Universal Health Coverage Pilot in Tamil Nadu: Has it delivered what was expected?

V R Muraleedharan, Umakant Dash et al , 2018

This is a RESYST-related publication. It was written by members of RESYST and is relevant to the research agenda, however, it was not funded by RESYST.

This paper, published by the Indian Institute of Technology Madras (IITM), reports on the impact of a pilot scheme to provide UHC in Tamil Nadu State. Strengthening primary health care services, in particular health sub-centres (HSC) was identified as the first step towards the achievement of UHC and interventions in the pilot included: strengthening physical infrastructure, provision of additional staff (Village Health Nurses), supply of adequate drugs and diagnostic equipment, and strengthening the information system.

The research reports on findings from two household surveys – one carried out prior to the introduction of the UHC-pilot and a second survey carried out eight months after roll out.

Key findings

  • Increased access and use of Health sub-Centres (HSC) with a corresponding fall in the proportion of people using private hospitals or higher-level public facilities for out-patient care.
  • Significant fall in out-of-pocket expenditure among those seeking care from any public facility, and a reduction in financial burden to patients due to the cost of purchasing drugs.
  • Significant improvement in economic efficiency of Tamil Nadu’s primary care delivery system, i.e. reduction in the cost of provision of outpatient care per visit
  • Enhanced confidence of Village Health Nurses to provide patient care and engage with community members.
  • The provision of primary clinical care at health sub-centres is a major step in the design and roll out of UHC. Over time, the package of primary care services will become more comprehensive and the quality of PHC services will improve as a result of the roll-out of interventions.
Research report | General