Rebuilt after 2018 Floods, Kerala's FHC Showcases State’s Resilient Public Health System

In an online event on July 24, Kerala Chief Minister Pinarayi Vijayan formally launched projects worth Rs 25 crore in the health sector as part of the Left Democratic Front (LDF) government’s 100-day programme. This included six upgraded Family Health Centres (FHCs) and 28 new health and wellness centres across the state. The inauguration of the new FHC in Vazhakkad in Malappuram, which had been completely destroyed during the floods in 2018, has now been rebuilt into the largest such facility in the country. It was the highlight of the event, showcasing the strides made by the state in building a resilient public healthcare system.

Vazhakkad Family Health Centre and the Rebuild Kerala Initiative

Three years ago in August, Kerala was ravaged by floods following unprecedented monsoon rainfall that was 96% above the long-term average rainfall in the state. The result was 433 deaths and an estimated total economic loss of around Rs 31,000 crore. According to a World Meteorological Organization (WMO) report, the flood was among the five major extreme flooding events in the world between 2015 and 2019. During the floods, the Chaliyar River, which flows through Malappuram district overflowed, completely destroying the government-run Primary Health Centre (PHC) in the village of Vazhakkad. The floods put the brakes on the previous LDF government’s attempt to upgrade PHCs into FHCs under the Aardram mission that aimed at reducing the dependence of the public on private hospitals.

Following the floods, the government established the Rebuild Kerala Initiative (RKI), envisioned as a participatory and inclusive process for a resilient and sustainable recovery and rebuilding of the state. The initiative aimed at “higher standards of infrastructure for recovery and reconstruction, and to build ecological and technical safeguards so that the restructured assets could better withstand floods in the future”. As part of RKI, the reconstruction of the destroyed health centre in Vazhakkad commenced in February 2019.

Spread over 15,000 square feet, the new FHC in Vazhakkad has an emergency room, a mini-operation theatre, doctors' consulting rooms, nurses' station, a medical store, a vaccine store, a sample collection centre, vision and dental clinic, an advanced laboratory and imaging department and a designated zone for mother and child, pregnant women and the elderly. The disabled-friendly facility also includes a conference hall, an open gymnasium, play area for children, and other amenities. Moreover, the FHC is also equipped with ten observation beds with oxygen concentrators and a stabilisation unit to attend to patients suffering from low oxygen saturation.

The eco-friendly and energy-efficient structure of the building is based on a design developed by faculty and students at Indian Institute of Technology (IIT) Madras. It uses a building panel made-up of calcined gypsum plaster, part of a technology known as Rapidwall, which eliminated the need for bricks, blocks, timber and steel wall frames and plasterboard linings. The building system boasts of being 100% recyclable, earthquake tested, and cyclone, fire, water and rot and termite resistant. Forty students from the School of Architecture and Planning at Government Engineering College, Thrissur contributed to the design of the facility.

The Rs 10 crore project was funded by VPS Healthcare, a hospital chain based in the United Arab Emirates (UAE), as part of its Corporate Social Responsibility (CSR) initiatives. Dr. Shamsheer Vayalil, Chairman and Managing Director of VPS Healthcare, thanked experts from different fields and the local population for their participation in the project while handing over the facility to the state government. Besides being equipped with modern facilities, the FHC, which used to take care of around 75,000 patients a year before the floods, is now expected to cater to around two lakh patients a year, said District Medical Officer K. Sakeena.

India’s Unequal Health Story and the Kerala Experience

A recent report by Oxfam India provided a comprehensive analysis of the health outcomes across different socio-economic groups and highlighted the alarming increase in health inequality in the country. According to the report, the trend towards supporting the growth of the private sector in healthcare has only exacerbated existing inequalities, leaving the poor and the marginalised with no viable healthcare provisions. High costs of health services and lack of quality leads to further impoverishment of the disadvantaged.

Oxfam’s 'Commitment to Reducing Inequality Report 2020' India ranks 154th in health spending – fifth from the bottom. The current expenditure on health by the Centre and the state governments combined is only about 1.25% of our GDP. In the middle of a health emergency, the Union Government’s budget allocation for the Ministry of Health and Family Welfare this financial year was Rs 71,269 crores, around 9.64% lower than the revised estimates for financial year 2020-21 (Rs. 78,866 crores). Out-of-pocket health expenditure in India (at 64.2%) in India is much higher than the world average of 18.2%. Exorbitant prices of healthcare have forced many to sell household assets and incur debts, and over 63 million people are pushed in to poverty every year due to health costs alone, according to government estimates. The situation has only exacerbated during the pandemic with the lockdown and diversion of resources to tackle COVID-19.

On the other hand, over the five years of the previous LDF government, health spending in Kerala had increased manifold, according to budget data (from 0.39% to 1.89% of the state GDP). This year’s budget allocation for the Department of Health and Family Welfare – at Rs. 10,354 crore – is around 29.9% higher than the revised estimates for FY 2020-21 (Rs. 7,971 crore). According to the fifth round of the National Family Health Survey (NFHS-5), average out-of-pocket expenditure per delivery at a public health facility actually decreased from the previous round in 2015-16, from Rs 6,901 to Rs 6,710. The usage of public health facilities during the same period increased from 38% to 48%.

With the six new Family Health Centres launched by the CM, the number of PHCs upgraded into FHCs now number 480. A total of 121 health institutions in the state currently have been accredited by the Union Health Ministry with the National Quality Assurance Standards (NQAS) certification. The top nine NQAS-ranked PHCs are all in Kerala and the state also has the highest number of urban PHCs having NQAS certification (30) in the country. Earlier, Kerala had also topped the NITI Aayog Health Index.

All this has meant that during the pandemic period, Kerala’s public health system has withstood COVID-19 and also managed to ensure access to other health services for the public during this period. Notably, this has meant that even as concerns are being raised about the high number of COVID-19 cases, Kerala has not witnessed huge numbers of ‘excess deaths’, unlike other states in the country.