1. Role of Government in strengthening the public health system to handle future challenges

2. GOVERNMENT HEALTH CARE FACILITIES
Govt. Institutions
Tertiary care
Secondary Care
Primary Care
DME
DM&RHS
DPH&PM
Doctors
Nurses
Other staff
Medical Colleges - 21
Multi Super Speciality Hospital -1
Hospitals – 43
Dental College - 1
Dental Hospital - 1
Doctors
Nurses
Other staff
HQ Hospitals - 29
SDH – 246
Doctors
Nurses
Other Staff-19103
HSCs
PHCs – 1753
Urb PHCs – 476 2

3. Outline
Treatment in Private vs Public facilities (65%:35%) : If true, there is a need to further improve public facilities
HR Issues
Financing Public Health Systems
Technological upgradation of public facilities
Need for expanding Urban PHCs

4. HR Issues
Creation, Recruitment and Retention of permanent staff (especially Doctors)
Dealing with Contract Staff- Initial years on contract followed by absorption in regular vacancies
Training and Motivation of staff
Increasing ‘Public perception and satisfaction’ in public facilities: Continuous Training

5. No. of Valid Registered Personnel in Various Councils (TN and Puducherry)
Sl. No
Category
Registered on the Rolls
(Aug 2016)
Numbers per 1000
(7.92 cr 2016)
Out-migration
(5 years)
In-migration 1
Doctors (Allopathy)
119373
1.5
7412 (6 yrs) NA 2
Dentists
22113
0.3
3847 3
Nurses (Renewed)
94,693
1.2
12,214
24,382 4
Ayurveda
5415
0.22
300 5
Yoga & Naturopathy
845 6
Unani
1428 7
Siddha
9644 8
Homoeopathy
21710
0.27
276 (1 year)

6. MRB- RECRUITMENT ABSTRACT ( Feb 2012 Onwards)
S.NO.
NAME OF THE POST
NO. OF CANDIDATES SELECTED 01
ASSISTANT SURGEON (GENERAL)
4908 02
ASSISTANT SURGEON (SPECIALITY)
996 03
ASSISTANT SURGEON (DENTAL-GENERAL) 59 04
ASSISTANT SURGEON (DENTAL-SPECIALITY) 67 05
DOCTORS FOR TAMIL NADU GOVT.MULTI SUPER SPECIALITY HOSPITAL 72 06
NURSES
7243 07
PHARMACIST
651 08
VILLAGE HEALTH NURSE
200 09
LAB TECHNICIAN GRADE III (RNTCP)
181 10
RADIOGRAPHER
194 11
FITTER GRADE II 60 12
PHYSIOTHERAPIST GRADE II 48 13
ECG TECHNICIAN 29 14
THERAPEUTIC ASSISTANT 8 15
PROSTHETIC CRAFTSMAN 33 16
EEG /EMG TECHNICIAN
TOTAL
14761

7. Financing Public Health System
Currently budgetary support from State Govt apart from NRHM funds / EAPs
Options:
Cost containment, strategic purchases, centralised services (instead of providing in all the facilities)
Additional Taxes/cess?
Co-payment?
Empanellment of PHCs? (Strengthening HR, lab and diagnostic services- bed occupancy)
Any other methods ???

8. Technological Upgradation
Medical technology is fast evolving
Public facilities need to upgrade to keep pace to attract and service more people
Unique Identification of patients
Help in knowing medical history, followup
Make use of HMIS
Aadhaar can possibly provide solution
Can enable to move towards a true referral system- can reduce crowding of tertiary care

9. Need for expanding Urban PHCs
Inadequate
Sparse
Hence public crowd secondary / tertiary care hospitals (located in urban areas) or seek private facilities
Need to expand urban PHCs at a quicker pace to move towards true referral system

10. Thank you !!! Dr. P. Senthilkumar IAS
Special Secretary, Health and Family Welfare
Chennai, Tamil Nadu