Das Gupta, MonicaDesikachari, B.R.Somanathan, T.V.Padmanaban, P.2012-03-192012-03-192009-10-01https://hdl.handle.net/10986/4265Public 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.CC BY 3.0 IGOADMINISTRATIVE CONTROLAGEDANTENATAL CAREBASIC HEALTHBIRD FLUBLINDNESSCANCERCENTER FOR DEVELOPMENTCHICKENPOXCHIKUNGUNYACHILD DEVELOPMENTCHILD HEALTH CARECHILD HEALTH SERVICESCHILD MORTALITYCHILD MORTALITY RATECHOLERACITIESCITIZENCITIZENSCLINICAL SERVICESCOMMUNICABLE DISEASESCOMMUNITY HEALTHCONTROLLING POPULATION GROWTHCROWDINGDEAD ANIMALSDEAD BODIESDEATHSDENGUEDEVELOPING COUNTRIESDIABETESDIARRHEAL DISEASESDISASTERSDISEASEDISEASE CONTROLDISEASE OUTBREAKDISEASE OUTBREAKSDISEASE PREVENTIONDISEASE PREVENTION AND CONTROLDISEASE SURVEILLANCEDISPENSARIESDOCTORSDRINKING WATEREARLY DETECTIONEARTHQUAKEECONOMIC CHANGEECONOMIC GROWTHEMERGENCIESENDEMIC DISEASESENVIRONMENTAL HEALTHEPIDEMICEPIDEMICSEXISTING RESOURCESEXPENDITURESFAMILY HEALTHFAMILY PLANNINGFAMILY WELFAREFINANCIAL RESOURCESFOOD CONTROLFOOD SAFETYGIGIIHAZARDHAZARDSHEALTH ACTIVISTSHEALTH AUTHORITIESHEALTH BUDGETSHEALTH CARE INDICATORSHEALTH CENTERSHEALTH CENTREHEALTH CENTRESHEALTH CONDITIONSHEALTH EDUCATIONHEALTH EXPENDITUREHEALTH EXPENDITURE PER CAPITAHEALTH EXPENDITURESHEALTH EXPERTSHEALTH IMPACTHEALTH IMPACT ASSESSMENTSHEALTH INDICATORSHEALTH INTERVENTIONSHEALTH MANAGEMENTHEALTH MANPOWERHEALTH MANPOWER DEVELOPMENTHEALTH NEEDSHEALTH ORGANIZATIONHEALTH OUTCOMESHEALTH PLANNINGHEALTH POLICYHEALTH PROBLEMSHEALTH PROFESSIONALSHEALTH REGULATIONSHEALTH RESOURCESHEALTH SECTORHEALTH SERVICEHEALTH SERVICE DELIVERYHEALTH SERVICE PROVISIONHEALTH SERVICESHEALTH SPECIALISTHEALTH SPENDINGHEALTH STATUSHEALTH SYSTEMHEALTH SYSTEMSHEALTH WORKERSHEALTH WORKFORCEHOSPITALHOSPITAL CAREHOSPITALSHUMAN DEVELOPMENTHYGIENEILLNESSIMMUNIZATIONINCOMEINFANTINFANT DEATHINFECTIONINFECTIOUS DISEASESINSECTICIDESINTERVENTIONIODINE DEFICIENCYJOB TRAININGLATRINESLAWSLEPROSYLEPTOSPIROSISLOCAL GOVERNMENTSLOCAL PUBLIC HEALTHMALARIAMALARIA CASESMALARIA CONTROLMALE HEALTHMALE HEALTH WORKERSMANAGING POPULATIONMASS GRAVESMATERNAL AND CHILD HEALTHMATERNAL CAREMATERNAL DEATHMEASLESMEATMEDICAL CAREMEDICAL CENTERSMEDICAL COLLEGEMEDICAL DOCTORSMEDICAL EDUCATIONMEDICAL OFFICERMEDICAL OFFICERSMEDICAL PRACTICEMEDICAL PRACTITIONERSMEDICAL RESEARCHMEDICAL SERVICESMEDICAL SPECIALISTSMEDICINESMIDWIFEMINISTRY OF HEALTHMORBIDITYMORTALITYMORTALITY RATENATIONAL EFFORTSNATIONAL HEALTHNATURAL DISASTERNATURAL DISASTERSNURSENURSESNURSINGNUTRITIONOCCUPATIONAL DISEASESOUTPATIENT CAREOUTREACH WORKERSPATIENTPATIENTSPERSONAL COMMUNICATIONPLAGUEPOISONINGPOLICY RESEARCHPOLICY RESEARCH WORKING PAPERPOLIOPREGNANCYPREGNANCY COMPLICATIONSPREVENTION ACTIVITIESPREVENTIVE HEALTH SERVICESPREVENTIVE MEDICINEPRIMARY HEALTH CAREPRIMARY HEALTH CARE SERVICESPRIVATE HOSPITALSPROGRESSPUBLIC EXPENDITUREPUBLIC EXPENDITURE ON HEALTHPUBLIC HEALTHPUBLIC HEALTH ADMINISTRATIONPUBLIC HEALTH CONCERNSPUBLIC HEALTH INTERVENTIONSPUBLIC HEALTH LAWSPUBLIC HEALTH PROGRAMSPUBLIC HEALTH SERVICESPUBLIC HEALTH SYSTEMPUBLIC HEALTH WORKERSPUBLIC SERVICESQUARANTINERODENTSRURAL AREASRURAL DEVELOPMENTSANITARY CONDITIONSSANITATIONSMALLPOXSOCIAL DEVELOPMENTSOCIAL MOBILIZATIONSOCIAL WELFARET.V.TBTEACHING HOSPITALSTERTIARY LEVELSTREATMENTURBAN AREASURBANIZATIONVACCINATIONVECTOR BORNE DISEASESVECTOR CONTROLVECTORSWASTEWORKERSWORLD HEALTH ORGANIZATIONYAWSZOONOSESZOONOTIC DISEASESWorld Bank10.1596/1813-9450-5073