Is Kerala's celebrated healthcare model weakening? Doctor's post sparks debate

Dr Haris Chirakkal, head of urology at the Government Medical College, Thiruvananthapuram, is not a man unfamiliar with Kerala’s health system—he’s been part of it for over two decades. He is also one of the few senior doctors in the state who has chosen not to engage in private practice, despite being entitled to do so under government rules.

Colleagues say he has politely declined private referrals over the years, opting instead to focus on his role in the public health sector.

Deeper malaise

When Dr Haris expressed his dismay over repeated surgical delays due to unavailable implants, it struck a nerve. His words — measured but firm — did not target individuals, but pointed to a deeper malaise: a public health system often praised for its top-line indicators, yet increasingly strained on the ground by procurement delays, infrastructure gaps, and administrative inertia.

The doctor’s statement, later deleted under pressure, was not an outburst, but a clear and specific articulation of how resource constraints directly impact patient care.

In this case, four urology surgeries had to be postponed in a single week, not due to lack of expertise or infrastructure, but because basic surgical tools were missing — a consequence, he said, of procedural failures in medical supply management.

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This wasn’t an isolated complaint. Across Kerala’s government hospitals — including many medical colleges — delays in procurement, outdated equipment, understaffing, and fund shortages have been noted for years, though rarely acknowledged so openly.

The strength of Dr Haris’s intervention lay in its tone: it was not political, nor defeatist, but rooted in the belief that Kerala’s health system could and should do better.

Probe ordered

The state government was quick to respond. Health minister Veena George, while defending the state’s record, acknowledged the concern raised by Dr Haris and ordered an internal inquiry.

A four-member committee led by Dr B Padmakumar was appointed to probe the delays in surgical implant availability and other supply issues.

The health minister’s initial remarks called Dr Haris a committed professional and reassured that no punitive action would follow. Instead, she said, the matter was an opportunity to understand procurement bottlenecks and rectify systemic inefficiencies.

“Yes, we have achieved a lot in the last eight years. But that doesn’t mean we are above criticism. If someone raises an issue in the interest of patients and public service, it must be taken seriously.”

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The minister also pointed out that over ₹700 crore worth of medical equipment had been purchased in recent years, and that logistical delays — including at the Kerala Medical Services Corporation — were being streamlined.

Still, the admission of gaps, especially in Kerala’s flagship medical institutions, marked a significant shift in tone from previous, often celebratory, narratives.

(Later, the equipment was flown in from Hyderabad, and the surgeries that had been postponed resumed on Tuesday. According to Dr Haris, the procedures were delayed due to the unavailability of probes—a concern he publicly raised on Friday.)

UDF's 'alternate health policy'

Sensing an opportunity to corner the government, the UDF jumped into the fray.

Leader of the Opposition VD Satheesan announced that the UDF would constitute an expert commission led by Congress leader Dr S S Lal to draft an “alternate health policy” for Kerala — one that would focus on addressing the “collapse of service delivery in the state’s premier health institutions”.

According to Satheesan, several schemes including Karunya, Hridyam and Arogya Kiran have been underperforming due to fund shortages and institutional mismanagement. He alleged that patients are increasingly being forced to buy essential medicines and devices on their own, which defeats the purpose of a universal public health system.

More pointedly, the UDF accused the LDF government of failing to uphold the public service values it claims to protect. “If even a senior doctor is considering resignation out of helplessness, that should tell us where we are headed,” Satheesan remarked.

As the Opposition UDF stepped up its campaign, projecting a “healthcare crisis” and announcing a commission to draft an alternate health policy for the state, health minister Veena George responded not just with rhetoric. She gave a detailed comparison of health outcomes and infrastructure growth under the LDF versus the UDF.

LDF vs UDF

In 2015–16, at the end of the UDF’s tenure, Kerala’s Maternal Mortality Rate stood at 43 per 100,000 live births. In 2024–25, that number has declined to 19, she noted. Similarly, the Infant Mortality Rate dropped from 12 to 6 per 1,000 live births, and the Neonatal Mortality Rate from 6 to 4.

“These are not just numbers — they represent thousands of lives saved,” she said, countering the UDF’s claim that the system is collapsing. “If we had failed, we would not be seeing improved outcomes across every core indicator, ” she pointed out.

Moving to financial protection, Veena George underscored that the free treatment ceiling per family had jumped from ₹30,000 under the UDF to ₹5 lakh under the LDF — a more than 16-fold increase. She added that the number of families benefiting from this scheme had risen from 28 lakh to 42.5 lakh, covering nearly three-fourths of Kerala’s population.

“Family Health Centres, virtually absent during the UDF period, now number close to 900. Urban People’s Health Centres, another LDF-era initiative, have reached 380 in number. Even tertiary care has improved, with 12 new cath labs installed in district hospitals — compared to none under the previous regime,” claimed the minister.

Infrastructure fatigue

And yet, as doctors and nurses often observe, these achievements coexist with significant constraints.

Medical colleges report chronic delays in equipment maintenance and recruitment. New medical institutions have opened, but without adequate staffing or specialist availability. Transfers and promotions have become increasingly politicised, and procurement remains a slow, bureaucratic process.

A recent National Sample Survey (NSSO) report, while praising Kerala for reducing household health expenditure by nearly 60 per cent, also flagged infrastructure fatigue and uneven quality across districts. Average rural household spending on health fell from ₹17,054 in 2016 to ₹10,929 in 2024 — a success — but one that risks being undermined if service delivery weakens at its base.

Renewal required

The significance of the current moment lies not in political blame games but in what it reveals about the maturity of Kerala’s health discourse. For years, constructive criticism of the system was often dismissed as politically motivated or ungrateful. What the current episode demonstrates is that criticism can — and must — coexist with pride in the system.

Doctors like Dr Haris, and many others who haven’t spoken out publicly, believe in the public system because they work within it. Their critique is not ideological opposition, but professional concern. Ignoring their voices, or treating them as political tools, would be a disservice to the very model the state takes pride in.

Kerala’s health sector doesn’t need reinvention, but renewal. That means strengthening procurement systems, depoliticising hospital administration, ensuring adequate staffing in new institutions, and building in feedback mechanisms that allow frontline health workers to speak up — without fear or favour.

As the government appointed expert panel begins its probe and the Opposition rolls out its own commission, the challenge now is to ensure that these parallel initiatives don’t become mere instruments of political signalling.

Kerala has the legacy, the infrastructure, and the human capital to lead once again — not just in health outcomes, but in creating a culture of responsive governance. The first step, as this episode shows, is to listen — especially when the voices come from inside the system.