Is Centralization Threatening Tamil Nadu’s Healthcare Success? A Deep Dive into the Ongoing Battle | Chennai News – Times of India

M K StalinWhen asked about her experience at a recent Nalam Kakkum Stalin (NKS) health camp in Chennai, wheelchair-using senior citizen from Mylapore, Fausia Beevi, said, “I came as an orphan, but I leave with a full heart.”Supported by committed health department staff and volunteers, Beevi, who would otherwise have had to endure a difficult journey to a govt hospital for routine check-ups, was able to undergo ECG, ECHO, and eye tests in one location and return home in a few hours with reports and prescriptions in hand.Launched with the vision of serving such citizens, the NKS scheme has drawn thousands of heartfelt responses. It is anchored in the belief that quality healthcare is a fundamental right, even though it can be prohibitively expensive or difficult to access for people from disadvantaged sections.The healthcare challenges before Tamil Nadu are not only affordability and access, but also the shifting health profile of a society achieving prosperity. Globally, it has been seen that as economies advance, non-communicable diseases rise sharply. A 2020 survey revealed that 33.9% of adults in Tamil Nadu lived with hypertension and 17.6% with diabetes, which often go undiagnosed for years.The National Family Health Survey-5 showed that only 9.8% of women between 30 and 49 in Tamil Nadu had ever undergone cervical cancer screening, and just 5.6% had breast cancer screening. While Tamil Nadu leads among Indian states in these indicators, the standards we must measure ourselves against are those of advanced economies worldwide.It is driven by a sense of moral responsibility and the urgent need to address these challenges, and to improve health outcomes, that the govt has launched a slew of healthcare schemes.While immediate and accessible schemes make it easier for people to act today, long-term investments in healthcare will strengthen it for tomorrow. For 2025-26, the health and family welfare department has been allocated Rs 21,906cr, which is 8.4% higher than the previous year.Every Saturday, NKS camps bring blood tests, ECGs and ECHOs under one roof. The setting is designed like a gathering, making preventive care something the community participates in. Within just two days of its launch on Aug 2, about 93,000 people benefited, with strong participation from rural areas.The pioneering and transformative Makkalai Thedi Maruthuvam scheme, the first of its kind in India, takes non-communicable disease monitoring to people’s doorsteps.It spans 385 rural blocks, 8,713 sub-centres, and 21 corporations, with coverage across 460 urban primary health centres. A survey by the State Planning Commission found that the scheme has halved out-of-pocket medical costs for lower income groups. Before the scheme, only a third of people from low-income groups were screened for diabetes and hypertension; after its launch, the number rose to nearly half. Without this outreach, many would have discovered their illness only when it was too late.Idhayam Kappom Thittam, launched in July 2023, as a state-led heart attack prevention initiative, delivers emergency doses of essential cardiac medication at PHCs and HSCs to prevent pre-hospital deaths; Padham Padhukappom Thittam, introduced in Oct 2024, tackles diabetic foot complications; while Inniyur Kappom: Nammai Kaakum–48 scheme doubles free accident treatment coverage within 48 hours from Rs 1 lakh to Rs 2 lakh.The state has expanded its tertiary care infrastructure with large-scale govt hospitals and specialized facilities across Tamil Nadu. The Dr M Karunanidhi Centenary Memorial Government Multi Super Specialty Hospital in Chennai, a 1,000-bed flagship facility, features advanced amenities like a robotic surgery centre and grey water recycling systems. The govt dental college and hospital’s suburban unit in Tambaram Sanatorium, Chennai, was launched with state-of-the-art dental care facilities, including 14 dental chairs and a training centre. To enhance rural healthcare, the govt also initiated the construction of 19 sub-district hospitals, to be upgraded to district headquarters hospital level. The state upgraded 11 govt medical college hospitals, each with 700-bed capacities.A cancer screening programme with the goal of achieving 100% coverage across the state, especially focusing on cervical, breast and oral cancers in women. At the same time, regional cancer centres have been strengthened to effectively treat the new cases that may be detected.Every scheme launched by the govt is rooted in the ethos of the Dravidian Model, which has long tied public health to social progress. Built on egalitarian principles, continuity across administrations, and universalist welfare, initiatives such as the Kalaignar Insurance Scheme and the 108 Free Ambulance Service remain enduring legacies.In 2008, M Karunanidhi took a landmark step by launching the cadaver transplant programme, making Tamil Nadu a pioneer in organ transplantation. The scheme not only gave thousands a second chance at life but also set a model that the rest of the country would look up to with admiration. Tamil Nadu continues to be the top state for transplants in India, and offers life-long free post-transplant medication. Kalaignar knew that healthcare was also a vehicle of social reform. One of the reasons for introducing a 3.5% reservation for Muslims in education in 2007, was to empower the community to produce more doctors so they feel secure in the public healthcare system.The govt fought a legal battle in the Supreme Court which upheld the 50% reservation for in-service doctors in super-specialty courses, ensuring diversity in govt hospitals and enabling expansion of tertiary care centres across the state.All of this is now being put to risk by the draconian actions of the Union govt. A recent recommendation report on state autonomy in health and medical education by Dr Ezhilan Naganathan, MLA and member of the TN state planning commission, highlights how the Centre’s centralising interventions have steadily eroded the federal spirit of India’s health system.Centralisation has deepened through the National Medical Commission, which replaced the state-representative Medical Council of India, and through national exams like NEET and NEXT, which disadvantage vernacular and rural students, undermining state-specific social justice policies. The NMC Act also permits higher fees in private colleges, fuelling commercialisation.Instead of sharing higher taxes with states, the introduction of centrally designed schemes with parallel structures and uniform templates has undermined state-specific models such as Tamil Nadu’s PHC system. Similarly, the increasing centralisation of drug regulation, organ transplant programmes and digital health systems is restricting state autonomy.This one-size-fits-all approach undermines innovation, creating policy-implementation gaps and failing to address diverse regional health needs of all states, not just Tamil Nadu. The Union govt must give all states the freedom and autonomy to design policies that address their specific demographic needs. Instead of acting as a rigid regulator, it should play the role of a facilitator and enabler so that all states achieve their health goals.FOOD FOR THOUGHTInspired by the legacy of the mid-day meals schemes, the Uttachathai Uruthi Sei nutritional programme was launched to combat malnutrition. Thousands of children under six were treated, and 77.3% recovered to normal nutritional levels. In the second phase launched in Nov 2024, about 76,700 infants and mothers receive nutrient-rich kits. Coupled with our pioneering breakfast scheme for children in schools, this scheme is not merely a fight against malnutrition but a preventive step against future non-communicable diseases