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FEATURE STORY

India: Reducing Infant and Maternal Mortality in Tamil Nadu

April 29, 2010

TAMIL NADU HEALTH INDICATORS IMPROVE

April 29, 2010 - To further improve  health services quality and access while supporting state-wide management systems implementation, the World Bank has provided $117.70 million to the State of Tamil Nadu today. This comes as additional financing to the $110.83 million Tamil Nadu Health Systems Project, approved December 16, 2004 that has demonstrated effective results in reducing infant and maternal mortality.

TAMIL NADU HEALTH SYSTEMS PROJECT CONTEXT

Tamil Nadu has made significant development progress over the last 15 years. It is one of India's most industrialized states with economic growth rates well above the national average. The state has made impressive gains in life expectancy, gender equality, reducing female mortality rates, and access to safe drinking water.

“The additional funding will support the continuation of successful activities, and will particularly focus on improving the quality of health care provision. The project will also enhance access to and utilization of health services by the state’s poor, remote, and tribal populations,” said Preeti Kudesia, World Bank Senior Public Health specialist.

SUCCESSFUL INITIATIVES OF THE HEALTH PROJECT

The Tamil Nadu Heath Project has utilized a number of innovative and effective measures to improve health indicators and outcomes.

80 Comprehensive Emergency Obstetrics and Neonatal Centers (CEmONCs) have been established and strengthened. This has led to improved access and qualityof care for pregnant women as well as mothers and infants. 385 ambulances provided under the project, and now managed under a Public Private Partenership, have strengthened the Emergency Transport Services in rural areas in Tamil Nadu.

Private Public Partnerships in tribal areas in the state provide mobile out-reach health services, sickle cell anemia screening interventions, patient counseling services, and a bed grant scheme offering inpatient care to tribal populations.

Two Non Communicable Disease (NCD) pilots on cervical cancer and cardiovascular diseases (CVD) have been carried out in two districts each over the last two years. The successful implementation has influenced a state-wide roll-out. Approximately 993,000 patients have been screened for hypertension using standard treatment protocols at the primary and secondary level of health care. 84% of women in the target age group of 30-60 years have been screened for cervical cancer.

A computerized Hospital Management System (HMS) is operational at 38 secondary level hospitals. This will now be extended to all 270 secondary hospitals, and to 18 medical colleges.

INFANT MORTALITY DECREASES 35%

The state has made major progress in improving maternal and child health (MCH) outcomes. According to the most recent National Family Health Survey (NFHS-3) carried out in 2005-2006, substantial progress has been made since the previous survey in 1998-1999 (NFHS-2).

There has been 35% reduction in the Infant Mortality Rate (IMR) from 48 deaths per 1,000 in 1999 to 31 deaths in 1,000 live births in 2006 although additional efforts are needed to bring Tamil Nadu’s IMR closer to its better-performing neighbors, such as Sri Lanka (IMR 18.8/1,000) and the state of Kerala (IMR is 14/1,000).

These improvements are in part due to a significant increase in overall vaccination coverage of children between 12 and 23 months. The overall nutrition status of children under age 3 also has improved, with an 18 percent reduction in underweight children.

MATERNAL MORTALITY IMPROVES BY 50%

The state’s Maternal Mortality Ratio (MMR), based on the Sample Registration System, decreased from 167 deaths per 100,000 live births in 1999 to 111 deaths per 100,000 live births in 2006. Notwithstanding this progress, the MMR continues to be 25 times higher than in developed countries. Further improvements are needed in the overall quality of care through strengthening the provisions of comprehensive emergency obstetric and neonatal care.