Clipped from: https://www.thehindu.com/sci-tech/health/can-tamil-nadus-reforms-change-transgender-healthcare-explained/article70275209.ece
What lessons does Tamil Nadu offer in building inclusive, rights-based healthcare?
Clinic for transgender persons at Rajiv Gandhi Government General Hospital in Chennai | Photo Credit: R Ragu
The story so far:
“Leave no one behind,” a core principle of the United Nations Sustainable Development Goals and Universal Health Coverage, urges governments to prioritise healthcare for the most marginalised. Yet, transgender persons continue to face significant barriers to affordable, quality healthcare. Tamil Nadu has emerged as a pioneer in addressing these inequities through inclusive public health policies and welfare schemes that recognise the intersection of health, dignity, and social rights.
Why do transgender persons face healthcare barriers?
Transgender persons encounter multiple, overlapping barriers. First, few healthcare providers are trained in transgender health, and they are often restricted to managing sexually transmitted infections or gender-affirming surgeries, neglecting the comprehensive, lifelong health needs. Second, systemic exclusion from education, housing, employment, and social security leaves many without stable income or insurance. Third, stigma and discrimination in health settings, along with poor awareness among both providers and the public, create hostile healthcare environments that erode trust in the health system. As a result, many transgender persons either delay or avoid seeking medical attention altogether.
What has Tamil Nadu done?
Tamil Nadu stands as a pioneer in transgender-inclusive healthcare. Since 2008, the Rajiv Gandhi Government General Hospital in Chennai has offered gender-affirming surgeries, supported by India’s first Transgender Welfare Board. This began many years before the 2019 Transgender Persons (Protection of Rights) Act mandated such services in at least one government hospital per State. Acting on sustained demands from the community, the National Health Mission (Tamil Nadu) established Gender Guidance Clinics (GGCs) in 2018 to provide multidisciplinary care under one roof. By 2025, eight districts in the State host GGCs, offering free gender-affirming procedures. Between April 2019 and March 2024, 7,644 transgender individuals accessed these clinics. Posters in English and Tamil in GGCs emphasise non-discrimination, inclusion, privacy, and confidentiality to ensure respectful care.
How has Tamil Nadu expanded insurance coverage?
Tamil Nadu has integrated gender-affirming surgeries and hormonal therapy into the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS-PMJAY) in 2022. Previously funded through hospital budgets, these services are now covered under a five-year (2022-27) policy with the United India Insurance Company, making India the first South Asian country to include transgender care in universal health coverage. The Centre’s 2022 PMJAY-Ayushman Bharat TG Plus scheme offers over 50 free procedures, but Tamil Nadu’s implementation, now in its fourth year, is more advanced.
To enhance accessibility, the State government removed the ₹72,000 annual income cap for CMCHIS-PMJAY enrolment and waived the requirement for a ration card bearing the transgender person’s name, recognising that barriers to healthcare extend beyond income to include stigma, discrimination, and family rejection. Based on a forthcoming WHO case study, as of October 2025, over 5,200 transgender individuals are enrolled in the scheme, with more than 600 undergoing gender-affirming surgeries or hormone therapy in 12 public and private empanelled hospitals. The scheme has disbursed ₹43.8 million, preventing financial ruin for many transgender persons from costly private care.
How have policy and legal reforms strengthened this model?
The 2019 Transgender Act (Section 15) mandates comprehensive healthcare, and Tamil Nadu has begun moving the needle. In October 2024, the National Health Mission, working with NGOs and LGBTQIA+ networks, trained doctors from GGCs on the World Professional Association for Transgender Health Standards of Care, Version 8.
The Madras High Court has reinforced transgender rights through rulings on marriage, curriculum reform, banning conversion therapy and intersex surgeries, reopening GGCs post-COVID, ending police harassment, and reducing societal prejudice. The 2019 Tamil Nadu Mental Health Care Policy and the 2025 State Policy for Transgender Persons further affirm healthcare, education, and property rights.
Why does Tamil Nadu stand out?
The study on Gender Guidance Clinics by the United Nations University-IIGH on Gender Guidance Clinics highlights how these developments are embedded in an enabling environment that has been created over decades in Tamil Nadu. The state has consistently been a cradle for transformative social reforms, rooted in principles of self-respect and social equity, while actively confronting pervasive gender and caste discrimination. The acceptance of transgender identities is evident right from the annual Koovagam Kuthandavar festival held over centuries to the recent publication of the 2022 government gazette, which adopted respectful Tamil terms for sexual and gender-diverse persons. Despite political rivalries, both major political parties have championed numerous welfare initiatives to support the transgender community.
What challenges remain?
While Tamil Nadu has set a benchmark for transgender-inclusive healthcare, challenges remain.
GGCs must expand to provide comprehensive primary-to-tertiary care, publish a dedicated health manual, regularly build provider competencies and hold them accountable, regulate empanelled hospitals, progressively include mental health in benefit packages, establish grievance mechanisms, encourage research, and tackle societal bias through cross-sectoral action. Engaging transgender communities at all stages of policy and implementation for transgender health is non-negotiable.
Only sustained commitment and action can transform Tamil Nadu’s promising model into lasting equity for transgender persons.
(Rajalakshmi RamPrakash, PhD, is a global health researcher with a special interest in intersections of health policy systems and gender equity. She is currently a Consultant with WHO (Geneva)-Human Reproduction Programme. Views are personal)
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