Female literacy rate in Kerala is almost equal to male literacy rate. This is the case at all levels of education. There is no appreciable difference between rural and urban areas in this matter. It is this advance in the field of education which is the basis for excellent progress achieved by Kerala in many fields including health.
Compared to the other states in India the number of doctors was less in Kerala. In 1946 the Bhore Committee had recommended that there should be one doctor per every 2000 people. In 1956 while there was one doctor per every 6300 people at the national level Kerala had one doctor for every 9260 people only.
The central government had accorded sanction to start the second Medical College in Kerala as part of the second five year plan. Chief Minister E.M.S. Namboodirippad had inaugurated the Medical College at Kozhikode on 15th March, 1959. Later three more Medical Colleges were started at Kottayam, Alappuzha and Thrissur.
The LDF government which assumed power in 2006 had shifted the O.P section of the Kozhikode Medical College to the Super Speciality Block, the construction of which was started as early as 1991. The state government was able to obtain 50 crores of rupees from the central government for the mother and baby care project by including it in the National Rural Health Mission Programme.
Fifty years after the formation of the state of Kerala, the health sector is facing numerous challenges and crises.
Impact of the Policies of Globalisation
The policies of privatization and liberalization implemented from 1991 onwards by the central government had its impact all over India and in Kerala. An important recommendation of the World Bank was that public funding to the service sectors like education and health shall be reduced. Accordingly the central government is reducing investment in the health sector. Though health is a subject under the state list, the central government has cut short the share of the several centrally sponsored health care and preventive programmes.
The Indian health care system is predominantly privatized. The government has set apart only 0.9% of GDP to this sector. Government spends only 17% of the total expenditure on health. But even in America it is 40%. In European countries it is more than 80%. As a result of the intervention of the Left, in the Common Minimum Programme the UPA government had agreed to set apart 2 to 3% for health care.
The Left Governments which came to power after the communist Government of 1957 have introduced several measures to resolve the challenges faced by the health sector. The most important among them was decentralization programme in the health sector implemented by the LDF Government of 1996.
Decentralisation in the Health Sector
The decentralization programme introduced in Kerala in 1997 by the Left Democratic Government had opened up the scope for great strides in health sector along with others. The local body governments had intervened to improve the efficiency of hospitals from the primary health centres to the district hospitals. Priority was given for local health problems, the planning for solving the problem was done at the local level and the mobilization of fund with the help of local support had enabled to cover come various difficulties. Out of the total plan fund given to the local bodies, 30% was set apart for the projects in the fields of education and health. By exploiting this congenial situation steps were taken to solve the local health problems with the co-operation of doctors, health workers and the public.
Steps are also being taken to enhance the standards of the Medical Colleges and to develop them as Super Speciality Centres. A committee consisting of six members was constituted to study the possibilities of the same and suggest recommendations. In order to solve the problem of the shortage of doctors in hospitals from rural dispensaries up to Medical Colleges, the government has adopted certain measures to declare rural service as compulsory to the young graduates in medicine.
As a result of the reduction of investment in the health education sector and as a consequence of the policies of globalization, unaided Medical Colleges began to spring up. The LDF government had adopted measures to ensure merit and social justice in admission of students. Separate legislation was made for admission of students. Law was enacted to curb the private sector. Besides, fifty seats each were enhanced in the admission to MBBS in Thrissur and Kottayam Medical Colleges. Nursing Colleges were started in the Medical Colleges in Alappuzha and Thrissur districts. These measures were adopted to strengthen the government Medical Colleges and to ensure that the meritorious students got ample opportunities.
Peoples' Health Policy in Kerala
The LDF government had promised to introduce a popular and democratic health policy to solve the health problem in Kerala. Steps have been taken to carry forward the policy formulated by the Communist Government of 1957 for a sustainable peoples' health programme to a meaningful conclusion. But the central government holds the authority in the matter of manufacturing of drugs and fixing their prices. In this context the authority of the state government is limited in controlling the prices of drugs. These problems can be solved only by building up resistance against the central government which follows the conditions imposed by the WTO.