Social Service

Medical and Public Health

Improvement in the health status of the people is one of the crucial areas in social development of a community. This can be achieved by improving the access to health services, especially for the underprivileged people. The foundation for a medical care system accessible to all citizens was laid in the State much before independence. Some of the hospitals in Kerala are more than 50 years old. Democratic decentralization since 1994 in Kerala improved the infrastructure facilities and equipment in primary and secondary healthcare institutions and widened healthcare delivery. Easy accessibility and coverage of medical care facilities has played a leading role in influencing the health status of Kerala. In Kerala, both Allopathy and AYUSH systems play a crucial role in providing, universal accessibility and availability even to the poorer sections of society.

Kerala has made significant gains in health indices like Infant Mortality Rate, Birth Rate, Death Rate,and expectancy of life at birth. The challenges before the State is to sustain the achievements in the health sector and to tackle the problems of life style diseases like diabetes, coronary heart disease, renal disease, cancer and geriatric problems. Communicable diseases like chikungunya, dengue, leptospirosis, and swine flu are also major concerns. Other than these, there are new threats to the health scenario of the State, like mental health problems, suicide, substance abuse and alcoholism, adolescent health issues and rising number of road traffic accidents. To tackle these, concerted and committed efforts with proper inter-sectoral co-ordination is essential.

Health Indicators of Kerala

The health indicators of the State are considerably superior to the national figures. The comparative figures of major health and demographic indicators at State and National level are given in Table 4.8.

Table 4.8
Demographic, Socio-economic and Health profile of Kerala and India

Sl. No. Indicator Kerala India
1 Total population (in crore) (Census 2011) 3.34 121.06
2 Decadal Growth ( per cent) (Census 2011) 4.90 17.7
3 Sex Ratio (Census 2011) 1084 943
4 Child Sex Ratio (Census 2011) 964 919
Sl. No. Indicator Kerala India
1 Birth Rate #   14.8 21.0
2 Death Rate #   6.6 6.7
    Male 7.6 7.1
    Female 5.8 6.2
3 Natural Growth Rate #   8.2 14.3
4 Infant Mortality Rate #   12 39
    Male 10 37
    Female 13 40
5 Neo Natal Mortality Rate*   7.00 35.00
6 Perinatal Mortality Rate*   13.00 35.00
7 Child Mortality Rate*   2.00 15.00
8 Under 5 mortality Rate*   14.00 69.00
9 Early Neo-natal Mortality Rate*   5.00 27.00
10 Late Neo-natal Mortality Rate*   2.00 8.00
11 Post Neo-natal Mortality Rate*   4.00 18.00
12 Death Rate*      
  (a) Children (0-4)   3.10 20.70
  (b) Children (5-14)   0.20 1.00
  (c) Children (15-49)   2.50 3.70
  (d) persons (60 and above)   42.10 46.60
  (e)Percentage of death receiving medical attention*      
    Government 38.00 17.40
    Private 33.40 12.10
    Qualified professional 12.20 37.90
    Untrained/others 16.40 32.60
13 Still Birth Rate*   7.00 8.00
14 Total Fertility Rate*   1.70 2.60
15 General Fertility Rate*   52.00 88.00
16 Total Marital Fertility Rate*   3.50 4.30
17 Gross Reproduction Rate*   0.80 1.20
18 Female age at effective marriage*      
  (a) Below 18   16.70 16.30
  (b) 18-20   19.20 19.00
  (c) Above 21   24.40 23.90
  (d) All age   24.40 20.70
19 Couple Protection Rate   62.30 52.00
20 Maternal Mortality Ratio**   66.00 178.00
21 Expectancy of Life at Birth* Male 71.40 62.60
    Female 76.30 64.20

Source: Directorate of Health Services # SRS 2016, July *SRS 2009 **Special Bulletin on MMR 2010-12

Draft National Health Policy 2015

The National Health Policy (1983 and 2002) has guided the approach towards the health sector in the country. Thirteen years after the health policy in 2002, the draft National Health Policy 2015 was formulated, which addressed the issues of universal health coverage, reduction of maternal mortality and infant mortality, improved access to free drugs and diagnosis. Salient features of the draft National Health Policy 2015 are;

i. Improve the care delivery system

ii. A National Health Rights Act to make health a Fundamental Right

iii. Denial of health care will be justiciable

iv. Raise public health expenditure to 2.5 per cent of GDP (Rs.3800 per capita) from current spending of 1.04 per cent of GDP (Rs.957 per capita)

v. Creation of health cess on the lines of educational cess

vi. Ensure universal access to free drugs and diagnosis in government hospitals

vii. States may voluntarily opt to adopt the Act through a resolution in the Legislative Assembly

Committee to Draft New State Health Policy

The Government has constituted a 17-member panel headed by Dr B Ekbal, Member, State Planning Board to draft a health policy for the state. The main thrust of the new Health Policy will be to provide universal comprehensive free health care to all the people of the State. The Policy will be based on primary health care, disease prevention, health education and family doctor approach. The health policy aims to take care of the needs of the marginalized sections like Adivasis and fisher folk. The Committee is formulating the health policy by organizing public hearings and discussions with various organizations.

Sustainable Development Goals

The sustainable development goal set by the United Nations for health and well-being aims at ensuring healthy lives and promoting well-being for all at all ages. The Government of Kerala has formulated short and medium term targets (draft) to be achieved by the state in the health sector. This is in keeping with the Sustainable Development Goals (SDG) Framework so that targets finalized by Kerala would be aligned to national and international targets. The relevance of the targets set by the UN to the State was examined by the Working Groups The targets to suit the State’s current epidemiological status and capacity were adopted. In addition to the targets listed by the U.N., Kerala has included targets in Dental, Ophthalmic and Palliative care also as they were considered important for the state. The Working Groups have recommended key strategies to achieve these targets. A survey is proposed to be conducted to assess the baseline values which will be the benchmark to measure progress in achievement of the targets. A repeat survey is intended to be carried out in 2021 to evaluate the performance of the state.