Government of Tamil Nadu - Final Report A COMPARATIVE … · 2018. 12. 21. · SECTION II – Inter Sectoral Coordination - Analysis of important on-going programmes and way forward

1

Final Report

A COMPARATIVE ASSESSMENT USING

MULTI-SECTORAL PUBLIC HEALTH INDICATORS

AT DISTRICT LEVEL IN TAMIL NADU

State Planning Commission, Tamil Nadu

Authored By:

Prof. (Dr.) Indira Chakravarty,

Ph.D., D.Sc.,FICAN(USA), FIC, FIMSA, FIWA, FIPHA, FONESA

Padmashri

Foundation for Community Support and Development

(Reff: 2250/SPC/HSW/2015-16)

2017

https://www.britannica.com/place/Tamil-Nadu/images-videos/Black-sand-on-a-beach-near-Kanniyakumari-Tamil-Nadu-India/117419

2

3

A COMPARATIVE ASSESSMENT USING

MULTI-SECTORAL PUBLIC HEALTH INDICATORS,AT

DISTRICT LEVEL IN TAMIL NADU

State Planning Commission, Tamil Nadu

Authored By:

Prof. (Dr.) Indira Chakravarty, Ph.D., D.Sc.,

FICAN(USA), FIC, FIMSA, FIWA, FIPHA, FONESA

Padmashri

Foundation for Community Support and Development

(Reff: 2250/SPC/HSW/2015-16)

2017

4

5

INDEX

Preface 7

Acknowledgement 9

List of Figures 11

List of Tables 13

Abbreviations 17

SECTION I - Multisectoral analysis of Public Health Indicators among all districtsof Tamil Nadu – To assess the impact of WASH on other sectors

19

1. Prologue 23

2. Introduction 26

3. Review of the Multi - sectoral impact 31

4. Ranking of District based on Public Health Indicators 38

5. Inter-District analysis of multisectoral Indicators 97

6. Summary and Conclusion 116

7. References 120

SECTION II – Inter Sectoral Coordination - Analysis of important on-going programmes and way forward

125

1. Inter Sectoral coordination 129

2. Suggested steps for Intersectoral Coordination 130

3. Indicators to assess intersectoral impact 131

4. Ongoing Programmes of Govt. of Tamil Nadu – Suggested Inter sectoral inputs for a multi dynamic approach

133

5. Way forward 145

SECTION III - Annexure 147

1. District wise Indicators 149

2. Ranking of Districts 171

3. A Review on Past status of Public Health in Tamil Nadu 213

6

7

PREFACE

The state of Tamil Nadu has been doing much better than most of the other states of the country

because of its strong political, technological as well as social commitment of the Government and

the people.

Hence, the objective of doing this study is to help the Government to put in place an improved ‘Inter-

Sectoral coordination and convergence’among all sectors. This is expected to make the outcome

from programmes being implemented, more effective, sustainable, acceptable and time bound along

with cost cuts.

The aim of this massive analytical report is, therefore, to assess the impact of one sectors

(particularly WASH) on other sectors.

All 32 districts of the state of Tamil Nadu has been covered while conducting this analysis.

The latest data sources viz DLHS-4; NFHS-4 etc. have been used while conducting this analysis. In

total about 40 indicators have been used, which have been divided into two groupsviz Input

indicators and Output indicators.

Initially in each district the status of each indicator has been assessed and then a rankinghas been

conducted for each indicator by comparing among the 32 districts of the state.

Subsequently the impact of any input on the outcome has been assessed, specially among the

sectors.

The basic ranking has been based on the sanitation status of each district, as it varies widely among

different districts. On the other hand, availability of drinking water is nearly uniform and excellent in

nearlyall the districts of the state.

Lastly, the 10 major programmes, as identified by the Health Department, State Planning

Commission, Tamil Nadu, has been individually assessed based on the inputs being provided.

Subsequesntly, the inter-sectoral coordination that can be included in these programmes has been

identified and suggested.

At the end, the way forward has been recommended, the mechanism for this has been suggested in

the ‘Suggested Steps’ part of Section II on Inter Sectoral Coordinations.

The entire report was prepared with constant help, support and most valuable hand holding by the,

State Planning Commission, which in turn also helped in forming excellent links with all the

concerned Departments viz Health, Social welfare, TWAD board etc.

Prof. (Dr.) Indira Chakravarty, Ph.D., D.Sc.,

FICAN(USA), FIC, FIMSA, FIWA, FIPHA

Padmashri

8

9

ACKNOWLEDGEMENT

The present report on “Comparative Assessment using Multi- sectoral Public Health

Indicators in various areas of Tamil Nadu” which is being supported by the State Planning

Commission, Tamil Nadu is a brain child of Thiru. Santha Sheela Nair, IAS, Former Vice

Chairman, Tamil Nadu State Planning Commission and Presently Officer on Special Duty (OSD)

in the Chief Minister’s Office, Government of Tamil Nadu.

Ms. Nair’s guidance, advice and support were constantly taken to write this report and it

was a most challenging but enjoyable experience. I feel deeply gratified to her.

The state has been doing rather well compared to most of the other states of India, so

highlighting the reasons for this as well as identifying the weaker areas needed a critical

review.

I am most grateful to Thiru. Anil Meshram, IAS, Member- Secretary, Tamil Nadu State

Planning Commission for kindly approving this first phase of evaluation. I sincerely look

forward to doing the next phase under his supervision.

But for the regular hand holding and support of Thiru. Sugato Dutt, I.F.S, Head of Division

(Land Use), Tamil Nadu State Planning Commission, this evaluation could never have been

conducted. He was a constant support right from the initial stage of data collection to the

assessment process. I am for ever grateful to him.

I am grateful to various Departmental Heads and MD, TAWD Board for their constant help

and advice. I would personally like to thank Dr. Kulandenswamy, DPH, Department of Health

and Family Welfare, Govt. of Tamil Nadu, for putting me in touch with all the relevant

officers of his department and creating an excellent team for me to take their help, advice

and support.

I am most grateful to Dr. K. Jayagandhi, HOD (HSW), Tamil Nadu State Planning Commission

for her constant assistance for creating a data base and also to Dr. V. Vijayalakshmi, DDHS,

Dr. Mohan Kumar, MO, DPH and all others who gave their support to write this report.

I render my heartfelt thanks to Govt. of Tamil Nadu and particularly to the State Planning

Commission for giving me this excellent opportunity and look forward to working with them

again.

Prof. (Dr.) Indira Chakravarty, Ph.D., D.Sc., Dated:

FICAN(USA), FIC, FIMSA, FIWA, FIPHA, FONESA June, 2016

Padmashri

10

11

LIST OF FIGURES

SECTION I

FIGURE NO. PAGE NO

Figure No. 1

Transmission pathways of faecal-oral diseases 32

Figure No. 2 Interplay of water quality, sanitation and hygiene with under nutrition and economic loss leading towards poor health

33

Figure No. 3 Water - Food Pollution Chain 36

Figure No. 4 Percentage distribution of the access to improved sources of sanitation for each district

151

Figure No. 5 Percentage distribution of the access to improved sources of drinking water for each district

151

Figure No. 6 Percentage distribution of currently married women below 18 years of age for each district

152

Figure No. 7 Percentage distribution of currently married women who are illiterate for each district

152

Figure No. 8 Percentage distribution of currently married women with 10 or more years of schooling for each district

153

Figure No. 9 Percentage distribution of Births to women aged 15-19 years out of total births for each district

153

Figure No. 10 Percentage distribution of Pregnant women who consumed 100 or more IFA Tablets/Syrup equivalent for each district

154

Figure No. 11 Percentage distribution of pregnant women who had full ante natal care for each district

154

Figure No. 12 Percentage distribution of women who know what to do when a child gets diarrhoea for each district

155

Figure No. 13 Percentage distribution of Number of Primary Health Centres for each district 155

Figure No. 14 Percentage distribution of number of Sub Health Centers for each district 156

Figure No. 15 Percentage distribution of CHC having 24x7 hours normal delivery services for each district

156

Figure No. 16 Percentage distribution of children (9-35 months) who received at least one dose of Vitamin A supplement in the last 6 months of the survey for each district

157

Figure No. 17 Percentage distribution of children with diarrhea in last two weeks who received ORS for each district

157

Figure No. 18 Percentage distribution of total children age 6-23 months receiving adequate diet for each district

158

Figure No. 19 Percentage distribution of IMR per 1000 live births 2011-12 for each district 159

Figure No. 20 Percentage distribution of MMR per 100,000 live births for each district 159

Figure No. 21 Percentage distribution of Under 5 Mortality Rate for each district 160

Figure No. 22 Percentage distribution of children with low birth weight for each district 160

Figure No. 23 Percentage distribution of live births for each district 161

Figure No. 24 Percentage distribution of Children under 5 years who are underweight (weight-for-age) for each district

161

Figure No. 25 Percentage distribution of Children under 5 years who are wasted (weight-for-height) for each district

162

12

FIGURE NO. PAGE NO

Figure No. 26 Percentage distribution of Children under 5 years who are stunted (height-for-age)for each district

162

Figure No. 27 Percentage distribution of incidence of diarrhea in last 2 weeks among children below 5 years for each district

163

SECTION III

FIGURE NO. PAGE NO

Figure No. 28 Crude Birth Rate – The Trend 221

Figure No. 29 Crude Death Rate – The Trend 222

Figure No. 30 Total Fertility Rate – The Trend 222

Figure No. 31 Maternal Mortality Rate 2010-2012 223

Figure No. 32 Infant Mortality Rate – The Trend 224

Figure No. 33 Indicators of Health in Tamil Nadu for the period from 1995-96 to 2009-10

225

Figure No. 34 Institutional Deliveries (%) 227

Figure No. 35 Coverage of Rural Habitation 246

13

LIST OF TABLES SECTION I

TABLE NO. PAGE

NO

Table No. 1 Gross State Domestic Product in Crores at Constant Prices 23

Table No. 2

Environmental classification of water-related infections 31

Table No. 3 Percentage distribution of Anaemia in 6-59 months Children for each district of Tamil Nadu

164

Table No. 4 Percentage distribution of Anaemia in 6-9 years old Children for each district of Tamil Nadu

165

Table No. 5 Percentage distribution of Anaemia in 10-19 Years old Children for each district of Tamil Nadu

166

Table No. 6 Percentage distribution of Anaemia in 15-19 aged Adolescent for each district of Tamil Nadu

167

Table No. 7 Percentage distribution of Anaemia in 15-49 aged Women for each district of Tamil Nadu

168

Table No. 8 Percentage distribution of Anaemia in 15-49 aged Pregnant women for each district of Tamil Nadu

169

Table No. 9 Ranking of Districts for Access to improved source of Sanitation 173

Table No. 10 Ranking of Districts for Access to improved source of Drinking Water 174

Table No. 11 Ranking of Districts for Percentage of currently married women below 18 years of age

175

Table No. 12 Ranking of Districts for Currently married women who are illiterate (%) 176

Table No. 13 Ranking of Districts for Currently married women with 10 or more years of schooling (%)

177

Table No. 14 Ranking of Districts for Births to women aged 15-19 years out of total births (%) 178

Table No. 15 Ranking of Districts for Pregnant women who consumed 100 or more IFA Tablets/Syrup equivalent (%)

179

Table No. 16 Ranking of Districts for Pregnant woman who had full Ante Natal care (%) 180

Table No. 17 Ranking of Districts for Women know about what to do when a child gets Diarrhoea (%)

181

Table No. 18 Ranking of Districts for Number of Primary Health Centres (PHC) (%) 182

Table No. 19 Ranking of Districts for Number of Sub-Health Centres (%) 183

Table No. 20 Ranking of Districts for Community Health centres (CHC) having 24X 7 hours normal delivery services (%)

184

Table No. 21 Ranking of Districts for Children (age 9-35 months) received at least one dose of vitamin A supplement in last 6 months (%)

185

Table No. 22 Ranking of Districts for Children with Diarrhoea in the last 2 weeks and received ORS in %

186

Table No. 23 Ranking of Districts for Total children age 6-23 months receiving an Adequate Diet. 187

Table No. 24 Ranking of Districts for IMR per 1000 live births 2011-12 188

Table No. 25 Ranking of Districts for MMR per 100,000 live births 189

Table No. 26 Ranking of Districts for U5 MR per 1000 live births Census 190

14

TABLE NO. PAGE

NO

Table No. 27 Ranking of Districts for Percentage of Children with low birth weight (below 2.5kg) (%)

191

Table No. 28 Ranking of Districts for Live births 192

Table No. 29 Ranking of Districts for Children under 5 years who are underweight (weight-for-age) in %, NFHS 4

193

Table No. 30 Ranking of Districts for Children under 5 years who are wasted (weight-for-height) in %, NFHS 4

194

Table No. 31 Ranking of Districts for Children under 5 years who are stunted (height-for-age) in %, NFHS 4

195

Table No. 32 Ranking of Districts for Diarrhoea in 2 weeks among children below 5 years (%) 196

Table No. 33 Ranking of Districts for Children 6-59 months having anaemia (Total) (%) 197

Table No. 34 Ranking of Districts for Children 6-59months having anaemia (severe) (%) 198

Table No. 35 Ranking of Districts for Children 6-9 Years having anaemia – Male (Total) (%) 199

Table No. 36 Ranking of Districts for Children 6-9 Years having anaemia – Male (severe)(%) 200

Table No. 37 Ranking of Districts for Children 6-9 Years having anaemia –Female (Total)(%) 201

Table No. 38 Ranking of Districts for Children 6-9 Years having anaemia – Female (severe)(%) 202

Table No. 39 Ranking of Districts for Children 10-19 Years having anaemia – Male (Total) (%) 203

Table No. 40 Ranking of Districts for Children 10-19 Years having anaemia –Male (severe)(%) 204

Table No. 41 Ranking of Districts for Children 10-19 Years having anaemia –Female (Total)(%) 205

Table No. 42 Ranking of Districts for Children10-19 Years having anaemia –Female (severe)(%) 206

Table No. 43 Ranking of Districts for Adolescent 15-19 years having anaemia (Total) (%) 207

Table No. 44 Ranking of Districts for Adolescents 15-19 years having anaemia (severe)(%) 208

Table No. 45 Ranking of Districts for Women 15-49 aged having anaemia (Total) (%) 209

Table No. 46 Ranking of Districts for Women (15-49 aged) having anaemia (severe) 210

Table No. 47 Ranking of Districts for Pregnant women 15-49 aged having anaemia (Total) 211

Table No. 48 Ranking of Districts for Pregnant women 15-49 aged having anaemia (severe) 212

SECTION III

TABLE NO. PAGE

NO

Table No. 49 Crude Birth Rate (per 1000) – 1991 Census 218

Table No. 50 Health Indicators in Major States – The Trend 220

Table No. 51 Indicators of Health in Tamil Nadu for the period from 1995-96 to 2009-10 224

Table No. 52 The results of trends in the indicators of health in Tamil Nadu for the period from 1995-96 to 2009-10 (Model: Y1 = a + bt)

225

Table No. 53 Cases and Death Reported by Diseases 2012-13 (No.) 226

15

TABLE NO PAGE

NO

Table No. 54 Functioning of PHCs (in lakhs) 227

Table No. 55 Institutional Deliveries in Tamil Nadu (%) 227

Table No. 56 Institutional Delivery among Major States (%) 228

Table No. 57 Health determinants in Tamil Nadu for the period from 1995-96 to 2009-10 229

Table No. 58 Results of trends in health determinants in Tamil Nadu state for the period from 1995-96 to 2009-10 (Model: Yt = a + bt)

230

Table No. 59 District Wise Nutritional Status of Children in TN, WB ICDS III 235

Table No. 60 Nutritional Status Select Indicators (2005-06) (%) – NFHS - 3 238

Table No. 61 Monitoring Targets (%) 240

Table No. 62 Objectives up to 2020 241

Table No. 63 Ground Water Utilization 243

Table No. 64 Categorisation of Blocks 243

Table No. 65 Annual water demand in TMC 244

Table No. 66 Supply/Demand in TMC 244

Table No. 67 Status of Rural Water Supply 245

Table No. 68 Performance of Eleventh 245

Table No. 69 Performance of Rural Water Supply in Eleventh Plan 245

Table No. 70 Civic status 247

Table No. 71 Status of Availability of Latrines 252

16

17

ABBREVIATIONS

DLHS District Level Household and Facility Survey

NFHS National Family Health Survey

SRS Sample Registration System Results

IFA Tablet Iron/Folic Acid Tablet

PHC Primary Health Centres

SHC Sub-Health Centres

CHC Community Health centres

IMR Infant Mortality Rate

MMR Maternal mortality rate

U5 MR Under-5 Mortality Rate

WASH Water, Sanitation and Hygiene

IIPS International Institute for Population Sciences

WHO World Health Organization

UNICEF The United Nations Children's Fund

LMIC Low And Middle Income Countries

EE Environmental Enteropathy

STH Soil-Transmitted Helminth

LBW Low birth weight

TWADB Tamil Nadu Water Supply And Drainage Board

IUCN International Union For Conservation Of Nature

ORS Oral Rehydration Solution

18

19

SECTION – I

MULTISECTORAL ANALYSIS OF PUBLIC

HEALTH INDICATORS AMONG ALL

DISTRICTS OF TAMIL NADU

– TO ASSESS THE IMPACT OF WASH ON

OTHER SECTORS

20

21

INDEX

1. Prologue 23

2. Introduction 26

3. Review of the Multi - sectoral impact 31

4. Ranking of District based on Public Health Indicators 38

5. Inter-District analysis of multisectoral Indicators 97

6. Summary and Conclusion 116

7. References 120

22

23

1. Prologue

Tamil Nadu is one of the 29 states of India. Its official language is Tamil, which is one of the longest-

surviving classical languages in the world.(Sanford,1998)

Its capital and largest city is Chennai (formerly known as Madras). Tamil Nadu (1) lies in the

southernmost part of the Indian Peninsula and is bordered by the union territory of Puducherry and

the South Indian states of Kerala, Karnataka, and Andhra Pradesh. It is bounded by the Eastern

Ghats on the north, by the Nilgiri, the Anamalai Hills, and Kerala on the west, by the Bay of Bengal in

the east, by the Gulf of Mannar and the Palk Strait on the southeast, and by the Indian Ocean on the

south. The state shares a maritime border with the nation of Sri Lanka.

It is one of the most advanced states of India – Scientifically, Technologically, and Culturally.

Tamil Nadu is the eleventh-largest state in India by area and the sixth-most populous. The state was

ranked sixth among states in India according to the Human Development Index in 2011, with the

second-largest state economy, (Suryanarayana M.H., Agrawal Ankush and Prabhu K.

Seeta,2011)(The Hindu,2008) with Rs. 4,789 billion (US$71 billion) in gross domestic product.( Gross

State Domestic Product,2004) The state has the highest number (10.56 per cent) of business

enterprises and stands second in total employment (9.97 per cent) in India(Sixth Economic Census),

compared with the population share of about 6 per cent. It is the most Urbanised state of India

(49%). (The Hindu, 2008)

Tamil Nadu was ranked as one of the top seven developed states in India based on a

"Multidimensional Development Index" in a 2013 report published by a panel headed by

former RBI governor Raghuram Rajan.(Rajan report)

Tamil Nadu is home to many natural resources. In addition, its people have developed and continue

classical arts, classical music, and classical literature. Historic buildings and religious sites include

Hindu temples of Tamil architecture, hill stations, beach resorts, multi-religious pilgrimage sites, and

eight UNESCO World Heritage Sites.(UNESCO,2012)(Press Information Bureau,2012)

Table 1 indicates the Gross domestic Product of the state.

Table No. 1: Gross State Domestic Product in Crores at Constant Prices

Year GSDP Growth Rate Share in India

2000–01 142,065 5.87% 7.62%

2001–02 139,842 −1.56% 7.09%

2002–03 142,295 1.75% 6.95%

2003–04 150,815 5.99% 6.79%

2004–05 219,003 11.45% 7.37%

2005–06 249,567 13.96% 7.67%

2006–07 287,530 15.21% 8.07%

2007–08 305,157 6.13% 7.83%

2008–09 321,793 5.45% 7.74%

2009–10 356,632 10.83% 7.89%

2010–11 403,416 13.12% 8.20%

2011–12 433,238 7.39% 8.26%

2012–13 447,944 3.39% 8.17%

24

2013–14 480,618 7.29% 8.37%

Source: GSDP at constant prices 2014

Tamil Nadu has historically been an agricultural state and is a leading producer of agricultural

products in India.

The state had registered the lowest fertility rate in India in year 2005–06 with 1.7 children born for

each woman, lower than required for population sustainability. (Distribution by Language,

2001)(Census by religious communities, 2002)

At the 2011 India census, Tamil Nadu had a population of 72,147,030.(Census of Tamil Nadu

2011) The sex ratio of the state is 995 with 36,137,975 males and 36,009,055 females. There are a

total of 23,166,721 households.(Census of Tamil Nadu 2011) The total children under the age of 6 are

7,423,832. A total of 14,438,445 people constituting 20.01 per cent of the total population belonged

to Scheduled Castes (SC) and 794,697 people constituting 1.10 per cent of the population belonged

to Scheduled tribes (ST).(SC/ST population in Tamil Nadu 2011)(Census of Tamil Nadu 2011)

The state has 51,837,507 literates, making the literacy rate 80.33 per cent. There are a total of

27,878,282 workers, comprising 4,738,819 cultivators, 6,062,786 agricultural labourers, 1,261,059 in

house hold industries, 11,695,119 other workers, 4,120,499 marginal workers, 377,220 marginal

cultivators, 2,574,844 marginal agricultural labourers, 238,702 marginal workers in household

industries and 929,733 other marginal workers. (Primary census abstract 2001)

As per 2001 census, 73 % of the state’s 6.24 crore people are literate. Among them, the literacy rate

for males is even higher at 82 %. But the relatively lower rate of 64 % for females also indicates the

gender gap. Another area of concern is the relatively lower literacy rate of 64 % for SC and STs. Even

within them, the literacy rate for females is lower at 53 % against the male literacy rate of 74 %. As a

whole, the performance of the state is commendable. But within the state of Tamil Nadu, female

literacy rate among the SC women is the lowest at 53 %. (District Human Development Report -

Dharmapuri District)

Vision 2023 Tamil Nadu identifies ten themes for the State as follows (Open Defecation Free Tamil

Nadu, 2013):

1. Tamil Nadu will be amongst India’s most economically prosperous states by 2023,

achieving a six-fold growth in per capita income (in real terms) over the next 11 years to

be on par with the Upper Middle Income countries globally.

2. Tamil Nadu will exhibit a highly inclusive growth pattern - it willlargely be a poverty free

state with opportunities for gainful and productiveemployment for all those who seek it, and

will provide care for the disadvantaged, vulnerable and the destitute in the state.

3. Tamil Nadu will be India’s leading state in social development and will have the

highestHuman Development Index (HDI) amongst all Indian states.

4. Tamil Nadu will provide the best infrastructure services in India in terms of universal

access to Housing, Water& Sanitation, Energy, Transportation, Irrigation, Connectivity,

Healthcare, and Education.

5. Tamil Nadu will be one of the top three preferred investment destinations inAsia and the

most preferredin India with a reputation for efficiency and competitiveness.

25

6. Tamil Nadu will be known as the innovation hub and knowledge capital of India, on the

strength of world class institutions in various fields and the best human talent.

7. Tamil Nadu will ensure Peace, Security and Prosperity for all citizens and business, enabling

free movement and exchange of ideas, people and trade with other Indian states and rest of

the world.

8. Tamil Nadu will preserve and care for its ecology and heritage.

9. Tamil Nadu will actively address the causes of vulnerability of the state and its people due to

uncertainties arising from natural causes, economic downturns, and other man-made

reasons and mitigate the adverse effects.

10. Tamil Nadu will nurture a culture of responsive and transparent Governance that ensures

progress, security, and equal opportunity to all stakeholders.

The Honourable Chief Minister had announced that the State would achieve Open Defecation Free

Status by 2015. A multi-pronged strategy is needed at this juncture to achieve the Chief Minister’s

Vision. (Open Defecation Free Tamil Nadu, 2013)

Annexure III is a preliminary Compilation of some of the earlier data from the state of Tamil Nadu

26

2. Introduction

Public Health has always been a major challenge for the Health Department because it deals mostly

with preventive issues which neither has an immediate impact nor is it recognised by the population

as an urgent need. The other most challenging fact is that non-health inputs like water, Sanitation,

hygiene, nutrition etc: which have a most critical role to prevent infections and diseases and

promote health are rarely considered as ‘health-related’ inputs.

Numerous studies and reports (Prüss A et. al.,2002; Kolsky et. al1995; Fewtrell Lornaet. al 2007;

Chakravarty Indira and Ahmed Tanvir, 2016;Chakravarty Indira, 1995;Esrey SA et. al 1985;

Chakravarty Indira, 1995;Humphrey J H, 2009; Prüss-Üstün A, Corvalán C, 2006; WHO, 2008; WHO-

SEARO, 2016; Bagchi Tet. al1986; Dean Spears, 2012; Ziegelbauer Ket. al2012; Olsen Aet. al 2001;

Chakravarty Indira, 1998; WHO, UNICEF,USAID, 2015; WHO, 2016) have now highlighted the fact

that without provision of comprehsive health and non-health inputs (as mentioned above) most of

the naggin problems which impact on health of people cannot be controlled.

A comprehensive approach of inputs provided covering WASH (Water, Sabnitation and hygiene);

Food & Nutrition; Health care; awareness generation etc: not only leads to reduction in infcetions

and diseases but also leads to cost cuts, timely control and over all all round sustainable.

An effort has been made in this report to conduct a comparative analysis of all the districts of Tamil

Nadu taking multiple Inputs as well as Output indicators by ranking them individually as per

performance in the first instance and subsequently making an inter-indicator comparison for each

district, using the latest data bese available viz. NFHS-4; DLHS-4 etc

This has resulted in a targeted evaluation to assess the reason for successes as well as assess where

further action is needed in a district-wise analysis of all the 32 districts of the state.

Based on the above mentioned review several multisectoral variants have been considered in this

report. These have been classified in two categories ‘Input Indicator’s and Output Indicators’. While

the Input Indicators represent the various services provided for the community for upgrading the

Public Health status, the Output Indicators give a base to analyse what has been the outcome on the

various Public Health related indices.

Multiple data sources have been used in this analysis trying to use only the latest available National

Survey data viz :-

District Level Household and Facility Survey, DLHS – 4, (2012-13)

National Family Health Survey, NFHS – 4, (2015-16)

Sample Registration System Results, SRS, (2012)

The Input Indicators used are as follows:-

1. Access to improved source of Sanitation (%) – (DLHS 4)

2. Access to improved source of drinking water (%) – (DLHS 4)

27

3. Percentage of currently married women below 18 years of age – (DLHS 4)

4. Currently married women who are illiterate (%) – (DLHS 4)

5. Currently married women with 10 or more years of schooling (%) – (DLHS 4)

6. Births to women aged15-19 years out of total births (%) – (DLHS 4)

7. Pregnant women who consumed 100 or more IFA Tablets/Syrup equivalent(%) – (DLHS 4)

8. Pregnant women who had full antenatal care (%)

9. Women who know about what to do when a child gets diarrhoea (%) – (DLHS 4)

10. Number of Primary Health Centres (PHC)(%) – (DLHS 4)

11. Number of Sub-Health Centres (SHC) (%) – (DLHS 4)

12. Community Health centres (CHC) having 24X 7 hours normal delivery services (%) – (DLHS 4)

13. Children (age 9-35 months) received at least one dose of vitamin A supplement in last 6 months (%) – (DLHS 4)

14. Children with diarrhoea in the last 2 weeks and received ORS in % – (DLHS 4)

15. Total adequate diet intake by 6-23 month children – (NFHS 4)

The Output Indicators based on which the existing situation is analysed are as follows:-

1. IMR per 1000 live births 2011-12 – (SRS, 2012)

2. MMR per 100,000 live births - (SRS, 2012)

3. U5 MR per 1000 live births Census – (NFHS 4)

4. Percentage of Children with low birth weight (below 2.5kg) (%) - (DLHS 4)

5. Live births – (DLHS 4)

6. Children under 5 years who are underweight (weight-for-age) in %, - (NFHS 4)

7. Children under 5 years who are wasted (weight-for-height) in %, - (NFHS 4)

8. Children under 5 years who are stunted (height-for-age) in %, - ( NFHS 4)

9. Incidence of Diarrhoea in last 2 weeks among children below 5 years (%) - (DLHS 4)

10. Children (6-59months) having anaemia (%) - (DLHS 4)

11. Children (6-59 months) having severe anaemia (%) - (DLHS 4)

12. Children (6-9 Years) having anaemia –Male - (DLHS 4)

13. Children (6-9 Years) having severe anaemia –Male –(DLHS 4)

14. Children (6-9 Years) having anaemia – Female –(DLHS 4)

15. Children (6-9 Years) having severe anaemia –Female - (DLHS 4)

16. Children (10-19 Years) having anaemia –Male - (DLHS 4)

17. Children (10-19 Years) having severe anaemia –Male - (DLHS 4)

18. Children (10-19 Years)having anaemia –Female - (DLHS 4)

28

19. Children (10-19 Years)having severe anaemia –Female - (DLHS 4)

20. Adolescent (15-19 Years)having anaemia - (DLHS 4)

21. Adolescents (15-19 Years)having severe anaemia - (DLHS 4)

22. Pregnant women (15-49 Years ) having anaemia - (DLHS 4)

23. Pregnant women 15-49 Years) having severe anaemia - (DLHS 4)

24. Women (15-49 Years) having an anaemia - (DLHS 4)

25. Women (15-49 Years) having severe anaemia - (DLHS 4)

Hence, in total 15 Input and 25 outputmulti sectoral indicators have been first compiled (Annexure I)

and then used for sectoral analysis,for assessment and evaluation in several stages.

The analysis has been made for all 32 districts of the state of Tamil Nadu. These arelisted as follows

prioratised on the basis of sanitation coverage:-

1. Ariyalur

2. Chennai

3. Coimbatore

4. Cuddalore

5. Dharmapuri

6. Dindigul

7. Erode

8. Kanniyakumari

9. Karur

10. Khancheepuram

11. Kirshnagiri

12. Madurai

13. Nagapattinam

14. Namakkal

15. Nilgiris

16. Perambalur

17. Pudukkottai

18. Ramanathapuram

19. Salem

20. Sivaganga

21. Thanjavur

22. Theni

23. Thirunelveli

24. Thiruvallur

25. Thiruvarur

26. Thoothukkudi

27. Tiruchirappalli

28. Tiruppur

29. Tiruvannamalai

29

30. Vellore

31. Viluppuram

32. Virudhunagar

It has been noted that for certain indicators the range (highest and lowest) varied widely among the

different districts, where as some indicators were more uniformly distributed in most districts. Eg:

1. Drinking water coverage in the state is excellent. The range varies from 89.2 to 99.3%

showing significant coverage in all the districts of the state. Most of the districts have more

than 90% coverage. Hence, inter district comparison for drinking water was thought to be of

not much significance.

2. The number of live births in the state is also excellent across the state, varying between to

90-100 only. So in this case also, inter district comparison was restricted.

3. The ranges are relatively smaller compared to others–

IMR (Varying from 6-20)

Least number of girls (15-19 years) who gave birth to babies (varying from .6-10.7%)

Low birth weight (Varying from 5.3 to 19.8)

Under-weight in under 5 children (Varying from 12.8 to 34.7)

Stunting in under 5 children (Varying from 17.2 to 37)

Under 5 mortality (Varying from 15.9 to 37.2)

4. Sanitation coverage on the other hand varied widely between 33.6% and 93.5%, the highest

being Kanniyakumari and lowest being Ariyalur.

In the next step all the Indicators (Input as well as Output) have been ranked individually

(AnnexureII) and based on this segregated tables have been created. The comparison on each issue

has been conducted based on the ranking of the district. It was most interesting to see that several

Indicators match well among various sectors.

Compared to the all India average, the state of Tamil Nadu has been doing remarkably well in many

areas like drinking water supply; various welfare programmes; health care; reduction in IMR and

other mortalities; no. of live births etc.

However, some of the issues that need more attention and improvement are Sanitation, Nutrition

and related problems and in some districts certain selected Health inputs.

It is difficult to measure the Input versus output, using a standard method because of the numerous

variables that exist. However, an impartial, de-segregated and issue wise assessment has indirectly

highlighted the status of various Public Health interventions and helped them to be categorised.

This may perhaps help the districts to target the inputs more cost effectively and in a more

comprehensive manner.

However, it can be stated after conducting this detailed analysis of all districts, that under the

existing leadership and administration the state is forging forward, specially on the issues that are

30

more linked to social development. This is a very positive sign as it gives a balanced and a positive

deviance for all human development indicators.

At the end, it can be concluded that the state is doing much better than the national averages in

nearly every field of human development, a few of these are mentioned above.

31

3. Review of the Multi-Sectoral impact

Status of health and well-being of any individual depends on multiple factors, which have already

been identified in the previous section. Hence, consideration of all these issues in a comprehensive

manner prevents diseases and improves the well-being of an individual. The WASH (Water,

Sanitation and Hygiene) and Nutrition are possibly the most critical inputs, supported by gender

issues, literacy, health care etc. Hence, instead of a vertical approach, if a state, district, block or

village can take up things after targeting the weaknesses that exist in any of these sectors then

perhaps it will be much more effective and useful. Some of these factors are briefly discussed below.

Any deviation from standards of water quality may lead to infections and subsequent sicknesses and

diseases. Sanitation and Hygiene are also the two important necessities to prevent infection.

Sanitation needs to be maintained at personal level through personal hygiene; at domestic level

through home hygiene and at environment level by maintaining overall cleanliness and no open

defecation.

Easy access to safe drinking water is essential so that it is available in required quantities and

collections from distant sources do not cause physical stress.

The importance of Safe water, Sanitation and Hygiene to maintain good health is a known fact,

because these prevent infections of various types which eventually lead to poor health and nutrition.

However, in many ways WASH (Water, Sanitation and Hygiene) also has a direct impact on the

nutritional status of communities in a number of ways. For this, maintenance of water quality along

with easy availability is essential(Blossner M, de Onis M, 2005).

Table No. 2: Environmental classification of water-related infections

Source: Chakravarty Indira et al, 2016

Sl. No.

category Infection Pathogenic agent

1. Faecal-oral Faecal-oral (water-borne or water-washed)

Diarrhoeas and dysenteries, Amoebic dysentery, Balantidiasis, Giardiasis Campylobacter enteritis, Cholera, E.coli diarrhoea, Salmonellosis, Shigellosis (bacillary dysentery), Yersiniosis, Enteric fevers, Typhoid Rotavirus diarrhoea, Paratyphoid, Poliomyelitis, Hepatitis A, Hepatitis E Leptospirosis Ascariasis, Trichuriasis

Protozoa Bacteria Virus Spirochaete Helminths

2. Water-washed: Skin and eye infections and others

Infectious skin diseases Infectious eye diseases Louse-borne typhus Louse-borne relapsing fever

Fungi Virus, Bacteria Ricaettsia Spirochaete

3. Water-washed: Penetrating skin/ingested

Guinea worm, Schistosomiasis, Clonorchiasis, Diphyllobothriasis, Fasciolopsiasis, Paragonimiasis

Helminths

4. Water-related insect vector: Biting near water Breeding in water

Sleeping sickness, Malaria Filariasis, River Blindness Yellow fever, Dengue, Encephalitis

Protozoa Helmenths Mosquito-borne viruses

32

Diarrhoeal diseases, subsequent malnutrition and their consequences may cause 2.4 million deaths

per year (Pruss-Ustun et al., 2008). The relationship between diarrhoeal diseases and malnutrition is,

however, complex (Brown et al., 2013). In low income settings, poor sanitation, the absence of a

safe means of excreta disposal, often results in individual households and environments becoming

contaminated with pathogen-ridden human faeces (Curtis et al., 2000) which, when passed through

the faecal-oral transmission route, cause diarrhoeal diseases (Clasen et al., 2010, Briend, 1990).

Repeated infection with diarrhoeal diseases contributes to chronic malnutrition by inhibiting

intestinal absorption of nutrients and is strongly correlated with stunting (Petri et al., 2008, Spears,

2013). Undernutrition in turn increases susceptibility to infectious diseases, such as diarrhoea, thus

perpetuating somewhat of a vicious circle (Mara et al., 2010).

Figure No. 1: Transmission pathways of faecal-oral diseases

Source: Pruss et al, 2002

The health status of an individual, a community or a nation is determined by the interplay and

integration of the entity’s internal environment and the external environment which surrounds it. A

disease is largely caused due to a disturbance in the delicate balance between humans and the two

environments which define us.

To protect human health and to prevent sickness and mortality, community water needs to be

reliable, in sufficient quantity, of adequate quality and be readily accessible to all segments of the

consumers. The direct impact on human health after any ecological imbalance occurs mainly due to

following selective reasons as shown in the following Figure.

33

Figure No. 2: Interplay of water quality, sanitation and hygiene with under nutrition and economic

loss leading towards poor health

Source: Chakravarty, Indira, 2010

The important role of sanitation and safe water in maintaining health has been recognised for

centuries, with the “sanitary revolution” in the 19th and early 20th century considered to play a vital

role in reducing illness and death from infectious diseases in industrialised countries (McKeown and

Record, 1962; Preston and van de Walle, 1978, Fewtrell and Colford, Jr., 2004).

WASH-related diseases are the single largest cause of sickness and death in the world and

disproportionately affect poor people. Faecal-oral infections that cause diarrhoea, cholera, typhoid,

and dysentery spread through contaminated water or more often by poor hygiene.

These problems related to WASH give rise to various health-related issues which eventually results in

other impacts such as malnutrition, socioeconomic loss etc. (Chakravarty, Indira et al., 2010;

Chakravarty, Indira and Ahmed Tanvir, 2016).

Good nutritional status is widely accepted as an important indicator of national development.

However, nutrition security not only indicates an outcome, but it is also a critical input that fuels

better health, human development and economic growth.

Nutritional stability can be significantly affected due to any ecological imbalance as it pollutes

drinking water, makes water more scarce and difficult to access, affects food security as well as

safety, degrades environmental stability, impacts on sanitation and hygiene etc. All these occur over

and above the impact that ecological imbalance has on food security status.

Despite India being one of the world’s largest economies, the figures from the 3rdIndian National

Family Health Survey estimated that 48 per cent of India’s children under the age of five are

stunted, 43 per cent are underweight, and 20 per cent are wasted (IIPS, 2007). The term ‘Asian

Enigma’ has been coined to describe this situation, namely that children in Asia are, on an average,

shorter than their generally poorer counterparts in Africa (Ramalingaswami et al., 1996). Thus, when

34

viewed alongside global estimates suggesting that 48 percent of India’s population practices open

defecation (WHO & UNICEF 2014), it is evident that the links between sanitation practices and

nutritional outcomes in India merit further investigation.

There is unacceptable prevalence of under-nutrition in our children and the reasons for this possibly

are –

Inadequate intake of food

Imbalanced diet

Loss of nutrients from body due to infections

Excessive physical labour

The last two causes are intricately related to unavailability of clean water, proper sanitation and

proper personal as well as environmental hygiene.

It is a well-known fact that unsafe food and water leads to infections like diarrhea, dysentery, etc.

which eventually result in causing under-nutrition and ill health. Street foods are a major source of

nutrition for the urban population and particularly for the urban poor. (Winarno FG, 1995 and

Chakravarty Indira, 2011). However, all these positive points gets compromised as it is also a source

of major infections (high contamination with faecal coliforms and other pathogens) due to the

following reasons (Chakravarty Indira, 1995; Chakravarty Indira and Canet C, 1996; Chakravarty

Indira, 2007)

Poor handling

Poor quality of water

Poor sanitation

Poor garbage disposal facilities

Poor storage conditions

Hence, food safety in this case which affects lives of millions of people is jeopardized due to unclean

water, poor handling, poor hygiene and poor environmental conditions. Hence, the major inputs

needed for such food establishments are availability of clean water, sanitation and proper hygiene

by vendors and cleanliness all around. (Chakravarty Indira, 2009)

Much evidence shows that sanitation and hygiene prevent and reduce stunting and that effective

WASH interventions are vital for improving nutritional status (Bhutta et al., 2008). Research on the

effects of toilets constructed in India’s national Total Sanitation Campaign (Spears, 2012) has found

reduced stunting in the districts where the campaign was implemented, comparable with the

average impact of other health and nutritional programmes.

High rates of open defecation are associated with stunting: Of the 20 countries with the highest

numbers of open defecators, 17 have stunting rates of 35 per cent or higher (UNICEF, 2012; WHO

and UNICEF, 2013). OD is particularly harmful where population density is high. India’s widespread

OD and high population density constitute a double threat.

35

The sanitation-nutrition nexus refers to the multiple connections between sanitation practices and

nutritional outcomes. There are three identified direct pathways through which poor sanitation (and

associated open defecation) may adversely affect nutritional outcomes in children: diarrhoeal

diseases (Briend, 1990), environmental enteropathy (Humphrey, 2009) and nematode infections

(Pruss- Ustun and Corvalan, 2006). Indeed, the World Health Organization estimates that as much as

50 per cent of childhood under nutrition is associated with poor WASH (Pruss-Ustun et al., 2008).

Evidence had shown that sanitation can prevent and reduce stunting; in an analysis of cross-sectional

data from eight low and middle income countries (LMICs). (Esrey, 1996)

Though diarrhoeal diseases could be a predictor of the effects of poor sanitation on weight-for-

height scores, there was limited and inconclusive evidence that poor sanitation is associated with

wasting. (Esrey, 1996)

Recently, it has been hypothesized that tropical or environmental enteropathy (EE), a subclinical

condition of the small intestines resulting from the ingestion of faecal bacteria, and which increases

gut permeability and Malabsorption of nutrients, may be a primary causal pathway from poor

sanitation to stunting (Humphrey, 2009).

Research shows that inadequate dietary intake alone does not explain the global burden of stunting,

and dietary interventions have not been able to normalise growth (Dewey and Adu-Afarwuah, 2008).

A recent multiple-country study, for example, found that diarrhoeal diseases, caused by poor

sanitation, accounted for 25 per cent of stunting in children up to 24 months (Checkley et al., 2008).

Meanwhile, an observational study in rural Bangladesh found that environmental contamination,

linked to open defecation, caused linear growth faltering through EE; and children living in clean

household environments had 0.54 standard deviation higher height-for- age scores (22 per cent

lower stunting) than their counterparts living in dirty environments (Lin et al., 2013).

The NFHS-3 survey highlighted widespread anaemia, with its prevalence actually increasing in some

categories, such as in children between 6-59 months, where the rates increased from 74% in NFHS-2

(1998-99) to 79% in NFHS-3 (2005-2006). Anaemia in women of reproductive age had also increased

from 52% to 56% over this same time period. 69% of boys and 70% of girls suffered from anaemia.

The causes of anaemia as we know are many:-

Lack of intake of iron-rich food

Intake of inhibitors affecting iron absorption in the body

Worm infestation due to lack of sanitation

Infections due to unsafe water or food, unhygienic environment etc. causing loss of

nutrients from the body as well as affecting absorption

Any other causes which leads to loss of iron from body, e.g., excessive bleeding, child

birth etc.

Specific physiological conditions like pregnancy.

Many of these are due to unsatisfactory WASH situation.

36

An in-depth study done in different districts of West Bengal on (Chakravarty, Indira, 1998) hookworm

and other parasitic infections indicated that hookworm infection was universal throughout West

Bengal with higher prevalence rates in rural areas with limited number of toilets and poor usage

rate. The worst sufferers were agricultural workers who had direct contact with soil.

The third direct pathway between poor sanitation and bad nutritional outcomes concerns soil-

transmitted helminth (STH) infections, such as Hookworm, Ascaris Lumbricoides and Trichuris

Trichiura. These infections result in the malabsorption of nutrients and growth retardation or failure

(O’Lorcain and Holland, 2000).

A recent systematic review found that access to sanitation was associated with decreased likelihood

of infection with any STH, and specifically with Ascaris Lumbricoides and Trichuris Trichiura (Strunz

et al., 2014).

It is a well-known fact that anaemia leads to Low birth-weight babies (LBW). The prevalence of LBW

Babies (weighing less than 2500 gms. at birth) is nearly unchanged since 1979. It is most pronounced

in urban slums and rural areas. The impact of anaemia on the incidence of LBW Babies is clearly

established (Gopalan C and Kaur Suminder’ 1989).

Accessibility to safe drinking water is another most important factor that perhaps impact on the

health and nutrition status of communities. Lack of safe water close to home has many indirect

effects on health and nutrition. A comprehensive investigation conducted with UNICEF support in

three regions (24 villages) of Nepal viz. Terai, hilly and mountainous(Chakravarty, Indira, 1995)

revealed that if water sources are provided near habitats then it saved the women a long walk

carrying water which resulted in a significant amount of saving of body energy (calories), as well as

time. This had a most positive impact on the health and nutritional status of not only the woman but

also the children (Chakravarty Indira et al., 2010; Chakravarty Indira and Ahmed Tanvir, 2016).

Pollutants in water like Arsenic, Fluoride etc. lead to a direct toxic impact on health and nutrition.

Moreover, they may enter the food chain at several points causing toxic implications through food as

well. Pollution occurs due to use of contaminated water not only for drinking but also for agriculture,

cooking etc.

Source: Chakravarty Indira, 2012

Figure No. 3: Water - Food Pollution Chain

Soil

Food Man

Animal Cooking

Water

Pollutant

37

Fluoride is one of the important factors affecting the people of Tamil Nadu. It exists in water sources

and is derived from fluorine. Kumar et al. (2007) had examined the status of fluorosis in the North

Western districts of Tamil Nadu using data generated by Tamil Nadu Water Supply and Drainage

Board (TWADB) during 1999-2000. The study collected the source of data from 5 contiguous North-

Western districts namely Dharmapuri, Erode, Krishnagiri, Salem and Vellore. The study has found

that majority of the people from selected 13 villages draw drinking water through community bore

wells, where the mean value of fluoride in drinking water ranged from 0.6 to 4.6 parts per

million/mg per litre. So the renowned Hogenakkal Water Supply Fluorosis Mitigation Project was

initiated. The dental mottling, among the total population of all age groups, ranged from 13.4 % to

40.8 % in the above five districts. The value was high i.e., 27-41 % in the Dharmapuri district and 16-

17 % in Vellore district. The prevalence of dental mottling in the groups of 5-14 years was more than

40 % in the districts of Dharmapuri, Krishnagiri and Salem. At the district level, Community Index for

Dental Fluorosis (CIDF) was more than 42 %. Under this project, 160 million liters of treated water is

being provided every day by treating surface water of river Cauvery drawn at Hogenakkal to the

people in the 3 Municipalities, 17 Town Panchayats and 6755 rural habitations in 18 Panchayat

unions in Dharmapuri and Krishnagiri districts @ 90 lpcd, 70 lpcd and 40 lpcd respectively (District

Human Development Report, 2011).

An excellent analysis of multisectoral data from Bangladesh and East India(represented by Assam,

West Bengal, and Tripura) supported by IUCN (International Union for Conservation of nature)

covering all the issues discussed above indicates that there is a direct link between water and

sanitation, and health, nutrition, and other indicators. However, there are discrepancies in some

places which are due to other related factors such as hygiene (environmental, domestic or personal),

behavior, infections, and diseases due to other reasons, environmental degradation, genetic

linkages, gender discrimination related factors, socio-economic reasons and occupation.

(Chakravarty Indira and Ahmed Tanvir, 2016)

The foregoing discussion indicates the various links that exists between WASH, Health and Nutrition.

Therefore, for effective implementation of any programme all these factors need to be taken into

account.

The next chapter focuses on a district-wise compilation of all the Indicators (Input and Output) of

Tamil Nadu and individual analysis of each after ranking them in order of effectiveness.

38

4. Ranking of District based on Public Health Indicators

All the Input Indicators (15) and Output Indicators (25) have been ranked individually for all the 32

districts of the state of Tamil Nadu.

Annexure Iprovides the Figures and Tables of each indicator in order of their success.

The Ranked tables are given in Annexure – II of the report

The list of indicators are given at Page 54-55 of Section II (Chapter 1 - Introduction)

The next part of this chapter analyses the Input and Output Indicators of each districts, based on

their ranking for all the 32 districts of Tamil Nadu.

The districts are arranged in order of success achieved to reduce Open Defecation, (Sanitation)

starting with Kanniyakumari, which has the highest Sanitation coverage.

1. Kanniyakumari

Input

1. This southern district of Tamil Nadu has performed exceedingly well in providing

improved sanitation to its population and is ranked 1st with 95.5% coverage.

2. The district is ranked 21st (95.1%) in providing access to improved source of drinking

water the highest being 99.3% in Vellore.

3. The district has no women married below 18 and is placed 1st.

4. Similarly, it has the minimum number of married women who are illiterate (9.8%) (Rank

1st).

5. It has the highest number of married women who have been to school for 10 or more

years (58.2%).

6. Pregnant women who have received full ante natal care in this district are 32.2 % and it

ranks 17th which is slightly lower than the average of the state at 36.9%.

7. In case of women between 15 to 19 years conceiving, the district records the lowest

percentage with 0.6 percent prevalence and tops the list.

8. The district ranks 23rd with 34% in pregnant women having consumed 100 or more IFA

tablets/ syrup. This is closer to the median at 42.1%.

9. In case of awareness in women regarding the handling of diarrhoea among below 5 years

children, the district is ranked 20th with more than 57.4 % women knowing what to do.

This is nearer to the median at 60.8%.

39

10. In the case of children (9-35 months) who received at least one dose of Vitamin A

supplement, the district ranks 29th out of 32 districts and 47.5% have received it.

11. In case of the reach of ORS among children the district it is ranked 20th with 33.3%

children who received it. This is a slightly lower than the state average at 48.8%.

12. The district has 25 sub health centers and ranks 7th in the state, marginally less than the

average at 29.

13. It also has 14 Primary Health Centers (PHCs) and ranks 8th, again marginally below the

median at 16.

14. Kanniyakumari ranks 7th in the number of Community Health Centers (CHC) having 24x7

hours normal delivery service with 12 such centers. This is equal to the median.

15. For children aged 6-23 months who received adequate diet, the NFHS-4 data shows that

the district ranks 4th but the intake is only 37.7% (above mean level)

Output

1. The district is ranked 3rd in regard to IMR at 9 out of 1000 live births which is very close to

the 6 out of 1000 live births which is the state highest.

2. In case of children born with low birth weight the district is ranked 17th with 12.7 %

children born with low weight. This is only marginally higher than the median which is at

11.8%.

3. In case of live births, the district the rank is 16th with 96.7%. The range is 100-90.7% and

Kanniyakumari is almost at the median level which is 97%.

4. In case of under 5 mortality rate it is ranked 5th with 22 out of 1000 live births. This is

lower than the median level at 28 out of 1000 live births.

5. In case of Maternal Mortality Rate (MMR) it is ranked the best with the lowest number of

such cases (30 out of 100,000 live births) being reported in this district, among all districts

of Tamil Nadu.

6. It also performs well in cases of children below 5 years with diarrhoea as it is ranked 2nd

with only 1.7% of such incidences.

7. In case of anaemia, the district performs well in regard to the prevalence of in children

below 5 and is ranked 2nd (44%) in case of total anaemia. But in the same age bracket in

case of severe anaemia, the district ranks 6th (1.7 %) however, this is much lower than the

median which is 3.7%.

8. In the bracket of 6-9 years male children we see that in total anaemia the district ranks 4th

with 36% of such cases, this is lower than the median at 46.1%. In severe anaemia

however, the district ranks 1st with no such cases.

9. Among females of same age group, total anaemia is 40.7% (rank 5th) this is also lower

than the average at 48.4%. In the case of severe anaemia here is also we find no such

cases and the district ranks 1st.

40

10. Among children between 10-19 years, the district records total anaemia of 20.9% (rank

2nd) among males and 30.4% (rank 1st) among females. Severe anaemia among males is

rank 6th at 0.8%, much lower than the state average at 1.2%. For females it is 1.5% (rank

8th). This too is much lower than the median at 2.1%.

11. Among adolescents total anaemia it is 20.4% (rank 1st) and severe anaemia is 1.4% (rank

9th) though lower than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 29.6% (rank 1st) among women

(15-49 years) it is 36.2% (rank 3rd). There are no reported cases of severe anemia among

pregnant women (15-49 years) (rank 1st). Among women (15-49 years) it is 0.7%, rank 1st.

13. In Kanniyakumari we find that the district has the least percentage of below 5 children

who are stunted (17.2%), wasted (9%) or underweight (12.8%) out of all 32 districts.

2. Chennai

Input

1. This predominantly urban district is ranked 2nd with 92.9% sanitation coverage.

2. In terms of access to improved drinking water the district ranks 13th with 97.6%

households having access.

3. In under age marriage the district ranks 5th with 2.2% of such cases only.

4. It records the second least percentage of married women who are illiterate (14.2%).

5. It also records the second highest percentage of married women who have been to

school for 10 or more years (57%).

6. In case of women between 15 to 19 years conceiving, the district records the second

lowest percentage with only 1.1% prevalence.

7. Pregnant women who have received full ante natal care in this district are 27.9% and it

ranks the district 23rd. This is lower than the median at 36.9%.

8. The district ranks lower 25th in women having consumed 100 or more IFA tablets with

29% coverage. This is lower than the state average at 42.1%.

9. In the case of children (9-35 months) having received at least one dose of Vitamin A

supplement, the district ranks 27th with 52.7% coverage, about 9% lower than the median

which is at 61.9%.

10. In case of the reach of ORS among children suffering from diarrhoea it is ranked 24th

(23.1%). This is rather lower than the state average at 48.8%.

11. In case of awareness in women regarding diarrhoea handling, the district is ranked 21st

with more than 56 percent women knowing what to do.

12. The district being mostly urban has no Sub Health Centres, PHCs, and Community Health

Centers (CHC) having 24x7 hours normal delivery service.

41


the district ranks 30th (Lowest) and the intake is only 13.8 (worst in Tamil Nadu)

Output

1. The district is ranked 2nd in regard to IMR with 7 out of 1000 live births, with hardly any

difference with Coimbatore recording the lowest at 6 out of 1000 live births.

2. In case of children born with low birth weight the district is ranked 15th at 11.6% of such

cases. This is however, almost at par with the median at 11.8%.

3. In case of live births, Chennai also performs well and is ranked 2nd at 99.7% live births.

4. It has performed the best in under 5 mortality rate and has recorded the lowest among all

the districts with 16 out of 1000 live births.

5. Even in case of MMR it has performed better than most of the districts and ranked 2nd

with 33 female deaths out of 100,000 live births.

6. The incidence of diarrhoea among children in the district also looks up and it ranks 8th

with 4.3% of such cases.

7. In case of total anaemia in children below 5 it is ranked 19th (63.1%). In the same age

bracket in case of severe anaemia, the district ranks 16th (3.7 %) this is same as the

median.

8. In the bracket of 6-9 years male children we see that in total anaemia the district ranks

23rd with 52.3% of such cases, this is lower than the median at 46.1%. In severe anaemia

however, the district ranks 1st with no such cases.

9. Among females of same age group total anaemia is 45.4% (rank 11th) this is also lower

than the average at 48.4%. Severe anaemia here is also 0% and the district ranks 1st.

10. In case of children between 10-19 years, the district records total anaemia of 32.4% (rank

19th) among males and 47.7% (rank 19th) among females. Severe anaemia among males is

15th at 2.1%, higher than the state average at 1.2%. For females it is 3.8% (rank 18th). This

is higher than the median at 2.1%.

11. Among adolescent total anaemia it is 36.2% (rank 14th) and severe anaemia is 1.7% (rank

11th) almost same as the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 66.3% (rank 25th), higher than the

median at 56.7%, among women (15-49 years) it is 51.1% (rank 14th). Severe anemia

among pregnant women (15-49 years) is 5.7% (rank 22nd) among women (15-49 years) it

is 2.5%, rank 11th.

13. Chennai has higher incidence of stunting (rank 26th, 30.9%) and wasting (rank 12th, 18.1)

among below 5 years children.

14. There are not too many underweight below 5 years children and the district ranks 3rd with

17.2% of such cases.

42

3. Thiruvallur

Input

1. This district is ranked 3rd in regard to sanitation with 66.1% coverage and is much higher

than the average which is 52%.

2. The district is ranked 5th in providing access to improved source of drinking water with

98.7%.

3. It is placed more or less in the midway, in 14th position in regard to women married below

18 years (5%).

4. And is placed 15th (32.9%) in the case of illiterate married women.

5. It records the 6th position in the percentage of married women who have been to school

for 10 or more years (40.6%).

6. In case of women between 15 to 19 years conceiving, the district records the 23rd place

with 8.3% of such cases. The median in this aspect is 4.3%.

7. In case of pregnant women receiving full ante natal care the district ranks 3rd (54.8%).

8. The district ranks higher than many other in pregnant women having consumed 100 or

more IFA tablets and is ranked 3rd and has 63.5% coverage.


supplement, the district is ranked 3rd marginally lower than Krishnagiri which is at the

highest with 65.2% coverage.

10. In case of the reach of ORS among children the district is ranked 12th, 50%. This is higher

than the average at 48.8%.

11. In case of awareness in women regarding diarrhoea handling, the district is ranked 17th

with more than 62% women knowing what to do.

12. The district has 23 sub health centers and ranks 9th in the state, lesser than the average at

29.


median at 16.

14. Thiruvallur ranks 6th in the number of Community Health Centers (CHC) having 24x7 hours

normal delivery service with 13 such centers. This is marginally higher than the median

which is 12.


the district ranks 29th (2nd lowest) and the intake is only 19.6% (very low)

Output

1. This district records IMR of 12 out of 1000 live births (rank 6th) as same as the median,

2. The MMR here is 80 female deaths out of 100,000 live births (rank 18th).

43

3. In LBW the district ranks 1st, 5.3%.

4. Under-5 mortality rate in the district is also quite impressive and ranks 2nd, 19 out 1000

live births.

5. Even live births is high (rank 4th, 99.5%, the highest being 100%).

6. Again the incidence of diarrhoea among children below 5 years is much lower than most

of the other districts (rank 3rd, 2.3%).


bracket in case of severe anaemia, the district ranks 12th (3%) this is lower than the

median at 3.7%.


with 40.2% of such cases, this is lower than the median at 46.1%. In severe anaemia

however, the district ranks 8th with 1.5% of such cases, again lower than the median at

1.8%.


than the average at 48.4%. Severe anaemia here is 1.3% and the district ranks 6th.



11th at 1.3%, marginally higher than the state average at 1.2%. For females it is 1.2% (rank

5th). This is much lower than the median at 2.1%.

11. Among adolescents total anaemia is 35.9% (rank 13th) and severe anaemia is 0.3% (rank

2nd) much lower than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 59.6% (rank 21st), higher than the

median at 56.7%, among women (15-49 years) it is 45.8% (rank 11th). Severe anemia is

quite low both among pregnant women (15-49 years), 0% (rank 1st) and among women

(15-49 years) it is 1.6%, rank 4th.

13. This district has several incidences of stunting (rank 24th, 30.1%, higher than the median

at 27%), wasting (rank 25th, 23.3%, again higher than the average at 19.9%) and 26.6%

underweight below 5 years children (rank 16th).

4. Nilgiris

Input

1. The district is ranked 4th in provided sanitation and has 64% coverage.

2. The district ranks 14th in terms of access to improved sources of drinking water (97.5%)

however, the rank is irrelevant here due to the small 99.3%-89.2%.

3. In case of female underage marriage the district is placed 6th with 2.3% of such cases.

44

4. It secures the 8th position with 25.2% in terms of illiterate married women but much

lower than the median at 32.2%

5. In case of married women with 10 or more years of schooling, this district secures the 3rd

position with 47.5% coverage.

6. In case of women between 15 to 19 years conceiving, the district records the 8th place

with 2.7% prevalence.

7. It secures the 8th position with 47.8% coverage in case of pregnant women receiving any

full natal care.

8. The district ranks 12th (49.4%) in pregnant women having consumed 100 or more IFA

tablets. This is higher than the average of 42.1%.

9. Nilgiris is ranked 7th with 71.1% coverage in case of children (9-35 months) having

received at least one dose of Vitamin A supplement.

10. In the reach of ORS among children the district secures 8th positions with 54.5% of such

cases. The median is much higher (48.8%).


with 67.5% women knowing the standard procedure.


average at 29.


median at 16.

14. This district ranks 14th in the number of Community Health Centers (CHC) having 24x7

hours normal delivery service with 4 such centers. This is lower than the median which is

12.

15. For children aged 6-23 months who received adequate diet. the NFHS-4 data shows that

the district ranks 13th but the intake is only 32.5% (Below mean level)

Output

1. In the Nilgiris the IMR is at the 5th rank (11 out 1000 live births). This is partially lower

than the median which is 12 out 1000 live births.

2. In LBW the rank is 14th with 11.3% of such cases.

3. Live births ranks 18th (95.8%). The state records high live births with a small variation

among the districts (100% to 90.7%). In that respect the ranking becomes less important.

4. Nilgiris records under 5 mortality rate at 26 out 1000 live births and ranks 9th, a little

above the median which is at 28 out of 1000 live births.

5. MMR in the district looks up and ranks 3rd (39 female deaths out of 100,000 live births)

among the other districts in the state.

45

6. The incidence of diarrhoea among children under 5 years is 5.6% (rank 13th) almost at the

same level as the average at 5.7%.

7. In case of total anaemia in children below 5 years it is ranked 1st (41.3%). In the same age

bracket in case of severe anaemia, the district ranks at 2nd (1.3%) this is much lower than

the median at 3.7%.

8. In the bracket of 6-9 years male children we see that in total anaemia the district ranks 1st

with 26.9% of such cases, this is naturally much lower than the median at 46.1%. In

severe anaemia also the district ranks 1st with 0% of such cases.

9. Among females of same age group total anaemia is 31.1% (rank 1st). In Severe anaemia

here it is only 1% and the district ranks 5th.


4th) among males and 35.6% (rank 5th) among females. Severe anaemia among males is 3rd

at 0.4%, much lower than the state average at 1.2%. For females it is 1.4% (rank 7th). This

is also much lower than the median at 2.1%.


9th), lower than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 37.7% (rank 2nd), among women

(15-49 years) it is 32.9% (rank 1st). Severe anemia among low pregnant women (15-49

years) is 1.9% (rank 9th) and among women (15-49 years) it is 1%, rank 2nd.

13. In Nilgiris when it comes to the incidence of stunting, wasting and underweight below 5

years children it is seen that the rank is 29th at 33.1%, 28th with 31%, and 23rd 30.7

respectively). In all three cases the percentages are much higher than the median (27% in

case on stunting, 19.9% in case of wasting, and 24.1% for underweight children).

5. Tiruppur

Input

1. The district is ranked 5th in regard to sanitation and has 62% coverage.

2. The district holds the 18th position in providing access to improved source of drinking

water with 96.6% coverage.

3. In case of female underage marriage the district is placed 9th with 3.6% of such cases only,

where as the median is at 5.3%.

4. It does not perform well in indicators relating to women’s consciousness and health. It

holds the 17th position (33.8%) in terms of illiterate married women. The average in this

regard is 32.2%.

5. It is placed at the 26th rank (28.2%) in regard to married women with 10 or more years of

schooling, the average being 36.3%.

46

6. In case of women between 15 to 19 years conceiving, the district records the 17th position

with 4.8% prevalence higher than the average at 4.3%.

7. In case of pregnant women receiving full ante natal care, the district is ranked 15th with

37.3% pregnant women receiving it. This is higher than the state average at 36.9%.


tablets. It is only marginally higher than the state average at 42.1%.

9. The district is ranked 13th (65.6%) the case of children (9-35 months) having received at

least one dose of Vitamin A supplement which is higher than the state average 61.9%.

10. In case of the reach of ORS among children the district secures 5th position with 66.7%

coverage, much higher than the median at 48.8%.

11. In the case of awareness in women in diarrhoea handling, the district is ranked 15th,

62.3%. This is again higher than the median at 60.8%.


29.

13. It also has 12 Primary Health Centers (PHCs) and ranks 10th, again below the median at 16.

14. The district ranks 4th in the number of Community Health Centers (CHC) having 24x7

hours normal delivery service with 16 such centers. This is higher than the median at 12.


the district ranks 10th but the intake is only 35.2% (above mean level)

Output

1. The district has performed well in IMR and ranks 2nd with 7 out 1000 live births. Much

lower than the median at 12 out 1000 live births.

2. In terms of LBW it ranks 20th with 14% of such incidence. It is slightly higher than the

average of Tamil Nadu which is at 11.8%

3. In terms of MMR the district ranks 14th with 73 female deaths out of 100,000 deaths.

4. The incidence of diarrhoea among children (below 5 years) is prevalent among 6.6% of

the children (rank 18th), slightly higher than the average of the state at 5.7%.

5. In case of total anaemia in children below 5 years it is ranked 15th (60.6%). In the same

age bracket in case of severe anaemia, the district ranks at 20th (6%) this is much higher

than the median at 3.7%.


14th with 43.9% of such cases, this is higher than the median at 46.1%. In severe anaemia

also the district ranks 11th with 1.8% of such cases.

7. Among females of same age group total anaemia is 49% (rank 16th). In severe anaemia

here it is only 1% and the district ranks 5th.

47

8. In case of children between 10-19 years, the district records total anaemia of 38% (rank

23rd) among males and 51.5% (rank 24th) among females. Severe anaemia among males is

15th at 2.1%, higher than the state average at 1.2%. For females it is 1.5% (rank 8th). This is

much lower than the median at 2.1%.



10. Total anaemia among pregnant women (15-49 years) is 55.8% (rank 13th) among women

(15-49 years) it is 54.5% (rank 20th). Severe anemia among low pregnant women (15-49

years) is 0.7% (rank 2nd) and among women (15-49 years) it is 2.6%, rank 12th.

11. Tiruppur has 29.4% (rank 21st) below 5 children who are stunted higher than the average

at 27%.

12. 20.4% children (rank 19th) are wasted (higher than the average at 19.9%) and 24.9% (rank

13th) below 5 children who are underweight, partially higher than the average at 24.1%.

6. Erode

Input

1. The district is ranked 6th in providing sanitation and has 60% coverage.

2. Erode holds the 16th position in providing access to improved source of drinking water

with 97.1% coverage.

3. It has the 14th rank terms of married women below 18 years with 5% such women present

in the district, a little less than the average at 5.3%

4. It is ranked 18th (34.7%) in terms of illiterate married women. This is higher than the state

average at 32.2%.

5. In terms of women receiving 10 or more years of school education this district performs

well and is in the 3rd position with 47.5% of such cases.

6. In case of women between 15 to 19 years conceiving, the district records the 12th position

with 4.2% prevalence, almost same as the median at 4.3%.

7. In case of pregnant women receiving full ante natal care, the district is ranked 11th with

45.8% prevalence.


tablets, quite higher than the median at 42.1%.

9. It is ranked 21st (57.5%) in the case of children (9-35 months) who received at least one

dose of Vitamin A supplement, this is lower than the average at 61.9%.

10. In case of the reach of ORS among children the district secures 12th position (50%), higher


48

11. In the case of awareness in women in diarrhoea handling, the district is ranked 24th with

54.9%, lower than the average at 60.8%.


29.

13. It also has 16 Primary Health Centers (PHCs) and ranks 6th, same as the median at 16.


hours normal delivery service with 12 such centers which is same as the median at 12.


the district ranks 22nd but the intake is only 28.7% (Below mean level)

Output

1. In Erode we see that IMR is impressive and it stands at the 3rd position (7 out of 100

children, 2013-14).

2. It however records relatively low MMR (rank 10th) with 64 female deaths out of 100,000

live births though quite less than the state average at 74 female deaths out of 100,000.

3. Low birth weight in this district looks positive at rank 10th (10.6% of such cases).

4. Live births are also high here at 99.4% (rank 5th).

5. Under 5 mortality rate is 21 out 1000 live births (rank 4th).

6. The case of diarrhoea among below 5 years children is high with 6.8% such cases (rank

20th out of 32 districts) higher than the state average at 5.7%.


age bracket in case of severe anaemia, the district ranks at 16th (3.7%) same as the

median at 3.7%.

8. In the bracket of 6-9 years male children we see that in total anaemia the district ranks 3rd

with 34.6% of such cases, this is much lower than the median at 46.1%. In severe anaemia

the district ranks 12th with 1.9% of such cases.

9. Among females of same age group total anaemia is 42.7% (rank 7th). In severe anaemia

here it is only 2.3% and the district ranks 13th.






18th), higher than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 63.4% (rank 23rd) among women


years) is 4.9% (rank 17th) and among women (15-49 years) it is 3.6%, rank 17th.

49

13. Erode has 25.6% (rank 11th) below 5 children who are stunted lower than the average at

27%.

14. 16.3% children (rank 8th) are wasted (lower than the average at 19.9%) and 16.1% (rank

2nd) below 5 children who are underweight, much lower than the average at 24.1%.

7. Kancheepuram

Input

1. The district is ranked 7th in providing sanitation and has 59.2% coverage.

2. The district also holds the 7th position in providing access to improved source of drinking

water with 98.4% coverage.

3. In underage marriage among women the district ranks 4th with 2.1% such cases.

4. In indicator relating to illiterate married women it is ranked 31st (50.8%), quite above the

average at 32.2%.

5. It ranks 25th (29%) in women receiving 10 years or more of school education the state

average being 36.3%.

6. It is again relatively better placed in case of women between 15 to 19 years conceiving

and holds the 4th position with 1.5% prevalence.

7. In case of pregnant women receiving full ante natal care, the district is ranked 2nd with

62.8% penetration.

8. The district ranks 2nd in pregnant women having consumed 100 or more IFA tablets

(64.7%).

9. It is ranked 23rd (57.1%) in the case of children (9-35 months) having received at least one

dose of Vitamin A supplement, the average being a little higher at 61.9%.

10. In case of the reach of ORS among children the district secures 2nd position (73.9%).

11. In the case of awareness in women in diarrhoea handling, the district is ranked 13th.


29.

13. It also has 16 Primary Health Centers (PHCs) and ranks 6th, same as the median range at

16.


hours normal delivery service with 13 such centers. This is higher than the median range

at 12.



50

Output

1. In terms of IMR this district has performed relatively well and is ranked 4th (10 out 1000

live births).

2. In case of children born with low birth weight the district is ranked 13th (11.1%) lower

than the average by a small fraction (11.8%).

3. This district has performed very well in case of live births and is placed at the top at 100%.

4. Under 5 mortality rate is low in this district is ranked 8th 25 out of 1000 live births.

5. In terms of MMR this district has is placed at the 17th position (79 female deaths out 1000

live births), the average being 74 female deaths out 1000 live births

6. The incidence of diarrhoea among children is 9.8% rank 28th, higher than the average at

5.7%.


age bracket in case of severe anaemia, the district ranks at 21st (6.1%) this is much higher



with 40.2% of such cases, this is lower than the median range at 46.1%. In severe anaemia

the district ranks 21st with 4.1% of such cases.





8th at 1%, lower than the state average at 1.2%. For females it is 3.2% (rank 17th). This is

much higher than the median range at 2.1%.

11. Among adolescents total anaemia is 37% (rank 17th) and severe anaemia is 1.8% (rank

12th), same as the average at 1.8%.


(15-49 years) it is 55.5% (rank 23rd). Severe anemia among low pregnant women (15-49

years) is 4.2% (rank 16th) and among women (15-49 years) it is 3%, rank 15th.

13. Kancheepuram has 25% (rank 8th) below 5 children who are stunted lower than the

average at 27%.

14. 13.9% children (rank 5th) are wasted (much lower than the average at 19.9%) and 16.1%

(rank 2nd) below 5 children who are underweight, much lower than the average at 24.1%.

8. Thirunelveli

Input

1. The district holds the 8th position in terms of sanitation and has 58.3% coverage.

51

2. It is at the 9th position in providing access to improved source of drinking water with

98.2% coverage

3. It fares well in respect to incidents of underage marriage among girls and is ranked 3rd

with 1.8% presence

4. It is also holds the same position in terms of illiterate married women (20.3%, rank 3rd).

5. In the case of married women with 10 or more years of schooling it is ranked 19th (32.8%).

The media being higher at 36.3%.

6. In case of women between 15 to 19 years conceiving the district ranks 5th with 2.1%

prevalence.

7. In pregnant women receiving full ante natal care the district is ranked 22nd with 29.2%

pregnant women receiving care. This is lower than the average which is 36.9%.


tablets/ syrup. This is also less than the median at 42.1%.

9. The district is better placed in the case of children (9-35 months) having received at least

one dose of Vitamin A supplement and is ranked 9th with 68.4%.

10. In case of the reach of ORS among children the district it is ranked 18th (35.3%). This is

quite lower than the state average at 48.8%.

11. In the case of awareness in women in diarrhoea handling, the district is ranked 23rd

(55.6%). This is also lower than the average at 60.8%.


average at 29.


median range at 16.


hours normal delivery service with 15 such centers. This is a above the median at 12.


the district ranks 23rd but the intake is only 28.5% (much below mean level)

Output

1. Thirunelveli is ranked 8th in terms of IMR (14 out of 1000 live births). This is above the

median which is at 12 out of 1000 live births.

2. In the case of low birth weight and is ranked 19th (13%). Again a little over the median

range at 11.8%.

3. Live birth in this district is ranked 14th (97.3%), the average being marginally above at

97%.

4. In under 5 mortality rate the district ranks 15th (32 out of 1000 live births). The state

average a lower with 28 out of 1000 live births.

52

5. In terms of MMR it is ranked at the 23rd position with 91 female deaths out of 100,000

live births. This is quite above the median which is 74 female deaths out of 100,000 live

births.

6. The incidence of diarrhoea among under 5 years old children is ranked 14th (5.7%). This is

same as the average of the state.

7. In case of total anaemia in children below 5 years it is ranked 21st (68%). In the same age

bracket in case of severe anaemia, the district ranks at 11th (2.9%) this is lower than the

median at 3.7%.


16tth with 45.9% of such cases, this is lower than the median range at 46.1%. In severe

anaemia also the district ranks 17th with 2.7% of such cases.


here it is 3.1% and the district ranks 15th.


17th) among males and 50% (rank 22nd) among females. Severe anaemia among males is


is higher than the median range at 2.1%.

11. Among adolescents total anaemia is 34.4% (rank 11th) and severe anaemia is 1% (rank




years) is 5% (rank 18th) and among women (15-49 years) it is 3%, rank 15th.

13. Thirunelveli has 30.8% (rank 25th) below 5 children who are stunted, higher than the

average at 27%.


10th) below 5 children who are underweight, lower than the average at 24.1%.

9. Thoothukkudi

Input

1. The district holds the 9th position in terms of sanitation and has 57% coverage.

2. It records 22nd position in providing access to improved source of drinking water with

94.4% coverage which is however, not very low as compared to the state average that

stands at 97%.

3. It holds the 15th position (5.2%) in underage marriage among women which is only

slightly lower as compared to the state average which is 5.3%

53

4. It is placed in the 19th position (35.3%) in case of the percentage of married women who

are illiterate and is placed higher than the state average (32.2%).

5. It is ranked 28th (27.6%) in terms of married women receiving 10 or more years of

schooling which lower than the state average (36.3%)

6. It is in the 6th position (2.5%) in case of women between 15 to 19 years conceiving and is

much lower than the state average (4.3%).

7. The district is placed 16th (36.9%) in case of pregnant having received full ante natal care

which is par with the state average (36.9%)

8. The district is placed 10th (51.5%) in pregnant women having consumed 100 or more IFA

tablets which is quite higher as compared to the national average (42.1%)

9. In the case of awareness in women in diarrhoea handling, the district is ranked 10th

(65.3%) which is higher than the state average (60.8%)

10. It is placed 6th (72.3%) in percentage of children (9-35 months) having received at least

one dose of Vitamin A supplement which is significantly higher than the state average

(61.9%)

11. The district is ranked 15th (44.4%) in case of the reach of ORS among children with

diarrhoea and is lower than the national average (48.8%)

12. The district is ranked 7th in number of health substations with 25 such substations and is

lower than the state average (29)

13. The district is ranked 10th in the number of primary health centres and has 10 such

centres and is lower placed than the state average (16)

14. The district is ranked 10th in case of community health centres having 24x7 delivery

services with 9 such centres and is lower compared to the state average (12).



Output

1. Thoothukkudi is placed at 5th in terms of IMR (11 out of 1000 live births).

2. In case of LBW it is placed at 15th (11.6%), the average is marginally higher at 11.8%.

3. In Live birth this district is placed at 12th (97.9%), the average is 97%.

4. It has performed well (rank 7th) in case of under 5 mortality rate with 24 out of 1000 live

births.

5. MMR performance is lower 25th rank with 100 female deaths out of 100,000 live births.

The average in this indicator is 74 female deaths out of 100,000 live births.

54


age bracket in case of severe anaemia, the district ranks at 22nd (6.4%) this is higher than

the median at 3.7%.


22nd with 51.7% of such cases, this is higher than the median range at 46.1%. In severe

anaemia the district ranks 10th with 1.7% of such cases.

8. Among females of same age group total anaemia is 53.6% (rank 22nd). In severe anaemia



22nd) among males and 48.2% (rank 20th) among females. Severe anaemia among males is

5th at 0.7%, lower than the state average at 1.2%. For females it is 1.4% (rank 7th). This is

lower than the median range at 2.1%.





years) is 2% (rank 10th) and among women (15-49 years) it is 48.3%, rank 11th.

12. Thoothukkudi has 21.2% (rank 3rd) below 5 children who are stunted, much lower than

the average at 27%.

13. 12.4% children (rank 2nd) are wasted (much lower than the average at 19.9%) and 17.6%

(rank 4th) below 5 children who are underweight, again much lower than the average at

24.1%.

10. Coimbatore

Input

1. The district holds the 10th position in terms of sanitation and has 55.2% coverage.

2. It records 2nd position in providing access to improved source of drinking water with

99.2% coverage which is higher than the state average (97%)

3. It holds the 10th position (3.9%) in underage marriage among women which is lower as

compared to the state average which is 5.3%

4. It is placed in the 25th position (41%) in case of the percentage of married women who

are illiterate and is placed higher than the state average (32.2).

5. It is ranked 22nd (31.1%) in terms of married women receiving 10 or more years of

schooling which lower than the state average (36.3%)

6. It is in the 6th position (2.5%) in case of women between 15 to 19 years conceiving and is

much lower than the state average (4.3%).

55

7. The district is placed 27th (25%) in case of pregnant having received full ante natal care

which is lower than the state average (36.9%)

8. The district is placed 26th (27.5%) in pregnant women having consumed 100 or more IFA

tablets which is quite lower as compared to the national average (42.1%)

9. In the case of awareness in women in diarrhoea handling, the district is ranked 32nd

position (34.2%) which is lower the state average (60.8%)

10. It is placed 26th (53%) in percentage of children (9-35 months) having received at least

one dose of Vitamin A supplement which is lower than the state average (61.9%)

11. The district is ranked 17th (36.4%) in case of the reach of ORS among children with

diarrhoea and is lower than the national average (48.8%)

12. The district is ranked 8th in the number of health substations with 24 such substations

and is lower than the state average (29).

13. The district is ranked 8th in the number of primary health centres and has 14 such centres

and is lower placed than the state average (16).

14. The district is ranked 7thin case of community health centres having 24x7 delivery

services with 12 such centres and is higher compared to the state average (12).


the district ranks 26th but the intake is only 25% (much below mean level)

Output

1. This district has topped the chart in terms of IMR with 6 out of 1000 live births.

2. In terms of low birth weight the district has ranked 22nd with 15.6% the average being

11.8%.

3. In case of live birth, it is ranked 14th with 97.3% of such cases. The average is marginally

lower at 97%.

4. It has shown good performance in case of under 5 mortality (rank 3rd) with 20 out of 1000

live births.

5. In case of MMR it is ranked 6th with 58 female deaths out of 100,000 live births. The

average is much higher at 74 female deaths out of 100,000 live births.

6. The incidence of diarrhoea among under 5 years old children is ranked 6th with 3.9%

prevalence.

7. In case of total anaemia in children below 5 years it is ranked 8th (56.2%). In the same age

bracket in case of severe anaemia, the district ranks at 8th (2.2%) this is lower than the

median at 3.7%.


19th with 49.6% of such cases, this is higher than the median range at 46.1%. In severe


56



10. In case of children between 10-19 years, the district records total anaemia of 28% (rank


12th at 1.4%, higher than the state average at 1.2%. For females it is 2% (rank 11th). This is

marginally lower than the median at 2.1%.






13. The district has 27.3% (rank 15th) below 5 children who are stunted, marginally higher

than the average at 27%.

14. 21.3% children (rank 21st) are wasted (higher than the average at 19.9%) and 22.9% (rank


11. Madurai

Input

1. The district holds the 10th position in terms of sanitation with 55.2% coverage.

2. It ranks 20th in providing access to improved source of drinking water with 95.9%

coverage, a little below the median at 97%.

3. In case of female underage marriage the district is placed 13th with 4.2% of such cases,

the average being higher at 5.3%.

4. It is ranked 13th (31.1%) in the percentage of married women who are illiterate, lower

than the median range at 32.2%.

5. In terms of married women receiving 10 or more years of schooling, the district is placed

10th with 35.4% women finishing 10 or more years of schooling, lower than the median at

36.3%.

6. In terms of women between 15 to 19 years conceiving, the district ranks 16th with 5.1% of

such cases, slightly above 4.3%.

7. 52.2% women in this district have received full ante natal care and in this respect the

district is well placed in 4th position, much higher than median at 36.9%.

8. In indicators relating to pregnant women having consumed 100 or more IFA tablets the

district ranks 7th (54.7%), above the median range at 42.1%.

9. In case of children (9-35 months) having received at least one dose of Vitamin A

supplement it is ranked 15th (63.4%), again above the median range at 61.9%.

57

10. In case of the reach of ORS among children the district is ranked 6th with 57.1% coverage,

much higher than the average at 48.8%.

11. In the case of awareness in women in diarrhoea handling, the district is ranked quite low

at 26th position (51.6%), quite below that median range at 60.8%.

12. The district is ranked 9th in the number of sub health centres with 23 such centers and is

lower than the state average (29).


and is placed above the state average (16).

14. The district is ranked 6th in case of community health centres having 24*7 delivery



the district ranks 11th but the intake is only 33.3% (Above mean level)

Output

1. Madurai has ranks 6th in IMR with 12 out of 1000 live births.

2. In terms of low birth weight the district has ranked 25th with 19.8% the average being

11.8%.

3. In case of live birth, it is ranked 17th with 95.9% of such cases. The average is higher at

97%.

4. In case of under 5 mortality, Madurai is ranked 20th with 39 out of 1000 live births. The

average is much lower at 28 out of 1000 live births.


average is much lower at 74 female deaths out of 100,000 live births.


prevalence. The average marginally lower at 5.7%.


age bracket in case of severe anaemia, the district ranks at 3rd (1.4%) this is much lower



29th with 67.5% of such cases, this is quite higher than the median range at 46.1%. In

severe anaemia the district ranks 20th with 3.9% of such cases.




24th) among males and 59% (rank 27th) among females. Severe anaemia among males is



58

11. Among adolescents total anaemia is 44% (rank 25th) and severe anaemia is 2.5% (rank





13. The district has 21.2% (rank 3rd) below 5 children who are stunted, lower than the

average at 27%.

14. 12.7% children (rank 3rd) are wasted (much lower than the average at 19.9%) and 19.5%


24.1%.

12. Thiruchilappalli

Input

1. The district holds the 11th position in terms of sanitation with 43% coverage.

2. It is placed at the 12th position in providing access to improved source of drinking water.

3. In terms of underage marriages among women, the district is placed 7th with 2.8% such

cases occurring in the reference period.

4. It holds the 9th position in terms of married women who are illiterate.

5. The district holds the 5th position in reference to married women receiving 10 or more

years of schooling.


such cases. The median being marginally lower at 4.3%.


district is placed in 13th position, above the median at 36.9%.

8. In the indicator relating to pregnant women having consumed 100 or more IFA tablets the

district ranks 15th, 42.6%, marginally above the median at 42.1%.


supplement it is ranked 8th with 69% children having received it.

10. In case of the reach of ORS among children the district is ranked 22nd (31.3%), the median

is higher at 48.8%.

11. In the case of awareness in women in diarrhoea handling, the district is ranked quite high

at 3rd position with 75.4% women knowing what to do.




centres and is placed below the state average (16).

59





Output

1. The district is ranked 6th in regard to IMR with 12 out of 1000 live births, same as the

average of Tamil Nadu.


cases. This is however almost at par with the median range at 11.8%.

3. In case of live births, Tiruchirappalli is ranked 23rd at 92.1% live births, the average is

higher at 97%.

4. It has ranked 16th in under 5 mortality rate and has recorded 35 deaths out of 1000 live

births. The average in the state is 28 deaths out of 1000 live births.

5. In case of MMR it has ranked 22nd with 89 female deaths out of 100,000 live births. The

average in the district is 74 female deaths out of 100,000 live births.

6. The incidence of diarrhoea among children in the district also looks up and it ranks 19th

with 6.7% of such cases, above the median at 5.7%.


bracket in case of severe anaemia, the district ranks 16th (3.7 %) this is same as the

median.


30th with 68.7% of such cases, this is much higher than the median range at 46.1%. In

severe anaemia however, the district ranks 16th with 2.4% of such cases.

9. Among females of same age group total anaemia is 53.7% (rank 23rd) this is higher than

the average at 48.4%. Severe anaemia here is also 1.5% and the district ranks 8th.



3rd at 0.4%, higher than the state average at 1.2%. For females it is 3.1% (rank 16th). This is

higher than the median range at 2.1%.

11. Among adolescent total anaemia it is 44.1% (rank 26th) and severe anaemia is 3.2% (rank

19th) higher than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 80% (rank 30th), higher than the

median at 56.7%, among women (15-49 years) it is 66.4% (rank 29th). Severe anemia

among pregnant women (15-49 years) is 5.5% (rank 20th) among women (15-49 years) it is

5.3%, rank 21st.

13. The district has 30% (rank 23rd) below 5 children who are stunted, higher than the

average at 27%.

60

14. 19% children (rank 15th) are wasted (marginally lower than the average at 19.9%) and

27.6% (rank 17th) below 5 children who are underweight, higher than the average at

24.1%.

13. Theni

Input


2. The district is only well placed at 3rd position with 99% coverage pertaining to access to

improved source of drinking water.

3. In case of female underage marriage the district is placed 23rd with 8% of such cases, the

average being lower at 5.3%.

4. It is ranked 21st (36.8%) in the percentage of married women who are illiterate,

marginally higher than the median range at 32.2%.


16th with 33.4% women finishing 10 or more years of schooling, lower than the median

at 36.3%.

6. In terms of women between 15 to 19 years conceiving, the district ranks 12th with 4.2%

of such cases, almost same as the state average at 4.3%.


district is placed in 21st position, lower than median at 36.9%.


district ranks 24th (31.5%), below the median range at 42.1%.

9. In case of children (9-35 months) receiving at least one dose of Vitamin A supplement it

is ranked 14th (64.3%), which is above the median at 61.9%.

10. In case of the reach of ORS among children the district is ranked 12th with 50% coverage,

higher than the average at 48.8%.

11. In the case of awareness in women in diarrhoea handling, the district is ranked at 18th

position (61%), above that median range at 60.8%.




and is placed below the state average (16).




the district ranks 27th but the intake is only 24.4% (much below mean level)

61

Output

1. Theni has ranked 10th in IMR with 17 out of 1000 live births while the average is 12 out of

1000 live births.

2. In terms of low birth weight the district has ranked 2nd with only 6.1% of such cases. The

average in the state being much higher at 11.8%.

3. In case of live birth, it is ranked 6th with 99.2% of such cases. The average is lower at 97%.

4. In case of under 5 mortality, the district is ranked 21st with 44 out of 1000 live births. The

average is much lower at 28 out of 1000 live births.


average is lower at 74 female deaths out of 100,000 live births.


prevalence. The average is marginally lower at 5.7%.

7. In case of total anaemia in children below 5 years it is ranked 3rd (46.2%). In the same age

bracket in case of severe anaemia, the district ranks at 14th (3.3%) this is marginally lower



10th with 40.7% of such cases, this is lower than the median range at 46.1%. In severe


9. Among females of same age group total anaemia is 35.4% (rank 3rd). In severe anaemia

here it is 1% and the district ranks 5th.


12th) among males and 32.9% (rank 2nd) among females. Severe anaemia among males is

3rd at 0.4%, lower than the state average at 1.2%. For females it is 2% (rank 11th). This is

lower than the median at 2.1%.

11. Among adolescents total anaemia is 26.4% (rank 3rd) and severe anaemia is 0.7% (rank





13. The district has 27.4% (rank 16th) below 5 children who are stunted, almost the same as

the average at 27%.

14. 14% children (rank 6th) are wasted (much lower than the average at 19.9%) and 22% (rank

7th) below 5 children who are underweight, again lower than the average at 24.1%.

62

14. Nagapattinam

Input

1. The district holds the 13th position in terms of sanitation with 52% coverage.

2. It is placed at the 12th position (97.7%) in providing access to improved source of drinking

water.

3. It has performed well in terms of the percentage of underage married women and ranks

2nd with 1.3% such cases.

4. It holds the 4th position (21.2%) in terms of married women who are illiterate.

5. The district holds the 8th position (39.6%) in reference to married women receiving 10 or

more years of schooling.


such cases. The median being much higher at 4.3%.


district is placed in 6th position, much above the median at 36.9%.

8. In the indicator relating to pregnant women having consumed 100 or more IFA tablets

the district ranks 6th, 57.5%, quite above the median at 42.1%.


supplement it is ranked 18th with 59.5% children having received it, lesser than the

average at 61.9%.

10. In case of the reach of ORS among children the district is ranked 12th (50%), the median

is lower at 48.8%.

11. In the case of awareness in women in handing diarrhoea among below 5 years old

children, the district is ranked quite high at 5th position with 72.4% women knowing what

to do.

12. The district is ranked 1st in the number of sub health centres with 45 such centers and is

much higher than the state average (29).

13. The district is ranked 1st in the number of primary health centres and has 22 such centres

and is placed way above the state average (16).


services with 11 such centres and is slightly lower compared to the state average (12).


the district ranks 25th but the intake is only 25.2% (Much below mean level)

Output

1. The district is ranked 8th in regard to IMR with 14 out of 1000 live births, higher than the

average of Tamil Nadu which is at 12 out of 1000 live births .

63


cases. This is however, almost at par with the median range at 11.8%.

3. In case of live births, the district is ranked 11th at 98% live births, the average is lower at

97%.

4. It has ranked 11th in under 5 mortality rate and has recorded 28 deaths out of 1000 live

births. The average in the state is the same.

5. In case of MMR it has ranked 21st with 88 female deaths out of 100,000 live births. The

average in the state is 74 female deaths out of 100,000 live births.

6. The incidence of diarrhoea among children in the district is ranked at 12th with 5.4% of

such cases, below the median at 5.7%.


bracket in case of severe anaemia, the district ranks 1st (1 %).



anaemia however, the district ranks 1st with no such recorded cases.

9. Among females of same age group total anaemia is 48.9% (rank 15th) this is marginally

higher than the average at 48.4%. Severe anaemia here is also 2.2% and the district

ranks 11th.

10. In case of children between 10-19 years, the district records total anaemia of 35.9%

(rank 21st) among males and 44.8% (rank 14th) among females. Severe anaemia among

males is 4th at 0.6%, much lower than the state average at 1.2%. For females it is 1.6%

(rank 9th). This is much lower than the median at 2.1%.

11. Among adolescent total anaemia it is 37% (rank 17th) and severe anaemia is 1.4% (rank

9th) lower than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 54.2% (rank 11th), lower than

the median at 56.7%, among women (15-49 years) it is 54% (rank 19th). Severe anemia

among pregnant women (15-49 years) is 0% (rank 1st), among women (15-49 years) it is

1.8%, rank 6th.

13. The district has 24.5% (rank 7th) below 5 children who are stunted, lower than the

average at 27%.

14. 17.4% children (rank 10th) are wasted (lower than the average at 19.9%) and 22.9%

(rank 11th) below 5 children who are underweight, lower than the average at 24.1%.

15. Namakkal

Input

1. It holds the 14th position in terms of sanitation and has 51.9% penetration in this.

64

2. In terms of improved access to drinking water, it is placed at 10th position which entails

98.1% reach.

3. In case of female underage marriage the district is placed 12th with 4.1 % of such cases,

the average being higher at 5.3%.

4. It is ranked 20th (35.4%) in the percentage of married women who are illiterate, higher




at 36.3%.

6. In terms of women between 15 to 19 years conceiving, the district ranks 21st with 6.7%

of such cases, higher than the state average at 4.3%.


district is placed in 7th position, much higher than median at 36.9%.


district ranks 9th (51.6%), above the median range at 42.1%.


is ranked 25th (55.5%), which is below the median at 61.9%.

10. In case of the reach of ORS among children the district is ranked 23rd with 30.8%

coverage, lower than the average at 48.8%.


position (71%), quite above that median range at 60.8%.


higher than the state average (29).

13. The district is ranked 3rd in the number of primary health centres and has 20 such

centres and is placed way above the state average (16).


services with 15 such centres and is much higher compared to the state average (12).


the district ranks 7th but the intake is only 36.9% (Higher than the mean level)

Output

1. Namakkal has ranked 8th in IMR with 14 out of 1000 live births while the average is 12

out of 1000 live births.

2. In terms of low birth weight the district has ranked 8th with only 9.8% of such cases. The

average in the state being quite higher at 11.8%.

3. In case of live birth, it is ranked 7th with 99.1% of such cases. The average is lower at

97%.

65

4. In case of under 5 mortality, the district is ranked 10th with 27 out of 1000 live births.

The average is much lower at 28 out of 1000 live births.




prevalence. The average is higher at 5.7%.


age bracket in case of severe anaemia, the district ranks at 23rd (6.6%) this is much

higher than the median at 3.7%.



anaemia the district ranks 1st with no of such recorded cases.




(rank 10th) among males and 47.5% (rank 17th) among females. Severe anaemia among

males is 16th at 2.6%, higher than the state average at 1.2%. For females it is 2.5% (rank

13th). This is higher than the median at 2.1%.




(15-49 years) it is 43.5% (rank 8th). Severe anemia among pregnant women (15-49 years)

is 5.1% (rank 19th) and among women (15-49 years) it is 2.8%, rank 13th.

13. The district has 25.2% (rank 10th) below 5 children who are stunted, less than the

average at 27%.

14. 15% children (rank 7th) are wasted (much lower than the average at 19.9%) and 18%


24.1%.

16. Krishnagiri

Input

1. It holds the 15th position in terms of sanitation and has 51.8% penetration in this.

2. In terms of improved access to drinking water, it is placed at 23rd position which entails

93.8% reach.

3. In case of female underage marriage the district is placed 22nd with 7.1% of such cases,

the average being lower at 5.3%.



66


11th with 35.3% women finishing 10 or more years of schooling, marginally lower than

the median at 36.3%.


such cases, lower than the state average at 4.3%.


district is placed in 1st position, much higher than median at 36.9%.


district ranks 1st (65.2%), above the median range at 42.1%.



10. In case of the reach of ORS among children the district is ranked 9th with 53.8%

coverage, much higher than the average at 48.8%.


position (60.3%), almost the same as the median range at 60.8%.

12. The district is ranked 3rd in the number of sub health centres with 43 such centers and is



centres and is placed above the state average (16).


services with 11 such centres and is lower compared to the state average (12).


the district ranks 1st and the intake is only 81.6% (very high) – Highest course in the state

and way above the 2nd highest which is only 45.2%

Output

1. The district has ranked 10th in IMR with 17 out of 1000 live births while the average is 12


2. In terms of low birth weight the district has ranked 3rd with only 7.3% of such cases. The

average in the state being higher at 11.8%.

3. In case of live birth, it is ranked 13th with 97.7% of such cases. The average is marginally

lower at 97%.


average is marginally lower at 74 female deaths out of 100,000 live births.

5. The incidence of diarrhoea among under 5 years old children is ranked 4th with 3%

prevalence. The average is much higher at 5.7%.


age group in case of severe anaemia, the district ranks at 10th (2.8%) this is lower than

the median at 3.7%.




67




(rank 1st) among males and 41% (rank 8th) among females. Severe anaemia among males

is 7th at 0.9%, lower than the state average at 1.2%. For females it is 1.7% (rank 10th).

This is lower than the median at 2.1%.



11. Total anaemia among pregnant women (15-49 years) is 43.7% (rank 3rd) among women


years) is 2.3% (rank 11th) and among women (15-49 years) it is 2%, rank 13th.


average at 27%.

13. 20.1% children (rank 17th) are wasted (higher than the average at 19.9%) and 23.1%


17. Vellore

Input


2. In terms of improved access to drinking water, it tops among the districts of Tamil Nadu




4. It is ranked 22nd (36.9%) in the percentage of married women who are illiterate, higher




at 36.3%.




district is placed in 19th position, lower than median at 36.9%.


district ranks 18th (39.8%), below the median range at 42.1%.


is ranked 12th (66%), which is above the median at 61.9%.

10. In case of the reach of ORS among children the district is ranked 21st with 31.6%

coverage, much lower than the average at 48.8%.


position (65%), quite above that median range at 60.3%.

68




and is placed above the state average (16).

14. The district is ranked 3rd in case of community health centres having 24*7 delivery



the district ranks 5th and the intake is only 37.5% (Higher than the mean level)

Output

1. The district has ranked 5th in IMR with 11 out of 1000 live births while the average is 12


2. In terms of low birth weight the district has ranked 6th with only 8.2% of such cases. The

average in the state being lower at 11.8%.


97%.


average is at 74 female deaths out of 100,000 live births.

5. Under 5 mortality in this district is placed at 14th (31 out 1000 live births. The average of

the state is 28 out 1000 live births.




age group in case of severe anaemia, the district ranks at 17th (3.8%) this is almost same

as the median at 3.7%.


12th with 42% of such cases, this is lower than the median range at 46.1%. In severe

anaemia the district ranks 5th with 1% of such cases.

9. Among females of same age group total anaemia is 33.3% (rank 2nd). In severe anaemia




males is 3rd at 0.4%, lower than the state average at 1.2%. For females it is 0.9% (rank

3rd). This is lower than the median at 2.1%.

11. Among adolescents total anaemia is 26.8% (rank 4th) and severe anaemia is 1% (rank





13. The district has 29% (rank 20th) below 5 children who are stunted, higher than the

average at 27%.


(rank 24th) below 5 children who are underweight, higher than the average at 24.1%.

69

18. Sivagangai

Input


2. In the case of improved access to drinking water, it is ranked at the 24th with 92.7%

coverage. The average in the state is 97%.

3. It is placed more or less in the midway, in 18th position in regard to women married

below 18 years (5.6%), marginally above the average (5.3%).

4. The district is placed 5th (22.2%) in the case of illiterate married women, much lower



for 10 or more years (42.3%), much higher than the median at 36.3%.


with 3.4% of such cases. The median in this aspect is higher at 4.3%.

7. In case of pregnant women receiving full ante natal care the district ranks 24th (27.5%).

This lower than the average at 36.9%.

8. The district in pregnant women having consumed 100 or more IFA tablets and is ranked

22nd and has 34.1% coverage. The average in the state is 42.1%.


supplement, the district is ranked 23rd (57.1%). A little lower than the median at 61.9%.

10. In case of the reach of ORS among children the district is ranked 10th 52.5%. This is



with 62.7% women knowing what to do. Again, higher than the average at 60.8%.

12. The district has 44 sub health centers and ranks 2nd in the state, higher than the average

at 29.

13. It also has 22 Primary Health Centers (PHCs) and ranks 1st, again higher than the median

at 16.

14. Sivagangai ranks 5th in the number of Community Health Centers (CHC) having 24x7

hours normal delivery service with 15 such centers. This is higher than the median range

which is 12.


the district ranks 4th but the intake is only 37.7% (Above the mean level)

Output

1. This district records IMR of 13 out of 1000 live births (rank 7th) marginally higher the

median (12 out of 1000 live births),

2. The MMR in the district is 80 female deaths out of 100,000 live births (rank 18th), above

the average at 74 female deaths out of 100,000 live births.

3. In under 5 mortality rate the district ranks 9th, 26 out 1000 live births, the average being

28 out 1000 live births.

70

4. In case of low birth weight the district ranks 11th, 10.8%, the average in the district is

11.8%.

5. In case of live births it is ranked 17th, 95.9%, the average being 97%.

6. Again the incidence of diarrhoea among children below 5 years is ranked 25th, 8.3%. The

average in the state being 5.7%.


bracket in case of severe anaemia, the district ranks 7th (2%) this is lower than the

median at 3.7%.


20th with 50.6% of such cases, this is higher than the median range at 46.1%. In severe

anaemia however, the district ranks 6th with 1.1% of such cases, lower than the median

at 1.8%.

9. Among females of same age group total anaemia is 48.4% (rank 14th) this is same as the

average at 48.4%. Severe anaemia here is 0.7% and the district ranks 2nd.


(rank 6h) among males and 46.3% (rank 15th) among females. Severe anaemia among

males is 1st no such cases, the state average being 1.2%. For females it is 1.3% (rank 6th).

This is much lower than the median range at 2.1%.


8th) lower than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 54.4% (rank 12th), lower than

the median at 56.7%, among women (15-49 years) it is 51.2% (rank 15th). Severe anemia

is quite low both among pregnant women (15-49 years), 1.1% (rank 4th) and among

women (15-49 years) it is 2%, rank 8th.

13. This district has several incidences of stunting (rank 2nd, 20.9%, lower than the median

range at 27%).

14. In the incidence of wasting among below 5 years old children is ranked 14th, 18.8%,

lower than the average at 19.9%, and 22.7% below 5 years children underweight (rank

10th).

19. Salem

Input


2. In terms of improved access to drinking water, it is ranked in 9th position with 98.2%

coverage.





71


21st with 31.3% women finishing 10 or more years of schooling, lower than the median

at 36.3%.

6. In terms of women between 15 to 19 years conceiving, the district ranks 22nd with 7.3%



district is placed in the 20th position, lower than median at 36.9%.


district ranks 14th (42.9%), marginally above the median range at 42.1%.



10. In case of the reach of ORS among children the district is ranked 1st with 91.7%

coverage, much higher than the average at 48.8%.


position (65.1%), quite below that median range at 60.3%.




centres and is placed at the same level as the state average (16).

14. The district is ranked 2nd in case of community health centres having 24x7 delivery



the district ranks 17th but the intake is only 31.6% (below the mean level)

Output

1. The district has ranked 6th in IMR with 12 out of 1000 live births, the average is the

same, 12 out of 1000 live births.

2. In terms of low birth weight the district has ranked 9th with 9.9% of such cases. The


3. In case of live birth, it is ranked 8th with 99% of such cases. The average is lower at 97%.



5. In case of under 5 mortality the district ranks 12th (29 out of 1000 live births). The

average is marginally lower at 28 out of 1000 live births.




age group in case of severe anaemia, the district ranks at 15th (3.4%) this is marginally





72


here it is 0.7% and the district ranks 2nd.


(rank 3rd) among males and 35.5% (rank 4th) among females. Severe anaemia among

males is 2nd at 0.3%, lower than the state average at 1.2%. For females it is 0.3% (rank

1st). This is much lower than the median at 2.1%.

11. Among adolescents total anaemia is 26.4% (rank 3rd) and severe anaemia is 1% (rank


12. Total anaemia among pregnant women (15-49 years) is 60.5% (rank 22nd) among

women (15-49 years) it is 41.6% (rank 6th). Severe anemia among low pregnant women

(15-49 years) is 2.3% (rank 11th) and among women (15-49 years) it is 1.9%, rank 7th.

13. The district has 27% (rank 14th) below 5 children who are stunted, same as the average

at 27%.

14. 22.5% children (rank 23rd) are wasted (higher than the average at 19.9%) and 22.2%


20. Thanjavur

Input

1. The district in sanitation coverage is ranked 20th with 47.9% coverage, the average being

52%.

2. For improved access to drinking water, it is ranked averagely at the 15th position with

97.4% coverage.

3. In case of female underage marriage the district is placed 13th with 4.2% of such cases.

The average being higher at 5.3% of such cases.

4. It secures the 6th position with 22.5% in terms of illiterate married women, much lower

than the median at 32.2%

5. In case of married women with 10 or more years of schooling, this district secures the

12th position with 35.1% coverage. The average of the state is 36.3%.


with 4.3% prevalence. This is the same as the average of the state.

7. It secures the 30th position with 18.1% coverage in case of pregnant women receiving full

ante natal care. This quite below the state average at 36.9%.


tablets. Lower than the average at 42.1%.

9. Tanjavur is ranked 5th with 73.7% coverage in case of children (9-35 months) having

received at least one dose of Vitamin A supplement.

10. In the reach of ORS among children the district secures 11th positions with 52.2% of such

cases. The median is lower (48.8%).


with 72.3% women knowing the standard procedure.

73

12. The district has 33 sub health centers and ranks 6th in the state, higher than the average

at 29.

13. It also has 22 Primary Health Centers (PHCs) and ranks 1st, again higher than the median

range at 16.


hours normal delivery service with 16 such centers. This is again higher than the median

which is 12.


the district ranks 14th but the intake is only 32.3% (Just below mean level)

Output

1. In the Tanjavur the IMR is at the 4th rank (10 out 1000 live births). This is higher than the

median which is 12 out 1000 live births.

2. In LBW the rank is 7th with 8.7% of such cases. The average is 11.8% of such cases.

3. Live births ranks 20th (95.6%). The state records high live births with a small variation

among the districts (100% to 90.7%). In that respect the ranking becomes less

important.

4. The district records under 5 mortality rate at 32 out 1000 live births and ranks 15th,

below the median which is at 28 out of 1000 live births.

5. MMR in the district looks up and ranks 4th (49 female deaths out of 100,000 live births)

among the other districts in the state. The average in the state is 74 female deaths out

of 100,000 live births.

6. The incidence of diarrhoea among children under 5 years is 7.3% (rank 21st) higher than

the average at 5.7%.

7. In case of total anaemia in children below 5 years it is ranked 23rd (70.3%). In the same

age bracket in case of severe anaemia, the district ranks at 17th (3.8%) this is almost the

same as the median at 3.7%.


21st with 51.2% of such cases, this is naturally higher than the median range at 46.1%. In

severe anaemia also the district ranks 16th with 2.4% of such cases.

9. Among females of same age group total anaemia is 52.8% (rank 20th). In Severe anaemia



(rank 25th) among males and 51.1% (rank 23rd) among females. Severe anaemia among


17th). This is also higher than the median range at 2.1%.

11. Among adolescents total anaemia is 42.3% (rank 22nd) and severe anaemia is 3.6% (rank

21st), much higher than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 73.2% (rank 28th), among

women (15-49 years) it is 54.5% (rank 21st). Severe anemia among low pregnant women

(15-49 years) is 0% (rank 1st) and among women (15-49 years) it is 3.6%, rank 17th.

13. In this district when it comes to the incidence of stunting, wasting and underweight

among below 5 years children it is seen that the ranks are 12th at 26%(stunting), 19th

74

with 20.4% (wasting), and 11th with 22.9% (underweight). In these cases the

percentages are higher than the median except in the case of stunting (27% in case on

stunting, 19.9% in case of wasting, and 24.1% for underweight children).

21. Thiruvarur

Input


2. In terms of improved access to drinking water, it is ranked in 15th position with 97.4%

coverage.

3. In case of female underage marriage the district is placed 8th with 3.3% of such cases, the

average being higher at 5.3%.

4. It is ranked 7th (22.5%) in the percentage of married women who are illiterate, lower




at 36.3%.


such cases, lower than the state average at 4.3%.




district ranks 21st (42.9%), marginally above the median range at 42.1%.


is ranked 10th (67.4%), which is above the median at 61.9%.




position (52.8%), quite below that median range at 60.3%.

12. The district is ranked 2nd in the number of sub health centres with 44 such centers and is



and is placed at the same level as the state average (16).


services with 12 such centres and is same as compared to the state average (12).


the district ranks 9th but the intake is only 36% (Above mean level)

Output

1. The district has ranked 5th in IMR with 11 out of 1000 live births, the average is slightly

higher, 12 out of 1000 live births.

75



3. In case of live birth, it is ranked 15th with 97.1% of such cases. The average is almost the

same at 97%.



5. In case of under 5 mortality the district ranks 3rd (20 out of 1000 live births). The average

is higher at 28 out of 1000 live births.

6. The incidence of diarrhoea among under 5 years old children is ranked 22nd with 7.4%

prevalence. The average is much lower at 5.7%.


age group in case of severe anaemia, the district ranks at 12th (3%) this is marginally



26th with 55.6% of such cases, this is higher than the median at 46.1%. In severe

anaemia the district ranks 22nd with 6.5% of such cases.










(15-49 years) it is 57% (rank 25th). Severe anemia among low pregnant women (15-49


13. The district has 28.4% (rank 19th) below 5 children who are stunted, slightly higher than

the average at 27%.



22. Ramnathapuram

Input

1. The district is ranked 21st in sanitation coverage with 44.6% coverage.

2. In terms of improved access to drinking water, it is ranked lowly at the 26th position with

89.2% coverage.


the average being marginally lower at 5.3%.

76

4. It is ranked 12th (30%) in the percentage of married women who are illiterate, lower




at 36.3%.


of such cases, lower than the state average at 4.3%.




district ranks 19th (38.9%), lower than the median at 42.1%.


is ranked 1st (78%), which is naturally above the median at 61.9%.




position (71.1%), quite above the median at 60.3%.



13. The district is ranked 2nd in the number of primary health centres and has 21 such

centres and is placed much above the state average (16).


services with 13 such centres and is slightly above the state average (12).


the district ranks 3rd but the intake is only 41.3% (Above mean level)

Output

1. The district has ranked 8th in IMR with 14 out of 1000 live births, the average is slightly

higher, 12 out of 1000 live births.




97%.




average is higher at 28 out of 1000 live births.

77

6. The incidence of diarrhoea among under 5 years old children is ranked 23rd with 7.7%



age group in case of severe anaemia, the district ranks at 19th (5.2%) this is higher than

the median at 3.7%.





here it is 0.8% and the district ranks 3rd.




9th). This is lower than the median at 2.1%.

11. Among adolescents total anaemia is 42.3% (rank 22nd) and severe anaemia is 2.4%

(rank 15th), higher than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 56.1% (rank 15th) among

women (15-49 years) it is 53.9% (rank 18th). Severe anemia among pregnant women

(15-49 years) is 1% (rank 3rd) and among women (15-49 years) it is 2.8%, rank 13th.


average at 27%.

14. 17% children (rank 9th) are wasted (lower than the average at 19.9%) and 22.6% (rank


23. Cuddalore

Input

1. The district is ranked lowly at 22nd position sanitation coverage with 40.8% coverage.

2. In terms of improved access to drinking water, it is well at the 6th position with 98.5%

coverage.

3. In case of female underage marriage the district is placed 11th with 4% of such cases, the

average being higher at 5.3%.




17th with 33.1% women finishing 10 or more years of schooling, higher than the median

at 36.3%.

78




district is placed in the 32nd position, much lower than median at 36.9%.


district ranks 31st (21.7%), lower than the median at 42.1%.


is ranked 2nd (75%), which is above the median at 61.9%.


coverage, higher than the average at 48.8%.


position (63.3%), above the median at 60.3%.



13. The district is ranked 3rd in the number of primary health centres and has 20 such

centres and is placed at the above the state average (16).


services with 16 such centres and is higher than the state average (12).


the district ranks 8th but the intake is only 36.1% (Above mean level)

Output

1. The district has ranked 6th in IMR with 12 out of 1000 live births, the average is the

same, 12 out of 1000 live births.


average in the state being only marginally higher at 11.8%.


97%.

4. In case of MMR it is ranked 23rd with 89 female deaths out of 100,000 live births. The



average is lower at 28 out of 1000 live births.



7. In case of total anaemia in children below 5 years it is ranked 22nd (68.9%). In the same

age group in case of severe anaemia, the district ranks at 25th (7.6%) this is higher than

the median at 3.7%.

79










11. Among adolescents total anaemia is 49.8% (rank 29th) and severe anaemia is 2.6%


12. Total anaemia among pregnant women (15-49 years) is 72.2% (rank 27th) among

women (15-49 years) it is 62% (rank 27th). Severe anemia among pregnant women (15-

49 years) is 5.6% (rank 21st) and among women (15-49 years) it is 5.1%, rank 20th.

13. The district has 28.2% (rank 18th) below 5 children who are stunted, slightly higher


14. 19.7% children (rank 16th) are wasted (marginally higher than the average at 19.9%)

and 25% (rank 14th) below 5 children who are underweight, marginally higher than the

average at 24.1%.

24. Perambalur

Input

1. The district is tied with Cuddalore in 22nd (40.8%) position in regard to sanitation

coverage.

2. In terms of improved access to drinking water, it is at the 19th position with 96.3%

coverage.

3. It is placed in the 21st position in regard to women married below 18 years (6.2%). The

median is lower at 5.3%.

4. And is placed 10th (29.7%) in the case of illiterate married women.


for 10 or more years (40.5%).


with 2.5% of such cases. The median in this aspect is higher at 4.3%.

7. In case of pregnant women receiving full ante natal care the district ranks 12th (39.6%).

8. The district ranks higher than many other in pregnant women having consumed 100 or

more IFA tablets and is ranked 13th and has 43.6% coverage.

80


supplement, the district is ranked 4th (73.8%) higher than the median at 61.9%.

10. In case of the reach of ORS among children the district is ranked 12th, 50%. This is slightly


11. In case of awareness in women regarding diarrhoea handling, the district is ranked 2nd

with more than 77.8% women knowing what to do. The average is lower at 60.8%.

12. The district has 25 sub health centers and ranks 7th in the state, less than the average at

29.

13. It also has 16 Primary Health Centers (PHCs) and ranks 6th, the same as the median at 16.

14. Perambalur ranks 13th in the number of Community Health Centers (CHC) having 24x7

hours normal delivery service with only 5 such centers. This is much lower than the

median which is 12.


the district ranks 2nd but the intake is only 45.2% (But way below the 1st, Khrisnagiri)

Output

1. This district records IMR of 15 out of 1000 live births (rank 9th). The average of the state

of Tamil Nadu is lower at 12 out 1000 live births.

2. The MMR here is 73 female deaths out of 100,000 live births (rank 14th). The average is

more or less the same at 74 female deaths out of 100,000 live births.

3. Low birth weight in Perambalur is quite high, 18.6%. The average in the state is 11.8%.

4. Live births in this district ranks 11th (98%). This is higher than the average which is 97%.

5. The incidence of diarrhoea among children below 5 years is much lower than most of

the other districts it ranks 1st with only 1.6% of such cases.


bracket in case of severe anaemia, the district ranks 17th (3.8%) this is almost the same

as the median at 3.7%.


2nd with 33.8% of such cases, this is lower than the median range at 46.1%. In severe

anaemia however, the district ranks 3rd with 0.8% of such cases, again lower than the

median at 1.8%.


than the average at 48.4%. there are no cases of severe anaemia in this district and

Perambalur ranks 1st with Chennai and Kanniyakumari.



males is 9th at 1.1%, marginally lower than the state average at 1.2%. For females it is

2.6% (rank 14th). This is marginally higher than the median at 2.1%.

81


18th) higher than the average at 1.8%.

11. Total anaemia among pregnant women (15-49 years) is 63.8% (rank 24th), higher than

the median at 56.7%, among women (15-49 years) it is 54.7% (rank 22nd). Severe anemia

is quite low both among pregnant women (15-49 years), 1.4% (rank 5th) and among

women (15-49 years) it is 2.9%, rank 14th.

12. This district has few incidences of stunting among children below 5 years (rank 5th, 24%,

lower than the median range at 27%)

13. Wasting among children below 5 years, the district ranks 13th 18.2%, again lower than

the average at 19.9%. The incidence of underweight below 5 years children, the district

ranks 7th, 22%. The average of the state is slightly higher at 24.1%.

25. Tiruvannamalai

Input

1. The district performs well in sanitation coverage and is ranked 23th with 40.4% sanitation

coverage.

2. In the case of improved access to drinking water, it is well placed at the 4th position with

98.8% coverage.

3. In underage marriage among women the district performs badly and is ranked 30th with

11.6% cases. The average in the state is 5.3%.

4. In case of the percentage illiterate married women the district is placed 26th with 42.7%

married women still illiterate. The average is lower at 32.2%.

5. It is ranked 22nd (31.1%) in regard to percentage of married women with 10 or more

years of schooling, lower than the median at 36.3%.

6. It is ranked 25th in percentage related to women between 15 to 19 years conceiving with

10.7% cases occurring. The average is lower at 4.3%.

7. In the case of married women receiving full ante natal care it is placed in the 18th

position with 31.1% of such cases. The average is higher, 36.9%.


tablets. This is lower than the average of 42.1%.

9. Tiruvannamalai is ranked 17th with 61.9% coverage in case of children (9-35 months)

having received at least one dose of Vitamin A supplement. The average in this respect is

the same as this district.

10. In the reach of ORS among children with diarrhoea the district secures the 3rd positions

with 70% of coverage. The median range is much lower (48.8%).

82

11. In case of awareness in women regarding diarrhoea handling, the district is ranked 31st

with 44% women knowing the standard procedure. The average is higher at 60.8%.

12. The district has 25 sub health centers and ranks 7th in the state, less than the average at

29.

13. It also has 16 Primary Health Centers (PHCs) and ranks 6th, this is same as the median

range at 16.

14. The district ranks 3rd in the number of Community Health Centers (CHC) having 24x7

hours normal delivery service with 19 such centers. This is higher than the median which

is 12.


the district ranks 20th but the intake is only 29.8% (below all district mean level)

Output

1. In Tiruvannamalai the IMR is at the 9th rank (15 out 1000 live births). This is higher than

the median which is 12 out 1000 live births.

2. In LBW the rank is 20th with 14% of such cases. The average in this respect is 11.8%.

3. The district ranks 1st in live births (100%). Live births in generally looks up in this state

with a very small variation, the range being 100% to 90.7%.

4. The district records under 5 mortality rate at 29 out 1000 live births and ranks 12th, a

little above the median range which is at 28 out of 1000 live births.

5. MMR in the district ranks 7th (60 female deaths out of 100,000 live births). This is lesser

than the average at 74 female deaths out of 100,000 live births.

6. The incidence of diarrhoea among children under 5 years is 8.8% (rank 27th) higher than

the average at 5.7%.


age bracket in case of severe anaemia, the district ranks at 4th (1.5%) this is much lower



9th with 40.5% of such cases, this is lower than the median at 46.1%. In severe anaemia

also the district ranks 15th with 2.3% of such cases.


it is only 1.4% and the district ranks 7th.



males is 5th at 0.7%, much lower than the state average at 1.2%. For females it is 2%

(rank 11th). This is also lower than the median at 2.1%.

11. Among adolescents total anaemia is 29.5% (rank 7th) and there are no cases of severe

anaemia in the district and it ranks 1st.

83

12. Total anaemia among pregnant women (15-49 years) is 47.3% (rank 7th), among women

(15-49 years) it is 43.5% (rank 8th). Severe anemia among pregnant women (15-49 years)

is 1.8% (rank 8th) and among women (15-49 years) it is 1.4%, rank 3rd.

13. In this district when it comes to the incidence of stunting among children below 5 years

it ranks 7th with 24.5% of such cases. This is lower than the average at 27%.

14. In the case of wasting in the same age group the district is placed at the 30th position

with 34.6% of such children. The average is much lower at 19.9%. In the case of

underweight children the district is placed at the 25th position with 34.7% of such cases.

The average is again lower at 24.1%.

26. Viluppuram

Input

1. The district does not perform well in regard to sanitation coverage and is ranked 24th


2. In terms of improved access to drinking water, it is well placed at the 11th position with

98% coverage.

3. In underage marriage among women the district performs badly and is ranked 25th with

8.5% cases. The average in this respect is lower at 5.3%.

4. In case of the percentage illiterate married women the district is placed near the bottom

with 29th rank with 45.5% of married illiterate women. The average in this respect is

lower at 32.2%.

5. It is ranked 26th in regard to percentage of married women with 10 or more years of

schooling with 28.2% of married women having completed the above mentioned term,

where as the average of the state is 36.3%.

6. It is ranked 17th in percentage related to women between 15 to 19 years conceiving with

5.8% cases occurring, again the average is lower at 4.3%.

7. In case of married women receiving full ante natal care it is situated lowly at 28th position

with only 24.3% women receiving it. The average in this case is higher at 36.9%.


district ranks at 29th with just 26.5% women receiving it. The average is much higher at

42.1%.

9. In case of children (9-35 months) receiving at least one dose of Vitamin A it is ranked

22nd with 57.4% coverage. The average once again is higher at 61.9%.

10. In case of the reach of ORS among children the district is ranked 25th with 20% coverage,

lower than the average at 48.8%.

84


position (49.5%), below that median range at 60.8%.





14. The district is ranked 1st in case of community health centres having 24x7 delivery



the district ranks 18th but the intake is only 31.2% (much below mean level)

Output

1. Villupuram has ranked 10th in IMR with 17 out of 1000 live births while the average is 12


2. In terms of low birth weight the district has ranked 24th with only 18.6% of such cases.

The average in the state being lower at 11.8%.

3. In case of live birth, it is ranked 2nd with 99.7% of such cases. The average is lower at

97%.


The average is marginally higher at 28 out of 1000 live births.


average is much higher at 74 female deaths out of 100,000 live births.




age bracket in case of severe anaemia, the district ranks at 8th (2.2%) this is lower than

the median at 3.7%.


18th with 47.5% of such cases, this is slightly higher than the median at 46.1%. In severe


9. Among females of same age group total anaemia is 53.5% (rank 21st). In severe anaemia




males is 10th at 1.2%, same as the state average at 1.2%. For females it is 2.5% (rank

13th). This is marginally higher than the median at 2.1%.


9th), lesser than the average at 1.8%.

85

12. Total anaemia among pregnant women (15-49 years) is 58.7% (rank 20th) and among

women (15-49 years) it is 53.4% (rank 17th). There are no cases of severe anemia among

pregnant women (15-49 years) in this district and is ranked 1st and among women (15-

49 years) it is 2.4%, rank 10th.

13. The district has 31.8% (rank 28th) below 5 children who are stunted, higher than the

average at 27%.


18th) below 5 children are underweight, higher than the average at 24.1%.

27. Karur

Input



2. In terms of improved access to drinking water, it is placed at the 14th position with

97.5% coverage.

3. In underage marriage among women the district is ranked 24th with 8.1% cases. The

average is lower with 5.3% of such cases.

4. In the case of the percentage illiterate married women the district is placed at the 14th

position (31.4%). The average in this case is 32.2%.

5. It is ranked 15th (33.8%) in regard to percentage of married women with 10 or more

years of schooling. The median in this respect is slightly higher with 36.3% of such cases.

6. It is also ranked 20th in percentage related to women between 15 to 19 years conceiving

with 6.5% of such cases, higher than the average which is 4.3%.

7. In case of married women receiving full ante natal care it is situated well at 5th position

with 51.6% women receiving it. The average is lower at 36.9%.


district ranks 4th position with 58.9% women receiving it. Once again this is better than

the average which is 42.1%.

9. In case of children (9-35 months) having received at least one dose of Vitamin A it is

ranked 16th with 63.3% children receiving it. The average in this respect is slightly lower

at 61.9%.

10. In case of the reach of ORS among children suffering from diarrhoea the district is

ranked 5th with 66.7% coverage, much higher than the average at 48.8%.


position (74.1%), above that median at 60.8%.

86


much higher than the state average (29).


centres and is placed at the same level as the state average (16).


services with 9 such centres and is lower as compared to the state average of 12 such

centres.


the district ranks 12th but the intake is only 32.9% (Just below average)

Output

1. The district of Karur has ranked 11th in IMR with 18 out of 1000 live births while the

average is 12 out of 1000 live births.

2. In terms of low birth weight the district has ranked 16th with only 12.4% of such cases.

The average in the state being slightly lower at 11.8%.

3. In case of live birth, it is ranked 21st with 94.1% of such cases. The average is higher at

97%.


The average is marginally lower at 28 out of 1000 live births.







the median at 3.7%.


27th with 56% of such cases, this is higher than the median at 46.1%. In severe anaemia

the district ranks 4th with 0.9% of such cases.

9. Among females of same age group total anaemia is 59.3% (rank 27th). In severe

anaemia here it is 3.7% and the district ranks 17th.




15th). This is marginally higher than the median at 2.1%.


(rank 22nd), higher than the average at 1.8%.

87



(15-49 years) in this district is ranked 9th and among women (15-49 years) it is 4.6%,

rank 19th.

13. The district has 27.5% (rank 17th) below 5 children who are stunted, marginally higher


14. 23% children (rank 24th) are wasted (higher than the average at 19.9%) and 28.9%

(rank 19th) below 5 children are underweight, higher than the average at 24.1%.

28. Dindigul

Input




98.7% coverage.

3. In underage marriage among women the district performs badly and is ranked 27th

with 8.9% cases. The average in this respect is 5.3%.

4. In indicator relating to married women who are illiterate it is ranked 11th (29.9%),

below the average at 32.2%.

5. It ranks 13th (34.8%) in women receiving 10 years or more of school education, the

state average being slightly higher at 36.3%.

6. It is placed at the 24th position in case of women between 15 to 19 years conceiving

with 9.7% prevalence. The average of Tamil Nadu is quite low at 4.3%.

7. In case of pregnant women receiving full ante natal care, the district is ranked 10th

with 46.5% penetration. The average in this respect is lower at 36.9%.

8. The district ranks 5th in pregnant women having consumed 100 or more IFA tablets

(57.8%). The average is lower at 42.1%.

9. It is ranked 11th (67.2%) in the case of children (9-35 months) having received at least

one dose of Vitamin A supplement, the average being a little lower at 61.9%.

10. In case of the reach of ORS among children suffering from diarrhoea the district

secures the 7th position (55.6%). The median in this respect is lower at 48.8%.

11. In the case of awareness in women in handling diarrhoea among children below 5

years, the district is ranked 1st with 80.5% women having the needed knowledge. The

average in this respect is much lower at only 60.8%.

12. The district has 33 sub health centers and ranks 6th in the state, higher than the

average at 29.

88

13. It also has 22 Primary Health Centers (PHCs) and ranks 1st, median being 16 PHCs.


hours normal delivery service with 16 such centers. This is higher than the median

range at 12.

15. For children aged 6-23 months who received adequate diet, the NFHS-4 data shows

that the district ranks 5th but the intake is only 37.5% (Above mean level)

Output

1. In terms of IMR this district has performed relatively well and is ranked 7th (13 out

1000 live births). This is more or less close to the average which is 12 out 1000 live

births.

2. In case of children born with low birth weight the district is ranked 18th (12.8%) higher

than the average (11.8%) by a small fraction.

3. This district has ranked 24th in live births, 92%. The average is higher at 97%.

4. Under 5 mortality rate is low in this district is ranked 15th, 32 out of 1000 live births.

The average is lower at 28 out of 1000 live births.

5. In terms of MMR this district has is placed at the 19th position (81 female deaths out

1000 live births). Once again the average is lower at 74 female deaths out 1000 live

births.

6. The incidence of diarrhoea among children is 5.8% rank 15th, almost the same as the

average at 5.7%.


age bracket in case of severe anaemia, the district ranks at 18th (5%) this is much

higher than the median at 3.7%.


17th with 47.4% of such cases, this is slightly higher than the median range at 46.1%. In

severe anaemia the district ranks 14th with 2.1% of such cases.


anaemia here it is only 1.3% and the district ranks 6th.


(rank 20th) among males and 49.1% (rank 21st) among females. Severe anaemia among

males is 7th at 0.9%, lower than the state average at 1.2%. For females it is also 0.9%

(rank 3rd). This is lower than the median range at 2.1%.

11. Among adolescents total anaemia is 43.1% (rank 23rd) and severe anaemia is 1.5%

(rank 10th), marginally lower than the average at 1.8%.



(15-49 years) is 5.9% (rank 23rd) and among women (15-49 years) it is 3.2%, rank 16th.

89

13. Dindigul has 31.1% (rank 27th) below 5 children who are stunted, higher than the

average at 27%.

14. 26.5% children (rank 26th) are wasted, again higher than the average at 19.9% and

29.8% (rank 22nd) below 5 children who are underweight, higher than the average at

24.1%.

29. Virudhunagar

Input



2. In terms of improved access to drinking water, it is placed at the 5th position with 98.7%

coverage along with Dindigul district.


average is almost the same with 5.3% of such cases.

4. In the case of the percentage illiterate married women the district is placed at the 23rd


5. It is ranked 23rd (30.3%) in regard to percentage of married women with 10 or more

years of schooling. The median in this respect is higher with 36.3% of such cases.

6. It is also ranked 14th in percentage related to women between 15 to 19 years conceiving

with 4.5% of such cases, marginally higher than the average which is 4.3%.

7. In case of married women receiving full ante natal care it is situated at 26th position with

26.4% women receiving it. The average is higher at 36.9%.


district ranks 27th position with 27.2% women receiving it. The average is much higher at

42.1%.


ranked 31st with 41.4% children receiving it. The average in this respect is again much

higher higher at 61.9%.

10. In case of the reach of ORS among children suffering from diarrhoea the district is ranked

15th with 42.1% coverage, slightly lower than the average at 48.8%.


position (49.9%), below the median at 60.8%.





90



centres.


the district ranks 21st but the intake is only 29% (below mean level)

Output

1. The district of Virudhunagar has ranked 6th in IMR with 12 out of 1000 live births same

as the average at 12 out of 1000 live births.

2. In terms of low birth weight the district has ranked 23rd with 15.8% of such cases. The


3. In case of live birth, it is ranked 22nd with 92.5% of such cases. The average is higher at

97%.


The average is marginally lower at 28 out of 1000 live births.


average is higher at 74 female deaths out of 100,000 live births.


prevalence. The average is lower at 5.7%.



the median at 3.7%.


15th with 44.2% of such cases, this is lower than the median at 46.1%. In severe



anaemia here it is 0.7% and the district ranks 2nd.



males is 12th at 1.4%, marginally higher than the state average at 1.2%. For females it is

3.1% (rank 16th). This is higher than the median at 2.1%.





(15-49 years) in this district is ranked 4th (1.1%) and among women (15-49 years) it is

1.6%, rank 4th.

91

13. The district has 29.9% (rank 22nd) below 5 children who are stunted, higher than the

average at 27%.

14. 17.7% children (rank 11th) are wasted (lower than the average at 19.9%) and 25.7%

(rank 15th) below 5 children are underweight, marginally higher than the average at

24.1%.

30. Dharmapuri

Input



2. In the case of improved access to drinking water, it is placed at the 8th position with

98.3% coverage.





5. It is ranked 18th (33%) in regard to percentage of married women with 10 or more

years of schooling. The median in this respect is higher with 36.3% of such cases.

6. It is also ranked 19th in percentage related to women between 15 to 19 years

conceiving with 6.4% of such cases, higher than the average which is 4.3%.

7. In case of married women receiving full ante natal care it is situated at 9th position

with 47.2% women receiving it. The average is lower at 36.9%.

8. In indicators relating to pregnant women having consumed 100 or more IFA tablets

the district ranks 8th position with 52.9% women receiving it. The average is lower at

42.1%.


ranked 19th with 59% children receiving it. The average in this respect is higher at

61.9%.


ranked 20th with 33.3% coverage, lower than the average at 48.8%.

11. In the case of awareness in women in diarrhoea handling, the district is ranked at 22nd

position (55.7%), this below the median at 60.8%.

12. The district is ranked 4th in the number of sub health centres with 42 such centers and

is much higher than the state average (29).


centres and is placed above the state average (16).

92



centres.


that the district ranks 29th but the intake is only 21.8% (much below mean level)

Output

1. Dharmapuri has ranked 12th in IMR with 20 out of 1000 live births, much higher than

the average at 12 out of 1000 live births.


average in the state being much higher at 11.8%.

3. In case of live birth, it is ranked 8th with 99% of such cases. The average is lower at

97%.




average is higher at 74 female deaths out of 100,000 live births.




age bracket in case of severe anaemia, the district ranks at 13th (3.2%) this is marginally



5th with 36.1% of such cases, this is lower than the median at 46.1%. In severe anaemia

the district ranks 2nd with 0.5% of such cases.




(rank 5th) among males and 33.2% (rank 3rd) among females. Severe anaemia among

males is 8th at 1%, lower than the state average at 1.2%. For females it is 1.1% (rank





women (15-49 years) it is 35.9% (rank 2nd). Severe anemia among pregnant women


1.4%, rank 3rd.

93


average at 27%.

14. 33% children (rank 29th) are wasted (higher than the average at 19.9%) and 29.6%


31. Pudukottai

Input

1. The district lags behind most in regard to sanitation coverage and is ranked 29th with

37.2% coverage.


91.4% coverage.





5. It is ranked 9th (38.5%) in regard to percentage of married women with 10 or more

years of schooling. The median in this respect is lower with 36.3% of such cases.

6. It is also ranked 3rd in percentage related to women between 15 to 19 years conceiving

with 1.3% of such cases, lower than the average which is 4.3%.

7. In case of married women receiving full ante natal care it is situated at 31st position

with 17.9% women receiving it. The average is higher at 36.9%.

8. In indicators relating to pregnant women having consumed 100 or more IFA tablets

the district ranks 32nd with 20.7% women receiving it. The average is higher at 42.1%.


ranked 20th with 57.8% children receiving it. The average in this respect is higher at

61.9%.


ranked 13th with 45% coverage, lower than the average at 48.8%.


position (45.7%), below the median at 60.8%.

12. The district is ranked 8th in the number of sub health centres with 24 such centers and

is lower than the state average (29).


centres and is placed marginally below the state average (16).

94


services with 11 such centres and is slightly lower as compared to the state average of

12 such centres.


that the district ranks 6th but the intake is only 37.1% (Above mean level)

Output

1. The district of Pudukkottai has ranked 6th in IMR with 12 out of 1000 live births same

as the average at 12 out of 1000 live births.




97%.


The average is higher at 28 out of 1000 live births.




prevalence. The average is almost the same at 5.7%.



the median at 3.7%.


11th with 41.5% of such cases, this is lower than the median at 46.1%. In severe

anaemia the district ranks 3rd with 0.8% of such cases.





males is 5th at 0.7%, lower than the state average at 1.2%. For females it is 1.4% (rank







2.5%, rank 11th.

95

13. The district has 26.7% (rank 13th) below 5 children who are stunted, marginally lower


14. 20.9% children (rank 20th) are wasted (higher than the average at 19.9%) and 25%


32. Ariyalur

Input

1. The district is the last (30th) in terms of sanitation coverage with 33.6%.

2. The district ranks 6h in terms of access to improved sources of drinking water (98.5%)

however, the rank is irrelevant here due to the small range 99.3%-89.2%.

3. In case of female underage marriage the district is placed 19th with 6% of such cases.

The average being lower at 5.3%.

4. It is ranked 16th (33.2%) in terms of illiterate married women. This is again marginally

higher than the state average at 32.2%.

5. In terms of women receiving 10 or more years of school education this district is in the

14th position with 34.5% of such cases. The average in this case is 36.3%.

6. In case of women between 15 to 19 years conceiving, the district records the 1st

position with only 0.6% prevalence, much lower than the median range at 4.3%.

7. In case of pregnant women receiving full ante natal care, the district is ranked 29th

with 22.4% prevalence. The average is higher at 36.9%.


tablets, lower than the median at 42.1%.

9. It is ranked 30th (41.8%) in the case of children (9-35 months) who received at least

one dose of Vitamin A supplement, lesser than the average at 61.9%.

10. In case of the reach of ORS among children the district secures the 5th position (66.7%),


11. In the case of awareness in women in diarrhoea handling, the district is ranked 30th

with 45.3%, lower than the average at 60.8%.

12. The district has 25 sub health centers and ranks 7th in the state, lesser than the

average at 29.

13. It also has 18 Primary Health Centers (PHCs) and ranks 5th, higher than the median at

16.


hours normal delivery service with 6 such centers which is lower than the median

range at 12.

96


that the district ranks 15th but the intake is only 32% (Below mean level)

Output

1. In Ariyalur we see that IMR is impressive and it stands at the 3rd position (9 out of 1000

children, 2013-14). The average is higher at 12 of 1000 children.

2. It records a rank of 8th in MMR with 61 female deaths out of 100,000 live births, quite

less than the state average at 73.8 female deaths out of 100,000.

3. Low birth weight in this district looks positive at rank 21st (14.4% of such cases). The

average in this respect is 11.8%.


97%.




prevalence. The average is lower at 5.7%.

7. In case of total anaemia in children below 5 years it is ranked 29th (76%). In the same

age bracket in case of severe anaemia, the district ranks at 24th (6.7%) this is higher




anaemia the district ranks 1st with no such cases.




(rank 28th) among males and 59% (rank 27th) among females. Severe anaemia among

males is 11th at 1.3%, marginally higher than the state average at 1.2%. For females it is

0.6% (rank 2nd). This is lower than the median at 2.1%.

11. Among adolescents total anaemia is 42.1% (rank 21st) and severe anaemia is 0.5%

(rank 3rd), lower than the average at 1.8%.

12. Total anaemia among pregnant women (15-49 years) is 71.9% (rank 26h) and among



3.7%, rank 18th.

13. The district has 37% (rank 30th) below 5 children who are stunted, higher than the

average at 27%.


(rank 21st) below 5 children are underweight, higher than the average at 24.1%.

97

5. Inter – District assessment of multi Sectoral Indicators

The previous chapter gives a detailed district wise ranking of the various Public health indicators

(Inputs and Outputs).

In this chapter a brief analysis has been conducted on each district along with suggestions on what

future steps may be needed.

1. Kanniyakumari

In Kanniyakumari, highest access to toilets among all districts of Tamil Nadu (95.5%) with reasonably

good access to drinking water (95.1%) supported by maximum no. of woman who had schooling

upto class X (58.2%) showed excellent outcomes, as far as Public Health indicators are concerned.

Excellent inputs in sanitation, linked to enhancement of age of marriage of women (over 18 years);

Minimum no. of girls (15-19yrs) who became mothers (Lowest in the state); and highliteracy of

women and has led to very positive out puts viz lowest MMR of women; stunting of under-5

children; wasting of under-5 children(2nd Lowest); comparatively lower rates of diarrhea in under-5

children; comparatively lowest or lower rates of anaemia among all age groups in both sexes,eg:

Anaemia is lowest among 10-19 years old girls and pregnant woman between 15-49 years of age;

Severe anaemia is lowest among all pregnant woman between 15 - 49 years of age; all woman (not

pregnant)between 15 - 49 years of age; girls of 10-19 years of age and boys of 6 - 9 years of age; Any

anaemia is 2nd lowest among 6 – 59 month old infants and 10 – 19 years old male children, while 3rd

lowest in woman (15 – 49 years) and Severe anaemia is 2nd lowest among girls of 6 – 9 years.

Kanniyakumari, as expected has the lowest percentage of underweight (12.8%), wasted (9%) and

stunted (17.2%) in under 5 children compared to all 32 districts.

Since total children (6-23 months) who had adequate diet is only to the extent of 37.7%, other

supportive factors like Sanitation possibly played a major role in the excellent outputs, with regards

to the nutritional status of children.

In summary, sanitation and gender support appear to be the most significant causes to have lead to

overall improvement in diarrhea status and all forms of under nutrition, while Tamil Nadu in general

needs to take urgent action to upgrade nutritional status of the community.

If the WASH input is supported by enhancing better reachability to health care service through

enhanced number of SHC’s, PHC’s, CHC’s etc.; having 24×7 hrs. service then the impact on health and

nutritional states is expected to further improve

The district needs to strengthen its inputs on water coverage marginally (though it is quite high at

95.1% even now); awareness on diarrhea management; ORS delivery (though it may be low as

episode rate of diarrhea is low in the district); and strengthen health delivery through better

coverage at all levels of health centres.

98

2. Chennai

Excellent inputs in sanitation (2nd highest), high literacy among married women has led to very

positive outputs viz lowest under-5 mortality, very low IMR and MMR, comparatively low diarrhea

rates and higher live births, lowest rate of severe anaemia in 6-9 years old girls and comparatively

lower severe anaemia rates in 6-9 years old boys, children of under-5 years age and underweight in

under-5 years children. The reasons for the positive indicators are possibly the same as that for

Kanniyakumari. Sanitation and literacy of women In Chennai

The total children (6-23 months) having adequate diet is surprisingly the lowest (13.8%) in the state.

So WASH and other gender related issues seems to have played an important role.

Chennai ranks 3rd (17.2%) with regards to underweight children; 12th (18.1%) with regards to wasted

children but a poor 26th (30.9%) with regards to stunted children. This indicates previous under

nutrition may be gradually improving now.

In this case also coverage of all levels of health centers, specially primary health centers, need to be

significantly enhanced to improve the health delivery indicators like vitamin A supplementation to

children, ORS delivery etc. to further improve the nutrition and micronutrient affected indicators,

including overall nutritional management, linked to deworming.

3. Thiruvallur

The district ranks 3rdin sanitation but is much lower in coverage compared to its first two sister

districts. Thiruvallur records a comparatively good coverage of IFA tablets in pregnant women,

vitamin A supplementation to children and reasonably high rate of literacy in married women and

also for ORS delivery.

Thiruvallur ranks 17th for underweight children which is better than the mean. But both wasting at

23.3 and Stunting at 30.1% are much higher than the state average. Though the state has the lowest

LBW but high rates of stunting and wasting could be because of its low (2nd from bottom) rate of

children (6-23 months) who received adequate diet.

Lowest LBW in the district possibly resulted in, improved rate of under-5 mortality rate (2nd). Low

diarrhea rates (3rd), good reduction in severe anaemia in some age groups (adolescents and adults)

and reasonably reduced anaemia in many of the other age groups (6th- 12thrank) are also certain

positive outcomes.

The district needs to strengthen its gender related issues and raise awareness on health and

nutrition related issues for further improvement. Though it ranks 3rd but more Sanitation coverage is

needed, along with better health care coverage and control of worm infestation.

99

4. Nilgiris

For sanitation, Nilgiris ranks 4th. It is much better compared to many other districts of the state.

Water supply in Nilgiris is 97.5%, which is only 2% lower than the best. It ranks higher than most

districts with regards to women married at later age (Post 18 years), literate married women, late

pregnancy (after 15-19 years of age) in women; intake of IFA tablets by women; ORS availability; and

vitamin A supplementation for under-5 children.

The impact assessment shows that the districts has reasonably better IMR, under-5 mortality and

MMR rates compared to most of the other districts while not in live birth though the range is very

small. The district has shown a consistently better impact on incidence of anaemia in nearly all sexes

of all age groups, including that in pregnant women, compared to most other districts. However, it

has not done well compared to other districts in relation to general nutrition indicators like

underweight, wasting and stunting in children. Diarrhea rate is also at about the median level with

women’s knowledge on diarrhea control being better than most.

Higher sanitation coverage and water supply along with positive gender issues may have possibly

lead to control of Anaemia. Better health coverage through improved health centre support is bound

to improve the already positive trends observed.

5. Tiruppur

Tiruppur ranks 5th in sanitation with 62% coverage, which is better than most of the other districts.

Water supply shows coverage of 96.6%. Though literacy of married women as well as age of

marriage (over 18 years) is better than most of theother districts but most women did not study till

class 10 and also got pregnant between 15-19 years of age, compared to other districts. Both vitamin

A supplementation to children and IFA tablets to women was at median level. ORS delivery was

better.

The results show a good impact on lowering of IMR (2nd) as well as on live birth (3rd) in spite of low

age of child birth. MMR is at median level. However, for nutrition indicators viz underweight,

stunting and wasting it ranks better than many of the other districts and for anaemia also it is at

about the median level or lower for all age groups. Incidence of diarrhea is also below the mean level

compared to other districts.

Children (6-23 months) receiving adequate diet ranks 10,being better than the mean level but is only

35.2%.

Hence, the district needs to further enhance health and hygiene education, control diarrhea, provide

better health care facilities to further improve the situation of anaemia, along with control of worm

infestation.

100

6. Erode

Erode ranks 6th with 60% coverage on sanitation and water supply stands at 97% compared to other

districts.Most women did not get married before 18 years of age and a high number had done

schooling till class X (3rd rank). It stood at about the median level where birth of babies between 15-

19 years of women was considered. About 50% women consumed IFA tablets while vitamin A

supplementation to children was at about 57.8% (20th rank). It is at about the mid-level in case of

health center coverage.

Output indicators show excellent impact on IMR at 7 (2nd rank, same as for Chennai), under 5

mortality rate (4th rank); MMR and live birth better than most (rank 10th and 5th respectively). Low

birth weight (LBW) incidence is 10.6, which is higher than mid-level and so is diarrhea in children.

Only 28.7% children (6-23 months) received total adequate diet which is below the average.

Anaemia rates are pretty high compared to most of the other districts though children of 6-9 years,

of both sexes seem to be better off. Ranks high showing lower rates of underweight children (2nd)

and is at about the mean level for both stunting and wasting in under-5 children.

Hence, health hygiene & nutrition education and control of anaemia linked to sanitation and worm

infestation is essential along with better health center coverage.

7. Khancheepuram

Sanitation coverage is at 59.2% (rank 7th) and water coverage is at 98.4% (rank 7th). Most women are

married after 18 years of age (rank 4th), gave birth to babies beyond 19 years of age (rank 4th) and

consumed IFA tablets during pregnancy (rank 2nd). However, literacy of married women is low and so

is the number of married women who have studied till class X. More than mean level of women

knew how to manage diarrhea.

The outcome indications show IMR at 10 (below average) at rank 4, under-5 mortality, MMR and

LBW around the mid-level. The district is the best where live births (rank 1st) are concerned.

Nutrition wise it has lower underweight in under-5 children (rank 2nd); lower wasting (rank 5th) and

stunting slightly over mean level (rank 8th). But total dietary intake of children (6-23 months) rank

24th with 25.7% intake, which is below the mean.

Diarrhea is lower (rank 5th) than most districts, ORS delivers is very good at 73.9% (rank 2nd).

Anaemia status indicates a high to median rate among all age groups.

Hence, input needed will be improved health, hygiene and nutrition awareness, specially knowledge

on balanced diet along with control of worm infestation and enhancement in numbers of sub health

centres. Literacy rate of woman also need to be enhanced along with more sanitary coverage.

101

8. Thirunelveli

The sanitation coverage is 58.3% (rank 8th) and drinking water 98.2% (rank 9th). It ranks high (3rd)

for both women married at age over 18th years as well as literacy of married women. It also ranks

well with regards to birth to women beyond 15-19 years of age. However, consumption of IFA

tablets by pregnant women and women’s knowledge to manage diarrhoea is low and so is receipt of

ORS.

Results show IMR, under-5 mortality, MMR as well as LBW to be higher than the average compared

to the state average, along with rate of live birth which is also below the mean level.

Nutrition indicators show underweight as well as stunting to be over the median level while wasting

is much better at 12.7 the range being 9 – 34.6 (Rank 4th). This indicates improvement in nutrition

status in recent period. However, children (6-23 months) receiving adequate diet is only 28.5%

(below average).

Anaemia status indicates it runs high on an average, for all.

Hence, overall awareness on Health, nutrition & hygiene is essential along with better sanitation

coverage and improvement in health care infrastructure. Worm infestation control is most critical

and needs to be linked to dietary inputs through ICDS, midday meals etc.and awareness generation.

9. Thoothukkudi

The district at 57% rank 9th for sanitation coverage and has 94.4% coverage of drinking water.

For gender issues like literacy of married woman, +10 year schooling of married women as well as

marriage of women post 18 years are either average on below median.

However, most women had babies after 15-19 year of age and received IFA tablets compared to

other districts. Women knowing management of diarrhoea in children is reasonably good but

receipt of ORS was below average.

IMR, under-5 mortality, LBW babies and live birth indicate slightly better than the mean data.

Diarrhoea rate is higher. Incidence of underweight is quite low (4th rank), wasting in under-5

children is even better (2nd rank) and so is stunting (3rd rank). So nutrition indicators are quite good

in the district. The total adequate diet intake by 6-23 months children is 31.7% which is below the

average. So other factors possibly played a significant role in this positive outcome.

Anaemia rates are high among all age groups but in majority of cases better than the average (mean)

level, including in pregnant women.

Sanitation coverage ranking 9th in the state with supported intake of IFA tables by pregnant women

and having babies at a later age possibly helped in improving some of the heath indicators and

nutrition indicators, compared to most of the other districts. However, control of anaemia is

required.

102

Hence, proper dietary advice, control of worm infestation, hygiene education is needed along with

improved community Health Centre, sub Health centre and primary health care services. Sanitation

coverage also needs to be enhanced.

10. Coimbatore

Coimbatore ranks 10th for sanitation with 55.2% coverage and 2nd for water availability at a high

99.2%.

Other input indicators show most of the women are married post 18 years of age (10th) and most

women deliver after 15-19 years of age. However, literacy as well as +10 class education in married

women is low and so are number of women who took full antenatal check-up or took IFA tablet

during pregnancy. Vitamin A intake in 19-35 month children is also low.

Surprisingly, though the district indicates the lowest awareness in women for diarrhoea

management in children but incidence of diarrhoea in below 5 years old children is not high (6th

rank), compared to most of the other districts. So ORS use is also not high. At all levels the health

centre coverage is at median level compared to other districts for all types.

Some of the critical health indicators are excellent in the district. IMR is lowest, under-5 mortality is

2nd lowest and MMR is 6th lowest but incidence of LBW babies is high at 15.6 (rank 22nd) while live

birth is also at median level.

Incidence of underweight children and stunting are just around the mean level but wasting is quite

high (rank 21st) at 21.3. The total adequate diet received by 6-23 months children is much lower

than the average.

Both total as well as severe anaemia is much lower than the mean level in under-5 years old

children.But in children of 6-9 years the anaemia is much higher than the mean level in boys (total

and severe) and girls (specially severe). For adolescents of 10-19 years it is around the mean median

level in boys (total & severe) and girls (specially severe). Anaemia in women of both types for both

pregnant and non-pregnant women is in a better state.

High coverage of water, low levels of diarrhoea, good ante natal check-up as well as high IFA tablet

intake possibly leads to some high health indicators.

For uniform improvement of health indicators and anaemia a more multi-sectoral health & hygiene

and nutrition awareness linked to worm control is essential, along with sanitation coverage.

11. Madurai

Madurai ranks 10th for sanitation coverage along with Coimbatore at 55.2% and water coverage is

95.9%. The district has done well in case of women receiving full ante natal care (4th) and IFA tablets

intake by pregnant women (rank 7th) . It is over the mean level for other indicators like literacy of

103

married women, +10 class schooling of married women, marriage after 18 years of age as well as

babies born to women after 19 years of age.

Knowledge of handling diarrhoea by women in children is low and comparatively diarrhoea in

children below 5 years of age rank quite highest is 5.9% the range being 1.6 – 9.8%.

IMR is 12 with minimum in Coimbatore being 6, under-5 mortality is very high at 39 being 2nd

highest in the state (the worst being Theni); MMR is 120; the LBW incidence is highest among all

districts at 19.8. Hence, health indicators need much improvement.

With regards to nutrition indicators, underweight in Madurai is lesser than most of the other districts

at 19.5, and stunting and wasting in under-5 children is also way better than nearly all districts

excepting two as it ranks 3rd best for both. the district ranks 11th with regards to total adequate diet

for 6-23 months children and is at the mean level, compared to all districts.

Total anaemia is comparatively higher in under-5 children but severe anaemia is less. But

subsequent to this anaemia is high in all ages and sexes. As a matter of fact, severe anaemia in

pregnant women is highest in this district.

In summary, high rate of severe anaemia at pregnancy can be linked to higher LBW and high IMR in

children. Though anaemia is high but nutrition related anthropologic indicators are better than most.

What is perhaps needed is better health care services, caring practices, universal deworming and

overall Nutrition (micronutrient supplementation), hygiene and health awareness generation, linked

to control of worm infestation and Sanitation.

12. Tiruchirappalli

The district has 53.6% Sanitation (rank 11th) and 97.7% coverage of drinking water.

The district ranks high in most of the gender support issues like marriage after 18 year of age,

literacy of married women; +10 class education of married woman; diarrhoea handling of children by

women etc. Diarrhoea rate is, however, above the mean level.

IMR stands at mid-level but both under-5 mortality rates as well as MMR are higher than the mean.

LBW incidence is also comparatively higher. Incidence of underweight is comparatively high and so

is wasting and stunting. The total adequate diet intake by 6-23 months children is 30.3% which is

below the all-district mean.

Both, total as well severe anaemia is also comparatively very high for all age groups, some of them

being highest in the district.

The district needs immediately a comprehensive approach to health care, nutrition support (through

ICDS, midday meal etc.), micronutrient supplementation, awareness generation, deworming etc.

linked to improve health service facilities and sanitation.

104

13. Theni

Theni ranks 12th for sanitation in the state, the coverage being 53.4%. Water supply has 98.2%

coverage. None of the women’s literacy indicators are above the average. IFA tablet off take is also

much below average.

Knowledge of handling diarrhoea in children by mothers is around the mean level among all-districts

and incidence of diarrhoea in under-5 children is also at the same level.

IMR in Theni is at 17 which is quite high, compared to the overall range which is 6-20. Under-5

mortality at 44 is highest in the state. MMR is around mean level and incidence of LBW is

comparatively much less (rank 2nd) at 6.1 and this is a positive sign.

Hence, post-natal care needs to be improved. Percentages of underweight children in Theni are

marginally higher than the mean level, so are stunted children but wasting is much less in children at

14% (rank 6th). This indicates some improvement in recent period.

However, total adequate diet received by 6-23 months children is only 24.4% (below mean).

Anaemia among all age groups and sexes vary from very good to good to average compared to other

districts and is not poor in any case, compared to the other districts.

Once again, the above discussion indicates that health and nutritional status may not have parity at

all times, however, like many other districts anaemia appears to have a direct impact on the

incidence of LBW babies. Hence, a more integrated approach is needed like strategic health delivery

linked to awareness generation and sanitation.

14. Nagapattinam

Nagapattinam has a sanitation coverage of 52% and drinking water coverage of 98.1%.

Its gender related supports are very good. For marriage at over 18 years it ranks 2nd, for literacy in

married women it ranks 4th, for +10 class education in married women it ranks 8th, for awareness

on diarrhoea handling of children by women it ranks 5th, for full antenatal care it ranks 6th, for

women getting pregnant after 19 years of age it ranks 7th and for IFA off take by pregnant women

also it ranks 6th.

Under this uniform back drop of positive input to gender related issues the demographic indicators

on health are – IMR is 14, under-5 mortality is 28%, MMR is 88 and LBW is 11.3. The first three are

much below the average while LBW is around the mean, so is incidence of diarrhoea.

Nutrition data indicate that while underweight and wasting are around the average, stunting is just

above mean value. The total adequate diet intake by 6-23 months children is only 25.2%. The total

anaemia, as compared among all districts, is around the mean level in most of the age groups.

However, severe anaemia appears to be much better controlled in most of the age groups viz. under-

105

5 children (rank 1st), 6-9 year old male and female children, 10-19 year old age and female children,

15-19 year old adults, pregnant women (nil) as well as in non-pregnant women.

Hence, inputs needed here are better sanitation & hygiene linked to comprehensive awareness

generation on all related issues along with control of worm infestation, to bring down total

anaemiaalong with improved health care services.

15. Namakkal

Namakkal has 51.9% (below average) sanitation and 98.1% water coverage. Issues related to gender

support are mixed. Ranks above average for indicators like receipt of full antenatal care and IFA

tablets for pregnant women which is possibly due to more than average number of sub health

centres, community health centres and primary health centres in the district.

Other indicators like post 18 years marriage, literacy of married women, +Class X education of

married women are below average.

Both diarrhoea awareness by mother as well as of diarrhoea episodes in the district are much better

than the all districts average. IMR is 14 (above average), under-5 mortality is 27 (around average),

MMR is 63 (below average), LBW babies is 9.8 (much less than average).

For underweight babies the percentage is very low at 4 (rank 5), wasting is also not high at 15 (rank

7) and stunting is also better than the average. The total adequate diet intake received by 6-23

months children also ranks high at 7th with better than all district mean coverage.

For anaemia the data fluctuates from age to age while it is quite low for under-5 year old children it

is significantly higher in upper age groups. However, severe anaemia is low in pregnant (lowest) and

non-pregnant women.

Once again it is seen that health demography may not match with entire set of nutritional status.

Severe anaemia in pregnant woman and incidence of LBW matches well. Hence, anaemia control is a

must. So supportive elements like sanitation and hygiene linked to health awareness and deworming

is essential.

16. Kirshnagiri

The district has 51.8% (below average) sanitation and 93.8% water coverage, which is on the lower

side, the range being 89.2 – 99.3%.

The district indicates maximum full antenatal coverage among all districts and also highest IFA table

receipt coverage. The sub, community and primary health centre coverage is also better than

average. However, vitamin A coverage of children is not high.

Post 18 year marriage as well as literacy of married women is less than average but +10 year

education of married woman and knowledge of diarrhoea handling by mother is better than the all

106

district mean. So diarrhoea episode in children (in 2 week period) is low (rank 4th) at 3% (1.6 – 9.8

range).

IMR as well as MMR are higher than the mean level but incidence of LBW is low at 7.3 (rank 3rd) the

range being 5.3 – 19.8.

Incidence of underweight and wasting is around the all district mean level. Stunting is slightly higher

than the average. Both total and severe anaemia is on the lower side in under-5 children but the

incidence becomes higher in school age group children. However, subsequently during adolescence

it starts improving, which is evident in all women and men, including pregnant ladies.

The district has a high (1st ), as a matter of fact much higher coverage (81.6%) than every other

district with regards to receipt of total adequate diet in 6-23 month children. The immediate 2nd is

way lower. The impact however is not as visible with regards to outcome indicators of nutrition.

Health care system seems to be stable but can be further improved. For anaemia control, specially

in school going ages, more integrated approach of sanitation, hygiene, deworming and health

awareness is needed. This will also improve demographic indicators of health. Once again low

anaemia in pregnant mothers and low LBW in babies is evident, which may be due to improved

dietary intake.

However, from Kirshnagiri, the learning on how such a high coverage of adequate diet to 6-23 month

children was achieved needs to be adopted. This indeed is a remarkable phenomena.

The district needs to otherwise improve health care, anaemia management, nutrition programme

(eg: ICDS, mid-day meal etc.) and link to deworming.

17. Vellore

Vellore has 51.5 (below average) sanitation coverage and 99.3% drinking water coverage, which is

the highest in Tamil Nadu. Most of the gender related indicators like literacy in women, past 18 year

marriage, +10 year educated women etc. are lower than the all district average.

However, both diarrhoea handling knowledge of mother as well as episodes of diarrhoea is better

than the state average. IFA tablet receipt is better than average, so is the health centre coverage at

all levels.

IMR and MMR rates are lower than the state mean level but under-5 mortality is higher. Incidence

of LBW babies is low at 8.2 (rank 6th) in Vellore.

Underweight in under-5 children is high (2nd highest), so is wasting (4th highest) as well as stunting

in Vellore. However, anaemia (both total and severe) is better than the all-district average in most

cases consistently.

Children (6-23 months) receiving adequate diet ranks better than the average but is at 37.5%

107

To improve overall nutritional status it is essential to link sanitation & hygiene inputs to nutrition

support programmes (e.g. ICDS) and health care services. Awareness on health, hygiene and

nutrition is essential. Once again low anaemia (comparatively) in pregnancy links to LBW rates.

18. Sivaganga

Sivaganga has 51.3% sanitation coverage with 92.7% drinking water coverage, which is lower than

most districts. Gender indicators show that the district has more than average literacy in married

woman, women having +Class X education as well as most women delivered after 19 years of age.

Health centre coverage (all types) are much better than the state average though IFA tablet receipt is

less than the state average. Knowledge on diarrhoea management by mothers is slightly above the

state mean but diarrhoea episode is higher than average.

IMR and MMR are marginally above the district average while incidence of under-5 mortality and

LBW is lower than the state average. Incidence of LBW babies is over the state average.

Underweight and wasting are slightly below the state average, while stunting is less than most (rank

2nd). So long term under nutrition may not be of great concern. The total adequate diet received by

6-23 months children rank high 4th with 37.7%. Anaemia data indicates that total anaemia is higher in

lower age groups compared to most of the other districts but it improves significantly during school

going and beyond ages which is evident in most of the adult groups, where it is around the state

average.

Overall intersectoral management including enhanced WASH inputs, better child support (by ICDS)

deworming in children linked to awareness generation is needed, including sanitation.

19. Salem

Sanitation coverage is 48.6% (below all district average) and drinking water coverage is 98.2%. Most

of the gender related indicators, as mentioned for other districts, are lower than the state average,

indicating that universal support is needed.

However, IFA tablet receipt and receipt of full antenatal care is around the average. Salem has 2nd

highest number of community health centres. It also has highest ORS coverage. But Vitamin A

coverage to children is low.

Both IMR and under-5 mortality are at about the state average level and MMR is marginally better.

Incidence of low birth weight (LBW) babies is also lower than that in many districts.

Incidence of underweight in under-5 years old children is better than the state average, stunting is

more or less at the average level but wasting is higher. Anaemia is uniformly better among all age

groups and sexes.

108

Lower rate of LBW may be due to overall better anaemia status in the district as compared to others.

This needs to be further improved and sustained by linking to awareness for better gender support

issues and health care. Good community health centre coverage is also reflected. Saniation coverage

needs to be enhanced.

20. Thiruvarur

Sanitation coverage is 48.3% (below all state average) and drinking water 97%. Literacy in women,

marriage age at post 18 years age and pregnancy past 19 years are better than the average. Receipt

of full antenatal care is also above average.

Sub health centre coverage is also above average. Knowledge of women on diarrhoea management

in children is lower than most districts which is reflected in higher episodes of diarrhoea in children

in Thiruvarur.

IMR at 11 and under-5 mortality at 20 it is better placed than may other districts. Incidence of LBW

babies is relatively less than the state average but MMR rate is much higher at 110 (mean being

73.8).

Underweight in children is 29.6%, wasting is higher at 22.1% and so is stunting at 28.4%. Anaemia is

lower than average in under-5 children but enhances after that. Coverage of 6-23 months children

for the total adequate diet is, however, at 36% which is higher than the all-district mean.

Maternal health support needed along with other programmes like school health, ICDS support etc.

Overall awareness and supportive health infrastructure needs to be provided along with Sanitation

as well as deworming.

21. Thanjavur

Thanjavur has 47.9% (less than mean) Sanitation coverage and 97.0% coverage of drinking water.

With regards to literacy rate, post 18 years marriage rate and pregnancy of woman post 19 years of

age, it ranks quite well. But with regards to receipt of IFA tablets and woman with full ante natal care

it ranks low. However, it ranks on the higher side for community centre, sub centre and primary

health centre coverage.

For diarrhea management in children by mothers, the district ranks high (6th) but incidence of

diarrhea in children is also high and much more than the all-district mean level. So, the reasons have

to be looked into.

The IMR and MMR are well controlled compared to most of the other districts but Under-5 mortality

needs attention. Incidence of LBW is also better than most of the others.

Incidences of under-weight, wasting as well as stunting are around the mean level. Coverage of 6-23

months children for the total adequate diet is 32.3% (slightly below all districts mean).

109

Anaemia is high in Under-5 children and is higher than the district averages for all age groups and

sexes for both total as well as severe types.

The state has low sanitation coverage but higher coverage of all types of health centres.

The state needs comprehensive nutrition care linked to sanitation and hygiene along with control of

worm infestation to control high anaemia levels. More awareness for inter-sectoral issues is needed

at all levels by the health centers along with improved ICDS, midday meal programmes etc.

22. Ramanathapuram

Ramanathapuram has sanitation coverage of 44.6% (much lower than the all-district average) and

drinking water supply at 89.2% (which is the lowest among all the districts).

Most of the gender related indicators are around the mean level compared to other districts.

However, it has highest number of children who received Vitamins A supplementation.

Though knowledge on diarrhea management is high for mothers but incidence of diarrhea in Under-

5 children is quite high. The reasons need to be looked into.

The district has more than the average number of health centres available for people, compared to

most of the other districts.

Both IMR & MMR are much higher in Ramanathpuram compared to most of the other districts. But it

is slightly better of in case of Under-5 mortality. Incidence of LBW in babies is also high in the district.

Both underweight and wasting in children are near the all-district mean level but the district has less

stunting.

The total adequate diet intake coverage of 6-23 months children is higher than most districts (rank

3rd) at 41.3%.

Incidence of Anaemia revels that it is universally high for all age groups and sexes immaterial of age,

compared to the all-district average.

High anaemia rate matches with high rate of LBW babies once again.

The state has low sanitation coverage but higher coverage of all types of health centres, but this has

not improved IMR, MMR or anaemia.


worm infestation. More awareness for inter-sectoral issues is needed at all levels by the health

centers, along with improved Nutrition support programmes like ICDS etc.

23. Cuddalore

The district has 40.8% coverage of sanitation (much lower than the district average) and 98.5%

drinking water coverage which is on the higher side.

110

Ranking of the district with regards to various gender related inputs are either near the average

range or lower. However IFA tablet receipt is very low (2nd from the bottom) while Vitamin A receipt

in children is high (2nd highest from top).

Health centre coverage is better than most of the other districts. Knowledge of woman on managing

diarrhea is quite high but this is not reflected in the incidence rate of diarrhea in children.

The total adequate diet received by 6-23 months children rank 8th at 36.6, which is better than the

all-district coverage.

Incidence rate of IMR and LBW of babies stands at the all district mean level but both MMR and

Under 5 mortality are worst off compared to the all-district mean.

Underweight, wasting as well as stunting in Under 5 children are all near about the all district

average level. Anaemia is higher than the all district average in all age groups in both sexes.

Moreover, severe anaemia is quite high in some cases.

The state has low sanitation coverage but higher coverage by health centres, but this has not helped

MMR, under-5 mortality or anaemia.


worm infestation. More awareness for inter-sectoral issues is needed at all levels with more support

from health centers.

24. Perambalur

Sanitation coverage at Perambalur is 40.8% (much below state average) and drinking water coverage

is 96.3%.

The Gender factors indicate literacy rate in married woman is over average with regards to most of

the indicators.

It rates well for both awareness of mothers on diarrhea management as well as incidence rate of

diarrhea (lowest in the State) in children. Vitamin A coverage of children is also good which may be a

supportive input.

Health Centre Coverage is not impressive.

IMR, MMR as well as Under-5 Mortality rates are around average or below. Incidence of LBW babies

is high at 18.6 (average being 11.8).

Incidence of underweight, wasted and stunted under-5 children is better than the all-district

averages. The total adequate diet coverage ranks high at 2nd for 6-23 months children but it is way

below Kirshnagiri which ranks 1st with 81.6% coverage.

111

Incidence of Anaemia shows it is much better than most of the other districts all through. However,

there is an increasing trend of anaemia in woman of reproductive age group which becomes more

marked during pregnancy. IFA tablet receipt is also below average supporting this outcome.

Once again higher rate of LBW babies match with increasing trend of anaemia during pregnancy.

Sanitation coverage needs to be enhanced along with hygiene and health education. Nutrition

coverage may be better than others but still need attention. Support to woman in reproductive age

group and pregnant woman needs to be strengthened. Overall health centre coverage needs to be

increased.

25. Tiruvannamalai

The district has a sanitation coverage of 40.4% which is much below the all-district average of 52.0%.

Water coverage is very good at 98.8%.

Gender related indicators are quite low in all cases; it has highest number of girls married before 18

years of age leading to highest number of woman who have babies before 19 years of age. IFA tablet

receipt is below the average.

Community Health Centre (CHC) is better but others are average. There is low percentage of mothers

who know how to manage diarrhea and incidence of diarrhea is also high.

Both IMR and Under-5 mortality are higher than the average but MMR is better. However, incidence

of Low Birth Weight babies is also comparatively higher.

Tiruvannamalai has highest incidence of Underweight and Wasted Under-5 children among all

districts. However, Stunting rates are better compared to the average.

For the total adequate diet coverage of 6-23 months children, it ranks 20th with 29.8% which is below

the mean.

Anaemia rates are much better than the district average for all groups.

The district needs to better itself with regards to certain gender issues and certainly with regards to

nutritional status in children. However, its anaemia status shows a brighter picture, dietary factors

may be the reason. But Sanitation and linked awareness will be most essential.

26. Viluppuram

Viluppuram has a sanitation coverage of 39.1% and water coverage of 98%.

The district has a relatively low rank in case of the gender related indicators in most of the cases,

including IFA tablet receipt by pregnant woman. It has the highest number of community health

centres but number of Sub and Primary health centres are on the lower side.

112

The IMR is high at 17 (3rd highest) compared to the district average of 12; MMR is 56 which is much

better than the average of 73.8 and Under-5 mortality is also better than average. LBW rate also is

high (2nd highest) at 18.6 with all district average being 11.8.

Both underweight as well as stunting rates are quite high in the district but wasting rates are less as

compared to the all-district average. The total adequate diet as received by 6-23 months children is

31.2% (Rank 18th) which is below the mean level.

Anaemia at Under-5 years is around the average or better. It becomes higher at school going age,

specially severe anaemia in girls of 6-9 years age which continues till adolescent ages. However, for

adult woman it improves significantly which is also evident in pregnant woman, though IFA tablet

receipt is low. The LBW rate also does not match. Dietary factors could be the reason.

Better health support Programmes, School health and Nutrition Programme, overall awareness on

Health and Hygiene, Sanitation Coverage etc. are all needed to be strengthened, along with

deworming.

27. Karur

Karur has a sanitation coverage of 38.1% (much lower than the district average) and water coverage

is at 97.5%

Ranks average or better in most of the gender related inputs. IFA tablet receipt is high and so is

awareness of mothers for diarrhea handling, which is reflected by low diarrhea rates.

Numbers of Community health centres are low but Primary and sub centres are higher.

IMR is very high (18) compared to average of 12; MMR is also high (98) compared to average of 73.8;

Under-5 Mortality is also on the higher side (30) compared to 28 average; LBW babies are also higher

(12.4) than average of 11.8.

Both underweight and wasted children number high in the district but stunting is around the

average. So, immediate nutritional as well as supportive Public Health inputs are needed.

The total adequate diet coverage in children (6-23 months) rank 12th with 32.9 coverage, which is

just below the mean level.

Anaemia in the district is high in Under-5 children, specially severe anaemia for both Under-5 as well

as school going children. Continues for woman in reproductive age group and pregnant woman. So

anaemia intervention linked to worm control is a must. Matches with high rate of LBW babies.

So, Sanitation, Hygiene, Worm infestation control, School health, maternal care etc. all need to be

supported.

113

28. Dindigul

The sanitation coverage in Dindigul is 37.8% (much lower than the all district average) and water

coverage is good 98.7%. The gender support issues vary. It is better than the most for literacy rate;

+10 class education, antenatal check-up rate and IFA tablet intake of mothers.

For diarrhea handling awareness of mothers it ranks the best which is not so well reflected at

incidence of diarrhea (which is around the state average)

Community health centre coverage is good.

Dindigul has more than average rates of IMR, MMR, Under-5 mortality as well as LBW babies.

Underweight children, wasting as well as stunting are all higher compared to the all-district average.

However, the total adequate diet coverage for 6-23 months children rank high among all districts of

5th with 37.5% coverage (above mean)

Anaemia runs higher than the state average in most cases. Though in pregnant woman the total

anaemia is slightly better but severe anaemia rates are high, which is reflected in more than average

rate of LBW babies.

So Sanitation, hygiene, control of worms, school health, maternal care and overall health support

interlinked with selective awareness generation is needed.

29. Virudhunagar

The sanitation coverage in the district is 37.5% and water coverage is a good 98.7%

The gender issues indicate average in most cases. Diarrhea handling and management is also not

high by mothers and diarrhea rate is also above average.

All types of health centre coverage is below the state average.

IMR is at average level; MMR is much better than the average; Under-5 Mortality is slightly higher

than the average and incidence of LBW babies is higher.

Underweight in under-5 Children, wasting as well as stunting are all higher than the state average.

The total adequate diet coverage of 6-23 months children is low at 29% (lower than mean)

Anaemia is less than the all-district average in most of the age groups and sexes, excepting in the

adolescent group. The reason for this positive output needs to be assessed so that it can be shared

with others.

Hence, inputs needed are a comprehensive health and nutrition care linked to WASH and other

related programme like ICDS, awareness generation to go hand in hand.

114

30. Dharmapuri

Sanitation coverage is 37.4% (lower than average) and drinking water coverage is 98.3%

Gender support issues indicate an average to lower rank for most issues.

However, both IFA tablet receipt as well as receipt of full antenatal check-up rank high.

Awareness on diarrhea management of mothers is less than average but diarrhea rate is better. This

may be due to some specific water treatment plants being implemented in the district.

Sub Health Centre and Primary health Centre coverage are higher but not community level health

centres. Dharmapuri has the highest IMR in the state at 20, high Under-5 mortality too at 30 but

MMR is less than the all-district average, this is reflected on the LBW which is also less prevalent

than most.

The underweight is high; the wasting is higher (2nd highest) but stunting is better than mean. This is

reflected in the total adequate diet received by 6-23 months old children where it ranks 3rd from

bottom with a low 21.8% coverage.

Anaemia rates are better than most other districts in all the age groups, both total and severe.

The impact of better anaemia status, specially of severe form, in pregnant mothers is once again

reflected as LBW babies are less prevalent.

Hence, inputs needed are a comprehensive health and nutrition care linked to WASH and other

related programmes like ICDS and awareness generation to go hand in hand. Sanitation coverage

enhancement is a must.

31. Pudukkottai

Saniatation coverage in Pudukkottai is 37.2% (much lower than the state average) with water

coverage at 91.4%.

The gender issues are relatively much better than others in relation to literacy of woman at +10 class

levels and also delivery of babies post 19 years of ages.

However, IFA tablet receipt is lowest in the district and so is woman receiving full antenatal check-

up. Both Sub Centre and Community Health Centre coverage is at average level.

Diarrhea management awareness of mothers is low and diarrhea incidence is at the average level.

IMR is at average level, MMR is higher than average but under-5 Mortality is lower. LBW is low at

7.8.

Both underweight and wasting in under-5 children is marginally higher than the all-district mean

level but stunting rate is lower. It has 37.1% coverage of total adequate diet coverage for 6-23

months, which is above the mean level with 6th rank.

115

Anaemia runs low in most of the age groups – both total and severe. As in Dindigul, the severe

anaemia rate in pregnant woman is high.

So Sanitation, hygiene, control of Worms, School health, maternal care health support and

interlinked awareness generation is needed. Worm infestation needs to be essentially implemented

along with supportive programmes of Social welfare Departments for children.

32. Ariyalur

Ariyalur has a sanitation coverage of 33.6% (Lowest in the state) and drinking water coverage of

98.5% (rank 6th)

Gender issues are better than average in all cases and ranks highest in case of womans delivery after

19 years of age.

IFA tablet intake is not on the higher side and so is the data on woman who received full ante natal

care and children who received Vitamin A between 9-35 months age.

Diarrhea awareness in mothers is not high and diarrhea incidence in under 5 children is also high (3rd

worst)

Health centre coverage is lower at all levels, specially for community health centres.

IMR and MMR rates are better than most but Under-5 mortality as well as LBW is higher than most

other districts.

Ariyalur has the highest rate of stunting among all-districts (37); underweight is also high (29.7) and

wasting is also above the mean level. The total adequate diet intake by 6-23 month children ranks

15th but is below the all district mean level.

Anaemia runs high in most age groups for both sexes but specially for girls. Severe anaemia in under-

5 is a point of concern. Anaemia in woman, specially pregnant woman is high.

Once again impact of anaemia in pregnant woman is reflected on the LBW status of babies in the

district, which has the lowest sanitation coverage and highest number of stunting in the state.

Comprehensive health and nutrition care, linked to worm infestation supported by enhanced

Sanitation coverage with hygiene education essentially needed. Supportive School health, ICDS

coverage, comprehensive awareness generation needs to be strengthened.

116

6. Summary and Conclusion

This report aims to cover an inter as well as intra sectoral evaluation among the 32 districts of Tamil

Nadu, using multiple Public Health related indicators, mainly to assess impact of WASH on other

sectors

Latest data sources have been used for this analysis, which are:-

District Level Household and Facility Survey – DLHS – 4, (2012-13)

National Family Health Survey - NFHS – 4, (2015-16)

Sample Registration System Results – SRS, (2012)

The Indicators have been classified into two groups viz:

Input Indicators – These cover the various WASH, Health, Nutrition, Gender related issues etc. that

are being provided by various departments of Govt. of Tamil Nadu (15 Indicators are identified, as

follows:-

1. Access to improve source of Sanitation (%) – (DLHS 4)

2. Access to improve source of drinking water (%) – (DLHS 4)

3. Percentage of currently married women below 18 years of age – (DLHS 4)

4. Currently married women who are illiterate (%) – (DLHS 4)

5. Currently married women with 10 or more years of schooling (%) – (DLHS 4)

6. Births to women aged15-19 years out of total births (%) – (DLHS 4)

7. Pregnant women who consumed 100 or more IFA Tablets/Syrup equivalent(%) – (DLHS 4)

8. Pregnant women who had full antenatal care (%)

9. Women know about what to do when a child gets diarrhoea (%) – (DLHS 4)

10. Number of Primary Health Centres (PHC)(%) – (DLHS 4)

11. Number of Sub-Health Centres (%) – (DLHS 4)

12. Community Health centres (CHC) having 24X 7 hours normal delivery services (%)

13. Children (age 9-35 months) received at least one dose of vitamin A supplement in last 6

months (%) – (DLHS 4)

14. Children with diarrhoea in the last 2 weeks and received ORS in % – (DLHS 4)

15. Total adequate Diet intake by 6-23 month children – (NFHS 4)

Please see Annexure I (Figure 4 to 18)

Output Indicators – These cover the various outputs that can be linked to the inputs being provided

as mentioned above 25 Indicators are identified as follows:-

1. IMR per 1000 live births 2011-12 – (SRS)

2. MMR per 100,000 live births - (SRS)

3. U5 MR per 1000 live births Census – (NFHS 4)

4. Percentage of Children with low birth weight (below 2.5kg) (%) - (DLHS 4)

5. Live births – (DLHS 4)

6. Children under 5 years who are underweight (weight-for-age) in %, - NFHS 4

117

7. Children under 5 years who are wasted (weight-for-height) in %, - NFHS 4

8. Children under 5 years who are stunted (height-for-age) in %, - NFHS 4

9. Incidence of Diarrhoea in last 2 weeks among children below 5 years (%) - (DLHS 4)

10. Anaemia in Children 6-59 months (Total) - (DLHS 4)

11. Anaemia in Children 6-59 months (severe) - (DLHS 4)

12. Anaemia in Children 6-9 Years Male (Total) - (DLHS 4)

13. Anaemia in Children 6-9 Years Male (severe) - (DLHS 4)

14. Anaemia in Children 6-9 Years Female (Total) - (DLHS 4)

15. Anaemia in Children 6-9 Years Female (severe) - (DLHS 4)

16. Anaemia in Children 10-19 Years Male (Total) - (DLHS 4)

17. Anaemia in Children 10-19 Years Male (severe) - (DLHS 4)

18. Anaemia in Children 10-19 Years Female (Total ) - (DLHS 4)

19. Anaemia in Children 10-19 Years Female (severe) - (DLHS 4)

20. Anaemia in an Adolescent 15-19 Years (Total) - (DLHS 4)

21. Anaemia in an Adolescents 15-19 Years (severe) – (DLHS 4)

22. Anaemia in a Women 15-49 Years (Total) - (DLHS 4)

23. Anaemia in a Women 15-49 Years (severe) - (DLHS 4)

24. Anaemia in a Pregnant women 15-49 Years (Total) - (DLHS 4)

25. Anaemia in a Pregnant women 15-49 Years (severe) – (DLHS 4)

Please see Annexure I (Figure 19 to 27 and Tables 3 to 8)

Ranking - The various indicators have then been ranked individually for each district and a

comparison has been made within the district to analyse the linkage between the indicators

assessed. Along with this, an inter district comparison has been made using the ranking method to

evaluate the performance of each district with regards to individual indicators used.

(Please see Annexure II (Table 9 to 23 for Input Indicators and Table 24 to 48 for Output Indicators)

Summary of Analysis conducted

In some districts a direct connection is observed between certain indicators while in some, it did not

exist.

Each issue is based on an all-district assessment and these are discussed in detail for each district.

Subsequesntly an assessment has been done based on the ranking conducted for each indicator.

Along with this suggestions are given for each district on what improvements are needed.

Some of the most relevant observations are as follows:-

5. Drinking water coverage in the state is excellent. The range varies from 89.2 to 99.3%

showing significant coverage in all the districts of the state. Most of the districts have more

than 90% coverage. Hence, inter district comparison for drinking water was thought to be of

not much significance.

118

6. The number of live births in the state is also excellent across the state, varying between to

90-100 only. So in this case also, inter district comparison was restricted.

7. The ranges are also relatively smaller among districts on the following issues –

IMR (Varying from 6-20)

Least number of girls (15-19 years) who gave birth to babies (varying from .6-10.7%)

8. For most of the other issues the variations are wide.

9. Sanitation coverage vary widely between 33.6% and 93.5%, the highest being Kanniyakumari

and lowest being Ariyalur. Wide variation in sanitation coverage has to be narrowed with

enhanced coverage.

10. TotalAdequate Diet Intake by 6-23 months old children vary widely between 13.8 and 81.6.

The first district Kirshnagiri at 81.6 is way above the 2nd highest 45.2. This is a very unusual

data.

11. Gender related education and awareness is quite good in the state but further improvement

will certainly support enhancement in all health and nutrition indicators.

12. Under nutrition covering underweight, wasting and stunting are the major public health

problems which are still significantly high in the state. This needs to be addressed through a

multi-pronged approach of mothers health; improved sanitation and hygiene; improved

nutrition with balanced diet; safe drinking water; health care; breast feeding; control of all

water, faecal and food borne diseases; awareness on all related issues etc. All nutrition

support programmes have to be enhanced, along with reduction in open defecation.

13. Anaemia is being dealt separately as this also is a major problem. It is higher in girls and

woman than men. School going and adolescents have high anaemia though under-5 are

marginally better off. In several districts a link is found between anaemia status of pregnant

mothers and Low birth weight ofbabies. Hence, this needs to be addressed by all inputs as

mentioned above for control of overall under nutrition along with a universal coverage of

control of worm infestation and IFA tablet distribution. Universal sanitation is of course a

must to prevent open defecation. Healthy habits like wearing shoes, washing hands etc.

need to be encouraged.

14. A clear link is seen between receipt of IFA tablets by pregnant woman and pregnant

mothers who received full ante natal check-up. So overall health care facilities need to be

become more proactive. Health centre coverage need to be increased in many districts

15. IMR and under-5 mortalities also are linked in some districts

16. Ariyalur, which has highest open defecation in the state with minimum sanitation coverage,

has highest rate of stunting.

119

17. Additionally other issues that may further help are Water quality monitoring to prevent

diarrhoea and other water borne diseases; enhancing accessibility to water; making

available more subsidised foods; better personal hygiene; cleaner environment and

knowledge on healthy diets.

Among all districts ‘Kanniyakumari’ appears to be doing the best followed by ‘Chennai’. Sanitation

coverage in these two districts also rank 1st and 2nd in the state.

120

7. Reference

1. Bagchi T., Bulusu S., Mukherjee S. and Chakravarty Indira (1986); Ecology of protein energy

intake : A Biosocial study on the Lodhas - The primitive tribal groups of West Bengal, Man

and Life; Vol. 12; No 1 & 2: 47 - 60;.

2. Blossner M, De Onis M (2005). Malnitrition – quantifying the health impact at national and

local levels. World Health Organization, Geneva. Environmental Burden of Disease Series No.

12.

3. Briend, A. (1990). Is Diarrhoea a major cause of malnutrition among the under-fives in

developing countries? A review of available evidence. European Journal of Clinical Nutrition,

44, 611-628.

4. Brown, J., Cairncross, S. & Ensink, J. H. J. (2013). Water, sanitation, hygiene and enteric

infections in children. Archives of Disease in Childhood.

5. Chakravarty Indira (1995). Working Paper, Street Foods in India, Food Inspection

(Microbiological & Sanitary), Street Food Project in Calcutta, FAO, Calcutta, India, (6-9

November).

6. Chakravarty Indira (1995); Street Foods; Alimentation de rue; Food and Nutrition Paper;

NO. 63; FAO.

7. Chakravarty Indira (1995); Time energy saving after provision of safe water in Nepal;

UNICEF Report; Nepal.

8. Chakravarty Indira, Canet C (1996.). FAO, 17/18, Food, Nutrition and Agriculture, Page. 30

9. Chakravarty Indira (1998); Extent of parasitic infection and their linkage with iron deficiency

anaemia in West Bengal, AIIHPH & STM; MI-IDRC; 59-60;.

10. Chakravarty Indira (2007). A Pilot Study to Assess the Safety of Street Foods in India, Ministry

of Food Processing Industries, Govt. of India

11. Chakravarty Indira. (2009). Final Report on Training and Motivation of Vendors /Consumers

to Improve the Management of Street Foods in Chennai, Burdwan and Howrah, WHO,

Sticker No: SE/08/032891.

12. Chakravarty Indira (2011). Framework of Action to Ensure Safety of Street Foods for

Implementation in the Countries of South-East Asia, WHO-SEARO.

13. Chakravarty Indira (2012); Arsenic in raw and cook food – Wrap up; International Conference

on Water Quality with Special Reference to Arsenic; Public Health Engineering Department;

Govt. of West Bengal; Ministry of Drinking Water and Sanitation; Govt. of India; Kolkata; pp.

211 – 222

121

14. Chakravarty Indira, Ahmed Tanvir (2016); A Synthesis Report of Bangladesh and India;

Exploring Impact of Drinking Water and Sanitation on Health, Nutrition and Socio-economic

Status of Communities; Ecosystem for Life: A Bangladesh-India Initiative; IUCN. pp. 1-68.

15. Checkley, W., Buckley, G., Gilman, R. H., Assis, A. M., Guerrant, R. L., Morris, S. S., Molbak, K.,

Valentiner-Branth, P., Lanata, C. F., Black, R. E., Malnutrition, A. T. C. & Network, I. (2008).

Multi-country analysis of the effects of Diarrhoea on childhood stunting. International

Journal of Epidemiology, 37, 816-830.

16. Clasen, T. F., Bostoen, K., Schmidt, W. P., Boisson, S., Fung, I. C., Jenkins, M. W., Scott, B.,

Sugden, S. & Cairncross, S. (2010). Interventions to improve disposal of human excreta for

preventing Diarrhoea. Cochrane Database Syst Rev, Cd007180.

17. Curtis, V., Cairncross, S. & Yonli, R. (2000). Domestic hygiene and Diarrhoea - pinpointing the

problem. Trop Med Int Health, 5, 22-32.

18. Dean Spears (2012); “Effects of Rural Sanitation on Infant Mortality and Childhood Stunting:

Evidence from India’s Total Sanitation Campaign”; Rice Working Paper, 3 July.

19. Dewey, K. G. & Adu-Afarwuah, S. (2008). Systematic review of the efficacy and effectiveness

of complementary feeding interventions in developing countries. Maternal & Child Nutrition,

4, 24-85.

20. District Human Development Report (2011); Dharmapuri District; Human development

research and co-ordination unit state planning commission ezhilagam, chepauk, chennai 600

005.

21. District Level Household and Facility Survey (DLHS-4) 2012-13; Ministry of Health and Family

Welfare, Government of India, International Institute for Population Sciences (IIPS) 2014.

India. Tamil Nadu: Mumbai: IIPS.

22. Esrey, S. A. (1996). Water, waste, and well-being: a Multicounty study. American Journal of

Epidemiology, 143, 608-623.

23. Esrey SA, Feachem RG and Hughes JM (1995); Interventions for the control of Diarrheas

diseases among young children: improving water supplies and disposal facilities. Bull. World

Health Organization; 64: 776-72;

24. Fewtrell Lorna, Prüss-Üstün A, R Bos, F Gore and J Bartram (2007); “Water, Sanitation and

Hygiene. Quantifying the Health Impact at National and Local Levels in Countries with

Incomplete Water Supply and Sanitation Coverage”, Environmental Burden of Disease

Series,15; Geneva: World Health Organization.

25. Gopalan C, Kaur Suminder (1989). Woman and Nutrition of India, Nutrition Foundation of

India.

122

26. Humphrey, J. H. (2009). Child undernutrition, tropical enteropathy, toilets, and

handwashing. The Lancet, 374, 1032-1035.

27. Kolsky, P.J., Blumenthal, U.J (1995); Environmental health indicators and sanitation-related

disease in developing countries. Limitations to the use of routine data sources. World Health

Statistics Quarterly 48, 132-139.

28. Iips (2007). National family health survey, India. Mumbai: International Institute for

Population Sciences.

29. Lin, A., Arnold, B. F., Afreen, S., Goto, R., Huda, T. M. N., Haque, R., Raqib, R., Unicomb, L.,

Ahmed, T., Colford, J. M. & Luby, S. P. (2013). Household environmental conditions are

associated with enteropathy and impaired growth in rural Bangladesh. The American Journal

of Tropical Medicine and Hygiene.

30. Mara, D., Lane, J., Scott, B. & Trouba, D.( 2010). Sanitation and health. PLoS Med, 7,

e1000363.

31. National Family Health Survey 3, Ministry of Health and Family Welfare, Govt of India,

International Institute for Population Science (IIPS) and Macro International. (2007).

International Family Health Survey (NFHS-3), (2005-06) : India, Volume I. Mumbai: IIPS.


International Institute for Population Science (IIPS) and Macro International. International

Family Health Survey (NFHS-4), (2015-16) : India, Volume I. Mumbai: IIPS., Survey Conducted

on 2015-16

33. Olsen A, Samuelsen H, Onyango-OumaW (2001); A study of risk factors for intestinal

helminth infections using epidemiological and anthropological approaches. J

BiosocSci33:569-84.

34. Petri, W. A., Jr., Miller, M., Binder, H. J., Levine, M. M., Dillingham, R. & Guerrant, R. L.

(2008). Enteric infections, diarrhea, and their impact on function and development. The

Journal of Clinical Investigation, 118, 1277-1290.

35. Pruss-Ustun, A. B. R. & Corvalan, C.(2006). Preventing disease through healthy

environments: Towards an estimate of the environmental burden of disease. Geneva: WHO

36. Pruss-Ustun, A. B. R., Gore, F. & Bartram, J. (2008). Safer Water, Better Health: Costs,

Benefits and Sustainability of Interventions to Protect and Promote Health. Geneva: WHO.

37. Prüss A, Kay D, Fewtrell L, Bartram J (2002); Estimating the burden of disease from water,

sanitation and hygiene at global level. Environmental Health Perspective; 110: 537-42

38. Ramalingaswami, V., Jonsson, U. & Rohde, J. (1996). Commentary: the Asian enigma. The

progress of nations, 11-17.

123

39. Sample Registration System Statistical Report (SRS) 2012; Office of the Registrar General,

India Ministry of Home Affairs Government of India New Delhi; Report no. 1 of 2013;

http://www.censusindia.gov.in/vital_statistics/SRS_Reports_2012.html

40. Spears, D. (2013). How much international variation in child height can sanitation explain?

World Bank Policy Research Working Paper (WPS 6351). Online: http://www-

wds.worldbank.org/external/default/

WDSContentServer/IW3P/IB/2013/02/05/000158349_20130205082533/Rendered/PDF/wps

6351.pdf.

41. Strunz, E. C., Addiss, D. G., Stocks, M. E., Ogden, S., Utzinger, J. & Freeman, M. C. (2014).

Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and

meta-analysis. PLoS Med, 11, e1001620.

42. World Health Organization(2008); Safer water, better health: Costs, benefits and

sustainability of interventions to protect and promote health; Available at:

(http://whqlibdoc.who.int/publications/2008/9789241596435_eng.pdf)

43. WHO & UNICEF, Joint Monitoring Program, (2014). Progress on drinking water and

sanitation: 2014 update. Geneva, WHO/UNICEF.

44. WorldHealthOrganization,UNICEF,USAID; (2015);

Improvingnutritionoutcomeswithbetterwater,sanitationand

hygiene:practicalsolutionsforpoliciesandprogrammes; ISBN: 978-924-1565103;Pg. 1-58.

45. World Health Organization; Regional Office for South-East Asia (2016); Strategies to prevent

Anaemia: Recommendations from an Expert Group Consultation; New Delhi, India; 5th-6th

December,.

46. World Health Organization (2016);World Health Statistics: Monitoring Health for the SDG,

Sustainable Development Goals;; ISBN: 9789241565264:1-136;

47. Winarno FG (1995). The Regulatory and Control Aspects of Street Foods, FAO, Calcutta, India,

(6-9 November).

48. Ziegelbauer K, Speich B, Ma¨usezahl D, Bos R, Keiser J et al (2012); Effect of sanitation on

soil- transmitted helminth infection: Systematic review and meta-analysis. PLoS Med, 9(1):

e1001162, doi: 10.1371/journal.pmed.1001162;

http://www-wds.worldbank.org/external/default/

http://www-wds.worldbank.org/external/default/

http://whqlibdoc.who.int/publications/2008/9789241596435_eng.pdf

124

125

SECTION – II

INTER SECTORAL COORDINATION -

ANALYSIS OF IMPORTANT ON-GOING

PROGRAMMES AND WAY FORWARD

126

127

INDEX

1 Inter Sectoral coordination 129

2 Suggested steps for Intersectoral Coordination 130

3 Indicators to assess intersectoral impact 131

4 Ongoing Programmes of Govt. of Tamil Nadu – Suggested Inter sectoral inputs for a multi dynamic approach

133

5 Way forward 145

128

129

1. Inter Sectoral coordination

From the forgoing chapters it is evident that there are clear linkages between different

sectoral indicators of Public Health. These are WASH (Water, Sanitation and Hygiene);

Nutrition (Wasting, Stunting and Under Nutrition) and Anaemia; Livebirth; Low birth

weight of babies; Infant mortality and Under 5 mortality rates; Health Care services (IFA

tablet receipt, ante natal check up); water borne diseases etc.

Hence, if a comprehensive approach is undertaken then interaction between the

concerned sectors is expected to make the inputs provided much for effective and

sustainable

It is a fact that unless all the concerned sectors work together in harmony and in

coordination with each other, the targets of “complete Health” can never be achieved.

The major departments of the Govt. that have a direct impact and needs to develop a

mechanism of interaction are, Departments dealing with -

Health and Family Welfare

Women and Child Development

Safe Water supply

Sanitation & Hygiene

Food Safety

Education

Other Partner Departments, agencies and individuals are:

Departments of Government e.g. Agriculture, Food and Civil Supplies, Food

Processing, Agriculture, Commerce, Finance, Planning etc.

Universities and Organizations

International agencies

Voluntary agencies, NGO’s and community representatives

Public and Private sector

Individual experts

Communities

130

2. Suggested steps for Intersectoral Coordination

Suggested steps for making inter sectoral coordination smooth, effective,

implementable and sustainable are as follows :-

1. While planning and initiation of any new project or programme all the related

departments need to be kept informed and requested to provide specific

supportive inputs which will strengthen the project to improve its outcome.

2. To achieve above, the nodal Department should undertake a reconessance

survey before planning and initiation of a programme or project, to identify

1. Needs of the focal department

2. Needs from the supportive departments.

3. Every programme must identify indicators which will highlight the output from

the project. These indictors should cover two (2) objectives –

1. Indicators which will cover the departments own outcome.

2. Indicators which will cover the impact on other related departments

outputs.

Eg:- WASH projects while identifying its own output indicators should

also assess its impact on selective health & nutrition related indicators

and vice versa.

131

3. Indicators to assess intersectoral impact

Some of the Indicators that may be selectively added to assess the impact of related

departments are given below, for mainly three departments

The following indicators show the status of inputs that are provided by other

Departments (sectors)

3.1. For Programmes of Health and Family Welfare Department-

Food Safety

Food Security

Water availability / Accessibility

Water quality

Latrine availability – community / individual

Hygiene – KAP of frontline workers (ASHA’s, ANM’s etc)

Hygiene related indicators-

– Hand washing

– Garbage disposal

– Water storage

– Water usage

– Infant caring practices etc.

Iron folifer tablet intake – compliance (including Reasons of non

compliance)

Epidemic outbreaks related to water and food borne diseases – type /

frequency

In Schools

– Availability of safe water and latrines in schools.

– Water source and quality in schools

– Availability of water in latrines in schools.

– Nutritional content and Hygiene levels during preparing / serving

midday meals

– Water and food quality monitoring

– Hygienic knowledge and behavior of children and teachers.

– Data on disaster prone zones and programmes in place.

3.2. For Programmes of Social Welfare and Noon mealDepartment

Nutritional content of food at ICDS ceners

Compliance of IF tablet intake (Reasons of non compliance)

Diarrheal disease rates among children, adolescents and women

User rate of primary health care facilities

132

Deworming programmes – coverage.

Water availability / quality in ICDS centre

Availability of sanitation facilities in ICDS centres

KAP of Angadwadi worker on hygiene and related issues.

Awareness levels of mothers on issues related to WES

Garbage disposal facilities in ICDS centers.

Food safety, water safety and hygiene practices in ICDS centers for

preparation of supplementary diets.

Hygiene related indicators-

– Hand washing

– Garbage disposal

– Water storage

– Water usage

– Infant caring methods

– Data on disaster prone zones and programmes in place.

3.3. For Programmes of Departments dealing with Drinking Water and Sanitation

IMR, MMR, under 5 Mortality etc.

Malnutrition status Eg. – ICDS date (weight for age), PHC data (Anaemia

levels in pregnant women, girls; worm infestation etc.)

Low Birth Weights (% of LBW babies)

Use of ORS

Use of deworming drugs

Coverage of iron folifer tablet distribution

Water borne disease rates – eg. dysentery, diarrhea, Cholera, etc.

Incidence of Malaria

Incidence of overall sicknesses

Food safety parameters

Hygiene issues – KAP of frontline workers

Epidemiology

Data on disaster prone zones and programs in place.

Indicators related directly to the actions of one department can be used by

another department to assess the impact it had on the outcome of any

programme after providing suitable interventions.

133

4. Ongoing Programmes of Govt. of Tamil Nadu –

Suggested Inter Sectoral inputs for a multi dynamic approach

4.1. Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS):

Backdrop:

Quality healthcare comes at a cost that is unaffordable for the economically weaker

sections of society. One way to address this is to provide free healthcare in Government

hospitals. But sometimes treatment is not possible at district and sub-district hospitals.

Furthermore, the demand for advanced healthcare leads to long waitlists for emergency

and life saving surgeries. To address these challenges and ensure availability of

advanced healthcare, the Government of Tamil Nadu introduced a scheme called the

“Chief Minister Kalaignar Insurance Scheme for life saving treatments” on 23rd July

2009. This scheme is for the poorest of the poor/low income/unorganized groups who

cannot afford costly treatment, as a supplementary facility for getting free treatment in

empanelled Government and private hospitals for such serious ailments.

Under the CMCHIS, treatment is provided for 1,016 procedures, 23 important

diagnostic procedures and 113 follow-up procedures. Smart cards have been issued to

1.58 crore families. Families with an annual income of Rs.72,000 or below are eligible.

Sri Lankan refugees living in camps and living outside the camps, but registered as

refugees in local police stations are eligible under this scheme without income ceiling.

Rs.4 lakh insurance coverage is being provided to each family in a block year (4 years).

The families of differently abled are eligible for enrolment under the scheme without

income ceiling. 751 hospitals including all the Government Medical College Hospitals

and the District Headquarters Hospitals are empanelled to provide treatment at free of

cost.

Comment:

1. The scheme mainly covers treatment and supportive diagnostic procedures for

the most needy. It is an excellent programme with a curative approach.

2. The data that gets generated from the patients can be segregated for certain

issues which can be used for providing future preventive care. Eg. Those

identified with Low Hb levels, under nutrition, osteoporosis, Vitamin D deficiency

etc. may be specially advised through IEC and also provided supplementation,

through other ongoing public health programmes.

3. Since hygiene is often a major cause of infections and diseases, those areas which

show high rate of use of the CMCHIS scheme should be identified for WASH

related issues like – Sanitation coverage; water quality monitoring; availability and

134

accessibility to potable water and state of personal, domestic and environmental

hygiene.

Involvement of other Departments:

Other than Health and Family Welfare Department the coordination with following

departments is suggested –

1. State Planning Commission, Tamil Nadu

2. Department of Rural Development

3. TAWD Board

4. Department of Social Welfare and Noon meal

4.2. Menstrual Hygiene Programme

Backdrop:

About 52% of the female population in the state are of reproductive age and most of

them are menstruating every month. The majority of them have no access to clean and

safe sanitary products, or to a clean and private space in which to change menstrual

cloths or pads and to wash. Menstruating women and girls are often supposed to be

invisible and silent. Besides the health problems due to poor hygiene during

menstruation, the lack or unaffordability of facilities and appropriate sanitary products

may push menstruating girls temporarily or sometimes permanently out of school,

having a negative impact on their right to education.

The best input to make an impact on improving the lives of girls and women is proper

water and sanitation. The role of good Menstrual Hygiene Management (MHM) is a

trigger for better development of women and girls.

This is another pioneering scheme launched by Hon’ble Chief Minister under which

Priceless Sanitary Napkins are distributed annually to around 33 lakh Adolescent Girls,

Women Prison inmates and inpatients in the Government Mental Hospital. Under this

scheme, 18 packs of sanitary napkins (six pads per pack) in a year at the rate of three

packs for two months are provided to each adolescent girl (10–19years), both school

going and non-school going, in rural areas. Sanitary Napkins are also given to post natal

mothers who deliver in Government institutions at the rate of seven packs each (six

pads per pack). Besides adolescent girls and mothers who deliver in Government

institutions, sanitary napkins are being given to each woman prison inmate and female

inpatients in the Institute of Mental Health, Chennai at the rate of 18 packs (six pads per

pack) in a year.

135

Comment:

1. It is a most laudable programme, as this is an excellent support system for the

usually ignored problem of all girls and woman in the reproductive age.

2. Since hygiene is one of the most critical issues that needs to be looked into,

therefore the programme needs to be linked to Programmes on Hygiene

education (overall personal hygiene) through Health Centre, ICDS centers, schools,

TAWD Bond (WSSO) Rural Development department etc.

3. Clean water and availability of latrines with water connection is a most important

factor for menstrual hygiene. So linking to WASH progress (TAWD board & Rural

Development Dept.) of the state will be most effective. Monitoring of Hb level

may also be linked on an annual basis to monitor anaemia status, which is a public

Health problems in the state. Adolescent girls may be particularly targetted.






3. TAWD Board


5. Department of School education

4.3. Hospital on Wheels Programme:

Backdrop:

This programme is implemented from the year 2011-2012 onwards in all the Blocks in

the State with modern Medical and Lab Investigation facilities. Every month 40 camps

are conducted in each Block. At present, 416 Mobile Medical Units are functioning

under this programme.

The medical unit is stationed at a particular place in a block and people in the

surrounding areas is informed through Primary Health Centres (PHCs) in advance.

Remote areas get top priority which have been identified.

The Hospital on Wheels concept is also involved in the implementation of various

healthcare schemes of the State Government and NRHM.

136

Comment:

1. The mobile units which are doing Laboratory investigations should cover water

Quality monitoring of the area, as unsafe water is a major cause of infection and

disease.

2. Data of Public health significance from the mobile Labs, like Hb level in blood;

worm infestation in stools; blood sugar levels etc. along with supportive data may

be compiled and shared with district authorities to highlight areas (zones) that will

need intense coverage of selective Public Health programmes like anaemia control

programmes; deworming programmes; WASH programmes on Hygiene etc.

3. Hygiene education should be part of all mobile units.






3. TAWD Board


4.4. Non Communicable Disease Prevention, Control and Treatment:

Backdrop:

Non-Communicable Diseases (NCD) prevention, control and treatment programme has

been implemented in 16 Districts during 2012 and extended in the remaining 16

Districts during 2013. Till May 2016, treatment has been provided for 31.76 lakh people

for Hypertension, 11.09 lakh people for Diabetic Mellitus, 3.84 lakh women for Cervical

Cancer and 1.70 lakh women for Breast Cancer.

“Nalamana Tamizhagam” is an initiative of Government of Tamil Nadu which aims to

screen the population and identifying the risk factors in the rural populations in Tamil

Nadu. This is attained through health promotion, behaviour change in the community.

States Non Communicable Disease Cell working with the State Health society, Tamil

Nadu has designed this programme which is implemented by the Directorate of Public

Health & Preventive Medicine. A Non Communicable Disease risk scoring using “ ENN

SCORE” also help to device effective screening strategies to unmask hidden burden of

the disease.

137

Comment:

1. This is an excellent preventive step as there is a fast increasing trend in nearly all

non communicable diseases. The health promotion activities should be linked to

departments dealing with food and dietary issues; physical activities; School

Health and Hygiene. Should be linked to IEC programmes on preventive measures

viz dietary habits physical activity, hygiene etc.

2. Early detectionof disease specially for cancer eg: Paps smear, Mammography etc.

should be linked to the programme.






3. TAWD Board


5. Department of School education

6. Department of Food and Civil supplies

4.5. Immunization Programme

Backdrop:

Tamil Nadu started Immunization programmes against six Vaccine Preventable Diseases

during 1978. In order to strengthen the Programme, Universal Immunization

Programme (UIP) was launched during 1985 with the aim of achieving 100 % coverage

of Infants and Pregnant women.

Annually, around 11.22 lakh pregnant women and 10.22 lakh infants in this State are

being targeted under immunization programme. More than 92% coverage has been

reported during 2015-16 in all vaccines.

The Ministry of Health & Family Welfare (MoHFW) GoI, launched Mission

Indradhanush in December 2014 to achieve more than 90% full immunization coverage

in the country by 2020(from 65% to 90%). A special drive to vaccinate all unvaccinated

and partially vaccinated children below 2 year and Pregnant Women under UIP. The

government has identified 201 high focus districts across the country that have nearly

50% of all unvaccinated or partially vaccinated children in the country.

138

In Tamilnadu, the 8 districts of Coimbatore, Kancheepuram, Madurai, Thiruchirapalli,

Thirunelveli, Thiruvallur, Vellore and Virudhunagar were identified in the first phase. In

the second phase, another 16 Health Unit Districts were being included viz. Nilgiris,

Tiruppur, Namakkal, Erode, Karur, Salem, Chennai Corporation, hill areas of districts and

urban slum areas of all corporations viz. Dindigul, Palani, Thanjavur, Tuticorin,

Dharmapuri, Krishnagiri, Tiruvannamalai, Theni and Kallakurichi.

Comment:

1. Based on the large scale success and reachability of this programme: many

essential health and nutrition related programmes can be dovetailed with this,

specially IEC programmes on hygiene; prevention of water borne diseases; diet

and food habits etc: These can be done through the health centres (may be by

Ashas) when the subject comes for immunization.

2. Health camps may also be organized where immunization is provided along with

health and hygiene education on above mentioned issues.






3. TAWD Board


4.6. Dr. Muthulakshmi Reddy Maternity Benefit Scheme

Backdrop:

This scheme is being implemented with a noble objective of providing assistance to

poor pregnant women / mothers to meet expenses on nutritious diet, to compensate

for the loss of income during motherhood and to avoid low birth weight of new born

babies. Assistance under this scheme has been enhanced from Rs.6000 to Rs.12,000 and

disbursed in three equal installments of Rs.4000 each to poor pregnant women covered

by the Scheme on conditional basis and restricted to two deliveries

139

Comment:

1. Data should be linked to anaemia prophylaxis programme for detection and

treatment of anaemia.

2. Worm infestation rate should also be monitored and steps taken for control and

also link to sanitation programme (WASH), along with hygiene inputs.






3. TAWD Board


4.7. Breast Milk Banks:

Backdrop:

Donor milk bank is a service, which includes collecting, screening, processing, storing

and prescribing donated human milk by lactating mothers to babies who are not

biologically related to the donor.

The following type of patients benefit from a donor milk bank. Premature babies who

weigh less than 1500 g (very low birth weight babies) and less than 1000 g (extremely

low birth weight babies) and sick babies where the biologically related mother is unable

to produce sufficient milk at any stage during the course of the neonatal stay.

Breast Milk Banks have been started in eight Government Medical College Hospitals.

In 352 Bus stands and Terminals, separate feeding rooms have been established to

enable the feeding mothers to breast feed their new born child in a safe enclosed room.

Comment:

1. Safety and hygiene of donors milk in milk banks need to be ensured, through

proper processing, testing and handling.

2. Hygiene education should be provided to recipient mothers on cleanliness and

Hygiene

140

3. In bus stands, terminals etc: where feeding rooms have been established,

“Health & Hygiene corners” may be established for awareness genreration

through WASH related programmes on issues related to Hygiene and also on

importance of breast feeding, proper weaning foods etc.






3. TAWD Board


5. Transport Department

6. Urban Development Department

4.8. School Health programme

Backdrop:

In Tamilnadu, for the past 3 decades, i.e. since 1962, the school health programme was

implemented by the Department of Public Health & Preventive Medicine for providing

comprehensive health care services for the school children studying in 1st to 12th

standard of Govt and Govt aided school. On Thursdays, health screening was done for

all the school children to identify minor’s ailments, nutritional deficiencies, refractive

errors and any other systemic illnesses. Minors ailments were treated on the spot by

the PHC level health team and the Children with major illnesses were referred to higher

medical Institutions for further Management. Under this Programme, two nodal

teachers from each school were identified and they were trained in identifying common

illness among children, providing assistance for the school health team and also to

follow the referred children.

During 2010-2012, the school health programme had been modified and renamed as

“Modified School health Programme”. The new initiatives under modified school health

programme had been included as

– Co-ordination between health & Education Department

– Comprehensive health education using a modified syllabus based on the School

Total Health Programme.

– Primary screening by teachers.

– Emergency care / first aid management at school

141

– Counseling services for the teenage students.

– Human resources management and capacity building.

During 2014, Government of India has initiated a new programme called Rashtriya Bal

Swasthya Karyakram (RBSK) – “Child health screening and Early intervention services

programme” under National Rural Health Mission and the programme aims at early

detection and management of the 4D’s – Defects at birth, Deficiencies, Diseases and

Developmental delays including disabilities along with Adolescent health concerns (38

health condition) among children.

Many schemes and components carried out under School Health Programme (SHP) in

Tamilnadu namely modified school Health programme Correction of Refractive Errors

(Kannoli Kaapom Thittam), Comprehensive school children Dental programme,

congenital Defects programme and various other NGO schemes had been merged under

RBSK.

To facilitate health screening, each community block is provided with 2 Mobile health

teams. Each team consist of 1- Medical officers (One team with 1-Male Medical officer

and another team with 1 – Female medical officer), 1- Staff nurse and 1- Pharmacist

with computer skills. The children in the block will be screened for 4D’s+A (38

conditions). Minor ailments will be treated on the spot.

The children with identified conditions will be referred to the District early intervention

centers (DEIC) for confirmation and further management.

The District Early Intervention Centers (DEIC) is placed at all District Head Quarters

Hospital / Medical college Hospitals which are having varied medical & paramedical

professionals to manage the referred children. The RBSK scheme is funded by National

Health Mission.

All Thursdays are scheduled as School Health Days. Two teachers from each

Government and Government aided school are trained in identifying common illnesses

of students for follow up action with the doctors. Students in need of higher medical

treatment are referred to higher medical institutions and Saturdays are referral days.

Comment:

1. This is an excellent programme for children of all age groups where teachers are

also playing an active role.

2. However, as seen from the objective of the programme the WASH related issues

seem to be lacking. This may be implemented in a 2 pronged manner –

142

Train the teachers and students on hygiene issues (Personal and

environmental), water quality monitoring etc; proper usage of water; hand

washing etc.

Monitor the sanitation and drinking water status in schools

3. As a matter of fact, students should be given complete knowledge on healthy life

style covering proper diet; physical activity; behavior; personal hygiene etc.




1. Education Department



4. TAWD Board


4.9. Modernization of Noon meal centers :

Backdrop:

In order to create ‘smoke free atmosphere’ in the Noon Meal Centers, under

Modernization of Noon Meal Centers, LPG connection is provided exclusively out of

State Funds. A sum of Rs.22,350/- is provided per unit for providing gas connection, gas

stove, construction of cooking platform, non returnable valve, safety measures etc., All

Noon Meal Employees are provided training by the respective gas agencies in handling

gas stoves.

Comment:

1. Mid day meal should be linked to monitoring of Food safety, water safety,

nutritional content of food, overall hygiene etc.

2. Training should be provided to teachers and students on healthy diet; safe

handling of food and water; importance of local food; kitchen gardens etc.




1. Education Department

143



4. TAWD Board


4.10. Establishment of Anganwadi cum Creches :

Backdrop:

Objectives of ICDS Mission are to institutionalize essential services and strengthen

structures at all levels by:

Implementing ICDS in Mission Mode to prevent undernutrition and assure

children of the best possible start to life and

Strengthening ICDS - AWC Platform as the first village post for health, nutrition

and early learning – as transformed Early Childhood Development Centre

(Anganwadi – Bal Vikas Kendra);

It takes care of children (below 5 years) of working mothers up to 6.00 p.m. in the

Anganwadi centres, orders were issued to establish 211 Anganwadi cum Crèches.

Accordingly, 211 Anganwadi cum crèches were established in urban areas in selected 13

districts viz., Chennai, Coimbatore, Dindigul, Kancheepuram, Kanyakumari, Perambalur,

Pudukkottai, Salem, Tirunelveli, Tiruvallur, Tiruvannamalai, Vellore and Villupuram

Districts.

Key indicators to achieve the goals and objectives are as follows:

Reduction in underweight prevalence

Improved IYCF

Contribute to reduction in anaemia, IMR and MMR in collaboration with health

Reduction in incidence of low birth weight babies

Improved early learning outcomes

Comment:

1. TAWD board (WSSO) and Department of Rural Development should have a

major role to play– Sanitation (Latrine) with water supply should be ensured in

all centers.

2. Health Dept. and Social Welfare Dept. – Monitoring of safety and nutritional

content of food should be put in place

144

3. TAWD Board and PHED (WSSO) & MOH&FW – overall hygiene parameters

should be checked

4. WCD – proper recording of data on nutritional status of children attending the

centers needs to be ensured


Other than Department of Social Welfare and noon meal the following Departments

need to be actively involved -


2. TAWD Board

3. Department of Health and Family Welfare

4. Planning Commission

145

5. Way forward

The forgoing discussion highlights the importance of related sectors for 10 excellent ongoing

programmes of the Govt. of Tamil Nadu.

The importance of “Inter sectoral coordination” for better implementation; improved socio

economic and health benefits; reduction in cost and time and assured sustainability is well

understood as input by related sectors have significant and positive impact on its sister

departments achevements.

Hence, it will be a worthwhile effort to try out certain pilot studies in Tamil Nadu, taking

limited areas to try out some of the recommendations made for conducting inter sectoral

coordination at field level, specially covering awareness generation.

The following considerations are suggested as a way forward :-

1. Each area will have their own problems and prospects. Hence, these shouldbe

first carefully assessed.

2. Pilot studies of longitudinal / cross sectional assessment need to be taken up by

an organization in small areas immediately, by providing certain suggested

inputs and impacts assessed subsequesntly covering inputs provided;

implementation methods; out come etc: with help of local govt.

3. Based on this detailed DPR’s may be created with help of District administration,

Panchayat and municipalities on an area based manner.

146

147

SECTION – III

ANNEXURES

148

149

Annexure – I

DISTRICT- WISE INDICATORS

Input Indicators

Sl. No

Indicators Type - No Page

1 Percentage distribution of the access to improved sources of sanitation for each district

Figure No.4 151

2 Percentage distribution of the access to improved sources of drinking water for each district

Figure No. 5 151

3 Percentage distribution of currently married women below 18 years of age for each district

Figure No. 6 152

4 Percentage distribution of currently married women who are illiterate for each district

Figure No. 7 152

5 Percentage distribution of currently married women with 10 or more years of schooling for each district

Figure No. 8 153

6 Percentage distribution of Births to women aged 15-19 years out of total births for each district

Figure No. 9 153

7 Percentage distribution of Pregnant women who consumed 100 or more IFA Tablets/Syrup equivalent for each district

Figure No. 10 154

8 Percentage distribution of pregnant women who had full ante natal care for each district

Figure No. 11 154

9 Percentage distribution of women who know what to do when a child gets diarrhoea for each district

Figure No. 12 155

10 Percentage distribution of Number of Primary Health Centres for each district

Figure No. 13 155

11 Percentage distribution of number of Sub Health Centers for each district

Figure No. 14 156

12 Percentage distribution of CHC having 24x7 hours normal delivery services for each district

Figure No. 15 156

13 Percentage distribution of children (9-35 months) who received at least one dose of Vitamin A supplement in the last 6 months of the survey for each district

Figure No. 16 157

14 Percentage distribution of children with diarrhea in last two weeks who received ORS for each district

Figure No. 17 157

15 Percentage distribution of total children age 6-23 months receiving adequate diet for each district

Figure No. 18 158

Output Indicators

Sl. No


1 Percentage distribution of IMR per 1000 live births 2011-12 for each district

Figure No. 19 159

150

Sl. No


2 Percentage distribution of MMR per 100,000 live births for each district

Figure No. 20 159

3 Percentage distribution of children with low birth weight for each district

Figure No. 21 160

4 Percentage distribution of Under 5 Mortality Rate for each district Figure No. 22 160

5 Percentage distribution of live births for each district Figure No. 23 161

6 Percentage distribution of Children under 5 years who are underweight (weight-for-age) for each district

Figure No. 24 161

7 Percentage distribution of Children under 5 years who are wasted (weight-for-height) for each district

Figure No. 25 162

8 Percentage distribution of Children under 5 years who are stunted (height-for-age) for each district

Figure No. 26 162

9 Percentage distribution of incidence of diarrhea in last 2 weeks among children below 5 years for each district

Figure No. 27 163

10 Percentage distribution of Anaemia in 6-59 months Children for each district of Tamil Nadu

Table No. 3 164

11 Percentage distribution of Anaemia in 6-9 years old Children for each district of Tamil Nadu

Table No.4 165

12 Percentage distribution of Anaemia in 10-19 Years old Children for each district of Tamil Nadu

Table No.5 166

13 Percentage distribution of Anaemia in 15-19 aged Adolescent for each district of Tamil Nadu

Table No.6 167

14 Percentage distribution of Anaemia in 15-49 aged Women for each district of Tamil Nadu

Table No.7 168

15 Percentage distribution of Anaemia in 15-49 aged Pregnant women for each district of Tamil Nadu

Table No.8 169

151

INPUT INDICATORS IN TAMIL NADU

Figure No 4: Percentage distribution of the access to improved sources of sanitation for each district

Source: The data are taken from DLHS 4 for each district for the state of Tamil Nadu

Figure No 5: Percentage distribution of the access to improved sources of drinking water for each district


95.5 92.9

66.1 64 62

60 59.2 58.3 57

55.2 55.2

53.6 53.4

52 51.9 51.8

51.5 51.3 48.6 48.3 47.9

44.6 40.8

40.8 40.4

39.1 38.1 37.8

37.5 37.4

37.2 33.6

52.0

0

20

40

60

80

100

120

Kan

niy

aku

mar

i

Ch

enn

ai

Thir

uva

llur

Nilg

iris

Tiru

pp

ur

Ero

de

Kh

anch

eep

ura

m

Thir

un

elve

li

Tho

oth

ukk

ud

i

Co

imb

ato

re

Mad

ura

i

Tiru

chir

app

alli

Then

i

Nag

apat

tin

am

Nam

akka

l

Kir

shn

agir

i

Vel

lore

Siva

gan

gai

Sale

m

Thir

uva

rur

Than

javu

r

Ram

anat

hap

ur…

Cu

dd

alo

re

Per

amb

alu

r

Tiru

van

nam

alai

Vilu

pp

ura

m

Kar

ur

Din

dig

ul

Vir

ud

hu

nag

ar

Dh

arm

apu

ri

Pu

du

kko

ttai

Ari

yalu

r

Ave

rage

Access to improved sources to sanitation

99.3 99.2 99

98.8 98.7 98.7 98.7 98.5 98.5

98.4 98.3 98.2 98.2 98.1 98

97.7 97.7 97.6 97.5 97.5 97.4

97.1 97 96.6 96.3

95.9 95.1

94.4 93.8

92.7

91.4

89.2

97.0

84

86

88

90

92

94

96

98

100

102

Vel

lore

Co

imb

…

Then

i

Tiru

van

…

Din

dig

ul

Thir

uva

…

Vir

ud

h…

Ari

yalu

r

Cu

dd

al…

Kh

anch

…

Dh

arm

…

Sale

m

Thir

un

…

Nam

ak…

Vilu

pp

…

Nag

ap…

Tiru

chi…

Ch

enn

ai

Kar

ur

Nilg

iris

Than

ja…

Ero

de

Thir

uva

…

Tiru

pp

ur

Per

am…

Mad

ura

i

Kan

niy

…

Tho

oth

…

Kir

shn

a…

Siva

ga…

Pu

du

kk…

Ram

an…

Ave

rage

Access to improved sources of drinking water

152

Figure No 6: Percentage distribution of currently married women below 18 years of age for each district


Figure No 7: Percentage distribution of currently married women who are illiterate for each district


0

1.3 1.8 2.1

2.2 2.3 2.8

3.3 3.6 3.9 4 4.1 4.2 4.2

5 5 5.2 5.4 5.5 5.6 6 6.1 6.2

7.1 8 8.1

8.5 8.8 8.9 9.2

9.6

11.6

5.3

0

2

4

6

8

10

12

14

Kan

niy

aku

mar

i

Nag

apat

tin

am

Thir

un

elve

li

Kh

anch

eep

ura

m

Ch

enn

ai

Nilg

iris

Tiru

chir

app

alli

Thir

uva

rur

Tiru

pp

ur

Co

imb

ato

re

Cu

dd

alo

re

Nam

akka

l

Mad

ura

i

Than

javu

r

Ero

de

Thir

uva

llur

Tho

oth

ukk

ud

i

Vir

ud

hu

nag

ar

Ram

anat

hap

ura

m

Siva

gan

gai

Ari

yalu

r

Pu

du

kko

ttai

Per

amb

alu

r

Kir

shn

agir

i

Then

i

Kar

ur

Vilu

pp

ura

m

Vel

lore

Din

dig

ul

Sale

m

Dh

arm

apu

ri

Tiru

van

nam

alai

Ave

rage

Percentage of currently married women married below age18 years.

9.8

14.2

20.3 21.2 22.2 22.5

24.6 25.2 26

29.7 29.9 30 31.1 31.4 32.9 32.9

33.2 33.8

34.7 34.7

35.3 35.4 36.8 36.9

37.2

40.2 41 42.7 42.8

43.9 45.5

50.8

32.2

0

10

20

30

40

50

60

Kan

niy

aku

mar

i

Ch

enn

ai

Thir

un

elve

li

Nag

apat

tin

am

Siva

gan

gai

Than

javu

r

Thir

uva

rur

Nilg

iris

Tiru

chir

app

alli

Per

amb

alu

r

Din

dig

ul

Ram

anat

hap

ura

m

Mad

ura

i

Kar

ur

Ari

yalu

r

Thir

uva

llur

Pu

du

kko

ttai

Tiru

pp

ur

Cu

dd

alo

re

Ero

de

Tho

oth

ukk

ud

i

Nam

akka

l

Then

i

Vel

lore

Vir

ud

hu

nag

ar

Kir

shn

agir

i

Co

imb

ato

re

Tiru

van

nam

alai

Dh

arm

apu

ri

Sale

m

Vilu

pp

ura

m

Kh

anch

eep

ura

m

Ave

rage

Currently married women who are illiterate (%)

153

Figure No 8: Percentage distribution of currently married women with 10 or more years of schooling for each

district


Figure No 9: Percentage distribution of Births to women aged 15-19 years out of total births for each district


58.2 57

47.5 47.5

42.3 41 40.6

40.5 39.6 38.5

35.4 35.3

35.1 35.1

34.8 34.5 33.8 33.4

33.1 33 32.8

32.8 32.3 31.3 31.1

31.1 30.3 29.1 29 28.2 28.2 27.6

36.3

0

10

20

30

40

50

60

70

Kan

niy

aku

mar

i

Ch

enn

ai

Ero

de

Nilg

iris

Siva

gan

gai

Tiru

chir

app

alli

Thir

uva

llur

Per

amb

alu

r

Nag

apat

tin

am

Pu

du

kko

ttai

Mad

ura

i

Kir

shn

agir

i

Than

javu

r

Thir

uva

rur

Din

dig

ul

Ari

yalu

r

Kar

ur

Then

i

Cu

dd

alo

re

Dh

arm

apu

ri

Ram

anat

hap

u…

Thir

un

elve

li

Nam

akka

l

Sale

m

Co

imb

ato

re

Tiru

van

nam

alai

Vir

ud

hu

nag

ar

Vel

lore

Kh

anch

eep

ur…

Tiru

pp

ur

Vilu

pp

ura

m

Tho

oth

ukk

ud

i

Ave

rage

Currently married women with 10 or more years of schooling (%)

0.6 0.6 1.1 1.3 1.5 1.5

2.1 2.5 2.5 2.5 2.6 2.7 2.8

3.4 3.9

4.2 4.2 4.3 4.5 4.5 4.8

5.1 5.8

5.8 6.3 6.4

6.5 6.7 7.3

8.3

9.7

10.7

4.3

0

2

4

6

8

10

12

Ari

yalu

r

Kan

niy

aku

mar

i

Ch

enn

ai

Pu

du

kko

ttai

Kh

anch

eep

ura

m

Thir

uva

rur

Thir

un

elve

li

Co

imb

ato

re

Per

amb

alu

r

Tho

oth

ukk

ud

i

Nag

apat

tin

am

Nilg

iris

Kir

shn

agir

i

Siva

gan

gai

Ram

anat

hap

ura

m

Ero

de

Then

i

Than

javu

r

Cu

dd

alo

re

Vir

ud

hu

nag

ar

Tiru

chir

app

alli

Mad

ura

i

Tiru

pp

ur

Vilu

pp

ura

m

Vel

lore

Dh

arm

apu

ri

Kar

ur

Nam

akka

l

Sale

m

Thir

uva

llur

Din

dig

ul

Tiru

van

nam

alai

Ave

rage

Births to women aged 15-19 years out of total births (%)

154

Figure No 10: Percentage distribution of Pregnant women who consumed 100 or more IFA Tablets/Syrup

equivalent for each district


Figure No 11: Percentage distribution of pregnant women who had full ante natal care for each district


65.2 64.7 63.5

58.9 57.8 57.5

54.7 52.9

51.6 51.5 50.2 49.4

43.6 42.9 42.6 42.3 40.4 39.8 38.9

37.6 37.5 34.1 34

31.5 29

27.5 27.2 27.1 26.5 23.4

21.7 20.7

42.1

0

10

20

30

40

50

60

70

Kir

shn

agir

i

Kh

anch

eep

…

Thir

uva

llur

Kar

ur

Din

dig

ul

Nag

apat

tin

…

Mad

ura

i

Dh

arm

apu

ri

Nam

akka

l

Tho

oth

ukk

…

Ero

de

Nilg

iris

Per

amb

alu

r

Sale

m

Tiru

chir

ap…

Tiru

pp

ur

Tiru

van

na…

Vel

lore

Ram

anat

h…

Thir

un

elve

li

Thir

uva

rur

Siva

gan

gai

Kan

niy

aku

…

Then

i

Ch

enn

ai

Co

imb

ato

re

Vir

ud

hu

na…

Ari

yalu

r

Vilu

pp

ura

m

Than

javu

r

Cu

dd

alo

re

Pu

du

kko

ttai

Ave

rage

Pregnant women who consumed 100 or more IFA Tablets/ Syrup equivalent

64.2 62.8

54.8 52.2 51.6

50.6 50.4

47.8 47.2 46.5

45.8

39.6 39.5 37.4

37.3 36.9

32.2 31.1

30.3 29.9

29.6 29.2 27.9

27.5 27.3 26.4 25

24.3 22.4

18.1 17.9 16.5

36.9

0

10

20

30

40

50

60

70

Kir

shn

agir

i

Kh

anch

eep

ura

m

Thir

uva

llur

Mad

ura

i

Kar

ur

Nag

apat

tin

am

Nam

akka

l

Nilg

iris

Dh

arm

apu

ri

Din

dig

ul

Ero

de

Per

amb

alu

r

Tiru

chir

app

alli

Sale

m

Tiru

pp

ur

Tho

oth

ukk

ud

i

Kan

niy

aku

mar

i

Tiru

van

nam

alai

Vel

lore

Ram

anat

hap

ura

m

Then

i

Thir

un

elve

li

Ch

enn

ai

Siva

gan

gai

Thir

uva

rur

Vir

ud

hu

nag

ar

Co

imb

ato

re

Vilu

pp

ura

m

Ari

yalu

r

Than

javu

r

Pu

du

kko

ttai

Cu

dd

alo

re

Ave

rage

Pregnant women who had full ante natal care (%)

155

Figure No 12: Percentage distribution of women who know what to do when a child gets diarrhoea for each

district


Figure No 13: Percentage distribution of Number of Primary Health Centres for each district


80.5 77.8

75.4 74.1 72.4 72.3 71.1 71

67.5 65.3

65.1 65

64.8 63.3

62.9

62.7 62 61

60.3 57.4 56 55.7

55.6 54.9

52.8 51.6

49.9 49.5 45.7 45.3 44

34.2

60.8

0

10

20

30

40

50

60

70

80

90 D

ind

igu

l

Per

amb

alu

r

Tiru

chir

app

alli

Kar

ur

Nag

apat

tin

am

Than

javu

r

Ram

anat

hap

ura

m

Nam

akka

l

Nilg

iris

Tho

oth

ukk

ud

i

Sale

m

Vel

lore

Kh

anch

eep

ura

m

Cu

dd

alo

re

Tiru

pp

ur

Siva

gan

gai

Thir

uva

llur

Then

i

Kir

shn

agir

i

Kan

niy

aku

mar

i

Ch

enn

ai

Dh

arm

apu

ri

Thir

un

elve

li

Ero

de

Thir

uva

rur

Mad

ura

i

Vir

ud

hu

nag

ar

Vilu

pp

ura

m

Pu

du

kko

ttai

Ari

yalu

r

Tiru

van

nam

alai

Co

imb

ato

re

Ave

rage

Women know about what to do when a child gets diarrhoea (%)

22 22 22 22 21

20 20 19

18 18 18 18

16 16 16 16 16 16 16 15 15

14 14 14 14 13

12 12 11 11

10

0

16

0

5

10

15

20

25

Din

dig

ul

Nag

apat

tin

am

Siva

gan

gai

Than

javu

r

Ram

anat

hap

ura

m

Cu

dd

alo

re

Nam

akka

l

Kir

shn

agir

i

Ari

yalu

r

Dh

arm

apu

ri

Mad

ura

i

Vel

lore

Ero

de

Kar

ur

Kh

anch

eep

ura

m

Per

amb

alu

r

Sale

m

Thir

uva

rur

Tiru

van

nam

alai

Nilg

iris

Pu

du

kko

ttai

Co

imb

ato

re

Kan

niy

aku

mar

i

Thir

un

elve

li

Thir

uva

llur

Then

i

Tiru

chir

app

alli

Tiru

pp

ur

Vilu

pp

ura

m

Vir

ud

hu

nag

ar

Tho

oth

ukk

ud

i

Ch

enn

ai

Ave

rage

Number of Primary Health Centres (PHC)

156

Figure No 14: Percentage distribution of number of Sub Health Centers for each district


Figure No 15: Percentage distribution of CHC having 24x7 hours normal delivery services for each district


45 44 44 43 42 42

34 33 33 33 33 33

25 25 25 25 25 25 25 25 25 24 24 24 24 24 24 24 23 23 23

0

29

0

5

10

15

20

25

30

35

40

45

50

Nag

apat

tin

am

Siva

gan

gai

Thir

uva

rur

Kir

shn

agir

i

Dh

arm

apu

ri

Ram

anat

hap

ura

m

Vel

lore

Cu

dd

alo

re

Din

dig

ul

Kar

ur

Nam

akka

l

Than

javu

r

Ari

yalu

r

Kan

niy

aku

mar

i

Kh

anch

eep

ura

m

Per

amb

alu

r

Sale

m

Thir

un

elve

li

Tho

oth

ukk

ud

i

Tiru

chir

app

alli

Tiru

van

nam

alai

Co

imb

ato

re

Ero

de

Nilg

iris

Pu

du

kko

ttai

Then

i

Vilu

pp

ura

m

Vir

ud

hu

nag

ar

Mad

ura

i

Thir

uva

llur

Tiru

pp

ur

Ch

enn

ai

Ave

rage

Numberof Sub-Health Centres

24

20 19 19

16 16 16 15 15 15 15

13 13 13 13 13 12 12 12 12

11 11 11 10

9 9 9 8

6 5

4

0

12

0

5

10

15

20

25

30

Vilu

pp

ura

m

Sale

m

Tiru

van

nam

alai

Vel

lore

Cu

dd

alo

re

Than

javu

r

Tiru

pp

ur

Din

dig

ul

Nam

akka

l

Siva

gan

gai

Thir

un

elve

li

Kh

anch

eep

ura

m

Mad

ura

i

Ram

anat

hap

ura

…

Thir

uva

llur

Tiru

chir

app

alli

Co

imb

ato

re

Ero

de

Kan

niy

aku

mar

i

Thir

uva

rur

Kir

shn

agir

i

Nag

apat

tin

am

Pu

du

kko

ttai

Vir

ud

hu

nag

ar

Dh

arm

apu

ri

Kar

ur

Tho

oth

ukk

ud

i

Then

i

Ari

yalu

r

Per

amb

alu

r

Nilg

iris

Ch

enn

ai

Ave

rage

Community Health centres (CHC) having 24X 7 hours normal delivery services

157

Figure No 16: Percentage distribution of children (9-35 months) who received at least one dose of Vitamin A

supplement in the last 6 months of the survey for each district


Figure No 17: Percentage distribution of children with diarrhea in last two weeks who received ORS for each

district


78 75 74.1 73.8 73.7

72.3 71.1 69 68.4

67.4 67.2 66 65.6

64.3 63.4 63.3 61.9 59.5 59

57.8 57.5 57.4 57.1 57.1

56.2 55.5 53 52.7 52.5

47.5

41.8 41.4

61.9

0

10

20

30

40

50

60

70

80

90

Ram

anat

hap

u…

Cu

dd

alo

re

Thir

uva

llur

Per

amb

alu

r

Than

javu

r

Tho

oth

ukk

ud

i

Nilg

iris

Tiru

chir

app

alli

Thir

un

elve

li

Thir

uva

rur

Din

dig

ul

Vel

lore

Tiru

pp

ur

Then

i

Mad

ura

i

Kar

ur

Tiru

van

nam

alai

Nag

apat

tin

am

Dh

arm

apu

ri

Pu

du

kko

ttai

Ero

de

Vilu

pp

ura

m

Kh

anch

eep

ur…

Siva

gan

gai

Kir

shn

agir

i

Nam

akka

l

Co

imb

ato

re

Ch

enn

ai

Sale

m

Kan

niy

aku

mar

i

Ari

yalu

r

Vir

ud

hu

nag

ar

Ave

rage

Children (age 9-35 months) received at least one dose of vitamin A supplement in last 6 months (%)

91.7

73.9 70

69.6 66.7

66.7 66.7

57.1 55.6 54.5 53.8

52.5 52.2

50 50 50

50 50 45

44.4 42.1 38.7 36.4

35.3 34.3 33.3

33.3 31.6

31.3 30.8

23.1 20

48.8

0

10

20

30

40

50

60

70

80

90

100

Sale

m

Kh

anch

eep

ura

m

Tiru

van

nam

alai

Cu

dd

alo

re

Ari

yalu

r

Kar

ur

Tiru

pp

ur

Mad

ura

i

Din

dig

ul

Nilg

iris

Kir

shn

agir

i

Siva

gan

gai

Than

javu

r

Ero

de

Nag

apat

tin

am

Per

amb

alu

r

Then

i

Thir

uva

llur

Pu

du

kko

ttai

Tho

oth

ukk

ud

i

Vir

ud

hu

nag

ar

Thir

uva

rur

Co

imb

ato

re

Thir

un

elve

li

Ram

anat

hap

ura

m

Dh

arm

apu

ri

Kan

niy

aku

mar

i

Vel

lore

Tiru

chir

app

alli

Nam

akka

l

Ch

enn

ai

Vilu

pp

ura

m

Ave

rage

Children with diarrhoea in the last 2 weeks and received ORS

158

Figure No 18: Percentage distribution of total children age 6-23 months receiving adequate diet for each

district

Source: The data are taken from NFHS 4 for each district for the state of Tamil Nadu

81.6

45.2

41.3 37.7

37.7 37.5

37.5 37.1

36.9 36.1

36 35.2 33.3

32.9 32.5

32.3 32

31.7 31.6

31.2 30.3 29.8 29

28.7 28.5

25.7 25.2

25 24.4

21.8 19.6

13.8

33.1

0

10

20

30

40

50

60

70

80

90 K

irsh

nag

iri

Per

amb

alu

r

Ram

anat

hap

ura

m

Kan

niy

aku

mar

i

Siva

gan

gai

Din

dig

ul

Vel

lore

Pu

du

kko

ttai

Nam

akka

l

Cu

dd

alo

re

Thir

uva

rur

Tiru

pp

ur

Mad

ura

i

Kar

ur

Nilg

iris

Than

javu

r

Ari

yalu

r

Tho

oth

ukk

ud

i

Sale

m

Vilu

pp

ura

m

Tiru

chir

app

alli

Tiru

van

nam

alai

Vir

ud

hu

nag

ar

Ero

de

Thir

un

elve

li

Kh

anch

eep

ura

m

Nag

apat

tin

am

Co

imb

ato

re

Then

i

Dh

arm

apu

ri

Thir

uva

llur

Ch

enn

ai

Ave

rage

Total children age 6-23 months receiving an adequate diet

159

OUTPUT INDICATORS IN TAMIL NADU

Figure No 19: Percentage distribution of IMR per 1000 live births 2011-12 for each district

Source: The data are taken from Sample Registration System Results, 2012 for each district for the state of

Tamil Nadu

Figure No 20: Percentage distribution of MMR per 100,000 live births for each district


Tamil Nadu

6 7 7 7

9 9 10 10

11 11 11 11 12 12 12 12 12 12 12

13 13 14 14 14 14

15 15

17 17 17 18

20

12

0

5

10

15

20

25

Co

imb

ato

re

Ch

enn

ai

Ero

de

Tiru

pp

ur

Ari

yalu

r

Kan

niy

aku

mar

i

Kan

chee

pu

ram

Than

javu

r

Tiru

varu

r

Tho

oth

uku

di

Nilg

iris

Vel

lore

Cu

dd

alo

re

Mad

ura

i

Pu

du

kko

ttai

Sale

m

Tiru

chir

apal

li

Tiru

vallu

r

Vir

ud

hu

nag

ar

Din

dig

ual

Siva

gan

gai

Nag

apat

tin

am

Nam

akka

l

Ram

anat

hap

ura

m

Tiru

nel

veli

Per

amb

alu

r

Tiru

van

nam

alai

Kri

shn

agir

i

Then

i

Vill

up

ura

m

Kar

ur

Dh

arm

apu

ri

Ave

rage

IMR

30 33 39

49 56 58 60 61 63 63 64 65 66 67

73 73 76 78 79 80 80 81 82 88 89 89

91 98 100 100

110

120

73.8

0

20

40

60

80

100

120

140

Kan

niy

aku

mar

i

Ch

enn

ai

Nilg

iris

Than

javu

r

Vill

up

ura

m

Co

imb

ato

re

Tiru

van

nam

alai

Ari

yalu

r

Nam

akka

l

Vir

ud

hu

nag

ar

Ero

de

Dh

arm

apu

ri

Vel

lore

Sale

m

Per

amb

alu

r

Tiru

pp

ur

Kri

shn

agir

i

Then

i

Kan

chee

pu

ram

Siva

gan

gai

Tiru

vallu

r

Din

dig

ual

Pu

du

kko

ttai

Nag

apat

tin

am

Cu

dd

alo

re

Tiru

chir

apal

li

Tiru

nel

veli

Kar

ur

Ram

anat

hap

ura

m

Tho

oth

uku

di

Tiru

varu

r

Mad

ura

i

Ave

rage

MMR

160

Figure No 21: Percentage distribution of Under 5 Mortality Rate for each district

Source: The data are taken from Census 2011 for each district for the state of Tamil Nadu. Data for two districts

were unavailable namely, Krishnagiri and Tiruppur

Figure No 22: Percentage distribution of children with low birth weight for each district


16 19 20 20

21 22 23 24 24 25 26 26 27 27 28 29 29 30 30 31 32 32 32 32

35 36 37 38 39

44

28

0

5

10

15

20

25

30

35

40

45

50

Under 5 Mortality Rate

5.3 6.1

7.3 7.7

7.8 8.2 8.7

9.8 9.9 10.6

10.8 10.9

11.1 11.3

11.3 11.6 11.6

11.6 11.6

12.4 12.4

12.7 12.8

13 14 14

14.4

15.6 15.8

18.6 18.6

19.8

11.8

0

5

10

15

20

25

Thir

uva

llur

Then

i

Kir

shn

agir

i

Dh

arm

apu

ri

Pu

du

kko

ttai

Vel

lore

Than

javu

r

Nam

akka

l

Sale

m

Ero

de

Siva

gan

gai

Thir

uva

rur

Kh

anch

eep

ur…

Nag

apat

tin

am

Nilg

iris

Ch

enn

ai

Cu

dd

alo

re

Tho

oth

ukk

ud

i

Tiru

chir

app

alli

Kar

ur

Ram

anat

hap

u…

Kan

niy

aku

mar

i

Din

dig

ul

Thir

un

elve

li

Tiru

pp

ur

Tiru

van

nam

alai

Ari

yalu

r

Co

imb

ato

re

Vir

ud

hu

nag

ar

Per

amb

alu

r

Vilu

pp

ura

m

Mad

ura

i

Ave

rage

Percentage of Children with low birth weight (out of those who weighted)( below 2.5kg ) (%)

161

Figure No 23: Percentage distribution of live births for each district


Figure No 24: Percentage distribution of Children under 5 years who are underweight (weight-for-age) for

each district


100 100 99.7

99.7 99.6 99.5

99.4 99.2 99.1 99 99

98.5 98.1 98

98 97.9 97.7

97.3 97.3

97.1 96.7 95.9

95.9 95.8 95.7 95.6

94.1

92.5 92.1 92

91.5 90.7

97.0

86

88

90

92

94

96

98

100

102

Kh

anch

eep

ura

m

Tiru

van

nam

alai

Ch

enn

ai

Vilu

pp

ura

m

Tiru

pp

ur

Thir

uva

llur

Ero

de

Then

i

Nam

akka

l

Dh

arm

apu

ri

Sale

m

Ram

anat

hap

ura

m

Vel

lore

Nag

apat

tin

am

Per

amb

alu

r

Tho

oth

ukk

ud

i

Kir

shn

agir

i

Co

imb

ato

re

Thir

un

elve

li

Thir

uva

rur

Kan

niy

aku

mar

i

Mad

ura

i

Siva

gan

gai

Nilg

iris

Cu

dd

alo

re

Than

javu

r

Kar

ur

Vir

ud

hu

nag

ar

Tiru

chir

app

alli

Din

dig

ul

Pu

du

kko

ttai

Ari

yalu

r

Ave

rage

Live births

12.8

16.1 16.1 17.2 17.6 18

19.5

22 22 22.2

22.6 22.7

22.7 22.9

22.9 22.9

23.1 24.9 25 25 25.7 26.6

27.6 28.6 28.9 29.6

29.6 29.7

29.8 30.7

32.6 34.7

24.1

0

5

10

15

20

25

30

35

40

Kan

niy

aku

mar

i

Ero

de

Kh

anch

eep

ura

m

Ch

enn

ai

Tho

oth

ukk

ud

i

Nam

akka

l

Mad

ura

i

Per

amb

alu

r

Then

i

Sale

m

Ram

anat

hap

ur…

Siva

gan

gai

Thir

un

elve

li

Co

imb

ato

re

Nag

apat

tin

am

Than

javu

r

Kir

shn

agir

i

Tiru

pp

ur

Cu

dd

alo

re

Pu

du

kko

ttai

Vir

ud

hu

nag

ar

Thir

uva

llur

Tiru

chir

app

alli

Vilu

pp

ura

m

Kar

ur

Dh

arm

apu

ri

Thir

uva

rur

Ari

yalu

r

Din

dig

ul

Nilg

iris

Vel

lore

Tiru

van

nam

alai

Ave

rage

Children under 5 years who are underweight (weight-for-age)

162

Figure No 25: Percentage distribution of Children under 5 years who are wasted (weight-for-height) for each

district


Figure No 26: Percentage distribution of Children under 5 years who are stunted (height-for-age)for each

district


9

12.4 12.7 12.9 13.9 14 15

16.3 16.3

17 17.4 17.7 18.1 18.2 18.8 19 19.7 20.1

20.3 20.4

20.4 20.9 21.3 22.1 22.5

23 23.3

26.5 27.5

31

33 34.6

19.9

0

5

10

15

20

25

30

35

40

Kan

niy

aku

mar

i

Tho

oth

ukk

ud

i

Mad

ura

i

Thir

un

elve

li

Kh

anch

eep

ura

m

Then

i

Nam

akka

l

Ero

de

Vilu

pp

ura

m

Ram

anat

hap

ura

m

Nag

apat

tin

am

Vir

ud

hu

nag

ar

Ch

enn

ai

Per

amb

alu

r

Siva

gan

gai

Tiru

chir

app

alli

Cu

dd

alo

re

Kir

shn

agir

i

Ari

yalu

r

Than

javu

r

Tiru

pp

ur

Pu

du

kko

ttai

Co

imb

ato

re

Thir

uva

rur

Sale

m

Kar

ur

Thir

uva

llur

Din

dig

ul

Vel

lore

Nilg

iris

Dh

arm

apu

ri

Tiru

van

nam

alai

Ave

rage

Children under 5 years who are wasted (weight-for-height)

17.2

20.9 21.2 21.2

22.5 24 24.2 24.5

24.5 25 25.1

25.2 25.6

26 26.7 27 27.3 27.4 27.5

28.2 28.4 29 29.4

29.9 30

30.1 30.8 30.9

31.1

31.8 33.1

37

27.0

0

5

10

15

20

25

30

35

40

Kan

niy

aku

mar

i

Siva

gan

gai

Mad

ura

i

Tho

oth

ukk

ud

i

Ram

anat

hap

ura

m

Per

amb

alu

r

Dh

arm

apu

ri

Nag

apat

tin

am

Tiru

van

nam

alai

Kh

anch

eep

ura

m

Kir

shn

agir

i

Nam

akka

l

Ero

de

Than

javu

r

Pu

du

kko

ttai

Sale

m

Co

imb

ato

re

Then

i

Kar

ur

Cu

dd

alo

re

Thir

uva

rur

Vel

lore

Tiru

pp

ur

Vir

ud

hu

nag

ar

Tiru

chir

app

alli

Thir

uva

llur

Thir

un

elve

li

Ch

enn

ai

Din

dig

ul

Vilu

pp

ura

m

Nilg

iris

Ari

yalu

r

Ave

rage

Children under 5 years who are stunted (height-for-age)

163

Figure No 27: Percentage distribution of incidence of diarrhea in last 2 weeks among children below 5 years

for each district


1.6 1.7 2.3 3

3.7 3.7 3.9 4.1 4.3 4.4 4.5

4.9 5.4 5.6

5.7 5.8 5.8

5.9 5.9 6.4 6.6

6.7 6.7

6.8 7.3 7.4 7.7

7.9 8.3

8.7 8.8

9.8

5.7

0

2

4

6

8

10

12

Per

amb

alu

r

Kan

niy

aku

mar

i

Thir

uva

llur

Kir

shn

agir

i

Sale

m

Vilu

pp

ura

m

Co

imb

ato

re

Nam

akka

l

Ch

enn

ai

Vel

lore

Kar

ur

Dh

arm

apu

ri

Nag

apat

tin

am

Nilg

iris

Thir

un

elve

li

Din

dig

ul

Pu

du

kko

ttai

Mad

ura

i

Then

i

Vir

ud

hu

nag

ar

Tiru

pp

ur

Tho

oth

ukk

ud

i

Tiru

chir

app

alli

Ero

de

Than

javu

r

Thir

uva

rur

Ram

anat

hap

ura

m

Cu

dd

alo

re

Siva

gan

gai

Ari

yalu

r

Tiru

van

nam

alai

Kh

anch

eep

ura

m

Ave

rage

Diarrhoe in 2 weeks among children below 5 years (%)

164

ANAEMIA STATUS IN TAMIL NADU

Table No. 3: Percentage distribution of Anaemia in 6-59 months Children for each district of Tamil Nadu

SL No

Children of 6-59 months of age having anaemia

Districts Total (%) Districts Severe (%)

1 Nilgiris 41.3 Nagapattinam 1.0

2 Kanniyakumari 44.0 Nilgiris 1.3

3 Theni 46.2 Madurai 1.4

4 Kirshnagiri 51.8 Tiruvannamalai 1.5

5 Vellore 51.9 Virudhunagar 1.6

6 Tiruvannamalai 53.2 Kanniyakumari 1.7

7 Dharmapuri 55.1 Sivaganga 2.0

8 Coimbatore 56.2 Coimbatore Viluppuram

2.2

9 Salem 56.4 Pudukkottai 2.4

10 Perambalur 57.3 Kirshnagiri 2.8

11 Pudukkottai 59.2 Thirunelveli 2.9

12 Thiruvallur

Virudhunagar 59.7

Thiruvallur Thiruvarur

3.0

13 Erode

Thiruvarur 59.8 Dharmapuri 3.2

14 Namakkal 60.1 Theni 3.3

15 Tiruppur 60.6 Salem 3.4

16 Thoothukkudi Viluppuram

60.8 Chennai

Erode Tiruchirappalli

3.7

17 Nagapattinam 61.8 Perambalur Thanjavur

Vellore 3.8

18 Madurai 62.4 Dindigul 5.0

19 Chennai 63.1 Ramanathapuram 5.2

20 Ramanathapuram 66.8 Tiruppur 6.0

21 Thirunelveli 68.0 Khancheepuram 6.1

22 Cuddalore 68.9 Thoothukkudi 6.4

23 Thanjavur 70.3 Namakkal 6.6

24 Tiruchirappalli 70.8 Ariyalur 6.7

25 Sivaganga 71.8 Cuddalore 7.6

26 Khancheepuram 72.1 Karur 8.1

27 Dindigul 72.7 - -

28 Karur 75.9 - -

29 Ariyalur 76.0 - -

Source: District Level Household and Facility Survey DLHS – 4, 2012-13)

165

Table No. 4: Percentage distribution of Anaemia in 6-9 years old Children for each district of Tamil Nadu

Sl No.

Children of 6-9 Years having anaemia

Male Female

District Total(%

) District

Severe (%)

District Total (%)

District Severe

(%)

1 Nilgiris 26.9

Ariyalur Chennai

Kanniyakumari Nagapattinam

Namakkal Nilgiris

0.0

Nilgiris 31.1

Chennai Kanniyakumari

Perambalur 0.0

2 Perambalur 33.8 Dharmapuri 0.5 Vellore 33.3 Salem

Sivaganga Virudhunagar

0.7

3 Erode 34.6 Perambalur Pudukkottai

0.8 Theni 35.4 Ramanathapuram 0.8

4 Kanniyakumari 36.0 Karur Theni

0.9 Dharmapuri 39.0 Pudukkottai 0.9

5 Dharmapuri 36.1 Vellore

Virudhunagar 1.0 Kanniyakumari 40.7

Nilgiris Theni

Tiruppur 1.0

6 Namakkal 37.2 Sivaganga 1.1 Salem 41.3 Dindigul

Thiruvallur Vellore

1.3

7 Salem 37.5 Salem 1.4 Erode 42.7 Madurai

Tiruvannamalai 1.4

8 Khancheepuram

Thiruvallur 40.2 Thiruvallur 1.5 Namakkal 43.0 Tiruchirappalli 1.5

9 Tiruvannamalai 40.5 Viluppuram 1.6 Perambalur

Tiruvannamalai 43.5 Thoothukkudi 1.6

10 Theni 40.7 Thoothukkudi 1.7 Virudhunagar 44.9 Cuddalore Kirshnagiri

1.7

11 Pudukkottai 41.5 Tiruppur 1.8 Chennai 45.4 Ariyalur

Thanjavur 1.9

12 Vellore 42.0 Erode 1.9 Khancheepuram

Thiruvallur 45.9 Nagapattinam 2.2

13 Nagapattinam 42.7 Ramanathapura

m 2.0 Coimbatore 47.4

Dharmapuri Erode

Namakkal 2.3

14 Kirshnagiri Tiruppur

43.9 Dindigul 2.1 Sivaganga 48.4 Thiruvarur 2.7

15 Virudhunagar 44.2 Tiruvannamalai 2.3 Nagapattinam 48.9 Coimbatore Thirunelveli

3.1

16 Thirunelveli 45.9 Thanjavur

Tiruchirappalli 2.4

Kirshnagiri Tiruppur

49.0 Viluppuram 3.5

17 Dindigul 47.4 Thirunelveli 2.7 Pudukkottai 49.1 Karur

Khancheepuram 3.7

18 Viluppuram 47.5 Cuddalore Kirshnagiri

2.9 Ramanathapura

m 50.0 - -

19 Coimbatore 49.6 Coimbatore 3.4 Dindigul 51.9 - -

20 Sivaganga 50.6 Madurai 3.9 Thanjavur 52.8 - -

21 Thanjavur 51.2 Khancheepuram 4.1 Viluppuram 53.5 - -

22 Thoothukkudi 51.7 Thiruvarur 6.5 Thoothukkudi 53.6 - -

23 Chennai 52.3 - - Tiruchirappalli 53.7 - -

24 Ramanathapuram 52.4 - - Cuddalore 55.0 - -

25 Cuddalore 53.8 - - Thirunelveli 55.7 - -

26 Thiruvarur 55.6 - - Thiruvarur 57.3 - -

27 Karur 56.0 - - Karur 59.3 - -

28 Ariyalur 61.7 - - Madurai 60.3 - -

29 Madurai 67.5 - - Ariyalur 78.8 - -

30 Tiruchirappalli 68.7 - - - - - -

Source: District Level Household and Facility Survey DLHS – 4, 2012-13

166

Table No. 5: Percentage distribution of Anaemia in 10-19 Years old Children for each district of Tamil Nadu

Sl No.

Children of 10-19 Years having anaemia

Male* Female**

District Total (%)

District Severe

(%) District

Total (%)

District Severe

(%)

1 Kirshnagiri 17.9 Sivaganga 0.0 Kanniyakumari 30.4 Salem 0.3

2 Kanniyakumari 20.9 Salem 0.3 Theni 32.9 Ariyalur 0.6

3 Salem 21.2

Nilgiris Theni

Tiruchirappalli Vellore

0.4 Dharmapuri 33.2 Dindigul Vellore

0.9

4 Nilgiris 24.3 Nagapattinam 0.6 Salem 35.5 Dharmapuri 1.1

5 Dharmapuri 24.5 Pudukkottai

Thoothukkudi Tiruvannamalai

0.7 Nilgiris 35.6 Thiruvallur 1.2

6 Sivaganga 25.1 Kanniyakumari 0.8 Coimbatore 36.8 Sivaganga 1.3

7 Pudukkottai 25.5 Dindigul

Kirshnagiri 0.9 Vellore 38.4

Nilgiris Pudukkottai

Thoothukkudi 1.4

8 Vellore 25.6 Dharmapuri

Khancheepuram 1.0 Kirshnagiri 41.0

Kanniyakumari Tiruppur

1.5

9 Tiruvannamalai 26.1 Perambalur 1.1 Erode 42.3 Nagapattinam

Ramanathapuram 1.6

10 Namakkal 27.9 Viluppuram 1.2 Thiruvallur 42.5 Erode

Kirshnagiri 1.7

11 Coimbatore 28.0 Ariyalur

Thiruvallur 1.3 Tiruvannamalai 42.6

Coimbatore Theni

Tiruvannamala 2.0

12 Theni 28.7 Coimbatore Thirunelveli

Virudhunagar 1.4 Pudukkottai 42.8 Thirunelveli 2.3

13 Virudhunagar 28.9 Madurai

Thanjavur 1.5

Khancheepuram

44.6 Namakkal

Viluppuram 2.5

14 Perambalur 29.3 Ramanathapuram

Thiruvarur 1.7 Nagapattinam 44.8 Perambalur 2.6

15 Erode 30.9 Chennai

Karur Tiruppur

2.1 Sivaganga 46.3 Karur 2.9

16 Khancheepuram 31.7 Cuddalore

Erode Namakkal

2.6 Perambalur 47.4

Madurai Thiruvarur

Tiruchirappalli Virudhunagar

3.1

17 Thirunelveli 31.8 - - Namakkal 47.5 Khancheepuram

Thanjavur 3.2

18 Thiruvallur 31.9 - - Virudhunagar 47.6 Chennai 3.8

19 Chennai 32.4 - - Chennai

Thiruvarur 47.7 Cuddalore 4.3

20 Dindigul 32.8 - - Thoothukkudi 48.2 - -

21 Nagapattinam 35.9 - - Dindigul 49.1 - -

22 Thoothukkudi 36.2 - - Thirunelveli 50.0 - -

23 Tiruppur 38.0 - - Thanjavur 51.1 - -

24 Madurai 39.1 - - Tiruppur 51.5 - -

25 Ramanathapuram

Thanjavur 39.3 - - Ramanathapuram 52.3 - -

26 Viluppuram 40.7 - - Viluppuram 57.1 - -

27 Karur 40.8 - - Ariyalur Madurai

59.0 - -

28 Ariyalur 41.2 - - Karur 59.5 - -

29 Thiruvarur

Tiruchirappalli 43.2 - - Cuddalore 59.7 - -

30 Cuddalore 48.7 - - Tiruchirappalli 59.9 - -

* Anyanaemia below 11g/dl,severeanaemia below7g/dl. ; **Excludingagegroup19years Source: District Level Household and Facility Survey DLHS – 4, 2012-13

167

Table No. 6: Percentage distribution of Anaemia in 15-19 aged Adolescent for each district of Tamil Nadu

SL No

Adolescent of 15-19 aged having anaemia

Districts Total (%) Districts Severe

(%)

1 Kanniyakumari 20.4 Tiruvannamalai 0.0

2 Dharmapuri 25.6 Thiruvallur 0.3

3 Salem Theni

26.4 Ariyalur 0.5

4 Vellore 26.8 Theni 0.7

5 Nilgiris 27.1 Thoothukkudi 0.9

6 Pudukkottai 29.2 Salem

Thirunelveli Vellore

1.0

7 Tiruvannamalai 29.5 Tiruppur 1.1

8 Coimbatore 29.7 Pudukkottai

Sivaganga 1.3

9 Kirshnagiri 30.3


Nilgiris Viluppuram

1.4

10 Thoothukkudi 33.9 Dharmapuri

Dindigul 1.5

11 Thirunelveli 34.4 Chennai 1.7

12 Namakkal 35.4 Khancheepuram 1.8

13 Thiruvallur 35.9 Kirshnagiri 2.2

14 Chennai 36.2 Thiruvarur 2.3

15 Sivaganga 36.5 Coimbatore Namakkal

Ramanathapuram 2.4

16 Erode 36.6 Madurai 2.5

17 Khancheepuram Nagapattinam

37.0 Cuddalore 2.6

18 Perambalur 37.7 Erode

Perambalur 2.8

19 Virudhunagar 38.3 Tiruchirappalli 3.2

20 Tiruppur 40.8 Virudhunagar 3.4

21 Ariyalur 42.1 Thanjavur 3.6

22 Ramanathapuram

Thanjavur 42.3 Karur 4.2

23 Dindigul 43.1 -

24 Madurai 44.0 -

25 Tiruchirappalli 44.1 -

26 Viluppuram 44.7 -

27 Thiruvarur 46.2 -

28 Karur 49.7 -

29 Cuddalore 49.8 -

30 - -

31 - -

32 - -


168

Table No. 7: Percentage distribution of Anaemia in 15-49 aged Women for each district of Tamil Nadu

SL No Women of 15-49 aged having anaemia


1 Nilgiris 32.9 Kanniyakumari 0.7

2 Dharmapuri 35.9 Nilgiris 1.0

3 Kanniyakumari 36.2 Dharmapuri

Tiruvannamalai 1.4

4 Kirshnagiri 38.1 Thiruvallur

Virudhunagar 1.6

5 Theni 40.7 Vellore 1.7

6 Salem 41.6 Nagapattina 1.8

7 Vellore 42.4 Salem Theni

1.9

8 Namakkal

Tiruvannamalai 43.5

Kirshnagiri Sivaganga

2.0

9 Virudhunagar 44.1 Madurai 2.3

10 Coimbatore 45.1 Coimbatore Viluppuram

2.4

11 Thiruvallur 45.8 Chennai

Pudukkottai Thoothukkudi

2.5

12 Thoothukkudi 48.3 Tiruppur 2.6

13 Pudukkottai 49.5 Namakkal

Ramanathapuram 2.8

14 Chennai 51.1 Perambalur 2.9

15 Sivaganga 51.2 Khancheepuram

Thirunelveli 3.0

16 Erode

Thirunelveli 51.9 Dindigul 3.2

17 Viluppuram 53.4 Erode

Thanjavur 3.6

18 Ramanathapuram 53.9 Ariyalur 3.7

19 Nagapattinam 54.0 Karur 4.6

20 Tiruppur 54.5 Cuddalore Thiruvarur

5.1

21 Thanjavur 54.6 Tiruchirappalli 5.3

22 Perambalur 54.7 -

23 Khancheepuram 55.5 -

24 Madurai 55.7 -

25 Thiruvarur 57.0 -

26 Dindigul 57.5 -

27 Cuddalore 62.0 -

28 Karur 62.7 -


30 Ariyalur 66.5 -

31 - -

32 - -


169

Table No. 8: Percentage distribution of Anaemia in 15-49 aged Pregnant women for each district of Tamil

Nadu

SL No Pregnant Women of 15-49 aged having anaemia


1 Kanniyakumari 29.6


Thanjavur Thiruvallur Viluppuram

0.0

2 Nilgiris 37.7 Tiruppur 0.7

3 Kirshnagiri 43.7 Ramanathapuram 1.0

4 Virudhunagar 44.3 Sivaganga

Virudhunagar 1.1

5 Thoothukkudi 46.9 Perambalur 1.4

6 Coimbatore 47.1 Coimbatore 1.5

7 Tiruvannamalai 47.3

Dharmapuri 1.7

8 Vellore 49.2 Tiruvannamalai 1.8

9 Dindigul 51.5 Karur

Nilgiris 1.9

10 Thiruvarur 53.7 Thoothukkudi 2.0

11 Dharmapuri

Nagapattinam 54.2

Kirshnagiri Salem

2.3

12 Sivaganga 54.4 Vellore 2.4

13 Tiruppur 55.8 Ariyalur 3.2

14 Thirunelveli 55.9 Thiruvarur 3.4

15 Ramanathapuram 56.1 Theni 3.6

16 Madurai

Theni 57.1 Khancheepuram 4.2

17 Pudukkottai 57.4 Erode 4.9

18 Khancheepuram 58.3 Thirunelveli 5.0

19 Namakkal 58.6 Namakkal 5.1

20 Viluppuram 58.7 Tiruchirappalli 5.5

21 Thiruvallur 59.6 Cuddalore 5.6

22 Salem 60.5 Chennai 5.7

23 Erode 63.4 Dindigul 5.9

24 Perambalur 63.8 Pudukkottai 6.7

25 Chennai 66.3 Madurai 8.3

26 Ariyalur 71.9 -

27 Cuddalore 72.2 -

28 Thanjavur 73.2 -

29 Karur 74.5 -



170

171

Annexure – II

RANKING OF DISTRICTS AS PER INPUT AND OUTPUT INDICATORS

Input Indicators

Sl. No


1 Ranking of Districts for Access to improved source of Sanitation Table No. 9 173

2 Ranking of Districts for Access to improved source of Drinking Water Table No. 10 174

3 Ranking of Districts for Percentage of currently married women below 18 years of age

Table No. 11 175

4 Ranking of Districts for Currently married women who are illiterate (%)

Table No. 12 176

5 Ranking of Districts for Currently married women with 10 or more years of schooling (%)

Table No. 13 177

6 Ranking of Districts for Births to women aged 15-19 years out of total births (%)

Table No. 14 178

7 Ranking of Districts for Pregnant women who consumed 100 or more IFA Tablets/Syrup equivalent (%)

Table No. 15 179

8 Ranking of Districts for Pregnant woman who had full Ante Natal care (%)

Table No. 16 180

9 Ranking of Districts for Women know about what to do when a child gets Diarrhoea (%)

Table No. 17 181

10 Ranking of Districts for Number of Primary Health Centres (PHC) (%) Table No. 18 182

11 Ranking of Districts for Number of Sub-Health Centres (%) Table No. 19 183

12 Ranking of Districts for Community Health centres (CHC) having 24X 7 hours normal delivery services (%)

Table No. 20 184

13 Ranking of Districts for Children (age 9-35 months) received at least one dose of vitamin A supplement in last 6 months (%)

Table No. 21 185

14 Ranking of Districts for Children with Diarrhoea in the last 2 weeks and received ORS in %

Table No. 22 186

15 Ranking of Districts for Total children age 6-23 months receiving an Adequate Diet.

Table No. 23 187

Output Indicators

Sl. No

Indicators Type – No Page

1 Ranking of Districts for IMR per 1000 live births 2011-12 Table No. 24 188

2 Ranking of Districts for MMR per 100,000 live births Table No. 25 189

3 Ranking of Districts for U5 MR per 1000 live births Census Table No. 26 190

4 Ranking of Districts for Percentage of Children with low birth weight (below 2.5kg) (%)

Table No. 27 191

5 Ranking of Districts for Live births Table No. 28 192

172

Sl. No


6 Ranking of Districts for Children under 5 years who are underweight (weight-for-age) in %, NFHS 4

Table No. 29 193

7 Ranking of Districts for Children under 5 years who are wasted (weight-for-height) in %, NFHS 4

Table No. 30 194

8 Ranking of Districts for Children under 5 years who are stunted (height-for-age) in %, NFHS 4

Table No. 31 195

9 Ranking of Districts for Diarrhoea in 2 weeks among children below 5 years (%)

Table No. 32 196

10 Ranking of Districts for Children 6-59 months having anaemia (Total) (%)

Table No. 33 197

11 Ranking of Districts for Children 6-59months having anaemia (severe) (%)

Table No. 34 198

12 Ranking of Districts for Children 6-9 Years having anaemia – Male (Total) (%)

Table No. 35 199

13 Ranking of Districts for Children 6-9 Years having anaemia – Male (severe) (%)

Table No. 36 200

14 Ranking of Districts for Children 6-9 Years having anaemia –Female (Total) (%)

Table No. 37 201

15 Ranking of Districts for Children 6-9 Years having anaemia – Female (severe) (%)

Table No. 38 202

16 Ranking of Districts for Children 10-19 Years having anaemia – Male (Total) (%)

Table No. 39 203

17 Ranking of Districts for Children 10-19 Years having anaemia –Male (severe) (%)

Table No. 40 204

18 Ranking of Districts for Children 10-19 Years having anaemia –Female (Total) (%)

Table No. 41 205

19 Ranking of Districts for Children 10-19 Years having anaemia –Female (severe) (%)

Table No. 42 206

20 Ranking of Districts for Adolescent 15-19 years having anaemia (Total) (%)

Table No. 43 207

21 Ranking of Districts for Adolescents 15-19 years having anaemia (severe) (%)

Table No. 44 208

22 Ranking of Districts for Women 15-49 aged having anaemia (Total) (%) Table No. 45 209

23 Ranking of Districts for Women (15-49 aged) having anaemia (severe) Table No. 46 210

24 Ranking of Districts for Pregnant women 15-49 aged having anaemia (Total)

Table No. 47 211

25 Ranking of Districts for Pregnant women 15-49 aged) having anaemia (severe)

Table No. 48 212

173

INPUT INDICATORS

Table No. 9: Ranking of Districts for Access to improved source of Sanitation

RANKNG DISTRICT ACCESS TO IMPROVE SOURCE OF

SANITATION %

(Range 95.5-33.6)


2 Chennai 92.9

3 Thiruvallur 66.1

4 Nilgiris 64

5 Tiruppur 62

6 Erode 60

7 Khancheepuram 59.2

8 Thirunelveli 58.3

9 Thoothukkudi 57

10 Coimbatore 55.2

10 Madurai 55.2

11 Tiruchirappalli 53.6

12 Theni 53.4

13 Nagapattinam 52

14 Namakkal 51.9

15 Kirshnagiri 51.8

16 Vellore 51.5

17 Sivagangai 51.3

18 Salem 48.6

19 Thiruvarur 48.3

20 Thanjavur 47.9

21 Ramanathapuram 44.6

22 Cuddalore 40.8

22 Perambalur 40.8


24 Viluppuram 39.1

25 Karur 38.1

26 Dindigul 37.8

27 Virudhunagar 37.5

28 Dharmapuri 37.4

29 Pudukkottai 37.2

30 Ariyalur 33.6

Average 52.0


174

Table No. 10: Ranking of Districts for Access to improved source of Drinking Water

RANKING DISTRICT ACCESS TO IMPROVE SOURCE OF

DRINKING WATER %

(Range 99.3-89.2)

1 Vellore 99.3

2 Coimbatore 99.2

3 Theni 99


5 Dindigul 98.7

5 Thiruvallur 98.7

5 Virudhunagar 98.7

6 Ariyalur 98.5

6 Cuddalore 98.5


8 Dharmapuri 98.3

9 Salem 98.2

9 Thirunelveli 98.2

10 Namakkal 98.1

11 Viluppuram 98

12 Nagapattinam 97.7


13 Chennai 97.6

14 Karur 97.5

14 Nilgiris 97.5

15 Thanjavur 97.4

16 Erode 97.1

17 Thiruvarur 97

18 Tiruppur 96.6

19 Perambalur 96.3

20 Madurai 95.9


22 Thoothukkudi 94.4

23 Kirshnagiri 93.8

24 Sivagangai 92.7

25 Pudukkottai 91.4


Average 97.0


175

Table No. 11: Ranking of Districts for Percentage of currently married women below 18 years of age

RANKING DISTRICT

PERCENTAGE OF CURRENTLY MARRIED WOMEN MARRIED BELOW

AGE18 YEARS (MARRIAGES THAT OCCURRED DURING THE REFERENCE

PERIOD) (%)

(Range 0-11.6)

1 Kanniyakumari 0

2 Nagapattinam 1.3

3 Thirunelveli 1.8

4 Khancheepuram 2.1

5 Chennai 2.2

6 Nilgiris 2.3


8 Thiruvarur 3.3

9 Tiruppur 3.6

10 Coimbatore 3.9

11 Cuddalore 4

12 Namakkal 4.1

13 Madurai 4.2

13 Thanjavur 4.2

14 Erode 5

14 Thiruvallur 5

15 Thoothukkudi 5.2

16 Virudhunagar 5.4


18 Sivagangai 5.6

19 Ariyalur 6

20 Pudukkottai 6.1

21 Perambalur 6.2

22 Kirshnagiri 7.1

23 Theni 8

24 Karur 8.1

25 Viluppuram 8.5

26 Vellore 8.8

27 Dindigul 8.9

28 Salem 9.2

29 Dharmapuri 9.6


Average 5.3


176

Table No. 12: Ranking of Districts for Currently married women who are illiterate (%)

RANKING DISTRICT CURRENTLY MARRIED WOMEN WHO

ARE ILLITERATE (%)

(Range 9.8-50.8)

1 Kanniyakumari 9.8

2 Chennai 14.2

3 Thirunelveli 20.3

4 Nagapattinam 21.2

5 Sivagangai 22.2

6 Thanjavur 22.5

7 Thiruvarur 24.6

8 Nilgiris 25.2

9 Tiruchirappalli 26

10 Perambalur 29.7

11 Dindigul 29.9

12 Ramanathapuram 30

13 Madurai 31.1

14 Karur 31.4

15 Ariyalur 32.9

15 Thiruvallur 32.9

16 Pudukkottai 33.2

17 Tiruppur 33.8

18 Cuddalore 34.7

18 Erode 34.7


20 Namakkal 35.4

21 Theni 36.8


24 Kirshnagiri 40.2

25 Coimbatore 41


27 Dharmapuri 42.8

28 Salem 43.9

29 Viluppuram 45.5


Average 32.2


177

Table No. 13: Ranking of Districts for Currently married women with 10 or more years of schooling (%)

RANKING DISTRICT CURRENTLY MARRIED WOMEN WITH 10

OR MORE YEARS OF SCHOOLING (%)

(Range 58.2-27.6)


2 Chennai 57

3 Erode 47.5

3 Nilgiris 47.5

4 Sivagangai 42.3


6 Thiruvallur 40.6

7 Perambalur 40.5

8 Nagapattinam 39.6

9 Pudukkottai 38.5

10 Madurai 35.4

11 Kirshnagiri 35.3

12 Thanjavur 35.1

12 Thiruvarur 35.1

13 Dindigul 34.8

14 Ariyalur 34.5

15 Karur 33.8

16 Theni 33.4

17 Cuddalore 33.1

18 Dharmapuri 33


19 Thirunelveli 32.8

20 Namakkal 32.3

21 Salem 31.3

22 Coimbatore 31.1



24 Vellore 29.1

25 Khancheepuram 29

26 Tiruppur 28.2

26 Viluppuram 28.2


Average 36.3


178

Table No. 14: Ranking of Districts for Births to women aged 15-19 years out of total births (%)

RANKING DISTRICT BIRTHS TO WOMEN AGED15-19

YEARS OUT OF TOTAL BIRTHS² (%)

(Range 0.6-10.7)

1 Ariyalur 0.6

1 Kanniyakumari 0.6

2 Chennai 1.1

3 Pudukkottai 1.3

4 Khancheepuram 1.5

4 Thiruvarur 1.5

5 Thirunelveli 2.1

6 Coimbatore 2.5

6 Perambalur 2.5

6 Thoothukkudi 2.5

7 Nagapattinam 2.6

8 Nilgiris 2.7

9 Kirshnagiri 2.8

10 Sivagangai 3.4


12 Erode 4.2

12 Theni 4.2

13 Thanjavur 4.3

14 Cuddalore 4.5

14 Virudhunagar 4.5


16 Madurai 5.1

17 Tiruppur 5.8

17 Viluppuram 5.8

18 Vellore 6.3

19 Dharmapuri 6.4

20 Karur 6.5

21 Namakkal 6.7

22 Salem 7.3

23 Thiruvallur 8.3

24 Dindigul 9.7


Average 4.3


179

Table No. 15: Ranking of Districts for Pregnant women who consumed 100 or more IFA Tablets/Syrup

equivalent (%)

RANKING DISTRICT PREGNANT WOMEN WHO

CONSUMED 100 OR MORE IFA TABLETS/SYRUP EQUIVALENT (%)

(Ranking 65.2-20.7)

1 Kirshnagiri 65.2


3 Thiruvallur 63.5

4 Karur 58.9

5 Dindigul 57.8

6 Nagapattinam 57.5

7 Madurai 54.7

8 Dharmapuri 52.9

9 Namakkal 51.6


11 Erode 50.2

12 Nilgiris 49.4

13 Perambalur 43.6

14 Salem 42.9


16 Tiruppur 42.3


18 Vellore 39.8



21 Thiruvarur 37.5

22 Sivagangai 34.1

23 Kanniyakumari 34

24 Theni 31.5

25 Chennai 29

26 Coimbatore 27.5


28 Ariyalur 27.1

29 Viluppuram 26.5

30 Thanjavur 23.4

31 Cuddalore 21.7

32 Pudukkottai 20.7

Average 42.1


180

Table No. 16: Ranking of Districts for Pregnant woman who had full Ante Natal care (%)

RANKING DISTRICT PREGNANT WOMAN WHO HAD FULL

ANTE NATAL CARE (%)

(Range 64.2-16.5)

1 Kirshnagiri 64.2


3 Thiruvallur 54.8

4 Madurai 52.2

5 Karur 51.6

6 Nagapattinam 50.6

7 Namakkal 50.4

8 Nilgiris 47.8

9 Dharmapuri 47.2

10 Dindigul 46.5

11 Erode 45.8

12 Perambalur 39.6


14 Salem 37.4

15 Tiruppur 37.3




19 Vellore 30.3


21 Theni 29.6


23 Chennai 27.9

24 Sivaganga 27.5

25 Thiruvarur 27.3


27 Coimbatore 25.0

28 Viluppuram 24.3

29 Ariyalur 22.4

30 Thanjavur 18.1

31 Pudukkottai 17.9

32 Cuddalore 16.5

Average 36.9


181

Table No. 17: Ranking of Districts for Women know about what to do when a child gets Diarrhoea (%)

RANKING DISTRICT WOMEN KNOW ABOUT WHAT TO DO WHEN A CHILD GETS DIARRHOEA (%)

(Range 80.5-34.2)

1 Dindigul 80.5

2 Perambalur 77.8


4 Karur 74.1

5 Nagapattinam 72.4

6 Thanjavur 72.3


8 Namakkal 71

9 Nilgiris 67.5


11 Salem 65.1

12 Vellore 65


14 Cuddalore 63.3

15 Tiruppur 62.9

16 Sivagangai 62.7

17 Thiruvallur 62

18 Theni 61

19 Kirshnagiri 60.3


21 Chennai 56

22 Dharmapuri 55.7


24 Erode 54.9

25 Thiruvarur 52.8

26 Madurai 51.6


28 Viluppuram 49.5

29 Pudukkottai 45.7

30 Ariyalur 45.3

31 Tiruvannamalai 44

32 Coimbatore 34.2

Average 60.8


182

Table No. 18: Ranking of Districts for Number of Primary Health Centres (PHC) (%)

RANKING DISTRICT NUMBER OF PRIMARY HEALTH

CENTRES (PHC) (%)

(Range 22-0)

1 Dindigul 22

1 Nagapattinam 22

1 Sivagangai 22

1 Thanjavur 22

2 Ramanathapuram 21

3 Cuddalore 20

3 Namakkal 20

4 Kirshnagiri 19

5 Ariyalur 18

5 Dharmapuri 18

5 Madurai 18

5 Vellore 18

6 Erode 16

6 Karur 16

6 Khancheepuram 16

6 Perambalur 16

6 Salem 16

6 Thiruvarur 16

6 Tiruvannamalai 16

5 Nilgiris 15

5 Pudukkottai 15

6 Coimbatore 14

6 Kanniyakumari 14

6 Thirunelveli 14

6 Thiruvallur 14

7 Theni 13


8 Tiruppur 12

9 Viluppuram 11

9 Virudhunagar 11

10 Thoothukkudi 10

11 Chennai 0

Average 15.8


183

Table No. 19: Ranking of Districts for Number of Sub-Health Centres (%)

RANKING DISTRICT NUMBER OF SUB-HEALTH CENTERS

(SHC) (%)

(Range 45-0)

1 Nagapattinam 45

2 Sivagangai 44

2 Thiruvarur 44

3 Kirshnagiri 43

4 Dharmapuri 42

4 Ramanathapuram 42

5 Vellore 34

6 Cuddalore 33

6 Dindigul 33

6 Karur 33

6 Namakkal 33

6 Thanjavur 33

7 Ariyalur 25

7 Kanniyakumari 25

7 Khancheepuram 25

7 Perambalur 25

7 Salem 25

7 Thirunelveli 25

7 Thoothukkudi 25


7 Tiruvannamalai 25

8 Coimbatore 24

8 Erode 24

8 Nilgiris 24

8 Pudukkottai 24

8 Theni 24

8 Viluppuram 24

8 Virudhunagar 24

9 Madurai 23

9 Thiruvallur 23

9 Tiruppur 23

10 Chennai 0

Average 28.8


184

Table No. 20: Ranking of Districts for Community Health centres (CHC) having 24X 7 hours normal delivery

services (%)

RANKING DISTRICT COMMUNITY HEALTH CENTRES (CHC)

HAVING 24X 7 HOURS NORMAL DELIVERY SERVICES (%)

(Range 24-0)

1 Viluppuram 24

2 Salem 20

3 Tiruvannamalai 19

3 Vellore 19

4 Cuddalore 16

4 Thanjavur 16

4 Tiruppur 16

5 Dindigul 15

5 Namakkal 15

5 Sivagangai 15

5 Thirunelveli 15

6 Khancheepuram 13

6 Madurai 13

6 Ramanathapuram 13

6 Thiruvallur 13


7 Coimbatore 12

7 Erode 12

7 Kanniyakumari 12

7 Thiruvarur 12

8 Kirshnagiri 11

8 Nagapattinam 11

8 Pudukkottai 11

9 Virudhunagar 10

10 Dharmapuri 9

10 Karur 9

10 Thoothukkudi 9

11 Theni 8

12 Ariyalur 6

13 Perambalur 5

14 Nilgiris 4

15 Chennai 0

Average 12.4


185

Table No. 21: Ranking of Districts for Children (age 9-35 months) received at least one dose of vitamin A

supplement in last 6 months (%)

RANKING DISTRICT

CHILDREN (AGE 9-35 MONTHS) RECEIVED AT LEAST ONE DOSE OF

VITAMIN A SUPPLEMENT IN LAST 6 MONTHS (%)

(Range 78-41.4)

1 Ramanathapuram 78

2 Cuddalore 75

3 Thiruvallur 74.1

4 Perambalur 73.8

5 Thanjavur 73.7

6 Thoothukkudi 72.3

7 Nilgiris 71.1


9 Thirunelveli 68.4

10 Thiruvarur 67.4

11 Dindigul 67.2

12 Vellore 66

13 Tiruppur 65.6

14 Theni 64.3

15 Madurai 63.4

16 Karur 63.3



19 Dharmapuri 59

20 Pudukkottai 57.8

21 Erode 57.5

22 Viluppuram 57.4


23 Sivagangai 57.1

24 Kirshnagiri 56.2

25 Namakkal 55.5

26 Coimbatore 53

27 Chennai 52.7

28 Salem 52.5


30 Ariyalur 41.8


Average 61.9


186

Table No. 22: Ranking of Districts for Children with Diarrhoea in the last 2 weeks and received ORS in %

RANKING DISTRICT CHILDREN WITH DIARRHOEA IN THE LAST 2 WEEKS AND RECEIVED ORS IN

%, DLHS 4

(Range 91.7-20)

1 Salem 91.7


3 Tiruvannamalai 70

4 Cuddalore 69.6

5 Ariyalur 66.7

5 Karur 66.7

5 Tiruppur 66.7

6 Madurai 57.1

7 Dindigul 55.6

8 Nilgiris 54.5

9 Kirshnagiri 53.8

10 Sivagangai 52.5

11 Thanjavur 52.2

12 Erode 50

12 Nagapattinam 50

12 Perambalur 50

12 Theni 50

12 Thiruvallur 50

13 Pudukkottai 45



16 Thiruvarur 38.7

17 Coimbatore 36.4



20 Dharmapuri 33.3


21 Vellore 31.6


23 Namakkal 30.8

24 Chennai 23.1

25 Viluppuram 20

Average 48.8


187

Table No. 23: Ranking of Districts for Total children age 6-23 months receiving an Adequate Diet.

RANKINGS DISTRICT TOTAL CHILDREN AGE 6-23 MONTHS

RECEIVING AN ADEQUATE DIET.

(Range 81.6-13.8)

1 Kirshnagiri 81.6

2 Perambalur 45.2



4 Sivagangai 37.7

5 Dindigul 37.5

5 Vellore 37.5

6 Pudukkottai 37.1

7 Namakkal 36.9

8 Cuddalore 36.1

9 Thiruvarur 36

10 Tiruppur 35.2

11 Madurai 33.3

12 Karur 32.9

13 Nilgiris 32.5

14 Thanjavur 32.3

15 Ariyalur 32


17 Salem 31.6

18 Viluppuram 31.2



21 Virudhunagar 29

22 Erode 28.7




26 Coimbatore 25

27 Theni 24.4

28 Dharmapuri 21.8

29 Thiruvallur 19.6

30 Chennai 13.8

Average 33.1


188

OUTPUT INDICATORS

Table No. 24: Ranking of Districts for IMR per 1000 live births 2011-12

RANKING DISTRICT IMR PER 1000 LIVE BIRTHS 2011-12

(Range 6-20)

1 Coimbatore 6

2 Chennai 7

2 Erode 7

2 Tiruppur 7

3 Ariyalur 9

3 Kanniyakumari 9

4 Kancheepuram 10

4 Thanjavur 10

5 Tiruvarur 11

5 Thoothukudi 11

5 Nilgiris 11

5 Vellore 11

6 Cuddalore 12

6 Madurai 12

6 Pudukkottai 12

6 Salem 12

6 Tiruchirapalli 12

6 Tiruvallur 12

6 Virudhunagar 12

7 Dindigual 13

7 Sivagangai 13

8 Nagapattinam 14

8 Namakkal 14

8 Ramanathapuram 14

8 Tirunelveli 14

9 Perambalur 15

9 Tiruvannamalai 15

10 Krishnagiri 17

10 Theni 17

10 Villupuram 17

11 Karur 18

12 Dharmapuri 20

Average 12


Tamil Nadu

189

Table No. 25: Ranking of Districts for MMR per 100,000 live births

RANKING DISTRICT MMR PER 100,000 LIVE BIRTHS

(Range 30-120)

1 Kanniyakumari 30

2 Chennai 33

3 Nilgiris 39

4 Thanjavur 49

5 Villupuram 56

6 Coimbatore 58

7 Tiruvannamalai 60

8 Ariyalur 61

9 Namakkal 63

9 Virudhunagar 63

10 Erode 64

11 Dharmapuri 65

12 Vellore 66

13 Salem 67

14 Perambalur 73

14 Tiruppur 73

15 Krishnagiri 76

16 Theni 78

17 Kancheepuram 79

18 Sivagangai 80

18 Tiruvallur 80

19 Dindigual 81

20 Pudukkottai 82

21 Nagapattinam 88

22 Cuddalore 89

22 Tiruchirapalli 89

23 Tirunelveli 91

24 Karur 98


25 Thoothukudi 100

26 Tiruvarur 110

27 Madurai 120

Average 73.8


Tamil Nadu

190

Table No. 26: Ranking of Districts for U5 MR per 1000 live births Census

RANKING DISTRICT U5 MR PER 1000 LIVE BIRTHS

CENSUS

(Range 16-44)

1 Chennai 16

2 Thiruvallur 19

3 Coimbatore 20

3 Thiruvarur 20

4 Erode 21

5 Kanniyakumari 22

6 Pudukkotti 23

7 Ramanathpuram 24

7 Thoothukudi 24

8 Kancheepuram 25

9 Sivganga 26

9 Nilgiris 26

10 Namakkal 27

10 Viluppuram 27

11 Nagapattinam 28

12 Salem 29

12 Tiruvannaamalai 29

13 Karur 30

13 Virudhunagar 30

14 Vellore 31

15 Thanjavur 32

15 Cuddalore 32

15 Tirunelveli 32

15 Dindigul 32

16 Tirchirappalli 35

17 Dharmapuri 36

18 Perambalur 37

19 Ariyalur 38

20 Madurai 39

21 Theni 44

Average 28

Source: The data are taken from Census 2011 for each district for the state of Tamil Nadu. Data for two districts

were unavailable namely, Krishnagiri and Tiruppur

191

Table No. 27: Ranking of Districts for Percentage of Children with low birth weight (below 2.5kg) (%)

RANKING DISTRICT PERCENTAGE OF CHILDREN WITH

LOW BIRTH WEIGHT (BELOW 2.5KG) (%)

(Range 5.3-19.8)

1 Thiruvallur 5.3

2 Theni 6.1

3 Kirshnagiri 7.3

4 Dharmapuri 7.7

5 Pudukkottai 7.8

6 Vellore 8.2

7 Thanjavur 8.7

8 Namakkal 9.8

9 Salem 9.9

10 Erode 10.6

11 Sivagangai 10.8

12 Thiruvarur 10.9



14 Nilgiris 11.3

15 Chennai 11.6

15 Cuddalore 11.6



16 Karur 12.4



18 Dindigul 12.8

19 Thirunelveli 13

20 Tiruppur 14


21 Ariyalur 14.4

22 Coimbatore 15.6


24 Perambalur 18.6

24 Viluppuram 18.6

25 Madurai 19.8

Average 11.8


192

Table No. 28: Ranking of Districts for Live births

RANKING DISTRICT LIVE BIRTHS

(Range 100-90.7)

1 Khancheepuram 100


2 Chennai 99.7

2 Viluppuram 99.7

3 Tiruppur 99.6

4 Thiruvallur 99.5

5 Erode 99.4

6 Theni 99.2

7 Namakkal 99.1

8 Dharmapuri 99

8 Salem 99


10 Vellore 98.1

11 Nagapattinam 98

11 Perambalur 98


13 Kirshnagiri 97.7

14 Coimbatore 97.3


15 Thiruvarur 97.1


17 Madurai 95.9

17 Sivagangai 95.9

18 Nilgiris 95.8

19 Cuddalore 95.7

20 Thanjavur 95.6

21 Karur 94.1



24 Dindigul 92

25 Pudukkottai 91.5

26 Ariyalur 90.7

Average 97.0


193

Table No. 29: Ranking of Districts for Children under 5 years who are underweight (weight-for-age) in %,

NFHS 4

RANKING DISTRICT CHILDREN UNDER 5 YEARS WHO ARE

UNDERWEIGHT (WEIGHT-FOR-AGE) IN %, NFHS 4

(Range 12.8-34.7)


2 Erode 16.1


3 Chennai 17.2

4 Thoothukkudi 17.6

5 Namakkal 18

6 Madurai 19.5

7 Perambalur 22

7 Theni 22

8 Salem 22.2


10 Sivagangai 22.7


11 Coimbatore 22.9


11 Thanjavur 22.9

12 Kirshnagiri 23.1

13 Tiruppur 24.9

14 Cuddalore 25

14 Pudukkottai 25


16 Thiruvallur 26.6


18 Viluppuram 28.6

19 Karur 28.9

20 Dharmapuri 29.6

20 Thiruvarur 29.6

21 Ariyalur 29.7

22 Dindigul 29.8

23 Nilgiris 30.7

24 Vellore 32.6


Average 24.1


194

Table No. 30: Ranking of Districts for Children under 5 years who are wasted (weight-for-height) in %, NFHS 4

RANKING DISTRICT CHILDREN UNDER 5 YEARS WHO ARE WASTED (WEIGHT-FOR-HEIGHT) IN

%, NFHS 4

(Range 9-34.6)

1 Kanniyakumari 9

2 Thoothukkudi 12.4

3 Madurai 12.7

4 Thirunelveli 12.9


6 Theni 14

7 Namakkal 15

8 Erode 16.3

8 Viluppuram 16.3

9 Ramanathapuram 17



12 Chennai 18.1

13 Perambalur 18.2

14 Sivagangai 18.8


16 Cuddalore 19.7

17 Kirshnagiri 20.1

18 Ariyalur 20.3

19 Thanjavur 20.4

19 Tiruppur 20.4

20 Pudukkottai 20.9

21 Coimbatore 21.3

22 Thiruvarur 22.1

23 Salem 22.5

24 Karur 23

25 Thiruvallur 23.3

26 Dindigul 26.5

27 Vellore 27.5

28 Nilgiris 31

29 Dharmapuri 33


Average 19.9


195

Table No. 31: Ranking of Districts for Children under 5 years who are stunted (height-for-age) in %, NFHS 4

RANKING DISTRICT CHILDREN UNDER 5 YEARS WHO ARE

STUNTED (HEIGHT-FOR-AGE) IN %, NFHS 4

(Range 17.2-37)


2 Sivagangai 20.9

3 Madurai 21.2

3 Thoothukkudi 21.2


5 Perambalur 24

6 Dharmapuri 24.2

7 Nagapattinam 24.5


8 Khancheepuram 25

9 Kirshnagiri 25.1

10 Namakkal 25.2

11 Erode 25.6

12 Thanjavur 26

13 Pudukkottai 26.7

14 Salem 27

15 Coimbatore 27.3

16 Theni 27.4

17 Karur 27.5

18 Cuddalore 28.2

19 Thiruvarur 28.4

20 Vellore 29

21 Tiruppur 29.4



24 Thiruvallur 30.1


26 Chennai 30.9

27 Dindigul 31.1

28 Viluppuram 31.8

29 Nilgiris 33.1

30 Ariyalur 37

Average 27.0


196

Table No. 32: Ranking of Districts for Diarrhoea in 2 weeks among children below 5 years (%)

RANKING DISTRICT DIARRHOEA IN 2 WEEKS AMONG

CHILDREN BELOW 5 YEARS (%)

Range (1.6-9.8)

1 Perambalur 1.6

2 Kanniyakumari 1.7

3 Thiruvallur 2.3

4 Kirshnagiri 3

5 Salem 3.7

5 Viluppuram 3.7

6 Coimbatore 3.9

7 Namakkal 4.1

8 Chennai 4.3

9 Vellore 4.4

10 Karur 4.5

11 Dharmapuri 4.9

12 Nagapattinam 5.4

13 Nilgiris 5.6

14 Thirunelveli 5.7

15 Dindigul 5.8

15 Pudukkottai 5.8

16 Madurai 5.9

16 Theni 5.9

17 Virudhunagar 6.4

18 Tiruppur 6.6

19 Thoothukkudi 6.7


20 Erode 6.8

21 Thanjavur 7.3

22 Thiruvarur 7.4


24 Cuddalore 7.9

25 Sivagangai 8.3

26 Ariyalur 8.7



Average 5.7


197

ANAEMIA

Table No. 33: Ranking of Districts for Children 6-59 months having anaemia (Total) (%)

RANKING DISTRICT CHILDREN 6-59MONTHS HAVING

ANAEMIA (TOTAL) (%)

(Range 41.3-76)

1 Nilgiris 41.3

2 Kanniyakumari 44

3 Theni 46.2

4 Kirshnagiri 51.8

5 Vellore 51.9


7 Dharmapuri 55.1

8 Coimbatore 56.2

9 Salem 56.4

10 Perambalur 57.3

11 Pudukkottai 59.2

12 Thiruvallur 59.7


13 Erode 59.8

13 Thiruvarur 59.8

14 Namakkal 60.1

15 Tiruppur 60.6


16 Viluppuram 60.8


18 Madurai 62.4

19 Chennai 63.1


21 Thirunelveli 68

22 Cuddalore 68.9

23 Thanjavur 70.3


25 Sivagangai 71.8


27 Dindigul 72.7

28 Karur 75.9

29 Ariyalur 76

Average 61.1


198

Table No. 34: Ranking of Districts for Children 6-59months having anaemia (severe) (%)

RANKING DISTRICT CHILDREN 6-59MONTHS HAVING

ANAEMIA (SEVERE) (%)

(Range 1- 8.1)

1 Nagapattinam 1

2 Nilgiris 1.3

3 Madurai 1.4


5 Virudhunagar 1.6

6 Kanniyakumari 1.7

7 Sivagangai 2

8 Coimbatore 2.2

8 Viluppuram 2.2

9 Pudukkottai 2.4

10 Kirshnagiri 2.8

11 Thirunelveli 2.9

12 Thiruvallur 3

12 Thiruvarur 3

13 Dharmapuri 3.2

14 Theni 3.3

15 Salem 3.4

16 Chennai 3.7

16 Erode 3.7


17 Perambalur 3.8

17 Thanjavur 3.8

17 Vellore 3.8

18 Dindigul 5


20 Tiruppur 6


22 Thoothukkudi 6.4

23 Namakkal 6.6

24 Ariyalur 6.7

25 Cuddalore 7.6

26 Karur 8.1

Average 3.7


199

Table No. 35: Ranking of Districts for Children 6-9 Years having anaemia – Male (Total) (%)

RANKING DISTRICT CHILDREN 6-9 YEARS HAVING

ANAEMIA –MALE (TOTAL)

(Range 68.7-26.9)

1 Nilgiris 26.9

2 Perambalur 33.8

3 Erode 34.6

4 Kanniyakumari 36

5 Dharmapuri 36.1

6 Namakkal 37.2

7 Salem 37.5


8 Thiruvallur 40.2


10 Theni 40.7

11 Pudukkottai 41.5

12 Vellore 42


14 Kirshnagiri 43.9

14 Tiruppur 43.9



17 Dindigul 47.4

18 Viluppuram 47.5

19 Coimbatore 49.6

20 Sivagangai 50.6

21 Thanjavur 51.2


23 Chennai 52.3


25 Cuddalore 53.8

26 Thiruvarur 55.6

27 Karur 56

28 Ariyalur 61.7

29 Madurai 67.5


Average 46.1


200

Table No. 36: Ranking of Districts for Children 6-9 Years having anaemia – Male (severe)(%)

RANKING DISTRICT CHILDREN

6-9 YEARS HAVING ANAEMIA –MALE (SEVERE)

(Ranking 0-6.5)

1 Ariyalur 0

1 Chennai 0

1 Kanniyakumari 0

1 Nagapattinam 0

1 Namakkal 0

1 Nilgiris 0

2 Dharmapuri 0.5

3 Perambalur 0.8

3 Pudukkottai 0.8

4 Karur 0.9

4 Theni 0.9

5 Vellore 1

5 Virudhunagar 1

6 Sivagangai 1.1

7 Salem 1.4

8 Thiruvallur 1.5

9 Viluppuram 1.6

10 Thoothukkudi 1.7

11 Tiruppur 1.8

12 Erode 1.9

13 Ramanathapuram 2

14 Dindigul 2.1


16 Thanjavur 2.4


17 Thirunelveli 2.7

18 Cuddalore 2.9

18 Kirshnagiri 2.9

19 Coimbatore 3.4

20 Madurai 3.9


22 Thiruvarur 6.5

Average 1.8


201

Table No. 37: Ranking of Districts for Children 6-9 Years having anaemia –Female (Total)(%)

RANKING DISTRICT CHILDREN 6-9 YEARS HAVING ANAEMIA –FEMALE (TOTAL)

(Range 31.1-78.8)

1 Nilgiris 31.1

2 Vellore 33.3

3 Theni 35.4

4 Dharmapuri 39


6 Salem 41.3

7 Erode 42.7

8 Namakkal 43

9 Perambalur 43.5



11 Chennai 45.4


12 Thiruvallur 45.9

13 Coimbatore 47.4

14 Sivagangai 48.4


16 Kirshnagiri 49

16 Tiruppur 49

17 Pudukkottai 49.1


19 Dindigul 51.9

20 Thanjavur 52.8

21 Viluppuram 53.5



24 Cuddalore 55


26 Thiruvarur 57.3

27 Karur 59.3

28 Madurai 60.3

29 Ariyalur 78.8

Average 48.4


202

Table No. 38: Ranking of Districts for Children 6-9 Years having anaemia – Female (severe)(%)

RANKING DISTRICT CHILDREN 6-9 YEARS HAVING ANAEMIA –FEMALE (SEVERE)

(Range 0-3.7)

1 Chennai 0

1 Kanniyakumari 0

1 Perambalur 0

2 Salem 0.7

2 Sivagangai 0.7

2 Virudhunagar 0.7


4 Pudukkottai 0.9

5 Nilgiris 1

5 Theni 1

5 Tiruppur 1

6 Dindigul 1.3

6 Thiruvallur 1.3

6 Vellore 1.3

7 Madurai 1.4



9 Thoothukkudi 1.6

10 Cuddalore 1.7

10 Kirshnagiri 1.7

11 Ariyalur 1.9

11 Thanjavur 1.9

12 Nagapattinam 2.2

13 Dharmapuri 2.3

13 Erode 2.3

13 Namakkal 2.3

14 Thiruvarur 2.7

15 Coimbatore 3.1

15 Thirunelveli 3.1

16 Viluppuram 3.5

17 Karur 3.7


Average 1.6


203

Table No. 39: Ranking of Districts for Children 10-19 Years having anaemia – Male (Total) (%)


ANAEMIA – MALE (TOTAL)

(Range 17.9-48.7)

1 Kirshnagiri 17.9


3 Salem 21.2

4 Nilgiris 24.3

5 Dharmapuri 24.5

6 Sivagangai 25.1

7 Pudukkottai 25.5

8 Vellore 25.6


10 Namakkal 27.9

11 Coimbatore 28

12 Theni 28.7


14 Perambalur 29.3

15 Erode 30.9



18 Thiruvallur 31.9

19 Chennai 32.4

20 Dindigul 32.8



23 Tiruppur 38

24 Madurai 39.1


25 Thanjavur 39.3

26 Viluppuram 40.7

27 Karur 40.8

28 Ariyalur 41.2

29 Thiruvarur 43.2


30 Cuddalore 48.7

Average 32.2


204

Table No. 40: Ranking of Districts for Children 10-19 Years having anaemia –Male (severe)(%)


ANAEMIA –MALE (SEVERE)

(Range 0-2.6)

1 Sivagangai 0

2 Salem 0.3

3 Nilgiris 0.4

3 Theni 0.4


3 Vellore 0.4

4 Nagapattinam 0.6

5 Pudukkottai 0.7

5 Thoothukkudi 0.7


6 Kanniyakumari 0.8

7 Dindigul 0.9

7 Kirshnagiri 0.9

8 Dharmapuri 1

8 Khancheepuram 1

9 Perambalur 1.1

10 Viluppuram 1.2

11 Ariyalur 1.3

11 Thiruvallur 1.3

12 Coimbatore 1.4

12 Thirunelveli 1.4

12 Virudhunagar 1.4

13 Madurai 1.5

13 Thanjavur 1.5


15 Thiruvarur 1.7

15 Chennai 2.1

15 Karur 2.1

15 Tiruppur 2.1

16 Cuddalore 2.6

16 Erode 2.6

16 Namakkal 2.6

Average 1.2


205

Table No. 41: Ranking of Districts for Children 10-19 Years having anaemia –Female (Total)(%)


10-19 YEARS HAVING ANAEMIA –FEMALE (TOTAL)

(Range 30.4-59.9)


2 Theni 32.9

3 Dharmapuri 33.2

4 Salem 35.5

5 Nilgiris 35.6

6 Coimbatore 36.8

7 Vellore 38.4

8 Kirshnagiri 41

9 Erode 42.3

10 Thiruvallur 42.5


12 Pudukkottai 42.8



15 Sivagangai 46.3

16 Perambalur 47.4

17 Namakkal 47.5


19 Chennai 47.7

19 Thiruvarur 47.7


21 Dindigul 49.1

22 Thirunelveli 50

23 Thanjavur 51.1

24 Tiruppur 51.5


26 Viluppuram 57.1

27 Ariyalur 59

27 Madurai 59

28 Karur 59.5

29 Cuddalore 59.7


Average 46.4


206

Table No. 42: Ranking of Districts for Children10-19 Years having anaemia –Female (severe)(%)


10-19 YEARS HAVING ANAEMIA –FEMALE (SEVERE)

(Range 0.3-4.3)

1 Salem 0.3

2 Ariyalur 0.6

3 Dindigul 0.9

3 Vellore 0.9

4 Dharmapuri 1.1

5 Thiruvallur 1.2

6 Sivagangai 1.3

7 Nilgiris 1.4

7 Pudukkottai 1.4

7 Thoothukkudi 1.4

8 Kanniyakumari 1.5

8 Tiruppur 1.5

9 Nagapattinam 1.6


10 Erode 1.7

10 Kirshnagiri 1.7

11 Coimbatore 2

11 Theni 2

11 Tiruvannamalai 2

12 Thirunelveli 2.3

13 Namakkal 2.5

13 Viluppuram 2.5

14 Perambalur 2.6

15 Karur 2.9

16 Madurai 3.1

16 Thiruvarur 3.1


16 Virudhunagar 3.1


17 Thanjavur 3.2

18 Chennai 3.8

19 Cuddalore 4.3

Average 2.1


207

Table No. 43: Ranking of Districts for Adolescent 15-19 years having anaemia (Total) (%)

RANKING DISTRICT ADOLESCENT 15-19YEARS HAVING

ANAEMIA (TOTAL)

(Range 20.4-49.8)


2 Dharmapuri 25.6

3 Salem 26.4

3 Theni 26.4

4 Vellore 26.8

5 Nilgiris 27.1

6 Pudukkottai 29.2


8 Coimbatore 29.7

9 Kirshnagiri 30.3



12 Namakkal 35.4

13 Thiruvallur 35.9

14 Chennai 36.2

15 Sivagangai 36.5

16 Erode 36.6

17 Khancheepuram 37

17 Nagapattinam 37

18 Perambalur 37.7


20 Tiruppur 40.8

21 Ariyalur 42.1


22 Thanjavur 42.3

23 Dindigul 43.1

24 Madurai 44


26 Viluppuram 44.7

27 Thiruvarur 46.2

28 Karur 49.7

29 Cuddalore 49.8

Average 36.2


208

Table No. 44: Ranking of Districts for Adolescents 15-19 years having anaemia (severe)(%)

RANKING DISTRICT ADOLESCENTS 15-19YEARS HAVING

ANAEMIA (SEVERE)

(Range 0-4.2)

1 Tiruvannamalai 0

2 Thiruvallur 0.3

3 Ariyalur 0.5

4 Theni 0.7

5 Thoothukkudi 0.9

6 Salem 1

6 Thirunelveli 1

6 Vellore 1

7 Tiruppur 1.1

8 Pudukkottai 1.3

8 Sivagangai 1.3

9 Kanniyakumari 1.4

9 Nagapattinam 1.4

9 Nilgiris 1.4

9 Viluppuram 1.4

10 Dharmapuri 1.5

10 Dindigul 1.5

11 Chennai 1.7


13 Kirshnagiri 2.2

14 Thiruvarur 2.3

15 Coimbatore 2.4

15 Namakkal 2.4


16 Madurai 2.5

17 Cuddalore 2.6

18 Erode 2.8

18 Perambalur 2.8


20 Virudhunagar 3.4

21 Thanjavur 3.6

22 Karur 4.2

Average 1.8


209

Table No. 45: Ranking of Districts for Women 15-49 aged having anaemia (Total) (%)

RANKING DISTRICT WOMEN 15-49 AGED HAVING

ANEMIA (TOTAL)

(Range 32.9-66.5)

1 Nilgiris 32.9

2 Dharmapuri 35.9


4 Kirshnagiri 38.1

5 Theni 40.7

6 Salem 41.6

7 Vellore 42.4

8 Namakkal 43.5


9 Virudhunagar 44.1

10 Coimbatore 45.1

11 Thiruvallur 45.8


13 Pudukkottai 49.5

14 Chennai 51.1

15 Sivagangai 51.2

16 Erode 51.9


17 Viluppuram 53.4


19 Nagapattinam 54

20 Tiruppur 54.5

21 Thanjavur 54.6

22 Perambalur 54.7


24 Madurai 55.7

25 Thiruvarur 57

26 Dindigul 57.5

27 Cuddalore 62

28 Karur 62.7


30 Ariyalur 66.5

Average 50.1


210

Table No. 46: Ranking of Districts for Women (15-49 aged) having anaemia (severe)

RANKING DISTRICT WOMEN (15-49 AGED) HAVING

ANAEMIA (SEVERE)

(Range 0.7-5.3)

1 Kanniyakumari 0.7

2 Nilgiris 1

3 Dharmapuri 1.4


4 Thiruvallur 1.6

4 Virudhunagar 1.6

5 Vellore 1.7

6 Nagapattinam 1.8

7 Salem 1.9

7 Theni 1.9

8 Kirshnagiri 2

8 Sivagangai 2

9 Madurai 2.3

10 Coimbatore 2.4

10 Viluppuram 2.4

11 Chennai 2.5

11 Pudukkottai 2.5

11 Thoothukkudi 2.5

12 Tiruppur 2.6

13 Namakkal 2.8


14 Perambalur 2.9

15 Khancheepuram 3

15 Thirunelveli 3

16 Dindigul 3.2

17 Erode 3.6

17 Thanjavur 3.6

18 Ariyalur 3.7

19 Karur 4.6

20 Cuddalore 5.1

20 Thiruvarur 5.1


Average 2.7


211

Table No.47: Ranking of Districts for Pregnant women 15-49 aged having anaemia (Total)

RANKING DISTRICT PREGNANT WOMEN 15-49 AGED

HAVING ANAEMIA (TOTAL)

(Range 29.6-80)


2 Nilgiris 37.7

3 Kirshnagiri 43.7

4 Virudhunagar 44.3

5 Thoothukkudi 46.9

6 Coimbatore 47.1


8 Vellore 49.2

9 Dindigul 51.5

10 Thiruvarur 53.7

11 Dharmapuri 54.2


12 Sivagangai 54.4

13 Tiruppur 55.8



16 Madurai 57.1

16 Theni 57.1

17 Pudukkottai 57.4


19 Namakkal 58.6

20 Viluppuram 58.7

21 Thiruvallur 59.6

22 Salem 60.5

23 Erode 63.4

24 Perambalur 63.8

25 Chennai 66.3

26 Ariyalur 71.9

27 Cuddalore 72.2

28 Thanjavur 73.2

29 Karur 74.5


Average 56.7


212

Table No. 48: Ranking of Districts for Pregnant women 15-49 aged) having anaemia (severe)

RANKING DISTRICT PREGNANT WOMEN 15-49 AGED)

HAVING ANAEMIA (SEVERE)

(Range 0-8.3)

1 Kanniyakumari 0

1 Nagapattinam 0

1 Thanjavur 0

1 Thiruvallur 0

1 Viluppuram 0

2 Tiruppur 0.7

3 Ramanathapuram 1

4 Sivagangai 1.1

4 Virudhunagar 1.1

5 Perambalur 1.4

6 Coimbatore 1.5

7 Dharmapuri 1.7


9 Karur 1.9

9 Nilgiris 1.9

10 Thoothukkudi 2

11 Kirshnagiri 2.3

11 Salem 2.3

12 Vellore 2.4

13 Ariyalur 3.2

14 Thiruvarur 3.4

15 Theni 3.6


17 Erode 4.9

18 Thirunelveli 5

19 Namakkal 5.1


21 Cuddalore 5.6

22 Chennai 5.7

23 Dindigul 5.9

24 Pudukkottai 6.7

25 Madurai 8.3

Average 2.8


213

ANNEXUREIII

A REVIEW ON PAST STATUS OF PUBLIC

HEALTH IN TAMIL NADU

214

215

INDEX

1 Health 217

2 Nutrition 233

3 WASH (Water, Sanitation and Hygiene) 242

4 References 259

216

217

I.1. Health

1. Prologue

Good health is an essential pre-requisite which contributes significantly both to the improvement in

labour productivity and human resource development. Health care is widely recognized to be a

public good with strong positive externalities. Universal access, of an adequate level of care, with

equitable distribution of financial costs, cost effective use of the results of relevantresearch and

special attention to vulnerable groups such as children, women, disabled and the aged is a key

component of a modern civilized society. The role of government is crucial for addressing these

challenges and achieving equity in health. To achieve this, Government of Tamil Nadu presently has

converged more resources on health and nutrition, strengthening health infrastructure to reach

world class standard, augmenting medical manpower resources and encouraging health outreach

activities. The primary, secondary and tertiary health care delivery systems are being revamped and

fine-tuned in such a way that health care is delivered efficaciously to the people at the bottom of

the economic pyramid. Considerable achievements have been made in Tamil Nadu in health

indicators like life expectancy at birth, infant mortality rate and maternal mortality rate.(Policy Note

2013-14)

The health status is usually measured by some vital indicators namely life expectancy at birth, infant

mortality rate, fertility rate, crude birth rate and crude death rate. These rates are determined by

numerous factors such as per capita income, nutrition, housing, sanitation, safe drinking water,

social infrastructure, health and above all, public intervention in providing health care

services.(District Human Development Report)

Health is no longer considered as merely ‘absence of diseases’. It has come to mean total quality of

life, with a number of components such as income security, environmental factors, literacy, socio-

economic issues, infra-structural facilities such as hygiene, sanitation, safe drinking water, access to

institutional health care etc. Hence it is no longer possible to formulate a health policy merely on the

basis of availability of doctors, drugs and hospitals. It should be an integrated one, involving all the

social sectors, including education, social welfare, environment etc. (Public Health in Tamil Nadu,

2000)

2. History

The Government of Tamil Nadu had claimed complete success in terms of major health indicators

during 1999.(Public Health in Tamil Nadu, 2000)

“Tamil Nadu had already achieved the targets set in the National Health Policy (for 2000 AD) for

improving the health status of the people. The infant mortality rate was brought down to 54 (vs

target 60) per 1000 live births, the crude birth rate had fallen to 19.2 (vs target21) and the crude

death rate has come down to 7.8 (vs target 9)”(Policy Note on Public Health, 1998-99)

218

Table No. 49: Crude Birth Rate (per 1000) – 1991 Census

Tamil Nadu India

Year Rural Urban Total 1971 32.9 27.8 31.4 36.9

1981 29.7 23.9 28.0 33.9

1991 20.8 20.8 20.8 29.5

1992 21.7 20.0 20.7 29.2

1993 19.7 19.1 19.5 28.7

1994 19.7 18.3 19.2 28.7

1995 21.0 19.0 20.3 28.3

1996 20.0 18.4 19.5 27.5

(Source: Census 1991 – State Profile)

Over the period 1960 – 1996, there has been a significant (40%) decline in crude birth rate in Tamil

Nadu. Till 1979 the CBR declined quite well, but it plateaued around 1984. Again it recorded

impressive decline till 1994. It stagnated subsequently.(Public Health in Tamil Nadu, 2000)

2.1. Life Expectancy

In 1970-75, Tamil Nadu had a life expectancy at birth of49.6 (compared to the Indian level of 49.8).

In 1989-1993, as calculated by State profile (Census ofIndia), life expectancy in Tamil Nadu was 62.4

years (rural:60.5 years and urban: 66.3 years)(Public Health in Tamil Nadu, 2000)

“In Life Expectancy, Tamil Nadu with 62.4 years finished in fifth place among major States as of 1989-

93, next to Kerala (72), Punjab (66.4), Maharashtra (64.2) and Haryana (62.9)”(Tamil Nadu – An

Economic Appraisal 1996-97)

2.2. Morbidity

The India Human Development Report Published in 1999indicates that the general health situation

of people in Tamil Nadu, especially among women and the aged and the general short-term health

situation, is far from satisfactory, and needed serious attention.(Public Health in Tamil Nadu, 2000)

2.3. Primary Health Care

Both the Alma Ata declaration (1978), signed by most governments, and the Health Policy Document

(1983) of the Indian Government identified primary health care as a key strategic intervention for

universal access to health care. (Public Health in Tamil Nadu, 2000)

In Tamil Nadu, as in most other States, the government sector is the major provider of primary

health care, particularly in rural areas.(Public Health in Tamil Nadu, 2000)

“The State met the Government of India norm of one PHC for every 30000/20000 population in the

plains / hills and one HSC for every 5000/3000 population in the plains / hills. As of 1996-97, there

were1420 primary health centres including 68 communityHealth Centres and 8682 Health Sub-

centres.”(Tamil Nadu – An Economic Appraisal 1996-97)

2.4. Budget Outlay

“The government allocated 1.5% of its budget for health care. (Tamil Nadu Peoples’ Manifesto, 1996)

219

“ The provision under the Medical and Public Health Demands in Budget Estimate 2000-2001 was

5.86% of the total expenditure on the Revenue account of Rs. 21564.87 crores”(Policy Note on

Medical & Public Health., 2000-2001)

3. Developments

As mentioned, in the start of this chapter, the present Govt. in Tamil Nadu has made utmost effort to

totally revamp the primary, secondary as well as tertiary health care efforts to ensure a health for all

status in the state.

The box shows the Health Sector Vision of 2023

Box No. 1: Health Sector Vision 2023

It envisages Tamil Nadu to become number one State in India in terms of social indicators

and also raise the standard of health delivery to international standard by ensuring

universal access to health facility. Some of the key initiatives of the Vision 2023 are:

Increase the capacity of primary and secondary healthcare network by improving

theinfrastructure of hospitals such as bed strength, laboratory, radiology facilities

and dietprovision and ensuring that a referral centre is available within a

maximum distance of five kilometres from every sub-centre.

15 new medical colleges attached to district hospitals will be established.

17 medical colleges attached to hospitals will be upgradedto international

standard.

Creation of two med. Cities in South and Western Tamil Nadu to serve the

medical tourism industry by investment in hospital and education facilities,

logistics and hospitality services.

Trauma, ambulatory, disaster management care anddiagnostic services to be

improved and neutralized.

Electronic medical records management and hospital management system will be

implemented in all districts and Taluk hospitals.

Ensuring 100 percent availability of drugs at all locations.

The Vision document envisages an investment ofRs.11,000 Crores

Category Rs. Crore

New Medical Facilities 7900.00

Upgrading Medical Facilities 1500.00

Other Projects 1600.00

Total Investment 11000.00

Source: Vision 2023, Government of Tamil Nadu

220

The Twelfth Plan (2012-2017) has focused its attention on reducing infant mortality rate to 13 per

thousand live births and maternal mortality rate to 44 per lakh live births, universal access to

public health services, prevention and control of communicable and non- communicable diseases,

maintaining gender and demographic balance, revitalize Indian Systems of Medicine

andpromoting a healthy lifestyle. The total funds earmarked for health sector during the plan period

is Rs.10, 832 crore which accounted for 5.1 percent of the total Twelfth Plan outlay of the

State.(Chapter XII - Tamil Nadu Health)

The health of the population has been assessed by taking into account different indicators like

Infant Mortality Rate (IMR), Death Rate, Birth Rate, Total Fertility Rate (TFR), Maternal Mortality

Rate (MMR) and Life Expectancy at Birth (LEB). A State wise comparison is provided in the

following table (Table No. 50)

Table No.50: Health Indicators in Major States – The Trend

Category CBR CDR IMR TFR MMR LEB

2002 2012 2002 2012 2002 2012 2002 2011 2004 -06

2010 -12

2001 -05

2006 -10

Andhra Pradesh

20.7 17.5 8.1 8.6 62 41 2.2 1.8 154 110 64.0 65.8

Assam 26.6 22.5 9.2 7.9 70 55 3.0 2.4 480 328 58.7 61.9

Bihar 30.9 27.7 7.9 6.6 61 43 4.3 3.6 312 219 61.1 65.8

Gujarat 24.7 21.1 7.7 6.6 60 38 2.8 2.4 160 122 63.9 66.8

Haryana 26.6 21.6 7.1 6.4 62 42 3.1 2.3 186 146 65.8 67.0

Karnataka 22.1 18.5 7.2 7.2 55 32 2.4 1.9 213 144 65.2 67.2

Kerala 16.9 14.9 6.4 6.9 10 12 1.8 1.8 95 66 73.8 74.2

Madhya Pradesh

30.4 26.6 9.8 8.1 85 56 3.8 3.1 335 230 57.7 62.4

Maharashtra 20.3 16.6 7.3 6.3 45 25 2.3 1.8 130 87 67.0 69.9

Odisha 23.2 19.9 9.8 8.5 87 53 2.6 2.2 303 235 59.2 63.0

Punjab 20.8 15.9 7.1 6.8 51 28 2.3 1.8 192 155 69.1 69.3

Rajasthan 30.6 25.9 7.7 6.6 78 49 3.9 3.0 388 255 61.7 66.5

Tamil Nadu 18.5 15.7 7.7 7.4 44 21 2.1 1.7 111 90 66.0 68.9

Uttar Pradesh 31.6 27.4 9.7 7.7 80 53 4.4 3.4 440 292 59.7 62.7

West Bengal 20.5 16.1 6.7 6.3 49 32 2.3 1.7 141 117 64.7 69.0

All India 25.0 21.6 8.1 7.0 63 42 3.0 2.4 254 178 63.1 66.1

Note: CBR – Crude Birth Rate, CDR – Crude Death Rate, IMR –Infant Mortality Rate, TFR – Total Fertility Rate, MMR – Maternal Mortality Rate and LEB – Life Expectancy at Birth. Source: Sample Registration Scheme (SRS), Registrar General, New Delhi.

According to these indicators there was a dramatic improvement in the health situation of the public

in the State. The State had experienced a diminishing trend with respect to Infant Mortality Rate

(IMR), Birth Rate, Total Fertility Rate (TFR), Maternal Mortality Rate (MMR) and an upward trend in

Life Expectancy at Birth. The good accomplishments are the result of many factors including greater

health consciousness amongst the public, improvement in the female literacy rate and female

empowerment, growing industrialization, faster urbanization, rising nutritional status, early

221

detection, treatment and control of outbreak of epidemics, easy accessibility to an efficacious

healthcare delivery system, infectious disease prevention control, application of modern medical

practices in diagnosis and treatment of various ailments and effective administration of universal

immunization. The State-wise comparison of health indicators has help to bring to light the following

findings. (Chapter XII - Tamil Nadu Health)

Crude Birth Rate (CBR) indicates thenumber of live births occurring during the year perthousand

populations. There was a steady decline in the crude birth rate of Tamil Nadu. It was from 18.5 in

2002 to 15.7 in 2012. Besides successful implementation of the family planning programme in the

State by the successiveGovernments, widepropagation of higher age at marriage, a much widerreach

of mass media facilitating speeder diffusion of small family norm, increasing literacy rate, improving

status of women, better road connections between rural and urban areas, higher participation of

femalesin non-farm activities, declining fertility rate, rising aspirations of the people in the contest of

improving living standards are the reasons behind this decline. The crude birth rate in the State at

15.7 in 2012 was lower than all-India (21.6). Among the major States and as well as Southern States,

Tamil Nadu (15.7) stood second next only to Kerala (14.9). At the end ofthe 12th Plan (2012-17), the

State targets a crude birth rate of 14.0.(Chapter XII - Tamil Nadu Health)

Figure No.28: Crude Birth Rate – The Trend

Crude Death Rate (CDR) indicates the totalnumber of deaths per year per thousand populations.

Over the years it had steadily declined in the state. This was the result of greater health

consciousness amongst the public, increasing education levels, rising nutritional status, improving

standard of living,early detection, treatment and control of outbreakepidemics, easy accessibility to

an efficacious healthcare delivery systems, infectious disease prevention control, application of

modern medical practices indiagnoses and treatment various ailments andeffective

administration of universal immunisation, better connectivity of roads and easy transportation

between rural and urban areas. Between 2002 and 2012 the crude death rate in the State had

declined from 7.7 to 7.4. The crude death rate in the State at 7.4 in 2012 was slightly higher than that

of all-India (7.0). This was mainly due to more deaths because of accidents and suicidesoccurred in

the State. The State has contemplated to bring down thecrude death rate by the end of the 12th

Plan (2012-17) (Chapter XII - Tamil Nadu Health)

31.4 28

20.8 19.1

15.9 15.7

36.9 33.9

29.5

25.4

21.8 21.6

1971 1981 1991 2001 2011 2012

Crude Birth Rate - The Trend

TN All India

222

Figure No.29: Crude Death Rate – The Trend

Total Fertility Rate (TFR) measures the number of children born to women during her entire re-

productive period. There was a fall in the total fertility rate in Tamil Nadu from 2.1 in 2002 to 1.7 in

2011.This has been due to a combination of factors including propagation of higher age at marriage,

wider diffusion of small family norm, improved levels of female literacy, increasing opportunity for

women to engage in non-farm occupations, rising aspiration of people, postponement of child

barring, improvement in women empowerment and autonomy etc., Among the states, the total

fertility rate varied between 3.6 (Bihar) and 1.7(TN & West Bengal) in 2011.The fertility rate in the

state at 1.7 was lower than all India (2.4).Tamil Nadu with the total fertility rate 1.7 in 2011 shared

first place with West Bengalamong major States. During the Twelfth Plan (2012-2017) period Tamil

Nadu envisaged tobring down the fertility rate to 1.6.(Chapter XII - Tamil Nadu Health)

Figure No.30: Total Fertility Rate – The Trend

Maternal Mortality Rate (MMR) which measures the number of women of re-productive age

(15-49 years) dying due to maternal causes per one lakh live births. Besides the improvement in the

awareness among women, higher female literacy rate, increasing institutional deliveries, marked

accessibility of modern medical technology, functioning of 108 ambulance services, provisioning of

14.4

11.8

8.8 7.7

7.1 7

14.9

12.5

9.8

8.4 7.4 7.4

1971 1981 1991 2001 2011 2012

Crude Death Rate - The Trend

TN All India

3.4 3.2

2.1

1.7 1.7

4.5

3.8

3

2.5 2.4

1971 1981 1991 2001 2011

Total Fertility Rate - The Trend

TN All India

223

hospitals on wheels in 385 blocks for Re-productive and Child Health (RCH) outreached services,

establishment of 24x7 delivery services in all PHCs, establishment of Basic Emergency Obstetric

and New born Care (BEmONC) and Comprehensive Emergency and Obstetric Neonatal Care

(CEmONC) centres, strengthening referral linkages in PHCs, functioning of PHC operation theatres,

tracking and transfer of mothers with high risk to higher facilities, admission of mother with known

high risk factors well in advance in centres (CEmONC), implementation of Dr. Muthulakshmi Reddy

Maternity Benefit Scheme etc., had helped to bring down MMR in the State. The MMR in the State

had come down from 111 in 2004-06 to 90 in 2010-12. The MMR during the period 2010-12 at 90

in Tamil Nadu was significantly lower than the all India (178). Among the major States it was the

highest in Assam (328) and lowest in Kerala (66). Tamil Nadu ranked third next only to Kerala (66)

and Maharashtra (87). However, the major causes of maternal mortality continue to be unsafe

abortions, ante and post-partum haemorrhage, anaemia, obstructed labour, hypertensive disorders

and post-partum sepsis. It is proposed to bring down the ratio to 44 in Tamil Nadu during the 12th

Plan period (2012-17).(Chapter XII - Tamil Nadu Health)

Figure No.31: Maternal Mortality Rate 2010-2012

Infant Mortality Rate (IMR) which indicates thedeath of children beforethe age of one year

perthousand live births is a reliable indicator of health andnutritional status of the population. The

concertedefforts of the State through setting up of ComprehensiveEmergency and Obstetric and

Neonatal Care Centres,ensuring 24x7 delivery services in all PHCs by postingfive medical officers and

three staff nurses with theprovision of necessary equipment’s, introducing specialvehicles for

transport of new-borns, control of birthasphyxia and death due to hypothermia andimplementing

strategies for reduction and managementof neonatal sepsis, inculcating the pregnant mothers

onexclusive breast feeding, complementary foods, child care practices, danger signs in sicknew-borns

and immunization of preventable diseases, risingfemale literacy rate andincreasing institutional

deliveries had paid rich dividends in bringing down the infant mortalityrate considerably in the State.

The IMR in the State declined from 44 in 2002 to 21 in 2012.The decline in IMR between these two

years was more perceptible in Tamil Nadu (23) ascompared to all-India (21). The IMR in the State was

110

328

219

122 146 144

66

230

87

235

155

255

90

292

177 178

0

50

100

150

200

250

300

350

Maternal Mortality Rate 2010-2012

224

significantly was lower than at all-India(42) in 2012. Among the major States and as well as Southern

States, Tamil Nadu rankedsecond next only to Kerala (12). During the 12th Plan it is programmed to

bring down the IMRin Tamil Nadu to 13 which would require faster reduction in years to

come.(Chapter XII - Tamil Nadu Health)

Figure No.32: Infant Mortality Rate – The Trend

Life Expectancy at Birth indicates the average number of years that a new-born is expected to live if

current mortality rates continue to apply. With the improvements in the prevention and control of

major childhood infectious diseases, nutritional status, housing condition and modern medical care

resulted in an increase in life expectancy in the State. There was a improvement in the lifeexpectancy

at birth in Tamil Nadu from 66.0 years (2001-05) to 68.9 years (2006-10). At the all India level, life

expectancy rose from 63.1 to 66.1 years. Tamil Nadu with the life expectancy at birth at 68.9 years

occupied the second place among the southern States next only to Kerala (74.2) and well ahead of all

India (66.1) during the period 2006-10.(Chapter XII - Tamil Nadu Health)

A summary of changes over years is given in the following Table No. 4 and Figure No. 6

Table No. 51: Indicators of Health in Tamil Nadu for the period from 1995-96 to 2009-10

Year Life Expectancy Birth Rate Death Rate IMR 1995-96 64.09 20.3 8.0 54

1996-97 64.10 19.5 8.0 53

1997-98 64.14 19.0 8.0 53

1998-99 64.29 19.2 8.5 53

1999-00 65.31 19.3 8.0 52

2000-01 65.41 19.3 7.9 51

2001-02 65.09 19.1 7.6 49

2002-03 65.11 18.5 7.7 44

2003-04 65.15 18.3 7.6 43

2004-05 66.22 17.1 7.5 41

2005-06 67.11 16.5 7.4 37

2006-07 67.21 16.2 7.5 37

2007-08 67.31 15.8 7.2 35

2008-09 67.75 16.0 7.4 31

2009-10 67.98 16.3 7.6 28

Source: (i) Directorate of Medical and Rural Services, Chennai(41)

(ii) 1991 Census of India

(iii) 2001 Census of India

129

110

80

66

44 42

113

91

57 49

22 21

1971 1981 1991 2001 2011 2012

Infant Mortality Rate - The Trend

TN

All India

225

Figure No.33: Indicators of Health in Tamil Nadu for the period from 1995-96 to 2009-10

Table No52: The results of trends in the indicators of health in Tamil Nadu for the period from

1995-96 to 2009-10 (Model: Y1 = a + bt)

Sl. No Health Indicators Coefficients

R2

a b 1. Life Expectancy at birth 63.3587 0.661* (11.948) 0.917

2. Birth rate 20.6152 -0.3235* (-10.269) 0.890

3. Death rate 8.2123 -0.0607* (-4.998) 0.657 4. Infant Mortality Rate 66.7430 -1.1034* (-4.257)* 0.582

Source : Computed from secondary data.(44)

Note : Figures in parentheses are‘t’ values * Significant at 5 per cent level.

From Table 5 the trend and the annual rate of change of four health indicators have been observed.

Life expectancy at birth has registered an increasing trend and its annual rate of changes is, 0.661.

The birth rate, death rate and infant mortality rate have shown a declining trend, with the annual

rate of changes being -0.3235, -0.0607 and -1.1034 respectively. All these rates are significant

statistically.

During the study period, Life expectancy had increased from 64.09 to67.98 in the state. It had

increased at the rate of 0.299 per annum. Among the four health indicators, Infant mortality rate

had undergone the largest change. It had decreased from 54 to 28 and its higher annual rate of

change was -1.1034. The birth rate had decreased from 20.30 to 16.30 during the study period and

the annual rate of change was -0.3235. The death rate had also declined from 8.00 to7.60 in the

state and the rate of change per annum was –0.0607. The birth rate increased and death rate had

declined but annual rate of the decline in birth rate (- 0.3235) was higher than the decline in death

rate (-0.0607). These trends imply remarkable enhancement in the health status of Tamil Nadu for

the period from1995-96 to 2009-10.

0

10

20

30

40

50

60

70

80

19

95

-96

19

96

-97

19

97

-98

19

98

-99

19

99

-00

20

00

-01

20

01

-02

20

02

-03

20

03

-04

20

04

-05

20

05

-06

20

06

-07

20

07

-08

20

08

-09

20

09

-10

Ind

icat

ors

YEAR

Life Expectancy Birth Rate Death Rate IMR

226

Health, economic, demographic, social and educational variables are among the several

factors, which determine the status of health. Table 13 explicitly demonstrates the trends in

various health determinants in the state of Tamil Nadu.

The health care sector has witnessed a significant shift from non-institutional to institutional

deliveries over the years. Institutional delivery refers to the child birth at a technology-equipped

medical facility under the supervision of skilled medical staff. In an institutional delivery, various

modern medical tools and technologies are used to ascertain that the health of neonate or mother

is safeguarded. Better road connectivity between rural and urban, easytransportation, change in

attitude of the public, better access to health facilities and implementation of Dr.Muthulakshmi

Reddy Maternity Benefit Scheme had allhelped to improve the percentage ofmothers

whoreceived medical attention at delivery either at Government / private hospitals in the State. As a

result, there was a steady increase in institutional deliveries in the State. Theproportion of

institutional deliveries in the State had increased from 76 per cent in 2006 to92.4 in 2011. At this

level, the State is well above theall India (66.6%). Among the major States and as wellas southern

States, Tamil Nadu occupied the secondposition, next only to Kerala (99.7%).(Chapter XII - Tamil Nadu

Health)

Disease Burden

Disease burdenis the impact of a health problem as measured by mortality and morbidity. High cost

of medicines and longer duration of treatment leads to financial burden to low income groups. An

attempt has been made to assess the disease burden of various diseases in the State during 2012-13.

Among thevariousdiseases the number of casesreported in the State was thehighest in respect of

AcuteRespiratory Infections (27.37lakh), followed by diarrhealdiseases (2.0 lakh),A higher proportion

of 33per cent of cases reportedundercholera. (Policy Note 2013-14)

Table No.53: Cases and Death Reported by Diseases 2012-13 (No.)

Diseases Tamil Nadu All India

Cases Deaths Cases Deaths

Malaria 15486 0 953710 446

Chikungunya Fever 5018 0 15783 0

Japanese Encephalitis 935 64 7948 1190

Dengue 12264 66 47029 242

Cholera 523 0 1583 1

Diarrheal Diseases 199930 17 11701755 1647

Typhoid 34611 0 1477699 428

Acute Respiratory Infection 2737294 21 31684628 4155

Measles 623 0 22589 40

Viral hepatitis 10628 0 118880 551

Pneumonia 59187 54 779794 3750

Swine Flu 750 40 5044 405

Source: Directorate of National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, government of India, New Delhi.

227

Health Delivery System

The State has excelled in meeting the norms asenvisaged.

i. One Health Sub-Centre (HSC) for a population of 5,000 in plains and 3,000 in hilly and tribal

areas.

ii. One Primary Health Centre (PHC) for 30,000population in plains and 20,000 in hilly and tribal

areas and one Community Health Centre (CHC) for a population of one lakh.

Table No.54: Functioning of PHCs (in lakhs)

Category 2010-11 2011-12 2012-13 2013-14

No. of PHCs functioning 1539 1592 1614 1751

Total Patients Treated 822.76 844.23 899.50 934.69

Outpatients 811.48 832.55 885.26 919.36

Inpatients 11.28 11.68 14.24 15.33

No. of Deliveries conducted 2.08 1.94 1.64 1.58

Normal 2.03 1.86 1.55 1.47

Caesarean 0.05 0.08 0.09 0.11

No. of referral Cases 0.36 0.43 0.43 0.43

Source: Department of Public Health and Preventive Medicine, Chennai-6.

Therefore, the Institutional delivery rates have been increasing significantly over the years

Table No.55: Institutional Deliveries in Tamil Nadu (%)

Year Rural Urban 2006 59.4 99.0

2007 70.9 99.4

2008 78.7 99.3

2009 80.8 99.6

2010 85.8 98.5

2011 87.5 99.1

Source: Union Planning Commission, Government of India

Figure No.34: Institutional Deliveries (%)

76 82.8

87.5 88.6 91.2 92.4

34.9 38.6

47.1

58.2 60.5 66.6

2006 2007 2008 2009 2010 2011

Institutional Deliveries (%)

TN All India

228

A comparison with other states indicate that Tamil Nadu is only next to Kerala (highest) for

Institutional delivery

Table No. 56: Institutional Delivery among Major States (%)

States 2006 2011 Andhra Pradesh 56.2 90.7

Assam 25.1 61.8

Bihar 22.4 48.4

Gujarat 53.2 84.4

Haryana 33.7 69.9

Karnataka 60.4 88.4

Kerala 99.2 99.7

Madhya Pradesh 22.8 66.6

Maharashtra 58.1 59.7

Odisha 26.6 62.6

Punjab 42.7 73.4

Rajasthan 24.1 76.6

Tamil Nadu 76.0 92.4

Uttar Pradesh 15.0 48.4

West Bengal 44.8 70.5

All India 34.9 66.6

Source: Union Planning Commission, Government of India.

Among the rural and urban areas in Tamil Nadu, the institutional deliveries in the urban areas were

significantly higher than in rural areas. In rural areas it had gradually picked up from 59.4 per cent in

2006 to 87.5 per cent in 2011. In urban areas it hovered around 99.0 per cent Households in rural

areas still opt for home delivery because it involves less cost than at private/public health centres

without adequately recognizing the risk.(Chapter XII - Tamil Nadu Health)

A comparative Assessment

The following tables reveal that in terms of determinants in Tamil Nadu, all the determinants were

significant except one determinant namely per capita food availability which has not recorded any

significant trend. All others have shown significant and positive trends except PHC per million

populations and the fertility rate which are favourable to improve the health status. Among the 18

selected determinants, 15 determinants have significant and positive trends. Per capita income at

current prices, public health expenditure, and provision of drinking watervillages covered, have

shown the highest growth rate; whereas female literacy rate, literacy rate, couple protection rate,

sex ratio and number of hospitals have shown the lowest growth rate. The growth rate of other

determinants was moderate during the study period in the state. The favourable and unfavourable

monsoons during the study period resulted in fluctuations in food production and output. This was

the reason for insignificant and negative trend in per capita food availability in the state. Secondly,

PHC per million populations was statistically significant and its growth was marginally negative.

Thirdly the fertility rate had also negative trend which exhibited the awareness of people in small

family norms.

229

Table No57: Health determinants in Tamil Nadu for the period from 1995-96 to 2009-10

Year No. of PHCs

+ HSCs

Population per Bed ratio

No. of Doctors + Nurses

Population per Doctor Ratio

Female Literacy

Rate

Per capita food availability (in

Kg.)

Couple protect

Rate

Fertility rate

Sex ratio

Density of population per sq.km.

No. of Beds in PHCs

No. of Hospital

1995-96 10106 1926 22262 20511 55.41 143.00 50.90 2.2 981.00 445.00 29812 306

1996-97 10102 1954 23354 20698 56.77 167.20 51.80 2.1 981.00 451.00 30108 306

1997-98 10099 1977 22416 20784 58.12 107.40 53.00 2.0 982.00 456.00 30397 314

1998-99 10090 1995 22470 20853 59.48 114.90 54.90 2.0 982.00 462.00 30503 314

1999-00 10091 2031 22504 20978 60.84 133.00 54.60 2.0 84.00 468.00 30641 314

2000-01 10096 2015 22608 21010 62.20 126.50 56.20 2.0 984.00 473.00 30716 314

2001-02 10099 2017 22664 21018 63.36 135.00 57.30 2.0 980.00 475.00 30769 314

2002-03 10100 2018 22700 21025 64.55 146.60 58.70 2.0 986.00 478.00 30791 314

2003-04 10103 2019 22761 21034 65.31 147.21 59.21 2.0 991.00 479.00 30821 321

2004-05 10106 2021 22799 21045 67.91 149.24 61.21 1.9 991.00 479.00 30845 321

2005-06 10109 2023 22816 21051 68.21 150.15 61.25 1.7 991.00 479.00 30859 321

2006-07 10110 2025 22861 21063 68.31 151.21 62.24 1.7 993.00 481.00 30877 321

2007-08 10113 2027 22893 21065 68.43 152.14 62.31 1.7 993.00 481.00 30899 321

2008-09 10115 2079 22909 21068 68.54 152.31 65.21 1.7 993.00 481.00 30905 321

2009-10 10117 2030 22968 21069 68.91 152.43 65.20 1.6 993.00 481.00 30935 321

Source: (i) ‘Tamil Nadu – An Economic Appraisal’ for various years, Published by Department of Evaluation and Applied Research, Chennai.

(ii) Statistical Hand Book of Tamil Nadu for various years. (iii) 1991 Census of India, (iv) 2001 Census of India.

230

Table No. 58: Results of trends in health determinants in Tamil Nadu state for the period from 1995-96 to 2009-10 (Model: Yt = a + bt)

SL. NO DETERMINANTS OF HEALTH COEFFICIENTS

R2 a b

1 PHCs and HSCs (X1) 10092.79 1.3678* (4.051) 0.558

2 Population per bed ratio (X2) 1957.95 6.5642* (5.086) 0.666

3 Doctors and Nurses (X3) 22514.16 27.2714*(1.859) 0.210

4 Population per doctor ratio(X4) 20703.58 30.986*(5.412)* 0.693

5 Female literacy rate (X5) 55.543 1.026*(15.192) 0.947

6 Per capita food availability (X6) 128.893 1.624 (1.862) 0.210

7 PHC per million population (X7) 0.040 0.0047*(15.958) 0.951

8 Per capita income (X8) 10033.58 698.16*(5.768) 0.719

9 Public Health expenditure (X9) 23581.867 2712.008*(7.983) 0.830

10 Literacy rate (X10) 64.972 1.005*(37.601) 0.991

11 Employment in organised Sector (X11) -39012.68 7814.92 (1.740) 0.1889

12 Provision of drinking water – Villages Covered (X12) 8258.590 829.167* (19.027) 0.9653

13 Couple protection rate (X13) 50.03009 1.0298* (31.394) 0.9869

14 Fertility rate (X14) 2.20381 -0.0371* (-8.925) 0.8596

15 Sex rate (X15) 978.971 1.053* (13.939) 0.9372

16 Density of population (X16) 451.780 2.4357* (7.443)* 0.8099

17 Beds (X17) 30155.304 62.903* (6.1427) 0.7437

18 Hospitals (X18) 307.628 1.0714* (7.368)* 0.8068

Source: Computed from secondary data Note : Figures in parentheses denote ‘t’ values

*Significant at 5 per cent level

231

Per capita income at current prices in the state had increased from Rs.7352 to Rs.18314 that is, a

two fold increase during the study period. Public healthexpenditure had risen from Rs.13071.34

lakhs to Rs.58624.19 lakhs, a threefold increase. The inflationary effect might have partly

contributed to this huge income in public health expenditure. Villages covered for provision of safe

drinking water,increased from 8134 to 19341. The female literacy rate had been accelerated from

54.35 to 71.99 in the state, thanks to Total Literacy Campaign launched by the National Literacy

Mission, New Delhi between 1991 and 1995. The per capita food availability in the state increased

from 117.30 kilograms to146.60 kilograms during the study period. PHC per million was 0.082 in

1994-95 and it had declined to 0.044 due to growing population,low commitment to open up new

additional PHCs and cut in health budget during the last decade, owing to the impact of globalisation

and New Economic Policy of 1991.

The National Rural Health Mission (NRHM)

The state also very successfully implemented the National Rural Health Mission (NRHM) as indicated

below (Policy Note 2013-14):-

The focus of the mission was on establishing a fully functional, community owned,

decentralized health delivery system with inter-sectoral convergence at all levels to ensure

simultaneous action on a wide range of determinants of health like water, sanitation, education,

nutrition, social and gender equity. It aimed to improve the health status of the people especially

those who live in villages by providing rural healthcare services effectively and efficiently. Basic

thrust of NRHM was(Policy Note 2013-14):

Provision of accessible affordable, accountable, effective and reliable primary health care

facilities, especially to the poor and vulnerable sections of the population,

Bridging the gap in rural health care services through creation of a cadre of Accredited

Social Health Activities (ASHA),

Improved hospital care,

Decentralized planning,

Ensuring population stabilization,

Inter-sectoral, convergence and maintaining gender balance.

Health Insurance Scheme

The Chief Minister’s Comprehensive Health Insurance Scheme was also launched in the State in

2011-12 with the aim to provide Universal Healthcare to all by providing free medical surgical

treatment inGovernment and private hospitals to any family whose annual income is less than Rs.72,

000 by meeting allexpenses relating to the hospitalizationof the beneficiary. (Chapter XII - Tamil Nadu

Health)

The Way Forward:

Health promotion and prevention need to be given more attention to reduce the

incidence of Non-Communicable Diseases (NCDs) and their risk factors.

Integration of crosscutting components like health promotion, prevention, screening of

population, training, referral services, emergency medical services, publicawareness

232

programme management, monitoring &evaluation etc. would save on costs and make

implementation more effective.

Early Diagnosis through periodic/opportunistic screening of population and better diagnostic

facilities is found to be more effective.(Policy Note 2013-14)

233

I.2. Nutrition

1. Prologue

Nutritional status is one of the indicators of the overall wellbeing of population and human

resources development. Malnutrition is the cumulative effect of factors like poverty, inadequate

access to food, illiteracy, large size of families, poor environmental sanitation, and lack of basic

minimal health care, lack of personal hygiene, lack of easy access to adequate safe drinking water

and lack of awareness. The manifestations of malnutrition could be seen in the prevalence of

specific nutrient-deficiency disorders such as protein-energy malnutrition, anaemia night blindness,

goitre, susceptibility to a number of infectious diseases, low birthweight of children, high IMR and

MMR, lack of resistance to illnesses among mothers and children, growth retardation (both physical

and mental) and stunting among toddlers.(Policy Note 2013-14)

Adequate health and nutrition status of individuals is, both, an end in itself and a means to promote

the productive potential of the population in the interest of economic development. (Anuradha K

Rajivan, 2005)

The concept of nutritional status has undergone considerable change over the years – it is no longer

understood simply as the outcome of deficiencies or excesses of one or more essential nutrients. It is

well recognized today that nutritional status cannot be viewed independently of health status as

there are complex biomedical relationships between an individual’s food intake, nutrient absorption

and utilization by the body, individual activity levels and the incidence of disease.(Anuradha K

Rajivan, 2005)

“A child’s growth rate reflects, better than any other single index, his state of health and nutrition,

and often indeed his psychological situation also. Similarly, the average value of children’s heights

and weights reflect accurately the state of a nation’s public health and average nutritional status of

its citizens, when appropriate allowance is made for differences, if any, in genetic potential. This is

especially true in developing and disintegrating countries(Anuradha K Rajivan, 2005)(Eveleth, P.G. and

J.M. Tanner, 1976.)

Systematic variations in anthropometric outcomes, like weights and heights, among populations

have been largely attributed to the social, economic and environmental conditions in which people

live. A combination of poverty, ill- health and deprivation can result in lower growth, weights and

heights. This is a phenomenon observed internationally. Of course, heredity also plays a crucial role.

Anthropometric measurements are always an outcome of, both, heredity and the environment in

which children grow. However, repeatedly, international data have demonstrated that variations in

growth within very broad racial groupings can primarily be attributed to the effects of the conditions

in which populations live. (Thoday, 1965; Fischbein, 1977; Bergman and Goracy, 1984; Eveleth and

Tanner, 1976; Martorell and Habicht, 1988)(Anuradha K Rajivan, 2005)

Consequences of inadequate health and nutrition are poor physical and mental growth, illness and

death in terms of concerns regarding human development. In terms of economic development

consequences like inadequately skilled labour, absenteeism, avoidable expenditures on curative

services and low productivity lead to high costs for any economy. In recognition of this the

Government of Tamil Nadu have put in place a network of services and infrastructure for health

and direct nutrition interventions. TN has also benefited from its relatively developed position as

234

compared with other States in India because of which there is a general upward trend in the overall

health and nutritional status of the population.(Anuradha K Rajivan, 2005)

Heights and weights provide information on different aspects of nutrition status. In Tamil Nadu

weight-for-age is used as an indicator to assess short term, current nutritional status. This takes into

account the body mass. Theextent of weight deficiency for particular ages as compared with pre-

determined reference weights represents current malnutrition among children. (Similarly, height-

for-age deficits as compared with reference heights capture past malnutrition not used in mass

direct nutrition schemes in the State) (Anuradha K Rajivan, 2005). Malnutrition and Infection are the

two most important factors that affect the growth of children. In most cases of childhood infections,

the cause can be traced to insufficient food intake or absorption, which renders the human system

vulnerable to infections. The magnitude of the problem of malnutrition among children under five

years of age is high throughout in India (William Roseline F, Bijou Joel, Ali Mohamad, Velan Vinayaka).

More than 26,000 children under the age of 5 die around the world each day mostly conditions due

to preventable causes. Nearly all of them live in developing countries or, more precisely in 60

developing countries(Child Survival.Report of UNICEF; 2008). A child’s entire life is determined in

large measures by the food given to him during his first five years. Childhood is a period of rapid

growth and development, and nutrition is one of the influencing factors in this period (Shills ME,

Young VREd, 1998). A number of anthropometric indices have been used successfully for many years

to estimate the prevalence of under-nutrition among pre-school children. These include height-for-

age, weight-for-age and weight-for-height. Height-for-age is an index of cumulative effect of under-

nutrition during the life of the child. Weight-for-age is the combined effects of both, the recent and

the long-term levels of nutrition, whereas weight-for-height reflects the recent nutritional

experiences of the child. These indices are reasonably sensitive indicators of the immediate and

underlying general causes of nutrition(Malik AS, Mazhar AU, 2006). The risk of mortality is inversely

related to children’s height-for-age and weight-for-height(Khan ME, 1993) (Pelletier DL, Frongillo EA,

Scroeder DG, Habicht JP, 1994). Freedom from hunger and malnutrition is a basic human right and

their alleviation is a fundamental prerequisite for human and national development(Health and

Development, 2009).

2. History

In Tamil Nadu around 45% of children below 5 years are under-weight(Weight-for-age below 2SD of

median). The percentages are higher in rural areas (52%) as compared with urban (37%). While this

is better than the all India situation, of 53% overall, states like Kerala, Haryana and even Rajasthan

seem to be doing better than TN.(Anuradha K Rajivan, 2005)

While levels of under nutrition may be high, the trend shows an improvement in the nutrition status

of the preschool children in TN over the last two decades. This is in keeping with the all-India trend

observed from the mid-1970s.(Anuradha K Rajivan, 2005)

A district wise comparison of Nutritional state of children in Tamil Nadu between 1996 and 2001 is

given in the following table.

235

Table No. 59: District Wise Nutritional Status of Children in TN, WB ICDS III

Sl. No. District

Moderately Malnourished

Severely Malnourished

1996 2001 1996 2001

1. Coimbatore 6.7 3.7 0.5 0.2

2. Dharmapuri 16.3 11.0 1.3 0.1

3. Kanyakumari 6.8 2.5 0.2 0.1

4. Madurai 11.7 5.7 0.9 0.2

5. Theni 11.7 4.5 0.9 0.1

6. Vellore 9.4 5.7 0.8 0.3

7. Erode 13.9 4.4 0.7 0.1

8. Ramanathapuram 14.3 9.2 2.1 0.3

9. Salem 16.7 4.4 1.3 0.1

10. Namakkal 16.7 5.4 1.3 0.2

11. Cuddalore 20.4 9.5 0.9 0.2

12. Villupuram 19.2 13.5 1.8 0.3

13. Thanjavur 17.4 8.7 2.0 0.2

14. Trichy 17.3 6.8 1.6 0.2

15. Tirunelveli 12.3 8.4 1.5 0.5

16. Virudhunagar 12.4 9.6 1.6 0.6

17. Thoothukudi 9.0 5.5 0.9 0.3

18. Sivagangai 15.4 6.1 1.6 0.2

19. Tiruvannamalai 13.0 9.6 1.6 0.4

20. Dindigul 12.5 6.0 0.8 0.1

21. Nagapattinam 28.2 11.9 4.6 0.4

22. Tiruvarur 15.4 10.0 1.2 0.3

23. Karur 17.3 5.5 1.6 0.2

24. Perambalur 17.3 7.2 1.6 0.2

Source:Food Security and Nutrition; Tenth Five year Plan 2002-2007; State Planning Commission; Govt. of

Tamil Nadu

These improvements can be attributed to all three factors(Anuradha K Rajivan, 2005):

a. The overall improvement in the incomes of households resulting in more resources available

for food within households,

b. Theincrease in education levels among the population contributing to‘health seeking

behaviour’,

c. The consistent public policy of state provisioning of health and nutrition services.

History of Direct Nutrition Interventions in TN -

Providing food for children outside the home is not a new idea in TN. In some form or other this has

been in operation from way back in 1956.(Anuradha K Rajivan, 2005)

236

2.1. School Mid -day Meals:

In 1956 a school mid -day meals scheme was in operation in what was then the Madras State. It

functioned in 8000 elementary schools covering 2 lakhs children.In 1961 CARE offered food

commodity assistance (Bulgar wheat) which was readily accepted and the scheme’s implementation

was extended to cover 16 lakhs children in 30,000 schools.(Anuradha K Rajivan, 2005)

Starting on July 1st1982, TN saw the beginning of one of the largest phased expansions of mid -day

feeding through the Noon Meals Program.(Anuradha K Rajivan, 2005)

2.2. Central Kitchens:

In 1967 the system was radically modified to operate through Central Kitchens.In a year 200 days

were prescribed feeding days, of which 100 were supposed to be rice days and 100 CARE food

days.(Anuradha K Rajivan, 2005)

2.3. NMP:

Starting on July 1st1982, TN saw one of the largest expansions of mid-day feeding through the Noon

Meals Program (NMP) of the former Chief Minister, MGR, who felt that no child should go hungry.

This time it was the pre-schoolers who were first covered. It was sheer personal commitment and

political will which saw the program through its teething and bureaucratic doubts about funding and

logistics. It had also caught the imagination of the Government of India, which is now a national

Programme.(Anuradha K Rajivan, 2005)

Government of TN has been spending significantly on the NMP and complementary feeding through

nutrition supplements for pre-schoolers, pregnant and nursing women, and has brought about an

integration of allmajor health and nutrition interventions for children. In1994, a State Policy on

Nutrition has been explicitly drafted with technical support from the UNICEF. TN is probably the first

state to have such a policy, following the National Nutrition Policy, 1993. (Anuradha K Rajivan, 2005)

2.4. Hunger to Nutrition:

While initially feeding programs may have been started to combat hunger in a visible, centre based

fashion, over the years the government in TN have made serious attempts to combine provision of

food under the Noon Meal Program (NMP) with other services like health care, immunization,

growth monitoring, pre and post natal care for women, communication and nutrition education. This

has been done through two main nutrition and child development programs: the Integrated Child

Development Services Scheme (ICDS) which started as a small pilot in 1976 and the TN Integrated

Nutrition Project (TINP), which started in its phase I in1980. As both these nutrition schemes

expanded, they were integrated with the Noon Meal Program infrastructure for pre-schoolers.(25)

In the State Policy however for the first time in the year there is an explicit recognition that food

alone cannot eradicate malnutrition.(Anuradha K Rajivan, 2005)

2.5. ICDS Programme:

The centrally sponsored ICDS was introduced in TN in 1976, starting small with just three projects: 2

rural and 1 urban. At present there are 113 General ICDS projects (69 rural, 44 in urban slums). An

integrated package of health, supplementary nutrition, together with cognitive and psycho-social

237

services was contemplated for children under 6. Their services are provided through a network of

Anganwadis. (2016??)(Anuradha K Rajivan, 2005)

It can be seen that over the between year 1992 – 93 to 2002 - 2003 the state’s budgetary

commitment to nutrition has increased significantly in absolute terms. From Rs. 27,231 lakhs in

1992-93, it has increased to as much as Rs. xxxx lakhsin 2002-03 (Anuradha K Rajivan, 2005)

3. Developments

3.1. “Malnutrition free” Tamil Nadu

“To live a life without malnutrition is a fundamental human right. The persistence of malnutrition,

especially among children and mothers, in this world of plenty, is immoral. Nutrition improvement

anywhere in the world is not a charity but a societal, household and individual right. It is the world

community’s responsibility to find effective ways and means to invest for better livelihood and

to avoid future unnecessary social and economic burdens. With collective efforts at

international, national and community levels, ending malnutrition is both a credible and achievable

goal.”(Report Food and Nutrition Bulletin, 2000) (Food Security and Nutrition, Tenth Five year Plan 2002-

2007)

The Government of Tamil Nadu is fully committed to promote, protect and fulfil the rights of all

people to food and nutrition as enshrined in several International Declarations and Conventions on

Human Rights.(Food Security and Nutrition, Tenth Five year Plan 2002-2007)

It is recognised that the social and economic costs of poor nutrition are huge. Social investment in

nutrition will reduce health care costs, reduce the burden of non-communicable diseases, improve

productivity and economic growth and promote education, intellectual capacity and social

development.(Food Security and Nutrition, Tenth Five year Plan 2002-2007)

Nutrition has been very high on the political agenda of Tamil Nadu State for many decades and many

nutrition programmes for young children and mothers were planned and implemented. Yet, the

incidence of malnutrition compared to developed countries and even some of the developing

countries are a matter of concern. The prevalence of Low Birth Weight and the prevalence of

malnutrition and micro nutrient deficiencies among children, women, adolescents in Tamil Nadu are

all relatively high. Further, the prevalence of diet related, non-communicable diseases such as

coronary heart disease, diabetes and high blood pressure are increasing as a result of increasing

obesity. The trends of urbanisation, industrialisation and globalisation have resulted in lifestyles that

are harmful to good health and nutrition among all sections of society.(Food Security and Nutrition,

Tenth Five year Plan 2002-2007)

The National Family Health Survey-III (2005-06) throws light on the nutritional status of the people

among the States. Based on the data the following inferences were drawn:

With regard to the nutritional status of the children, 29.8 per cent of the children below five

years in the State were having underweight. It was comparatively lower than all India as

well as Andhra Pradesh and Karnataka.

30.9 per cent of the children were having stunted growth in the State as compared to48 per

cent at all India. Among the southern States the ratio was the lowest in Kerala.

238

22.2 per cent of children in Tamil Nadu were with wasted growth. The proportion was

higher than all India as well as the three neighbouring southern States.

Among 6-59 months children 64.2 per cent were anaemic in Tamil Nadu and it stood second

lowest among the southern States, the first being Kerala with 44.5 per cent.

In respect of married women (15-49 years) 53.2 per cent were anaemic in Tamil Nadu.The

State occupied the third place among southern States; the best two performingStates were

Kerala (32.8%) and Karnataka (51.5%).

In the case of pregnant women, 53.3 per cent in Tamil Nadu were anaemic. At this level,

the State was better placed over Andhra Pradesh (56.4%), Karnataka (59.5%) and all India

(57.8%).

With regard to the proportion of women and men having body mass index below normal

Tamil Nadu ranked second next only to Kerala.

Turning to overweight, the proportion among men and women in Tamil Nadu was higher

than all India as well as the other two southern States Andhra Pradesh and Karnataka. This

proportion in Kerala was higher than in Tamil Nadu.(Policy Note 2013-14)

Table No. 60: Nutritional Status Select Indicators (2005-06) (%) – NFHS - 3

Indicators Andhra Pradesh

Karnataka Kerala Tamil Nadu

All India

1. Nutritional Status of Children below 5 years

a. Stunted Growth 42.2 43.7 24.5 30.9 48.0

b. Wasted Growth 12.2 17.6 15.9 22.2 19.8

c. Under Weight 32.5 37.6 22.9 29.8 42.5

2. Anaemic Status

a. 6-59 months Children 70.8 70.4 44.5 64.2 69.5

b. 15-49 age marriedwomen 62.9 51.5 32.8 53.2 55.3

c. 15-49 age Pregnantwomen 56.4 59.5 33.1 53.3 57.8

d. 15-49 age marriedmen 23.3 19.1 8.0 16.5 24.2

3. Nutritional Status of Adults

a. Women Body mass (below normal) 33.5 33.5 18.0 28.4 35.6

b. Men Body mass (below normal) 30.8 33.9 21.5 27.1 34.2

c. Women Overweight 15.6 15.3 28.1 20.9 12.6

d. Men Overweight 13.6 10.9 17.8 14.5 9.3

Source: National Family Health Survey – III (2005-06), Ministry of Health and Family Welfare, Government of India.

Through the implementation of Integrated Child Development Services Schemes (ICDS) through

54.439 Child Centres (49,499 Anganwadi Centres+ 4940 mini Anganwadi Centres) in 434 child

Development blocks (385 rural,47 urban and 2 tribal) and Puratchi Thalaivar MGR Nutritious Meal

Programme the State has envisaged to improve the nutritional status of children, pregnant women,

lactating mothers and adolescent girls and thereby to attain the goal of Malnutrition free Tamil

Nadu. These two schemes together had benefited 88.65 lakh persons in the State in a year. Of them

as high as 87.8 per cent were children,7.6 per cent pregnant women, 4.5 per cent adolescent girls

and 0.1 per cent old age pensioners. (Policy Note 2013-14)

239

A coordinated effort of all Government programmes and inputs is needed in a “Mission Mode”,

coupled with a massive social marketing campaign that would generate a people’s movement

towards healthy lifestyles based on scientific understanding.(Food Security and Nutrition, Tenth Five

year Plan 2002-2007)

With this new vision and approach, the Government of Tamil Nadu announced in 2002 its intention

to make Tamil Nadu “Malnutrition free.” (G.O Ms.No.55 dated 8.4.2002).(Food Security and Nutrition,


The major Nutrition intervention in this regards are given in the following box:

Major nutrition interventions for 'Malnutrition Free State'

i. Promoting Behavioural Change Communication

Family Counselling & Follow up by Community Volunteers and

Government health and nutrition staff for all families with pregnant

women and children under three years

Local community education on key family health and nutrition

practices using participatory and traditional communication

methodologies

Mass media Campaign on key family health and nutrition practices on

long term sustained basis

ii. Curative health care improved at village level in Government and private

health facilities

iii. Social marketing of iodised salt, Iron and folic Acid and Vitamin A

supplements, nutritious food mixes and other low cost

vitamin/mineral premixes

iv. School based interventions including water, sanitation and health care

facilities, health and nutrition education on key family practices and life skills

training

v. Revamping of Public Distribution System to enable

management by women’s Self Help groups

diversify the food items available

ensure constant supply of necessary nutrients in adequate quantities

for poor families

vi. Revamping of existing direct nutrition programmes to enable management by

women’s Self Help Groups and /or Local Bodies. (Food Security and Nutrition,


240

3.2. Goal for 2020

The Policy for a ‘Malnutrition Free Tamil Nadu' will guide the State's long - term multi - Sectoral response to mal nutrition from the year 2003 to 2020.(Food Security and Nutrition, Tenth Five year

Plan 2002-2007)

12th Plan Targets and Outlay

Hence, the state has developed clear cut objectives for the 12th Five Year Plan, which is clearly

envisaged in its target and outlay as follows:-

Total Outlay for nutrition – Rs.11285 crore

Share in total 12th Plan outlay – 5.3 percent

Objectives

Eradicating malnutrition among children 0-6 years

Promoting nutritive value of millets

Focusing on life style approach for improving nutrition and health status

Holistic empowerment of adolescent girls

Strengthening, modernizing and improving service delivery

Building the capacity of field functionaries

Table No. 61: Monitoring Targets (%)

Monitoring Targets (%)

Indicators 2017

Low Birth weight 10

Underweight children 0-3 years 16

Children 0-3 years with stunting 18

Children 0-3 years with anaemia 32

Adolescent girls with anaemia 20

Pregnant women with anaemia 30

Women among 15-49 years with anaemia 33

Source: 12thPlan Document, State PlanningCommission,Chennai-5.

Hence the goal is to reduce human malnutrition of all types including sub-clinical deficiencies, to the

levels of the best performing countries in the world. (Food Security and Nutrition, Tenth Five year Plan

2002-2007)

Box No. 2: Malnutrition Free Tamil Nadu

Goals for 2020

Low Birth Weight - 10%

Anaemia in Adolscent girls - 20%

Anaemia among children - 20%

Anaemia in pregnant women - 30%

241

Table No. 62: Objectives up to 2020

Indicator (in %) 2000 2007 2012 2020

Low Birth Weight 23 20 15 10

Underweight among 0-3 years 36.7 30 20 15

Stunting among 0-3 years 29.4 25 20 15

Anaemia in Adolescent Girls 50-60 40 30 20

Anaemia in 0-3 year Children 69 50 40 20

Anaemia in Pregnant women 60 50 40 30

Average weight (kg) at 17 boys 48.3 68.9

Average weight at 17 (kg) girls 43.1 56.6

Average height at 17 (cm) boys 162 176.8

Average height at 17 (cm) girls 153.2 163.7

Body Mass Index (BMI)

BMI < 18.5 women 38.2 <10

BMI < 18.5 men 35.5 <10

BMI > 25 women 8.9

BMI > 25 men 7.0

The family will be considered as the unit for targeting interventions rather than focussing on

individual children women, adolescents etc. In this way the entire lifecycle approach can be easily

addressed.(Food Security and Nutrition, Tenth Five year Plan 2002-2007)

242

1.3. WASH

Water

In 2010 the United Nations general assembly recognized to declare that safe and clean drinking

water and sanitation as human rights. (JMP, 2012)

Millennium Development Goals have played a very important role in the development of very basic

need of a human being i.e. drinking water and sanitation. Safe drinking water is necessary for living a

healthy and hygienic life for each and every individual. Before the implementation of Millennium

Development Goals in the year 2000, both the drinking water source and sanitation facilities were

poor in Tamilnadu which led to lots of diseases that killed many innocent lives and that children

were the first victims for all sorts of impacts between 2001 and 2011. (Ministry of home affairs,

population census of India, 2011)

Tamil Nadu state has a geographical area of 1,30,058 sq.km and is situated between North Latitudes

080 00’ and 13o30’ and East Longitudes 76o15’ and 80o 18’. The State is bounded by Bay of Bengal

in the east, Indian Ocean in the south, Western Ghats in the west and the States of Karnataka and

Andhra Pradesh in the north. (TWAD Board)

For administrative purpose, the State is divided in to 32 Districts, 209 Taluks and 385 Blocks. The

State has 10Corporations, 150 Municipalities, 559 Town Panchayats, 12,620 Panchayat Villages and

93,699 Habitations.(TWAD Board)

Physiographically, Tamil Nadu State is divided into Four units viz..

Coastal Plains

Eastern Ghats

Central Plateau

Western Ghats

The coastal Plains stretch over a distance of about 998 kms extending from Pulicat Lake to Cape

comerin. (TWAD Board)

Tamil Nadu is predominantly a shield area with 73% of the area covered under hard crystalline

formations while the remaining 27% comprises of unconsolidated sedimentary formations. As far as

ground water resource is concerned scarcity is the major problem in hard rock environment while

salinity is the problem in sedimentary areas. (TWAD Board)

Tamil Nadu is a state with limited water resources and the rainfall in the state is seasonal. The

annual average rainfall in the state is 970 mm. Approximately 33 % of this is from the southwest

monsoon and 48 % from the northeast monsoon. (TWAD Board)

The task of providing safe drinking water and sanitation facilities for the rural areas in the State is

the responsibility of the Department of Rural Development & Panchayat Raj and Tamil Nadu Water

Supply & Drainage Board (TWAD). (Twelfth Five year Plan)

The Chennai Metropolitan Water Supply and Sewerage Board (CMWSSB) has been playing a

crucial role in delivery of protected water supply and sewerage services to the Chennai Metropolitan

Area. (Twelfth Five year Plan)

243

The Municipal Corporations and Special Grade Municipalities are also empowered to take up water

supply schemes on their own. (Twelfth Five year Plan)

Surface water:

Tamil Nadu has 17 major river basins with a surface water potentialof 853 Thousand Million Cubic

feet (TMC). More than 90% of the surface water has already been utilized. The State has initiated

several schemes in the Twelfth Five year Plan for interlinking of rivers in the State.(Twelfth Five year

Plan)

Surface water Potential

The total surface water potential of the river basins of Tamil Nadu is assessed as 24160 MCM (853

TMC).(TWAD Board)

Ground Water:

The total available ground water in Tamil Nadu as per the Ground water estimation Committee is

734 TMC. According to the Committee, the status of utilization of ground water in the 385 blocks of

the State is shown in Table 15.(Twelfth Five year Plan)

Table No. 63: Ground Water Utilization

Category Ground Water Utilization No. of Blocks

Over exploited More than 100 % 138

Critical 90 to 100 % 33

Semi-Critical 70 to 90 % 67

Safe Less than 70 % 136

Poor Quality 11

Total 385

Source: Tamil Nadu Water Supply Board

Groundwater Potential:

Table No. 64: Categorisation of Blocks

Categorisation of Blocks No. of Blocks

OverExploited (>100%) 142

Critical (90100 %) 33

Semicritical (7090%) 57

Safe (<70%) 145

Saline Blocks 8

Total 385

Source: TWAD Board

Water Supply

Water availability is a pre requisite for food security and water now is becoming a scarce

commodity. The other sectors like industries, hydro power, domestic, livestock and environment

need increasing share of water. The demand from the various sectors as assessed by the Institute of

Water Studies, Government of Tamil Nadu is presented in the table below.(Twelfth Five year Plan)

244

Table No. 65: Annual water demand in TMC

S.No Sectors Annual water demand in TMC

1 Drinking Water sector Corporation : 13.80 TMC Municipalities : 9.60 TMC Town Panchayat : 10.00 TMC Rural : 18.00 TMC

51.40

2 Irrigation Sector 1766.00

3 Industries 54.90

4 Power 4.20

5 Live stock 18.30

Total demand 1894.80

Source: TWAD Board

The following table depicts the gap between the demand vs availability. The challenge is how best

this gap could be bridged by reducing the demand or by efficient water management.(Twelfth Five

year Plan)

Table No. 66: Supply/Demand in TMC

Description Supply/Demand in TMC Total Assessed water Resources 1587.00

Drinking water demand 51.40

Irrigation demand 1766.00

Industries, Power, Live stock 77.40

Total Demand 1894.80

Gap (Demand – Availability) 307.80

Source: TWAD Board

Rural Water Supply

Modified rural water supply guidelines issued under National Rural Drinking Water Project

(NRDWP) emphasize a paradigm shift from the existing habitation coverage into household coverage

as issued by theGovernment of India. A State Level Water and Sanitation Mission (SWSM) was

formed in Tamil Nadu in 2009 to achieve the above goals and also for the effective implementation

of works under the NRDWP.(Twelfth Five year Plan)

A survey was conducted in the Statein 2011, to assess the status of water supplycoverage in the

habitations. As per the survey,out of total 94,614 habitations, 84,003 habitations (89%) were

supplied 40 LPCD or more (fully covered) and 10,611 habitations were provided 10 to 39 LPCD

water (partially covered). There were no uncovered habitations at the end of the Eleventh Plan. (See

Table 16) (Twelfth Five year Plan)

245

Table No. 67: Status of Rural Water Supply

Status Hibernations

Fully Covered 84003

Partially Covered 10611

Uncovered Nil

Total 94614

Source: Tamil Nadu water Supply &DrainageBoard

Table No. 68: Performance of Eleventh

Year Habitations Benefitted

Expenditure

2007-08 12549 749.69

2008-09 10255 824.48

2009-10 8193 872.02

2010-11 7004 666.04

2011-12 6000 753.00

Total 44001 3865.23

Source: Tamil Nadu water Supply &DrainageBoard

Coverage of habitations also involves schemes for water supply to schools, Anganwadis,

primary health centres, government hostels in rural areas. In addition to water supply schemes,

programmes for artificial recharge of ground water, Quality monitoring and surveillance, Testing and

arresting contamination were also implemented by TWAD Board.(Twelfth Five year Plan)

Table No.69: Performance of Rural Water Supply in Eleventh Plan

S.No Programme Unit Target Achievement

1 Coverage of Habitations Nos 40880 44001

2 Water Supply Schemes to Schools Nos 9436 9427

3 Rejuvenation of Water Supply Schemes to Schools Nos 4186 5043

4 Water Supply Schemes to Anganwadis Nos 20738 20738

5 Water Supply Schemes to Primary Health Centre Nos 239 239

6 Water Supply Schemes to Veterinary Hospitals Nos 314 314

7 Water Supply Schemes to BC/ MBC, TW/ADW Hostels Nos 578 578

8 Water Supply Schemes to Cattle Market, Bus stand, Weekly market

Nos 744 744

9 Recharge Structures Nos 2143 2861

10 Rural Water Supply Under Minimum Needs Programme/ ARWSP/NRDWP (Spl. Components)

Nos 12928 12928

11 Rural Water Supply Under Minimum Needs Programme /ARWSP/NRDWP (TSP Plan)

Nos 1436 1436

12 Schemes for Artificial Ground Water Recharge Structure

Nos 1412 1412

13 Jalmani -Standalone Purification System Nos 8500 8500

14 Water Quality Monitoring and Surveillance - Testing of water sources by laboratories

Nos 556734 556734

15 Water Quality Monitoring and Surveillance – Supply of Field testing kit to Village Panchayats

Nos 16628 16628

16 Supply of field H2S vials to Panchayat Nos 1803068 1803068

246

Presidents to test for bacteriological contamination

Source: Tamil Nadu Water Supply and Drainage Board

Coverage of Rural Habitations

In Tamil Nadu as on 1.4.2010 there are93,699 habitations, of which 8,970 habitations are partially

covered habitations and 84,729 are fully covered(TWAD Board)

Rural Habitations are covered through Individual Power Pump Schemes and Combined Water Supply

Schemes. (TWAD Board)

Figure No.35: Coverage of Rural Habitation

Urban Water Supply

Access to and provision of safe drinking water to every household in the ULBs has been one of the

primary concerns of the Government. Ensuring equitable and adequate supply of drinking water

and its effective delivery is a major challenge for the ULBs. (Twelfth Five year Plan)

To achieve the above primary objective the Government has initiated various water supply projects

under TNUDP-III, UIG, UIDSSMT (JnNURM), JICA, KfW. Agencies such as TWAD Board, CMWSS Board

have also taken up implementation of water supply schemes. Apart from the above agencies,

certain Corporations and Municipalities have also started implementation of major water supply

schemes on their own.(Twelfth Five year Plan)

247

Water Supply Status in Urban Towns

Table No.70: Civic status

Civic status Good Average Poor Total Corporations (excluding Chennai) 2 7 - 9

Municipalities 44 93 13 150

Town Panchayats (Erstwhile RTP &UTP) 346 208 5 559

Total 392 308 18 718

Source: TWAD Board

IntegratedUrban Water Management (Global water Partnership)

Alignment of water sub-sectors within cities and beyond

Water conservation and efficiencyefforts

Water sensitive planning and design (including urban layout and landscaping)

Storm water and waste water source control, pollution prevention and flow and quality

management

Use of mixtures of ecological solutions and infrastructure

Use of non-structural tools such as education, pricing incentives, regulations and restriction

regimes

Special Programmes

1. Rain Water Harvesting (RWH)

Rain is the pre-dominant source of all fresh water on earth. Rain Water Harvesting is relevant for

both rural and urban areas and at Macro and Micro levels.

Rain water harvesting structures have been created throughout the State during the Tenth Plan

period. This intensive programme had helped the ground water table to rise substantially and had

led to better recharge of underground aquifer. (Twelfth Five year Plan)

2. Water Quality

The present status of water quality in terms of Potability in Tamil Nadu in respect of major

parameters such as Iron, Fluoride, TDS, Nitrate, Feacal Coliform bacteria in water has been mapped

based on the testing of 3,42,854 drinking water sources up to 2011

As per the test results, it is evident that all the districts have at least any one of the quality problems

and 3.94% of sources are having quality problem. It is essential to recognize water quality as a

dynamic factor, and periodic testing should be conducted to ensure the quality

In order to achieve the objective of ensuring quality water supply to the public, the TWAD Board has

established one State level, 31 District level and 51 Sub divisional level laboratories.(Twelfth Five

year Plan)

3. Rejuvenation ofTraditional Water Bodies

Ooranies are traditional water bodies created to harvest rain water for drinking and other

purposes.

248

The Rejuvenation of Ooranies project has ensured clean water for the communities throughout the

year with minimum O&M cost.

The `Edaiyur Model,’ attracted the attention of many, including the German Government. (Twelfth

Five year Plan)

4. Microcredit for water connections in Tamil Nadu

In Tiruchirapalli in Tamil Nadu, the NGO Gramalaya, established in 1987, and women self-help

groups promote access to water supply and sanitation by the poor through microcredit. Among the

benefits are that women can spend more time with their children, earn additional income, and sell

surplus water to neighbours. This money contributes to her repayment of the WaterCredit loan. The

initiative is supported by the US-based non-profit Water Partners International. (Water Partners

International, 2008)

Twelfth Five Year Plan

The State has set a Vision to provide “A World Class, Secure, Affordable and Sustainable Water

Supply, Sanitation and Sewerage system Accessible to Every Citizen of Tamil Nadu” by the end of

2023. The objectives of the Twelfth Five Year Plan would be towards achieving the goals set by the

Vision 2023 by ensuring Drinking Water Security and Source Sustainability.(Twelfth Five year Plan)

The Twelfth Five Year Plan will see a paradigm shift with respect to water and the prime focus would

be water security instead of mere water supply. (Twelfth Five year Plan)

A State Water Policy would be governed by two principles“Public Trust” and “Right to water”. The

first implies that water is held by the State on behalf of the community and the second implies that

the State shall ensure minimum quantity of water to individuals.(Twelfth Five year Plan)

In the Twelfth Five year Plan, the State would undertake various artificial recharge projects in the

over exploited, critical and semi critical blocks and where there is minimum 25 per cent

dependability. (Twelfth Five year Plan)

District level water security plans – The Twelfth Five Year Plan would see increased community

participation by the activation of District level and Village level Water and Sanitation Committees

(DWSC). The committees would provide inputs and be involved with the “WISE” water practices to

prioritize water usage. (Twelfth Five year Plan)

Water sanctuaries

The mission of water Sanctuaries is to serve as the trustee for the nation’s system of protected areas

of water catchment and storage to conserve, protect, and enhance their biodiversity, ecological

integrity and cultural legacy. This concept is being mooted to protect the scarce freshwater sources

on similar lines as Marine water sanctuaries. These fresh water sanctuaries however, will ensure

drinking water sustainability with standard quality.(Working Group on Water Supply and Sanitation)

Domestic Water Supply

The State envisages the supply of 24×7 piped water supply to all households living in both urban and

rural areas as outlined in the Vision Tamil Nadu 2023. (Twelfth Five year Plan)

249

Under THAI scheme systematic efforts are being made to identify habitation wise existing coverage

status and minimum water requirement of 40 LPCD is ensured to all habitations.(Twelfth Five year

Plan)

Water use and Disposal – A Circular flow

In the Twelfth Five Year Plan, all water supply schemes would be integrated with concomitant water

disposal system. Planning for water schemes if linked with reuse and recycling components is more

sustainable in the long run. A major focus of the strategy is the creation of a circular process which

involves reuse, rather than the historic linear process from use to disposal. This process requires

recognition of four key stages in any wastewater management system from source to eventual

return to the environment:

1. Managing wastewater at source (including water conservation and recycling)

2. Collection and treatment

3. Re use of treated wastewater and sludge

4. Re-entry of treated waste into an ecosystem(Twelfth Five year Plan)

Special Schemes in the Twelfth Five year Plan

1. Augmenting Drinking Water Supply toChennai City

Formation of a new reservoir near Kannankottai and Thervaikandigai

Formation of New Storage Scheme near Thirukandalam and Bandikavanoor in Tiruvallur

District

Creation of additional Water Storage in Cholavaram, Porur,Nemam and

AyanapakkamandRestorationof Additional Storage Space in Chembarampakkam Tank

(Twelfth Five year Plan)

2. Hogenakkal Water Supply and Fluorosis Mitigation Project

The Hogenakkal Water Supply and Fluorosis Mitigation Project is being implemented

with the aim of supplying safe and potable drinking water to the people of Dharmapuri

and Krishnagiri Districts. This project covers 3 Municipalities, 17 Town Panchayats and

6,755 Rural habitations in 18 Panchayat Unions in both the Districts at a cost of

`1,928.80 crore. The population covered under this is 29.80 lakh.(Twelfth Five year

Plan)

3. Desalination plants

A 100 Million Litres per Day (MLD) desalination plant is being implemented at Nemmeli

with the assistance of JnNURM, 100 MLD desalination plant on PPP mode at Minjur and

another 400 MLD desalination plant south of Chennai.(Twelfth Five year Plan)

4. New Water supply schemes in extended areas:

Water supply schemes are under implementation in Ambattur, Alandur, Avadi,

Maduravoyal, Nerkundram, Tambaram, Ulagaram-Puzhuthivakkam, Porur, IT corridor

and Tiruvottiyur. (Twelfth Five year Plan)

250

Many others are on the civil eg:

Projects under Japan International Cooperative Agency (JICA) Funded Water

supply scheme to Madhavaram Municipality;

Water Distribution as a part of JnNURM in Chennai City;

Combined Water Supply Scheme to Melur and 2 Other Municipalities;

Augmentation of Water Supply to Palladam Municipality, in Coimbatore and Tiruppur

Districts with Pillur Dam as source etc. (Twelfth Five year Plan)

Twelfth Plan Strategies for Water Supply

The following are the strategies with regard to the Water Supply for both rural and urban

areas.(Twelfth Five year Plan)

Managing water resources efficiently and effectively (addressing both quantity and quality

aspects)

Planning and establishing an Integrated Drinking Water Grid for the State

Formulate a State Drinking Water Policy and comprehensive drinking water legislation and

guidelines

Ensure stakeholder participation in the decision-making process

Achieve capacity building within water- related institutions and promote water awareness in

all water-using sectors

Develop innovative technologies with respect to wise water use, water and waste water

treatment, water reuse and recycling and alternative water sources

Engage in extensive research and development in the water management

Carry out assessment studies/protection for each river basin

Establish monitoring and enforcement mechanisms

Develop water-quality management taking into consideration the carrying capacity of the

rivers and sustainable development indicators

Mobilize mass media/NGOs over water awareness

Develop multi-stake discussion and dialogues on relevant solutions

Strengthen water-related institutions

Build up a database on water sector and disseminate information

The initiatives proposed in the Twelfth Five year Plan would lead to better water access, equitable

distribution, community management of resources and capacity building of all the

stakeholders.(Twelfth Five year Plan)

Sanitation

Access to clean water and sanitation and proper utilisation of the facilities is important for healthy

living. Mere provision of facilities or creation of infrastructure do not either suffice in making

sanitation a sustainable process or make the desired impact. Only when accompanied by adoption of

correct behavioural practices and education these can have a positive impact on the health and

hygiene conditions of the community.(Twelfth Five year Plan)

251

As per the Census 2011 report, in Tamil Nadu, 48 per cent of the households have access to latrine

facilities within premises and5 per cent of households usepublic latrines against the all India

average of 47 per cent and 3 per cent respectively. But in the State as high as 45.72 per cent

households resort to open defecation against the average 49.84 per cent households in all India. In

rural areas, this proportion is 73.27 per cent which is higher thanthe rural India average of 67.33 per

cent. In urban areas too, Tamil Nadu’s share of households practicing open defecation is16.21 per

cent against 12.63 per cent in India.(Twelfth Five year Plan)

Source: UNICEF /Census 2011

Tamil Nadu which had achieved considerable progress in the household access to sanitation has

been ranked among the worst10 states in India and is the worst performing state in southern India.

The State contributes to six percent of Open Defecation in the country and the state may not

achieve the MDG target. (Open Defecation Free Tamil Nadu, 2013)

While the access to household amenities like vehicles, television, mobile phone is better, the poor

access to sanitation is a cause for concern. (Open Defecation Free Tamil Nadu, 2013)

Sanitation and safe disposal of human waste is a critical element of public health, directly impacting

the wellbeing of people. The absence of adequate number of toilets linked underground sewerage

scheme, absence of sufficient and well maintained public/ community toilets and the age old

practice of open defecation are posing serious sanitation problems and health hazards. Recognising

this, the State has formulated two strategies in the sanitation sector, coverage of all towns by Under

Ground Sewerage System and total elimination of Open Defecation by 2015. The district wise status

if availability of latrines is given in the following Table No.19.(Twelfth Five year Plan)

252

Table No 71: Status of Availability of Latrines

S.No. District HHS with Latrine facility within the

Premises (%)

HHS without Latrine facility

within the

Alternative sources of HH without Latrine

facility Public

Latrine Open

1 Ariyalur 18.14 81.86 2.21 97.79

2 Chennai 95.59 4.41 86.56 13.44

3 Coimbatore 66.69 33.31 33.46 66.54

4 Cuddalore 36.08 63.92 3.28 96.72

5 Dharmapuri 19.01 80.99 2.42 97.58

6 Dindigul 33.28 66.72 12.00 88.00

7 Erode 49.01 50.99 17.87 82.13

8 Kancheepuram 65.53 34.47 5.64 94.36

9 Kanniyakumari 87.46 12.54 43.15 56.85

10 Karur 41.24 58.76 9.40 90.60

11 Krishnagiri 33.02 66.98 4.08 95.92

12 Madurai 59.18 40.82 13.06 86.94

13 Nagapattinam 39.54 60.46 4.35 95.65

14 Namakkal 40.69 59.31 26.06 73.94

15 Perambalur 22.18 77.82 5.58 94.42

16 Pudukkottai 27.97 72.03 3.17 96.83

17 Ramanathapuram 36.62 63.38 5.28 94.72

18 Salem 34.95 65.05 17.17 82.83

19 Sivaganga 40.70 59.30 6.17 93.83

20 Thanjavur 45.06 54.94 7.42 92.58

21 The Nilgiris 51.89 48.11 23.80 76.20

22 Theni 39.35 60.65 33.81 66.19

23 Thiruvallur 67.85 32.15 6.91 93.09

24 Thiruvarur 39.71 60.29 5.76 94.24

25 Thoothukkudi 49.98 50.02 7.87 92.13

26 Tiruchirappall 48.52 51.48 16.19 83.81

27 Tirunelveli 47.64 52.36 17.65 82.35

28 Tiruppur 57.17 42.83 17.30 82.70

29 Tiruvannamalai 22.78 77.22 1.81 98.19

30 Vellore 41.11 58.89 4.08 95.92

31 Viluppuram 21.11 78.89 2.09 97.91

32 Virudhunagar 30.92 69.08 24.09 75.91

Total 48.29 51.71 11.58 88.42

Source: Census 2011

The Total Sanitation Campaign (TSC) renamed currently as Nirmal Bharat Abhiyan (NBA) of

Government of India is a major programme for rural sanitation. Under Ground Sewerage Systems

(UGSS) under JnNURM is a major scheme for urban sanitation.(Twelfth Five year Plan)

253

Total Sanitation Campaign

Total Sanitation Campaign was a Centrally Sponsored scheme to promote sanitation. The main

objectives of the TSC are as under (Open Defecation Free Tamil Nadu, 2013):

a. Bring about an improvement in the general quality of life in the rural areas.

b. Accelerate sanitation coverage in rural areas to access to toilets to all by 2012.

c. Motivate communities and Panchayat Raj Institutions promoting sustainable Sanitation

facilities through awareness creation and health education.

d. In rural areas, cover Schools and Anganwadis by March 2012, with sanitation facilities and

promote hygiene education and sanitary habits among students.

e. Encourage cost effective and appropriate technologies for ecologically safe and sustainable

sanitation.

f. Develop community managedenviron- mental sanitation systems focusing on solid &

liquid waste management.

The main components of the programme are (Open Defecation Free Tamil Nadu, 2013):

a. Start-up Activities

b. IEC Activities

c. Rural Sanitary Marts and Production Centers

d. Provision of Revolving Fund in the District

e. Constructionof IndividualHouseholdLatrines

f. Community Sanitary Complex

g. Institutional Toilets

h. Ecological Sanitation

i. Solid and Liquid Waste Management

j. Administrative Charges

For the implementation of TSC, State Governments set up a Communication & Capacity

Development Units (CCDUs) for taking up statelevel HRD & IEC activities as well as monitoring of TSC

projects. Gram Panchayats were given a pivotal role in the implementation of Total Sanitation

Campaign. (Open Defecation Free Tamil Nadu, 2013)

The State Planning Commission organized a Workshop on “Achieving Open Defecation Free

Status” with an objective to formulate strategies achieve the Chief Minister’s Vision by learning

from the past experience, explore various technology options to suit local conditions,

involvement of local body leaders in the initiative so as to hasten the pace. Under the able

chairmanship of the then Vice Chairman of State Planning Commission, Smt. Santha Sheela Nair, IAS

(Retd) (Open Defecation Free Tamil Nadu, 2013)

In theworkshop, the findings of aStudy by the Department of Media Sciences,Anna University under

the aegis of UNICEF and Department of Rural Development & Panchayat Raj was presented. The

aim of the study was to find the status of the individual household latrines constructed earlier, to

find out the causes for failures so as to formulate future strategies. (Open Defecation Free Tamil

Nadu, 2013)

254

The study was conducted in 3 districts. The study employeda household survey by canvassing an

interview schedule with the beneficiaries under TSC in these districts. Focused Group Discussions

were also held with the community. (Open Defecation Free Tamil Nadu, 2013)

Many reasons could be attributed for failure of toilets. The first and foremost is lack of awareness

among the people on safe sanitationpractices and non-willingness to behavioural change. Other

reasons include myths about toilet possession andusage, lack of technical know-how of toilets, lack

of IEC activities on Sanitation, male centred mindset, unaware of health problems dueto poor

sanitation, considering the cost and economics in construction and maintenance of a toilet and not

the benefits. (Open Defecation Free Tamil Nadu, 2013)

It was felt that Efficient and effective communication support would help to improve Sanitation and

Hygiene Behaviour Change. (Open Defecation Free Tamil Nadu, 2013)

The Department of Rural Development& Panchayat Raj presented the key initiatives to improve

rural sanitation by renovation of Integrated Sanitary Complexes for Women and New Sanitary

Complexes for Men, Revival of “CLEAN VILLAGE CAMPAIGN” and convergence of Nirmal

BharathAbhiyan with MGNREGS and Central & State Housing Programmes to increase coverage of

individual household toilets, Construction of School toilets, baby- friendly in Anganwadi Centers and

enhancing the unit cost for construction of toilets and improved type designs. The State has

initiated a new IEC campaign in association with UNICEF for awareness generation and construction

of Individual Household toilets. (Open Defecation Free Tamil Nadu, 2013)

Though the purpose of toilets is toprovide safe sanitation, the type could differ from place to place.

Rural Sanitary Mart was a commercial venture with a social objective to provide materials Services

and guidance needed for constructing IHHL & other sanitary facilities which are technologically and

financially suitable to the area. (Open Defecation Free Tamil Nadu, 2013)

Final outcome highlighted that Tamil Nadu is a progressive State in social aspects. The performance

in improving literacy, access to education, reducing Infant Mortality rate, Maternal Mortality Ratio

and Child Mortality Rate are remarkable. The State has surpassed the MDG goals in terms of poverty

reduction, universalization of primary education, improving child survivalrates, improving maternal

healthand has been regarded as the Early Achiever. The slow progress in ensuring sanitation is a

decelerator. (Open Defecation Free Tamil Nadu, 2013)

The Government of Tamil Nadu in association with UNICEF has formulated strategies to improve

access to Sanitation. The following are the key among them. (Open Defecation Free Tamil Nadu,

2013)

Making Sanitation aspirational

Addressing Open Defecation asan Unacceptable Social Practice

CommunitybehaviourChange towards sanitation

Feasible Sustainabletechnological solutions

Integrating Sanitation and Hygiene Practice including Hand Washing

Multi-pronged approach involving Government Departments, Panchayat Raj Institutions,

Self Help Groups, Civil Society, Corporate and Media

Roll out of CommunicationCampaign

255

Convergence of Nirmal Bharat Abhiyan, Mahatma Gandhi National Rural Employment

Guarantee Scheme

Finalising Technological designs

Appointing Sanitation Messengers - Swatchchctha Doots as front line functionaries in all

Village Panchayats

Monitoring and Evaluation of the Campaign

Twelfth Five Year Plan Approach and Strategies

The State has have given a new thrust to the Sanitation front towards declaring Tamil Nadu as an

‘Open Defecation Free State’, by strengthening institutional arrangements for implementation,

ensuring availability of funds, provision of infrastructure and also through sustained IEC campaigns.

All the Integrated Women Sanitary Complexes in rural areas have been renovated and efforts are on

to ensure continuous usage and maintenance through the Habitation level user groups. ‘Clean

Village Campaign’ for promotion of clean environment and sanitation in rural areas has been

reintroduced. Effective disposal of solid and liquid wastes, ban on use of plastics with due emphasis

on water conservation and rain water harvesting structures will be part of the campaign.(Twelfth

Five year Plan)

A policy for achieving Open Defecation FreeStatus in the urban areas by 2015 is being formulated

that will ensure provision of sanitation facilities through UGSS, increased public conveniences to

ensure that the health of the urban population in the state is protected and at the same time,

pollution of land and water resources in the State is mitigated. (Twelfth Five year Plan)

The Statehas formulated two major schemes for Urban Infrastructure Development - the Chennai

Mega City Development Mission (CMCDM) for Chennai and suburban areas and the Integrated

Urban Development Mission (IUDM) for all other Corporations, Municipalities and Town Panchayats,

to supplement the available funds under various schemes.(Twelfth Five year Plan)

Parameters for Sustainable Sanitation Village(Arghyam, 2009):

No open defecation in village leading to pollution of water sources

100 percent coverage and usage of toilets

Special provision for aged, differently-abled, pregnant women

100 percent school sanitation (separate toilets for girls and boys)

Water supply available for toilets

No additional burden on women for fetching water for toilets

Presence of a well-maintained drainage system (drain should not be clogged; water should

not stagnate; should not pollute water sources)

Grey water treated and reused

Presence of solid waste management systems (like composts etc.; solid waste not found

littered in the village; not clogging drains)

High in hygiene behaviour (every one washes hand after defecation; handles drinking water

with clean hands)

Issues of menstrual hygiene addressed

Local capacity available for operating and maintain sanitation systems

256

Water quality tested by the community twice a year (indicative) and

informationdisseminated and follow-up by confirmative tests and follow-up action taken

Reduction in water borne diseases in the village validated by VHNs; no deaths reported

Schemes for the Twelfth Five Year Plan

1. Nirmal Bharat Abhiyan

Total Sanitation Campaign implemented during Eleventh Five Year Plan has been renamed as

NirmalBharat Abhiyan, and will be continued to be implemented as a major sanitation programme

for rural areas during the Twelfth Five Year Plan. This programme would be implemented in a

demand driven mode and on a saturation approach Anganwadi toilets, school toilets. (Twelfth Five

year Plan)

2. Integrated Sanitary Complexes forWomen

Each village Panchayat has been provided with one such complex with assured water supply during

the Tenth Plan period. But due to improper maintenance, many of the complexes became defunct

during Eleventh Plan. (Twelfth Five year Plan)

As a measure to improve sanitation, all sanitation facilities have been taken up for repair and

rejuvenation.

3. Integrated Sanitary complexes forMen

Similar to the women sanitary complexes, sanitary complexes for men are planned to be

constructed. Uninterrupted water supply and efficient waste handling system would ensure

better functioning of sanitary complexes.

During the Twelfth Five Year Plan it is planned to install Zero Discharge Bio- digester Plant in the

sanitary complexes in a phased manner. (Twelfth Five year Plan)

4. Toilets for the Differently Abled

The Town Panchayats have taken special efforts to provide barrier free toilet facilities for the

differently abled. (Twelfth Five year Plan)

5. School Sanitation and HygieneEducation

School Sanitation and Hygiene Education is very high on the National priority. The Government of

Tamil Nadu is also laying a lot of emphasis on the same through the Total Sanitation Campaign (TSC)

and Sarva Siksha Abiyan (SSA).(Twelfth Five year Plan)

In a study conducted by UNICEFon50 most backward blocks of Tamil Nadu, it was found that water

and sanitation is one of the main issues affecting the education of children, especially girls. There are

separate toilets provided for girls in most of the schools, especially in middle schools. However,

water facilities are lacking in 50 per cent of the schools in the districts. (Twelfth Five year Plan)

Benefits of Investing inSchool Sanitation(Twelfth Five year Plan):

257

Effective learning

Increases enrolment of girls

Reduces incidence of disease and worm infections

Environmental cleanliness

Implementing child rights

The following will be ensured for improving School Sanitation during the Twelfth Five Year Plan

In all the Primary/Middle/High/Higher Secondary Schools separate latrines / urinals for boys

and girls with adequate water supply will be provided.

The toilets and other Water Sanitation& Hygiene (WASH) infrastructures constructed in

the Elementary schools will be child friendly

The existing Girls toilet blocks constructed in Schools will be improved as Girl friendly toilets

with facilities for safe disposal of soiled sanitary Napkins. The new constructions will contain

all the features of a Girl friendly toilet including Incinerator.

All the schools will be provided with Hand Washing Facility with Soap

Hygiene Education will be promoted. All the Schools will have a Teacher trained in Hygiene

Education, especially in Menstrual Hygiene.

All the Schoolswill have Sanitation Committees.

6. Menstrual Hygiene Management

The recent State initiative to supply napkins procured from the SHG units is a laudable one and

offers immense potential in terms of social and economic capital formation at the Panchayat level.

The State has taken a very positive and pioneering stand to promote the menstrual hygiene among

the women and adolescent girls. (Twelfth Five year Plan)

7. Solid and Liquid Waste Management

Corporation of Chennai is taking several new initiatives to cope with this daunting problem. The

three distinct aspects relating to Solid Waste Management during the Twelfth Plan is as

follows(Twelfth Five year Plan):

Setting up of Integrated Municipal Solid Waste processing facilities for the Chennai city and

local bodies

Remediation and Scientific closure of two major dump yards

Street Cleaning, Door-to-door collection of garbage and transportation to integrated

processing facilities site

The Municipal Administration Department is also taking steps to access the best practices and

technologies adopted in other parts of the country.(Twelfth Five year Plan)

During the Twelfth Plan Period, a major thrust will be given to Solid Waste Management in rural

areas too.

258

8. Establishing Common ScientificSanitary Landfill (CoSSLaFi)

Effective Solid Waste Management also requires Scientific Sanitary landfill management. (Twelfth

Five year Plan)

9. Sewerage

The State Government has accorded priority to the implementation of sewerage schemes, with

proper sewerage treatment plants in all the ULBs in a phased manner, in order to provide better

sanitation. (Twelfth Five year Plan)

10. Waste Water Management

A comprehensive Action Plan for Waste Water Management to improve and integrate the sewerage

system in Chennai and its suburban areas has been prepared.(Twelfth Five year Plan)

11. Recycling Waste Water

The Government, as a policy promotes the recycling of sewage to meet purposes other than

drinking.(Twelfth Five year Plan)

259

REFERENCE

1. ACC/SCN Report Food and Nutrition Bulletin, vol. 21, no. 3 (supplement) © The United

Nations University, 2000

2. Annual Report (2009 – 10); Arghyam (India); Pg. 1-40; www.arghyam.org

3. Census by Religious Communities; 2002.

4. Census of Tamil Nadu; 2011.

5. Census 1991 – State Profile

6. Census of India; 1991



9. Chapter 9.11. Food Security and Nutrition; Tenth Five year Plan 2002-2007; State Planning

Commission; Govt. of Tamil Nadu; www.spc.tn.gov.in/tenthplan/CH_9_11.PDF

10. Chapter XII - Tamil Nadu Health; www.tn.gov.in/dear/Health.pdf

11. Department of Public Health and Preventive Medicine, Chennai-6

12. Distribution by Language; States and Union Territories; 2001; Retrieved 10

September 2012;www.censusindia.gov.in

13. District Human Development Report - Dharmapuri District; Human Development Research

and Co-ordination Unit; State Planning Commission; Ezhilagam, Chepauk, Chennai 600005;

Department of Economics; University of Madras;

www.spc.tn.gov.in/reports/DHARMAPURI.pdf.

14. Directorate of Medical and Rural Services, Chennai

15. Directorate of National Vector Borne Disease Control Programme, Ministry of Health and

Family Welfare, government of India, New Delhi

16. E-census India 2002.

17. Eveleth, P.G. and J.M. Tanner, 1976. Worldwide Variations in Human Growth. Cambridge

University Press.

18. Gross State Domestic Product at Constant 2004–05 Prices (in Rs. Crore) and Growth (%

YoY)" (PDF). Planning Commission of India. 2004. Retrieved 2

February 2015.http://planningcommission.nic.in

19. Gross State Domestic Product at constant prices 2014.

20. Health and Development; Cited on Jan 25, 2009; www.who.int/nutrition

21. Joint monitoring programme (JMP) for water supply and sanitation, progress on Drinking

water and sanitation : 2012 update, United nations children’s fund and World Health

Organization, New York and Geneva, 15 (2012)

260

22. Khan ME. Cultural determinants of infant mortality in India. J Fam Welfare. 1993; 39(2):3–

13.

23. Malik AS, Mazhar AU. Assessment of nutritional status of children under 48 months of

age. Pak Paed Jr. 2006; 30(1):38–47.

24. Ministry of home affairs, population census of India, (2011)


International Institute for Population Science (IIPS) and Macro International. (2007).

International Family Health Survey (NFHS-3), (2005-06) : India, Volume I. Mumbai: IIPS.


International Institute for Population Science (IIPS) and Macro International. International

Family Health Survey (NFHS-4), (2015-16) : India, Volume I. Mumbai: IIPS., Survey Conducted

on 2015-16

27. Open Defecation free; Tamil Nadu; State Planning Commission; Workshop Series: 2 / RD &

DP / 2013; 5th July 2013, Pg.: 1 - 36; www.spc.tn.gov.in/reports/ODF.pdf

28. Pelletier DL, Frongillo EA, Scroeder DG, Habicht JP. A methodology for estimating the

contribution of malnutrition to child mortality in developing countries. J

Nutr. 1994;124:2106–22.[PubMed]

29. Policy Note on Medical & Public Health., 2000-2001

30. Policy Note on Public Health, Govt. of Tamil Nadu, 1998-99

31. Policy Note 2013-14, Health and Family Welfare Department, Government of Tamil Nadu

32. Press Information Bureau English Releases; Pib.nic.in. 2012; Retrieved: 10th September 2012.

33. "Primary census abstract 2001". Directorate of Census Operations – Tamil Nadu. 2001.

Retrieved 8 June 2012.

34. Public Health in Tamil Nadu; Tamil Nadu Social Development Report; Tamil Nadu Peoples

Forum for Social Development; December 2000;

35. "Rajan report: Odisha, Bihar least developed; Goa, Kerala on top". http://profit.ndtv.com

36. Rajivan Anuradha K.; History of Direct Nutrition Schemes in Tamil Nadu;

2005;www.righttofoodindia.org; Pg. 1-15

37. Sample Registration System Statistical Report (SRS) 2012; Office of the Registrar General,

India Ministry of Home Affairs Government of India New Delhi; Report no. 1 of 2013;

http://www.censusindia.gov.in/vital_statistics/SRS_Reports_2012.html

38. Sanford (1998), "Introduction", in Steever, Sanford, The Dravidian Languages, London:

Routledge, pp. 1–39, ISBN 0-415-10023-2

39. SC/ST population in Tamilnadu 2011(PDF), A-5 Union Primary Census

Abstract;http://www.censusindia.gov.in/2011census

261

40. Shills ME, Young VREd; Modern nutrition in health and disease. Philadelphia: Lea and

Febiger. 1998. 50-58.

41. Sixth Economic Census; Guide for Enumerators & Supervisors; Ministry of Statistics and

Programme Implementation, Govt. of India. 2012-13. Retrieved 10

September 2012.www.mospi.gov.in

42. Statistical Hand Book of Tamil Nadu for various years.

43. Suryanarayana M.H., Agrawal Ankush and Prabhu K. Seeta; Inequality adjusted Human

Development Index for India's States, United Nations Development Programme;

http://www.in.undp.org (2011).

44. ‘Tamil Nadu – An Economic Appraisal’ for various years, Published by Department of

Evaluation and Applied Research, Chennai. 1996-97

45. Tamil Nadu Culture, Latest News, Politics, Art, Food, History, Travel; Tamil Nadu; Retrieved

24th January 2015.http://tamilnadu.com

46. Towards Integrated Urban Water Management, Global Water Partnership; www.gwp.org

47. Tamil Nadu Peoples’ Manifesto, 1996

48. Tamil Nadu The Most Urbanised State Minister; The Hindu; Chennai, India; 18 May 2008;

Retrieved 10 September 2012.

49. TamilNadu Water Supply And Drainage (TWAD) Board; www.twadboard.gov.in

50. The State of World Children. Child Survival.Report of UNICEF; 2008.

51. Thoday, 1965; Fischbein, 1977; Bergman and Goracy, 1984; Eveleth and Tanner, 1976;

Martorell and Habicht, 1988.

52. UNESCO World Heritage List; Whc.unesco.org; Retrieved 10

September 2012.http://whc.unesco.org/en/list

53. UNICEF /Census 2011

54. Union Planning Commission, Government of India

55. Vision 2023, Government of Tamil Nadu

56. Water Partners International; Mrs. Manonmani's Story; Archived 16 June 2008 at

the Wayback Machine.

57. Water Supply and Sanitation; Twelfth Five Year Plan, Tamil Nadu, (2012-2017); State

Planning Commission, Chennai, Pg. 231 – 262; www.spc.tn.gov.in

58. Weight-for-age below 2SD of median

59. William Roseline F, Bijou Joel, Ali Mohamad, Velan Vinayaka. Nutritional Assessment of

Children in the 3–5 Y of Age Group in Karaikal District, Puducherry. Nut J Res Com Med.2012;

1(2) Editorial article.

60. Working Group on Water Supply and Sanitation

61. 12thPlan Document; State PlanningCommission; Chennai-5

Documents

Government of Tamil Nadu - Final Report A COMPARATIVE … · 2018. 12. 21. · SECTION II – Inter Sectoral Coordination - Analysis of important on-going programmes and way forward