What is the National Health Mission initiatives in Kerala?

Answer: Kerala is the first state in India which has attained health and demographic goals of the National Rural Health Mission several years before this is being launched. The National Health Mission (NHM) encompasses its two Sub-Missions, The National Rural Health Mission (NRHM) and The National Urban Health Mission (NUHM).

When was Ardram mission launched in Kerala?

Since the WHO’s Alma Ata Declaration on Primary Health Care (PHC) there has been debate about the advisability of adopting comprehensive or selective PHC. Proponents of the latter argue that a more selective approach will enable interim gains while proponents of a comprehensive approach argue that it is needed to address the underlying causes of ill health and improve health outcomes sustainably.

Under the more comprehensive model, activities were along a continuum of promotive, preventive, rehabilitative and curative. Under the selective model, the focus moved to rehabilitative and curative with very little other activities. Government of India is aiming at providing comprehensive health care Via health and wellness centres.

Aardram Mission is one of the four missions under the ‘Nava Kerala Mission’ initiated by the government of Kerala, which aims at the same deliverables at the grass root level, It was launched with the objective to completely transform the public health sector in the backdrop of the Sustainable Development Goals (SDGs) 2030 of the United Nations (UN).

Aardram Mission’s primary focus is on SDG 3, ‘Good Health and Well-being’. The health status of Kerala being different from the rest of the country, there was a need to redefine the SDGs in the context of the state as a part of which Mission Aardram was launched in February 2017. Kerala has set short-term goals to be achieved by 2020 and long-term goals to be achieved by 2030 as part of the SDGs.

This was formulated by various expert committees who worked on health issues prevailing in Kerala. The main objectives of Mission Aardram are:

  1. People-friendly Outpatient Services
  2. Re-engineering PHCs into FHCs
  3. Access to comprehensive health services for the marginalised/vulnerable population
  4. Standardization of services from primary care settings to tertiary settings.8

The main focus on the PHC to FHC transformation aspect of Mission Aardram, which is a phased series of infrastructural and administrative changes. With the strong emergence ofthe profit-oriented private healthcare sector in Kerala that seemed to have been gaining increasing popularity among all sections of society, people began to lose faith in the public healthcare system (the PHCs in this context).

A stronger curative focus gave the private hospitals an upper hand and forced PHCs across the state to compete along the same lines tomerely stay afloat. An overall shift in the direction of curative healthcare services drastically increased the out of pocket expenditure for patients, and combined with the epidemiologic anddemographic transition, government intervention through Mission Aardram eventually becamenecessary.

In addition to playing the role of the street-level bureaucrat when it comes to SDG-3,the transformation envisions comprehensive healthcare provision inclusive of ‘preventive, promotive, curative, palliative and rehabilitative services.’The changes that accompanied the transformation can be categorised into those pertaining to strengthening primary care, improving the quality of services, addressing the social determinants of health and community participation.

Strengthening primary care and improving the quality of service provision largely focuses on infrastructural improvements, human resource training, record management through the e-Health system, improved laboratory facilities and amore preventive rather than curative outlook towards healthcare service provision.

The Panchayat Raj Act of 1994 that transferred institutions like to PHCs to the local self-governing bodies proved especially beneficial at the time of the transformation as it paved the way for increased convergence with other departments and national, state, or panchayat level programmes, thereby better positioning the transformed FHCs to address the social determinants of health.

Community Participation is an important characteristic of a Family Health Centre, especially in the more rural FHCs as they bring the community together to work towards improving the quality of living in the area through its different forums, for which a notable mention in this context would be ‘Arogyasena.’ Observably, one of the most significant changes would be concerning how the patients are dealt with at the FHCs.

There exists a pre-established chronological sequence of checkpoints that the patients are guided through, allowing better patient flow. This has a doubly positive effect on the functioning of the FHC as it not only allows better service provision at each step through specialisation, but also allows the centre to deal with higher volumes of patients.

Co-ordination and Community Involvement The involvement and autonomy of operation of the local-self governments in the functioning of the FHCs proves beneficial because the LSGs are perfectly positioned to act as co-ordinator and involve other departments, organisations and Panchayaths. Involvement of such organisations is quintessential as it helps in addressing the social determinants of health in a more wholesome manner.

Lack of good health in a community doesn’t imply that the Health Department and Panchayat aren’t carrying out their function, as there exists several non-health related social determinants of health, affiliated with other departments. The involvement of the LSGs provides the perfect platform for such a kind of inter-sectoral co-ordination Mission Aardram also ensures community participation for available services through ASHA,WHNSC, Kudumbashree health volunteers, and an initiative they have received much praise for, ‘Arogyasena.’ Since FHCs are geographically bound to a particular Panchayath, it is possible tointuitively derive quantitative indicators relating to reach or impact of certain outreachprogrammes.

For instance, based on the population of a Panchayath, which is commonknowledge to all staff at the FHC, and considering the statistic that 20% of the populationis prone to develop diabetes28, an approximation can be drawn comparing recordedcases of diabetes in the area using eHealth to expected numbers of diabetic patients.While this requires no official documentation and can be carried out at very low costs, it’snot the best or most accurate measure there is.

It does not account for the residents thatmight choose to visit private hospitals instead, and the very premise of the number ofcases on eHealth could it in itself be incorrect owing to its limited reach. The Floods that occurred in Kerala in 2018-19 severely deterred progress in Phase 2 ofMission Aardram.

The Health Department and LSGs had to redirect their funding andfocus towards rescue and rehabilitation operations. Several of the newly established centres and ongoing construction sites were badly damaged. In this light, it is importantto set aside contingency reserves to lessen the blow that unforseen events like the secould have on implementation of a particular project.

Outside of the compilation of the Health Status Report, other outcome documentation,measurement and evaluation methods aren’t uniform across FHCs in the State. Allcentres need to undergo the same treatment in order to conduct a fair comparisonbetween them.

  1. Analysing and understanding the gap and what caused it, and how itmany have been bridged at another centre is the first step towards solving it, and for thisvery reason, a uniform measurement that identifies certain KPIs as listed in the National Health Policy.
  2. Only the best performing FHCs areidentified for the NQAS (National Quality Assurance Standards), which are broadlyarranged under “Areas of Concern”– Service Provision, Patient Rights, Inputs, SupportServices, Clinical Care, Infection Control, Quality Management and Outcome.

These standards are ISQUA accredited and meets global benchmarks in terms ofcomprehensiveness, objectivity, evidence and rigour of development.29 NQAS ratings at FHC Poozhanad are 99%, with an LEIKERT score of 4.4 / 5, and it is the first centre togo completely paperless.

The following points are of great importance while measuring and evaluating outcomes under Mission Aardram While reviews and gap analyses are being conducted frequently, it was so evident that There is less focus on documenting and communicating the results to the large network of people involved in delivering the outcome of this project.

The environment is enabling for doing population enumeration and perfect dissemination of preventive and promotive services. It is time that the society of Kerala should be made aware of Health seeking behaviour rather than Treatment seeking behaviour, leading to high out of pocket expenditure.

  • Healthy food campaign
  • Exercise and yoga promotion
  • DE addiction and against drug abuse
  • Cleanliness and sanitation
  • Importance to Health seeking rather than treatmentseeking

OUTCOME- By conducting effective IEC/BCC activities in all the 826 panchayaths for preventive promotive areas of the above said 5 domains will be aiming at huge beneficiary improvement in the following areas:

  1. Population enumeration to happen in all operational Health and wellness centres (826)
  2. Population based screening
  3. Health promotion and NCD awareness activities
  4. Promotion of physical activities
  5. Diet modification
  6. Other lifestyle modifications
  7. Defaulter tracking and ensuring treatment
  8. Support groups for physical activity promotion, rehabilitation( counselling)
  9. Creating spaces for physical activity, Yoga, sports and outdoor games, exercise etc in association with LSGD/other agencies
  10. School and workplace interventions ( nurses outreach)Screening for mental illness using screening questionnaires as per “sampoornamanasikarogyam”/ “AASWAS”/ “Ammamanasu” guidelines and referran
  11. Ensuring treatment compliance and follow up of patients with mental disorders.
  12. Defaulter tracking
  13. Facilitate access to support groups.
  14. Vulnerability mapping, identification, mobilisation, treatment compliance follow up and referral of COPD/Asthma cases to FHC
  15. Tobacco cessation activities and COTPA
  16. IEC/BCC activities at community and schools level for primary and secondary prevention
  17. Identify and inform symptomatic cases to nearest health worker and facilitate medical care
  18. Active case search/ survey during an outbreak.
  19. Suchitwa mapping and hot spots identification
  20. Linkage with WHSNC, LSG, other line departments, NGOs and Harithakeralammission to address social determinants of health.
  21. Awareness on airborne infections, cough hygiene and hand washing, need for isolation.
  22. Immunisation
  23. High risk screening,
  24. Sanitary survey of drinking water sources and ensuring chlorination
  25. Periodic water quality monitoring.
  26. Maintaining ORS Depot
  27. Activities in connection with enforcement of public health and food safety laws
  28. Integrated Vector Management activities
  29. Migrant screening
  30. Active blood smear collection for detection of Malaria &Filaria.
  31. Mass and contact survey of malaria cases.
  32. Morbidity management of lymphatic filariasis
  33. MDA -TAS activities
  34. Doxy prophylaxis for high risk groups (handling domestic animals, fishing, farming etc)
  35. Rodent control activities
  36. Identification, mobilisation and screening of individuals with hypo/erythematous patches and other symptoms suggestive of leprosy ( Aswamedham )
  37. Periodic screening of school children and migrants
  38. Mobilisation of close contacts of leprosy patients for screening
  39. Ensuring treatment compliance in leprosy
  40. Vulnerable population mapping
  41. Identification of cases with cough more than two weeks/weight loss/ prolonged unexplained fever and referral to FHC for Sputum AFB
  42. Identify and train DOTS provider
  43. Promote HIV and diabetes screening in TB cases
  44. Ensure treatment compliance, identify adverse drug reactions and refer in TB treatment
  45. Identifying high risk pregnancies and follow up
  46. Planning and implementation of activities at community level
  47. Premarital counselling of eligible couples and Support for planning of pregnancy
  48. Pre-conception supply of folic acid to prevent NTD
  49. Early detection, registration of pregnancy and issuing of ID number and MCP Card
  50. Antenatal check-up including screening of Hypertension, Diabetes, Anaemia etc
  51. Immunization for pregnant woman-TD
  52. IFA and Calcium supplementation
  53. Transport entitlements
  54. Follow-up of Gestational Diabetes Mellitus and Pregnancy Induced Hypertension.
  55. Registration in RCH portal and MCP card.
  56. Initiation and management of ARI/Diarrhoea and other common illnesses and referral
  57. Screening, referral (DIEC/FHC) and follow up/tracking for disabilities, developmental delays and behavioural abnormalities.
  58. Ensuring full immunization coverage
  59. Vitamin A supplementation
  60. Reporting of Adverse Events
  61. Following Immunization (AEFI)
  62. Follow up to ensure prophylactic and therapeutic compliance of IFA/WIFS
  63. Regular Post- partum care visits
  64. Home based new-born care through 7 visits in case of home delivery and 6 visits in case of institutional delivery
  65. Educating mother and family on new born danger signals.
  66. Identification and care of high risk new-born – low birth weight, preterm and sick new-born (with referral as required)
  67. Counselling and support for early and exclusive breast feeding complimentary feeding practices
  68. Identification of congenital anomalies and appropriate referral to DEIC/FHC
  69. Mobilization and follow up for immunization services
  70. Reporting of neonatal death
  71. Awareness about programs like Hridyam, New born screening (SalabhamJatakseva), SruthiTarangam, RBSK, Arogyakiranam and follow-up of beneficiaries
  72. Growth Monitoring, IYCF and food supplementation linked to ICDS
  73. Identification of acute malnutrition referral and follow up care for SAM
  74. Prevention of Anaemia – Iron supplementation and Deworming
  75. Prevention of Diarrhoea/ ARI
  76. Promotion of Home Available Fluids (HAF) and ORS
  77. Pre-school and School level Child Health activities – Biannual screening, School health records, Eye care, De-worming etc
  78. Screening of children as per national and state programs to cover 4’D’s Viz. Defect at birth, Deficiencies, Diseases, Development delay including disability (RBSK and Arogyakiranam)
  79. Awareness creation on proper use of electronic gadgets like mobile phone, tab, TV etc
  80. Promotion of physical activity and healthy food habits like reduced salt and sugar intake and increasing consumption of fruits and vegetables
  81. Adolescent Health
  82. Awareness creation, Counselling and follow up on:
  83. Improving nutrition
  84. Sexual and reproductive health
  85. Prevention of substance misuse (Vimukthi program)
  86. Healthy life style promotion
  87. prevention of Anaemia
  88. Provision of IFA under National Program
  89. Identification of eligible couples for temporary and permanent methods
  90. Follow up of contraceptive users
  91. Counselling and facilitation of safe abortion services
  92. Follow up for any complication after abortion and appropriate referral if needed
  93. Awareness creation and referral services for infertility
  94. Identification and referral of visual impairment or defects in general population.
  95. Identification and referral of cases for cataract surgery
  96. Promoting annual retinopathy screening for all diabetic and hypertensive patients.
  97. Screening for common oral diseases/conditions and referral with special emphasis on geriatrics and palliative care patients.
  98. Screening for oral cancer and premalignant conditions in high risk individuals and referral
  99. Tobacco cessation activities and COTPA and IEC/BCC activities at community and schools level for primary and secondary prevention
  100. Identification of high-risk groups like persons living alone, widows, persons with co morbid conditions, addictions, bed ridden patients etc

Since the WHO’s Alma Ata Declaration on Primary Health Care (PHC) there has been debate about the advisability of adopting comprehensive or selective PHC. Proponents of the latter argue that a more selective approach will enable interim gains while proponents of a comprehensive approach argue that it is needed to address the underlying causes of ill health and improve health outcomes sustainably.

Under the more comprehensive model, activities were along a continuum of promotive, preventive, rehabilitative and curative. Under the selective model, the focus moved to rehabilitative and curative with very little other activities. Government of India is aiming at providing comprehensive health care Via health and wellness centres.

Aardram Mission is one of the four missions under the ‘Nava Kerala Mission’ initiated by the government of Kerala, which aims at the same deliverables at the grass root level, It was launched with the objective to completely transform the public health sector in the backdrop of the Sustainable Development Goals (SDGs) 2030 of the United Nations (UN).

  • Aardram Mission’s primary focus is on SDG 3, ‘Good Health and Well-being’.
  • The health status of Kerala being different from the rest of the country, there was a need to redefine the SDGs in the context of the state as a part of which Mission Aardram was launched in February 2017.
  • Erala has set short-term goals to be achieved by 2020 and long-term goals to be achieved by 2030 as part of the SDGs.

This was formulated by various expert committees who worked on health issues prevailing in Kerala.

Which mission is aimed to transform public health sector in Kerala?

Programme Description ‘ Aardram Mission ‘, is a state government effort to make government hospitals people- friendly by improving basic infrastructure and quality of services by upgrading Primary Health Centres (PHCs) as Family Health Centres (FHC).

What has Kerala done for health?

Human Resources- Education – Education in Kerala is both inclusive in nature and accessible to all the sections of population. The State, having attained very high rates of literacy and schooling, has a very well developed system that addresses the requirements and demands of all children up to 18 years.

The State, with a few exceptions, has nearly zero dropout rate between classes 1 and 10 among the different sections of population. Education in a sense is the backbone of the Kerala’s exceptional development experience. Although the status of education is remarkable and there are many laudable achievements in this sector, there are some issues that need to be addressed.

Education, especially higher education, in Kerala requires careful attention and improvement. The main task now is to focus on the quality of education, both school education and higher education. The issues which need to be addressed are related to academic achievement, skill education, incorporating technology in the curriculum, new training programmes for teachers, a focus on sports and fine arts, charting programmes that specifically address the requirements of differentially abled children, gender sensitivity, etc.

While sustaining excellence in academics and improving its inclusive nature remain the primary focus of all Plans, we also need to keep in mind the changing times and the changing demands of both productive and higher education sectors. Keeping in sight the importance and the modern day requirements of education, the 13th Five-Year Plan has marked it as one of the main thrust areas for State interventions.

On the State government’s side education is one of the four Missions initiated in 2016. Funds have been earmarked for strengthening the Education Mission, “Pothu Vidyabhyasa Samrakshana Yajnam” to meet the changing requirements of time and to upgrade classrooms and curriculum.

In order to address the relevant issues in three sectors of education – school, higher, and technical education – and to formulate focussed projects for implementation during 13th Five-Year Plan, State Planning Board had constituted Working Groups. After meetings and consultations with experts, the Working Groups have submitted the reports.

Box 4.1.1 Pothu Vidyabhyasa Samrakshana Yajnam (Public Education Rejuvenation Campaign) Targets

  1. Upgradation of 1,000 Schools as centre of excellence.
  2. Conversion of all class rooms from Standard 9 to 12 as hi-tech class rooms.
  3. Improvement of infrastructure facility in schools where more than 1,000 students are studying.
  4. Improvement of infrastructure of primary schools
  5. Encouragement of proficiency in English language.
  6. Special packages for renovation of Schools which have completed 50 and 100 Years.

Organisational Structure A State level mission with Chief Minister as the Chairman and Secretary, General Education as the mission secretary has been formed for coordinating various activities in connection with Public Education Rejuvenation campaign.

District level mission has also been constituted with Chairperson, District Planning Committee as the Chairperson and District Collector as Mission Secretary. State and District Level Task Forces are also functioning for implementing various activities related with the campaign. Upgradation of 1000 Schools as Centres of Excellence The State Government will bear 50 per cent of total expenditure or maximum 5 crore for one School.

The balance amount has to be borne by the participating agency or school PTA apart from depositing 1 crore for meeting the recurring expenditure. As a first phase KITCO has prepared master Plan of 37 Schools and Government has accorded administrative sanction to these schools.

As the second phase, KITCO has prepared master Plan of 69 schools and government has accorded administrative sanction to these schools also. Source: Directorate of Public Instruction Literacy Literacy and education are important indicators of development in a society and play a central role in human development.

As regards literacy, Kerala ranks first in the country with literacy rate of 93.91 per cent closely followed by Lakshadweep (92.28 per cent) and Mizoram (91.58 per cent) (Census of India, 2011). Kerala’s literacy rate, which was only 47.18 per cent in 1951, has almost doubled by 2011.

The male-female literacy gap which was 22 per cent in 1951 has narrowed down to 4.41 per cent in 2011. Kerala holds the first place in the country in female literacy with 92 per cent and Rajasthan records the lowest female literacy rate(52.66 per cent) (Census of India, 2011). Literacy rate of the State from 1951 to 2011 is shown in,

Variation in literacy rate among the districts of Kerala is low. While Pathanamthitta district (96.93 per cent) reports the highest literacy rate in the State followed by Kottayam (96.4 per cent) and Alappuzha (96.26 per cent), Palakkad district has the lowest literacy rate in the State (88.49 per cent).

The low rate of literacy of the Palakkad district may be due to the prevalence of substantial percentage of Scheduled Caste (SC) and Scheduled Tribe (ST) population in the district.11.01 per cent of the ST population in the State reporting an average literacy of 74.44 per cent are residing in the district.

(The share of ST population in the district population is 1.67 per cent). The share of SC population in the district population is the highest in the State. Literacy rate by sex for districts from 2005 to 2017 are given in, Kerala State Literacy Mission has been implementing literacy and equivalency programmes by appointing “Preraks” (field workers for propagating and continuing literacy programmes).

  1. Details of the number of people benefitted from equivalency programme of Literacy Mission from 2007-08 to 2015-16 are given in,
  2. It is seen that the number of persons who attend the 7th equivalency examination is steadily decreasing.
  3. Over these 10 years, it decreased from 11,631 in 2005 to 4,939 in 2016.

This indicates that the persons without atleast education equivalent to 7th standard are decreasing drastically over the years in the State. Box 4.1.2 Changathi: Literacy Programme for Migrant Workers Changathi is a programme of the Kerala State Literacy Mission Authority for migrant workers.

It aims to make them competent in reading and writing in Malayalam. The project was launched by Hon. Chief Minister of Kerala, Sri. Pinarai Vijayan on 12th December 2016 in Perumbavur municipality, Ernakulam district, the town with the largest migrant labour population in the State. For this programme, KSLMA has prepared a text book titled “Hamari Malayalam” (Our Malayalam) and the lessons of human rights, Constitutional values, rights of the workers and necessity of a healthy and hygienic living are incorporated in this text book.

The book has been designed in such a way that migrant workers can interact with local people freely and fluently in their daily life. For identifying the migrant workers, a survey was conducted in Perumbavur Municipality and 3211 workers were identified.

The classes have been started and 432 migrant workers have registered for “Çhangathi.” Classes are being conducted in 27 batches at various places including madrassa halls, factories, library halls and other public places. On the basis of the success of the programme in Perumbavur, KSLMA has extended the project to all Districts.

For the second phase of the programme, one local body from each district has been identified and surveys are being conducted in those selected local bodies. As the second phase of programme, the programme also aims at improving the literacy standards of migrants in Hindi with a view to helping them to adopt a healthy lifestyle.

  • Special committees have been formed in the selected local bodies to reach out to the migrants and enrol them in the programme.
  • This special initiative of the State Government is expected to be beneficial for around 25 lakh workers, who migrated to the State from different parts of the country.
  • Source: KSLMA, 2017 Elementary Education There were 12,981 schools in Kerala in 2016-17; 4,695 (36.17 per cent) government schools, 7,220 (55.62 per cent) aided schools and 1,066 (8.2 per cent) unaided schools.

More government schools are functioning in lower primary section than upper primary or high school sections. Aided schools outnumber government schools in all sections. Malappuram District has the largest number of schools (1,558) in the State followed by Kannur (1,308) and Kozhikode (1,283).

  1. Malappuram also has the largest number of government (553) and unaided schools (198) in the State.
  2. But the largest number of aided schools is functioning in Kannur district (963).
  3. Details of district-wise, management-wise and stage-wise number of schools in Kerala in 2016-17 are given in,
  4. There are 1,436 schools in the State which are offering syllabi other than the one prescribed by the State Government.

These include 1229 CBSE schools, 157 ICSE schools, 36 Kendriya Vidyalaya and 14 Jawahar Navodayas. One Jawahar Navodaya Vidyalaya school each is functioning in all the districts. District-wise details of schools with syllabi other than State syllabus in the year 2016-17 are given in, Physical Infrastructure and Facilities in Government Schools All the government schools in Kerala are functioning in pucca buildings. Own buildings have to be constructed for 126 government schools, which are now working in rented buildings. District-wise details of government schools having building facilities are given in,

  • Local Self Government Institutions (LSGI) and programmes like Sarva Shiksha Abhiyan (SSA) have contributed much to the overall development and improvement of physical infrastructure and common facilities in government schools in the State.
  • Data shows that 98.6 per cent of government schools have access to drinking water and 99.95 per cent have urinals/latrine facilities.

District–wise details of government schools having drinking water/latrines/urinal facilities in Kerala in 2017-18 are given in, Enrolment of Students Enrolment of students in the State has been declining in recent years; the number has declined from 37.02 lakh in 2016-17 to 36.8 lakh in 2017-18 (provisional).

But there is slight increase in the enrolment in lover primary (LP) section and the increase from 2016-17 to 2017-18 in the number of the students in LP section is 18,066. The decline in Upper Primary (UP) section is 11,505 numbers in 2017-18, and the High School (HS) section shows a decrease of 28,641 students over the previous year.

The stage-wise enrolment of students in schools in Kerala from 2013-14 to 2017-18 are given in, Details of management-wise and standard-wise enrolment of students in schools in Kerala in 2017-18 are given in, District-wise, stage-wise and sex-wise enrolment of students in schools in the State during 2017-18 is given in, A positive change has happened in terms of enrolment of students in government and government aided schools. In 2017, LP section saw an increase of 14,268 students and 8,070 in government schools alone compared to the enrolment of previous year. It is a known fact that the number of children is decreasing over the years due to the demographic transition of low birth rate in Kerala.

Management Standards Total I to X
Government 5703 354 1346 667 8070 -5192 -2409 469
Aided 6495 -1243 216 1302 6770 -5798 -17143 -16171
Un Aided -1122 63 -128 615 -572 -2834 -1729 -5135
Grand Total 11076 -826 1434 2584 14268 -13824 -21281 -20837
Source: Directorate of Public Instruction

Enrolment of Girls in Schools Girl students constitute 48.98 per cent of the total student enrolment in schools. Boys outnumbered girls in all the districts. But the gender gap is very narrow in Kerala in terms of enrolment. Strength of Scheduled Caste and Scheduled Tribe Students In 2017-18, Scheduled Caste (SC) students constitute 10.60 per cent of total students in the State.

The percentage of SC students in government schools, private aided schools and private unaided schools are 13.48 per cent, 10.33 per cent and 4.13 per cent respectively. It is seen that the percentage of SC students in government schools is higher than that of private aided and private unaided schools.

Scheduled Tribe (ST) students constitute 2.07 per cent of total enrolment in schools in the year 2017-18. The percentage of ST students in government schools, private aided schools and private unaided schools are 3.86 per cent, 1.44 per cent and 0.46 per cent respectively in 2017-18.

Management Others SC ST
Government 82.66 13.48 3.86
Private Aided 88.23 10.33 1.44
Private Unaided 95.41 4.13 0.46
Total 87.33 10.60 2.07
Source: Directorate of Public Instruction

Dropout Rate Kerala has achieved the distinction of having the lowest dropout rate of school students among the Indian States. In the year 2016-17, dropout ratio among school students in Kerala was 0.22 per cent.The dropout ratios in lower primary stage and high school stage are higher compared to that of the UP stage.

Dropout rate is highest among high school students. Among the districts, Idukki has the highest dropout ratio in the lower primary section (0.55 per cent). In upper primary section and high school, Wayanad has the highest ratios with 0.58 per cent and 2.8 per cent respectively. The high dropout ratio may be attributed to the higher population of ST students in these districts.

District-wise/stage-wise dropout ratio in schools in 2016-17 is given in, Dropout ratio among SC students in Kerala in 2016-17 was 0.26 per cent and that of ST students was 2.27 per cent. District wise and stage wise details of drop out among SC and ST students in Kerala for 2016-17 are given in and,

  1. Number of Teachers The number of school teachers in Kerala including Teachers Training Institute (TTI) teachers during 2016-17 was 163,160.
  2. Out of this 97,457 (59.7 per cent) teachers are working in aided schools and 15,457 (9.47 per cent) teachers are working in private unaided schools.
  3. The remaining 30.8 per cent of teachers are working in government schools.51.53 per cent of total teachers in the State are teaching in high schools, 24.61 per cent in upper primary schools, 23.51 per cent in lower primary schools and the remaining (0.34 per cent) in TTI’s.72.66 per cent of total teachers in the State are women.

Details of stage-wise and management-wise number of teachers in Kerala in 2016-17 are given in, Uneconomic Schools Schools with insufficient strength of pupils (below an average of 15 students per class) are termed as uneconomic schools. In 2016-17, there were 5,723 uneconomic schools in the State, which was an increase of 142 schools over the previous year.

  1. Out of these 2,589 were government schools and 3,134 were in the aided sector.
  2. District-wise analysis shows that highest number of uneconomic schools was in Kannur (737) followed by Kozhikode (603) and Kottayam (562).The highest number of uneconomic schools in aided sector is in Kannur (601) followed by Kozhikode (433).

In the government sector, Ernakulam has the largest (283) number of uneconomic schools followed by Thiruvananthapuram (281). Among the government uneconomic schools, 73.23 per cent are lower primary schools. In the aided sector also 78.05 per cent of uneconomic schools are from lower primary section.

  1. District-wise details of uneconomic schools in the State in 2016-17 are given in,
  2. Sarva Shiksha Abhiyan (SSA) Sarva Shiksha Abhiyaan was introduced in 2000-2001 as a flagship programme of Government of India to provide useful and relevant elementary education for all children in the age group of 6 to 14 by 2010.

The programme seeks active participation of the community in the management of schools without social, regional, economic and gender barriers. It comprises all activities of school education-providing physical infrastructure, free text book for children, encouraging enrolment of girls and teacher training.

The sharing of funds between the Central and the State governments was 75:25 in the 10th Five-Year Plan. The funding pattern has been modified to 60:40. Higher Secondary Education Higher Secondary courses were introduced in the State in 1990-91 to reorganise the secondary level of education in accordance with National Education Policy.

There were 2,073 Higher Secondary Schools in 2016 in the State. Out of these 833 (40.18 per cent) are Government schools, 854 (41.2 per cent) are aided schools and the remaining 386 (18.62 per cent) are unaided and technical schools. Among the districts, Malappuram has the largest number of Higher Secondary Schools (248) in the State followed by Ernakulam (209) and Thrissur (204) respectively.

There are 7,245 batches of higher secondary classes in 2017. The enrolment in Higher Secondary Schools was 382,051. Malappuram had the largest number of batches (1,052) with an enrolment capacity of 56,802 students. District-wise and management-wise number of Higher Secondary Schools and number of batches are given in and District-wise enrolment of students in Higher Secondary Schools are given in,

The pass percentage of students in higher secondary courses decreased to 70.91 per cent in 2016-17 from 73.18 per cent in 2015-16. During 2017, there were 11,911 students who secured A+ and 305,373 students were eligible for higher studies. The details are given in and,

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The pass percentage of SC and ST students in Higher Secondary schools has slightly increased in 2016-17 compared to 2015-16. The pass percentage of SC students increased from 57.77 per cent to 59.42 per cent and ST students from 58.12 per cent to 58.13 per cent during 2016-17. Details are given in and,

Vocational Higher Secondary Education Vocational higher secondary education was introduced in the State in 1983-84 to impart education at plus two level with the objective of achieving self/wage/direct employment as well as vertical mobility. There are 389 Vocational Higher Secondary Schools in the State with a total of 1,101 batches.

Out of these 261 are in the Government sector and 128 in the Aided sector. Kollam (52) followed by Thiruvananthapuram (41) has the largest number of Vocational Higher Secondary Schools in the State. District wise details of Vocational Higher Secondary Schools and courses during 2017-18 are given in, The percentage of students eligible for higher education in Vocational Higher Secondary examination in March 2017 is 81.5 per cent registering a rise from 74.92 per cent in 2016 March.

The number of students who appeared and those who passed Vocational Higher Secondary examination from 2010 to 2017 and the results of school going students are given in and, Box 4.1.3 Working Group for 13th Five-Year Plan on School Education The major recommendations of 13th FYP Working Group on School Education are:

  • Integration and co-ordination of the functions of the different Departments and Centrally Sponsored Agencies, including the higher secondary, vocational higher secondary education, SSA and RMSA under a single Directorate of School Education.
  • School Sanitation Scheme- Clean campus programme to cater to cleanliness of campus, construction and maintenance of separate toilets for boys and girls, disposal of sanitary napkins and other accessories, upkeep of noon-meal serving areas etc. are the suggested components.
  • A new Tribal Education Package aiming at the complete elimination of the drop outs among tribal students has to be introduced.
  • Develop a ‘School Education Information System (SEIS)’ which maintains all the performance indicators of schools including detailed statistics of academic performance, profiles of students and teachers, performance of schools in various competitions.
  • Introduction of a Comprehensive School Health Programme that not only envisages, healthcare, food and nutrition but also envisages the development of the child into a physically equipped and mentally alert individual. Arts, Sports and Crafts should be included in the school curriculum.
  • Creation and development of smart classrooms that would enable the learner to use state-of-art technologies of learning.
  • Creation of classroom libraries as well as school libraries cum reading rooms.
  • Establishment of Biodiversity Parks to enhance the learning environment in schools in communion with nature.
  • Provision for the wholesome development of the differently abled children in the school environment so that inclusive education becomes viable in both concept and practice.
  • The selection and appointment of teachers in aided schools and deployment of protected teachers in government schools should be handed over to Kerala Public Service commission.
  • The integration of the financing of education by the State Government, Central Government Schemes and Philanthropic agencies through the Creation of an Integrated Education Fund, that would monitor the acquisition and allocation of finances and utilisation in each sector.
  • Development of SCERT into an autonomous institute of research and training centre.
  • To provide linkages between the SCERT, DIETs, BRCS and CRCs so as to improve the training imparted to school teachers and for academic monitoring.
  • Curriculum Committee constituted should have experts acknowledged at national level.
  • The textbook committee should monitor the preparation of textbooks, educational accessories and technologies and the timely delivery of these resources to schools.

Source: 13th FYP Working Group Report on School Education, 2017 13th Five-Year Plan Working Group Report on School Education The Working Group on School Education addresses four major categories of the issues. The first one is related to the infrastructural needs which include maintenance and up-gradation of school buildings, class room facilities, play grounds, water taps, libraries, laboratories, toilets, facilities for Noon Meal Scheme and canteen facilities.

  1. The second is the up-gradation of pedagogy in schools including online facilities, smart class rooms, upgradation of teachers including state-of-art of teachers training.
  2. The third is the transformation of curriculum and syllabi that brings school education on par with the quality criteria existing all over the world.

There is also the need to address the special requirements of the marginalised and excluded, including Adivasis, Dalits, language minorities and coastal children who are the victims of a system that primarily caters to the needs of the elite classes in society.

  • The report also points out the importance of integrating the pedagogy for differently-abled children with the existing system.
  • University and Higher Education There are 14 universities functioning in the State.
  • Out of these, four universities viz.
  • Erala, Mahatma Gandhi, Calicut and Kannur are general in nature and offer general science and arts subjects courses.

Sree Sankaracharya University of Sanskrit, Thunchath Ezhuthachan Malayalam University, Cochin University of Science and Technology, Kerala Agricultural University, Kerala Veterinary and Animal Science University, Kerala University of Health Sciences, Kerala University of Fisheries and Ocean Studies and Kerala Technological University offer specialised courses in specified subject areas.

Besides these, the National University of Advanced Legal Studies (NUALS) established in 2005 and the Central University established in Kasargod district are also functioning in the State. Arts and Science Colleges There are 217 Arts and Science Colleges in the State comprising 156 private aided colleges and 61 Government Colleges.

In 2016-17, Ernakulam (25) had the largest number of Arts and Science colleges in the State followed by Kottayam (23). Thiruvananthapuram and Kozhikode (10) have the largest number of Government colleges in the State. District-wise number of Arts and Science colleges in the State in 2016-17 is given in,

  • In addition to the government and aided colleges there are large number of unaided arts and science colleges functioning in the State.
  • Enrolment of Students Total number of students enrolled in various Arts and Science Colleges (excluding unaided colleges) under the four general universities in Kerala during 2016-17 is 2.96 lakh.

Of this 2.03 lakh (68.68 per cent) are girls. (Table 4.1.3).

Course Total Girls Boys % of Girls
B.A. 117,874 77,334 40,540 65.61
B.Sc. 99,017 73,809 25,208 74.54
B.Com. 42,519 26,819 15,700 63.08
Total 259,410 177,962 81,448 68.60
M.A. 13,733 9,307 4,426 67.77
MSc. 16,772 11,705 5,067 69.79
M.Com 5,632 4,009 1,623 71.18
Total 36,137 25,021 11,116 69.24
Grand Total 295,547 202,983 92,564 68.68
Source: Directorate of Collegiate Education

Out of the total students enrolled for degree courses, 45.43 per cent are enrolled for BA degree courses, 38.17 per cent enrolled for BSc and 16.39 per cent enrolled for B.Com degree courses. Girls constitute 68.68 per cent of total enrolment for degree courses.

For BA degree courses, 27 subjects are offered. Among the subjects, Economics has the largest number of enrolment of students. Besides, 31 subjects are offered for BSc course and Mathematics has the largest number of student enrolment. Details of enrolment of students in Arts and Science Colleges for BA, BSc and B.Com are given in, and,

In the State, 36,137 students were doing post graduate course in 2016-17. Girl students constitute 69.24 per cent of those enrolled. Details of enrolment of students in Arts and Science colleges for MA, MSc and M.Com courses are given in, and, Box 4.1.4 Recommendations of Working Group on Higher Education The Working Group has examined the areas where qualitative changes in higher education are necessary.

  • For improving the quality of education, transforming the benefits from Higher Education Institutions to General Public and to enhance the employability of the students, the Working Group has focussed on areas such as teaching-learning process, research, infrastructure, skilling and innovation.
  • Having examined these aspects, the report recommends some proposals and projects for implementation in 13th Five-Year Plan.

In order to ensure quality education in government and aided sectors, it is recommended to strengthen monitoring mechanisms and recruitment processes at various levels. Policy recommendations have also been made to transform the administrative and academic structures that are impeding the growth of academic excellence in the Higher Education sector.

  • Massive Open Online Courses (MOOCS)
  • State Open University
  • National Knowledge Network (NKN)
  • Internal Quality Assurance Cell (IQAC)
  • Ensure optimal student-teacher ratio
  • Industry-Student-University linkages
  • Promote collaboration and develop Linkages
  • Implement Erudite Programme
  • Provide a Public Research Fund
  • Inter University Centres should be strengthened with more financial resources
  • Start Dual Degree Programme
  • Start Capacity Development Initiatives
  • Ensure Job Training and Apprenticeship for Students
  • Implement Scheme for Fostering Community Engagement
  • Implement Science and Social Science Popularisation Programmes
  • Start Student Support Schemes
  • Initiate Faculty Support Programmes
  • Establish Emeritus Professorship
  • Provide Scholarships, Grants and Incentives to students
  • Avoid Duplication of Activities
  • Evaluate of On-going Programmes
  • Enhance Physical Infrastructure and Lab/Library Infrastructure
  • Ensure Career Awards Scheme for Mid-Career Faculty

Source: 13th FYP Working Group Report on Higher Education Scheduled Caste/Scheduled Tribe Students The enrolment of SC students in degree and post graduate course in the State is 33,968 and 4,847 respectively. SC students constitute 13.13 per cent of total students in 2016-17. (Table 4.1.4) Among SC students, girls constitute 72.02 per cent of total students in Arts and Science colleges.

Name of Course Total Students SC Students % of SC Students ST Students % of ST Students
B.A 117,874 13,685 11.61 2946 2.50
B.Sc 99,017 14,476 14.62 929 0.94
B.Com 42,519 5,807 13.66 748 1.76
Total 259,410 33,968 13.09 4,623 1.78
M.A 13,733 2,125 15.47 702 5.11
M.Sc 16,772 1,996 11.90 494 2.95
M.Com 5,632 726 12.89 133 2.36
Total 36,137 4,847 13.41 1,329 3.68
Grand Total 295,547 38,815 13.13 5,952 2.01
Source: Directorate of Collegiate Education

The number of ST students enrolled for courses in arts and science colleges in 2016-17 is 5,952. The enrolment of ST students in degree and post graduate courses are 4,623 and 1,329 respectively. Girls constitute 66.81 per cent of the total ST enrolment in Arts and Science colleges. Scholarships Central and State sector scholarships of 13 types are given to students. Various scholarships including Kerala State Suvarna Jubilee Scholarship (for 4,000 students), District Merit Scholarship (for 11,586 students) and Post Matric Scholarships (for 1,21,215 students) have been given during 2016-17.

The Directorate of Collegiate Education has set up LED display board giving the details of scholarships offered by the Government of Kerala and India. The details of number of scholarships offered from 2014-15 to 2016-17 is given in, Teachers The number of teachers in Arts and Science Colleges in the State in 2016-17 was 9,742, out of whom 56.12 per cent are women.

University-wise number of teachers in Arts and Science Colleges in the year 2014-15 to 2016-17 is given in, There are 3,343 (34.31 per cent) teachers in Arts and Science Colleges in the State having Ph.D degree. Details are given in, A total of 2,393 guest lecturers were working in Arts and Science Colleges of the State in 2016-17.

Details are given in, Kerala Council for Historical Research (KCHR) Kerala Council for Historical Research is an autonomous academic institution, established in 2001, committed to scientific research in archaeology, history and social sciences. It is a recognised research centre of the University of Kerala and has academic affiliations with and has bilateral academic and exchange agreements with leading universities and research institutes in India and abroad.

KCHR is to publish a comprehensive volume on the scientific history of Kerala from pre-historic to the present times. A sustainable/historical tourism project is conceived in the Kodungallur-Paravur zone and KCHR is identified as the nodal agency to provide technical assistance.

From 2006-07 onwards KCHR has successfully undertaken multi-disciplinary excavation at Pattanam. The excavation has yielded significant evidences for re-conceptualising the early history of Kerala. Kerala State Skill Development Project and ASAP The Kerala State Skill Development Project was launched in July 2012 to enhance the employability of the youth and create opportunities for productive employment within and outside the State.

The Asian Development Bank (ADB) through Department of Economic Affairs, Government of India has been engaged and partnered by the State for strengthening and scaling up ASAP. Additional Skill Acquisition Programme (ASAP) is designed by the Department of Higher Education and the Department of General Education to address the issue of low employability of the students.

It aims at tackling the problem of educational unemployment by introducing market-relevant foundation training, vocational training and career counseling alongside the general curriculum at the higher secondary and under graduate levels. ASAP is being implemented in 836 Higher Secondary Schools, 26 VHSEs and 108 colleges in 2016-17.

A total of 29,411 students are undergoing training in the year 2016-17. More than 200 programme managers have been engaged to help the ASAP Secretariat for running the programme and 1,900 Skill Development Executives have been recruited for providing foundation training in Communicative English and Information Technology.

Eighty five skill courses in 30 sectors have been included for the trainings in 2016-17. Technical Education Technical education aims at human resource development by way of application of technology for the benefit of the society, in terms of improving the quality of life, enhancing industrial productivity and improvising technologies for the overall development of the community.

Technical education imparts education to young generation enabling them to contribute to the sustainable development and improvement of quality of life of the society. Directorate of Technical Education is the nodal department for technical education in the State.

  1. The details of technical institutions under the administrative and financial control of Directorate of Technical Education is given in,
  2. Various projects are being undertaken through funding from different agencies including Ministry of Human Resource Development, All India Council for Technical Education, Technical Education Quality Improvement Programme (TEQIP), Trivandrum Engineering Science and Technology (TREST) Research Park, Technology Business Incubators (TBI), Department of Science and Technology (DST), and University Grants Commission etc.

Apart from this, up gradation of laboratories in various institutions are being taken up under Modernisation and Removal of Obsolescence (MODROBS) scheme of AICTE. Box 4.1.5 Working Group on Technical Education Major specific suggestions by the Working Group to address the issues in the area of Technical Education in the State are:

  • State Skills and Employment Policy to be developed.
  • Develop and adopt a Quality Assurance Framework in line with NSQF.
  • Develop a Professional and Career Development Policy (PCD) for Technical and Vocational Education Training (TVET) managerial and academic personnel.
  • Formation of a bridge organisation to relate R&D institutes and vocational education system. It should help the vocationally trained person to get the benefits of R&D
  • A central vocational training standardisation system, accredited nationally and globally, for maintaining the quality of the vocational education can enhance credibility of vocationally trained persons in the industry.
  • Training need analysis should be done taking into consideration job potential in local and global perspective. Creating job opportunities regionally can help to maintain the equilibrium in future days for ensuring inclusive socio-economic growth.
  • Working group also examined the concept of Academic Autonomy in order to achieve the
    • Aforesaid objectives of quality education and it recommended Academic Autonomy ensuring
    • Accountability by all the stakeholders.

Source: 13th FYP Working Group Report on Technical Education Engineering Colleges There are 180 engineering colleges in the State with a sanctioned intake of 57,544 in 2017. Out of these engineering colleges, 168 (93.33 per cent) are self financing colleges (unaided), 9 (5 per cent) are government colleges and 3 (1.67 per cent) are private aided colleges.

Largest number of the unaided engineering colleges are functioning in Ernakulum (33) followed by Thiruvananthapuram (28). There is no government engineering college in Kollam, Pathanamthitta, Alappuzha, Ernakulam, Malappuram and Kasargod Districts. The district wise and management wise details of engineering colleges and sanctioned intake are given in,

The sanctioned intake of Govt. colleges during 2017 was 3,340 (5.48 per cent), aided colleges 1,850 (3.22 per cent) and unaided colleges 52,354 (90.98 per cent). Of the engineering colleges in Kerala, the largest number of branch wise seats was in Electronics and Communication (11,211) followed by Mechanical Engineering (10,912), Civil Engineering (10,038) and Computer Science and Engineering (9,897).

Branch-wise distribution of seats in engineering colleges in 2017-18 is given in, The number of students enrolled in government and aided engineering colleges for graduate courses in 2017-18 increased to 6,222 from 5,134 in 2016-17. The proportion of girls’ enrolment has also increased to 39.86 per cent in 2017-18 from 36.42 per cent in 2016-17.

For post graduate courses, 1,606 students have been admitted in government and aided engineering colleges in 2017-18. Girl students constitute 58.78 per cent of total students in government and aided engineering colleges studying for post graduate courses.

Details are given in and, Box 4.1.6 Technology Business Incubation Centres in Engineering Colleges and Polytechnics To promote entrepreneurial ventures of the students in campus, the State Government has started Technology Business Incubation centres in various Engineering Colleges and Polytechnics in the State.

Government has sanctioned Technology Incubation Centres in 8 Government engineering colleges, 4 polytechnics and one at Supervisory Development Centre at Kalamassery. The major objectives of the initiative are:

  • Assist prospective entrepreneurs in nurturing their technology ideas and promote successful corporate entity at pre-start up and start up stages.
  • Promote innovation among budding engineers trained by institution.
  • Commercialise the ongoing research.
  • Spot and nurture entrepreneurial talents from among the students.

At present there are eight incubators in CET and many applications are being mentored. Government Engineering College, Thrissur has proposed to widen the services of TBI and extend further by developing more infrastructure and providing more services to students.

  1. At GEC Sreekrishnapuram, five cubicles are ready while at GEC Kannur, the number of cubicles is six.
  2. At present five start up companies have registered and are in the GECBH- TBI.
  3. The incubates are M/s CAIRUZ, M/s Lotus Button, M/s Mear Enterprises, M/s KRACKiT and M/s CREA8.
  4. Source: Directorate of Technical Education, Kerala Academic Excellence in Engineering Colleges The academic excellence in Government Engineering Colleges is high and appreciable and this was due to the high pass percentage and increasing placement of students in reputed firms.

The placement record of the students in various government institutions is also relatively high. A large number of students are also getting qualified for higher studies through competitive examinations like GATE, CAT etc. Most of the students get placement in multinational firms like WIPRO, MAHENDRA, TCS, and BOSCH etc.

Sl No. Name of College No. of offers
1 College of Engineering, Thiruvananthapuram 960
2 Government. Engineering College, Barton Hill 132
3 RIT, Kottayam 129
4 Government Engineering College, Idukki 13
5 Government Engineering College, Thrissur 353
6 Government Engineering College, Palakkad 35
7 Government Engineering College, Kozhikkode 4
8 Government Engineering College, Wayanad 3
9 Government Engineering College, Kannur 101
Total 1,730
Source: Directorate of Technical Education

To enhance the academic excellence, visiting faculty programmes are conducted in Government Engineering Colleges of the State and the details are given in, Polytechnics and Technical High Schools Forty five Government polytechnics and 6 private aided polytechnics are functioning in Kerala.

The annual intake of students in government polytechnics and private aided polytechnics during 2017-18 are 10,749 and 1,531 respectively. The total number of students in government polytechnics during the year 2017-18 is 27,163 and that of private aided polytechnics is 4,209. Details of annual intake and student strength in polytechnics for the year 2015-16 to 2017-18 are given in and,

Details of trade-wise annual intake of students in polytechnics of the State in 2017-18 are given in, Student intake is highest in the trade of Computer Engineering (2,016) followed by Electronics Engineering (2,000), Mechanical Engineering (1,660) and Civil Engineering (1,310).

Type of Institutions 2014 2015 2016 2017
Government 21 20 20 18
Private (Aided) 11 10 11 11
Total 19 17 18 16
Source: Directorate of Technical Education

Details of number of students and teachers in polytechnics are given in, Number of SC/ST students and SC/ST teachers in polytechnics in the reporting year are given in, It is seen that the percentage of SC/ST students is low and it is decreasing over the last three years. (Table 4.1.7).

Type of Institution 2014-15 2015-16 2016-17
SC ST Others Total SC ST Others Total SC ST Others Total
Government 8.19 1.01 90.8 100 7.08 0.86 92.06 100 6.86 0.71 92.43 100
Private (Aided) 9.84 0.47 89.69 100 5.46 0.38 94.16 100 5.13 0.47 94.40 100
Total 8.4 0.94 90.66 100 6.86 0.79 92.36 100 6.62 0.68 92.70 100
Source: Directorate of Technical Education

Thirty nine Government technical high schools are functioning in the State. Total number of students and teachers in technical high schools in the year 2017-18 are 7,996 and 731 respectively. Women teachers constitute 26.13 per cent of teachers in technical high schools.

Number of students and teachers in technical high schools in 2015-16 to 2017-18 are given in, Compared to the previous year, the percentage of SC and ST students in technical high schools has declined from 12.76 per cent to 9.36 per cent and from 0.96 per cent to 0.63 per cent respectively. Details are given in and,

The higher and technical education in Kerala has to be capable of meeting the increasing employment opportunities in various sectors. For meeting the needs, the State has to introduce various industry based, skill based and job oriented courses and also impart life skills to the graduates.

  1. The skill based courses need to be collated so that duplication can be avoided and linkages can be established between various agencies.
  2. Plan Outlay for and Expenditure on Education During the first year of the 11th Five-Year Plan 590.24 crore had been earmarked for education sector of which 98.78 per cent was expended.

The outlay has increased significantly during these five years with 1,330.79 crore being earmarked in 2016-17. The percentage share of higher education has increased significantly over these five years whereas outlay of technical education has increased only marginally during this period.

Sector Annual Plan 2012-13 Annual Plan 2013-14 Annual Plan 2014-15 Annual Plan 2015-16 Annual Plan 2016-17 12th Five Year Plan
Outlay Exp Outlay Exp Outlay Exp Outlay Exp Outlay E xp Outlay Exp % of expenditure
School 287.15 290.6698 333.15 318.5813 367.81 302.3843 379.75 341.6872 502.51 503.4127 1870.37 1756.735 93.92
Higher 202 188.8691 247.99 292.4577 367.97 206.5545 510.42 418.5926 592.81 243.0481 1921.19 1349.522 70.24
Technical 101.09 139.2316 117.86 152.9403 143.22 145.8392 184.45 366.6027 235.41 166.9842 782.03 971.598 124.24
Total 590.24 618.7705 699 763.9793 879 654.778 1074.62 1126.883 1330.73 913.445 4573.59 4077.855 89.16
Source: Plan Documents

Though the total outlay for all the three sub-sectors is increasing over these five years (Figure 4.1.4), except for the last year, the percentage share of school education shows a declining trend during this period. It decreased from 56 per cent in 2012-13 to 37.8 per cent in 2016-17. This may be due to the fact that the State has achieved most of the primary targets in school education. Source: Plan Documents Way Forward As per the recently published Report on Gender Vulnerability Index by Plan International (NGO working in the field of Child Rights in India), Kerala is one of the safest place for girls to live and the State is ranked 2nd safest place just after Goa.

  1. But Kerala’s rank in the Educational Index is only 8th.
  2. It is seen in the report that the indicator of “the percentage of the State Budget earmarked for Education” in Kerala is below the national average.
  3. Likewise, clean toilets available for girls are also not up to the mark.
  4. Though the methodological validity of the index can be debatable, Kerala’s 8th position in educational ranking raises some critical questions regarding the education system of the State.

Many other reports including ASER Report, Expert Committee Reports of 12th Five-Year Plan and Working Group Reports of 13th Five-Year Plan send out warning signals on the consistent fall in the quality of education in the State and this requires immediate attention and urgent action of the Government.

Improvement in health status of the people is one of the crucial areas in social development of a community. This can be achieved by improving the access to health services especially for the underprivileged people. Kerala has achieved a good health status compared to other States in India. Easy accessibility and coverage of medical care facilities, apart from other social factors such as a high literacy rate, well-functioning public distribution system, less exploitation of the workers due to the presence of workers organisations etc.

have played a leading role in influencing the health system in Kerala. The Peoples Campaign for Decentralised Planning initiated in 1996 helped improve infrastructure and service in primary and secondary healthcare institutions and widened healthcare delivery.

What is the Kerala Public Health Act 2023?

Kerala Assembly passes new Kerala Public Health Bill March 21, 2023 11:53 pm | Updated 11:53 pm IST

The new and comprehensive Kerala Public Health Bill, 2023, unifying the provisions in the Madras Public Health Act, 1939 and the Travancore-Cochin Public Health Act, 1955 was passed by the Assembly on Tuesday. However, amidst the ongoing tussle and war of words between the government and the Opposition in the Assembly, the final Bill approved by the 15-member select committee of the legislature was passed tamely without any discussion The Kerala Public Health Ordinance, 2021 was promulgated by the Governor of Kerala on February 23, 2021 and in October 2021 a Bill to replace the ordinance was presented in the Assembly, to be referred to a select committee.It is after several rounds of discussions with experts from various public health fora and after gathering public opinion on various aspects of the proposed law that the select committee drafted the final Bill, Health Minister Veena George said while addressing the media here on Tuesday. The new Bill has been drafted on the basis of a much broader premise that public health protection has to be on the basis of the One Health approach and that beyond mere diagnosis and curative services, public health should focus on improving the social determinants of health such as clean water and environment, sanitation and waste management.The Bill also stresses the fact that the scope of a new public health law should encompass the threats posed by climate change, new and emerging viruses, heightened threat of the spill over of zoonotic diseases, non-communicable diseases spiraling out of control and the need for special care and attention for the vulnerable,including the elderly, chronically bedridden and the disabled.Kerala Public Health Bill, 2023 thus lays out the responsibilities of the State and local health authorities in many new areas, including NCD (non-communicable disease) control and creating a conducive environment (including creation of open spaces and facilities to help people become physically active) to embrace lifestyle changes, checking zoonotic disease outbreaks, welfare of migrant labourers, food safety, blood banks and blood safety, biomedical waste management, tackling antimicrobial resistance and even ensuring adequate toilet facilities in public spaces. The Director of Health Services will be the State Public Health Authority, with powers to constitute ad hoc public health advisory committees to manage public health emergencies. The State/ district and local health authorities will prepare annual action plans before the commencement of every financial year, charting out the activities that need to be taken up in advance to prevent seasonal epidemics and manage its impact on public health

The DHS will have the power to collect data from the public and private health-care establishments in the State on public health matters. She/he will publish standard medical treatment protocols that are to be followed by public and private health-care providers and health-care establishments in respect of the National Health Programmes and the diseases notified under this Bill.

  • Every health-care establishment, public or private, is required to report data on any communicable/notifiable disease they treat to the local health authority and follow the standard treatment guidelines issued by the DHS.
  • The Bill also requires local bodies to earmark a portion of the health budget for implementing programmes for the prevention and control of NCDs Ms.

George said that the Bill does not prevent an individual from seeking treatment from a registered medical practitioner from any recognised system of medicine. While some members of the select committee expressed their dissent that the Bill allows only practitioners of modern medicine to issue certificates that a person is disease-free, Ms.

What is the name of Kerala health scheme?

Karunya Health Insurance Scheme or the ‘Karunya Arogya Suraksha Padhathi’ is a Critical Illness Health Plan for underprivileged people in Kerala. The State Lotteries Department (Taxes) oversees the functioning of this scheme, and the Karunya Benevolent Fund finances it.

What is the recently added mission in Kerala?

Nava Kerala Mission Country-wide initiative in India

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Nava Kerala Mission addressing the gathering at the declaration of the Open Defecation Free Kerala CountryIndiaStateLaunched10 November 2016 ; 6 years ago ( 2016-11-10 ) StatusActive Website Nava Kerala Mission is an initiative of the -led launched in November 2016.

What is the name of the health program of Nava Kerala Mission?

Ardram is a health-oriented mission in Nava Kerala. The scheme is for the cleanliness of the State and to organise various waste management schemes.

Who introduced life mission in Kerala?

Name of the scheme Life Mission Housing Scheme
Launched in Kerala
Launched by Pinarayi Vijayan
Falls under Pradhan Mantri Awas Yojana
Official portal http://lifemission.kerala.gov.in

What are the four missions of Kerala government?

Nava Kerala mission in Kerala – Kerala historically known as Keralam is an Indian state in South India on the Malabar Coast. It was formed on 1 November 1956. It is a well known destination for the tourist because of its tea, coffee, and spice plantations as well as wildlife.

S.NO Things Need to know About the Mission Detailed Information
1 Project Name Nava Kerala Mission
2 State which Launched this project Kerala
3 Who Launched this Scheme Chief Minister or Kerala, Mr. Pinarayi Vijayan
4 Four Projects listed under this Mission “Nava Kerala” · Health · Education · Housing · Sanitation
5 Where did the Four Projects Under this Mission Announced? Thiruvananthapuram
6 When did the Four Projects Announcement Came? 10 th of November 2016

Government of Kerala is trying to develop all the sector of state and want to make its own position on the map of India. It will become easy for the government because Kerala is already a developed state of India

As it is slight state and the population is slight, and people are well educated in this state, so it is easy for the government to launch more and more project for individuals and implement than for people. Governor of the state P Sathasivam has launched a Nava Keralam Mission to grow the development of a state. Given a flag to Nava Keralam Mission, P Sathasivam said Kerala has previously set a role model for lots of other states in health, education, sanitation and housing sectors. Nava Keralam Mission consists of four segments which are health, education, housing, and sanitation. Govt basic aim under this mission is to compete for all the basic requirement of state people.

Here we explain a brief about the missions: Haritha Keralam: One of the schemes under this project is, Haritha Keralam. This project force on the cleanness of the state and to organizing various waste management schemes. This scheme will take away the wastage from the state to make a proper and healthy environment.

  • As a clean environment will keep the society healthy and free from many diseases.
  • And increase the chances of tourist so also increase the income.
  • That why govt take the agenda under which govt is trying to keep the state clean.
  • So the schemes are, Haritha Keralam that predict a clean state by taking up various waste management programs Ardram: This plan is concerned with the health facilities in state for the poor people.

In the present government hospital provides very less services to the state people because of less development of hospital. That why the government starts this Ardram scheme which is for improving facilities in government-run hospitals with a view to making bigger treatment at a realistic cost.

Government plan is to develop the government hospitals under this project. So after this scheme, every poor people will also get the proper treatments for the disease. There will be very fewer people in the state which will stay without medicine; also they can get medicine at very reasonable rates. And people will not die without medicine.

The government will make better facilities under this scheme in the medical field. I hope Ardram would bring in a sea change in the state’s healthcare sector. Life Scheme : As the house is the very basic need for every people and every people want to have the house.

But there are large numbers of poor people in the state who live without the house. So government launches a life scheme under which provides the home to every individual who has no home to live. Life is a mission for providing the house to homeless people besides a mission to protect public education system by taking up an extensive modification in teaching methodology.

So after this, no people will be without the roof on their head. The declared target of the plan to build houses for an estimated 4.32 lakh families in Kerala who do own any land or houses. And approximate budget for this will be Rs.6, 000-6,500 crore Education system: As education rate is very high in Kerala compare to another state, and they are very fewer people who are not educated.

  1. To motivate people more about education, government decide to launch the new plan for education in the state.
  2. This scheme is for the school system whose primary person is to distribute training in the middle of every individual.
  3. So that, every kid can get the basic education.
  4. This is a scheme to protect and strengthen the public school system of Kerala.

Also, this scheme is to ensure public school system by taking up complete changes in the teaching methodologies. Govt plan changed 1000 government schools to international standards and to get better the teaching and learning program at the high school level.

Sanitation Taking up sanitation schemes protects water sources and farming development with the help of promotion of organic farming would be the major focus of Haritha Keralam. In this way increase the production on the farming so the overall growth of state The chief minister Pinarayi Vijayan said that this project is a move to reach the entire expansion with the active contribution of all sections of the people.

He also thought that in its place of making claims on the attainment by now made, the government is searching forward to get more and more success in different sectors. Mission of Nava Kerala mission projects The fundamental purpose of Nava Kerala mission projects is to give all necessary facilities to all the people of the state so that poor people will also get the all the things that they deserved.

  1. And make the state most excellent in the entire field on the map of the country.
  2. Basic target is to provide health, education and housing facilities in the middle of the poor people so that they can also enjoy the necessary things.
  3. As Kerala is one of progressive state in India, so if these schemes will implement correctly then Kerala will come on top if Indian map in every field mentioned above and there will be no lack of medicine for any people.

Every people will have roof, and every kid will get the proper education from government school (with same facilities as the private school provides) The people of the state Kerala especially from the rural areas should cooperate with the government, so that they can get a state with all the facilities in nearby future.

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Why Kerala in India has a good health system?

Health successes – Kerala provides an example of an approach that can provide vastly improved health at a rapid rate. Overall, Kerala has maintained low infant and maternal mortality rates, and higher literacy rates, when compared to the national average.19 Kerala has also continued to innovate to meet the needs of more vulnerable populations including establishing a Weekly Iron and Folic acid Supplementation (WIFS) Program and Adolescent Friendly Health Clinics (AFHCs) to benefit adolescent health.19 Kerala is also forward-thinking in its health policy planning.

How did Kerala government improve health care system in Kerala?

Major Problems Of Health Services In India – A few of the problems of health services in India are as below:

Neglect of the rural population is a significant flaw in the Indian healthcare system Emphasis on culture method The inadequate outlay for health Social inequality Shortage of medical personnel Medical research Expensive health service

The state government took some unprecedented steps to improvise the healthcare system in Kerala. They decided to provide 40% of the revenue accumulated to the rural areas more than a decade ago. These helped the rural areas in Kerala to develop their own healthcare system robustly.

  • If one notices, the healthcare system in rural areas is flawed in India.
  • People do not have proper access to the right kind of medical care and treatment.
  • However, Kerala has seen massive strides in the healthcare industry.
  • One of the prime examples of that would be the Cheruthazham centre.
  • It is one of the 35 primary health centres present in the state.

They are newly established. State health authorities want to have more than 700 of them throughout the state. These family health centres play a significant role in ensuring that the health of the citizens in and around the region is good. Every family health centre has 3 doctors, 4 nurses, 1 dentist, 1 pharmacist, and 1 lab technician.

Why is Kerala No 1?

State of States 2016: Why Kerala remains India’s No 1, Tamil Nadu most improved

  • Best state


  1. Kerala topped three categories-law and order, health and environment.
  2. It found place among top five states in five out of 10 categories.

Life in Kerala reflects its Overall Best Big State crown: it’s the safest, healthiest, most environment-friendly and only second-best in education and agriculture. The state has shown improvements in all categories except inclusive development, in which it slipped three ranks.

  • Infant mortality in Kerala was the lowest (12 per thousand live births) in 2013 against the all-India average of 30.
  • It reported 99.7 per cent births assisted by trained personnel in 2013-14, the highest in the country.
  • Violent crime in the state is one of the lowest: 4 per cent.
  • Spending on education increased by 25 per cent from 2013-14 to 2014-15, 4 percentage points higher than the all-India mark.

In Kerala, you breathe easy, literally. Respirable Suspended Particulate Matter concentrations were the lowest in 2013; tree cover (outside forest area) increased from 7.09 per cent in 2013 to 7.59 per cent in 2015. “Our government is committed to improving the quality of life through best practices of governance,” says Chief Minister Pinarayi Vijayan.

  • Most improved state
  • WHY NO.1
  • Tamil Nadu showed improvement in eight out of 10 catergories.
  • It ranked among the top 10 states in nine categories.

Tamil Nadu Chief Minister Jayalalithaa Tamil Nadu has emerged as a major building block in the national economy. It was ranked the second economically most competitive state in 2016, on the basis of macroeconomic stability, financial, business and manpower conditions, quality of life, infrastructure development and governance.

It is one of the three most-preferred states for investment and one of the eight states where poverty dropped at a higher rate than the all-India average. Its per capita income is the third highest among the big states. Health, education and safety of women are other areas the state made strides in. Tamil Nadu has the lowest infant mortality after Kerala.

At 42 per cent, the gross enrolment ratio in higher education is the highest. Eighty per cent of the 72 million population is literate. The state has developed into an innovation-based economy with a strong performance in manufacturing and services. Largely free of communal, left-wing extremist and religious fundamentalist violence, Tamil Nadu pioneered all-women police stations, which now operate in every police subdivision.

Why Kerala is better than other states?

Discovering another face of India – India has a lot of facettes, sometimes paradoxical even, in the eyes of tourists and travellers. This country fascinates as much as it can cause worry. I mentionned it in (before going on the trip) and I know some of you are still reticent to go due to its, sometimes, infamous reputation.

  • But I promise you that Kerala will change your mind for good and show you a beautiful side of this country.
  • From what I had read : With a population of over 34 million people, Kerala is one of the richest states in India.
  • It’s quite advanced in comparison to other regions on a social level.
  • Eralites have the best quality of life and have access to excellent medical and educational facilites, on parr with some western coutries.

The state boasts a high level of literacy, way above the country’s standard (for men AND women) and life expentancy is the highest in the whole Indian sub-continent. With its communist political regime, Kerala is one of India’s most stable states, where its citizens are the most involved. From what i saw and felt over there : To be honest, even though I travelled comfortably around the region, my friends (girls) and I never felt unsafe, which seems to be the general consensus with other reports i’ve read from people who have travelled there.

  1. The region is clean, poverty is not so « in your face », people are extremely kind and hospitable, you don’t feel stared at quite so much in a crowd, and you get less unsollicited interest from beggars, sellers, etc.
  2. I would say that although the North of the country has so much to offer in terms of its rich history and culture, it may be more uncomfortable to visit for less experienced travellers.

One of the things i really enjoyed in a world terrorised by religion at the moment, was the harmony with which these different religions live together. In the cities you’ll literally find a synagog next to a church, right by a hindu temple below a mosque ! The believers seem to live in peace amongst each other.

Why Kerala has highest heart disease?

Why are heart diseases on the rise among youngsters in Kerala? Cardiovascular ailments top the list of diseases that kill. Symptoms are many and only the right treatment at the right time can save lives. World Heart Federation celebrates 29th September as ‘World Heart Day’ – a day to increase awareness on preventive measures to avert heart diseases.

  • But then, not many are willing to take these measures.
  • Only when they realise that an unexpected heart attack can drag them to death, do they start thinking of ways to prevent them.
  • By then it could be too late.
  • Why is the number of heart patients increasing alarmingly? Results of a study, jointly conducted by the Public Health Foundation of India and the Harvard School of Public Health that included eight lakh people from 27 Indian states, have been published in the journal called Plus Medicine.

People between the ages of 34 and 70 were examined for a period of three years. The subject of the study was the increasing number of heart patients in India and the reasons for the surge. Kerala is leading in terms of the severity of heart disease.19.90 per cent of people in Kerala have a dangerously increased risk of heart disease.

In 1993, the incidence of heart disease in Kerala was 1.4 per cent, but in two and a half decades, it has jumped to 19.90 per cent. Men (32%) are more prone to the disease than women (15pc). While smoking is considered the leading cause of heart disease in the lower economic middle class, high blood pressure, elevated cholesterol, diabetes, and obesity are the main risk factors among those in the upper strata.

Another study conducted in 2016 put the number of people with cardiovascular diseases in India at 54.5 million. Cardiovascular diseases claim one in four lives. The Registrar General of India has been publishing statistics at regular intervals. Death from heart disease has more than doubled in the last 30 years – from 15pc in 1980 to 32pc in 2013.

According to a survey in 2018-19, the death rate from heart disease among people aged between 40 and 69 in Kerala was 37.8pc. Among those over the age of 70, the number rises to 45.7pc. At least 63,000 people die due to heart attacks in Kerala every year. In India, an average of 29pc die of heart disease, while in Kerala it is more than 40pc.

It is estimated that by 2030, 35pc of the Indian population will die of a heart attack. It’s alarming. The condition of people below 30 years is pitiable. In September 2020, Srichithira Thirunal Institute, Thiruvananthapuram, published the results of a study conducted between 1978-2017, based on the risk of heart attack and subsequent death in people under 30 years of age.

Most of the studies to date have been conducted on people aged between 30 and 74. When people below 30 were admitted to the Srichithira Thirunal Institute for heart attack and treated for the next 10 years, it was observed that 30 percent of them succumbed to death; 48 percent died after 20 years. This death rate surprised everyone.

It was found that the condition of people under 30 is more pitiable than that of older adults who suffer heart attacks. The results of 40 years of extensive research and observations were published in the September 2020 issue of the Indian Journal of Medical Research.

  1. Delay in receiving treatment is the main cause of death among the young: 38 percent reach the hospital after the desired time limit.
  2. Primary treatments (primary angioplasty, thrombolytic therapy to dissolve blood clots) are only beneficial if received within a specific time frame.
  3. The ‘golden period’ is an hour and a half.

If a patient is able to undergo primary angioplasty within this time frame, the narrowed coronary artery can be resected (or expanded) by placing a stent. In this way, it is possible to pump blood to heart cells that are close to expiry but not yet dead.

  • Heart cells that are suffocating due to blood deficiency will receive vital air and nutrients and return to their original state and heart function will be balanced.
  • On the other hand, hours or days after a heart attack, heart cells die or become weak.
  • The heart’s contractility declines and such patients die quickly.

When risk factors become the main villain A high prevalence of traditional risk factors was seen in 95 percent of people admitted with heart attacks. Cholesterol was found to be excessively elevated in 88.5pc. Various risk factors like smoking (63.5 percent), alcohol consumption (20.8 percent), high blood pressure (8.8 percent), and diabetes (4.4 percent) were associated with heart disease.

No obvious risk factors could be found in 4.4 percent. Alarmingly, even after being discharged from the hospital after a heart attack, a good percentage of people failed to follow the doctor’s instructions and persisted with their bad habits. According to the study, 34 percent continued to smoke, 16.8 percent drank alcohol, 50 percent refused to exercise, 41 percent stopped taking prescribed medications, and 79 percent did not follow the diet.

So these are the reasons for the increased death rate among youngsters. What is the Kerala paradox? In terms of literacy, Kerala ranks first (96.2 percent) among other states in India. It also leads the country in terms of life expectancy. The study shows that life expectancy of Indians has increased by more than 10 years in the last three decades.

But life expectancy varies in different states due to various reasons. Kerala ranks the highest for life expectancy. In 1990, the average life expectancy in India was 59.6 years. In 2019 it was 70.8 years. Currently, the life expectancy in Kerala is 77.3 years. However, this cannot be considered a healthy life expectancy as several people live with diseases and physical challenges as they age.

The phenomenon seen in India and other countries is that infectious diseases are decreasing (currently the spread of Covid-19 is a standout) and lifestyle diseases are increasing. Thirty years ago, maternal mortality, malnutrition and infectious diseases reduced the life expectancy of South Indians.

  1. In 1990, infectious diseases were only 29 percent.
  2. But today it has risen to 58 percent.
  3. Heart disease, diabetes, high blood pressure, stroke, bone diseases, lung diseases, etc have deteriorated the health of Indians in the past 30 years.
  4. In Kerala, which stands out in terms of literacy and life expectancy, it should be assumed that heart diseases and other lifestyle ailments such as blood pressure, diabetes, obesity, etc.

are low. But the truth is the opposite. That is Kerala paradox. Heart diseases are on the rise. Related lifestyle diseases are also far ahead of the Indian average.60% of men and 40% of women in Kerala die before the age of 65 after cardiovascular disease, a consequence of early-onset arterial conditions.

  1. Here the first heart attack occurs 10 years earlier than in other states.
  2. It should be remembered that 60-80% of a family’s income could be wiped out if an economically backward person suffers a heart attack.
  3. When heart disease leads to death It appears that Keralites are not afraid of diseases, especially lifestyle ailments.

If at all, they have some fear of infectious diseases like COVID-19. The Covid pandemic has claimed 6.5 million lives globally until September. A good percentage of these people must have had heart diseases.17.9 million people worldwide die from heart disease every year.

That means heart disease is still the leading cause of death in the world. Heart disease can be prevented, but Malayali hardly care Can heart disease be prevented? Of course, but what if the Malayali doesn’t want it? Even if you tell a Malayali after assessing his quality of life and the risk factors, that he might be prone to heart attack or death, he is not hassled.

Even if they are told that by regularizing their lifestyle and preventing the risk factors, at least 90 percent of heart diseases can be avoided, they are not willing to listen or obey. This is the current situation. Finally, the same Malayali will burst into tears when he is admitted to the intensive care unit with a heart attack.

Then you can witness a rush to regain health and life. He would sell everything and get an angioplasty or bypass done. Therefore, hospitals are now competing to set up Cath labs in Kerala. It is estimated that there are more than 140 Cath labs in Kerala. It should be remembered that these facilities are comparable to any civilized country in the world.

The reason is that there is no place to treat heart patients when they multiply. According to a massive inter-heart study conducted on 27000 people from 52 countries by Canada-based Malayali Prof Salim Yusuf, it was found that the prevalence of nine risk factors (smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of exercise, poor diet, alcohol consumption, and stress) accounted for 90 percent of heart disease.

It has been shown that 90 percent of heart diseases can be prevented by identifying and controlling these risk factors. Hereditary and genetic factors, which account for 10 percent, are not controllable. Don’t you want to know the severity of the risk factors seen in Malayalis which are much more than the Indian average? Statistics show that 65,600 people die every year in Kerala due to the effects of high blood pressure, increased cholesterol accounts for 52.3 percent, high blood pressure at 38.6 percent, diabetes at 15.2 percent, and smoking at 28.1 percent.

Today, 40 percent of people who come for examination in the outpatient department in Kerala have high blood pressure. A survey conducted in 2016 found that 66.1 percent with high blood pressure were not receiving treatment. About 40 percent of people are not aware that they have high blood pressure.

Similarly, more than half of the food-obsessed Malayalis have elevated cholesterol. Remember that prevention is the key. Treatment and screening for heart diseases are expensive. It is better to prevent the disease than go bankrupt due to rising treatment costs. It is only a misconception that you don’t need to worry if you have access to a good doctor and a big hospital.

(Dr. George Thayil is Senior Consultant Cardiologist, Lourdes Hospital, Ernakulam) : Why are heart diseases on the rise among youngsters in Kerala?

Which is the first public health act in Kerala?

State Legislative Brief The Kerala Public Health Bill, 2021

Key Features

The Bill creates a three-tier public health system at the state, district and local level, and designates existing health officials as public health authorities. The Bill provides measures for the control of communicable and non-communicable diseases, along with management of water supply, waste management, and vector control. The State Public Health Authority will specify conditions for declaring a public health emergency.

Key Issues and Analysis

The Bill does not provide adequate safeguards for health data collection and processing. All medical practitioners may not have the expertise to examine people for communicable diseases and provide certificates accordingly.

The Bill does not define malicious abuse of power by the Local Public Health Authority, or specify the method of investigation for such cases.

The Bill was introduced in the Kerala Legislative Assembly on October 27, 2021. It seeks to replace the Travancore-Cochin Public Health Act, 1955 and the Madras Public Health Act, 1939 and provide a three-tier public health governance system in the state. The Bill has been referred to a Select Committee.

PART A: HIGHLIGHTS OF THE BILL Context Public health includes preventing disease, prolonging life and promoting health through organised efforts. Water, sanitation, environmental factors, and lack of quality housing are public health concerns due to their ability to influence health outcomes.

  • Under the Constitution, states have the power to regulate health.
  • Pursuant to this power, several states such as Kerala, Tamil Nadu, Andhra Pradesh, Madhya Pradesh, Goa, and Assam have passed public health laws.
  • These laws regulate the spread of communicable diseases, water supply, sanitation, and conduct of festivals.

(See Table 2 in the Annexure for a comparison of public health laws across states.) With the onset of Covid-19, many states notified regulations under the Epidemic Diseases Act, 1897 to control the spread of the virus.,, The Parliamentary Standing Committee on Home Affairs (2020) had noted that the 1897 Act is outdated and recommended updating it to effectively deal with future emergencies like epidemics.

  1. In 2014, the Law Commission included the 1897 Act in the category of laws whose repeal had been recommended by various commissions.
  2. The central government has made attempts in the past to revisit the law.
  3. In Kerala, the Tamil Nadu Public Health Act, 1939 was in force in the Malabar region, and the Travancore-Cochin Public Health Act, 1955, was applicable in the rest of the state.4, 5 The Kerala Public Health Ordinance, 2021 was promulgated in February 2021 to unify the legal framework for public health governance in the state.

It also sought to: (i) provide health functionaries in the state with necessary powers for the administration of public health and (ii) ensure the preparation of action plans for dealing with communicable and non-communicable diseases. A Bill to replace the Ordinance could not be introduced in the subsequent session of the Legislative Assembly, and it was promulgated again in July 2021 and August 2021.

Three-tier public health governance system: The Bill creates a three-tier public health system and designates existing officials as public health authorities: (i) the Director of Health Services will be the State Public Health Authority (State Authority), (ii) the district medical officer (health) will be the District Public Health Authority (District Authority), and (iii) the medical officer of the concerned local self-government institution (local government) will be the Local Public Health Authority (Local Authority). State level: The State Authority will play a supervisory and policy setting role. Its functions include: (i) preparing a public health annual action plan for the state, (ii) issuing directions as delegated by the government, (iii) fixing standards for areas such as medical treatment, disease surveillance, and prevention and control of communicable diseases, (iv) preparing guidelines for preventive activities such as vector control, and (v) collecting data on public health matters. The state government may also delegate powers to issue directions to the State Authority. District level: Functions of the District Authority include: (i) conducting public health investigations, (ii) preparing a public health annual action plan for the district, and (iii) issuing guidelines to the Local Authority. Local level: Functions of the Local Authority include: (i) preparing a public health annual action plan for the local area, (ii) directing any person or authority to desist from or undertake any activity for the promotion of public health, and (iii) levying fines, compounding any offence, or entering and inspecting places for control of contamination, preventing spread of infection, and vector control. Inter-sectoral coordination: The State Authority and the District Authority may issue directions to any state department on matters relating to public health. In case of public health emergencies, the State Authority may constitute an ad hoc advisory committee with nominees of relevant departments and other experts. Coverage: The Bill lists both communicable and non-communicable diseases that will be covered. It also lists notifiable communicable diseases, which have different reporting requirements than communicable diseases. The state government may notify such additional diseases. It may also notify diseases covered under the Bill on which data needs to be collected. The Bill also provides for regulating water supply, sanitary conveniences, and vector control. It empowers the Local Authority to carry out measures related to reproductive, maternal, neonatal, child, and adolescent health.

Communicable diseases: Communicable diseases listed in the Bill include malaria, dengue, and HIV. Notifiable communicable diseases include malaria, nipah and covid-19. Medical practitioners must report incidents or outbreak of these diseases to the Local Authority. The Local Authority will forward the details to the District and State Surveillance Officers. The Local Authority will make arrangements for hospitals and wards, conveyance and free diagnosis and treatment of infected persons. The government may confer special powers on officers for preventing the spread of communicable diseases. The Local Authority and District Authority have powers of inspection, search, seizure, and imposition of penalties in case of non-compliance with their directions.

Non-Communicable Diseases : Non-communicable diseases (NCDs) listed in the Bill include cancer, coronary artery disease, Alzheimer disease, obesity, and diabetes. The state government will issue guidelines for the preventive, promotive, curative, rehabilitative, and palliative activities for the control of NCDs. The Local Authority will: (i) implement these guidelines, (ii) encourage control of NCDs through measures like control of air pollution, promotion of physical activity, early diagnosis and treatment and high-risk screening, and (iii) encourage greater availability of healthy food items for people with or suspected to have NCDs. The local governments will set aside a portion of their heath budget for the planning and implementation of these programmes.

Public health emergencies: A public health emergency has been defined as the occurrence of an illness or health condition which has a high probability of causing death or serious disabilities in the affected population. Such emergencies may be caused due to communicable or non-communicable diseases. The State Authority will specify conditions for declaring a public health emergency. It will also have the power to constitute ad hoc advisory committees to assist and give expert opinions in case of public emergencies. The State Authority and District Authority will advise the state government or the district magistrate to declare a public health emergency in the state or district.

PART B: KEY ISSUES AND ANALYSIS Lack of adequate safeguards for data collection and processing Under the Bill, there are several provisions for health authorities and medical practitioners to collect health data of individuals. For example, the State Authority has the power to collect data on public health matters from healthcare establishments.

All healthcare establishments are required to report data regarding any communicable or notifiable communicable diseases to the District and Local Authorities. Further, every medical practitioner and healthcare establishment will be required to provide data to the Local Authority or the District Authority on any disease of public health importance.

Medical practitioners are also required to furnish reports on communicable and notifiable communicable diseases to the Local Authority who forwards this data to Surveillance Officers. Contravening such provisions will lead to a penalty. The Bill does not specify safeguards for such data collection and processing.

  1. There may be a need to collect health data of individuals to manage public health at the local level.
  2. For example, it may be necessary to identify individuals infected with certain communicable diseases and isolate them to prevent further spread of the disease.
  3. There may also be a need to assess trends related to the spread and intensity of a disease at local, district and state levels.

However, the Bill provides no safeguards to be followed while collecting and processing such data. In particular, it does not require data to be anonymised before sending it to the district and state levels. This is in contrast to a similar Act in Assam.

  1. The Assam Public Health Act, 2010 provides that every patient has the right that all information about his health status, medical condition, diagnosis, health care and all other personal information (which is identified or identifiable to him), must be kept confidential, even after his death.
  2. Such confidential information can only be disclosed if the patient gives explicit consent or if provided by any other law.

The information may be used for study, teaching or research only if authorised by the patient, the head of the health care establishment concerned and the Institutional Ethics Committee of the establishment. Other laws which require collection of personal data of individuals for public purposes provide for some safeguards.

  1. For instance, the Collection of Statistics Act, 2008 provides that all statistical information published should be arranged such that any particulars do not become identifiable (unless consented to by the informant).
  2. When disclosing information to other institutions, the name and address of the informant to whom the information is related to must be deleted.

The statistics officer must comply with security provisions of the Act when recording or copying any of the information collected. The Collection of Statistics Rules, 2011 specify that the appropriate government or statistics office must satisfy itself that the information collected is limited to what is absolutely necessary.

They also provide that all agencies collecting statistics should take reasonable measures to ensure that personal information is: (i) protected against unauthorised access, disclosure or misuse, and (ii) used for data processing only with adequate security checks. Under the Census Act, 1948 census-officers are penalised if they disclose any information which they have received through a census return, without prior sanction of the government.

Under the Census Rules, 1990 the Census Commissioner decides what data should be public. After processing, the canvassed schedules are preserved at the office of the Director of Census Operations or any place directed by the Director. Further, the schedules and connected papers are destroyed in accordance with the directions issued by the Census Commissioner.

All medical practitioners may not be able to examine communicable diseases The Bill provides that a person may approach any registered medical practitioner of modern medicine for a certificate specifying they are free from a communicable disease. The practitioner will have to examine them and issue such a certificate if they are not suffering from such disease or have been cured.

Refusal to do so is punishable with a fine. However, all medical practitioners may not have the expertise or specialisation to examine people for all communicable diseases specified. For instance, a gynaecologist may not have the expertise to examine people for tuberculosis or dengue and issue such a certificate.

  1. Lack of clarity with respect to cases of malicious abuse of power The Bill proposes that malicious abuse of power by the Local Authority, secretary of the local government or employee of the government will be punished with a fine of up to Rs 10,000.
  2. The Bill does not define ‘malicious abuse of power’ or specify the method of investigation to be followed in such cases.

Note that the Kerala Panchayat Raj Act, 1994 provides for the appointment of an ombudsman at the state level. The ombudsman investigates charges of corruption, maladministration or irregularities in the discharge of administrative functions against the local government and their officers.

Cases of malicious abuse of power under this Bill may overlap with cases that can be tried by the ombudsman. Financial implications have not been specified The Bill proposes establishing surveillance mechanisms, provision of free medical treatment in times of epidemic, and measures for tackling non-communicable diseases.

This may require additional expenditure by the state. However, the Financial Memorandum of the Bill states that no additional funds will be required from the Consolidated Fund of the state for implementing the provisions of the Bill. The implementation of the Bill may be affected if adequate funds are not available.

Provision Proposed Regime
The Travancore-Cochin Public Health Act, 1955 and the Madras Public Health Act, 1939 The Kerala Public Health Bill, 2021
Governance structure

Two-tier structure with the Director of Public Health at the state level, and Health Officers appointed by urban local bodies. The 1939 Act also set up a Public Health Board to advise the state government on matters referred to it.

Three-tier (State, District, and Local Public Health Authorities) (Director of Health Services → District Medical Officer (Health) → Health Officer of concerned local body)
Public health emergency Provision for appointing temporary Health Officers and assigning public health staff from one urban local authority for temporary duty in another urban local authority.

Such emergency may be declared by state government/ District Magistrate on advice of the State/ District Public Health Authority. State Authority may constitute Ad hoc Public Health Advisory Committees to give expert opinion and co-ordinate with other departments. Provision for appointing temporary Health Officers and assigning staff of a public healthcare establishment for temporary duty in the area of another such establishment.

Communicable diseases Classifies diseases into: (i) infectious diseases, (ii) notified infectious diseases, and (iii) venereal diseases (sexually transmitted diseases). Leprosy is classified as a separate category. In the 1939 Act leprosy is classified as both an infectious and notified infectious disease.

Provides for communicable diseases (including leprosy) and notifiable communicable diseases. No provision for venereal diseases. HIV/AIDS, which may be transmitted sexually, is included as a communicable disease.

Infectious diseases include malaria, polio, measles, chickenpox, cholera, dysentery, rabies, tuberculosis (TB), and typhoid. Adds chikungunya, dengue fever, Ebola, tetanus, epidemic influenza, infective hepatitis, etc. to the list of communicable diseases.
Notified infectious diseases include certain infectious diseases (such as malaria, chickenpox, cholera, rabies, and TB). That is, all notified infectious diseases are also infectious diseases. Notifiable communicable diseases include certain communicable diseases (such as TB, polio, and tetanus), and certain other diseases (such as yellow fever, nipah, and covid-19).
Non-communicable diseases No provision

Includes cancer, chronic lung disease, dementia, hypertension, diabetes, obesity, and stroke. Local Public Health Authorities to implement policies and guidelines formulated by the state government for preventing and controlling non-communicable diseases.

Communicable/ infectious diseases The concerned local body may provide: (i) additional health staff, medicines, equipment, etc., and (ii) hospitals and wards for receiving and treating patients, and ambulances to carry them. Duty of medical practitioner to inform the concerned authority of any cases of infection.

Communicable diseases and notifiable communicable diseases are to be treated similarly, under the Bill. Local Public Health Authority to provide (as required): (i) free diagnosis and treatment of persons, (ii) hospitals and wards, and (iii) suitable conveyances for carriage of patients. Duty of medical practitioner, officer-in-charge of healthcare establishment, manager of a factory or public building, head of a family, owner/ occupier of a house to inform the Local Authority of cases of infection. In case of prevalence of a communicable or notifiable disease in a local area, the District Collector may prohibit assembly of more than a specified number of persons. Registered medical practitioners of modern medicine must, at the instance of the concerned persons and after satisfying themselves, certify such persons as free from infection. State government and State Authority may issue guidelines for: (i) diagnosis and treatment of patients, (ii) bio-medical waste management, and (iii) management of blood banks.

Notifiable communicable diseases

Duty of medical practitioner, manager of a factory or public building, head of a family, owner/ occupier of a house to inform the concerned authority of cases of infection in their premises. In case of prevalence of a notified disease in a local area, a Magistrate may prohibit assembly of more than 50 persons.

Sources: The Travancore-Cochin Public Health Act, 1955; The Madras Public Health Act, 1939; The Kerala Public Health Bill, 2021; PRS.

Table 2: State-wise comparison of public health laws
Provision Kerala (2021 Bill) Tamil Nadu 5 Andhra Pradesh 7 Madhya Pradesh 6 Uttar Pradesh (2020) Goa 8 Assam (2010)

Appoints existing health officials as public health authorities at state, district and local levels. State Authority has a supervisory and policy setting role. State and District Authority may issue directions to any department on matters relating to public health.

State Public Health Board advises the government. Director of Public Health may advise local authorities to improve public health administration in their areas. Government will appoint Health Officers at local level.

State Public Health Board advises the government. Director of Public Health may advise local authorities to improve public health administration in their areas. Government will appoint Health Officers at local level.

State Public Health Board advises the government. Director of Health Services may advise local authorities to improve public health administration in their areas. Local Authority will appoint Health Officers.

Government may declare an epidemic and make regulations to control its spread. State Epidemic Control Authority will advise the government and order measures. District Authority will implement these orders.

Public Health Board advises the government on matters referred to it. Director of Health Services may advise local authorities to improve public health administration. Government will appoint Health Officers.

Health and Family Welfare Department has to provide healthcare access to all. State Public Health Board will prepare and implement strategies and identify health goals. District Board will implement strategies.

Public health coverage

Covers communicable and non-communicable diseases listed in the Bill. Additional diseases may be notified. Provides for regulation of water supply, sanitary conveniences, vector control, and maternal and child health.

Lists infectious diseases. Additional diseases may be notified. Also covers venereal diseases. Provides for regulation of water supply, sanitary conveniences, mosquito breeding areas, and maternity and child welfare.

Lists infectious diseases. Additional diseases may be notified. Also covers venereal diseases. Provides for regulation of water supply, sanitary conveniences, mosquito breeding areas, and maternity and child welfare.

Lists infectious diseases. Additional diseases may be notified. Also covers venereal diseases. Provides for regulation of water supply, sanitary conveniences, mosquito breeding areas, and maternity and child welfare.

Covers epidemic disease which are contagious or infectious diseases afflicting the entire or part of the state. Prescribes penalties for violating quarantine orders, and inciting others to violate provisions of the Act

Lists infectious diseases. Additional diseases may be notified. Also covers venereal diseases. Provides for regulation of water supply, sanitary conveniences, mosquito breeding areas, and maternity and child welfare.

Every person has the right to appropriate healthcare, reproductive health services, safe drinking water, sanitation and environmental hygiene, among others.

Water supply Local Authority will monitor and give directions to ensure supply of safe drinking water. Local Authority will monitor and provide drinking water. Local Authority may levy water tax, as sanctioned by government. Local Authority will monitor and provide drinking water. Local Authority may levy water tax, as sanctioned by government. Local Authority will monitor and provide drinking water. Local Authority may levy water tax, as sanctioned by government. No specific provision Local Authority will monitor and provide drinking water. Local Authority may levy water tax, as sanctioned by government. Health Department will coordinate with other departments to provide safe drinking water.
Sanitation Local government will provide and maintain public sanitary conveniences. Local authority will provide and maintain public sanitary conveniences. Local authority will provide and maintain public sanitary conveniences. Local authority will provide and maintain public sanitary conveniences. No specific provision Local authority will provide and maintain public sanitary conveniences. Health Department will coordinate and provide sanitation.
Vector Control Local government will take measures for prevention and control of insects. Act prohibits mosquito breeding in standing water. Health Officer will take steps to control mosquito breeding. Act prohibits mosquito breeding in standing water. Health Officer will take steps to control mosquito breeding. Act prohibits mosquito breeding in standing water. Health Officer will take steps to control mosquito breeding. No specific provision Act prohibits mosquito breeding in standing water. Health Officer will take steps to control mosquito breeding. Health Department will coordinate and provide sanitation through control of insects.
Public Health Emergency State Authority will specify conditions for a public health emergency. It may constitute ad hoc advisory committees during emergencies. Government may appoint temporary Health Officers to prevent spread of diseases during emergencies. Government may appoint temporary Health Officers to prevent spread of diseases during emergencies. Government may appoint temporary Health Officers to prevent spread of diseases during emergencies. No specific provision related to emergency. Act provides for the government to declare outbreak of an epidemic. Government may appoint temporary Health Officers to prevent spread of diseases during emergencies. Defined as threat of illness which needs immediate public health intervention to prevent death or disability.

Sources: Refer to endnotes 4, 5, 6, 7, 26, 27; PRS. Item 6 of State List in the Seventh Schedule to the Constitution of India. Andhra Pradesh Public Health Act, 1939. Assam Public Health Act, 2010, https://legislative.assam.gov.in/documents-detail/the-assam-public-health-act-2010assam-act-noxii-of-2010,

DISCLAIMER: This document is being furnished to you for your information. You may choose to reproduce or redistribute this report for non-commercial purposes in part or in full to any other person with due acknowledgement of PRS Legislative Research (“PRS”). The opinions expressed herein are entirely those of the author(s).

PRS makes every effort to use reliable and comprehensive information, but PRS does not represent that the contents of the report are accurate or complete. PRS is an independent, not-for-profit group. This document has been prepared without regard to the objectives or opinions of those who may receive it.

Is Medisep started in Kerala?

MEDISEP Medical Insurance Scheme for State Employees and Pensioners (abbr, MEDISEP ) is an scheme launched by to provide comprehensive coverage to all serving State Government employees and, The beneficiaries include newly recruited employees and their family, part time employees, all staff of aided schools and colleges and their family, pensioners and their spouses and family pensioners.

  1. The scheme was formally inaugurated by the on 1 July 2022.
  2. Within six months of its launch, the scheme attracted more than a total of 2.9 million beneficiaries and dependents and a participation of 480 hospitals most of which are located within Kerala.
  3. The scheme is envisaged to provide cashless medical assistance with a comprehensive coverage up to Rs.3 lakhs per year.

The annual premium is Rs.4800 plus 18 per cent GST for the policy period of 2022-24. A monthly premium of Rs.500 is being deducted from the salary of June and pension of July 2022 onward. MEDISEP is being implemented through, a public sector insurance company.

Does Kerala have free healthcare?

Steps were taken by Kerala Government to improve healthcare – The government of Kerala has taken several steps to enhance healthcare inside the nation. Here are some key projects and measures applied: 1. Comprehensive Health Policy: The Kerala authorities formulated a Comprehensive Health Policy that emphasizes the principles of equity, affordability, and exceptional healthcare.

The coverage objectives are to provide on-hand and cheap healthcare offerings to all citizens of the country.2. Primary Health Centers and Hospitals: The government has mounted a network of primary fitness centers (PHCs) and hospitals across the country. These facilities provide basic healthcare offerings, which include preventive care, maternal and baby health offerings, immunizations, and treatment for not unusual ailments.

The government has also upgraded district hospitals and strong point hospitals to provide advanced hospital treatment.3. Free Healthcare: Kerala has carried out several schemes to ensure unfastened healthcare for certain sections of the populace. For instance, the Karunya Health Scheme presents economic help to economically backward families by availing of highly-priced medical remedies.

  • The Arogya Keralam initiative’s objective is to provide free healthcare offerings to all residents of the country.4.
  • Telemedicine and Mobile Health Units: The government has introduced telemedicine services to enhance get admission to healthcare in far-flung and rural areas.
  • Telemedicine centers join sufferers with docs through video consultations, permitting them to get hold of medical advice and prescriptions while not having to travel long distances.

Mobile fitness units geared up with medical professionals and necessary devices also are deployed to offer healthcare services to faraway areas.5. National Health Mission: Kerala actively participates in the National Health Mission (NHM), an imperative authorities initiative to enhance healthcare delivery throughout the country.

  • The kingdom government collaborates with NHM to put in force various programs and schemes aimed at enhancing maternal and infant fitness, infectious disorder manipulation, and healthcare infrastructure development.6.
  • Health Insurance Schemes: The government has launched health insurance schemes like Rashtriya Swasthya Bima Yojana (RSBY) and Comprehensive Health Insurance Agency of Kerala (CHIAK) to provide monetary protection and get the right of entry to first-class healthcare for the marginalized and economically weaker sections of the society.7.

Health Education and Awareness: The government conducts health education and attention campaigns to sell preventive healthcare practices, hygiene, and sickness prevention. These campaigns attention to various fitness troubles, such as communicable sicknesses, non-communicable diseases, and maternal and baby fitness.8.

Human Resources Development: Kerala has invested in schooling and developing healthcare specialists to fulfill the growing healthcare demands. The authorities have hooked up scientific colleges, nursing schools, and paramedical establishments to decorate the availability of skilled healthcare personnel.

These are some of the steps taken by means of the Kerala government to enhance healthcare. These initiatives purpose is to strengthen healthcare infrastructure, beautify get admission to scientific offerings, and make certain high-quality healthcare for the population of Kerala.

Which health insurance is best in Kerala?

Best Health Insurance Companies in Kerala 2022

Health Insurance Plans Bajaj Allianz Health Guard Care Health Insurance Plan
Claim Settlement Ratio (CSR) 94% 90%
Network Hospitals 6,500+ 5,050+
Sum Insured Options ₹2 Lakh – ₹50 Lakh Up to ₹50 Lakh
Premiums Starting at* Starting from ₹3,200 Starting from ₹4,472

Which is the free health scheme in India?

Public Health is a State subject; hence, the responsibility of providing medical assistance to patients of all income group is of respective State/ UT Governments. However, National Health Mission (NHM) – a flagship programme of the Ministry with its two Sub-Missions, National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), supports States /UTs to strengthen their health care systems so as to provide universal access to equitable, affordable and quality health care services.

  • Janani Shishu Suraksha Karyakaram (JSSK)
  • Rashtriya Kishor Swasthya Karyakram(RKSK)
  • Rashtriya Bal Swasthya Karyakram (RBSK)
  • Universal Immunisation Programme
  • Mission Indradhanush (MI)
  • Janani Suraksha Yojana (JSY)
  • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
  • Navjaat Shishu Suraksha Karyakram (NSSK)
  • National Programme for Family planning
  • LaQshya’ programme (Labour Room Quality Improvement Initiative)

National Nutritional Programmes

  • National Iodine Deficiency Disorders Control Programme
  • MAA (Mothers’ Absolute Affection) Programme for Infant and Young Child Feeding
  • National Programme for Prevention and Control of Fluorosis (NPPCF)
  • National Iron Plus Initiative for Anaemia Control

Communicable diseases

  • Integrated Disease Surveillance Programme (IDSP)
  • Revised National Tuberculosis Control Programme (RNTCP)
  • National Leprosy Eradication Programme (NLEP)
  • National Vector Borne Disease Control Programme (NVBDCP)
  • National AIDS Control Programme (NACP)
  • Pulse Polio Programme
  • National Viral Hepatitis Control Program (NVHCP)
  • National Rabies Control Programme
  • National Programme on Containment of Anti-Microbial Resistance (AMR)

Non-communicable diseases

  • National Tobacco Control Programme(NTCP)
  • National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS)
  • National Programme for Control Treatment of Occupational Diseases
  • National Programme for Prevention and Control of Deafness (NPPCD)
  • National Mental Health Programme
  • National Programme for Control of Blindness & Visual Impairment (NPCB&VI)
  • Pradhan Mantri National Dialysis Programme (PMNDP)
  • National Programme for the Health Care for the Elderly (NPHCE)
  • National Programme for Prevention & Management of Burn Injuries (NPPMBI)
  • National Oral Health programme

Support under NHM to States/UTs includes provision of a host of free services such as maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as Tuberculosis, HIV/ AIDS, vector borne diseases like Malaria, Dengue and Kala Azar, Leprosy etc.

Other major initiatives include Janani Shishu Suraksha Karyakram (JSSK) (under which free drugs, free diagnostics, free blood and diet, free transport from home to institution, between facilities in case of a referral and drop back home is provided), Rashtriya Bal Swasthya Karyakram (RBSK) (which provides newborn and child health screening and early interventions services free of cost for birth defects, diseases, deficiencies and developmental delays to improve the quality of survival), implementation of Free Drugs and Free Diagnostics Service Initiatives and PM National Dialysis Programme.

Mobile Medical Units (MMUs) & Telemedicine are also being implemented with NHM support to improve healthcare access particularly in rural areas.

  • The Ayushman Bharat Programme launched last year provides for holistic and integrated health care and is the principal vehicle for achieving Universal Health Coverage (UHC).
  • It’s Health and Wellness Centre component (AB-HWC) provides essential primary and community health services such as maternal, neonatal and child health services including immunization and nutrition, thus fostering human capital development during children’s critical early years. These centres also provide services to prevent and manage common NCDs and major communicable diseases.
  • The other component, AB-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) provides free and cashless care to about 500 million poor and deprived people for secondary and tertiary hospitalization care.
  • To enhance the facilities for tertiary care of cancer, Strengthening of Tertiary Care for Cancer Scheme is being implemented to support setting up of State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country. Oncology in its various aspects has focus in case of new AIIMS and many upgraded institutions under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY).
  • Financial assistance to patients living below poverty line for life threatening diseases under the schemes such as Rashtriya Arogya Nidhi (RAN), Health Minister’s Cancer Patient Fund (HMCPF) and Health Minister’s Discretionary Grant (HMDG) is also provided.
  • Affordable Medicines and Reliable Implants for Treatment (AMRIT) Deendayal outlets have been opened with an objective to make available drugs and implants for Cardiovascular Diseases (CVDs), Cancer and Diabetes at discounted prices to the patients.

Services at Ayushman Bharat – Health and Wellness Centres (AB-HWCs) are free and universal to all individuals residing in the service area. Under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the State/ UT wise number of hospital admissions is given below:

Status as on 24.06.2019
Sl. No. State No of Hospital Admissions
1 Andaman And Nicobar Islands 22
2 Andhra Pradesh 135,346
3 Arunachal Pradesh 652
4 Assam 47,631
5 Bihar 48,711
6 Chandigarh 835
7 Chhattisgarh 564,568
8 Dadra And Nagar Haveli 12,081
9 Daman and Diu 4,465
10 Goa 1,415
11 Gujarat 487,636
12 Haryana 27,811
13 Himachal Pradesh 19,145
14 Jammu And Kashmir 19,303
15 Jharkhand 184,760
16 Karnataka 197,799
17 Kerala 531,740
18 Lakshadweep
19 Madhya Pradesh 96,029
20 Maharashtra 139,906
21 Manipur 3,289
22 Meghalaya 15,404
23 Mizoram 13,422
24 Nagaland 945
25 Sikkim 122
26 Tamil Nadu 239,438
27 Tripura 17,505
28 Uttar Pradesh 119,204
29 Uttarakhand 49,815
30 West Bengal 17,636
Grand Total 2,996,635

AB-PMJAY provides health coverage of up to Rs 5.00 lakh per family per year to 10.74 crore poor, deprived families as per Socio Economic Caste Census (SECC) database. Details of the entitlement criteria are given below:

Ayushman Bharat – PMJAY is an entitlement-based scheme with entitlement to be decided on the basis of deprivation and occupational criteria in the SECC database.

The different categories in rural area include:

Automatically included households (based on fulfilling any of the 5 parameters of inclusion):

  1. Households without shelter.
  2. Destitute, living on alms.
  3. Manual scavenger families.
  4. Primitive tribal groups.
  5. legally released bonded labour

Total of (a) to (e) = 15.95 lakh

Standard Deprivation Parameter Households
Only one room with kucha walls and kucha roof (D1) 2.38 crore
No adult member between age 16 to 59 (D2) 65.33 lakh
Female headed households with no adult male member between age 16 to 59 (D3) 69.43 lakh
Disabled member and no able bodied adult member (D4) 7.20 lakh
SC/ST households (D5) 3.87 crore
No literate adult above 25 years (D6) 4.22 crore
Landless households deriving major part of their income from manual casual labour (D7) 5.40 crore
Total deprived Households targeted for PM-JAY who belong to one of the six deprivation criteria amongst D1, D2, D3, D4, D5 and D7 8.03 crore

For urban areas, 11 defined occupational categories are entitled under the scheme. Targeted Urban Household categories proposed to be included in PM-JAY : 2.33 crore

Sr. No. Worker Category Households
1 Rag picker 23,825
2 Beggar 47,371
3 Domestic worker 6,85,352
4 Street vendor/ Cobbler/hawker / Other service provider working on streets 8,64,659
5 Construction worker/ Plumber/ Mason/ Labor/ Painter/ Welder/ Security guard/ Coolie and other head-load worker 1,02,35,435
6 Sweeper/ Sanitation worker / Mali 6,06,446
7 Home-based worker/ Artisan/ Handicrafts worker / Tailor 27,58,194
8 Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller 27,73,310
9 Shop worker/ Assistant/ Peon in small establishment/ Helper/ Delivery assistant / Attendant/ Waiter 36,93,042
10 Electrician/ Mechanic/ Assembler/ Repair worker 11,99,262
11 Washer-man/ Chowkidar 4,60,433
Total Targeted Urban Households 2.33 crore

Total families covered under PMJAY

Sr. No. Categories Households (number in crore)
1 i) Rural (based on deprivation criteria) 8.03
ii) Rural (automatically included) 0.16
2 Urban 2.33
3 Such number of families that are currently enrolled under RSBY but not in targeted SECC data 0.22
Total 10.74

The Minister of State (Health and Family Welfare), Sh Ashwini Kumar Choubey stated this in a written reply in the Lok Sabha here today. ***** MV/LK

What were the steps taken by the Kerala government to improve health facilities?

Answer: Kerala is the topmost state whose health care facilities have improved in a tremendous way compared to any other state in India. Explanation:

Kerala’s health standards have increased due to the wide infrastructure of the primary health centres.There are over 9491 government and private medical institutions in Kerala, which is one of the largest numbers.One of the major strategies implemented by Kerala for improving health was making vaccinations mandatory for public servants, prisoners, and students.There is also a state-supported nutrition programme for pregnant and new mothers.Kerala has improved in nutrition primarily due to better and feasible healthcare access as well as equality in food supply across different income groups and within families.The neonatal mortality rate and infant mortality rate are very low compared to other states of India.

How did Kerala government improve health care system in Kerala?

Emphasis on health reform – India is a middle-income South Asian country with a population of over 1.2 billion.1 India was formed in 1947 and was divided into states starting in 1956. At present, there are 29 states and 7 union territories.2 In India, healthcare is managed at the state level.

  • Lower infant mortality rate of 12 per 1,000 live births in Kerala vs.40 per 1,000 live births in India),
  • Lower maternal mortality ratio of 66 per 100,000 live births in Kerala vs.178 per 100,000 live births in India,
  • Higher literacy among both males at 96% in Kerala vs.82% in India and females with 92% in Kerala vs.65% in India 4

The health gains made in Kerala can be attributed to several factors, including strong emphasis from the state government on public health and primary health care (PHC), health infrastructure, decentralized governance, financial planning, girls’ education, community participation and a willingness to improve systems in response to identified gaps 5 6 7 8 9 10 11 When it established statehood, the area that made up Kerala already had a long history of health-focused policies; for example, vaccinations were made mandatory for certain segments of the community – including public workers and students – ad early as 1879 6 12,” Once it achieved statehood, Kerala invested in infrastructure to create a multilayered health system designed to provide first-contact access for basic services at the community level and expanded integrated primary health care coverage to achieve access to a range of preventive and curative services.13 Additionally, Kerala rapidly expanded the number of medical facilities, hospital beds, and doctors.

What is the reason for the success of Kerala health care program?

Kerala’s success in healthcare is due to a successful primary healthcare infrastructure : Dr. M I Sahadulla – ET HealthWorld An organised approach in healthcare is very much the need of our country, only then the masses can benefit and affordable healthcare is very important. In an interview with ETHealthworld,, Chairman & MD,, Trivandrum, Kerala, shares KIMS mission to improve the of the state. Edited excerpt:

Your comments on the healthcare landscape of Kerala? What are the challenges that you see? What are the expansion and growth plans of KIMS? How is IT placed in KIMS? Please highlight the role and importance of quality healthcare.

The healthcare landscape in Kerala is ahead in many parameters when compared to other states. Kerala is far ahead in infant mortality, maternal mortality and also in the longevity of life. We are also comparable with international standards of advanced countries.

We have achieved this progress in Kerala because of a very good infrastructure of primary healthcare. There has also been a lot of improvement in the secondary and tertiary care. If you look at the last two decades, Kerala had several private hospitals coming in the private sector and has a very good government public healthcare delivery system.

So the recognition of the private sector has become a inevitable reality even though there were resistance initially however public health and also how we deliver the care is an important question that we have to ask all over India. As a state policy and as a national policy I would like to see that the central government and the state government give more importance to health in general.

In India the percentage of GDP spent on healthcare is under 2 percent. The countries where healthcare is advanced are France, Italy, England, Canada or United States of America and they all have double digits of GDP being spent for health. An organised approach in this area is very much the need of our country, only then the masses can benefit and affordable healthcare is very important.

The insurance sector has opened up to a great extent to the international players, but only to the Indian insurance companies. A lot of revolution has to happen in this area if we want to see the dream of healthcare for everyone in India. While the private healthcare in India has improved, many corporate chains have come up and also it has extracted many patients from outside.

  • We are looking for expansion opportunities in India, we have already finalised one in Tamil Nadu and are looking for opportunities in Karnataka.
  • We are looking at not only the primary healthcare but also the aged population which is much more in Kerala and we are trying to double up the home care concept.

There is a lot of scope and need for home care in Kerala and this is one area where we want to specialise and extend it to all the people available. For this we already have central hospitals in various cities and towns, primary centres are there and will be increasing.

  • By this we can drive the home care and we can provide quality care to the population of Kerala.
  • We are very much fond of IT in healthcare delivery and we believe that it is the only way that we can go forward.
  • From the very beginning we went into hospital information system.
  • It’s been seven years, we have no out-patient files at all, patients come and just say a medical record number.

Recently in Trivandrum we have recently introduced the inpatient electronic medical record. Though there are also a lot of challenges in this because the doctors are to use it, the patients have to accept the value of it and a lot of storage problems are also seen.

  1. We are studying methods by which we can store it in the cloud but that also brings in challenges because the confidentially part is very important.
  2. It is not paperless but it is a less paper hospital in many respects.
  3. We are also looking at how we can utilise the telemedicine for management of patients.

One of the areas where we want to use telemedicine is as a TeleIntensive care. We are very near in introducing the Tele-ICU system and Telepathology is another area where we want to expand. Quality in healthcare is a very important concept. In healthcare, quality in the perception of the patient and measuring that is the major challenge that all of us had.

  1. Many of the advanced countries have progressed in it and today India is also progressing in quality and is given utmost importance at KIMS.
  2. We have got performing indices for each department; we have got patient related parameters, like waiting time, satisfaction survey in each of the areas and even with the doctors.

Quality is a way of life and it is total quality management that we are practising. It is also very much based on ethics. and ethical principles is a virtue that is not very much practised in healthcare like in many other fields because of the degenerating values of our society in this point of time.

Published On Feb 22, 2017 at 08:38 AM IST

: Kerala’s success in healthcare is due to a successful primary healthcare infrastructure : Dr. M I Sahadulla – ET HealthWorld