What Happened
- Tamil Nadu, long regarded as a model state for public healthcare delivery, faces a new wave of challenges despite its historical achievements in maternal health, immunisation, and infectious disease control.
- The state's wide, well-distributed network of Primary Health Centres (PHCs) forms the backbone of its public health system, but the rising burden of Non-Communicable Diseases (NCDs) is straining this infrastructure.
- NCDs now account for nearly 69% of all deaths in Tamil Nadu, with diabetes and hypertension emerging as major concerns.
- The state launched the Makkalai Thedi Maruthuvam (Healthcare at the Doorstep) scheme in 2021, deploying trained Women Health Volunteers for doorstep NCD screening and follow-up.
- Implementation gaps persist, including limited home visits, overburdened volunteers, data duplication, and inflated coverage claims.
Static Topic Bridges
India's Primary Healthcare Infrastructure and Health & Wellness Centres
India's public health delivery follows a three-tier structure in rural areas: Sub-Centres (SC), Primary Health Centres (PHC), and Community Health Centres (CHC). Under the Ayushman Bharat scheme (launched 2018), the government is converting 1.5 lakh existing Sub-Centres and PHCs into Health and Wellness Centres (HWCs) to provide Comprehensive Primary Health Care (CPHC), including screening and management of NCDs, mental health, and geriatric care.
- Indian Public Health Standards (IPHS): 1 PHC per 30,000 population in rural areas (20,000 in hilly/tribal areas); 1 CHC per 1,20,000 population.
- HWCs are designed to shift focus from episodic, curative care to comprehensive, preventive, and promotive healthcare closer to communities.
- HWCs provide 12 service packages including NCD screening, care for common ophthalmic and ENT problems, basic oral health, elderly and palliative care, and mental health services.
- As per the National Health Mission, over 1.6 lakh HWCs have been operationalised across India.
- Tamil Nadu has been a pioneer in the HWC model, integrating its Makkalai Thedi Maruthuvam doorstep services with the HWC network.
Connection to this news: Tamil Nadu's challenge illustrates the broader national transition from a communicable-disease-focused primary care system to one that must handle chronic NCDs, which require sustained follow-up rather than one-time interventions.
The NCD Burden in India: Epidemiological Transition
India is undergoing a rapid epidemiological transition where the disease burden is shifting from communicable diseases to non-communicable diseases. NCDs -- including cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases -- now account for approximately 65-69% of all deaths in India. This transition is driven by urbanisation, dietary changes, sedentary lifestyles, and an ageing population.
- WHO estimates that NCDs account for 66% of all deaths in India (2023 data).
- India bears approximately 20% of the global NCD burden.
- The National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), formerly NPCDCS, covers cardiovascular diseases, diabetes, cancer, and stroke at district level.
- India's National Multisectoral Action Plan for Prevention and Control of NCDs (2017-2022) set a target of 25% relative reduction in premature mortality from NCDs by 2025.
- Key risk factors: tobacco use (28.6% of adults), harmful alcohol use, physical inactivity, unhealthy diet, air pollution.
- Population-based screening under Ayushman Bharat targets persons above 30 years for hypertension, diabetes, and common cancers.
Connection to this news: Tamil Nadu's experience -- high success in controlling communicable diseases but now struggling with NCDs -- exemplifies the broader epidemiological transition challenge that all Indian states will eventually face.
The Tamil Nadu Model of Public Healthcare
Tamil Nadu has been consistently ranked among the top-performing states in health indicators. Its success is attributed to sustained investment in public health infrastructure, a strong cadre of trained health workers, and progressive health policies dating back to the 1980s. The Tamil Nadu Health System Reform Program, supported by the World Bank, has further strengthened quality of care and NCD management.
- Tamil Nadu's Infant Mortality Rate (IMR): approximately 12 per 1,000 live births (national average: 28 per 1,000).
- Institutional delivery rate in Tamil Nadu exceeds 99%, among the highest nationally.
- The state has one of the highest doctor-to-population ratios among Indian states.
- Makkalai Thedi Maruthuvam (2021): deploys Women Health Volunteers, Village Health Nurses, Health Inspectors, and Mid-Level Health Providers for doorstep NCD screening of persons above 30.
- The scheme has reached over 2.5 crore people in four years, improving hypertension control to 17% and diabetes control to 16.7% from baseline measures.
- Tamil Nadu Health Policy Vision 2030 aims to achieve Universal Health Coverage with focus on NCDs, geriatric care, and mental health.
Connection to this news: The Tamil Nadu model demonstrates that even a well-functioning public health system must reinvent itself to address the shifting disease burden, and offers lessons for other states yet to undergo this transition.
Key Facts & Data
- NCDs account for approximately 66-69% of deaths in India; similar proportion in Tamil Nadu.
- India carries about 20% of the global NCD burden.
- Tamil Nadu IMR: approximately 12 per 1,000 live births vs. national average of 28.
- IPHS norm: 1 PHC per 30,000 rural population; 1 CHC per 1,20,000 population.
- Ayushman Bharat HWC target: 1.5 lakh centres; over 1.6 lakh operationalised.
- Makkalai Thedi Maruthuvam (2021): reached 2.5 crore people; screens persons above 30 for diabetes, hypertension, and mental health.
- NP-NCD programme covers cardiovascular diseases, diabetes, cancer, and stroke.
- Key NCD risk factors: tobacco (28.6% adult prevalence), unhealthy diet, physical inactivity, air pollution.