Health and Family Welfare Department Policy Note
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HEALTH AND FAMILY WELFARE DEPARTMENT Demand No.19 POLICY NOTE 2018-19 Dr. C. VIJAYABASKAR Minister for Health © Government of Tamil Nadu 2018 INDEX Sl. Page No CHAPTER No. 1 Introduction 1-34 2 History 35-44 3 Health Administration 45-52 4 Medical Education 53-77 5 Medical and Rural Health Services 78-84 6 Public Health and Preventive Medicine 85-111 7 Family Welfare Programme 112-127 8 Medical and Rural Health Services 128-129 (Employees' State Insurance Scheme) 9 Indian Medicine and Homoeopathy 130-154 10 Food Safety and Drugs Administration 155-177 11 Tamil Nadu State Health Transport 178-187 Department 12 Human Resources and Medical 188-194 Services Recruitment Board 13 National Health Mission-Tamil Nadu 195-255 14 Tamil Nadu Urban Health Care 256-258 Project 15 Comprehensive Emergency Obstetric 259-260 and Newborn Care Centres (CEmONC) 16 Hospital Management Information 261-264 Systems and Other E-Governance Initiatives 17 Tamil Nadu Medical Services 265-288 Corporation Limited 18 Tamil Nadu State AIDS Control 289-305 Society 19 Tamil Nadu State Blindness Control 306-312 Society 20 Revised National Tuberculosis Control 313-333 Programme 21 National Mental Health Programme 334-348 22 Communicable Diseases 349-386 23 Non-Communicable Disease 387-404 Prevention, Control and Treatment 24 Other National Programmes 405-419 25 Geriatric Care 420-423 26 Tamil Nadu Accident and Emergency 424-451 Care Initiative (TAEI), Accident and Trauma Care Centres and ‘108’ Emergency Care Services 27 Chief Minister’s Comprehensive Health 452-463 Insurance Scheme 28 Certain Important Acts 464-473 29 Research and Training 474-483 Chapter – 1 INTRODUCTION Ïêt¿ªJ c©gh‹f© Ï‹g«nghš ã‰F« fêng® Ïiuah‹f© nehŒ (FwŸ 946) “As pleasure dwells with him who eats moderately, so disease (dwells) with the glutton who eats voraciously.” 1.1 Tamil Nadu has emerged as a model State in India in not only providing “State of Art” health care services but also making available excellent human resources and infrastructure. It has pioneered several landmark schemes, which has enabled the State in being ranked among the top three States in the “Healthy State Progressive India” report brought out by the NITI Aayog. The State also has the distinction of bagging three consecutive best State award in deceased organ transplantation. The State has also received awards and 1 accolades from various independent review missions and institutions. 1.2 The State Government is aware that achieving further improvements in the relevant Health Indicators would require further intensification of its efforts and addressing the intra and inter district challenges. The State has set itself an ambitious goal of achieving the levels attained by developed nations by 2023 well ahead of the time set for achieving the health specific Sustainable Development Goals (SDG). 1.3 Tamil Nadu is credited with introduction of several landmark initiatives such as starting of first of its kind Tamil Nadu Medical Services Corporation (TNMSC), Tamil Nadu State AIDS Control Society (TNSACS), Transplant Authority of Tamil Nadu (TRANSTAN) on the one hand and implementation of pioneering schemes at the State level such as Dr.Muthulakshmi Reddy 2 Maternity Benefit Scheme with enhanced assistance, Chief Minister’s Comprehensive Health Insurance Scheme, Menstrual Hygiene Programme, Birth Companion Programme, Amma Baby Care Kit, Amma Arogya Thittam, Amma Whole Body Check-up, Amma Magaperu Sanjeevi among others. Ensuring access to the Comprehensive Emergency Obstetric and Newborn Care (CEmONC) Centres, Neonatal Intensive Care Units, Blood Banks and Blood Storage Centres have been pivotal to the improvement in maternal and child health indicators. Apart from this, the State also has implemented all the programmes and schemes under the National Health Mission and achieved the targeted outputs and outcomes ahead of time. State Profile 1.4 As against a population of 7.21 crore as per 2011 census in our State, it is estimated that 3 the mid-year population in 2018 would be 8.03 crore. The State has 42 Health Unit Districts (HUD) in addition to Chennai Corporation. The State has the lowest Total Fertility Rate (TFR) of 1.6 and has achieved an Infant Mortality Rate (IMR) of 17 per 1,000 live births as per Sample Registration System (SRS) 2016. The State has achieved the Maternal Mortality Ratio (MMR) of 66 as per the SRS 2014-16 and as per the State records has attained a figure of 62 per lakh live births. The State has achieved nearly 100% institutional delivery and 94.4% women register within the first trimester. Current Scenario 1.5 The current scenario in the Government Medical and Health Facilities in Tamil Nadu is given below: 4 Government Medical and Health Facilities in Tamil Nadu Sl. Description Units No. 1 Government Medical Colleges 22 Hospitals attached with the 2 48 Medical Colleges Tamil Nadu Government Multi 3 1 Super Speciality Hospital Tamil Nadu Government Dental 4 1 College and Hospital 5 District Headquarters Hospitals 29 6 Taluk and Non-Taluk Hospitals 273 7 Primary Health Centres (PHCs) 1,806 8 Health Sub Centres (HSCs) 8,706 Urban Primary Health Centres 9 (UPHCs) including Chennai 460 Corporation New Community Health Centres 10 (CHCs) being established under 15 NHM in Chennai Corporation Employees’ State Insurance 11 10 (ESI) Hospitals 12 ESI Dispensaries 216 Indian System of Medicine 13 1,491 Hospitals and Dispensaries 5 1.6 This department has staff strength of over one lakh persons serving on an average of over 6.5 lakh out-patients and about 70,000 in- patients per day. The above facilities serve as the base through which cross cutting programme such as National Health Mission, innovative scheme pioneered by our State under State fund and services under Indian Medicine and all other programmes are implemented thus furthering the cause of prevention and cure and also achievement of targeted outcomes. 1.7 The schemes of the Government have been described in detail in the rest of the Chapters in the Policy Note while a summary of few significant achievements have been narrated below: 6 Significant Achievements in the Health Sector during the last Seven Years Health Indicators Infant Mortality Rate (IMR) was 24 in 2010 and this has been reduced to 17 per 1,000 live births in 2016 as per SRS data 2016 against the National IMR of 34. This Government has received a sum of Rs.489.40 crore during the period from 2012-13 to 2014-15 as incentive from the Government of India for the reduction in IMR. As per latest SRS data 2014-16, the Maternal Mortality Ratio (MMR), which was 90 in 2010-12, has been reduced to 66 per one lakh live births. Now, it is reduced to 62 as per 2016-17 State Health Management Information System Data. The current MMR of India is 130. 7 The current Total Fertility Rate (TFR) is 1.6, the target of 12th Five Year Plan has already been achieved by the Government. This is the lowest in India against the India’s status of 2.3. State Schemes In order to achieve the objectives of Universal Health Care to the people of Tamil Nadu, Chief Minister’s Comprehensive Health Insurance Scheme was introduced in 2012 for providing treatment for 1,016 procedures, 23 important diagnostic procedures and 113 follow up procedures providing an insurance cover of Rs.1 lakh per year and Rs.1.5 lakh for certain procedures. Smart cards were issued to 1.58 crore families. 881 hospitals including all the Government Medical Colleges Hospitals and the District Headquarters Hospitals were empanelled to 8 provide treatment under this scheme. During the five years period of implementation upto 10th January, 2017, 17.30 lakh persons benefitted under the scheme with the approved amount being Rs.3,398.66 crore. Out of this, 6.93 lakh beneficiaries treated in Government Hospitals at an insurance coverage of Rs.1,161.61 crore. After successful implementation for five years the insurance scheme is continued from 11.01.2017 as announced in the Budget 2016-17, through the United India Insurance Company Limited, which is a public sector company. The coverage is 1 lakh per year per family and the provision for certain specialized procedures has been increased from Rs.1.5 lakh to Rs.2 lakh. 312 new procedures have been added and 252 existing procedures have been merged 9 and 49 low utilization procedures have been removed making the scheme qualitatively better with 1,027 medical & surgical treatment procedures, 154 specialized procedures, 154 follow up procedures, 38 standalone diagnostic procedures and 8 High end procedures. 158 treatment procedures have been reserved for Government Hospitals. Migrants including construction workers who reside in the State for more than six months will be included and orphans as defined by the State Government will be given Insurance Card. 5,43,540 persons have got insurance coverage for Rs.977.70 crore from 11.01.2017 upto 31.03.2018 under this scheme. A corpus fund has been created with the Government contribution of Rs.35 crore and contribution from insurance receipts in 10 Government Hospitals to meet the expenditure towards eight specialized high end surgeries requiring amounts higher than Rs.2 lakh and so far, 6,119 beneficiaries have been benefited and the total approved amount is Rs.440.98 crore. Government is implementing Dr.Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS) with the noble objective of providing assistance to poor pregnant women / mothers to meet the expenses on nutritious diet and to compensate them for the loss of income during the delivery period, so as to prevent low birth weight in newborn babies.