Kerala, a state within India, is renowned for its effective policies in education, literacy, and healthcare. Kerala has the second-lowest rate of poverty in India, and that figure has been steadily declining since 1994. Health policies that provide affordable and accessible healthcare to the state’s low-income populations have been critical in its success defeating poverty, but relatively high levels of inequality and emerging health challenges, including an aging population and lifestyle diseases like diabetes, remain policy challenges for Kerala moving forward.
Kerala’s Current Health Needs
One of Kerala’s most pressing healthcare challenges is caring for its rapidly aging population. Kerala’s population over the age of 60 is expected to double by 2050, and as a larger proportion of people are retired, the state needs a healthcare infrastructure designed to support the health needs of the elderly.
A trustee of an NGO focused on healthcare for the underprivileged in Kerala, who wished to remain anonymous, pointed out changing lifestyles as the cause of some of Kerala’s growing health issues. Non-communicable diseases are on the rise; cancer and diabetes have become the two largest causes of death in the state.
While infectious diseases remain under control compared to other parts of India, re-emergence of certain diseases have led to rather high morbidity in some areas. Additionally, despite significant efforts on the part of the state to place healthcare in the hands of local authorities, and what the NGO trustee says is the highest ratio of doctors to the public in rural areas of any state in India, rural parts of Kerala still do not receive the same quality of care as do urban areas. Likewise, although Kerala has the lowest infant mortality and maternal mortality rates of any Indian state, the government still aims to reduce these rates further.
Because healthcare in India is managed at the state level, Kerala’s state government is responsible for formulating its own comprehensive healthcare policy. The state has a history and culture of providing health services to the public; as early as 1879, vaccinations were made mandatory for specific subsets of the population. Since India’s independence in 1947, Kerala has worked to expand easy, community-based access to primary care, prevention services, and specialized treatments.
Kerala’s decentralized healthcare model is a key component of its success in providing affordable and accessible care. After a statewide movement towards expensive private healthcare in the 1980s due to a lack of resources in the public health sector, in 1996, Kerala’s state government decentralized public healthcare through the People’s Campaign for Decentralized Planning. Decentralization shifted approximately 40 percent of state healthcare funding to local governments, prioritizing creating community-based services that are accessible to all regardless of income or caste, as a private-dominated system was consistently barring the poor from accessing care across Kerala.
Looking to the Future
Another key element of Kerala’s healthcare successes has been its willingness to generate policies anticipating future healthcare needs. As the state’s population ages rapidly, policy is already being generated to combat this coming issue. Senior care facilities are already being constructed across the state, existing facilities are being made more equipped for geriatric care, and the Pain and Palliative Care Policy of 2008 has increased the amount of home-based care at the local level.
Likewise, to combat the re-emergence of infectious diseases like diarrhea, typhoid, and Dengue fever, Kerala has invested in information-gathering at the household level in order to observe the spread of such illnesses. As diabetes, cancer, and cardiovascular disease came to account for more than half of all deaths in Kerala, the National Programme for Prevention of CVD, Diabetes, Cancer and Stroke (NPCDCS) was introduced in Pathanamthitta district in 2010 and has since been expanded statewide.
This year, Kerala’s government passed a policy for comprehensive healthcare reform. This new policy seeks to reshape the state’s health services to better account for an aging population, re-emerging infectious diseases and non-communicable lifestyle diseases like diabetes and cardiovascular disease, and to expand mental healthcare. It will increase public spending on healthcare more than eightfold in order to further lower the price of public health services as well as providing treatment guidelines to ensure a more even quality of treatment across the state. This comes at the same time as the state is expanding its public health insurance coverage.
Impact on Poverty
Despite the government’s continued efforts to decrease the cost of healthcare and the fact that privatized healthcare services are still largely inaccessible to the poor, Kerala has accomplished several significant victories in providing affordable and accessible healthcare. According to the NGO trustee, no one needs to travel more than 10 kilometers to a primary health centre (PHC), and medicines are provided for free at PHCs across Kerala. Decentralization of healthcare has cut costs significantly, and the state’s new health policy seeks to encourage subsidized public healthcare even further while increasing insurance coverage.
Certainly, Kerala’s innovative health policy is a critical component of its low and steadily decreasing poverty rate. However, underprivileged individuals–including the poor, those in rural areas, women, and the elderly–continue to receive lower quality care and less of it. That is why NGOs and nonprofits like the trustee’s organization must continue to exist, and why the government continues its fight for constant improvement of Kerala’s health policy.
– Macklyn Hutchison