Tamil Nadu Health Model – PHC Network, TNMSC Drug Model, CMCHIS, Makkalai Thedi Maruthuvam & Maternal-Child Health Outcomes | TNPSC Notes

The Tamil Nadu health model is the name given to the public health system that has made Tamil Nadu one of the best-performing States in India on infant and maternal mortality. Its main pillars are a separate Directorate of Public Health (1923 as per the Health Policy Note) and the Public Health Act (1939); a three-tier rural network of Health Sub Centres (HSCs), Primary Health Centres (PHCs) and block-level hospitals; the Tamil Nadu Medical Services Corporation (TNMSC, 1994) and its drug passbook system; the 108 emergency ambulance service (2008); the Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS, 2012); Makkalai Thedi Maruthuvam (2021); Innuyir Kaappom – Nammai Kaakkum 48 (2021); and the Dr. Muthulakshmi Reddy Maternity Benefit Scheme. As per the Sample Registration System (SRS) 2024, the State's infant mortality rate is 11 per 1,000 live births, against 24 for India.

தமிழில் படிக்க

These notes are written for TNPSC Group 1, 2/2A and 4 aspirants and are meant to be complete on their own. The topic belongs mainly to Indian Economy and Development Administration in Tamil Nadu (health schemes, social welfare, human development indicators of Tamil Nadu). New SRS and NFHS data, award news and scheme changes are asked under Current Events; public health as a State subject comes under Indian Polity; and Dr. Muthulakshmi Reddy and the social-reform roots of maternal care belong to History, Culture, Heritage and Socio-Political Movements of Tamil Nadu. Every number below is given with its source and year, because exam questions often depend on the year of the data.

Tamil Nadu Health Model at a Glance

Background: Why Tamil Nadu's Public Health System Is Different

Under the Constitution, "public health and sanitation; hospitals and dispensaries" is a subject in the State List (Seventh Schedule). Each State therefore designs much of its own health system, with Central support through the National Health Mission. Tamil Nadu began early.

• 1923 – separate Directorate of Public Health: as per the Health Policy Note 2023-24, the Madras Government formed a Directorate only for public health in 1923; it is now the Directorate of Public Health and Preventive Medicine (DPH). Some accounts date the change to 1922, and the Directorate marked its centenary in 2022.
• 1939 – Public Health Act: the Madras Public Health Act, 1939 (now the Tamil Nadu Public Health Act) gave health officers legal powers over sanitation, water and the control of infectious diseases. As per the Health Policy Note 2023-24, Tamil Nadu was the first State in India to enact a law for public health.
• Two separate cadres: doctors in the public health cadre (under the DPH) manage PHCs and preventive programmes, while the medical services cadre runs hospitals. This separate public health cadre is often cited as a reason for the State's strong management of primary care.
• Village Health Nurse: each HSC is run by a Village Health Nurse (VHN), who registers pregnant women and follows up immunisation.

The Three-Tier Rural Health Network

Primary health care in rural Tamil Nadu is delivered through three levels, followed by district headquarters hospitals and government medical college hospitals at the secondary and tertiary levels.

National population norms (Indian Public Health Standards): one HSC for 5,000 people in the plains and 3,000 in hilly or tribal areas; one PHC for 30,000 (20,000 in hilly or tribal areas); one CHC for 1,20,000 (80,000 in hilly or tribal areas). Since 2023, HSCs and PHCs upgraded as Health and Wellness Centres under Ayushman Bharat are called Ayushman Arogya Mandirs.

Exam tip: the figure 8,713 for HSCs is stable across recent Policy Notes; PHC totals differ slightly from document to document because urban, rural, upgraded and block PHCs are counted differently. Always write the year and source with a PHC count.

Tamil Nadu Medical Services Corporation (TNMSC, 1994)

Before 1994, drugs for government hospitals were bought by many offices, often in small lots, and shortages were common. The State set up a government company to buy, test, store and supply drugs for the whole public health system.

• Incorporated: 1 July 1994 under the Companies Act, 1956; it began buying and distributing drugs in January 1995. It is owned by the Government of Tamil Nadu through the Health and Family Welfare Department.
• Central purchase: drugs on an essential drug list are bought in bulk directly from manufacturers through an open, transparent tender.
• District warehouses: suppliers deliver to TNMSC warehouses in the districts, and hospitals and PHCs of each district collect their drugs from there.
• Passbook system: every hospital and PHC gets a passbook with a money value fixed according to its budget allocation. It can draw any drug on the approved list from the nearest warehouse until the value is used up.
• Quality testing: every batch is tested in laboratories before it is issued to hospitals.
• Other work: TNMSC also buys medical equipment and supplies veterinary drugs to veterinary institutions.

Significance: the model lowered drug prices, cut shortages and brought more patients to government hospitals. An IIM Bangalore article and a World Bank blog note that several States, including Rajasthan, set up corporations on the lines of TNMSC; the World Bank blog calls it a cost-effective model.

Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS)

CMCHIS is the State's health insurance scheme for low-income families. It pays for costly treatments and surgeries on a cashless basis in empanelled government and private hospitals, and the State pays the full premium.

• Implementing agency: the Tamil Nadu Health Systems Project (TNHSP) of the Health and Family Welfare Department administers the scheme (World Bank case study, 2020).
• Who can join: families with annual income up to Rs 1.2 lakh, enrolled with an income certificate from the Village Administrative Officer, the family ration card and Aadhaar.
• Link with Ayushman Bharat: since 2018 Pradhan Mantri Jan Arogya Yojana (PM-JAY) has been implemented in Tamil Nadu together with CMCHIS, through the same scheme network.

Makkalai Thedi Maruthuvam (2021)

Makkalai Thedi Maruthuvam ("medicine in search of people") is a doorstep health-care scheme for non-communicable diseases (NCDs) such as diabetes and high blood pressure, which often go undetected in villages.

• Launched: 5 August 2021 by Chief Minister M. K. Stalin at Samanapalli village, Krishnagiri district; it began at the same time in several other districts.
• Target group: people above 45 years of age and people who cannot easily travel to a hospital.
• Services: screening for hypertension and diabetes with medicines delivered home every month; screening for kidney disease and congenital defects in children with follow-up; physiotherapy; and dialysis support for kidney patients.
• Workers: women health volunteers, health workers, nurses and physiotherapists.
• Reach: it crossed one crore beneficiaries (Health Policy Note 2023-24), and the two-crore mark was marked in Erode district in December 2024.
• Award: on 25 September 2024 the UN Interagency Task Force on NCDs (UNIATF) gave its 2024 award, in the ministries-of-health category, to the Health and Family Welfare Department of Tamil Nadu for this programme.

Innuyir Kaappom – Nammai Kaakkum 48 (2021)

The first hours after a road accident (the "golden hour") decide whether a victim survives. This scheme removes cost as a reason for delay.

• Launched: 18 December 2021 at Melmaruvathur (Chengalpattu district).
• Benefit: free treatment for the first 48 hours after a road accident in Tamil Nadu, in empanelled government and private hospitals.
• Who is covered: anyone injured in a road accident within the State – residents of other States and foreign nationals included, irrespective of income and whether or not they are CMCHIS members.
• Ceiling at launch: up to Rs 1 lakh per person for 81 listed life-saving procedures, in 609 hospitals (201 government and 408 private).
• After 48 hours: CMCHIS members continue under that scheme; others are stabilised and shifted to a government hospital for free treatment, or may continue in a private hospital at their own cost.
• Enhancement: the ceiling was raised from Rs 1 lakh to Rs 2 lakh in late 2024. By January 2025, over 3.2 lakh people had benefited, with 721 hospitals empanelled (news reports, January 2025).

108 Emergency Ambulance Service (2008)

• Started: September 2008, when about 200 ambulances were deployed; the service was introduced by Chief Minister M. Karunanidhi's government.
• Model: public-private partnership – the State funds and supervises, and GVK EMRI (Emergency Management and Research Institute) operates the service.
• Free service: anyone can dial 108 for medical, accident or pregnancy-related emergencies.
• Fleet: 1,353 emergency vehicles, as stated at the service's 15th-anniversary event in September 2023.
• National link: the 108 service was first started in Andhra Pradesh in 2005 and later adopted by many States.

Maternal and Child Health

Dr. Muthulakshmi Reddy Maternity Benefit Scheme (MRMBS)

Named after Dr. Muthulakshmi Reddy, the first woman legislator of British India and a pioneer of women's health, this scheme gives cash and nutrition support to poor pregnant women so that they can rest, eat well and deliver in a hospital.

• Instalments: linked to early registration (before 12 weeks), antenatal check-ups, delivery and the baby's immunisation, so the money also encourages use of health services.

Other maternal and child health measures

• PICME (Pregnancy and Infant Cohort Monitoring and Evaluation): online registration of every pregnancy with an RCH ID, used to track care and release benefits.
• Round-the-clock PHCs with delivery facilities, and blood storage in upgraded PHCs, reduce delays in obstetric emergencies.
• Thaimaaman Thanga Mothiram Thittam (2026): a one-gram gold ring for each baby born in a government hospital to a family permanently resident in Tamil Nadu, with an annual outlay of about Rs 755.83 crore (news reports, 2026).

Health Outcomes: What the Data Show

Sample Registration System (SRS) – Office of the Registrar General of India

With an MMR of 35 for 2021-23, Tamil Nadu is among the States with the lowest maternal mortality in India. The SRS bulletin for 2022-24, released in May 2026, puts India's MMR at about 87 and lists Tamil Nadu among the States already below the SDG target of 70. Tamil Nadu's TFR of 1.3 is well below the replacement level of 2.1.

National Family Health Survey – NFHS-5 (2019-21) and NFHS-6 (2023-24)

Reading the table: access to care is almost universal (institutional births near 100 per cent), but nutrition is the weak area – child anaemia rose between NFHS-4 and NFHS-5, and wasting rose again in NFHS-6. More than half of women aged 15-49 were anaemic in NFHS-5.

Strengths and Challenges

Key Health Schemes – Summary Table

Writing Mains Answers on the Tamil Nadu Health Model (Group 1 / Group 2)

Descriptive papers ask about Tamil Nadu's health achievements, a particular scheme, or the challenges ahead. Support every point with a fact and its year.

"Tamil Nadu has achieved better health outcomes than most States." Discuss (about 200–250 words)

• Introduction: IMR 11 (SRS 2024) against India 24; MMR 35 (SRS 2021-23) against 88.
• Institutions: separate public health directorate (1923 as per the Health Policy Note), Public Health Act (1939), public health cadre.
• Access: 8,713 HSCs and round-the-clock PHCs; 108 ambulances since 2008; institutional births 99.6% (NFHS-5).
• Drugs: TNMSC (1994) – central purchase, passbook, quality testing.
• Financial protection: CMCHIS, maternity benefit of Rs 18,000.
• New approaches: Makkalai Thedi Maruthuvam (2021, UN award 2024); Innuyir Kaappom (2021).
• Conclusion: next focus – nutrition, anaemia, NCDs and C-section audit.

Explain the TNMSC model of drug procurement (about 150 words)

• Government company, 1 July 1994, Companies Act 1956; operations from January 1995.
• Essential drug list; bulk purchase from manufacturers by open tender.
• District warehouses; passbook with money value for each hospital.
• Batch-wise laboratory testing; computerised stock.
• Outcome: lower prices, fewer stock-outs, model for other States such as Rajasthan.

Evaluate Makkalai Thedi Maruthuvam (about 150 words)

• Need: undetected diabetes and hypertension in rural areas.
• Design: launched 5 August 2021 (Samanapalli, Krishnagiri); home screening, monthly medicines, physiotherapy.
• Strengths: two crore beneficiaries by December 2024; UNIATF award 2024.
• Gaps: follow-up and control of disease, staff workload, data quality.
• Way forward: link with PHC records and digital tracking.

Practice: Match the Following

Common Mistakes to Avoid

• MMR vs IMR units: MMR is per 1,00,000 live births; IMR is per 1,000 live births.
• MMR period: SRS gives MMR for a three-year period (for example 2021-23), while IMR is given for a single year.
• CMCHIS dates: the 2009 scheme was the Kalaignar insurance scheme; CMCHIS itself began on 11 January 2012.
• Innuyir Kaappom covers the first 48 hours – not 24 or 72 – and covers non-residents too.
• TNMSC is a company under the Companies Act, 1956 – not a society or a department.
• Rs 18,000 under the maternity scheme includes Rs 4,000 of nutrition kits – the cash part is Rs 14,000.
• NFHS vs SRS: NFHS is a sample survey (2019-21, 2023-24 rounds); SRS is the Registrar General's continuous registration system.

Quick Revision Table

TNPSC Key Points (PYQ-style facts)

• Public health is in the State List of the Seventh Schedule.
• Separate public health directorate in Madras: 1923 (as per the Health Policy Note); Public Health Act: 1939 (the first public health law in India, as per the Health Policy Note).
• HSCs: 8,713; urban PHCs: 487; rural PHCs 1,830 (Health Policy Note 2023-24).
• TNMSC: 1 July 1994; Companies Act 1956; passbook system; district warehouses; batch testing.
• 108 ambulance in TN: September 2008; PPP with GVK EMRI.
• CMCHIS: 11 January 2012; Rs 5 lakh per family per year (2022–27); income limit Rs 1.2 lakh (2021); Rs 25 lakh announced 19 August 2026.
• Makkalai Thedi Maruthuvam: 5 August 2021, Samanapalli, Krishnagiri; UNIATF award 2024.
• Innuyir Kaappom – Nammai Kaakkum 48: 18 December 2021, Melmaruvathur; 81 procedures; Rs 1 lakh, now Rs 2 lakh.
• Dr. Muthulakshmi Reddy Maternity Benefit Scheme: Rs 18,000 (Rs 14,000 cash + Rs 4,000 kits) since 2018.
• IMR: 11 (SRS 2024); MMR: 35 (SRS 2021-23); TFR: 1.3 (SRS 2024).
• NFHS-5: institutional births 99.6%; full immunisation 89.2%; stunting 25.0%; child anaemia 57.4%.

Frequently Asked Questions

What is meant by the "Tamil Nadu health model"?

It refers to the way Tamil Nadu built a strong public health system: a separate Directorate of Public Health from the early 1920s and the Public Health Act of 1939; a dense network of Health Sub Centres and 24-hour Primary Health Centres; low-cost drug supply through the Tamil Nadu Medical Services Corporation (1994); free emergency transport (108, from 2008); State health insurance (CMCHIS, from 2012); doorstep care for non-communicable diseases (Makkalai Thedi Maruthuvam, 2021); and cash support for mothers (Dr. Muthulakshmi Reddy Maternity Benefit Scheme). The results show in low infant and maternal mortality – an IMR of 11 as per SRS 2024 and an MMR of 35 as per the SRS bulletin for 2021-23.

What is the passbook system of the Tamil Nadu Medical Services Corporation?

TNMSC, incorporated on 1 July 1994 under the Companies Act, 1956, buys essential drugs centrally from manufacturers and stores them in district warehouses. Each government hospital or PHC gets a passbook with a money value fixed according to its budget allocation; it can draw any drug on the approved list from the nearest warehouse until that value is used up. Every batch is tested in laboratories before it is issued.

What does the Chief Minister's Comprehensive Health Insurance Scheme provide?

CMCHIS gives cashless treatment in empanelled government and private hospitals to low-income families. It began on 11 January 2012, replacing the Kalaignar insurance scheme of 2009. The 2022–27 policy (G.O. No. 16 of 2022, United India Insurance Company) gives Rs 5 lakh per family per year; the income ceiling was raised from Rs 72,000 to Rs 1.2 lakh in 2021. On 19 August 2026 the Chief Minister announced in the Assembly that the annual cover would be raised to Rs 25 lakh.

What are Makkalai Thedi Maruthuvam and Innuyir Kaappom – Nammai Kaakkum 48?

Makkalai Thedi Maruthuvam ("medicine in search of people") was launched on 5 August 2021 at Samanapalli in Krishnagiri district; health workers screen people at home for diabetes and hypertension and deliver medicines, physiotherapy and other care. It won the UN Interagency Task Force Award in 2024. Innuyir Kaappom – Nammai Kaakkum 48, launched on 18 December 2021 at Melmaruvathur, gives free treatment to any road-accident victim in Tamil Nadu for the first 48 hours, up to Rs 1 lakh at first and Rs 2 lakh from late 2024.

What are Tamil Nadu's latest IMR and MMR figures?

As per the Sample Registration System, Tamil Nadu's infant mortality rate was 12 in 2023 and 11 in 2024 (India: 25 and 24). Its maternal mortality ratio was 38 for 2020-22 and 35 for 2021-23 (India: 88), among the lowest in the country; the SRS bulletin for 2022-24 (May 2026) puts India at about 87 and lists Tamil Nadu among the States below the SDG target of 70. NFHS-5 (2019-21) recorded 99.6 per cent institutional births and 89.2 per cent full immunisation in the State.

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