Kerala - a glimpse into its very heart!

An attempt to highlight the enchanting features, great achievements and vexing problems of a truly remarkable land!

Tuesday, May 01, 2007

KERALA NEEDS NEW HEALTH POLICY - DESPERATELY!


Kerala has made remarkable achievements in health, comparable to that of even developed countries during the last fifty years.


Kerala’s achievements in health, in spite of its economic backwardness and low health spending, has prompted analysts to rave about a unique ‘Kerala Model of Health’, worth emulating by other developing parts of the world. The salient features of this Model are good health at low cost, based on social equality and justice.

There are many socio-economic conditions unique to Kerala, which have been postulated to make this health model possible. The highly literate population, especially the female population, has to be given due credit when we look for explanatory factors. Kerala has nurtured a political climate wherein the rights of the poor and underprivileged have been fought for and upheld. The agrarian reforms ended the feudal relationship in agriculture, giving land to the tillers. This improved the social living conditions of the landless poor in the rural areas. The public distribution system of food through fair priced ration shops ensured minimum food materials at relatively cheap cost to the people, warding off poverty-related diseases.

Apart from the socio-economic factors outlined above, the universally available public health system in Kerala has also contributed to the high health status of the people. Kerala has a three –tier system of health care evenly distributed both in the urban and the rural areas. Apart from Modern Medicine, Ayurveda, Homeopathy and other alternative systems are also very popular in Kerala

However, the widely acclaimed Kerala Model of Health has started showing a number of disturbing trends recently.

Although the mortality is low, the morbidity is high in Kerala compared to the other states- the ‘Low Mortality High Morbidity Syndrome’. Both infectious diseases and the so-called ‘lifestyle diseases’ are prevalent in Kerala.

Many epidemics, like Maalria, which were supposed to have been eliminated from Kerala, are definitely staging a comeback. In addition, new epidemics like Chikungunya are also rearing their heads, killing many. Suicide rates in Kerala are three times the national average – about 25 people commit suicide every day! Death and disability due to road traffic accidents are also very high in Kerala.

Though the incidence of AIDS is still low in Kerala, considering the strong presence of stigma and discrimination towards the sufferers, it may also emerge, in future, as a major public health problem in Kerala.

The most disturbing trend is the Public Health System getting alienated from the people – statistics show that only thirty percent of people seek medical help from government hospitals. This is obviously because of the fall in the quality of services at the government hospitals.

Deep rooted corruption, bureaucratic inefficiency and lack of political commitment have all contributed to this sorry state of affairs. This perceived inefficiency of the government medical facilities is the major factor providing the impetus for the overgrowth of the private medical care setup in the state. The privatization of medical care, in turn, is leading to severe escalation of health care cost.

The establishment of a large number of self-financing medical colleges is worsening the situation. Because of the private sector boom and also the tendency towards specialization, doctors are refusing to join the government hospitals, causing a severe
dearth of doctors in the rural and even some urban centres and medical colleges. The net result is the marginalization of the poor as far as access to quality health care is considered.

It is an accepted fact that most of the private hospitals are primarily concerned with financial profit. These managements are not averse to using any unscrupulous method to this end. Most of these hospitals do not even posess an incinerator, instead preferring to dump the tons of bio-medical waste they generate in public places, even in the neighbouring states!

Toning up the health care system in the state and making it capable of taking on the burden of provision of equitable, efficient and quality health care need concerted action from the political parties, social movements and the professional bodies. Taking into consideration the specific problems of the Kerala health scenario, a People’s Health Policy for Kerala should be formulated.

Reinstating the primacy of the government health services, with its emphasis on primary health care, should form the basis of the health policy. There should be social control and auditing of the private sector. The health expenditure should be controlled. With the handing over of the institutions- from the Public Health Centres to the district hospitals- to the local bodies as part of the decentralization process, there is tremendous scope for solving the health crisis through which Kerala is now undoubtedly passing. The Panchayathi Raj Institutions provide the possibility for the people to demand the resources to operate a health service in which the people themselves will play the dominant role and of which they will be the chief beneficiaries. Only thus can a cost-effective, humane and accountable health service be provided that is funded and operated by the local bodies with the technical assistance of the health professionals.

The people can be mobilized to improve not only the curative area but also the area of health education, as in the prevention and control of diseases that originate in their environment. Once the primary and secondary health care facilities are improved through local bodies, the tertiary care centres like the medical colleges can concentrate on education and research.

If the health and local administration departments work in unison, the health scenario can be changed, so as to bring in a decentralised and participatory model of health care. In case this becomes a reality, Kerala will provide another unique model of health care, worth emulating by the other Indian states-and also other developing parts of the world. However, there is a long way to go yet!

Reference : Article by Dr.B.Ekbal, former Vice Chancellor, Kerala University

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