The new government has its task cut out as far as the health sector is concerned.
With dwindling Central investment in health and rising expenditure on health care, one of the toughest tasks before the government will be to bring down the increasing out of pocket (OoP) expenditure on health in the State.
And this requires not just innovative health policies but the administrative will to ensure that free and comprehensive medical care is provided for all in all government healthcare institutions.
“We already have a good and strong network of hospitals and infrastructure but where we are seriously lacking is in human resources. We need to invest more in HR, get more doctors and paramedical staff in our hospitals and focus on providing free, universal healthcare,” says K.P. Aravindan, public health activist and president of the Kerala Sasthra Sahithya Parishad.
High morbidity burden has been one of the crucial factors pushing up the health care costs and the OoP expenditure in the State.
Curative services
“The focus on curative services should shift to preventive and primary care so that our morbidity burden can be brought down. Primary healthcare services should be strengthened so that chronic conditions like diabetes and hypertension can be controlled before its complications set in,” says K. Vijayakumar, a former Professor of Community Medicine and a public health activist.
Setting up a separate pubic health cadre to manage public health efficiently, including environment cleanliness and sanitation, is another proposal that all public health activists have been mooting for long.
Though the State has already kicked off a non-communicable diseases management programme at the primary care level, one of the main challenges faced by the government has been ensuring uninterrupted supply of NCD drugs through the PHCs.
Even though the State health system has a good number of secondary and tertiary care hospitals, there is an increasing reliance on the private sector for healthcare provision.
“Our hospitals are under-staffed, overcrowded and the lack of hospitality is a big turn-off for people, especially when it comes to delivery care services. The long queues to see the doctor, poor administrative systems, processes, and logistics make government hospitals an unattractive proposition for people,” points out a senior health official.
Private sector
This increasing reliance on private health sector means that households pay for more than three-quarter of all healthcare expenses in the State (76%), while the government contribution accounts for less than a fifth, at 19.6 per cent.
“Regulation of private health sector and addressing issues of quality, rational care, and costs must be the priority to the government, if it has to bring down the health expenditure. This is possible only if it shows the political will to implement the Clinical Establishment Bill, which has been in cold storage for the past several years,” points out Arun B. Nair, consultant, Health Systems Research India Initiative.
HEALTH CHALLENGES
Highest morbidity at 30.8% against national average of 9.8%
Burden of chronic
diseases put at 20.8%
Out of pocket health expenditure is four times that of public spending
Highest per capita expenditure on health in the country at 7,636 a year
Medicines account for 39% of the total expenditure on health in State
