NEW DELHI, March 27 -- Recently I asked a senior health official from Tamil Nadu how the state had achieved such an outstanding performance in public health delivery. Was it a combination of enlightened culture, and high literacy levels? Her response was immediate: "All that, yes, but the key factor has been votes." Indeed, successive governments in Tamil Nadu, and in Kerala, have consistently promised big, and delivered, on public health. Sadly, these states are exceptions. In the recent state elections, one major party in Kerala had an election manifesto with 43 specific health points; another in Uttar Pradesh had no health manifesto. No surprise that India continues to be in the bottom quartile of the world's nations in maternal and chil...