Tamil Nadu’s Public Health

Context

Despite Tamil Nadu’s well-established healthcare infrastructure and successful public health indicators, the State is now grappling with a serious healthcare workforce crisis—marked by staff shortages, unfilled vacancies, and discontent among healthcare workers, which threatens to undermine years of public health progress.

From Health Leadership to Workforce Stagnation: Tamil Nadu’s Looming Health Crisis

Achievements and Institutional Framework

Robust Infrastructure:
- Over 11,000 government healthcare institutions span primary, secondary, and tertiary levels. Tamil Nadu’s institutions like the Tamil Nadu Medical Services Corporation (TNMSC) and Transplant Authority are recognized for transparency and efficiency.
Flagship Programmes:
- Makkalai Thedi Maruthuvam (MTM) delivers screening and drugs for NCDs at doorsteps.
- Muthulakshmi Reddy Maternity Benefit Scheme offers nutritional and financial aid.
- CM’s Comprehensive Health Insurance Scheme ensures access to expensive procedures.
Key Health Gains:
- Maternal Mortality Ratio: Reduced from 45.5 (2023–24) to 39.4 (2024–25)
- Infant Mortality Rate: Reduced from 8.2 to 7.7
- Under-5 Mortality: Reduced to 8.2
- Hypertension and Diabetes control indicators have improved notably under MTM.

Workforce Deficiencies and Administrative Gaps

Vacant Posts Across Cadres:
- 2,013 Village Health Nurse (VHN) posts and 1,251 Auxiliary Nurse Midwife (ANM) posts are unfilled due to legal and procedural delays.
- VHNs cover 2–3 villages each, leading to overburden and reduced service quality.
Specialist Shortages:
- Skewed distribution and absence of super-specialty cadre (e.g., cardiothoracic surgery, vascular surgery) at secondary/tertiary levels.
- Despite recruiting ~3,500 Medical Officers, specialist gaps persist.
Contractualisation and PPP Concerns:
- The proposed PPP models in services like haemodialysis have triggered opposition from permanent staff over fears of job dilution and corporatization.

Impact, Concerns and the Road Ahead

Impact on Service Delivery:
- An overstretched workforce negatively affects patient outcomes, public trust, and morale of frontline health workers.
Failure to Match Infrastructure with Human Resources:
The growth in patient inflow and disease burden has not been matched with proportionate workforce expansion.
Need for Structural Reform:
- Tamil Nadu must adopt a comprehensive Human Resources for Health (HRH) policy, ensure faster recruitment cycles, and adopt Indian Public Health Standards (IPHS) benchmarks for staffing.

1. Makkalai Thedi Maruthuvam (MTM)

Launched: 2021
Objective: Home-based screening and drug delivery for diabetes, hypertension, cancer.
Significance: Ensures early detection, improves compliance, reduces hospital overload.

2. Village Health Nurse (VHN)

Role: Antenatal care, delivery services, immunization, maternal/child health monitoring.
Norm: 1 VHN per 5,000–6,000 population.
Current Shortage: Each VHN covering multiple villages—affecting service depth.

3. Tamil Nadu Medical Services Corporation (TNMSC)