Health Secretary, Kerala

Dr K Ellangovan,
Secretary, Kerala

Kerala has the advantage of better human resources in numbers and skills in comparison to other states, and we continue to lead in healthcare sector too, says Dr K Ellangovan, Health Secretary, Kerala. Karthik Sharma and Nayana Singh take a closer look at the health sector in the state.

Kerala has been at the forefront as far as health standard of people are concerned. Please give an overview of operations of health department in the state?
Health department in Kerala has structure to similar to other states. It has eight HOD. We have very responsive workforce coupled with demanding patients. The Kerala has a high morbidity rate but a lower mortality rate paradox. Health system has to meet its challenge only by being effective and efficient. And we also have the advantage of better human resources in numbers and skills in comparison to other states. The department as a whole in structure is similar to other states. However, on account of human resource and virtue of people seeking high level of health care, the department is doing very well.

eHealth is first of its kind initiative in the country which has its origin in Kerala. So, please tell us something about it and how far it has been successful?
eHealth is a very ambitious project that is appropriately approved and sanctioned by the ministry of information technology. We have done fairly a detailed job in terms of documentation of our needs. Our request for proposal document is quite comprehensive. Essentially, it has got two parts EHR (Electronic Health Record) and EMR (Electronic Medical Record). The EHR is population based record and EMR is episodic based record. We have get into a mechanism by which ministry of health and family welfare requirement are also taken into consideration. So stipulated by the ministry of health and family welfare EGR and EMR has been built in our system. We have tendered out a RFP and selected a vendor or a client or a service provider. Work has just begun for it.

It has two parts. The first tender is on software part this is to deliver a business process cycle in hospitals and after that go for hardware tender to equip the institutes with computers, tablets and note pads. Idea is to capture the entire transaction between physician and a patient in on electronic format. So that data is ready not only for research, policy formulation but also patient management. This begins with appointment of patients and doctors, post treatment followup and survey. Entire episode will be captured into electronic format. In two three months, we will finalize the software, customize it and finalize it and in next six months it will be implemented on pilot basis in districts of Thiruvananthapuram.

For such an ambitious project are you planning to carry it on PPP mode to carry it out? How are you planning to ute it out?
No, we have selected a service provider; we have tendered it out on the lowest bid. We have formulated committees and project management team that interact with service provider on day-today basis. In this way data information is shared across on both sides and concept is developed to work further. There is no PPP and third party.

Public health care in the Kerala is one of the highest in India as cited by various indices and studies?
Tell us about its success? Public health care is quite successful here in Kerala by push and pull factors. We have a policy of decentralized planning. In terms of Public Health Care at the lowest levels decisions are made at Panchayat ward level committees headed by ward member named as ward level sanitation committees. So every year, this committee is given money by Gram Panchayats, Government and NGRM. Gram Sabhas having money with them at ward levels identify public health threat. They do awareness things with Panchayats. At the lowest level the public health is discussed and from there the information is goes up to Panchayts, Blocks and District Panchyats yayet. So, the health care in Kerala is decentralized to the ward level.

As far as rural health care in Kerala is concerned, How do look at rural health in Kerala?
Kerala basically is a rural urban continual, you dont really demarcate and urban and rural area here. But we have such pockets as tribal and costal blocks. We depends heavily on the field staff department, JPHS to public health nurses, lady health inspectors and blocks PHCS. Data from these areas communicable diseases is shared. Integrated Surveillance of Disease ISDP projects are being carried out. We have well connected web based system. System of close monitoring and reporting of communicable diseases instances work here.

As you said Kerala is Rural- Urban continual, It is one of the most urbanized areas in India, What steps are you taking to assure public health in urban areas?
We have a good share of Urban Health Mission. In fact corporations are responsible for health care in urban areas. But we have introduced urban health centers. We find many of people coming to these centers. Urban Health Mission, that was earlier separate from NHRM last year now has integrated and has become NHM mission. NHM now caters to urban as well as urban health component.

Please throw light on your views how you are planning at policy level to ensure health standards for women and children, especially?
We have strong system of women role in decision making in Kerala. With respect to women health the strength is seen in public health by excellent performance in reduction of EMR and IMR. That is because of the awareness of people. There are three mandatory anti natal check ups for possibly highest in the country in Kerala. This way maternal health is taken care off in the state. We also have vibrant public health nurses JPHS and supplement field health care workers known as Ashas. Ashas are educated young enterprise health care workers.

Along with being an IAS officer you are also a Medicine Doctor, where do you see Kerala in terms of health care in coming times?
In the area of health care, Kerala has strong fundamentals in terms of terms of institutional support and the people in the state have high health seeking behavior. The health is an important area in Kerala because people have attached lots of importance to health consciousness. They dont neglect their own health. And government is also extremely active about the health of masses, therefore have spent a good amount of money on health during four years.

There has been an increase of 58% in 58% in plan outlay. An amount of 445 crores was incurred on health during 2010-11 and that rose to 665 crores in 2013-14, with an increase of 15 to 16 percent every year. That is considerably 7 to 8 percent annually for other states of India in comparison. With this type of plan outlay, you will be able to increase the number of staff. We have added almost 3,000 staff in Kerala health department in last three years.

We through NHRM supplemented in personal and difficult areas. I think, Kerala is doing well in health care sector. The challenge is not communicable diseases but communicable diseases. We are concentrating special focus on controlling and managing diabetes, hyper tension and lifestyle disorder and diseases for Kerala in coming times.

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