The Transformation Kerala’s Health System Needs

Health System.

The words may sound simple but a proper health system encompasses organizations, people, and their actions to promote, restore or maintain health. Such a system should fundamentally have four objectives.
• Improvement of public health.
• Meeting or exceeding the public’s expectations of quality healthcare.
• Providing financial protection against ill-health costs.
• Monitoring and preparing for ailments on a mass scale.

To achieve these objectives, the system needs to
• Deliver health services
• Allocate revenues to purchase services
• Invest in infrastructure, people, drugs, supplies and equipment
• Lead and govern the resources

Let’s take the World Health Organization’s Health System framework for reference. It has 6 building blocks.
• Service delivery
• Workforce
• Information
• Medical products, vaccines and technologies
• Financing
• Leadership and governance

Now comes the questions.

Is Kerala’s Public Health System meeting its objectives?

In the wake of the pandemic COVID-19, we believe Kerala does have access to resources and financial backing to transform their health system to deliver more efficient results.

How?

Let’s go at it step by step.

Integrating & Synergizing Systems Of Institutions

In order to build a strong health system in Kerala, a suggestive guideline for the Kerala Ministry Of Health is to integrate systems of primary, secondary and tertiary care institutions which can enhance the test, trace and treatment phases on a district level. Such an integration can also enhance the capacity of local organizations and the interactions between them. Maximizing synergies between such institutions, private health players, contributing non-health sectors and the administrators is one important approach to fortifying health systems.

The right use of information

An ideal health system ensures the production, analysis, dissemination and use of reliable and relevant health information by decision-makers at different levels. Though Kerala has a system that synthesizes information, it still does not effectively promote the application of knowledge for timely decision-making. We believe the Kerala Health System still relies on the submission of reports which can delay critical decision-making. Our recent bouts with COVID-19 emphasizes that we need to strengthen the health surveillance information system for diseases that affect public health on a wide scale.

Medical products, supplies, vaccines & technologies

Quality control of medical products, supplies, vaccines & technologies and equitable access to all of them is vital for a strong health system. Moreover, the health system should also focus on the efficacy and cost-effectiveness of all of these. To do this, the Kerala Public Health System must revisit the Indian Public Health Standards (IPHS) for district and sub-district hospitals and community health centers and ensure that these public health institutions maintain the standards in terms of service delivery, human resources, equipment, supplies, and infrastructure. This effectively ensures better health outcomes. Presently, the Kerala Health System relies on institutional governance to take care of their needs with little revisits of their standards. However, the supply, storage and distribution policies are attended to.

Leadership and governance

Kerala Government should drive more focus on overseeing the Public Health System to ensure the existence of strategic frameworks that can help us combat situations like the current pandemic scenario better. The second wave hit Kerala hard and the third wave may hit us harder without efficient leadership. Effective supervision, providing appropriate regulations and incentives, attention to system-design, and ensuring accountability must be given critical significance.

Presently, the Public Health System in Kerala is not resilient enough, we feel. This is our observation and we believe our Public Health System can garner international praise if we just focus on the basic building blocks of a health system recommended by WHO.