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Why Kerala is India’s healthiest state

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NITI Aayog member Dr V.K. Paul tells ThePrint it’s because of a sustained focus on health, and a good footprint of the private sector.

New Delhi: A health index report titled ‘Healthy States Progressive India’ released Friday by the NITI Aayog ranked Kerala as the top performing state in the health sector, followed by Punjab and Tamil Nadu, for 2015-16.

The report – a repository of state-wise data on key health outcomes and other service delivery and institutional measures collected from various sources – has listed Uttar Pradesh as the worst-performing state, followed by Rajasthan and Bihar. The rankings released by Niti Aayog are crucial as central funding assistance will be given to states based on it.

Kerala is the top state according to the report in the base year of 2014-15 too, highlighting the state’s consistent performance on several health outcomes parameters like neonatal mortality rate (NMR), the under-five mortality rate (U5MR), and sex ratio at birth, among others. The state’s health indicators have surpassed other states since the 1980s.

NMR denotes the number of deaths occurring in the first 28 days of life per thousand live births. U5MR reflects the probability of death before attaining the age of five. Almost 68 per cent infant deaths in India take place in the neonatal stage. As per the report, Kerala registered only six neonatal deaths and 13 under-five deaths in both the years, and has already achieved a replacement-level fertility.

What’s the secret?

Health experts say Kerala has a unique health model.

Dr V.K. Paul, member (health) of the NITI Aayog, says Kerala has a historical advantage, since over a period of time, with an accelerated response and good governance, the state has built a solid foundation in the health sector. It also has a good footprint of the private sector.

“Kerala has also got a responsive public health system. Moreover, the state has also focused on women’s empowerment and put emphasis on health and education as core priorities,” Paul told ThePrint.

“However, Kerala too needs improvement in certain areas, such as non-communicable diseases,” he added.

The state recorded the highest sex ratio at birth (SRB) among all states. Between 2012 and 2014, Kerala registered an SRB of 974, while between 2013 and 2015, the SRB was 967. Kerala doesn’t feature on top of the list in full immunisation coverage for infants between 9 and 11 months, but it hovers around 94.6 and 95.5 per cent. The state has registered a high percentage of institutional deliveries, along with Gujarat.

However, the state has one of the highest out-of-pocket expenditure per delivery in a public health facility, at Rs 6,901.

Kerala also has fewer vacancies for staff nurses at primary health centres (PHCs) and community health centres, and medical officers at PHCs – important for immediate medical intervention. It also lacks 24×7 functional PHCs.

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