HEALTH AND FAMILY WELFARE DEPARTMENT

DEMAND NO. 19

POLICY NOTE
2013-2014

THIRU K.C. VEERAMANI

Minister for Health

©
GOVERNMENT OF TAMIL NADU
2013
 POLICY NOTE ON 14 Tamil Nadu Medical Services 156 - 163
HEALTH AND FAMILY WELFARE Corporation
2013-14 15 Tamil Nadu State AIDS 164 - 173
Control Society
CONTENTS 16 Tamil Nadu State Blindness 174 - 177
Control Society
Sl 17 Revised National 178 - 181
Chapter Page No
No Tuberculosis Control
1 Introduction 1- 10 Programme
2 Health Administration 11 - 16 18 National Mental Health 182 - 188
Programme
3 Medical Education 17 - 25
19 National Vector Borne 189 - 198
4 Medical and Rural Health 26 - 30 Diseases Control
Services Programmes
5 Public Health and Preventive 31 - 54 20 National Programme for 199 - 200
Medicine Prevention and Control of
6 Family Welfare 55 - 68 Cancer, Diabetes and Cardio-
7 Medical and Rural Health 69 - 70 Vascular Diseases
Services (Employees State 21 National Tobacco Control 201 - 202
Insurance Hospitals) Programme
8 Indian Medicine and 71 - 85 22 National Leprosy Eradication 203
Homoeopathy Programme
9 Food Safety and Drugs 86 - 94 23 Accident And Trauma Care 204 - 206
Control Administration Centres
10 Tamil Nadu State Health 95 - 102 24 Chief Minister’s 207 - 210
Transport Department Comprehensive Health
11 Medical Services Recruitment 103 - 104 Insurance Scheme
Board 25 Important Acts 211 - 217
12 State Health Society 105 - 137 26 Education, Training and 218 - 223
13 Tamil Nadu Health Systems 138 - 155 Research
Project
 Chapter 1

INTRODUCTION

c‰wh‹ msΫ ÃâmsΫ fhyK«

f‰wh‹ fU¢ braš. (FwŸ 949)

The learned physician should ascertain the

condition of his patient, the nature of his
disease and the season of the year and then
proceed with his treatment.

1.1 Government of Tamil Nadu is totally

committed to building healthy people, not
only by making available quality medicare
facilities to everyone in the State, but also
by providing medical facilities of the highest
order, keeping pace with rapid technological
developments in the field of medicine.
Government of Tamil Nadu provides
preventive and curative care to all through
various Hospitals, Dispensaries, and
Institutions.

State Profile

1.2 Tamil Nadu is one of the best

performing states and has consistently
strived for ensuring that the citizens are
provided with the best possible medical
care. It is the seventh most populous State
 2

in the country with a population of 7.21

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

1.3 These achievements in macro indicators

have been backed by several pioneering
 3

initiatives. With the vision and guidance

of Hon’ble Chief Minister, the State has
been implementing several landmark
initiatives with a view to ensure Universal
Health Care. Starting of Tamil Nadu Medical
Services Corporation in 1994, initiating
maternal and child health initiatives like 24
hour services at Primary Health Centre
(PHC), starting of one 30 bedded PHC in
each block, providing adequate blood banks,
creating facilities for night caesarean,
opening neo natal stabilisation and intensive
care units and upgrading capacity for
comprehensive obstetric and neonatal care,
starting birth companion programme,
maternal audits, universal immunisation
programme, achieving all targets in the
national programmes are some among
many such landmark initiatives being
implemented by the State. In addition to
consolidating the initiatives and the
programmes which are already being
successfully implemented, the state has also
launched the menstrual hygiene
programme, the modified Chief Minister’s
Comprehensive Insurance Scheme and is
also implementing Dr.Muthulakshmi Reddy
Maternity Benefit Scheme with an increased
financial assistance. Currently the focus of
the State is to provide equal attention to
 4

public health and prevention of diseases.

The State is also ensuring these quality
facilities for treatment are easily accessible
to the people. In addition to the emerging
challenges of Non Communicable diseases
on one side, the State has also effectively
responded to the challenge of vector borne
diseases such as dengue which showed an
increase in incidence worldwide last year.

History

1.4 Our ancient Indian system of Medicine

“Siddha” and “Ayurveda” are in practice for
over thousands of years. Siddha System of
Medicine has been recorded to have been
practiced by the eighteen Siddhars and that
is why it is called “Siddhar Maruthuvam”.
Susrushta and Charaka were the pioneers of
Ayurveda. History tells us that there were
well organized hospitals even during the
days of Buddha and Ashoka. Roots of
modern medicine are linked to the advent of
the Britishers. It is believed that the first
British Hospital was established in 1639 to
treat the sick soldiers of the East India
Company. The origin of the modern
Government Hospital has been traced back
to 1644, when it was started as a small
hospital which has now grown into the
 5

prestigious General Hospital attached to the

Madras Medical College which itself was
started in 1835.

1.5 With the growth of the Medical Services,

the Civil Medical Service was separated and
established under the management of a
Head of the Department called as “Surgeon
General with the Government”. That post
was subsequently re-designated as Director
of Medical Services (DMS) during 1960.
Medical Services Department was bifurcated
and the Department of Medical Education
was formed in the year 1966. Similarly
Department of Indian Medicine was
established in the year 1976 and the
Department of Drugs control in November
1981. The Family Welfare scheme, which
was dealt by the Medical Services
Department, was separated and an
independent Department of Family Welfare
was formed in 1983, to look after the Family
Welfare Scheme.

1.6 On the Public Health and Preventive

Medicine side, the Directorate of Public
Health and Preventive Medicine was formed
during 1923 with the main objectives of
providing Maternal and Child Health care to
the rural and urban population and for the
 6

prevention and control of communicable

diseases. Lieutenant Colonel A.T.H. Russell
was the first Director of Public Health and
Preventive Medicine in the Pre-independent
era. Public Health Act, 1939 is the legal
instrument enacted before independence of
the country which empowers the Health
Officers to enforce public health law to
safeguard the health of the people. This is
currently being reviewed and will be
amended to reflect the latest felt needs of
the Public Health Sector. During 1965, the
Primary Health Centres were separated from
the Medical Services Department and
brought under the Public Health
Department. The Public Health and
Preventive Medicine Department is
functioning with 42 Health Unit Districts
each unit under a Deputy Director of Health
Services. The State Health Transport
Department, which was with the Public
Health Department, was separated and a
Directorate of Health Transport was formed
on 15.07.1981.

Current Scenario

1.7 Medical and Health facilities in Tamil

Nadu in the Government sector have grown
rapidly and the current scenario is given in
Table No.1.
 7

Table No.1 - Medical and Health

Facilities in Tamil Nadu in the
Government Sector

Sl. No. Description No.

1. Medical Colleges 18
2. Medical College attached hospitals 43
3. Dental College and Hospital 1
4. District Headquarters Hospitals 30
5. Sub District Hospitals 237
6. Primary Health Centres (PHCs) 1614
7. Health Sub Centres (HSCs) 8706
8. Urban Primary Health Centres (UPHCs) 135
9. ESI Hospitals (include the ESI Hospital,
8
Chennai - 78)
10. ESI Dispensaries 195
11. Indian System of Medicine Hospitals 4
12. Indian System of Medicine
1375
Dispensaries

1.8 In addition to the above facilities and

institutions, Tamil Nadu has a number of
maternity homes, dispensaries and health
posts run by municipalities and municipal
corporations. With the network of primary,
secondary and tertiary hospitals and a
plethora of cross cutting programmes such
as the National Rural Health Mission, Health
Systems Project, AIDS Control Society,
 8

Maternal and Child Health initiatives, Indian

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

1.9 The provision for Health and Family

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

and Non- Plan

Non –Plan

Total Plan
Demand

Centre and
Sponsored
State Plan

Centrally

State

Total

19.
Health
and
*
Family
3610.22 2256.34 637.66 7.00 2901.00 6511.22
Welfare
Depart-
ment

* A sum of Rs.54.59 lakh have also been

allotted under Charged head and the total
allocation is Rs.6,511.76 crore.
 9

This includes Rs.6265.95 crores on the

Revenue Account and Rs.245.28 crores on
the Capital Account. The provision on the
Revenue Account works out to 5.31% of the
total Revenue Expenditure of
Rs.1,17,915.81 crores in the Tamil Nadu
State Budget for the year 2013 -2014.

Note: Apart from the above provision,

Rs.249.85 crores has been allocated
towards Civil Works being undertaken by
Public Works Department under Demand
No.39.

1.10 The Directorate wise allocation for

2013-2014 under Demand No.19 Health and
Family Welfare is as follows:-

(Rupees in crores)

1 Secretariat, Health and Family 7.93

Welfare Department
2 Directorate of Medical and Rural 789.65
Health Services
3 Directorate of Medical Education 1775.52
4 Directorate of Public Health and 2189.96
Preventive Medicine
5 Directorate of Family Welfare 175.96
6 Tamil Nadu Food Safety and 42.99
Drug Administration
 10

7 Directorate of Indian Medicine 169.13

and Homoeopathy
8 Tamil Nadu State Health 26.71
Transport Department
9 Reproductive and Child Health 387.86
Project
10 Tamil Nadu Health Systems 945.52
Project
Total 6511.22

Note: Provision towards ESI Scheme

Hospitals for Rs.219.86 crore have been
made in the Labour and Employment
Demand No.32.
 11

Chapter 2

HEALTH ADMINISTRATION

2.1 The Health and Family Welfare

department in the Secretariat is
administratively responsible for the
following Directorates:-

 Directorate of Medical Education

 Directorate of Medical and Rural
Health Services
 Directorate of Public Health and
Preventive Medicine
 Directorate of Indian Medicine and
Homeopathy
 Directorate of Family Welfare
 Directorate of Food Safety and
Drugs Control Administration
 Directorate of State Health
Transport Department
 Medical Services Recruitment Board

Apart from these Directorates, the staff for

the Directorate of Medical Services (ESI)
under the Labour and Employment
department are sent from Health
department.
 12

Other Programmes and Initiatives

2.2 The Directorates are supported by a

number of other initiatives which are
implemented across the Directorates such
as:-

 National Rural Health Mission -

State Health Society
 Tamil Nadu Health Systems Project
 Tamil Nadu State AIDS Control
Society
 Tamil Nadu Blindness Control
Society
 Tamil Nadu Medical Services
Corporation
 Tamil Nadu Medicinal Plant Farms
and Herbal Medicine Corporation
Limited (TAMPCOL)
Under the State Health Society and through
the Directorates several National
Programmes such as the Revised National
Tuberculosis Programme, National Mental
Health Programme, National Vector Borne
Diseases Control Programme, Universal
Immunization Programme, and School
Health Programme among others are
implemented. These have been explained in
detail in subsequent chapters.
 13

Councils

2.3 The following councils are established

through various acts to register the qualified
medical, nursing and paramedical
professionals to regulate their practice in
Tamil Nadu.

i. Tamil Nadu Medical Council

ii. Tamil Nadu Dental Council
iii. Tamil Nadu Nurses Council
iv. Tamil Nadu Pharmacy Council
v. Tamil Nadu Siddha Medical Council
(Siddha & Traditional practitioners)
vi. Board of Indian Medicine
(Ayurveda, Unani and Yoga &
Naturopathy)
vii. Tamil Nadu Homeopathy Council

These are all the Statutory Bodies regulated

by Government of India and Government of
Tamil Nadu. Apart from this, there is also a
Government order for constituting a
Physiotherapists Council in the State.
 14

Classification of Hospitals and

Dispensaries

2.4 Government of Tamil Nadu provides

preventive and curative care to all, through
various hospitals, dispensaries, and
institutions. The state has a variety of
categories of hospitals. The classification of
hospitals and dispensaries in the state are
as follows:

i. State–Public Medical Institutions:

All Medical institutions – Allopathy and
Indian System of Medicine maintained
through State funds and are directly
managed by the Government. These
form the backbone of the health care.
It ranges from the grassroots level-
8,706 Health Sub Centres catering to
an average population of 5,000 to the
1,614 PHCs catering to an average
population of 30,000 at the next level.
These are followed by secondary and
tertiary care hospitals, details of which
have already been given in Table No.1
in the first chapter.

ii. State–Special Medical Institutions:

All institutions intended to serve
special sections of public such as
 15

Police, State owned corporations /

undertakings, Employees State
Insurance Medical Institutions etc.

iii. Medical Institutions under the

Local Bodies: These Medical
Institutions are under the
management of Municipal
Corporations, Municipalities and
Panchayat Unions. With the state
taking over most of these facilities
they are now very few in number
especially in rural areas. Conversion
of the remaining rural medical
institutions to Government medical
institutions is under the active
consideration of the Government.

iv. Private Aided Medical Institutions:

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

v. Private Non-Aided Medical

Institutions: All hospitals,
dispensaries and clinics solely
managed by private persons /
establishments.
 16

Tamil Nadu Dr.M.G.R. Medical

University

2.5 The Government of Tamil Nadu

established this Medical University in the
year 1987 by passing the Tamil Nadu
Medical University Act, 1987 (Act
No.37/1987). The name was later amended
as the Tamil Nadu Dr.M.G.R. Medical
University and the University is functioning
from July, 1988. This University is
relentlessly working to fulfill a number of
objectives including improving the standards
in medical and para medical education,
medical research in addition to making an
impact on the progress of Health Care.

2.6 Thus, the Health Administration

encompasses the entire gamut of services,
facilities extended throughout the State and
strives to ensure that both preventive,
curative, research and development needs
of the State are adequately taken care of. It
is also getting constantly upgraded to keep
pace with the demands posed by emerging
diseases and migratory challenges.
 17

Chapter 3

MEDICAL EDUCATION

3.1 The State needs well qualified

manpower not only for manning the
medical facilities at all levels, but also to
address the health related challenges.
Medical Education is critical to provision of
the crucial human resources to ensure that
the State has adequate number of qualified
health personnel both in the government
and private domain. The Department of
Medical Education plays a pivotal role in
producing quality medical and Para-medical
personnel to cater to the health needs of the
State. The department also has a role to
play in the establishment and maintenance
of well-equipped teaching institutions, which
are the premier referral centres with state of
the art equipment, technology and research.
The Directorate of Medical Education was
formed in the year 1966 from the
Directorate of Medical Services and is
functioning as an independent Directorate.
It is managing the Medical Colleges and
teaching hospitals attached to them.
 18

Administrative Structure

3.2 The Director of Medical Education is the

head of the directorate. All the Government
medical colleges and attached institutions
are part of this directorate. These are
manned by the Deans and Principals
respectively.

 Deans, Government Medical Colleges

and hospitals
 Director, Government Institute of
Rehabilitation Medicine, Chennai
 Director, Institute of Child Health and
Hospital for Children, Chennai
 Director, Institute of Thoracic
Medicine, Chennai
 Director, Institute of Mental Health
and Government Mental Hospital,
Chennai
 Director and Superintendent, Institute
of Obstetrics and Gynecology and
Government Hospital for Women,
Chennai
 Director and Superintendent, Institute
of Social Obstetrics and Kasturba
Gandhi Hospital for Women and
Children, Chennai
 Director, Regional Institute of
 19

Ophthalmology and Government

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

3.3 Currently there are 18 Government

Medical Colleges, one Government Dental
College, two Pharmacy Colleges (B.Pharm),
two Physiotherapy Colleges, four Nursing
Colleges (B.Sc.Nursing) along with 23
Schools of Nursing offering Diploma in
Nursing and 44 hospitals (including one
Dental Hospital) under the control of
Directorate of Medical Education. The total
 20

number of bed strength in these hospitals is

30,900. The daily average of out-patents is
71,753 and the daily average Inpatients is
25,188.

3.4 Table No.2 shows the intake capacity of

the Medical Institutions for Under Graduate
and Post Graduate Courses.

Table No.2 - Number of seats available

in each course in Government sector-
Under graduate and Diploma courses

Name of the Course Number of

seats
M.B.B.S. 2145
B.D.S. 100
B.Sc. Nursing 200
Post Basic ( B.Sc. Nursing) 90
B.Sc. Radio Diagnosis 30
B.Sc. Radiotherapy 20
Bachelor of Physiotherapy 50
B.Pharm 120
Diploma in Nursing 2000
Diploma in Pharmacy 240
Paramedical Courses 5732
(23 Courses)

3.5 Table No.3 shows the details of the

specialties which are available in the
 21

colleges in Tamil Nadu for the students to

do their post-graduation.

Table No.3 - Number of Specialties and

intake capacity under the Post
Graduate (P.G) courses

Number of Total intake

Courses
Specialties Capacity
P.G. Degree (Medical) 23 706
P.G. Diploma(Medical) 15 403
MDS ( Dental) 8 35
Higher Specialties 16 189
M.Pharmacy 4 64
M.Sc. (Nursing) 5 65
M.Sc. (Medical Physics) 1 10
M.Phil (Clinical Social 1 15
Work)
M.Sc. (Molecular Virology) 1 21

3.6 In addition, there are private self

financing institutions affiliated to the Tamil
Nadu Dr.M.G.R. Medical University providing
Medical and Para Medical Education in the
State. The details of total number of seats
available in these private Institutions as well
as the seats surrendered for allotment by
the Government may be seen from Table
No.4 below.
 22

Table No.4 - Seats surrendered by

Private Self Financing Colleges for
allotment by the Government

Number of
seats
No. of Number
College surrendered
Colleges of seats
to
Government
Medical College 11 1460 838
Dental College 18 1515 909
Pharmacy College 31 1950 1124
(B.Pharm)
Physiotherapy College 21 1030 639
(BPT)
Nursing College (B.Sc) 145 7880 5067

Occupational Therapy 1 50 33
College (BOT)
D.Pharm to B.Pharm 26 1520 152
(Lateral entry 10%)
Post Basic B.Sc. 46 1630 1062
(Nursing)

Admission to professional courses in

Medicine

3.7 Admission to the Professional Courses

in Medicine in the State is made based on
the marks obtained in the relevant subjects
of the Plus two examinations. The selection
to MBBS / Bachelor of Dental Surgery
(BDS)/ B.Sc. Nursing / Bachelor of
Pharmacy (B.Pharm) as well as Diploma
courses in Nursing is done by a Selection
 23

Committee under a Single Window System

following the rules of reservation in
accordance with the policy of the
Government. Admission to Post Graduate
Diploma, Post Graduate Degree, and Master
of Dental Surgery (MDS) and Higher
specialties courses is done by the Selection
Committee through a common entrance
examination followed by counselling duly
adopting the rule of reservation.

The State has been consistently opposing

the National Eligibility and Entrance Test
(NEET) and currently the case on this issue
is pending in the Supreme Court. The State
is taking all steps to ensure that there is no
interference in its policy on Medical and
Dental college admissions, at Under
Graduate and Post Graduate levels.

Services

3.8 The hospitals attached to the medical

colleges serve as the referral centres where
people all over the State are able to access
state of art facilities. In addition to providing
quality care in all conceivable specialties,
the hospitals are backed by excellent
diagnostic support and state of art
equipments. The hospitals also share their
role in implementation of state wide
 24

programmes. The geographical spreads of

these hospitals have ensured that the
primary and the secondary care institutions
have adequate tertiary care support
anywhere in the state. The medical colleges
and the professionals attached to the
specialties in each college and hospitals,
have competence in providing valuable
inputs for treatment protocols for the
diseases. Dental Care, Rehabilitation
Medicine, Child Health, Thoracic Medicine,
Mental Health, Obstetrics and Gynecology
and Social Obstetrics, Ophthalmology,
Preventive Medicine and Research,
Physiotherapy College, TB Sanatorium are
among the focus areas where the
Directorate has separate institutions. Stem
cell research, rare surgeries, accessible
tertiary cares are some of the important
contributions made by these institutions.
These are in addition to all the specialties
which are mandatorily provided for in a
medical college hospital. The role of these
institutions as part of health and family
welfare programmes spread across
directorates has been separately brought
out under the relevant portions of this policy
note.
 25

Multi Super Specialty Hospital

3.9 The Multi Super Specialty Hospital being

established by converting the new building
in Omandurar Government Estate, Chennai
is expected to strengthen tertiary health
care in the State by providing better and
expert treatment for serious ailments to the
economically weaker sections.
 26

Chapter 4

MEDICAL AND RURAL HEALTH

SERVICES

4.1 The Department of Medical and Rural

Health Services is being entrusted with the
responsibility of rendering medical care
services to the public through the Non-
Teaching Medical Institutions. Through the
pursuit of various policies and programmes,
the department is aiming to translate the
Alma Ata Declaration of Health for All in to
reality.

4.2 The Directorate of Medical and Rural

Health Services is implementing the curative
medical care services through the grid of 30
District Head Quarters Hospitals, 158 Taluk
Hospitals, 79 Non-Taluk Hospitals, 19
Dispensaries, 10 Mobile Medical Units, seven
Women and Children Hospitals, two T.B.
Hospitals / Sanatoriums’ which are under
the control of this Department. The
Hospitals under the control of this
department are Secondary care
Hospitals.The Medical Services Department
of the State has implemented a unique
Medical monitoring system - Hospital
Management Information System and
 27

Hospital Management system and is also

implementing the following medical
programmes:-

i. Providing extended medical speciality

services like Medicine, Surgery,
Obstetrics and Gynaecology,
Ophthalmology, E.N.T, Venereology,
Orthopaedics, Anaesthesiology, Child
Health, Comprehensive Emergency
Obstetrics and Newborn Care
Services(CEmONC) Dental, Psychiatry,
Ambulance Services, Laboratory
Services, Leprosy, Tuberculosis,
Diabetology, Cardiology and Non
Communicable Diseases (NCD)

ii. Accident and Emergency Services

iii. Family Welfare and Maternity and

Child Health Services

iv. T.B. Control and Blindness Control

Programmes

v. Tamil Nadu Illness Assistance Society

vi. Mental Health Programme

 28

Administrative Structure

Director of Medical and Rural Health

Services

Joint Director of District Head Quarters

Health Services Hospitals.
Taluk Hospitals.
Non Taluk Hospitals.
Dispensaries.
Mobile Medical Units.
TB Hospitals / Clinics.
Leprosy Hospitals.

Deputy Director of Medical Family welfare

and Rural Health Services programme in
and Family Welfare the District.

Deputy Director of Medical TB control programme

Services (TB) in the District.

Deputy Director of Medical

Services. (Leprosy) Leprosy control
programme.

The leprosy programme has since been

integrated with the Department of Public
Health and Preventive Medicine.
 29

4.3 The Director of Medical and Rural Health

Services is the Chairman of the Multiple
Appropriate Authority for the
implementation of Pre–Conception and Pre-
Natal Diagnostic Techniques (Prohibition of
Sex Selection) Act 1994.The Director of
Medical and Rural Health Services is also the
State Appropriate Authority under the
Transplantation of Human Organ Act, 1994.
The Directorate also looks after the
implementation of the following
programmes -

 District Mental Health Programme.

 State Illness Assistance Society.

Services

4.4 The Medical services was the basic wing

from which the other Directorates ultimately
emerged and till this date serves as a very
crucial secondary care institution. It is the
main link between primary health care and
tertiary care. With the implementation of
the Health Systems Project and the
concurrent improvements in the facilities
and quality of care, these institutions have
provided much needed relief to both in-
patients and out-patients needing higher
level of treatment and assistance. On an
 30

average about 2 lakh outpatients and

18,000 inpatients get treated every day
cumulatively in these institutions and it also
provides obstetric and neonatal care in
addition to rendering accident and trauma
and other needed clinical services. It also
has a critical role in all the nationally and
state level programmes implemented across
directorates which are detailed separately
under the relevant headings.
 31

Chapter 5

PUBLIC HEALTH AND PREVENTIVE

MEDICINE

5.1 The Department of Public Health and

Preventive Medicine of Tamil Nadu is
engaged in protecting and improving the
health of people of the State, by
immunization, health education, control of
communicable diseases, application of
sanitary measures, and monitoring of
environmental hazards, thereby reducing
the burden of morbidity, mortality and
disability in the State.

Administrative Structure

Director

Additional Directors, Financial Advisor and

Chief Accounts Officer and Joint Directors

Deputy Directors of Health Services

Block Primary Health Centres, Primary

Health Centres and Health Sub-Centres
 32

 Regional Health and Family welfare

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

5.2 The Directorate of Public Health and

Preventive Medicine plays an important role
in the prevention and control of
communicable diseases apart from providing
community based maternity and child health
services. Under this Directorate, 1,614
Primary Health Centres (PHCs) and 8,706
Health Sub Centres (HSCs) are functioning
besides 385 Hospital on Wheels.

5.3 This Directorate is responsible for civil

registration and implementing major health
programmes such as Reproductive and Child
Health Programme, National Rural Health
Mission (NRHM) supported programmes,
Dr.Muthulakshmi Reddy Maternity Benefit
Scheme (MRMBS), National Immunisation
Programme, National Family Welfare
Programme, National Diarrhoeal Diseases
Control Programme (NDDCP), National
Vector Borne Diseases Control Programme
(NVBDCP), Integrated Disease Surveillance
 33

Programme (IDSP), Non-Communicable

Diseases Control Programme (NCDCP),
National Leprosy Elimination Programme,
School Health Programme, National Iodine
Deficiency Disorders Control Programme
and Tobacco Control Programme. New
initiatives Viz., Hospital on Wheels
Programme, Menstrual Hygiene Programme,
and Telemedicine Services to remote areas,
Establishment of Urban Primary Health
Centres, Establishment of level-I and II MCH
centres and 24x7 Helpline are also being
implemented.

5.4 The Directorate of Public Health and

Preventive Medicine is also responsible for
the implementation of various Public Health
Acts such as Tamil Nadu Public Health Act,
1939, Cigarette and Other Tobacco Products
(Prohibition of Advertisement and
Regulation of Trade and Commerce,
Production, Supply and Distribution) Act,
2003 and Registration of Births and Deaths
Act, 1969. Active support is provided by the
PHCs for the implementation of Revised
National Tuberculosis Control Programme,
National AIDS Prevention / Control
Programme, National Blindness Control
Programme, Integrated Child Development
Scheme, Rural Water Sanitation Schemes
 34

and other Community Development

Programmes.

5.5 As brought out in the introductory

chapter, due to the health facilities at
primary, secondary and tertiary levels and
in particular due to the sustained efforts of
the network of public health institutions, the
performance of the State in various para
meters viz., Infant Mortality Rate, Maternal
Mortality Ratio, Birth Rate, Total Fertility
Rate, control of communicable diseases and
elimination of vaccine preventable diseases
have significantly improved over the years.
Consequently Tamil Nadu has emerged as a
pioneering State in the country in providing
public health care.

Infant Mortality Rate (IMR)

5.6 Children are the fountains of life.

Ensuring the survival and healthy
development of every child born is the key
for the development of any nation. Infant
Mortality Rate is the key sensitive indicator
of child health in a country. The current
level of IMR in Tamil Nadu for the year 2011
is 22 per 1000 live births as per the Sample
Registration System survey (2011). The
State ranks as the second lowest among the
major states in the country.
 35

5.7 Seventy percent of the infant deaths

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

Table No.5 - Trend of IMR for India and

Tamil Nadu
Year

1980

1990

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011
Tamil 93 59 51 49 44 43 41 37 37 35 31 28 24 22
Nadu
India 114 80 68 66 64 60 58 58 57 55 53 50 47 44

Source: Sample Registration System (SRS)

Bulletins
 36

Trends in IMR in Tamil Nadu

UIP, CSSM, RCH, NRHM,
1985 1992 1997 2005

130.0 127
121
115.0 113
110 104 Rural
100.0
Combined 91 93
85.0
80
70.0 81 65
77 60
Urban 57 55
55.0 53
55 54 49
38 34
40.0
42 39 35 31 30 25
35 24
25.0 28
31 28 24 22
26 22
10.0 19
-5.0
1971 1976 1981 1986 1991 1996 2001 2007 2008 2009 2010 2011
Source: SRS

UIP - Universal Immunisation Programme

CSSM - Child Survival and Safety
Motherhood
RCH - Reproductive and Child Health
NRHM - National Rural Health Mission

5.8 To improve maternal and child health

care facilities, the following initiatives are
being implemented:

 Antenatal care
 Immunization of every child
 37

 Establishment of Basic Emergency

Obstetric and Newborn Care
(BEmONC)
 Upgraded PHCs at the rate of one per
block
 Establishment of Comprehensive
Emergency and Obstetric and
Neonatal Care (CEmONC) Centres in
select Government Hospitals and
Medical College Hospitals
 Establishment of Newborn Intensive
Care Units (NICUs) in selected
Government Hospitals and all Govt.
Medical College hospitals
 Establishment of Newborn corners in
all PHCs and provision of necessary
equipments like warmer, phototherapy
units for the Newborn corner
 Hospital on Wheels in 385 Blocks for
providing community based
Reproductive and Child Health (RCH)
outreach services
 Establishment Sick Newborn Care
Units (SNCU) and training of staff
 Hiring of Private pediatricians for
providing emergency newborn care in
all PHCs
 Establishment of 42 MCH level-II
centres (BEmONC) PHCs to provide
 38

emergency newborn care services

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

Apart from the strengthening of 108

ambulance services with neonatal transport
support facilities, several training
programmes are being imparted viz.

 Skilled Birth Attendant training for

Staff Nurses and VHN/ANM
 Integrated Management of Newborn
and Childhood (IMNCI) training to
PHC medical officers
 Facility based IMNCI training to
Medical Officers and Staff nurses
 Home based newborn care training to
Village Health Volunteers in tribal
areas
 Placement of Village Health Link
volunteers in 15 high IMR blocks to
provide home based new born care
 Ultra Sonogram training for prenatal
screening to UGPHC Medical Officers
 39

In addition to these, health education to

pregnant mothers on exclusive breast
feeding, complementary foods, child care
practices, danger signs in sick newborns,
preventing child marriage (less than 18) and
family planning, have helped in reducing
IMR. It is proposed to establish
Telemedicine Centre in the identified MCH
Level-1 Centers (HSCs) in hilly/tribal areas
to provide basic health care on 24x7 basis.
Provision of free transport, monitoring of
every pregnancy and infant through web-
based Pregnancy and Infant Cohort
Monitoring System, Recording / uploading of
Maternal and Child Health data by Village
Health Nurses and investigation and audit of
every infant death and initiating measures
to prevent similar deaths in future have
contributed to the significant decline of
infant mortality rate in Tamil Nadu.

Maternal Mortality Ratio (MMR)

5.9 Maternal mortality represents the most

sensitive and key indicator of women’s
health and status. National Rural Health
Mission’s (NRHM) primary focus is to reduce
MMR and prioritizing the resource allocation
for the same.
 40

5.10 Tamil Nadu ranks second lowest in

MMR among the major Indian states. In
2011-2012, Tamil Nadu reported 767
maternal deaths (amounting to an MMR of
73 per 100,000 live births). All efforts are
being taken to reduce the MMR further with
the multipronged approach to achieve the
same.
 41

Steps taken for reduction of MMR

5.11 Detection, investigation and audit of

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

obstetricians and anesthetists to provide

emergency obstetric care, investigation of
all maternal deaths by an expert team with
two Obstetricians in each Health District (24
to 48 hours death) to identify the avoidable
factors and preventing the recurrence of
such events are the major contributing
factors for the declining maternal mortality
ratio. It is proposed to further intensify
these efforts.

Primary Health Centres (PHCs)

5.12 PHC Infrastructure: A primary

health center is established for a population
of about 30,000 in plain areas and 20,000 in
hill areas. As already mentioned, there are
1,614 Primary Health Centres functioning in
Tamil Nadu. While 1,512 PHCs are
functioning in Government Buildings,
construction of buildings is under progress
in respect of 79 Primary Health Centres. 135
Urban PHCs are sanctioned under the
control of the Directorate of Public Health
and Preventive Medicine to improve
availability of Primary Health Care services
to the urban poor.
 43

Services

5.13 On an average 2.4 lakh outpatients

get treated each day in the 1,614 PHCs
spread across the state in addition to about
3,250 inpatients per day. PHCs across the
state conducted 2.08 lakh deliveries per
annum and deliveries in PHCs constitute an
average of 13 per PHC / per month of all the
institutional deliveries. 24x7 delivery care
services with 3 Staff Nurses are provided in
all the PHCs. The institutional services
offered in the PHCs are being monitored
through a web enabled Institutional Services
Monitoring Report (ISMR) and feed back is
sent to the districts for further
improvements.

Upgradation of Primary Health Centres

5.14 It is the policy of the Government to

provide at least one 30 bedded upgraded
Primary Health Centre in each block where
there is no such health facility, in a phased
manner. Each Upgraded Primary Health
Centre has an operation theatre, modern
diagnostic equipments like Ultra Sonogram,
ECG, Semi Auto Analyzer, X-ray and an
ambulance vehicle. Five doctors are posted
to the upgraded PHCs. At present 341
 44

upgraded Primary Health Centres are

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

ISO 9001 Certification

5.15 Government have been taking

conscious steps to inculcate quality
consciousness among the Government
Medical institution to constantly improve
quality of services. 48 Primary Health
Centres in 12 Health Unit Districts have
been awarded ISO 9001 certificates. In each
of the remaining 30 HUDs, one PHC has
been identified for ISO certification. Each of
these 30 PHCs have adopted 2 PHCs for
quality improvement. It is proposed to
grade the PHCs based on quality parameters
and performance indicators.

Dental health care services in PHCs

5.16 Dental health care services are

provided in 266 PHCs to treat dental
ailments. The dental services have received
good response from the public. The
Government has planned to provide dental
health care services in all the upgraded and
block level PHCs in a phased manner.
 45

Health Sub Centres

5.17 A Health Sub Centre (HSC) is

established for a population of 5,000 in plain
areas and 3,000 in hilly areas. Each centre
is manned by a Village Health Nurse. There
are 8,706 HSCs in Tamil Nadu. While 6,510
HSCs are functioning in Government
Buildings, 2,196 HSCs are functioning in
Rented/Rent free Buildings. Buildings for
139 HSCs are under construction at a total
cost of Rs.20.91 crores. Under the NRHM,
construction and renovation of HSC
buildings are being done in a phased
manner. It is proposed to increase the
number of HSCs based on 2011 census.

Services and programmes

5.18 Since the services and programmes in

the PHCs are provided at the grass roots
level, most of the cross cutting programmes
are embedded in the public health side such
as the Universal Immunisation, Vector
Borne Diseases Control, and School Health
Programme.

Universal Immunization Programme

5.19 The Universal Immunization

Programme was started in 1985 to protect
 46

the children from vaccine preventable

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

Pulse Polio Immunization (PPI)

5.20 For the eradication of poliomyelitis,

Pulse Polio Immunization campaign was
 47

introduced in the year 1995-96, which along

with efficient routine immunization coverage
has successfully eliminated the dreaded
disease from the State. During 2013, two
rounds of pulse polio immunization
campaigns have been conducted (on
20.01.2013 and 24.02.2013) as part of the
nationwide PPI campaign in order to prevent
the importation of Polio virus and to sustain
the zero polio status.

Focus on Migrant Children

5.21 Immunizing the Migrant children is

essential to protect these children from polio
and also prevent importation of polio.
Special initiatives are being taken to cover
the children living in temporary settlements
and migrant population to protect the
children from Vaccine Preventable Diseases.
Special polio rounds were conducted on
22.12.2012 and 23.03.2013.

Japanese Encephalitis (JE) vaccination

5.22 JE vaccination programme is being

implemented in identified endemic districts
namely Cuddalore, Villupuram,
Virudhunagar, Madurai, Tiruvarur,
Tiruchirapalli, Perambalur, Thanjavur and
Tiruvannamalai to prevent Japanese
 48

Encephalitis especially among children under

the age of 15 years. Under the Acute
Encephalitis Syndrome (AES)/Japanese
Encephalitis (JE) Preventive Scheme of
Government of India, it is proposed to take
intensive immunization drive during
2013-2014. It is planned to extend JE
vaccination coverage to Karur and
Pudukkottai districts during the current
year.

Impact of Immunization Programme

5.23 Due to successful implementation of

immunization programme, the State has
achieved and is maintaining polio free
status since 2004. Neonatal tetanus
elimination status has also been certified by
World Health Organization in 2006. The
incidence of diphtheria, pertussis and
tetanus has become epidemiologically
insignificant. There is also a significant
reduction in the number of measles cases.

Dr.Muthulakhsmi Reddy Maternity

Benefit Scheme

5.24 The State Government have launched

a revised Dr. Muthulakhsmi Reddy Maternity
Benefit Scheme from 01.06.2011 by
enhancing the maternity benefit to the poor
 49

pregnant women mothers from Rs.6,000 to

Rs.12,000. The cash assistance is given in
three installments on conditional basis and
restricted to two deliveries. From 1st
October 2012, benefits under the scheme
are disbursed directly from Treasury to the
bank account of the beneficiaries (ECS
mode). On an average, 6 lakh women
benefit from the scheme every year. During
2012-2013, Rs.625.51 crore has been
disbursed. For the current financial year, Rs.
720 crore has been allocated for this
programme.

Hospital on Wheels Programme

5.25 385 Mobile Medical Units were

upgraded at a cost of Rs.40 crores with
necessary additional manpower, laboratory
facilities and other diagnostic equipments to
provide high quality medical care with focus
on Mother and Child Health Services,
Communicable and Non-Communicable
Diseases covering all the remote villages
and hamlets as per the fixed day fixed time
plan specific for each block. Fixed tour
programme of the scheme is displayed in
the health department website.
(www.nrhmtn.gov.in) Hon’ble Chief
Minister of Tamil Nadu has inspected one
prototype vehicle developed for the Hospital
 50

on Wheels Programme and approved the

same. 86 new vehicles are provided by the
Government for this special programme.
The fabrication of 195 vehicles has been
completed and vehicles have been sent to
the field. The fabrication work of the
remaining vehicles is on. 385 Laboratory
Technicians will be appointed through
Medical Services Recruitment Board (MRB)
for this programme. The entire field service
of this programme is monitored through a
Public Private Partnership.

Promotion of Menstrual Hygiene

5.26 The Menstrual Hygiene Programme

was launched by the Hon’ble Chief
Minister on 27.03.2012. Under this
scheme, 18 packs of sanitary napkins are
being provided to school going and non
school going adolescent (10-19 years) girls
in rural areas. Three packs are given for two
months (At six pads per pack). In every
school in the rural areas, the designated
teachers are responsible to distribute the
sanitary napkins to school students.

5.27 The Village Health Nurses along with

Anganwadi Workers are responsible for
distribution of the sanitary napkins to the
 51

girls who are not covered in the schools.

The objective of the scheme is to increase
awareness among adolescent girls on
menstrual hygiene, build self-esteem and
empower girls for greater socialization also
to increase access to the use of high quality
sanitary napkins apart from ensuring safe
disposal of sanitary napkins. Sanitary
Napkins to post natal mothers who delivered
in Government institutions at the rate of
seven packs each (six pads per pack) has
commenced in three Health Unit Districts
(Poonamallee, Tiruvallur and
Kancheepuram) and all the remaining
districts will be covered soon. Sanitary
Napkins would also be given to each women
prison inmate at the rate of 12 pack (six
pads per pack) per year and also to women
patients in Mental Hospital.

School Health Programme

5.28 School Health Programme is

implemented in Tamil Nadu to provide
comprehensive health care services to all
students studying in Government and
Government aided schools. Special
emphasis is given to heart diseases, eye
disorders, nutritional disorders, skin
diseases and dental problems. All Thursdays
 52

are scheduled as School Health Days.

Students in need of higher medical
treatment are referred to higher medical
institutions and Saturdays are referral days.
Two teachers from each school are identified
and trained in identifying common illnesses
of students for follow up action with the
doctors. During the last year, among the
school students, 41,84,643 were treated for
one or other health problems and 32,669
referred to higher medical institutions for
further treatment.

Control of Communicable Diseases

5.29 Control of Communicable diseases is

one of the foremost activities of the
Directorate of Public Health which is carried
out in close coordination with the local
bodies. They have been described in detail
under the relevant programmes.

Water Analysis Laboratories

5.30 It is essential to monitor the quality of

water throughout the state to keep a tab on
water borne diseases. The Water Analysis
Laboratories at Chennai and Coimbatore
collect and examine water samples from
various protected water sources to monitor
contamination of drinking water. These
 53

laboratories also assist the Tamil Nadu

Pollution Control Board in examining
samples of Industrial Wastes and conducting
field surveys to ensure the prevention and
control of environmental and industrial
water pollution. Two more water analysis
laboratories are being established in
Tiruchirapalli and Tirunelveli. Apart from
these, Tamil Nadu Water Supply and
Drainage Board (TWAD Board) and Chennai
Water Supply and Sewerage Board (CWSSB)
are also independently undertake water
analysis regularly and follow up action is
taken.
Establishment of District Public Health
Laboratories
5.31 Laboratory services are an essential
component of disease surveillance,
epidemiological surveys and operational
research. The District Public Health
Laboratories are the backbone of the
laboratory network in disease surveillance
programmes for the prevention and control
of epidemic prone diseases. In view of the
emerging and re-emerging communicable
diseases, the Government have issued
orders to establish District Public Health
Laboratories (DPHL) in all the districts in the
District Headquarters to augment the
disease control programmes. One
 54

Microbiologist, One Laboratory Technician

and One Cleaner post have been sanctioned
on contract basis in these labs to support
the disease control activities at the district
level.
 55

Chapter 6

FAMILY WELFARE

6.1 Government of India launched the

National Family Welfare Programme in 1951
with the objective of "reducing the birth
rate” to the extent necessary to stabilize the
population at a level consistent with the
requirement of the National economy. The
Family Welfare Programme in India is
recognized as a priority area, and is being
implemented as a 100% centrally sponsored
programme. The National Family Welfare
Programme is being implemented in the
state since 1956. The department
implements family welfare programmes in
coordination with various related
departments. Tamil Nadu is considered as a
pioneer in the implementation of the family
welfare programmes in the country. In view
of commendable progress in reducing the
birth rate, the focus has shifted from a
"Target based approach" to a "Community
Needs Assessment Approach” where
importance is given to meeting the unmet
needs for family planning services and
improving maternal and child health. This
has been achieved due to the strong social
and political commitment and a robust
 56

administrative setup. The National Family

Welfare Programme is being implemented
through the following programmes for the
fathers and the mothers.

 Providing permanent family welfare

methods like Vasectomy, Tubectomy
and Laparoscopic Sterilisation
 Providing temporary family welfare
methods like Copper-T insertion, Oral
pill cycles and condoms for spacing
between births.
 Medical Termination of Pregnancy
services are also available in
government hospitals and approved
private nursing homes.
 Emergency contraception.

Administrative Structure

Director

Deputy Director of Medical and Rural

Health Services and Family Welfare
(in the districts)

 Post Partum Centres in Government

Hospitals.
 57

 Urban Family Welfare Centres

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

Demographic Indicators

6.2 As already mentioned in the

introductory chapter of this policy note,
Tamil Nadu is the seventh most populous
State in India. As per 2011 census, the
population of Tamil Nadu is 7.21 crores with
decadal growth rate of 15.6 %. It accounts
for 6 % of the country’s total population.
The demographic scenario of the state for
2011 (SRS) is furnished in Table No.6
below:

Table No.6 - Demographic scenario of

Tamil Nadu – 2011

Sl. Current
Indicators
No level
1 Crude Birth Rate 15.9 / 1000
population
2 Crude Death Rate 7.4 / 1000
population
 58

3 Total Fertility Rate

1.7
(2010)
4 Infant Mortality 22 /1000 live
Rate births
5 Maternal Mortality 73 /1,00,000
Ratio * live births
6 Natural Growth
0.85 %
Rate

* Based on the actual maternal deaths

occurred in the State-2011 -12.

Goals

6.3 The Table No.7 shows the demographic

goals fixed to be achieved by 2017.

Table No.7 - Demographic goals

Sl.
Indicators Goals
No
<13 / 1000
1 Infant Mortality Rate
live Births
14 / 1000
2 Crude Birth Rate
Population
44/1,00,000
3 Maternal Mortality Ratio
Live Births
4 Total Fertility Rate 1.6
 59

5 Couple Protection Rate 65 percent

Reduction of Higher
6 <10 percent
Order Births

Thrust areas and Strategies for

achieving the goal

6.4 Out of 10.8 lakh births occurring in the

State 9.6 % (2011) of the births are still
Higher Order Births (HOB) i.e. one lakh.
The unmet needs under spacing methods
are 4.1 percent and permanent methods are
4.8%. The male participation under the
sterilization programme is less than 1%.
Action will be taken to increase the male
participation to 10% under Sterilisation
Programme. As per SRS 2011, the infant
mortality rate was 22 per 1000 live births.
Among these infant deaths nearly 75% are
neonatal deaths and in coordination with all
the other directorates steps would be taken
to further reduce it. In this background, the
following strategies will be adopted to
achieve the goals proposed for the Twelfth
Five Year Plan period.

i. Area specific approach will be adopted

to identify village wise eligible couples
with three and above order of living
children and motivate them by a block
 60

level team to adopt different methods

of contraception.
ii. At present 372 Operation theatres are
functioning in the Primary Health
Centres. Steps will be taken to make
the remaining Operation theatres in
the Primary Health Centres functional
in a phased manner.
iii. 1,930 private nursing homes have
been involved besides the
Government institutions to provide
family welfare services in the State.
The unapproved private nursing
homes which satisfy quality standards
will be systematically approved to
render Family Welfare services.
iv. The Self Help Groups, Elected
representatives and Non-Government
sector will be involved along with the
Government to provide better Family
Welfare services to the eligible
couples.
v. An effort will be made to train at least
one MBBS doctor in each upgraded
PHC (which has a functioning
operating theatre) in tubectomy
sterilization, Mini-lap and No Scalpel
Vasectomy. These doctors will also be
trained in Manual Vacuum Aspiration
techniques to provide safe abortion
 61

services at the PHC level. Training in

Post Partum IUCD insertion has also
been started to ensure that high risk
mothers are given a reliable form of
contraception with their consent.

Activities undertaken by the

department

6.5 Post Partum Programme: The main

objective of the post-partum programme is
to motivate the Eligible Couples to adopt
any one of Family Welfare methods through
education and motivation particularly during
Antenatal, Natal and Postnatal period. At
present, there are 110 Post-Partum Centres
functioning in Government hospitals in Tamil
Nadu to improve the health of mothers and
children through maternal and child health
and Family Welfare Programmes. Nearly
35% of sterilization operations done in the
State are performed in these post-partum
centres.

6.6 Urban Family Welfare Centres: There

are 108 Urban Family Welfare Centres
functioning in the state to render Family
Welfare services in the small Municipalities
of urban areas. These Urban Family Welfare
Centres have been classified into three
 62

types based on the size of the population it

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

6.7 Urban Health Posts: A special

programme of Urban Revamping Scheme to
render outreach services has been launched
and is in progress. Under this scheme, 193
Health Posts of type ‘D’ covering 50,000
populations and above are functioning to
provide Family Welfare & Maternal and Child
Health services in the urban slum areas.

6.8 Rural Family Welfare Centres: Family

Welfare Programme is implemented in the
rural areas through the Rural Family Welfare
Centres attached to the Primary Health
Centres. There are 382 Rural Family Welfare
Centres in the State. 372 primary Health
Centres are functioning with Operation
Theatres to provide Sterilization Services to
the Rural People. Nearly 25% of the total
sterilization operations done in the State are
performed in Primary Health Centres. The
spacing methods like Intra uterine
contraceptive device insertion, Oral pills and
Condom distribution to the eligible couples
in the rural areas are supplied through
1,614 Primary Health Centres and 8,706
Health Sub Centres.
 63

6.9 Medical Termination of Pregnancy

Programme: Medical Termination of
Pregnancy (MTP) is a health care measure
which helps to reduce the maternal
morbidity and mortality through the
provision of safe abortion services. The
strategy for the provision of safe abortion
services includes the implementation of
simple and safe technologies like Manual
Vacuum Aspiration (MVA) Technique which
can be performed up to 8 weeks of
gestation in any institution with basic
facilities. In the State, approximately
60,000 MTPs are performed in the
Government and the private institutions
annually which include nearly 15,000 MVA
performances. To improve the safe abortion
services, the Doctors and Staff Nurses
working in Government facilities are being
given MVA training.

6.10 No Scalpel Vasectomy (NSV): To

encourage the participation of male and to
propagate the awareness on NSV
technique, 192 NSV camps once in two
months will be organized in District Head
Quarters Hospitals and Taluk Hospitals
during the year 2013-2014 and a sum of
Rs.67.20 lakh will be allocated for
organizing the camps.
 64

6.11 Information, Education and

Communication (IEC): The sustained IEC
activities on Family Welfare Programme in
the State have improved by creating
awareness among the public to adopt “Small
Family Norm”. The National Family Health
Survey-3 result reveals that awareness of
Family Welfare methods among masses in
the State is universal. IEC activities are
being geared up through closed circuit T.V.
System, Electronic Display, Wall paintings,
Press Advertisements and Innovative
activities like erection of Hoardings,
Conducting Seminars, Workshops and Self
Help Groups.

6.12 Participation of Non-Governmental

Organizations: 27 Voluntary Organizations
and 1,930 approved private Nursing Homes
in the State are also extending the Family
Welfare services and the contribution as a
whole is 34.6%.

6.13 Group Insurance Scheme to

Sterilization Acceptors: The Government
of India have renewed the family planning
insurance scheme in tie up with ICICI
Lombard Insurance Company Limited with
effect from 1st January 2012 with the
following insurance benefits for the family
 65

welfare sterilization acceptors and service

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

Table No.8 - Group Insurance Scheme

to Sterilization Acceptors

Death following
sterilization in hospital or
within 7 days from the Rs.2 lakh
date of discharge from the
hospital
Death following
sterilization within 8 to 30
Rs.50,000
days from the date of
discharge from the hospital
Failure of sterilization
leading/non-leading to Rs.30,000
child birth
Cost of treatment upto 60
Actual cost
days arising out of
not exceeding
complication from the date
Rs. 25,000
of discharge
Indemnity insurance per
Up to Rs.2
doctor per facility but not
lakh per
more than 4 cases per
claim
Doctor in a year
 66

6.14 Compensation to Sterilization

Acceptors: Compensation for loss of
wages to the sterilization acceptors is being
implemented in the State as detailed below
in Table No.9.

Table No.9 - Compensation to sterilization

Acceptors

Acceptors of male sterilization in

Rs. 1,100
public health facilities
Acceptors of female sterilization
belonging to Below poverty Line
Rs. 600
and SC / ST in public health
facilities
Acceptors of female sterilization
belonging to Above poverty Line Rs. 250
in public health facilities.

Interpersonal Counselling to Higher

Order Birth Mothers in the selected
Village Panchayat

6.15 As per the 2011 Delivery Report, the

Higher Order Birth (3rd and above order of
birth) in the State is 9.6%. It has been
identified that the Higher Order Births are
more than State average in 17 Districts.
As a new initiative, the interpersonal
 67

counselling will be organized in 202 Blocks

and 30 Health posts where the Higher order
Birth is more than 12.5% to create
awareness among the mothers about risk
related to higher order birth and to reduce
the maternal morbidity and mortality and
also to reduce the prevalence of more than
2 children to bring about the small family
norms and to stabilize the population in
Tamil Nadu. The scheme will be
implemented at a cost of Rs.23.20 lakh.

Training in Laparoscopic Sterilization

6.16 Eight Government Hospitals (Chennai,

Coimbatore, Dindigul, Thanjavur,
Tiruchirappalli, Tirunelveli and Villupuram)
have been identified as training centres for
Laparoscopic Sterilisation. During the year
2013-2014, 12 batches of Laparoscopic
Training will be conducted in each centre.
Totally 96 number of Doctors will be trained
along with operation theatre (OT) Nurses
and OT Technicians in these training centres
and a sum of Rs.47.54 lakh will be allocated
for these training.
 68

Training in Mini-Lap Tubectomy

Sterilization

6.17 The untrained doctors in Mini-Lap

Tubectomy Sterilization who are working in
Government Hospitals and Urban Health
Posts will be trained in this procedure during
the year 2013-2014. Totally 100 Doctors
will be trained and a sum of Rs.18.25 lakh
will be incurred for this training.

6.18 The family welfare department is a

critical department and continued thrust in
this area would be needed for the State to
sustain the gains achieved so far.
 69

Chapter 7

MEDICAL AND RURAL HEALTH SERVICES

(Employees’ State Insurance Hospitals)

7.1 The Employees’ State Insurance

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

Administrative Structure
Director of Medical and Rural Health
Services (ESI)

Joint Director

Regional Administrative Deputy Director Superintendent,

Medical Officers of ESI Hospitals
Chennai, Coimbatore,
Salem and Madurai
 70

The details of the activities have been

brought out in the Labour and Employment
department policy note.
 71

Chapter 8

INDIAN MEDICINE AND HOMEOPATHY

8.1 India has a long tradition of various

systems of medicine. Even before the
advent of the modern medicine, these
Indian Systems of Medicine (ISM) have
been offering cost effective and sustainable
relief to all the sections of the society from
various ailments without any adverse side
effects. The Siddha system of medicine
illustrates the ancient wisdom and
knowledge of the Tamils to the world. Indian
systems of medicine are gaining popularity
as a reliable health care system relief.

8.2 When there was an outbreak of Dengue

fever last year, the traditional medicines
played an admirable role in treating the
patients affected with Dengue Fever and
other similar viral fevers along with the
modern medicine as a complementary
treatment. Thanks to the Hon’ble Chief
Minister’s directions, the Government
issued instructions to all the Government
Hospitals of Modern Medicine in the State to
provide the traditional medicines of
Pappaya Leaf Juice, Malaivembu leaf
juice and Nilavembu Kudineer to the
 72

in-patients admitted in the Government

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

8.3 The Government formed the

“Department of Indian Medicine and
Homeopathy’’ in the year 1970. The
Department is responsible for teaching as
well as for providing health care in five
systems of Indian medicine viz., Siddha,
Ayurveda, Unani, Yoga & Naturopathy, and
Homeopathy. This Department functions as
the nodal Department for the all round
development of Indian Systems of Medicine
and Homeopathy in the State.

Administrative Structure

Commissioner/Director

 Principals of Government Siddha,

Ayurveda, Homeopathy, Unani and
Yoga and Naturopathy Medical
Colleges
 State Licensing Authority (Indian
Medicine)
 Government Analyst, Drugs Testing
Laboratory(Indian Medicine)
 73

 Superintendent, Govt. Arignar Anna

Hospital of Indian System of Medicine,
Chennai
 District Siddha Medical Officers

Government Siddha,
Ayurveda, Unani, Yoga
and Naturopathy and
Homeopathy Dispensaries
attached to Government
Hospitals/PHCs and
Siddha wards in
Government Hospitals

Objectives of the Department

8.4 The Main objectives of the department

are:

i. Opening of ISM wings/Hospitals at

various levels in all the districts
ii. Development of educational
institutions in Siddha, Ayurveda,
Unani, Yoga & Naturopathy and
Homoeopathy
iii. Encouraging the cultivation of
Medicinal Plants, processing and
manufacturing of ISM drugs and
promoting research and
development in ISM
 74

iv. Making improvements to the

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

Currently the department has a sanctioned

strength of 4,990 employees.

Medical Treatment

8.5 There are 1,375 total of ISM institutions

including the medical colleges in the State
provide medical treatment under Indian
Systems of Medicine and Homeopathy, with
 75

an inpatient capacity of 1,210 beds. Details

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

Table No.10 - Institutions under ISM

System Total
Siddha 1,047
Ayurvedha 100
Unani 65
Homoeopathy 107
Yoga and Naturopathy 56
Total 1,375

8.6 The brief details of the various

Hospitals/ Wings managed by this
department are-

 350 bedded Hospital attached to

Government Siddha Medical College,
Palayamkottai, Tirunelveli
 310 bedded Hospital attached to
Arignar Anna Government Hospital of
Indian Medicine, Chennai
 50 bedded Hospital attached to
Government Homeopathic Medical
College, Tirumangalam, Madurai District
 25 bedded ward in Government
Pentland Hospital, Vellore
 76

 25 bedded Siddha Wards in District

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

Medical Education

8.7 Tamil Nadu is the only State in the

country where Government Medical Colleges
have been established in all the five
 77

disciplines of Indian systems of Medicine.

The total number of Government Medical
Colleges of ISM and the number of ISM
Private Medical Colleges available in the
State for Indian Medicines can be seen from
the Table No.11.

Table No.11 - Number of Government

and Private Medical Colleges of ISM

Sl.
Medical System No. of colleges
No.
Govt. Private
1 Siddha 2 5
2 Ayurveda 1 3
3 Unani 1 --
4 Homeopathy 1 8
5 Yoga & Naturopathy 1 4
Total 6 20
The Government Colleges are as follows-

 Government Siddha Medical College,

Palayamkottai, Tirunelveli District
 Government Siddha Medical College,
Anna Hospital Campus, Arumbakkam
 Government Yoga & Naturopathy Medical
College, AAGHIM campus, Arumbakkam
 Government Homeopathy Medical
College, Tirumangalam, Madurai District
 78

 Government Unani Medical College,

AAGHIM Campus.
 Government Ayurveda Medical College,
Kottar, Nagercoil, Kanniyakumari District.

Paramedical Human Resources

8.8 Indian Medicine and Homeopathy

Department is conducting the following
para-medical courses:

i. Diploma in Nursing Therapy

ii. Diploma in Integrated Pharmacy

A new Diploma course in Integrated

Pharmacy is being imparted in pharmacy
training and manufacturing practices in all
the disciplines of Indian Medicine (except
Yoga & Naturopathy). In addition, a
diploma course in Nursing Therapy is being
conducted for all disciplines of Indian
Medicine (except Homoeopathy). These two
Diploma Courses aimed at promoting
Pharmacists and Nursing Therapists are
being conducted at Arignar Anna
Government Hospital of Indian Medicine,
Chennai and Government Siddha Medical
College, Palayamkottai, Tirunelveli. Number
of seats available in the Government
Colleges and the Private Colleges for the
 79

admission to the Under Graduate (UG) and

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

Table No.12 - Number of seats

available in the Government Colleges
and the Private Colleges

Details of Seats available for

admission
Sl. Government Private
Discipline Colleges Colleges
No. Total
UG PG UG PG

1. Siddha 150 94 200 -- 444

2. Ayurveda 50 -- 160 -- 210
3. Homoeopathy 50 -- 400 24 474
Yoga &
4. 20 -- 200 -- 220
Naturopathy
5. Unani 26 -- -- -- 26

Total 296 94 960 24 1374

UG – Under Graduate ; PG-Post Graduate

The number of seats sanctioned for Diploma

Course in Integrated Pharmacy and for
Nursing Therapy available are furnished in
Table No.13.
 80

Table No.13 - Number of seats sanctioned

for Diploma Course in Integrated Pharmacy
and for Nursing Therapy

Number of seats
Diploma
Sl. Name of the Diploma in
in Total
No. Institution Integrated
Nursing
Pharmacy
Therapy
1. Arignar Anna 50 50 100
Government
Hospital of Indian
Medicine,
Chennai
2. Government 50 50 100
Siddha Medical
College,
Palayamkottai,
Tirunelveli
Total 100 100 200

Co-Location of ISM Wings in

Government Health Facilities

8.9 At present ISM facilities are available in

30 District Headquarters Hospitals, 231
Taluk Hospitals and Non-Taluk Hospitals and
954 PHCs (including the 475 wings opened
under NRHM).

Additionalities under National Rural

Health Mission

8.10 NRHM has been separately covered in

detail in the chapter 12 under the State
 81

Health Society. Some of the additionalities

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

No. of NRHM Wings in PHC

Y & N - 51

Homoeo - 57
Siddha - 275

Unani - 40

Ayurveda - 52

A total of four new schemes have been

approved under NRHM for this Department
at an out lay of Rs.2.46 crore for the year
2012-2013. The total fund allocation for
ISM for the fiscal year 2012-2013 from the
NRHM flexi-pool was Rs.17.65 crore details
of which can be seen in the
Table No.14.
Table No.14 - Schemes approved for the
year 2012-2013 under NRHM
Sl. Budget (Rs.
Scheme Details
No. in crore)
1. Hiring charges for the Human 15.19
Resources engaged (on going Scheme)
2. Information Education and 0.34
 82

Communication activities (New

Scheme) at Rs. 2500 per ISM unit for
all 1360 units
3. Training to all VHNs in Yoga and 0.87
Naturopathy to impart yoga exercise to
pregnant women for natural and safe
delivery (New Scheme)
4. Provision of Kit Medicine to pregnant 1.00
mothers during antenatal and postnatal
period (New Scheme) through 370 PHC
in the first phase
5. Networking the Commissionerate with 0.25
District Siddha Medical Offices and the
Colleges (New Scheme)
Total 17.65

State Drug Licensing Authority for

Indian Medicine

8.11 Till 28-11-2007, licensing of Indian

System of Medicine drugs was with the
Department of Drugs Control. Now this is
done by the State Licensing Authority
(Indian Medicine) with effect from
29.11.2007 as per Drugs and Cosmetics Act,
1940 and Rules, 1945. The District Siddha
Medical Officers are the Drug Inspectors for
the purpose of implementation of the
provisions pertaining to renewal of license,
inspection, sampling, and prosecution in
respect of Siddha, Ayurveda and Unani
drugs.
 83

Standardisation of ISM Drugs and

Strengthening of Drug Testing
Laboratory

8.12 Its primary function is to test the

quality of the statutory samples lifted and
sent by the Drug Inspectors and District
Siddha Medical Officers in discharge of their
statutory function under section 33G of
Drugs and Cosmetics Act 1940. Advanced
and modern equipment have been installed
in the Laboratory for the purpose of
standardization and quality control of the
ISM medicines. The results of the test are
given in Table No.15. It can be seen that
over the years more samples are being
lifted for testing.

Table No.15 - Results of the test

Total No
Not of
of Standard
Year Standard
Samples Quality
Quality
tested
2009-2010 203 141 62
2010-2011 248 175 73
2011-2012 505 330 175

2012-2013 1,185 878 307

 84

National Institute of Siddha

8.13 The National Institute of Siddha at

Tambaram, Chennai was inaugurated in the
year of 2005 with the fund of State and
Central Government. The Capital
expenditure is shared between Government
of India and the Government of Tamil Nadu
in the ratio of 60:40 and the Revenue
expenditure in the ratio of 75:25 for the
project period of 6 years as per the
understanding between the Government of
India and the State Government. The
Institute is imparting quality Post Graduate
education in Siddha apart from research
activities.

Tamil Nadu Medicinal Plant Farms &

Herbal Medicine Corporation Ltd.,
(TAMPCOL)

8.14 TAMPCOL was incorporated in the year

1983. TAMPCOL is currently manufacturing
92 ISM Medicines viz. 58 Siddha medicines,
26 Ayurveda medicines and 8 Unani
medicines like chooranam, thailam, vennai,
kudineer, parparm, chenduram, lehiyam,
tablets, capsules, syrups, etc. Nilavembu
Kudineer, an effective Siddha Sastric
medicine in preventing and treating viral
 85

fever including dengue fever has been

supplied to all ISM units in the State and
TAMPCOL has played a significant role by
effecting timely supplies of medicines to all
ISM Units. The Corporation has been
earning profit consistently. It is pertinent to
note that it is supplying medicines to the
institutions under the control of Indian
Medicine and Homoeopathy Department at
very nominal prices in the interest of
general public as these medicines are issued
to them free of cost by the Government.
 86

Chapter 9

FOOD SAFETY AND DRUGS CONTROL

ADMINISTRATION

Food Safety

9.1 To regulate all activities connected to

production of food and food related
industries, the Food Safety and Standards
Act, 2006 was enacted by Government of
India after repealing the Prevention of Food
Adulteration Act, 1954. This act has come
into force in the entire country from
05.08.2011. Under the provisions of this
act, Tamil Nadu Food Safety and Drug
Administration Department was created in
the State.

9.2 At State level, Commissioner of Food

Safety Office has been created as the Head
office. All 32 revenue districts have
Designated Officers under the Act. At the
field level, 584 Food Safety officers have
been appointed (385 for each block-rural
area and 199 for Municipal areas).

9.3 The field officers have the primary

responsibility of ensuring safety of food and
food related items in their areas of
operation. As per this act, all Food Business
 87

operators have to either take a license or

get a registration depending on their annual
turnover. Food Business Operators with less
than Rs.12 lakh annual turnover have to
register themselves with concerned Food
Safety Officers. Food Business Operators
with greater than Rs. 12 lakh annual
turnover have to take license through the
Designated Officers. The time for taking
license / registration has been extended till
4th February 2014 by the Food Safety and
Standards Authority of India. Till March
2013, 29,129 Food Business Operators have
taken the license and 2,03,889 Food
Business Operators have registered
themselves with the Food Safety
Department. All the Designated Officers and
Food Safety Officers have been given a 5
day training course to familiarize
themselves about the provisions of the Food
Safety and Standards Act.

9.4 To test the quality of food, there are six

Food Analysis Laboratories in Tamil Nadu.
They are located at Chennai (Guindy),
Thanjavur, Madurai, Tirunelveli
(Palayamkottai), Salem and Coimbatore. All
six laboratories have been notified as per
the act for testing the food related samples.
 88

Drug control Administration

9.5 The Drugs Control Administration, which

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

Administrative Structure.

Commissioner of Food Safety and Drug Control

Food Safety
department

Director, Drugs Control

State Drugs Testing

Laboratory
Joint Director

Deputy Directors
 89

Zonal Assistant Directors

Senior Drugs
Inspectors / Drug
Inspectors

9.6 There are 14 Zonal Offices (5 in the City

and 9 in the Moffusil areas) in the State,
each headed by an Assistant Director of
Drugs Control who is the Licensing Authority
for the Grant / Renewal of Sale Licences in
the zone. There are three posts of Deputy
Director of Drugs Control and one post of
Joint Director of Drugs Control. There are 15
Senior Drugs Inspectors and 146 Drug
Inspectors in the department. 12 Senior
Drugs Inspectors and 140 Drug Inspectors
in various Zones and three Senior Drug
Inspectors and six Drug Inspectors are
positioned in the Office of the Director of
Drugs Control, Chennai. The Intelligence
Wing, with a Mobile Van, is under the
charge of a Deputy Director of Drugs
Control and three Drug Inspectors are part
of the Intelligence Wing. There is a Legal
Adviser to handle legal issues.

9.7 Drugs Control Department, being a

statutory body, performs a very important
role in supporting healthcare service
 90

regulations and enhancing the safety of our

community. As a statutory body for Drugs
Control, the department distinguishes the
massive challenges posed by spurious
/adulterated /sub standard quality drugs,
selling drugs at excess pricing, misleading
advertisements by some manufacturers and
dealers. The Drugs Control Administration
has the prime mandate of enforcement the
following enactments for regulating the
manufacture, distribution and sale of Drugs
and Cosmetics.

i. Drugs and Cosmetics Act, 1940 and

Rules, 1945
ii. Drugs Prices Control Order, 1995
iii. Drugs and Magic Remedies
(Objectionable Advertisement) Act,
1954

The officers of this department are also

empowered to act under Narcotic Drugs and
Psychotropic Substances Act, 1985. The
Director of Drugs Control is the controlling
authority and licensing authority for grant
and renewal of licences for manufacture (for
sale) of Allopathic, Homeopathic medicines
and Cosmetics and also the licensing
authority for the blood Banks in the state
along with the Central Licence Approving
 91

Authority. For the implementation and the

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

Table No.16

i. Manpower details of Drugs Control

Administration

Sl. No. of
Name of the Post
No Posts
1 Director of Drugs Control 1
2 Joint Director of Drugs Control 1
3 Deputy Director of Drugs Control 3
 92

4 Assistant Director of Drugs 15

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

ii. Manpower details of Drugs Testing

Laboratory

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

Functioning of Mobile Squad and Legal

cum Intelligence Wing

9.8 A Mobile Squad with its headquarters

at Madurai and a Legal-cum-Intelligence
Wing in this Directorate attend to
complaints relating to spurious drugs and
investigates specific complaints in Southern
Region and in Chennai respectively. Apart
from this work, the Legal-cum-Intelligence
Wing processes legal matters and
undertakes special investigations.

Drugs Testing Laboratory

9.9 Drugs Testing Laboratory attached to

this Department undertakes testing of
samples, drawn by the Drugs Inspectors
(other than parenteral preparations) from
various retail, wholesale Units,
manufacturing units and hospitals, private
as well as in government sector.

Prosecutions Sanctioned

9.10 Prosecutions have been sanctioned for

certain contraventions under Drugs and
Cosmetics Act, 1940 and other acts in 301
cases. The details can be seen from Table
No.17.
 94

Table No.17 - Prosecutions for certain

contraventions under Drugs and
Cosmetics Act, 1940 and other Acts

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

Action Taken for Violation under Drugs

and Cosmetics Act and Rules

9.11 During 2012-2013, action was initiated

against 17 companies under the Drugs and
Cosmetics Act / Rules.
 95

Chapter 10

TAMIL NADU STATE HEALTH

TRANSPORT DEPARTMENT

10.1 The State Health Transport

Organisation was started with six Mobile
Maintenance Units to look after the
maintenance of Health Department Vehicles
in the year 1959. During the year 1971,
Government of India with a substantial
financial assistance from UNICEF evolved an
all India pattern according to which each
state would have a State Health Transport
Organisation. From the year 1973, 15
Mobile Maintenance Units started
functioning under State Health Transport
Organisation. Later, during the year 1981,
the above organization was made as a
separate department for the effective
maintenance of Health and Family Welfare
Department vehicles. During the Year
1995, this Department was converted as
Tamil Nadu State Police Transport Workshop
to maintain the Police Department vehicles.
Subsequently due to the persistent demand
of the Medical Officers, this Department
was again revived and restored back to its
original form from 1.1.1997 and is till date
functioning successfully to attend to all the
 96

needs of Health and Family Welfare

vehicles.

10.2 The aim of the State Health Transport

Department is to

 Reduce the down time of the vehicles

which are taken up for repairs
 Ensure high percentage of fleet
utilization of vehicles
 Provide more fleet for the successful
implementation of health programmes
 Keep more number of vehicles in good
running condition and to conduct
periodical servicing, maintenance and
to undertake all types of repairs
 Register new vehicles allotted for the
various wings of Health and Family
Welfare and to distribute them
according to the allotment given by
the Head of the Departments
 Suggest the suitability of vehicles to
Head of the Departments as per the
existing code rules and Government
Orders
 Advice the Unit Officers of Health and
Family Welfare Department regarding
Fitness Certificate, getting Tax free
 97

tokens, Transfer of Ownership etc. for

the vehicles under their control
 Propose the vehicles for natural and
premature condemnation based on the
report of Technical Expert Committee
of the Tamil Nadu State Health
Transport Department
 Conduct classes on fleet management,
Tamil Nadu Departmental Vehicle
Control rules to Medical Officers and
other staff at various Health Training
Centres
 Impart Apprenticeship Training to
Degree, Diploma and ITI Certificate
Holders
 Supply of Batteries and tyres to the
Health and Family Welfare
Department Vehicles

Administrative Structure

Director

a. Regional Workshops (7)

b. District Headquarters
Workshops (9)
c. Mobile Vehicle Maintenance
Units (29)
 98

d. Reconditioning and Central

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

Table No.18: Sanctioned staff strength

of the State Health Transport
Department
Sanctioned
Sl. posts
Name of the post
No. (As on
31.3.2013)
1 Director 1
2 Deputy Director (Technical) 1
3 Deputy Director 1
(Administration)
4 Accounts Officer 1
5 Automobile Engineer 1
6 Technical Officer 1
7 Material Manager 1
8 Workshop Superintendent 7
9 Assistant Accounts Officer 7
10 Assistant Engineer 9

11 General Foreman 10
12 Ministerial Staff 87
13 Technical Staff 448
14 Office Assistant, Sweeper, 94
Watchman and Gardener
TOTAL 669
 99

10.3 This department has made several

significant strides as it passed through
different phases of its development. At
present, seven regional workshops, nine
district workshops and twenty nine mobile
workshops, four mini workshops and one
reconditioning unit are functioning under the
administrative control of this directorate.
Currently, this department maintains 2,739
vehicles attached to the various Directorates
of Health and Family Welfare Department
(as detailed below) and a three-tier
structure is followed for the proficient
maintenance of vehicles.

Table No.19 - Directorate wise Fleets

Maintained (as on 31.3.2013)

No. of
Sl. Name of the
vehicles
No. Directorate
maintained
1 Directorate of Public 1,586
Health and Preventive
Medicine
2 Directorate of Medical 347
and Rural Health
Services
3 Directorate of Medical 256
Education
4 Directorate of Family 462
Welfare
 100

5 Directorate of Drugs 4
Control
6 Directorate of Indian 8
Medicine and
Homoeopathy
7 Tamil Nadu State 53
Health Transport
Department
8 Medical Services 2
Recruitment Board
9 Directorate of Food 19
Safety & Drugs
Administration
10 State Health Society 2
Total 2,739

Activities of Regional / District / Mobile

Workshops in brief

10.4 The seven regional workshops located

at Chennai, Salem, Madurai, Coimbatore,
Tiruchirappalli, Tirunelveli, Vellore maintain
a fleet of about 400 Vehicles each. Nine
district workshops at Chengalpattu,
Dharmapuri, Virudhunagar, Udhaga-
mandalam, Erode, Thanjavur, Pudukkottai,
Nagercoil and Villupuram and 29 mobile
workshops that are spread all over the State
are functioning to assist the regional
 101

workshops in maintaining all the vehicles in

an effective manner. The mobile workshop,
based on their advance tour programme,
visits the hospital premises and takes up
periodical servicing and executes minor
repairs, on the spot. If the nature of repairs
in a vehicle is beyond the limits of the
mobile workshop, the required major repairs
are executed in the nearby regional or
district workshop.

Functions of the Department

10.5 This department provides trouble free

mobility for implementing various health
programmes. It also collects data related to
the vehicles maintained by it. This
department also identifies obsolete vehicles
for their condemnation. During the year
2011-2012, 208 Ambulances and
30 Mortuary vehicles were identified and
condemned. Further during important
Health care programmes like Pulse polio
immunization, this Department deputes its
staff concerned to the office of the Deputy
Director of Health Service to attend to break
down vehicles for successful implementation
of the programmes.
 102

Training Programmes

10.6 Apprenticeship training is also being

imparted in this Department every year to
45 I.T.I. Certificate holders, 29 Diploma
holders and 17 B.E. Graduates sponsored by
the different Government authorities.

Improvement in the performance

10.7 Several tools and machineries that are

required for undertaking complicated repair
works have been installed in the Workshops
attached to this Department. With these
facilities, the down time required to carry
out the works have been drastically reduced
which in turn has facilitated in the early
delivery of vehicles. Computers have also
been installed to expedite the activities of all
workshops of this Department. The
performance of the workshops in terms of
fleet utilization, downtime of repairs,
inventory control, man-hour utilization and
budgetary control has improved. The
percentage of fleet in operation which was
72.6% in the year 1981 has progressively
improved to 97%.
 103

Chapter 11

MEDICAL SERVICES RECRUITMENT

BOARD (MRB)

11.1 In order to fill up the posts in a speedy

manner, the Government has constituted a
separate Board namely ‘Medical Services
Recruitment Board’ (MRB) which consists of
a Chairman, a Member and a Member
Secretary. The MRB is in-charge of direct
recruitment (of all posts which are not
coming under the purview of Tamil Nadu
Public Service Commission) of all Para
Medical Staff including Nurses required for
the various departments functioning under
the Health and Family Welfare Department.

11.2 Medical Services Recruitment Board

conducts recruitment by obtaining seniority
list from the Employment Exchange, verifies
their eligibility and declares results as per
seniority and communal rotation. MRB has
so far recruited and filled up 18 posts of
Physiotherapist Grade – II, 63 posts of
Skilled Assistant (Fitter Grade – II) and 29
posts of ECG Technician. Currently MRB is
finalizing the list of eligible candidates for
255 posts of Radiographer.
 104

11.3 In addition, the Medical Services

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

11.4 Medical Services Recruitment Board is

striving to improve and quicken the system
of recruitment of Health and Family Welfare
Department.
 105

Chapter 12

STATE HEALTH SOCIETY

12.1 The National Rural Health Mission

(NRHM) was launched in 2005 to provide
accessible, affordable and quality health
services even to the poorest and remotest
rural regions. The State has established
State and District Health Missions. The
State Health Society, Tamil Nadu was
registered and all the District Health
Societies have been registered under Tamil
Nadu Societies Registration Act, 1975.
Integration of the multiple societies of
different national health programmes at
State and District levels, as envisaged under
the NRHM has also been done.

Vision, Goals, Objectives of National

Rural Health Mission

12.2 Vision - ‘Healthy People – Now and in

the Future.’

12.3 Goals of the Mission are

 To provide accessible and affordable

health care based on people’s need
 106

 To deliver high quality of health

services
 To improve the long term health
status of the population
 To improve the management of health
services and make them more
accountable to the people

12.4 Objectives of the Mission are

 Reduction in Infant mortality and

maternal mortality
 Universal access to public health
services - women’s health, child
health, drinking water, sanitation and
hygiene, nutrition and universal
immunization.
 Prevention and control of
communicable and non-communicable
diseases
 Population stabilization – Gender and
demographic factors
 Access to integrated comprehensive
primary health care
 Revitalizing local health tradition and
mainstreaming ISM
 Promotion of healthy life styles
 107

State Health Society

12.5 To achieve the objectives of the

mission, the State Government entered into
a Memorandum of Understanding (MoU)
with the Government of India, stating their
agreement to the policy framework of the
Mission and the timelines and performance
benchmarks against identified activities. The
State Health Society, Tamil Nadu was
registered under the Tamil Nadu Societies
Registration Act on 15.3.2006. Similarly all
the District Health Societies have been
registered under the Tamil Nadu Societies
Registration Act, 1975. The first phase
project period was for 7 years upto March
2012. The sharing pattern of the project
expenditure in the XI Plan is 85:15 between
Government of India and State
Government. Government of India has
extended the project in the XII plan period
with revised funding sharing pattern of
75:25 between GOI and State government.
The Programme Implementation Plan (PIP)
for the year 2012-2013 has been approved
by the National Programme Coordination
Committee (NPCC) of NRHM. The
components of National Rural Health Mission
along with the scheme wise allocation
approved by Government of India under PIP
 108

2012-2013 are given in the Table No.20

below:-

Table No.20 - Allocation under Programme

Implementation Plan 2012-2013

Amount
Sl. Name of the Programme under approved
No. NRHM (Rs. in
Crores)
Scheme: A
1 RCH Flexible Pool
438.55
2 Additionalities under NRHM (Mission
525.40
Flexible Pool)
3 Immunisation – Total
15.90

Total (A) 979.85

Scheme: B
National Disease Control
Programme
4 National Vector Borne Disease Control
9.08
Programme
5 Revised National Tuberculosis Control
17.71
Programme
6 National Programme for Control of
24.47
Blindness
7 National Leprosy Eradication
2.28
Programme
8 National Iodine Deficiency Disorder
0.24
Control Programme
Integrated Disease Surveillance
9 1.10
Project
Total (B) 54.88
 109

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

For the year 2013-2014 it is anticipated that

about Rs.1,400 crore will be approved in the
PIP. The funds for all the programmes are
routed through the State Health Society at
the state level and the District Health
Society at the district level. This has
contributed to the smooth release of funds
to reach the field. Sub committees have also
been formed at the state level to facilitate
coordination and policy planning under the
various components.

12.6 A short description of the various

important activities taken up under the first
two components (RCH and NRHM flexi pool)
is given below. The activities carried out
under the other components and disease
control programmes are discussed in the
relevant Department of the Policy Note.

Reproductive and Child Health

12.7 The State has been providing a wide

range of Reproductive and Child Health
 110

Services including institutional delivery,

emergency obstetric care, safe abortions,
family planning services and adolescent
health services in the rural areas as well as
the small urban towns. There has also been
a thrust towards increasing the utilization of
primary health centres through improving
the atmosphere and service in these
centres. Due to these efforts there has
been significant fall in the major RCH
indicators, viz. MMR and IMR.

Maternal Health

12.8 Delivery Care Services in all PHCs -

24 x 7 Hours: One of the remarkable
achievements after the introduction of the
NRHM has been the manifold increase in the
number of the deliveries conducted in the
PHCs. This has been made possible due to
the introduction of 24 x 7 hour delivery
services in every PHC by posting 3 staff
nurses for rendering round the clock duty.
The daily OP attendance and IP attendance
have also increased. This intervention has
been implemented in all the PHCs and will
be continued in 2013-2014 at a total cost of
Rs.40.22 crore.
 111

12.9 Janani Suraksha Yojana: Janani

Suraksha Yojana aims to reduce the
maternal and infant mortality by focusing on
increasing institutional deliveries. This
scheme is implemented in urban and rural
areas. An amount of Rs.700 in rural and
Rs.600 in urban areas is paid to below the
poverty line mothers delivering in
institutions for the first two live births. In
Tamil Nadu, the amount is given to the
women after delivery, in addition to the
financial assistance under Dr. Muthulakhsmi
Reddy Maternity Benefit Scheme of
Rs.12,000 per mother. This scheme has a
provision of Rs.33.47 crore for the year
2013-2014.

12.10 Janani Sishu Suraksha

karyakaram (JSSK): The scheme of
Janani Sishu Suraksha Karyakaram entitles
every pregnant women and sick neonate
with free drugs, diagnostics, and diet for the
duration of the stay, free transport from
home to facility, inter facility transfer and
transport from facility back to home. The
scheme aims at reducing out of pocket
expenses for pregnant women and sick
neonates.

12.11 Mobile Medical Units (MMU):

Mobile Medical Units have been provided to
 112

all the 385 blocks under NRHM and are

functioning since February 2009 under the
control of the PHC Patient Welfare Societies.
Each Mobile Medical Unit visits 40 camp
sites in a month as per fixed tour
programme and covers all unserved and
underserved villages. Each Mobile Medical
Unit team consists of a Doctor and a Staff
Nurse. Visits of MMU team are linked with
the Village Health and Nutrition (VHN) day.
These MMUs have now been upgraded as
Hospital on Wheels with improved facilities
in the vehicle and addition of lab services.
The Hospital on wheels project has been
launched in all 385 blocks to provide basic
medical services at the door step of the
remote and far flung villages.

12.12 Provision of Second Medical

Officer in PHCs with Single Doctor: 213
PHCs in the State which were Panchayat
Union dispensaries and subsequently
converted into PHCs had only one Medical
Officer. To make them function effectively in
line with other PHCs, one more Medical
Officer has been placed in 163 PHCs in
2011-2012. The remaining 50 PHCs are
covered in the year 2012-2013. Rs.8.26
crore has been budgeted for this activity in
2013-2014.
 113

12.13 Integration of 402 Integrated

Counselling and Testing Centre (ICTC)
Established under TANSACS in Block
PHC: There are 797 ICTCs spread across
Government Medical College hospitals,
Government District head quarters
hospitals, Taluk head quarters hospitals,
Government PHCs, prisons, corporation and
municipal health posts, bus terminus,
railway stations and private hospitals
established by TANSACS (Tamil Nadu State
Aids Control Society) out of which 402 ICTC
units in the PHCs are funded by NRHM.
Rs.11.94 crore has been budgeted for this
activity in 2013-2014.

12.14 Provision of feeding and dietary

charges for Ante-natal mothers: AN
Mothers who stay for undergoing
investigation like ultrasound scan etc., in
the PHCs are being provided with food
during the Ante natal Clinics at the PHCs. To
maintain the extra facilities and to meet out
the increasing demands of the ante natal
mothers attending the PHC, the PHCs are
provided with extra amount based on the
number of deliveries conducted. This
Scheme is under implementation during
2012-2013 with the Budget provision of
Rs. 2.44 crore. This scheme has been
 114

budgeted at a cost of Rs.3.72 crore for

implementation during the year 2013-2014.

12.15 Observation of High Risk AN

Mothers: Pregnant mothers who have been
diagnosed as high risk pregnancy will be
admitted, in 30 bedded PHCs, well before
expected date of delivery, along with an
attender for round the clock monitoring of
maternal and foetal well being and timely
referral to appropriate higher facility, at a
total cost of Rs. 4.25 crore.

12.16 Placement of RMNCH counsellors:

172 Counsellors have been placed in 110
identified post partum centres to provide
counselling to mothers, on Reproductive,
Maternal, and Neonatal and Child Health
Care. The scheme will be continued by
further expanding it to 66 more institutions
in 2013-2014.

12.17 Provision of specialist services –

Obstetricians, Anaesthetists for
Emergency Obstetric Care (EmOC): The
lack of manpower in the FRUs has been
managed through hiring of Obstetricians
and Anaesthetists for family welfare and
emergency obstetric care services. The
Government/Private/Retired personnel are
 115

hired for the above services at PHCs and

District hospitals. Caesarean deliveries are
also conducted in PHCs by hiring private
gynaecologists under RCH. In 2013-2014,
an amount of Rs. 6.75 crore has been
budgeted to implement this scheme.

12.18 To hire super-specialists and

diagnostic services, an amount of
Rs.4 crore has been budgeted for the year
2013-2014. Government of India approved
short term training courses for 24 weeks in
Life Saving Anaesthesia (LSAS) and
Emergency Obstetrics Care for medical
officers of primary and secondary health
care centres. Tamil Nadu is the leader in
conducting these courses which are used to
meet this specialist gap. So far, 318
Doctors have been trained in LSAS and 52
Doctors have been trained in EmOC.

12.19 Maternal Anaemia Control

Programme: The prevention and control of
maternal anaemia is a serious concern for
the State. Treatment guidelines (protocols)
for implementation of moderate and severe
anaemia control programme have been
introduced during the year 2010-2011 to
tackle this problem. This includes
deworming for all pregnant women and use
 116

of injectable iron sucrose for cases of

moderate and persistent anaemia. An
amount of Rs.3.00 crore has been
budgeted in PIP 2013-2014 for the
continuation of management of maternal
anaemia using the protocol based
intervention.

12.20 Gestational Diabetes Control

Programme: All PHCs have been supplied
with Semi auto analysers. A scheme for
early detection of gestational diabetes using
the Glucose Challenge Test approach has
been functioning at the block PHC level
using the semi auto analyzers provided
under RCH. The scheme has been extended
to all PHCs using the services of trained
staff nurses, wherever lab technicians are
not available, at a total cost of Rs.16.14
crore.

12.21 Ensuring blood safety-

Conduction of Community Blood
Donation Camps, Establishment of
blood storage centres in all Upgraded
PHCs: Provision of safe blood at the level of
First Referral Units is a priority area for
reducing deaths due to post partum
haemorrhage which is a major cause of
maternal mortality. With the inputs of
 117

NRHM, 268 CHCs have been provided with

blood storage facilities in phased manner till
2012-2013 to enable them to function as
First Referral Unit’s. Blood donation camps
will continue to be conducted at the rate of
two per block. This will facilitate supply of
sufficient quantity of all blood types to these
blood storage centres. In the year
2013-2014 the budget of Rs.75.87 lakh has
been proposed for conduction of blood
donation camps and maintenance of blood
storage centres.

12.22 Maternal and Child Health (MCH)

Centres: 42 Community Health Centres
have been identified at the rate of one
centre per HUD to function as level II
Maternal and Child Health (MCH) centres
based on strategic location to offer higher
level Maternal and Child Care. These centres
are being developed as comprehensive MCH
centres to provide the RCH package of Ante
natal and post natal care, Emergency
Obstetric Care, Safe Abortion Services,
Sterilization Services, Adolescent Clinics,
Reproductive tract infections/ sexually
transmitted infectious disease management,
Poison Management services etc., will also
be provided at these centres. 31 health sub
centres in remote / difficult areas have been
 118

identified to provide Level - I MCH centres

with additional facilities.

Child Health

12.23 Comprehensive intervention to

reduce neonatal deaths in districts with
high IMR: With the support of NRHM, the
neonatal care and referral services in the
State have been strengthened by
establishing Neonatal Intensive Care Units
(NICU) in the districts in phased manner.64
Neonatal intensive care units (NICU) have
been operationalised. All the Medical College
Hospitals and the district head quarters
hospitals and 16 identified Sub District
Hospitals are providing NICU services. Nine
trained staff nurses, three paediatricians /
trained Medical Officers are provided to each
NICU/district and sub district hospitals to
ensure 24x7 care of the neonates in the
NICU. Priority has been given for
standardized civil work as well as provision
of inputs for housekeeping and security
services. An amount of Rs.22.15 crore has
been proposed in 2013-2014 for funding the
recurring expenditure.
 119

12.24 Essential new born care services

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

12.25 Comprehensive intervention to

reduce neonatal deaths in 15 blocks
with high IMR: A new strategy has been
drawn for enhancing child care services with
a focused attention for reduction of neonatal
deaths in blocks with high IMR. Paediatrician
 120

in each centre would be identified to

conduct weekly field visit / well baby clinics
in the PHCs in the Blocks with high IMR.
These clinics will provide an array of
diagnostic and preventive care services.
Anganwadi workers as Village Health
Volunteers will be providing follow up
support for high risk babies discharged from
NICU in the local setting for home based
new born care. The scheme is being
implemented as a convergence activity with
Integrated Child development Services
(ICDS). It is proposed to expand the
scheme in 20 more identified high IMR
blocks in the PIP 2013-2014.

12.26 Capacity building for Health Care

Providers in Prenatal screening to
detect foetal anomaly: Under this
scheme, Medical Officers of 256 Upgraded
PHCs from all districts are provided hands
on and online training of prenatal screening
to detect foetal abnormalities using
ultrasonography. This scheme is being
implemented in partnership with the
reputed private sector organizations who is
specialized in ultrasonography , through a
custom designed software for prenatal
screening of foetal abnormalities in first,
second and third trimester. Continuous audit
 121

of the images documented by trained

Medical Officers and refining their skills for a
minimum period of one year from the date
of commencement is being done through
these reputed organizations. Memorandum
of Agreement has been signed and training
for all districts has been completed. This
training programme is being extended to
another 232 centres (78 CEmONC centres
and 154 CHCs) for training two doctors/
centre at a cost of Rs.3.27 crore in
2013-2014.

12.27 Establishment of Early

Intervention Centres in two Districts
(Pilot Project): Cuddalore and
Thoothukudi districts have been selected on
pilot basis for establishing early intervention
Centres, in the allocated four Primary Health
Centres per district. The children (0-3
years) identified by active screening with
developmental delay / disability etc. will be
managed by appropriate Special Educator /
Therapist at the Early Intervention Centres.
These centres are being provided with
therapy equipments and manpower. The
NGO ‘Maduram Narayanan’ Centre has been
nominated by the Commissionerate of
Differently abled as a mentor for Exceptional
 122

Children and consultant for this project and

MoU has been signed.

12.28 Managing Children with

Malnutrition: Considering the high IMR
status for the past three years in the
districts of Dharmapuri and Perambalur
(State HMIS data), the establishment of one
Nutrition Rehabilitation centre (NRC) each at
the Medical College Hospital at Dharmapuri
district and District Head Quarters hospital
of Perambalur district for management of
children with severe malnutrition has been
approved in the last year plan. In the plan
for 2013-2014 it has been proposed to
continue the scheme at a cost of Rs.63 lakh.

12.29 Strengthening of Infant death

audit: The Infant death audit is being
conducted in two stages i.e. Verbal autopsy
at the district level and Institutional audit in
the Medical Institution where the death
occurred. Verbal autopsy is being conducted
by the Medical Officer in Rural and Urban
area within 15 days of occurrence of death.
District Infant Death Audit Committee under
the Chairmanship of district collector audits
selected infant death at district level and
take appropriate action to rectify the
defects. A facility level committee in all
SNCUs is investigating the events leading to
 123

Neonatal death as this constitutes the major

component of IMR.

Adolescent Health Programme

12.30 Control of Anaemia: Anaemia is a

major concern among adolescent girls as it
leads not only to developmental deficiencies
but also to increased maternal mortality.
Nearly 97% of adolescent girls in the state
are anaemic. One of the major focus of the
RCH programme is towards adolescent
anaemia control. The programme involves
distribution of one Iron and Folic Acid (IFA)
tablet a week to all adolescent girls, both in
school and out of school along with biannual
deworming. The IFA and deworming tablet
would be distributed through the school for
school going girls and through adolescent
link workers for non school going girls.
School going adolescent boys will be
included in the current year and the scheme
has been budgeted at a cost of Rs.22.51
crore.

12.31 Modified School Health

Programme: On a pilot basis Modified
School Health Programme was implemented
in six districts of Cuddalore, Dindigul,
Kancheepuram,Kanniyakumari, Thoothukudi
and Ramanathapuram during 2009-2010
 124

and four districts of Salem, Dharmapuri,

Tiruvannamalai and Tiruvarur during
2010-2011. The Modified School Health
Programme has been extended to the
remaining 20 districts. The Scheme will be
implemented in all the districts in the
coming academic year. 30,000 school
teachers and 600 health and education
department officials have been trained
under this programme during 2012-2013.
The implementation of the scheme for the
year 2013-2014 has been budgeted at a
cost of Rs.13.63 crore.

12.32 Urban Health Programme: In the

urban areas, especially in smaller urban
towns, major lacunae exist in providing
urban health services which is further
compounded by the ever growing urban
population. The National Rural Health
Mission seeks to provide effective health
care to these areas by establishing urban
primary health centre similar to that of rural
PHCs. It is proposed to provide uniform
basic infrastructure and staff for these
Urban Health Centres. With NRHM inputs
towards the cost towards the renovation
and repairs of Urban Health Centres, rent
for Urban Centres, drugs, equipment,
furniture’s, establishment of Urban Health
 125

Centres in 135 Municipalities has been

ordered. These centres have been brought
under the administrative control of the
Director of Public Health and Preventive
Medicine. It is proposed to cover 25 Town
Panchayats with Urban PHCs at a total cost
of Rs.23.96 crore in 2013-2014. Urban
health programme is also implemented
through 14 Medical colleges by adopting one
urban heath post from where the medical
colleges are getting large number of primary
cases for the minor ailments with the view
to reduce the case load. These Urban health
centres adopted have been provided with
necessary equipments and materials.

Tribal Health

12.33 Village Health Volunteers -

Accredited Social Health Activist (VHV-
ASHA) in 12 districts with tribal
population: Despite a number of
interventions by the State Government, the
vulnerable tribal community is still unable to
access basic health care. They continue to
face a number of social, cultural, and
economic constraints. To promote and
improve availability of basic health care
services to the tribal/ remote and difficult
areas, 2,650 VHV - ASHA have been
 126

selected and placed. The training of VHV in

seven modules has been completed in
collaboration with the NGO - SOCHARA and
two master trainers at the state level. An
amount of Rs.3.17 crore has been proposed
for performance based incentives to 2,650
VHV in the plan for 2013-2014.

12.34 Establishment of Birth waiting

room: Out of the 34 tribal PHCs, 17 foot hill
PHCs have been provided with Birth waiting
rooms. Antenatal mothers especially the
high risk cases are brought to these waiting
rooms well in time prior to the expected
date of delivery, to stay in a comfortable
atmosphere and have access to emergency
obstetric care. A scheme for providing diet
to the antenatal mothers and one of their
attenders in tribal areas for 1 week of stay
before the expected date of delivery is being
implemented at all tribal PHCs. An amount
of Rs.1.48 crore has been budgeted in the
Current year to continue the scheme.

12.35 Mobile Medical Unit (MMU) in

Tribal Areas: To reach the remotest
pockets, mobile medical services for
outreach services with 20 MMUs are being
provided in 10 districts through NGOs in
collaboration with Tamil Nadu Health
 127

System Project (TNHSP). In order to reach

those tribal areas which are inaccessible,
supply of new four wheel drive vehicles
suitably equipped as ambulances were
approved in 24 identified points in tribal /
hilly areas under NRHM. The amount
proposed for supporting this scheme for
outreach services in tribal villages is Rs.5.76
crore.

12.36 Tribal Counsellors in 10

Government Hospitals: Tribal Counsellors
have been appointed in 10 Government
Hospitals in the Tribal districts. These
persons function as health activists in the
institution and create awareness on health
and its determinants. They motivate the
community towards healthy living practices.
It is proposed to extend the initiative to
another 32 Institutions in 2013-2014. The
total budget proposed is Rs.26.50 lakh for
2013-2014.

12.37 Repairs, Renovations and

extension of AN wards, PN wards,
Labour room, Operation theatre etc. :
With surging institutional deliveries, there is
an urgent need to provide larger space in
the PHCs to accommodate expectant
mothers so that they stay in the health
 128

facility where they deliver for at least 48

hours post delivery. Hence under RCH,
essential civil works for the PHC buildings
which need repairs, renovation and
extension especially to provide facilities for
the additional delivery load are being
provided. It is proposed to take up
extension and renovations to labour rooms,
OTs, ante natal wards, post natal wards and
area extension to accommodate other
specialized MCH care service and other
works in the current year also at a cost of
Rs.21 crore.

Training and Human Resource

Development

12.38 Strengthening of Training

Centres: In Tamil Nadu, there are six
training centres under the Directorate of
Public Health and 10 rural health training
centres located in the PHCs where the ANM
trainees are trained. In view of the
increased need for both pre service and in-
service training as a result of RCH/ NRHM
initiatives, it is required to upgrade the
facilities available in these training centres.
The facilities in the training centres will be
upgraded along with provision of skill labs
for training and evaluation of field staff at
 129

cost of Rs.1.1 crores. 7 new ANM training

schools are proposed at a cost of Rs.18
crore.

Additionalities under National Rural

Health Mission (NRHM)

12.39 Placement of 4,200 Programmers

specific VHV-ASHAs (Village Health
Volunteers - Accredited Social Health
Activist) in non tribal areas: The State
has decided to position programmers
specific Village Health Volunteers in HBNBC,
Leprosy, malaria and blindness control.
Since these VHVs will be functioning in the
plain areas under the close supervision of
the VHNs, the guidelines for their job
functions and incentive schemes are being
redesigned based on the programme needs
which are relevant in these areas. The VHVs
will receive training and performance based
incentives for the programmes for which
they are selected. This scheme will be
continued in 2013-2014.

12.40 Patient Welfare Societies: Patient

Welfare Societies have been constituted in
all the 1,614 PHCs, 18 Medical College
Hospitals and their attached institution, 30
District Headquarters Hospitals and 231
 130

Taluk / Non-Taluk Hospitals. All the societies

are registered and functioning effectively.
These societies coordinate with health staff
for better functioning of the health
Institutions by providing patient amenities
and bridging service gaps which will
definitely facilitate achievement of the
objectives of NRHM. An amount of Rs.10
lakh per Medical College Hospital, Rs.5 lakh
per District Head Quarters Hospital, and
Rs.1 lakh per Medical College attached
Institutions and Taluk/Non-Taluk Hospital,
and Rs.1 lakh per Primary Health Centre, Rs
1 lakh per urban health centre per annum
under this scheme is given every year. An
amount of Rs.25.78 crore is proposed in the
PIP 2013-2014 towards this scheme.

12.41 Annual Maintenance Grant to

PHCs/HSCs/CHCs/DH/SDH/ Urban
PHCs /MCH and attached Institutions:
An Annual Maintenance Grant of Rs.1 lakh
each is allotted to MCH/DH/SDH/PHCs and
30 bedded PHCs and CHCs providing
BEmONC and referral services to ensure
quality services through functional physical
infrastructure. Similarly, an annual
maintenance grant of Rs.50,000 for
other PHCs and urban PHCs is allotted per
annum for provision of water, toilets, their
 131

use and their maintenance and other

activities which has resulted in the better
functioning of the health facilities. Annual
Maintenance Grant of Rs.10,000/- is also
provided per annum for the maintenance of
HSCs with own buildings. An amount of
Rs.20.39 crore has been proposed for this
core activity in the year 2013-2014.

12.42 Untied grants to Health Facilities:

Untied funds are given to all health facilities
to meet out unexpected, essential and
immediate expenses towards day to day
maintenance. Flexibility is also given to the
patient welfare societies for spending this
money based on actual requirement at the
field level. An amount of Rs.10,000/- is
allotted as untied grant for each Health Sub
Centre per annum. An amount of
Rs.25,000/- is allotted to each Primary
health centre and Urban primary health
centre per annum. An amount of Rs
Rs.50,000 per annum is allotted to taluk
and non-taluk hospitals and Rs.1 Lakh Per
annum to district head quarter hospitals.

12.43 Village Health Water Sanitation

and Nutrition Committee (VHWSNC):
The village is the basic unit for assessing
the health needs of the people and for
 132

developing village specific plans. Village

Health and sanitation Committees have
been formed in all the village panchayats in
Tamil Nadu, with representatives of the
Panchayat Raj Institutions, women’s groups
and other village level officials related to
health and determinants of health such as
water and sanitation. Similarly village health
and water sanitation committees have been
formed in town panchayats. Every
committee is entitled to an annual untied
grant of Rs.10,000/- which will be used for
improvement of the health and sanitation of
the village. The committee members have
already been given training regarding the
village health activities. The financial
allocation proposed for these committees
during 2013-2014 is Rs.15.07 crore.

12.44 Village Health and Nutrition Day

(VHN Day): The VHN day is conducted
once a month by each VHWSC in one of the
Anganwadi Centres in the Panchayat by
rotation. During this session, both the VHN
and the ICDS Anganwadi worker will offer
joint services. A clinical session including
Ante Natal Care will be conducted in the
forenoon by the VHN and IEC activities will
be conducted in the afternoon. The revised
strategy for conducting VHN day has
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provided the health system with ample

opportunities to interact with the ICDS
workers and disseminate/counsel/manage
the different substrata of the community
based on their varying health needs. The
expenditure will be met from the PHC/HSC
funds.

12.45 Infrastructure Upgradation in

PHCs /FRU: Public Health Infrastructure
plays a crucial role in undertaking curative
and preventive health care for the total
population of the State. In terms of physical
infrastructure, a network of sub-health
centres, PHCs, CHCs, taluk /non-taluk and
District Hospitals exist in the state. To
improve the overall health infrastructure,
several strengthening activities have been
initiated in the State under NRHM.
A detailed facility survey has been
conducted through Tamil Nadu Health
Systems Project for identification of
infrastructure gaps in the secondary
hospitals, especially in view of the
increasing patient load. Up-gradation of the
maternity and neonatal care services and
provision of support services to improve the
overall functioning of the institution have
been given priority. Provision of equipment
for the increased work load or replacement
of old and obsolete equipment including
 134

major repairs of essential equipment will be

taken up as a part of infrastructure
strengthening in selected FRUs and DME
institutions. Based on the facility survey, the
civil works required in FRUs have been
taken up in 2012-2013. To strengthen the
facilities with equipment, a cost of Rs. 14.72
crore for First Referral Units (FRUs) and Rs.
9.67 crore for tertiary care institutions was
budgeted in 2012-2013. The balance
amount of Rs.28.73 crore is budgeted in the
current year PIP.

12.46 As part of the district planning

process, it is evident that there is a
continuing need for infrastructure
upgradation in the PHCs due to increased
utilization of PHC services by the public. In
addition to facilities like additional wards,
labour rooms and theatres, another major
requirement is the construction of staff
nurse quarters to house the nurses
providing 24x7 care in the PHCs, It was
decided in 2011-2012 that PHCs will be
selected based on need and infrastructure
provided on a case to case basis on the
requirements submitted by the districts. The
amount proposed for continuing this scheme
in PIP 2013-2014 is Rs.21.00 crore.
 135

12.47 Quality Assurance Cell: A Quality

Assurance Cell with 4 wings-Maternal, Child
Health, Quality Management and MCTS has
been established in the State Health Society
to improve the Quality care services of PHCs
and closely monitor their services.

12.48 Mainstreaming of AYUSH:

Mainstreaming of AYUSH is also one of the
strategies envisaged under National Rural
Health Mission with an objective to improve
outreach and quality of health delivery in
rural areas. The use of AYUSH has
expanded and gained popularity with the
tremendous expansion. AYUSH is an
important component of primary health care
delivery in the State. 479 clinics have been
well established in PHCs across the state.
During 2009-10, the AYUSH services were
extended to another 300 PHCs and in 2010-
11 to 175 PHCs under NRHM due to the
growing demand, bringing the coverage to
more than 60% of the PHCs. The amount
proposed for the implementation of the
scheme in the current year is Rs.37.31 crore
which includes a drug budget of Rs.5.24
crore.
 136

EMRI (Emergency Management

Research Institute)

12.49 The Government has signed a MoU

with EMRI Hyderabad to provide integrated
Emergency Response Management Services
bringing together the departments of Health
and Family Welfare, Police and Fire
Prevention. Emergency Management service
is in operation from 15.09.2008 and an
Emergency Response Centre has been
established at the Government Kasturba
Gandhi Hospital for Women and Children,
Chennai. The scheme is being continued in
2013-2014.

Elderly Clinics

12.50 With the growing prevalence of non-

communicable diseases in the State along
with a perceptible increase of elderly in the
community, provision of Geriatric services at
the gross root level is the felt need of the
rural masses. Hence it is proposed to
establish Elderly Clinic at each block PHC of
the state and the activity is budgeted at a
cost of Rs.6.22 crore towards equipments
and running services of Physiotherapist.
 137

Dental Services in the Government

Institution

12.51 The Dental Units in rural area will

raise the level of dental health awareness
and combine prevention with curative
treatment among the rural population, with
their active participation, to achieve our
goal of “Caries – free children” under NRHM.
At present 208 PHCs and 22 Taluk/Non taluk
Hospitals are providing dental services for
three days in a week. This service has been
extended to another seven Taluk Hospitals
and 58 UG PHCs. It has been proposed to
extend the Dental Services to another 133
Upgraded PHCs at a cost of Rs.11.74 crore
during 2013-2014, thereby covering 399
PHCs in the State.
 138

Chapter 13

TAMIL NADU HEALTH SYSTEMS

PROJECT

13.1 Tamil Nadu Health Systems Project

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

(i) the state-wide expansion of the

Non-Communicable Disease (NCD)
 139

prevention and control activities

which were piloted in two districts in
the state of Tamil Nadu

(ii) the state-wide implementation of

the Hospital and Health
Management Information Systems
(HMS & HMIS) in health facilities
including tertiary care institutions;
and

(iii) the expansion of maternal and

neonatal health services to the
tertiary level.

13.2 The Project interventions are to

enhance the overall development impact
and effectiveness which is expected to serve
as a model for other states in India as they
attempt similar health interventions and
reforms. The outcome indicators were
designed to reflect two types of outcomes
expected as a result of additional financing.

(i) The consolidation of successful new

modalities to reform the provision of
Health Care Services and improve
health outcomes in Tamil Nadu.
 140

(ii) State-wide expansion of key services

and systems which can serve as models
for other states in India.

13.3 The Phase II of the project is being

implemented at a total additional financing
cost of Rs. 627.74 crore from October 2010
and is expected to close on 30th September
2013. The following are the components and
sub-components of the project;

Component 1: Increasing access to and

utilization of service. This component
supports-

i. Reducing Maternal/neonatal Mortality

by supporting the effective ongoing
operations of 80 Comprehensive
Emergency Obstetric and New born
Care (CEmONC) Centres the
construction and equipping of higher
maternity referral institutions at eight
medical colleges and the design and
provision of various IEC materials;
ii. Improving Tribal Health through
implementation of the Tribal
Development Plan in all identified tribal
areas in 12 districts in Tamil Nadu in
order to increase access to health care
among tribal populations and to
 141

strengthen existing primary and

secondary services in tribal areas
through public-private partnership; and
iii. Facilitating use of hospitals by the poor
and the disadvantaged through the
provision of effective patient counseling
services, the provision of ambulances
and mortuary vans, strengthening of
laboratories and financing
housekeeping services at selected
Project hospitals.

Component 2: Non-Communicable Disease

(NCD) Prevention and Control. This
component supports

i. Health Promotion activities for

preventing Non-Communicable diseases
through school-based, work place-
based and community-based health
promotion programs; and
ii. NCD Interventions throughout the state
of Tamil Nadu covering Prevention,
Screening, treatment, and follow-up for
cervical & Breast cancer and
cardiovascular diseases (Hypertension)
and Diabetes Mellitus through Clinic
based, Work-place based, School based
and Community based interventions.
In addition, the component would
 142

finance the salaries of female NCD staff

nurses contracted and placed at
primary, secondary and tertiary level
facilities, wide spread IEC activities and
supervision, monitoring and evaluation
of NCD interventions.

Component 3: Building Capacity for Health

System Oversight and Management. This
component supports -

i. Strengthening Monitoring and

Evaluation capacity of the Department
of Health and Family Welfare of Tamil
Nadu by establishing a computerized
Hospital Management System (HMS) in
the remaining 222 secondary level
hospitals in Tamil Nadu out of the total
270 hospitals as well as extending to
selected Medical Colleges (tertiary level
hospitals and their attached hospitals;
ii. Improving Quality of Care through
continuous monitoring of quality of
care, the provision, management and
training on rational use of drugs for
hospital and Primary Health
Centre(PHC) staff; and enhancing the
capacity for the hospital accreditation
process within the Department of
 143

Health and Family Welfare of Tamil

Nadu;
iii. Strengthening Health Care Waste
Management through extensive training
on Infection Control and Waste
Management to all health personnel at
primary, secondary and tertiary levels
of healthcare, and carrying out an
impact evaluation of the
implementation of the Environment
Management Plan;
iv. Capacity building for Strategy
Development and Implementation by
expansion of the Directorate of Medical
Services (annexe building), training of
doctors and TNHSP staff, supporting
the TNHSP Society by financing its
operating costs, and supporting the
establishment of a data resource
center.

Component 4: Improving Effectiveness and

Efficiency of Public Sector to Deliver
Essential Services. This component
supports -

i. Equipment rationalization and

strengthening of equipment and
pharmaceuticals management through
the procurement of essential equipment
 144

and strengthening pharmaceutical and

equipment procurement, logistics,
repair and maintenance system in the
Tamil Nadu Medical Services
Corporation (TNMSC); and
ii. Human Resource Planning and
Development by financing additional
contractual staff in project hospitals in
order to improve overall efficiency and
performance.

During the year 2013-2014, it is proposed

to undertake the following activities.

Improvement of Maternal and

Child Health

13.4 With a view to improve the maternal

and child health, the following activities
would be undertaken –

 Improvement of infrastructure to 24
hrs Comprehensive Emergency
Obstetric and Newborn Care centres
(CEmONC).
 Provision of equipment for operation
theatres and labour wards.
 Coordination meetings will be
conducted with referral units to
improve the referral system.
 145

 Follow-up of referred out cases.

 Conducting review of Maternal
Mortality through video conferences.
 Re-certification of CEmONC centres.
 Training of Doctors and Nurses on
labour ward practices.
 Fresh frozen plasma will be made
available in all CEmONC centres.
 To establish Maternal ICU in all
CEmONC centres.
 Untied fund of Rs.1.00 lakh per
hospital per annum will be provided to
each of the CEmONC hospitals for
incidental expenditure.

Non-communicable Diseases

13.5 Cardio Vascular Diseases

Prevention and Control Programme:
During the pilot programme conducted in
the districts of Virudhunagar and Sivagangai
for a period of 30 months during Phase I of
the project, more than 12 lakh persons have
been screened and of them 77,757 persons
have been found to be having hypertension
and are now getting regular treatment in
Government Hospitals. Due to this, they
have been prevented from getting serious
diseases like coronary artery disease,
 146

stroke, chronic renal failure etc. Emphasis is

being given for creating awareness in the
community on modifiable risk factors
leading to cardio vascular diseases. The
community is sensitized for life style
modification such as changes in food habits
such as reduction of oil and salt in the food,
to maintain optimum weight for the height,
to increase physical activity, encourage
walking and cycling, to stop smoking/ not to
initiate smoking and stress management.
This programme is being implemented as a
multi departmental activity involving
Education Department for school based
activities, Labour and Employment
Department for work place based activities,
Rural Development Department for
community based activities and Municipal
Administration Department for involving
municipal hospitals and urban population.
Currently the programme is being
implemented in 16 districts involving 973
Government institutions including Municipal
/Primary/ Secondary/Tertiary care medical
institutions. During the financial year
2012-2013, out of 29,80,835 patients
screened for hypertension 2,29,838
hypertension cases were identified and
brought under treatment protocol. These
patients will also be monitored during the
 147

follow-up for any complications due to

hypertension and will be treated
appropriately.

13.6 Prevention and Treatment of

Diabetes Mellitus: In all the above 16
districts the patients attending OP above the
age of 30 years are also screened for the
presence of Diabetes Mellitus. During
2012-2013, out of 13,33,534 patients
screened for Diabetes Mellitus 59,583 cases
have been identified and brought under the
treatment. These patients will also be
monitored during the follow-up for any
complications due to Diabetes Mellitus and
will be treated appropriately.

13.7 Prevention and Treatment of

Cancer Cervix: During the Pilot programme
which was implemented in Theni and
Thanjavur districts more than 4.70 lakh
women were screened, of them 20,000 were
found positive for Cancer Cervix, and
referred to higher institutions for
confirmation and further management.
Therefore this programme was extended to
entire Tamil Nadu. During 2012-2013 in the
1st phase the screening for Cancer cervix
was initiated in 16 districts among 973
institutions. Out of 4,35,886 patients
 148

screened for Cancer Cervix, 19,143 cases

were found positive and referred to higher
referral institutions for confirmation and
treatment. During the financial year
2013-2014, it is planned to implement this
programme in the remaining 16 districts.
All the women attending the Out Patient
Department who are of 30 years and above
are to be screened for cancer cervix.

13.8 Prevention and Treatment of

Breast Cancer: Under this programme all
the women in the age group of 30 years and
above attending Out Patient Department are
screened for Breast Cancer. Along with the
Screening and Treatment program for
Cervical Cancer, an early detection, and
treatment for Breast Cancer is also being
implemented in all districts of Tamil Nadu in
a phased manner. In this program all
women above the age of 30 years are
taught about self breast examination and
are subjected to clinical breast examination,
in all the Government health facilities. Those
women who are found to be having the
problem are subjected to further tests and
treatment are provided in the tertiary care
centres. During 2012-2013 in the 1st phase
the screening for Breast Cancer has been
initiated in 16 districts among 973 number
 149

of institutions. Out of 8,87,555 patients

screened for breast cancer 8,563 patients
were found positive and they were referred
to higher referral institutions for
confirmation and treatment. During the
year 2013-2014 this programme will be
implemented in the remaining 16 districts.

Health Management Information

System (HMIS)

13.9 Health Management Information

System provides information based support
for the implementation of cutting-edge
reforms by the Tamil Nadu Health Systems
Project. Apart from Primary Health Centers
and Secondary Care Hospitals, this project
is envisaged to cover all the Tertiary Care
Hospitals including the Medical Colleges and
Medical University. This is a combination of
Information Technology (IT) and Manage-
ment Systems, to deliver improved evidence
based health care to the public at large.
HMIS was started as Pilot project during the
year 2008 in five secondary care hospitals.
Because of the encouraging results the
project was extended to Phase-1 during the
year 2009 for thirty six hospitals in five
districts. Subsequently Phase-II activity
commenced during the year 2010 for two
 150

Hundred and Twenty Two hospitals.

Currently we are in the completing stage of
Phase II hospital implementation. Under
revised Phase III activities, HMS for 8 Govt.
Medical College hospitals (only OP work
flow) Management Information System
(MIS), College Management System (CMS)
and University automation for 17 medical
colleges, 47 institutions under the Medical
Education Directorate and Tamil Nadu
Dr.MGR Medical University have been
planned and SRS preparation is in progress.
The total budget allocated for the pilot,
phase –I, II and III is Rs.128.40 crore. As
on date, 265 out of 267 hospitals are
functioning with HMIS.

Provision of Modern Equipment to

Government Hospitals

13.10 Tamil Nadu Health Systems Project

has provided following modern equipments
for the efficient health care delivery to the
public -

 Digital X-ray units with PACS, have

been provided in 23 Government
District Head Quarters Hospitals, and
also in 7 Government Medical College
Hospitals, at a cost of Rs.31.60 crore.
 151

 Dialysis Machines with Reverse

Osmosis plant, have been provided in
16 Government District Head Quarters
Hospitals and also in 1 Government
Medical College Hospital, at a cost of
Rs.2.38 crore.
 Hepa Filter with AC system, have been
provided in 10 Government Secondary
Care Hospitals getting prepared for
Accreditation by NABH, at a cost of
Rs.83.61 lakh.
 Pulse Oximeter with Adult and
Pediatric probe has been provided in
119 Government Secondary Care
Hospitals, at a cost of Rs.97.44 lakh.
 Equipment for CEmONC services in
eight Government Medical College
Hospitals: Maternity blocks are being
constructed in eight Govt. Medical
College Hospitals and are nearing
completion. Anesthesia machines,
Ultrasonograms with color doppler,
Echocardiograms with color Doppler,
New Born Ventilators etc will be
provided to these Hospitals at a cost
of Rs.14.59 crore.
 Mammography Unit will be provided
for 30 Government District Head
Quarters hospitals at a cost of
Rs.6.40 crore.
 152

Setting up of Hospital Accreditation Cell

13.11 Twelve Government Hospitals are

being prepared to obtain certification under
National Accreditation Board for Hospitals
(NABH), a unit of the Quality Council of
India. Of them two hospitals have secured
NABH accreditation, and in another hospital
the final assessment was over and the result
is awaited. In the remaining nine hospitals
pre-final assessment is over and the
hospitals are being prepared for final
assessment. An Accreditation cell is set up
to facilitate accreditation of hospitals. The
cost involved in the above activity including
other quality of care improvement activities
is Rs.3.47 crore.

Poison Treatment Centres

13.12 Tamil Nadu Health Systems Project

has established Poison Treatment Centres in
66 Government Hospitals which save many
patients who are brought to the centres due
to snake bite and poisoning. During the
current year, 35,972 patients were admitted
and treated in these centres out of which
35,389 people got cured. These centres
play useful role in bringing down the death
rate due to poisoning.
 153

Emergency Ambulance Services

13.13 The 108 ambulance service is under

operation in Tamil Nadu through PPP mode
by signing an MOU with EMRI, Hyderabad.
At present 629 vehicles are in operation
with 6,34,364 beneficiaries. Apart from
providing emergency services inter facility
transfers between secondary care
institutions to tertiary care institution for
specialty care treatment, patients are being
transported through Advanced Life Support
(ALS) ambulances irrespective of distance.
These ambulances are fitted with life saving
equipments. To provide care during transit
trained staff nurses are posted. The staff
nurses will manage the case in consultation
with the physicians at Emergency Response
Center in transit. Also to save sick new born
babies who require specialty care at tertiary
care institutions, specially designed neo-
natal ambulances with equipment are under
operation in Chennai, Kancheepuram,
Cuddalore, Dharmapuri, Madurai and
Vellore. To provide continuous care during
transit, one trained staff nurse is posted in
this ambulance. During this financial year
Rs.69.64 crore is provided by Government
of Tamil Nadu to operationalise this
programme. It is planned to induct more
 154

vehicles into the system so as to make the

fleet strength to 714 including 29 neo natal
ambulances and 54 four wheel drive
vehicles for hilly and coastal areas to cover
all the uncovered areas.

Tribal Health Development

13.14 The Project has been operating 12

Mobile Out-reach health services in Tribal
areas through NGOs during the Phase I of
the Project. This programme is extended by
addition of eight more teams making a total
of 20 teams. During the current year
10,927 number of trips were made to the
tribal areas and 2,84,605 persons were
treated.
Tribal Counsellors

13.15 There are 42 Tribal Counsellors

employed in Government Hospitals and
Primary Health Centres in the tribal areas to
help the tribal people accessing these
institutions for treatment. During the
current year, 4,29,227 persons were
benefitted by this programme.

Mortuary Van Services

13.16 The Government is providing Free

Hearse (Mortuary) service in all the
 155

Government Medical Institutions to

transport the deceased from Government
Medical Institutions to their destination or
cremation ground. This programme is being
implemented in partnership with Indian Red
Cross Society, Tamil Nadu Branch on PPP
mode since 2011. At present 132 vehicles
are in operation in all the Government
Medical College Hospitals, District Head
quarters and some of the Taluk hospitals.
So far 45,827 number of bodies have been
transported to their hometown / cremation
ground within the state and adjacent states
also. Government has allotted Rs. 18.95
crore during this financial year. It is
planned to increase the fleet strength to 180
to cover all the Government Medical
institutions during 2013-2014.
 156

Chapter 14

TAMIL NADU MEDICAL SERVICES

CORPORATION

14.1 Tamil Nadu Medical Services

Corporation (TNMSC) established in 1994,
under the Companies Act, 1956 ensures the
availability of drugs and medical supplies to
all the Government Medical institutions and
Primary Health Centres. TNMSC’s role
encompasses procurement, storage,
distribution and quality control of drugs,
medicines, surgical and sutures. It draws
up a list of essential drugs, procures and
organizes their storage at different points
and distributes these to the health facilities.
TNMSC maintains drug warehouses
throughout the State. The health facilities
draw their requirements from the
warehouses through an indenting system on
a pre-determined schedule. Each facility is
given an annual fund allotment for indenting
drugs from the warehouse to avoid over
drawal of supplies and this is monitored
through a pass Book issued to each facility.
The system is, however, not rigid as the
facilities have the freedom to seek
additional allotment at times of emergency.
The entire operation of TNMSC is
 157

computerized and through the computer

network it monitors, on a daily basis, drug
flows and stocks at all its warehouses.

14.2 Over the years, TNMSC has built a

network of warehouses across the State
which has helped the State to minimize the
out of pocket expenses for the patients
visiting the government medical institutions.
TNMSC also plays a vital role in procuring
and maintaining high-end equipments
including CT/MRI Scan Centres at various
Government Hospitals and payment wards
at Rajiv Gandhi Government General
Hospital, Chennai and IOG, Chennai etc.
TNMSC has extended the ambit of its
operations to the medical facilities in Police,
Prisons, Juvenile Homes, Transport
Corporations, Veterinary Department and
Cooperative Institutions also. TNMSC also
established MRI centres in some of the
teaching hospitals and CT scan centres in
several Government Hospitals providing
diagnostic services on payment basis; the
charges being at a lower rate than the
private investor-owned centres. TNMSC is
the agency to procure equipment and
accessories to all the Health facilities in the
State and to manage maintenance system
for major equipments. The major activities
 158

include procurement, storage and

distribution of Drugs.

Procurement

14.3 Essential Drugs and Medicines,

specialty drugs and surgical and suture
items from reputed manufacturers are
procured through a transparent tender
process. In addition drugs and chemicals
for the Animal Husbandry Department are
procured by the TNMSC. The Warehouse-
wise requirement of drugs, placing of supply
orders and distribution of drugs is monitored
online by use of Information Technology.
TNMSC is an ISO 9001:2008 Certified
Organization. Under the scheme
‘Pudhuyugam”, procurement and supply of
Beltless napkins for implementation of
menstrual hygiene programme for
adolescent girls in rural areas is being done.
The Government has allotted Rs.55 crore for
the scheme under the Public Health head of
account.

Storage and Distribution

14.4 The Government medical institutions

are provided with pass books based on the
allotment made by the respective Head of
 159

Departments to enable the institutions to

draw their requirement of drugs and
medicines from the warehouses to which
they are attached. The Corporation
maintains six months’ physical stock in the
warehouses and two months’ stock in
pipeline for ensuring uninterrupted supply of
medicines to hospitals.

Quality Assurance

14.5 Quality Control is essential to ensure

the quality of drugs procured. To ensure the
quality of drugs the Quality Control Wing
draws samples from each batch of supply
and get them tested in empanelled
analytical laboratories, selected through
transparent tender system. Only the drugs
which pass quality tests are issued to
Hospitals. The quality control measures are
being upgraded to meet the new challenges
in the field to improve the quality.

Other Activities

14.6 Operation of CT and MRI Scanners

and Lithotripsy Machines: A network of
48 CT Scanners including one 128 slice CT
Scanner and 2 nos. of 64 slice CT scanners
have been established in 41 Centres in
 160

Government Hospitals. The Corporation is

collecting nominal user charges at the rate
of Rs.350/- per scan for in-patients and
Rs.500 per scan for out-patients with an
extra charge of Rs.200 for contrast scan.
The Corporation is also maintaining 10 MRI
Scanners and providing scanning facility
to the public at a nominal charge of
Rs.2,500 with an extra charge of
Rs.1,500/- for contrast scan. The
Corporation is also maintaining two
Lithotripsy machines, one each at Rajiv
Gandhi Government General Hospital,
Chennai and Government Rajaji Hospital,
Madurai. A nominal fee of Rs.5,000,
Rs.4,500 and Rs.4,000 is fixed for first,
second and third sitting respectively for
this treatment. TNMSC Limited has now
replaced the existing 10 numbers of CT
Scanners which are old and also the
work of installing eight more CT Scanners in
Taluk hospitals is in progress. MRI Scan
have been installed in the Medical College
Hospitals at Kilpauk, Chennai and
Villupuram and are functioning. The
installation of two more MRI Scanners at
Government Medical College Hospitals at
Dharmapuri and Chengalpattu are in
advanced stages.
 161

14.7 Providing logistic support to

payment wards: TNMSC is providing
logistic support to the pay wards at the
following hospitals and acts as Custodian of
Funds for these Centres.

i. The ISO 9001 certified Liver

Transplant Centre in Government
Stanley Hospital, Chennai.
ii. Maternity Pay ward in IOG, Egmore,
Chennai.
iii. Maternity Pay ward at Kasturba
Gandhi Hospital for Women and
Children, Chennai established.
iv. Pay wards at Rajiv Gandhi
Government General Hospital,
Chennai.
v. Master Health Checkup Centre at Rajiv
Gandhi Government General Hospital,
Chennai.

The proposal for handing over these to the

respective institutions is under consideration
of the Government.

14.8 Regional Diagnostic Centres: The

Corporation is also maintaining the Regional
Diagnostic Centres at seven Government
Headquarters Hospitals at Villupuram,
Virudhunagar, Tiruvannamalai, Tiruppur,
 162

Ramanathapuram, Namakkal and

Pudukkottai.

14.9 Construction of Warehouses:

TNMSC operates modern Drug Warehouses
at 25 convenient locations i.e. at the District
Headquarters of Tamil Nadu. Action is being
initiated to construct five more warehouses
at Perambalur, Krishnagiri, Namakkal,
Nagapattinam and Tiruppur.

14.10 Purchase and Supply of Medical

Equipment: Specialized and high
technology medical equipments, required for
all the Government Hospitals are procured
and supplied by TNMSC based on specific
Government Orders. Further, TNMSC is the
procurement agency for Tamil Nadu Health
Systems Project, aided by World Bank. The
World Bank is actively considering engaging
TNMSC as an authorized procurement
agency in respect of procurement of Drugs
and Medicines, Equipment for their projects
in other States.

14.11 Consultancy Services: TNMSC is

a well known brand name in Drug Logistics
and Warehousing for the whole country.
Many States in the country are emulating
the methodology followed by this
 163

Corporation. TNMSC has rendered

consultancy services for the Health and
Family Welfare Department, Government of
Andhra Pradesh and Rajasthan. For the
State of Madhya Pradesh, TNMSC has
rendered consultancy services for two years
for the procurement activities both for drugs
and mmedicines. The Government of
Chattisgarh is requesting to extend the
support as is being done for Government
of Madhya Pradesh by the TNMSC. The
Corporation has been receiving a number of
delegates from all over the country and
abroad to emulate and replicate the TNMSC
model. TNMSC is constantly striving to
improve the system and delivery.
 164

Chapter 15

TAMIL NADU STATE AIDS CONTROL

SOCIETY (TANSACS)

15.1 Tamil Nadu has been a front runner in

managing (Human Immuno Deficiency
Virus) HIV / (Acquired Immuno Deficiency
Syndrome) AIDS. State AIDS Project Cell
was started in January 1993. This cell was
converted as Tamil Nadu State AIDS Control
Society (TANSACS) during May 1994.
Initially the HIV/AIDS was rising and it
reached 1.13% in 2001. With active
co-ordination of Government health system
and various supporting units like NGOs and
CBOs, TANSACS has been able to reduce it
to 0.25%.

15.2 Since 2011, TANSACS is working to

achieve the aim of “Getting to Zero – No
new infection, No HIV/AIDS related death,
No HIV/AIDS related Stigma and
Discrimination”. TANSACS is funded by
National AIDS Control Organisation (NACO)
and the fund allocated for 2013-2014 is
Rs.75.28 crore.
 165

The basic components of TANSACS activities

are as follows:-

 Prevention of New Infections

 Care, Support and Treatment
 Strategic Information Management
System

Prevention of New Infections

15.3 A multipronged approach is used to

ensure that all sectors of population are
covered by access to services and necessary
information is provided to prevent HIV
infection. The following schemes are being
implemented to ensure prevention of new
infections.

ICTC (Integrated Counselling and

Testing Centres)
15.4 ICTC is the initial contact point for
HIV/AIDS related services. These centres
are located at Medical Colleges /
Government Hospitals / Primary Health
Centres. A novel approach of Private Public
Partnership (PPP) has also been started and
many private hospitals are now part of this
network. To cover the remote areas, 17
mobile ICTC Vans equipped with all relevant
facilities are being utilized in various
 166

districts. At present, there are 1,471 ICTCs

in the State, which provide counseling and
testing.

PPTCT (Prevention of Parent to Child

Transmission)

15.5 One of the major routes of HIV

transmission is through Parent-to-Child
transmission. This Programme aims to
provide prevention, care and treatment
intervention to all pregnant couples with a
package of services. HIV positive women
are given ARV prophylaxis /treatment to
reduce the transmission of HIV virus. The
new born baby is given ARV prophylaxis.
Intensive training has been given to the
concerned medical personnel to ensure that
this scheme is extended to all mothers.
The budgeted expenditure for 2013-2014
for ICTC is Rs.17.25 crore.

Sexually Transmitted Infection (STI)

Services

15.6 156 designated Sexually Transmitted

Infection (STI) / Reproductive Tract
Infection (RTI) clinics are functioning under
Tamil Nadu State AIDS Control Society
including Chennai Corporation AIDS
Preventive and Control Society (CAPACS).
 167

These clinics are branded as "SUGA VAZHVU

MAIYAM" (SURAKSHA- Well being clinics)
functioning in Government Medical Colleges,
Government Headquarters Hospitals &
Government Hospitals. Medical Officers,
Staff Nurse and Lab Technician from each
hospital are trained on STI/RTI treatment,
care and follow up and condom promotion &
partner treatment. They treat the STI cases
using syndromic case management
approach using colour coded drug kits.

Targeted Intervention

15.7 The targeted intervention is aimed at

bringing the behaviour change among
specific population groups whose risks of
contracting HIV infections is high. In the
State, the focus is on Female Sexual Worker
(FSW), Men having sex with Men (MSM),
(Intravenous Drug Use) IDU, Truckers and
Migrants. This programme is implemented
through the Non-Governmental
Organizations (NGOs) / Community Based
Organizations (CBOs). At present 92 NGOs
are functioning & approximately 75465 High
Risk Group (HRG) population is covered.
During the 2013-2014, Rs.14.38 crore has
been budgeted for these intervention
projects.
 168

Link Workers Scheme

15.8 This Scheme is implemented in 21

districts, predominantly in rural areas to
cover the high risk & vulnerable population.
For 2013-2014, Rs.5.68 crore are budgeted
for this scheme.

Condom Promotion

15.9 Condoms are the most effective means

for prevention of HIV infection among high
risk and general population. TANSACS
provides free condoms to people through
NGO’s, STI clinics, ICTC / ART Centres and
other outreach programmes. During
2012-2013, approximately Rs.4.77 crore of
condoms were distributed.

Blood Safety

15.10 It is essential to provide

adequate, safe & quality blood and blood
component supply to meet the need of
patients. In the State there are 274 blood
banks (85 Government, 9 Central
Government, and 180 Private). Apart from
these blood banks, there are 253 Blood
Storage Centres (Government 196 and
Private 57) where only the storage facilities
are available. To ensure safe blood,
 169

Voluntary Blood Donation is promoted and

94% of all collected blood comes from
Voluntary donors. To optimally utilize the
blood, the use of blood components is being
encouraged. There are 86 blood component
separation units in the State (15 in
Government sector, one Central
Government and 70 in Private sector).
During the year 2012-2013, 6,92,000 units
blood were collected in Tamil Nadu.

Information, Education and

Communication (IEC)

15.11 To prevent new HIV infections, it

is essential that awareness is created
among the general population and the high
risk group. IEC campaigns aimed at general
population are designed to educate the
public about the basic details related to
various aspects of HIV/AIDS. Among the
high risk groups, the awareness campaigns
aim for motivating them for behavior
change. Various formats of media and
various strategies are used to disseminate
messages to different audiences to create a
demand for using the health services & for
following safe practices like condom usage.
Mass media is used to provide general
messages to the whole population.
Television, Radio and Print media is used
 170

through Advertisements, Talk shows, Long

format programmes etc. Two Mobile IEC
vans are operated to take the HIV/AIDS
related messages to remote areas where
other channels may not have adequate
reach. These vans utilize Audio-visual aids,
pamphlets, posters etc. to provide
information. Red Ribbon Club is a major
strategy to cover a large number of youth in
the State. At present 2,387 Colleges have
Red Ribbon Clubs and they work on the
aspect of risk perception and behavior
change through behavior change
communication. Life Skill Education
Programme provides information related to
HIV/AIDS to the adolescent group. It has
been implemented in 10,006 Schools with
18,000 trained teachers and 20,012 Peer
Educators. (Two Peer Educators per school).
Other IEC activities include Static
advertising like hoardings, Bus Panel
brandings apart from organization of specific
events like Blood Donation Day and World
AIDS Day. A large number of Government
Departments are being given awareness
training to ensure that they are sensitized
about all the aspects of HIV/AIDS. For this
financial year 2013-2014, an amount of
Rs.10.20 crore is allocated for all IEC
activities.
 171

Care, Support & Treatment

15.12 With proper care & treatment, a

person with HIV can live a normal life.
Towards this, Government provides various
facilities to improve the quality of life of
people living with HIV/AIDS. The main
activities are as follows:-

Anti-Retro Viral Therapy (ART)

15.13 ART provides medicines to

inhibit the replication of HIV Virus and to
reduce the chances of other infection.
Proper ART regimen significantly improves
the quality of life of the person with HIV
infection. Free screening facilities for CD4
tests are provided at ART centres & all
eligible persons are provided free ART
drugs. Counselling Services are also
provided before and during the treatment.
At present there are 44 ART centres. Apart
from the main ART centres, there are 99
Link ART Centres which provide regular
medicines to PLHIV. 68,090 persons are
taking regular ART medicines through these
centres. Community Care centers are
short stay home supported by TANSACS
which provide treatment for minor
opportunistic infections on IP and OP basis,
Counselling, outreach for ART adherence
 172

and home based care for people living with

HIVs (PLHIVs). 29 Community Care Centres
(CCC) are currently functional in the State
which is run by NGO's and CBO's.

Strategic Information and Management

System (SIMS)

15.14 SIMS is a web based integrated

Monitoring and Evaluation Service where all
the units of TANSACS report through this
system. The data gathered is used for
monitoring & taking corrective efforts to
streamline the system. To monitor the
works of centres located in a district the
District AIDS Prevention and Control Unit
(DAPCU) functions as a nodal point in the
district. There are 29 DAPCUs in the 29 high
prevalence districts. Apart from the above
mentioned National Aids Control
Organisation (NACO) supported
programmes, there are some unique
initiatives being run in the State for
providing Care & Support to PLHIVs. Legal
Aid Clinics are run in 16 districts with the
help of District Free Legal Aid Authority to
provide Legal Counselling for their legal
issues. In cases where it is required, free
legal service is provided for taking legal
recourse to claim their rights. A separate
 173

Trust has been established for providing

assistance to Orphan and Vulnerable
Children (Tamil Nadu Trust for Children
affected by AIDS). This trust provides
nutritional, educational support to infected
and affected children. Under Farmers
Protection Scheme (Uzhavar Padukappu
Thittam), any member of farmer who is on
ART medicines with CD4 count below 350 is
provided a pension of Rs.1,000 per month.
As of 31st March 2013, 2,663 persons were
being given this pension.
 174

Chapter 16

TAMIL NADU STATE BLINDNESS

CONTROL SOCIETY (TNSBCS)

16.1 Blindness is a major problem

throughout India. National Programme for
Control of Blindness (NPCB) was launched in
the year 1976 as a 100% centrally
sponsored programme with the goal of
achieving a prevalence rate of blindness to
0.3% of population. The four pronged
strategy of the programme is:

 strengthening service delivery

 developing human resources for eye
care
 promoting outreach activities and
public awareness
 Developing institutional capacity

The implementation of the programme was

decentralized in 1994-1995 with formation
of District Blindness Control Society in each
district of the country. The Society has
taken various steps to create awareness
among the public regarding the need for the
Eye donation. On 01.04.1996, the Tamil
Nadu State Blindness Control Society was
formed as a separate entity, to give thrust
 175

to the goal by planning, execution and

monitoring at the District level. The Tamil
Nadu State Blindness Control Society is
functioning under the control of Mission
Director, State Health Society, National
Rural Health Mission, and Chennai with
effect from 01.04.2007. The Project Director
is the Secretary of the society for the
implementation of the scheme. Every
district in the state has one District
Blindness Control Society to govern the
activities of the National Programme for
Control of Blindness.

16.2 For effective implementation and

monitoring of the work at District level, a
District Blindness Control Society has been
formed in all the Districts. The District
Blindness Control Society conducts eye
camps with the help of Voluntary
Organisations and District Mobile
Ophthalmic Units, provides financial
assistance to Voluntary Organisations for
performing Cataract Operations, undertakes
propaganda activities under health
education programme in the District and
monitors the implementation of the
Blindness Control Programme in District
level as per the directions of Government of
India / State Government / State Blindness
 176

Control Society. District Blindness control

Societies are under the Chairmanship of the
District Collectors.

16.3 The cataract, being the major cause

for the avoidable blindness, was given
importance and various infrastructure
facilities like base eye wards, dark rooms
etc., have been built till 2002 and are now
in use. The State has been a pioneer in
tackling blindness, particularly arising from
cataract.

16.4 During the year 2012-2013, 6,17,581

persons have been done cataract surgery.

Government has taken the following

measures to increase the cataract surgeries
in Government Institutions:-

i. The District Blindness Control

Societies are permitted to hire private
Ophthalmic Surgeons to do cataract
surgeries in Government Institutions
and pay Rs.150 per cataract case
ii. The District Blindness Control Society
is permitted to hire private staff
nurses trained in the field of
ophthalmic surgery to assist cataract
surgeries in Government Institutions
and to pay Rs.50 per cataract case
 177

16.5 The following activities will be

carried out during 2013-2014:-

i. Performing cataract operations and fix

Intra Ocular Lens (IOL)
ii. Screening of school children for
detection of refractive error and
provide free spectacles to poor
children
iii. Collection of eyes for transplantation
in persons with corneal blindness
iv. Providing training to eye surgeons in
modern cataract surgery and other
specialised procedures
v. Enhancing capacities for eye care
services in public sector by providing
assistance to hospitals at various
levels
vi. Development of eye banks and eye
donation centres to facilitate collection
and processing of donated eyes. Eye
bank has been functioning at Regional
Institute of Ophthalmology and
Government Ophthalmic Hospital,
Chennai in co-ordination with Lions
International and also at Government
Medical College Hospitals at Salem,
Coimbatore and Vellore
 178

Chapter 17

REVISED NATIONAL TUBERCULOSIS

CONTROL PROGRAMME (RNTCP)

17.1 Revised National TB Control

Programme (RNTCP) is implemented in the
State, from the year 1999, in a phased
manner. The entire State has been covered
under RNTCP since 2002. The Revised
National TB Control Programme aims at
detecting maximum number of Tuberculosis
patients, especially the sputum positive
(infectious type) TB patients and curing
them by Direct Observation Treatment Short
course (DOTS) through DOT Centres.

At the State level, State Health Society -

RNTCP which was formed under the
Chairmanship of Secretary to Government
(Health) has been merged with the State
Health Society and the funding has been
brought under the National Rural Health
Mission. The Programme is implemented in
close coordination with the Directorate of
Public Health and Preventive Medicine.

In the State, there are 142 TB Units. One TB

Unit (TU) is formed for every five lakh
population. Each TB Unit is manned by one
 179

of the PHC Medical Officers in the Unit, who

is designated as Medical Officer (TB
Control). He is assisted by one (Senior
Treatment Supervisor (STS), and one Senior
TB Laboratory Supervisor (STLS). For Multi
drug resistant TB, four treatment centres
are functioning at Government Hospital at
Tambaram, Madurai, Vellore and
Coimbatore.

Designated Microscopy Centres (DMCs)

and Specialty Laboratories

17.2 There are 791 Designated Microscopy

Centres in the State. One Designated
Microscopy Centre (DMC) has been formed
for every one lakh population such that
there are at least five DMCs functioning in
each TB Unit. Each Microscopy Centre has
one Laboratory Technician and has been
provided with a Binocular Microscope.

Distribution of Tuberculosis Drugs

17.3 The required Anti - TB drugs are

supplied in Patient Wise Boxes (PWB) by the
Central TB Division, New Delhi directly to
the Government Medical Store Depot. From
Government Medical Store Depot, the Drugs
are transferred to the two State Drug Stores
 180

at Chennai and Tiruchirapalli. From these

State Drug Stores, the drugs are distributed
to the other districts. For the year
2012-2013 a sum of Rs.7.37 crore was
allotted to Tamil Nadu under RNTCP.

Government T.B. Sanatorium,

Tambaram, Chennai
17.4 This Sanatorium is attached to the
Government Stanley Medical College,
Chennai. There is a rehabilitation centre
called Amrith Nagar Colony attached to this
Sanatorium. This centre was established on
25.08.1948 on the following objectives.

i. To provide every individual member of

the colony with work according to his
capacity and to make room for fresh
cases in the Sanatorium by
transferring convalescent cases to the
Colony
ii. To admit members into the colony
who are non-infectious so that they
could live with their families
iii. To provide occupations like printing
and carpentry to begin with
iv. To pay remuneration to the members
for work done
v. To make arrangements for recreation
and periodical medical examination
 181

Amrith Nagar Colony occupies an area of

17.14 acres and situated about half a
kilometer away from the TB Sanatorium,
Tambaram. The centre is under the
supervisory control of the superintendent
Government T.B. Sanatorium, Tambaram
and advised by an advisory committee for
which he is the Secretary.
 182

Chapter 18

NATIONAL MENTAL HEALTH

PROGRAMME

Mental Health Care

18.1 The Institute of Mental Health,

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

18.2 Government of India has sanctioned a

onetime grant under National Mental Health
 183

Programme for strengthening of psychiatric

wings to the following Medical Institutions
under the control of the Directorate of
Medical Education:-

i. Madras Medical College, Chennai

ii. Government Kilpauk Medical College,
Chennai
iii. Government Stanley Medical College,
Chennai
iv. Chengalpattu Medical College,
Chengalpattu
v. Government Mohan Kumaramangalam
Medical College Hospital, Salem
vi. Thanjavur Medical College Hospital,
Thanjavur
vii. Mahatma Gandhi Memorial
Government Hospital, Tiruchirappalli
viii. Government Thoothukudi Medical
College Hospital, Thoothukudi
ix. Government Coimbatore Medical
College Hospital, Coimbatore
x. Government Kanniyakumari Medical
College Hospital, Nagercoil.
xi. Government Theni Medical College
Hospital, Theni.
xii. Government Rajaji Hospital, Madurai.
 184

District Mental Health Programme

18.3 The District Mental Health Programme

is a community based Programme based on
the guidelines of National Mental Health
Programme fully funded by the Government
of India. A sum of Rs. 2.01 crore was
allocated during 2012-2013. The aims of the
District Mental Health Programme which is
under implementation in the state are as
follows -

i. To create awareness regarding Mental

Health in the community.
ii. To integrate and implement Mental
Health Services through all the wings
of the Health Department,
iii. To facilitate the early detection and
treatment of the patient within the
community itself.
iv. To reduce the stigma attached
towards mental illness through change
attitude and public education.
v. To treat the rehabilitated mental
patients discharged from mental
hospital within the community.

18.4 The programme is under

implementation in the following 16 Districts
 185

of Tamil Nadu since the year indicated in

Table No.21.

Table No.21 - Districts implementing

the District Mental Health programme

Sl. Year of
Name of the Districts
No Implementation
1 Tiruchirapalli 1997

2 Madurai and Ramanathapuram 2001

3 Theni, Kanniyakumari, 2005-2006

Dharmapuri,
Erode and Nagapattinam
4 Tiruvallur, Kancheepuram, 2007-2008
Chennai, Cuddalore, Tiruvarur,
Namakkal, Perambalur and
Virudhunagar

18.5 Implementation of District Mental

Health Programme is proposed for the
following six more Districts –

i. Coimbatore
ii. Pudukkottai
iii. Sivagangai
iv. Thoothukudi
v. Villupuram
vi. Dindigul
 186

State Mental Health Authority (SMHA)

18.6 In 1994 the State Mental Health

Authority - Tamil Nadu (SMHA - TN) was
formed as a statutory body under section 4
of the Mental Health Act, 1987. It is
functioning under the superintendence,
direction and control of the State
Government. The Secretary to Government,
Health and Family Welfare Department is
the Chairman. Seven other official are its
members and three non-government
experts in the field of psychiatry are its
members. The authority is mandated with
the responsibility of developing regulating
and coordinating mental health services in
the State. The office of State Mental Health
Authority is functioning in the campus of
Institute of Mental Health, Chennai from
01.08.2012.

18.7 The Institute of Mental Health at

Chennai is the major Hospital under the
Government sector offering all mental
health related services. Further the
Departments of Psychiatry headed by a
senior Psychiatrist are functioning in all the
Government run Medical College hospital
taking care of teaching psychiatry to the
medical students and providing treatment to
 187

mentally ill patients. Apart from these

psychiatry units are being run in all the
District headquarters hospital in the State.
In so far as private sector is concerned
there are a number of Private Mental Health
Nursing Homes / Hospitals for which licence
is granted by the Director, Institute of
Mental Health.

18.8 The State Mental Health Authority

provides mental health related services
which include:-

i. Supervising the psychiatric

hospitals/ Nursing homes and
other Mental Health Services
Agencies
ii. Advise the State Government on
all matters relating to Mental
Health
iii. Advocate for integration of mental
health in general health care and
in all social Development sectors.

18.9 The SMHA is striving to enhance the

role of government in integrating mental
health hospitals/ units, private organisations
and the society at large thereby taking care
of the mentally ill patients. From the
societal point of view, State Mental Health
 188

Authority aims to increase the level of

awareness and acceptance of the people
towards the mentally ill patients and to
provide a platform for harnessing their
potential in order to mainstream them in the
society.
 189

Chapter 19

NATIONAL VECTOR BORNE DISEASES

CONTROL PROGRAMMES

Dengue

19.1 Dengue fever is a mosquito borne

virus disease. Dengue is reported in more
than 107 countries and from almost all the
states in India. Dengue is transmitted by
Aedes species of mosquitoes. Last year a
spurt in incidences of Dengue was seen in
Tamil Nadu and due to the swift action
taken by the Government, spread of the
disease was controlled. Government of India
has identified 31 Sentinel Surveillance
Hospitals including Medical College
Hospitals, Zonal Entomological Teams,
Institute of Vector Control and Zoonoses,
Hosur, King Institute of Preventive Medicine,
Guindy and District Headquarters Hospitals,
Cuddalore and Ramanathapuram for
diagnosis of Dengue and Chikungunya. This
facility has been extended to other Head
Quarters Hospitals also by the Government.
Elimination of vector breeding places, like
artificial containers are critical for control of
Aedes mosquito which spreads these
diseases. Last year up to December 2012,
 190

13,204 cases were recorded and 66 deaths

reported. Introduction of Indian medicines
such as Papaya juice extract, Nilavembu and
Malaivembu kudineer had a positive effect
on control of Dengue. The disease is now
under control and is under surveillance.

Malaria

19.2 Malaria remains an important public

health issue in few urban and rural areas
viz., Chennai, Ramanathapuram,
Thoothukudi, Dharmapuri, Krishnagiri,
Tiruvannamalai and Kanniyakumari
Districts. The total number of positive cases
recorded in the State last year (up to
December 2012) was 18,869 of which 37.8
percent were reported from rural areas,
while 62.2 percent from urban areas. This
disease also is now under control and is
under surveillance.

Japanese Encephalitis

19.3 Japanese Encephalitis (JE) is one of

the public health problems in the state.
Japanese Encephalitis Control Units at
Cuddalore, Villupuram, and Perambalur with
Monitoring Unit in Chennai are carrying out
Japanese Encephalitis Vector Control
 191

activities. Districts such as Perambalur,

Villupuram, Cuddalore, Tiruvannamalai,
Virudhunagar, Tiruchirapalli, Thanjavur,
Tiruvarur and Madurai report JE cases. JE
vaccination is being carried out in the above
said districts under routine immunization
and all children at the age of 18 months are
being immunized. JE vector monitoring is
being carried out regularly in the endemic
districts. Fogging operation is being carried
out in villages where suspected JE cases are
reported.

19.4 Acute Encephalitis Syndrome (AES)

Surveillance is being carried out in District
Head Quarters Hospitals, Medical College
Hospitals and major private hospitals.
Serum samples are taken from the AES
cases for diagnosis of JE. Lab diagnosis is
done in 7 Sentinel Surveillance Hospitals
which includes King Institute of Preventive
Medicine and six Medical College Hospitals.
When JE is confirmed by laboratory
diagnosis, necessary symptomatic treatment
is given to the patient in Medical College
Hospitals. During 2012, 954 AES cases with
72 deaths and 33 JE cases with 5 deaths
have been reported. In Tamil Nadu five
districts (viz.,) Villupuram, Madurai,
Thanjavur, Tiruvarur and Karur have been
 192

identified as the focus districts under the

control of JE/AES programme of
Government of India.

Acute Encephalitis Syndrome

19.5 Acute Encephalitis Syndrome (AES) is

a general description of the clinical
presentation of a disease characterized by
high fever and altered consciousness,
seizures, convulsions etc, mostly in children
below 15 years. Acute Encephalitis
Syndrome (AES) has a very complex
etiology, and JE virus is only one of the
many causative agents of encephalitis.
Hence AES surveillance is being conducted
to pick up all the JE cases.

Existing system of Surveillance

19.6 Cases with signs and symptoms of

Acute Encephalitis Syndrome are identified
in all Government District Head Quarters
Hospitals and Government Medical College
Hospitals to pick up the JE cases. Serum /
CSF is taken from the Acute Encephalitis
Syndrome cases and sent to the Sentinel
Surveillance Hospital for JE virus detection.
There are seven Sentinel Surveillance
Hospitals in Tamil Nadu where JE virus is
detected by ELISA IgM test kit supplied by
 193

National Institute of Virology (NIV), Pune.

Following are the list of Sentinel
Surveillance Hospitals

 King Institute of Preventive

Medicine, Guindy
 KAP Viswanatham Government
Medical College, Tiruchirapalli
 Government Villupuram Medical
College, Villupuram
 Government Thanjavur Medical
College, Thanjavur
 Government Madurai Medical
College, Madurai
 Government Tirunelveli Medical
College, Tirunelveli
 Government Coimbatore Medical
College, Coimbatore
The data for Acute Encephalitis Syndrome /
Japanese Encephalitis in Government
Hospital and Government Medical College
Hospitals are collected by the Deputy
Director of Health Services in the respective
District and submitted to the state level.

Case Management, Prevention and

Control measures
19.7 Case management for Acute
Encephalitis Syndrome / Japanese
 194

Encephalitis is done in all Government

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

Filaria

19.8 The National Filarial Control

Programme is under implementation in the
State from 1957. The filarial disease control
activities are carried out in 43 urban areas.
In these urban areas, 25 control Units and
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44 Night Clinics are functioning. Mass Drug

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

Chikungunya

19.9 Chikungunya is caused by mosquito

borne virus transmitted to humans by Aedes
mosquitoes. There is a decline in
Chikungunya cases due to the control
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measures taken by the Department. Up to

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

Vector borne diseases control and

epidemic control activities

19.11 Tamil Nadu is one of the top States

in most of the health indicators. The State
is also at the forefront in eliminating
communicable diseases.
 197

19.12 On this issue, Hon’ble Chief

Minister conducted a series of review
meetings and issued detailed instructions.
Accordingly, at the district level, the District
Collectors have been coordinating the
control measures by involving all the
departments. Some of the important actions
implemented based on the decisions of
review meetings conducted by the Hon’ble
Chief Minister were –

i. Release of short films and

advertisements educating the masses
of their role in preventing mosquito
breeding
ii. Increase in the number of Elisa Test
Centres from 31 to 60
iii. Making available adequate cell
counters, medicine, blood and blood
components
iv. Conduct of fever camps
v. Sending medical teams to the districts
that reported higher incidence of fever
vi. Organizing entomological surveillance
report based actions
vii. Putting in place 10 persons per block
under the Health Department, 20
persons per block through the Rural
Development Department and
 198

additional labourers in Town

Panchayats/Municipalities and
Corporations for identifying and
eradicating sources of breeding
viii. Providing adequate equipment for
vector control
ix. Providing traditional medicines and
promoting natural healing through
Indian Systems of Medicines

19.13 The District Collectors take

continuous action to conduct and review and
control of these diseases at the field level.
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Chapter 20

NATIONAL PROGRAMME FOR

PREVENTION AND CONTROL OF
CANCER, DIABETES AND CARDIO-
VASCULAR DISEASES

20.1 Most forms of cancer are curable when

detected and treated early. Besides Arignar
Anna Cancer Institute, Karapettai,
Kancheepuram, a Regional cancer centre
each at Madurai and Coimbatore have been
established to improve the treatment
facilities of increasing cancer patients of
Southern and Western regions of the State.
In the current year, it is proposed to
establish regional cancer centres at
Thanjavur and Tirunelveli Medical College
hospitals at a cost of Rs.30.00 crore. In
order to provide specialized and
comprehensive cancer care and to provide
training and research pertaining to all types
of cancer with focus on oral, cervical and
breast cancer, Government have identified
the following six institutions:

i. Government Arignar Anna Memorial

Cancer Institute, Kancheepuram
ii. Mahatma Gandhi Memorial
Government Hospital, Tiruchirapalli
 200

iii. Institute of Non communicable

Diseases and Government
Royapettah Hospital, Chennai
iv. Rajiv Gandhi Government General
Hospital, Chennai
v. Institute of Obstetrics and
Government Hospital for Women
and Children, Chennai
vi. Government Thanjavur Medical
College Hospital, Thanjavur

20.2 Under National Programme for control

of Cancer, Diabetes, Cardio-Vascular
Diseases and Stroke provision has been
made for purchase of certain modern
equipment for Treatment of Cancer. The
state is also creating more regional cancer
centres.
 201

Chapter 21

NATIONAL TOBACCO CONTROL

PROGRAMME

21.1 The National Tobacco Control

Programme is being implemented in Tamil
Nadu since 2003. The State Tobacco Control
Cell is functioning under the Director of
Public Health and Preventive Medicine since
2007. The District Tobacco Control Cell has
been formed in all the districts and functions
under the supervision of the Deputy Director
of Health Services. Under the National
Tobacco Control Program, two districts
namely Villupuram and Kancheepuram have
been selected as pilot districts for
implementation of the District Tobacco
Control Programme. Government of India
has provided financial assistance of
Rs.50.67 lakh. So far, 68,376 violators have
been fined for a total of Rs.77.46 lakh.

Smoke Free Chennai

21.2 The State Tobacco Control Cell has

been functioning under the “Smoke Free
Chennai” project under the support of
Bloomberg Global Initiatives. Four
enforcement vehicles are covering Chennai
 202

city and other suburban areas to create

awareness and enforcement of tobacco
control laws. Capacity building workshops
have been conducted for various
Government and Private sector people in
Chennai.
 203

Chapter 22

NATIONAL LEPROSY ERADICATION

PROGRAMME

22.1 National Leprosy Eradication

Programme (NLEP) was launched in
1954-1955 with the main thrust in detection
and regular treatment of all leprosy
patients. Multi Drug Therapy was launched
in 1983 in a phased manner and a complete
geographical coverage in the State was
achieved in 1991. The prevalence rate
118/10,000 population in the year 1983 was
brought down to 0.42/10000 population in
2012. The vertical programme had been
integrated with General Health Care System
during 1997. Out of 385 blocks, 50 blocks
are identified as High Endemic areas and
focused activities are carried out in these
blocks.
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Chapter 23

ACCIDENT AND TRAUMA CARE CENTRES

23.1 The Government has been taking a

number of initiatives to reduce the deaths
due to traffic accidents. In the multi
pronged approach, use of 108 ambulances
have reduced the reaction time to about 20
minutes thereby ensuring that the accident
victims are attended to. The Transport
department has also identified the hot spots
and has taken up a number of measures on
its part apart from education of the road
users. In order to develop a network of
Trauma Care Centres along with Golden
Quadrilateral of the National Highways and
to provide Trauma services for the accident
victims, the Government of India have
introduced a scheme. The Government of
India has released funds for development of
network of Accident and Trauma Care
Centre in the following institutions:

i. Government Vellore Medical

College Hospital, Vellore
ii. Government Kilpauk Medical
College Hospital, Chennai
iii. Government Rajaji Hospital,
Madurai
 205

iv. Government Tirunelveli Medical

College Hospital, Tirunelveli
v. Government Kanniyakumari
Medical College Hospital, Nagercoil
vi. Government Mohan Kumara-
mangalam Medical College
Hospital, Salem

Upgradation and Strengthening of

Trauma Care Centre

23.2 During the 11th Plan period

(2007-2012), the Government of India has
upgraded and Strengthened the Trauma
Care Centres in certain Government
Hospitals located along Golden
Quadrilateral, North-South, and East–West
corridors of National Highways. Under the
above scheme, the Government of India
have released a total amount of Rs.2.75
crore as grants-in-aid for construction of
building only for Trauma Care centre in
Government District Headquarters Hospitals
at Karur, Krishnagiri, Kovilpatti and
Dindigul.

23.3 Building work for Trauma Care Centre

at Government District Head Quarters
Hospitals Krishnagiri, Dindigul and Kovilpatti
have been completed and these Trauma
 206

Care Centres are now functioning. The

building work for Trauma Care Centre in
Government District Headquarters Hospital,
Karur is nearing Completion. These centres
are being equipped with necessary
infrastructure to ensure quality care.
 207

Chapter 24

CHIEF MINISTER’s COMPREHENSIVE

HEALTH INSURANCE SCHEME

24.1 In order to achieve the objective of

Universal Health Care to the People of Tamil
Nadu, the Government have issued orders
for implementation of a New Insurance
Scheme, the “Chief Minister’s
Comprehensive Health Insurance
Scheme”. Families with an income of
Rs.72,000 per annum or below are eligible
under the new scheme. The sum assured is
Rs.1/- lakh per year per family, along with a
provision to pay upto Rs.1.50 lakh per year
per family for certain specified 77
procedures; Rs.4 lakh coverage is also being
provided to each family in 4 years. The
new scheme covers 1016 procedures which
include 23 important diagnostic procedures
and 113 follow up procedures. So far,
Rs.1.07 crore smart cards have been
distributed in the districts.

24.2 For identifying the beneficiaries under

the scheme, new smart cards are being
generated by using the existing data base
and distributed to the beneficiaries.
Additional new enrollment is done through
 208

District kiosks established in the District

Collectorates. As on 31.3.2013, 817
hospitals have been empanelled to provide
treatment, including all the Government
Medical College Hospitals and the District
Head Quarters Hospitals. Till 31st March
2013, 2.96 lakh persons have benefited
under the scheme with the approved
amount being Rs.623.58 crore. Out of this,
1,04,953 beneficiaries have been treated in
Government Hospitals at an insurance
coverage of Rs.217.70 crore.

24.3 Surgeries such as Liver

Transplantation, Renal Transplantation
including post transplant procedure for
immunosuppressant therapy, Bone marrow
transplantation, Cochlear implantation and
stem cell transplantation cost more than
Rs.1.50 lakh and range from Rs.3 lakh to
Rs.22 lakh. It is not possible for the poor
patients to pay the extra cost for the
surgery. Hospitals approved under the
scheme cannot also be insisted upon to
perform the surgeries within the cost of
Rs.1.50 lakh. The Hon’ble Chief Minister
has, therefore, announced the creation of a
Corpus Fund of Rs.10.00 crore to help the
needy and poor people, especially children,
who have to undergo such costly surgeries.
The extra cost of the surgery exceeding the
 209

eligible amount Rs.1.50 lakh per annum is

to be met from this Corpus Fund. The
patient who needs to undergo the
specialized surgery need not pay any
amount from his / her personal sources.
The entire cost of specialized surgery will be
borne by the Insurance Company upto
Rs.1.50 lakh and the remaining amount will
be met from the Corpus Fund. All such
cases are cleared by an Expert Committee.

TAMIL NADU STATE ILLNESS SOCIETY

24.4 Government of India had requested

the State Governments to constitute a
‘Revolving Fund’ for extending financial
assistance to the poor with the contribution
received both from the Government of India
and State Government. Accordingly, the
Government of Tamil Nadu have constituted
a ‘Revolving Fund’ by name ‘Tamil Nadu
State Illness Assistance Society’ in the ratio
of 2:1 (Two shares by State Government
and one share by Government of India) with
an initial corpus of Rs.15 crore and have
also formed ‘Tamil Nadu State Illness
Assistance Society’ (Registered on
20.03.1998 under Tamil Nadu Societies
Registration Act 1975) to administer the
fund. The affairs of the Tamil Nadu State
Illness Assistance Society is administered by
 210

the Executive Committee under the

Chairmanship of the Secretary to
Government, Health and Family Welfare
Department and the Director of Medical and
Rural Health Services as the Member
Secretary. The objective of the scheme is to
render financial assistance from Rs.5,000 to
Rs.25,000 according to the nature of
surgery to Below Poverty Line people.
Through this society, there are two patterns
of assistance offered -

i. Revolving fund fixed to the 14

Government Medical College
Hospitals for performance of specified
surgeries by paying cost of
consumables, which works out to
Rs.2.90 crore per annum
ii. Revolving fund fixed to the 32
District Collectors for disbursement
of Financial Assistance of Rs.25,000
to the individuals / at accredited
private hospitals, after the
performance of specified surgeries /
treatment and after the issuance of
Government Order in each case and
this revolving fund works out to
Rs.3.95 crore per annum.
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Chapter 25

IMPORTANT ACTS

Pre-conception and Pre-Natal

Diagnostic (Prohibition of Sex
Selection) Act, 1994

25.1 The female sex ratio declines mainly

due to female foeticide, infanticide and
neglect of female child from birth. In order
to prevent Sex determination, the
Government of India has enacted the
Pre-Conception and Pre-Natal Diagnostic
Techniques (Prohibition of Sex Selection)
Act, 1994. The object of the Act is to
eradicate female foeticide and for
maintaining the high level juvenile sex ratio
(0-6 years) and male and female ratio.

25.2 For effective implementation of this

Act, the State, District and Sub-District level
Advisory Committees have already been
formed. At State level there is Multi Member
Appropriate Authority wherein the Director
of Medical and Rural Health Services is the
Chairperson, the other members are the
Secretary, Guild of Service, Chennai and
Deputy Secretary to Government, Law
Department. For the District Level, District
 212

Collector is the District Appropriate

Authority. For Sub–District Level, Revenue
Divisional Officer is the Sub-District
Appropriate Authority. Under the Act all
such organizations involving in the Pre-Natal
Diagnostic Techniques should register
themselves with the Appropriate Authorities.
Offences under the Act such as
non-registration and misusing the
equipments to disclose the sex of the foetus
are punishable as cognizable, non-bailable
and non-compoundable offences up to 3
years of imprisonment. The doctors who
are found indulging in malpractices are also
liable to lose their Registration for Medical
Practice. So far 4,978 scan centres have
been registered under the Act and cases
have been filed against 72 scan centres for
the violation of this Act. Judgment had
already been delivered in 62 cases and 10
cases are under trial. This Act is
implemented very strictly in the Taluks and
Districts where the juvenile sex ratio is
below the State level of 946 by maintaining
constant vigil over the scan centres and MTP
centres.
 213

TRANSPLANTATION OF HUMAN ORGAN

ACT, 1994

25.3 The Act has been enacted by the

Government of India during the year 1994
to eradicate human organ trade and to
promote Cadaver Organ Transplantation
programme.

The transplantations are being done only in

the approved hospitals in Tamil Nadu. The
Hospitals which are applying for registration
under the Transplantation of Human Organ
Act, 1994 are inspected by a team of
specialists and the senior member among
the team is the convener and co-coordinator
of the team. The team inspects the
hospitals and furnish the inspection report in
the prescribed format. The Director of
Medical and Rural Health Services is the
State Appropriate Authority for issuing the
Registration Certificate based on the
inspection report to the Government /
Private Hospitals. The Tamil Nadu
Government has constituted three
Authorization Committee region wise at
Chennai, Madurai and Coimbatore for
scrutiny of each and every non relative case
for approval of organ transplantation.
 214

25.4 Accordingly, the registered hospitals,

region wise submit their application for
organ transplantations to the respective
Authorization Committee. The donors and
the recipients have to appear before the
Committee. Each and every case of non
relative is verified and approved by
Committee for carrying out the
transplantations. In the State 72 hospitals
are registered under this Act for performing
renal, heart, liver, lungs and corneal
transplantations.

Cadaver Transplant Programme

25.5 In order to curtail human organ trade

and to save the lives of patients who are in
critical stages of disease by utilizing the
organs of brain death patients, the State
had initiated this programme during the
year 2008. Now, Tamil Nadu ranks top at
the national level in the implementation of
the Cadaver Transplant Programme. This
programme is supported by an Advisory
Committee that has been formed to
establish formats and procedures, to
oversee compliance with procedures, to
ensure stability of functioning of the
programme and to recommend a
coordinating body to institutionalize and
 215

streamline the programme. Currently 38

Hospitals are involved in this programme.
The Rajiv Gandhi Government General
Hospital, Chennai and the Stanley Hospital,
Chennai are actively involved in the
programme. Transplant hospitals in the
State have been divided into three zones
and organ donations from cadaver arising in
a zone are allocated first within that zone as
detailed below-

North Zone - Chennai and

neighbourhood, Vellore
South Zone - Tiruchirapalli, Madurai,
Tirunelveli, Nagercoil
West Zone - Coimbatore, Erode, Salem

Up to March 2013, there are 324 donors and

1820 organs were harvested out of which
959 were major organs (Heart, Lungs, Liver
and Kidneys).

Civil Registration system

25.6 Tamil Nadu has a long tradition of

registration of births and deaths. Prior to
the introduction of Registration of Births and
Deaths Act, 1969 by the Government of
India, registration of births and deaths in
 216

Tamil Nadu was carried out under the

provisions of Madras Panchayats Act 1899 in
Rural Areas, the Madras Districts
Municipalities Act, 1920 in the Municipalities
and selected Town Panachayats and the
Madras City Municipal Act 1919 in Chennai
Corporation. There are 16,046 Registration
Units in 32 Revenue Districts including
Chennai Urban District. The Registration of
Births and Deaths was made compulsory at
the place of occurrence.

With the introduction and implementation of

Tamil Nadu Registration of Birth and Death
Rules, 2000 with effect from 1.1.2000 in
accordance with the provisions of sec. 30 of
The Registration of Births and Deaths Act 18
of 1969. The registration of Birth and Death
should be done within 21 days of its
occurrence.

The Birth and Death Registration system

has been computerized in the entire rural
and urban areas of Tamil Nadu. In Chennai
Corporation, the Birth and Death Certificates
are issued online. Tamil Nadu has achieved
98% in birth registration and 91% in death
registration during 2010.
 217

Issue of Free Birth Certificates at PHCs

25.7 Since the implementation of Birth and

Death Registration at Primary Health Centre
level from 2009 August, 9,80,780 Free
Birth Certificates have been issued up to
February, 2013 to the beneficiaries in the
state.

Medical Certification of Cause of Deaths

(MCCD)

25.8 The MCCD scheme is a part of Civil

Registration System and is the only source
which provides cause specific mortality data.
The scheme was introduced in seven
selected Municipalities and Chennai
Corporation during 1969 and later it was
extended to all Municipalities and
Corporations from 1980. To improve Medical
Certification of Cause of Death, regular
trainings are given to doctors every year.
 218

Chapter 26

EDUCATION, TRAINING AND RESEARCH

The Tamil Nadu Dr. M.G.R. Medical

University

26.1 The details of the University and about

medical education have been given in
chapters two, three and eight. As mentioned
earlier, the Tamil Nadu Dr.M.G.R. Medical
University was started to promote academic
excellence, research and advancement of
knowledge in the field of Medical and Para
Medical Education. At present, 328
institutions, conducting various courses in
Medicine and allied sciences, are affiliated to
this University. The University Library
serves as a Regional Medical Library and
Medical informatics centre.

King Institute of Preventive Medicine

and Research

26.2 King Institute of Preventive Medicine

was established on 07.11.1899. Started as
a Depot for Small pox vaccine by the British
Government, it is named after Lieutenant
Colonel W.G.King, FMS, and the then
 219

Sanitary Commissioner to the Madras

Presidency. It is unique in its activities –
production of vaccine and sera, academic
activities, diagnostic work (bacterial & viral),
certification of schedule -C drugs. The
institute is under the administrative control
of Directorate of Medical Education since
1966. In the past, during epidemics in
Tamil Nadu, King Institute played an
important role by way of production and
supply of Anti Cholera and Anti Typhoid
Vaccines. It was originally designed to serve
as a Vaccine Lymph Depot of State. This
institute has been developed into a major
Public Health Laboratory in the country,
manufacturing human vaccines and sera
with allied Teaching and Research in the
field of Microbiology. The institute has
facility for identifying 23 different types of
viruses.

International Vaccination Centre

26.3 Functioning for the past 40 years, this

Centre is one among the 14 centres
recognized by the Ministry of Health,
Government of India. This centre mainly
deals with the inoculation of Yellow Fever
vaccine and issue of International
Vaccination Certificate to the public
 220

traveling to Yellow Fever endemic areas.

Haj Pilgrims are inoculated with
Meningococcal vaccine.

Training and Continuing Health

Education Programme under Public
health

26.4 Continuing education, in-service

training and pre-service training
programmes are organized for the health
officers, medical officers, nurses and other
paramedical staff through six regional
training centres namely Institute of Public
Health, Poonamallee, Health and Family
Welfare Training Centres at Egmore,
Madurai and Gandhigram, Health Manpower
Development Institutes at Villupuram and
Salem, Regional Institute of Public Health,
Thiruvarankulam and Institute of Vector
Control and Zoonoses, Hosur. The institute
of Public Health, Poonamallee is recognized
as a national collaborative training centre
for various programmes organized by the
Reproductive and Child Health Programme
and the National Rural Health Mission.

26.5 Multi skilling, task shifting training

programmes are organized for medical
officers in life saving anesthesia and
 221

obstetrics for a period of six months to

improve the availability of specialist services
in rural areas particularly in Primary Health
Centres. Ultra sonogram training is given to
PHC doctors for detection of congenital
deformities during pregnancy in
coordination with renowned private sector
ultra sound agencies. Skill Birth Attendant
training, training on integrated management
of newborn and childhood illnesses and
immunization training are organized for
improving the mother and child care
services in PHCs.

26.6 The Multi Purpose Health Worker

(Male) Training Course is conducted in
Medical Colleges and Regional Training
Centres. During 2011-2012 three hundred
candidates were trained and during
2012-2013, permission has been accorded
to train 600 candidates. The Auxiliary Nurse
Midwife (ANM) course is being conducted in
seven ANM training schools. Three new ANM
training schools at Theni, Namakkal and
Sivagangai districts are being established in
Tamil Nadu with assistance from the
Government of India. ANM training has
been started during the current year for
filling up of the existing vacancies of Village
Health Nurses and Auxiliary Nurse Midwives.
 222

E-Governance in Public Health

26.7 The Directorate of Public Health and

Preventive Medicine is actively implementing
the e-governance policy of the government.
All the PHCs are provided with computers
and internet connectivity. Web portals are
developed and used for data management
at various levels. The List of Web Portals
include Pregnancy and Infant Cohort
Monitoring and Evaluation (PICME),
Dr.Muthulakshmi Reddy Maternity Benefit
Scheme (MRMBS), National Anti-Malaria
Management Information System
(NAMMIS), Specialty Medical Camps, Health
Management Information System (HMIS),
Communicable and Non-Communicable
Diseases data, Civil Registration System
(CRS), National Rural Health Mission
(NRHM-MIS), Integrated Disease
Surveillance Project (IDSP) and Central Plan
Scheme Monitoring System (CPSMS).

26.8 In addition regular training is

organized for various levels under the
institutions under DME and DMS and DPH.
The Health Systems project and the
National Rural Health Mission also have
allocated funds for training.
 223

The department is taking continuous steps

as per saying ‘Health is Wealth’ and to
realize the objectives of the ‘Vision 2023’
released by the Hon’ble Chief Minister.

K.C.VEERAMANI
Minister for Health