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Round Table Discussion on
Human Development
& Agriculture Diversification
and Water Resources Management
Proceedings
State Planning CommissionChennai
(18 ± 19, May 2005)
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Human Development
and
Health
Human Development
and
Health
By Health Secretary,
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Human Development
Human Development is not only growth in
income, wealth or consumption but the
expansion of human capabilities.
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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.
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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
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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
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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
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HDI ± INDIA & MAJOR STATES 2001
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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
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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
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CO PO E S OF R (2002)
Source: SRS
(0-6 DAYS)
(7-27 DAYS)
(28-364 DAYS)
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CLASS F C A O OF DEL VER ES - 2004-05CLASS F C A O OF DEL VER ES - 2004-05
Source: PHC Records
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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 (%)
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THENI ± DELIVERY PERFORMANCE
(% OF CONTRIBUTION)
THENI ± DELIVERY PERFORMANCE
(% OF CONTRIBUTION)
DO
HSC
PHC
GH
P H
Source: PHC Records
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SEXW SE . .R A L ADUSEXW SE . .R A L ADU
SOURCE: SRS
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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
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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
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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
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COMPREHENSIVE EMERGENCY OBSTETRIC AND
NEWBORN CARE (CEmONC))
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 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
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� 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)
COMPREHENSIVE EMERGENCY OBSTETRIC AND
NEWBORN CARE (CEmONC)
ROUND THE CLOCK
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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
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� 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)
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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
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BIRTH COMPANION INITIATIVE
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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%
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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
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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
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� 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
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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.
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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
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Tackling Female Infanticide :
Tamil Nadu Experience
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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
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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
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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)
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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)
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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
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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
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BUDGET
TOTAL BUDGET : Rs.31,655.53 crores
Budget for Health : Rs.1,652.04 crores
% to the total budget : 5.
22
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CHALLENGES / CONCERNS
� Urban health care
� Regional variations
� Mainstreaming ISM� Rational drug use
� Addressing Life style Diseases - Hypertension,Diabetes, Cancers
� Geriatric care
� Accidents and fatalities
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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