AARDRAM – A Kerala Model Initiative to Revamp Public Health Institutions
The legacy of Kerala in the health sector is of exalted Ashtavaidyas, rejuvenating Kalari-Marma medicinal practices, innovative folk systems and the decentralized use of modern medicines. We had always considered health as the birth right of the people and medical treatment has never been money oriented. The great teachers of this sector had taught to consider the medical treatment as a service to the patients, irrespective of their race, creed or financial status. Taking cue from these great heritage, the first democratically elected government in the State in 1957 under the leadership of E.M.S. Nampoothiripad has laid down the foundation of a strong and sustainable people friendly health policy in the State. The health strategy developed by that government ensured the outreach of the curing effects of modern medicines and the healing traits of traditional practices to the population at large. This people friendly health policy has made significant contributions towards the ‘Kerala Model Development’ which has brought down the mortality and morbidity rates of the population considerably and set the health indices as high as of the rich countries. The free and universal healthcare strategies were followed by all subsequent governments, until the Structural Adjustment Programme was initiated by the Union Government in early 1990s wherein the subject ‘health’ also has become a matter of business and profit. The UDF governments in Kerala that have followed the liberalization and privatization policies diluted the people friendly health policies followed for more than three decades in the State and the great network of public health institutions have been weakened. As a result, the medical treatment has become costly and unaffordable to the common people. In the absence of effective public health institutions,they were chased out to the Shylockian super-specialty institutions where the poor and ordinary people could not afford the treatment expenses.The post 1990s Left Democratic Front governments had to struggle heavily to maintain pro people health policies which was necessary to keep the health standards of Kerala.The LDF government that has assumed office in 2016 is also keen to uphold a policy that will take care of the health demands of common people of Kerala. It is considered as part of the political strategies of the LDF government to salvage the ordinary people from the menace of globalization. The government has therefore designed various strategies to provide effective healthcare system to the people in the public domain with better infrastructure and quality services.
Currently, the State has a wide network of Healthcare Institutions, ranging from sub-Centres to Medical College Hospitals (MCH), both in Allopathy and AYUSH streams. Specialist treatments are mostly given by MCHand institutions like Regional Cancer Centres. However, these institutions are currently not able to manage the large volume of patients who approach them for treatments. This is mainly due to the fact that majority of patients approach these hospitals directly and in the first instance itself without any reference from the lower hospitals. Although many of the ailments they are suffering from can be treated at lower level hospitals, due to the inadequate facilities at these levels they are forced to approach the Medical Colleges etc., at the first instance itself. Unless this issue is tackled properly, our MCHs and speciality centres will not be able to deliver quality services.
The only way to resolve this problem is to strengthen the lower level hospitals where the health issues of majority of the population can be effectively addressed.Emphasis has to be given for primary prevention of communicable as well as non-communicable diseases. On the other hand, the Medical College Hospitals and the specialist Centres should function only as referral hospitals. This will go a long way in reorienting the institutions with proper distribution of duties and responsibilities. There are systemic deficiencies in the public health institutions and fundamental alterations are warranted to make them truly pro-people and patient friendly.
Government of Kerala, as part of the Development Vision, has designed a scheme ‘Aardram’ to revamp the health sector of the state and to revitalize the public health institutions. The objective of ‘Aardram’ mission is to deliver patient friendly quality health care services in Government Hospitals and to add speciality and super speciality facilities in District and Taluk Hospitals. It also envisages to develop Primary Health Centre into Family Health Centres, capable of meeting the healthcare needs of all members of the family and to address the preventive, promotive and rehabilitative healthcare interventions of local community. When fully functional, this will enable Web based appointment system, patient reception and registration, electronic display boards for each consultant, facility for patient to wait for their turn, improved amenities in the waiting areas, location maps and signage etc. This will be done in a phased manner andin the first phase the Medical College Hospitals and District Hospitals will be transformed within one Year with these enhanced facilities.
In order to ensure efficient and timely implementation of the scheme, a core team will be formed in each hospital and projects will be prepared for that institutions taking into consideration of its strengths, weaknesses and opportunities. Importance will be given to modernize Causality,Outpatient and Inpatient departments, labour rooms, operation theatres and laboratory and also to obtain modern X-ray and ultra sound machines.
The whole system will be technically upgraded. Introduction of Electronic Health Card for each individual will be a meaningful step in this direction. With this, all vital details of a person, aliment history and the treatment given from time to time can be collected and stored electronically. When any person approaches the hospital with a health issue, this data will be of immense help for the speedy and proper diagnosis of the disease and providing appropriate treatments. Similarly, when a patient is referred to a higher level hospital it will be helpful to alert the referral hospital and also transfer the vital details of the referred patient.
At the organisation level, ‘Aardram’ mission plans to give importance to PHC’s, Taluk Hospitals and District Hospitals. Facilities in these hospitals will be considerably improved. General medicine, Gynaecology, Surgery, Paediatrics, Psychiatry and physical medicine units will be established in selected hospitals. Taluk hospitals will have facilities like dialysis unit, three stage labour rooms and new born stabilization units. Laboratory facilities like Haematology, Biochemistry and Serology will be made available. District hospitals will have Cardiology, Nephrology and Neurology Units. Strict measures will be undertaken for infection control in the hospitals.
It is true that setting up of different departments and sourcing of modern equipment will not by itself ensure quality health care delivery system. Hence, as a method of quality assurance, treatments protocols will be developed for all major ailment and proper system will be put in place to ensure effective service delivery system. In addition to this, the Local Self Governments also will have important roles to play for ensuring proper functioning of the mission.
Through ‘Aardram’, Government of Kerala envisages radical changes in the field of healthcare.This can be achieved by systematic preparations and proper monitoring at State Government and Local self-Government levels. Different departments like Health Services and Medical education have to play vital roles to make this mission a success.Ward health sanitation committee will have activeparticipation in this programme. Similarly, the Hospital Management Committees will have a major role to play in making the hospital as patient friendly. For expert services, help may be sought even from some of the private institutions and extra governmental agencies in this sector. Services of experts from other states as well as countries also will be solicited.
The importance of the Mission is evident from its organizational structure. The Chief Minister is the Chairman and Health Minister is the Co-chairperson. The Additional Chief Secretary of Health will function as the Chief Executive Officer of the Mission. It will have adequate budgetary support and part of the expenditure will be met through Kerala Infrastructure Investment Fund Board. A portion of the funds of National Health mission and Local Self Governments will be utilized for the effective implementation of the Mission. The funds are properly tied up to ensure hassle free operation of the Mission.
With the implementation of Aardram Mission, the State is going to make a great leap in the health sector. The maladies of communicable diseases, seasonal health hazards, life style diseases and the new generation health issues will be confronted effectively by the new Mission. As a result, the public health institutions will surely gain predominant status and the best health services will be provided by such institutions. Aardram is looking for such an achievement. With the proper and efficient implementation of Aardram, we will be able to address many issues currently prevailing in the health sector of Kerala and to make the health standards of the people of Kerala equivalent to those of the most advanced societies. Since the victory of every government programme lies with the active participation and cooperation of the people, we have to work together to make Aardram a great success.