State health system belies expectations

C. Maya

Need for more investment, innovations

Infant mortality rate going up in State

Maternal mortality rate still a matter of concern

Thiruvananthapuram: On World Health Day, Kerala has little to be proud of as all its latest health indicators show a steady slide. While the neighbouring Tamil Nadu has been investing heavily on the public health system, Kerala’s allocation in this sector is going down.

Kerala’s public health system has not been able to meet the expectations or increased demand for equitable health services, despite the availability of increased Central funds at its disposal.

A few key indicators give cause for alarm. The infant mortality rate (IMR) in the State has been going up. The present IMR is 15. What is pertinent is that the State has not been able to sustain the IMR of 10, which it had achieved in 2003.

Fall in immunisation

The routine immunisation coverage has slipped to 75.3 per cent, much lower than Tamil Nadu; the percentage of anaemic women in reproductive age has also been going up and is at present 33.1 per cent.

Even though women have access to good antenatal services and 98.9 per cent delivery cases take place in hospitals, Kerala’s maternal mortality rate (MMR) continues to be a matter of concern. The Registrar General of India’s Special MMR Survey (2003) puts Kerala’s MMR at 110 (per one lakh live births) behind Tamil Nadu’s figure of 100. This is the latest official MMR figure quoted for Kerala at the national level. However, the Directorate of Health Services (DHS) data tells a different story altogether. According to DHS data, the State has an average of 5.5 lakh delivery cases annually. In 2005-06, the number of reported deaths in Kerala was 188, which puts the MMR at 33.

DHS data

The 2006-07 DHS data actually shows a decline in maternal deaths. The reported maternal deaths in 2006-07 was 146, which would put the MMR at 26. “We have not been able to explain the disparity in the official MMR figure of 110 and the State’s MMR assessment at 26. Even though 65 per cent of the delivery cases in the State take place in the private sector, all maternal deaths have to be reported and audited. We ne ed to take a closer look at our reporting system,” says P.K. Jamila, Additional Director of Health Services (H &FW).

“What is most tragic is that in a State with little rural-urban divide and excellent transport facilities, four per cent of all maternal deaths have occurred either at home or on the way to hospital. Post-partum haemorrhage accounts for 22 per cent and pre-eclampsia for nine per cent of all maternal deaths. In short, 30-35 per cent of maternal deaths in the State are preventable,” Dr. Jamila says.

It points to the failure of the public health system that despite the accessibility to ante-natal services and 98.9 per cent institutional deliveries, anaemia and hypertension in pregnant women (which leads to post-partum haemorrhage and eclampsia) are not picked up and treated early. Unless the State decides to invest money and attention in the public health sector and comes up with innovative healthcare programmes, in the next five years the system may collapse, experts says.

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