Revamping Kerala's healthcare sector

THIRUVANANTHAPURAM: For a state that once boasted of health indicators comparable to the developed countries, retrieving past eminence is undoubtedly a humongous task. The government has now entrusted an expert panel headed by Dr B. Ekbal with the task of formulating a people's health policy to address core issues in the sector. In the run-up to policy formulation, the panel has undertaken a massive exercise of eliciting opinion from various stakeholders. Over 1,000 suggestions came up at the panel's four-day sitting held in Capital recently. Similar response is expected at the forthcoming sittings in Kozhikode, Thrissur and Thiruvananthapuram.

The state is faced with huge challenges in primary, tertiary and specialty care sectors. Social determinants, women's health, child and adolescent health, non-communicable disease control and burden, infectious diseases, cancer care, trauma care, human resource, elderly care, oral health, infrastructure facilities and staff pattern are some of the issues being addressed by the policy. "We are aware of the challenges. The policy will equip us to deal with issues effectively. Focus will be on family health, free health care for maximum people, containing communicable and lifestyle diseases," said health minister K.K. Shylaja.

She said the district hospitals which were underutilised, would be revived. "Hospitals are bursting at the seams but we continue to work with a staff pattern sanctioned in 1961," she added. Non-communicable diseases (NCDs); cardiovascular diseases, cancer, diabetes and hypertension are increasing alarmingly among Kerala's population. According to estimates, 180 out of every 1,000 persons in the state have one or the other chronic illness. While prevalence of cardiac diseases is 7.5 per cent in rural areas and 12 per cent in urban areas, close to 20 per cent population is diabetic.

Consequently, about 20 per cent of all deaths taking place in state are due to heart attacks. The mortality rate among men and women is 380 and 128 respectively per lakh patients. These are quite high compared to many countries. About 60 per cent of cardiac deaths in men and 40 per cent in women are taking place before 65 years of age. Experts say lifestyle diseases that are inversely proportionate to resistance to infections, has compounded the problem. Increase in lifestyle diseases including high cholesterol, sugar levels and blood pressure had lowered the resistance of people across the state resulting in increasing morbidity and mortality due to fevers.

Almost all vector, waterborne, air borne diseases; chikungunya, Japanese encephalitis, H1N1, dengue, malaria, cholera, jaundice and scrub typhus have returned. Cancer Care With nearly 40,000 new cancer cases being reported in state annually, the cancer care institutions are under huge pressure. Cancers of mouth, throat and lungs caused mainly because of tobacco and alcohol, form 50 per cent of cancer cases among males. Among women, breast cancers are the highest at 30 to 35 per cent. More than 1,200 new breast cancers are registered in RCC Thiruvananthapuram annually.

Geriatric care is another challenge that is staring the state. With the elderly population projected to go up from the present 13.5 per cent to 18 per cent of the state's total population in a decade, there is a need for a comprehensive policy addressing the core issues of aged people. "Focus should be on public health rather than curative health. Also basic facilities like adequate water to health institutions, clean surroundings, clean bed sheets and cots.

CT scan, MRIs can come later. Staff quarters are required to ensure 24/7 availability of doctors, nurses and para medical staff in hospital campuses," said noted cardiologist Dr G Vijayaraghavan. He said the private sector which account for 78 per cent hospital beds was ready to cooperate with the government in every possible way. The government is eliciting opinion from organisations of doctors, nurses, paramedical, professionals. "We are holding in house discussions on 140 major points. A comprehensive document containing our suggestions will be submitted soon," said Indian Medical Association (IMA) state president Dr Jayakrishnan A.V.

Public health expert Dr V. Ramankutty said the focus was on improving primary care and disease prevention. "I personally believe that whether a government officially announces a policy or doesn’t, there is still a policy. In 1983 the union government came out with a policy which perhaps was the most ideal and best in the world. But it remained on papers. The governments can behave in funny ways. The first thing I tell my students is that the policy is not what government says but what government does," he said. Experts hope this time the policy will not be kept in cold storage but implemented on the ground to bring groundbreaking changes in the health sector.