Context: The Government of India, Government of Tamil Nadu (GoTN) and the World Bank recently signed a $287 million loan agreement for the Tamil Nadu Health System Reform Programme.

About the Tamil Nadu Health System Reform Programme:

• The programme aims to improve the quality of health care, reduce the burden of non-communicable diseases (NCDs), and fill equity gaps in reproductive and child health services in Tamil Nadu.
• The programme supports interventions to strengthen institutional and state capacity to achieve results.
• The programme will promote population-based screening, treatment and follow-up for NCDs, and improve monitoring and evaluation. Patients will be equipped with knowledge and skills to self-manage their conditions. Lab services and health provider capacity will also be strengthened to address mental health. To tackle road injuries, the programme will improve in- hospital care, strengthen protocols, strengthen the 24×7 trauma care services and establish a trauma registry.
• Another key aim of this programme is to reduce the equity gaps in reproductive and child health. Special focus will be given to nine priority districts, which constitute the bottom quintile of the RCH indicators in the state and have a relatively large proportion of tribal populations.
• This Programme focuses on results instead of inputs through a Programme-for-Results (PforR) lending instrument. This will provide a much greater focus on outputs and outcomes through better alignment of expenditures and incentives with results.

The Tamil Nadu Health System Reform Program will support the state government to:

• develop clinical protocols and guidelines;
• achieve national accreditation for primary, secondary, and tertiary-level health facilities in the public sector;
• strengthen physicians, nurses and paramedics through continuous medical education;
• strengthen the feedback loop between citizens and the state by making quality and other data accessible to the public.

Background:

Tamil Nadu ranks third among all Indian states in the NITI Aayog Health Index which is reflected in vastly improved health outcomes. The state’s maternal mortality rate has declined from 90 deaths per 100,000 live births in 2005 to 62 deaths in 2015-16 while infant mortality has declined from 30 deaths per 1000 live births to 20 in the same period. A key contribution to these achievements has been the establishment of emergency obstetric and neonatal care centres and the 108 ambulance service with previous support from the World Bank. These have ensured that no mother has to travel more than 30 minutes to access emergency obstetric and neonatal care 24 hours a day, seven days a week.