From keeping Tamil Nadu poliofree for the last 18 years to managing seasonal outbreaks of vector-borne diseases, taking primary healthcare to people to ensuring immunisation of children and tackling newly emerging challenges including the COVID-19 pandemic, Tamil Nadu’s Directorate of Public Health (DPH) and Preventive Medicine has come a long way in its journey of 100 years.
In fact, 2022 is a significant year for the DPH. It was a century ago in 1922 that Sanitation and Public Health became a transferred subject under the control of the Minister in charge of the Local Self-Government Department. The title of Sanitary Commissioner of the Madras Presidency was changed to Director of Public Health and the Sanitary Department was called the Public Health Department. Nevertheless, the Sanitary Department had its origin in 1864, according to records available at the State Public Health Library.
An important milestone in the history of the DPH is the passing of the Madras Public Health Act in 1939, now called the Tamil Nadu Public Health Act. Until then, statutory provisions relating to public health administration were vague, unsatisfactory and embodied in more than one Act. The need for a compact public health Act embodying all important public health provisions under the various Acts was realised for efficient administration, according to the records.
Post-independence, 450 combined medical and public health primary centres and 25 group centres were sanctioned for the first quinquennium commencing in 1948. Of them, 6 primary health centres each were opened in 1948 in the then composite districts of North Arcot and Coimbatore.
Today, the DPH provides primary healthcare services through 1,804 Primary Health Centres. The State’s 8,713 Health Sub Centres serve as the first point of service delivery.
With disease surveillance, prevention and control being at the centre of the DPH, it now encompasses a long list of services and schemes starting with running of primary health centres, immunisation, maternal and child health, vector-borne disease control, universal health coverage and epidemics. The Director of Public Health is also the Chief Registrar of Births and Deaths of the State.
“Disease prevention and control is the objective of the department. We see the health of human beings determined not only by disease-causing bacteria or viruses but the result of interaction with social, cultural and economic influences over health. Non-communicable diseases like stress, depression, hypertension and diabetes are some of the examples. Disease prevention, early diagnosis and treatment is not only cost- effective but also makes suffering less for the people,” says Director of Public Health T. S. Selvavinayagam.
“One of the reasons for creation of the public health and sanitary commission was cholera and the plague. Control and prevention of cholera, which was pandemic then, has brought the number of deaths to zero now. Though multiple factors played a role, environmental and sanitation control through the Directorate was a critical one,” he notes.
K. Kolandaswamy, former Director of Public Health, listed the key achievements of the DPH. “Tamil Nadu was well ahead of other States in the eradication of smallpox, and guinea worm disease that was prevalent in hill areas such as Yercaud and Kalvarayan Hills. Elimination of neonatal tetanus was another significant milestone.”
Among the other achievements is the elimination of filarisis, leprosy and cholera and plague control, and a significant reduction in measles. He points out that Tamil Nadu is ahead of many other States in maternal and child health indicators.
“The DPH has been the parent department for many programmes. The Department of Rural Development’s sanitation programme was designed by the DPH. Similarly, drugs control, food safety and health transport were part of the DPH earlier,” he recalls.
The COVID-19 pandemic had put the State’s public health machinery to test. “Both COVID-19 and vaccination emerged as public health challenges,” Dr. Selvavinayagam notes.
Dr. Kolandaswamy adds that the technical support and know-how of the DPH served as a pillar in COVID-19 management.
The cadre is a key highlight of the directorate. “Tamil Nadu’s public health directorate has an exclusive cadre. Ours is the only State to have medical graduates with public health qualification to serve full-time in the administration,” according to Dr. Selvavinayagam.
The presence of public health services at the grass-root level through the village health nurses (VHN) is another highlight. “Each of our VHNs cover a population of 3,000 to 5,000. They reach the grass-root level and have details of the entire family register with them,” he adds.
Way ahead
Looking forward, epidemiological transition is crucial. “There should be a reduction in mortality and morbidity. Along with maternal and child health, we need to move to NCD control. We need to adopt health intelligence. This huge data will play a main role in prediction and prevention of diseases. We want to get alerts on happenings, on unusual incidents. These triggers will help in surveillance and rapid responses,” he explains.
Dr. Kolandaswamy bats for more VHNs to improve the quality of healthcare services. “The infectious diseases control cadre has been diluted. It should be reconstituted. Now, diabetes, hypertension and cancer are emerging as major public health problems. A separate female cadre should be created for NCD control on a par with the existing cadre involved in maternal and child health, immunisation and family welfare,” he says.
