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Integrated service delivery in Primary Health Care – Tamil Nadu experience

Integrated service delivery in Primary Health Care – Tamil Nadu experience. Dr.P.Padmanaban Advisor NHSRC. Slide presentation. Tamil Nadu Medical Services Corporation – Flexibility for the doctors to indent any drugs depending on the morbidity pattern of the area

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Integrated service delivery in Primary Health Care – Tamil Nadu experience

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  1. Integrated service delivery in Primary Health Care – Tamil Nadu experience Dr.P.Padmanaban Advisor NHSRC

  2. Slide presentation • Tamil Nadu Medical Services Corporation – Flexibility for the doctors to indent any drugs depending on the morbidity pattern of the area • Dedicated Public Health Cadre to implement all National Health Programmes • Use of untied funds- NRHM • Multi skill training of medical and para medical staff • Integrated service delivery in the PHCs • New services in PHCs/ CHCs

  3. DEMOGRAPHIC PROFILE

  4. STRENGTHS OF TAMIL NADU HEALTH SYSTEM • Strong political will • Government is the dominant provider of Maternal and Child health services • 5.6% of the revenue budget allocated to health sector & 10% of the budget allotted for drugs and consumables • No user fees • Public Health qualified medical professionals implement all National Health Programmes thro Primary Health Centres and Health Sub centres. • Sensitive media

  5. STRENGTHS OF TAMIL NADU HEALTH SYSTEM • Quality generic drugs and equipment procurement system- Tamil Nadu medical Services Corporation- ISO certified organisation • Transparency in the procurement of drugs and equipements • Drug pass book system for institutions • Quality drugs at lower rates

  6. 24 availability of multipurpose paramedical staff – nurse in the PHCs • 24 hour delivery services with 3 staff nurses introduced in all the 1421 PHCs ( With NRHM support) • Provide minor ailments treatment • Assist in provision of tubectomy operations • Scope for developing Nurse practitioners

  7. DELIVERY PERFORMANCE (%) [July’08] Domi. PVT GH PHC HSC

  8. Use of untied funds for upgrading the patient amenities • Flexible funding to PHCs / CHCs for all the activities irrespective MCH,HIV/AIDS, IDSP etc. • Private sector participation for patient welfare initiatives • No need to get the permission of PWD for execution of the minor works • Multipurpose fund for Village Health and Sanitation committees • Untied funds for the HSCs I

  9. Multi skill training of medical and para medicals • 6 months anesthesia training for M.B.B.S doctors (84 trained) and x-ray training for lab technicians • Scan training for MBBS doctors for one month • X ray training for Lab technicians • Training the ANMs, LHVs in the use AYUSH drugs • Manual Vacuum Aspiration training • Training nurses in HIV testing -RCH / HIV convergence • Cancer cervix screening training for the PHC staff • Blood bank training to the PHC staff • Diabetes training distance education programme for doctors

  10. Integrated service delivery in the PHCs • Routine MCH services • Blood storage facilities • RTI/STI clinics • Family Welfare services including MVA and tubectomy services • Birth certificate distribution in the PHCs • New born screening for disabilities initiated with NGO support in selected PHCs • Mainstreaming AYUSH • Convergence of HIV/AIDS • Integrated Disease Surveillance Programme, TB , Leprosy case detection and management

  11. Integrated service delivery in the PHCs • Special clinics • - Diabetes and hypertension clinics • - Gestational diabetes screening ( pregnant women) ( scan and semi autonalyser in PHCs) • - RTI/STI clinics • - Cancer Cervix screening clinics using VIA method ( 2 districts and Chennai corporation) • - Mental health programme ( 7 districts) • - Dental clinics – weekly two day clinics ( 35 clinics) • - Eye clinics – cataract screening and refractive error screening ( ophthalmic assts in 385 BPHCs) • - Hiring the services of private specialists

  12. School Health programme • - Screening for communicable diseases- • - Deworming • - Dental health programme with hiring of private dental surgeons • - Anemia control • - Adolescent health • - Refractive error screening & free spectacles • - Rheumatic heart disease prevention • - Congenital heart disease detection • - Free heart surgery programme for the children

  13. Free heart surgeries for children • Heart Surgeries are done for children with private sector participation to reduce the waiting time for surgery • Planned to carryout 10,000 surgeries • Private hospitals are paid for the surgeries at mutually agreed rates • Private sponsors also donate funds for the scheme

  14. Blindness control programme • Cataract screening by ophthalmic assistants in the PHCs and outreach areas • Refractive error screening & free spectacle distribution • Follow up care for cataract operated cases • Scope for capacity building of ophthalmic assts in the detection of eye complications among diabetics

  15. Suggested new services in the PHCs • Online reporting system launched for all RCH services . Unified reporting system remains a challenge • Adolescent clinics • Nutrition surveillance • Couple counseling for family welfare services • Newborn screening for developmental delays

  16. THANK YOU

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