The Reserve Bank of India (RBI) has lauded Kerala’s investment in the public healthcare system, which helped in containing the spread of COVID-19 in the first wave of infections, and in keeping the state’s mortality rate low. The RBI’s praise for the state was recorded in its annual publication, ‘State Finance: A Study of Budgets’, which analyses the fiscal position of state governments on the basis of primary state-level data. The report for 2020 was released on October 27.
“Kerala was the first state in India to record a case of COVID-19. It also led the country in the number of active cases up to March 2020. Given the high global migration of its residents and it being an international tourist destination, it was feared that Kerala would develop into a hotspot. The state, however, successfully managed to contain the spread of the pandemic in the first wave of infections. However, the state witnessed a second wave of infections with the arrival of non-resident Keralites from outside the state and with easing of restrictions. The state now ranks third in active cases (as on October 13, 2020) and also has the highest percentage of active cases to total confirmed cases. However, Kerala reports a lower death rate at 0.3 per cent compared to the all-India average of 1.5 per cent,” the report states.
As of Monday, the test positivity rate in the state was 12.14%, while the case fatality rate was 0.34%. The national fatality rate was 1.49%.
“In the face of rising cases, Kerala has set up 101 COVID First Line Treatment Centres across the state and is focusing on intense contact tracing, testing and quarantine to minimise the community spread of the disease. The presence of empowered local governance institutions and community participation helped the state in effectively reaching out to affected people. With the resurgence in new cases, Kerala is actively roping in the services of local self-governments (LSGs) in its fight against the pandemic. LSGs have been entrusted with the task of collecting information, spreading awareness, identifying the vulnerable sections, ensuring quarantine and lockdown guidelines being followed, cleaning and disinfecting the public places and ensuring the supply of essential services to those under quarantine. Thus, panchayats have emerged as frontline institutions in containing the disease and in alleviating the distress caused to the poor and vulnerable,” the report says. Recently, Kerala recorded the highest number of COVID-19 cases in the country, yet the death rate in the state continues to be low.
The report also lauds Kerala's efforts in the last two decades “to empower LSGs through devolution of both financial resources and political and administrative power has strengthened the resource base of these institutions and this leaves in a better position to deal with COVID-19 than before.”
“Kerala's 1200-strong LSGs worked in tandem with the state government to create effective interventions during the COVID-19 crisis. Intensive contact tracing and case isolation followed by LSGs succeeded in containing large scale community transmission of the infection. LSGs managed to create this system with the help of health workers, Kudumbashree members, Anganawadi staff, local authorities and the state police. The state also set up a 3,00,000-strong volunteer force for working with their respective local government bodies. Substantial devolution of funds to the local governments over the years has helped to strengthen these institutions,” the report further reads.
According to the report, Kerala has significantly higher spending on healthcare per capita than all the other states. This higher-than-average government spending, as well as out of pocket spending, has borne dividend in the successful handling of the Nipah outbreak, as well as in keeping COVID-19 mortality rates relatively low despite unfavourable demographics.
Disparities in access to healthcare
The report observes that significant inter-state disparities exist in access to and affordability of healthcare. In terms of healthcare human resources, the availability of which is crucial to deal with the fallout from COVID-19, the number of doctors per unit of population in India is broadly comparable with Asian countries with similar demographic characteristics. However, there are significant state-level differences: southern states (except Telangana) have significantly better coverage of medical doctors; while the coverage in low-income states of Uttar Pradesh, Bihar and Jharkhand is among the lowest in the country, the report points out.