Medical
(excluding IRL) College & Christian
Medical College,
Vellore)

336
Liquid Culture 2
Laboratories for 2nd line (Chennai IRL,
DST Madurai IRL)
Cartridge Based Nucleic
Acid Amplification 68 + 2 (Mobile)
Testing (CBNAAT) Labs
Nodal Drug Resistant TB
7
Centre (DRTBC) (MDR TB
Nodal DRTB Centres
Wards)
District Drug Resistant
TB Centre (DDRTBC) 24
(MDR TB Wards)

21.4 Monitoring, Notification regarding

number of cases diagnosed, number
of cases treated:

 All Patients registered are now being

monitored online using the web portal
Nikshay. Notification of TB cases
diagnosed/treated by the private sector is
also ensured through this portal. So far
22,960 private health facilities are
registered in Nikshay.

337
  In 2018, 1,04,055 TB patients were
notified in Nikshay web portal

 Drug logistics are monitored & managed

using the web portal Nikshay Aushadhi.

21.5 Programmatic Management of Drug

Resistant TB (PMDT):

 DR-TB wards have been created for

programmatic management of Drug
Resistance TB (DR-TB). Extremely Drug
Resistance TB cases are managed at
Nodal DR-TB Centres established at
GHTM, Tambaram – Kanchipuram District,
Chennai, Coimbatore, Madurai,
Tirunelveli, Thanjavur and Vellore.

 Specialised lab diagnostic services such as

Solid Culture Test (LJ-Lowenstein Jensen
Medium), Liquid Culture Test (MGIT –
Mycobacterium Growth Indicator Test),
Line Probe Assay (LPA) are done at
Intermediate Reference Laboratory (IRL)
and Culture and Drug Sensitivity Test
(C&DST) Labs.

338
  New TB drugs namely Bedaquiline for
Adult TB patients and Delamanid for
pediatric TB patients have been
introduced in our state for the first time in
the country for DR-TB patients. As on
31st, March 2019, in Tamil Nadu there are
276 eligible patients being treated with
Bedaquiline.

21.6 TB – HIV Services: All the presumptive

TB cases and registered TB patients are being
screened for HIV. All the HIV-TB co-infected
patients are started on TB treatment and
referred to ART Centres for Anti Retro Viral
Treatment and CPT (Cotrimoxazole Prophylaxis
Treatment).

HIV HIV-TB
YEAR CPT ART
TESTED COINFECTED
2018 75,662 3,047 3,550 3,531
2019
(upto 20,111 780 767 769
March)

339
21.7 Paediatric Services (Diagnosis and
Chemoprophylaxis):

 Fixed Drug Combinations (FDCs) for

Paediatric cases, depending on weight
bands are available under the programme.

 Any child contact of a microbiologically

confirmed TB case between the ages of six
months to six years is given Isoniazid
Prophylactic Therapy (IPT) to decrease the
risk of TB disease.

21.8 Nutrition Support through Direct

Benefit Transfer (DBT):

 As nutritional status is an important

component for recovery from TB, the
Government has decided to give Rs.500/-
monthly for all TB patients taking
treatment in both public and private
sectors. This money will be transferred
directly to their bank account.

 Monetary incentives for private service

providers are given in two installments,
first installment at the time of notification
and the second at the time of outcome

340
 declaration. Incentive for treatment
supporter is also being given as DBT.

21.9 Involvement of private sector for

increasing case detection:

 In 2018, the project "Joint Effort for

Elimination of TB" (JEET) was launched to
engage the private service providers to
notify the TB patients.

 As a part of Patient Provider Support

Agency (PPSA) “Zero TB Chennai Project –
2023” has been initiated in Greater
Chennai Corporation along with NGO
Partners for notifying, providing
investigation, treatment, counselling,
nutritional support and follow-up services
for the patients treated in the private
sector. In addition to this, 21 districts have
been covered under PPSA Lite (one
coordinator for three districts).

21.10 New Initiatives:

 As the incidence of TB cases in Tamil Nadu

is showing a steady decrease, “TB Free
Tamil Nadu – 2025” Strategy in all

341
 districts based on the four pillars of
national strategic plan, namely “Detect –
Treat – Prevent – Build” (DTPB), has been
initiated.

 Active Case Finding (ACF) was conducted

in all the districts of Tamil Nadu using two
mobile CBNAAT vans.

 Screening of inmates of prisons and other

closed settings like Swadhar and Ujjwala
homes for both TB & HIV.

21.11 Government Welfare Schemes for

persons affected by T.B.

 Tamil Nadu Government provides financial

support of Rs.1,000/- per month to the
T.B affected persons who possess Farmers
Protection card.

 Tamil Nadu is taking necessary steps to

eliminate T.B by the year 2025 well ahead
of target year 2030.

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 Chapter – 22

NATIONAL TOBACCO CONTROL

PROGRAMME

22.1 The National Tobacco Control

Programme (NTCP) was launched by the Ministry
of Health and Family Welfare, Government of
India in 2007-2008, during the 11th five year
plan, with the following objectives: to bring
about greater awareness about the harmful
effects of tobacco use and Tobacco Control Laws
and to facilitate effective implementation of the
Tobacco Control Laws. The National Tobacco
Control Cell (NTCC) at the Ministry of Health and
Family Welfare is responsible for overall policy
formulation, planning, implementation,
monitoring and evaluation of the different
activities envisaged under the National Tobacco
Control Programme (NTCP).

22.2 The interventions under the National

Tobacco Control Programme have been largely

343
planned at the primordial and primary levels of
prevention. The main thrust areas for the
National Tobacco Control Programme are as
follows:

i) Training of health and social workers,

NGOs, School Teachers, Enforcement
Officers and others.

ii) Information, Education and

Communication (IEC) activities.

iii) School Programmes.

iv) Monitoring Tobacco Control Laws.

v) Co-ordination with Panchayat Raj

Institutions for village level activities.

vi) Setting-up and strengthening of cessation

facilities including provision of
pharmacological treatment facilities at
district level.

344
 Implementation of the Programme
in Tamil Nadu

22.3 The National Tobacco Control

Programme is 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 functioning under
supervision of the Deputy Director of Health
Services.

22.4 Tamil Nadu is the first State in India

to collect maximum fine amount from the
violators of the Cigarette and Other Tobacco
Products Act (COTPA), 2003. From 2nd October,
2008 to 22nd May, 2019, 2,07,114 persons were
fined and Rs.3.23 crore has been collected from
the violators of COTPA, 2003. Enforcement
squad is formed at State, District, Block and
Village Level to monitor the violations under the
COTPA, 2003. Officials from Government
Departments such as Police, Education, Railway,
Airport, Health, etc., and Non-Government
organizations such as civil societies, self-help

345
group, youth club, police boys club, etc., were
trained on tobacco control.

In Tamil Nadu, 12,798 schools and 1,344

colleges were declared as “Tobacco Free
Educational Institutions” under specified criteria.
684 Medical Officers, 148 NCD Staff Nurses, 53
ICTC Counsellors 178 youth Health volunteers
were trained on tobacco cessation
methodologies for setting up of tobacco
cessation clinic / centres in their Hospitals /
Primary Health Centres. Mass IEC campaigns
such as celebration of World No Tobacco Day,
Rally, IEC on Wheels, Human Chain, Signature
campaign, distribution of pamphlets etc., has
been held on regular basis to educate public
about ill-effects of tobacco.

346
 Chapter – 23

The Tamil Nadu Dr.M.G.R Medical University

23.1 The Tamil Nadu Dr.M.G.R Medical

University is one of the largest Medical
Universities in India. The University was
established by the Tamil Nadu Dr.M.G.R Medical
University Chennai, Act 1987 and started
functioning from July 1988.

23.2 This is the only Health Sciences

University in Tamil Nadu capable of granting
affiliation to new institutions under Government
or Self-financing establishments in Medical,
Dental, AYUSH, Pharmacy, Nursing,
Physiotherapy, Occupational therapy and various
Allied Health Sciences Educational Streams,
awarding degrees.

23.3 Various departments of the

university have had good performance records
over the last year. The HIV Testing Laboratory in
the Department of Experimental Medicine has
been accredited by NABL (National Accreditation
Board for Laboratories) with validity till May

347
2021. The Department NRL has been identified
as one of the HIV sentinel surveillance testing
centres. Apart from routine laboratory tests, the
Department and its laboratory are part of the
External Quality Assurance programme of NACO
and have scored 100% in Proficiency Testing.

23.4 The Department of Transfusion

Medicine runs the M.D. Immuno Haematology
and Blood Transfusion programme with an
annual intake of five candidates. The
department, which is also a NACO recognised
‘Regional Training Centre’ for Blood transfusion
Services, has conducted more than 80 Blood
Donation Motivation Programmes and around 60
Voluntary Blood donation Camps in the academic
year 2018-2019. The department’s Advanced
Immuno Haematology Laboratory has been able
to resolve 71 discrepant samples.

23.5 The Department of Epidemiology has

been vividly active during the academic year. In
an enthusiastic attempt to set the bar of
standard well above the average, the
department has trained over 2600 participants

348
in 15 training workshops in Research Methods,
Scientific Medical Writing and Health Statistics
Software. With two externally funded projects
related to Improvement of Maternal Health and
Infant Health, the department is involved in
several projects including that of Needs
Assessment for Capacity Building in Cardio-
Pulmonary Resuscitation. The Department runs
two Masters programmes, one in Public Health
and the other in Epidemiology.

23.6 The Department of Immunology is an

ICMR Nodal Centre for Zika, dengue and
Chikungunya virus testing. The Department
conducts regular training programmes and does
regular quantitative analysis of Hepatitis viruses.

23.7 The Department of Medical Genetics

offers diagnostic services, conducts capacity
building workshops and pursues applicative
research. The department runs special clinics at
the Institute of Child Health, Egmore and at
Kasturba Gandhi Hospital, Triplicane. The
department was awarded the European
Cytogenetic Association Fellowship in France.

349
This is the first time that anyone from India wins
this award. Apart from winning prizes at Paed
Endo 2019, Myocon 2018 and ENRICH 2018, the
department has been able to publish its research
work in peer reviewed International and National
journals.

23.8 The Department of Siddha has a

recognized Drugs Standardisation Laboratory.
Siddha out-patient clinics are run in the
University campus itself and the department
conducts Research Methodology workshops for
AYUSH postgraduate students.

23.9 All departments are involved in

periodic conduct of continuing education
programmes. 21 such continuing educational
programmes and 27 workshops have been
conducted in the academic year 2018-2019.

23.10 The University campus houses the

main University Administrative building, Blood
Bank, Auditorium, Guest House and Canteen.
The University offers students a conducive
atmosphere for learning by providing easy

350
access in the library and also accommodating an
Own Books Reading Hall in the campus.

23.11 The Regional Medical Library

provides information in electronic format in
Virtual Library. It also offers online access to
International journals through e-consortium to
students and faculty of affiliated colleges. The
auditorium has a seating capacity of 950 and is
designed like an Amphitheatre.

23.12 The University has established

University Research Council & Center for CME
accreditation, so that the graduates are properly
trained in order to meet International Standards.
Meritorious students in all fields of Medicine,
Dentistry, AYUSH and Allied Health Sciences are
awarded Endowment Gold and Silver medals.

23.13 The quasi-academic and

administrative workload of the Tamil Nadu Dr.
M.G.R. Medical University is also huge and time-
bound. On an average, over 7800 eligibility
certificates to various candidates are issued
annually. In the first quarter of the academic
year 2019-2020, around 1000 eligibility

351
certificates have already been issued. About
1500 to 2000 migration certificates are issued
annually. The university currently has 99,345
students spread across its affiliated institutions.

23.14 With over 600 institutions of

medical, dental, AYUSH, pharmacy, nursing, and
various other Allied Health streams under its
fold, the Tamil Nadu Dr. M.G.R. Medical
University has set itself the twin objectives of
Quality Education and Applicative Research.

23.15 This university addresses the factor

of Quality Education by several measures. One
such measure is to ensure high quality
examination and evaluation. Stringent and
fool-proof methods are adopted in all processes
of the examination right from the level of setting
questions to the time of publication of results.
We have implemented the system of on-screen
evaluation to avoid any mishandling or
tampering of answer scripts. The system
ensures a quick and efficient evaluation process.
The system has been refined and fine tuned
further, from the time of its original inception

352
and as a result, has anchored itself in academic
excellence. Consequent to such robust
refinement, this university has been requested
by other universities and academic bodies
around the country to help in the setting up of
similar systems in their respective consoles.

23.16 The sector of Medical and related

education is ever expanding and thereby calls
for not only academic accreditations but also
educational research. Measures are being
undertaken to strengthen the research
programmes of the university and the affiliated
institutions. The TN Dr. M.G.R. Medical
University has been conducting several allied
health science programmes. Integrating the
spirit of an allied health programme and that of
health awareness, a new programme on health
journalism has been designed. This new
programme will attempt to train ambitious
young aspirants in the art and craft of health
journalism and health promotion journalism.
Activities ranging from the creation of a book
with an exclusive style to the designing of

353
empathetic health reports will form part of this
programme.

23.17 Intellectual plagiarism is a problem

of the emerging world. With more and more
technological advancement, it becomes easier to
plagiarise than to install measures to curb it. We
have dedicated ourselves to resolve this issue.
The university is set to embark on a project to
not just ensure protection but provide
appropriate recognition of intellectual property.
Such a measure will not only fortify existing
research avenues but also open the doors for
newer and better focussed projects.

23.18 In addition to being a medical or

Health Sciences University, the TN Dr MGR
Medical University also strives to be a health
promotion University. Plans and proposals in this
regard are in the pipeline. In a bid to create
adequate and appropriate awareness about
various disease-control and health promotion
measures, the university is already conducting
awareness programmes in various schools and
colleges. The initiative will be further extended

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to have regular interactive programmes on
topics of health care interest. As of now, these
interactive programmes are proposed to be held
fortnightly at the Guindy campus of the
university utilising the expertise and services of
various speciality exponents in the University
and the affiliated institutions.

23.19 Efforts are under way to start

appropriate joint programmes in Medical law,
Legal medicine and genetic technology in
coordination with certain other universities of
the State.

23.20 Overall, the University is positively

contributing to the growth of Health Sciences
Education, while upholding the highest ethical
and professional standards.

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 Chapter - 24

CERTAIN IMPORTANT ACTS

24.1 The Tamil Nadu Clinical Establishments

(Regulation) Act, 1997:

The Government of Tamil Nadu, as a

pioneer State to other States and the Central
Government had enacted Tamil Nadu Private
Clinical Establishment (Regulation) Act, 1997 in
order to regulate and control Private Hospitals,
Nursing Homes and Other Clinical
establishments in the State of Tamil Nadu.
However this Act was not brought into force due
to non-framing of the Rules. Meanwhile, the
Government of India has enacted the Clinical
Establishment (Registration and Regulation) Act,
2010 and sent draft model State Rule to all
State Governments, including this Government
for consideration and adoption. Since Tamil
Nadu has already enacted the Tamil Nadu
Private Clinical Establishment (Regulation) Act,
1997, it was decided to constitute a Committee
comprising of eminent persons to examine the
salient features of above two Acts and submit its
recommendations to the Government.

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Accordingly, a Committee was constituted and
the Committee submitted its report to the
Government. Based on the recommendations of
the said Committee, the Tamil Nadu Act of 1997
has been suitably amended by enacting two
legislations viz. Tamil Nadu Clinical
Establishment (Regulations) Amendment Act,
2018 and the Tamil Nadu Clinical Establishment
(Regulation) Rules, 2018 to bring all the clinical
establishments including the clinical
establishments maintained by the Government
and the Local Bodies under the purview of the
said Tamil Nadu Act. As per the Act, all Clinical
Establishments have to apply for registration
and registration certificates, after following the
procedures laid down in the Act and Rules, are
being issued.

24.2 Pre-Conception and Pre-Natal

Diagnostic Techniques (Prohibition of
Sex Selection) Act, 1994:

Pre-Conception and Pre Natal Diagnostic

Techniques (Prohibition of Sex Selection) Act,
1994 is being implemented effectively in this
State to curtail the highly adverse sex ratio and

357
to prevent female foeticide. For effective
implementation of the Act, State, District and
Sub District level Advisory Committees have
been constituted. Under the Act, all such
organizations involving in the Pre-Natal
Diagnostic Techniques should register
themselves with the Appropriate Authorities.
Under the Act, 6,853 Scan Centres have been
registered so far and cases have been filed
against 140 centres for the violation of the Act.
Out of 140 cases filed, judgement has been
delivered in 109 cases and remaining 31 cases
are under trail. Surprise check of the Scan
Centres and MTP Centres has been conducted,
where the Juvenile Sex Ratio is below the State
level of 946.

24.3 Transplantation of Human Organ Act,

1994:

The Transplantation of Human Organ Act,

1994 was enacted by the Government of India
to eradicate the menace of human organs trade
and to regulate the removal, storage and
transplantation of human organ for the
therapeutic purpose. In Tamil Nadu,

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transplantation of human organs is being done
only in the hospitals registered for this purpose
under this Act. The Director of Medical and Rural
Health Services who is the State Appropriate
Authority under the Act, issues the registration
certificate to the applying hospital based on the
inspection report furnished by the team of
specialists appointed for this purpose. The
hospitals which are registered under this Act
alone can conduct Human Organ
Transplantation. In Tamil Nadu, 130 hospitals
are registered under this Act for performing
renal, heart, liver, lungs and heart valves
transplantations.

24.4 Deceased Organ Transplant

Programme:

Tamil Nadu continues to be the leader in

organ donation in the country. Tamil Nadu was
one of the first States to start the programme
way back in 1995, after a resolution was passed
in the Tamil Nadu State Assembly to adopt the
Central Act. It has had an organ sharing network
since 2000. The present Deceased Organ
Transplant Programme has been implemented in

359
the State of Tamil Nadu from 16.09.2008 and a
“Premier” State in the country, with ten times
higher than the average rate of other States.
The Government of Tamil Nadu has formed
Transplant Authority of Tamil Nadu (TRANSTAN),
under the Chairmanship of the Hon’ble Chief
Minister which enables extension of more
effective implementation of the scheme. It was
registered as Society in 2015 to give it
necessary functional and operational
independence on the lines of the Tamil Nadu
Medical Services Corporation (TNMSC) and Tamil
Nadu State AIDS Control Society (TANSACS).
Tamil Nadu ranks number one in the
implementation of the Deceased Organ
Transplant Programme. The State has bagged
awards consecutively for four years from 2015
to 2018.

24.5 Since the establishment of the

programme, 1,243 donors have donated the
organs. The details of Donors and Organs
donated in Tamil Nadu are given below:

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 From October
2008 to April 2019
Donors 1,243
Heart 504
Lung 401
Liver 1,152
Kidney 2,250
Pancreas 25
Small Bowel 3
Hands 2
Total Major Organs 4,338
Skin 718
Corneas 1,886
Heart Valves 794
Blood Vessels 2
Bone 37
Spine Bone & Disc
21
Tissue
Abdominal Flap 1
TOTAL 7,197

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24.6 Tamil Nadu Public Health Act, 1939 :

Tamil Nadu is the first State in the country

to enact a law for public health namely Tamil
Nadu Public Health Act, 1939. The Act has been
amended in 1941, 1944 and 1958 and the Act
was modified in 1970. The main focus of the
Public Health Act, 1939 is on environmental
health, communicable disease control, food
hygiene and maternity and child health
measures. Since newer challenges such as
emerging and re-emerging diseases, increasing
industries in food production, emerging social
issues like Gender issues, adolescents, geriatric
issues, increasing environmental hazards –
Ozone layer depletion, weaning greenery,
radiation, bio-degradation, environmental
pollution due to change in life style have
emerged, the Public Health Act needs a relook
and the Government is taking action to amend
the Act. Tamil Nadu, to its credit also had the
first Act in the country for food adulteration i.e.
the Tamil Nadu Prevention of Food Adulteration
Act, 1918, till the Act was repealed by the
Central Act, 1954. It has since been enacted as
the Food Safety and Standards Act, 2006 and
Rules, 2011 and has replaced the Prevention of
Food Adulteration Act, 1954.

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 24.7 Civil Registration System: Prior to
the introduction of Registration of Births and
Deaths Act, 1969 by the Government of India,
registration of births and deaths in 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 in selected Town Panchayats
and the Madras City Municipal Act, 1919 in
Chennai Corporation. The Registration of Births
and Deaths has been made compulsory at the
place of occurrence under the Central Act, 18 of
1969. With the implementation of Tamil Nadu
Registration of Birth and Death Rules, 2000 with
effect from 01.01.2000 and in accordance with
the provisions of Section 30(2)(b) of the
Registration of Births and Deaths Act, 1969, the
registration of birth and death should be done
within 21 days of its occurrence for registration.
However, provisions are made in the Act and
rules to register the events beyond 21 days also.
After 21 days but within 30 days, the events can
be registered with late fee. After 30 days but
within a period of one year, the events can be
registered with a written permission of the

363
prescribed authorities along with late fee. For
the events which have not been registered
within one year of its occurrence, only the
Executive Magistrate not below the rank of
Revenue Divisional Officer is empowered to
grant permission to register. Further, the child’s
name once registered cannot be changed. For all
births / deaths which are registered within 21
days, one copy of birth / death certificate is
issued at free of cost to the informant. As per
the Act, the birth or death can be registered at
the place of occurrence and not in the native
place or at the place of burial.

The Registration of Birth and Death Act,

18 of 1969 came into force in Tamil Nadu from
01.04.1970. As per the Act, all births and
deaths have to be reported compulsorily for
registration at the place of occurrence within
21 days of their occurrence. The Registration
work is governed by Tamil Nadu Registration of
Birth and Death Rules, 2000. The Birth and
Death registration activity is carried out by
Birth and Death Registrars of various
departments in 32 Revenue Districts through
16,501 Registration Units. At present the level

364
of registration has attained 100% in Birth and
Death. CRS Common Software developed by
this department is successfully functioning from
01.01.2018 onwards. A total of 9,01,822 births
and a total of 5,31,138 deaths have been
registered in the CRS common software during
the year 2018 and the birth/death certificates
are generated in the above software by the
Birth and Death Registrars of all connected
departments. In order to issue free birth
certificate to the mother before discharge from
the Government Medical Institution and to issue
free death certificate to the relatives / persons
who accompany the deceased, the Government
have ordered for the appointment of Multi
Purpose Health Supervisor (Male) as Birth and
Death Registrars for all Govt. District Head
Quarters Hospital, Taluk/Non-Taluk Hospital,
Government Medical College Hospital, ESI
Hospitals and Women and Children Hospitals
situated in Village Panchayats, Town
Panchayats, Municipalities and Corporations
(other than Chennai). Through CRS common
software Birth and Death certificates are issued
free of cost.

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24.8 Medical Certification of Cause of
Death:

The Medical Certification of Cause of Death

(MCCD) procedure is a part of Civil Registration
System and was introduced in seven selected
Municipalities and Chennai Corporation during
1969 and later it was extended to all
Municipalities and Corporations from 1980.
Further, it was extended throughout the State
from 1984. Regular trainings are given to
Doctors every year to improve Medical
Certification of cause of death. In order to
capture cause of death, the software developed
by NCDIR (ICMR), Bengaluru e-Mor is to be
piloted shortly.

24.9 Cigarettes and Other Tobacco

Products Act (COTPA), 2003

In order to discourage tobacco use and

protect the youth and masses from the harmful
effects of tobacco usage and Second Hand
Smoke (SHS), Government of India enacted
“Cigarettes and other Tobacco Products
(Prohibition of Advertisement and Regulation of
Trade and Commerce, Production, Supply and

366
Distribution) Act, (COTPA) in 2003”. The Act
imposes progressive restriction on all tobacco
products to reduce their demand and supply.
The law is applicable to all tobacco products and
extends to whole of India. The specific
provisions of the COTPA include:

i. Section 4: Prohibition of smoking in

public places

ii. Section 5: Prohibition of direct and

indirect advertisement, promotion and
sponsorship of cigarette and other
tobacco products.

iii. Section 6(a): Prohibition of sale of

cigarette and other tobacco products to
a person below the age of eighteen
years.

iv. Section 6(b): Prohibition of sale of

tobacco products within a radius of 100
yards of educational institutions.

v. Section 7: Mandatory depiction of

Statutory warnings (including pictorial
warnings on tobacco packs).

vi. Section 7(5): Display of tar and nicotine

contents on tobacco packs.

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 Chapter - 25

RESEARCH AND TRAINING

25.1 Government of India has created a new

Department (Department of Health Research)
under the Ministry of Health and Family Welfare
to promote health research activities and three
schemes namely, Establishment of Multi-
Disciplinary Research Units, Establishment of
Network Laboratories for managing epidemics
and natural calamities and Establishment of
Model Rural Health Research Units have been
launched. State has always promoted health
research and allowed concurrent studies on its
programmes with a view to keep improving the
scheme outputs and ultimately outcomes in the
health sector.

25.2 Multi-Disciplinary Research Units

(MDRUs):

This scheme has been approved to

establish Multi-disciplinary Research Units
(MRUs) in State Government run Medical
Colleges during 12th plan, with a view to create a
dedicated infrastructure for research in
Government Medical Colleges with special focus

368
on Non-Communicable Diseases. Five MDRUs
have been sanctioned to Tamil Nadu for Madras
Medical College, Tirunelveli Medical College,
Coimbatore Medical College, Dr.ALM Post
Graduate Institute of Basic Medical Sciences,
Taramani and Chengalpattu Medical College.

25.3 Objectives of the MDRUs are:

 Encourage and strengthen an environment

of research in Medical Colleges.

 Bridge the gap in the infrastructure which

inhibits health research in the Medical
Colleges by assisting them to establish
multi- disciplinary research facilities, with
a view to improve the health research and
health services.

 To ensure the geographical spread of

health research infrastructure, in order to
cover un-served and under-served Medical
Colleges and other institutions.

 To improve the overall health status of the

population by creating evidence-based
application of diagnostic procedures /
processes / methods.

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25.4 Establishment of Network of
Research Laboratories for Managing
Epidemics and Natural Calamities -
Viral Research Diagnostic Laboratory
(VRDL):

These labs are being established at

Madurai Medical College and Government
Medical College, Theni. The scheme entails
establishment of labs in the State Government
Medical Colleges for timely diagnosis and
management of viral epidemics and new viral
infection at a cost of about Rs.1.44 crore for
equipment and civil works / renovation of
building each under the scheme. In addition,
recurring expenditure of Rs.30 lakh per annum,
comprising expenses on staffing, consumables
and contingencies and training is also provided.
With a view to provide diagnostic facilities for
viral diseases within the district using State
funds, Molecular Virology Lab has been
established in the Madras Medical College and
Government Medical Colleges of Madurai,
Coimbatore and Tirunelveli at a cost of Rs.125
lakh each.

370
25.5 Model Rural Health Research Unit:

Such a unit has been established at

Government Primary Health Centre, Kallur,
Tirunelveli district and linked to Tirunelveli
Medical College, Tirunelveli in order to serve as
model for transferring the technology to State
health personnel working for the rural masses
for early diagnosis and management of various
diseases for the benefit of rural population.

Public Health

25.6 Tamil Nadu is currently undertaking many

innovative initiatives through State, National and
International collaborations.
i) An innovative project with the funding
support of the State Planning Commission
under TANII, has been launched for
Surveillance of Acute Encephalitis
Syndromes in District Public Health
Laboratories, Medical College Hospitals
and King Institute of Preventive Medicine,
Guindy.
ii) Centre for Disease Control (CDC) – India
Funding Projects.

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  Tiruvallur District has been taken as
model district for disease control in
collaboration with National Institute of
Epidemiology (NIE) with funding
support of CDC India.
 Anti-Microbial Resistance (AMR)
Programme through Global Health
Security Agenda (GHSA) in two
districts (Kancheepuram and
Tirunelveli) with funding support from
CDC India.
 Acute Febrile Illness pilot Project in
Krishnagiri and The Nilgiris district
with funding support from CDC, India.
 Global Food Borne Diseases
Prevention Network scheme in two
districts viz. Kancheepuram and
Cuddalore through funding from
NCDC.

These Programmes are continuing.

 The Tamil Nadu Dr. M.G.R. Medical

University and the Government
Medical Colleges also serve as base
where the teaching staff also engage

372
 in publishing research papers which
are topical in Nature and useful for
furthering the cause of Medicine.

25.7 Training and Continuing Health

Education Programme:

Continuing education, In-service training

and Pre-service training programmes are
organized for the Health Officers, Medical
Officers, Nurses and other paramedical staff
through eight Regional Training Institutes (RTI)
namely Institute of Public Health, Poonamallee,
Health and Family Welfare Training Centres
(HFWTC) at Egmore and Madurai, Health
Manpower Development Institutes at Villupuram
and Salem, Institute of Vector Control and
Zoonoses, Hosur and Regional Institute of Public
Health, Thiruvarankulam, Pudukottai and
HFWTC, Gandhigram, Dindigul. The Institute of
Public Health, Poonamallee is recognised as a
National Collaborative Training Centre with
National Institute of Health and Family Welfare,
New Delhi. During the year April 2018 - March
2019, 26,831 Medical, Para Medical Staff and
other Staff were trained in these Institutions.

373
The Training programmes organised by the
National Health Mission, Capacity Building
Trainings in Skilled Birth Attendance (SBA),
Emergency Obstetric Care (EmOnC, six months
training), Life Saving Anaesthesia Skills (LSAS-
six months training), Skill lab programmes,
Integrated Management of Neonatal and
Childhood Illness, Immunization, Integrated
Disease Surveillance and Control Programme
(IDSP), Computer Training and other NHM
training programmes are organized in these
training institutes. Ultra sonogram training is
given to doctors working in the Primary Health
Centres for detection of congenital deformities
during pregnancy in Public Private Partnership
mode. Presently, there are 11 Auxiliary Nurse
and Midwifery (ANM) Training Schools
functioning in the State and they have been
permitted to train 60 candidates each from 2018
onwards. These training schools conduct two
year ANM course. The Anganwadi workers from
ICDS department and candidates from
Government Service Homes are being selected
for this course. During the year 2018-2019, 660
candidates have been selected and they are

374
undergoing ANM training course in these
Institutions.

25.8 The Director of Public Health and

Preventive Medicine (DPH&PM), is the Chairman
for Board of Examination for ANM Training
Course run by Private Institutions. Accordingly,
36 Private Trusts / Institutions have been
permitted to start ANM Training Schools for the
academic year 2017-2018 and 2018-2019. The
DPH&PM, is also Chairman for Board of
Examination for Multi Purpose Health Worker
(Male) / Health Inspector / Sanitary Inspector
Training Course run by Private Institutions.
Accordingly, 54 Private Trusts / Institutions have
been permitted to start MPHW(M) / Health
Inspector /Sanitary Inspector Course Training
Institutes for the academic year 2017-2018 and
2018-2019.

25.9Multi Purpose Health Workers (Male)

Training Course:

One month in-service training was given

to 296 Multi Purpose Health Workers (Male)
working in this department in a phased manner
at the Regional Training Institutes at Madurai

375
and Hosur. Further, 40 Laboratory Technicians
Grade-III were given Multi Purpose Health
Worker training at the Regional Training
Institute at Hosur. Besides this, one year Multi
Purpose Health Worker (Male) Training was
given to 6 candidates from National Leprosy
Eradication Programme. Apart from this, 10
Sanitary Supervisors from Municipal
Administration Department are undergoing one
year Sanitary Inspector Training course at
Institute of Public Health, Poonamallee.

25.10 Universal Health Care Coverage:

Under Universal Health care Coverage, it is

planned to provide one month training to 803
Staff Nurses in 4 Training Institutes and 2 days
training to 918 Staff Nurses in 10 Training
Institutes. 6 months certificate course in
Community Health Care for Village Health
Nurses with supportive guidance and affiliation
of The Tamil Nadu Dr. MGR Medical University,
Chennai has been started from January, 2019
onwards in 10 Training Institutes. 420 VHNs /
ANMs have undergone Mid-Level Health Care
Provider (MLHP) Training in 7 Training Institutes.

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 25.11 Tamil Nadu is implementing several
land mark schemes and has State of Art
facilities, robust public private partnership, well
qualified human resources, fore runner in
implementing Maternal, Child Care and Family
Welfare services which enabled the State in
being ranked among the top three States in the
Healthy State - Progressive India report released
by the NITI Aayog. All these efforts will
continue to be implemented to achieve the
health indicators on par with developed
countries as indicated in the Vision 2023
document.

Tamil Nadu Health and Family Welfare

Department is committed to ensure top quality
health care services to the people of the State
and strives to attain highest inter-national
standards.

Dr. C. VIJAYABASKAR
Minister for Health and Family Welfare

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