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Chapter - 4 PUBLIC HEALTH AND PREVENTIVE MEDICINE The policy of the Government is to provide a healthy and disease free life to the people of Tamilnadu. Towards this the Government has been formulating and implementing several programmes of Public Health through Primary Health Care approach. I. PRIMARY HEALTH CARE In Tamilnadu 1411 Primary Health Centres and the 8682 Health Sub Centres attached to these Primary Health Centres provide the preventive, promotive, curative and rehabilitative health care services. All the Primary Health Centres have been equipped with basic facilities like Cold chain equipments, Surgical instruments for minor surgeries and deliveries, laboratory facilities, drugs, etc,. There are six beds in each block Primary Health Centre. However upgraded Primary Health Centres are provided with 30 beds and in 24 hour Primary Health Centres there are 10 beds. The upgraded Primary Health centres have the facility of X - Ray equipment and operation theatres. The Block Primary Health centres have facilities for detection of cataract cases and treatment of minor eye ailments. Sufficient drugs are supplied to the Primary Health Centres through Tamilnadu Medical Services Corporation. Out of 1411 Primary Health Centres, 25 Primary Health Centres are located in tribal areas. 241 Primary Health Centres are functioning as 24 Hours Primary Health Centres. Out of 1411 Primary Health Centres, 69 Primary Health Centres and 6 Health Sub Centres are adopted by industrial institutions. 97 % of the Primary Health Centres function in own buildings., 421.17 lakhs of out patients and 1,18,488 inpatients were treated in these Primary Health Centres during the 2001-2002. A chart showing comparison indices of average Out Patients per Primary Health Centre per day during 2000-2001 and 2001-2002 (month wise) is available in Annexure 2. Women Doctors for Primary Health Centres The Maternal and Child Health Services constitute one of the most important services provided by the Public Health Department and towards improving the services, sanction was accorded for filling up of 350 posts of Medical Officers exclusively by Women Doctors through Special recruitment and 555 posts of Medical Officers through Employment Exchange. So far 300 women doctors and 485 doctors have joined duty. Upgradation of Primary Health Centres The Policy of the Government is to provide one 30 bedded institution with specialists doctors and equipments at the rate of one per block. There are 385 blocks in Tamil Nadu. Many block headquarters already have hospitals namely 25 District Headquarters Hospitals, 162 Taluk Hospitals, 79 Non-Taluk Hospitals and 59 upgraded Primary Health Centres/Community Health Centres and all these institutions have adequate facilities to provide better Medical Care. During 2000-2001, 21 Primary Health Centres were sanctioned for upgradation. All the remaining blocks, the block level Primary Health Centre will be upgraded in the next 3 year period. II. MOBILE HEALTH SERVICES In order to ensure that people living in tribal remote and inaccessible areas get the medical facilities, 25 mobile health dispensaries are functioning at present. III.PARTICIPATORY COMMUNITY HEALTH COMMITTEE Since access to comprehensive health care has a poverty alleviating effect, quality of health care services rendered at Primary Health Centres should be of high order. To ensure this aspect and to involve the participation of the Community in the maintenance on primary health centres, participatory Community Health Committees are being formed in all Primary Health Centres. Out of 1411 Primary Health Centres Participatory Community Health Committee have been formed in 1297 Primary Health Centres. IV. MATERNAL AND CHILD HEALTH SERVICES Maternal and Child Health services are provided through the Primary Health Centres and Health Sub Centres. There are 8682 Health Sub Centres in the State of which 5946 function from Government buildings. The services provided by the Health Sub Centres are Antenatal registration, Antenatal checkup, vaccination against tetanus, immunisation against vaccine preventable diseases, delivery care and post natal care. At present 87.6 % are institutional deliveries in Tamilnadu. A bar diagram showing the comparison indices of deliveries conducted at Primary Health Centres during 2000-2001 and 2001-2002 (month wise) is available in Annexure 1. Immunisation against vaccine preventable diseases are sustained at 100% every year. Apart from the routine immunisation, Pulse Polio Immunisation is conducted every year and all children below 5 years of age are given two additional doses of oral polio vaccine. As a result of the sustained coverage of various immunisation activities, the incidence of vaccine preventable diseases are under control and no polio cases have been reported in the state for the past two years. V. IRON DEFICIENCY - ANAEMIA CONTROL In Tamilnadu anaemia among women is persistently high. This leads to high Maternal Mortality rate, Infant Mortality rate and complications during pregnancy. In order to tackle the problem of anaemia and consequently reduce the Infant Mortality rate and Maternal Mortality rate, a scheme of giving IFA (L) tablet to each adolescent girl was launched on 8.2.2002. This scheme is expected to cover about 50 lakhs adolescent girls in the age group of 11 to 19 years. VI. NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME The National Iodine Deficiency Disorders Control Programme is implemented in the State from 1991 and the state Iodine Deficiency Disorder cell started functioning from 1.7.94 on wards. The objective of the programme is to identify the problem districts through goitre surveys and take control measures through dietary supplementation of iodised salt through IEC activities. A notification under the Prevention of Food Adulteration Act has been issued banning the sale of non-iodised salt for edible purposes. Spot testing of the salt samples for the retailers and spot testing of the kitchen salt samples are being done to access the presence of iodine and know the availability and use of iodised salt. Non statutory salt samples are lifted and tested to know the iodine content in salt. VII. SCHOOL CHILDREN HEALTH PROGRAMME School age children account for 25% of the population. School Children Health Programme help attain them full potential in physical, psychological, emotional and intellectual growth and development. The two fold purpose is improvement of health and health promotion. Thus under the programme, school children examined for early detection of the presence of ailments that may hamper their education as well as health and treated giving special emphasis on rheumatic heart problems, eye disorders, dental problems etc,. All Thursdays are School Health Days. Students requiring special treatment are referred to the higher medical institutions for specialised and continued treatments. Medicines worth of Rs.300 lakhs are supplied through TNMSC Ltd. All Saturdays are referral days. For the successful implementation of the scheme two teachers from each school are identified to co-ordinate and they are given training in identifying common ailments and interact with doctors. During the year 2001-2002, medical teams visited 40,308 schools. During their visit the number of students examined were 87,99,189. Out of the students examined above, 55,87,905 were treated for minor ailments. 70,252 students were referred to special treatments. Morbidity pattern of school children under School Health Programme:
A bar diagram showing morbidity pattern among school going children during 2001-2002 is available in Annexure 4. VIII. CONTROL OF COMMUNICABLE DISEASES Acute Diarrhoeal Diseases and suspected Cholera are common among the water borne diseases. 1.52 lakhs of anti cholera inoculations were given and 50,173 water sources were chlorinated during 2001-2002 as preventive measures. Administration of oral Rehydration salt has been popularised through Health Education and preparation of ORS solution is also demonstrated by the field staff to the public. National Surveillance Programme of Communicable Diseases Communicable Disease Surveillance is important to develop strategies for control and prevention. It helps forecast epidemics and to be prepared to initiate timely action to control out breaks in epidemic prone areas. In Tamilnadu a National surveillance project on communicable diseases is launched as a pilot programme in Dharmapuri, Villupuram, Coimbatore and Madurai Districts. IX. INDUSTRIAL HYGIENE AND HEALTH Water samples from various protected water sources to control pollution and contamination of drinking water are collected from the Water Analysis laboratories established at Chennai and Coimbatore. Air pollution surveys are also carried out to assess air quality. 29,461 water samples have been tested by these laboratories, during the year 2001-2002. X. PREVENTION OF FOOD ADULTERATION Food Safety needs to be placed high on the Agenda. For this purpose, Prevention of Food Adulteration Act 1954 and Tamilnadu Prevention of Food Adulteration Rules 1955 are implemented in Tamilnadu. The entire State is notified for Prevention of Food Adulteration Act and rules and is being implemented. Samples were analysed out of which 283 samples were adulterated. The percentage of adulteration is 11.77%. 90 cases were launched for prosecutions and 15 were convicted and fined with imprisonment. XI. BAN ON PAAN MASALA AND GUTKA In the interest of public health, the sale of chewing tobacco, gutka and paan masala containing tobacco or any other ingredients injurious to health is banned in the State of Tamilnadu for a period of 5 years with effect form 19.11.2001 This is to prevent primarily the younger generation from getting addicted to the ill habit of chewing tobacco, gutka and paan masala which is responsible for the high incidence of oral cancer. Raids are being conducted through out Tamil Nadu with the help of police and 2690 kilograms of 16 banned products have been seized. 20 prosecutions were sanctioned. XII. VITAL STATISTICS The system of registration of Births and Deaths is revamped from 1.1.2000 and implemented as per Tamilnadu Birth and Death registration rules 2000 with effect from 1.1.2000. All the connected officials have been trained under the revamped system of birth and death registration. XIII.VECTOR BORNE DISEASES CONTROL PROGRAMME Malaria Malaria is prevalent mainly in urban, coastal, riverine areas in this State. In Tamil Nadu, 60 to 70% of the total Malaria cases occur in Urban areas and Chennai is the main problem area. Malaria cases are detected through active and passive surveillance and immediate treatment at door steps are given. During 2001, 31,616 were detected in Tamil Nadu of which 23,655 cases are from Chennai city. Corporation authorities undertake malaria control measures in corporation area, and in other areas ante mosquito measures using synthetic pyrithroids is undertaken. National Filarial Control Programme The National Filarial Control Programme is implemented in Tamilnadu since 1957. The recent advances in the field of Filariasis control indicates that Annual single dose mass DEC administration for atleast 5 years is the most cost effective. Initially this programme was implemented as pilot study in Cuddalore district. Subsequently this programme was extended to other filarial endemic districts viz Thiruvallore, Kancheepuram, Vellore, Thiruvannamalai, Villupuram, Nagapattinam, Thiruvarur, Thiruchirapalli, Pudukottai, Thanjavur, Perambalur and Kanyakumari in the State. In March 2002, the 5th round of mass DEC administration was done covering 2.8 crores of people. The programme was supported by World Health Organisation and Indian Council for Medical Research and was the biggest of its kind in the world. Leptospirosis Control Programme Government have sanctioned 7 Leptospirosis clinics at Taluk / District Head quarters Hospital at Poonamallee, Thiruvallur and Madurai Health Districts for the control of leptospirosis. These clinics are functioning in the above areas at present. XIV.INSTITUTE OF VECTOR CONTROL AND ZOONOSES - HOSUR The institute of vector control and zoonoses, Hosur is made as a nodal agency for Plague Control activities. An 'arbovirus' laboratory has also been established with all facilities at the Institute of Vector Control and Zoonoses, Hosur for diagnosis of Dengue and Japanese Encephalitis. In addition to Malaria and Filaria, Japanese Encephalities and Dengue are emerging diseases at present transmitted by mosquito vectors. Leptospirosis and anthrox are zoonotic diseases spread from animals to human. Disease surveillance units have been established in 5 districts to study the prevalence and forecast the outbreak of these diseases which will help in organising timely preventive measures. XV. NATIONAL LEPROSY ERADICATION PROGRAMME The National Leprosy Eradication Programme which was launched in 1954-55 with the main thrust on early detection and sustained regular treatment of all leprosy patients has been integrated with the primary health care services in Tamilnadu. The prevalence rate which was 118 per 10,000 population in 1983 has now been brought down to 4.5 per 10,000 population. The programme is moving towards total elimination of Leprosy and the target of the case load to less than 1 per 10,000 population will be achieved in a couple of years. A graph showing the progress made in National Leprosy Eradication
Programme is available in XVI. SPECIALITY CAMPS A network of health care institutions provide medical care to rural people through which common ailments are treated effectively. But specialised treatments are not easily accessible to rural people for illness like cancer, diabetes and heart ailments which are now in increasing proportions. It is necessary to provide skilled treatment in remote and rural areas. The Tamilnadu Government have introduced the scheme of speciality camps for diseases like cancer, diabetes, hypertension and heart ailments and geriatric problems in all 385 blocks in the state. So far 130 camps have been conducted. Totally 2,27,509 people attended the camps. A pictorial diagram showing the morbidity pattern of the diseases identified during the Speciality Medical Camps conducted in the year 2002 is available in Annexure 5. XVII. BORDER DISTRICT CLUSTER STRATEGY PROGRAMME IN TAMILNADU Border District Cluster Strategy Programme in Tamilnadu is a programme executed in Tamilnadu with the support of UNICEF in Tiruvallur and Vellore districts mainly to strengthen the Mother and Child Health services with inter-sectoral co-ordination of sectors like Health Nutrition, Non Governmental Oraganisation, Local Body and with people's participation. It is implemented in both rural and urban areas at a cost of Rs. 83,68,048. For expansion of the programme a high level meeting has been conducted. XVIII.PUBLIC HEALTH TRAINING AND CONTINUING EDUCATION In order to ensure that the doctors and the field public health staff are kept updated in respect of various programmes under implementation, various in service training programmes are organised by this department including the training on development of administrative skills for the officials concerned. Regional level training institutions are established at Chennai Egmore, Poonamalle, Madurai, Salem, Villupuram and Gandhigram. 28 Rural Health Training Centres are functioning at selected Primary Health Centres. Regular long time training courses are conducted in 5 Multipurpose Health Workers (Female) school and one Multipurpose Health Supervisor (Female) Training School at Chennai. Voluntary Health Organisations and reputed institutions like Cancer Institute, Adyar, SPASTIC Society etc. are also involved in imparting training. XIX.HEALTH CARE SERVICES TO SC/ST POPULATION The programmes carried out by the Department of Public Health and Preventive Medicine caters generally to the need of the entire community. However for the benefit of the SC/ST population, 1436 Health sub centres have been established in Adi Dravida and Tribal Colonies. Also 25 Primary Health Centers are functioning under tribal sub plan. In order to see that the infant and maternal deaths do not occur during deliveries, 27805 Adi Dravida girls were trained in Basic First Aids and Asceptic delivery practices. Mobile Health Services has been introduced to take care of tribal and difficult areas. ACTION PLAN FOR 2002-2003 1.
300 Sub Health Centres building would be constructed at a cost of Rs.18
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