Last week, on February 18 and 19, Kolkata played host to the ninth Kolkata Group workshop, chaired by Nobel Economics Laureate Professor Amartya Sen. At the workshop, 45 participants from different fields, including academics, social scientists, policy makers and development experts, focused on social equity in India, as reflected in estimates of poverty, elementary education and healthcare.

The workshop then adopted the ‘Kolkata Declaration' which demanded universal entitlements to publicly provided primary healthcare for all, and stressed that at least 3 per cent of the country's gross domestic product (GDP) should be devoted to healthcare.

The Kolkata Group pointed out that India's public spending on health – a little over one per cent of GDP – is among the lowest in the world.

This has led to an extremely high burden of private out-of-pocket health expenditure, which a huge part of the population cannot afford.

Earlier, writing in The Hindu , Dr Sen had pointed out how “it is silly to be obsessed about overtaking China in the rate of growth of Gross National Product (GNP), while not comparing ourselves with China in other respects, like education, basic health, or life expectancy.”

Dr Sen went on to provide some eye-opening statistics: Life expectancy at birth in China is 73.5 years; in India, it is still 64.4 years. Infant mortality rate is 50 per thousand in India, compared with just 17 in China, and the under-5 mortality rate is 66 for Indians and 19 for the Chinese.

China's adult literacy rate is 94 per cent, compared with India's 65 per cent, and mean years of schooling in India is 4.4 years, compared with 7.5 years in China. In our effort to reverse the lack of schooling of girls, India's literacy rate for women between the ages of 15 and 24 has certainly risen, but it is still below 80 per cent, whereas in China, it is 99 per cent. Almost half of our children are undernourished compared with a very tiny proportion in China. Only 66 per cent of Indian children are immunised with triple vaccine, as opposed to 97 per cent in China.

Economic review

In this context, the Kerala State Planning Board's Economic Review 2010, tabled last week in the Assembly, reveals that Kerala still retains promise on the healthcare front, having had a head start since the 1960s and 1970s, with successive governments – of either of the popular, rival political formations – being forced by people-centred mass movements and community-based public action forcing a concerted attention on public health delivery and sound primary healthcare.

As the latest Economic Review tells us, Kerala's much acclaimed outcomes in healthcare had their origins in the State's vast network of public health institutions, namely, primary health centres (PHCs), community health centres (CHCs), Taluk/District Hospitals and Medical College Hospitals (MCHs) at the primary, secondary and tertiary levels. More important, the State ensured universal accessibility and availability of medical care to the poor and more marginalised sections of society.

The results are shiningly evident. Compare the basic health indicators of Kerala with those of India as a whole during 2010. Birth rate (‘000 population): 14.6 (Kerala), 22.8 (India); Death rate (‘000 population): 6.6 and 7.4; Infant mortality rate (‘000 population): 12 and 53; Child mortality rate 0-4 years (‘000 population): 3 and 17; Maternal mortality rate (per lakh live birth): 110 and 301; Total fertility rate (children per woman): 1.7 and 2.9; Couple protection rate (in per cent) 62.3 and 52; Life at birth: (a) Male: 71.4 and 62.6; (b) Female: 76.3 and 64.2; (c) Total: 74 and 63.5.

Better than China

On many counts, Kerala fares better than even China. Consider life expectancy (74, versus 73.5 in China, and which is also higher than the life expectancy of the people of Brazil), infant mortality rate (12 vs 17), overall literacy rate (100 per cent in Kerala). Also, an analysis of the Hunger Index for Indian States places Kerala at the second rank, behind Punjab, indicating a relatively low prevalence of endemic hunger in the State.

Despite all these glowing achievements, Kerala cannot afford to be complacent. Already, there are signs that the State's public health infrastructure is straining at the seams for want of funding and financial prowess. Increased public social action and budgetary support, along with innovative measures to garner financial and non-financial support, will be needed to maintain Kerala's superior human development and health profile. That is the perennial goal for Kerala's governments.

The writer can be contacted at kgkumar@gmail.com

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