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Hiring of private anaesthetists at First Referral Units and Primary Health Centres, Tamil Nadu
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Subject Area="First Referral Units." Objective="Availability of anaesthetists."
Details for Reform Option "Hiring of private anaesthetists at First Referral Units and Primary Health Centres, Tamil Nadu"

Background: An acute shortage of anaesthetists in the public health system meant that even if other facilities were available, operations could not be conducted. Action: Under the Reproductive and Child Health (RCH) programme, the Medical Officers (MOs) at the First Referral Units (FRUs) and Primary Health Centres (PHCs) in Tamil Nadu were empowered to contract in private anaesthetists (local practising anaesthetists or a retired anaesthetist). Initially, it was permitted at FRUs to provide emergency obstetric care including the conduct of Caesareans and hysterectomies. Later, anaesthetists could also be hired to conduct tubectomies and other elective gynaecological surgical cases at FRUs and tubectomies in PHCs where operation theatres are functional, on specific days. Results: On average, 12% of the total number of Caesareans (around 2,500 Caesarean surgeries per year) were performed in the secondary level hospitals (FRUs) by hiring the services of private anaesthetists. During the last 4 years around 48,000 additional tubectomies were performed by hiring private anaesthetists at FRUs and PHCs. 112 more PHC operation theatres were made functional.

Cost INR 1100 which includes INR 100 for conveyance per case of caesarean or major gynaecological/obstetric surgery. Similarly for conducting tubectomies, INR 1100 per visit which includes INR 100 for conveyance per visit. No minimum number tubectomies are prescribed for each visit. It is generally between 5 and 10 cases. If the number of tubectomies performed exceeds 10, INR 100 (€1.76) is paid for every additional tubectomy.
Place 44 PHCs in the districts viz. Thanjavur, Thiruvarur, Nagappattinam, Dharmapuri, Krishnagiri, Madurai and Theni and selected 75 FRUs in 24 districts. The scheme is now extended to all the PHCs and government hospitals in the state except the medical college hospitals and urban municipal hospitals.
Time Frame Six months.

Local service: Enables emergency obstetric surgeries to be conducted in FRUs without patients having to waste time and money on travel. Reduces the unnecessary referral from one institution to another for want of anaesthetists. Life-saving: Reduces the maternal deaths due to timely availability of anaesthetists. Patient-friendly: Enables tubectomy surgery to be carried out at the PHC which most people prefer because of the ‘family atmosphere’.


Opposition: The government doctors association initially resisted the entry of private specialists. Due to frequent review of the FRU performance the situation changed.


Availability of local anaesthetist within the reach of the FRU /PHC. Delays should be avoided in the release of funds to the anaesthetists.

Who needs to be consulted

State and District level officials. Medical Officers at FRUs and PHCs. Government doctors association.



Sustainable if the funding is in place.

Chances of Replication

Tamil Nadu Public Health department plans to continue the scheme under RCH2 and to extend it to the urban municipal corporation hospitals.




Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. September 2004.

Status Active
Reference Files
GO.doc Government Order No 475 dated 10-11-1999 regarding hiring of anaesthetists for abortion services at PHCs
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