Primary Health Centres: Preferred Option for Birthing Care in Tamilnadu, India, from Users’ Perspectives.

Tamilnadu state of India witnessed an increasing trend of institutional deliveries since the beginning of 1990s, with decline of domiciliary deliveries to nearly zero now. Among the institutional deliveries, a shift has been observed since 2006 wherein primary health centres (PHC) have shown a four-fold increase in the number of deliveries while other public and private health facilities showed a decline, despite equal access by people to all categories of health facilities. A qualitative study was designed to explore the determinants that led to increased preference of PHCs for birthing care. In-depth interviews and FGDs were conducted with recently-delivering women and their spouses. User-friendly ambience, courteous attitude and behaviour of staff, good infrastructure, availability of qualified staff, and relative absence of informal payments have contributed to increased preference for birthing care in PHCs. Barriers to seeking care from secondary and tertiary-level public hospitals and private hospitals have also made women prefer PHCs.

Innovations and Challenges in Reducing Maternal Mortality in Tamil Nadu, India.

Although India has made slow progress in reducing maternal mortality, progress in Tamil Nadu has been rapid. This case study documents how Tamil Nadu has taken initiatives to improve maternal health services leading to reduction in maternal morality from 380 in 1993 to 90 in 2007. Various initiatives include establishment of maternal death registration and audit, establishment and certification of comprehensive emergency obstetric and newborn-care centres, 24-hour x 7-day delivery services through posting of three staff nurses at the primary health centre level, and attracting medical officers to rural areas through incentives in terms of reserved seats in postgraduate studies and others. This is supported by the better management capacity at the state and district levels through dedicated public-health officers. Despite substantial progress, there is some scope for further improvement of quality of infrastructure and services. The paper draws out lessons for other states and countries in the region.

Laboratory-based dengue fever surveillance in Tamil Nadu, India.

Dengue fever and dengue haemorrhagic fever (DF/DHF) have become a serious public health problem in many parts of India in recent years. Several vertical national programmes for communicable diseases, which include vector-borne diseases such as malaria and filariasis have been in operation for over five decades in India. The remarkable increase in dengue fever and DHF related deaths during the last decade has necessitated an effective surveillance system to detect the cases and adopt appropriate control measures against dengue vectors. Although the existence of all the four serotypes of dengue virus was proved as early as in 1960s, it was only after 1990, several outbreaks of DF/DHF were reported in Tamil Nadu. Further, dengue, once considered as urban problem has now penetrated into rural areas also, due to various changes in the environment. The geographic spread, increase in number of cases, reporting system, laboratory diagnosis, monitoring of vector density and investigation of outbreaks in Tamil Nadu during the last decade are comprehensively documented and discussed here to further strengthen the surveillance network to prevent possible major outbreaks of DF/DHF.