A Study on the Development of Healthcare Facilities in Kerala State, India

74 A Study on the Development of Healthcare Facilities in Kerala State, India Shyni M. C., Full time research scholar, Department of Management Studies, Kannur University, Kerala, India ABSTRACT Like in any other public financed economy health competes for resources with other sectors of the economy although health can be treated as a commodity or not is widely debated several movements through have made deep inroads into several sectors of the Indian economy, their presence in social sectors like health is notably low. An exception is Kerala where hospitals have come to play a significant role. The hospitals in the private sectors and co-operative sectors are also playing a crucial role in the state s achievement in the field of health. Many developments outside health, such as growing literacy, increasing household incomes and population ageing (leading to increased numbers of people with chronic afflictions), probably fuelled the demand for health care already created by the increased access to health facilities. Since the government institutions could not grow in number and quality at a rate that would have satisfied this demand, health sector development in Kerala after the mid 1980s has been dominated by the private sector. Expansion in private facilities in health has been closely linked to developments in the government health sector. Public institutions play by far the dominant role in training personnel. They have also sensitized people to the need for timely health interventions and thus helped to create demand.do the hospital in these sectors such as cooperative, public and private witness any significant change in the development of healthcare facilities while making a comparison? To find the answer the researcher proposes to make a detailed study of the selected cooperative, public and private hospitals in Kerala. Keywords: Healthcare, 1. INTRODUCTION Kerala has to its credit a fairly developed healthcare infrastructure and Kerala has a long history of organized health care. When the State was founded in 1956, the foundation for a sound health care system had already been laid. Thereafter, there was remarkable growth and expansion of government health services. The number of beds in government hospitals rose from 13,000 in 1960 to 38,000 in 1996. The annual compound rate of government expenditure on health during that period was higher than the compound rate of total government expenditure and higher than the annual compound rate of growth of the state domestic product.the easy accessibility and coverage of medical care facilities has played a dominant role in shaping the health status of Kerala. Some of the hospitals in Kerala are more than 50 years old. Health had been a major area of spending in the budget from early years in Kerala.(Gangadaharan,2005). The growth of health facilities in Kerala offers many lessons in development. The active role of the state government has seen a key factor in the expansion of health care facilities. The initial period of rapid growth in health facilities was dominated by the public sector up to the 1980s. By the mid 1980s because of fiscal and other problems, there was a slow down n the growth of government health institutions. This affected not only the growth in absolute number of beds, but probably the maintenance of quality as well. However, by this time, the private sector was paired for growth and it took the lead in the growth of health care facilities in Kerala. The growth of the private sector in Kerala should not be seen as independent phenomena. The public sector paved the way for its development by sensitizing the population to the need for sophisticated care and creating demand. The government continues to play leadership role in the training of all strata of health professionals, who are then largely absorbed by the private sector. Factors outside the health field, such a growing income, improvement of literacy and population ageing all contributed to this trend. Kerala knows for its model of Good Health at Low cost achieved through universal availability, accessibility and performance of government healthcare delivery system to even poorer sections of the society. Competition from govt. facilities often serves as an important factor in determining treatment cost in private hospitals (Aravindan, 2000) The annual growth rate of government health care expenditure has been showing a steady increase. India s first ever Human Development Report published in 2002, placed the southern State of Kerala on top of all other states in India, because of easy accessibility and coverage of medical care facilities. Kerala is one state where private health sector, both indigenous and western systems of medicine, has played a crucial role. The Ayurvedic system of treatment practiced in Kerala dates back to centuries. In the field of modern medicine system, missionary hospitals have contributed profusely by even

75 going into the interiors of the state. High level of education especially among Women and greater health consciousness has played a key role in the attainment of good health standards in Kerala. Today with the mushrooming of private hospitals that offer quality services, matching international standards and with the tie up of the health care industry with the tourism sector, health care in Kerala is growing by leaps and bounds (Soman,2007). As such the present study aims to investigate the development of healthcare facilities of the selected private, co-operative and government hospitals in Kerala in order to understand the healthcare sector in Kerala in detail. 2. LITERATURE REVIEW Chattarjee (2002) argued that there are large number of factors which promote the growth of the health care institutions in private sectors in India, there are equally a large number of factors, which frustrate the growth of the private health care institutions in India. Hence efforts are being made to see reasons and allow the private sector health care institutions to grow in the interest of the community.the rate at which the current population is being affected by diverse diseases, it will be essential that the total load of treatment be shared both by public and private sector health institutions in future. Nabae (1997) in his article has analyzed the past accomplishment and new challenges faced by the health care system in Kerala. He also suggests some measures to overcome the challenges faced by the public sector over the private sector.. He suggests that, Kerala must invest in the public sector to revitalize the system. To achieve this, tax revenue must be increased. Second, Kerala must streamline the system through decentralization. Third, Kerala must take a step to revamp the health care system in a way that the public and private sectors effectively cooperate and complement each other to meet the needs of the people. Dilip (2008) tries to understand the characteristics of private hospitals and their equity in assessing their services, using secondary data available for the period 1986-2004. The data indicates that private hospitals did not expand in numbers but a strong consolidation by large hospitals has taken place.public policy favoring increased private sector participation in medical education coupled with opening of super specialty hospitals has led to a situation where small hospitals or nursing homes are losing their significance and a large number of them have been phased out.analysis also shows that the duration of hospitalization is lesser if treated in a private hospitals than in a government hospital and that the charity component in the so called charitable hospitals is disappearing. Kunchikannan and Aravindan (1999 ) aims to link the socio economic and health status of the Kerala state. The study followed up a sample of households surveyed in 1987and conducted a repeat survey of their health and socio economic status in 1996. Panikar(2004) in his special article had examined the achievements of Kerala in the health field.his primary focus is on the rural population,who generally constitute the predominant majority. The conclusion to which this case study leads is that given proper policies and priorities, lack of resources need not be an impediment to improve health status even in low income countries. Gangadharan (2007) have examined the success indicators of health in Kerala with that of the national health and the issues connected with the health care investments and morbidity prevalence in Kerala. The study has great relevance in the present socio economic and environmental contest. The state Kerala which has been considered as a state with advanced human development index and better health status is now ailing from acute morbidities of different communicable and chronic illness. Since high morbidity prevalence in the basic issue of the Kerala s health sector, greater attention is needed to reduce the intensity morbidity prevalence private health care can only be a complementary to public institution and not as a substitute to achieve health for all at least in the near future. To attain the status of health for all, aged population has to be properly rehabilitated and efforts should be made to augment the utilization of health services among the marginal deprived and venerable sections of the society. Moreover there should be better of safe drinking water sanitation and utmost care should be provided for better environmental cleaners both in the urban and rural areas.. 3. SIGNIFICANCE OF THE STUDY Kerala has a long history of organized health care. When the State was founded in 1956, the foundation for a sound health care system had already been laid. Kerala has a vast health care infrastructure under Allopathy, Ayurveda and Homoeopathy system of medicine. In the health sector the role of Allopathy stream is very important and the major participation is focused in the Allopathic sector which has hospitals both in the private and public sector.therefore the paper proposed to conduct a detailed study of the major role played by this sectors in the health care scenario of Keral 4. RESEARCH METHODOLOGY The research is designed as both explorative and descriptive. So the major data source is primary in character. However secondary data from print media

76 (books, reports, monographs) and the official record of the government are also made used. The sample units for the study is selected by multi stage stratified random sampling. First of all the total population is divided into three strata based on region, based on ownership and based on bed strength of each selected hospitals. After the stratification the data are collected from the hospitals according to their bed strength of each private, cooperative and government hospitals.. The bed strength ranging below50, between 51-150, and above 150 forms the group. For the purpose of analyzing the data suitable scaling techniques, mathematical tool like percentage etc 5. RESULTS AND DISCUSSIONS Every hospital requires certain basic facilities to be provided irrespective of the kind of services being made available. Facilities in a hospital refer to the infrastructural and delivery mechanisms comprising of theatres, equipments, devices and supportive services. Techniques for collecting information at this stage include eliciting key information through interviews. The following particulars are collected such as number of laboratories, number of operation theaters, number of radiotherapy units, number of X ray, number of ECG, number of ultrasound scan, number of CT scanner, number of labour rooms, number causality, number of pharmacy etc. of each private,co-operative and government hospitals for making comparison. 5.1Facilities structure of in Kannur district Table 5.1 Section * Cross tabulation- Facilities Section Laboratory 14 18 12 44 OT 23 19 7 49 X Ray 10 13 3 26 ECG 22 20 8 50 Ultrasound Scan 6 3 1 10 C T Scanner 1 2 0 3 Ward 52 47 102 201 Labour Room 6 6 5 17 Casualty 7 8 6 21 Pharmacy 14 18 19 51 Total 155 154 163 472 5.2 Facilities structure of in Ernakulam district Table 5.2 Section * Cross tabulation Facilities Section Laboratory 20 15 14 49 OT 22 14 7 43 X Ray 11 5 3 19 ECG 20 9 7 36 Ultrasound Scan 7 2 1 10 C T Scanner 2 0 1 3 Ward 54 30 104 188 Labour Room 6 3 6 15 Casualty 9 2 7 18 Pharmacy 16 11 12 39 Total 167 91 162 420

77 Table 5.1, 5.2, 5.3 and chart cleared that the facilities available in government hospitals in three district is comparatively lower with private and co-operative hospitals except the number of wards available. Other facilities such as laboratory, operation theatre, X ray, ECG, Ultrasound scan, CT scanner, causality and Pharmacy are maximum in private and co-operative hospitals.there is only slight variation in number with private and co-operative hospitals. 5.3 Facilities structure of in Thiruvananthapuram district Table 5.3 Section * Crosstabulation Facilities Section Laboratory 22 13 35 OT 24 8 32 X Ray 12 4 16 ECG 25 9 34 Ultrasound Scan 8 1 9 C T Scanner 2 0 2 Ward 58 109 167 Labour Room 8 8 16 Casualty 10 8 18 Pharmacy 18 13 31 Total 187 173 360 Table 5.4 Section * Crosstabulation Facilities available (in number overall) Section Laboratory 44 35 49 128 OT 49 32 43 124 X Ray 26 16 19 61 ECG 50 34 36 120 Ultrasound Scan 10 9 10 29 C T Scanner 3 2 3 8 Ward 201 167 188 556 Labour Room 17 16 15 48 Casualty 21 18 18 57 Pharmacy 51 31 39 121 Total 472 360 420 1252 The overall analysis from the table5.4 and chart reveals there is only slight variation in number of facilities available in each private, co-operative and government

78 hospitals. But while comparing, it is clear that the availability of facilities are maximum in private hospitals when all three sample districts are concerned. The analysis reveals that basic facilities were available in more than 90 percent of the hospitals. The availability of facilities, equipment and instrument is of vital concern for a hospital. They should be available in sufficient numbers and be in a working condition. They should be well maintained. Through observation the researcher found out that the majority of the sample hospitals that they were kept in an organized manner. Basic cleanliness was maintained with regard to the facilities, equipment and instruments. But the concern is that some facilities and services such as availability of X ray facilities, ECG, ultrasound scan, CT scanner, operation theater and some services such as gynecology, ophthalmology,general surgery, dermatology were inadequate in some of the hospitals. Through observation the researcher find out that all the sample hospitals are functioning without a cardiology and neurology department at the time of survey. Mostly these services are available in medical colleges. It is lamented that availability of facilities and services provided was very poor in public health institutions especially in hospitals with bed strength below 50. So performance wise there exist significant difference between private, co-operative and public hospitals. CONCLUSION AND LIMITATIONS Thus the study concluded that the development of healthcare facilities of the selected hospitals is varying but their role in the health care sector in Kerala is very significant. Every hospitals evolved certain basic facilities need to be provided irrespective of the services being provided. From the study it is clear that the facilities available in government hospitals in three districts are comparatively lower with private and co-operative hospitals except the number of wards available. Other facilities such as laboratory, operation theatre, X ray, ECG, Ultrasound scan, CT scanner, causality and Pharmacy are maximum in private and co-operative hospitals. There is only slight variation in number with private and co-operative hospitals. But while comparing, it is clear that the availability of facilities are maximum in private hospitals when all three sample districts are concerned. The major limitation for this study is that it has not covered the other types of institutions in the health sector such as Ayurvedic, Homeopathic, and Unani etc and it has become difficult for the researcher to collect data from different hospitals. Perceptions of the respondents are measured through observation, personal interview, questionnaire and schedules. The power structure in India may cause respondents to answer with partially frank acknowledgement of feelings. It became very difficult to meet and elicit opinion of administrators due to their busy schedules. Majority of administrators are under the impression that research on management means probing in to their internal affairs especially in health care sector with this opinion they hesitated in providing the required data. REFERENCES [1] Gangadharan, K. (2005). Utilisation of Health Services in Kerala. New Delhi: Serial Publications. [2] Gangadharan, K. (2007). Morbidity and Health Care in Kerala: A distributional profile and implications. Indian journal of social development, 7(2), pp 195-211. [3] Aravindan, K. T. (1999). Changes in the health status of Kerala 1987-1995. Thiruvanathapuram: Kerala Sasthra Sahithya Parishad. [4] Soman, C. R. (2007). Kerala's Crisis in Public Health. New Delhi: Ministry of Health and Family Welfare. [5] Nabae, K. (1997). The health care system in Kerala- Its past accomplishments and new challenges. Journal of the National Institute of Public Health, 5(15), pp 24-28. [6] Chaterrjee, A. K. (2002). Factors that frastrate the growth of private health sector in India. Economic and Political weekly, 145-152. [7] Muraleedharan, V. R. (2000). Characteristics and structure of private sector hospital in urban India,A study of Madras City. Partnership For Health Reform Project Associates Ltd, Madras. [8] Panikar, P. G. (2004). Resources not the constraint on health improvement- A case study of Kerala. Economic And Political Weekly, 14, pp 85-92. [9] Rajan, I. A. (1993). Kearala's health Status : Some issues. Economic & political weekly, 28(36), pp 1889-1992. [10] Ramankutty, V. (2000). Historical Analysis of the Development of health care facilities in Kerala State,India. Health Policy and Planning, 15, 103-109. [11] Dilip, T. R. (2008). Role of private hospitals in Kerala : An Exploration. Thiruvananthapuram: Centre for Development Studies.