There is an ongoing debate on how #Kerala's health care system came to be the way it is now. I wanted to explain it in detail in the long story, but was limited by the lack of print real estate. Here are some nuggets anyway
When asked about it, KP Kannan of CDS said: “There is a history of governmental intervention in Kerala in health and education that goes back to more than 100 years. But when Kerala was formed, the majority of the poor people did not have access to health and education."
A bit of context: KP Kannan is the former Director of Centre for Development Studies or CDS. The CDS in 1975 did a landmark study on the state's best practices for the UN, later known as the 'Kerala Model', although the study itself did not use such a term
Kannan continued: "The communist party (that alternatively ruled Kerala for last few decades) had an ideological commitment to develop and strengthen the public sector, public systems, although in the matter of industries and similar things they have also failed in that"
"Historically, they have further developed it, and it is only because of the Left government that poorer people get access to it. But our health and education systems have always been a priority on state budgets, irrespective of the governments,” said Kannan.
In short, as he says, #Kerala’s performance is not based on any instant application of a preconceived model. It is the result of a long term process of strengthening the public health care in which the people’s planning and Panchayati Raj institutions achieved an important role
The existence of a reasonably well functioning Panchayati Raj system, which ensured a greater devolution of greater funds and decision-making powers right down to the villages, illuminates a lot on Kerala’s success.
When the Panchayati Raj system was introduced by Rajiv Gandhi in 1993, it was taken up very enthusiastically by Kerala. But the first bill brought out by a Cong government under K Karunakaran was felt as inadequate and struggled against protest from opposition and academics.
For the Left, it was also a long-term political agenda to reach out to the grassroots. So when the Left govt came to power in 1996, it decided to devolve 40% of the budget to provincial and city governments, which they can spend as they wish.
Documentation of that era tells how streets after streets buzzed with community town halls to decide what to do with the fresh funds coming in— it was Rs 21000 crore in 2021— in the move that was popularly known as ‘Janakeeya Aasoothranam’ (People’s Planning Programme).
What did it do? It gave functions, functionaries and finance for village governments. They further strengthened their social capital reserves— from better schools to hospitals, official estimates show.
For example: Every panchayat in Kerala now has 15-20 full-time staff on average. At least two primary health centres exist for every three villages. That is one primary health centre for every 3.95 km, against the national average of one for every 7.3km (NSSO data)
Every primary health care center has, official estimates say, more than one doctor— usually two, in some three— who acts as a health director to the local government. In total, they have about 20 staffers, which is almost unknown in most parts of India.
They are helped by around 30 Accredited Social Health Activist (ASHA) workers usually coming from Kudumbashree— Kerala's 4.2 million-strong, women's only network spread in 2 lakh neighbourhood groups who are into everything from MGNREGA to microfinance to running metro trains
In addition, the primary health centers are also helped by Anganwadi (nursery homes) workers, who attend pregnant mothers and small children on a frequent basis and provide supplementary nutrients and meals.
All said, one cannot show this kind of a network of public health care prospering without its strong connections with the active public sphere Kerala has developed over a period of time. This is what I tried to detail in today's story for the most part
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