Silvi Kurian & Sumita Kale: Neglecting God's own

The Reproductive and Child Health Survey (RCH), 2002-04 and Facility Survey, 2003 give us valuable insights into the extent of success of the various health services providing healthcare in India and the case of Kerala stands out as an interesting one. Based on the performance of ten indicators, RCH assigns a rank to all the states in India according to which Kerala performs the best. Infant mortality rate (IMR) is used as a widely accepted measure of the general health of the population. Kerala performs rather marvellously on this front, with an IMR of 11 per 1,000 population, which is the lowest among all states in India. The state's performance is also way above others when we look at figures on birth rates, proportion of institutional births, life expectancy, proportion of persons hospitalised, and so on. The story would have been perfect if we look at health indicators alone. However, the Facility Survey of the Primary Health Centres (PHCs) paints a somewhat different picture of the state.

The availability of facilities in the PHCs in Kerala is the lowest when compared to other states in the south. In terms of the infrastructure availability in PHCs, Kerala has the lowest percentage with adequate infrastructure, 42.9 per cent compared to 64.7 per cent in Tamil Nadu. There are also wide district disparities "" just 8.9 per cent of Kannur's PHCs have adequate infrastructure while in Palakkad this percentage is 55. In terms of the training imparted to the PHC staff, at 18.6 per cent, Kerala PHCs are much below even states like Jharkhand (42.5 per cent) and Jammu and Kashmir (30.3 per cent). The poor performance is perhaps the most glaring in terms of the supply of equipment to the PHCs. While 92.2 per cent of Tamil Nadu's PHCs have adequate supply of equipment, only 34.3 per cent of PHCs in Kerala qualify on this criterion. The percentage of PHCs having at least one basic laboratory is 31.4 per cent in Kerala and 67.5 per cent in Tamil Nadu.

The current discrepancy between health indicators and facilities can be resolved to some extent by looking at the growth of the private health sector in the state. NSS data show that private hospitals accounted for 63 per cent of treated ailments in rural areas and 78 per cent in urban areas. Kerala is a state with high health awareness and its excellent health status is a consequence of the groundwork laid in the past by the government. So the growth and spread of private sector healthcare in the last two decades is rather conspicuous, especially in a state with a strong Left orientation. Even though Kerala had initiated the decentralisation of the health care sector to local self-governments in 1996, the facilities in PHCs remain inadequate. Clearly, those losing out on quality health care would be the lower income groups who access public health facilities in the rural areas.

Regional disparities in health facilities within the state are another cause for concern. The Economic Survey 2005 of the state government mentions this point "" the government doctor to population ratio is just 1:6,344 in Wayanad, compared to 1:11,746 in Mallapuram. Fiscal crisis and lowered efficiency have taken their toll on the public healthcare system and though Kerala used to be cited worldwide for its model of development, clearly all is not well in God's own country.

The writers are with Indicus Analytics. They can be reached at silvi@indicus.net and sumita@indicus.net