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8/4/2019 8-ChallengesTN-PreetiWB

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Challenges facing the health sector in

Tamil Nadu

Unfinished Agenda: Further reduction ofMMR and IMR and provision of basic andcomprehensive emergency obstetric andneonatal care.

Growing Burden of NCDs: Cardiovasculardisease, cancer, trauma and accidents.

The private health sector in Tamil Nadu:Wide range of players single doctorclinics to super-speciality hospitals;

informal service providers.


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Poor Quality of Care: Both, in the public andprivate sector

Equity Issues: Regional disparities in healthoutcomes and access to the poor and SC/STpopulation

Low Levels of Health Financing:Low level ofpublic expenditure on health services; 75%allocated to salaries; maintenance budget forhealth facilities and equipment.

Challenges facing the healthsector in Tamil Nadu contd.


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Key Institutional Constraints

Stewardship and oversight function -Strategic and financial planning for thesector, setting technical standards; oversight

of the private sector including qualityassurance

Health promotionacross the health sector

integrating different programs Limited experience with NCDsespecially

with regard population based preventionstrategies; risk factor prevention


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Key Institutional Constraints contd.

Management of public facilitiesauthority of hospital administrators to

spend funds; accountability of healthfacilities to local communities; relativelack of managerial capacities amongsthealth personnel; performance basedincentives of health facilities/providers


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Tamil Nadu Health Systems Project

The Project Development Objective would be tosignificantly 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 toaddress key health challenges, specifically non-communicable diseases; (iii) improved health outcomes,

access and quality of service delivery through strengthenedoversight of the public sector health systems and greaterengagement of non-governmental sector; and (iv)increased effectiveness of public sector hospital services,primarily at district and sub-district levels.


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Knowledge Partnership Matrix

The development objectives in the knowledge partnershipmatrix could include:

public expenditure efficiency, including making the publichealth system more efficient and improving the expenditure

composition;governance and service delivery, including qualityimprovement of health care delivery (grading of healthfacilities and accreditation), health manpower issues(absenteeism, performance monitoring, professionalincentives, transparency in postings); and

partnerships with the non-government sector to improvereach of health care to remote and disadvantagedpopulations.


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HIV/AIDS

In Tamil Nadu, rates among high risk groupssuch as commercial sex workers andintravenous drug users are above 5%, although

the rate among antenatal mothers, a proxy forthe 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 thestate level and ii) mainstreaming of response toHIV/AIDS within various departments of thegovernment.


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HIV/AIDS contd.

Consolidation of response to HIV/AIDS at thestate level : While the State has respondedproactively to the issue of HIV/AIDS, different

sources of funds have led to the establishmentof a number of mechanisms in the state toaddress various aspects of the issue.Coordination is dependent on goodwill rather

than well established processes that are builtinto the system. Consolidation of response toHIV/AIDS at the state level are likely to greatlyimprove outcomes in the State.


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HIV/AIDS - contd.

Mainstreaming of response to HIV/AIDS withinvarious departments of the government: Therehas been some attempt to orient somegovernment departments to the issue of

HIV/AIDS. Nevertheless, there needs to be amainstreaming of the issue into the work ofseveral 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/AIDScell and adoption of a coherent plan of action bythe department that embeds the HIV/AIDS issuewithin the health agenda of that department.

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