The Dravidian model adopted by successive governments in Tamil Nadu has transformed public healthcare by expanding healthcare infrastructure not just at the tertiary level but at the neighbourhood and community levels, as well. Introduction of schemes reserving 50% seats in post-graduate and super speciality courses for in-service government doctors have resulted in skilled healthcare professionals working in primary health centres and health sub centres in rural areas.
The investment in creating a skilled force has been a boon for residents as the state has a doctor-patient ratio of 1:253, which is on par with Scandinavian countries and well above the WHO stipulated norms of 1:500. This has aided the steady rise in the availability of multi-specialty experts not only in cities like Chennai, Coimbatore and Madurai, but also tier-2 cities as early as in the 1990s.
Tamil Nadu ranks among the top three states in various vital health indicators and has been at the forefront of taking steps to tackle diseases by bringing healtcare to the people. Putting its words to action, the state government ensured that the Covid-19 vaccines were available to people in the state; rolled out Inniyur Kappom: Nammai Kaakum-48 Thittam to provide free medical care to road accident victims and in 2021 launched the Makkalai Thedi Maruthuvam scheme to tackle non-communicable diseases (NCDs) like diabetes mellitus, hypertension, cancer, cardiac diseases and others, to name a few.
Besides, during the 2024-25 budget presentation, Finance Minister Thangam Thennarasu said the government will implement a new cancer management mission that will focus on disease management strategies, including creating awareness, early detection, effective treatment and rehabilitative care. This year, `20,198 crore was allocated for the Health and Family Welfare Department, which is an 8.2% increase from the last budget.
Several multi-pronged approaches towards health and well-being of ante-natal mothers are being taken to avoid maternal deaths and audits are conducted at the district and state levels for continuous monitoring.
The state has already achieved the targets for IMR and MMR under the Sustainable Development Goals, which are due for 2030. Maternal and child health issues are being given renewed focus with death audits at community, institution and district and state levels so as to reach the standards of developed countries.
The state government also tweaked rules for disbursing financial assistance under the Dr. Muthulakshmi Reddy Maternity Benefit Scheme so that the state can release its share even if the centre delays it. Under the scheme, Rs 18,000 is disbursed to pregnant women in three instalments.
The MMR has reduced by 40% to 52 per one lakh live births during 2023-24 from 90 during 2021-2022. This was the first time the state reported a rise in MMR as at the peak of Covid-19, around 900 maternal deaths were recorded. During 2018-20, MMR in the state was 54, against the the national average of 97.
Also, keeping up with the times and understanding the importance of mental health, institutional screening for mental health disorders is being done by utilising the services of trained staff nurses in all the healthcare facilities in the state. Community-based screening for mental health disorders has been incorporated into the population-based screening programme for NCDs by women health volunteers/Accredited Social Health Activist (ASHAs) through an incentive model. Follow-up mental health counselling is also given to survivors of suicide bids at nearby PHCs.
Aid for accident victims
Every life matters and every minute matters to save a life, especially during the Golden Hour. The scheme ‘Inniyur Kappom: Nammai Kaakum-48 Thittam’ ensures the state will bear the cost of treating road accident victims in the first 48 hours after the incident, with a threshold of `2 lakh. The victims will be treated in empanelled hospitals and the victims can even be people from another state or country.
“The health department’s focus on trauma care services by introducing the Inniyur Kappom is a welcome move. Apart from this, counselling for doctors, staff nurses and others have been conducted transparently, which is a good thing. But, the manpower shortage is yet to be addressed,” said Dr J A Jayalal, secretary general of Commonwealth Medical Association and former national president of Indian Medical Association.
“With the available funds, the government is trying to run existing schemes and at the same time trying to maintain vital statistics like Maternal Mortality Rate and Infant Mortality Rate,” said Dr K Senthil, president, Tamil Nadu Government Doctors Association.
Dr G Ravindranath, general secretary, Doctors’ Association for Social Equality (DASE), said during the second wave of Covid-19, there was a shortage of medical oxygen and beds, but the present government handled it smoothly. “They also increased the pay of reproductive and child health sanitary workers in primary health centres from Rs 1,500 to Rs 18,000. The allowance for post graduate service doctors also increased. However, the jobs of contract workers need to be regularised,” he said.
Health is wealth
Schemes like Dr Muthulakshmi Reddy Maternity Benefit Scheme, Pregnancy and Infant Cohort Monitoring and Evaluation (PICME), Reproductive and Child Health (RCH) registration and others helped the state bring down the maternal mortality rate
The Civil Registration System has been linked with PICME. This linkage ensures 100% tracking of pregnant women irrespective of their place of residence
Dr Muthulakshmi Reddy Maternity Benefit Scheme was started in 2006 with financial assistance of Rs 6,000. In 2012, this amount was increased to Rs 12,000 and later increased to Rs 18,000
Makkalai Thedi Maruthuvam scheme aims to tackle non-communicable diseases like diabetes mellitus, hypertension, cancer, cardiac diseases and others at the doorstep
Under ‘Inniyur Kappom: Nammai Kaakum-48 Thittam’ the cost of treating road traffic accident victims will be borne by the state. The treatment will be free during the first 48 hours of the accident, with a threshold of Rs 2 lakh