1. Introduction

The DANIDA Tamil Nadu Area Health Care Project is a centrally sponsored externally aided project. The phase III currently in progress was implemented since 24-12-1996, covers the districts of Dharmapuri, Thanjavur, Nagapattinam and Thiruvarur for most of the activities, extends some of the activities to the old districts of Salem, Namakkal, Cuddalore & Villupuram and supports some state level activities like training, drug supply logistics etc. at a total outlay of Rs.59.10 crores (including direct funding of Rs.6.00 crores). The overall objective of this project is to improve the health and family welfare status of the rural population in the project area, especially of the weaker sections. With a view to improving and strengthening the facilities for the delivery of health and family welfare services in an integrated manner in accordance with the National Health Policy, DANIDA is one of the bilateral donors in the Health Sector in providing financial assistance to the Government of Tamil Nadu. The funding is on reimbursement basis with 85% share by DANIDA, 5% by Government of India and 10% by Government of Tamil Nadu.

Based on the recommendation of the Mid Term Review (MTR), the project outlay was revised to Rs.70.76 crores including direct funding Rs. 7.89 crore and extended the project period upto 31.12.2002. Further to fully achieve the objectives of the phasing out plan recommended in the MTR, the State Project Coordinating Committee(SPCC) meeting held on 26.08.2002 has agreed to extend the project period by one year upto 31.12.2003 with no extra cost. Accordingly the GOI/RDE has extended the project period till 31.12.2003.

2. Organisation and Management

The project is implemented through a Project Directorate set up at Chennai headed by the Project Director at state level. It coordinates with health and other departments such as Directorate of Public Health and Preventive Medicine, Directorate of Family Welfare, Tamil Nadu Medical Services Corporation etc. in the implementation after the proposals are approved by the State Project Coordination Committee / Empowered Committee. At district level, District Management Cells consisting of minimum supportive staff are created to assist the Deputy Directors of health services of the project districts in the implementation of project activities. The project activities are monitored by the State Project Monitoring Committee at State level and the District Project Monitoring Committee at District level.

3. Achievements and Progress during Phase III

3.1. Construction activities:

1. Out of 368 community supported HSCs sanctioned for construction in the new project districts, 302 HSCs have been completed and funtioning, 63 are in finishing works and the remaining 3 are above the foundation level.
2. All the planned 82 HSCs have been renovated and 646 old HSCs have been provided with water supply and electricity facilities in the project districts.
3. 1000 old HSCs have been provided with gas connection facilities in the project districts.
4. All the planned 113 PHCs (including the Marndahalli PHC) have been renovated in the new project districts.
5. Infrastructure facilities have been strengthened in all the 5 ANM training schools in the state.
6. Infrastructure facilities of 18 RHTCs have been strengthened and work was dropped for the remaining 2 centers due to damaged condition of the building.
7. Infrastructure facilities of MPHS(F) training school at Chennai, IVCZ at Hosur, HFWTCs at Chennai, Madurai and Gandhigram, IPH at Poonamallee and the HMDIs at Salem and Villupuram were strengthened.
8. Central Drug Warehouses for TNMSC have been constructed at Dharmapuri and Thiruvarur.
9. Decentralized preventive maintenance and cleaning up campaign of PHCs and HSCs is underway in the project districts.
10. Minor repair works to old PHCs including equipment support were provided to about 253 PHCs in the project districts.
11. Minor repair works to old HSCs including equipment support were provided to about 809 HSCs in the project districts.
12. The training centre at Marandahalli was renovated.
13. A compound wall has been constructed for Central Drug Warehouse at Villupuram.

3.2 Improving Awareness (IEC):

1. Street corner drama (Kalaipayanam) troupes have performed about 2150 health IEC programmes in Dharmapuri and 930 programmes in Thiruvarur districts. A similar programme will be conducted in selected blocks of Salem districts.
2. About 9265 elected local body members including block level trainers were trained in orientation training on health issues in Dharmapuri district.
3. Conduct of school health competitions in new project districts is underway.
4. IEC related wall painting, hoarding, stickers etc were disseminated in the old and new project districts.
5. A radio serial "Budding Blossoms" on adolescent health was broadcasted in AIR for 78 weeks.
6. Health messages will be propagated to the community (Social Marketing Modal) in Salem district for which pilot testing has been done in a block and block level training has been completed. Activity will be implemented during the February' 03.
7. Mass Media campaign on health IEC is underway through AIR in the form of jingles and DD in the form serial.
8. Exhibition panels, portable photographic posters were produced supplied to all DDHSs in the project districts and conduct of school exhibitions are under way.

3.3 Improved Technical Knowledge & Skills of Service Providers (Training):

1. A State Training Cell (STC) was created in the O/o the DPH&PM to help implement the entire training programmes in the state.
2. District Training Teams(DTTs) were created in 10 districts including the 8 project districts to cover the staff of Health Subcentres (HSCs) by periodic in-service training and continuing education.
3. The 6 RTIs in addition to IVCZ at Hosur and LHV School at Chennai were provided with uniform stipend for the trainees.
4. The 6 RTIs, IVCZ at Hosur, LHV School at Chennai, Marandahalli Training Centre, 5 ANM Schools and 20 RHTCs were provided with equipment and library facilities.
5. Printing and supply of Indian Systems of Medicine training manuals is underway through TNMSC for which training manuals have been finalized.

3.4 Health Services Mangement:

1. A PHC services monitoring system using OMR machine, was developed and mainstreamed to DPH&PM, Chennai.
2. The monitoring system of the DDHSs of the project districts has been strengthened by providing vehicles, additional fuel, computers and necessary office equipments.
3. Management training has been imparted to 517 MOs of PHCs in the state.
4. Integrated district health plans were developed for the projects districts.
5. HMIS registers and records for HSCs have been simplified and revised records and registers were printed and supplied to all HSCs in the state.
6. Simplified HMIS registers and records for PHCs/VBDCs and FRUs/GHs are designed. Printing of the registers and records are underway by TNMSC.
7. To improve HMIS capability, computers were provided to 31 block PHCs of Salem and Namakkal districts. About 2496 state and district level staff have been given in-depth training on computer.
8. HMIS training on the revised registers will be imparted for the users of HSCs/PHCs/FRUs in the state.
9. IT training will be imparted for the staff of PHCs and HSCs in Salem and Namakkal districts.
10. Vital Events Surveys has been conducted for the reference years 1996,1997,1998 and 1999 and district wise rates arrived and sensitized the health staff with respect of IMR, MMR, FI etc.
11. About 3513 female field health functionaries in the project districts have been trained in moped driving. Two set of uniforms were also provided to all the VHNs/ANMs as part of training kit. About 1106 were given loan for purchase of mopeds. A revolving fund has been created for this purpose.
12. The computerization of the personal training information of the staff of DPH&PM is currently underway by PTCs.

3.5 Improvement of Medical Supplies:

1. Equipment like computers and warehouse equipment were supplied to all the 23 CDWs of TNMSC. Procurement of additional equipment to these CDWs is underway by TNMSC for which funds released.
2. All the 4 regional managers of TNMSC were provided with LMV vehicle.
3. A drug quantification study was conducted and the findings are incorporated in the drug management training.
4. About 3,000 staffs in the category of VHNs /SHNs /CHNs have so far been trained in basic treatment procedures on ASM and ISM drugs against the planned 10,000 staff.
5. The services of Drug Logistics Expert have been utilized by TNMSC.
6. The drug formulary for the use of MO of PHCs is currently under printing by TNMSC, will be supplied to all MO of PHCs in the state.
7. Equipment kit will be procured for the use of 10,000 VHNs/ANMs in the state as part of basic treatment procedure training kit.

Further as per the decision of the State Project Coordination Committee meeting held on 22.01.2003, the savings in various GOs will be utilized properly for software components after getting approval from the State Project Monitoring Committee.

Proposed Activities for 2001 and 2002:

In addition to the above activities, the project is now in the process of obtaining the new estimated cost escalated budget of Rs 70.70 crores and extends the project period till December 2002, for which the approval of the Government of Tamilnadu and Government of India is awaited. After obtaining the cost escalated budget, proposals for the following activities will be placed before SPCC/EC:

1. The District Training Teams, which are functioning in the old, and new project districts will be extended to the entire state with Training of Trainers, uniform stipend, fees, etc. like RTIs.
2. The HMIS will be streamlined by covering the function of Health Inspector's, PHCs and FRUs
3. Extension of the scheme for VHN's on moped driving and moped loan from the project districts to the entire state.
4. Training of PHC staff on Rational Drug use and printing and supply of manual on Primary Medical Care for VHN's and Drug Logistics Management for Pharmacists.
5. Strengthening the construction wing of TNMSC.
6. Corpus fund establishment for preventive maintenance of Health Subcentres.
7. Convergences of all IEC activities through self help groups in the villages in close collaboration with Tamilnadu Women Development Corporation, Department of Public Health and Preventive Medicine, Department of Family Welfare and Social Welfare Departments.

Programmes under DANIDA

1. Danida supported National Leprosy Eradication Programme (DANLEP)

The project contributes to the implementation and qualitative development of the National Leprosy Eradication Programme (NLEP) through rendering support at district-, state - and central levels. Having satisfactorily achieved its objectives, second phase of the project came to an end in 1998. The main objective of the present third phase is the development of strategies and means for integrating the "vertical" anti-leprosy activities into the ordinary primary health sector. This integration is succeeding in three states: Orissa, Madhya Pradesh and Chattisgarh. In Tamil Nadu integration is being prepared. The project supports development of medical supply systems, development of training curricula for health staff, development of a disease surveillance system and of new methods for the prevention handicaps as a result of leprosy. Finally, the project gives support to the active participation of the population in detection of new leprosy-cases. The project co-operates closely with state governments on developing methods for using the "Geographical Information System" (GIS) as a tool for planning within the health sector.

2. Danida supported Revised National Tuberculosis Control Programme (RNTCP)

The project, which is in its first phase, supports the GOI with the implementation of the RNTCP in 14 - predominantly tribal - districts in Orissa. In the project districts an information campaign and methods for improved diagnosis and treatment of TB-patients are developed. A disease surveillance system and a medicinal supply system are being developed for the whole state. Experiences from the project - both at district- and state-level - will be exploited for the continuous improvement of the national TB-program. Further, this programme receives support by training of staff placed at central level and by establishing operational research capacity. A second phase of the project is under preparation; it is expected to start 2002.

3. Danida supported National Blindness Control Program (DANPCB)

The overall objective of the present third phase of the project (started 1997), is to bring about decrease in the prevalence of blindness and sight-reduction through rendering support to the National Program for Control of Blindness at district-, state - and central levels. In particular the project focuses on reaching the women and the poor rural population and to inform about the importance of offering proper professional treatment of eye-diseases and sight deficiencies through a well-functioning eye-health care service. The programme has initiated an investigation of eye-patients' "disease-behaviour", and has described the obstacles patients have to pass before they finally turn to the public eye-health care service. A comprehensive, phased registration of blind persons has been done; this registration will subsequently be the basis for prioritisation of patients for surgical treatment. Training of eye-surgeons and -assistants has started according to plans. Problems concerning the establishing of a National Eye Care Resource Center have so far remained unsolved.