Kerala model


The Kerala model refers to the practices adopted by the Indian state of Kerala to further human development. It is characterised by results showing strong social indicators when compared to the rest of the country such as high literacy and life expectancy rates, highly improved access to healthcare, and low infant mortality and birth rates. Despite having a lower per capita income, the state is sometimes compared to developed countries. These achievements along with the factors responsible for such achievements have been considered characteristic results of the Kerala model.
Academic literature discusses the primary factors underlying the success of the Kerala model as its decentralization efforts, the political mobilization of the poor, and the active involvement of civil society organizations in the planning and implementation of development policies.
More precisely, the Kerala model has been defined as:
  • A set of high material quality of life indicators coinciding with low per-capita incomes, both distributed across nearly the entire population of Kerala.
  • A set of wealth and resource redistribution programmes that have largely brought about the high material quality-of-life indicators.
  • High levels of political participation and activism among ordinary people along with substantial numbers of dedicated leaders at all levels. Kerala's mass activism and committed cadre are able to function within a large democratic structure, which their activism has served to reinforce.

    History

The Kerala model originally differed from conventional development thinking which focuses on achieving high GDP growth rates, however, in 1990, Pakistani economist Mahbub ul Haq changed the focus of development economics from national income accounting to people centered policies. To produce the Human Development Report, Haq brought together a group of well-known development economists including: Paul Streeten, Frances Stewart, Gustav Ranis, Keith Griffin, Sudhir Anand, and Meghnad Desai.
File:UN Headquarters 2.jpg|thumb|right|200px|The Human Development Index, which was introduced by the United Nations Development Programme, has become one of the most influential and widely used indices to measure human development across countries.
Economists have noted that despite low income rates, the state had high literacy rates, healthy citizens, and a politically active population. Researchers began to delve more deeply into what was going in the Kerala model, since human development indices seemed to show a standard of living which was comparable with life in developed nations, on a fraction of the income. The development standard in Kerala is comparable to that of many first world nations and is widely considered to be the highest in India at that time. However, the state's total debt has surged by 80% in five years, government plans to halve its plan size for 2024-25 budget.

Human Development Index

The United Nations developed the Human Development Index in 1990 as a composite statistic used to rank countries by level of "human development" and separate developed, developing, and underdeveloped countries. The HDI is used in the United Nations Development Programme's annual Human Development Reports and is composed from data on life expectancy, education and per-capita GDP collected at the national level using a formula. This index, which has become one of the most influential and widely used indices to compare human development across countries, gave the Kerala model international recognition since Kerala has consistently had scores comparable to developed countries since the HDI's inception.
In 2022, Kerala again tops the HDI among the major Indian states with a score of 0.758, according to the Global Data Lab.

Public health

History

Kerala's improved public health relative to other Indian states and countries with similar economic circumstances is founded on a long history of successful health-focused policies.
One of the first key strategies Kerala implemented was making vaccinations mandatory for public servants, prisoners, and students in 1879 prior to Kerala becoming a state, when it was composed of autonomous territories. Moreover, the efforts of missionaries in setting up hospitals and schools in underserved areas increased access to health and education services. Though class and caste divisions were rigid and oppressive, a rise in subnationalism in the 1890s resulted in the development of a shared identity across class and caste groups and support for public welfare. Simultaneously, the growth in agriculture and trade in Kerala also stimulated government investment in transportation infrastructure. Thus, leaders in Kerala began increasing spending on health, education, and public transportation, establishing progressive social policies. By the 1950s, Kerala had a significantly higher life expectancy than neighboring states as well as the highest literacy rate in India.
Once Kerala became a state in 1956, public scrutiny of schools and health care facilities continued to increase, along with residents' literacy and awareness of the necessity of access health services. Gradually, health and education became top priorities, which was unique to Kerala according to a local public health researcher. The state's high minimum wages, road expansion, strong trade and labor unions, land reforms, and investment in clean water, sanitation, housing, access to food, public health infrastructure, and education all contributed to the relative success of Kerala's public health system. In fact, declining mortality rates during this time period doubled the state's population, and immunization services, infectious disease care, health awareness activities, and antenatal and postnatal services became more widely available. In the 1970s, a decade before India initiated its national immunization program with WHO, Kerala launched an immunization program for infants and pregnant women. In addition, smaller private medical institutions complemented the government's efforts to increase access to health services and provided specialized healthcare. As a result, life expectancy continued to increase in Kerala, though household income remained low. Thus, the concept of the "Kerala model" was coined by development researchers in Kerala in the 1970s and the state received international recognition for its health outcomes despite a relatively low per capita income.
In the mid-1970s to the early 1990s, a fiscal crisis caused the government to reduce spending on health and other social services. Reductions in federal health spending also affected Kerala's health budget. As a result, the quality and abilities of public healthcare facilities declined and residents protested. Eventually, private health services began to take over, enabled by a lack of government regulation. In fact, by the mid-1980s, only 23% of households regularly utilized government health services, and from 1986 to 1996, private-sector growth significantly surpassed public-sector growth.
In 1996, Kerala began to decentralize public healthcare facilities and fiscal responsibilities to local self-governments by implementing the People's Campaign for Decentralized Planning in response to public distrust and national recommendations. For instance, new budgetary allocations gave local governments control of 35 to 40% of the state budget. Moreover, the campaign emphasized improving care and access, regardless of income level, caste, tribe, or gender, reflecting a goal of not just effective but also equitable coverage. A three-tier system of self-governance was established, consisting of 900 panchayats, 152 blocks, and 14 districts. The current healthcare system arose from local self-governments supporting the construction of sub-centers, primary health centers that support five to six sub-centers and serve a village, and community health centers. The new system also allowed local self-governments to create hospital management committees and purchase necessary equipment.

Present

The basis for the state's health standards is the state-wide infrastructure of primary health centers. Under the current system, the primary health centers and sub-centers were brought under the jurisdiction of local self-governments to respond to local health needs and work more closely with local communities. As a result, health outcomes and access to healthcare services have improved. There are over 9,491 government and private medical institutions in the state, which have about 38000 beds for the total population, making the population to bed ratio 879—one of the highest in the country.
There is an active, state-supported nutrition programme for pregnant and new mothers and about 99% of child births are institutional/hospital deliveries, leading to infant mortality in 2018 being 7 per thousand, compared to 28 in India, overall and 18.9 for low- middle income countries generally. The birth rate is 40 percent below that of the national average and almost 60 percent below the rate for impoverished countries in general. Kerala's birth rate is 14.1 and decreasing. India's rate is 17 the rate of the U.S. is 11.4. Life expectancy at birth in Kerala is 77 years, compared to 70 years in India and 84 years in Japan, one of the highest in the world. Female life expectancy in Kerala exceeds that of the male, similar to that in developed countries. Kerala's maternal mortality ratio is the lowest in India at 53 deaths per 100,000 live births.
According to the India State Hunger Index, in 2009, Kerala was one of the four states where hunger was only moderate. The hunger index score of Kerala was 17.66 and was second only to Punjab, the state with the lowest hunger index. The nationwide hunger index of India was 23.31. Despite the fact that Kerala has a relatively low dietary intake of 2,200 kilocalories per day, the infant-mortality rate and the percentage of the population facing severe undernutrition in Kerala is far lower than in other Indian states. In early 2000, more than a quarter of the population faced severe undernutrition in three states—Orissa, Uttar Pradesh, and Madhya Pradesh—though they had a higher average dietary intake than Kerala. Kerala's improved nutrition is primarily due to better healthcare access as well as greater equality in food distribution across different income groups and within families.
Medical Colleges34
Hospitals1280
Community Health Centres229
Primary Health Centres933
Sub Centres5380
AYUSH Hospitals/Dispensary162/1473
Total Beds38004
Blood Banks169

District-wise Hospital Bed Population Ratio as per the 2011
DistrictPopulation CensusNumber of bedsPopulation Bed Ratio
Alappuzha21277893424621
Ernakulam32823884544722
Idukki110897410961012
Kannur25230032990844
Kasaragod130737510871203
Kollam263537523881104
Kottayam19745512817701
Kozhikode308629328201094
Malappuram411292025031643
Palakkad280993426221072
Pathanamthitta11974121948615
Thiruvananthapuram33014274879677
Thrissur31212003519887
Wayanad8174201367598
Total3340606138004879

The Health Index, ranking the performance of the States and the Union Territories in India in Health sector, published in June 2019 by the NITI Ayong, Ministry of Health and Family Welfare, Government of India and The World Bank has Kerala on top with an overall score of 74.01.Kerala has already achieved the SDG 2030 targets for Neonatal Mortality Rate, Infant Mortality Rate, Under-5 Mortality rate and Maternal Mortality Ratio.
The Economist has recognized the Kerala government for providing palliative care policy and funding for community-based care programmes. Kerala pioneered universal health care through extensive public health services. Hans Rosling also highlighted this when he said Kerala matches U.S. in health but not in economy and took the example of Washington, D.C. which is much richer but less healthy compared to Kerala.
Key Health Development indicators- 'Kerala & India'
Health IndicatorsKeralaIndia
Life expectancy at birth 74.3969.51
Life expectancy at birth 79.9872.09
Life expectancy at birth 77.2870.77
Birth rate 14.117.64
Death rate 7.477.26
Infant mortality rate 728
Under 5-Mortality rate1036
Maternal mortality ratio 53.49178.35