Ensuring Health for All : Kerala’s Inclusive Healthcare Model

Kerala’s healthcare system stands out for its universal coverage, ensuring access to medical services for all residents regardless of socio-economic status. This is supported by a robust network of primary and community health centers and hospitals that provide comprehensive care. Emphasizing primary healthcare enables early disease detection and prevention, alleviating pressure on higher-level healthcare facilities. In Kerala, conscious policy efforts have helped in extending healthcare access to the most vulnerable and marginalised groups such as women, children, the elderly, disabled individuals, Scheduled Castes, Scheduled Tribes, migrants, and transgender persons. These initiatives provide affordable healthcare to everyone and free care specifically to these disadvantaged groups, underscoring the state’s commitment to inclusivity and equity. Specialized programmes targeting maternal and child health, alongside initiatives focused on improving nutrition and sanitation, have been pivotal in achieving Kerala’s impressive health outcomes. Focus on Women Kerala has made significant strides in women’s health, setting a benchmark for other Indian states. The state has the highest female life expectancy in the country at 77.8 years, compared to the national female average of 71.4 (SRS, 2022), due to comprehensive healthcare services and targeted programmes. Maternal and child health initiatives have been particularly successful, resulting in one of the lowest maternal mortality rates in India, thanks to widespread access to prenatal and postnatal care and skilled birth attendants. Additionally, Kerala’s focus on women’s education and empowerment has led to increased health awareness and better health outcomes for women across the state. Kerala’s inclusive health policies have significantly improved women’s health through various targeted programmes, such as reproductive health, breast and cervical cancer screenings, and anemia prevention. Recent initiatives like VIVA (Vilarchayil Ninnu Valarchayilekku) for anemia and special cancer screening programmes exemplify the government’s timely interventions. Public health campaigns and community-based efforts have ensured these services reach even remote areas, promoting equitable access to essential healthcare. This gender-sensitive approach has empowered women to take charge of their health, enhancing individual outcomes and contributing to the state’s socioeconomic development.

Free Health Care to the Children

The state has achieved internationally comparable lowest infant mortality and child mortality rates through continuous efforts of child care and universal vaccination. Special schemes and interventions in the area of child health are being implemented by Kerala government for ensuring healthy and happy childhood. All children below 18 years are given free treatment in the government hospitals of Kerala. Apart from this, under Thalolam scheme free treatment is provided to the children below age of 18, who suffer from Kidney diseases, Cardiovascular diseases, Cerebral Palsy, Hemophilia, Thalassemia, Sickle Cell Anemia, Orthopedic deformities, and other Neuro-Developmental Disabilities. Currently Thalolam scheme is a part of Karunya Arogya Suraksha Padhathi (KASP) which is being implemented as a comprehensive programme focusing on deserving segments of the population. Mittayi is the scheme for providing insulin and other treatment to children who have Type -1 diabetics.

Inclusion of Elderly

The proportion of aging population in the State has been increasing over the years and it has reached to 16.5 percent in 2021 as per Elderly in India Report, 2021. Apart from giving free treatment to elderly from BPL families in government hospitals, special schemes are being implemented exclusively for 60+ people in the State. Some of the health schemes for elderly were initiated by Social Justice Department. Sayam Prabha scheme, which is a comprehensive scheme, intends to address the physical as well as mental health of elderly. Sayam Prabha has components of Mandhahasam which provides free tooth sets for senior citizens, Vayoamrutham which is implemented with the support of the Indian System of Medicine for Ayurveda treatment for persons in Government old age homes, Vayomadhuram which supplies glucometers for old age people under the BPL category free of cost and Psycho-Social Care in Old Age Homes in association with NIMHANS. Smruthipadham, the Kerala State Initiative on Dementia provides day care facility to the needy. Vayomithram: A social safety net programme implemented by Kerala Social Security Mission provides health care and support to elderly above the age of 65 years residing urban areas. The project provides health care and support by conducting free medical check-ups and treatment through mobile clinics. Apart from these, geriatric wards function in taluk, district and general hospitals for giving exclusive attention to elderly. Special schemes for elderly are also being implemented by the Ayush department.

Health Care Interventions for Scheduled Castes and Scheduled Tribes

Kerala provides free treatment in government hospitals and special health schemes for Scheduled Castes and Scheduled Tribes. The T-Grants site offers treatment assistance, including Rs. 2 lakh relief for the death of a sole income earner. Close to 29 homoeo dispensaries function in different SC areas across the state and a dedicated medical college in Palakkad is functioning to pay more attention on the medical education of students from scheduled caste category. Kerala’s major health care schemes for Scheduled Tribes include the Comprehensive Tribal Health Programme, financial assistance for sickle cell anemia patients, Janani Janmraksha for pregnant women and adolescents, financial support for tribal healers, and mobile medical clinics. In 2022- 23, 1,67,912 people received medical assistance, 889 sickle cell anemia patients got Rs. 2500 monthly, 9,601 pregnant and lactating mothers received Rs. 2500 monthly, 261 tribal healers received an annual grant of Rs. 10,000, and 3,900 medical camps were organized .

Persons with Disability

Social Justice Department, the nodal agency for disabled persons, undertakes various activities in collaboration with Health Department for addressing the health needs of persons with disability. Apart from various programmes for education, livelihood and rehabilitation, the Kerala Social Security Mission provides monthly assistance of ₹600 to the caregivers of patients of those categories who need a full-time caregiver like 100 per cent People with visual disability, bedridden patients suffering from cancer, cerebral palsy, autism, mental illness, intellectual disabilities, and also to the bedridden old aged under Aswasakiranam scheme. Anuyatra Programme, an umbrella scheme for disabled, includes District Early Intervention Centres (DEIC) to ensure early screening of disabilities and provide appropriate health services. Child Development Centre (CDC), IMHANS, National Institute of Speech and Hearing (NISH) and National Institute of Physical Medicine and Rehabilitation (NIPMR) are the organisations under Government of Kerala which undertake detection, management and rehabilitation of persons with disability. These organisations have various therapeutic departments and units for providing medical and therapeutic services.

Addressing health needs of Transgender Persons

Kerala is the first State in India to declare a Transgender (TG) Policy in 2015. The State started to implement a comprehensive programme, Mazhavillu, for transgender persons. The programme includes financial assistance for sex reassignment surgery (SRS) and post-SRS surgeries and insurance. Apart from this, all transgender persons are eligible for cashless treatment under KASP.

Health Care Interventions for Guest Workers

Migrant workers, addressed as guest workers, and their families receive special health attention, including general check-ups, medication distribution, health awareness and sanitation maintenance. The services provided by the department remain accessible by the migrants by adopting an innovative approach. A dedicated team ‘Mobile Immigrant Screening team’ (MIST) is designated so that services are delivered at places and time of their convenience. This team regularly visits and screens migrants for various diseases, actively detects tuberculosis, HIV, and STDs, conducts awareness campaigns at their rest stops, work sites, construction sites, etc. They also provide antenatal and postnatal care and immunization services, ensuring comprehensive healthcare for migrants. Health Insurance for Interstate Migrant Workers (AWAAZ): Government has introduced a Health cum death Insurance scheme for guest workers. Accordingly an insured will get health insurance of ₹25,000 and two lakh of accident death insurance claim. A total of 516320 guest workers have taken registration card under this scheme.

Affordable health care through Karunya Arogya Suraksha Padhathi

Kerala comprehensive s implementing a health insurance programme called the Karunya Arogya Insurance Progrmme (KASP) through the State Health Agency (SHA) as an assurance mode. Central scheme of Ayushman Bharath programme is also implemented by SHA as a part of KASP. Apart from the beneficiaries identified by the Socio-Economic Survey for Ayushman Bharath Programme, nearly 22 lakh households were identified by the State as beneficiaries of KASP. Thus, currently 42 lakh beneficiaries are covered by KASP. As Ayushman Bharath programme is part of KASP, migrant workers are also benefitting out of this. Since last year, provision has also been given for cashless treatment to disabled, and transgender persons.