Editorial: A model for the rest of India

Published in The Hindu on February 20, 2013

It comes as no surprise that Tamil Nadu has once again been applauded for its “excellent” maternal and child-care services by the Common Review Mission of the National Rural Health Mission (NRHM). Suffice it to say that at a time when 99 per cent of global maternal mortality occurs in developing regions of the world, Tamil Nadu, Kerala and Maharashtra have become pockets that have bucked the trend. Even as India has been reducing its maternal mortality ratio — defined as the number of maternal deaths per 100,000 live births — the rate of reduction, from 380 in 1993 to 97 during 2007-2009, has been rapid in the case of Tamil Nadu. So much so that Tamil Nadu, along with Kerala (81) and Maharashtra (104), has already achieved the Millennium Development Goal of 109 maternal deaths per 100,000 live births by 2015. Compare this with the national average — an MMR of 212 for 2007-2009, which is more than double the MDG target. The State has been able to accomplish this by taking up a multi-pronged approach. First, it has equipped all health-care settings, starting with the 1,612 primary health-care centres, with trained staff nurses available round the clock and all essentials required for safe deliveries. Second, it has through innovative and women-friendly initiatives ensured that most deliveries take place in health-care settings. According to a recent survey by the University of Delhi, institutional deliveries are as high as 99 per cent in Tamil Nadu. The national average is about 73 per cent.

More than the very high percentage of institutional deliveries, what is more significant is the percentage of deliveries taking place in government-run institutions. Nearly 67 per cent of deliveries take place in government institutions, compared to 33 per cent in the private sector. The PHCs alone account for 27 per cent; it was about seven per cent in 2005. In fact, today, PHCs face a demand-side pressure. Compare this with Kerala — where the private sector accounts for roughly 60 per cent of deliveries. The primary reason why women in Tamil Nadu are flocking to government facilities is the changed nature of health-care services being provided. As many as 105 PHCs in the State have the facilities to conduct C-sections and store blood, and their main focus is maternal and child heath care. Women-friendly services like screening and appropriate intervention for gestational diabetes, hypertension and anaemia have had a magnetic effect. But the most critical contributor has been the strong and continued importance accorded to health-care services by whichever political party is in power.