How to Improve Public Health Systems : Lessons from Tamil Nadu

Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health...

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Main Authors:	Das Gupta, Monica, Desikachari, B.R., Somanathan, T.V., Padmanaban, P.
Format:	Policy Research Working Paper
Language:	English
Published:	2012
Subjects:	ADMINISTRATIVE CONTROL AGED ANTENATAL CARE BASIC HEALTH BIRD FLU BLINDNESS CANCER CENTER FOR DEVELOPMENT CHICKENPOX CHIKUNGUNYA CHILD DEVELOPMENT CHILD HEALTH CARE CHILD HEALTH SERVICES CHILD MORTALITY CHILD MORTALITY RATE CHOLERA CITIES CITIZEN CITIZENS CLINICAL SERVICES COMMUNICABLE DISEASES COMMUNITY HEALTH CONTROLLING POPULATION GROWTH CROWDING DEAD ANIMALS DEAD BODIES DEATHS DENGUE DEVELOPING COUNTRIES DIABETES DIARRHEAL DISEASES DISASTERS DISEASE DISEASE CONTROL DISEASE OUTBREAK DISEASE OUTBREAKS DISEASE PREVENTION DISEASE PREVENTION AND CONTROL DISEASE SURVEILLANCE DISPENSARIES DOCTORS DRINKING WATER EARLY DETECTION EARTHQUAKE ECONOMIC CHANGE ECONOMIC GROWTH EMERGENCIES ENDEMIC DISEASES ENVIRONMENTAL HEALTH EPIDEMIC EPIDEMICS EXISTING RESOURCES EXPENDITURES FAMILY HEALTH FAMILY PLANNING FAMILY WELFARE FINANCIAL RESOURCES FOOD CONTROL FOOD SAFETY GI GII HAZARD HAZARDS HEALTH ACTIVISTS HEALTH AUTHORITIES HEALTH BUDGETS HEALTH CARE INDICATORS HEALTH CENTERS HEALTH CENTRE HEALTH CENTRES HEALTH CONDITIONS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH EXPENDITURES HEALTH EXPERTS HEALTH IMPACT HEALTH IMPACT ASSESSMENTS HEALTH INDICATORS HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH MANPOWER HEALTH MANPOWER DEVELOPMENT HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH PROBLEMS HEALTH PROFESSIONALS HEALTH REGULATIONS HEALTH RESOURCES HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICE PROVISION HEALTH SERVICES HEALTH SPECIALIST HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH WORKFORCE HOSPITAL HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INFANT INFANT DEATH INFECTION INFECTIOUS DISEASES INSECTICIDES INTERVENTION IODINE DEFICIENCY JOB TRAINING LATRINES LAWS LEPROSY LEPTOSPIROSIS LOCAL GOVERNMENTS LOCAL PUBLIC HEALTH MALARIA MALARIA CASES MALARIA CONTROL MALE HEALTH MALE HEALTH WORKERS MANAGING POPULATION MASS GRAVES MATERNAL AND CHILD HEALTH MATERNAL CARE MATERNAL DEATH MEASLES MEAT MEDICAL CARE MEDICAL CENTERS MEDICAL COLLEGE MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL OFFICER MEDICAL OFFICERS MEDICAL PRACTICE MEDICAL PRACTITIONERS MEDICAL RESEARCH MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFE MINISTRY OF HEALTH MORBIDITY MORTALITY MORTALITY RATE NATIONAL EFFORTS NATIONAL HEALTH NATURAL DISASTER NATURAL DISASTERS NURSE NURSES NURSING NUTRITION OCCUPATIONAL DISEASES OUTPATIENT CARE OUTREACH WORKERS PATIENT PATIENTS PERSONAL COMMUNICATION PLAGUE POISONING POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLIO PREGNANCY PREGNANCY COMPLICATIONS PREVENTION ACTIVITIES PREVENTIVE HEALTH SERVICES PREVENTIVE MEDICINE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIVATE HOSPITALS PROGRESS PUBLIC EXPENDITURE PUBLIC EXPENDITURE ON HEALTH PUBLIC HEALTH PUBLIC HEALTH ADMINISTRATION PUBLIC HEALTH CONCERNS PUBLIC HEALTH INTERVENTIONS PUBLIC HEALTH LAWS PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SERVICES PUBLIC HEALTH SYSTEM PUBLIC HEALTH WORKERS PUBLIC SERVICES QUARANTINE RODENTS RURAL AREAS RURAL DEVELOPMENT SANITARY CONDITIONS SANITATION SMALLPOX SOCIAL DEVELOPMENT SOCIAL MOBILIZATION SOCIAL WELFARE T.V. TB TEACHING HOSPITALS TERTIARY LEVELS TREATMENT URBAN AREAS URBANIZATION VACCINATION VECTOR BORNE DISEASES VECTOR CONTROL VECTORS WASTE WORKERS WORLD HEALTH ORGANIZATION YAWS ZOONOSES ZOONOTIC DISEASES
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institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English
topic	ADMINISTRATIVE CONTROL AGED ANTENATAL CARE BASIC HEALTH BIRD FLU BLINDNESS CANCER CENTER FOR DEVELOPMENT CHICKENPOX CHIKUNGUNYA CHILD DEVELOPMENT CHILD HEALTH CARE CHILD HEALTH SERVICES CHILD MORTALITY CHILD MORTALITY RATE CHOLERA CITIES CITIZEN CITIZENS CLINICAL SERVICES COMMUNICABLE DISEASES COMMUNITY HEALTH CONTROLLING POPULATION GROWTH CROWDING DEAD ANIMALS DEAD BODIES DEATHS DENGUE DEVELOPING COUNTRIES DIABETES DIARRHEAL DISEASES DISASTERS DISEASE DISEASE CONTROL DISEASE OUTBREAK DISEASE OUTBREAKS DISEASE PREVENTION DISEASE PREVENTION AND CONTROL DISEASE SURVEILLANCE DISPENSARIES DOCTORS DRINKING WATER EARLY DETECTION EARTHQUAKE ECONOMIC CHANGE ECONOMIC GROWTH EMERGENCIES ENDEMIC DISEASES ENVIRONMENTAL HEALTH EPIDEMIC EPIDEMICS EXISTING RESOURCES EXPENDITURES FAMILY HEALTH FAMILY PLANNING FAMILY WELFARE FINANCIAL RESOURCES FOOD CONTROL FOOD SAFETY GI GII HAZARD HAZARDS HEALTH ACTIVISTS HEALTH AUTHORITIES HEALTH BUDGETS HEALTH CARE INDICATORS HEALTH CENTERS HEALTH CENTRE HEALTH CENTRES HEALTH CONDITIONS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH EXPENDITURES HEALTH EXPERTS HEALTH IMPACT HEALTH IMPACT ASSESSMENTS HEALTH INDICATORS HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH MANPOWER HEALTH MANPOWER DEVELOPMENT HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH PROBLEMS HEALTH PROFESSIONALS HEALTH REGULATIONS HEALTH RESOURCES HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICE PROVISION HEALTH SERVICES HEALTH SPECIALIST HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH WORKFORCE HOSPITAL HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INFANT INFANT DEATH INFECTION INFECTIOUS DISEASES INSECTICIDES INTERVENTION IODINE DEFICIENCY JOB TRAINING LATRINES LAWS LEPROSY LEPTOSPIROSIS LOCAL GOVERNMENTS LOCAL PUBLIC HEALTH MALARIA MALARIA CASES MALARIA CONTROL MALE HEALTH MALE HEALTH WORKERS MANAGING POPULATION MASS GRAVES MATERNAL AND CHILD HEALTH MATERNAL CARE MATERNAL DEATH MEASLES MEAT MEDICAL CARE MEDICAL CENTERS MEDICAL COLLEGE MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL OFFICER MEDICAL OFFICERS MEDICAL PRACTICE MEDICAL PRACTITIONERS MEDICAL RESEARCH MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFE MINISTRY OF HEALTH MORBIDITY MORTALITY MORTALITY RATE NATIONAL EFFORTS NATIONAL HEALTH NATURAL DISASTER NATURAL DISASTERS NURSE NURSES NURSING NUTRITION OCCUPATIONAL DISEASES OUTPATIENT CARE OUTREACH WORKERS PATIENT PATIENTS PERSONAL COMMUNICATION PLAGUE POISONING POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLIO PREGNANCY PREGNANCY COMPLICATIONS PREVENTION ACTIVITIES PREVENTIVE HEALTH SERVICES PREVENTIVE MEDICINE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIVATE HOSPITALS PROGRESS PUBLIC EXPENDITURE PUBLIC EXPENDITURE ON HEALTH PUBLIC HEALTH PUBLIC HEALTH ADMINISTRATION PUBLIC HEALTH CONCERNS PUBLIC HEALTH INTERVENTIONS PUBLIC HEALTH LAWS PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SERVICES PUBLIC HEALTH SYSTEM PUBLIC HEALTH WORKERS PUBLIC SERVICES QUARANTINE RODENTS RURAL AREAS RURAL DEVELOPMENT SANITARY CONDITIONS SANITATION SMALLPOX SOCIAL DEVELOPMENT SOCIAL MOBILIZATION SOCIAL WELFARE T.V. TB TEACHING HOSPITALS TERTIARY LEVELS TREATMENT URBAN AREAS URBANIZATION VACCINATION VECTOR BORNE DISEASES VECTOR CONTROL VECTORS WASTE WORKERS WORLD HEALTH ORGANIZATION YAWS ZOONOSES ZOONOTIC DISEASES
spellingShingle	ADMINISTRATIVE CONTROL AGED ANTENATAL CARE BASIC HEALTH BIRD FLU BLINDNESS CANCER CENTER FOR DEVELOPMENT CHICKENPOX CHIKUNGUNYA CHILD DEVELOPMENT CHILD HEALTH CARE CHILD HEALTH SERVICES CHILD MORTALITY CHILD MORTALITY RATE CHOLERA CITIES CITIZEN CITIZENS CLINICAL SERVICES COMMUNICABLE DISEASES COMMUNITY HEALTH CONTROLLING POPULATION GROWTH CROWDING DEAD ANIMALS DEAD BODIES DEATHS DENGUE DEVELOPING COUNTRIES DIABETES DIARRHEAL DISEASES DISASTERS DISEASE DISEASE CONTROL DISEASE OUTBREAK DISEASE OUTBREAKS DISEASE PREVENTION DISEASE PREVENTION AND CONTROL DISEASE SURVEILLANCE DISPENSARIES DOCTORS DRINKING WATER EARLY DETECTION EARTHQUAKE ECONOMIC CHANGE ECONOMIC GROWTH EMERGENCIES ENDEMIC DISEASES ENVIRONMENTAL HEALTH EPIDEMIC EPIDEMICS EXISTING RESOURCES EXPENDITURES FAMILY HEALTH FAMILY PLANNING FAMILY WELFARE FINANCIAL RESOURCES FOOD CONTROL FOOD SAFETY GI GII HAZARD HAZARDS HEALTH ACTIVISTS HEALTH AUTHORITIES HEALTH BUDGETS HEALTH CARE INDICATORS HEALTH CENTERS HEALTH CENTRE HEALTH CENTRES HEALTH CONDITIONS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH EXPENDITURES HEALTH EXPERTS HEALTH IMPACT HEALTH IMPACT ASSESSMENTS HEALTH INDICATORS HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH MANPOWER HEALTH MANPOWER DEVELOPMENT HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH PROBLEMS HEALTH PROFESSIONALS HEALTH REGULATIONS HEALTH RESOURCES HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICE PROVISION HEALTH SERVICES HEALTH SPECIALIST HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH WORKFORCE HOSPITAL HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INFANT INFANT DEATH INFECTION INFECTIOUS DISEASES INSECTICIDES INTERVENTION IODINE DEFICIENCY JOB TRAINING LATRINES LAWS LEPROSY LEPTOSPIROSIS LOCAL GOVERNMENTS LOCAL PUBLIC HEALTH MALARIA MALARIA CASES MALARIA CONTROL MALE HEALTH MALE HEALTH WORKERS MANAGING POPULATION MASS GRAVES MATERNAL AND CHILD HEALTH MATERNAL CARE MATERNAL DEATH MEASLES MEAT MEDICAL CARE MEDICAL CENTERS MEDICAL COLLEGE MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL OFFICER MEDICAL OFFICERS MEDICAL PRACTICE MEDICAL PRACTITIONERS MEDICAL RESEARCH MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFE MINISTRY OF HEALTH MORBIDITY MORTALITY MORTALITY RATE NATIONAL EFFORTS NATIONAL HEALTH NATURAL DISASTER NATURAL DISASTERS NURSE NURSES NURSING NUTRITION OCCUPATIONAL DISEASES OUTPATIENT CARE OUTREACH WORKERS PATIENT PATIENTS PERSONAL COMMUNICATION PLAGUE POISONING POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLIO PREGNANCY PREGNANCY COMPLICATIONS PREVENTION ACTIVITIES PREVENTIVE HEALTH SERVICES PREVENTIVE MEDICINE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIVATE HOSPITALS PROGRESS PUBLIC EXPENDITURE PUBLIC EXPENDITURE ON HEALTH PUBLIC HEALTH PUBLIC HEALTH ADMINISTRATION PUBLIC HEALTH CONCERNS PUBLIC HEALTH INTERVENTIONS PUBLIC HEALTH LAWS PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SERVICES PUBLIC HEALTH SYSTEM PUBLIC HEALTH WORKERS PUBLIC SERVICES QUARANTINE RODENTS RURAL AREAS RURAL DEVELOPMENT SANITARY CONDITIONS SANITATION SMALLPOX SOCIAL DEVELOPMENT SOCIAL MOBILIZATION SOCIAL WELFARE T.V. TB TEACHING HOSPITALS TERTIARY LEVELS TREATMENT URBAN AREAS URBANIZATION VACCINATION VECTOR BORNE DISEASES VECTOR CONTROL VECTORS WASTE WORKERS WORLD HEALTH ORGANIZATION YAWS ZOONOSES ZOONOTIC DISEASES Das Gupta, Monica Desikachari, B.R. Somanathan, T.V. Padmanaban, P. How to Improve Public Health Systems : Lessons from Tamil Nadu
geographic_facet	The World Region The World Region
relation	Policy Research working paper ; no. WPS 5073
description	Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the system s shortfalls. Tamil Nadu s public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their people s health.
format	Publications & Research :: Policy Research Working Paper
author	Das Gupta, Monica Desikachari, B.R. Somanathan, T.V. Padmanaban, P.
author_facet	Das Gupta, Monica Desikachari, B.R. Somanathan, T.V. Padmanaban, P.
author_sort	Das Gupta, Monica
title	How to Improve Public Health Systems : Lessons from Tamil Nadu
title_short	How to Improve Public Health Systems : Lessons from Tamil Nadu
title_full	How to Improve Public Health Systems : Lessons from Tamil Nadu
title_fullStr	How to Improve Public Health Systems : Lessons from Tamil Nadu
title_full_unstemmed	How to Improve Public Health Systems : Lessons from Tamil Nadu
title_sort	how to improve public health systems : lessons from tamil nadu
publishDate	2012
url	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20091013150143 http://hdl.handle.net/10986/4265
_version_	1764390659579445248
spelling	okr-10986-42652021-04-23T14:02:16Z How to Improve Public Health Systems : Lessons from Tamil Nadu Das Gupta, Monica Desikachari, B.R. Somanathan, T.V. Padmanaban, P. ADMINISTRATIVE CONTROL AGED ANTENATAL CARE BASIC HEALTH BIRD FLU BLINDNESS CANCER CENTER FOR DEVELOPMENT CHICKENPOX CHIKUNGUNYA CHILD DEVELOPMENT CHILD HEALTH CARE CHILD HEALTH SERVICES CHILD MORTALITY CHILD MORTALITY RATE CHOLERA CITIES CITIZEN CITIZENS CLINICAL SERVICES COMMUNICABLE DISEASES COMMUNITY HEALTH CONTROLLING POPULATION GROWTH CROWDING DEAD ANIMALS DEAD BODIES DEATHS DENGUE DEVELOPING COUNTRIES DIABETES DIARRHEAL DISEASES DISASTERS DISEASE DISEASE CONTROL DISEASE OUTBREAK DISEASE OUTBREAKS DISEASE PREVENTION DISEASE PREVENTION AND CONTROL DISEASE SURVEILLANCE DISPENSARIES DOCTORS DRINKING WATER EARLY DETECTION EARTHQUAKE ECONOMIC CHANGE ECONOMIC GROWTH EMERGENCIES ENDEMIC DISEASES ENVIRONMENTAL HEALTH EPIDEMIC EPIDEMICS EXISTING RESOURCES EXPENDITURES FAMILY HEALTH FAMILY PLANNING FAMILY WELFARE FINANCIAL RESOURCES FOOD CONTROL FOOD SAFETY GI GII HAZARD HAZARDS HEALTH ACTIVISTS HEALTH AUTHORITIES HEALTH BUDGETS HEALTH CARE INDICATORS HEALTH CENTERS HEALTH CENTRE HEALTH CENTRES HEALTH CONDITIONS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH EXPENDITURES HEALTH EXPERTS HEALTH IMPACT HEALTH IMPACT ASSESSMENTS HEALTH INDICATORS HEALTH INTERVENTIONS HEALTH MANAGEMENT HEALTH MANPOWER HEALTH MANPOWER DEVELOPMENT HEALTH NEEDS HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH POLICY HEALTH PROBLEMS HEALTH PROFESSIONALS HEALTH REGULATIONS HEALTH RESOURCES HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICE PROVISION HEALTH SERVICES HEALTH SPECIALIST HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH WORKFORCE HOSPITAL HOSPITAL CARE HOSPITALS HUMAN DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INFANT INFANT DEATH INFECTION INFECTIOUS DISEASES INSECTICIDES INTERVENTION IODINE DEFICIENCY JOB TRAINING LATRINES LAWS LEPROSY LEPTOSPIROSIS LOCAL GOVERNMENTS LOCAL PUBLIC HEALTH MALARIA MALARIA CASES MALARIA CONTROL MALE HEALTH MALE HEALTH WORKERS MANAGING POPULATION MASS GRAVES MATERNAL AND CHILD HEALTH MATERNAL CARE MATERNAL DEATH MEASLES MEAT MEDICAL CARE MEDICAL CENTERS MEDICAL COLLEGE MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL OFFICER MEDICAL OFFICERS MEDICAL PRACTICE MEDICAL PRACTITIONERS MEDICAL RESEARCH MEDICAL SERVICES MEDICAL SPECIALISTS MEDICINES MIDWIFE MINISTRY OF HEALTH MORBIDITY MORTALITY MORTALITY RATE NATIONAL EFFORTS NATIONAL HEALTH NATURAL DISASTER NATURAL DISASTERS NURSE NURSES NURSING NUTRITION OCCUPATIONAL DISEASES OUTPATIENT CARE OUTREACH WORKERS PATIENT PATIENTS PERSONAL COMMUNICATION PLAGUE POISONING POLICY RESEARCH POLICY RESEARCH WORKING PAPER POLIO PREGNANCY PREGNANCY COMPLICATIONS PREVENTION ACTIVITIES PREVENTIVE HEALTH SERVICES PREVENTIVE MEDICINE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIVATE HOSPITALS PROGRESS PUBLIC EXPENDITURE PUBLIC EXPENDITURE ON HEALTH PUBLIC HEALTH PUBLIC HEALTH ADMINISTRATION PUBLIC HEALTH CONCERNS PUBLIC HEALTH INTERVENTIONS PUBLIC HEALTH LAWS PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SERVICES PUBLIC HEALTH SYSTEM PUBLIC HEALTH WORKERS PUBLIC SERVICES QUARANTINE RODENTS RURAL AREAS RURAL DEVELOPMENT SANITARY CONDITIONS SANITATION SMALLPOX SOCIAL DEVELOPMENT SOCIAL MOBILIZATION SOCIAL WELFARE T.V. TB TEACHING HOSPITALS TERTIARY LEVELS TREATMENT URBAN AREAS URBANIZATION VACCINATION VECTOR BORNE DISEASES VECTOR CONTROL VECTORS WASTE WORKERS WORLD HEALTH ORGANIZATION YAWS ZOONOSES ZOONOTIC DISEASES Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the system s shortfalls. Tamil Nadu s public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their people s health. 2012-03-19T19:12:53Z 2012-03-19T19:12:53Z 2009-10-01 http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20091013150143 http://hdl.handle.net/10986/4265 English Policy Research working paper ; no. WPS 5073 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank Publications & Research :: Policy Research Working Paper The World Region The World Region

How to Improve Public Health Systems : Lessons from Tamil Nadu

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