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City Report and Action Plan
Chennai
Dr. Kandasamy Manivasan
Joint Commissioner (Health) and Project Director
Health and District Family Welfare Bureau
Chennai Corporation
India
CITY REPORT
Chennai is India's fourth-largest city and a
major port. It is the capital of Tamil Nadu state and its population,
which was 4.85 million in 2004, is steadily growing. Major industries
of the city include automobile components, leather and textiles, film,
petrochemicals and manufacturing. The city is also strong in education
and IT. Poverty is widespread with many people living in slums.
The Chennai Municipal Corporation is headed
by a mayor, followed by a deputy mayor, standing committees, ward
committees and a commissioner. The mayor is directly elected to serve a
five-year term.
Reproductive Health
At the national level, the immediate policy
objectives are to address the unmet needs for contraception, health
care infrastructure and health care personnel, and to provide
integrated services for basic reproductive and child care health. As
part of the policy, the central government has devised the following
components with regard to reproductive and child health: (1) Prevention
and management of unwanted pregnancy, (2) maternal care that includes
antenatal, delivery and postpartum services (3) survival services for
infants and (4) management of STIs and RTIs.
In Chennai, the Indian Population Project 5
was implemented in 1989 with the following objectives: (1) universal
immunization, (2) universal antenatal care, (3) universal post-natal
care, (4) 98% institutional delivery, (5) reduction in third and higher
births, (6) 60% couple protection rate and (7) increased examinations
for infants. The city achieved these objectives in 1995 and continues
to make improvements where possible.
HIV/AIDS
Tamil Nadu is considered a high risk state in
India. HIV/AIDS here is not confined only to high-risk groups. The
infection rate among pregnant women aged 15-24 is 0.5%. In 2004,
intravenous drug use accounted for almost 40% of HIV infections,
followed by heterosexual transmission at 8% and homosexual transmission
at 6.8%.
In 1998, the Chennai Corporation AIDS
Prevention and Control Society was established, with the city
commissioner serving as the organization's president and the joint
commissioner of health as the project director. The mayor, ruling and
opposition party leaders, and representatives of NGOs and people living
with AIDS comprise the executive committee.
In order to reduce the spread of HIV/AIDS and
strengthen capacity to respond to HIV/AIDS on a long-term basis, a
multi-pronged approach is being adopted which focuses on the most
critical interventions to limit HIV transmission. Services are needed
for both prevention (both for high risk and low risk groups) and care
(both for those infected and their family members).
Specific measures on HIV/AIDS implemented in
Chennai include (1) establishment of counseling and testing centers,
(2) family health awareness campaigns, (3) low-cost care including
provision of drugs and establishment of community and drop-in centers,
(4) training programs for medical staff, (5) telephone counseling, and
(6) various IEC activities.
Challenges relating to HIV/AIDS include
increasing civil society involvement, securing private sector
participation, integrating HIV/AIDS initiatives with existing health
programs and services, provision of low cost or free services to the
needy, stigma and discrimination of people living with HIV/AIDS and
migration.
ACTION PLAN
Vision
The adolescents will be free from
malnutrition and disease, that they will acquire knowledge and skills
to enable them to have normal physical and mental development, and to
make them responsible citizens.
Goal
To ensure that youths have access to
healthcare services for adolescents, and to empower them to make
decisions about changes in their behavior and lives.
The health and education infrastructure is
not youth friendly. We need adolescent reproductive health services,
including those targeted toward family planning.
Objectives
To prevent anemia, dental disorders, worm
infestations, skin disorders, etc., and to educate youth on all aspects
of sexual and reproductive health. (We have in fact reduced anemia by
large numbers.) To prevent sexually transmitted infections.
Target group:
Nearly 800,000 people, counting 16 percent of
the total population belong to the age group of 15-24 years old. Every
year there are 14,000 unwanted births. Sexually transmitted infections
are found in 8 to 10 percent of adolescents.
The current school program makes the task
difficult. There was no sex education before; it has just recently been
introduced. There is increasing sexual activity, lack of awareness of
contraception and STIs, and lack of empowerment. There are 13 abortion
clinics in the city. There is both child and adolescent abuse.
How did we arrive here?
India's five-year plan calls for the fertility rate to reach net
replacement level by 2010. The problem with the family planning
approach aimed at reaching a target was that it led to cheating on
reporting. Now we are using the cafeteria program approach. Adolescent
health was never part of the program, even though the age for marriage
in India is one of the lowest in the world. Unabated migration is also
a problem. Also, NGOs, CBOs (community-based organizations), and
religious leaders were not taken on board in family planning issues.
Misconceptions about solutions for these
issues include believing the following options would be sufficient on
their own:
- Increasing the facilities.
- Increasing the manpower.
- Providing more money.
There are two options:
- Targeted interventions:
Advantages: The focus, effectiveness and short period of implementation
of targeted interventions.
Disadvantages: Interventions are costly, and are difficult to
coordinate and sustain.
- Integrate solutions with existing health delivery
system.
Advantages: cost-effective, sustainable, trained staff.
Disadvantages: overloading of system, may lack focus.
Recommendation
A peer education program for school/college
students, and for the out-of-school population.
Budget
Funds of 102,770 U.S. dollars are available.
Funding is not an issue. My supervisor says, "Funds are no problem -
produce results."
Timeline
- Planning - Months 1-2. I am an advocate of sitting
down with stakeholders and planning with them.
- Training - Month 3. Needs assessment.
- Hardware - Month 6. Print materials and hold exhibits
in selected schools.
- Advocacy - Publicize using television and radio,
street plays, traveling van exhibits, and print media.
Monitoring
Use monthly reviews and peer meetings.
Evaluation by an outside agency is very important.
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