Kerala model

The Kerala model of Development refers to the practices adopted by the Indian state of Kerala. It is characterised by results showing strong social indicators when compared to the rest of the country such as high literacy and life expectancy rates, highly improved access to healthcare and low infant mortality and birth rates. Despite having a lower per capita income, the state is often compared, at all metrics, to developed countries.^[1] These achievements along with the factors responsible for such achievements have been considered characteristic results of the Kerala model.^[1][2]

More precisely, the Kerala model has been defined as:

• A set of high material quality-of-life indicators coinciding with low per-capita incomes, both distributed across nearly the entire population of Kerala.
• A set of wealth and resource redistribution programmes that have largely brought about the high material quality-of-life indicators.
• 

  Human Development Index- Various Indian States, 2018
  High levels of political participation and activism among ordinary people along with substantial numbers of dedicated leaders at all levels. Kerala's mass activism and committed cadre are able to function within a large democratic structure, which their activism has served to reinforce.

History[]

K. N. Raj

The Centre for Development Studies at Thiruvananthapuram, with the help of United Nations, conducted a case study of selected issues with reference to Kerala in the 1970s as a part of their study. The results and recommendations of this study came to be known as the 'Kerala model' of equitable growth which emphasised land reforms, poverty reduction, educational access and child welfare. Economy professor K. N. Raj was the main contributor behind this study. He started the Centre for Development Studies in Thiruvananthapuram in 1971, by the request of the Kerala Chief Minister C Achutha Menon.^[3][4]

The Kerala model originally differed from conventional development thinking which focuses on achieving high GDP growth rates, however, in 1990, Pakistani economist Mahbub ul Haq changed the focus of development economics from national income accounting to people centered policies. To produce the Human Development Report (HDRs), Haq brought together a group of well-known development economists including: Paul Streeten, Frances Stewart, Gustav Ranis, Keith Griffin, Sudhir Anand, and Meghnad Desai.

In collaboration with Raj's close colleague, Indian economist Amartya Sen, he persuaded the UNDP to carry out work on Human Development Indicators (HDIs), which started playing a large role beside GDP in the framing of development policies. Another decade down the road, the Millennium Development Goals, embracing many of the Kerala Model's features – with the notable omission of land reforms – became the new charter of development. Raj's seminal contribution to development policy thus had worldwide repercussions.^[3][4]

1970[]

The Human Development Index, which was introduced by the United Nations Development Programme (a branch of the United Nations Organisation), has become one of the most influential and widely used indices to measure human development across countries.

Economists have noted that despite low income rates, the state had high literacy rates, healthy citizens, and a politically active population. Researchers began to delve more deeply into what was going in the Kerala Model, since human development indices seemed to show a standard of living which was comparable with life in developed nations, on a fraction of the income. The development standard in Kerala is comparable to that of many first world nations, and is widely considered to be the highest in India at that time.^[5]

Despite having high standards of human development, the Kerala Model ranks low in terms of industrial and economic development. The high rate of education in the region has resulted in a brain drain, with many citizens migrating to other parts of the world for employment. The job market in Kerala is forcing many to relocate to other places.

Human Development Index[]

1990[]

From 1990 onwards, the United Nations came with the Human Development Index (HDI). This is a composite statistic used to rank countries by level of "human development" and separate developed (high development), developing (middle development), and underdeveloped (low development) countries. The statistic is composed from data on Life Expectancy, Education and per-capita GDP (as an indicator of Standard of living) collected at the national level using a formula. This index, which has become one of the most influential and widely used indices to compare human development across countries, give Kerala Model an international recognition. The HDI has been used since 1990 by the United Nations Development Programme for its annual Human Development Reports. From the starting of this index, Kerala has scored high, comparable to developed countries.

2011[]

The India Human Development Report, 2011 prepared by Institute of Applied Manpower Research, placed Kerala on top of the index for achieving highest literacy rate, quality health services and consumption expenditure of people.^[6][7]

2019[]

The state again tops the HDI among the Indian States with a score of 0.782, according to the Global Data Lab^[8]

Health care[]

Calicut Medical College in Kozhikode. Kerala has around 9,491 government and private medical institutions in the state, with a Population Bed ratio of 879, one of the highest in the country.^[9]

Kerala’s achievements in health scenario is on par with developed countries. It topped the performance in meeting Millennium Development Goals. The state has a better health standard with low birth and death rate, rapidly declining growth rate, high level of acceptance of family planning methods and increased life expectancy.In spite of these achievements, the higher morbidities due to demographic transitions and the Non-Communicable Diseases(NCD), form a public health threat which demands a multidimensional management through inter-sectoral co-ordination. This, during the COVID-19 pandemic, has formed the foundation for Kerala to set specific targets to be achieved in line with the Sustainable Development Goal No.3, through the initiative named AARDRAM mission. The initiative aims to provide quality health services at all levels.The program envisages to convert primary health centres into family health centres in a phased manner in order to deliver effective family centred health services.^[10] The state has set specific targets on Hepatitis, Leprosy,Lymphatic Filariasis, Malaria, Tuberculosis and AIDS.In addition to seven SDG targets of UN, Kerala has set target 8 on Dental health, Eye health & Palliative care.^[10]

Government Medical College, Thiruvananthapuram. Founded in 1951, it is the oldest Medical College in Kerala and one of the largest tertiary care hospitals in the state. During the 1950s Asian flu pandemic, it was the principal institute to isolate and research the virus. ^[11]

The basis for the state's health standards is the state-wide infrastructure of primary health centres. There are over 9491 government and private medical institutions in the state; they have about 38000 beds for the total population, making the population bed ratio of 879, making it one of the highest in the country.^[12][9] Almost all mothers are taught to breast-feed and a state-supported nutrition programme for pregnant and new mothers is active, and about 99% of the total deliveries/child births are institutional/hospital deliveries,^[13] leading to infant mortality in 2018 being 7 per thousand,^[14] compared to 28 in India, overall^[15] and 18.9 for low- middle income countries generally^[16].The birth rate is 40 per cent below that of the national average and almost 60 per cent below the rate for impoverished countries in general. Kerala's birth rate is 14.1^[17] (per 1000 population)and decreasing. India's rate is 17^[18] and that of the U.S. is 11.4.^[19] Life expectancy at birth in Kerala is 77 years compared to 70 years in India^[20] and 84 years, in Japan,^[21] one of the highest in the world. Female life expectancy in Kerala exceeds that of the male, similarly to that in developed countries.^[22] Kerala's maternal mortality ratio is the lowest in India at 53 deaths per 100,000 live births.^[20]

Primary Health Centre, Thuravoor, Kerala

Community Health Centre, at Periya, Kasargode District

District-wise Hospital Bed Population Ratio as per the 2011^[23]

Health and Family Welfare Training Centre, Kozhikode

The Health Index, ranking the performance of the States and the Union Territories in India in Health sector, published in June 2019 by the NITI Ayong, Ministry of Health and Family Welfare, Government of India and The World Bank has Kerala on top with an overall score of 74.01.Kerala has already achieved the SDG 2030 targets for Neonatal Mortality Rate, Infant Mortality Rate, Under-5 Mortality rate and Maternal Mortality Ratio.^[24]

According to a white paper on the quality of death, released by the Economist Intelligence Unit in 2010, has projected the community model healthcare system from Kerala as a beacon of hope for providing palliative care services. The report from The Economist compared and ranked 40 countries across the world on end-of-life care facilities on the basis of 24 indicators on healthcare environment and availability, cost and quality of care. In the overall score, India with a score of 1.9 out of 10 ranked the 40th, behind countries such as Slovakia, Malaysia, Turkey, Brazil and even Uganda. The United Kingdom topped the list, followed by Australia and New Zealand.^[25][26]

While India ranks at the bottom of the index in overall score, and performs badly on many indicators, Kerala, if measured on the same points, would buck the trend. With only 3% of India's population, the tiny state provides two-thirds of India's palliative care services. The Economist has lauded the 'Kerala Community Model' in healthcare. Moreover, The Economist has patted the Kerala Government for providing palliative care policy (It is the only Indian state with such a policy) and funding for community-based care programmes. Kerala had pioneered universal health care through extensive public health services.^[27][28] Hans Rosling also highlighted this when he said Kerala matches United States in health but not in economy and took the example of Washington, D.C. which is much richer but is less healthy compared to Kerala.^[29][30]

The magazine said that Kerala is one of the first of India's states to relax narcotics regulations to permit use of morphine by palliative care providers. Kerala has also extended the definition of palliative care to include the long-term chronically ill and even the mentally incapacitated. Kerala's formal palliative care policy, the only state with such a policy, the community-based Neighbourhood Network in Palliative Care (NNPC) Project that employs an army of volunteers and the Government funding for these local community-based care units, almost 260 in number, has earned it many an accolade.

Key Health Development indicators- Kerala & India

The report said twenty nine out of the 40 countries studied have no formal palliative care strategy, revealed the report. Only seven – Australia, Mexico, New Zealand, Poland, Switzerland, Turkey and UK – have national policies, while four others – Austria, Canada, Ireland and Italy – are in the process of drafting one. Kerala has long recognised the importance of palliative care as can be seen from the growth of community-based care units. "The State's community-operated care system is funded largely through local micro-donations of as little as Rs 10 (21 US cents) per month. The volunteers in these units, after training can provide psychological, social and spiritual support. It is this that marks the NNPC out from more medical-oriented and expensive systems in use elsewhere," said the report.

Studying Kerala's combination of government support and civic involvement in end-of-life care, a number of similar models are being tried out in Ethiopia, Bangladesh, Seychelles and even Switzerland. "Kerala provides a useful lesson for other countries, particularly as ageing population puts increasing pressures on existing healthcare services," said the report. While countries such as Taiwan and Hungary have managed to get on the top 15 of the index, one possible reason cited for the poor show by India and China is their large population, with the care coverage reaching only a fraction of those in need.^[25][26]

Health Initiative Programs- National Health Mission, Government of Kerala ^[31][]

Aardram[]

Aardram Mission is one of the four missions under the ‘Nava Kerala Mission’ initiated by the government of Kerala, which aims at the same deliverables at the grass root level. It was launched with the objective to completely transform the public health sector in the backdrop of the Sustainable Development Goals (SDGs) 2030 of the United Nations (UN). Its main objectives are to have people friendly outpatient services, re-engineering of Primary Health Centres to Family Health Centres, access to comprehensive health services for the marginalised/ vulnerable population and standardisation of services from primary care settings to tertiary care settings.^[32]

Non Communicable Diseases Control Program[]

Kerala also has the Non Communicable Diseases as a major threat to the public health system and is the major contributor to the mortality, morbidity and disease burden. The state NRHM(National Rural Health Mission) has designed a non communicable diseases prevention and control programme(Amrutham Aarogyam) in the state – which is the first of its kind in the country- to address this challenge, and successfully pilot tested in a taluk of Trivandrum district and whole of Wayanad district. The essential component of this programme is ASHA service and from there on the NRHM machinery working together with state health service system at various levels.^[33]

Communicable Disease Control Program[]

Accredited Social Health Activist[]

Accredited Social Health Activists (ASHAs) are being deployed for every 1000 population in the state. ASHAs are voluntary workers who are paid incentives based on performance.ASHAs act as a link between the community and health care services and ensure that the primary health care services reaches rural population. The role of ASHAs has been extended to other fields also like Prevention & Control of Communicable diseases, Identification & Control of NCD’s, Palliative care and Community based Mental Health Programme.^[34]

Child Health Programs[]

Cardiac care[]

This is a web based solution for system management of care of children with Congenital Heart Disease (CHD). This can be used as web based registry for CHD cases across Kerala, monitoring the progress of program envisaged for management of children with CHD, identify the bottlenecks for implementing the protocols established at any point, understand the case status and response time for systems in place and ultimately the outcome of the program.^[35]

New born screening[]

It is a comprehensive screening programme for birth defects among new-borns (within 48 hours of birth) as envisaged in the national Child Health Policy. This includes all components of newborn screening and intervention packages, viz. visible birth defects, metabolic defects, hearing impairment, and congenital heart defects.The programme covers all 98 government delivery nodes and simultaneously initiate care protocols for each child identified with birth defects.^[36]

Adolescent Health Programme/RKSK (Rashtriya Kishor Swasthya Karyakram)[]

The program aims at enabling the adolescents of Kerala to realise their full potential by making them informed and responsible on decisions related to their health and well being and providing them access to the existing services and support systems for resolving issues. The specific objectives of the program are improving nutrition, enabling /enhancing sexual, reproductive and maternal health, enhancing mental health, preventing/reducing injuries and violence, preventing Substance abuse and addressing non-communicable diseases prevention.^[37]

Safe Motherhood Intervention[]

Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM). This scheme is in operation in Kerala from 2005-06 and is implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery. The beneficiaries are pregnant women falling in the BPL category, aged 19 years and above and also vulnerable population categories opting deliveries in public or accredited private health institutions.^[38]

COVID-19 Response[]

India's first case of COVID-19 was registered in Kerala on 30 January 2020.The initial response focused on surveillance and screening of all incoming passengers from China and the close contacts of these travellers. The State Emergency Operations Centre (SEOC) and the office of Kerala State Disaster Management Authority worked in tandem with the Health Department for response and mitigation efforts.The state government’s prompt response to COVID-19 can be attributed to its experience and investment made in emergency preparedness and outbreak response in the past, during Kerala floods in 2018 and especially, the NIPAH outbreak in 2019.  The state used innovative approaches and its experience in disaster management planning enabled it to quickly deploy resources and put up a timely and comprehensive response in collaboration with key stakeholders. Active surveillance, setting up of district control rooms for monitoring, capacity-building of frontline health workers, risk communication and strong community engagement, and addressing the psychosocial needs of the vulnerable population are some of the key strategic interventions implemented by the state government that kept the disease in control.^[39]

The health system is completely equipped with the facility to fight the pandemic now. Kerala has developed a portal named ' COVID Jagratha' portal, a comprehensive solution for effective daily reporting/monitoring of the quarantine and health status of the people under surveillance. This portal is designed for distributing information related to Covid 19 and accessing emergency services for the public. The ' Hospital Dashboard' in the portal shows the occupancy status and availability of hospital beds and ICUs.^[40]

Political awareness[]

Political awareness among the common people is quite high,^{[citation needed]} thanks to its history of social reformers like Sree Narayana Guru, Shree Chattambi Swamigal, Vakkom Moulavi, Kuriakose Elias Chavara, Ayyankali etc., leftist Movements and the unique political situation that exists in Kerala. Political history in Kerala shows a trend of an alternating elected communist-led Left Democratic Front governments and Congress led United Democratic Front governments, which results in an increase in public welfare activities, much to the benefit of the common man. In each town square, political parties maintain their icons – a statue of EMS or Indira Gandhi or a portrait of Marx, Engels, and Lenin in careful profile. Strikes, agitations, and stirs, a sort of wildcat job action, are so common as to be almost unnoticeable. Environmentalist Bill McKibben once stated: "Though Kerala is mostly a land of paddy-covered plains, statistically Kerala stands out as the Mount Everest of social development; there's truly no place like it."^[22][41]

Education[]

A government school in Kottarakara

The Pallikkoodam, a school model started by Buddhists was prevalent in the Malabar region, Kingdom of Cochin, and Kingdom of Travancore. This model was later imbibed by Christian missionaries initiated by the then Archbishop of Verapoly, Bernardo (Giuseppe) Baccinelli, O.C.D., paved the way for an educational revolution in Kerala by making education accessible to all, irrespective of caste or religion. Christian missionaries introduced Western education methods to Kerala. Communities such as Ezhavas, Nairs and Dalits were guided by monastic orders (called ashrams) and Hindu saints and social reformers such as Sree Narayana Guru, and Ayyankali, who exhorted them to educate themselves by starting their own schools. That resulted in numerous Sree Narayana schools and colleges, Nair Service Society schools. The teachings of these saints have also empowered the poor and backward classes to organize themselves and bargain for their rights. The Government of Kerala instituted the system to help schools with operating expenses such as salaries for running these schools.^{[citation needed]}

Kerala had been a notable centre of Vedic learning, having produced one of the most influential Hindu philosophers, Adi Shankaracharya. The Vedic learning of the Nambudiris is an unaltered tradition that still holds today, and is unique for its orthodoxy, unknown to other Indian communities. However, in feudal Kerala, though only the Nambudiris received an education in Vedas, other castes as well as women were open to receive education in Sanskrit, mathematics and astronomy, in contrast to other parts of India.^{[citation needed]} Tirunavaya was a centre of Vedic learning in early medieval period. Ponnani in Kerala was a global centre of Islamic learning during the medieval period.

The upper castes, such as Nairs, Tamil Brahmin migrants, Ambalavasis, St Thomas Christians, as well as backward castes such as Ezhavas had a strong history of Sanskrit learning. In fact many Ayurvedic Physicians (such as Itty Achudan) were from the backward Ezhava community and Muslim community (such as the father of renowned Mappila Paattu poet Moyinkutty Vaidyar). Vaidyaratnam P. S. Warrier was a prominent Ayurvedic physician. This level of learning by non-Brahmin learning was not seen in other parts of India. Also, Kerala had been the site of the notable Kerala School which pioneered principles of mathematics and logic, and cemented Kerala's status as a place of learning.^{[citation needed]}

The prevalence of education was not only restricted to males. In pre-colonial Kerala, women, especially those belonging to the matrilineal Nair caste, received an education in Sanskrit and other sciences, as well as Kalaripayattu, a martial art. This was unique to Kerala, but was facilitated by the inherent equality shown by Kerala society to females and males,^{[citation needed]} since Kerala society was largely matrilineal, as opposed to the rigid patriarchy in other parts of India which led to a loss of women's rights.^{[citation needed]}

The rulers of the princely state of Travancore (were at the forefront in the spread of education. A school for girls was established by the Maharaja in 1859, which was an act unprecedented in the Indian subcontinent. In colonial times, Kerala exhibited little defiance against the British Raj. However, they had mass protests for social causes such as rights for "untouchables" and education for all. Popular protest to hold public officials accountable is a vital part of life in Kerala.^{[citation needed]}

By 1981, the general literacy rate in Kerala was 70 per cent – almost twice the all-India rate of 36 per cent. The rural literacy rate was almost identical, and female literacy, at 66 per cent, was not far behind. The government continued to press the issue, aiming for "total literacy," usually defined as about 95 per cent of the people being able to read and write.^{[citation needed]}

A pilot project began in the Ernakulam region, an area of 3 million people that includes the city of Kochi. In late 1988, 50,000 volunteers fanned out around the district, tracking down 175,000 illiterates between the ages of 5 and 60, two-thirds of them women. Within a year, it was hoped, the illiterates would read Malayalam at 30 words a minute, copy a text at 7 words a minute, count and write from 1 to 100, and add and subtract three-digit numbers. On 4 February 1990, 13 months after the initial canvass, Indian Prime Minister V. P. Singh marked the start of World Literacy Year with a trip to Ernakulam, declaring it the country's first totally literate district. In 2001, Kerala's literacy rate was 91%^[42] almost as high as that of China (93%) and Thailand (93.9%).

The following table shows the literacy rate of Kerala from 1951 to 2011, measured every decade:^[43]

State policy[]

In 1957 Kerala elected a communist government headed by EMS Namboothiripad, introduced the revolutionary Land Reform Ordinance. The land reform was implemented by the subsequent government, which had abolished tenancy, benefiting 1.5 million poor households. This achievement was the result of decades of struggle by Kerala's peasant associations. In 1967 in his second term as Chief Minister, EMS again pushed for reform. The land reform initiative abolished tenancy and landlord exploitation; effective public food distribution that provides subsidised rice to low-income households; protective laws for agricultural workers; pensions for retired agricultural laborers; and a high rate of government employment for members of formerly low-caste communities.^{[citation needed]}

Hunger[]

According to the India State Hunger Index, Kerala is one of the four states where hunger is only moderate. Hunger index score of Kerala is 17.66 and is next only to Punjab. Nation hunger index of India is 23.31.^[44]

Opinions[]

British Green activist Richard Douthwaite interviewed a person who remembers once saying that "in some societies, very high levels – virtually First World levels – of individual and public health and welfare are achieved at as little as sixtieth of US nominal GDP per capita and used Kerala as an example".^{[45]: 310–312} Richard Douthwaite states that Kerala "is far more sustainable than anywhere in Europe or North America".^[46] Kerala's unusual socioeconomic and demographic situation was summarized by author and environmentalist Bill McKibben:^[47]

Kerala, a state in India, is a bizarre anomaly among developing nations, a place that offers real hope for the future of the Third World. Though not much larger than Maryland, Kerala has a population as big as California's and a per capita annual income of less than $3000. But its infant mortality rate is very low, its literacy rate's among the highest on Earth, and its birthrate's below that of America's and falling faster. Kerala's residents live nearly as long as Americans or Europeans. Though mostly a land of paddy-covered plains, statistically Kerala stands out as the Mount Everest of social development; there's truly no place like it.[47]

References[]

External links[]

• Amartya Sen and the "Kerala Model"
• "How Missionaries help ended slave trade in Kerala"