Puducherry beats national average on most health indicators: Here's why

Between 8.00 and 9.00 am every day, 150 diabetes patients gather at the out-patient department (OPD) of Puducherry’s Kosapalayam Primary Health Centre (PHC) to get their daily insulin shots. This is a rarity in India’s public health system, as it requires good community-wide disease management and consistent supply of medicines, something Puducherry’s health system is uniquely known for.

The union territory of Puducherry surpasses India’s performance on most health indicators. Its infant mortality rate is 16 per 1,000 live births same as Vietnam, while India’s average is 41 same as Ethiopia. Nearly 99.9% of births take place in health institutions and 91.3% of children are immunised, as against the Indian average of 78.4% institutional births and 62% child immunisation.

Part of Puducherry’s success is thanks to its small population–its 1.24 million people give the state a population density of just 2,598 persons per square kilometre (sq km). By contrast, Delhi has 16.8 million people, or 11,297/sq km.

However, more credit goes to the fact that Puducherry’s administration has long prioritised healthcare by, among other steps, spending more per capita on health than other, richer states; setting up adequate numbers of medical colleges; and leaving no positions vacant in its health administration.

IndiaSpend visited Puducherry to see what lessons it can offer the rest of India.

Higher spending

Established on July 1, 1963, Puducherry, formerly Pondicherry, is a Union Territory–governed by the federal government–formed out of four enclaves of former French India and named after the largest, Pondicherry.

Puducherry and Delhi are two union territories entitled by special constitutional amendments to have an elected legislative assembly and a cabinet of ministers, which gives it partial statehood powers. The special provision permits the administration to make laws on certain matters.

Puducherry consists of four small, unconnected districts: Pondicherry, Karaikal and Yanam in the Bay of Bengal, and Mahé on the Arabian Sea. It has a total area of 492 sq km and a total population of 1.24 million.

Puducherry’s focus on healthcare is clear from its budgetary spending: the UT spends 1.85% of its gross domestic product (GDP) on health, compared with 0.86% in Delhi and 0.74% that most major states spend, according to National Health Profile, 2017. Its per capita health spending is 28% more than Delhi’s and 98% more than major states’–Rs 2,778, as against Rs 2,088 in Delhi and Rs 940 in major states.

 

Ashwini T, medical officer at Kosapalayam PHC, Puducherry telling about NCD clinics

 

The PHC at Kosapalayam is among the few that work two shifts–8 am to 2 pm, and 2 pm to 8 pm “We see about 250-350 patients in OPD every day,” said Ashwini T., the medical officer, explaining that the high footfall is thanks to the availability of health staff in two shifts, free medicines and diagnostics, and better awareness.

The PHC is has two doctors, four nurses, three health assistants, one inspector, eight Auxiliary Nurse Midwives (ANM), one laboratory technician, two pharmacists and one tuberculosis health visitor. There are no vacancies.

“Here in Pondicherry, people are very active [aware], they themselves come and seek treatment in PHC,” Ashwini said. Even people from neighbouring Tamil Nadu come to PHCs in Puducherry for their better facilities, she said.

(Yadavar is a principal correspondent with IndiaSpend.)

Reprinted with permission from IndiaSpend.org, a data-driven, public-interest journalism non-profit organisation.