Round Table Discussion on

Human Development
&
Agriculture Diversification
and Water Resources Management
(18 – 19, May 2005)

Proceedings

State Planning Commission

Human Development
and
Health
By Health Secretary,
 Human Development

Human Development is not only growth in

income, wealth or consumption but the
expansion of human capabilities.
 Human Development Index
The Human Development Index (HDI) is a
composite index covering longevity
measured by life expectancy at birth,
educational attainment computed as a
combination of adult literacy and enrolment
ratios at the primary, secondary and tertiary
levels combined and the standard of living
measured by per capita, real GDP adjusted
for purchasing power parity in dollors.
 Basic Demographic Indicators
Tamilnadu

INDICATORS 1971 1981 1991 2001

Population (Million) 41.2 48.2 55.9 62.4

Decennial growth (%) 22.3 17.5 15.4 11.2

Density (Popn./km2) 317 372 429 478

Urban Population (%) 30.3 33.0 34.2 44.0

Sex Ratio 978 977 974 987

Juvenile sex Ratio 984 974 948 939

Source: Census
 DEMOGRAPHIC PROFILE

VITAL EVENTS - 2002 TAMILNADU

Birth rate 18.5
Death rate 7.7
Infant mortality rate 44.0
Total fertility rate 2.0
Under 5 morality rate 57.0
Maternal mortality ratio 112
Juvenile sex ratio 939
Life expectancy at birth M 67.0
(2001-06)
Source: Registrar General & DPH&PM
 TAMILNADU HUMAN DEVELOPMENT
INDICATORS - 2003
Life expectancy at birth (Years) 66.74

Literacy rate (%) 73.5

Real GDP per capita in PPP 2097.09

Life expectancy at birth index 0.696

Education index 0.767

Income index 0.508
Human development index 0.657

Human development index (India) 0.571

Source: Human Development Report - 2001

HDI – INDIA & MAJOR STATES 2001
HEALTH INFRASTRUCTURE
• Teaching institutions (Govt.) (beds 21,399)14
• Teaching institutions (quasi govt.) 1
• Private medical colleges 7
• Nursing colleges (Govt.) 2
• Nursing colleges (Pvt.) 45
• Nursing schools (Govt.) 21
• Nursing schools (Pvt.) 110
• District headquarters hospitals 29
• Taluk Hospitals 155
• Non-taluk hospitals 80
• Women and children hospital 7
• Urban health posts 243
• Primary health centres (beds 7191) 1415
• Health sub-centres 8682
 INFANT MORTALITY RATE – 1971 TO 2002

140
TAMIL NADU
129
120 INDIA
113
100

80

60 63

44
40

20

0
1971 1981 1991 2002

Source : SRS
 COMPONENTS OF IMR (2002)

(0-6 DAYS)

(28-364 DAYS)

(7-27 DAYS)

Source: SRS
CLASSIFICATION OF DELIVERIES - 2004-05

Source: PHC Records

 GROWTH
GROWTH OF
OF SAFE
SAFE DELIVERIES
DELIVERIES (%)
(%)
1971 1981 1991

61.7 50.9 18.8

24.4

18.1 56.8
18.0 20.3 31.0

1996 2005 INSTITUTIONAL DELIVERIES

20.9 DELIVERIES CONDUCTED BY

14.4 5.5
TRAINED PERSONNEL
94.3
0.2
64.7 DELIVERIES CONDUCTED
BY UNTRAINED PERSONNEL
 THENI – DELIVERY PERFORMANCE
(% OF CONTRIBUTION)

PNH

GH

PHC

HSC

DOMI

Source: PHC Records

 SEXWISE I.M.R IN TAMIL NADU

SOURCE: SRS
FEMALE INFANTICIDE IN TAMIL NADU
(1994-2003)

4000
3417
3500 3317
3226
3004 3002 3014
3000
2568
2500

2000

1500 1281

1000

372
500 225

0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

SOURCE: PHC RECORDS

 NUMBER OF MATERNAL DEATHS
REPORTED

1800 1636
1600 1498
1432
1400 1297 1307
1253 1219
1200 1089 1100

1000 905

800640
600

400
200
0
1996

1997

2000

2003

2004
1994

1995

1998

1999

2001

2002
Source: PHC Records
TRENDS IN HIGHER ORDER OF BIRTHS

40 .8
37

35
.7
28

30

.9

.2
24

24
25

.2

.9
20

18
20

15
1985 1990 1995 2000 2002 2003

Source : DFW
 COMPREHENSIVE EMERGENCY OBSTETRIC AND
NEWBORN CARE (CEmONC))

• 62 CEmONC centres , (2 to 3 for each district),

have been identified for the provision of CEmONC
services.
• Of these, 51 are district and sub district hospitals
and 11 are tertiary institutions.
• The CEmONC centres are selected so that the
EOC and NB services are available within 1 hour
travel time.
• During the second phase more centres will be
identified to reduce the travel time to half an hour
COMPREHENSIVE EMERGENCY OBSTETRIC AND
NEWBORN CARE (CEmONC)

ROUND THE CLOCK

• Caesarean services
• Separate casualty for obstetrics, newborn
and for general cases. 3 doctors
separately for each casualty
• Blood bank / storage centre services
COMPREHENSIVE EMERGENCY OBSTETRIC
AND NEWBORN CARE (CEmONC)
SERVICES
• Manual removal of placenta
• D&C
• Caesarean services
• Management of PIH
• Management of diseases complicating pregnancy
• Hysterectomy
• Blood transfusion services
• Emergency newborn care services
• Lab. services
COMPREHENSIVE EMERGENCY OBSTETRIC
AND NEWBORN CARE (CEmONC)

SPECIALIST NORMS
(One specialist will be on stay in duty)

• Obstetricians 4
• General surgeons 2
• Paediatricians 4
• Anaesthetists 2 (on call duty)
• Hiring private anesthetists from the panel
 BIRTH COMPANIONSHIP

The presence of a female relative in labour

room is a low-cost intervention that has
proven to be beneficial to labour outcomes.
Introduced in all government medical
institutions in the State
BIRTH COMPANION INITIATIVE
 MOBILITY TRAINING
• The female field health functionaries given
moped loan
• 5 day training was organised to impart
mobility and communication skills
• The percentage of VHNs using mopeds
increased from 30% to 90%
 Notification of Maternal Deaths
in Tamil Nadu

• Sensitization of health care providers

• Information thro telegram / fax/ E mail
• Investigation within 15 days
• Feed back on the analysis
• Launched verbal autopsy system for
maternal deaths with narrative reports
• District maternal death audit
POSITIVE OUTCOMES OF MATERNAL
DEATH VERBAL AUTOPSY
• Service providers are sensitized to minimise delays
• Greater accountability of service providers
• Advance information to the referral centres
• Better coordination between referring and referral
institutions
• Very few unrecorded referrals
 Vital Events Survey
• Only state in the country which conducts vital events
survey.

• SRS provides only state wise data.

• VES provides district wise vital rates which is useful for

planning.

• Vital events survey covers both municipal and non

municipal areas in all the districts.

• Yearly district wise vital events survey conducted from

1996 to 1999 and 2003.
TACKLING FEMALE INFANTICIDE :
TAMIL NADU EXPERIENCE

• A systematic social mobilization campaign was

carried out using the strategy of KALAJATHA /
KALAIPAYANAM or travelling street theater in
Dharmapuri and Theni

• Elected local body leaders and health system

functionaries at all levels in the high female
IMR districts were systematically sensitised on
gender issues and female infanticide through
workshops, seminars etc.
TACKLING FEMALE INFANTICIDE :
TAMIL NADU EXPERIENCE

• Organisation of special awareness programmes

for adolescent girls along with local body leaders
and high risk families.

• Cradle baby scheme of the Hon’ble Chief Minister

• Girl Child Protection Scheme

• Convergence of schemes of Social Welfare, Health

Department, Police and District Administration
Tackling Female Infanticide :
Tamil Nadu Experience
 Tackling Female Infanticide :
Tamil Nadu Experience
• The results are truly dramatic : The number
of female infanticide deaths has declined from
an annual average of around 3000 between
1995 and 1999 to just 225 in 2003.
• Even allowing for some under reporting, this
is highly significant
• The Lesson : Committed intervention by
government promoting social mobilization can
make a difference
• Sustaining the improvement is essential
 Indian Systems of Medicine
Mainstreaming
• State level workshop on Sensitiation of ISM
drugs was organised

• Trainers training under progress

• Proposed to train 12,000 health factionaries

• Drug kit with 50 identified ISM drugs to promote

health, prevent illness and treat ailments
 HMIS
A Tamil Nadu Initiative
Institutional Service Monitoring Report (ISMR)

• Until late 1990s monitoring systems covered

only outreach activities
• Monitoring of institutional activities especially
regarding PHCs were not available
• ISMR introduced in April 1999
HMIS – A TAMILNADU INITIATIVE
• Services like OP, IP, deliveries, special clinics, laboratory
investigations, minor surgeries, utilisation of ambulances
etc in the PHC are included in the format
• The Optical Mark Reader (OMR) scans the special format
of the ISMR through a computer link, enables tabulations,
consolidations and analysis for a number of parameters
• Average OP per day per PHC increased from 79 in 2000-
01 to 118 in 2004-05
• Average delivery per PHC per month increased from 3.2
in 2000-01 to 4.9 in 2004-05 (upto March)
 Initiatives Under Process
Challenges
• Anaemia control through ISM drugs
• Upgrading skills of para-medicals – nurse
clinicians (doctor substitute)
• Emergency transport
• Common help line number
• Control room
• Link with police
• Setting up a health maintenance and
construction corporation
• Regulation of private medical institutions
• Bio-medical waste management
 OUTPATIENTS SERVICES
AVERAGE DAILY OP IN GOVT. INSTITUTIONS

• All PHCs : 1,66,970

• All Govt. hospitals : 1,87,000
• All Teaching hospitals :66,840

No. of patient visits to all

govt. institutions in one year : 15,35,95,650
 BUDGET

TOTAL BUDGET : Rs.31,655.53 crores

Budget for Health : Rs.1,652.04 crores

% to the total budget : 5.22

CHALLENGES / CONCERNS
• Urban health care
• Regional variations
• Mainstreaming ISM
• Rational drug use
• Addressing Life style Diseases - Hypertension,
Diabetes, Cancers
• Geriatric care
• Accidents and fatalities
 CHALLENGES / CONCERNS
CHALLENGES
• Declining juvenile sex ratio – female foeticide
• High still birth rate
• Slow decline of IMR
• Poor male participation in contraception
• 19% higher order births
• Upgrading tertiary level / teaching institutions
(improvement and research support)
• Regulation of deemed universities
• Improving quality of care in government hospitals