6 HD and Health SEC

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Round Table Discussion on

Human Development

& Agriculture Diversification

and Water Resources Management

Proceedings

State Planning CommissionChennai

(18 ± 19, May 2005)



Human Development

and

Health

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 acomposite index covering longevity

measured by life expectancy at birth,

educational attainment computed as acombination 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.



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

Basic Demographic IndicatorsTamilnadu

Source: Census



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

2001-06

M 67.0

DEMOGRAPHIC PROFILE

Source: Registrar General & DPH&PM



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

TAMILNADU HUMAN DEVELOPMENTINDICATORS - 2003

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



0

20

40

60

80

100

120

140

1971 1981 1991 2002

TAMIL NADU

INDIA

INFANT MORTALITY RATE 1971 TO 2002

113

44

Source : SRS

63

129



CO PO E S OF R (2002)

Source: SRS

(0-6 DAYS)

(7-27 DAYS)

(28-364 DAYS)



CLASS F C A O OF DEL VER ES - 2004-05CLASS F C A O OF DEL VER ES - 2004-05

Source: PHC Records



1971 1981 1991

1996

20.318.0

61.7

31.018.1

50.9

56.8

24.418.8

64.7

20.9

14.4

INSTITUTIONAL DELIVERIES

DELIVERIES CONDUCTED BY

TRAINED PERSONNEL

DELIVERIES CONDUCTED

BY UNTRAINED PERSONNEL

2005

94.3 5.50.2

GROW H OF SAFE DEL VER ES (%)GROW H OF SAFE DEL VER ES (%)



THENI ± DELIVERY PERFORMANCE

(% OF CONTRIBUTION)

THENI ± DELIVERY PERFORMANCE

(% OF CONTRIBUTION)

DO

HSC

PHC

GH

P H

Source: PHC Records



SEXW SE . .R A L ADUSEXW SE . .R A L ADU

SOURCE: SRS



3004

3226

3002

33173417

3014

2568

1281

372225

0

500

1000

1500

2000

2500

3000

3500

4000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

FE ALE FA CIDE IN T A IL N ADU

(1994-2003)FE ALE INFANTICIDE IN T A IL N ADU

(1994-2003)

SOURCE: PHC RECORDS



NUMBER OF MATERNAL DEATHSREPORTED

NUMBER OF MATERNAL DEATHSREPORTED

Source: PHC Records

640

905

1089 1100

12971253

1432

1636

1498

1307

1219

0

200

400

600

800

1000

1200

1400

1600

1800

1 9 9 4

1 9 9 5

1 9 9 6

1 9 9 7

1 9 9 8

1 9 9 9

2 0 0 0

2 0 0 1

2 0 0 2

2 0 0 3

2 0 0 4



2 8 . 7

2 4 . 2

1 8 . 9

2 4 . 9

2 0 . 2

3 7 . 8

15

20

25

30

35

40

1985 1990 1995 2000 2002 2003

Source : DFW

TRENDS IN HIGHER ORDER OF BIRTHS



COMPREHENSIVE EMERGENCY OBSTETRIC AND

NEWBORN CARE (CEmONC))


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 hospitalsand 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





� Caesarean services

� Separate casualty for obstetrics, newborn

and for general cases. 3 doctors

separately for each casualty

� Blood bank / storage centre services


NEWBORN CARE (CEmONC)


NEWBORN CARE (CEmONC)

ROUND THE CLOCK



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

CO PREHENSI VE E ERGENC Y OBSTETRIC

AND NEWBORN C ARE (CEmONC)CO PREHENSI VE E ERGENC Y OBSTETRIC

AND NEWBORN C ARE (CEmONC)

SERVICES



� Obstetricians 4� General surgeons2

� Paediatricians 4

� Anaesthetists 2 (on call duty)

� Hiring private anesthetists from the panel

CO PREHENSI VE E ERGENC Y OBSTETRIC

AND NEWBORN C ARE (CEmONC)CO PREHENSI VE E ERGENC Y OBSTETRIC

AND NEWBORN C ARE (CEmONC)

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



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 TRAININGMOBILITY TRAINING

� The female field health functionariesgiven moped loan

� 5 day training was organised to impartmobility and communication skills

� The percentage of VHNs using mopeds

increased from 30% to 90%





Notification of Maternal Deathsin 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



� Only state in the country which conducts vital eventssurvey.

� SRS provides only state wise data.

� VES provides district wise vital rates which is useful for

planning.

� Vital events survey covers both municipal and nonmunicipal areas in all the districts.

� Yearly district wise vital events survey conducted from

1996 to 1999 and 2003.

Vital Events Survey



T ACKLING FE ALE INFANTICIDE :

T A IL N ADU EXPERIENCE

A systematic social mobilization campaign wascarried out using the strategy of KALAJATHA / KALAIPAYANAM or travelling street theater in

Dharmapuri and Theni

Elected local body leaders and health systemfunctionaries at all levels in the high female

IMR districts were systematically sensitised ongender issues and female infanticide throughworkshops, seminars etc.



T ACKLING FE ALE INFANTICIDE :

T A IL N ADU EXPERIENCE

Organisation of special awareness programmesfor adolescent girls along with local body leadersand high risk families.

Cradle baby scheme of the Honble Chief Minister

Girl Child Protection Scheme

Convergence of schemes of Social Welfare, HealthDepartment, Police and District Administration



Tackling Female Infanticide :

Tamil Nadu Experience



The results are truly dramatic : The numberof female infanticide deaths has declined froman annual average of around 3000 between

1995 and 1999 to just 225 in 2003.

Even allowing for some under reporting, thisis highly significant

The Lesson : Committed intervention bygovernment promoting social mobilization canmake a difference

Sustaining the improvement is essential

Tackling Female Infanticide :

Tamil Nadu Experience



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 topromote health, prevent illness and treat

ailments



HMIS

A Tamil Nadu Initiative

� Until late 1990s monitoring systems

covered only outreach activities

� Monitoring of institutional activities

especially regarding PHCs were not

available

� ISMR introduced in April 1999

Institutional Service Monitoring Report (ISMR)



HMIS ± A TAMILNADU INITIATIVE

� Services like OP, IP, deliveries, special clinics, laboratoryinvestigations, minor surgeries, utilisation of ambulancesetc in the PHC are included in the format

� The Optical Mark Reader (OMR) scans the special formatof the ISMR through a computer link, enablestabulations, 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 3.2in 2000-01 to 4.9 in 2004-05 (upto March)



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 andconstruction corporation

� Regulation of private medical institutions

� Bio-medical waste management

Initiatives Under Process



OUTPATIENTS SERVICES

� All PHCs : 1,66,970

� All Govt. hospitals : 1,87,000

� All Teaching hospitals : 66,840

AVERAGE DAILY OP IN GO VT. INSTITUTIONS

No. of patient visits to allgovt . 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� 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

CHALLENGES / CONCERNS

Documents

6 HD and Health SEC