13. HEALTH AND FAMILY WELFARE

Health and Family Welfare

13

HEALTH AND FAMILY WELFARE

c‰wh‹ msΫ ÃâmsΫ fhyK« f‰wh‹ fU¢ braš. - ÂU¡FwŸ 949 The habitudes of patient and disease, the crises of the ill: These must be learned leech think over well, then use his skill. - Thirukkural 949

Vision 2023 envisages that Tamil Nadu will be ’s leading State on social development and will have the highest Human Development Index (HDI) amongst all Indian States.

Introduction even among those who are financially secured. High health care costs can lead to The health of the people in the State impoverisation or exacerbation of poverty. is an essential component of development, The importance of public provisioning of vital to the economic growth and internal quality health care at affordable costs and stability of the State. Assuring a minimal and provision of reliable heath services cannot be universal level of health care to the population underestimated. is a critical constituent of the development process. Human Development Index consists Health makes education possible of three components namely Education, Life and vice versa. Education of women delays Expectancy at Birth and Command over age at marriage, improves knowledge of Resources i.e. purchasing power parity. The contraceptives and enhances their status healthier the population, the more will be in society. Considering the above facts, the Index Value. Loss of health is most often the has been irreversible and the potential loss of output bestowing more attention on female education for the individual cannot be compensated. and focused health care. The Government’s Considerable achievements have been made principal health policy is to ensure “Health over the last six decades to improve health for all” and universal guarantee of basic standards such as Life Expectancy, Child health and education. In Tamil Nadu, both Mortality, Infant Mortality and Maternal public and private sector hospitals have been Mortality. The strong link between poverty catering to the health care requirements of and ill health needs to be recognised. Ill the public. The State’s objective is to ensure health and morbidity create immense stress that health care services are rendered with

585 Twelfth Five Year Plan Tamil Nadu the core principles of accessibility, equity, The delivery mechanism provides curative, excellence and affordability by building a wide preventive and rehabilitative care. health care network throughout the State.

UNIVERSAL HEALTH COVERAGE BY 2022: THE VISION

ENTITLEMENT NATIONAL HEALTH PACKAGE CHIOCE OF FACILITIES

Universal health Guaranteed access to an People are free to entitlement to every essential health package choose between citizen (including in-patient and out- patient care provided free-of- • Public sector cost) facilities; and

• Primary care • Contracted-in • Secondary care Private • Tertiary care providers

Source: High Level Expert Group, UPC – 2011 Fig. 13.1: Universal Health Coverage Vision

Vision Tamil Nadu 2023 • 15 new Medical Colleges attached to The Vision Tamil Nadu 2023 sets the district hospitals will be established and plan for infrastructure development of the the already existing 17 medical colleges State to reach the desired outcomes by 2023. attached to hospitals will be upgraded to It envisages Tamil Nadu to become not only international standards. the Numero Uno State in India in terms of • The State Government aims to establish social indicators, but also to reach the levels and strengthen ten or more Centres of attained by developed countries in human Excellence - these would essentially be development by ensuring universal access to world class organisations that are at the health care facilities. The key infrastructure cutting edge in their respective domains, development in the Health sector is in which would include life style diseases for providing universal access. Some of the key the health sector. initiatives proposed are: • Tamil Nadu is already renowned • Increase the capacity of primary and for healthcare facilities and the key secondary healthcare network by factors responsible for promoting improving the infrastructure of the Medical Tourism Industry are world hospitals such as enhancement of bed class treatment at competitive rates, strength, laboratory and radiology facilities international connectivity, availability of and diet provisioning and ensuring that professional healthcare skills, knowledge a referral centre is available within a and resources. It will further develop this maximum distance of five kilometres from reputation by aggressively positioning every Sub-Centre. itself as the medical tourism destination

586 Health and Family Welfare

of South Asia. Medical Tourism would laboratories, collection centres, radiology emerge as a thrust area as per the Vision centres will be networked. 2023. • Electronic Medical Records Management • Two Medi-cities will be created in Southern and Hospital Management System will and Western Tamil Nadu with a mission be implemented in all District and Taluk to serve the medical tourism industry hospitals. by investment in hospital and education • The State will ensure availability of facilities, logistics and hospitality services. items on the Essential Drug List (EDL) • Trauma, ambulatory and disaster to all citizens. The State will also ensure management care facilities will be improved 100 percent availability of drugs at all across the State. Diagnostic services like locations.

Fig. 13.2: Rajiv Gandhi Government General Hospital

587 Twelfth Five Year Plan Tamil Nadu

13.1 MEDICAL EDUCATION AND RESEARCH

Medical Education in the total bed strength of these hospitals is 25,413 Government Sector and their daily average in-patients and out- patients strength is 22,002 and 70,919 Good health provisioning and respectively. planning in the State would require quality health workers in various categories. There The Tamil Nadu Dr. M.G.R. Medical is a need to focus on Medical Education to University is conducting various courses provide leadership in research and practice in Medicine and allied health sciences in different medical conditions and research through the 328 institutions affiliated to the themes. University. Selection to the courses are made by the Selection Committee, Directorate Medical Institutions in the of Medical Education and the respective Government sector which are offering medical Institutions by the merit list. The University and paramedical education including nursing Library serves as a Regional Medical Library is given in the Table 13.1.1. and Medical Informatics Centre.

Review of Eleventh Plan Table 13.1.1: Government Medical Institutions in Tamil Nadu Strengthening of teaching institutions and their attached hospitals in terms of Institutions Numbers additional infrastructure, provision of modern Government Medical 17 medical equipment and strengthening of Colleges diagnostic facilities were the priority areas of Government Dental College 1 the Eleventh Plan. Physiotherapy Colleges 2 During the Eleventh Plan period, Nursing Colleges 4 three new Government Medical Colleges Schools of Nursing were opened at Dharmapuri, Villupuram and 23 (Diploma) Thiruvarur. Additional buildings including Total 47 hostel buildings were constructed in the existing medical colleges and the statutory Source: Dept. of Health and Family Welfare, requirements in terms of staff, equipment GoTN etc.,were provided in order to create additional The above Medical Institutions and seats in the postgraduate, super speciality the 63 Hospitals attached to the medical and nursing courses. The Table 13.1.2 gives colleges are functioning under the control the overall increase of seats in the various of the Directorate of Medical Education. The disciplines during the Plan period.

588 Health and Family Welfare

Table 13.1.2: Physical Performance of the Eleventh Plan No. of seats S.No. Name of the Course Beginning End (2007-08) (2011-12) I Diploma Course 1 Diploma in Nursing 1795 1875 II U.G. Courses 1 M.B.B.S. 1645 1945 2 B.D.S. 100 100 3 B. Physiotherapy 50 50 4 B.Sc (Nursing) 50 175 5 B. Pharmacy 106 120 III P.G. Courses 1 P.G. Degree (Medical) 429 706 2 P.G. Diploma 349 403 3 M.D.S. 36 37 4 Higher Specialities 69 187 5 M. Pharmacy 32 64 6 M.Sc. (Nursing) 8 65 7 M.Sc. (Medical Physics) - 10 Source: Dept. of Health and Family Welfare, GoTN

The Government Arignar Anna In the Eleventh Plan period, an Cancer Institute, Karapettai, Kancheepuram initiative was taken to create a network of was made the Regional Centre of Excellence super speciality hospitals to afford quality for Cancer and a Linear Accelerator was tertiary health care to the people. A super established at a cost of `10.00 crore to provide speciality hospital with trauma block was set modern medical care to poor cancer patients. up at a cost of `139.10 crore in the Mohan Mammography units were established in Kumaramangalam Medical College Hospital, Rajiv Gandhi Government General Hospital, Salem with the GoI assistance of `100.00 Hospital and Kilpauk crore under Pradhan Manthri Swasthya Medical College Hospital, . Suraksha Yojana.

The Paramedical education was During the Eleventh Plan, an outlay given priority by opening two new Nursing of `2,730.00 crore was allocated for the Colleges at Salem and Chengalpattu and a Health Sector and the expenditure incurred new Nursing School at Vellore. The number was `4,719.00 crore. of M.Pharm seats were increased in Chennai Twelfth Five Year Plan and Pharmacy Colleges and new Diploma and Certificate courses for medical The Hon’ble Chief Minister of technicians were started in 15 Medical Tamil Nadu at the 22nd Convocation of Colleges. Dr.M.G.R Medical University, highlighted that the Government is fully confident that

589 Twelfth Five Year Plan Tamil Nadu the various schemes proposed in the health • To provide research relevant to human sector would definitely propel the State to a development and quality of life. premium position in the provision of quality health care to the entire population. Strategies Objectives It is proposed to achieve the above objectives with quality care through the The objectives setforth for the following strategies: Eleventh Plan have not been fully achieved. Although the status of Human Resources • To open one fully equipped new medical for Health has improved during the Eleventh college every year with the approval of Plan period, much more needs to be done. Medical Council of India (MCI) in the A substantial scale-up of the uncovered districts of the State. health workforce is needed across several • To upgrade the infrastructure and cadres. Priority should be accorded to manpower as well as facilities for students the development and deployment of non- in the existing medical and paramedical physician health care providers, ranging colleges. from community health workers to mid-level health workers. Doctors are of great value • To improve the curriculum and quality of in providing certain specialised health care, medical education imparted. yet primary health care services should not • To provide special focus for development be doctor dependent. Even in secondary and of family medicine as a specialisation in tertiary care, skilled support services should medical care. be provided by suitably trained nurses and allied health professionals. Planning • To provide modern medical and diagnostic for health professional education should equipments to existing tertiary hospitals. reflect this paradigm. Universal Health Care mandates that health care needs rather than • To set up a network of Regional Centres population norms, guide the deployment of of Excellence to provide basic super human resources at different levels of health speciality care with ease of access for the care service provisioning. In this regard, the people of the State. State Government has to plan for the human • To provide a special thrust in the provision resource needs of the different districts, of medical care for the vulnerable sections based on the requirements and lags in the such as geriatric care and mental health vital indicators. care. There seems to be a sizeable expansion in teaching institutions for • Trauma Care Training: Basic life saving Doctors. Therefore, it is proposed to continue procedures in trauma now tackled by the following important objectives during the super specialists will be imparted to Twelfth Plan period: General Surgeons/Ortho Surgeons so as to cover Taluk level hospitals. • To provide highly skilled medical and para- medical manpower by providing access Ongoing Schemes to quality medical and para-medical education at an affordable cost. Improvements in Medical Colleges • To provide effective tertiary care to A thrust will be given to improve all sections of the public by making the existing medical colleges to satisfy MCI available modern medical techniques norms, which are revised from time to time and technologies in Government teaching to ensure quality in medical education. It is hospitals. proposed to rectify the infrastructure gaps at

590 Health and Family Welfare a cost of `75.00 crore in the existing Medical Departments of Medical College Hospitals. Colleges. Student amenities such as hostels The facilities at the Barnard Institute of for postgraduates and undergraduates, Radiology and Oncology at the Rajiv Gandhi library facilities etc., will be given importance Government General Hospital, Chennai will with an outlay of `75.00 crore for medical, be improved to fulfill the needs of increasing dental and paramedical students to enable influx of patient referral for radiology them to concentrate on their education and procedures. Based on the increasing need emerge as competent professionals. of this cadre in the State, it is proposed to start paramedical degree courses in Radio- Improvements to the Tertiary Care Diagnosis and Radiotherapy Techniques Hospitals and to provide digital X-Rays in uncovered medical colleges and allied institutions. The total cost for these schemes will be `50.00 The State of Tamil Nadu is well known crore. at the national level for provision of Super Speciality Services in the health sector. Though private hospitals have taken lead in Promotion of Geriatric Care and this area, public hospitals also follow close Services behind and needs to be strengthened as most of the downtrodden people cannot afford The unprecedented increase in human such treatments in private sector. In the first longevity in the 20th century has resulted phase, the State has established a super in the phenomenon of increasing geriatric speciality hospital at Salem and has proposed population. With more than eight percent to set up two more, one at Madurai with GoI of the population aged above 65, health of assistance and the other at Tiruchirappalli the aged has become a major concern. The using State funds at a cost of `100.00 crore. infrastructure and trained manpower in the The State will create a network of super current healthcare system is grossly deficient speciality hospitals in the Twelfth Plan. for provision of comprehensive health care to the elderly at all levels. The elderly suffer from The setting up of the Multi Super multiple and chronic diseases among which Speciality Hospital at Omandurar Government non-communicable diseases are common Estate, Chennai with facilities on par with irrespective of the socio-economic status. It that of All India Institute of Medical Sciences, is proposed to develop a full-fledged Institute New Delhi will ensure that the public of the of Ageing in the State will get high quality medical care at a with central assistance, using the Geriatrics centre nearest to them. In addition, some of Department as a base. Furthermore, in the existing Centres of Therapeutic Excellence the next five years, Geriatrics Department such as the Institute for Burns, Institute of would be developed in all the Medical Hand Reconstructive Surgery, Departments College Hospitals as a first phase and in the of Medical and Surgical Gastroenterology district hospitals in the second phase, with etc., in existing medical college hospitals specialists in M.D. Geriatrics. The cost of will be strengthened to offer quality care to the above development works out to `100.00 the public as well as to train medical post crore. It is expected that a substantial part graduates. A sum of `150.00 crore will be of the expenditure would be met under the provided in the Plan period for setting up of National Programme of Health Care for the these Multi Super Speciality Hospitals. Elderly, which has been announced by the Central Government. A special programme will be taken up to provide state of the art equipment in the Operation Theatres and Radiology

591 Twelfth Five Year Plan Tamil Nadu

Cadaver Transplant Programme The total exercise will cost the Government `50.00 crore during the Plan The Cadaver Transplant Programme period. A portion of these resources will be has been successfully implemented in Tamil drawn from the GoI under the scheme for Nadu with streamlined procedures, making strengthening nursing education. Tamil Nadu a leading State in the Country in its implementation. However, the programme New Schemes needs awareness among the public to carry forward voluntary donation of organs of dead Expansion of Medical Education bodies. An outlay of `5.00 crore would be made in the Plan to strengthen this programme Although Tamil Nadu has a good by creating awareness and participation of track record when compared to the rest of the hospitals in cadaver based organ donation. country, there is still a shortage of medical practitioners to serve in the rural areas and Nursing Schools and Colleges specialists to man the secondary and tertiary hospitals. In addition, there is also a growing There are four Nursing Colleges and need for specialists in the areas of mental 23 Nursing Schools under the control of the health, geriatric and palliative care. It is Directorate of Medical Education. Thrust therefore proposed to start new Government will be given to improvement of Nursing Medical Colleges during the Plan period at a Education in the Government Sector, which cost of `750.00 crore. will also serve as a benchmark for colleges and schools in the private sector. Steps Efforts will be taken to increase will be taken to set up schools/colleges of the speciality and super speciality seats in nursing in all the medical colleges in the the existing medical colleges by providing State. Gaps in basic infrastructure facilities additional manpower, equipment, in the existing Government nursing schools infrastructure etc., as per MCI requirement such as buildings, equipment, staff and at a cost of `100.00 crore. hostel facilities will be provided on a priority basis. Initiatives will be undertaken to build One of the focus areas for the State partnerships with internationally reputed during this period will be the introduction of institutions to improve the quality of nursing a course in Family Medicine. and to provide faculty training. students in this speciality would be trained in providing health education to patients, Nursing Curriculum Improvement their families and the community and also emphasising hygiene and nutrition. In order A special effort will be taken to revamp to make quality affordable Health Care the nursing curriculum to make it more skill available throughout the State, there will oriented and less theoretical in its approach. be a conscious effort to encourage medical Nurses who are employed in Government students to pursue studies in this discipline. Hospitals would be put to Continuing Medical Education (CME) programmes to update Efforts will be made to initiate their expertise under the National Rural discussion with MCI to allow taluk hospitals Health Mission, Tamil Nadu Health Systems and district hospitals to be utilised for Project etc. By improvement of the nursing undergraduate medical training. This will curriculum, evaluation methods and quality enable qualified teachers to go to smaller of clinical training, the overall quality of towns and the facilities of smaller hospitals services in Government and private hospitals will be upgraded. would be improved.

592 Health and Family Welfare

Curriculum Reforms Setting up of Comprehensive Cancer Therapeutic Centres Importance will be given to skill development in the medical profession rather The incidence of Cancer has seen than rote learning. There is need to re-orient a steady increase and has become a major medical education to support rural health cause of mortality in the State. Most forms of issues including integration of medical care cancer are treatable if detected early. Since with medical ethics. Training in Cardiac 70 percent of various types of cancer patients Critical Care for postgraduate students, seek treatment in an advanced stage, steps Compulsory Rotary Residential Internship will be taken to establish one Early Cancer (CRRI) and Training in Disaster Management Detection Centre initially in each medical for all medical and non medical staff and college with the necessary infrastructure. Training for resuscitation of newborns for This would be combined with a state-wide all doctors will be implemented in a phased screening and prevention campaign under manner. Computer training for medical and the World Bank assisted Tamil Nadu Health paramedical students will also be stressed Systems Project. Special focus will be given on upon as part of the medical curriculum. using simple screening methods for cervical Courses for Pain, Palliative care and Distance cancer, breast cancer and oral cancer in all Education Programme using telemedicine the district and medical college hospitals. A and video conferencing to improve basic life State Cancer Registry, the first in India will saving skills will be introduced during the be conceptualised and implemented in the Twelfth Plan period. The cost of these new coming Plan period. schemes is estimated to be `50.00 crore. Introducing Cancer Chemotherapy Improvement of Quality in Education Administration in all medical college hospitals require careful monitoring of the Closely allied to curriculum reform choice of drugs and regimens, the site is the need to improve the quality of and type of cancer (curable cancers) and education and training imparted in medical intention of the treatment i.e. intention to and paramedical institutions. Head of cure or palliate. Cancer treatment has to Departments and senior teaching faculty will be carried out using a multi-disciplinary be trained in teaching methods in coordination approach. The three departments which are with the University. Such senior teachers required for comprehensive cancer treatment and researchers would be allowed to attend are Surgical Oncology, Medical Oncology National and International Conferences and Radiation Oncology. These have to be in order to encourage better teaching and supported by the ancillary departments research practices. Possibilities for exchange of Histopathology, Cytology, Imaging, programmes and tie-ups with national Haematology, Microbiology, Dentistry and and international medical schools will be Blood Bank Services. Thus a definite policy explored to provide training to doctors in new has to be laid down for the management of techniques and treatments and Continuing different types and stages of cancer. Medical Education (CME) for existing faculty to upgrade their skills. Libraries in existing There are two Regional Cancer institutions will also be interlinked so that all Centres in the State, namely the Cancer medical and para medical students will have Institute at Adyar and the Arignar Anna access to the latest international journals and Cancer Hospital at Karappettai near multimedia resources. The total expenditure Kancheepuram. Two more Regional Cancer for this exercise will be `50.00 crore. Centres have been proposed to be set up at the Government Rajaji Hospital in Madurai

593 Twelfth Five Year Plan Tamil Nadu and Medical College Hospital in . Strengthening of King Institute of A minimum of four Medical College Hospitals Preventive Medicine & Research will be converted into Comprehensive Cancer Therapeutic Centres to provide services to The services and contributions of people near their homes. The total outlay for the King Institute have been recognised this scheme including starting of the new by National and International bodies such departments is `200.00 crore. as the UN, WHO, ICMR, DBT, FICCI etc. The facilities of all the departments at King Strengthening of Pharmacy Department Institute may be strengthened with the aid of new technological innovations on par with global standards to serve society by providing The graduate B.Pharmacy course is best healthcare strategies. The proposed cost conducted in the colleges of Pharmacy at of these improvements is `20.00 crore. Chennai and Madurai only, while Diploma in Pharmacy course is conducted in the schools of Pharmacy at Thanjavur, Coimbatore and Governance and Medical Services Madurai. It is proposed to start a B.Pharmacy Recruitment Board course in Thanjavur and Coimbatore. The Government wishes to ensure It is also proposed to improve the good governance in all hospitals, as most of buildings, equipment and infrastructure the problems they face pertain to managerial as well as provide hostel facilities to the shortcomings. The Government is providing students of the existing Pharmacy schools hospital administration training to all Senior and colleges. The Pharmacy Department Medical Officers and those who are likely at Madras Medical College, Chennai will be to become Chief Medical Officers shortly. A modernised to improve the teaching and separate Medical Service Administrative Cadre research capabilities of this department. The will be formed in the Health Department for total expenditure for this scheme is estimated better management of Government Hospitals. at `25.00 crore. As of now, more vacancies exist in Dental College the category of doctors, staff nurses, para- medical staff and hospital workers in the There is only one Government Dental Government Hospitals and PHCs. In order College functioning in the State and it does to fill up the existing vacancies and future not fulfill the requirements of students in vacancies expeditiously, a Medical Services dental education and hence it is proposed to Recruitment Board has been formed in construct a Government Dental College in the Tamil Nadu to provide uninterrupted health southern region of Tamil Nadu at Madurai, at services to the public. This Medical Services a cost of `55.00 crore. Recruitment Board, which is the first of its kind in India would ensure that doctors and The Tamil Nadu Dental College paramedical staff are always in position in all Hospital will be upgraded as a Centre of Government Hospitals and PHCs including Excellence. those institutions located in the backward districts.

594 Health and Family Welfare

Outlay for Medical Education and Research The scheme-wise outlays for the Medical Education and Research during the Twelfth Plan are given in the Table 13.1.3.

Table 13.1.3: Twelfth Plan Outlay – Medical Education and Research (` crore)

S.No. Name of the scheme Outlay

Ongoing schemes

1 Improvements in Medical Colleges 150.00

2 Improvements to the Tertiary care hospitals 300.00

3 Promotion of Geriatric Care and Services 100.00

4 Cadaver Transplant Programme 5.00

5 Nursing Schools and Colleges including Nursing Curriculum Improvement 50.00

Total – Ongoing schemes 605.00

New Schemes

1 Expansion of Medical Education 850.00

2 Curriculum Reforms in Medical Education 50.00

3 Improvement of Quality in Education 50.00

4 Setting up of Comprehensive Cancer Therapeutic Centres 200.00

5 Strengthening of Pharmacy Departments 25.00

6 Dental College 55.00

7 Strengthening of King Institute of Preventive Medicine and Research 20.00

Total – New schemes 1250.00

Grand Total 1855.00

595 Twelfth Five Year Plan Tamil Nadu

13.2 HEALTH CARE DELIVERY AND SERVICES

Introduction (PHC) for a population of 30,000 in the plains and one PHC for a population of 20,000 in the The health care delivery system must hilly tracts. It is heartening to note that the reach the far-flung areas of the State to cater Government has already achieved the above to all sections of the population - especially goal with health care services being delivered those more marginalised than others. at district, taluk, block and village levels. The Healthcare delivery is carried out at primary, PHCs and Health Sub-Centres act as a focal secondary and tertiary levels. Tertiary care is point in rural areas. All the above institutions specialised consultative health care, usually have been fine tuned and stream lined under provided for inpatients following referral from the National Rural Health Mission. primary or secondary health professionals, in an institution that has personnel and Universal Health Care facility for advanced laboratory and imaging This scheme focuses on effective investigations as well as for highly skilled health care delivery to the rural population clinical management. with a fixed mission and a holistic approach. The cyclical benefits accruing Keeping in view the above fact, due to universal health coverage has been the Government of Tamil Nadu has been presented in the figure below (13.2.1). The establishing health care networks in all parts capacity building and strengthening of health of the State and the health care infrastructure care infrastructure at the village level with now has a broad base. The Government’s universal access are the principal objectives goal is to set up one Primary Health Centre

Source: High Level Expert Group, UPC - 2011

Fig. 13.2.1: Universal Health Coverage

596 Health and Family Welfare of the scheme. It is worth mentioning that • Universal access to Public Health Services the Death Rate, Birth Rate, Infant Mortality - Women health, child health, drinking Rate and Maternal Mortality Ratio have been water, sanitation and hygiene, nutrition showing a downward trend during successive and universal immunisation. Plan periods because of operation of various • Prevention and control of communicable factors such as growing industrialisation, and non-communicable diseases. faster urbanisation, marked breakthrough in medical technology, efficacious health • Population stabilisation – Maintaining care delivery system, better nutrition, gender and demographic balance. changing role of women with education and • Access to integrated comprehensive empowerment and the role of mass media in primary health care. awareness creation about birth control. The resources spent on creation of sound health • Revitalising local health tradition and infrastructure and deployment of medical mainstreaming Indian System of Medicine. personnel has therefore paid due dividend. • Promotion of healthy life styles.

In spite of such efforts taken by the Under the broad framework proposed Government, the onset of new strains of above, Tamil Nadu is striving to protect, diseases such as Chickungunya, Dengue, promote, maintain and improve the health HIV infection etc., is a cause of concern. status of the people. Of the three levels of The burden of infectious diseases that care providing services to the people in the need timely diagnosis, effective treatment Government sector, the tertiary sector has and their incidence inflicts severe financial been discussed in the previous section. strain on the poor. The strategies identified The network of tertiary and secondary care to address these issues are availability of medical institutions provide curative and adequate trained health manpower, sufficient emergency services to the people while health care infrastructure, risk reduction the primary health care system forms the and communication, efficient disease framework for programmes for prevention surveillance, response system for early and control of various diseases. detection, treatment of cases and control of Quality Dimension of Health care outbreaks of epidemics. Quality can be measured in three Twelfth Plan Objectives ways, viz. 1.Structure (infrastructure and • Reduction in Infant Mortality and Maternal medicine) 2.Process (quality of medical

Mortality.

Doctors – 5150 Medical Colleges - 17 Nurses – 6282 DME College Hospitals – 48 Other staff – 5577 Tertiary Care Taluk Hospitals - 154 Non-Taluk Doctors – 3966 DMS Hospitals - 76 Nurses – 4864 Secondary Care HeadQuarters Other staff – 11906 Hospitals - 31

Doctors – 4408 DPH HSCs - 8706 Nurses – 18705 Primary Care PHCs - 1303 Other staff – 18749 UGPHC - 309

Source: Dept. of Health and Family Welfare, GoTN Fig.13.2.2: Overview of Health Care System

597 Twelfth Five Year Plan Tamil Nadu advice) 3.Outcomes (impact of care on Family Welfare patient’s health). Process quality in health The main objective of the Directorate care means when a patient visits the doctor, is to stabilise the population growth as the quality of care he receives depends upon well as improve maternal and child health (1) whether the doctor is present (the extensive status, thereby reducing the vital indicators margin of effort) (2) What the doctor knows such as the Infant Mortality Rate (IMR) and (competence) and (3) What the doctor does Maternal Mortality Ratio (MMR). Tamil Nadu (effort), the latter two reflects the intensive is considered as a model State for the other margin of care. States in the implementation of the Family Primary Health Care System Welfare Programmes. As the State has made commendable progress in reducing the Birth The Primary Health Care and Rate, the focus has shifted from a “Target Preventive Health Services in the State are Based Approach” to a “Community Based delivered through a network of 1612 PHCs Approach” where importance is given to and 8706 HSCs under the control of the meeting the unmet needs for family planning Directorate of Public Health and Preventive services and improving maternal and child Medicine. Tamil Nadu is the only State in the health. The major factor behind the success Country which has an exclusive public health of the programme in the State has been management cadre at the district level. These the strong social and political commitment doctors who possess Diploma in Public Health coupled with a systematic administrative are able to acquire administrative experience backup. The programme is implemented and contribute significantly to the design through the PHCs in rural areas and Post and execution of the public health system. Partum Centres, Urban Health Posts and Separate sections for Dental treatment are Urban Family Welfare Centres in the Urban being formed in the Primary Health Centres. areas. Approved private nursing homes also Secondary Health Care System play an important role in the Family Welfare The Directorate of Medical and Rural Programmes. Health Services administers and provides The State is also implementing the following health care services through the Birth Companionship Programme in the network of 31 District Head Quarters all the Tertiary, Secondary and Primary Hospitals, 154 Taluk Hospitals, 76 Non-Taluk care hospitals. A female companion who Hospitals, 19 Dispensaries, 10 Mobile Medical has undergone the process of labour is Units, 7 Women and Children Hospitals, allowed inside the labour room with hygiene 2 T.B. Hospitals/Sanatorium, 2 T.B. Clinics precautions during childbirth. The presence and 7 Leprosy Hospitals/Centres: of companion makes the woman in labour, • Primary and Secondary level care for the feel more secure and comfortable. This public under the basic specialities such programme shortens labour, involves fewer as Medicine, Surgery, Obstetrics and medical procedures, reduces caesarean Gynaecology, Paediatrics, Ophthalmology, sections and decreases postpartum E.N.T, Orthopaedics, Psychiatry and depression. Dental services. Regulatory Functions • Comprehensive Emergency Obstetric and A separate Department “Food Neonatal Care services (CEmONC) for Safety and Drug Control Administration” pregnant women and newborns. has been formed to ensure prevention of • Family Welfare services. health disorders due to contamination and adulteration. This will focus on preventing • Accident and Emergency services. food adulteration and supply of non-spurious drugs to the public.

598 Health and Family Welfare

The Director of Medical and Rural to Government, Health and Family Welfare Health Services is the designated Nodal Department. An outlay of `20.00 crore has Authority for implementation of the been proposed for Food Safety and Drug other major Acts such as Human Organ Control Administration during the Plan Transplantation Act and the Pre-Conception period. and Pre-Natal Diagnostic Techniques Monitorable Indicators (Prohibition of Sex Selection) Act, 1994. The table 13.2.1 gives the goals and Tamil Nadu Clinical Establishment WDUJHWV À[HG XQGHU WKH PDMRU PDWHUQDO DQG Act, 1997 and the Clinical Establishment child health indicators and their achievements Registration and Regulation Act, 2010 for the country and the State of Tamil Nadu. enacted by the Government of India will be The performance under these indicators and implemented in Tamil Nadu after review the related objectives are discussed, outlining by a Committee constituted under the how the current strategies have worked and Chairmanship of the Principal Secretary the path for the future.

Table: 13.2.1: Monitorable Indicators

Recent status Twelfth Plan Indicators India Tamil Nadu Target for TN Maternal Mortality Ratio (per 212 73 44 1,00,000 live births) (SRS 2007-09) (State HMIS 2011-12)

Infant Mortality Rate (per 44 22 13 1,000 live births) (SRS 2012) (SRS 2012) Total Fertility Rate 2.5 1.7 1.6 (SRS 2010) (SRS 2008) Sex Ratio (Females/1000 940 995 998 males) (Census 2011) (Census 2011) Juvenile Sex Ratio 914 946 965 (Census 2011) (Census 2011)

Life Expectancy at M- 67.3 M- 68.6 M- 70 Birth F- 69.3 F - 71.8 F- 73 (NHP2011) MoHFW

Crude Birth Rate 22.1 15.9 14 (SRS 2011) (SRS 2012) Crude Death Rate 7.2 7.6 6 (SRS 2011) (SRS 2012) Couple Protection Rate NA 60 (NFHS III) 65

Still Birth Rate 8 11 (SRS 2009) (SRS 2009) 6 Neonatal Mortality Rate 34 19 (SRS 2009) (SRS 2010) 10 Source: Dept. of Health and Family Welfare, GoTN

599 Twelfth Five Year Plan Tamil Nadu

The State of Tamil Nadu is fast delivery care in all PHCs as well as providing emerging as a good Public Health model Skilled Birth Attendant training to all staff for the rest of the country, especially for nurses and Auxillary Nurse Midwives (ANM) maternal and child care and particularly along with improved facilities for emergency for its achievements in the areas of Infant obstetric care developed under the World Mortality Rate (IMR) and Maternal Mortality Bank funded Health Systems Project has Ratio (MMR). lowered the MMR of the State. Tamil Nadu has already achieved the Millenium Development The consistent policy of the State to Goal (MDG) of reducing MMR below 107. This strengthen the primary health care system huge success rate was also supported by a by posting three staff nurses to provide 24x7 number of programmes to reduce maternal death by properly managing antenatal care.

Graph 13.2.1: Maternal Mortality Ratio

Source: Dept. of Health and Family Welfare, GoTN

Although the State recorded a fall in reduce the IMR such as setting up of IMR from 35 in the year 2007 to 22 in the year Neonatal Intensive Care Units, introducing 2011 (SRS 2012), a fall of more than one third special vehicles for transport of newborns, over a four year period, there still remains control of birth asphyxia and deaths due to number of issues. The State Government hypothermia and implementing strategies undertook a number of programmes to for reduction and management of neonatal sepsis.

600 Health and Family Welfare

Graph 13.2.2: Infant Mortality Rate

Source: Dept. of Health and Family Welfare, GoTN

A home based newborn care Box 13.2.1: Right to Health for programme will be implemented in high IMR Migrant Children blocks. Drop home facilities are being provided Migrant families in Tamil Nadu for mothers who deliver in Government health have been on the rise in the past few facilities for safe transportation of mothers years. These families are not covered by and babies from Government hospitals to any of the social security schemes and their residence. are the most vulnerable. Children of migrant labourers are most susceptible With a view to protect children to infections due to their constant from preventable diseases like Diphtheria, movement and missing of routine Pertusis, Tetanus, Poliomyelitis, Tuberculosis immunisation. Tamil Nadu is the first and and Measles, the Universal Immunisation only State to include polio immunisation Programme has been in operation since 1985. for migrant children apart from IPPI It covers around 11 lakh infants and 12 lakh (Intensified Pulse Polio Immunisation) pregnant women every year. Tamil Nadu has and routine immunisation. 35,000 been included for pentavalent vaccine in children were covered under this special 2012, which provides protection against DPT, polio round of immunisation conducted Hepatitis-B and Haemophilus influenza-B. A by the Directorate of Public Health with second dose of measles vaccine at the age of Rotary International for maintaining the 18 months is also being added. polio free status of Tamil Nadu.

601 Twelfth Five Year Plan Tamil Nadu

Another significant achievement of education, nutrition and free access to family Tamil Nadu has been the fall in the Total welfare services. The SRS surveys show that Fertility Rate (TFR) which was achieved the TFR has now stabilised between 1.6 and during the Nineties. This has largely been due 1.7. to a combination of factors including women’s Graph 13.2.3: Total Fertility Rate (TFR)

1997 2004 2008

2 2 National Target < 1.8 2.1 by 2012 1.6 1.5

1

0.5

0 Before RCH RCH NRHM

Source : Dept. of Health and Family Welfare, GoTN

In addition to the above programmes, Tamil Nadu has been implementing the The State has made efforts to prevent School Health Programme with a School the practice of female foeticide/infanticide Health Day, when health personnel from the contributing to the decline in child sex ratio. PHC visit schools for preventive care. Under The Pre-Conception and Pre-Natal Diagnostic NRHM, it is proposed to strengthen the Techniques Act, 1994 has been effectively inputs for school health under the Modified implemented in the State by nominating School Health Programme (MSHP) which has District and Sub-District level appropriate now been expanded to cover the entire State. authorities. Under the Act, all organisations Gender in Health Care involved in implementing pre-natal diagnostic techniques (largely ultra-sound scan centres) In the perspective of Gender in should register themselves with the respective Health Care, universality in health coverage appropriate authority. Offences such as non- is essential to achieve equality in access. registration and disclosure of sex of the foetus Gender disparities, particularly persistent in are punishable as cognisable, non-bailable anti-female biases are most glaringly reflected and non-compoundable offences resulting in the declining female-to-male ratios among in upto 3 years of imprisonment. Doctors children below six (with the sex ratio among who are found indulging in malpractices children declining from 927 girls per 1,000 are also liable to lose their medical practice boys in 2001 to 914 in 2011) at All India registration. Level. In Tamil Nadu, the Child Sex Ratio increased from 942 in 2001 to 946 in 2011. Schemes for the Twelfth Plan – In many of the critical districts with adverse with Gender perspective sex ratios in 2001, due to concerted efforts, it The following schemes have been has improved and other districts have fallen proposed in the Plan period to strengthen into a lower sex ratio indicating that policies Health Care Delivery and Services in the addressing sex ratios should be universal State: and implemented across the State.

602 Health and Family Welfare

Promotion of Menstrual Hygiene period at a proposed outlay of `3,000.00 crore. Since, the Village Health Nurses play an Promotion of Menstrual Hygiene important role in implementing the scheme, among adolescent girls will go a long they would be provided Laptops free of cost to way in reducing the risk of infection and maintain the details about pregnant women, infertility among women in the future. The babies and mothers who were covered by the Government of India announced a scheme for scheme. sale of sanitary napkins to rural adolescent Chief Minister’s Comprehensive Health Insurance scheme

In order to achieve the objective of Universal Health care to the people of Tamil Nadu, the Government is implementing the Chief Minister’s Comprehensive Health Insurance Scheme. Under the new scheme, the eligibility criteria will be persons with income ceiling limit below `72,000/-per Fig. 13.2.3: Sanitary Napkin annum. While the sum assured is `1.00 lakh per year per family along with a provision to girls at a subsidised cost of `6/- per pack pay upto `1.5 lakh per year per family for of 6 napkins in 10 districts. The initiative certain specified procedures, the new scheme of the Government of Tamil Nadu is unique will cover 1016 life saving procedures. This from the national programme, wherein, new scheme not only includes life saving sanitary napkins are distributed to rural procedures, but also essential medical adolescent girls free of cost through Schools procedures, diagnostics and follow up and Anganwadis in the entire State. It is also procedures to ensure comprehensive care to extended to postnatal mothers and women the people. Government hospitals will also prisoners for the first time in the country. be encouraged to participate fully under the The State has also apportioned funds for scheme. The scheme has been launched disposal mechanism for the used napkins. in January 2012 with an outlay cost of This is a path breaking scheme as Tamil `3500.00 crore for the Plan period. Nadu is the only State in the country to take up implementation for the entire State using its funds. An outlay of `300.00 crore has been proposed during the Plan period.

Dr. Muthulakshmi Reddy Maternity Benefit Scheme

The State has always given precedence to the empowerment of women and children. As evidence of this priority, a number of health programmes focusing on women welfare have been announced for implementation, Fig. 13.2.4: Health Insurance Card of which Dr.Muthulakshmi Reddy Maternity Certain treatments involving Benefit Scheme is one of the major schemes. transplants cost much higher than the ceiling The scheme has been strengthened to provide of `1.50 lakh stipulated under the CMCHIS ` enhanced maternity assistance of 12,000.00 and to bear the additional expenditure, a upto two deliveries for poor women. The corpus fund has been created. scheme will be continued in the Twelfth Plan

603 Twelfth Five Year Plan Tamil Nadu

Hospital on Wheels with additional supply of medical and life saving equipments. It is also proposed As a new initiative and in order to to set up ‘state of the art’ computer aided provide health care services at the door step laboratory facilities in all the districts under of remote and far flung areas of the State, a Public Private Partnership mode in a phased new scheme “Hospital on Wheels Scheme” has manner. been launched and the existing 385 Mobile Medical Units (MMU) have been strengthened National Rural Health Mission with additional man power and lab facilities. The State Government entered into a The medical team will visit remote villages Memorandum of Understanding (MoU) with based on a fixed tour programme. the Government of India (GoI), stating their agreement to the policy framework of the Mission and the timelines and performance benchmarks against identified activities. The State has since established “State and District Health Missions”.

The State Health Society, Tamil Nadu was registered under the Tamil Nadu Societies Registration Act, 1975. Similarly, all the 30 district health societies have been registered under the Act.

Most of the schemes for reduction of Infant and Maternal mortality as well as Fig. 13.2.5: Hospital on Wheels the National Disease Control Programmes are being operated under the National Rural Though there has been significant Health Mission (NRHM) funds. The sharing improvements in the health care delivery in proportion for NRHM during the Twelfth Plan the rural areas of the State, it is a matter of period is 75:25 between the Central and State concern that the under privileged population Governments. An allocation of `835.00 crore in the urban slums and small urban towns would be provided for the matching grant for are unserved and underserved and so a NRHM funding during the Plan period. comprehensive plan for urban health care service delivery has been implemented. It National Urban Health Mission will focus on the improvement of primary Although there is no Memorandum health care facilities in urban areas on par of Understanding (MoU) between the State with the PHCs in rural areas. The existing and Central Governments such as with the urban health posts will be strengthened by National Rural Health Mission, it is crucial providing 24 hour delivery care. for the State to consider the National Urban Health Mission in the implementation of The World Bank assisted Tamil Nadu the Twelfth Five Year Plan. No systematic Health Systems Project has mainly been investments or efforts have been made to focusing on infrastructure improvement in improve health care in urban areas. The the Government Hospitals, so as to improve Public Health Network in urban areas the services available to the public. Utilising functions with lack of manpower, equipment the funds allotted to the project in the and drugs. A focus on Reproductive Child second phase, the diagnostic services for Health (RCH) and Public Health is needed poison treatment centres in all the District for addressing the health needs of the urban Head Quarters Hospitals will be upgraded population. Public Health will be taken up

604 Health and Family Welfare as a thrust area for the State’s Twelfth Five has been revived and all visible congenital Year Plan, aided by the launch of the National defects in children under the age of 15 years Urban Health Mission (NUHM) with a focus would be surveyed and those children who on slums and urban poor. The NUHM’s core need surgery for congenital disorders will be strategies include Decentralised Planning operated in the Government Medical College with the flexibility to develop city specific Hospitals or through the comprehensive models, Strengthening the urban health insurance scheme, free of cost. system, Capacity building, Communalisation and development of partnerships with Government has launched a survey of Community Based Organisations (CBO), birth defects in rural areas through NRHM Non Governmental Organisations funds. The aim is to identify and treat all birth (NGO), Charitable Organisations and defects in children between the age of 0-15. other stakeholders, Development of IT Once the back log is cleared, it is proposed and e-Governance systems for effective to put a system in place for identifying them programme monitoring, Evaluation and on a regular basis and providing timely implementation and focus on inter-sectoral interventions. It is also proposed to open a convergence with other programmes like the birth defect registry. The programme would Jawaharlal Nehru National Urban Renewable be combined with Immunisation schedule. Mission (JNNURM), Rajiv Awaas Yojana (RAY) etc. Accident and Emergency Care - Emergency Ambulance Services Urban Primary Health Care - Small Urban Towns Response time is vital for all types In the last year of the Eleventh of medical emergencies, road accidents, Plan, steps have been taken to start 135 suicides, crimes etc. Although a good Urban Primary Health Centres (U-PHCs) in network of medical facilities is prevalent accordance with the National Urban Health in Tamil Nadu, ambulance services Mission (NUHM) in uncovered small urban were not available round the clock due towns under the administrative control of the to various operational / administrative Public Health Department. These U-PHCs reasons. Considering the importance of will provide services to the entire urban providing emergency ambulance services population in their service areas. to save precious lives, the Government has established free Comprehensive Emergency Considering the growing urbanisation Management Services in partnership with of the State, it is proposed to establish more Emergency Management Research Institute Urban PHCs and strengthen urban health (EMRI), Hyderabad. Currently, there are 436 services under the control of Director of ambulances on road in all the 32 districts, Public Health and Preventive Medicine during which will be increased to 654 before the the Twelfth Plan period at a proposed outlay end of the current Plan period. Each vehicle of `20.00 crore. is provided with life-saving equipment and staffed with an Emergency Medical Technician Birth Defect and Developmental (EMT) trained in emergency pre-hospital Disorders Survey management along with a pilot (Driver). In the Tenth Plan, a scheme was taken Neonatal Ambulances are also provided up to screen all children under 15 years for on call, for attending critical postpartum congenital disorders and ensure that all complications. children with cleft lip and palate were operated in the Government Medical College Hospitals, At present, 14 Secondary Care so that Tamil Nadu would become a “cleft Hospitals located along National Highways lip-cleft palate free State”. This programme

605 Twelfth Five Year Plan Tamil Nadu have Comprehensive Emergency Care categories of Medical Institutions with respect Services established with support from the to diagnostic services. Hospitals and PHCs GoI and it is proposed to establish similar will be made to perform the necessary tests centers in 20 more hospitals located along available with them and for other tests, they National Highways during the Twelfth Plan will function as sample collection centres. period. Information and Communication Technology will be fully utilised to deliver the results of The ambulances of “108” Emergency the tests. Atleast one major laboratory which Ambulance Services will be stationed will perform all tests will be made available strategically at locations vulnerable to to each district and Chennai will have a accidents. The emergency services will be master laboratory which will be able to strengthened further at a cost of `350.00 perform all types of highly specialised tests. crore. Furthermore, a 24x7 Medical Services The modernisation of diagnostic services Helpline will be formed for emergency help to during the Twelfth Plan period will be carried the general public and patients, information out at a cost of `60.00 crore. Public-Private about the availability of medical services in Partnership will also be encouraged to the Government hospitals, blood availability strengthen the laboratory system in the State. in blood banks and other assistances. Equipment provision and Strengthening of Secondary Care Equipment Maintenance System Hospitals Rationalisation of the equipment in The Secondary Care Hospitals namely secondary care hospitals will be carried out the District Headquarters Hospitals, Taluk in the forthcoming Plan period. A robust Hospitals and Sub Taluk hospitals will be Equipment Maintenance System will be strengthened with additional buildings, introduced in all Government Health Care equipment and staff based on a detailed Institutions during the Twelfth Plan period. facility survey. There will be a special focus The cadre of bio-medical engineers already on providing a basic package of services in introduced in the system will be expanded atleast one hospital in each district. Dental to cover all medical colleges, medical Health will be given its due importance and college hospitals and PHCs. The Equipment dental clinics will be started in all hospitals Maintenance System will be implemented at and upgraded PHCs. The hospital diet was a cost of `30.00 crore during the Twelfth Plan recently revised and the system of allocating period. Dieticians / Nutritionists will be brought into all major hospitals to advice on proper House Keeping Services and diet for patients. The cost for strengthening Hospital Waste Management of secondary care hospitals with additional buildings, staff and equipment works out to There is a need for improvement of be `210.00 crore. Resources from NRHM and cleaning, sanitation, security, laundry and Central funds will also be used to strengthen catering services in Government Hospitals. the district hospitals. In a pilot project, the Government had outsourced some of these services from Modernisation of Diagnostic private firms in four hospitals. Analysis of Services the outsourcing services in these hospitals was found to be quite encouraging and it The Diagnostic Services consisting is proposed to extend the outsourcing of of imaging services and laboratory services housekeeping services of all Medical College will be modernised during the Twelfth Hospitals, District Head Quarters Hospitals Plan period. Norms and protocols will and certain major Taluk Hospitals during the be developed and introduced for different Twelfth Plan Period.

606 Health and Family Welfare

The Bio-Medical Waste (Management Tobacco Control and Handling) (Third Amendment) Rules 2003, outline a proper system of segregation, Tobacco use increases the risk for storage, transportation and end disposal that cancers of the oral cavity, larynx and lungs. has to be implemented in all institutions The National Tobacco Control Programme from tertiary level to the primary level. The has been launched by GoI to reduce tobacco Government of Tamil Nadu has developed related diseases and deaths. The Public Health an integrated infection control and waste Department is implementing the programme management plan with operational with the formation of the State Tobacco procedures, standardised protocols, Control Cell and District Tobacco Control monitoring and supervision procedures Cell. The department has taken initiatives to and training modules for proper disposal achieve a smoke-free Chennai with a special of bio-medical waste to institutionalise a focus on enforcement of Tobacco control comprehensive Infection Control and Waste laws and creation of awareness. The funds Management System in all Government for IEC campaign will be secured through the Health Institutions. An allocation of `150.00 National Rural Health Mission. crore has been earmarked for the above activities during the Plan period. IEC activities through Resource Centre for Tobacco Control at For the maintenance of hospital Cancer Institute premises, improving sanitation, cleaning and protection of the environment of hospitals, The Resource Centre for Tobacco 4000 multipurpose workers would be Control at Cancer Institute has been offering appointed on consolidated pay/ outsourcing evidence based cessation services at various basis and to strengthen the security system levels such as hospitals, community, schools, in hospitals, 2,176 security staff would be colleges and corporates. The Centre has been outsourced. involved in training health care professionals and various stakeholders on cessation and Skill Development of Health Care tobacco control advocates. During the Twelfth Providers Plan, training programmes will be conducted in each district by the Resource Centre for Under the Tamil Nadu Health Tobacco Control at Cancer Institute targeting Systems Project and National Rural Health educational institutions, enforcement Mission, large scale skill development officials, cessation training for health care programmes are underway for the health care professionals and others such as Media, providers. Trainings such as labour ward Traders, Panchayat Presidents, Councillors, skill development, neo-natal resuscitation, NSS, NCC etc., at a cost of `5.00 crore. intensive care unit, poison treatment, ventilator, dialysis, ultra-sonogram, echo- Mental Health Programme cardiogram, rationalisation of drug and hospital administration have been planned. The Mental Health programme was Short courses in CEmONC and anaesthesia under implementation in 8 districts before have already been introduced with a the Eleventh Plan and was extended to 8 more reasonable amount of success. It is also districts during the Eleventh Plan period with proposed to train the ministerial staff and the GoI’s assistance. This Programme would nursing superintendents on administration be extended throughout the State during and hospital services. During the Twelfth the Twelfth Plan period. Under the centrally Plan, all the above trainings will be conducted sponsored programme, the psychiatric at an outlay of `75.00 crore. departments in most medical colleges and the Institute of Mental Health have been

607 Twelfth Five Year Plan Tamil Nadu strengthened. Setting up of another mental greater than the incidence of communicable hospital in Theni and extending the Mental diseases and has become the leading cause Health Programme throughout the State of death. Tamil Nadu is currently tackling is in progress. It is the only State where the burden of both Communicable and Non- a psychiatrist is available at all District Communicable Diseases (NCD). The rising Headquarters Hospitals. Apart from providing burden of NCDs is putting a strain on health mental health services, to monitor and care systems and the overall cost of diagnosis improve the health of the mentally ill persons, and management of NCDs are inflicting a “Mental Health Monitoring Committee” with financial strain on individuals, families and District Collector, Government Officials, society. In an effort to address the lifestyle NGO representatives and the relatives of the diseases, the Tamil Nadu Health Systems patients have been formed in 11 programmed Project (TNHSP) has undertaken two pilot districts. schemes, one for prevention, screening and treatment of Cardiovascular Diseases (CVD) Communicable Diseases and another for prevention, screening and treatment of Cervical Cancer, in two districts The Communicable diseases are each. As the pilots were quite successful, endemic in many parts of the State and TNHSP now has initiated steps to scale up continue to be a major public health these activities throughout the State along problem. Programmes for disease control with prevention and treatment of Diabetes have been undertaken to tackle disease Mellitus and early detection and treatment of prevalence such as the Vector Borne Disease Breast cancer at a cost of `50.00 crore. Control Programme (Malaria, Japanese Encephalitis, Filaria, Dengue, Chikungunya, Silicosis prevention and control Leptospirosis etc.,) and the Revised National measures will be taken for the welfare of TB Control Programme (DOTS). The State workers in silicosis prone industries like has been a successful performer under the quarries, construction sector and road laying. Revised National TB Control Programme. Chronic Kidney diseases will be tackled in a The prevalence of Leprosy has been brought multi-pronged approach like treatment of down to less than 0.5 in the State. hypertension and diabetes, increasing IEC activities to bring lifestyle modifications, Continued efforts will also be made establishment of dialysis services in all major to involve the private sector fully and use hospitals, encouragement for cadaveric the services of NGOs working in the field transplantation and improvement of facilities to improve the compliance and reduce the for transplantation surgeries in the medical default rate at all levels. Improvement of lab college hospitals. services by constant training and quality upgradation will also feature in the proposals It is proposed to maintain a registry for the focus areas during the current year. of cancer, acute myocardial infarction and stroke in the major hospitals. The screening Non-Communicable Diseases (Life and treatment of Non-Communicable Style Diseases) Diseases during the Twelfth Plan period would continue at a cost of `58.00 crore. Lifestyle diseases are Non- Communicable and Chronic Diseases that Nalamaana Thamilagam (Healthy are associated with the way a person lives. Tamil Nadu) Incidence of Non Communicable Diseases (NCDs) such as Cardiovascular diseases, ''Nalamaana Thamilagam'', a non- Diabetes Mellitus, Chronic respiratory communicable disease control programme diseases, cancers of Cervix, Breast etc., is was implemented for screening of diabetes

608 Health and Family Welfare and hypertension. Based on the success of Central Government through the National Nalamaana Thamilagam, a new programme AIDS Control Organisation (NACO). The “Pengal Nalathittam” was proposed in Policy programme monitors trends in HIV infection Implementation Plan (PIP) 2011-12 to by place, by group and by time, through spread awareness regarding risk for breast testing of blood samples. and cervical cancer to detect and treat early asymptomatic and undiagnosed cases Health Management Information especially those at high risk and to prevent System (HMIS) complications through prompt and effective treatment of diagnosed cases. The screening Tamil Nadu Health Systems Project programme is planned in a camp mode to is now in the process of establishing an cover all rural women aged 30 years and integrated and sustainable plan of 11 above. Regional Training Centers (including seven Government and four Private Medical College Tamil Nadu State AIDS Control Institutions) in coordination with different Society (TANSACS) stakeholders including Tamil Nadu Pollution Control Board, TamilNadu State AIDS Control The Tamil Nadu State AIDS Control Society, State Health Society, Civil Societies Society was set up with effect from 11th May and Private Medical College Institutions 1994 under the control of Health Department which aims to enhance the quality of infection to implement strategies for HIV/ AIDS control in all the health sub-centres, primary prevention and control in the State. As a health centres, secondary care hospitals, result of effective programme management, tertiary care hospitals, blood banks, the HIV / AIDS prevalence rate in Tamil Nadu maternity homes, dispensaries and health has decreased. The immediate focus of this posts run by 151 municipalities and 10 society is to make “Tamil Nadu AIDS free and municipal corporations. HMIS is a judicious No New Infection State”. combination of Information Technology (IT) and management system to deliver improved TANSACS is giving various evidence based health care to the public. programmes to prevent infection, treatment, HMIS in the State has been implemented care, support and surveillance, monitoring as pilot, Phase-I and Phase-II in the past. and training activities. IEC interventions This system integrates data collection, have also helped to reduce stigma and processing, reporting and utilisation of discrimination associated with HIV/AIDS existing information for improving the and to safeguard and protect the human efficacy of health services in addition to better rights of People Living with HIV/AIDS (PLHA). management. Anti Retroviral Treatment (ART) is given to increase the life span and improve quality of All the 1612 PHCs, 267 Government life of the people living with HIV/AIDS. secondary care hospitals, 17 medical colleges and 47 tertiary care medical education A new web based reporting application institutions will be actively utilising HMIS “Strategic Information Management System” during the Twelfth Five Year Plan. The (SIMS) was developed as a mechanism of cost for establishment of web based Health improving computerised reporting on the Management Information System and its activities of TANSACS. At the State level, maintenance during the Twelfth Plan Period an Integrated Biological and Behavioural has been estimated at `180.00 crore. Assessment (IBBA) and at district level, HIV Sentinel Surveillance (HSS) will be conducted. The HSS programme is implemented by the Health and Family Welfare Department of the

609 Twelfth Five Year Plan Tamil Nadu

Information and Communication trained and placed in tribal habitations. In Technology (ICT) Initiatives in Tamil Nadu, ASHAs (Accredited Social Health Health Sector Activists) are designated as Village Health Volunteers (VHV) and training and monitoring The State has proposed to ensure good carried out through district training team. governance in the Health Sector through the As per GoI instructions, performance based following ICT initiatives at a cost of `20.00 incentive is given to the VHVs. Birth Waiting crore: Rooms (BWR) have been established in 17 PHCs in the foothills of the Tribal areas to • Telemedicine is the use of provide better health care and family welfare telecommunication and information services to tribal population. BWR would be technologies to provide clinical health care utilised to bring pregnant women and birth at a distance. It is also used to save lives companion earlier to the date of delivery for in critical care and emergency situations. nutrition education and diet counselling. • Telehealth supports long-distance clinical health care, patient and professional Diet to the antenatal mothers and health-related education and training, one of their attendants are provided in Tribal public health and health administration. areas for staying for one week before the expected date of delivery in 35 Tribal PHCs. • Teleconsultation enables clinical The feeding and dietary charges for the consultation between geographically beneficiaries are supported by NRHM. Tamil separated individuals such as health care Nadu Health System Project (TNHSP) has professionals and their patients. established 20 Mobile Medical Units (MMU) • Telemonitoring is used as an adjunct in 13 tribal districts in addition to the MMUs to proctoring in the privileging process already functional in the tribal blocks. The but should not alone be a substitute for mobile outreach health team consists of one proctoring to determine competency. medical officer, one staff nurse, one auxiliary Integration of Telemonitoring into the nurse midwife, one lab technician and one proctoring process may reduce, but not driver. The TNHSP has selected 32 tribal eliminate the number of on-site proctored counsellors from the tribal community and cases required. appointed them in 27 Government Hospitals and 5 PHCs in The Nilgiris District and these • Teletreatment provides specialised counsellors assist poor patients by providing treatment to patients even in remote counselling. The existing EMRI vehicles are places through Telemedicine. not able to reach the tribal hamlets due to the • Telediagnostics enables online diagnosis size of the vehicles and the poor condition of of a patient. the roads. In order to reach those tribal areas which are inaccessible, new four wheel drive Tribal Health vehicles suitably equipped as ambulances are stationed in 24 identified points in There is a consensus that the health tribal / hilly areas to transport sick mothers status of the tribal population is very poor and and newborns. It is proposed to implement worst among the primitive tribes because of bed grant scheme in the four private hospitals their isolation, remoteness and being largely of the tribal districts to provide for minor unaffected by the developmental processes ailments and surgeries utilising the NRHM going on in the State. In view of the difficulties funds at a cost of `250.00 crore. faced by the tribal population, many schemes are implemented for tribal health under the Tamil Nadu Health Systems Project and the National Rural Health Mission. 2650 Village Health Volunteers (VHVs) were selected,

610 Health and Family Welfare

Decentralising Health - Village Maintenance of Current System of Health, Nutrition and Water Access to Medicine - TNMSC Sanitation Committee (VHNWSC) The Tamil Nadu Medical Services The village is the basic unit for Corporation Ltd. (TNMSC) has been set up with assessing the health needs of the people the primary objective of ensuring availability and developing village specific plans. of all essential drugs and medicines in the In Tamil Nadu, 12,618 Village Health, Government medical institutions throughout Nutrition and Sanitation Committees have the State. It has adopted a streamlined been formed in 12,618 Village Panchayats procedure for procurement, storage and with representatives of the Panchayati Raj distribution of drugs. The Corporation Institutions (PRIs), women groups and other procures and supplies 260 types of essential village level officials related to health and drugs, 192 items of speciality drugs and determinants of health, water and sanitation. medicines, 113 varieties of suture items and Similarly, 2,540 village health and water 75 surgical items to various Government sanitation committees have been formed in hospitals, primary health centres and through 561 Town Panchayats. them to the health sub-centres throughout Tamil Nadu every year. It is making effective The Village Health, Nutrition and Water use of Information Technology in inventory Sanitation Committees have been established management including placing of orders, in each village and Town Panchayat under receipt of supplies, distribution to medical NRHM. An annual untied grant of `10,000/- institutions, making payment to the suppliers is given to each committee for improving the etc. and also maintains a user friendly web health and sanitation of the village. The site www.tnmsc.com. The Corporation is Panchayat President is the chairperson for involved in procuring all ranges of equipment the committee. The representatives of PRIs from Sphygmomanometer to 3 Tesla MRI who are the committee members have already scanners for the use of all Government been trained focusing on health care delivery medical institutions. The TNMSC’s customer system of the area concerned and local base is also widening day by day and it is health issues and the corrective measures to catering not only to the needs of the health be taken for better health of the community. sector, but also the non-health sector. It It is planned to train all PRI Members, Village also maintains specialised services like CT Health, Water Sanitation and Nutrition Scan, MRI Scan and Lithotripsy etc., on Committee Members, local NGOs and SHGs user charges basis in Government hospitals on the current changes in the health systems. and has taken up consultancy works for the Government of Andhra Pradesh, Madhya Establishment of Water Analytical Pradesh and Rajasthan for the procurement Laboratories of drugs and medical equipment.

Protected potable water supply is The State will ensure availability of provided by Tamil Nadu Water Supply and items on the Essential Drug List (EDL) to Drainage Board to Rural and Urban areas. The all citizens. The State will also ensure 100 Public Health Water Analytical Laboratories percent availability of drugs at all locations. at Guindy and Coimbatore monitor the water The TNMSC pioneered the “Free Medicines quality at present. To extend the facility of for All” system which is becoming a model for water quality monitoring and surveillance to Public Health Facilities across the country, all the districts, it is proposed to establish most significantly with the Centre’s intention laboratory facilities in each district during to emulate this model during the upcoming the Plan period at an outlay of `8.00 crore. Twelfth Plan period.

611 Twelfth Five Year Plan Tamil Nadu

Table 13.2.2: Twelfth Plan Outlay – Health Care Delivery and Services (` crore) Outlay S.N Total Name of the Scheme Department-wise Ongoing New o. Outlay Schemes Schemes I Medical and Rural Health Services (MRHS) 1. Strengthening of Secondary Care Hospitals 210.00 210.00 2. Modernisation of Diagnostic Services 60.00 60.00 3. House-keeping Services 150.00 150.00 4. Skill Development of Health Care Providers 75.00 75.00 5. Tele-Medicine 20.00 20.00

Total – MRHS 210.00 305.00 515.00

II Tamil Nadu Health Systems Project (TNHSP) 1. Chief Minister’s Comprehensive Health Insurance 3500.00 3500.00 Scheme - 2. Accident and Emergency Care 350.00 350.00 3. Non-Communicable Diseases 108.00 108.00 4. Health Management Information System 180.00 180.00

Total – TNHSP 4138.00 - 4138.00

Public Health and Preventive Medicine(PH&PM) III 1. Dr. Muthulakshmi Reddy Maternity Benefit Scheme 3000.00 3000.00 2. Urban Primary Health Centre 20.00 20.00 3. Establishment of Water Analytical Laboratories 8.00 8.00 4. IEC activities through Resource Centre for Tobacco 5.00 5.00 Control at Cancer Institute 5. Menstrual Hygiene Programme 300.00 300.00 Total – PH&PM 3020.00 313.00 3333.00 IV National Rural Health Mission (NRHM) 1. National Rural Health Mission 835.00 - 835.00 Total – NRHM 835.00 - 835.00 Tamil Nadu Medical Services Corporation (TNMSC) V 30.00 30.00 1. Equipment Maintenance System Total – TNMSC 30.00 30.00 VI Food Safety and Drug Control Administration 1. Strengthening of Food Testing and Drug Testing 20.00 20.00 Laboratory Total - FS&DCA 20.00 20.00

Grand Total 8203.00 668.00 8871.00

612 Health and Family Welfare

13.3 INDIAN MEDICINE AND HOMEOPATHY

Introduction The success and growth of Allopathic medicine stands on the edifice of its scientific The traditional health care systems approach and clinical research. If the Indian of India are embodied as cultured health Systems of Medicine are to be built along the practices and they are effective, sound, region above lasting foundations, it is necessary specific involving medicinal plants available that good teaching and research institutions across the country. The WHO has estimated are established. Tamil Nadu is the only that 70 percent of the world’s population still State in the country where there are AYUSH depends on the ethnic medicine systems of disciplines in all Medical Colleges. It is that particular geographical location for their significant to note that the Government itself health care. has established one college in each discipline.

Review of Eleventh Plan

During the Eleventh Plan period, the Government implemented numerous programmes in the areas of Medical Education, Research, Standardisation and Promotion. In the area of Medical Education, the Siddha Medical Colleges at Chennai and Palayamkottai were upgraded. Under Medical Research Programmes, a separate research group has been constituted to focus on AIDS under ISM for encouraging Research and Development Programmes in Indian System of Medicine and Homeopathy.

As part of standardisation Fig. 13.3.1: Indian medicines programmes, the State pharmacies were The Indian Systems of Medicine modernised at a cost of `1.30 crore to prepared through herbal formulations for a ensure affordable and efficacious ISM wide range of diseases was at a high level of drugs are available. All works connected excellence in ancient India. In order to ensure with the inspection, sampling, prosecution that the public receive benefits of both the and licensing of Indian System of Medicine Indian System of Medicine (ISM) and modern drugs are now carried out by the State Drug medicine, the Government of Tamil Nadu has Licensing Authority (Indian Medicine). In been following the policy of co-location of ISM addition, the Drug Testing Laboratory (IM) wings in the Government Hospitals and large has been established at a cost of `1.47 crore Primary Health Centres. At present AYUSH with advanced equipment and instruments (Ayurveda, Yoga and Naturopathy, Unani, to strengthen the enforcement machinery of Siddha and Homeopathy) practitioners are the Drug and Cosmetics Act, 1940. available in 30 District Hospitals, 231 Taluk and Non Taluk Hospitals and 954 Primary Indian Systems of Medicine wings in Health Centres. 300 Primary Health Centers were opened at a cost of `7.01 crore under National Rural Health Mission. Financial assistance to the tune of `46.66 crore was received from the

613 Twelfth Five Year Plan Tamil Nadu

Government of India towards provision of medicines prepared by the traditional infrastructural facilities for the above 300 practitioners and to provide them with the newly opened wings. best modern technology. • To establish computerised online clinical The Government also undertook documentation in various systems of programmes for the promotion of Herbal Indian medicine. Gardens in Kolli Hills. However, due to adverse geographical and climatic conditions, • To standardise the drugs used in the the land was unfit for their establishment Indian Systems of Medicine and to lay and so the project was aborted and the land down their pharmacopoeial specification surrendered to the Revenue department. with suitable punitive action in case of Since most of the tribal areas are by default in violation. forest areas, this task can be better handled by the Forest Department in collaboration Ongoing Schemes with the Tribal Societies. The Forest Opening of ISM&H wings in Primary department can establish the herbal garden Health Centres in the tribal areas with the technical support of the Indian Medicine and Homoeopathy As of now, out of 1612 PHCs, ISM&H Department and with the additional aid wings are available in 954 PHCs on regular of Agricultural Universities and other Life and part time basis. ISM wings would be Science Universities to ensure proper extended to 250 PHCs during the Twelfth documentation and to satisfy research needs. Plan period at an approximate cost of `52.32 The maintenance of herbal gardens would be crore. taken up in a full-fledged manner at all ISM wings in the available land within the PHC New Schemes premises. The Schemes proposed to be Twelfth Five Year Plan implemented during the Twelfth Plan are narrated below: Objectives I. Awareness Creation of ISM The objectives of this sector for the through Information, Education and Twelfth Plan are: Communication • To extend the health care under Indian Systems of Medicine by establishing ISM The treatment facilities available in wings with adequate staff, medicines and the ISM wings, diseases for which treatment infrastructure. facilities are given, the salient features of ISM medicines viz., side effect free, pure and • To upgrade the quality of education natural ingredients etc., have to be brought imparted in Government ISM&H colleges to the attention of the masses through throughout the State. posters, pamphlets, sign boards etc. Hence, • To provide adequate and liberal funding an intensified awareness programme coupled for propagation of the benefits of Indian with aggressive outreach programmes will be Systems of Medicine through aggressive undertaken on a massive scale in order to awareness campaigns and sustained sustain these time-tested health care systems outreach medical camps. at an estimated cost of `8.26 crore. • To conduct clinical as well as pharmacological research to improve the Shastric preparations as well as the

614 Health and Family Welfare

II. Upgradation of Infrastructure in Provision of Modern Kitchen to AAGHIM, ISM Hospitals Chennai and GSMC, Tirunelveli Hospitals of ISM Laboratories Diet plays an important role in the At present, the laboratories available treatment of patients through Indian systems in the hospitals attached to Government of Medicine. At present, kitchen facilities Siddha Medical College, Palayamkottai and are available at Arignar Anna Government Arignar Anna Government Hospital of Indian Hospital of Indian Medicine, Chennai Medicine, Chennai only conduct routine and Government Siddha Medical College, pathological and biochemical tests. Facilities Tirunelveli. Modern Kitchen is the need of are required in these institutions to confirm the hour in these two Hospitals, in order to the diseases diagnosed through conventional provide hygienic food. An amount of `0.23 clinical assessment under the ISM protocol crore has been proposed for this purpose. before the commencement of treatment. Hence, lab facilities at Arignar Anna Separate OP and IP Block at Government Hospital of Indian Medicine at Government Homoeopathy Medical Chennai and Government Siddha Medical College, Thirumangalam, Madurai College and Hospital at Tirunelveli would be District upgraded at a cost of `1.00 crore. At present, the hospital is Ultra sonogram and X-ray facilities to temporarily accommodated at Government Government Ayurveda Medical College Hospital campus and has to be shifted to Hospital, Maravankulam where college buildings are already situated. A separate outpatient (OP) The fifty-bedded hospital attached and inpatient (IP) block is essential within to Government Ayurveda Medical College the college campus to demonstrate clinical has no facility for an Ultra sonogram and cases to students and for the benefit of the X-ray machine. Provision of a full-fledged rural public, which would be established at a Radiology Department with a Radiologist, cost of `1.30 crore. Radiographer and an X-ray attendant with an Ultra sonogram and X-ray machine at a Provision of Animal House for cost of `1.00 crore is required to fulfill the Government Siddha Medical Colleges requirements of the Central Council of Indian at Tirunelveli and Chennai Medicine norms. For the students of Postgraduate Provision of Obstetric and Gynaecology courses in Government Siddha Medical ward to AAGHIM, Chennai Colleges at Chennai and Tirunelveli, dissertation work is compulsory for research In the Indian Medicine Central Council projects and so, Animal House would be Act and Central Council of Homoeopathy Act, provided in the above two colleges at a cost the provision of Obstetrics and Gynaecology of `1.33 crore. Department with Labour Ward and Operation Theatre is necessary and this department Enhancing the number of Undergraduate would be established with a 25 bedded Departments in Government Unani labour ward and operation theatre in the Medical College, Chennai Arignar Anna Government Hospital of Indian Medicine, Chennai at a cost of `1.43 crore. The norms of Central Council of Indian Medicine (CCIM) for establishment of Unani Medical Colleges prescribe a minimum of fourteen departments, of which only seven

615 Twelfth Five Year Plan Tamil Nadu undergraduate departments are available Strengthening of Drug Control in the Unani Medical College, Chennai. Mechanism Remaining departments would be started in this college at a cost of `3.00 crore in the There is a separate Drug Licensing Twelfth Plan period. Authority exclusively for Indian Medicine. To enforce the provisions of Chapter IV of the Construction of additional building Drugs and Cosmetic Act and Magic Remedies for Women’s Hostel for Government Act, the District Siddha Medical Officers have Homeopathy Medical College (GHMC), been given the authority as drug Inspectors Thirumangalam, for their respective jurisdictions, as an additional responsibility. The enforcement At present, the available facility can mechanism is still at the infant stage while accommodate only a maximum of 45 students substandard medicines in the market are which is far below the requirement with the becoming a serious issue. Enforcement of remaining students seeking accommodation the Drug control mechanism, by appointing elsewhere. Hence, an additional building separate Drug Inspectors would ensure is necessary and an amount of `1.70 crore enforcement of the Act. The jurisdiction of would be provided for its construction. the proposed Drug Inspectors will be redrawn by dividing the whole State into ten zones, III. Improvements in Medical Colleges each headed by a Drug Inspector. Separate enforcement machinery will be created at an Infrastructure facilities in Kottar estimated cost of `2.76 crore. Ayurveda Medical College in and Palayamkottai Siddha Medical V. Provision of Computerised Online College in will be upgraded Clinical Documentation facilities to at a cost of `10.00 crore. all ISM Hospitals and wings

IV. Quality Control In AYUSH sector, effective treatment is available for a number of diseases such Strengthening of Drug Testing as Rheumatic disorders, Nervous disorders, Laboratory (IM) Skin disorders, Diabetes, Infertility and Vector borne diseases such as Chikungunya Provision of quality and standard and other diseases for which the modern drugs play a major role in the delivery of systems do not offer a dependable cure. It is health care system. The current standards proposed to introduce computerised online of medicine manufactured are not up to the clinical documentation system with software mark. Substandard quality of raw drugs and developed by NIC in all ISM wings for failure in adopting procedures of purification monitoring efficiency of treatment at District of its metallic constituents are the main Headquarters, Taluk, Non-taluk Hospitals reasons for this. Regular testing of raw drug and Primary Health Centres at a total cost of samples and the manufactured medicines `10.00 crore in the Plan period. by the State Licensing Authority will help in addressing the above issue. A well equipped VI. Anaemia Control in the Indian Drug Testing Laboratory is available in the System of Medicine department, but it lacks manpower. The strengthening of this Laboratory is absolutely Anaemia is one of the most extensive imperative and the total expenditure involved public health problem, which mainly affects for this scheme will be `10.67 crore. women and young girls. Certain programmes to control anaemia are already under implementation under National Rural Health

616 Health and Family Welfare

Mission. Indian System of Medicine may be pregnant women and adolescent girls using tried for the reduction of anaemia among the Indian System of Medicine during the pregnant women and children. A pilot project Plan period, at a proposed outlay of `1.00 would be implemented for anaemia control in crore.

Table 13.3.1: Twelfth Plan Outlay - Indian Medicine and Homeopathy (` crore) S.No. Name of the scheme Outlay Ongoing schemes 1 Opening of ISM&H wing in PHCs 52.32 Total Ongoing Schemes 52.32 New Schemes 1 Awareness creation 8.26 2 Upgradation of Laboratories in ISM Hospitals 1.00 3 Provision of Ultra Sonogram and X-Ray to Government Ayurvedha 1.00 Medical College Hospital, Nagercoil 4 Provision of Obstetric and Gynaecology ward to AAGHIM, Chennai 1.43 5 Provision of modern kitchen to AAGHIM, Chennai and GSMC, 0.23 Palayamkottai, Tirunelveli 6 OP&IP Block at Government Homeopathy Medical College, 1.30 Thirumangalam 7 Provision of animal house for Government Siddha Medical Colleges at 1.33 Palayamkottai and Chennai 8 Setting up of Undergraduate Departments in the Unani Medical College, 3.00 Chennai 9 Construction of Additional Buildings for Women’s hostel in GHMC, 1.70 Thirumangalam, Madurai 10 Improvements in Medical Colleges 10.00 11 Strengthening of Drug Testing Laboratory (IM) 10.67 12 Strengthening of Drug Control Mechanism 2.76 13 Online Clinical Documentation of ISM Hospitals 10.00 14 Anaemia Control in the Indian System of Medicine 1.00

Total New Schemes 53.68 Grand Total 106.00

617 Twelfth Five Year Plan Tamil Nadu

Twelfth Plan Outlay - An Abstract crore as shown in the Table 13.3.2. Of the total amount of `10,832.00 crore, a major The total Twelfth Plan proposed outlay allocation of 82 percent is for the Health Care for Health and Family Welfare is at `10,832.00 Delivery and Services component.

Table 13.3.2.: Abstract of Twelfth Plan Outlay - Health and Family Welfare (` crore)

S.No. Activity Outlay Percentage

1. Medical Education and Research 1855.00 17.12

2. Health Care Delivery and Services 8871.00 81.89

3. Indian Medicine and Homoeopathy 106.00 0.09

Total 10832.00 100.00

Graph 13.3.1: Share of Components in Health and Family Welfare Outlay

618