Health Family Welfare 3

HEALTH AND FAMILY WELFARE DEPARTMENTDEMAND NO. 19 POLICY NOTE 2013-2014 THIRU K.C. VEERAMANI Minister for Health © GOVERNMENT OF TAMIL NADU 2013 POLICY NOTE ON HEALTH AND FAMILY WELFARE 2013-14 CONTENTS Sl No 1 2 3 4 5 6 7 Chapter Introduction Health Administration Medical Education Medical and Rural Health Services Public Health and Preventive Medicine Family Welfare Medical and Rural Health Services (Employees State Insurance Hospitals) 14 15 16 Page No 111 17 26 31 55 69 10 16 25 30 54 68 70 17 18 19 20 21 71 86 85 94 22 23 24 8 9 10 11 12 13 Indian Medicine and Homoeopathy Food Safety and Drugs Control Administration Tamil Nadu State Health Transport Department Medical Services Recruitment Board State Health Society Tamil Nadu Health Systems Project 95 - 102 103 - 104 25 105 - 137 138 - 155 26 Tamil Nadu Medical Services Corporation Tamil Nadu State AIDS Control Society Tamil Nadu State Blindness Control Society Revised National Tuberculosis Control Programme National Mental Health Programme National Vector Borne Diseases Control Programmes National Programme for Prevention and Control of Cancer, Diabetes and CardioVascular Diseases National Tobacco Control Programme National Leprosy Eradication Programme Accident And Trauma Care Centres Chief Minister’s Comprehensive Health Insurance Scheme Important Acts Education, Training and Research 156 - 163 164 - 173 174 - 177 178 - 181 182 - 188 189 - 198 199 - 200 201 - 202 203 204 - 206 207 - 210 211 - 217 218 - 223 Chapter 1 INTRODUCTION c‰wh‹ msΫ ÃâmsΫ fhyK« f‰wh‹ fU¢ braš. (FwŸ 949) The learned physician should ascertain the condition of his patient, the nature of his disease and the season of the year and then proceed with his treatment. 1.1 Government of Tamil Nadu is totally committed to building healthy people, not only by making available quality medicare facilities to everyone in the State, but also by providing medical facilities of the highest order, keeping pace with rapid technological developments in the field of medicine. Government of Tamil Nadu provides preventive and curative care to all through various Hospitals, Dispensaries, and Institutions. State Profile 1.2 Tamil Nadu is one of the best performing states and has consistently strived for ensuring that the citizens are provided with the best possible medical care. It is the seventh most populous State 2 in the country with a population of 7.21 crore as per 2011 census. The State has 32 districts. For the management of public health services, the State has been divided into 42 Health Unit Districts. Tamil Nadu is also one of the best performing States in terms of implementing Reproductive and Child Health schemes and has already achieved the National Rural Health Mission / Reproductive Child Health goals. The current Infant Mortality Rate of the State is 22 (Sample Registration System 2011), which is well below the national target of 30 per 1000 live births. Against the national target of 100 per lakh live births for the Maternal Mortality Ratio, the State had already achieved a Maternal Mortality Ratio of 97 as per Sample Registration System 2007-2009. Now, as per the State Health Management Information System data collected in 2011-2012, this has gone down further to 73 per lakh live births. The State has also achieved replacement level and the current Total Fertility Rate is 1.7 which is the lowest in the country. The Union Planning Commission and many independent review missions have commended the performance of the State. 1.3 These achievements in macro indicators have been backed by several pioneering In addition to consolidating the initiatives and the programmes which are already being successfully implemented. initiating maternal and child health initiatives like 24 hour services at Primary Health Centre (PHC). starting birth companion programme. achieving all targets in the national programmes are some among many such landmark initiatives being implemented by the State. Starting of Tamil Nadu Medical Services Corporation in 1994. With the vision and guidance of Hon’ble Chief Minister.Muthulakshmi Reddy Maternity Benefit Scheme with an increased financial assistance.3 initiatives. the state has also launched the menstrual hygiene programme. starting of one 30 bedded PHC in each block. universal immunisation programme. providing adequate blood banks. Currently the focus of the State is to provide equal attention to . creating facilities for night caesarean. opening neo natal stabilisation and intensive care units and upgrading capacity for comprehensive obstetric and neonatal care. the State has been implementing several landmark initiatives with a view to ensure Universal Health Care. maternal audits. the modified Chief Minister’s Comprehensive Insurance Scheme and is also implementing Dr. 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. In addition to the emerging challenges of Non Communicable diseases on one side. Susrushta and Charaka were the pioneers of Ayurveda. The origin of the modern Government Hospital has been traced back to 1644.4 public health and prevention of diseases.4 Our ancient Indian system of Medicine “Siddha” and “Ayurveda” are in practice for over thousands of years. History 1. It is believed that the first British Hospital was established in 1639 to treat the sick soldiers of the East India Company. Roots of modern medicine are linked to the advent of the Britishers. History tells us that there were well organized hospitals even during the days of Buddha and Ashoka. Siddha System of Medicine has been recorded to have been practiced by the eighteen Siddhars and that is why it is called “Siddhar Maruthuvam”. when it was started as a small hospital which has now grown into the . The State is also ensuring these quality facilities for treatment are easily accessible to the people. which was dealt by the Medical Services Department. 1. The Family Welfare scheme. 1.5 With the growth of the Medical Services. was separated and an independent Department of Family Welfare was formed in 1983. to look after the Family Welfare Scheme. That post was subsequently re-designated as Director of Medical Services (DMS) during 1960. 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 On the Public Health and Preventive Medicine side. Medical Services Department was bifurcated and the Department of Medical Education was formed in the year 1966.5 prestigious General Hospital attached to the Madras Medical College which itself was started in 1835. Similarly Department of Indian Medicine was established in the year 1976 and the Department of Drugs control in November 1981. the Civil Medical Service was separated and established under the management of a Head of the Department called as “Surgeon General with the Government”. . Public Health Act.6 prevention and control of communicable diseases. Lieutenant Colonel A.1. The State Health Transport Department.T. This is currently being reviewed and will be amended to reflect the latest felt needs of the Public Health Sector. the Primary Health Centres were separated from the Medical Services Department and brought under the Public Health Department.H.7 Medical and Health facilities in Tamil Nadu in the Government sector have grown rapidly and the current scenario is given in Table No. The Public Health and Preventive Medicine Department is functioning with 42 Health Unit Districts each unit under a Deputy Director of Health Services. 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.07. which was with the Public Health Department. During 1965.1981. Russell was the first Director of Public Health and Preventive Medicine in the Pre-independent era. Current Scenario 1. was separated and a Directorate of Health Transport was formed on 15. 10. Chennai . dispensaries and health posts run by municipalities and municipal corporations. 4. With the network of primary. 3.78) ESI Dispensaries Indian System of Medicine Hospitals Indian System of Medicine Dispensaries No.7 Table No.8 In addition to the above facilities and institutions. 6. 7. 1. AIDS Control Society. 9. Tamil Nadu has a number of maternity homes. Description Medical Colleges Medical College attached hospitals Dental College and Hospital District Headquarters Hospitals Sub District Hospitals Primary Health Centres (PHCs) Health Sub Centres (HSCs) Urban Primary Health Centres (UPHCs) ESI Hospitals (include the ESI Hospital.1 . 8. 12. . 18 43 1 30 237 1614 8706 135 8 195 4 1375 1. 11. No. 2. secondary and tertiary hospitals and a plethora of cross cutting programmes such as the National Rural Health Mission. Health Systems Project. 5.Medical and Health Facilities in Tamil Nadu in the Government Sector Sl. Health and Family Welfare Department 3610. Indian Medicine and other focused programmes and special initiatives. in crores) Plan Shared between Centre and State Total Plan and Non. 1.8 Maternal and Child Health initiatives.22 Non –Plan Demand Centrally Sponsored State Plan 19.9 The provision for Health and Family Welfare Department under Demand No.Plan * 6511.511.59 lakh have also been allotted under Charged head and the total allocation is Rs.34 637.54.00 * A sum of Rs.76 crore.19 for 2013-2014 is Rs.00 2901.22 crore as detailed below:(Rs.511.6. Total .6.22 2256.66 7. 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. 28 crores on the Capital Account. Note: Apart from the above provision.245.96 42. Rs.9 This includes Rs.65 1775.17.249.10 The Directorate wise allocation for 2013-2014 under Demand No. Health and Family Welfare Department Directorate of Medical and Rural Health Services Directorate of Medical Education Directorate of Public Health and Preventive Medicine Directorate of Family Welfare Tamil Nadu Food Safety and Drug Administration 7.915.31% of the total Revenue Expenditure of Rs.95 crores on the Revenue Account and Rs. 1.96 175.1.81 crores in the Tamil Nadu State Budget for the year 2013 -2014.6265. The provision on the Revenue Account works out to 5.93 789.19 Health and Family Welfare is as follows:(Rupees in crores) 1 2 3 4 5 6 Secretariat.39.85 crores has been allocated towards Civil Works being undertaken by Public Works Department under Demand No.99 .52 2189. 71 387.52 6511.10 7 8 9 10 Directorate of Indian Medicine and Homoeopathy Tamil Nadu State Health Transport Department Reproductive and Child Health Project Tamil Nadu Health Systems Project Total 169.22 Note: Provision towards ESI Scheme Hospitals for Rs.86 crore have been made in the Labour and Employment Demand No.13 26.32.86 945.219. . 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.11 Chapter 2 HEALTH ADMINISTRATION 2. National Mental Health Programme. . Universal Immunization Programme. and School Health Programme among others are implemented.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 Vector Borne Diseases Control Programme. These have been explained in detail in subsequent chapters. . there is also a Government order for constituting a Physiotherapists Council in the State.13 Councils 2. i. These are all the Statutory Bodies regulated by Government of India and Government of Tamil Nadu. nursing and paramedical professionals to regulate their practice in Tamil Nadu. Unani and Yoga & Naturopathy) Tamil Nadu Homeopathy Council vii. Tamil Nadu Medical Council Tamil Nadu Dental Council Tamil Nadu Nurses Council Tamil Nadu Pharmacy Council Tamil Nadu Siddha Medical Council (Siddha & Traditional practitioners) Board of Indian Medicine (Ayurveda. iii. Apart from this. iv. ii.3 The following councils are established through various acts to register the qualified medical. vi. v. details of which have already been given in Table No. and institutions. dispensaries. The state has a variety of categories of hospitals.1 in the first chapter. . 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.000 to the 1. It ranges from the grassroots level8.000 at the next level.14 Classification of Hospitals and Dispensaries 2.4 Government of Tamil Nadu provides preventive and curative care to all. State–Special Medical Institutions: All institutions intended to serve special sections of public such as ii. These are followed by secondary and tertiary care hospitals.706 Health Sub Centres catering to an average population of 5.614 PHCs catering to an average population of 30. The classification of hospitals and dispensaries in the state are as follows: i. through various hospitals. v. Private Non-Aided Medical Institutions: All hospitals. Conversion of the remaining rural medical institutions to Government medical institutions is under the active consideration of the Government. With the state taking over most of these facilities they are now very few in number especially in rural areas. State owned corporations / undertakings. iii. Employees State Insurance Medical Institutions etc. iv. Medical Institutions under the Local Bodies: These Medical Institutions are under the management of Municipal Corporations. dispensaries and clinics solely managed by private persons / establishments.15 Police. Municipalities and Panchayat Unions. . Private Aided Medical Institutions: Institutions supported / guaranteed by private contribution and receiving Government aid as well. R. 2.R.5 The Government of Tamil Nadu established this Medical University in the year 1987 by passing the Tamil Nadu Medical University Act. Medical University and the University is functioning from July. 1987 (Act No.6 Thus. medical research in addition to making an impact on the progress of Health Care. .16 Tamil Nadu Dr. This University is relentlessly working to fulfill a number of objectives including improving the standards in medical and para medical education. the Health Administration encompasses the entire gamut of services.G.G. curative.37/1987). research and development needs of the State are adequately taken care of. The name was later amended as the Tamil Nadu Dr. It is also getting constantly upgraded to keep pace with the demands posed by emerging diseases and migratory challenges. Medical University 2.M. facilities extended throughout the State and strives to ensure that both preventive.M. 1988. . which are the premier referral centres with state of the art equipment. The Directorate of Medical Education was formed in the year 1966 from the Directorate of Medical Services and is functioning as an independent Directorate. The department also has a role to play in the establishment and maintenance of well-equipped teaching institutions. It is managing the Medical Colleges and teaching hospitals attached to them. 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.17 Chapter 3 MEDICAL EDUCATION 3. 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. but also to address the health related challenges.1 The State needs well qualified manpower not only for manning the medical facilities at all levels. technology and research. Institute of Mental Health and Government Mental Hospital. Institute of Thoracic Medicine. Chennai Director.2 The Director of Medical Education is the head of the directorate.      Deans. Chennai Director. Government Medical Colleges and hospitals Director. Institute of Obstetrics and Gynecology and Government Hospital for Women. Chennai Director and Superintendent. Chennai Director and Superintendent. Institute of Social Obstetrics and Kasturba Gandhi Hospital for Women and Children. Chennai Director. Government Institute of Rehabilitation Medicine. These are manned by the Deans and Principals respectively. Regional Institute of    . All the Government medical colleges and attached institutions are part of this directorate. Chennai Director. Institute of Child Health and Hospital for Children.18 Administrative Structure 3. Tiruchirappalli Superintendent. Tambaram. one Government Dental College. King Institute of Preventive Medicine and Research. Otteri. Chennai Director. Government Physiotherapy College. Government Dental College and Hospital. Chennai Chief Medical Officers of Peripheral Hospitals attached to Teaching Hospitals Medical Officers of Dispensaries attached to Teaching Hospitals Principals of other colleges 3. four Nursing Colleges (B.Pharm).Sc. Government TB Hospital. two Physiotherapy Colleges.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. Chennai Superintendent. Guindy.3 Currently there are 18 Government Medical Colleges. Chennai Principal. Government TB Sanatorium. The total . two Pharmacy Colleges (B.19         Ophthalmology and Government Ophthalmic Hospital. Chennai Principal. B.188.Sc.B. B. 3. Nursing) B.Sc.S.Pharm Diploma in Nursing Diploma in Pharmacy Paramedical Courses (23 Courses) Number of seats 2145 100 200 90 30 20 50 120 2000 240 5732 3.S.Number of seats available in each course in Government sectorUnder graduate and Diploma courses Name of the Course M.2 shows the intake capacity of the Medical Institutions for Under Graduate and Post Graduate Courses.20 number of bed strength in these hospitals is 30.2 .B.900.3 shows the details of the specialties which are available in the .753 and the daily average Inpatients is 25. Radiotherapy Bachelor of Physiotherapy B.5 Table No.4 Table No. The daily average of out-patents is 71. Nursing Post Basic ( B.Sc. Radio Diagnosis B.D.Sc. Table No. 4 below. Table No. (Molecular Virology) Number of Specialties 23 15 8 16 4 5 1 1 1 Total intake Capacity 706 403 35 189 64 65 10 15 21 3. . Degree (Medical) P.3 .Sc. 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.Sc.Phil (Clinical Social Work) M.G.Number of Specialties and intake capacity under the Post Graduate (P. there are private self financing institutions affiliated to the Tamil Nadu Dr.Sc.G) courses Courses P. (Nursing) M. Medical University providing Medical and Para Medical Education in the State.Pharmacy M.G. (Medical Physics) M.6 In addition.R.21 colleges in Tamil Nadu for the students to do their post-graduation. Diploma(Medical) MDS ( Dental) Higher Specialties M.G.M. Nursing / Bachelor of Pharmacy (B.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.Seats surrendered by Private Self Financing Colleges for allotment by the Government Number of seats surrendered to Government 838 909 1124 639 5067 33 152 1062 College No. of Colleges 11 18 31 21 145 1 26 46 Number of seats 1460 1515 1950 1030 7880 50 1520 1630 Medical College Dental College Pharmacy College (B.Pharm) as well as Diploma courses in Nursing is done by a Selection . (Nursing) Admission to professional courses in Medicine 3.Sc) Occupational Therapy College (BOT) D.Sc.Pharm) Physiotherapy College (BPT) Nursing College (B.Pharm to B.Sc.22 Table No.Pharm (Lateral entry 10%) Post Basic B.4 . 23 Committee under a Single Window System following the rules of reservation in accordance with the policy of the Government. In addition to providing quality care in all conceivable specialties. Admission to Post Graduate Diploma. The hospitals also share their role in implementation of state wide . The State is taking all steps to ensure that there is no interference in its policy on Medical and Dental college admissions. 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. at Under Graduate and Post Graduate levels.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. 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. Services 3. the hospitals are backed by excellent diagnostic support and state of art equipments. Post Graduate Degree. TB Sanatorium are among the focus areas where the Directorate has separate institutions. Mental Health.24 programmes. Stem cell research. Ophthalmology. The medical colleges and the professionals attached to the specialties in each college and hospitals. Physiotherapy College. 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. 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. rare surgeries. Preventive Medicine and Research. These are in addition to all the specialties which are mandatorily provided for in a medical college hospital. Thoracic Medicine. Child Health. accessible tertiary cares are some of the important contributions made by these institutions. Rehabilitation Medicine. Dental Care. Obstetrics and Gynecology and Social Obstetrics. have competence in providing valuable inputs for treatment protocols for the diseases. . 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.9 The Multi Super Specialty Hospital being established by converting the new building in Omandurar Government Estate. .25 Multi Super Specialty Hospital 3. two T.26 Chapter 4 MEDICAL AND RURAL HEALTH SERVICES 4. 158 Taluk Hospitals. 4. seven Women and Children Hospitals. Hospitals / Sanatoriums’ which are under the control of this Department.B. 79 Non-Taluk Hospitals. Through the pursuit of various policies and programmes. 10 Mobile Medical Units.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 NonTeaching Medical Institutions. 19 Dispensaries. The Hospitals under the control of this department are Secondary care Hospitals. the department is aiming to translate the Alma Ata Declaration of Health for All in to reality.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.The Medical Services Department of the State has implemented a unique Medical monitoring system .Hospital Management Information System and . Tuberculosis. v. Child Health. iii. Ambulance Services.N. Providing extended medical speciality services like Medicine. Control and Blindness Control Programmes Tamil Nadu Illness Assistance Society Mental Health Programme . iv. Orthopaedics. Surgery. Obstetrics and Gynaecology. Leprosy. Psychiatry. T. Ophthalmology.B. Laboratory Services. Cardiology and Non Communicable Diseases (NCD) Accident and Emergency Services Family Welfare and Maternity Child Health Services and ii.T. Venereology. Comprehensive Emergency Obstetrics and Newborn Care Services(CEmONC) Dental. vi. Diabetology. Anaesthesiology. E.27 Hospital Management system and is also implementing the following medical programmes:i. 28 Administrative Structure Director of Medical and Rural Health Services Joint Director of Health Services District Head Quarters Hospitals. Mobile Medical Units. Deputy Director of Medical and Rural Health Services and Family Welfare Deputy Director of Medical Services (TB) Deputy Director of Medical Services. Taluk Hospitals. Family welfare programme in the District. The leprosy programme has since been integrated with the Department of Public Health and Preventive Medicine. . TB Hospitals / Clinics. Non Taluk Hospitals. Dispensaries. TB control programme in the District. Leprosy Hospitals. (Leprosy) Leprosy control programme. On an .  State Illness Assistance Society. The Directorate also looks after the implementation of the following programmes  District Mental Health Programme.The Director of Medical and Rural Health Services is also the State Appropriate Authority under the Transplantation of Human Organ Act.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. 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 inpatients and out-patients needing higher level of treatment and assistance. Services 4.29 4. 1994. It is the main link between primary health care and tertiary care.3 The Director of Medical and Rural Health Services is the Chairman of the Multiple Appropriate Authority for the implementation of Pre–Conception and PreNatal Diagnostic Techniques (Prohibition of Sex Selection) Act 1994. 30 average about 2 lakh outpatients and 18. 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.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. . Primary Health Centres and Health Sub-Centres . Financial Advisor and Chief Accounts Officer and Joint Directors Deputy Directors of Health Services Block Primary Health Centres.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. health education. mortality and disability in the State. by immunization.31 Chapter 5 PUBLIC HEALTH AND PREVENTIVE MEDICINE 5. Administrative Structure Director Additional Directors. control of communicable diseases. and monitoring of environmental hazards. application of sanitary measures. thereby reducing the burden of morbidity. Chennai and Coimbatore.Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS). 5. 5. Hosur. 1.3 This Directorate is responsible for civil registration and implementing major health programmes such as Reproductive and Child Health Programme. National Vector Borne Diseases Control Programme (NVBDCP). Institute of Vector Control and Zoonoses.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. National Immunisation Programme. Water Analysis Laboratories in the King Institute. Under this Directorate. Guindy. National Family Welfare Programme.706 Health Sub Centres (HSCs) are functioning besides 385 Hospital on Wheels. National Diarrhoeal Diseases Control Programme (NDDCP).614 Primary Health Centres (PHCs) and 8. National Rural Health Mission (NRHM) supported programmes. Dr. Integrated Disease Surveillance .32    Regional Health and Family welfare Training Institutes. Integrated Child Development Scheme. Establishment of level-I and II MCH centres and 24x7 Helpline are also being implemented. National Blindness Control Programme. and Telemedicine Services to remote areas. National AIDS Prevention / Control Programme. Rural Water Sanitation Schemes .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. Menstrual Hygiene Programme. School Health Programme. New initiatives Viz. Hospital on Wheels Programme. Establishment of Urban Primary Health Centres. Active support is provided by the PHCs for the implementation of Revised National Tuberculosis Control Programme.33 Programme (IDSP). 1939. Non-Communicable Diseases Control Programme (NCDCP). 1969. Cigarette and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce. 5. National Leprosy Elimination Programme.. 2003 and Registration of Births and Deaths Act. Supply and Distribution) Act. National Iodine Deficiency Disorders Control Programme and Tobacco Control Programme. Production. Infant Mortality Rate. Birth Rate. Infant Mortality Rate (IMR) 5.6 Children are the fountains of life..5 As brought out in the introductory chapter. due to the health facilities at primary. 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). Infant Mortality Rate is the key sensitive indicator of child health in a country. Ensuring the survival and healthy development of every child born is the key for the development of any nation. Consequently Tamil Nadu has emerged as a pioneering State in the country in providing public health care. control of communicable diseases and elimination of vaccine preventable diseases have significantly improved over the years. Maternal Mortality Ratio. The State ranks as the second lowest among the major states in the country. Community Development 5. . 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.34 and other Programmes. Total Fertility Rate. 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 24 47 Tamil Nadu India 93 114 59 80 51 68 49 66 44 64 43 60 41 58 37 58 37 57 35 55 31 53 28 50 Source: Sample Registration System (SRS) Bulletins 2011 22 44 36 Trends in IMR in Tamil Nadu UIP, 1985 127 121 113 110 104 91 CSSM, 1992 RCH, 1997 NRHM, 2005 130.0 115.0 100.0 85.0 70.0 55.0 40.0 25.0 10.0 -5.0 Rural 93 80 Combined 77 81 65 57 54 42 55 Urban 60 53 55 49 38 34 35 31 31 28 39 35 30 25 28 24 26 22 24 22 19 2011 1971 1976 1981 1986 1991 1996 2001 2007 2008 2009 2010 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     have helped in reducing IMR.39 In addition to these. 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. 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. health education to pregnant mothers on exclusive breast feeding. child care practices. monitoring of every pregnancy and infant through webbased Pregnancy and Infant Cohort Monitoring System. Maternal Mortality Ratio (MMR) 5. preventing child marriage (less than 18) and family planning. danger signs in sick newborns. National Rural Health Mission’s (NRHM) primary focus is to reduce MMR and prioritizing the resource allocation for the same. . complementary foods. Provision of free transport.9 Maternal mortality represents the most sensitive and key indicator of women’s health and status. 000 live births). Tamil Nadu reported 767 maternal deaths (amounting to an MMR of 73 per 100. . In 2011-2012. All efforts are being taken to reduce the MMR further with the multipronged approach to achieve the same.10 Tamil Nadu ranks second lowest in MMR among the major Indian states.40 5. Telephones for all PHCs to strengthen referral linkages. establishment of BEmONC centres. establishment of Blood Storage centres in PHCs.11 Detection. networking with all CEmONC centres. establishment of CEmONC centres. Hospital on Wheels in 385 Blocks for RCH outreach services. Cell phones for VHNs. EMRI 108 ambulance services. obstetrics. Birth companion scheme. admission of mothers with known high risk factors well in advance in CEmONC centres. Dr. establishment of 24x7 delivery centres in all PHCs. investigation and audit of every maternal death. tracking and transfer of mothers with high risks to higher facilities. multiskill training in anesthesia. identification of circumstances leading to the death and prevention of similar deaths in future. establishment of birth waiting homes in the foot hills. and ultra-sonogram to PHC medical officers. establishment of 42 MCH level-II centres. provision for hiring of the services of . Muthulakhsmi Reddy Maternity Benefit Scheme to eligible mothers.41 Steps taken for reduction of MMR 5. professional partners and community partners. establishment of urban PHCs. functioning of PHC Operation Theatres. It is proposed to further intensify these efforts. As already mentioned. . 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.614 Primary Health Centres functioning in Tamil Nadu.000 in hill areas. construction of buildings is under progress in respect of 79 Primary Health Centres.12 PHC Infrastructure: A primary health center is established for a population of about 30.512 PHCs are functioning in Government Buildings. 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. Primary Health Centres (PHCs) 5.42 obstetricians and anesthetists to provide emergency obstetric care. there are 1. While 1.000 in plain areas and 20. PHCs across the state conducted 2. Five doctors are posted to the upgraded PHCs.13 On an average 2. in a phased manner. 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. At present 341 .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. Upgradation of Primary Health Centres 5.43 Services 5. Semi Auto Analyzer. modern diagnostic equipments like Ultra Sonogram. Each Upgraded Primary Health Centre has an operation theatre. ECG.08 lakh deliveries per annum and deliveries in PHCs constitute an average of 13 per PHC / per month of all the institutional deliveries.250 inpatients per day.614 PHCs spread across the state in addition to about 3. 24x7 delivery care services with 3 Staff Nurses are provided in all the PHCs. X-ray and an ambulance vehicle.4 lakh outpatients get treated each day in the 1. Dental health care services in PHCs 5. The dental services have received good response from the public. ISO 9001 Certification 5.16 Dental health care services are provided in 266 PHCs to treat dental ailments. In each of the remaining 30 HUDs. 48 Primary Health Centres in 12 Health Unit Districts have been awarded ISO 9001 certificates. .44 upgraded Primary Health Centres are functioning in 310 blocks. The Government has planned to provide dental health care services in all the upgraded and block level PHCs in a phased manner. It is proposed to grade the PHCs based on quality parameters and performance indicators. one PHC has been identified for ISO certification. Each of these 30 PHCs have adopted 2 PHCs for quality improvement. These facilities will be extended to the uncovered blocks in the coming years.15 Government have been taking conscious steps to inculcate quality consciousness among the Government Medical institution to constantly improve quality of services. 706 HSCs in Tamil Nadu. Each centre is manned by a Village Health Nurse. Services and programmes 5. most of the cross cutting programmes are embedded in the public health side such as the Universal Immunisation.19 The Universal Immunization Programme was started in 1985 to protect .45 Health Sub Centres 5.18 Since the services and programmes in the PHCs are provided at the grass roots level. construction and renovation of HSC buildings are being done in a phased manner.17 A Health Sub Centre (HSC) is established for a population of 5. Universal Immunization Programme 5. and School Health Programme. Under the NRHM. It is proposed to increase the number of HSCs based on 2011 census. 2.20. Buildings for 139 HSCs are under construction at a total cost of Rs.196 HSCs are functioning in Rented/Rent free Buildings. While 6. There are 8.510 HSCs are functioning in Government Buildings. Vector Borne Diseases Control.000 in plain areas and 3.91 crores.000 in hilly areas. tuberculosis and measles. poliomyelitis. 2011. tetanus. In addition. About 11 lakh Children are getting benefit under this programme. Pulse Polio Immunization (PPI) 5. The newly added Hib will prevent life threatening pneumonia and meningitis.20 For the eradication of poliomyelitis. Tamil Nadu is one of the two states selected by the Government of India for introducing pentavalent vaccination. Pentavalent vaccine gives protection against diphtheria. 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. Pentavalent vaccine was introduced in Tamil Nadu from 21st December. 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 campaign was . Hepatitis-B and Haemophilus influenzae-B. tetanus.46 the children from vaccine preventable diseases like diphtheria. pertussis. 12 lakh pregnant mothers are immunized every year with Tetanus Toxoid injection for prevention of tetanus infection during delivery. pertussis. Special initiatives are being taken to cover the children living in temporary settlements and migrant population to protect the children from Vaccine Preventable Diseases.03.02. which along with efficient routine immunization coverage has successfully eliminated the dreaded disease from the State.2013.47 introduced in the year 1995-96. Japanese Encephalitis (JE) vaccination 5.12. Virudhunagar.2012 and 23. Perambalur.22 JE vaccination programme is being implemented in identified endemic districts namely Cuddalore. two rounds of pulse polio immunization campaigns have been conducted (on 20. Special polio rounds were conducted on 22. Tiruvarur. During 2013. Thanjavur and Tiruvannamalai to prevent Japanese . Villupuram. Focus on Migrant Children 5.01.2013 and 24.21 Immunizing the Migrant children is essential to protect these children from polio and also prevent importation of polio. Madurai.2013) as part of the nationwide PPI campaign in order to prevent the importation of Polio virus and to sustain the zero polio status. Tiruchirapalli. 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 643 were treated for one or other health problems and 32. The Water Analysis Laboratories at Chennai and Coimbatore collect and examine water samples from various protected water sources to monitor contamination of drinking water.669 referred to higher medical institutions for further treatment.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. 41.30 It is essential to monitor the quality of water throughout the state to keep a tab on water borne diseases. Two teachers from each school are identified and trained in identifying common illnesses of students for follow up action with the doctors. These . Control of Communicable Diseases 5. among the school students. They have been described in detail under the relevant programmes. During the last year. Water Analysis Laboratories 5.52 are scheduled as School Health Days. Students in need of higher medical treatment are referred to higher medical institutions and Saturdays are referral days.84. Establishment of District Public Health Laboratories 5. 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.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. One . In view of the emerging and re-emerging communicable diseases. epidemiological surveys and operational research. 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. Two more water analysis laboratories are being established in Tiruchirapalli and Tirunelveli. 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.31 Laboratory services are an essential component of disease surveillance. Apart from these. . 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.54 Microbiologist. 55 Chapter 6 FAMILY WELFARE 6. The National Family Welfare Programme is being implemented in the state since 1956. In view of commendable progress in reducing the birth rate. Tamil Nadu is considered as a pioneer in the implementation of the family welfare programmes in the country. The department implements family welfare programmes in coordination with various related departments. This has been achieved due to the strong social and political commitment and a robust . and is being implemented as a 100% centrally sponsored programme.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. 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. Administrative Structure Director    Deputy Director of Medical and Rural Health Services and Family Welfare (in the districts)  Post Partum Centres in Government Hospitals. . Tubectomy and Laparoscopic Sterilisation Providing temporary family welfare methods like Copper-T insertion.  Providing permanent family welfare methods like Vasectomy. Emergency contraception. Medical Termination of Pregnancy services are also available in government hospitals and approved private nursing homes. The National Family Welfare Programme is being implemented through the following programmes for the fathers and the mothers. Oral pill cycles and condoms for spacing between births.56 administrative setup. 6 below: Table No. No 1 2 Indicators Crude Birth Rate Crude Death Rate Current level 15.6 .Demographic scenario of Tamil Nadu – 2011 Sl. the population of Tamil Nadu is 7.57      Urban Family Welfare Centres Urban Health Posts Rural Family Welfare Centres(PHC) Approved Nursing Homes Voluntary Organisations.6 %. Demographic Indicators 6. As per 2011 census.2 As already mentioned in the introductory chapter of this policy note.4 / 1000 population . Tamil Nadu is the seventh most populous State in India. The demographic scenario of the state for 2011 (SRS) is furnished in Table No.9 / 1000 population 7.21 crores with decadal growth rate of 15. It accounts for 6 % of the country’s total population. 00.3 The Table No.7 .7 shows the demographic goals fixed to be achieved by 2017.6 .000 live births 0.000 Live Births 1.85 % * Based on the actual maternal deaths occurred in the State-2011 -12. No 1 2 3 4 Indicators Infant Mortality Rate Crude Birth Rate Maternal Mortality Ratio Total Fertility Rate Goals <13 / 1000 live Births 14 / 1000 Population 44/1. Goals 6.7 22 /1000 live births 73 /1. Table No.00.58 3 4 5 6 Total Fertility Rate (2010) Infant Mortality Rate Maternal Mortality Ratio * Natural Growth Rate 1.Demographic goals Sl. 59 5 6 Couple Protection Rate Reduction of Higher Order Births 65 percent <10 percent Thrust areas and Strategies for achieving the goal 6. The unmet needs under spacing methods are 4. 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 . Action will be taken to increase the male participation to 10% under Sterilisation Programme. the infant mortality rate was 22 per 1000 live births.e. As per SRS 2011.8 lakh births occurring in the State 9. In this background.4 Out of 10. 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.1 percent and permanent methods are 4. the following strategies will be adopted to achieve the goals proposed for the Twelfth Five Year Plan period. i.8%.6 % (2011) of the births are still Higher Order Births (HOB) i. one lakh. The male participation under the sterilization programme is less than 1%. level team to adopt different methods of contraception. At present 372 Operation theatres are functioning in the Primary Health Centres. iii. Steps will be taken to make the remaining Operation theatres in the Primary Health Centres functional in a phased manner. Mini-lap and No Scalpel Vasectomy. iv.60 ii. The unapproved private nursing homes which satisfy quality standards will be systematically approved to render Family Welfare services. The Self Help Groups. 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. Elected representatives and Non-Government sector will be involved along with the Government to provide better Family Welfare services to the eligible couples.930 private nursing homes have been involved besides the Government institutions to provide family welfare services in the State. These doctors will also be trained in Manual Vacuum Aspiration techniques to provide safe abortion . 1. 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.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. 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. Nearly 35% of sterilization operations done in the State are performed in these post-partum centres.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.61 services at the PHC level. Activities undertaken by the department 6. These Urban Family Welfare Centres have been classified into three . Natal and Postnatal period. At present. 6. 7 Urban Health Posts: A special programme of Urban Revamping Scheme to render outreach services has been launched and is in progress. The spacing methods like Intra uterine contraceptive device insertion. 372 primary Health Centres are functioning with Operation Theatres to provide Sterilization Services to the Rural People. . There are 382 Rural Family Welfare Centres in the State.62 types based on the size of the population it covers.706 Health Sub Centres.614 Primary Health Centres and 8. Oral pills and Condom distribution to the eligible couples in the rural areas are supplied through 1. 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. 193 Health Posts of type ‘D’ covering 50. Under this scheme.000 populations and above are functioning to provide Family Welfare & Maternal and Child Health services in the urban slum areas. They are rendering outreach services to the urban population. 6. Nearly 25% of the total sterilization operations done in the State are performed in Primary Health Centres. To improve the 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. approximately 60. 6.000 MVA performances.20 lakh will be allocated for organizing the camps.67.9 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. 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.63 6. . In the State.10 No Scalpel Vasectomy (NSV): To encourage the participation of male and to propagate the awareness on NSV technique.000 MTPs are performed in the Government and the private institutions annually which include nearly 15. the Doctors and Staff Nurses working in Government facilities are being given MVA training. Wall paintings. 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. 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”. Press Advertisements and Innovative activities like erection of Hoardings. System. 6.930 approved private Nursing Homes in the State are also extending the Family Welfare services and the contribution as a whole is 34. Conducting Seminars.11 Information.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 .6%. 6.64 6. Workshops and Self Help Groups.12 Participation of Non-Governmental Organizations: 27 Voluntary Organizations and 1. Electronic Display. Table No.50.000 Rs.000 Up to Rs. The benefits may be seen from the Table No.Group Insurance Scheme to Sterilization Acceptors Death following sterilization in hospital or within 7 days from the date of discharge from the hospital Death following sterilization within 8 to 30 days from the date of discharge from the hospital Failure of sterilization leading/non-leading to child birth Cost of treatment upto 60 days arising out of complication from the date of discharge Indemnity insurance per doctor per facility but not more than 4 cases per Doctor in a year Rs.65 welfare sterilization acceptors and service providers.2 lakh Rs.8.000 Actual cost not exceeding Rs.2 lakh per claim .8 .30. 25. As a new initiative.9. the interpersonal .Compensation to sterilization Acceptors Acceptors of male sterilization in public health facilities Acceptors of female sterilization belonging to Below poverty Line and SC / ST in public health facilities Acceptors of female sterilization belonging to Above poverty Line in public health facilities. 1.14 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. Rs.15 As per the 2011 Delivery Report. the Higher Order Birth (3rd and above order of birth) in the State is 9. 250 Interpersonal Counselling to Higher Order Birth Mothers in the selected Village Panchayat 6. Table No.66 6. 600 Rs.6%. It has been identified that the Higher Order Births are more than State average in 17 Districts.100 Rs.9 . . The scheme will be implemented at a cost of Rs.54 lakh will be allocated for these training. Coimbatore.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. Thanjavur.23. 12 batches of Laparoscopic Training will be conducted in each centre. Training in Laparoscopic Sterilization 6. Tirunelveli and Villupuram) have been identified as training centres for Laparoscopic Sterilisation. Dindigul.16 Eight Government Hospitals (Chennai.67 counselling will be organized in 202 Blocks and 30 Health posts where the Higher order Birth is more than 12.20 lakh. Tiruchirappalli.47. 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. During the year 2013-2014. Totally 100 Doctors will be trained and a sum of Rs.25 lakh will be incurred for this training.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 2013-2014.68 Training in Mini-Lap Tubectomy Sterilization 6. . 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.18. In all the regions. Coimbatore.69 Chapter 7 MEDICAL AND RURAL HEALTH SERVICES (Employees’ State Insurance Hospitals) 7. Administrative Structure Director of Medical and Rural Health Services (ESI) Joint Director Regional Administrative Medical Officers of Chennai. Central Medical Store is functioning to supply the Drugs and Dressing to the ESI Dispensaries. ESI Hospitals .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. Salem and Madurai Deputy Director Superintendent. 70 The details of the activities have been brought out in the Labour and Employment department policy note. . the Government issued instructions to all the Government Hospitals of Modern Medicine in the State to provide the traditional medicines of Pappaya Leaf Juice. 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.2 When there was an outbreak of Dengue fever last year.71 Chapter 8 INDIAN MEDICINE AND HOMEOPATHY 8.1 India has a long tradition of various systems of medicine. 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. 8. Even before the advent of the modern medicine. Malaivembu leaf juice and Nilavembu Kudineer to the . 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. Thanks to the Hon’ble Chief Minister’s directions. 72 in-patients admitted in the Government Hospitals across the State. Drugs Testing Laboratory(Indian Medicine)   . 8. Yoga & Naturopathy. Administrative Structure Commissioner/Director  Principals of Government Siddha.3 The Government formed the “Department of Indian Medicine and Homeopathy’’ in the year 1970. Homeopathy.. Unani. This Department functions as the nodal Department for the all round development of Indian Systems of Medicine and Homeopathy in the State. The Department is responsible for teaching as well as for providing health care in five systems of Indian medicine viz. Unani and Yoga and Naturopathy Medical Colleges State Licensing Authority (Indian Medicine) Government Analyst. Siddha. Ayurveda. There has been overwhelming response from the public on these initiatives. Ayurveda. and Homeopathy. Unani. Opening of ISM wings/Hospitals at various levels in all the districts Development of educational institutions in Siddha. Ayurveda. Ayurveda. ii. Govt. Chennai District Siddha Medical Officers Government Siddha.73   Superintendent. Yoga & Naturopathy and Homoeopathy Encouraging the cultivation of Medicinal Plants. Yoga and Naturopathy and Homeopathy Dispensaries attached to Government Hospitals/PHCs and Siddha wards in Government Hospitals Objectives of the Department 8. Unani. processing and manufacturing of ISM drugs and promoting research and development in ISM iii. . Arignar Anna Hospital of Indian System of Medicine.4 The Main objectives of the department are: i. v. vii.375 total of ISM institutions including the medical colleges in the State provide medical treatment under Indian Systems of Medicine and Homeopathy. viii. vi.74 iv. ix. Medical Treatment 8. 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 Opening of new Medical Colleges in these systems Encouraging research and development programmes in these systems of Medicines Making arrangements to grow medicinal herbs and manufacturing essential drugs Encouraging the growth of Centre of Excellence in the field of Indian medicine Improving the standard Medical Education in Private sector Currently the department has a sanctioned strength of 4.990 employees.5 There are 1. with . 75 an inpatient capacity of 1.047 100 65 107 56 1.6 The brief details of the various Hospitals/ Wings managed by this department are 350 bedded Hospital attached to Government Siddha Medical College. Palayamkottai. Table No. Tirunelveli 310 bedded Hospital attached to Arignar Anna Government Hospital of Indian Medicine.10 . Chennai 50 bedded Hospital attached to Government Homeopathic Medical College. Details of the institutions under Indian Medicine may be seen from the Table No. Tirumangalam. Vellore    .Institutions under ISM System Siddha Ayurvedha Unani Homoeopathy Yoga and Naturopathy Total Total 1.375 8.10.210 beds. Madurai District 25 bedded ward in Government Pentland Hospital. 76        25 bedded Siddha Wards in District Headquarters Hospitals in the Districts of Erode. Cuddalore District 15 bedded ward Siddha at Non-Taluk Hospital. Kumbakonam. Nagercoil and Mettur 15 Bedded ward Siddha at Taluk Hospital. Tiruchirappalli. Tiruvarur.7 Tamil Nadu is the only State in the country where Government Medical Colleges have been established in all the five . Sivagangai. Thoothukudi 16 bedded Siddha ward in District Headquarters Hospitals in the Districts of Namakkal. Villupuram. Nagapattinam. Medical Education 8. Nagercoil. Karur. Virudhunagar. Dindigul.Chidambaram. Kancheepuram and Tiruppur 15 bedded Siddha Ward in Medical College 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. 2 1 1 1 1 6 Private 5 3 -8 4 20 The Government Colleges are as follows Government Siddha Medical College. of colleges Govt. Palayamkottai. Anna Hospital Campus. 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.77 disciplines of Indian systems of Medicine. Arumbakkam  Government Homeopathy Medical College.Number of Government and Private Medical Colleges of ISM Sl. Tirunelveli District  Government Siddha Medical College. 1 2 3 4 5 Medical System Siddha Ayurveda Unani Homeopathy Yoga & Naturopathy Total No. Arumbakkam  Government Yoga & Naturopathy Medical College. No.11.11 . Madurai District . AAGHIM campus. Tirumangalam. Table No. 8 Indian Medicine and Homeopathy Department is conducting the following para-medical courses: i. 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. Tirunelveli. Diploma in Nursing Therapy 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). ii. Paramedical Human Resources 8. Kanniyakumari District. Palayamkottai. Nagercoil. In addition.78  Government Unani Medical College. Kottar. AAGHIM Campus.  Government Ayurveda Medical College. Number of seats available in the Government Colleges and the Private Colleges for the . a diploma course in Nursing Therapy is being conducted for all disciplines of Indian Medicine (except Homoeopathy). 12. 1. 2. 4. No.12 .79 admission to the Under Graduate (UG) and Post Graduate (PG) Courses of ISM are given in Table No. 5. PG-Post Graduate The number of seats sanctioned for Diploma Course in Integrated Pharmacy and for Nursing Therapy available are furnished in Table No.Number of seats available in the Government Colleges and the Private Colleges Details of Seats available for admission Government Private Colleges Colleges Total UG PG UG PG 150 50 50 20 26 296 94 ----94 200 160 400 200 -960 --24 --24 444 210 474 220 26 1374 Sl. . 3.13. Table No. Discipline Siddha Ayurveda Homoeopathy Yoga & Naturopathy Unani Total UG – Under Graduate . 80 Table No. Palayamkottai. No. 231 Taluk Hospitals and Non-Taluk Hospitals and 954 PHCs (including the 475 wings opened under NRHM).9 At present ISM facilities are available in 30 District Headquarters Hospitals. 50 50 100 100 100 200 Co-Location of ISM Wings in Government Health Facilities 8. Tirunelveli Total Total 100 2.10 NRHM has been separately covered in detail in the chapter 12 under the State . Name of the Institution Arignar Anna Government Hospital of Indian Medicine. 1. Chennai Government Siddha Medical College.13 . Additionalities under National Rural Health Mission 8.Number of seats sanctioned for Diploma Course in Integrated Pharmacy and for Nursing Therapy Number of seats Diploma Diploma in in Integrated Nursing Pharmacy Therapy 50 50 Sl. Some of the additionalities under NRHM under the Indian systems of Medicine are briefly described below – No. in crore) 15.19 0. of NRHM Wings in PHC Y & N .Schemes approved for the year 2012-2013 under NRHM Sl. Table No.57 Siddha .52 A total of four new schemes have been approved under NRHM for this Department at an out lay of Rs.14.17. The total fund allocation for ISM for the fiscal year 2012-2013 from the NRHM flexi-pool was Rs. No.275 Unani .34 . 1.81 Health Society.65 crore details of which can be seen in the Table No.40 Ayurveda .14 .2. 2.46 crore for the year 2012-2013. Scheme Details Hiring charges for the Human Resources engaged (on going Scheme) Information Education and Budget (Rs.51 Homoeo . 11. Ayurveda and Unani drugs.2007 as per Drugs and Cosmetics Act. licensing of Indian System of Medicine drugs was with the Department of Drugs Control. 1940 and Rules.25 17.11 Till 28-11-2007.00 5. inspection. 0. 1945. The District Siddha Medical Officers are the Drug Inspectors for the purpose of implementation of the provisions pertaining to renewal of license. 0. . and prosecution in respect of Siddha.65 State Drug Licensing Authority for Indian Medicine 8. 2500 per ISM unit for all 1360 units Training to all VHNs in Yoga and Naturopathy to impart yoga exercise to pregnant women for natural and safe delivery (New Scheme) Provision of Kit Medicine to pregnant mothers during antenatal and postnatal period (New Scheme) through 370 PHC in the first phase Networking the Commissionerate with District Siddha Medical Offices and the Colleges (New Scheme) Total 3. sampling. Now this is done by the State Licensing Authority (Indian Medicine) with effect from 29. 1.87 4.82 Communication activities (New Scheme) at Rs. Results of the test Total No of Samples tested 203 248 505 1.185 Standard Quality 141 175 330 878 Not of Standard Quality 62 73 175 307 Year 2009-2010 2010-2011 2011-2012 2012-2013 . The results of the test are given in Table No. It can be seen that over the years more samples are being lifted for testing.15.12 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 1940.15 . Table No.83 Standardisation of ISM Drugs and Strengthening of Drug Testing Laboratory 8. Advanced and modern equipment have been installed in the Laboratory for the purpose of standardization and quality control of the ISM medicines. tablets. 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. an effective Siddha Sastric medicine in preventing and treating viral .14 TAMPCOL was incorporated in the year 1983. capsules. etc. parparm. Chennai was inaugurated in the year of 2005 with the fund of State and Central Government. Tamil Nadu Medicinal Plant Farms & Herbal Medicine Corporation Ltd. 58 Siddha medicines. TAMPCOL is currently manufacturing 92 ISM Medicines viz. kudineer. 26 Ayurveda medicines and 8 Unani medicines like chooranam.84 National Institute of Siddha 8. thailam.. chenduram. The Institute is imparting quality Post Graduate education in Siddha apart from research activities. (TAMPCOL) 8. syrups. vennai. lehiyam.13 The National Institute of Siddha at Tambaram. Nilavembu Kudineer. 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. . The Corporation has been earning profit consistently.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. 1954. 9.2 At State level. Tamil Nadu Food Safety and Drug Administration Department was created in the State. Under the provisions of this act. 9.08. This act has come into force in the entire country from 05. As per this act. all Food Business .86 Chapter 9 FOOD SAFETY AND DRUGS CONTROL ADMINISTRATION Food Safety 9. 584 Food Safety officers have been appointed (385 for each block-rural area and 199 for Municipal areas). the Food Safety and Standards Act. Commissioner of Food Safety Office has been created as the Head office.2011. All 32 revenue districts have Designated Officers under the Act.1 To regulate all activities connected to production of food and food related industries.3 The field officers have the primary responsibility of ensuring safety of food and food related items in their areas of operation. 2006 was enacted by Government of India after repealing the Prevention of Food Adulteration Act. At the field level. Food Business Operators with less than Rs. They are located at Chennai (Guindy). 12 lakh annual turnover have to take license through the Designated Officers. . All six laboratories have been notified as per the act for testing the food related samples. there are six Food Analysis Laboratories in Tamil Nadu. 29. The time for taking license / registration has been extended till 4th February 2014 by the Food Safety and Standards Authority of India. Salem and Coimbatore.87 operators have to either take a license or get a registration depending on their annual turnover.889 Food Business Operators have registered themselves with the Food Safety Department. Tirunelveli (Palayamkottai).03. Thanjavur. Madurai.12 lakh annual turnover have to register themselves with concerned Food Safety Officers. 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.4 To test the quality of food. 9. Food Business Operators with greater than Rs. Till March 2013.129 Food Business Operators have taken the license and 2. 5 The Drugs Control Administration." Administrative Structure. under the overall administrative control of "Commissioner of Food Safety & Drug Administration. It is now functioning under the Tamil Nadu Food Safety and Drug Control Administration (TNFS & DA) Department.88 Drug control Administration 9.1981 with the Director of Drugs Control as its Head of Department.11. Drugs Control State Drugs Testing Laboratory Joint Director Deputy Directors . Commissioner of Food Safety and Drug Control Food Safety department Director. which was functioning as a separate Department with effect from 26. each headed by an Assistant Director of Drugs Control who is the Licensing Authority for the Grant / Renewal of Sale Licences in the zone.6 There are 14 Zonal Offices (5 in the City and 9 in the Moffusil areas) in the State. being a statutory body. with a Mobile Van.7 Drugs Control Department. Chennai. The Intelligence Wing.89 Zonal Assistant Directors Senior Drugs Inspectors / Drug Inspectors 9. performs a very important role in supporting healthcare service . There are three posts of Deputy Director of Drugs Control and one post of Joint Director of Drugs Control. 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. There is a Legal Adviser to handle legal issues. There are 15 Senior Drugs Inspectors and 146 Drug Inspectors in the department. 9. is under the charge of a Deputy Director of Drugs Control and three Drug Inspectors are part of the Intelligence Wing. As a statutory body for Drugs Control. selling drugs at excess pricing. distribution and sale of Drugs and Cosmetics. The Director of Drugs Control is the controlling authority and licensing authority for grant and renewal of licences for manufacture (for sale) of Allopathic.90 regulations and enhancing the safety of our community. The Drugs Control Administration has the prime mandate of enforcement the following enactments for regulating the manufacture. Drugs and Cosmetics Act. ii. Homeopathic medicines and Cosmetics and also the licensing authority for the blood Banks in the state along with the Central Licence Approving . misleading advertisements by some manufacturers and dealers. 1995 Drugs and Magic Remedies (Objectionable Advertisement) Act. 1940 and Rules. 1954 The officers of this department are also empowered to act under Narcotic Drugs and Psychotropic Substances Act. the department distinguishes the massive challenges posed by spurious /adulterated /sub standard quality drugs. iii. 1985. i. 1945 Drugs Prices Control Order. scrutinizing the misleading advertisements to safeguard the interests of the unwary people. purity and safety. to undertake the analysis.91 Authority. of Posts 1 1 3 . Table No.16 i. Manpower details of Drugs Control Administration Sl. three Deputy Directors of Drugs Control and one Assistant Director of Drugs Control (Administration) are assisting the Director of Drugs Control.16. Drugs Control Department monitors the quality. It draws samples of Drugs and Cosmetics for the purpose of test or analysis to ascertain its quality. one Joint Director of Drugs Control. It has a well equipped statutory laboratory. efficacy and rational use of drugs at controlled prices. safety. The total manpower available in the Directorate is detailed in Table No. No 1 2 3 Name of the Post Director of Drugs Control Joint Director of Drugs Control Deputy Director of Drugs Control No. For the implementation and the enforcement of Drugs and Cosmetics Act. collection and supply of safe blood and blood components. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Name of the Post Government Analyst Deputy Government Analyst Senior Analyst Junior Analyst Junior Administrative Officer Technician Grade-I Technician Grade-II Electrician Grade-I Plumber Laboratory Attendant Animal Attendant Ministerial Staff Office Assistant Sweeper Sweeper-cum-Watchman TOTAL No.92 4 5 6 7 8 9 10 11 12 13 Assistant Director of Drugs Control Assistant Director of Drugs Control (Administration) Senior Drugs Inspector Drugs Inspectors Legal Adviser Assistant Accounts Officer Ministerial Staff Office Assistant Driver Telephone Operator TOTAL 15 1 15 146 1 1 117 79 4 1 385 ii. of Posts 1 2 14 38 1 6 4 1 1 7 1 10 5 1 1 93 . Manpower details of Drugs Testing Laboratory Sl. 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. Drugs Testing Laboratory 9. private as well as in government sector.17. . drawn by the Drugs Inspectors (other than parenteral preparations) from various retail. manufacturing units and hospitals. The details can be seen from Table No.9 Drugs Testing Laboratory attached to this Department undertakes testing of samples. wholesale Units. Prosecutions Sanctioned 9. the Legal-cum-Intelligence Wing processes legal matters and undertakes special investigations. 1940 and other acts in 301 cases.93 Functioning of Mobile Squad and Legal cum Intelligence Wing 9.10 Prosecutions have been sanctioned for certain contraventions under Drugs and Cosmetics Act. 17 .11 During 2012-2013. 1945 Contraventions under DMR (OA Act) 1954 Drugs Price Control Order.Prosecutions for certain contraventions under Drugs and Cosmetics Act. 1940 and other Acts Sl.94 Table No. . of cases 9 38 229 24 1 Action Taken for Violation under Drugs and Cosmetics Act and Rules 9. No 1 2 3 4 5 Details Spurious/Adulterated drugs for having manufactured and sold Not of standard Quality drugs (manufactured and sold) Other Contraventions under Drugs and Cosmetics Act. 1940 and Rules. 1995 No. action was initiated against 17 companies under the Drugs and Cosmetics Act / Rules. the above organization was made as a separate department for the effective maintenance of Health and Family Welfare Department vehicles. this Department was converted as Tamil Nadu State Police Transport Workshop to maintain the Police Department vehicles. during the year 1981.95 Chapter 10 TAMIL NADU STATE HEALTH TRANSPORT DEPARTMENT 10. 15 Mobile Maintenance Units started functioning under State Health Transport Organisation. From the year 1973. Later.1997 and is till date functioning successfully to attend to all the . Subsequently due to the persistent demand of the Medical Officers.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 1995.1. 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. During the year 1971. this Department was again revived and restored back to its original form from 1. 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. Health and Family Welfare 10.96 needs of vehicles. getting Tax free . 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. Diploma and ITI Certificate Holders Supply of Batteries and tyres to the Health and Family Welfare Department Vehicles Administrative Structure Director a. 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. c. Tamil Nadu Departmental Vehicle Control rules to Medical Officers and other staff at various Health Training Centres Impart Apprenticeship Training to Degree. Transfer of Ownership etc. Regional Workshops (7) District Headquarters Workshops (9) Mobile Vehicle Maintenance Units (29) .97     tokens. b. Watchman and Gardener TOTAL Sanctioned posts (As on 31. No. Sweeper. e.3.2013) 1 1 1 1 1 1 1 7 7 9 10 87 448 94 669 .98 d. Reconditioning and Central Body Repairing Unit (1) Mini Workshops (4) Table No.18: Sanctioned staff strength of the State Health Transport Department Sl. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Name of the post Director Deputy Director (Technical) Deputy Director (Administration) Accounts Officer Automobile Engineer Technical Officer Material Manager Workshop Superintendent Assistant Accounts Officer Assistant Engineer General Foreman Ministerial Staff Technical Staff Office Assistant. Currently.586 347 256 462 . this department maintains 2.99 10.Directorate wise Fleets Maintained (as on 31.739 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.3 This department has made several significant strides as it passed through different phases of its development. four mini workshops and one reconditioning unit are functioning under the administrative control of this directorate. No. Table No. of vehicles maintained 1. nine district workshops and twenty nine mobile workshops.19 .2013) Sl. seven regional workshops. 1 2 3 4 Name of the Directorate Directorate of Public Health and Preventive Medicine Directorate of Medical and Rural Health Services Directorate of Medical Education Directorate of Family Welfare No.3. At present. Vellore maintain a fleet of about 400 Vehicles each.739 Activities of Regional / District / Mobile Workshops in brief 10. Nagercoil and Villupuram and 29 mobile workshops that are spread all over the State are functioning to assist the regional . Tirunelveli. Nine district workshops at Chengalpattu. Tiruchirappalli. Udhagamandalam. Erode. Pudukkottai. Thanjavur. Madurai. Salem.4 The seven regional workshops located at Chennai. Coimbatore. Dharmapuri.100 5 6 7 8 9 10 Directorate of Drugs Control Directorate of Indian Medicine and Homoeopathy Tamil Nadu State Health Transport Department Medical Services Recruitment Board Directorate of Food Safety & Drugs Administration State Health Society Total 4 8 53 2 19 2 2. Virudhunagar. This department also identifies obsolete vehicles for their condemnation. The mobile workshop. the required major repairs are executed in the nearby regional or district workshop.5 This department provides trouble free mobility for implementing various health programmes. During the year 2011-2012. If the nature of repairs in a vehicle is beyond the limits of the mobile workshop. . It also collects data related to the vehicles maintained by it. visits the hospital premises and takes up periodical servicing and executes minor repairs. on the spot.101 workshops in maintaining all the vehicles in an effective manner. based on their advance tour programme. 208 Ambulances and 30 Mortuary vehicles were identified and condemned. Functions of the Department 10. 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. Further during important Health care programmes like Pulse polio immunization. 6 Apprenticeship training is also being imparted in this Department every year to 45 I.E. downtime of repairs. man-hour utilization and budgetary control has improved. the down time required to carry out the works have been drastically reduced which in turn has facilitated in the early delivery of vehicles.7 Several tools and machineries that are required for undertaking complicated repair works have been installed in the Workshops attached to this Department. Improvement in the performance 10. Graduates sponsored by the different Government authorities.T. The performance of the workshops in terms of fleet utilization. . Computers have also been installed to expedite the activities of all workshops of this Department.6% in the year 1981 has progressively improved to 97%.102 Training Programmes 10. With these facilities.I. 29 Diploma holders and 17 B. The percentage of fleet in operation which was 72. inventory control. Certificate holders. the Government has constituted a separate Board namely ‘Medical Services Recruitment Board’ (MRB) which consists of a Chairman. MRB has so far recruited and filled up 18 posts of Physiotherapist Grade – II.1 In order to fill up the posts in a speedy manner. 63 posts of Skilled Assistant (Fitter Grade – II) and 29 posts of ECG Technician. a Member and a Member Secretary.103 Chapter 11 MEDICAL SERVICES RECRUITMENT BOARD (MRB) 11. 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. . verifies their eligibility and declares results as per seniority and communal rotation.2 Medical Services Recruitment Board conducts recruitment by obtaining seniority list from the Employment Exchange. Currently MRB is finalizing the list of eligible candidates for 255 posts of Radiographer. The recruitment process for the nurses will be initiated by the MRB. Accordingly. Similarly. Government has also mandated recruitment of nurses through open advertisement.159 temporary posts of Medical Officers including Speciality Medical Officers and Medical Officers (Dental) through open advertisement. .2013 and is in the process of conducting examination. the Medical Services Recruitment Board has been mandated by the Government to recruit 2.104 11.3 In addition.4 Medical Services Recruitment Board is striving to improve and quicken the system of recruitment of Health and Family Welfare Department. the MRB has published notification for recruitment of Medical Officers on 31. 11.03. after the pending court cases are finalized. 105 Chapter 12 STATE HEALTH SOCIETY 12.3 Goals of the Mission are  To provide accessible and affordable health care based on people’s need .1 The National Rural Health Mission (NRHM) was launched in 2005 to provide accessible. Vision. Integration of the multiple societies of different national health programmes at State and District levels. as envisaged under the NRHM has also been done. Goals. Objectives of National Rural Health Mission 12.’ 12. Tamil Nadu was registered and all the District Health Societies have been registered under Tamil Nadu Societies Registration Act. The State Health Society. affordable and quality health services even to the poorest and remotest rural regions. 1975.‘Healthy People – Now and in the Future.2 Vision . The State has established State and District Health Missions. 106    To deliver high quality of services To improve the long term status of the population To improve the management of services and make them accountable to the people health health health more 12. nutrition and universal immunization.women’s health.4 Objectives of the Mission are   Reduction in Infant mortality and maternal mortality Universal access to public health services . drinking water. sanitation and hygiene. 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      . child health. the State Government entered into a Memorandum of Understanding (MoU) with the Government of India.2006. stating their agreement to the policy framework of the Mission and the timelines and performance benchmarks against identified activities. 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.5 To achieve the objectives of the mission.107 State Health Society 12. The sharing pattern of the project expenditure in the XI Plan is 85:15 between Government of India and State Government. The components of National Rural Health Mission along with the scheme wise allocation approved by Government of India under PIP . Similarly all the District Health Societies have been registered under the Tamil Nadu Societies Registration Act. 1975. The Programme Implementation Plan (PIP) for the year 2012-2013 has been approved by the National Programme Coordination Committee (NPCC) of NRHM. The State Health Society. The first phase project period was for 7 years upto March 2012. Tamil Nadu was registered under the Tamil Nadu Societies Registration Act on 15.3. 55 525.88 .40 15.71 24.08 17.20 below:Table No.108 2012-2013 are given in the Table No.Allocation under Programme Implementation Plan 2012-2013 Sl.28 0.47 2.20 .85 4 5 6 7 8 9 9.24 1.10 54. Name of the Programme under NRHM Amount approved (Rs. No.90 979. in Crores) Scheme: A 1 2 3 RCH Flexible Pool Additionalities under NRHM (Mission Flexible Pool) Immunisation – Total Total (A) Scheme: B National Disease Control Programme National Vector Borne Disease Control Programme Revised National Tuberculosis Control Programme National Programme for Control of Blindness National Leprosy Eradication Programme National Iodine Deficiency Disorder Control Programme Integrated Disease Surveillance Project Total (B) 438. 7 The State has been providing a wide range of Reproductive and Child Health . 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.87 For the year 2013-2014 it is anticipated that about Rs.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. Sub committees have also been formed at the state level to facilitate coordination and policy planning under the various components. This has contributed to the smooth release of funds to reach the field.400 crore will be approved in the PIP.109 Scheme: C 10 Infrastructure Maintenance(treasury Transfer)(C) Grand Total (A)+(B)+(C) 298.1.14 1332. 12. family planning services and adolescent health services in the rural areas as well as the small urban towns. Maternal Health 12. safe abortions. MMR and IMR. The daily OP attendance and IP attendance have also increased. emergency obstetric care.40.110 Services including institutional delivery. Due to these efforts there has been significant fall in the major RCH indicators. 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. .22 crore. viz.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. There has also been a thrust towards increasing the utilization of primary health centres through improving the atmosphere and service in these centres. This intervention has been implemented in all the PHCs and will be continued in 2013-2014 at a total cost of Rs. 12. Muthulakhsmi Reddy Maternity Benefit Scheme of Rs. free transport from home to facility.600 in urban areas is paid to below the poverty line mothers delivering in institutions for the first two live births. This scheme is implemented in urban and rural areas.11 Mobile Medical Units (MMU): Mobile Medical Units have been provided to .700 in rural and Rs. and diet for the duration of the stay. diagnostics.9 Janani Suraksha Yojana: Janani Suraksha Yojana aims to reduce the maternal and infant mortality by focusing on increasing institutional deliveries. in addition to the financial assistance under Dr.10 Janani Sishu Suraksha karyakaram (JSSK): The scheme of Janani Sishu Suraksha Karyakaram entitles every pregnant women and sick neonate with free drugs.12. inter facility transfer and transport from facility back to home.33. 12. The scheme aims at reducing out of pocket expenses for pregnant women and sick neonates. An amount of Rs. In Tamil Nadu.000 per mother.47 crore for the year 2013-2014. This scheme has a provision of Rs.111 12. the amount is given to the women after delivery. 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. . Each Mobile Medical Unit team consists of a Doctor and a Staff Nurse. These MMUs have now been upgraded as Hospital on Wheels with improved facilities in the vehicle and addition of lab services. one more Medical Officer has been placed in 163 PHCs in 2011-2012.8. Each Mobile Medical Unit visits 40 camp sites in a month as per fixed tour programme and covers all unserved and underserved villages. Visits of MMU team are linked with the Village Health and Nutrition (VHN) day. The remaining 50 PHCs are covered in the year 2012-2013. To make them function effectively in line with other PHCs.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.26 crore has been budgeted for this activity in 2013-2014. Rs. 12.112 all the 385 blocks under NRHM and are functioning since February 2009 under the control of the PHC Patient Welfare Societies. This scheme has been .94 crore has been budgeted for this activity in 2013-2014.14 Provision of feeding and dietary charges for Ante-natal mothers: AN Mothers who stay for undergoing investigation like ultrasound scan etc. 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. bus terminus.113 12. the PHCs are provided with extra amount based on the number of deliveries conducted. in the PHCs are being provided with food during the Ante natal Clinics at the PHCs..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.44 crore. Taluk head quarters hospitals. Rs.11. This Scheme is under implementation during 2012-2013 with the Budget provision of Rs. corporation and municipal health posts. Government PHCs. To maintain the extra facilities and to meet out the increasing demands of the ante natal mothers attending the PHC. 12. prisons. Government District head quarters hospitals. 2. The Government/Private/Retired personnel are . well before expected date of delivery.72 crore for implementation during the year 2013-2014.3. 12. 12. along with an attender for round the clock monitoring of maternal and foetal well being and timely referral to appropriate higher facility. 12. The scheme will be continued by further expanding it to 66 more institutions in 2013-2014. in 30 bedded PHCs.25 crore. 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. on Reproductive. at a total cost of Rs. Maternal.15 Observation of High Risk AN Mothers: Pregnant mothers who have been diagnosed as high risk pregnancy will be admitted.114 budgeted at a cost of Rs. and Neonatal and Child Health Care. 4.16 Placement of RMNCH counsellors: 172 Counsellors have been placed in 110 identified post partum centres to provide counselling to mothers.17 Provision of specialist services – Obstetricians. 12. This includes deworming for all pregnant women and use . 12.19 Maternal Anaemia Control Programme: The prevention and control of maternal anaemia is a serious concern for the State.75 crore has been budgeted to implement this scheme.4 crore has been budgeted for the year 2013-2014. an amount of Rs. 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.115 hired for the above services at PHCs and District hospitals. So far. In 2013-2014. 318 Doctors have been trained in LSAS and 52 Doctors have been trained in EmOC. 6. Caesarean deliveries are also conducted in PHCs by hiring private gynaecologists under RCH. Treatment guidelines (protocols) for implementation of moderate and severe anaemia control programme have been introduced during the year 2010-2011 to tackle this problem. an amount of Rs.18 To hire super-specialists and diagnostic services. Tamil Nadu is the leader in conducting these courses which are used to meet this specialist gap. 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. 12. wherever lab technicians are not available. 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.3.14 crore. at a total cost of Rs. The scheme has been extended to all PHCs using the services of trained staff nurses.20 Gestational Diabetes Control Programme: All PHCs have been supplied with Semi auto analysers.16. An amount of Rs.21 Ensuring blood safetyConduction of Community Blood Donation Camps.00 crore has been budgeted in PIP 2013-2014 for the continuation of management of maternal anaemia using the protocol based intervention. With the inputs of .116 of injectable iron sucrose for cases of moderate and persistent anaemia. 12. Reproductive tract infections/ sexually transmitted infectious disease management. 12. Adolescent Clinics.75. Emergency Obstetric Care. 31 health sub centres in remote / difficult areas have been .87 lakh has been proposed for conduction of blood donation camps and maintenance of blood storage centres. Safe Abortion Services.. 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.117 NRHM.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. This will facilitate supply of sufficient quantity of all blood types to these blood storage centres. Blood donation camps will continue to be conducted at the rate of two per block. Poison Management services etc. will also be provided at these centres. These centres are being developed as comprehensive MCH centres to provide the RCH package of Ante natal and post natal care. In the year 2013-2014 the budget of Rs. Sterilization Services. .64 Neonatal intensive care units (NICU) have been operationalised. 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. Priority has been given for standardized civil work as well as provision of inputs for housekeeping and security services.23 Comprehensive intervention to reduce neonatal deaths in districts with high IMR: With the support of NRHM.I MCH centres with additional facilities.118 identified to provide Level . Nine trained staff nurses. Child Health 12. 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.15 crore has been proposed in 2013-2014 for funding the recurring expenditure. All the Medical College Hospitals and the district head quarters hospitals and 16 identified Sub District Hospitals are providing NICU services. An amount of Rs.22. New Born Stabilization Unit.34 crore is proposed in the PIP 2013-2014.NBSU and Sick Neonatal Care Unit –SNCU.3.I MCH centres and 135 new Urban Primary Health centres was completed in the year 2012-2013. 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.New Born Corner (NBC).8. New Born Corner has been established in 1.24 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 . Provision of equipments to NBCC in 73 new PHCs. As per the norms.New born stabilization Units (NBSUs) are established. In 42 level-II MCH centres and 114 FRUs . For essential new born care services at these Government Institutions an amount of Rs. 31 identified Level . Paediatrician . A recurring cost of Rs.421 PHCs with necessary inputs from NRHM in terms of equipments and facility based training of health personnel.50 crore has been proposed for the year 2013-2014.119 12. It is proposed to expand the scheme in 20 more identified high IMR blocks in the PIP 2013-2014. through a custom designed software for prenatal screening of foetal abnormalities in first. 12. This scheme is being implemented in partnership with the reputed private sector organizations who is specialized in ultrasonography . Continuous audit . 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.120 in each centre would be identified to conduct weekly field visit / well baby clinics in the PHCs in the Blocks with high IMR. The scheme is being implemented as a convergence activity with Integrated Child development Services (ICDS).26 Capacity building for Health Care Providers in Prenatal screening to detect foetal anomaly: Under this scheme. These clinics will provide an array of diagnostic and preventive care services. 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. second and third trimester. 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. The children (0-3 years) identified by active screening with developmental delay / disability etc.3.27 crore in 2013-2014. The NGO ‘Maduram Narayanan’ Centre has been nominated by the Commissionerate of Differently abled as a mentor for Exceptional . 12. These centres are being provided with therapy equipments and manpower. will be managed by appropriate Special Educator / Therapist at the Early Intervention Centres. in the allocated four Primary Health Centres per district.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. 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. Memorandum of Agreement has been signed and training for all districts has been completed. Verbal autopsy is being conducted by the Medical Officer in Rural and Urban area within 15 days of occurrence of death.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). A facility level committee in all SNCUs is investigating the events leading to .63 lakh. Verbal autopsy at the district level and Institutional audit in the Medical Institution where the death occurred. 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. In the plan for 2013-2014 it has been proposed to continue the scheme at a cost of Rs. 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. 12.122 Children and consultant for this project and MoU has been signed. 12.29 Strengthening of Infant death audit: The Infant death audit is being conducted in two stages i.e. 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. both in school and out of school along with biannual deworming. Adolescent Health Programme 12.123 Neonatal death as this constitutes the major component of IMR. Kancheepuram. One of the major focus of the RCH programme is towards adolescent anaemia control.51 crore. School going adolescent boys will be included in the current year and the scheme has been budgeted at a cost of Rs.Kanniyakumari. Thoothukudi and Ramanathapuram during 2009-2010 . Dindigul. Nearly 97% of adolescent girls in the state are anaemic. 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.31 Modified School Health Programme: On a pilot basis Modified School Health Programme was implemented in six districts of Cuddalore. The programme involves distribution of one Iron and Folic Acid (IFA) tablet a week to all adolescent girls.22. furniture’s.000 school teachers and 600 health and education department officials have been trained under this programme during 2012-2013. establishment of Urban Health . 12. Dharmapuri.124 and four districts of Salem. especially in smaller urban towns. The implementation of the scheme for the year 2013-2014 has been budgeted at a cost of Rs. The Modified School Health Programme has been extended to the remaining 20 districts. Tiruvannamalai and Tiruvarur during 2010-2011. 30. With NRHM inputs towards the cost towards the renovation and repairs of Urban Health Centres.32 Urban Health Programme: In the urban areas.63 crore. major lacunae exist in providing urban health services which is further compounded by the ever growing urban population. The Scheme will be implemented in all the districts in the coming academic year. It is proposed to provide uniform basic infrastructure and staff for these Urban Health Centres. drugs.13. 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. rent for Urban Centres. equipment. cultural. and economic constraints.125 Centres in 135 Municipalities has been ordered.650 VHV .96 crore in 2013-2014. To promote and improve availability of basic health care services to the tribal/ remote and difficult areas. Tribal Health 12. 2.23. the vulnerable tribal community is still unable to access basic health care. These centres have been brought under the administrative control of the Director of Public Health and Preventive Medicine.ASHA have been . It is proposed to cover 25 Town Panchayats with Urban PHCs at a total cost of Rs.33 Village Health Volunteers Accredited Social Health Activist (VHVASHA) in 12 districts with tribal population: Despite a number of interventions by the State Government. These Urban health centres adopted have been provided with necessary equipments and materials. They continue to face a number of social. 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. 650 VHV in the plan for 2013-2014. The training of VHV in seven modules has been completed in collaboration with the NGO .126 selected and placed.3. mobile medical services for outreach services with 20 MMUs are being provided in 10 districts through NGOs in collaboration with Tamil Nadu Health . 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.34 Establishment of Birth waiting room: Out of the 34 tribal PHCs.17 crore has been proposed for performance based incentives to 2. An amount of Rs.SOCHARA and two master trainers at the state level. An amount of Rs. 12.1. Antenatal mothers especially the high risk cases are brought to these waiting rooms well in time prior to the expected date of delivery.48 crore has been budgeted in the Current year to continue the scheme. 17 foot hill PHCs have been provided with Birth waiting rooms. 12.35 Mobile Medical Unit (MMU) in Tribal Areas: To reach the remotest pockets. The total budget proposed is Rs. Labour room.5. The amount proposed for supporting this scheme for outreach services in tribal villages is Rs. 12. Renovations and extension of AN wards. PN wards.50 lakh for 2013-2014.76 crore.26. there is an urgent need to provide larger space in the PHCs to accommodate expectant mothers so that they stay in the health .36 Tribal Counsellors in 10 Government Hospitals: Tribal Counsellors have been appointed in 10 Government Hospitals in the Tribal districts.127 System Project (TNHSP). It is proposed to extend the initiative to another 32 Institutions in 2013-2014. In order to reach those tribal areas which are inaccessible. These persons function as health activists in the institution and create awareness on health and its determinants.37 Repairs. Operation theatre etc. : With surging institutional deliveries. supply of new four wheel drive vehicles suitably equipped as ambulances were approved in 24 identified points in tribal / hilly areas under NRHM. 12. They motivate the community towards healthy living practices. ante natal wards. It is proposed to take up extension and renovations to labour rooms. OTs.38 Strengthening of Training Centres: In Tamil Nadu. Hence under RCH.128 facility where they deliver for at least 48 hours post delivery. In view of the increased need for both pre service and inservice training as a result of RCH/ NRHM initiatives. essential civil works for the PHC buildings which need repairs. The facilities in the training centres will be upgraded along with provision of skill labs for training and evaluation of field staff at .21 crore. renovation and extension especially to provide facilities for the additional delivery load are being provided. 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. Training and Human Resource Development 12. it is required to upgrade the facilities available in these training centres. 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. 7 new ANM training schools are proposed at a cost of Rs.Accredited Social Health Activist) in non tribal areas: The State has decided to position programmers specific Village Health Volunteers in HBNBC. malaria and blindness control. 18 Medical College Hospitals and their attached institution. This scheme will be continued in 2013-2014.39 Placement of 4. the guidelines for their job functions and incentive schemes are being redesigned based on the programme needs which are relevant in these areas.614 PHCs.200 Programmers specific VHV-ASHAs (Village Health Volunteers . The VHVs will receive training and performance based incentives for the programmes for which they are selected.1.40 Patient Welfare Societies: Patient Welfare Societies have been constituted in all the 1.1 crores. Since these VHVs will be functioning in the plain areas under the close supervision of the VHNs. 12. Leprosy.129 cost of Rs. 30 District Headquarters Hospitals and 231 .18 crore. Additionalities under National Rural Health Mission (NRHM) 12. 1 lakh per Medical College attached Institutions and Taluk/Non-Taluk Hospital. and Rs.130 Taluk / Non-Taluk Hospitals. and Rs.50. 12.1 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.41 Annual Maintenance Grant to PHCs/HSCs/CHCs/DH/SDH/ Urban PHCs /MCH and attached Institutions: An Annual Maintenance Grant of Rs.000 for other PHCs and urban PHCs is allotted per annum for provision of water. Similarly. toilets.25.1 lakh per Primary Health Centre.10 lakh per Medical College Hospital. All the societies are registered and functioning effectively. Rs.78 crore is proposed in the PIP 2013-2014 towards this scheme. Rs 1 lakh per urban health centre per annum under this scheme is given every year. An amount of Rs. an annual maintenance grant of Rs. 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.5 lakh per District Head Quarters Hospital. their . An amount of Rs. is also provided per annum for the maintenance of HSCs with own buildings.1 Lakh Per annum to district head quarter hospitals.is allotted as untied grant for each Health Sub Centre per annum.000/.is allotted to each Primary health centre and Urban primary health centre per annum.131 use and their maintenance and other activities which has resulted in the better functioning of the health facilities. An amount of Rs. Flexibility is also given to the patient welfare societies for spending this money based on actual requirement at the field level. 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 .000/. An amount of Rs.20.50. An amount of Rs.000/.39 crore has been proposed for this core activity in the year 2013-2014. 12.000 per annum is allotted to taluk and non-taluk hospitals and Rs.10.10. An amount of Rs Rs. essential and immediate expenses towards day to day maintenance. Annual Maintenance Grant of Rs.25.42 Untied grants to Health Facilities: Untied funds are given to all health facilities to meet out unexpected. Village Health and sanitation Committees have been formed in all the village panchayats in Tamil Nadu.07 crore.132 developing village specific plans. with representatives of the Panchayat Raj Institutions. Similarly village health and water sanitation committees have been formed in town panchayats.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.10. 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 financial allocation proposed for these committees during 2013-2014 is Rs. Every committee is entitled to an annual untied grant of Rs.15. The committee members have already been given training regarding the village health activities. 12. The revised strategy for conducting VHN day has . both the VHN and the ICDS Anganwadi worker will offer joint services. women’s groups and other village level officials related to health and determinants of health such as water and sanitation.which will be used for improvement of the health and sanitation of the village.000/. especially in view of the increasing patient load. Provision of equipment for the increased work load or replacement of old and obsolete equipment including . 12. A detailed facility survey has been conducted through Tamil Nadu Health Systems Project for identification of infrastructure gaps in the secondary hospitals. 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. In terms of physical infrastructure. taluk /non-taluk and District Hospitals exist in the state. The expenditure will be met from the PHC/HSC funds. PHCs. a network of sub-health centres. To improve the overall health infrastructure. several strengthening activities have been initiated in the State under NRHM. CHCs.133 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.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. 9.28. 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.21. .46 As part of the district planning process.72 crore for First Referral Units (FRUs) and Rs.67 crore for tertiary care institutions was budgeted in 2012-2013. The balance amount of Rs.134 major repairs of essential equipment will be taken up as a part of infrastructure strengthening in selected FRUs and DME institutions.00 crore. In addition to facilities like additional wards. 12.73 crore is budgeted in the current year PIP. 14. the civil works required in FRUs have been taken up in 2012-2013. 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. Based on the facility survey. To strengthen the facilities with equipment. a cost of Rs. labour rooms and theatres. During 2009-10.24 crore. AYUSH is an important component of primary health care delivery in the State. 12. The amount proposed for the implementation of the scheme in the current year is Rs.5.135 12. 479 clinics have been well established in PHCs across the state. Child Health.47 Quality Assurance Cell: A Quality Assurance Cell with 4 wings-Maternal. The use of AYUSH has expanded and gained popularity with the tremendous expansion. 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. .37.48 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 AYUSH services were extended to another 300 PHCs and in 201011 to 175 PHCs under NRHM due to the growing demand. bringing the coverage to more than 60% of the PHCs.31 crore which includes a drug budget of Rs. Elderly Clinics 12.09.49 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. The scheme is being continued in 2013-2014. Police and Fire Prevention. .2008 and an Emergency Response Centre has been established at the Government Kasturba Gandhi Hospital for Women and Children. Emergency Management service is in operation from 15.136 EMRI (Emergency Management Research Institute) 12.6. Chennai. provision of Geriatric services at the gross root level is the felt need of the rural masses.22 crore towards equipments and running services of Physiotherapist.50 With the growing prevalence of noncommunicable diseases in the State along with a perceptible increase of elderly in the community. 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. to achieve our goal of “Caries – free children” under NRHM.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.11. It has been proposed to extend the Dental Services to another 133 Upgraded PHCs at a cost of Rs.137 Dental Services in the Government Institution 12. . with their active participation.74 crore during 2013-2014. This service has been extended to another seven Taluk Hospitals and 58 UG PHCs. thereby covering 399 PHCs in the State. At present 208 PHCs and 22 Taluk/Non taluk Hospitals are providing dental services for three days in a week. 138 Chapter 13 TAMIL NADU HEALTH SYSTEMS PROJECT 13.15 crore. Remote and Tribal populations in Tamil Nadu. In addition. 597. As the Project had completed all the activities and spent the money well within the Project period.1 Tamil Nadu Health Systems Project (TNHSP) is a World Bank assisted project implemented since January 2005. 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) . Improving Quality of Health Care and Improving Human Resource planning and capacity. The Phase I of the Project was implemented from January 2005 to September 2010 at a total Project cost of Rs. 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. The Project is being implemented in two Phases. 13. and (iii) the expansion of maternal and neonatal health services to the tertiary level.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.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. (i) The consolidation of successful new modalities to reform the provision of Health Care Services and improve health outcomes in Tamil Nadu. The following are the components and sub-components of the project. .140 (ii) State-wide expansion of key services and systems which can serve as models for other states in India. This component supportsi.74 crore from October 2010 and is expected to close on 30th September 2013.3 The Phase II of the project is being implemented at a total additional financing cost of Rs. Component 1: Increasing access to and utilization of service. 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. 627. 13. 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 ii. 141 iii. and follow-up for cervical & Breast cancer and cardiovascular diseases (Hypertension) and Diabetes Mellitus through Clinic based. This component supports i. ii. School based and Community based interventions. strengthen existing primary and secondary services in tribal areas through public-private partnership. In addition. and NCD Interventions throughout the state of Tamil Nadu covering Prevention. work placebased and community-based health promotion programs. strengthening of laboratories and financing housekeeping services at selected Project hospitals. and Facilitating use of hospitals by the poor and the disadvantaged through the provision of effective patient counseling services. Work-place based. Health Promotion activities for preventing Non-Communicable diseases through school-based. the provision of ambulances and mortuary vans. treatment. Screening. the component would . Component 2: Non-Communicable Disease (NCD) Prevention and Control. . monitoring and evaluation of NCD interventions. wide spread IEC activities and supervision. Component 3: Building Capacity for Health System Oversight and Management. and enhancing the capacity for the hospital accreditation process within the Department of ii. management and training on rational use of drugs for hospital and Primary Health Centre(PHC) staff.142 finance the salaries of female NCD staff nurses contracted and placed at primary. Improving Quality of Care through continuous monitoring of quality of care. secondary and tertiary level facilities. 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. the provision. This component supports i. training of doctors and TNHSP staff. and supporting the establishment of a data resource center. This component supports - i. Component 4: Improving Effectiveness and Efficiency of Public Sector to Deliver Essential Services. secondary and tertiary levels of healthcare. and carrying out an impact evaluation of the implementation of the Environment Management Plan. Capacity building for Strategy Development and Implementation by expansion of the Directorate of Medical Services (annexe building). iv. Equipment rationalization and strengthening of equipment and pharmaceuticals management through the procurement of essential equipment . Strengthening Health Care Waste Management through extensive training on Infection Control and Waste Management to all health personnel at primary.143 iii. supporting the TNHSP Society by financing its operating costs. Health and Family Welfare of Tamil Nadu. logistics.144 ii.  Provision of equipment for operation theatres and labour wards. repair and maintenance system in the Tamil Nadu Medical Services Corporation (TNMSC). and Human Resource Planning and Development by financing additional contractual staff in project hospitals in order to improve overall efficiency and performance. the following activities would be undertaken –  Improvement of infrastructure to 24 hrs Comprehensive Emergency Obstetric and Newborn Care centres (CEmONC). it is proposed to undertake the following activities. Improvement of Maternal and Child Health 13. During the year 2013-2014. .  Coordination meetings will be conducted with referral units to improve the referral system.4 With a view to improve the maternal and child health. and strengthening pharmaceutical and equipment procurement. 145  Follow-up of referred out cases. more than 12 lakh persons have been screened and of them 77.  To establish Maternal ICU in all CEmONC centres.00 lakh per hospital per annum will be provided to each of the CEmONC hospitals for incidental expenditure. Non-communicable Diseases 13.  Training of Doctors and Nurses on labour ward practices.757 persons have been found to be having hypertension and are now getting regular treatment in Government Hospitals.  Conducting review of Maternal Mortality through video conferences.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. they have been prevented from getting serious diseases like coronary artery disease.1.  Fresh frozen plasma will be made available in all CEmONC centres. .  Re-certification of CEmONC centres. Due to this.  Untied fund of Rs. During the financial year 2012-2013.146 stroke. Rural Development Department for community based activities and Municipal Administration Department for involving municipal hospitals and urban population. 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 stop smoking/ not to initiate smoking and stress management. Emphasis is being given for creating awareness in the community on modifiable risk factors leading to cardio vascular diseases.80.838 hypertension cases were identified and brought under treatment protocol. to increase physical activity. to maintain optimum weight for the height. This programme is being implemented as a multi departmental activity involving Education Department for school based activities. out of 29.29. Labour and Employment Department for work place based activities. chronic renal failure etc. Currently the programme is being implemented in 16 districts involving 973 Government institutions including Municipal /Primary/ Secondary/Tertiary care medical institutions. encourage walking and cycling.835 patients screened for hypertension 2. These patients will also be monitored during the . 33.70 lakh women were screened. During 2012-2013 in the 1st phase the screening for Cancer cervix was initiated in 16 districts among 973 institutions. These patients will also be monitored during the follow-up for any complications due to Diabetes Mellitus and will be treated appropriately.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. Therefore this programme was extended to entire Tamil Nadu.583 cases have been identified and brought under the treatment. 13.147 follow-up for hypertension appropriately.7 Prevention and Treatment of Cancer Cervix: During the Pilot programme which was implemented in Theni and Thanjavur districts more than 4. and referred to higher institutions for confirmation and further management. out of 13. During 2012-2013. of them 20.886 patients . Out of 4.534 patients screened for Diabetes Mellitus 59. any complications and will be due to treated 13.000 were found positive for Cancer Cervix.35. an early detection.148 screened for Cancer Cervix. During 2012-2013 in the 1st phase the screening for Breast Cancer has been initiated in 16 districts among 973 number . Along with the Screening and Treatment program for Cervical Cancer. 19. in all the Government health facilities. All the women attending the Out Patient Department who are of 30 years and above are to be screened for cancer cervix. 13. In this program all women above the age of 30 years are taught about self breast examination and are subjected to clinical breast examination.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. and treatment for Breast Cancer is also being implemented in all districts of Tamil Nadu in a phased manner.143 cases were found positive and referred to higher referral institutions for confirmation and treatment. 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 the financial year 2013-2014. it is planned to implement this programme in the remaining 16 districts. 9 Health Management Information System provides information based support for the implementation of cutting-edge reforms by the Tamil Nadu Health Systems Project.87. During the year 2013-2014 this programme will be implemented in the remaining 16 districts. to deliver improved evidence based health care to the public at large. Out of 8.563 patients were found positive and they were referred to higher referral institutions for confirmation and treatment. this project is envisaged to cover all the Tertiary Care Hospitals including the Medical Colleges and Medical University. Apart from Primary Health Centers and Secondary Care Hospitals. Health Management Information System (HMIS) 13. Because of the encouraging results the project was extended to Phase-1 during the year 2009 for thirty six hospitals in five districts. This is a combination of Information Technology (IT) and Management Systems.555 patients screened for breast cancer 8. Subsequently Phase-II activity commenced during the year 2010 for two .149 of institutions. HMIS was started as Pilot project during the year 2008 in five secondary care hospitals. The total budget allocated for the pilot. 47 institutions under the Medical Education Directorate and Tamil Nadu Dr. As on date. 265 out of 267 hospitals are functioning with HMIS. College Management System (CMS) and University automation for 17 medical colleges. Currently we are in the completing stage of Phase II hospital implementation.MGR Medical University have been planned and SRS preparation is in progress. phase –I.31.128. have been provided in 23 Government District Head Quarters Hospitals.150 Hundred and Twenty Two hospitals. Provision of Modern Equipment to Government Hospitals 13. Medical College hospitals (only OP work flow) Management Information System (MIS). at a cost of Rs. II and III is Rs.60 crore.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.40 crore. . and also in 7 Government Medical College Hospitals. HMS for 8 Govt. Under revised Phase III activities. 2. have been provided in 16 Government District Head Quarters Hospitals and also in 1 Government Medical College Hospital.83. Hepa Filter with AC system. at a cost of Rs. New Born Ventilators etc will be provided to these Hospitals at a cost of Rs.40 crore.6. Ultrasonograms with color doppler.38 crore.59 crore.14. at a cost of Rs. Medical College Hospitals and are nearing completion. Pulse Oximeter with Adult and Pediatric probe has been provided in 119 Government Secondary Care Hospitals.61 lakh.44 lakh.151      Dialysis Machines with Reverse Osmosis plant. Anesthesia machines. Equipment for CEmONC services in eight Government Medical College Hospitals: Maternity blocks are being constructed in eight Govt. at a cost of Rs. . have been provided in 10 Government Secondary Care Hospitals getting prepared for Accreditation by NABH. Echocardiograms with color Doppler.97. Mammography Unit will be provided for 30 Government District Head Quarters hospitals at a cost of Rs. 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. and in another hospital the final assessment was over and the result is awaited.152 Setting up of Hospital Accreditation Cell 13. Of them two hospitals have secured NABH accreditation.972 patients were admitted and treated in these centres out of which 35.389 people got cured.3. During the current year. These centres play useful role in bringing down the death rate due to poisoning. The cost involved in the above activity including other quality of care improvement activities is Rs.47 crore. . Poison Treatment Centres 13. An Accreditation cell is set up to facilitate accreditation of hospitals. 35.11 Twelve Government Hospitals are being prepared to obtain certification under National Accreditation Board for Hospitals (NABH). a unit of the Quality Council of India. In the remaining nine hospitals pre-final assessment is over and the hospitals are being prepared for final assessment. 13 The 108 ambulance service is under operation in Tamil Nadu through PPP mode by signing an MOU with EMRI.364 beneficiaries.69.64 crore is provided by Government of Tamil Nadu to operationalise this programme. These ambulances are fitted with life saving equipments. The staff nurses will manage the case in consultation with the physicians at Emergency Response Center in transit. Madurai and Vellore. To provide care during transit trained staff nurses are posted. Kancheepuram. Dharmapuri. At present 629 vehicles are in operation with 6. specially designed neonatal ambulances with equipment are under operation in Chennai. To provide continuous care during transit. It is planned to induct more . one trained staff nurse is posted in this ambulance. patients are being transported through Advanced Life Support (ALS) ambulances irrespective of distance.153 Emergency Ambulance Services 13.34. Also to save sick new born babies who require specialty care at tertiary care institutions. Hyderabad. Cuddalore. During this financial year Rs. Apart from providing emergency services inter facility transfers between secondary care institutions to tertiary care institution for specialty care treatment. 14 The Project has been operating 12 Mobile Out-reach health services in Tribal areas through NGOs during the Phase I of the Project.227 persons were benefitted by this programme.29. Tribal Health Development 13.927 number of trips were made to the tribal areas and 2. Mortuary Van Services 13.84. Tribal Counsellors 13. This programme is extended by addition of eight more teams making a total of 20 teams.16 The Government is providing Free Hearse (Mortuary) service in all the . 4. During the current year 10.605 persons were treated. During the current year.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.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. This programme is being implemented in partnership with Indian Red Cross Society. At present 132 vehicles are in operation in all the Government Medical College Hospitals.95 crore during this financial year. Tamil Nadu Branch on PPP mode since 2011. It is planned to increase the fleet strength to 180 to cover all the Government Medical institutions during 2013-2014.155 Government Medical Institutions to transport the deceased from Government Medical Institutions to their destination or cremation ground.827 number of bodies have been transported to their hometown / cremation ground within the state and adjacent states also. So far 45. Government has allotted Rs. . 18. District Head quarters and some of the Taluk hospitals. TNMSC’s role encompasses procurement. under the Companies Act.156 Chapter 14 TAMIL NADU MEDICAL SERVICES CORPORATION 14. The entire operation of TNMSC is . surgical and sutures. distribution and quality control of drugs. not rigid as the facilities have the freedom to seek additional allotment at times of emergency. 1956 ensures the availability of drugs and medical supplies to all the Government Medical institutions and Primary Health Centres.1 Tamil Nadu Medical Services Corporation (TNMSC) established in 1994. however. The health facilities draw their requirements from the warehouses through an indenting system on a pre-determined schedule. procures and organizes their storage at different points and distributes these to the health facilities. The system is. medicines. storage. TNMSC maintains drug warehouses throughout the State. It draws up a list of essential drugs. 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. Chennai etc. drug flows and stocks at all its warehouses.2 Over the years. 14. Transport Corporations. 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 has extended the ambit of its operations to the medical facilities in Police. 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. Veterinary Department and Cooperative Institutions also. Prisons. the charges being at a lower rate than the private investor-owned centres. 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. 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. on a daily basis. Chennai and IOG. The major activities . Juvenile Homes.157 computerized and through the computer network it monitors. Storage and Distribution 14. In addition drugs and chemicals for the Animal Husbandry Department are procured by the TNMSC. specialty drugs and surgical and suture items from reputed manufacturers are procured through a transparent tender process.4 The Government medical institutions are provided with pass books based on the allotment made by the respective Head of . distribution of Drugs. The Warehousewise requirement of drugs. storage and Procurement 14. TNMSC is an ISO 9001:2008 Certified Organization. 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.3 Essential Drugs and Medicines.55 crore for the scheme under the Public Health head of account.158 include procurement. placing of supply orders and distribution of drugs is monitored online by use of Information Technology. Under the scheme ‘Pudhuyugam”. selected through transparent tender system.159 Departments to enable the institutions to draw their requirement of drugs and medicines from the warehouses to which they are attached.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.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. of 64 slice CT scanners have been established in 41 Centres in . Other Activities 14. Quality Assurance 14. 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. The Corporation maintains six months’ physical stock in the warehouses and two months’ stock in pipeline for ensuring uninterrupted supply of medicines to hospitals. Rs. A nominal fee of Rs. The Corporation is also maintaining 10 MRI Scanners and providing scanning facility to the public at a nominal charge of Rs.500 with an extra charge of Rs.500/.500 per scan for out-patients with an extra charge of Rs.1. The Corporation is collecting nominal user charges at the rate of Rs.000 is fixed for first. Madurai. The installation of two more MRI Scanners at Government Medical College Hospitals at Dharmapuri and Chengalpattu are in advanced stages.4. Chennai and Villupuram and are functioning. MRI Scan have been installed in the Medical College Hospitals at Kilpauk. 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.2. one each at Rajiv Gandhi Government General Hospital.4.200 for contrast scan. Chennai and Government Rajaji Hospital.350/. second and third sitting respectively for this treatment.5.160 Government Hospitals. The Corporation is also maintaining two Lithotripsy machines.000. .for contrast scan.per scan for in-patients and Rs.500 and Rs. Maternity Pay ward in IOG. Chennai established.8 Regional Diagnostic Centres: The Corporation is also maintaining the Regional Diagnostic Centres at seven Government Headquarters Hospitals at Villupuram. ii. iv. Chennai. Chennai. Tiruppur. Chennai. Tiruvannamalai. i. Virudhunagar.161 14. iii. Egmore. Chennai.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. . Maternity Pay ward at Kasturba Gandhi Hospital for Women and Children. Pay wards at Rajiv Gandhi Government General Hospital. The proposal for handing over these to the respective institutions is under consideration of the Government. Master Health Checkup Centre at Rajiv Gandhi Government General Hospital. 14. v. The ISO 9001 certified Liver Transplant Centre in Government Stanley Hospital. Equipment for their projects in other States. Nagapattinam and Tiruppur.10 Purchase and Supply of Medical Equipment: Specialized and high technology medical equipments. Namakkal and 14. Action is being initiated to construct five more warehouses at Perambalur. TNMSC is the procurement agency for Tamil Nadu Health Systems Project. at the District Headquarters of Tamil Nadu. 14. The World Bank is actively considering engaging TNMSC as an authorized procurement agency in respect of procurement of Drugs and Medicines.e.162 Ramanathapuram. aided by World Bank. required for all the Government Hospitals are procured and supplied by TNMSC based on specific Government Orders. Namakkal. 14. Many States in the country are emulating the methodology followed by this .11 Consultancy Services: TNMSC is a well known brand name in Drug Logistics and Warehousing for the whole country.9 Construction of Warehouses: TNMSC operates modern Drug Warehouses at 25 convenient locations i. Pudukkottai. Further. Krishnagiri. The Government of Chattisgarh is requesting to extend the support as is being done for Government of Madhya Pradesh by the TNMSC. TNMSC has rendered consultancy services for two years for the procurement activities both for drugs and mmedicines. For the State of Madhya Pradesh. The Corporation has been receiving a number of delegates from all over the country and abroad to emulate and replicate the TNMSC model. Government of Andhra Pradesh and Rajasthan. TNMSC has rendered consultancy services for the Health and Family Welfare Department. TNMSC is constantly striving to improve the system and delivery.163 Corporation. . State AIDS Project Cell was started in January 1993. No HIV/AIDS related Stigma and Discrimination”. TANSACS has been able to reduce it to 0. TANSACS is funded by National AIDS Control Organisation (NACO) and the fund allocated for 2013-2014 is Rs.1 Tamil Nadu has been a front runner in managing (Human Immuno Deficiency Virus) HIV / (Acquired Immuno Deficiency Syndrome) AIDS. TANSACS is working to achieve the aim of “Getting to Zero – No new infection. No HIV/AIDS related death.2 Since 2011. 15.164 Chapter 15 TAMIL NADU STATE AIDS CONTROL SOCIETY (TANSACS) 15.75.13% in 2001.25%. This cell was converted as Tamil Nadu State AIDS Control Society (TANSACS) during May 1994. With active co-ordination of Government health system and various supporting units like NGOs and CBOs. .28 crore. Initially the HIV/AIDS was rising and it reached 1. A novel approach of Private Public Partnership (PPP) has also been started and many private hospitals are now part of this network. 17 mobile ICTC Vans equipped with all relevant facilities are being utilized in various .165 The basic components of TANSACS activities are as follows:   Prevention of New Infections Care.4 ICTC is the initial contact point for HIV/AIDS related services. ICTC (Integrated Counselling and Testing Centres) 15. The following schemes are being implemented to ensure prevention of new infections. Support and Treatment Strategic Information Management System Prevention of New Infections 15. To cover the remote areas. These centres are located at Medical Colleges / Government Hospitals / Primary Health Centres.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. 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 20 crore is allocated for all IEC activities. . Long format programmes etc. Bus Panel brandings apart from organization of specific events like Blood Donation Day and World AIDS Day.000 trained teachers and 20. A large number of Government Departments are being given awareness training to ensure that they are sensitized about all the aspects of HIV/AIDS. to provide information. (Two Peer Educators per school). Life Skill Education Programme provides information related to HIV/AIDS to the adolescent group. Other IEC activities include Static advertising like hoardings. pamphlets.006 Schools with 18. posters etc. For this financial year 2013-2014.012 Peer Educators.387 Colleges have Red Ribbon Clubs and they work on the aspect of risk perception and behavior change through behavior change communication. Red Ribbon Club is a major strategy to cover a large number of youth in the State. At present 2. These vans utilize Audio-visual aids. Talk shows. Two Mobile IEC vans are operated to take the HIV/AIDS related messages to remote areas where other channels may not have adequate reach.170 through Advertisements. an amount of Rs. It has been implemented in 10.10. Apart from the main ART centres. Towards this. The main activities are as follows:Anti-Retro Viral Therapy (ART) 15. Counselling Services are also provided before and during the treatment. Free screening facilities for CD4 tests are provided at ART centres & all eligible persons are provided free ART drugs. a person with HIV can live a normal life. Support & Treatment 15. Community Care centers are short stay home supported by TANSACS which provide treatment for minor opportunistic infections on IP and OP basis. outreach for ART adherence . there are 99 Link ART Centres which provide regular medicines to PLHIV. Counselling. Proper ART regimen significantly improves the quality of life of the person with HIV infection. 68. Government provides various facilities to improve the quality of life of people living with HIV/AIDS.12 With proper care & treatment.13 ART provides medicines to inhibit the replication of HIV Virus and to reduce the chances of other infection.171 Care. At present there are 44 ART centres.090 persons are taking regular ART medicines through these centres. 29 Community Care Centres (CCC) are currently functional in the State which is run by NGO's and CBO's. The data gathered is used for monitoring & taking corrective efforts to streamline the system. 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.172 and home based care for people living with HIVs (PLHIVs).14 SIMS is a web based integrated Monitoring and Evaluation Service where all the units of TANSACS report through this system. A separate . In cases where it is required. free legal service is provided for taking legal recourse to claim their rights. Apart from the above mentioned National Aids Control Organisation (NACO) supported programmes. 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. Strategic Information and Management System (SIMS) 15. There are 29 DAPCUs in the 29 high prevalence districts. there are some unique initiatives being run in the State for providing Care & Support to PLHIVs. 000 per month. As of 31st March 2013. Under Farmers Protection Scheme (Uzhavar Padukappu Thittam). educational support to infected and affected children.663 persons were being given this pension. This trust provides nutritional. any member of farmer who is on ART medicines with CD4 count below 350 is provided a pension of Rs. 2.173 Trust has been established for providing assistance to Orphan and Vulnerable Children (Tamil Nadu Trust for Children affected by AIDS).1. . 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. On 01.04. the Tamil Nadu State Blindness Control Society was formed as a separate entity. to give thrust .1 Blindness is a major problem throughout India.3% of population.174 Chapter 16 TAMIL NADU STATE BLINDNESS CONTROL SOCIETY (TNSBCS) 16. The Society has taken various steps to create awareness among the public regarding the need for the Eye donation.1996. 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. National Rural Health Mission. The Project Director is the Secretary of the society for the implementation of the scheme.04. Every district in the state has one District Blindness Control Society to govern the activities of the National Programme for Control of Blindness. and Chennai with effect from 01. execution and monitoring at the District level. The District Blindness Control Society conducts eye camps with the help of Voluntary Organisations and District Mobile Ophthalmic Units. 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 .2007. provides financial assistance to Voluntary Organisations for performing Cataract Operations. The Tamil Nadu State Blindness Control Society is functioning under the control of Mission Director. State Health Society.2 For effective implementation and monitoring of the work at District level.175 to the goal by planning. a District Blindness Control Society has been formed in all the Districts. 16. 16. 6.581 persons have been done cataract surgery. The State has been a pioneer in tackling blindness. 16. was given importance and various infrastructure facilities like base eye wards.17.176 Control Society. District Blindness control Societies are under the Chairmanship of the District Collectors. The District Blindness Control Societies are permitted to hire private Ophthalmic Surgeons to do cataract surgeries in Government Institutions and pay Rs.. dark rooms etc.3 The cataract.50 per cataract case ii.150 per cataract case 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. particularly arising from cataract.4 During the year 2012-2013. have been built till 2002 and are now in use. . Government has taken the following measures to increase the cataract surgeries in Government Institutions:i. being the major cause for the avoidable blindness. 177 16.5 The following activities will be carried out during 2013-2014:i. ii. Performing cataract operations and fix Intra Ocular Lens (IOL) Screening of school children for detection of refractive error and provide free spectacles to poor children Collection of eyes for transplantation in persons with corneal blindness Providing training to eye surgeons in modern cataract surgery and other specialised procedures Enhancing capacities for eye care services in public sector by providing assistance to hospitals at various levels 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 iii. iv. v. vi. 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 To admit members into the colony who are non-infectious so that they could live with their families To provide occupations like printing and carpentry to begin with To pay remuneration to the members for work done To make arrangements for recreation and periodical medical examination ii. iii. iv. v. Tambaram and advised by an advisory committee for which he is the Secretary. Tambaram. Sanatorium.14 acres and situated about half a kilometer away from the TB Sanatorium. .181 Amrith Nagar Colony occupies an area of 17.B. The centre is under the supervisory control of the superintendent Government T. 18. Besides giving treatment to mentally ill patients.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. Chennai is the only Hospital functioning in the state for the treatment of Psychiatric patients.182 Chapter 18 NATIONAL MENTAL HEALTH PROGRAMME Mental Health Care 18.2 Government of India has sanctioned a onetime grant under National Mental Health . The existing N.R. The Hospital has 1.800 beds and the patients from neighboring States are also coming to this Hospital for taking treatment.1 The Institute of Mental Health. A Mental Health Rehabilitation Centre will be established at Erwadi in Ramanathapuram District. 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. ix. Coimbatore Government Kanniyakumari Medical College Hospital. Madras Medical College. Tiruchirappalli Government Thoothukudi Medical College Hospital. iv. vi. xi. Chennai Government Kilpauk Medical College. Salem Thanjavur Medical College Hospital. Chengalpattu Government Mohan Kumaramangalam Medical College Hospital. x. Madurai. Thanjavur Mahatma Gandhi Memorial Government Hospital. Chennai Chengalpattu Medical College. vii. v. Chennai Government Stanley Medical College. iii. Nagercoil. Government Rajaji Hospital. Thoothukudi Government Coimbatore Medical College Hospital. ii.183 Programme for strengthening of psychiatric wings to the following Medical Institutions under the control of the Directorate of Medical Education:i. Government Theni Medical College Hospital. xii. . Theni. viii. The aims of the District Mental Health Programme which is under implementation in the state are as follows i. 2. To create awareness regarding Mental Health in the community.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. To reduce the stigma attached towards mental illness through change attitude and public education. To integrate and implement Mental Health Services through all the wings of the Health Department. iv.184 District Mental Health Programme 18. A sum of Rs. 18. v.4 The programme is under implementation in the following 16 Districts . To treat the rehabilitated mental patients discharged from mental hospital within the community. ii. iii.01 crore was allocated during 2012-2013. To facilitate the early detection and treatment of the patient within the community itself. 5 Implementation of District Mental Health Programme is proposed for the following six more Districts – i. ii. Namakkal. Coimbatore Pudukkottai Sivagangai Thoothukudi Villupuram Dindigul . Table No. v.21. Perambalur and Virudhunagar Year of Implementation 1997 2001 2005-2006 2007-2008 18. vi. No 1 2 3 4 Name of the Districts Tiruchirapalli Madurai and Ramanathapuram Theni. iv.21 . Dharmapuri. Cuddalore. iii. Erode and Nagapattinam Tiruvallur. Kancheepuram. Kanniyakumari. Chennai.Districts implementing the District Mental Health programme Sl.185 of Tamil Nadu since the year indicated in Table No. Tiruvarur. The authority is mandated with the responsibility of developing regulating and coordinating mental health services in the State.2012. 18. 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 .Tamil Nadu (SMHA . The office of State Mental Health Authority is functioning in the campus of Institute of Mental Health. Chennai from 01.7 The Institute of Mental Health at Chennai is the major Hospital under the Government sector offering all mental health related services. direction and control of the State Government.TN) was formed as a statutory body under section 4 of the Mental Health Act. 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.6 In 1994 the State Mental Health Authority .08. It is functioning under the superintendence. The Secretary to Government.186 State Mental Health Authority (SMHA) 18. 1987. Institute of Mental Health. Apart from these psychiatry units are being run in all the District headquarters hospital in the State. iii. From the societal point of view.187 mentally ill patients. State Mental Health . 18. ii.9 The SMHA is striving to enhance the role of government in integrating mental health hospitals/ units. Supervising the psychiatric hospitals/ Nursing homes and other Mental Health Services Agencies Advise the State Government on all matters relating to Mental Health Advocate for integration of mental health in general health care and in all social Development sectors. 18.8 The State Mental Health Authority provides mental health related services which include:i. private organisations and the society at large thereby taking care of the mentally ill patients. 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. 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. . like artificial containers are critical for control of Aedes mosquito which spreads these diseases. This facility has been extended to other Head Quarters Hospitals also by the Government. Elimination of vector breeding places. spread of the disease was controlled. Cuddalore and Ramanathapuram for diagnosis of Dengue and Chikungunya. King Institute of Preventive Medicine. Last year up to December 2012. Institute of Vector Control and Zoonoses. Zonal Entomological Teams. Government of India has identified 31 Sentinel Surveillance Hospitals including Medical College Hospitals. Guindy and District Headquarters Hospitals.189 Chapter 19 NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMMES Dengue 19. Dengue is reported in more than 107 countries and from almost all the states in India. Hosur. 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.1 Dengue fever is a mosquito borne virus disease. . Japanese Encephalitis Control Units at Cuddalore.2 percent from urban areas.869 of which 37.2 Malaria remains an important public health issue in few urban and rural areas viz.190 13. Japanese Encephalitis 19. and Perambalur with Monitoring Unit in Chennai are carrying out Japanese Encephalitis Vector Control . The disease is now under control and is under surveillance. Thoothukudi. Dharmapuri. Introduction of Indian medicines such as Papaya juice extract.204 cases were recorded and 66 deaths reported. Chennai. Ramanathapuram. Tiruvannamalai and Kanniyakumari Districts. Villupuram. while 62.8 percent were reported from rural areas. Malaria 19. This disease also is now under control and is under surveillance.. The total number of positive cases recorded in the State last year (up to December 2012) was 18. Krishnagiri. Nilavembu and Malaivembu kudineer had a positive effect on control of Dengue.3 Japanese Encephalitis (JE) is one of the public health problems in the state. Cuddalore. Districts such as Perambalur. Tiruchirapalli. 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.. Fogging operation is being carried out in villages where suspected JE cases are reported.) Villupuram. Thanjavur. Tiruvannamalai. Medical College Hospitals and major private hospitals. In Tamil Nadu five districts (viz.191 activities. Tiruvarur and Madurai report JE cases.4 Acute Encephalitis Syndrome (AES) Surveillance is being carried out in District Head Quarters Hospitals. During 2012. Tiruvarur and Karur have been . Virudhunagar. Madurai. Lab diagnosis is done in 7 Sentinel Surveillance Hospitals which includes King Institute of Preventive Medicine and six Medical College Hospitals. Thanjavur. 954 AES cases with 72 deaths and 33 JE cases with 5 deaths have been reported. 19. necessary symptomatic treatment is given to the patient in Medical College Hospitals. Villupuram. JE vector monitoring is being carried out regularly in the endemic districts. When JE is confirmed by laboratory diagnosis. Serum samples are taken from the AES cases for diagnosis of JE. seizures. mostly in children below 15 years.5 Acute Encephalitis Syndrome (AES) is a general description of the clinical presentation of a disease characterized by high fever and altered consciousness.192 identified as the focus districts under the control of JE/AES programme of Government of India. There are seven Sentinel Surveillance Hospitals in Tamil Nadu where JE virus is detected by ELISA IgM test kit supplied by . 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. Acute Encephalitis Syndrome (AES) has a very complex etiology. Serum / CSF is taken from the Acute Encephalitis Syndrome cases and sent to the Sentinel Surveillance Hospital for JE virus detection. convulsions etc. Acute Encephalitis Syndrome 19. Hence AES surveillance is being conducted to pick up all the JE cases. and JE virus is only one of the many causative agents of encephalitis. Madurai Government Tirunelveli 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. Thanjavur Government Madurai Medical College.193 National Institute of Virology (NIV). Prevention and Control measures 19. Tirunelveli Government Coimbatore Medical College. Following are the list of Sentinel Surveillance Hospitals        King Institute of Preventive Medicine. Tiruchirapalli Government Villupuram Medical College.7 Case Encephalitis management for Acute Syndrome / Japanese . Guindy KAP Viswanatham Government Medical College. Villupuram Government Thanjavur Medical College. Case Management. Pune. initially children in the age group of 1-15 years were given SA 14-14-2 type of JE vaccine in campaign mode. 25 control Units and . Villupuram. Vector control activities are done by outdoor thermal fogging using technique.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. Perambalur. The filarial disease control activities are carried out in 43 urban areas. Thanjavur. Malathion to reduce the JE vector density in all AES/JE reported areas.8 The National Filarial Control Programme is under implementation in the State from 1957. Tiruvarur. Filaria 19. Thanjavur and Tiruvannamalai districts were covered by campaign and later included under routine immunization for children in the age group of 16 months. Cuddalore. Virudhunagar. Madurai. For the prevention and control of Japanese Encephalitis. Karur and Madurai are the priority districts for this disease. Tiruchirapalli. Tiruvarur. In these urban areas. Villupuram. 000 per month now. Morbidity management kits are also issued to these patients for foot care. 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.4.400 per month was given to Grade IV Lymphatic Filaria patients. The entire operational cost is met by the State Government. Chikungunya 19.1% for which Rs.9 Chikungunya is caused by mosquito borne virus transmitted to humans by Aedes mosquitoes. Mass Drug Administration for 2012 was conducted on 29th April. This has been enhanced to Rs.195 44 Night Clinics are functioning. A sum of Rs.1.947 Lymphatic filariasis cases have been recorded in this state. Self-care practices training for the Lymphoedema cases and Hydroceletomy for hydrocele cases are organized.00 crore was allotted by Government of India. 2012 and 26th August. 33. There is a decline in Chikungunya cases due to the control . 2012 with coverage of 94. Mass Drug Administration programme with Diethyl Carbamazine Citrate (DEC) tablet was started in 1996 in Cuddalore District as a pilot project. 587 cases were recorded of which only one death was confirmed. Up to December 2012. The Institute of Vector Control and Zoonoses. treatment and control measures. Up to December 2012. A State Level Reference Laboratory is functioning at State Head Quarters to provide laboratory confirmation and training. 3.356 cases were suspected out of which 514 cases were confirmed and treated. Hosur is given the responsibility of investigation during outbreaks with specialized Team. The State is also at the forefront in eliminating communicable diseases. .196 measures taken by the Department. Seven leptospirosis clinics are functioning in Tiruvallur and Madurai districts for diagnosis and treatment. Leptospirosis 19. Vector borne diseases control and epidemic control activities 19. 5.10 Leptospirosis is one of the serious zoonotic diseases which require timely diagnosis. Rapid diagnostic kits have been supplied to these clinics and the nine Zonal Entomological Teams in the state.11 Tamil Nadu is one of the top States in most of the health indicators. v. vi. Accordingly. . at the district level. medicine. blood and blood components Conduct of fever camps Sending medical teams to the districts that reported higher incidence of fever Organizing entomological surveillance report based actions Putting in place 10 persons per block under the Health Department. iv. Some of the important actions implemented based on the decisions of review meetings conducted by the Hon’ble Chief Minister were – i.197 19. Release of short films and advertisements educating the masses of their role in preventing mosquito breeding Increase in the number of Elisa Test Centres from 31 to 60 Making available adequate cell counters. 20 persons per block through the Rural Development Department and ii. iii. Hon’ble Chief Minister conducted a series of review meetings and issued detailed instructions. the District Collectors have been coordinating the control measures by involving all the departments.12 On this issue. vii. 13 The District Collectors take continuous action to conduct and review and control of these diseases at the field level. ix.198 viii. additional labourers in Town Panchayats/Municipalities and Corporations for identifying and eradicating sources of breeding Providing adequate equipment for vector control Providing traditional medicines and promoting natural healing through Indian Systems of Medicines 19. . cervical and breast cancer. 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.1 Most forms of cancer are curable when detected and treated early. DIABETES AND CARDIOVASCULAR DISEASES 20. Karapettai. it is proposed to establish regional cancer centres at Thanjavur and Tirunelveli Medical College hospitals at a cost of Rs. Government have identified the following six institutions: i. ii.00 crore. Besides Arignar Anna Cancer Institute. Kancheepuram. Kancheepuram Mahatma Gandhi Memorial Government Hospital. 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. Government Arignar Anna Memorial Cancer Institute. Tiruchirapalli .199 Chapter 20 NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER. In the current year.30. The state is also creating more regional cancer centres. vi. Chennai Institute of Obstetrics and Government Hospital for Women and Children. Institute of Non communicable Diseases and Government Royapettah Hospital. iv. Thanjavur 20. .200 iii. Chennai Rajiv Gandhi Government General Hospital. v. Diabetes.2 Under National Programme for control of Cancer. Chennai Government Thanjavur Medical College Hospital. Cardio-Vascular Diseases and Stroke provision has been made for purchase of certain modern equipment for Treatment of Cancer. So far. Government of India has provided financial assistance of Rs. Smoke Free Chennai 21.67 lakh. The District Tobacco Control Cell has been formed in all the districts and functions under the supervision of the Deputy Director of Health Services.201 Chapter 21 NATIONAL TOBACCO CONTROL PROGRAMME 21.50. two districts namely Villupuram and Kancheepuram have been selected as pilot districts for implementation of the District Tobacco Control Programme.2 The State Tobacco Control Cell has been functioning under the “Smoke Free Chennai” project under the support of Bloomberg Global Initiatives.46 lakh.1 The National Tobacco Control Programme is being implemented in Tamil Nadu since 2003.376 violators have been fined for a total of Rs. Under the National Tobacco Control Program. The State Tobacco Control Cell is functioning under the Director of Public Health and Preventive Medicine since 2007. 68. Four enforcement vehicles are covering Chennai .77. .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. The vertical programme had been integrated with General Health Care System during 1997. 50 blocks are identified as High Endemic areas and focused activities are carried out in these blocks. The prevalence rate 118/10. Multi Drug Therapy was launched in 1983 in a phased manner and a complete geographical coverage in the State was achieved in 1991.203 Chapter 22 NATIONAL LEPROSY ERADICATION PROGRAMME 22.000 population in the year 1983 was brought down to 0.1 National Leprosy Eradication Programme (NLEP) was launched in 1954-1955 with the main thrust in detection and regular treatment of all leprosy patients. . Out of 385 blocks.42/10000 population in 2012. 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 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. ii. Government Vellore Medical College Hospital.204 Chapter 23 ACCIDENT AND TRAUMA CARE CENTRES 23. the Government of India have introduced a scheme. In the multi pronged approach. Vellore Government Kilpauk Medical College Hospital. The Government of India has released funds for development of network of Accident and Trauma Care Centre in the following institutions: i. Madurai . Chennai Government Rajaji Hospital.1 The Government has been taking a number of initiatives to reduce the deaths due to traffic accidents. use of 108 ambulances have reduced the reaction time to about 20 minutes thereby ensuring that the accident victims are attended to. iii. 75 crore as grants-in-aid for construction of building only for Trauma Care centre in Government District Headquarters Hospitals at Karur.3 Building work for Trauma Care Centre at Government District Head Quarters Hospitals Krishnagiri. Salem Upgradation and Strengthening of Trauma Care Centre 23. vi. Dindigul and Kovilpatti have been completed and these Trauma .2 During the 11th Plan period (2007-2012). and East–West corridors of National Highways. Krishnagiri. Government Tirunelveli Medical College Hospital. Under the above scheme.2. v. Tirunelveli Government Kanniyakumari Medical College Hospital. Nagercoil Government Mohan Kumaramangalam Medical College Hospital. 23.205 iv. North-South. the Government of India has upgraded and Strengthened the Trauma Care Centres in certain Government Hospitals located along Golden Quadrilateral. the Government of India have released a total amount of Rs. Kovilpatti and Dindigul. These centres are being equipped with necessary infrastructure to ensure quality care. Karur is nearing Completion. .206 Care Centres are now functioning. The building work for Trauma Care Centre in Government District Headquarters Hospital. 1 In order to achieve the objective of Universal Health Care to the People of Tamil Nadu.50 lakh per year per family for certain specified 77 procedures. Rs. Additional new enrollment is done through . The new scheme covers 1016 procedures which include 23 important diagnostic procedures and 113 follow up procedures. new smart cards are being generated by using the existing data base and distributed to the beneficiaries. The sum assured is Rs. So far.4 lakh coverage is also being provided to each family in 4 years. the “Chief Minister’s Comprehensive Health Insurance Scheme”.2 For identifying the beneficiaries under the scheme. Families with an income of Rs.1. along with a provision to pay upto Rs. 24. the Government have issued orders for implementation of a New Insurance Scheme.72. Rs.207 Chapter 24 CHIEF MINISTER’s COMPREHENSIVE HEALTH INSURANCE SCHEME 24.1/.000 per annum or below are eligible under the new scheme.lakh per year per family.1.07 crore smart cards have been distributed in the districts. It is not possible for the poor patients to pay the extra cost for the surgery. As on 31.3 Surgeries such as Liver Transplantation. including all the Government Medical College Hospitals and the District Head Quarters Hospitals.3.623.96 lakh persons have benefited under the scheme with the approved amount being Rs.10. Bone marrow transplantation. 1. announced the creation of a Corpus Fund of Rs.50 lakh. Out of this. The Hon’ble Chief Minister has.2013.1.217. 24.58 crore.50 lakh and range from Rs. Cochlear implantation and stem cell transplantation cost more than Rs. Hospitals approved under the scheme cannot also be insisted upon to perform the surgeries within the cost of Rs. Till 31st March 2013.70 crore. The extra cost of the surgery exceeding the . who have to undergo such costly surgeries.208 District kiosks established in the District Collectorates. therefore.3 lakh to Rs.00 crore to help the needy and poor people. Renal Transplantation including post transplant procedure for immunosuppressant therapy. 2. especially children.1.04. 817 hospitals have been empanelled to provide treatment.953 beneficiaries have been treated in Government Hospitals at an insurance coverage of Rs.22 lakh. 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. TAMIL NADU STATE ILLNESS SOCIETY 24.50 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.03.1.209 eligible amount Rs. Accordingly. The entire cost of specialized surgery will be borne by the Insurance Company upto Rs.50 lakh and the remaining amount will be met from the Corpus Fund.1998 under Tamil Nadu Societies Registration Act 1975) to administer the fund.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. The affairs of the Tamil Nadu State Illness Assistance Society is administered by . All such cases are cleared by an Expert Committee.1. 25.3. there are two patterns of assistance offered 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.000 according to the nature of surgery to Below Poverty Line people.90 crore per annum ii.95 crore per annum.210 the Executive Committee under the Chairmanship of the Secretary to Government. Through this society. 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. . i.000 to the individuals / at accredited private hospitals. Revolving fund fixed to the 32 District Collectors for disbursement of Financial Assistance of Rs.2.5. The objective of the scheme is to render financial assistance from Rs.000 to Rs.25. Health and Family Welfare Department and the Director of Medical and Rural Health Services as the Member Secretary. the State. Chennai and Deputy Secretary to Government. the Government of India has enacted the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act. the other members are the Secretary.2 For effective implementation of this Act. infanticide and neglect of female child from birth. For the District Level. 1994. In order to prevent Sex determination.211 Chapter 25 IMPORTANT ACTS Pre-conception and Pre-Natal Diagnostic (Prohibition of Sex Selection) Act. 25. At State level there is Multi Member Appropriate Authority wherein the Director of Medical and Rural Health Services is the Chairperson. Guild of Service. 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. District . 1994 25.1 The female sex ratio declines mainly due to female foeticide. Law Department. District and Sub-District level Advisory Committees have already been formed. non-bailable and non-compoundable offences up to 3 years of imprisonment. Judgment had already been delivered in 62 cases and 10 cases are under trial. . So far 4. 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. For Sub–District Level. Offences under the Act such as non-registration and misusing the equipments to disclose the sex of the foetus are punishable as cognizable. The doctors who are found indulging in malpractices are also liable to lose their Registration for Medical Practice. Under the Act all such organizations involving in the Pre-Natal Diagnostic Techniques should register themselves with the Appropriate Authorities.212 Collector is the District Appropriate Authority.978 scan centres have been registered under the Act and cases have been filed against 72 scan centres for the violation of this Act. Revenue Divisional Officer is the Sub-District Appropriate Authority. 1994 25. The transplantations are being done only in the approved hospitals in Tamil Nadu. Madurai and Coimbatore for scrutiny of each and every non relative case for approval of organ transplantation. .213 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.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 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. The team inspects the hospitals and furnish the inspection report in the prescribed format. The Hospitals which are applying for registration under the Transplantation of Human Organ Act. Now. liver. lungs and corneal transplantations.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. to ensure stability of functioning of the programme and to recommend a coordinating body to institutionalize and . The donors and the recipients have to appear before the Committee.214 25.4 Accordingly. region wise submit their application for organ transplantations to the respective Authorization Committee. In the State 72 hospitals are registered under this Act for performing renal. Each and every case of non relative is verified and approved by Committee for carrying out the transplantations. heart. to oversee compliance with procedures. This programme is supported by an Advisory Committee that has been formed to establish formats and procedures. Tamil Nadu ranks top at the national level in the implementation of the Cadaver Transplant Programme. the State had initiated this programme during the year 2008. the registered hospitals. Cadaver Transplant Programme 25. Prior to the introduction of Registration of Births and Deaths Act. 1969 by the Government of India. The Rajiv Gandhi Government General Hospital. Civil Registration system 25. registration of births and deaths in . Erode. Nagercoil Coimbatore. Lungs. Chennai and the Stanley Hospital.215 streamline the programme. Liver and Kidneys). Madurai. Currently 38 Hospitals are involved in this programme. Chennai are actively involved in the programme. there are 324 donors and 1820 organs were harvested out of which 959 were major organs (Heart. Vellore Tiruchirapalli. Salem Up to March 2013.6 Tamil Nadu has a long tradition of registration of births and deaths. 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 belowNorth Zone South Zone West Zone Chennai and neighbourhood. Tirunelveli. The Registration of Births and Deaths was made compulsory at the place of occurrence. 1920 in the Municipalities and selected Town Panachayats and the Madras City Municipal Act 1919 in Chennai Corporation.046 Registration Units in 32 Revenue Districts including Chennai Urban District. the Madras Districts Municipalities Act. In Chennai Corporation.216 Tamil Nadu was carried out under the provisions of Madras Panchayats Act 1899 in Rural Areas.2000 in accordance with the provisions of sec. the Birth and Death Certificates are issued online. Tamil Nadu has achieved 98% in birth registration and 91% in death registration during 2010. With the introduction and implementation of Tamil Nadu Registration of Birth and Death Rules.1. . The Birth and Death Registration system has been computerized in the entire rural and urban areas of Tamil Nadu. 30 of The Registration of Births and Deaths Act 18 of 1969. 2000 with effect from 1. The registration of Birth and Death should be done within 21 days of its occurrence. There are 16. 8 The MCCD scheme is a part of Civil Registration System and is the only source which provides cause specific mortality data. 2013 to the beneficiaries in the state. To improve Medical Certification of Cause of Death. 9. .217 Issue of Free Birth Certificates at PHCs 25. 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. Medical Certification of Cause of Deaths (MCCD) 25.80.780 Free Birth Certificates have been issued up to February. regular trainings are given to doctors every year.7 Since the implementation of Birth and Death Registration at Primary Health Centre level from 2009 August. conducting various courses in Medicine and allied sciences.218 Chapter 26 EDUCATION. At present. Medical University was started to promote academic excellence. 328 institutions.G.King.G. Started as a Depot for Small pox vaccine by the British Government.2 King Institute of Preventive Medicine was established on 07. three and eight. and the then .1 The details of the University and about medical education have been given in chapters two. M.1899.11. it is named after Lieutenant Colonel W. research and advancement of knowledge in the field of Medical and Para Medical Education. the Tamil Nadu Dr. King Institute of Preventive Medicine and Research 26.G.R.M. TRAINING AND RESEARCH The Tamil Nadu Dr. are affiliated to this University. As mentioned earlier. The University Library serves as a Regional Medical Library and Medical informatics centre.R. FMS. Medical University 26. It was originally designed to serve as a Vaccine Lymph Depot of State. The institute has facility for identifying 23 different types of viruses. This institute has been developed into a major Public Health Laboratory in the country. diagnostic work (bacterial & viral). It is unique in its activities – production of vaccine and sera.219 Sanitary Commissioner to the Madras Presidency. this Centre is one among the 14 centres recognized by the Ministry of Health. academic activities. Government of India. during epidemics in Tamil Nadu. International Vaccination Centre 26. King Institute played an important role by way of production and supply of Anti Cholera and Anti Typhoid Vaccines.3 Functioning for the past 40 years. This centre mainly deals with the inoculation of Yellow Fever vaccine and issue of International Vaccination Certificate to the public . certification of schedule -C drugs. manufacturing human vaccines and sera with allied Teaching and Research in the field of Microbiology. In the past. The institute is under the administrative control of Directorate of Medical Education since 1966. 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. The institute of Public Health. Health and Family Welfare Training Centres at Egmore. Haj Pilgrims are inoculated with Meningococcal vaccine. Regional Institute of Public Health. medical officers. Health Manpower Development Institutes at Villupuram and Salem. 26.5 Multi skilling. Madurai and Gandhigram. Training and Continuing Health Education Programme under Public health 26. nurses and other paramedical staff through six regional training centres namely Institute of Public Health.4 Continuing education. Thiruvarankulam and Institute of Vector Control and Zoonoses. Hosur.220 traveling to Yellow Fever endemic areas. in-service training and pre-service training programmes are organized for the health officers. task shifting training programmes are organized for medical officers in life saving anesthesia and . Poonamallee. Namakkal and Sivagangai districts are being established in Tamil Nadu with assistance from the Government of India. Skill Birth Attendant training. Three new ANM training schools at Theni. Ultra sonogram training is given to PHC doctors for detection of congenital deformities during pregnancy in coordination with renowned private sector ultra sound agencies. During 2011-2012 three hundred candidates were trained and during 2012-2013. The Auxiliary Nurse Midwife (ANM) course is being conducted in seven ANM training schools.6 The Multi Purpose Health Worker (Male) Training Course is conducted in Medical Colleges and Regional Training Centres. permission has been accorded to train 600 candidates. 26. . training on integrated management of newborn and childhood illnesses and immunization training are organized for improving the mother and child care services in PHCs. ANM training has been started during the current year for filling up of the existing vacancies of Village Health Nurses and Auxiliary Nurse Midwives.221 obstetrics for a period of six months to improve the availability of specialist services in rural areas particularly in Primary Health Centres. Integrated Disease Surveillance Project (IDSP) and Central Plan Scheme Monitoring System (CPSMS). Dr. The List of Web Portals include Pregnancy and Infant Cohort Monitoring and Evaluation (PICME). Civil Registration System (CRS). National Rural Health Mission (NRHM-MIS). Web portals are developed and used for data management at various levels.8 In addition regular training is organized for various levels under the institutions under DME and DMS and DPH.222 E-Governance in Public Health 26. Health Management Information System (HMIS).7 The Directorate of Public Health and Preventive Medicine is actively implementing the e-governance policy of the government. National Anti-Malaria Management Information System (NAMMIS). Communicable and Non-Communicable Diseases data. . Specialty Medical Camps. The Health Systems project and the National Rural Health Mission also have allocated funds for training. 26. All the PHCs are provided with computers and internet connectivity.Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS). VEERAMANI Minister for Health .C. K.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.