Pankaj Kumar Bansal,
Ex-officio Special Secretary,
Health and Family Welfare Department,
Government of Tamil Nadu

Pankaj Kumar Bansal, Ex-officio Special Secretary, Health and Family Welfare Department, Government of Tamil Nadu, talks to Elets News Network (ENN) about why Tamil Nadu has low mortality rates and effective healthcare services for citizens

Please provide an overview of the work that NRHM is doing in Tamil Nadu.
The aim of NRHM (National Rural Health Mission) in Tamil Nadu is to provide universal access to equitable, affordable and quality healthcare services. Efforts are being made to add and operationalise new urban and rural PHCs (Primary Healthcare Centres) and provide support for strengthening secondary and tertiary care centres as well.
All the PHCs are manned by two Medical Officers so that the quality of care remains universal. New PHCs are established every year and we are also in the process of upgrading one PHC in each block into an Upgraded PHC with 30 beds and better infrastructure. One upgraded PHC in each Health Unit District is being developed into a comprehensive MCH Centre which can handle obstetric emergencies including caesarean section. These centres are adequately provided with manpower and equipments. Tamil Nadu is the only state in the country where almost 70 percent of deliveries take place in government institutions.
NRHM has strengthened the infrastructure and provided high-end equipments in the Secondary Healthcare Sector, supplementing the inputs by the World Bank funded Tamil Nadu Health System Project. In the Tertiary Healthcare Sector, focus is provided more on very high quality MCH care and every year two medical colleges are strengthened into RCH – Centre of Excellence with additional buildings, equipments and manpower.

Most young MBBS doctors do not prefer to work in rural areas. In what ways are you encouraging them to opt for rural areas?
Tamil Nadu is one of the few states in the country with minimum vacancy in healthcare sector, even in rural areas. Credit goes to our recruitment system through which we have successfully encouraged doctors to work in rural places. We have set up Medical Recruitment Board, which is an organisation entitled to recruit doctors by conducting examinations. Recently we have recruited more than 1,500 doctors. We have 19 medical colleges in the state and around 50 percent of post graduate seats are reserved for government doctors. A doctor is entitled for two marks for every year of service in rural areas in his PG entrance exam.
Moreover, the facilities and infrastructure available in rural PHCs are at par with medical standards. This gives doctors the satisfaction of putting their medical education to effective use, hence encouraging them further to serve in rural areas.

Service to the Public
Tamil Nadu Medical Services Corporation Ltd (TNMSC) was set up in 1994 with the primary objective of ensuring easy availability of all essential drugs and medicines in government medical institutions throughout the state. It is engaged in the procurement, storage and distribution of: 268 drugs and medicines, 84 suture items and 63 surgical items to various Government Hospitals, Primary Health Centres and through them to the health sub-centres across the state.

114 veterinary drugs to various veterinary dispensaries under the control of the Directorate of Animal Husbandry.The bulk purchase of medicines and other items through TNMSC brings down the prices. Also, suppliers are aware that there should be no compromise in the quality of drugs and other supplies else they would be blacklisted. TNMSC also ensures that there is no shortage of medicine in any government hospital.


What has been NRHMs most significant achievement in Tamil Nadu the past ten years?

Tamil Nadu is ranked among the highperforming states in India, in the area of human resource development. The state is noted for its low mortality rates and effective healthcare services for which NRHM has been catalytic in the last decade.
The three-staff nurse model in PHCs has enhanced service availability and has ensured that there is one skilled birth attendant at any point of time to provide quality service or appropriate referral to higher centres without delay. This along with the improved facilities and infrastructure has increased the number of deliveries in PHCs from few thousands to 3 lakhs at present. This has also enabled us to make all 1,614 PHCs as 24×7 centres for maternity care. This model is being emulated by other states also.
NRHM has significantly contributed to the fall in IMR (Infant Mortality Rate) in the state. Under NRHM, 47 NICUs (Neonatal Intensive Care Units) and 42 NBSUs (New Born Stabilisation Units) have been established, while 17 NICUs and 114 NBSUs have been strengthened. With support from NRHM, the state has added 211 New PHCs and in the current year 118 New PHCs are in the pipeline. It is noteworthy that 209 PHCs have been upgraded with 30-bedded facilities and we have planned to upgrade 60 more in the current year.
385 Mobile Medical Units are functioning as Hospital on Wheels at one per block. This caters to the people in remote areas by providing healthcare at their doorsteps. Tailor-made healthcare plans are being uted for the tribal population. Birth waiting rooms are provided in tribal areas where the pregnant mother along with one relative can stay well before her expected date. Their food and other expenses during the stay are being met from NRHM allocation.
Other than Maternal and Child Healthcare Services, we have created Provision of Emergency Management Services through 108 ambulances with a response time of less than 15 minutes in urban areas and 20 minutes in rural areas; Inter-sectoral Coordination with the Departments of School Education, Sarva Shiksha Abhyan and SCERT; mainstreaming of AYUSH (Ayurvedha, Yoga & Naturopathy, Unani, Siddha and Homeopathy) services; Palliative Care services (next to the state of Kerala); hierarchal steps to reduce the prence of preventable blindness from 1.4-0.3 percent through involvement of NGOs; entrusting the public with increased awareness about health related issues both Communicable and Noncommunicable and many others.

Maternity Benefits
Dr Muthulakshmi Reddy Maternity Benefit Scheme by the Government of Tamil Nadu offers financial assistance of Rs 12,000 to pregnant women from poor families. The grant is given in three instalments: 1st Rs 4,000 after minimum of three ante-natal check-ups at the end of seven months
2nd  Rs 4,000 after the baby is delivered in a government institution

3rd Rs 4,000 when the baby completes immunisation up to the third dose of DPT

Criteria for Benefits
The woman should be 19 years and above
She should belong to the BPL category

Under this scheme, Rs 600 crore is currently being transferred to more than three lakh beneficiaries annually. The entire process is online for which it has linked all PHCs in the state with broadband connectivity


What are the challenges in managing a robust healthcare sector in Tamil Nadu?

Huge infrastructure is required to provide efficient and effective healthcare to the people. At present, we have the capacity to admit about 70,000 in-patients in all government facilities of the state. Every year we are constructing new buildings and increasing the manpower in these facilities to meet the increasing needs. Today the state has 19 Government Medical Colleges and every year we are improving our medical education system by increasing the number of seats and by opening new medical colleges. But our main challenge lies in addressing the gaps in effective coordination among all the health directorates.
There are certain areas of Health Provision which need to be strengthened and we also need to involve the private sector for better outcome in those areas. In fact, we are already partnering with many private organisations for implementing the Chief Ministers Comprehensive Health Insurance Scheme for the people. Also we are involving the Private Sector, wherever necessary, in all high-end requirements. We have made a detailed plan and hope to address the health needs of large number of poor people who live in urban areas and in urban slums through the forthcoming Urban Health Mission.

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