LOCAL SELF GOVERNANCE HELPED FIGHT COVID- KERALA MODEL
Kerala being a fairly populated state of India with a population size of about 3.46 crores has emerged as an improving state in terms of health structure and practices. The simple targeted planning and expenditure has made it to the top in every year since 2006. The population bed ratio in 2017 was at 879. not just that kerala was highlighted to have a better management of the first wave of covid in terms of restricting increase in infections and low fatality rate throughout both the waves in India. Kerala was recorded as the best performing state with an index score of 74.01 in a health index report published by niti ayog in 2018. kerala released its state-wide all-cause mortality data in february, which showed that the state, despite accounting for the second highest number of covid-19 infections in india, recorded over 16,000 fewer deaths in 2020 compared to the average of the previous five years.
THE QUESTION ARISES HOW KERALA HAS MANAGED TO BE ON THE TOP IN TERMS OF HEALTH EXPENDITURE AND ITS EFFECTIVE IMPLEMENTATION TO FIGHT COVID?
- to understand the health expenditure practices of kerala
- to observe how practises have helped in prevention of first wave of covid and subsequently managed low fatality rate
- to highlight the best practices that can serve as example for other states
WHO- “Five months on since the country’s first positive case of Novel Coronavirus Disease (COVID-19) was reported in Kerala, the state with over a population of 35 million, has reported 4189 cases of COVID-19 as on 30 June 2020 and 23 deaths with an impressive recovery rate of 51.7%”
Kerala managed the first wave efficiently along with getting appraisal for low death rates and higher recovery rates.
Kerala government emphasis on how to spend rather than how much to spend on health indicators . Kerala follows a systematic plan of decentralisation of funds .
Kerala every year spends around 7000 crores on health and family welfare by not just focusing on money in the hands of the main government but following a policy of distributing the funds at district and localise level. kerala gives out large funds in the name of general purpose transfers rather than allocating to a specific use. These funds are then distributed to panchayats and district level bodies to spend according to the development funds which basically serves the purpose of district level development be it infrastructure or equipment.
Funds categorising as maintenance funds are put to the upkeep of primary health care centres at panchayati levels
popularising the concept of local self governments , kerala has also used LSG’s as a major role in health care development. The model of LSG in kerala today has about 1200 of them working at different levels ensuring more participation of citizens in implementation of policies . LSG ensures direct and focused planning with greater impact.
To keep track of activities and flow of funds Kerala government uses its “information knowledge mission’’ as a database . This leads to transparency and a well accounted record book of each local body. needs of specific locality and relevant use.
This has been evidently proved in the first wave of covid , kerala was appreciated and was known to form an example model. Kerala used its decentralised model to fight covid as the local bodies were responsible for their localities which made it easy to search for patients and monitor the ongoing crisis closely . not just that this system helped in locating the barriers for different age grouped and occupational populations and rectify them at early stages. kerala was recorded with lowest number of infections in the 1st wave of covid which is believed to be a consequence of its decentralised management.
with the upcoming of second wave of covid in the country , kerala has recorded to have lowest case fatality rate of 0.4% in the country even after being the second state to record highest infection
- Kerala poses the qualities of a decentralised governance which has proved to be important in the health sector . power and functioning of local bodies has impacted the health infra at a large extent and thus making kerala the top in the list of indian states.
- The impact of lsg was evident as when the pandemic was at its first high in the country , kerala by its efficient management became a role model with lowest infections during 1st wave and lowest death rate in the second wave.
- The states consistently performing lower in the health index like uttar pradesh can also try to implement decentralised systems, as the largest population residing with the lowest of resources is better to be managed by small local bodies for more focused implementation of schemes .
TWP PUBLIC HEALTH EXPENDITURE IN INDIA - WORKING PAPER 2018
HEALTH INDEX REPORT BY NITI AYOG 2019
HEALTH AT A GLANCE 2018- KERALA GOVERNMENT