Tamil Nadu’s health managers must be delighted the way the State’s illustrious maternal and child healthcare programme is being feted worldwide. The latest feather in Tamil Nadu’s cap is The Lancet’s mention of the programme as a “success story”.
The April edition of The Lancet records appreciation for Tamil Nadu in its article: ‘Good health at low cost 25 years on: lessons for the future of health systems strengthening’.
“Despite spending only one per cent of its gross domestic product on health, this region has made great progress in improving population health. Between 1980 and 2005, infant mortality fell in Tamil Nadu by 60 per cent, compared to 45 per cent for India as a whole, with the greatest gain in rural areas,” the authors Umakant Dash and V.R. Muraleedharan have said.
The study, which examined the situation in Tamil Nadu up until 2006 (before the introduction of the National Rural Health Mission, which has arguably changed the equation since), recorded that the greatest achievement in Tamil Nadu has been the reduction of maternal mortality, from 319 deaths per 1,00,000 livebirths in the early 1980s, to 111 deaths per 1,00,000 live births in 2004-2006. It has fallen further subsequently; the government data puts the maternal mortality rate of 2011-1012 at 73. Again, this decline was much faster than that in the country over all.
The authors have noted a key aspect that lends to better outcomes in Tamil Nadu: 90 per cent of deliveries attended to by skilled personnel, and 81 per cent of infants are fully immunised. “There were four factors that led to this kind of achievements,” explains Prof. Muraleedharan, who is also a professor at the Department of Humanities and Social Sciences, IIT Madras. Like the four mutant ninjas battling petty criminals, these factors have battled with the odds to improve healthcare systems in the State. Tamil Nadu was among the first few States to build an extensive network of primary healthcare centres, Prof. Muraleedharan added.
By 2005, about 1500 PHCs were open in the State, and a further 8680 health sub-centres – this was about the highest levels of coverage in any State. Secondly, it was the first to hire multipurpose workers: women with 10 years of schooling were trained to become village health nurses. Thirdly, a reliable supply of essential drugs was established with the formation of the Tamil Nadu Medical Services Corporation. “This is to be credited with substantial improvements in drug supply and management, and contributed to driving costs down,” he observed.
The fourth key initiative that the authors identified was the rapid scaling up of the immunisation schedules, assisted by agencies such as UNICEF, Rotary, and Christian Medical College, Vellore. Integration of immunisation within primary care greatly helped too.
“Certainly, there was a strong commitment to health by successive governments,” explained Prof. Muraleedharan. The article is actually a concise rendition of the key aspects of the book similarly titled, and funded by the Rockefeller Foundation. The original project, ‘Good health at low cost, 25 years earlier’, looked at why certain countries (China, Costa Rica, Sri Lanka and Kerala) achieve better health outcomes than others at a similar stage of growth.