How to Improve Public Health Systems : Lessons from Tamil Nadu

Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the system s shortfalls. Tamil Nadu s public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their people s health.

Bibliographic Details

Main Authors:	Das Gupta, Monica, Desikachari, B.R., Somanathan, T.V., Padmanaban, P.
Format:	Policy Research Working Paper biblioteca
Language:	English
Published:	2009-10-01
Subjects:	ADMINISTRATIVE CONTROL, AGED, ANTENATAL CARE, BASIC HEALTH, BIRD FLU, BLINDNESS, CANCER, CENTER FOR DEVELOPMENT, CHICKENPOX, CHIKUNGUNYA, CHILD DEVELOPMENT, CHILD HEALTH CARE, CHILD HEALTH SERVICES, CHILD MORTALITY, CHILD MORTALITY RATE, CHOLERA, CITIES, CITIZEN, CITIZENS, CLINICAL SERVICES, COMMUNICABLE DISEASES, COMMUNITY HEALTH, CONTROLLING POPULATION GROWTH, CROWDING, DEAD ANIMALS, DEAD BODIES, DEATHS, DENGUE, DEVELOPING COUNTRIES, DIABETES, DIARRHEAL DISEASES, DISASTERS, DISEASE, DISEASE CONTROL, DISEASE OUTBREAK, DISEASE OUTBREAKS, DISEASE PREVENTION, DISEASE PREVENTION AND CONTROL, DISEASE SURVEILLANCE, DISPENSARIES, DOCTORS, DRINKING WATER, EARLY DETECTION, EARTHQUAKE, ECONOMIC CHANGE, ECONOMIC GROWTH, EMERGENCIES, ENDEMIC DISEASES, ENVIRONMENTAL HEALTH, EPIDEMIC, EPIDEMICS, EXISTING RESOURCES, EXPENDITURES, FAMILY HEALTH, FAMILY PLANNING, FAMILY WELFARE, FINANCIAL RESOURCES, FOOD CONTROL, FOOD SAFETY, GI, GII, HAZARD, HAZARDS, HEALTH ACTIVISTS, HEALTH AUTHORITIES, HEALTH BUDGETS, HEALTH CARE INDICATORS, HEALTH CENTERS, HEALTH CENTRE, HEALTH CENTRES, HEALTH CONDITIONS, HEALTH EDUCATION, HEALTH EXPENDITURE, HEALTH EXPENDITURE PER CAPITA, HEALTH EXPENDITURES, HEALTH EXPERTS, HEALTH IMPACT, HEALTH IMPACT ASSESSMENTS, HEALTH INDICATORS, HEALTH INTERVENTIONS, HEALTH MANAGEMENT, HEALTH MANPOWER, HEALTH MANPOWER DEVELOPMENT, HEALTH NEEDS, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH PLANNING, HEALTH POLICY, HEALTH PROBLEMS, HEALTH PROFESSIONALS, HEALTH REGULATIONS, HEALTH RESOURCES, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICE PROVISION, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH SPENDING, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH WORKERS, HEALTH WORKFORCE, HOSPITAL, HOSPITAL CARE, HOSPITALS, HUMAN DEVELOPMENT, HYGIENE, ILLNESS, IMMUNIZATION, INCOME, INFANT, INFANT DEATH, INFECTION, INFECTIOUS DISEASES, INSECTICIDES, INTERVENTION, IODINE DEFICIENCY, JOB TRAINING, LATRINES, LAWS, LEPROSY, LEPTOSPIROSIS, LOCAL GOVERNMENTS, LOCAL PUBLIC HEALTH, MALARIA, MALARIA CASES, MALARIA CONTROL, MALE HEALTH, MALE HEALTH WORKERS, MANAGING POPULATION, MASS GRAVES, MATERNAL AND CHILD HEALTH, MATERNAL CARE, MATERNAL DEATH, MEASLES, MEAT, MEDICAL CARE, MEDICAL CENTERS, MEDICAL COLLEGE, MEDICAL DOCTORS, MEDICAL EDUCATION, MEDICAL OFFICER, MEDICAL OFFICERS, MEDICAL PRACTICE, MEDICAL PRACTITIONERS, MEDICAL RESEARCH, MEDICAL SERVICES, MEDICAL SPECIALISTS, MEDICINES, MIDWIFE, MINISTRY OF HEALTH, MORBIDITY, MORTALITY, MORTALITY RATE, NATIONAL EFFORTS, NATIONAL HEALTH, NATURAL DISASTER, NATURAL DISASTERS, NURSE, NURSES, NURSING, NUTRITION, OCCUPATIONAL DISEASES, OUTPATIENT CARE, OUTREACH WORKERS, PATIENT, PATIENTS, PERSONAL COMMUNICATION, PLAGUE, POISONING, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POLIO, PREGNANCY, PREGNANCY COMPLICATIONS, PREVENTION ACTIVITIES, PREVENTIVE HEALTH SERVICES, PREVENTIVE MEDICINE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE HOSPITALS, PROGRESS, PUBLIC EXPENDITURE, PUBLIC EXPENDITURE ON HEALTH, PUBLIC HEALTH, PUBLIC HEALTH ADMINISTRATION, PUBLIC HEALTH CONCERNS, PUBLIC HEALTH INTERVENTIONS, PUBLIC HEALTH LAWS, PUBLIC HEALTH PROGRAMS, PUBLIC HEALTH SERVICES, PUBLIC HEALTH SYSTEM, PUBLIC HEALTH WORKERS, PUBLIC SERVICES, QUARANTINE, RODENTS, RURAL AREAS, RURAL DEVELOPMENT, SANITARY CONDITIONS, SANITATION, SMALLPOX, SOCIAL DEVELOPMENT, SOCIAL MOBILIZATION, SOCIAL WELFARE, T.V., TB, TEACHING HOSPITALS, TERTIARY LEVELS, TREATMENT, URBAN AREAS, URBANIZATION, VACCINATION, VECTOR BORNE DISEASES, VECTOR CONTROL, VECTORS, WASTE, WORKERS, WORLD HEALTH ORGANIZATION, YAWS, ZOONOSES, ZOONOTIC DISEASES,
Online Access:	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20091013150143 http://hdl.handle.net/10986/4265
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