HEALTH AND FAMILY WELFARE DEPARTMENT

DEMAND NO. 19

POLICY NOTE

2013-2014

THIRU K.C. VEERAMANI Minister for Health

©

GOVERNMENT OF TAMIL NADU

2013

POLICY NOTE ON

HEALTH AND FAMILY WELFARE

2013-14

CONTENTS

Sl

No Chapter Page No

1 Introduction 1 - 10

2 Health Administration 11 - 16

3 Medical Education 17 - 25

4 Medical and Rural Health Services

26 - 30

5 Public Health and Preventive

Medicine

31 - 54

6 Family Welfare 55 - 68

7 Medical and Rural Health Services (Employees State

Insurance Hospitals)

69 - 70

8 Indian Medicine and Homoeopathy

71 - 85

9 Food Safety and Drugs

Control Administration

86 - 94

10 Tamil Nadu State Health

Transport Department

95 - 102

11 Medical Services Recruitment

Board

103 - 104

12 State Health Society 105 - 137

13 Tamil Nadu Health Systems

Project

138 - 155

14 Tamil Nadu Medical Services Corporation

156 - 163

15 Tamil Nadu State AIDS Control Society

164 - 173

16 Tamil Nadu State Blindness

Control Society

174 - 177

17 Revised National

Tuberculosis Control Programme

178 - 181

18 National Mental Health

Programme

182 - 188

19 National Vector Borne

Diseases Control Programmes

189 - 198

20 National Programme for

Prevention and Control of Cancer, Diabetes and Cardio-

Vascular Diseases

199 - 200

21 National Tobacco Control

Programme

201 - 202

22 National Leprosy Eradication Programme

203

23 Accident And Trauma Care Centres

204 - 206

24 Chief Minister’s

Comprehensive Health Insurance Scheme

207 - 210

25 Important Acts 211 - 217

26 Education, Training and

Research

218 - 223

Chapter 1

INTRODUCTION

c‰wh‹ msΫ ÃâmsΫ 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 totally

committed to building healthy people, not only by making available quality medicare

facilities to everyone in the State, but also by providing medical facilities of the highest

order, keeping pace with rapid technological developments in the field of medicine.

Government of Tamil Nadu provides

preventive and curative care to all through various Hospitals, Dispensaries, and

Institutions.

State Profile

1.2 Tamil Nadu is one of the best performing states and has consistently

strived for ensuring that the citizens are provided with the best possible medical

care. It is the seventh most populous State

2

in the country with a population of 7.21

crore as per 2011 census. The State has 32 districts. For the management of public

health services, the State has been divided into 42 Health Unit Districts. Tamil Nadu is

also one of the best performing States in terms of implementing Reproductive and

Child Health schemes and has already achieved the National Rural Health Mission /

Reproductive Child Health goals. The current Infant Mortality Rate of the State is 22

(Sample Registration System 2011), which is well below the national target of 30 per

1000 live births. Against the national target of 100 per lakh live births for the Maternal

Mortality Ratio, the State had already

achieved a Maternal Mortality Ratio of 97 as per Sample Registration System 2007-2009.

Now, as per the State Health Management Information System data collected in

2011-2012, this has gone down further to 73 per lakh live births. The State has also

achieved replacement level and the current Total Fertility Rate is 1.7 which is the lowest

in the country. The Union Planning Commission and many independent review

missions have commended the performance of the State.

1.3 These achievements in macro indicators have been backed by several pioneering

3

initiatives. With the vision and guidance

of Hon’ble Chief Minister, the State has been implementing several landmark

initiatives with a view to ensure Universal Health Care. Starting of Tamil Nadu Medical

Services Corporation in 1994, initiating maternal and child health initiatives like 24

hour services at Primary Health Centre (PHC), starting of one 30 bedded PHC in

each block, providing adequate blood banks, creating facilities for night caesarean,

opening neo natal stabilisation and intensive care units and upgrading capacity for

comprehensive obstetric and neonatal care, starting birth companion programme,

maternal audits, universal immunisation

programme, achieving all targets in the national programmes are some among

many such landmark initiatives being implemented by the State. In addition to

consolidating the initiatives and the programmes which are already being

successfully implemented, the state has also launched the menstrual hygiene

programme, the modified Chief Minister’s Comprehensive Insurance Scheme and is

also implementing Dr.Muthulakshmi Reddy Maternity Benefit Scheme with an increased

financial assistance. Currently the focus of the State is to provide equal attention to

4

public health and prevention of diseases.

The State is also ensuring these quality facilities for treatment are easily accessible

to the people. In addition to the emerging challenges of Non Communicable diseases

on one side, the State has also effectively responded to the challenge of vector borne

diseases such as dengue which showed an increase in incidence worldwide last year.

History

1.4 Our ancient Indian system of Medicine

“Siddha” and “Ayurveda” are in practice for over thousands of years. Siddha System of

Medicine has been recorded to have been

practiced by the eighteen Siddhars and that is why it is called “Siddhar Maruthuvam”.

Susrushta and Charaka were the pioneers of Ayurveda. History tells us that there were

well organized hospitals even during the days of Buddha and Ashoka. Roots of

modern medicine are linked to the advent of the Britishers. It is believed that the first

British Hospital was established in 1639 to treat the sick soldiers of the East India

Company. The origin of the modern Government Hospital has been traced back

to 1644, when it was started as a small hospital which has now grown into the

5

prestigious General Hospital attached to the

Madras Medical College which itself was started in 1835.

1.5 With the growth of the Medical Services,

the Civil Medical Service was separated and established under the management of a

Head of the Department called as “Surgeon General with the Government”. That post

was subsequently re-designated as Director of Medical Services (DMS) during 1960.

Medical Services Department was bifurcated and the Department of Medical Education

was formed in the year 1966. Similarly Department of Indian Medicine was

established in the year 1976 and the

Department of Drugs control in November 1981. The Family Welfare scheme, which

was dealt by the Medical Services Department, was separated and an

independent Department of Family Welfare was formed in 1983, to look after the Family

Welfare Scheme.

1.6 On the Public Health and Preventive Medicine side, the Directorate of Public

Health and Preventive Medicine was formed during 1923 with the main objectives of

providing Maternal and Child Health care to the rural and urban population and for the

6

prevention and control of communicable

diseases. Lieutenant Colonel A.T.H. Russell was the first Director of Public Health and

Preventive Medicine in the Pre-independent era. Public Health Act, 1939 is the legal

instrument enacted before independence of the country which empowers the Health

Officers to enforce public health law to safeguard the health of the people. This is

currently being reviewed and will be amended to reflect the latest felt needs of

the Public Health Sector. During 1965, the Primary Health Centres were separated from

the Medical Services Department and brought under the Public Health

Department. The Public Health and

Preventive Medicine Department is functioning with 42 Health Unit Districts

each unit under a Deputy Director of Health Services. The State Health Transport

Department, which was with the Public Health Department, was separated and a

Directorate of Health Transport was formed on 15.07.1981.

Current Scenario

1.7 Medical and Health facilities in Tamil

Nadu in the Government sector have grown rapidly and the current scenario is given in

Table No.1.

7

Table No.1 - Medical and Health

Facilities in Tamil Nadu in the Government Sector

Sl. No. Description No.

1. Medical Colleges 18

2. Medical College attached hospitals 43

3. Dental College and Hospital 1

4. District Headquarters Hospitals 30

5. Sub District Hospitals 237

6. Primary Health Centres (PHCs) 1614

7. Health Sub Centres (HSCs) 8706

8. Urban Primary Health Centres (UPHCs) 135

9. ESI Hospitals (include the ESI Hospital, Chennai - 78)

8

10. ESI Dispensaries 195

11. Indian System of Medicine Hospitals 4

12. Indian System of Medicine Dispensaries

1375

1.8 In addition to the above facilities and

institutions, Tamil Nadu has a number of maternity homes, dispensaries and health

posts run by municipalities and municipal corporations. With the network of primary,

secondary and tertiary hospitals and a plethora of cross cutting programmes such

as the National Rural Health Mission, Health Systems Project, AIDS Control Society,

8

Maternal and Child Health initiatives, Indian

Medicine and other focused programmes and special initiatives, the department is

fully involved in implementing the two pronged strategy of prevention and cure to

ensure that the Health needs of the citizens in our state are taken care of.

1.9 The provision for Health and Family

Welfare Department under Demand No.19 for 2013-2014 is Rs.6,511.22 crore as

detailed below:- (Rs. in crores)

Dem

and

Non –

Pla

n

Plan

Tota

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n

and N

on-

Pla

n

Sta

te P

lan

Centr

ally

Sponsore

d

Share

d betw

een

Centr

e a

nd

Sta

te

Tota

l

19.

Health

and

Family

Welfare

Depart-

ment

3610.22

2256.34

637.66

7.00

2901.00

*

6511.22

* A sum of Rs.54.59 lakh have also been allotted under Charged head and the total

allocation is Rs.6,511.76 crore.

9

This includes Rs.6265.95 crores on the

Revenue Account and Rs.245.28 crores on the Capital Account. The provision on the

Revenue Account works out to 5.31% of the total Revenue Expenditure of

Rs.1,17,915.81 crores in the Tamil Nadu State Budget for the year 2013 -2014.

Note: Apart from the above provision,

Rs.249.85 crores has been allocated towards Civil Works being undertaken by

Public Works Department under Demand No.39.

1.10 The Directorate wise allocation for

2013-2014 under Demand No.19 Health and

Family Welfare is as follows:-

(Rupees in crores)

1 Secretariat, Health and Family Welfare Department

7.93

2 Directorate of Medical and Rural Health Services

789.65

3 Directorate of Medical Education 1775.52

4 Directorate of Public Health and

Preventive Medicine

2189.96

5 Directorate of Family Welfare 175.96

6 Tamil Nadu Food Safety and Drug Administration

42.99

10

Note: Provision towards ESI Scheme Hospitals for Rs.219.86 crore have been

made in the Labour and Employment

Demand No.32.

7 Directorate of Indian Medicine

and Homoeopathy

169.13

8 Tamil Nadu State Health

Transport Department

26.71

9 Reproductive and Child Health

Project

387.86

10 Tamil Nadu Health Systems

Project

945.52

Total 6511.22

11

Chapter 2

HEALTH ADMINISTRATION

2.1 The Health and Family Welfare

department in the Secretariat is administratively responsible for the

following Directorates:-

Directorate of Medical Education

Directorate of Medical and Rural Health Services

Directorate of Public Health and Preventive Medicine

Directorate of Indian Medicine and Homeopathy

Directorate of Family Welfare

Directorate of Food Safety and Drugs Control Administration

Directorate of State Health Transport Department

Medical Services Recruitment Board

Apart from these Directorates, the staff for the Directorate of Medical Services (ESI)

under the Labour and Employment department are sent from Health

department.

12

Other Programmes and Initiatives

2.2 The Directorates are supported by a

number of other initiatives which are implemented across the Directorates such

as:-

National Rural Health Mission -

State Health Society

Tamil Nadu Health Systems Project

Tamil Nadu State AIDS Control Society

Tamil Nadu Blindness Control Society

Tamil Nadu Medical Services Corporation

Tamil Nadu Medicinal Plant Farms

and Herbal Medicine Corporation Limited (TAMPCOL)

Under the State Health Society and through the Directorates several National

Programmes such as the Revised National Tuberculosis Programme, National Mental

Health Programme, National Vector Borne Diseases Control Programme, Universal

Immunization Programme, and School Health Programme among others are

implemented. These have been explained in detail in subsequent chapters.

13

Councils

2.3 The following councils are established

through various acts to register the qualified medical, nursing and paramedical

professionals to regulate their practice in Tamil Nadu.

i. Tamil Nadu Medical Council

ii. Tamil Nadu Dental Council

iii. Tamil Nadu Nurses Council

iv. Tamil Nadu Pharmacy Council

v. Tamil Nadu Siddha Medical Council

(Siddha & Traditional practitioners)

vi. Board of Indian Medicine

(Ayurveda, Unani and Yoga &

Naturopathy)

vii. Tamil Nadu Homeopathy Council

These are all the Statutory Bodies regulated

by Government of India and Government of Tamil Nadu. Apart from this, there is also a

Government order for constituting a Physiotherapists Council in the State.

14

Classification of Hospitals and

Dispensaries

2.4 Government of Tamil Nadu provides preventive and curative care to all, through

various hospitals, dispensaries, and institutions. The state has a variety of

categories of hospitals. The classification of hospitals and dispensaries in the state are

as follows:

i. State–Public Medical Institutions: All Medical institutions – Allopathy and

Indian System of Medicine maintained through State funds and are directly

managed by the Government. These

form the backbone of the health care. It ranges from the grassroots level-

8,706 Health Sub Centres catering to an average population of 5,000 to the

1,614 PHCs catering to an average population of 30,000 at the next level.

These are followed by secondary and tertiary care hospitals, details of which

have already been given in Table No.1 in the first chapter.

ii. State–Special Medical Institutions:

All institutions intended to serve special sections of public such as

15

Police, State owned corporations /

undertakings, Employees State Insurance Medical Institutions etc.

iii. Medical Institutions under the

Local Bodies: These Medical Institutions are under the

management of Municipal Corporations, Municipalities and

Panchayat Unions. With the state taking over most of these facilities

they are now very few in number especially in rural areas. Conversion

of the remaining rural medical institutions to Government medical

institutions is under the active

consideration of the Government.

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.

16

Tamil Nadu Dr.M.G.R. Medical

University

2.5 The Government of Tamil Nadu established this Medical University in the

year 1987 by passing the Tamil Nadu Medical University Act, 1987 (Act

No.37/1987). The name was later amended as the Tamil Nadu Dr.M.G.R. Medical

University and the University is functioning from July, 1988. This University is

relentlessly working to fulfill a number of objectives including improving the standards

in medical and para medical education, medical research in addition to making an

impact on the progress of Health Care.

2.6 Thus, the Health Administration

encompasses the entire gamut of services, facilities extended throughout the State and

strives to ensure that both preventive, curative, research and development needs

of the State are adequately taken care of. It is also getting constantly upgraded to keep

pace with the demands posed by emerging diseases and migratory challenges.

17

Chapter 3

MEDICAL EDUCATION

3.1 The State needs well qualified

manpower not only for manning the medical facilities at all levels, but also to

address the health related challenges. Medical Education is critical to provision of

the crucial human resources to ensure that the State has adequate number of qualified

health personnel both in the government and private domain. The Department of

Medical Education plays a pivotal role in producing quality medical and Para-medical

personnel to cater to the health needs of the

State. The department also has a role to play in the establishment and maintenance

of well-equipped teaching institutions, which are the premier referral centres with state of

the art equipment, technology and research. The Directorate of Medical Education was

formed in the year 1966 from the Directorate of Medical Services and is

functioning as an independent Directorate. It is managing the Medical Colleges and

teaching hospitals attached to them.

18

Administrative Structure

3.2 The Director of Medical Education is the

head of the directorate. All the Government medical colleges and attached institutions

are part of this directorate. These are manned by the Deans and Principals

respectively.

Deans, Government Medical Colleges and hospitals

Director, Government Institute of Rehabilitation Medicine, Chennai

Director, Institute of Child Health and Hospital for Children, Chennai

Director, Institute of Thoracic

Medicine, Chennai

Director, Institute of Mental Health

and Government Mental Hospital, Chennai

Director and Superintendent, Institute of Obstetrics and Gynecology and

Government Hospital for Women, Chennai

Director and Superintendent, Institute of Social Obstetrics and Kasturba

Gandhi Hospital for Women and Children, Chennai

Director, Regional Institute of

19

Ophthalmology and Government

Ophthalmic Hospital, Chennai

Director, King Institute of Preventive

Medicine and Research, Guindy, Chennai

Principal, Government Dental College and Hospital, Chennai

Principal, Government Physiotherapy College, Tiruchirappalli

Superintendent, Government TB Sanatorium, Tambaram, Chennai

Superintendent, Government TB Hospital, Otteri, Chennai

Chief Medical Officers of Peripheral Hospitals attached to Teaching

Hospitals

Medical Officers of Dispensaries attached to Teaching Hospitals

Principals of other colleges

3.3 Currently there are 18 Government Medical Colleges, one Government Dental

College, two Pharmacy Colleges (B.Pharm), two Physiotherapy Colleges, four Nursing

Colleges (B.Sc.Nursing) along with 23 Schools of Nursing offering Diploma in

Nursing and 44 hospitals (including one Dental Hospital) under the control of

Directorate of Medical Education. The total

20

number of bed strength in these hospitals is

30,900. The daily average of out-patents is 71,753 and the daily average Inpatients is

25,188.

3.4 Table No.2 shows the intake capacity of the Medical Institutions for Under Graduate

and Post Graduate Courses.

Table No.2 - Number of seats available in each course in Government sector-

Under graduate and Diploma courses

Name of the Course Number of

seats

M.B.B.S. 2145

B.D.S. 100

B.Sc. Nursing 200

Post Basic ( B.Sc. Nursing) 90

B.Sc. Radio Diagnosis 30

B.Sc. Radiotherapy 20

Bachelor of Physiotherapy 50

B.Pharm 120

Diploma in Nursing 2000

Diploma in Pharmacy 240

Paramedical Courses

(23 Courses)

5732

3.5 Table No.3 shows the details of the

specialties which are available in the

21

colleges in Tamil Nadu for the students to

do their post-graduation.

Table No.3 - Number of Specialties and intake capacity under the Post

Graduate (P.G) courses

Courses Number of

Specialties

Total intake

Capacity

P.G. Degree (Medical) 23 706

P.G. Diploma(Medical) 15 403

MDS ( Dental) 8 35

Higher Specialties 16 189

M.Pharmacy 4 64

M.Sc. (Nursing) 5 65

M.Sc. (Medical Physics) 1 10

M.Phil (Clinical Social

Work)

1 15

M.Sc. (Molecular Virology) 1 21

3.6 In addition, there are private self

financing institutions affiliated to the Tamil Nadu Dr.M.G.R. Medical University providing

Medical and Para Medical Education in the State. The details of total number of seats

available in these private Institutions as well as the seats surrendered for allotment by

the Government may be seen from Table No.4 below.

22

Table No.4 - Seats surrendered by

Private Self Financing Colleges for allotment by the Government

College No. of

Colleges Number of seats

Number of seats

surrendered to

Government

Medical College 11 1460 838

Dental College 18 1515 909

Pharmacy College (B.Pharm)

31 1950 1124

Physiotherapy College (BPT)

21 1030 639

Nursing College (B.Sc) 145 7880 5067

Occupational Therapy College (BOT)

1 50 33

D.Pharm to B.Pharm (Lateral entry 10%)

26 1520 152

Post Basic B.Sc. (Nursing)

46 1630 1062

Admission to professional courses in

Medicine

3.7 Admission to the Professional Courses

in Medicine in the State is made based on the marks obtained in the relevant subjects

of the Plus two examinations. The selection to MBBS / Bachelor of Dental Surgery

(BDS)/ B.Sc. Nursing / Bachelor of

Pharmacy (B.Pharm) as well as Diploma courses in Nursing is done by a Selection

23

Committee under a Single Window System

following the rules of reservation in accordance with the policy of the

Government. Admission to Post Graduate Diploma, Post Graduate Degree, and Master

of Dental Surgery (MDS) and Higher specialties courses is done by the Selection

Committee through a common entrance examination followed by counselling duly

adopting the rule of reservation.

The State has been consistently opposing

the National Eligibility and Entrance Test (NEET) and currently the case on this issue

is pending in the Supreme Court. The State is taking all steps to ensure that there is no

interference in its policy on Medical and

Dental college admissions, at Under Graduate and Post Graduate levels.

Services

3.8 The hospitals attached to the medical

colleges serve as the referral centres where people all over the State are able to access

state of art facilities. In addition to providing quality care in all conceivable specialties,

the hospitals are backed by excellent diagnostic support and state of art

equipments. The hospitals also share their role in implementation of state wide

24

programmes. The geographical spreads of

these hospitals have ensured that the primary and the secondary care institutions

have adequate tertiary care support anywhere in the state. The medical colleges

and the professionals attached to the specialties in each college and hospitals,

have competence in providing valuable inputs for treatment protocols for the

diseases. Dental Care, Rehabilitation Medicine, Child Health, Thoracic Medicine,

Mental Health, Obstetrics and Gynecology and Social Obstetrics, Ophthalmology,

Preventive Medicine and Research, Physiotherapy College, TB Sanatorium are

among the focus areas where the

Directorate has separate institutions. Stem cell research, rare surgeries, accessible

tertiary cares are some of the important contributions made by these institutions.

These are in addition to all the specialties which are mandatorily provided for in a

medical college hospital. The role of these institutions as part of health and family

welfare programmes spread across directorates has been separately brought

out under the relevant portions of this policy note.

25

Multi Super Specialty Hospital

3.9 The Multi Super Specialty Hospital being

established by converting the new building in Omandurar Government Estate, Chennai

is expected to strengthen tertiary health care in the State by providing better and

expert treatment for serious ailments to the economically weaker sections.

26

Chapter 4

MEDICAL AND RURAL HEALTH

SERVICES

4.1 The Department of Medical and Rural Health Services is being entrusted with the

responsibility of rendering medical care services to the public through the Non-

Teaching Medical Institutions. Through the pursuit of various policies and programmes,

the department is aiming to translate the Alma Ata Declaration of Health for All in to

reality.

4.2 The Directorate of Medical and Rural

Health Services is implementing the curative medical care services through the grid of 30

District Head Quarters Hospitals, 158 Taluk Hospitals, 79 Non-Taluk Hospitals, 19

Dispensaries, 10 Mobile Medical Units, seven Women and Children Hospitals, two T.B.

Hospitals / Sanatoriums’ which are under the control of this Department. The

Hospitals under the control of this department are Secondary care

Hospitals.The Medical Services Department

of the State has implemented a unique Medical monitoring system - Hospital

Management Information System and

27

Hospital Management system and is also

implementing the following medical programmes:-

i. Providing extended medical speciality

services like Medicine, Surgery, Obstetrics and Gynaecology,

Ophthalmology, E.N.T, Venereology, Orthopaedics, Anaesthesiology, Child

Health, Comprehensive Emergency Obstetrics and Newborn Care

Services(CEmONC) Dental, Psychiatry,

Ambulance Services, Laboratory Services, Leprosy, Tuberculosis,

Diabetology, Cardiology and Non Communicable Diseases (NCD)

ii. Accident and Emergency Services

iii. Family Welfare and Maternity and

Child Health Services

iv. T.B. Control and Blindness Control

Programmes

v. Tamil Nadu Illness Assistance Society

vi. Mental Health Programme

28

Administrative Structure

Director of Medical and Rural Health

Services Joint Director of District Head Quarters Health Services Hospitals. Taluk Hospitals. Non Taluk Hospitals. Dispensaries. Mobile Medical Units. TB Hospitals / Clinics.

Leprosy Hospitals. Deputy Director of Medical Family welfare and Rural Health Services programme in and Family Welfare the District.

Deputy Director of Medical TB control programme Services (TB) in the District. Deputy Director of Medical Services. (Leprosy) Leprosy control

programme.

The leprosy programme has since been

integrated with the Department of Public Health and Preventive Medicine.

29

4.3 The Director of Medical and Rural Health

Services is the Chairman of the Multiple Appropriate Authority for the

implementation of Pre–Conception and Pre-Natal Diagnostic Techniques (Prohibition of

Sex Selection) Act 1994.The Director of Medical and Rural Health Services is also the

State Appropriate Authority under the Transplantation of Human Organ Act, 1994.

The Directorate also looks after the implementation of the following

programmes -

District Mental Health Programme.

State Illness Assistance Society.

Services

4.4 The Medical services was the basic wing from which the other Directorates ultimately

emerged and till this date serves as a very crucial secondary care institution. It is the

main link between primary health care and tertiary care. With the implementation of

the Health Systems Project and the concurrent improvements in the facilities

and quality of care, these institutions have provided much needed relief to both in-

patients and out-patients needing higher level of treatment and assistance. On an

30

average about 2 lakh outpatients and

18,000 inpatients get treated every day cumulatively in these institutions and it also

provides obstetric and neonatal care in addition to rendering accident and trauma

and other needed clinical services. It also has a critical role in all the nationally and

state level programmes implemented across directorates which are detailed separately

under the relevant headings.

31

Chapter 5

PUBLIC HEALTH AND PREVENTIVE

MEDICINE

5.1 The Department of Public Health and Preventive Medicine of Tamil Nadu is

engaged in protecting and improving the health of people of the State, by

immunization, health education, control of communicable diseases, application of

sanitary measures, and monitoring of

environmental hazards, thereby reducing the burden of morbidity, mortality and

disability in the State.

Administrative Structure

Director

Additional Directors, Financial Advisor and

Chief Accounts Officer and Joint Directors

Deputy Directors of Health Services

Block Primary Health Centres, Primary Health Centres and Health Sub-Centres

32

Regional Health and Family welfare

Training Institutes,

Institute of Vector Control and

Zoonoses, Hosur,

Water Analysis Laboratories in the

King Institute, Guindy, Chennai and Coimbatore.

5.2 The Directorate of Public Health and

Preventive Medicine plays an important role in the prevention and control of

communicable diseases apart from providing community based maternity and child health

services. Under this Directorate, 1,614 Primary Health Centres (PHCs) and 8,706

Health Sub Centres (HSCs) are functioning

besides 385 Hospital on Wheels.

5.3 This Directorate is responsible for civil registration and implementing major health

programmes such as Reproductive and Child Health Programme, National Rural Health

Mission (NRHM) supported programmes, Dr.Muthulakshmi Reddy Maternity Benefit

Scheme (MRMBS), National Immunisation Programme, National Family Welfare

Programme, National Diarrhoeal Diseases Control Programme (NDDCP), National

Vector Borne Diseases Control Programme (NVBDCP), Integrated Disease Surveillance

33

Programme (IDSP), Non-Communicable

Diseases Control Programme (NCDCP), National Leprosy Elimination Programme,

School Health Programme, National Iodine Deficiency Disorders Control Programme

and Tobacco Control Programme. New initiatives Viz., Hospital on Wheels

Programme, Menstrual Hygiene Programme, and Telemedicine Services to remote areas,

Establishment of Urban Primary Health Centres, Establishment of level-I and II MCH

centres and 24x7 Helpline are also being implemented.

5.4 The Directorate of Public Health and

Preventive Medicine is also responsible for

the implementation of various Public Health Acts such as Tamil Nadu Public Health Act,

1939, Cigarette and Other Tobacco Products (Prohibition of Advertisement and

Regulation of Trade and Commerce, Production, Supply and Distribution) Act,

2003 and Registration of Births and Deaths Act, 1969. Active support is provided by the

PHCs for the implementation of Revised National Tuberculosis Control Programme,

National AIDS Prevention / Control Programme, National Blindness Control

Programme, Integrated Child Development Scheme, Rural Water Sanitation Schemes

34

and other Community Development

Programmes.

5.5 As brought out in the introductory chapter, due to the health facilities at

primary, secondary and tertiary levels and in particular due to the sustained efforts of

the network of public health institutions, the performance of the State in various para

meters viz., Infant Mortality Rate, Maternal Mortality Ratio, Birth Rate, Total Fertility

Rate, control of communicable diseases and elimination of vaccine preventable diseases

have significantly improved over the years. Consequently Tamil Nadu has emerged as a

pioneering State in the country in providing

public health care.

Infant Mortality Rate (IMR)

5.6 Children are the fountains of life.

Ensuring the survival and healthy development of every child born is the key

for the development of any nation. Infant Mortality Rate is the key sensitive indicator

of child health in a country. The current level of IMR in Tamil Nadu for the year 2011

is 22 per 1000 live births as per the Sample Registration System survey (2011). The

State ranks as the second lowest among the major states in the country.

35

5.7 Seventy percent of the infant deaths

occur during the neonatal period. Around 30% of infant deaths occur at home. The

major causes of Infant deaths are Pneumonia, Hypothermia, Congenital heart

diseases and Multiple Congenital anomalies. United Nation’s Millennium Development

Goal is to reduce the IMR by three quarters from 1990 to 2015. Government of Tamil

Nadu is committed to reduce Infant Mortality Rate below 13 (No. of infant

deaths per year for every 1000 live births) by the year 2017.

Table No.5 - Trend of IMR for India and

Tamil Nadu

Year

19

80

19

90

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

Tamil

Nadu

93 59 51 49 44 43 41 37 37 35 31 28 24 22

India 114 80 68 66 64 60 58 58 57 55 53 50 47 44

Source: Sample Registration System (SRS)

Bulletins

36

110

80

242530

55

3438

6065

93

104

121127

192226

4239

3531 28

7781

55 54

222428

91

113

4953

57

3135

-5.0

10.0

25.0

40.0

55.0

70.0

85.0

100.0

115.0

130.0

1971 1976 1981 1986 1991 1996 2001 2007 2008 2009 2010 2011

Rural

Urban

Trends in IMR in Tamil Nadu

Source: SRS

CSSM, 1992

RCH, 1997

NRHM, 2005

UIP, 1985

Combined

UIP - Universal Immunisation Programme

CSSM - Child Survival and Safety Motherhood

RCH - Reproductive and Child Health NRHM - National Rural Health Mission

5.8 To improve maternal and child health

care facilities, the following initiatives are being implemented:

Antenatal care

Immunization of every child

37

Establishment of Basic Emergency

Obstetric and Newborn Care (BEmONC)

Upgraded PHCs at the rate of one per

block

Establishment of Comprehensive

Emergency and Obstetric and Neonatal Care (CEmONC) Centres in

select Government Hospitals and Medical College Hospitals

Establishment of Newborn Intensive

Care Units (NICUs) in selected Government Hospitals and all Govt.

Medical College hospitals

Establishment of Newborn corners in

all PHCs and provision of necessary equipments like warmer, phototherapy

units for the Newborn corner

Hospital on Wheels in 385 Blocks for providing community based

Reproductive and Child Health (RCH)

outreach services

Establishment Sick Newborn Care Units (SNCU) and training of staff

Hiring of Private pediatricians for

providing emergency newborn care in

all PHCs

Establishment of 42 MCH level-II centres (BEmONC) PHCs to provide

38

emergency newborn care services

(1per HUD) on 24x7 basis

Establishment of New born Stabilization Unit (NBSU) in 42

identified MCH Level 2 centres to improve maternal and child care

facilities

Apart from the strengthening of 108

ambulance services with neonatal transport support facilities, several training

programmes are being imparted viz.

Skilled Birth Attendant training for Staff Nurses and VHN/ANM

Integrated Management of Newborn and Childhood (IMNCI) training to

PHC medical officers

Facility based IMNCI training to

Medical Officers and Staff nurses

Home based newborn care training to

Village Health Volunteers in tribal areas

Placement of Village Health Link volunteers in 15 high IMR blocks to

provide home based new born care

Ultra Sonogram training for prenatal

screening to UGPHC Medical Officers

39

In addition to these, health education to

pregnant mothers on exclusive breast feeding, complementary foods, child care

practices, danger signs in sick newborns, preventing child marriage (less than 18) and

family planning, have helped in reducing IMR. It is proposed to establish

Telemedicine Centre in the identified MCH Level-1 Centers (HSCs) in hilly/tribal areas

to provide basic health care on 24x7 basis. Provision of free transport, monitoring of

every pregnancy and infant through web-based Pregnancy and Infant Cohort

Monitoring System, Recording / uploading of Maternal and Child Health data by Village

Health Nurses and investigation and audit of

every infant death and initiating measures to prevent similar deaths in future have

contributed to the significant decline of infant mortality rate in Tamil Nadu.

Maternal Mortality Ratio (MMR)

5.9 Maternal mortality represents the most

sensitive and key indicator of women’s health and status. National Rural Health

Mission’s (NRHM) primary focus is to reduce MMR and prioritizing the resource allocation

for the same.

40

5.10 Tamil Nadu ranks second lowest in

MMR among the major Indian states. In 2011-2012, Tamil Nadu reported 767

maternal deaths (amounting to an MMR of 73 per 100,000 live births). All efforts are

being taken to reduce the MMR further with

the multipronged approach to achieve the same.

41

Steps taken for reduction of MMR

5.11 Detection, investigation and audit of

every maternal death, identification of circumstances leading to the death and

prevention of similar deaths in future, Dr. Muthulakhsmi Reddy Maternity Benefit

Scheme to eligible mothers, establishment of BEmONC centres, establishment of

CEmONC centres, establishment of 24x7 delivery centres in all PHCs, establishment

of urban PHCs, establishment of birth

waiting homes in the foot hills, Birth companion scheme, establishment of Blood

Storage centres in PHCs, EMRI 108 ambulance services, Hospital on Wheels in

385 Blocks for RCH outreach services, establishment of 42 MCH level-II centres,

Cell phones for VHNs, Telephones for all PHCs to strengthen referral linkages,

functioning of PHC Operation Theatres, tracking and transfer of mothers with high

risks to higher facilities, admission of mothers with known high risk factors well in

advance in CEmONC centres, networking with all CEmONC centres, professional

partners and community partners, multi-

skill training in anesthesia, obstetrics, and ultra-sonogram to PHC medical officers,

provision for hiring of the services of

42

obstetricians and anesthetists to provide

emergency obstetric care, investigation of all maternal deaths by an expert team with

two Obstetricians in each Health District (24 to 48 hours death) to identify the avoidable

factors and preventing the recurrence of such events are the major contributing

factors for the declining maternal mortality ratio. It is proposed to further intensify

these efforts.

Primary Health Centres (PHCs)

5.12 PHC Infrastructure: A primary

health center is established for a population of about 30,000 in plain areas and 20,000 in

hill areas. As already mentioned, there are

1,614 Primary Health Centres functioning in Tamil Nadu. While 1,512 PHCs are

functioning in Government Buildings, construction of buildings is under progress

in respect of 79 Primary Health Centres. 135 Urban PHCs are sanctioned under the

control of the Directorate of Public Health and Preventive Medicine to improve

availability of Primary Health Care services to the urban poor.

43

Services

5.13 On an average 2.4 lakh outpatients

get treated each day in the 1,614 PHCs spread across the state in addition to about

3,250 inpatients per day. PHCs across the state conducted 2.08 lakh deliveries per

annum and deliveries in PHCs constitute an average of 13 per PHC / per month of all the

institutional deliveries. 24x7 delivery care services with 3 Staff Nurses are provided in

all the PHCs. The institutional services offered in the PHCs are being monitored

through a web enabled Institutional Services Monitoring Report (ISMR) and feed back is

sent to the districts for further

improvements.

Upgradation of Primary Health Centres

5.14 It is the policy of the Government to provide at least one 30 bedded upgraded

Primary Health Centre in each block where there is no such health facility, in a phased

manner. Each Upgraded Primary Health Centre has an operation theatre, modern

diagnostic equipments like Ultra Sonogram, ECG, Semi Auto Analyzer, X-ray and an

ambulance vehicle. Five doctors are posted to the upgraded PHCs. At present 341

44

upgraded Primary Health Centres are

functioning in 310 blocks. These facilities will be extended to the uncovered blocks in

the coming years.

ISO 9001 Certification

5.15 Government have been taking conscious steps to inculcate quality

consciousness among the Government Medical institution to constantly improve

quality of services. 48 Primary Health Centres in 12 Health Unit Districts have

been awarded ISO 9001 certificates. In each of the remaining 30 HUDs, one PHC has

been identified for ISO certification. Each of

these 30 PHCs have adopted 2 PHCs for quality improvement. It is proposed to

grade the PHCs based on quality parameters and performance indicators.

Dental health care services in PHCs

5.16 Dental health care services are

provided in 266 PHCs to treat dental ailments. The dental services have received

good response from the public. The Government has planned to provide dental

health care services in all the upgraded and block level PHCs in a phased manner.

45

Health Sub Centres

5.17 A Health Sub Centre (HSC) is

established for a population of 5,000 in plain areas and 3,000 in hilly areas. Each centre

is manned by a Village Health Nurse. There are 8,706 HSCs in Tamil Nadu. While 6,510

HSCs are functioning in Government Buildings, 2,196 HSCs are functioning in

Rented/Rent free Buildings. Buildings for 139 HSCs are under construction at a total

cost of Rs.20.91 crores. Under the NRHM, construction and renovation of HSC

buildings are being done in a phased manner. It is proposed to increase the

number of HSCs based on 2011 census.

Services and programmes

5.18 Since the services and programmes in

the PHCs are provided at the grass roots level, most of the cross cutting programmes

are embedded in the public health side such as the Universal Immunisation, Vector

Borne Diseases Control, and School Health Programme.

Universal Immunization Programme

5.19 The Universal Immunization

Programme was started in 1985 to protect

46

the children from vaccine preventable

diseases like diphtheria, pertussis, tetanus, poliomyelitis, tuberculosis and measles.

About 11 lakh Children are getting benefit under this programme. A second dose of

measles vaccine at the age of 18 months is introduced during the current year in

addition to the first dose given at the age of tenth month. In addition, 12 lakh pregnant

mothers are immunized every year with Tetanus Toxoid injection for prevention of

tetanus infection during delivery. Pentavalent vaccine was introduced in Tamil

Nadu from 21st December, 2011. Pentavalent vaccine gives protection against

diphtheria, pertussis, tetanus, Hepatitis-B

and Haemophilus influenzae-B. The newly added Hib will prevent life threatening

pneumonia and meningitis. Tamil Nadu is one of the two states selected by the

Government of India for introducing pentavalent vaccination. The main

advantages of giving pentavalent vaccination to the children include

protection against five life threatening diseases and fewer needle pricks to a child.

Pulse Polio Immunization (PPI)

5.20 For the eradication of poliomyelitis, Pulse Polio Immunization campaign was

47

introduced in the year 1995-96, which along

with efficient routine immunization coverage has successfully eliminated the dreaded

disease from the State. During 2013, two rounds of pulse polio immunization

campaigns have been conducted (on 20.01.2013 and 24.02.2013) as part of the

nationwide PPI campaign in order to prevent the importation of Polio virus and to sustain

the zero polio status.

Focus on Migrant Children

5.21 Immunizing the Migrant children is

essential to protect these children from polio and also prevent importation of polio.

Special initiatives are being taken to cover

the children living in temporary settlements and migrant population to protect the

children from Vaccine Preventable Diseases. Special polio rounds were conducted on

22.12.2012 and 23.03.2013.

Japanese Encephalitis (JE) vaccination

5.22 JE vaccination programme is being

implemented in identified endemic districts namely Cuddalore, Villupuram,

Virudhunagar, Madurai, Tiruvarur, Tiruchirapalli, Perambalur, Thanjavur and

Tiruvannamalai to prevent Japanese

48

Encephalitis especially among children under

the age of 15 years. Under the Acute Encephalitis Syndrome (AES)/Japanese

Encephalitis (JE) Preventive Scheme of Government of India, it is proposed to take

intensive immunization drive during 2013-2014. It is planned to extend JE

vaccination coverage to Karur and Pudukkottai districts during the current

year.

Impact of Immunization Programme

5.23 Due to successful implementation of

immunization programme, the State has achieved and is maintaining polio free

status since 2004. Neonatal tetanus

elimination status has also been certified by World Health Organization in 2006. The

incidence of diphtheria, pertussis and tetanus has become epidemiologically

insignificant. There is also a significant reduction in the number of measles cases.

Dr.Muthulakhsmi Reddy Maternity

Benefit Scheme

5.24 The State Government have launched a revised Dr. Muthulakhsmi Reddy Maternity

Benefit Scheme from 01.06.2011 by enhancing the maternity benefit to the poor

49

pregnant women mothers from Rs.6,000 to

Rs.12,000. The cash assistance is given in three installments on conditional basis and

restricted to two deliveries. From 1st October 2012, benefits under the scheme

are disbursed directly from Treasury to the bank account of the beneficiaries (ECS

mode). On an average, 6 lakh women benefit from the scheme every year. During

2012-2013, Rs.625.51 crore has been disbursed. For the current financial year, Rs.

720 crore has been allocated for this programme.

Hospital on Wheels Programme

5.25 385 Mobile Medical Units were

upgraded at a cost of Rs.40 crores with necessary additional manpower, laboratory

facilities and other diagnostic equipments to provide high quality medical care with focus

on Mother and Child Health Services, Communicable and Non-Communicable

Diseases covering all the remote villages and hamlets as per the fixed day fixed time

plan specific for each block. Fixed tour programme of the scheme is displayed in

the health department website. (www.nrhmtn.gov.in) Hon’ble Chief

Minister of Tamil Nadu has inspected one prototype vehicle developed for the Hospital

50

on Wheels Programme and approved the

same. 86 new vehicles are provided by the Government for this special programme.

The fabrication of 195 vehicles has been completed and vehicles have been sent to

the field. The fabrication work of the remaining vehicles is on. 385 Laboratory

Technicians will be appointed through Medical Services Recruitment Board (MRB)

for this programme. The entire field service of this programme is monitored through a

Public Private Partnership.

Promotion of Menstrual Hygiene

5.26 The Menstrual Hygiene Programme

was launched by the Hon’ble Chief Minister on 27.03.2012. Under this

scheme, 18 packs of sanitary napkins are being provided to school going and non

school going adolescent (10-19 years) girls in rural areas. Three packs are given for two

months (At six pads per pack). In every school in the rural areas, the designated

teachers are responsible to distribute the sanitary napkins to school students.

5.27 The Village Health Nurses along with

Anganwadi Workers are responsible for distribution of the sanitary napkins to the

51

girls who are not covered in the schools.

The objective of the scheme is to increase awareness among adolescent girls on

menstrual hygiene, build self-esteem and empower girls for greater socialization also

to increase access to the use of high quality sanitary napkins apart from ensuring safe

disposal of sanitary napkins. Sanitary Napkins to post natal mothers who delivered

in Government institutions at the rate of seven packs each (six pads per pack) has

commenced in three Health Unit Districts (Poonamallee, Tiruvallur and

Kancheepuram) and all the remaining districts will be covered soon. Sanitary

Napkins would also be given to each women

prison inmate at the rate of 12 pack (six pads per pack) per year and also to women

patients in Mental Hospital.

School Health Programme

5.28 School Health Programme is implemented in Tamil Nadu to provide

comprehensive health care services to all students studying in Government and

Government aided schools. Special emphasis is given to heart diseases, eye

disorders, nutritional disorders, skin diseases and dental problems. All Thursdays

52

are scheduled as School Health Days.

Students in need of higher medical treatment are referred to higher medical

institutions and Saturdays are referral days. Two teachers from each school are identified

and trained in identifying common illnesses of students for follow up action with the

doctors. During the last year, among the school students, 41,84,643 were treated for

one or other health problems and 32,669 referred to higher medical institutions for

further treatment.

Control of Communicable Diseases

5.29 Control of Communicable diseases is one of the foremost activities of the

Directorate of Public Health which is carried

out in close coordination with the local bodies. They have been described in detail

under the relevant programmes.

Water Analysis Laboratories

5.30 It is essential to monitor the quality of

water throughout the state to keep a tab on water borne diseases. The Water Analysis

Laboratories at Chennai and Coimbatore collect and examine water samples from

various protected water sources to monitor contamination of drinking water. These

53

laboratories also assist the Tamil Nadu

Pollution Control Board in examining samples of Industrial Wastes and conducting

field surveys to ensure the prevention and control of environmental and industrial

water pollution. Two more water analysis laboratories are being established in

Tiruchirapalli and Tirunelveli. Apart from these, Tamil Nadu Water Supply and

Drainage Board (TWAD Board) and Chennai Water Supply and Sewerage Board (CWSSB)

are also independently undertake water analysis regularly and follow up action is

taken.

Establishment of District Public Health

Laboratories

5.31 Laboratory services are an essential component of disease surveillance,

epidemiological surveys and operational research. The District Public Health

Laboratories are the backbone of the laboratory network in disease surveillance

programmes for the prevention and control of epidemic prone diseases. In view of the

emerging and re-emerging communicable diseases, the Government have issued

orders to establish District Public Health Laboratories (DPHL) in all the districts in the

District Headquarters to augment the disease control programmes. One

54

Microbiologist, One Laboratory Technician

and One Cleaner post have been sanctioned on contract basis in these labs to support

the disease control activities at the district level.

55

Chapter 6

FAMILY WELFARE

6.1 Government of India launched the

National Family Welfare Programme in 1951 with the objective of "reducing the birth

rate” to the extent necessary to stabilize the population at a level consistent with the

requirement of the National economy. The Family Welfare Programme in India is

recognized as a priority area, and is being implemented as a 100% centrally sponsored

programme. The National Family Welfare Programme is being implemented in the

state since 1956. The department

implements family welfare programmes in coordination with various related

departments. Tamil Nadu is considered as a pioneer in the implementation of the family

welfare programmes in the country. In view of commendable progress in reducing the

birth rate, the focus has shifted from a "Target based approach" to a "Community

Needs Assessment Approach” where importance is given to meeting the unmet

needs for family planning services and improving maternal and child health. This

has been achieved due to the strong social and political commitment and a robust

56

administrative setup. The National Family

Welfare Programme is being implemented through the following programmes for the

fathers and the mothers.

Providing permanent family welfare methods like Vasectomy, Tubectomy

and Laparoscopic Sterilisation

Providing temporary family welfare

methods like Copper-T insertion, Oral pill cycles and condoms for spacing

between births.

Medical Termination of Pregnancy

services are also available in government hospitals and approved

private nursing homes.

Emergency contraception.

Administrative Structure

Director

Deputy Director of Medical and Rural Health Services and Family Welfare

(in the districts)

Post Partum Centres in Government Hospitals.

57

Urban Family Welfare Centres

Urban Health Posts

Rural Family Welfare Centres(PHC)

Approved Nursing Homes

Voluntary Organisations.

Demographic Indicators

6.2 As already mentioned in the

introductory chapter of this policy note, Tamil Nadu is the seventh most populous

State in India. As per 2011 census, the population of Tamil Nadu is 7.21 crores with

decadal growth rate of 15.6 %. It accounts for 6 % of the country’s total population.

The demographic scenario of the state for 2011 (SRS) is furnished in Table No.6

below:

Table No.6 - Demographic scenario of Tamil Nadu – 2011

Sl. No

Indicators Current

level

1 Crude Birth Rate 15.9 / 1000

population

2 Crude Death Rate 7.4 / 1000

population

58

3 Total Fertility Rate

(2010) 1.7

4 Infant Mortality

Rate

22 /1000 live

births

5 Maternal Mortality Ratio *

73 /1,00,000 live births

6 Natural Growth Rate

0.85 %

* Based on the actual maternal deaths occurred in the State-2011 -12.

Goals

6.3 The Table No.7 shows the demographic goals fixed to be achieved by 2017.

Table No.7 - Demographic goals

Sl. No

Indicators Goals

1 Infant Mortality Rate <13 / 1000 live Births

2 Crude Birth Rate 14 / 1000

Population

3 Maternal Mortality Ratio 44/1,00,000

Live Births

4 Total Fertility Rate 1.6

59

5 Couple Protection Rate 65 percent

6 Reduction of Higher

Order Births <10 percent

Thrust areas and Strategies for

achieving the goal

6.4 Out of 10.8 lakh births occurring in the

State 9.6 % (2011) of the births are still Higher Order Births (HOB) i.e. one lakh.

The unmet needs under spacing methods

are 4.1 percent and permanent methods are 4.8%. The male participation under the

sterilization programme is less than 1%. Action will be taken to increase the male

participation to 10% under Sterilisation Programme. As per SRS 2011, the infant

mortality rate was 22 per 1000 live births. Among these infant deaths nearly 75% are

neonatal deaths and in coordination with all the other directorates steps would be taken

to further reduce it. In this background, the following strategies will be adopted to

achieve the goals proposed for the Twelfth Five Year Plan period.

i. Area specific approach will be adopted

to identify village wise eligible couples with three and above order of living

children and motivate them by a block

60

level team to adopt different methods

of contraception.

ii. At present 372 Operation theatres are

functioning in the Primary Health Centres. Steps will be taken to make

the remaining Operation theatres in the Primary Health Centres functional

in a phased manner.

iii. 1,930 private nursing homes have

been involved besides the Government institutions to provide

family welfare services in the State. The unapproved private nursing

homes which satisfy quality standards will be systematically approved to

render Family Welfare services.

iv. The Self Help Groups, Elected representatives and Non-Government

sector will be involved along with the Government to provide better Family

Welfare services to the eligible couples.

v. An effort will be made to train at least one MBBS doctor in each upgraded

PHC (which has a functioning operating theatre) in tubectomy

sterilization, Mini-lap and No Scalpel Vasectomy. These doctors will also be

trained in Manual Vacuum Aspiration techniques to provide safe abortion

61

services at the PHC level. Training in

Post Partum IUCD insertion has also been started to ensure that high risk

mothers are given a reliable form of contraception with their consent.

Activities undertaken by the

department

6.5 Post Partum Programme: The main

objective of the post-partum programme is to motivate the Eligible Couples to adopt

any one of Family Welfare methods through education and motivation particularly during

Antenatal, Natal and Postnatal period. At present, there are 110 Post-Partum Centres

functioning in Government hospitals in Tamil

Nadu to improve the health of mothers and children through maternal and child health

and Family Welfare Programmes. Nearly 35% of sterilization operations done in the

State are performed in these post-partum centres.

6.6 Urban Family Welfare Centres: There

are 108 Urban Family Welfare Centres functioning in the state to render Family

Welfare services in the small Municipalities of urban areas. These Urban Family Welfare

Centres have been classified into three

62

types based on the size of the population it

covers. They are rendering outreach services to the urban population.

6.7 Urban Health Posts: A special

programme of Urban Revamping Scheme to render outreach services has been launched

and is in progress. Under this scheme, 193 Health Posts of type ‘D’ covering 50,000

populations and above are functioning to provide Family Welfare & Maternal and Child

Health services in the urban slum areas.

6.8 Rural Family Welfare Centres: Family Welfare Programme is implemented in the

rural areas through the Rural Family Welfare

Centres attached to the Primary Health Centres. There are 382 Rural Family Welfare

Centres in the State. 372 primary Health Centres are functioning with Operation

Theatres to provide Sterilization Services to the Rural People. Nearly 25% of the total

sterilization operations done in the State are performed in Primary Health Centres. The

spacing methods like Intra uterine contraceptive device insertion, Oral pills and

Condom distribution to the eligible couples in the rural areas are supplied through

1,614 Primary Health Centres and 8,706 Health Sub Centres.

63

6.9 Medical Termination of Pregnancy

Programme: Medical Termination of Pregnancy (MTP) is a health care measure

which helps to reduce the maternal morbidity and mortality through the

provision of safe abortion services. The strategy for the provision of safe abortion

services includes the implementation of simple and safe technologies like Manual

Vacuum Aspiration (MVA) Technique which can be performed up to 8 weeks of

gestation in any institution with basic facilities. In the State, approximately

60,000 MTPs are performed in the Government and the private institutions

annually which include nearly 15,000 MVA

performances. To improve the safe abortion services, the Doctors and Staff Nurses

working in Government facilities are being given MVA training.

6.10 No Scalpel Vasectomy (NSV): To

encourage the participation of male and to propagate the awareness on NSV

technique, 192 NSV camps once in two months will be organized in District Head

Quarters Hospitals and Taluk Hospitals during the year 2013-2014 and a sum of

Rs.67.20 lakh will be allocated for organizing the camps.

64

6.11 Information, Education and

Communication (IEC): The sustained IEC activities on Family Welfare Programme in

the State have improved by creating awareness among the public to adopt “Small

Family Norm”. The National Family Health Survey-3 result reveals that awareness of

Family Welfare methods among masses in the State is universal. IEC activities are

being geared up through closed circuit T.V. System, Electronic Display, Wall paintings,

Press Advertisements and Innovative activities like erection of Hoardings,

Conducting Seminars, Workshops and Self Help Groups.

6.12 Participation of Non-Governmental Organizations: 27 Voluntary Organizations

and 1,930 approved private Nursing Homes in the State are also extending the Family

Welfare services and the contribution as a whole is 34.6%.

6.13 Group Insurance Scheme to

Sterilization Acceptors: The Government of India have renewed the family planning

insurance scheme in tie up with ICICI Lombard Insurance Company Limited with

effect from 1st January 2012 with the following insurance benefits for the family

65

welfare sterilization acceptors and service

providers. The benefits may be seen from the Table No.8.

Table No.8 - Group Insurance Scheme to Sterilization Acceptors

Death following

sterilization in hospital or within 7 days from the

date of discharge from the

hospital

Rs.2 lakh

Death following

sterilization within 8 to 30 days from the date of

discharge from the hospital

Rs.50,000

Failure of sterilization leading/non-leading to

child birth

Rs.30,000

Cost of treatment upto 60

days arising out of complication from the date

of discharge

Actual cost

not exceeding Rs. 25,000

Indemnity insurance per doctor per facility but not

more than 4 cases per Doctor in a year

Up to Rs.2

lakh per claim

66

6.14 Compensation to Sterilization

Acceptors: Compensation for loss of wages to the sterilization acceptors is being

implemented in the State as detailed below in Table No.9.

Table No.9 - Compensation to sterilization

Acceptors

Acceptors of male sterilization in public health facilities

Rs. 1,100

Acceptors of female sterilization

belonging to Below poverty Line and SC / ST in public health

facilities

Rs. 600

Acceptors of female sterilization

belonging to Above poverty Line

in public health facilities.

Rs. 250

Interpersonal Counselling to Higher Order Birth Mothers in the selected

Village Panchayat

6.15 As per the 2011 Delivery Report, the Higher Order Birth (3rd and above order of

birth) in the State is 9.6%. It has been

identified that the Higher Order Births are more than State average in 17 Districts.

As a new initiative, the interpersonal

67

counselling will be organized in 202 Blocks

and 30 Health posts where the Higher order Birth is more than 12.5% to create

awareness among the mothers about risk related to higher order birth and to reduce

the maternal morbidity and mortality and also to reduce the prevalence of more than

2 children to bring about the small family norms and to stabilize the population in

Tamil Nadu. The scheme will be implemented at a cost of Rs.23.20 lakh.

Training in Laparoscopic Sterilization

6.16 Eight Government Hospitals (Chennai,

Coimbatore, Dindigul, Thanjavur, Tiruchirappalli, Tirunelveli and Villupuram)

have been identified as training centres for

Laparoscopic Sterilisation. During the year 2013-2014, 12 batches of Laparoscopic

Training will be conducted in each centre. Totally 96 number of Doctors will be trained

along with operation theatre (OT) Nurses and OT Technicians in these training centres

and a sum of Rs.47.54 lakh will be allocated for these training.

68

Training in Mini-Lap Tubectomy

Sterilization

6.17 The untrained doctors in Mini-Lap Tubectomy Sterilization who are working in

Government Hospitals and Urban Health Posts will be trained in this procedure during

the year 2013-2014. Totally 100 Doctors will be trained and a sum of Rs.18.25 lakh

will be incurred for this training.

6.18 The family welfare department is a

critical department and continued thrust in this area would be needed for the State to

sustain the gains achieved so far.

69

Chapter 7

MEDICAL AND RURAL HEALTH SERVICES (Employees’ State Insurance Hospitals)

7.1 The Employees’ State Insurance

Scheme (ESIS) of Tamil Nadu has eight hospitals and 195 Dispensaries functioning

under the overall control of the Labour and

Employment department except for limited administrative purposes of placing the

personnel. The ESIS is divided into four regions and each region is placed under a

Regional Administrative Officer to manage the ESI Dispensaries in the respective

regions. In all the regions, Central Medical Store is functioning to supply the Drugs and

Dressing to the ESI Dispensaries.

Administrative Structure Director of Medical and Rural Health

Services (ESI)

Joint Director

Regional Administrative Deputy Director Superintendent, Medical Officers of ESI Hospitals Chennai, Coimbatore, Salem and Madurai

70

The details of the activities have been

brought out in the Labour and Employment department policy note.

71

Chapter 8

INDIAN MEDICINE AND HOMEOPATHY

8.1 India has a long tradition of various

systems of medicine. Even before the advent of the modern medicine, these

Indian Systems of Medicine (ISM) have been offering cost effective and sustainable

relief to all the sections of the society from various ailments without any adverse side

effects. The Siddha system of medicine illustrates the ancient wisdom and

knowledge of the Tamils to the world. Indian systems of medicine are gaining popularity

as a reliable health care system relief.

8.2 When there was an outbreak of Dengue

fever last year, the traditional medicines played an admirable role in treating the

patients affected with Dengue Fever and other similar viral fevers along with the

modern medicine as a complementary treatment. Thanks to the Hon’ble Chief

Minister’s directions, the Government issued instructions to all the Government

Hospitals of Modern Medicine in the State to provide the traditional medicines of

Pappaya Leaf Juice, Malaivembu leaf juice and Nilavembu Kudineer to the

72

in-patients admitted in the Government

Hospitals across the State. There has been overwhelming response from the public on

these initiatives.

8.3 The Government formed the “Department of Indian Medicine and

Homeopathy’’ in the year 1970. The Department is responsible for teaching as

well as for providing health care in five systems of Indian medicine viz., Siddha,

Ayurveda, Unani, Yoga & Naturopathy, and Homeopathy. This Department functions as

the nodal Department for the all round development of Indian Systems of Medicine

and Homeopathy in the State.

Administrative Structure

Commissioner/Director

Principals of Government Siddha,

Ayurveda, Homeopathy, Unani and Yoga and Naturopathy Medical

Colleges

State Licensing Authority (Indian

Medicine)

Government Analyst, Drugs Testing

Laboratory(Indian Medicine)

73

Superintendent, Govt. Arignar Anna

Hospital of Indian System of Medicine, Chennai

District Siddha Medical Officers

Government Siddha, Ayurveda, Unani, Yoga

and Naturopathy and Homeopathy Dispensaries

attached to Government Hospitals/PHCs and

Siddha wards in Government Hospitals

Objectives of the Department

8.4 The Main objectives of the department are:

i. Opening of ISM wings/Hospitals at

various levels in all the districts

ii. Development of educational

institutions in Siddha, Ayurveda, Unani, Yoga & Naturopathy and

Homoeopathy

iii. Encouraging the cultivation of

Medicinal Plants, processing and manufacturing of ISM drugs and

promoting research and development in ISM

74

iv. Making improvements to the

existing Government Indian System of Medicine and

Homeopathy Medical Colleges and thereby improving the standard of

Medical Education in these systems

v. Opening of new Medical Colleges in

these systems

vi. Encouraging research and

development programmes in these systems of Medicines

vii. Making arrangements to grow medicinal herbs and

manufacturing essential drugs

viii. Encouraging the growth of Centre

of Excellence in the field of Indian

medicine

ix. Improving the standard Medical

Education in Private sector

Currently the department has a sanctioned strength of 4,990 employees.

Medical Treatment

8.5 There are 1,375 total of ISM institutions

including the medical colleges in the State provide medical treatment under Indian

Systems of Medicine and Homeopathy, with

75

an inpatient capacity of 1,210 beds. Details

of the institutions under Indian Medicine may be seen from the Table No.10.

Table No.10 - Institutions under ISM

System Total

Siddha 1,047

Ayurvedha 100

Unani 65

Homoeopathy 107

Yoga and Naturopathy 56

Total 1,375

8.6 The brief details of the various

Hospitals/ Wings managed by this department are-

350 bedded Hospital attached to Government Siddha Medical College,

Palayamkottai, Tirunelveli 310 bedded Hospital attached to

Arignar Anna Government Hospital of Indian Medicine, Chennai

50 bedded Hospital attached to Government Homeopathic Medical

College, Tirumangalam, Madurai District 25 bedded ward in Government

Pentland Hospital, Vellore

76

25 bedded Siddha Wards in District

Headquarters Hospitals in the Districts of Erode, Nagapattinam, Dindigul,

Kancheepuram and Tiruppur 15 bedded Siddha Ward in Medical

College Hospital, Thoothukudi 16 bedded Siddha ward in District

Headquarters Hospitals in the Districts of Namakkal, Villupuram,

Virudhunagar, Tiruvarur, Karur, Sivagangai, Kumbakonam,

Tiruchirappalli, Nagercoil and Mettur 15 Bedded ward Siddha at Taluk

Hospital,Chidambaram, Cuddalore District

15 bedded ward Siddha at Non-Taluk

Hospital, Kadayanallur 15 bedded Siddha Ward in District

Headquarters Hospitals in the Districts of Ramanathapuram, Dharmapuri and

Cuddalore 100 bedded Ayurveda Hospital attached

to Government Ayurveda Medical College, Nagercoil.

Medical Education

8.7 Tamil Nadu is the only State in the

country where Government Medical Colleges have been established in all the five

77

disciplines of Indian systems of Medicine.

The total number of Government Medical Colleges of ISM and the number of ISM

Private Medical Colleges available in the State for Indian Medicines can be seen from

the Table No.11.

Table No.11 - Number of Government and Private Medical Colleges of ISM

Sl.

No. Medical System No. of colleges

Govt. Private

1 Siddha 2 5

2 Ayurveda 1 3

3 Unani 1 --

4 Homeopathy 1 8

5 Yoga & Naturopathy 1 4

Total 6 20

The Government Colleges are as follows-

Government Siddha Medical College, Palayamkottai, Tirunelveli District

Government Siddha Medical College,

Anna Hospital Campus, Arumbakkam

Government Yoga & Naturopathy Medical

College, AAGHIM campus, Arumbakkam

Government Homeopathy Medical

College, Tirumangalam, Madurai District

78

Government Unani Medical College,

AAGHIM Campus.

Government Ayurveda Medical College,

Kottar, Nagercoil, Kanniyakumari District.

Paramedical Human Resources

8.8 Indian Medicine and Homeopathy

Department is conducting the following para-medical courses:

i. Diploma in Nursing Therapy

ii. Diploma in Integrated Pharmacy

A new Diploma course in Integrated Pharmacy is being imparted in pharmacy

training and manufacturing practices in all

the disciplines of Indian Medicine (except Yoga & Naturopathy). In addition, a

diploma course in Nursing Therapy is being conducted for all disciplines of Indian

Medicine (except Homoeopathy). These two Diploma Courses aimed at promoting

Pharmacists and Nursing Therapists are being conducted at Arignar Anna

Government Hospital of Indian Medicine, Chennai and Government Siddha Medical

College, Palayamkottai, Tirunelveli. Number of seats available in the Government

Colleges and the Private Colleges for the

79

admission to the Under Graduate (UG) and

Post Graduate (PG) Courses of ISM are given in Table No.12.

Table No.12 - Number of seats

available in the Government Colleges and the Private Colleges

Sl. No.

Discipline

Details of Seats available for admission

Government Colleges

Private Colleges

Total

UG PG UG PG

1. Siddha 150 94 200 -- 444

2. Ayurveda 50 -- 160 -- 210

3. Homoeopathy 50 -- 400 24 474

4. Yoga & Naturopathy

20 -- 200 -- 220

5. Unani 26 -- -- -- 26

Total 296 94 960 24 1374

UG – Under Graduate ; PG-Post Graduate

The number of seats sanctioned for Diploma Course in Integrated Pharmacy and for

Nursing Therapy available are furnished in Table No.13.

80

Table No.13 - Number of seats sanctioned for Diploma Course in Integrated Pharmacy

and for Nursing Therapy

Sl. No.

Name of the Institution

Number of seats

Total Diploma in Integrated Pharmacy

Diploma in

Nursing Therapy

1. Arignar Anna Government Hospital of Indian Medicine,

Chennai

50 50 100

2. Government Siddha Medical College, Palayamkottai,

Tirunelveli

50 50 100

Total 100 100 200

Co-Location of ISM Wings in Government Health Facilities

8.9 At present ISM facilities are available in

30 District Headquarters Hospitals, 231 Taluk Hospitals and Non-Taluk Hospitals and

954 PHCs (including the 475 wings opened under NRHM).

Additionalities under National Rural Health Mission

8.10 NRHM has been separately covered in

detail in the chapter 12 under the State

81

Health Society. Some of the additionalities

under NRHM under the Indian systems of Medicine are briefly described below –

A total of four new schemes have been

approved under NRHM for this Department at an out lay of Rs.2.46 crore for the year

2012-2013. The total fund allocation for ISM for the fiscal year 2012-2013 from the

NRHM flexi-pool was Rs.17.65 crore details of which can be seen in the

Table No.14.

Table No.14 - Schemes approved for the

year 2012-2013 under NRHM

Sl. No.

Scheme Details Budget (Rs.

in crore)

1. Hiring charges for the Human Resources engaged (on going Scheme)

15.19

2. Information Education and 0.34

Siddha - 275

Ayurveda - 52

Unani - 40

Homoeo - 57

Y & N - 51

No. of NRHM Wings in PHC

82

Communication activities (New Scheme) at Rs. 2500 per ISM unit for all 1360 units

3. Training to all VHNs in Yoga and Naturopathy to impart yoga exercise to pregnant women for natural and safe delivery (New Scheme)

0.87

4. Provision of Kit Medicine to pregnant mothers during antenatal and postnatal period (New Scheme) through 370 PHC in the first phase

1.00

5. Networking the Commissionerate with District Siddha Medical Offices and the Colleges (New Scheme)

0.25

Total 17.65

State Drug Licensing Authority for Indian Medicine

8.11 Till 28-11-2007, licensing of Indian

System of Medicine drugs was with the

Department of Drugs Control. Now this is done by the State Licensing Authority

(Indian Medicine) with effect from 29.11.2007 as per Drugs and Cosmetics Act,

1940 and Rules, 1945. The District Siddha Medical Officers are the Drug Inspectors for

the purpose of implementation of the provisions pertaining to renewal of license,

inspection, sampling, and prosecution in respect of Siddha, Ayurveda and Unani

drugs.

83

Standardisation of ISM Drugs and

Strengthening of Drug Testing Laboratory

8.12 Its primary function is to test the

quality of the statutory samples lifted and sent by the Drug Inspectors and District

Siddha Medical Officers in discharge of their statutory function under section 33G of

Drugs and Cosmetics Act 1940. Advanced and modern equipment have been installed

in the Laboratory for the purpose of standardization and quality control of the

ISM medicines. The results of the test are given in Table No.15. It can be seen that

over the years more samples are being

lifted for testing.

Table No.15 - Results of the test

Year

Total No

of

Samples

tested

Standard

Quality

Not of

Standard

Quality

2009-2010 203 141 62

2010-2011 248 175 73

2011-2012 505 330 175

2012-2013 1,185 878 307

84

National Institute of Siddha

8.13 The National Institute of Siddha at

Tambaram, Chennai was inaugurated in the year of 2005 with the fund of State and

Central Government. The Capital expenditure is shared between Government

of India and the Government of Tamil Nadu in the ratio of 60:40 and the Revenue

expenditure in the ratio of 75:25 for the project period of 6 years as per the

understanding between the Government of India and the State Government. The

Institute is imparting quality Post Graduate education in Siddha apart from research

activities.

Tamil Nadu Medicinal Plant Farms &

Herbal Medicine Corporation Ltd., (TAMPCOL)

8.14 TAMPCOL was incorporated in the year

1983. TAMPCOL is currently manufacturing 92 ISM Medicines viz. 58 Siddha medicines,

26 Ayurveda medicines and 8 Unani medicines like chooranam, thailam, vennai,

kudineer, parparm, chenduram, lehiyam, tablets, capsules, syrups, etc. Nilavembu

Kudineer, an effective Siddha Sastric medicine in preventing and treating viral

85

fever including dengue fever has been

supplied to all ISM units in the State and TAMPCOL has played a significant role by

effecting timely supplies of medicines to all ISM Units. The Corporation has been

earning profit consistently. It is pertinent to note that it is supplying medicines to the

institutions under the control of Indian Medicine and Homoeopathy Department at

very nominal prices in the interest of general public as these medicines are issued

to them free of cost by the Government.

86

Chapter 9

FOOD SAFETY AND DRUGS CONTROL

ADMINISTRATION

Food Safety

9.1 To regulate all activities connected to production of food and food related

industries, the Food Safety and Standards Act, 2006 was enacted by Government of

India after repealing the Prevention of Food Adulteration Act, 1954. This act has come

into force in the entire country from 05.08.2011. Under the provisions of this

act, Tamil Nadu Food Safety and Drug Administration Department was created in

the State.

9.2 At State level, Commissioner of Food Safety Office has been created as the Head

office. All 32 revenue districts have Designated Officers under the Act. At the

field level, 584 Food Safety officers have been appointed (385 for each block-rural

area and 199 for Municipal areas).

9.3 The field officers have the primary responsibility of ensuring safety of food and

food related items in their areas of operation. As per this act, all Food Business

87

operators have to either take a license or

get a registration depending on their annual turnover. Food Business Operators with less

than Rs.12 lakh annual turnover have to register themselves with concerned Food

Safety Officers. Food Business Operators with greater than Rs. 12 lakh annual

turnover have to take license through the Designated Officers. The time for taking

license / registration has been extended till 4th February 2014 by the Food Safety and

Standards Authority of India. Till March 2013, 29,129 Food Business Operators have

taken the license and 2,03,889 Food Business Operators have registered

themselves with the Food Safety

Department. All the Designated Officers and Food Safety Officers have been given a 5

day training course to familiarize themselves about the provisions of the Food

Safety and Standards Act.

9.4 To test the quality of food, there are six Food Analysis Laboratories in Tamil Nadu.

They are located at Chennai (Guindy), Thanjavur, Madurai, Tirunelveli

(Palayamkottai), Salem and Coimbatore. All six laboratories have been notified as per

the act for testing the food related samples.

88

Drug control Administration

9.5 The Drugs Control Administration, which

was functioning as a separate Department with effect from 26.11.1981 with the

Director of Drugs Control as its Head of Department. It is now functioning under the

Tamil Nadu Food Safety and Drug Control Administration (TNFS & DA) Department,

under the overall administrative control of "Commissioner of Food Safety & Drug

Administration."

Administrative Structure. Commissioner of Food Safety and Drug Control

Food Safety

department

Director, Drugs Control

State Drugs Testing

Laboratory

Joint Director

Deputy Directors

89

Zonal Assistant Directors

Senior Drugs

Inspectors / Drug

Inspectors

9.6 There are 14 Zonal Offices (5 in the City

and 9 in the Moffusil areas) in the State, each headed by an Assistant Director of

Drugs Control who is the Licensing Authority for the Grant / Renewal of Sale Licences in

the zone. There are three posts of Deputy Director of Drugs Control and one post of

Joint Director of Drugs Control. There are 15 Senior Drugs Inspectors and 146 Drug

Inspectors in the department. 12 Senior

Drugs Inspectors and 140 Drug Inspectors in various Zones and three Senior Drug

Inspectors and six Drug Inspectors are positioned in the Office of the Director of

Drugs Control, Chennai. The Intelligence Wing, with a Mobile Van, is under the

charge of a Deputy Director of Drugs Control and three Drug Inspectors are part

of the Intelligence Wing. There is a Legal Adviser to handle legal issues.

9.7 Drugs Control Department, being a statutory body, performs a very important

role in supporting healthcare service

90

regulations and enhancing the safety of our

community. As a statutory body for Drugs Control, the department distinguishes the

massive challenges posed by spurious /adulterated /sub standard quality drugs,

selling drugs at excess pricing, misleading advertisements by some manufacturers and

dealers. The Drugs Control Administration has the prime mandate of enforcement the

following enactments for regulating the manufacture, distribution and sale of Drugs

and Cosmetics.

i. Drugs and Cosmetics Act, 1940 and

Rules, 1945

ii. Drugs Prices Control Order, 1995

iii. Drugs and Magic Remedies

(Objectionable Advertisement) Act, 1954

The officers of this department are also

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

Director of Drugs Control is the controlling authority and licensing authority for grant

and renewal of licences for manufacture (for sale) of Allopathic, Homeopathic medicines

and Cosmetics and also the licensing authority for the blood Banks in the state

along with the Central Licence Approving

91

Authority. For the implementation and the

enforcement of Drugs and Cosmetics Act, one Joint Director of Drugs Control, three

Deputy Directors of Drugs Control and one Assistant Director of Drugs Control

(Administration) are assisting the Director of Drugs Control. Drugs Control Department

monitors the quality, safety, efficacy and rational use of drugs at controlled prices,

collection and supply of safe blood and blood components, scrutinizing the

misleading advertisements to safeguard the interests of the unwary people. It draws

samples of Drugs and Cosmetics for the purpose of test or analysis to ascertain its

quality, purity and safety. It has a well

equipped statutory laboratory, to undertake the analysis. The total manpower available

in the Directorate is detailed in Table No.16.

Table No.16

i. Manpower details of Drugs Control

Administration

Sl.

No Name of the Post

No. of

Posts

1 Director of Drugs Control 1

2 Joint Director of Drugs Control 1

3 Deputy Director of Drugs Control 3

92

4 Assistant Director of Drugs

Control

15

5 Assistant Director of Drugs

Control (Administration)

1

6 Senior Drugs Inspector 15

7 Drugs Inspectors 146

8 Legal Adviser 1

9 Assistant Accounts Officer 1

10 Ministerial Staff 117

11 Office Assistant 79

12 Driver 4

13 Telephone Operator 1

TOTAL 385

ii. Manpower details of Drugs Testing Laboratory

Sl. No Name of the Post No. of

Posts

1 Government Analyst 1

2 Deputy Government Analyst 2

3 Senior Analyst 14

4 Junior Analyst 38

5 Junior Administrative Officer 1

6 Technician Grade-I 6

7 Technician Grade-II 4

8 Electrician Grade-I 1

9 Plumber 1

10 Laboratory Attendant 7

11 Animal Attendant 1

12 Ministerial Staff 10

13 Office Assistant 5

14 Sweeper 1

15 Sweeper-cum-Watchman 1

TOTAL 93

93

Functioning of Mobile Squad and Legal

cum Intelligence Wing

9.8 A Mobile Squad with its headquarters at Madurai and a Legal-cum-Intelligence

Wing in this Directorate attend to complaints relating to spurious drugs and

investigates specific complaints in Southern Region and in Chennai respectively. Apart

from this work, the Legal-cum-Intelligence Wing processes legal matters and

undertakes special investigations.

Drugs Testing Laboratory

9.9 Drugs Testing Laboratory attached to

this Department undertakes testing of samples, drawn by the Drugs Inspectors

(other than parenteral preparations) from various retail, wholesale Units,

manufacturing units and hospitals, private as well as in government sector.

Prosecutions Sanctioned

9.10 Prosecutions have been sanctioned for certain contraventions under Drugs and

Cosmetics Act, 1940 and other acts in 301 cases. The details can be seen from Table

No.17.

94

Table No.17 - Prosecutions for certain

contraventions under Drugs and Cosmetics Act, 1940 and other Acts

Sl.

No Details

No. of

cases

1 Spurious/Adulterated drugs for

having manufactured and sold

9

2 Not of standard Quality drugs

(manufactured and sold)

38

3 Other Contraventions under

Drugs and Cosmetics Act, 1940

and Rules, 1945

229

4 Contraventions under DMR (OA

Act) 1954

24

5 Drugs Price Control Order, 1995 1

Action Taken for Violation under Drugs

and Cosmetics Act and Rules

9.11 During 2012-2013, action was initiated

against 17 companies under the Drugs and Cosmetics Act / Rules.

95

Chapter 10

TAMIL NADU STATE HEALTH

TRANSPORT DEPARTMENT

10.1 The State Health Transport Organisation was started with six Mobile

Maintenance Units to look after the maintenance of Health Department Vehicles

in the year 1959. During the year 1971, Government of India with a substantial

financial assistance from UNICEF evolved an all India pattern according to which each

state would have a State Health Transport Organisation. From the year 1973, 15

Mobile Maintenance Units started

functioning under State Health Transport Organisation. Later, during the year 1981,

the above organization was made as a separate department for the effective

maintenance of Health and Family Welfare Department vehicles. During the Year

1995, this Department was converted as Tamil Nadu State Police Transport Workshop

to maintain the Police Department vehicles. Subsequently due to the persistent demand

of the Medical Officers, this Department was again revived and restored back to its

original form from 1.1.1997 and is till date functioning successfully to attend to all the

96

needs of Health and Family Welfare

vehicles.

10.2 The aim of the State Health Transport Department is to

Reduce the down time of the vehicles

which are taken up for repairs

Ensure high percentage of fleet utilization of vehicles

Provide more fleet for the successful implementation of health programmes

Keep more number of vehicles in good running condition and to conduct

periodical servicing, maintenance and to undertake all types of repairs

Register new vehicles allotted for the various wings of Health and Family

Welfare and to distribute them according to the allotment given by

the Head of the Departments

Suggest the suitability of vehicles to

Head of the Departments as per the

existing code rules and Government Orders

Advice the Unit Officers of Health and Family Welfare Department regarding

Fitness Certificate, getting Tax free

97

tokens, Transfer of Ownership etc. for

the vehicles under their control

Propose the vehicles for natural and

premature condemnation based on the report of Technical Expert Committee

of the Tamil Nadu State Health Transport Department

Conduct classes on fleet management, Tamil Nadu Departmental Vehicle

Control rules to Medical Officers and other staff at various Health Training

Centres

Impart Apprenticeship Training to

Degree, Diploma and ITI Certificate Holders

Supply of Batteries and tyres to the

Health and Family Welfare Department Vehicles

Administrative Structure

Director

a. Regional Workshops (7)

b. District Headquarters Workshops (9)

c. Mobile Vehicle Maintenance Units (29)

98

d. Reconditioning and Central

Body Repairing Unit (1) e. Mini Workshops (4)

Table No.18: Sanctioned staff strength

of the State Health Transport Department

Sl.

No. Name of the post

Sanctioned

posts (As on

31.3.2013)

1 Director 1

2 Deputy Director (Technical) 1

3 Deputy Director

(Administration)

1

4 Accounts Officer 1

5 Automobile Engineer 1

6 Technical Officer 1

7 Material Manager 1

8 Workshop Superintendent 7

9 Assistant Accounts Officer 7

10 Assistant Engineer 9

11 General Foreman 10

12 Ministerial Staff 87

13 Technical Staff 448

14 Office Assistant, Sweeper,

Watchman and Gardener

94

TOTAL 669

99

10.3 This department has made several

significant strides as it passed through different phases of its development. At

present, seven regional workshops, nine district workshops and twenty nine mobile

workshops, four mini workshops and one reconditioning unit are functioning under the

administrative control of this directorate. Currently, this department maintains 2,739

vehicles attached to the various Directorates of Health and Family Welfare Department

(as detailed below) and a three-tier structure is followed for the proficient

maintenance of vehicles.

Table No.19 - Directorate wise Fleets

Maintained (as on 31.3.2013)

Sl. No.

Name of the Directorate

No. of

vehicles maintained

1 Directorate of Public Health and Preventive

Medicine

1,586

2 Directorate of Medical and Rural Health

Services

347

3 Directorate of Medical

Education

256

4 Directorate of Family Welfare

462

100

Activities of Regional / District / Mobile

Workshops in brief

10.4 The seven regional workshops located at Chennai, Salem, Madurai, Coimbatore,

Tiruchirappalli, Tirunelveli, Vellore maintain a fleet of about 400 Vehicles each. Nine

district workshops at Chengalpattu, Dharmapuri, Virudhunagar, Udhaga-

mandalam, Erode, Thanjavur, Pudukkottai,

Nagercoil and Villupuram and 29 mobile workshops that are spread all over the State

are functioning to assist the regional

5 Directorate of Drugs

Control

4

6 Directorate of Indian

Medicine and Homoeopathy

8

7 Tamil Nadu State

Health Transport Department

53

8 Medical Services Recruitment Board

2

9 Directorate of Food

Safety & Drugs Administration

19

10 State Health Society 2

Total 2,739

101

workshops in maintaining all the vehicles in

an effective manner. The mobile workshop, based on their advance tour programme,

visits the hospital premises and takes up periodical servicing and executes minor

repairs, on the spot. If the nature of repairs in a vehicle is beyond the limits of the

mobile workshop, the required major repairs are executed in the nearby regional or

district workshop.

Functions of the Department

10.5 This department provides trouble free mobility for implementing various health

programmes. It also collects data related to the vehicles maintained by it. This

department also identifies obsolete vehicles

for their condemnation. During the year 2011-2012, 208 Ambulances and

30 Mortuary vehicles were identified and condemned. Further during important

Health care programmes like Pulse polio immunization, this Department deputes its

staff concerned to the office of the Deputy Director of Health Service to attend to break

down vehicles for successful implementation of the programmes.

102

Training Programmes

10.6 Apprenticeship training is also being imparted in this Department every year to

45 I.T.I. Certificate holders, 29 Diploma holders and 17 B.E. Graduates sponsored by

the different Government authorities.

Improvement in the performance

10.7 Several tools and machineries that are required for undertaking complicated repair

works have been installed in the Workshops attached to this Department. With these

facilities, the down time required to carry out the works have been drastically reduced

which in turn has facilitated in the early

delivery of vehicles. Computers have also been installed to expedite the activities of all

workshops of this Department. The performance of the workshops in terms of

fleet utilization, downtime of repairs, inventory control, man-hour utilization and

budgetary control has improved. The percentage of fleet in operation which was

72.6% in the year 1981 has progressively improved to 97%.

103

Chapter 11

MEDICAL SERVICES RECRUITMENT

BOARD (MRB)

11.1 In order to fill up the posts in a speedy manner, the Government has constituted a

separate Board namely ‘Medical Services Recruitment Board’ (MRB) which consists of

a Chairman, a Member and a Member Secretary. The MRB is in-charge of direct

recruitment (of all posts which are not coming under the purview of Tamil Nadu

Public Service Commission) of all Para Medical Staff including Nurses required for

the various departments functioning under the Health and Family Welfare Department.

11.2 Medical Services Recruitment Board conducts recruitment by obtaining seniority

list from the Employment Exchange, verifies their eligibility and declares results as per

seniority and communal rotation. MRB has so far recruited and filled up 18 posts of

Physiotherapist Grade – II, 63 posts of Skilled Assistant (Fitter Grade – II) and 29

posts of ECG Technician. Currently MRB is

finalizing the list of eligible candidates for 255 posts of Radiographer.

104

11.3 In addition, the Medical Services

Recruitment Board has been mandated by the Government to recruit 2,159 temporary

posts of Medical Officers including Speciality Medical Officers and Medical Officers

(Dental) through open advertisement. Accordingly, the MRB has published

notification for recruitment of Medical Officers on 31.03.2013 and is in the process

of conducting examination. Similarly, Government has also mandated recruitment

of nurses through open advertisement. The recruitment process for the nurses will be

initiated by the MRB, after the pending court cases are finalized.

11.4 Medical Services Recruitment Board is striving to improve and quicken the system

of recruitment of Health and Family Welfare Department.

105

Chapter 12

STATE HEALTH SOCIETY

12.1 The National Rural Health Mission

(NRHM) was launched in 2005 to provide accessible, affordable and quality health

services even to the poorest and remotest rural regions. The State has established

State and District Health Missions. The State Health Society, Tamil Nadu was

registered and all the District Health Societies have been registered under Tamil

Nadu Societies Registration Act, 1975. Integration of the multiple societies of

different national health programmes at

State and District levels, as envisaged under the NRHM has also been done.

Vision, Goals, Objectives of National

Rural Health Mission

12.2 Vision - ‘Healthy People – Now and in the Future.’

12.3 Goals of the Mission are

To provide accessible and affordable

health care based on people’s need

106

To deliver high quality of health

services

To improve the long term health

status of the population

To improve the management of health

services and make them more accountable to the people

12.4 Objectives of the Mission are

Reduction in Infant mortality and

maternal mortality

Universal access to public health

services - women’s health, child health, drinking water, sanitation and

hygiene, nutrition and universal

immunization.

Prevention and control of

communicable and non-communicable diseases

Population stabilization – Gender and demographic factors

Access to integrated comprehensive primary health care

Revitalizing local health tradition and mainstreaming ISM

Promotion of healthy life styles

107

State Health Society

12.5 To achieve the objectives of the mission, the State Government entered into

a Memorandum of Understanding (MoU) with the Government of India, stating their

agreement to the policy framework of the Mission and the timelines and performance

benchmarks against identified activities. The State Health Society, Tamil Nadu was

registered under the Tamil Nadu Societies Registration Act on 15.3.2006. Similarly all

the District Health Societies have been registered under the Tamil Nadu Societies

Registration Act, 1975. The first phase project period was for 7 years upto March

2012. The sharing pattern of the project

expenditure in the XI Plan is 85:15 between Government of India and State

Government. Government of India has extended the project in the XII plan period

with revised funding sharing pattern of 75:25 between GOI and State government.

The Programme Implementation Plan (PIP) for the year 2012-2013 has been approved

by the National Programme Coordination Committee (NPCC) of NRHM. The

components of National Rural Health Mission along with the scheme wise allocation

approved by Government of India under PIP

108

2012-2013 are given in the Table No.20

below:-

Table No.20 - Allocation under Programme Implementation Plan 2012-2013

Sl. No.

Name of the Programme under NRHM

Amount approved

(Rs. in

Crores)

Scheme: A

1 RCH Flexible Pool 438.55

2 Additionalities under NRHM (Mission Flexible Pool)

525.40

3 Immunisation – Total 15.90

Total (A) 979.85

Scheme: B

National Disease Control Programme

4 National Vector Borne Disease Control Programme

9.08

5 Revised National Tuberculosis Control Programme

17.71

6 National Programme for Control of Blindness

24.47

7 National Leprosy Eradication

Programme 2.28

8 National Iodine Deficiency Disorder Control Programme

0.24

9 Integrated Disease Surveillance

Project 1.10

Total (B) 54.88

109

Scheme: C

10 Infrastructure Maintenance(treasury

Transfer)(C)

298.14

Grand Total (A)+(B)+(C) 1332.87

For the year 2013-2014 it is anticipated that about Rs.1,400 crore will be approved in the

PIP. The funds for all the programmes are routed through the State Health Society at

the state level and the District Health Society at the district level. This has

contributed to the smooth release of funds to reach the field. Sub committees have also

been formed at the state level to facilitate coordination and policy planning under the

various components.

12.6 A short description of the various

important activities taken up under the first two components (RCH and NRHM flexi pool)

is given below. The activities carried out under the other components and disease

control programmes are discussed in the relevant Department of the Policy Note.

Reproductive and Child Health

12.7 The State has been providing a wide

range of Reproductive and Child Health

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Services including institutional delivery,

emergency obstetric care, safe abortions, family planning services and adolescent

health services in the rural areas as well as the small urban towns. There has also been

a thrust towards increasing the utilization of primary health centres through improving

the atmosphere and service in these centres. Due to these efforts there has

been significant fall in the major RCH indicators, viz. MMR and IMR.

Maternal Health

12.8 Delivery Care Services in all PHCs -

24 x 7 Hours: One of the remarkable

achievements after the introduction of the NRHM has been the manifold increase in the

number of the deliveries conducted in the PHCs. This has been made possible due to

the introduction of 24 x 7 hour delivery services in every PHC by posting 3 staff

nurses for rendering round the clock duty. The daily OP attendance and IP attendance

have also increased. This intervention has been implemented in all the PHCs and will

be continued in 2013-2014 at a total cost of Rs.40.22 crore.

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12.9 Janani Suraksha Yojana: Janani

Suraksha Yojana aims to reduce the maternal and infant mortality by focusing on

increasing institutional deliveries. This scheme is implemented in urban and rural

areas. An amount of Rs.700 in rural and Rs.600 in urban areas is paid to below the

poverty line mothers delivering in institutions for the first two live births. In

Tamil Nadu, the amount is given to the women after delivery, in addition to the

financial assistance under Dr. Muthulakhsmi Reddy Maternity Benefit Scheme of

Rs.12,000 per mother. This scheme has a provision of Rs.33.47 crore for the year

2013-2014.

12.10 Janani Sishu Suraksha karyakaram (JSSK): The scheme of

Janani Sishu Suraksha Karyakaram entitles every pregnant women and sick neonate

with free drugs, diagnostics, and diet for the duration of the stay, free transport from

home to facility, inter facility transfer and transport from facility back to home. The

scheme aims at reducing out of pocket expenses for pregnant women and sick

neonates.

12.11 Mobile Medical Units (MMU):

Mobile Medical Units have been provided to

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all the 385 blocks under NRHM and are

functioning since February 2009 under the control of the PHC Patient Welfare Societies.

Each Mobile Medical Unit visits 40 camp sites in a month as per fixed tour

programme and covers all unserved and underserved villages. Each Mobile Medical

Unit team consists of a Doctor and a Staff Nurse. Visits of MMU team are linked with

the Village Health and Nutrition (VHN) day. These MMUs have now been upgraded as

Hospital on Wheels with improved facilities in the vehicle and addition of lab services.

The Hospital on wheels project has been launched in all 385 blocks to provide basic

medical services at the door step of the

remote and far flung villages.

12.12 Provision of Second Medical

Officer in PHCs with Single Doctor: 213 PHCs in the State which were Panchayat

Union dispensaries and subsequently converted into PHCs had only one Medical

Officer. To make them function effectively in line with other PHCs, one more Medical

Officer has been placed in 163 PHCs in 2011-2012. The remaining 50 PHCs are

covered in the year 2012-2013. Rs.8.26 crore has been budgeted for this activity in

2013-2014.

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12.13 Integration of 402 Integrated

Counselling and Testing Centre (ICTC) Established under TANSACS in Block

PHC: There are 797 ICTCs spread across Government Medical College hospitals,

Government District head quarters hospitals, Taluk head quarters hospitals,

Government PHCs, prisons, corporation and municipal health posts, bus terminus,

railway stations and private hospitals established by TANSACS (Tamil Nadu State

Aids Control Society) out of which 402 ICTC units in the PHCs are funded by NRHM.

Rs.11.94 crore has been budgeted for this activity in 2013-2014.

12.14 Provision of feeding and dietary charges for Ante-natal mothers: AN

Mothers who stay for undergoing investigation like ultrasound scan etc., in

the PHCs are being provided with food during the Ante natal Clinics at the PHCs. To

maintain the extra facilities and to meet out the increasing demands of the ante natal

mothers attending the PHC, the PHCs are provided with extra amount based on the

number of deliveries conducted. This Scheme is under implementation during

2012-2013 with the Budget provision of Rs. 2.44 crore. This scheme has been

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budgeted at a cost of Rs.3.72 crore for

implementation during the year 2013-2014.

12.15 Observation of High Risk AN Mothers: Pregnant mothers who have been

diagnosed as high risk pregnancy will be admitted, in 30 bedded PHCs, well before

expected date of delivery, along with an attender for round the clock monitoring of

maternal and foetal well being and timely referral to appropriate higher facility, at a

total cost of Rs. 4.25 crore.

12.16 Placement of RMNCH counsellors: 172 Counsellors have been placed in 110

identified post partum centres to provide

counselling to mothers, on Reproductive, Maternal, and Neonatal and Child Health

Care. The scheme will be continued by further expanding it to 66 more institutions

in 2013-2014.

12.17 Provision of specialist services – Obstetricians, Anaesthetists for

Emergency Obstetric Care (EmOC): The lack of manpower in the FRUs has been

managed through hiring of Obstetricians and Anaesthetists for family welfare and

emergency obstetric care services. The Government/Private/Retired personnel are

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hired for the above services at PHCs and

District hospitals. Caesarean deliveries are also conducted in PHCs by hiring private

gynaecologists under RCH. In 2013-2014, an amount of Rs. 6.75 crore has been

budgeted to implement this scheme.

12.18 To hire super-specialists and diagnostic services, an amount of

Rs.4 crore has been budgeted for the year 2013-2014. Government of India approved

short term training courses for 24 weeks in Life Saving Anaesthesia (LSAS) and

Emergency Obstetrics Care for medical officers of primary and secondary health

care centres. Tamil Nadu is the leader in

conducting these courses which are used to meet this specialist gap. So far, 318

Doctors have been trained in LSAS and 52 Doctors have been trained in EmOC.

12.19 Maternal Anaemia Control

Programme: The prevention and control of maternal anaemia is a serious concern for

the State. Treatment guidelines (protocols) for implementation of moderate and severe

anaemia control programme have been introduced during the year 2010-2011 to

tackle this problem. This includes deworming for all pregnant women and use

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of injectable iron sucrose for cases of

moderate and persistent anaemia. An amount of Rs.3.00 crore has been

budgeted in PIP 2013-2014 for the continuation of management of maternal

anaemia using the protocol based intervention.

12.20 Gestational Diabetes Control

Programme: All PHCs have been supplied with Semi auto analysers. A scheme for

early detection of gestational diabetes using the Glucose Challenge Test approach has

been functioning at the block PHC level using the semi auto analyzers provided

under RCH. The scheme has been extended

to all PHCs using the services of trained staff nurses, wherever lab technicians are

not available, at a total cost of Rs.16.14 crore.

12.21 Ensuring blood safety-

Conduction of Community Blood Donation Camps, Establishment of

blood storage centres in all Upgraded PHCs: Provision of safe blood at the level of

First Referral Units is a priority area for reducing deaths due to post partum

haemorrhage which is a major cause of maternal mortality. With the inputs of

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NRHM, 268 CHCs have been provided with

blood storage facilities in phased manner till 2012-2013 to enable them to function as

First Referral Unit’s. Blood donation camps will continue to be conducted at the rate of

two per block. This will facilitate supply of sufficient quantity of all blood types to these

blood storage centres. In the year 2013-2014 the budget of Rs.75.87 lakh has

been proposed for conduction of blood donation camps and maintenance of blood

storage centres.

12.22 Maternal and Child Health (MCH) Centres: 42 Community Health Centres

have been identified at the rate of one

centre per HUD to function as level II Maternal and Child Health (MCH) centres

based on strategic location to offer higher level Maternal and Child Care. These centres

are being developed as comprehensive MCH centres to provide the RCH package of Ante

natal and post natal care, Emergency Obstetric Care, Safe Abortion Services,

Sterilization Services, Adolescent Clinics, Reproductive tract infections/ sexually

transmitted infectious disease management, Poison Management services etc., will also

be provided at these centres. 31 health sub centres in remote / difficult areas have been

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identified to provide Level - I MCH centres

with additional facilities.

Child Health

12.23 Comprehensive intervention to reduce neonatal deaths in districts with

high IMR: With the support of NRHM, the neonatal care and referral services in the

State have been strengthened by establishing Neonatal Intensive Care Units

(NICU) in the districts in phased manner.64 Neonatal intensive care units (NICU) have

been operationalised. All the Medical College Hospitals and the district head quarters

hospitals and 16 identified Sub District

Hospitals are providing NICU services. Nine trained staff nurses, three paediatricians /

trained Medical Officers are provided to each NICU/district and sub district hospitals to

ensure 24x7 care of the neonates in the NICU. Priority has been given for

standardized civil work as well as provision of inputs for housekeeping and security

services. An amount of Rs.22.15 crore has been proposed in 2013-2014 for funding the

recurring expenditure.

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12.24 Essential new born care services

at PHCs and new born stabilisation unit (NBSUs) at First Referral Units(FRUs):

The Government of India have provided norms (Indian Public Health standards) for

Child Care Service Units - New Born Corner (NBC), New Born Stabilization Unit- NBSU

and Sick Neonatal Care Unit –SNCU. As per the norms, New Born Corner has been

established in 1,421 PHCs with necessary inputs from NRHM in terms of equipments

and facility based training of health personnel. Provision of equipments to NBCC

in 73 new PHCs, 31 identified Level - I MCH centres and 135 new Urban Primary

Health centres was completed in the year

2012-2013. For essential new born care services at these Government Institutions

an amount of Rs.3.50 crore has been proposed for the year 2013-2014. In 42

level-II MCH centres and 114 FRUs - New born stabilization Units (NBSUs) are

established. A recurring cost of Rs.8.34 crore is proposed in the PIP 2013-2014.

12.25 Comprehensive intervention to reduce neonatal deaths in 15 blocks

with high IMR: A new strategy has been drawn for enhancing child care services with

a focused attention for reduction of neonatal deaths in blocks with high IMR. Paediatrician

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in each centre would be identified to

conduct weekly field visit / well baby clinics in the PHCs in the Blocks with high IMR.

These clinics will provide an array of diagnostic and preventive care services.

Anganwadi workers as Village Health Volunteers will be providing follow up

support for high risk babies discharged from NICU in the local setting for home based

new born care. The scheme is being implemented as a convergence activity with

Integrated Child development Services (ICDS). It is proposed to expand the

scheme in 20 more identified high IMR blocks in the PIP 2013-2014.

12.26 Capacity building for Health Care Providers in Prenatal screening to

detect foetal anomaly: Under this scheme, Medical Officers of 256 Upgraded

PHCs from all districts are provided hands on and online training of prenatal screening

to detect foetal abnormalities using ultrasonography. This scheme is being

implemented in partnership with the reputed private sector organizations who is

specialized in ultrasonography , through a custom designed software for prenatal

screening of foetal abnormalities in first, second and third trimester. Continuous audit

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of the images documented by trained

Medical Officers and refining their skills for a minimum period of one year from the date

of commencement is being done through these reputed organizations. Memorandum

of Agreement has been signed and training for all districts has been completed. This

training programme is being extended to another 232 centres (78 CEmONC centres

and 154 CHCs) for training two doctors/ centre at a cost of Rs.3.27 crore in

2013-2014.

12.27 Establishment of Early Intervention Centres in two Districts

(Pilot Project): Cuddalore and

Thoothukudi districts have been selected on pilot basis for establishing early intervention

Centres, in the allocated four Primary Health Centres per district. The children (0-3

years) identified by active screening with developmental delay / disability etc. will be

managed by appropriate Special Educator / Therapist at the Early Intervention Centres.

These centres are being provided with therapy equipments and manpower. The

NGO ‘Maduram Narayanan’ Centre has been nominated by the Commissionerate of

Differently abled as a mentor for Exceptional

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Children and consultant for this project and

MoU has been signed.

12.28 Managing Children with Malnutrition: Considering the high IMR

status for the past three years in the districts of Dharmapuri and Perambalur

(State HMIS data), the establishment of one Nutrition Rehabilitation centre (NRC) each at

the Medical College Hospital at Dharmapuri district and District Head Quarters hospital

of Perambalur district for management of children with severe malnutrition has been

approved in the last year plan. In the plan for 2013-2014 it has been proposed to

continue the scheme at a cost of Rs.63 lakh.

12.29 Strengthening of Infant death audit: The Infant death audit is being

conducted in two stages i.e. Verbal autopsy at the district level and Institutional audit in

the Medical Institution where the death occurred. Verbal autopsy is being conducted

by the Medical Officer in Rural and Urban area within 15 days of occurrence of death.

District Infant Death Audit Committee under the Chairmanship of district collector audits

selected infant death at district level and take appropriate action to rectify the

defects. A facility level committee in all SNCUs is investigating the events leading to

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Neonatal death as this constitutes the major

component of IMR.

Adolescent Health Programme

12.30 Control of Anaemia: Anaemia is a major concern among adolescent girls as it

leads not only to developmental deficiencies but also to increased maternal mortality.

Nearly 97% of adolescent girls in the state are anaemic. One of the major focus of the

RCH programme is towards adolescent anaemia control. The programme involves

distribution of one Iron and Folic Acid (IFA) tablet a week to all adolescent girls, both in

school and out of school along with biannual deworming. The IFA and deworming tablet

would be distributed through the school for

school going girls and through adolescent link workers for non school going girls.

School going adolescent boys will be included in the current year and the scheme

has been budgeted at a cost of Rs.22.51 crore.

12.31 Modified School Health

Programme: On a pilot basis Modified School Health Programme was implemented

in six districts of Cuddalore, Dindigul, Kancheepuram,Kanniyakumari, Thoothukudi

and Ramanathapuram during 2009-2010

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and four districts of Salem, Dharmapuri,

Tiruvannamalai and Tiruvarur during 2010-2011. The Modified School Health

Programme has been extended to the remaining 20 districts. The Scheme will be

implemented in all the districts in the coming academic year. 30,000 school

teachers and 600 health and education department officials have been trained

under this programme during 2012-2013. The implementation of the scheme for the

year 2013-2014 has been budgeted at a cost of Rs.13.63 crore.

12.32 Urban Health Programme: In the

urban areas, especially in smaller urban

towns, major lacunae exist in providing urban health services which is further

compounded by the ever growing urban population. The National Rural Health

Mission seeks to provide effective health care to these areas by establishing urban

primary health centre similar to that of rural PHCs. It is proposed to provide uniform

basic infrastructure and staff for these Urban Health Centres. With NRHM inputs

towards the cost towards the renovation and repairs of Urban Health Centres, rent

for Urban Centres, drugs, equipment, furniture’s, establishment of Urban Health

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Centres in 135 Municipalities has been

ordered. These centres have been brought under the administrative control of the

Director of Public Health and Preventive Medicine. It is proposed to cover 25 Town

Panchayats with Urban PHCs at a total cost of Rs.23.96 crore in 2013-2014. Urban

health programme is also implemented through 14 Medical colleges by adopting one

urban heath post from where the medical colleges are getting large number of primary

cases for the minor ailments with the view to reduce the case load. These Urban health

centres adopted have been provided with necessary equipments and materials.

Tribal Health

12.33 Village Health Volunteers - Accredited Social Health Activist (VHV-

ASHA) in 12 districts with tribal population: Despite a number of

interventions by the State Government, the vulnerable tribal community is still unable to

access basic health care. They continue to face a number of social, cultural, and

economic constraints. To promote and improve availability of basic health care

services to the tribal/ remote and difficult areas, 2,650 VHV - ASHA have been

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selected and placed. The training of VHV in

seven modules has been completed in collaboration with the NGO - SOCHARA and

two master trainers at the state level. An amount of Rs.3.17 crore has been proposed

for performance based incentives to 2,650 VHV in the plan for 2013-2014.

12.34 Establishment of Birth waiting

room: Out of the 34 tribal PHCs, 17 foot hill PHCs have been provided with Birth waiting

rooms. Antenatal mothers especially the high risk cases are brought to these waiting

rooms well in time prior to the expected date of delivery, to stay in a comfortable

atmosphere and have access to emergency

obstetric care. A scheme for providing diet to the antenatal mothers and one of their

attenders in tribal areas for 1 week of stay before the expected date of delivery is being

implemented at all tribal PHCs. An amount of Rs.1.48 crore has been budgeted in the

Current year to continue the scheme.

12.35 Mobile Medical Unit (MMU) in Tribal Areas: To reach the remotest

pockets, mobile medical services for outreach services with 20 MMUs are being

provided in 10 districts through NGOs in collaboration with Tamil Nadu Health

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System Project (TNHSP). In order to reach

those tribal areas which are inaccessible, supply of new four wheel drive vehicles

suitably equipped as ambulances were approved in 24 identified points in tribal /

hilly areas under NRHM. The amount proposed for supporting this scheme for

outreach services in tribal villages is Rs.5.76 crore.

12.36 Tribal Counsellors in 10

Government Hospitals: Tribal Counsellors have been appointed in 10 Government

Hospitals in the Tribal districts. These persons function as health activists in the

institution and create awareness on health

and its determinants. They motivate the community towards healthy living practices.

It is proposed to extend the initiative to another 32 Institutions in 2013-2014. The

total budget proposed is Rs.26.50 lakh for 2013-2014.

12.37 Repairs, Renovations and

extension of AN wards, PN wards, Labour room, Operation theatre etc. :

With surging institutional deliveries, there is an urgent need to provide larger space in

the PHCs to accommodate expectant mothers so that they stay in the health

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facility where they deliver for at least 48

hours post delivery. Hence under RCH, essential civil works for the PHC buildings

which need repairs, renovation and extension especially to provide facilities for

the additional delivery load are being provided. It is proposed to take up

extension and renovations to labour rooms, OTs, ante natal wards, post natal wards and

area extension to accommodate other specialized MCH care service and other

works in the current year also at a cost of Rs.21 crore.

Training and Human Resource

Development

12.38 Strengthening of Training

Centres: In Tamil Nadu, there are six training centres under the Directorate of

Public Health and 10 rural health training centres located in the PHCs where the ANM

trainees are trained. In view of the increased need for both pre service and in-

service training as a result of RCH/ NRHM initiatives, it is required to upgrade the

facilities available in these training centres. The facilities in the training centres will be

upgraded along with provision of skill labs for training and evaluation of field staff at

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cost of Rs.1.1 crores. 7 new ANM training

schools are proposed at a cost of Rs.18 crore.

Additionalities under National Rural

Health Mission (NRHM)

12.39 Placement of 4,200 Programmers specific VHV-ASHAs (Village Health

Volunteers - Accredited Social Health Activist) in non tribal areas: The State

has decided to position programmers specific Village Health Volunteers in HBNBC,

Leprosy, malaria and blindness control. Since these VHVs will be functioning in the

plain areas under the close supervision of

the VHNs, the guidelines for their job functions and incentive schemes are being

redesigned based on the programme needs which are relevant in these areas. The VHVs

will receive training and performance based incentives for the programmes for which

they are selected. This scheme will be continued in 2013-2014.

12.40 Patient Welfare Societies: Patient

Welfare Societies have been constituted in all the 1,614 PHCs, 18 Medical College

Hospitals and their attached institution, 30 District Headquarters Hospitals and 231

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Taluk / Non-Taluk Hospitals. All the societies

are registered and functioning effectively. These societies coordinate with health staff

for better functioning of the health Institutions by providing patient amenities

and bridging service gaps which will definitely facilitate achievement of the

objectives of NRHM. An amount of Rs.10 lakh per Medical College Hospital, Rs.5 lakh

per District Head Quarters Hospital, and Rs.1 lakh per Medical College attached

Institutions and Taluk/Non-Taluk Hospital, and Rs.1 lakh per Primary Health Centre, Rs

1 lakh per urban health centre per annum under this scheme is given every year. An

amount of Rs.25.78 crore is proposed in the

PIP 2013-2014 towards this scheme.

12.41 Annual Maintenance Grant to PHCs/HSCs/CHCs/DH/SDH/ Urban

PHCs /MCH and attached Institutions: An Annual Maintenance Grant of Rs.1 lakh

each is allotted to MCH/DH/SDH/PHCs and 30 bedded PHCs and CHCs providing

BEmONC and referral services to ensure quality services through functional physical

infrastructure. Similarly, an annual maintenance grant of Rs.50,000 for

other PHCs and urban PHCs is allotted per annum for provision of water, toilets, their

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use and their maintenance and other

activities which has resulted in the better functioning of the health facilities. Annual

Maintenance Grant of Rs.10,000/- is also provided per annum for the maintenance of

HSCs with own buildings. An amount of Rs.20.39 crore has been proposed for this

core activity in the year 2013-2014.

12.42 Untied grants to Health Facilities: Untied funds are given to all health facilities

to meet out unexpected, essential and immediate expenses towards day to day

maintenance. Flexibility is also given to the patient welfare societies for spending this

money based on actual requirement at the

field level. An amount of Rs.10,000/- is allotted as untied grant for each Health Sub

Centre per annum. An amount of Rs.25,000/- is allotted to each Primary

health centre and Urban primary health centre per annum. An amount of Rs

Rs.50,000 per annum is allotted to taluk and non-taluk hospitals and Rs.1 Lakh Per

annum to district head quarter hospitals.

12.43 Village Health Water Sanitation and Nutrition Committee (VHWSNC):

The village is the basic unit for assessing the health needs of the people and for

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developing village specific plans. Village

Health and sanitation Committees have been formed in all the village panchayats in

Tamil Nadu, with representatives of the Panchayat Raj Institutions, women’s groups

and other village level officials related to health and determinants of health such as

water and sanitation. Similarly village health and water sanitation committees have been

formed in town panchayats. Every committee is entitled to an annual untied

grant of Rs.10,000/- which will be used for improvement of the health and sanitation of

the village. The committee members have already been given training regarding the

village health activities. The financial

allocation proposed for these committees during 2013-2014 is Rs.15.07 crore.

12.44 Village Health and Nutrition Day

(VHN Day): The VHN day is conducted once a month by each VHWSC in one of the

Anganwadi Centres in the Panchayat by rotation. During this session, both the VHN

and the ICDS Anganwadi worker will offer joint services. A clinical session including

Ante Natal Care will be conducted in the forenoon by the VHN and IEC activities will

be conducted in the afternoon. The revised strategy for conducting VHN day has

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provided the health system with ample

opportunities to interact with the ICDS workers and disseminate/counsel/manage

the different substrata of the community based on their varying health needs. The

expenditure will be met from the PHC/HSC funds.

12.45 Infrastructure Upgradation in PHCs /FRU: Public Health Infrastructure

plays a crucial role in undertaking curative and preventive health care for the total

population of the State. In terms of physical infrastructure, a network of sub-health

centres, PHCs, CHCs, taluk /non-taluk and District Hospitals exist in the state. To

improve the overall health infrastructure,

several strengthening activities have been initiated in the State under NRHM.

A detailed facility survey has been conducted through Tamil Nadu Health

Systems Project for identification of infrastructure gaps in the secondary

hospitals, especially in view of the increasing patient load. Up-gradation of the

maternity and neonatal care services and provision of support services to improve the

overall functioning of the institution have been given priority. Provision of equipment

for the increased work load or replacement of old and obsolete equipment including

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major repairs of essential equipment will be

taken up as a part of infrastructure strengthening in selected FRUs and DME

institutions. Based on the facility survey, the civil works required in FRUs have been

taken up in 2012-2013. To strengthen the facilities with equipment, a cost of Rs. 14.72

crore for First Referral Units (FRUs) and Rs. 9.67 crore for tertiary care institutions was

budgeted in 2012-2013. The balance amount of Rs.28.73 crore is budgeted in the

current year PIP.

12.46 As part of the district planning

process, it is evident that there is a continuing need for infrastructure

upgradation in the PHCs due to increased

utilization of PHC services by the public. In addition to facilities like additional wards,

labour rooms and theatres, another major requirement is the construction of staff

nurse quarters to house the nurses providing 24x7 care in the PHCs, It was

decided in 2011-2012 that PHCs will be selected based on need and infrastructure

provided on a case to case basis on the requirements submitted by the districts. The

amount proposed for continuing this scheme in PIP 2013-2014 is Rs.21.00 crore.

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12.47 Quality Assurance Cell: A Quality

Assurance Cell with 4 wings-Maternal, Child Health, Quality Management and MCTS has

been established in the State Health Society to improve the Quality care services of PHCs

and closely monitor their services.

12.48 Mainstreaming of AYUSH: Mainstreaming of AYUSH is also one of the

strategies envisaged under National Rural Health Mission with an objective to improve

outreach and quality of health delivery in rural areas. The use of AYUSH has

expanded and gained popularity with the tremendous expansion. AYUSH is an

important component of primary health care

delivery in the State. 479 clinics have been well established in PHCs across the state.

During 2009-10, the AYUSH services were extended to another 300 PHCs and in 2010-

11 to 175 PHCs under NRHM due to the growing demand, bringing the coverage to

more than 60% of the PHCs. The amount proposed for the implementation of the

scheme in the current year is Rs.37.31 crore which includes a drug budget of Rs.5.24

crore.

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EMRI (Emergency Management

Research Institute)

12.49 The Government has signed a MoU

with EMRI Hyderabad to provide integrated Emergency Response Management Services

bringing together the departments of Health and Family Welfare, Police and Fire

Prevention. Emergency Management service is in operation from 15.09.2008 and an

Emergency Response Centre has been established at the Government Kasturba

Gandhi Hospital for Women and Children, Chennai. The scheme is being continued in

2013-2014.

Elderly Clinics

12.50 With the growing prevalence of non-

communicable diseases in the State along with a perceptible increase of elderly in the

community, provision of Geriatric services at the gross root level is the felt need of the

rural masses. Hence it is proposed to establish Elderly Clinic at each block PHC of

the state and the activity is budgeted at a cost of Rs.6.22 crore towards equipments

and running services of Physiotherapist.

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Dental Services in the Government

Institution

12.51 The Dental Units in rural area will raise the level of dental health awareness

and combine prevention with curative treatment among the rural population, with

their active participation, to achieve our goal of “Caries – free children” under NRHM.

At present 208 PHCs and 22 Taluk/Non taluk Hospitals are providing dental services for

three days in a week. This service has been extended to another seven Taluk Hospitals

and 58 UG PHCs. It has been proposed to extend the Dental Services to another 133

Upgraded PHCs at a cost of Rs.11.74 crore

during 2013-2014, thereby covering 399 PHCs in the State.

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Chapter 13

TAMIL NADU HEALTH SYSTEMS

PROJECT

13.1 Tamil Nadu Health Systems Project (TNHSP) is a World Bank assisted project

implemented since January 2005. The Project is being implemented in two Phases.

The Phase I of the Project was implemented from January 2005 to September 2010 at a

total Project cost of Rs. 597.15 crore. As the Project had completed all the activities

and spent the money well within the Project period, the additional financing was

provided for the project for continuation of

successful activities which were accomplished with success in areas such as

Maternal and Child Health, Improving Access and Utilization of Health Services by

the poor, Remote and Tribal populations in Tamil Nadu, Improving Quality of Health

Care and Improving Human Resource planning and capacity. In addition, the

additional financing was provided to scale up specific activities in addition which were

well performing including

(i) the state-wide expansion of the Non-Communicable Disease (NCD)

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prevention and control activities

which were piloted in two districts in the state of Tamil Nadu

(ii) the state-wide implementation of

the Hospital and Health Management Information Systems

(HMS & HMIS) in health facilities including tertiary care institutions;

and

(iii) the expansion of maternal and neonatal health services to the

tertiary level.

13.2 The Project interventions are to

enhance the overall development impact and effectiveness which is expected to serve

as a model for other states in India as they attempt similar health interventions and

reforms. The outcome indicators were designed to reflect two types of outcomes

expected as a result of additional financing.

(i) The consolidation of successful new modalities to reform the provision of

Health Care Services and improve health outcomes in Tamil Nadu.

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(ii) State-wide expansion of key services

and systems which can serve as models for other states in India.

13.3 The Phase II of the project is being

implemented at a total additional financing cost of Rs. 627.74 crore from October 2010

and is expected to close on 30th September 2013. The following are the components and

sub-components of the project;

Component 1: Increasing access to and utilization of service. This component

supports-

i. Reducing Maternal/neonatal Mortality

by supporting the effective ongoing operations of 80 Comprehensive

Emergency Obstetric and New born Care (CEmONC) Centres the

construction and equipping of higher maternity referral institutions at eight

medical colleges and the design and provision of various IEC materials;

ii. Improving Tribal Health through implementation of the Tribal

Development Plan in all identified tribal areas in 12 districts in Tamil Nadu in

order to increase access to health care among tribal populations and to

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strengthen existing primary and

secondary services in tribal areas through public-private partnership; and

iii. Facilitating use of hospitals by the poor and the disadvantaged through the

provision of effective patient counseling services, the provision of ambulances

and mortuary vans, strengthening of laboratories and financing

housekeeping services at selected Project hospitals.

Component 2: Non-Communicable Disease

(NCD) Prevention and Control. This component supports

i. Health Promotion activities for preventing Non-Communicable diseases

through school-based, work place-based and community-based health

promotion programs; and

ii. NCD Interventions throughout the state

of Tamil Nadu covering Prevention, Screening, treatment, and follow-up for

cervical & Breast cancer and cardiovascular diseases (Hypertension)

and Diabetes Mellitus through Clinic based, Work-place based, School based

and Community based interventions. In addition, the component would

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finance the salaries of female NCD staff

nurses contracted and placed at primary, secondary and tertiary level

facilities, wide spread IEC activities and supervision, monitoring and evaluation

of NCD interventions.

Component 3: Building Capacity for Health System Oversight and Management. This

component supports -

i. Strengthening Monitoring and Evaluation capacity of the Department

of Health and Family Welfare of Tamil Nadu by establishing a computerized

Hospital Management System (HMS) in

the remaining 222 secondary level hospitals in Tamil Nadu out of the total

270 hospitals as well as extending to selected Medical Colleges (tertiary level

hospitals and their attached hospitals;

ii. Improving Quality of Care through

continuous monitoring of quality of care, the provision, management and

training on rational use of drugs for hospital and Primary Health

Centre(PHC) staff; and enhancing the capacity for the hospital accreditation

process within the Department of

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Health and Family Welfare of Tamil

Nadu;

iii. Strengthening Health Care Waste

Management through extensive training on Infection Control and Waste

Management to all health personnel at primary, secondary and tertiary levels

of healthcare, and carrying out an impact evaluation of the

implementation of the Environment Management Plan;

iv. Capacity building for Strategy Development and Implementation by

expansion of the Directorate of Medical Services (annexe building), training of

doctors and TNHSP staff, supporting

the TNHSP Society by financing its operating costs, and supporting the

establishment of a data resource center.

Component 4: Improving Effectiveness and

Efficiency of Public Sector to Deliver Essential Services. This component

supports -

i. Equipment rationalization and strengthening of equipment and

pharmaceuticals management through the procurement of essential equipment

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and strengthening pharmaceutical and

equipment procurement, logistics, repair and maintenance system in the

Tamil Nadu Medical Services Corporation (TNMSC); and

ii. Human Resource Planning and Development by financing additional

contractual staff in project hospitals in order to improve overall efficiency and

performance.

During the year 2013-2014, it is proposed to undertake the following activities.

Improvement of Maternal and

Child Health

13.4 With a view to improve the maternal

and child health, the following activities would be undertaken –

Improvement of infrastructure to 24

hrs Comprehensive Emergency Obstetric and Newborn Care centres

(CEmONC).

Provision of equipment for operation

theatres and labour wards.

Coordination meetings will be

conducted with referral units to improve the referral system.

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Follow-up of referred out cases.

Conducting review of Maternal Mortality through video conferences.

Re-certification of CEmONC centres.

Training of Doctors and Nurses on

labour ward practices.

Fresh frozen plasma will be made

available in all CEmONC centres.

To establish Maternal ICU in all

CEmONC centres.

Untied fund of Rs.1.00 lakh per

hospital per annum will be provided to each of the CEmONC hospitals for

incidental expenditure.

Non-communicable Diseases

13.5 Cardio Vascular Diseases

Prevention and Control Programme: During the pilot programme conducted in

the districts of Virudhunagar and Sivagangai for a period of 30 months during Phase I of

the project, more than 12 lakh persons have been screened and of them 77,757 persons

have been found to be having hypertension and are now getting regular treatment in

Government Hospitals. Due to this, they have been prevented from getting serious

diseases like coronary artery disease,

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stroke, chronic renal failure etc. Emphasis is

being given for creating awareness in the community on modifiable risk factors

leading to cardio vascular diseases. The community is sensitized for life style

modification such as changes in food habits such as reduction of oil and salt in the food,

to maintain optimum weight for the height, to increase physical activity, encourage

walking and cycling, to stop smoking/ not to initiate smoking and stress management.

This programme is being implemented as a multi departmental activity involving

Education Department for school based activities, Labour and Employment

Department for work place based activities,

Rural Development Department for community based activities and Municipal

Administration Department for involving municipal hospitals and urban population.

Currently the programme is being implemented in 16 districts involving 973

Government institutions including Municipal /Primary/ Secondary/Tertiary care medical

institutions. During the financial year 2012-2013, out of 29,80,835 patients

screened for hypertension 2,29,838 hypertension cases were identified and

brought under treatment protocol. These patients will also be monitored during the

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follow-up for any complications due to

hypertension and will be treated appropriately.

13.6 Prevention and Treatment of

Diabetes Mellitus: In all the above 16 districts the patients attending OP above the

age of 30 years are also screened for the presence of Diabetes Mellitus. During

2012-2013, out of 13,33,534 patients screened for Diabetes Mellitus 59,583 cases

have been identified and brought under the treatment. These patients will also be

monitored during the follow-up for any complications due to Diabetes Mellitus and

will be treated appropriately.

13.7 Prevention and Treatment of

Cancer Cervix: During the Pilot programme which was implemented in Theni and

Thanjavur districts more than 4.70 lakh women were screened, of them 20,000 were

found positive for Cancer Cervix, and referred to higher institutions for

confirmation and further management. Therefore this programme was extended to

entire Tamil Nadu. During 2012-2013 in the 1st phase the screening for Cancer cervix

was initiated in 16 districts among 973 institutions. Out of 4,35,886 patients

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screened for Cancer Cervix, 19,143 cases

were found positive and referred to higher referral institutions for confirmation and

treatment. During the financial year 2013-2014, it is planned to implement this

programme in the remaining 16 districts. All the women attending the Out Patient

Department who are of 30 years and above are to be screened for cancer cervix.

13.8 Prevention and Treatment of

Breast Cancer: Under this programme all the women in the age group of 30 years and

above attending Out Patient Department are screened for Breast Cancer. Along with the

Screening and Treatment program for

Cervical Cancer, an early detection, and treatment for Breast Cancer is also being

implemented in all districts of Tamil Nadu in a phased manner. In this program all

women above the age of 30 years are taught about self breast examination and

are subjected to clinical breast examination, in all the Government health facilities. Those

women who are found to be having the problem are subjected to further tests and

treatment are provided in the tertiary care centres. During 2012-2013 in the 1st phase

the screening for Breast Cancer has been initiated in 16 districts among 973 number

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of institutions. Out of 8,87,555 patients

screened for breast cancer 8,563 patients were found positive and they were referred

to higher referral institutions for confirmation and treatment. During the

year 2013-2014 this programme will be implemented in the remaining 16 districts.

Health Management Information

System (HMIS)

13.9 Health Management Information System provides information based support

for the implementation of cutting-edge reforms by the Tamil Nadu Health Systems

Project. Apart from Primary Health Centers

and Secondary Care Hospitals, this project is envisaged to cover all the Tertiary Care

Hospitals including the Medical Colleges and Medical University. This is a combination of

Information Technology (IT) and Manage-ment Systems, to deliver improved evidence

based health care to the public at large. HMIS was started as Pilot project during the

year 2008 in five secondary care hospitals. Because of the encouraging results the

project was extended to Phase-1 during the year 2009 for thirty six hospitals in five

districts. Subsequently Phase-II activity commenced during the year 2010 for two

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Hundred and Twenty Two hospitals.

Currently we are in the completing stage of Phase II hospital implementation. Under

revised Phase III activities, HMS for 8 Govt. Medical College hospitals (only OP work

flow) Management Information System (MIS), College Management System (CMS)

and University automation for 17 medical colleges, 47 institutions under the Medical

Education Directorate and Tamil Nadu Dr.MGR Medical University have been

planned and SRS preparation is in progress. The total budget allocated for the pilot,

phase –I, II and III is Rs.128.40 crore. As on date, 265 out of 267 hospitals are

functioning with HMIS.

Provision of Modern Equipment to

Government Hospitals

13.10 Tamil Nadu Health Systems Project has provided following modern equipments

for the efficient health care delivery to the public -

Digital X-ray units with PACS, have

been provided in 23 Government District Head Quarters Hospitals, and

also in 7 Government Medical College Hospitals, at a cost of Rs.31.60 crore.

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Dialysis Machines with Reverse

Osmosis plant, have been provided in 16 Government District Head Quarters

Hospitals and also in 1 Government Medical College Hospital, at a cost of

Rs.2.38 crore.

Hepa Filter with AC system, have been

provided in 10 Government Secondary Care Hospitals getting prepared for

Accreditation by NABH, at a cost of Rs.83.61 lakh.

Pulse Oximeter with Adult and Pediatric probe has been provided in

119 Government Secondary Care Hospitals, at a cost of Rs.97.44 lakh.

Equipment for CEmONC services in

eight Government Medical College Hospitals: Maternity blocks are being

constructed in eight Govt. Medical College Hospitals and are nearing

completion. Anesthesia machines, Ultrasonograms with color doppler,

Echocardiograms with color Doppler, New Born Ventilators etc will be

provided to these Hospitals at a cost of Rs.14.59 crore.

Mammography Unit will be provided for 30 Government District Head

Quarters hospitals at a cost of Rs.6.40 crore.

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Setting up of Hospital Accreditation Cell

13.11 Twelve Government Hospitals are

being prepared to obtain certification under National Accreditation Board for Hospitals

(NABH), a unit of the Quality Council of India. Of them two hospitals have secured

NABH accreditation, and in another hospital the final assessment was over and the result

is awaited. In the remaining nine hospitals pre-final assessment is over and the

hospitals are being prepared for final assessment. An Accreditation cell is set up

to facilitate accreditation of hospitals. The cost involved in the above activity including

other quality of care improvement activities

is Rs.3.47 crore.

Poison Treatment Centres

13.12 Tamil Nadu Health Systems Project has established Poison Treatment Centres in

66 Government Hospitals which save many patients who are brought to the centres due

to snake bite and poisoning. During the current year, 35,972 patients were admitted

and treated in these centres out of which 35,389 people got cured. These centres

play useful role in bringing down the death rate due to poisoning.

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Emergency Ambulance Services

13.13 The 108 ambulance service is under

operation in Tamil Nadu through PPP mode by signing an MOU with EMRI, Hyderabad.

At present 629 vehicles are in operation with 6,34,364 beneficiaries. Apart from

providing emergency services inter facility transfers between secondary care

institutions to tertiary care institution for specialty care treatment, patients are being

transported through Advanced Life Support (ALS) ambulances irrespective of distance.

These ambulances are fitted with life saving equipments. To provide care during transit

trained staff nurses are posted. The staff

nurses will manage the case in consultation with the physicians at Emergency Response

Center in transit. Also to save sick new born babies who require specialty care at tertiary

care institutions, specially designed neo-natal ambulances with equipment are under

operation in Chennai, Kancheepuram, Cuddalore, Dharmapuri, Madurai and

Vellore. To provide continuous care during transit, one trained staff nurse is posted in

this ambulance. During this financial year Rs.69.64 crore is provided by Government

of Tamil Nadu to operationalise this programme. It is planned to induct more

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vehicles into the system so as to make the

fleet strength to 714 including 29 neo natal ambulances and 54 four wheel drive

vehicles for hilly and coastal areas to cover all the uncovered areas.

Tribal Health Development

13.14 The Project has been operating 12

Mobile Out-reach health services in Tribal areas through NGOs during the Phase I of

the Project. This programme is extended by addition of eight more teams making a total

of 20 teams. During the current year 10,927 number of trips were made to the

tribal areas and 2,84,605 persons were

treated. Tribal Counsellors

13.15 There are 42 Tribal Counsellors employed in Government Hospitals and

Primary Health Centres in the tribal areas to help the tribal people accessing these

institutions for treatment. During the current year, 4,29,227 persons were

benefitted by this programme.

Mortuary Van Services

13.16 The Government is providing Free

Hearse (Mortuary) service in all the

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Government Medical Institutions to

transport the deceased from Government Medical Institutions to their destination or

cremation ground. This programme is being implemented in partnership with Indian Red

Cross Society, Tamil Nadu Branch on PPP mode since 2011. At present 132 vehicles

are in operation in all the Government Medical College Hospitals, District Head

quarters and some of the Taluk hospitals. So far 45,827 number of bodies have been

transported to their hometown / cremation ground within the state and adjacent states

also. Government has allotted Rs. 18.95 crore during this financial year. It is

planned to increase the fleet strength to 180

to cover all the Government Medical institutions during 2013-2014.

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Chapter 14

TAMIL NADU MEDICAL SERVICES CORPORATION

14.1 Tamil Nadu Medical Services

Corporation (TNMSC) established in 1994, under the Companies Act, 1956 ensures the

availability of drugs and medical supplies to all the Government Medical institutions and

Primary Health Centres. TNMSC’s role encompasses procurement, storage,

distribution and quality control of drugs, medicines, surgical and sutures. It draws

up a list of essential drugs, procures and organizes their storage at different points

and distributes these to the health facilities.

TNMSC maintains drug warehouses throughout the State. The health facilities

draw their requirements from the warehouses through an indenting system on

a pre-determined schedule. Each facility is given an annual fund allotment for indenting

drugs from the warehouse to avoid over drawal of supplies and this is monitored

through a pass Book issued to each facility. The system is, however, not rigid as the

facilities have the freedom to seek additional allotment at times of emergency.

The entire operation of TNMSC is

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computerized and through the computer

network it monitors, on a daily basis, drug flows and stocks at all its warehouses.

14.2 Over the years, TNMSC has built a

network of warehouses across the State which has helped the State to minimize the

out of pocket expenses for the patients visiting the government medical institutions.

TNMSC also plays a vital role in procuring and maintaining high-end equipments

including CT/MRI Scan Centres at various Government Hospitals and payment wards

at Rajiv Gandhi Government General Hospital, Chennai and IOG, Chennai etc.

TNMSC has extended the ambit of its

operations to the medical facilities in Police, Prisons, Juvenile Homes, Transport

Corporations, Veterinary Department and Cooperative Institutions also. TNMSC also

established MRI centres in some of the teaching hospitals and CT scan centres in

several Government Hospitals providing diagnostic services on payment basis; the

charges being at a lower rate than the private investor-owned centres. TNMSC is

the agency to procure equipment and accessories to all the Health facilities in the

State and to manage maintenance system for major equipments. The major activities

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include procurement, storage and

distribution of Drugs.

Procurement

14.3 Essential Drugs and Medicines, specialty drugs and surgical and suture

items from reputed manufacturers are procured through a transparent tender

process. In addition drugs and chemicals for the Animal Husbandry Department are

procured by the TNMSC. The Warehouse-wise requirement of drugs, placing of supply

orders and distribution of drugs is monitored online by use of Information Technology.

TNMSC is an ISO 9001:2008 Certified

Organization. Under the scheme ‘Pudhuyugam”, procurement and supply of

Beltless napkins for implementation of menstrual hygiene programme for

adolescent girls in rural areas is being done. The Government has allotted Rs.55 crore for

the scheme under the Public Health head of account.

Storage and Distribution

14.4 The Government medical institutions

are provided with pass books based on the allotment made by the respective Head of

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Departments to enable the institutions to

draw their requirement of drugs and medicines from the warehouses to which

they are attached. The Corporation maintains six months’ physical stock in the

warehouses and two months’ stock in pipeline for ensuring uninterrupted supply of

medicines to hospitals.

Quality Assurance

14.5 Quality Control is essential to ensure the quality of drugs procured. To ensure the

quality of drugs the Quality Control Wing draws samples from each batch of supply

and get them tested in empanelled

analytical laboratories, selected through transparent tender system. Only the drugs

which pass quality tests are issued to Hospitals. The quality control measures are

being upgraded to meet the new challenges in the field to improve the quality.

Other Activities

14.6 Operation of CT and MRI Scanners

and Lithotripsy Machines: A network of 48 CT Scanners including one 128 slice CT

Scanner and 2 nos. of 64 slice CT scanners have been established in 41 Centres in

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Government Hospitals. The Corporation is

collecting nominal user charges at the rate of Rs.350/- per scan for in-patients and

Rs.500 per scan for out-patients with an extra charge of Rs.200 for contrast scan.

The Corporation is also maintaining 10 MRI Scanners and providing scanning facility

to the public at a nominal charge of Rs.2,500 with an extra charge of

Rs.1,500/- for contrast scan. The Corporation is also maintaining two

Lithotripsy machines, one each at Rajiv Gandhi Government General Hospital,

Chennai and Government Rajaji Hospital, Madurai. A nominal fee of Rs.5,000,

Rs.4,500 and Rs.4,000 is fixed for first,

second and third sitting respectively for this treatment. TNMSC Limited has now

replaced the existing 10 numbers of CT Scanners which are old and also the

work of installing eight more CT Scanners in Taluk hospitals is in progress. MRI Scan

have been installed in the Medical College Hospitals at Kilpauk, Chennai and

Villupuram and are functioning. The installation of two more MRI Scanners at

Government Medical College Hospitals at Dharmapuri and Chengalpattu are in

advanced stages.

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14.7 Providing logistic support to

payment wards: TNMSC is providing logistic support to the pay wards at the

following hospitals and acts as Custodian of Funds for these Centres.

i. The ISO 9001 certified Liver

Transplant Centre in Government Stanley Hospital, Chennai.

ii. Maternity Pay ward in IOG, Egmore, Chennai.

iii. Maternity Pay ward at Kasturba Gandhi Hospital for Women and

Children, Chennai established.

iv. Pay wards at Rajiv Gandhi

Government General Hospital,

Chennai.

v. Master Health Checkup Centre at Rajiv

Gandhi Government General Hospital, Chennai.

The proposal for handing over these to the respective institutions is under consideration

of the Government.

14.8 Regional Diagnostic Centres: The Corporation is also maintaining the Regional

Diagnostic Centres at seven Government Headquarters Hospitals at Villupuram,

Virudhunagar, Tiruvannamalai, Tiruppur,

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Ramanathapuram, Namakkal and

Pudukkottai.

14.9 Construction of Warehouses: TNMSC operates modern Drug Warehouses

at 25 convenient locations i.e. at the District Headquarters of Tamil Nadu. Action is being

initiated to construct five more warehouses at Perambalur, Krishnagiri, Namakkal,

Nagapattinam and Tiruppur.

14.10 Purchase and Supply of Medical Equipment: Specialized and high

technology medical equipments, required for all the Government Hospitals are procured

and supplied by TNMSC based on specific

Government Orders. Further, TNMSC is the procurement agency for Tamil Nadu Health

Systems Project, aided by World Bank. The World Bank is actively considering engaging

TNMSC as an authorized procurement agency in respect of procurement of Drugs

and Medicines, Equipment for their projects in other States.

14.11 Consultancy Services: TNMSC is

a well known brand name in Drug Logistics and Warehousing for the whole country.

Many States in the country are emulating the methodology followed by this

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Corporation. TNMSC has rendered

consultancy services for the Health and Family Welfare Department, Government of

Andhra Pradesh and Rajasthan. For the State of Madhya Pradesh, TNMSC has

rendered consultancy services for two years for the procurement activities both for drugs

and mmedicines. The Government of Chattisgarh is requesting to extend the

support as is being done for Government of Madhya Pradesh by the TNMSC. The

Corporation has been receiving a number of delegates from all over the country and

abroad to emulate and replicate the TNMSC model. TNMSC is constantly striving to

improve the system and delivery.

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Chapter 15

TAMIL NADU STATE AIDS CONTROL

SOCIETY (TANSACS)

15.1 Tamil Nadu has been a front runner in managing (Human Immuno Deficiency

Virus) HIV / (Acquired Immuno Deficiency Syndrome) AIDS. State AIDS Project Cell

was started in January 1993. This cell was converted as Tamil Nadu State AIDS Control

Society (TANSACS) during May 1994. Initially the HIV/AIDS was rising and it

reached 1.13% in 2001. With active co-ordination of Government health system

and various supporting units like NGOs and

CBOs, TANSACS has been able to reduce it to 0.25%.

15.2 Since 2011, TANSACS is working to

achieve the aim of “Getting to Zero – No new infection, No HIV/AIDS related death,

No HIV/AIDS related Stigma and Discrimination”. TANSACS is funded by

National AIDS Control Organisation (NACO) and the fund allocated for 2013-2014 is

Rs.75.28 crore.

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The basic components of TANSACS activities

are as follows:-

Prevention of New Infections

Care, Support and Treatment

Strategic Information Management

System

Prevention of New Infections

15.3 A multipronged approach is used to ensure that all sectors of population are

covered by access to services and necessary information is provided to prevent HIV

infection. The following schemes are being implemented to ensure prevention of new

infections.

ICTC (Integrated Counselling and

Testing Centres)

15.4 ICTC is the initial contact point for HIV/AIDS related services. These centres

are located at Medical Colleges / Government Hospitals / Primary Health

Centres. A novel approach of Private Public Partnership (PPP) has also been started and

many private hospitals are now part of this network. To cover the remote areas, 17

mobile ICTC Vans equipped with all relevant facilities are being utilized in various

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districts. At present, there are 1,471 ICTCs

in the State, which provide counseling and testing.

PPTCT (Prevention of Parent to Child

Transmission)

15.5 One of the major routes of HIV

transmission is through Parent-to-Child transmission. This Programme aims to

provide prevention, care and treatment intervention to all pregnant couples with a

package of services. HIV positive women are given ARV prophylaxis /treatment to

reduce the transmission of HIV virus. The new born baby is given ARV prophylaxis.

Intensive training has been given to the

concerned medical personnel to ensure that this scheme is extended to all mothers.

The budgeted expenditure for 2013-2014 for ICTC is Rs.17.25 crore.

Sexually Transmitted Infection (STI) Services

15.6 156 designated Sexually Transmitted

Infection (STI) / Reproductive Tract Infection (RTI) clinics are functioning under

Tamil Nadu State AIDS Control Society including Chennai Corporation AIDS

Preventive and Control Society (CAPACS).

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These clinics are branded as "SUGA VAZHVU

MAIYAM" (SURAKSHA- Well being clinics) functioning in Government Medical Colleges,

Government Headquarters Hospitals & Government Hospitals. Medical Officers,

Staff Nurse and Lab Technician from each hospital are trained on STI/RTI treatment,

care and follow up and condom promotion & partner treatment. They treat the STI cases

using syndromic case management approach using colour coded drug kits.

Targeted Intervention

15.7 The targeted intervention is aimed at

bringing the behaviour change among specific population groups whose risks of

contracting HIV infections is high. In the

State, the focus is on Female Sexual Worker (FSW), Men having sex with Men (MSM),

(Intravenous Drug Use) IDU, Truckers and Migrants. This programme is implemented

through the Non-Governmental Organizations (NGOs) / Community Based

Organizations (CBOs). At present 92 NGOs are functioning & approximately 75465 High

Risk Group (HRG) population is covered. During the 2013-2014, Rs.14.38 crore has

been budgeted for these intervention projects.

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Link Workers Scheme

15.8 This Scheme is implemented in 21 districts, predominantly in rural areas to

cover the high risk & vulnerable population. For 2013-2014, Rs.5.68 crore are budgeted

for this scheme.

Condom Promotion

15.9 Condoms are the most effective means

for prevention of HIV infection among high risk and general population. TANSACS

provides free condoms to people through NGO’s, STI clinics, ICTC / ART Centres and

other outreach programmes. During 2012-2013, approximately Rs.4.77 crore of

condoms were distributed.

Blood Safety

15.10 It is essential to provide

adequate, safe & quality blood and blood component supply to meet the need of

patients. In the State there are 274 blood banks (85 Government, 9 Central

Government, and 180 Private). Apart from these blood banks, there are 253 Blood

Storage Centres (Government 196 and Private 57) where only the storage facilities

are available. To ensure safe blood,

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Voluntary Blood Donation is promoted and

94% of all collected blood comes from Voluntary donors. To optimally utilize the

blood, the use of blood components is being encouraged. There are 86 blood component

separation units in the State (15 in Government sector, one Central

Government and 70 in Private sector). During the year 2012-2013, 6,92,000 units

blood were collected in Tamil Nadu.

Information, Education and

Communication (IEC)

15.11 To prevent new HIV infections, it is essential that awareness is created

among the general population and the high

risk group. IEC campaigns aimed at general population are designed to educate the

public about the basic details related to various aspects of HIV/AIDS. Among the

high risk groups, the awareness campaigns aim for motivating them for behavior

change. Various formats of media and various strategies are used to disseminate

messages to different audiences to create a demand for using the health services & for

following safe practices like condom usage. Mass media is used to provide general

messages to the whole population. Television, Radio and Print media is used

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through Advertisements, Talk shows, Long

format programmes etc. Two Mobile IEC vans are operated to take the HIV/AIDS

related messages to remote areas where other channels may not have adequate

reach. These vans utilize Audio-visual aids, pamphlets, posters etc. to provide

information. Red Ribbon Club is a major strategy to cover a large number of youth in

the State. At present 2,387 Colleges have Red Ribbon Clubs and they work on the

aspect of risk perception and behavior change through behavior change

communication. Life Skill Education Programme provides information related to

HIV/AIDS to the adolescent group. It has

been implemented in 10,006 Schools with 18,000 trained teachers and 20,012 Peer

Educators. (Two Peer Educators per school). Other IEC activities include Static

advertising like hoardings, Bus Panel brandings apart from organization of specific

events like Blood Donation Day and World AIDS Day. A large number of Government

Departments are being given awareness training to ensure that they are sensitized

about all the aspects of HIV/AIDS. For this financial year 2013-2014, an amount of

Rs.10.20 crore is allocated for all IEC activities.

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Care, Support & Treatment

15.12 With proper care & treatment, a person with HIV can live a normal life.

Towards this, Government provides various facilities to improve the quality of life of

people living with HIV/AIDS. The main activities are as follows:-

Anti-Retro Viral Therapy (ART)

15.13 ART provides medicines to inhibit the replication of HIV Virus and to

reduce the chances of other infection. Proper ART regimen significantly improves

the quality of life of the person with HIV infection. Free screening facilities for CD4

tests are provided at ART centres & all

eligible persons are provided free ART drugs. Counselling Services are also

provided before and during the treatment. At present there are 44 ART centres. Apart

from the main ART centres, there are 99 Link ART Centres which provide regular

medicines to PLHIV. 68,090 persons are taking regular ART medicines through these

centres. Community Care centers are short stay home supported by TANSACS

which provide treatment for minor opportunistic infections on IP and OP basis,

Counselling, outreach for ART adherence

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and home based care for people living with

HIVs (PLHIVs). 29 Community Care Centres (CCC) are currently functional in the State

which is run by NGO's and CBO's.

Strategic Information and Management System (SIMS)

15.14 SIMS is a web based integrated

Monitoring and Evaluation Service where all the units of TANSACS report through this

system. The data gathered is used for monitoring & taking corrective efforts to

streamline the system. To monitor the works of centres located in a district the

District AIDS Prevention and Control Unit

(DAPCU) functions as a nodal point in the district. There are 29 DAPCUs in the 29 high

prevalence districts. Apart from the above mentioned National Aids Control

Organisation (NACO) supported programmes, there are some unique

initiatives being run in the State for providing Care & Support to PLHIVs. Legal

Aid Clinics are run in 16 districts with the help of District Free Legal Aid Authority to

provide Legal Counselling for their legal issues. In cases where it is required, free

legal service is provided for taking legal recourse to claim their rights. A separate

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Trust has been established for providing

assistance to Orphan and Vulnerable Children (Tamil Nadu Trust for Children

affected by AIDS). This trust provides nutritional, educational support to infected

and affected children. Under Farmers Protection Scheme (Uzhavar Padukappu

Thittam), any member of farmer who is on ART medicines with CD4 count below 350 is

provided a pension of Rs.1,000 per month. As of 31st March 2013, 2,663 persons were

being given this pension.

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Chapter 16

TAMIL NADU STATE BLINDNESS

CONTROL SOCIETY (TNSBCS)

16.1 Blindness is a major problem throughout India. National Programme for

Control of Blindness (NPCB) was launched in the year 1976 as a 100% centrally

sponsored programme with the goal of achieving a prevalence rate of blindness to

0.3% of population. The four pronged strategy of the programme is:

strengthening service delivery

developing human resources for eye

care

promoting outreach activities and

public awareness

Developing institutional capacity

The implementation of the programme was decentralized in 1994-1995 with formation of District Blindness Control Society in each

district of the country. The Society has taken various steps to create awareness

among the public regarding the need for the

Eye donation. On 01.04.1996, the Tamil Nadu State Blindness Control Society was

formed as a separate entity, to give thrust

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to the goal by planning, execution and

monitoring at the District level. The Tamil Nadu State Blindness Control Society is

functioning under the control of Mission Director, State Health Society, National

Rural Health Mission, and Chennai with effect from 01.04.2007. The Project Director

is the Secretary of the society for the implementation of the scheme. Every

district in the state has one District Blindness Control Society to govern the

activities of the National Programme for Control of Blindness.

16.2 For effective implementation and monitoring of the work at District level, a

District Blindness Control Society has been formed in all the Districts. The District

Blindness Control Society conducts eye camps with the help of Voluntary

Organisations and District Mobile Ophthalmic Units, provides financial

assistance to Voluntary Organisations for performing Cataract Operations, undertakes

propaganda activities under health education programme in the District and

monitors the implementation of the

Blindness Control Programme in District level as per the directions of Government of

India / State Government / State Blindness

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Control Society. District Blindness control

Societies are under the Chairmanship of the District Collectors.

16.3 The cataract, being the major cause

for the avoidable blindness, was given importance and various infrastructure

facilities like base eye wards, dark rooms etc., have been built till 2002 and are now

in use. The State has been a pioneer in tackling blindness, particularly arising from

cataract.

16.4 During the year 2012-2013, 6,17,581 persons have been done cataract surgery.

Government has taken the following

measures to increase the cataract surgeries in Government Institutions:-

i. The District Blindness Control Societies are permitted to hire private

Ophthalmic Surgeons to do cataract surgeries in Government Institutions

and pay Rs.150 per cataract case

ii. The District Blindness Control Society

is permitted to hire private staff nurses trained in the field of

ophthalmic surgery to assist cataract

surgeries in Government Institutions and to pay Rs.50 per cataract case

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16.5 The following activities will be

carried out during 2013-2014:-

i. Performing cataract operations and fix

Intra Ocular Lens (IOL)

ii. Screening of school children for

detection of refractive error and provide free spectacles to poor

children

iii. Collection of eyes for transplantation

in persons with corneal blindness

iv. Providing training to eye surgeons in

modern cataract surgery and other specialised procedures

v. Enhancing capacities for eye care services in public sector by providing

assistance to hospitals at various

levels

vi. Development of eye banks and eye

donation centres to facilitate collection and processing of donated eyes. Eye

bank has been functioning at Regional Institute of Ophthalmology and

Government Ophthalmic Hospital, Chennai in co-ordination with Lions

International and also at Government Medical College Hospitals at Salem,

Coimbatore and Vellore

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Chapter 17

REVISED NATIONAL TUBERCULOSIS

CONTROL PROGRAMME (RNTCP)

17.1 Revised National TB Control Programme (RNTCP) is implemented in the

State, from the year 1999, in a phased manner. The entire State has been covered

under RNTCP since 2002. The Revised National TB Control Programme aims at

detecting maximum number of Tuberculosis patients, especially the sputum positive

(infectious type) TB patients and curing them by Direct Observation Treatment Short

course (DOTS) through DOT Centres.

At the State level, State Health Society -

RNTCP which was formed under the Chairmanship of Secretary to Government

(Health) has been merged with the State Health Society and the funding has been

brought under the National Rural Health Mission. The Programme is implemented in

close coordination with the Directorate of Public Health and Preventive Medicine.

In the State, there are 142 TB Units. One TB

Unit (TU) is formed for every five lakh population. Each TB Unit is manned by one

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of the PHC Medical Officers in the Unit, who

is designated as Medical Officer (TB Control). He is assisted by one (Senior

Treatment Supervisor (STS), and one Senior TB Laboratory Supervisor (STLS). For Multi

drug resistant TB, four treatment centres are functioning at Government Hospital at

Tambaram, Madurai, Vellore and Coimbatore.

Designated Microscopy Centres (DMCs)

and Specialty Laboratories

17.2 There are 791 Designated Microscopy Centres in the State. One Designated

Microscopy Centre (DMC) has been formed

for every one lakh population such that there are at least five DMCs functioning in

each TB Unit. Each Microscopy Centre has one Laboratory Technician and has been

provided with a Binocular Microscope.

Distribution of Tuberculosis Drugs

17.3 The required Anti - TB drugs are supplied in Patient Wise Boxes (PWB) by the

Central TB Division, New Delhi directly to the Government Medical Store Depot. From

Government Medical Store Depot, the Drugs are transferred to the two State Drug Stores

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at Chennai and Tiruchirapalli. From these

State Drug Stores, the drugs are distributed to the other districts. For the year

2012-2013 a sum of Rs.7.37 crore was allotted to Tamil Nadu under RNTCP.

Government T.B. Sanatorium, Tambaram, Chennai

17.4 This Sanatorium is attached to the Government Stanley Medical College,

Chennai. There is a rehabilitation centre called Amrith Nagar Colony attached to this

Sanatorium. This centre was established on 25.08.1948 on the following objectives.

i. To provide every individual member of the colony with work according to his

capacity and to make room for fresh

cases in the Sanatorium by transferring convalescent cases to the

Colony

ii. To admit members into the colony who are non-infectious so that they

could live with their families

iii. To provide occupations like printing

and carpentry to begin with

iv. To pay remuneration to the members for work done

v. To make arrangements for recreation and periodical medical examination

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Amrith Nagar Colony occupies an area of

17.14 acres and situated about half a kilometer away from the TB Sanatorium,

Tambaram. The centre is under the supervisory control of the superintendent

Government T.B. Sanatorium, Tambaram and advised by an advisory committee for

which he is the Secretary.

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Chapter 18

NATIONAL MENTAL HEALTH

PROGRAMME

Mental Health Care

18.1 The Institute of Mental Health,

Chennai is the only Hospital functioning in the state for the treatment of Psychiatric

patients. The Hospital has 1,800 beds and the patients from neighboring States are

also coming to this Hospital for taking treatment. Besides giving treatment to

mentally ill patients, the hospital also provides rehabilitation to the cured persons.

The Government of India has permitted the

Institution to start a PG Diploma course in Institute of Mental Health as a part of the

Man Power Development Scheme under National Mental Health Programme. The

existing N.R.Thiagarajar Hospital at Theni is also being converted as a Mental Hospital to

take care of the mentally ill patients of the southern districts of Tamil Nadu. A Mental

Health Rehabilitation Centre will be established at Erwadi in Ramanathapuram

District.

18.2 Government of India has sanctioned a onetime grant under National Mental Health

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Programme for strengthening of psychiatric

wings to the following Medical Institutions under the control of the Directorate of

Medical Education:-

i. Madras Medical College, Chennai

ii. Government Kilpauk Medical College,

Chennai

iii. Government Stanley Medical College,

Chennai

iv. Chengalpattu Medical College,

Chengalpattu

v. Government Mohan Kumaramangalam

Medical College Hospital, Salem

vi. Thanjavur Medical College Hospital,

Thanjavur

vii. Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli

viii. Government Thoothukudi Medical College Hospital, Thoothukudi

ix. Government Coimbatore Medical College Hospital, Coimbatore

x. Government Kanniyakumari Medical College Hospital, Nagercoil.

xi. Government Theni Medical College Hospital, Theni.

xii. Government Rajaji Hospital, Madurai.

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District Mental Health Programme

18.3 The District Mental Health Programme is a community based Programme based on

the guidelines of National Mental Health Programme fully funded by the Government

of India. A sum of Rs. 2.01 crore was allocated during 2012-2013. The aims of the

District Mental Health Programme which is under implementation in the state are as

follows -

i. To create awareness regarding Mental

Health in the community.

ii. To integrate and implement Mental

Health Services through all the wings

of the Health Department,

iii. To facilitate the early detection and

treatment of the patient within the community itself.

iv. To reduce the stigma attached towards mental illness through change

attitude and public education.

v. To treat the rehabilitated mental

patients discharged from mental hospital within the community.

18.4 The programme is under

implementation in the following 16 Districts

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of Tamil Nadu since the year indicated in

Table No.21.

Table No.21 - Districts implementing the District Mental Health programme

Sl. No

Name of the Districts Year of

Implementation

1 Tiruchirapalli 1997

2 Madurai and Ramanathapuram 2001

3 Theni, Kanniyakumari, Dharmapuri, Erode and Nagapattinam

2005-2006

4 Tiruvallur, Kancheepuram, Chennai, Cuddalore, Tiruvarur, Namakkal, Perambalur and Virudhunagar

2007-2008

18.5 Implementation of District Mental Health Programme is proposed for the

following six more Districts –

i. Coimbatore

ii. Pudukkottai

iii. Sivagangai

iv. Thoothukudi

v. Villupuram

vi. Dindigul

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State Mental Health Authority (SMHA)

18.6 In 1994 the State Mental Health

Authority - Tamil Nadu (SMHA - TN) was formed as a statutory body under section 4

of the Mental Health Act, 1987. It is functioning under the superintendence,

direction and control of the State Government. The Secretary to Government,

Health and Family Welfare Department is the Chairman. Seven other official are its

members and three non-government experts in the field of psychiatry are its

members. The authority is mandated with the responsibility of developing regulating

and coordinating mental health services in

the State. The office of State Mental Health Authority is functioning in the campus of

Institute of Mental Health, Chennai from 01.08.2012.

18.7 The Institute of Mental Health at

Chennai is the major Hospital under the Government sector offering all mental

health related services. Further the Departments of Psychiatry headed by a

senior Psychiatrist are functioning in all the Government run Medical College hospital

taking care of teaching psychiatry to the medical students and providing treatment to

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mentally ill patients. Apart from these

psychiatry units are being run in all the District headquarters hospital in the State.

In so far as private sector is concerned there are a number of Private Mental Health

Nursing Homes / Hospitals for which licence is granted by the Director, Institute of

Mental Health.

18.8 The State Mental Health Authority provides mental health related services

which include:-

i. Supervising the psychiatric hospitals/ Nursing homes and

other Mental Health Services

Agencies

ii. Advise the State Government on

all matters relating to Mental Health

iii. Advocate for integration of mental health in general health care and

in all social Development sectors.

18.9 The SMHA is striving to enhance the role of government in integrating mental

health hospitals/ units, private organisations and the society at large thereby taking care

of the mentally ill patients. From the societal point of view, State Mental Health

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Authority aims to increase the level of

awareness and acceptance of the people towards the mentally ill patients and to

provide a platform for harnessing their potential in order to mainstream them in the

society.

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Chapter 19

NATIONAL VECTOR BORNE DISEASES

CONTROL PROGRAMMES

Dengue

19.1 Dengue fever is a mosquito borne virus disease. Dengue is reported in more

than 107 countries and from almost all the states in India. Dengue is transmitted by

Aedes species of mosquitoes. Last year a spurt in incidences of Dengue was seen in

Tamil Nadu and due to the swift action taken by the Government, spread of the

disease was controlled. Government of India

has identified 31 Sentinel Surveillance Hospitals including Medical College

Hospitals, Zonal Entomological Teams, Institute of Vector Control and Zoonoses,

Hosur, King Institute of Preventive Medicine, Guindy and District Headquarters Hospitals,

Cuddalore and Ramanathapuram for diagnosis of Dengue and Chikungunya. This

facility has been extended to other Head Quarters Hospitals also by the Government.

Elimination of vector breeding places, like artificial containers are critical for control of

Aedes mosquito which spreads these diseases. Last year up to December 2012,

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13,204 cases were recorded and 66 deaths

reported. Introduction of Indian medicines such as Papaya juice extract, Nilavembu and

Malaivembu kudineer had a positive effect on control of Dengue. The disease is now

under control and is under surveillance.

Malaria

19.2 Malaria remains an important public health issue in few urban and rural areas

viz., Chennai, Ramanathapuram, Thoothukudi, Dharmapuri, Krishnagiri,

Tiruvannamalai and Kanniyakumari Districts. The total number of positive cases

recorded in the State last year (up to

December 2012) was 18,869 of which 37.8 percent were reported from rural areas,

while 62.2 percent from urban areas. This disease also is now under control and is

under surveillance.

Japanese Encephalitis

19.3 Japanese Encephalitis (JE) is one of the public health problems in the state.

Japanese Encephalitis Control Units at Cuddalore, Villupuram, and Perambalur with

Monitoring Unit in Chennai are carrying out Japanese Encephalitis Vector Control

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activities. Districts such as Perambalur,

Villupuram, Cuddalore, Tiruvannamalai, Virudhunagar, Tiruchirapalli, Thanjavur,

Tiruvarur and Madurai report JE cases. JE vaccination is being carried out in the above

said districts under routine immunization and all children at the age of 18 months are

being immunized. JE vector monitoring is being carried out regularly in the endemic

districts. Fogging operation is being carried out in villages where suspected JE cases are

reported.

19.4 Acute Encephalitis Syndrome (AES) Surveillance is being carried out in District

Head Quarters Hospitals, Medical College

Hospitals and major private hospitals. Serum samples are taken from the AES

cases for diagnosis of JE. Lab diagnosis is done in 7 Sentinel Surveillance Hospitals

which includes King Institute of Preventive Medicine and six Medical College Hospitals.

When JE is confirmed by laboratory diagnosis, necessary symptomatic treatment

is given to the patient in Medical College Hospitals. During 2012, 954 AES cases with

72 deaths and 33 JE cases with 5 deaths have been reported. In Tamil Nadu five

districts (viz.,) Villupuram, Madurai, Thanjavur, Tiruvarur and Karur have been

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identified as the focus districts under the

control of JE/AES programme of Government of India.

Acute Encephalitis Syndrome

19.5 Acute Encephalitis Syndrome (AES) is

a general description of the clinical presentation of a disease characterized by

high fever and altered consciousness, seizures, convulsions etc, mostly in children

below 15 years. Acute Encephalitis Syndrome (AES) has a very complex

etiology, and JE virus is only one of the many causative agents of encephalitis.

Hence AES surveillance is being conducted

to pick up all the JE cases.

Existing system of Surveillance

19.6 Cases with signs and symptoms of

Acute Encephalitis Syndrome are identified

in all Government District Head Quarters Hospitals and Government Medical College

Hospitals to pick up the JE cases. Serum / CSF is taken from the Acute Encephalitis

Syndrome cases and sent to the Sentinel Surveillance Hospital for JE virus detection.

There are seven Sentinel Surveillance Hospitals in Tamil Nadu where JE virus is

detected by ELISA IgM test kit supplied by

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National Institute of Virology (NIV), Pune.

Following are the list of Sentinel Surveillance Hospitals

King Institute of Preventive

Medicine, Guindy

KAP Viswanatham Government

Medical College, Tiruchirapalli

Government Villupuram Medical

College, Villupuram

Government Thanjavur Medical

College, Thanjavur

Government Madurai Medical

College, Madurai

Government Tirunelveli Medical

College, Tirunelveli

Government Coimbatore Medical College, Coimbatore

The data for Acute Encephalitis Syndrome /

Japanese Encephalitis in Government Hospital and Government Medical College

Hospitals are collected by the Deputy Director of Health Services in the respective

District and submitted to the state level.

Case Management, Prevention and

Control measures

19.7 Case management for Acute

Encephalitis Syndrome / Japanese

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Encephalitis is done in all Government

Hospital and Government Medical College Hospitals. The case which needs tertiary

care is referred to Government Medical College Hospitals with Paediatric Intensive

Care Unit (PICU) where the case management is done. For the prevention

and control of Japanese Encephalitis, initially children in the age group of 1-15 years were

given SA 14-14-2 type of JE vaccine in campaign mode. Cuddalore, Villupuram,

Virudhunagar, Tiruchirapalli, Tiruvarur, Madurai, Perambalur, Thanjavur and

Tiruvannamalai districts were covered by campaign and later included under routine

immunization for children in the age group

of 16 months. Vector control activities are done by outdoor thermal fogging using

technique. Malathion to reduce the JE vector density in all AES/JE reported areas.

Villupuram, Thanjavur, Tiruvarur, Karur and Madurai are the priority districts for this

disease.

Filaria

19.8 The National Filarial Control Programme is under implementation in the

State from 1957. The filarial disease control activities are carried out in 43 urban areas.

In these urban areas, 25 control Units and

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44 Night Clinics are functioning. Mass Drug

Administration programme with Diethyl Carbamazine Citrate (DEC) tablet was

started in 1996 in Cuddalore District as a pilot project. Single dose mass DEC drug

administration programme is being carried out from 1997-98 in all endemic districts.

Diethyl Carbamazine Citrate (DEC) tablets are supplied by the Government of India.

The entire operational cost is met by the State Government. Self-care practices

training for the Lymphoedema cases and Hydroceletomy for hydrocele cases are

organized. 33,947 Lymphatic filariasis cases have been recorded in this state. Morbidity

management kits are also issued to these

patients for foot care. A sum of Rs.400 per month was given to Grade IV Lymphatic

Filaria patients. This has been enhanced to Rs.1,000 per month now. Mass Drug

Administration for 2012 was conducted on 29th April, 2012 and 26th August, 2012 with

coverage of 94.1% for which Rs.4.00 crore was allotted by Government of India.

Chikungunya

19.9 Chikungunya is caused by mosquito

borne virus transmitted to humans by Aedes mosquitoes. There is a decline in

Chikungunya cases due to the control

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measures taken by the Department. Up to

December 2012, 5,356 cases were suspected out of which 514 cases were

confirmed and treated.

Leptospirosis

19.10 Leptospirosis is one of the serious

zoonotic diseases which require timely

diagnosis, treatment and control measures. Seven leptospirosis clinics are functioning in

Tiruvallur and Madurai districts for diagnosis and treatment. Rapid diagnostic kits have

been supplied to these clinics and the nine Zonal Entomological Teams in the state.

The Institute of Vector Control and Zoonoses, Hosur is given the responsibility

of investigation during outbreaks with specialized Team. A State Level Reference

Laboratory is functioning at State Head Quarters to provide laboratory confirmation

and training. Up to December 2012, 3,587 cases were recorded of which only one

death was confirmed.

Vector borne diseases control and epidemic control activities

19.11 Tamil Nadu is one of the top States

in most of the health indicators. The State is also at the forefront in eliminating

communicable diseases.

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19.12 On this issue, Hon’ble Chief

Minister conducted a series of review meetings and issued detailed instructions.

Accordingly, at the district level, the District Collectors have been coordinating the

control measures by involving all the departments. Some of the important actions

implemented based on the decisions of review meetings conducted by the Hon’ble

Chief Minister were –

i. Release of short films and advertisements educating the masses

of their role in preventing mosquito breeding

ii. Increase in the number of Elisa Test

Centres from 31 to 60

iii. Making available adequate cell

counters, medicine, blood and blood components

iv. Conduct of fever camps

v. Sending medical teams to the districts

that reported higher incidence of fever

vi. Organizing entomological surveillance

report based actions

vii. Putting in place 10 persons per block

under the Health Department, 20 persons per block through the Rural

Development Department and

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additional labourers in Town

Panchayats/Municipalities and Corporations for identifying and

eradicating sources of breeding

viii. Providing adequate equipment for

vector control

ix. Providing traditional medicines and

promoting natural healing through Indian Systems of Medicines

19.13 The District Collectors take

continuous action to conduct and review and control of these diseases at the field level.

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Chapter 20

NATIONAL PROGRAMME FOR

PREVENTION AND CONTROL OF CANCER, DIABETES AND CARDIO-

VASCULAR DISEASES

20.1 Most forms of cancer are curable when detected and treated early. Besides Arignar

Anna Cancer Institute, Karapettai, Kancheepuram, a Regional cancer centre

each at Madurai and Coimbatore have been established to improve the treatment

facilities of increasing cancer patients of Southern and Western regions of the State.

In the current year, it is proposed to

establish regional cancer centres at Thanjavur and Tirunelveli Medical College

hospitals at a cost of Rs.30.00 crore. In order to provide specialized and

comprehensive cancer care and to provide training and research pertaining to all types

of cancer with focus on oral, cervical and breast cancer, Government have identified

the following six institutions:

i. Government Arignar Anna Memorial Cancer Institute, Kancheepuram

ii. Mahatma Gandhi Memorial Government Hospital, Tiruchirapalli

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iii. Institute of Non communicable

Diseases and Government Royapettah Hospital, Chennai

iv. Rajiv Gandhi Government General Hospital, Chennai

v. Institute of Obstetrics and Government Hospital for Women

and Children, Chennai

vi. Government Thanjavur Medical

College Hospital, Thanjavur

20.2 Under National Programme for control

of Cancer, Diabetes, Cardio-Vascular Diseases and Stroke provision has been

made for purchase of certain modern equipment for Treatment of Cancer. The

state is also creating more regional cancer

centres.

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Chapter 21

NATIONAL TOBACCO CONTROL

PROGRAMME

21.1 The National Tobacco Control Programme is being implemented in Tamil

Nadu since 2003. The State Tobacco Control Cell is functioning under the Director of

Public Health and Preventive Medicine since 2007. The District Tobacco Control Cell has

been formed in all the districts and functions under the supervision of the Deputy Director

of Health Services. Under the National Tobacco Control Program, two districts

namely Villupuram and Kancheepuram have

been selected as pilot districts for implementation of the District Tobacco

Control Programme. Government of India has provided financial assistance of

Rs.50.67 lakh. So far, 68,376 violators have been fined for a total of Rs.77.46 lakh.

Smoke Free Chennai

21.2 The State Tobacco Control Cell has

been functioning under the “Smoke Free Chennai” project under the support of

Bloomberg Global Initiatives. Four enforcement vehicles are covering Chennai

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city and other suburban areas to create

awareness and enforcement of tobacco control laws. Capacity building workshops

have been conducted for various Government and Private sector people in

Chennai.

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Chapter 22

NATIONAL LEPROSY ERADICATION

PROGRAMME

22.1 National Leprosy Eradication Programme (NLEP) was launched in

1954-1955 with the main thrust in detection and regular treatment of all leprosy

patients. Multi Drug Therapy was launched in 1983 in a phased manner and a complete

geographical coverage in the State was achieved in 1991. The prevalence rate

118/10,000 population in the year 1983 was brought down to 0.42/10000 population in

2012. The vertical programme had been

integrated with General Health Care System during 1997. Out of 385 blocks, 50 blocks

are identified as High Endemic areas and focused activities are carried out in these

blocks.

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Chapter 23

ACCIDENT AND TRAUMA CARE CENTRES

23.1 The Government has been taking a

number of initiatives to reduce the deaths due to traffic accidents. In the multi

pronged approach, use of 108 ambulances have reduced the reaction time to about 20

minutes thereby ensuring that the accident victims are attended to. The Transport

department has also identified the hot spots and has taken up a number of measures on

its part apart from education of the road users. In order to develop a network of

Trauma Care Centres along with Golden

Quadrilateral of the National Highways and to provide Trauma services for the accident

victims, the Government of India have introduced a scheme. The Government of

India has released funds for development of network of Accident and Trauma Care

Centre in the following institutions:

i. Government Vellore Medical College Hospital, Vellore

ii. Government Kilpauk Medical College Hospital, Chennai

iii. Government Rajaji Hospital, Madurai

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iv. Government Tirunelveli Medical

College Hospital, Tirunelveli

v. Government Kanniyakumari

Medical College Hospital, Nagercoil

vi. Government Mohan Kumara-

mangalam Medical College Hospital, Salem

Upgradation and Strengthening of Trauma Care Centre

23.2 During the 11th Plan period

(2007-2012), the Government of India has upgraded and Strengthened the Trauma

Care Centres in certain Government Hospitals located along Golden

Quadrilateral, North-South, and East–West

corridors of National Highways. Under the above scheme, the Government of India

have released a total amount of Rs.2.75 crore as grants-in-aid for construction of

building only for Trauma Care centre in Government District Headquarters Hospitals

at Karur, Krishnagiri, Kovilpatti and Dindigul.

23.3 Building work for Trauma Care Centre

at Government District Head Quarters Hospitals Krishnagiri, Dindigul and Kovilpatti

have been completed and these Trauma

206

Care Centres are now functioning. The

building work for Trauma Care Centre in Government District Headquarters Hospital,

Karur is nearing Completion. These centres are being equipped with necessary

infrastructure to ensure quality care.

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Chapter 24

CHIEF MINISTER’s COMPREHENSIVE

HEALTH INSURANCE SCHEME

24.1 In order to achieve the objective of Universal Health Care to the People of Tamil

Nadu, the Government have issued orders for implementation of a New Insurance

Scheme, the “Chief Minister’s Comprehensive Health Insurance

Scheme”. Families with an income of Rs.72,000 per annum or below are eligible

under the new scheme. The sum assured is Rs.1/- lakh per year per family, along with a

provision to pay upto Rs.1.50 lakh per year

per family for certain specified 77 procedures; Rs.4 lakh coverage is also being

provided to each family in 4 years. The new scheme covers 1016 procedures which

include 23 important diagnostic procedures and 113 follow up procedures. So far,

Rs.1.07 crore smart cards have been distributed in the districts.

24.2 For identifying the beneficiaries under

the scheme, new smart cards are being generated by using the existing data base

and distributed to the beneficiaries. Additional new enrollment is done through

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District kiosks established in the District

Collectorates. As on 31.3.2013, 817 hospitals have been empanelled to provide

treatment, including all the Government Medical College Hospitals and the District

Head Quarters Hospitals. Till 31st March 2013, 2.96 lakh persons have benefited

under the scheme with the approved amount being Rs.623.58 crore. Out of this,

1,04,953 beneficiaries have been treated in Government Hospitals at an insurance

coverage of Rs.217.70 crore.

24.3 Surgeries such as Liver

Transplantation, Renal Transplantation including post transplant procedure for

immunosuppressant therapy, Bone marrow

transplantation, Cochlear implantation and stem cell transplantation cost more than

Rs.1.50 lakh and range from Rs.3 lakh to Rs.22 lakh. It is not possible for the poor

patients to pay the extra cost for the surgery. Hospitals approved under the

scheme cannot also be insisted upon to perform the surgeries within the cost of

Rs.1.50 lakh. The Hon’ble Chief Minister has, therefore, announced the creation of a

Corpus Fund of Rs.10.00 crore to help the needy and poor people, especially children,

who have to undergo such costly surgeries. The extra cost of the surgery exceeding the

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eligible amount Rs.1.50 lakh per annum is

to be met from this Corpus Fund. The patient who needs to undergo the

specialized surgery need not pay any amount from his / her personal sources.

The entire cost of specialized surgery will be borne by the Insurance Company upto

Rs.1.50 lakh and the remaining amount will be met from the Corpus Fund. All such

cases are cleared by an Expert Committee.

TAMIL NADU STATE ILLNESS SOCIETY

24.4 Government of India had requested the State Governments to constitute a

‘Revolving Fund’ for extending financial assistance to the poor with the contribution

received both from the Government of India and State Government. Accordingly, the

Government of Tamil Nadu have constituted a ‘Revolving Fund’ by name ‘Tamil Nadu

State Illness Assistance Society’ in the ratio of 2:1 (Two shares by State Government

and one share by Government of India) with an initial corpus of Rs.15 crore and have

also formed ‘Tamil Nadu State Illness Assistance Society’ (Registered on

20.03.1998 under Tamil Nadu Societies

Registration Act 1975) to administer the fund. The affairs of the Tamil Nadu State

Illness Assistance Society is administered by

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the Executive Committee under the

Chairmanship of the Secretary to Government, Health and Family Welfare

Department and the Director of Medical and Rural Health Services as the Member

Secretary. The objective of the scheme is to render financial assistance from Rs.5,000 to

Rs.25,000 according to the nature of surgery to Below Poverty Line people.

Through this society, there are two patterns of assistance offered -

i. Revolving fund fixed to the 14 Government Medical College

Hospitals for performance of specified surgeries by paying cost of

consumables, which works out to Rs.2.90 crore per annum

ii. Revolving fund fixed to the 32 District Collectors for disbursement

of Financial Assistance of Rs.25,000 to the individuals / at accredited

private hospitals, after the performance of specified surgeries /

treatment and after the issuance of Government Order in each case and

this revolving fund works out to

Rs.3.95 crore per annum.

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Chapter 25

IMPORTANT ACTS

Pre-conception and Pre-Natal

Diagnostic (Prohibition of Sex Selection) Act, 1994

25.1 The female sex ratio declines mainly

due to female foeticide, infanticide and neglect of female child from birth. In order

to prevent Sex determination, the Government of India has enacted the

Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection)

Act, 1994. The object of the Act is to

eradicate female foeticide and for maintaining the high level juvenile sex ratio

(0-6 years) and male and female ratio.

25.2 For effective implementation of this Act, the State, District and Sub-District level

Advisory Committees have already been formed. At State level there is Multi Member

Appropriate Authority wherein the Director of Medical and Rural Health Services is the

Chairperson, the other members are the Secretary, Guild of Service, Chennai and

Deputy Secretary to Government, Law Department. For the District Level, District

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Collector is the District Appropriate

Authority. For Sub–District Level, Revenue Divisional Officer is the Sub-District

Appropriate Authority. Under the Act all such organizations involving in the Pre-Natal

Diagnostic Techniques should register themselves with the Appropriate Authorities.

Offences under the Act such as non-registration and misusing the

equipments to disclose the sex of the foetus are punishable as cognizable, non-bailable

and non-compoundable offences up to 3 years of imprisonment. The doctors who

are found indulging in malpractices are also liable to lose their Registration for Medical

Practice. So far 4,978 scan centres have

been registered under the Act and cases have been filed against 72 scan centres for

the violation of this Act. Judgment had already been delivered in 62 cases and 10

cases are under trial. This Act is implemented very strictly in the Taluks and

Districts where the juvenile sex ratio is below the State level of 946 by maintaining

constant vigil over the scan centres and MTP centres.

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TRANSPLANTATION OF HUMAN ORGAN

ACT, 1994

25.3 The Act has been enacted by the

Government of India during the year 1994 to eradicate human organ trade and to

promote Cadaver Organ Transplantation programme.

The transplantations are being done only in

the approved hospitals in Tamil Nadu. The Hospitals which are applying for registration

under the Transplantation of Human Organ

Act, 1994 are inspected by a team of specialists and the senior member among

the team is the convener and co-coordinator of the team. The team inspects the

hospitals and furnish the inspection report in the prescribed format. The Director of

Medical and Rural Health Services is the State Appropriate Authority for issuing the

Registration Certificate based on the inspection report to the Government /

Private Hospitals. The Tamil Nadu Government has constituted three

Authorization Committee region wise at Chennai, Madurai and Coimbatore for

scrutiny of each and every non relative case

for approval of organ transplantation.

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25.4 Accordingly, the registered hospitals,

region wise submit their application for organ transplantations to the respective

Authorization Committee. The donors and the recipients have to appear before the

Committee. Each and every case of non relative is verified and approved by

Committee for carrying out the transplantations. In the State 72 hospitals

are registered under this Act for performing renal, heart, liver, lungs and corneal

transplantations.

Cadaver Transplant Programme

25.5 In order to curtail human organ trade

and to save the lives of patients who are in critical stages of disease by utilizing the

organs of brain death patients, the State had initiated this programme during the

year 2008. Now, Tamil Nadu ranks top at the national level in the implementation of

the Cadaver Transplant Programme. This programme is supported by an Advisory

Committee that has been formed to establish formats and procedures, to

oversee compliance with procedures, to ensure stability of functioning of the

programme and to recommend a coordinating body to institutionalize and

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streamline the programme. Currently 38

Hospitals are involved in this programme. The Rajiv Gandhi Government General

Hospital, Chennai and the Stanley Hospital, Chennai are actively involved in the

programme. Transplant hospitals in the State have been divided into three zones

and organ donations from cadaver arising in a zone are allocated first within that zone as

detailed below-

North Zone - Chennai and neighbourhood, Vellore

South Zone - Tiruchirapalli, Madurai, Tirunelveli, Nagercoil

West Zone - Coimbatore, Erode, Salem

Up to March 2013, there are 324 donors and

1820 organs were harvested out of which 959 were major organs (Heart, Lungs, Liver

and Kidneys).

Civil Registration system

25.6 Tamil Nadu has a long tradition of registration of births and deaths. Prior to

the introduction of Registration of Births and Deaths Act, 1969 by the Government of

India, registration of births and deaths in

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Tamil Nadu was carried out under the

provisions of Madras Panchayats Act 1899 in Rural Areas, the Madras Districts

Municipalities Act, 1920 in the Municipalities and selected Town Panachayats and the

Madras City Municipal Act 1919 in Chennai Corporation. There are 16,046 Registration

Units in 32 Revenue Districts including Chennai Urban District. The Registration of

Births and Deaths was made compulsory at the place of occurrence.

With the introduction and implementation of

Tamil Nadu Registration of Birth and Death Rules, 2000 with effect from 1.1.2000 in

accordance with the provisions of sec. 30 of

The Registration of Births and Deaths Act 18 of 1969. The registration of Birth and Death

should be done within 21 days of its occurrence.

The Birth and Death Registration system

has been computerized in the entire rural and urban areas of Tamil Nadu. In Chennai

Corporation, the Birth and Death Certificates are issued online. Tamil Nadu has achieved

98% in birth registration and 91% in death registration during 2010.

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Issue of Free Birth Certificates at PHCs

25.7 Since the implementation of Birth and

Death Registration at Primary Health Centre level from 2009 August, 9,80,780 Free

Birth Certificates have been issued up to February, 2013 to the beneficiaries in the

state.

Medical Certification of Cause of Deaths (MCCD)

25.8 The MCCD scheme is a part of Civil

Registration System and is the only source which provides cause specific mortality data.

The scheme was introduced in seven

selected Municipalities and Chennai Corporation during 1969 and later it was

extended to all Municipalities and Corporations from 1980. To improve Medical

Certification of Cause of Death, regular trainings are given to doctors every year.

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Chapter 26

EDUCATION, TRAINING AND RESEARCH

The Tamil Nadu Dr. M.G.R. Medical

University

26.1 The details of the University and about

medical education have been given in chapters two, three and eight. As mentioned

earlier, the Tamil Nadu Dr.M.G.R. Medical University was started to promote academic

excellence, research and advancement of knowledge in the field of Medical and Para

Medical Education. At present, 328

institutions, conducting various courses in Medicine and allied sciences, are affiliated to

this University. The University Library serves as a Regional Medical Library and

Medical informatics centre.

King Institute of Preventive Medicine

and Research

26.2 King Institute of Preventive Medicine

was established on 07.11.1899. Started as a Depot for Small pox vaccine by the British

Government, it is named after Lieutenant Colonel W.G.King, FMS, and the then

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Sanitary Commissioner to the Madras

Presidency. It is unique in its activities – production of vaccine and sera, academic

activities, diagnostic work (bacterial & viral), certification of schedule -C drugs. The

institute is under the administrative control of Directorate of Medical Education since

1966. In the past, during epidemics in Tamil Nadu, King Institute played an

important role by way of production and supply of Anti Cholera and Anti Typhoid

Vaccines. It was originally designed to serve as a Vaccine Lymph Depot of State. This

institute has been developed into a major Public Health Laboratory in the country,

manufacturing human vaccines and sera

with allied Teaching and Research in the field of Microbiology. The institute has

facility for identifying 23 different types of viruses.

International Vaccination Centre

26.3 Functioning for the past 40 years, this

Centre is one among the 14 centres recognized by the Ministry of Health,

Government of India. This centre mainly deals with the inoculation of Yellow Fever

vaccine and issue of International Vaccination Certificate to the public

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traveling to Yellow Fever endemic areas.

Haj Pilgrims are inoculated with Meningococcal vaccine.

Training and Continuing Health

Education Programme under Public health

26.4 Continuing education, in-service

training and pre-service training programmes are organized for the health

officers, medical officers, nurses and other paramedical staff through six regional

training centres namely Institute of Public Health, Poonamallee, Health and Family

Welfare Training Centres at Egmore,

Madurai and Gandhigram, Health Manpower Development Institutes at Villupuram and

Salem, Regional Institute of Public Health, Thiruvarankulam and Institute of Vector

Control and Zoonoses, Hosur. The institute of Public Health, Poonamallee is recognized

as a national collaborative training centre for various programmes organized by the

Reproductive and Child Health Programme and the National Rural Health Mission.

26.5 Multi skilling, task shifting training

programmes are organized for medical officers in life saving anesthesia and

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obstetrics for a period of six months to

improve the availability of specialist services in rural areas particularly in Primary Health

Centres. Ultra sonogram training is given to PHC doctors for detection of congenital

deformities during pregnancy in coordination with renowned private sector

ultra sound agencies. Skill Birth Attendant training, training on integrated management

of newborn and childhood illnesses and immunization training are organized for

improving the mother and child care services in PHCs.

26.6 The Multi Purpose Health Worker (Male) Training Course is conducted in

Medical Colleges and Regional Training

Centres. During 2011-2012 three hundred candidates were trained and during

2012-2013, permission has been accorded to train 600 candidates. The Auxiliary Nurse

Midwife (ANM) course is being conducted in seven ANM training schools. Three new ANM

training schools at Theni, Namakkal and Sivagangai districts are being established in

Tamil Nadu with assistance from the Government of India. ANM training has

been started during the current year for filling up of the existing vacancies of Village

Health Nurses and Auxiliary Nurse Midwives.

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E-Governance in Public Health

26.7 The Directorate of Public Health and

Preventive Medicine is actively implementing the e-governance policy of the government.

All the PHCs are provided with computers and internet connectivity. Web portals are

developed and used for data management at various levels. The List of Web Portals

include Pregnancy and Infant Cohort Monitoring and Evaluation (PICME),

Dr.Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS), National Anti-Malaria

Management Information System (NAMMIS), Specialty Medical Camps, Health

Management Information System (HMIS),

Communicable and Non-Communicable Diseases data, Civil Registration System

(CRS), National Rural Health Mission (NRHM-MIS), Integrated Disease

Surveillance Project (IDSP) and Central Plan Scheme Monitoring System (CPSMS).

26.8 In addition regular training is organized for various levels under the

institutions under DME and DMS and DPH. The Health Systems project and the

National Rural Health Mission also have allocated funds for training.

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The department is taking continuous steps

as per saying ‘Health is Wealth’ and to realize the objectives of the ‘Vision 2023’

released by the Hon’ble Chief Minister.

K.C.VEERAMANI

Minister for Health