Cost effective healthcare for all

The TSI team picked up Ernakulam district as a case study. The people of the district are known to suffer from variety of ailments including typhoid, asthma, rat fever and leptospirosis (caused by working on pineapple plantations). 
 

“The district faces several challenges,” says district medical officer (DMO) Dr Sudhakaran. “There is heavy industrial and vehicular pollution. And the pressure of population is huge.”

One of the major problems faced is the inadequate supply of fresh potable water. Pipelines carrying fresh water often pass through drains where any damage, say corrosion in the pipe, leads to contamination of water. Disposal of non-organic and organic waste, is another problem. Often pipes connected to septic tanks dump the waste directly into the fresh water canals and rivers causing a major health crisis. “Most of the problems are caused by the irresponsible behaviour of the public,” says Dr Sudhakaran.
 

Presence of a large migrant labour force in one place is also a cause of distress. “Most of the migrant labour here are tobacco consumers. Shopkeepers catering to them stock tobacco products that in turn incites local people to try them,” Dr Sudhakaran told TSI.
 

The district has uneven topography and the climate varies from place to place. Shallow ponds with stagnant water are the breeding ground for mosquitoes, i.e., malaria and dengue.
“Water pollution leads to typhoid and industrial pollution causes asthma. Intermittent rains cause problems too, as do shallow ponds,” avers the MDO.
 

To overcome these challenges the state's health department has decided to intervene in number of areas. To tackle malaria and other waterborne diseases, the department conducts a three month anti-mosquito drive. On the other hand, MGNREGA labourers for instance, are regularly supplied with anti-leptospirosis tablets and people working on pineapple plantations are provided gum boots and gloves. In each case, the health department has been trying to find a way to provide relief first, and find solutions to long term management of a crisis as a second step.
 

The state health department's report card in Kerala has been impressive. In Kottayam district, the state's anti-tobacco drive has borne fruit, with Kottayam being declared tobacco free district. At the Aluva Taluk health centre, near Kochi, patients can access a state-of-the-art dialysis centre. The place is also famous for its blood bank. The blood bank is equipped with laboratory facilities that enable availability of blood plasma and red blood platelets, critical in treatment of dengue. “This blood bank has done a good job. It has bagged awards three times,” says Dr Haseena Mohammed, additional DMO of Kochi district.
 

The blood bank, which is being run by Dr Vijaykumar, has been successful in making even rare blood group available to the common man. Though retired now, Dr Vijaykumar is known to have started the drive to collect blood. He has held 384 blood donation camps in the last 10 years to encourage people to donate blood to the bank. 
 

Recently the Aluva Taluk health centre was upgraded to a district hospital. The dialysis centre at Aluva is popular with the patients who come from far away places to access affordable healthcare here. The centre, which currently has 12 dialysis units, is attached to the government hospital, but is run by non-government staff. In all 24 patients in two shifts can undergo treatment here. That is 144 patients a week. The cost of dialysis is Rs 200 per patient.
 

The availability of this service has been made possible by donations made by individuals that covers the cost of running the dialysis centre as well as salaries of its staff. “The dialysis would not have come up if P Rajeev, an MP from this district had not contributed to its making,” says Dr Vijaykumar. “The construction of the building and purchase of machines was made possible by the MP. He takes interest in the running of the centre,” adds the doctor.
 

Apart from regular health centres, Kerala is also known for its Ayurveda hospitals in each district. Dr Rex P Nelson, the DMO (Ayurveda) says, “At Ayurveda hospitals the Below Poverty Level (BPL) patients get free treatment. Free medicines are also made available to the needy.” In Ernakulam district, Ayurveda treatments such as 'thirummal' and 'kishi' (costing Rs 25,000 upwards for a session) are provided free to the people. Like Ayurveda, homeopathy treatment is also easily available. Almost every panchayat block boasts of a homeopathy clinic. “On an average 35-40 patients visit these clinics everyday,” says Dr Shaji Mathew, a homeopathy doctor.
 

All in all, Kerala's responsive approach to healthcare delivery has been appreciated by people. This has been enabled by cooperation between doctors, bureaucrats and even politicians, each one of which has contributed their might to make this dream a reality. Other states could do well to replicate the Kerala story.