Kerala Health Minister K.K. Shailaja (second from left) holds a meeting with officials to discuss ways of tackling coronavirus. Image Credit: ANI

The southern Indian state of Kerala has come in for worldwide praise for its proactive approach to prevent the spread of the coronavirus which has caused a global pandemic. The state’s health minister, K.K. Shailaja, in an exclusive interview to Gulf News, discusses the measures that brought success.

GULF NEWS: In the light of the ongoing COVID-19 crisis, the ‘Kerala Model’ in the health care sector is getting worldwide attention. What exactly is this model? Is it linked to the ‘Kerala model of development’?

SHAILAJA: We are happy that the public health care system in Kerala and the effective intervention during COVID-19 pandemic is acclaimed worldwide. It has become possible because of the strong public health network nurtured for long in the State. The exceptional initiatives taken by the present government to fortify the public health system of the State has enabled us to deal with the present crisis effectively. Kerala has a unique and viable model of public health care system which is people-oriented and comprehensive.

Structurally, the Public Health System in the State is designed to have Primary Health Centres/Family Health Centres at the first level. They are local health institutions which not only provide treatments for minor ailments, but also conduct universal health care programmes like immunisation and impart knowledge among the people about disease prevention and healthy living. Services of one PHC are available for approximately 30,000 people in rural areas and 50,000 people in urban areas.

The primary level health network connects each and every person in the society. At the secondary level there are Community Health Centres, Taluk Hospitals, District Hospitals and General Hospitals with speciality treatments. At the tertiary sector, there are Medical College Hospitals with super speciality facilities and sector specific research and treatment centres like Regional Cancer Centre etc.

The present government has introduced an innovative and progressive mission in health sector, namely, ‘Aardram’, to make government hospitals patient-friendly by improving their basic infrastructure and services. It ensures quality health care with minimal waiting time for outpatient medical check-up and other investigation facilities. As part of the Aardham project, 170 PHCs were converted into FHCs. In the second phase, 504 PHCs will be converted into FHCs. Through Aardham project, the clinical facilities at the primary levels have been enhanced significantly.

The admirable health status of the State is the result of large scale public spending in the sector. Average 5.6 per cent of the state spending is in the areas of health and family welfare. The distinctive feature of the popularly acknowledged ‘Kerala model of development’ is on account of achievements in social sectors like education, health care, etc. This, along with the wealth redistribution programmes, has resulted in high social development indices, comparable to those of financially developed countries.

Many trace these advances to the exceptional steps taken by political forces in the past. Is land reform at the heart of this success?

Yes, land reforms greatly contributed in making Kerala a better welfare state. Indian freedom struggle had nurtured great dreams and hopes in the minds of the people for a sovereign and egalitarian India wherein wealth would be equitably distributed. In conformity with the above aspirations, the first popularly elected government in Kerala (1957-59) under the leadership of E.M.S. Namboodiripad had taken concrete steps to execute certain social development programmes such as land reforms, free universal education, free health care, etc

The state has done a remarkable job in crisis management. In a recent public address you said from the moment ‘Wuhan’ was mentioned as an epicentre, you and the state authorities went on a war footing and took proactive steps. Please take us through this process.

We are yet to come out of the first wave and it is not proper to speak of deadly second wave. However, foreseeing such a situation, we are making adequate arrangements for addressing the challenge.

- K.K. Shailaja, minister of health and social welfare, Kerala, India

We have adopted a multipronged strategy:

(a) Testing of all persons coming to the state at the entry point itself for the symptoms of COVID-19. They were categorised and sent either on quarantine or isolation. All persons who reached the State after a particular date were asked to remain in self-quarantine for 28 days for those coming from high risk areas and 14 days for others.

(b) Strict monitoring of the situation was started since day one and 24x7 control rooms were set up in the State and at all district headquarters. Supervision of the activities is done directly by the health minister and the health secretary. Proper briefing to the media about the actual situation is done on a daily basis so that the fake news and rumours are not spread.

(d) Clear messages were given to people about social distancing, personal hygiene, usage of masks, hand washing, and complying the health directions, through awareness programmes, media, social organisations etc. A novel slogan ‘Break the Chain’ through social distancing was well received by the people in the state. This has created a collective will of the people to prevent the spread of COVID-19. Recovery of an elderly couple, aged 93 and 88 from COVID-19 on April 3 after treatment for 23 days in one of the Government Medical College Hospitals is a matter of pride to the State.

Tell us about health care centres in Kerala? This grassroot level facility has evolved into a model for others to emulate. How did such a communitarian public policy come about?

The erstwhile Travancore, Cochin and Malabar, the constituents later merged to form Kerala, had a history of public health care system, offering some treatment to poor people in certain areas. In the former two princely states there were location specific health care centres offering free treatment and medicines. Although these institutions offered limited treatment facilities, when the State of Kerala was formed, the legacy of the free health aid was protected and expanded. The first ministry in 1957 took very concrete steps to widen the network of primary health centres and strengthen higher level hospitals. An egalitarian approach can be seen in the health policy of that government. Although the duration of the first ministry was short, it laid down a solid foundation for public health which the successive governments could not violate. The left governments that came to power from time to time had taken special care to strengthen the communitarian health policy wherein the network of public health institutions are reinforced.

Did the earlier Nipah virus outbreak and the extraordinary success in overcoming that crisis help in tackling COVID-19? Are there significant differences between the two health crises?

Our previous experience in tackling the Nipah virus outbreak successfully has taught us very hard lessons but the situations related to the outbreak of Nipah and COVID-19 are fundamentally different. The infectability of the coronavirus [SARS-Cov2] is much more than that of Nipah. Although Nipah is more deadly than coronavirus, the scale of attack and the area of infection were lower in the case of Nipah. It was confined to two districts only and we could seal those districts and impose a lockdown within the districts and thereby prevent any spread elsewhere. Moreover, there was no ingress of virus from abroad. On the contrary, the COVID-19 attack is part of a pandemic and in many cases the disease has been brought to the State by travellers from abroad.

Undoubtedly our experience with the Nipah crisis helped in keeping the fatality rate less than one per cent of the infected persons; a record, compared to other parts of India and elsewhere in the world.

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Worldwide they talk about flattening the curve, your thoughts? Epidemic modelling is a challenge, does such a strategy work?

Epidemic modelling is really a challenge especially when there is no medicine/vaccine available and all members of society are susceptible to the infection and the spread is rapid. There is a potential threat that the health system will be overwhelmed with the infected and eventually collapse. In order to overcome this threat proper plans are to be evolved whereby the curve can be flattened.

Is the worst yet to come, can there be a second wave? Some alarming statistics have appeared in the media, your thoughts?

We are yet to come out of the first wave and it is not proper to speak of deadly second wave. However, foreseeing such a situation, we are making adequate arrangements for addressing the challenge.

Do share some personal details. You started as a Science teacher, and now you are a cabinet minister.

I was born in Kannur district on November 20, 1956, and had my college education in Pazhasi Raja N.S.S. College, Mattannur and Visvesvaraya College, in Karnataka. I learned Biology in my pre-degree classes and studied Chemistry, Physics and Mathematics for graduation. My knowledge of biology has helped me to a great extent in understanding the changes in health science. Subsequently, I worked as a teacher at Shivapuram High School. I resigned the job in 2004 to become a full time political activist. Presently, I am a member of the Central Committee of the Communist Party of India (Marxist).

I have authored two books: Indian Varthamanavum Sthreesamoohavum and China — Rashtram, Rashtreeyam, Kazhchakal, both in Malayalam. My husband Bhaskaran master is a former teacher and political activist.

— Ravi Menon is a Dubai-based writer and thinker, working on a series of essays on India and on a public service initiative called India Talks.