Challenges facing the health sector in Tamil Nadu

1
Challenges facing the health sector in Tamil Nadu

• Unfinished Agenda Further reduction of MMR and
  IMR and provision of basic and comprehensive
  emergency obstetric and neonatal care.
• Growing Burden of NCDs Cardiovascular disease,
  cancer, trauma and accidents.
• The private health sector in Tamil Nadu Wide
  range of players single doctor clinics to
  super-speciality hospitals informal service
  providers.

2
Challenges facing the health sector in Tamil Nadu
contd.

• Poor Quality of Care Both, in the public and
  private sector
• Equity Issues Regional disparities in health
  outcomes and access to the poor and SC/ST
  population
• Low Levels of Health Financing Low level of
  public expenditure on health services 75
  allocated to salaries maintenance budget for
  health facilities and equipment.

3
Key Institutional Constraints

• Stewardship and oversight function - Strategic
  and financial planning for the sector, setting
  technical standards oversight of the private
  sector including quality assurance
• Health promotion across the health sector
  integrating different programs
• Limited experience with NCDs especially with
  regard population based prevention strategies
  risk factor prevention

4
Key Institutional Constraints contd.

• Management of public facilities authority of
  hospital administrators to spend funds
  accountability of health facilities to local
  communities relative lack of managerial
  capacities amongst health personnel performance
  based incentives of health facilities/providers

5
Tamil Nadu Health Systems Project

• The Project Development Objective would be to
  significantly improve the effectiveness of the
  health system, both public and private, in Tamil
  Nadu through (i) increased access to and
  utilization of health services, particularly by
  poor, disadvantaged and tribal groups (ii)
  development and pilot testing of effective
  interventions to address key health challenges,
  specifically non-communicable diseases (iii)
  improved health outcomes, access and quality of
  service delivery through strengthened oversight
  of the public sector health systems and greater
  engagement of non-governmental sector and (iv)
  increased effectiveness of public sector hospital
  services, primarily at district and sub-district
  levels.

6
Knowledge Partnership Matrix

• The development objectives in the knowledge
  partnership matrix could include
• public expenditure efficiency, including making
  the public health system more efficient and
  improving the expenditure composition
• governance and service delivery, including
  quality improvement of health care delivery
  (grading of health facilities and accreditation),
  health manpower issues (absenteeism, performance
  monitoring, professional incentives, transparency
  in postings) and
• partnerships with the non-government sector to
  improve reach of health care to remote and
  disadvantaged populations.

7
HIV/AIDS

• In Tamil Nadu, rates among high risk groups such
  as commercial sex workers and intravenous drug
  users are above 5, although the rate among
  antenatal mothers, a proxy for the general
  population, is just under the 1 mark.
• Two of the main issues now facing the State are
  i) consolidation of response to HIV/AIDS at the
  state level and ii) mainstreaming of response to
  HIV/AIDS within various departments of the
  government.

8
HIV/AIDS contd.

• Consolidation of response to HIV/AIDS at the
  state level While the State has responded
  proactively to the issue of HIV/AIDS, different
  sources of funds have led to the establishment of
  a number of mechanisms in the state to address
  various aspects of the issue. Coordination is
  dependent on goodwill rather than well
  established processes that are built into the
  system. Consolidation of response to HIV/AIDS at
  the state level are likely to greatly improve
  outcomes in the State.

9
HIV/AIDS - contd.

• Mainstreaming of response to HIV/AIDS within
  various departments of the government There has
  been some attempt to orient some government
  departments to the issue of HIV/AIDS.
  Nevertheless, there needs to be a mainstreaming
  of the issue into the work of several government
  departments, e.g., education, police department,
  defence, commerce, PWD and transport, ports etc.
  This would require allocation of funding,
  establishment of a technically capable HIV/AIDS
  cell and adoption of a coherent plan of action by
  the department that embeds the HIV/AIDS issue
  within the health agenda of that department.