THIRUVANANTHAPURAM: Kerala’s health sector, once celebrated for indicators rivalling Western nations, now faces urgent challenges that demand immediate action.
Despite historical strengths in low mortality and high life expectancy, rooted in the progressive policies of Travancore, Cochin, and post-independence governments, the state is grappling with multiple problems. The recent spurt in cases of amoebic meningoencephalitis, which has already claimed 18 lives, has startled health experts as the exact source of infection is yet to be ascertained in some cases.
Infectious diseases also persist, recurring annually with alarming frequency. While Kerala excels in crisis management, it lacks a long-term strategy. The state boasts of Western-level health indicators but ignores its success in eradicating infectious diseases.
The state has witnessed Nipah virus (reported five times in eight years), Zika, West Nile fever, Shigella, scrub typhus, besides recurring incidence of malaria, chickenpox, chikungunya, cholera, Japanese Encephalitis, leptospirosis and scrub typhus. These diseases threaten all societal strata, not just marginalised groups.
Public health experts say action should be taken immediately when the first case is reported. But usually, it is only after 25 plus cases are reported, the governments of the day swing into action, something which is not acceptable in the 21st century.
It is said that all developed countries detect their first case, which is a signal; the second case is a disaster, and the third case shows how incompetent the government is to handle the disease. Many feel it is high time the disease surveillance system launched during the Nayanar Government’s period, 1996-2001, was restored, besides scaling up facilities at the Institute of Virology, and an exclusive public health cadre is formed.
So, why is Kerala experiencing such a situation? Many believe the state’s dense and rapid urbanisation, flawed ecological management and lack of robust monitoring mechanisms are major reasons responsible for emerging infections.
However, the health department says the robust health care system helps in the early detection of infections in the state. This is one of the reasons why most infections are first detected in Kerala and do not remain unnoticed for long, like in other states.
Lifestyle diseases pose a major challenge.
Lifestyle diseases, infectious diseases, non-communicable diseases – cancers, chronic pulmonary conditions, heart disease, and hypertension—are now major drivers of mortality, morbidity, and disability in the state.
According to government statistics, cardiac problems are the leading cause of death in Kerala. As many as 26 out of 100 deaths taking place in the state are due to cardiac problems. Women account for 27 per cent of the total incidence of heart diseases, while it is 25.53 per cent for men.
About 20 per cent of the state’s population is diabetic and prone to heart, kidney, pancreatic, nerve and nephro diseases.
Experts say 180 out of every 1,000 people suffer from chronic illnesses, emphasising the need for preventive and promotive primary healthcare rather than reliance on super-speciality solutions, which fail to address high morbidity. There is a need for a comprehensive overhaul of Kerala’s health policy to tackle this dual epidemic through prevention, not just treatment.
Kerala’s cardiac death rates are alarmingly high compared to many countries, with 60% of male and 40% of female cardiac fatalities occurring before age 65. These premature deaths, coupled with costly, prolonged treatments, place immense financial strain on families. So the mantra for a healthy life is: “Eat right in moderation, exercise daily, quit smoking, and limit alcohol.”
Medical College Hospitals are bursting at the seams
Kerala’s premier government medical college hospitals, particularly in Thiruvananthapuram, Kozhikode, Thrissur, Alappuzha, and Kottayam, are overcrowded, with their casualty wings—critical for saving lives—facing severe challenges. These include shortages of doctors, anaesthetists, nursing staff, equipment, resuscitation facilities, CT scans, X-ray units, and space.
At Thiruvananthapuram Medical College Hospital (MCH), the casualty wing handles 1000-2000 patients daily. Kozhikode MCH, serving 600-800 patients daily, mostly surgical and orthopaedic cases. The medical college serves patients from five Malabar districts, and even Gudalur.
Understaffed medical colleges
Kerala’s government medical colleges are severely understaffed, operating with doctor and staff allocations set in more than five decades ago. Despite a massive increase in patient load, there has been no significant increase in staff leaving hospitals overcrowded.
The Kerala Government Medical College Teachers Association (KGMCTA) says shortage of doctors, mainly assistant, additional and associate professors, critically impairs patient care, affecting outpatient services, inpatient care, super-speciality units, and specialised programs like organ transplantation.
Many medical colleges face a shortfall of up to 100 doctors between the sanctioned and actual staff. Delay in filling vacant posts, including those from retirements, further strains the system. Urgent reforms are needed to address these chronic staffing deficiencies.
The severe shortage of doctors is critically undermining patient care, particularly in outpatient (OP) wings. Ideally, doctors need 10-15 minutes to review a patient’s medical history, order lab tests, and determine treatment, but heavy patient loads limit them to just 5-6 minutes per patient—far below the 20-30 minutes standard in Western countries.
Super-speciality departments, including urology, neurology, cardiology, gastroenterology, nephrology, and neurosurgery, are also under immense pressure due to inadequate staffing. The KGMCTA’s long-pending demand includes revision of sanctioned staff strength, based on a scientific assessment of patient load, to address these critical gaps and improve care quality.
Creation of sufficient faculty posts in medical colleges as per National Medical Commission (NMC) norms, and additional posts in medical colleges proportional to patient load.
Recently, a urology professor spoke publicly about the shortage of equipment in Thiruvananthapuram Medical College, resulting in the postponement of surgeries. His statement triggered a major controversy, exposing the shortage of man and equipment in medical college hospitals across the state.
But the government says many problems are being blown out of proportion. Health Minister Veena George told the assembly that the government had spent Rs 1489 crore under the Karunya Arogya Suraksha Padhathi to provide free treatment for poor patients. Besides, Rs 80.66 crores was spent for purchasing equipment.
According to the minister, advanced health care services are being provided in government hospitals. Complex surgeries like liver, heart, and bone marrow transplants are being performed successfully. Liver transplants, which cost Rs 40 to 45 lakh in private hospitals, are now being done free in government hospitals.
The minister, while acknowledging systemic challenges in the health sector, says the government is doing its best to provide quality health care.
Kerala has led in many spheres. The state’s infant mortality rate is 5 per 1000 births, the lowest in the country, as per the Sample Registration System report. It is lower than the United States, which has 5.6 IMR.
The minister says such achievements have been secured because of the importance being given by the government to infant, child and maternal care. Sixteen hospitals in Kerala won national LaQshya certification, and six hospitals won national MusQan certification.
The government also runs the Hridayam scheme to identify and treat children with congenital heart diseases. So far, 8450 children have been given free heart surgeries.
Notwithstanding the achievements, many believe it’s time to constitute a special expert committee urgently to study the issues plaguing the Government health sector.
The habit of brushing issues under the rug and claiming that “we are on par with developed countries in health indices,” while feeling content comparing Keala’s achievements with those of poorly performing North Indian states, will only aggravate the problem.
Bullet points
Life expectancy in Kerala is approximately 75 years, national 72
The infant mortality rate is lower than in the US . It is 5 per 1000 births and in the US it is 5.6.
National average 25
Maternal Mortality Rate – 43 deaths per 100000 live births significantly lower than national average of 113.
Kerala has 5000 health sub centres, 850 PHCs and 230 CHCs, 160 taluk and district hospitals and 18 medical colleges and specialty hospitals.
Private sector – Over 2000 private hospitals and nursing homes, numerous speciality and superspeciality hospitals in urban centres, corporate hospital chains .
Per capita out of pocket expenditure on health in Kerala is Rs 7889
Per capita government spending on health is Rs 4338 which is the highest in the country.
The private sector accounts for nearly 70 per cent of inpatient care and 60 per cent of outpatient care in the state.
