THE FEVERISH STATE
K A Shaji /Alapuzha and Kottayam
Is the much trumpeted Kerala health model deteriorating? Given the nature of epidemics wreaking havoc in the erstwhile Travancore-Kochi region, it seems so. This year itself, till July 16, as many as 193 persons died due to the outbreak of various kinds of viral fevers including Chikungunya in the state. Though the Union health ministry and a number of research agencies continue to swear that Chikungunya is not a deadly disease, doctors working in the affected areas have nothing else to blame for. With the surfacing of a few Dengue fever cases from the same region, there are enough indications that the state is sliding into a public health quagmire.
As many as 8.75 lakh people suffered viral infections since May this year and about 8,011 among them are still undergoing treatment at different hospitals. So far, 157 cases of Chikungunya have been identified. A state which had been boasting of its high level of vaccination and its preparedness to fight any epidemic is rattled by these developments. Moreover, the death of 38 newborns at the Sree Avittom Thirunal (SAT) Hospital in Thiruvananthapuram due to in-house infection poses serious questions on the state’s so-called achievements in the public health sector.
Economically, the viral outbreak was a severe blow to the state. Since many of its staff are on medical leave, the Kerala State Road Transport Corporation is cancelling its services in many south-central districts, pushing the corporation into a huge debt-trap. Further, latest reports suggest that the Malayalam film industry is also badly hit by it: about 40 actors including superstar Mohanlal, a three-time National Award winner, and top actress Meera Jasmine are suffering from the disease. “The situation is alarming. But we are trying our best to bring it under control,” said Kerala Health Minister PK Sreemati.
Along with the medical teams of the defence services, many socio-political organisations are also involved in relief operations. However, the tussle between the 20,000-member strong Indian Medical Association (IMA) state unit and the health minister has turned out as a major embarrassment to the government. When former Chief Minister Oommen Chandy came out in the open saying the ima had not been invited to join the relief work, the minister replied by distributing copies of her letter to the ima office-bearers seeking their help.
The spread of epidemics has already turned into an annual affair in low-lying, coastal regions of Alappuzha, where the water contamination is very high. Along the backwaters, mosquitoes are rampant and there is no effective mechanism to control it. A few health experts are also highlighting the breeding of mosquitoes in rubber plantations in hilly areas where primitive forms of rubber processing is prevalent. “The Aedes mosquito that breeds in stagnant water can carry Chikungunya and Dengue viruses. To check the menace, keep the surroundings very clean,” said Dr K. Madhavan Kutty, former principal,
The decline of the Kerala health model has deep-rooted causes. Says Dr CR Soman who heads the Health Action by People: “It is a warning to other parts of the world which follow the Kerala model. A serious discussion at the international level is required on what’s happening in Kerala.” Prominent among them is the gradual withdrawal of the government from the public health sector though the Left Democratic Front and the United Democratic Front win alternate terms. The third National Family Health Survey (NFHS) in March 2007 shows that Infant Mortality Rate (IMR) in urban Kerala has increased to 18 per 1,000. It was 16 in the second survey (1998-99). The percentage of children, aged between 12 and 23 months, who have received all recommended vaccines have declined to 75 percent from the previous 80 percent. The percentage of children under three years who are underweight has gone up from 27 to 29 percent.
The state had claimed the eradication of diseases like Malaria. Not only have they made a comeback, but also hitherto unheard of diseases like Japan Encephalitis have arrived in the state. For decades, Kerala has had a unique place in any health index table. “Good health at low cost” was the motto of Kerala as Dr B. Ekbal, national convener, Jan Swasthya Abhiyan, puts it.
The movement began half a century ago when the health situation was abysmal. During 1957-58, Kerala’s expenditure on health was 8.48 percent of total revenue expenditure when the average was 4.36 percent across the country. The trend continued even in the 80s despite the fact that the state underwent a severe financial crisis. By the middle of that decade, each village had a primary health centre and there was a chain of government hospitals at the taluk and district levels. Further, a rise in the literacy level, especially among the women, also helped achieve better health standards.
The expenditure on health was 9.61 percent in 1960-61. It came down to 7.53 in 90-91 and 5.67 in 2001. According to the Economic Review 2006, it’s 6.3 percent in 2005-06 whereas the World Health Organisation recommends 13 to 15 percent as desirable. Pertinently, the population in Kerala was 2.91 crore in 1991 and it reached 3.18 crore in 2001: an increase that demands higher health sector allocation.
However, the chain of public health institutions built earlier exists even today but is in ruin. Most hospital buildings are near collapsing; the premises are cluttered with foliage and waste material. The wards are over flowing with patients and x ray machines and laboratories do not function. The situation in pharmacies is worse. The congested and under-staffed hospitals are the direct results of the political shortsightedness and administrative apathy.
Sums up Dr Soman: “It is a matter of shame. Kerala is fast becoming an urban state but we still have mosquito-borne epidemics. The Army health teams are doing what the local panchayats are supposed to do. Had they performed on time, there would have been no Chikungunya outbreak.”