Banking - Yojana

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Table I
Trend in Death Rate-International
Comparison
S.N. Countries 1970-75 1990-95
United Kingdom 12 12
2 U.S.A. 9 9
3 Japan 7 8
4 Belgium 12 12
5 Sweden 10 12
6 France II 10
7 Switzerland 9 10
Source: World Development Indicator- World
Bank 1999.
expectancy at birth (LEB). Life
expectancy in Kerala is similar to
the corresponding figures for
developed countries classified as
having achieved high human
developmen t in Human
development report-1993. A man
in Kerala is expected to live for
69 years or 10 years longer than
the average Indian man, and a
woman in kerala can expect to
live 74 years or 15 years longer
than the average Indian woman.
[Sen and Dreeze 1996]
In respect of all the above
variables, Kerala is found to have
done better than the middle
income and low income
countries. While the average IMR
and LEB in the high income
economies reflect better health
status than in Kerala, in terms of
CDR, Kerala outrun the position
of high income countries. In
terms of survival norms, Kerala's
record is comparable to that of
high income countries (Table 2).
It is surprising to note that
Kerala's remarkable achievement
in health sector is with a low
income base.
From the above analysis, it is
seen that uniqueness of the
achievement of Kerala in the field
of health, stands out not only from
the rest ofIndia but also the world.
Kerala has demonstrated what can
be achieved by a high level of social
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Table 2
Broad Jndices of Health-I 991
Health Kerala Low Income Middle High Income
Indicators Countries Income
CDR 6 10 10 9
CBR 18 28 24 13
IMR 17 80 73 7
LEB 71 60 62 77
Source: Abstract from Healt/; Transition in Kemla-P. G. K. Panicker-Discussion 1mper number
10, December, 1999 KRPL. CDS
development supported by a
modest medical services. It has
achieved at a cost ofless than $ 15
per capita, a health status
measured by IMR, LEB, DR, which
is almost comparable with that of
wealthiest country of the world
expenditure about $4000 per
capita. (N.H. Anitha)
Reasons
Let us now turn to the reasons
behind this achievement of Kerala.
A United Nation's study (1975) on
Kerala's health development
concludes that the development of
Kerala in lowering mortality rate
and rising life expectancy to almost
to the levels of more developed
countries must be attributed largely
to the widespread network of health
services and the scales which they
are used. Public health measures
such as sanitation, control of
infectious disease introduced by
Travancore and Cochin in 19th and
20th centuries were the key to
reduce mortality Nair [1974]
suggested that the extension of
primary health centres and public
health measures in the state has led
to the decline in the IMR and
mortality in 1950s and 1960s.
Panikker and Soman (1984) laid
equal emphasis on public health
and medical care services. While the
first phase of health status
improvement was attributed to
preventive health measures against
infectious disease, in the second
phase, the stress was on the
expansion of medical care. This was
also supported by KSSP study'
(1991). Thus major studies tend to
concentrate on the success of public
health measures in controlling
infectious diseases and on greater
accessibility and utilization of
medical care system in Kerala.
Though public health measures
played a vital role in improving
health indicators in the early
decades of 20th century, mushroom
growth of private sector played a
dominant role in the later periods.
Today, rate of utilization of private
sector has increased drastically
pointing to the poor performance
of public health sector. The KSSP
study found that in case of acute
illness, 66% of people depend on
private institutions. Nearly 43% of
the poor also utilizes the services of
private institutions. According to
Paniker (1992) private expenditure
in Kerala on health is one of the
highest in India. Thus, the
importance of the public health
sector in health service in the state,
has waned greatly.
Higher and increasing trend of
utilization of private sector even by
the poor is a good indicator of
several shortcomings of public
health care institutions like lack of
supplies, corruptions, bribing, out
moded equipment, internal
privatization etc. A study
conducted by T.P. Kunnikannan
and K.P. Aravindan (2000) looked
in to the reasons for opting private
YOJANAJuly 2002