Topic
Mortality, nutrition, immunisation, and access to healthcare across states and over time.
The model state, audited
Tamil Nadu built a public-health system other states are sent to study. The outcomes show it worked. They also show, honestly, the parts it has not fixed. Kerala still leads the country; this is the story of India's strongest replicable model.
01 · The headline outcomes
Infant mortality fell from 21 to 12 deaths per 1,000 live births between 2013 and 2023. Put plainly: for every 1,000 babies born, 9 more now reach their first birthday than a decade ago. TN sits a clear first among its peers and below the all-India rate of 25. Only Kerala does meaningfully better nationally.
Infant deaths per 1,000 live births · 2023
02 · Where TN ranks
Maternal mortality dropped from 90 to 49 per 100,000 live births, far under the all-India 93 and the SDG target of 70. This is the honest beat: TN is excellent, not supreme. Maharashtra ran the same race faster and now sits at 38.
Maternal deaths per 100,000 live births
03 · Why it worked
The outcomes trace back to deliberate machinery: a separate public-health cadre under the 1939 Public Health Act, a 24x7 primary-health-centre and emergency-obstetric network staffed by village health nurses, the Tamil Nadu Medical Services Corporation's pooled generic-drug procurement (1995), and routine maternal-death audits. The clearest fingerprint is where babies are born.
Share of births in a health facility · 2015 → 2024
04 · What's unfinished
A model is only honest if it names its failures. Tamil Nadu cut mortality decisively. It has not done the same for child nutrition, rural specialist staffing, or the share families pay themselves.
CHC specialist posts unfilled (%) · 2014-15 → 2022-23
Can it move the nutrition needle?
20.7% child stunting, 2024
Down from 27.1% in 2015 to 20.7%, now well below the all-India 29.3%. NFHS-6 shows the nutrition needle finally moving, though stunting remains the model's slowest-improving outcome and a nutrition problem, not a delivery one.
See the seriesCan it staff its rural specialists?
39.0% CHC specialist gap, 2022-23
Flat for a decade. TN solved facility births and drug supply, but the rural specialist gap is the system’s weakest joint.
See the seriesCan it protect families financially?
₹2,028 urban OOP per hospitalisation, per person, 2022-23
NSSO now puts urban out-of-pocket hospitalisation spending at ₹2,028 per person, above the ₹1,446 national average. TN’s public hospitals are near-free per admission, but its residents are hospitalised more often, so per-person spending runs high. Financial protection is the next frontier.
See the seriesThe mortality and longevity numbers behind the headline, and the delivery system that drives them.
Where the model has not yet delivered: child nutrition, rural specialists, and household financial protection.
The bottom line
Across infant survival, maternal survival and institutional delivery, Tamil Nadu’s outcomes rank among the best of the five states compared, the product of a long, sustained decline in mortality.
See how every figure is sourced & checked →