THIRUVANANTHAPURAM: Kerala’s public healthcare system has often been a hot topic in development debates across the country and even abroad, and for good reason. However, despite topping in five of the 11 indicators, the state has now been ranked fourth in the NITI Aayog’s ‘good health and wellbeing index’. Reason: Unscientific thinking against immunisation and institutional deliveries gaining ground in the state, as well as inclusion of three new parameters.
Gujarat now holds the top spot in the ranking.
NITI Aayog’s SDG India Index computes goal-wise scores on 17 sustainable development goals (SDGs) for states and union territories (UTs), besides a composite index.
One of them, SDG 3 on ‘good health and wellbeing’, assesses the performance in the health sector. Kerala topped SDG 3 in the first two index reports, but could not find a place even in the top 3 in later editions. However, the state has been retaining the top slot in the composite index — cumulative score of all goals — since the first edition.
When Kerala topped the SDG 3 chart in 2018 (the first edition) and 2019-20, it scored 92 and 82 points, respectively, well above the national average. In 2020-21 (third edition), three new indicators were included — suicide rate, accident death rate and out-of-pocket expenditure — and the state plummeted to 12th position with a score of 72 points, below the national average of 74. Gujarat stood first with a score of 86.
In the fourth and latest edition (2023-24), Kerala improved its score to 80 surpassing the national average of 77. However, it had to settle for fourth place in the country. Gujarat retained the top slot with a score of 90. It was followed by Maharashtra and Uttarakhand (84) and Himachal Pradesh (83). Karnataka shared the fourth spot with Kerala.
Vaccination percentage falls to 85.40 in 2023-24
States that finished last were Chhattisgarh and Madhya Pradesh (both 56 points). Among UTs, Delhi came first with a score of 93, followed by Chandigarh, 89.
SDG 3 is calculated on the basis of 11 indicators. While Kerala retained the top position in five categories — maternal mortality ratio, under-5 mortality rate, HIV incidence, life expectancy and health worker density — it registered a significant dip in the immunisation of children aged 9-11 months and institutional deliveries. Vaccination percentage came down from 92 in 2020-21 to 85.40 in 2023-24. Also, the percentage of institutional deliveries dropped from 99.90 to 99.85.
In addition, the state fared badly in the new categories. In the 2023-24 edition, Kerala’s suicide rate was 28.50 per lakh population, up from 24.30 in 2020-21. It was much higher than the national average of 12.4 and the prescribed target of 3.5. Though the road accident death rate declined from 12.42 to 12.10 per lakh population in the latest edition, it remained higher than the national average of 12.4, and the targeted 5.81. Monthly per capita out-of-pocket medical expenditure is 17%, the highest in the country. “Developed societies have comparatively higher suicide rates and the state needs to improve its counselling and treatment facilities,” said Dr N M Arun, a public health expert.
“The positive side is that the younger generation has played a role in reducing the stigma surrounding mental health compared to older ones. Facilities in the government sector should be improved. Many hospitals lack a properly designed cabin where a patient can open up to a psychiatrist,” he said. According to Arun, misinformation through social media is one of the reasons for the dip in vaccination and institutional deliveries. “Not just religious factors, misinformation through social media too is a reason for the inclination towards anti-vaccine arguments and home delivery,” he said.