T.N.'s health sector: feats and challenges

The Hindu

04-07-2025

The story so far: Tamil Nadu has consistently ranked high in the health sector. A robust public health system, 11,000+ institutions at the primary, secondary and tertiary care levels and scores of pioneering schemes have enabled the State to stay ahead in many of its key health indicators. Despite such achievements, the State's health sector is in the midst of a brewing crisis — a crisis fueled by a high number of vacancies, a strained workforce, and a lackadaisical attitude towards long-pending demands of doctors.
How has T.N. healthcare fared so far?
Over the years, the State has made significant strides in expanding its health infrastructure and improving health outcomes through focussed initiatives and innovative programmes, while prioritising core areas of maternal and child health, and prevention and control of infectious diseases. In particular, it has scaled up interventions targeting non-communicable diseases. Its flagship scheme, 'Makkalai Thedi Maruthuvam' (MTM), has taken screening and drug delivery for conditions such as diabetes and hypertension to people's doorsteps, while community-based cancer screening programmes have also taken off.
Moreover, the Tamil Nadu Medical Services Corporation streamlines drug procurement and supply for government hospitals; the Transplant Authority of Tamil Nadu (formerly Cadaver Transplant Programme) regulates the process of organ allocation and maintenance of wait lists; and the Dr. Muthulakshmi Reddy Maternity Benefit Scheme provides financial assistance and nutritional support to pregnant women belonging to economically and socially disadvantaged sections. Schemes such as the Chief Minister's Comprehensive Health Insurance Scheme have enabled better access to healthcare, especially for advanced procedures and surgeries such as organ transplants for the poor.
What gains have been made?
Such focussed measures have enabled the State to steadily bring down its maternal and infant mortality numbers. As per the State's Health Management Information System, the Maternal Mortality Ratio stands at 39.4 per 1,00,000 live births (2024-2025), a dip from 45.5 in 2023-2024, while the Infant Mortality Rate fell from 8.2 per 1,000 live births (2023-2024) to 7.7 in 2024-2025. The under-five mortality rate has also declined from 8.9 (2023-2024) to 8.2 during 2024-2025.
On its part, the MTM has demonstrated an improvement in the management of hypertension and diabetes in the State. Among adults with hypertension, the proportion with blood pressure control rose to 17% (previously 7.3%), while among those with diabetes, the proportion with blood sugar control rose to 16.7% (previously 10.8%) respectively.
These achievements are the outcomes of a resilient healthcare system that was built brick by brick over decades and stood the test of time during the COVID-19 pandemic. But certain deficiencies have surfaced in the State's public health sector, stemming from failures in addressing the needs of its workforce.
What are the unmet needs and gaps?
Despite exponential growth in terms of health infrastructure, there has been no proportionate expansion in the workforce. Delay in filling up vacant posts (across different levels) and lack of new posts' creation have left a dent in the sector. The health sector, including at the primary care level, is running the show by redeploying/diverting doctors and staff nurses to various facilities.
A crucial cadre of T.N.'s public health system are its Village Health Nurses (VHN), who play a vital role in maternal and child healthcare. As per the latest official data, 2,013 posts of VHNs (of the 8,713 sanctioned) and 1,251 posts of Auxiliary Nurse Midwives (of the 2,057 sanctioned) are lying vacant. There has been an inordinate delay in filling the vacant posts due to legal issues. VHNs spearhead antenatal care, delivery services, post-natal follow-up and immunisation. Instead of serving one village (population of 5,000 to 6,000 as per norms), each VHN is now covering at least two to three villages each. Facing an acute crisis, they have been rising concerns about falling behind in maternal and child healthcare services.
On the other hand, there is a growing concern about the shortage and skewed distribution of specialists in the State. Government doctors have been asking for an increase in their workforce as per patient strength, according to norms prescribed by Indian Public Health Standards. Many of them note that there is a huge rise in patient inflow to government hospitals, but no commensurate rise in staffing. In the last four years, the State recruited some 3,500-odd medical officers to its primary healthcare (point of entry) but is yet to address specialist shortfalls at the secondary and tertiary care levels. In particular, there is a huge deficit in super speciality cadre such as for cardiothoracic surgery and vascular surgery.
Additionally, contractual recruitments and proposed models for public private partnership in service delivery, such as for haemodialysis, are facing stiff opposition among the existing workforce.
For a State like Tamil Nadu, which takes pride in its advanced health infrastructure, a discontent and stretched workforce is detrimental in many ways. It could affect performance, patient outcomes, and public trust.