Behind containment in Kerala: robust healthcare system, effective strategies

hough Kerala has only been investing 5% of its total state plan outlay on healthcare — which is also roughly the national average spending in the sector — its focus on healthcare at the level of Primary Health Centres and Community Health Centres has stood it in good stead. (Source:: Kerala Govt PRD)

This community health legacy got a further boost as the state’s focus on literacy and women’s education helped it attain near 100% vaccination levels and develop a culture of personal hygiene. The World Health Organization, in a survey held in 12 countries in 2005, found that hand-washing with soap after defecation had a prevalence of 34% in Kerala, the highest among the states/countries surveyed. So when the state began its ‘Break the Chain’ campaign during the COVID-19 outbreak — to promote hand-washing and use of sanitisers — it only served to reiterate some of those best practices.

Data Source: Govt of Kerala. Click to enlarge

Health infrastructure

A critical factor in Kerala’s COVID-19 battle has been its robust healthcare system, considered on a par with those of many developed countries. In June 2019, Kerala topped all states on the NITI Aayog’s annual health index with an overall score of 74.01, more than 2½ times that of the least-performing state, UP (28.61).

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Though Kerala has only been investing 5% of its total state plan outlay on healthcare — which is also roughly the national average spending in the sector — its focus on healthcare at the level of Primary Health Centres and Community Health Centres has stood it in good stead. With the management of these centres in the hands of three-tier local bodies, many of these have modern diagnostic facilities and offer tele-medicine services.

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The state’s private health sector, once dominated by the Church, has grown rapidly in the last two decades, mainly on the back of investment from NRIs and corporate healthcare groups. At present, Kerala has 142,924 beds in its hospitals, of which the private sector accounts for 93,042.

Focus on the front line

On February 1, the state’s coronavirus control cells laid out guidelines on testing, quarantine, hospital admission and discharge criteria — a living document that is regularly updated.

Besides tracing contacts of positive cases, Kerala strictly enforced 28 days of home quarantine although the general incubation period of the virus is 14 days.

Until late January, the state did not have any testing facility and throat swabs of suspected cases had to be sent to the National Institute of Virology (NIV), Pune. But by the first week of February, NIV-Alappuzha got sanction to conduct the tests. Over the last two months, Kerala’s COVID-19 testing facilities have grown to 13, ten of those in the government sector.

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The state also stepped up its medical facilities, turning defunct hospitals into COVID-19 facilities. So far, 38 government hospitals have been converted into COVID-19 hospitals, and 800 ventilators in public hospitals and 1,578 in the private sector have been identified.

Coronavirus (COVID-19): Outside an isolation ward in Kerala. (PTI Photo/File)

Lessons from Nipah

While broadly sticking to the protocol set up by the Indian Council of Medical Research (ICMR), Kerala put in place its rigorous surveillance network, one that had been fine-tuned to perfection during the outbreak of the Nipah virus in 2018 and 2019.

Besides tracing contacts of positive cases, Kerala strictly enforced 28 days of home quarantine although the general incubation period of the virus is 14 days.

From early March, the state screened all international passengers. Even if someone managed to skip airport screening, they would have to deal with village committees, who kept the health department informed about fresh arrivals and ensured they remained indoors. In hotspots of Kasaragod and Kannur districts, some village panchayats even launched call centres, connecting those quarantined with the authorities.

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Besides, route maps of positive cases, drawn through GPS data, were released to help people self-report if they suspected they might have come in contact with an infected person. Geo-mapping of those under observation enabled better cluster management.

Once flight operations were suspended, the state focused on inter-state road and rail travellers. Those who reached Kerala from other states since March 8 – and their contacts – were asked to isolate themselves. It’s this strategy that helped the state rein in infections from participants of the Tablighi Jamaat event in Delhi. While several other states started acting only when positive cases from among the Tablighis were reported, Kerala had already placed around 217 such persons under observation. Eventually, 20 of them tested positive.

Social, political participation

Despite the largely bipolar nature of Kerala’s politics, almost the entire state would stay tuned to watch Chief Minister Pinarayi Vijayan address his daily press briefings on the state’s tackling of the situation. While Health Minister Shailaja holds daily meetings with district medical officers, the Chief Minister’s Office coordinates with other departments such as police, revenue, electricity, etc. Every evening, the CM chairs a review meeting attended by, among others, Dr B Ekbal, chairman of the expert committee on COVID-19.

The Kudumbashree Mission, the state’s poverty eradication and women empowerment programme, has been at the frontlines with volunteers pitching in to make masks and launching community kitchens.

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