K.G. Kumar

LAST week, one of Kerala's shining sectors lost a bit of its world-renowned sheen as services in 6,500 medical institutions in the State were affected as doctors went on a 24-hour strike to protest the alleged assault of a doctor by a former Minister.

Earlier, over 350 health workers employed at the Kozhikode Medical College Hospital (KMCH) went on a relay hunger strike in a protest that began on July 23. Their main demand is for a wage rise. KMCH only pays a minimum daily wage of Rs 70 to 110, even though the legal minimum daily wage in Kerala is Rs 140 to 170.

Will these rumblings of discontent ruffle the fabric of Kerala's three-tier healthcare system of primary health centres, community health centres, taluk and district hospitals, and medical colleges distributed evenly in both urban and rural areas? While attempting to answer that question, it must not be forgotten that Kerala is one of the better performing - if not the best - States in the country in terms of standards and delivery of public healthcare.

It is also worth remembering that Kerala has achieved an admirable parity of health status with the US by spending roughly $10 per capita per year, while the US spends about $3500 per capita per year on healthcare.

However, one disturbing trend is that Kerala's public healthcare system has shown signs of getting alienated from the people. According to one study, only 30 per cent of the people even from the lower income strata seek medical help from government hospitals.

The reason? Predictably, a marked fall in the quality of services in Kerala's government hospitals due to the lack of political commitment, bureaucratic inefficiencies and corruption at various levels.

According to Dr D. Varatharajan, Associate Professor (Health Economics and Policy), Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, a recent study of public hospitals in Kerala found that 60 per cent of land, 50 per cent of building space and 25 per cent of the beds remained unutilised. Twenty-eight per cent of the hospitals reported less than 25 per cent utilisation of their facilities.

Against that infrastructural lacuna, Kerala is also afflicted with the "low mortality, high morbidity syndrome".

Kerala displays a peculiar anomaly because infectious diseases like diarrhoea, hepatitis and tuberculosis are still prevalent in the State. Moreover, many epidemics that were supposed to have been eliminated from Kerala like malaria seem to be returning, say some observers.

Diseases like Japanese encephalitis, once so sporadic in Kerala, have raised their head in many parts of the State as near-epidemics.

All these developments show that Kerala's health sector is not quite in the pink of health. Both in terms of caring for the care providers themselves - the doctors, nurses and paramedics - and providing the best affordable healthcare for the State's citizenry, especially the poorer classes, the State seems to be falling behind.

That is a pity that calls for some prompt action.

The writer can be contacted at kgkumar@gmail.com

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