Kerala’s Health Evolution: From Grassroots Innovation to Global Recognition

It was getting cloudy by the beach side in Ward XVI, which was ASHA worker Sulaja’s area. She had a few more people to meet as part of the ‘Shaili’ survey and was determined to meet them all before she called it a day. This is a free android app developed by E Health, Kerala as part of the State Health App initiative. The screened people are assigned scores, and those with scores above 4 are asked to visit the nearest health center or HWC (Health and Wellness Centre), formerly called as Subcentre. The app was designed to help Asha workers in Kerala, provide lifestyle intervention to their beneficiaries. At almost the same time, Sindhu and Sabu, the palliative nurse and driver (names changed), were winding up their work. It was yet another busy day – changing catheters, inserting ryles tubes, cleaning bed sores and so on. Sindhu was relieved though, that she could spend more time caring for patients who needed actual palliative care because the past one year had seen tremendous changes with the introduction of Middle Level Service Providers (MLSPs) who visited and cared for patients who were ‘Homebound’ but otherwise quite well. They were the people who found it impossible to travel anywhere to even get their sugars and pressures checked due to various restraining conditions like being post-operative or being physically challenged. George, a 70-year-old gentleman, used to be in the habit of procrastinating his blood sugar checks and visits to the PHC because he lived in Ward X which was not exactly near to the PHC. But with the advent of the concept called HWCs, George is now regular with these.

He is happy that his sugars are under control with more care from his side, thanks to the IEC (information, education, communication) he gets from his doctor and all the health staff. In 2015, the countries under the UN (United Nations) had adopted the 2030 agenda for sustainable development. After all the efforts put in by every state, if in 2023 Kerala’s ranking stands at 75 as against 121 for India, it is a testimony to the Innovation, Diligence, Hardwork, and above all, Vision Kerala has been putting into it. Among all these Goals, the one goal which cuts through all other goals and whose successful implementation would ensure achievement of all other goals would be Good Health and Well-Being In 2015, the countries under the UN (United Nations) adopted the 2030 agenda for sustainable development. If, after all the efforts put in by every state, Kerala’s ranking stands at 75 in 2023 as against 121 for India, it is a testimony to the innovation, diligence, hard work, and vision that Kerala has been investing in it. Among all these goals, the one which cuts through all other goals and whose successful implementation would ensure the achievement of all other goals is Good Health and Well Being. Shedding light on the tremendous changes taking place in the health sector, Dr. Anilakumari, who is now the Medical Officer of FHC Vengola, says, “Immunization is perhaps the only work we continue to do today, and that has been there since the early days. Everything else has changed.

We have more medicines, funds, backing and support from various quarters, and newer projects. From being a sanctuary for those who couldn’t afford a visit to a private hospital during fevers and other communicable diseases, our hospitals have turned into centers sought after by everyone. Our Asha workers—they are our extended arms and provide means of intervention even before the beneficiaries reach out to us. Hotel inspections done during Healthy Kerala Campaigns ensure food safety. Water chlorination, outbreak mitigation, universal immunization with more outreach sessions, free availability of expensive medications and injections like anticancer medicines and erythropoietin injections for renal patients, e-Health—we have come a long way. I’d say that Good Health and Well Being is directly or indirectly linked to the betterment of the other goals like eradicating poverty, for example.” Her words give us an idea of how Kerala has managed to excel and how achieving this health-related goal, in turn, contributes to the betterment of indices included in the other goals. With projects like Health Grant, funds have been made available to Local Bodies to be implemented through Medical Officers wherein expensive tests like dengue tests, pregnancy tests, and malaria tests can be done even at the HWC level, either directly or by transporting the collected samples to the nearest laboratory through the hub-andspoke model of transport, for which funds are also allotted.

“When I embarked on this job as a JPHN, initiatives like these were not even heard of,” Jisha, a Junior Public Health Nurse whose fieldwork involves fishing harbours in the Goshree Islands of Ernakulam, says as she removes her surgical gloves after completing Pap smear collection for cervical cancer screening. Dr. Anitha smiled appreciatively as she oversaw the camp. “And to think that these women did not have to go to a tertiary care centre to get this service but visit their nearby local health center!” True, decentralization and empowerment of each person and each category are at the heart of Kerala’s success. Sheeba, a staff nurse in FHC Chittattukara, passionately elaborates on how Family Health Centres have become the solution and solace for a family’s complete health needs. “As a staff nurse working in an FHC, the one change that I feel proud to be a part of, apart from the various clinics like SWAAS clinics for respiratory illnesses and Mental Health clinics and De-addiction clinics, is the pre-check session that we nurses do when a patient initially comes to the OPD. We have the best quality digital BP apparatus today with accurate calibration and enough glucose testing strips and glucometers. The scope for compassion, which forms the cornerstone of the Ardram Mission, is tremendous through all these interventions,” she gushes. Sindhu reflects on the time when she started out as a palliative nurse. “Very few patients registered with us then. Today, the way this program is run in Kerala is a matter of pride and a point of emulation for other states. Today, our beneficiaries even have Bipap machines, water beds, and air beds at home provided through the State’s Palliative Care Program. There is an option for peritoneal dialysis, which is done as a home-based procedure. And, not only Palliative Nurses but also our MLSP nurses, physiotherapists, and doctors trained in Palliative Care visit these patients today,” she says. Thus, as one gets a glimpse into the health system in our state, one cannot help but be proud and awed at the vision and foresight that must have gone into making Good Health and Well-being a reality that we can be proud of