Exclusive Interview with K K Shylaja, Health Minister, Kerala

Health Minister KK Shylaja has been spearheading an ambitious program of Kerala’s LDF Government to upgrade government hospitals at primary, community, taluk, district and tertiary levels to modern standards by making them Family Health Centres, Speciality Hospitals, Super Speciality Hospitals, and Centres of Excellence, respectively. 

Meanwhile, Shylaja Teacher, as she is affectionately called in Kerala, has her plates full with significant outbreaks of dengue and H1N1 fevers that took many lives this year, not to say anything about the medical PG fees hike row. Not one to govern only from the Secretariat, she recently inspected Thiruvananthapuram General Hospital, and finding the hygiene standards appalling, ordered a massive clean-up drive then and there, which has since then spread to other major government hospitals.

Seasonal Magazine recently caught up with Shylaja Teacher for this exclusive interview.

As you complete your first year in office, what are the major initiatives of the Health Ministry that you wish to highlight?

There is a major impetus being given to Aardram scheme wherein we strive to make hospitals more patient-friendly, reduce medical treatment costs, and make available technical facilities. Even with the widespread availability of government hospitals, almost 60% of the public opts for private hospitals. Moreover, in Kerala a large portion of household income is spent on healthcare expenses. Needless to say, even the treatment costs have risen. In light of these developments, we hope to improve government hospital facilities so that people can be assured of the best treatment.

How is this plan going to be implemented?

We are following a 3 pronged strategy to address the challenge at multiple levels - primary, secondary & tertiary care. The detailed plan for enhancing hospital facilities has been prepared. As you know, there is a Primary Health Centre (PHC) in every Panchayat. Currently, there is only one doctor in many PHCs, and sometimes for just half a day. We intend to turn these into ‘Family Health Centres’. We would provide each centre with 3 doctors and develop a family doctor system. These doctors will look after the patients and ensure that they receive continued medical attention. The proposed Family Health Centres would have round-the-clock availability of 3 doctors, observation room, laboratories, restroom facilities, and neat toilets. We hope to convert around 170 primary health centres into such family health centres this year. Towards this, we have already created 609 posts and have announced the same in the Assembly.

Will it involve fresh construction of facilities, or usage of existing PHC buildings? What would be the costs involved, and how it will be met?

If it is possible, existing infrastructure will be upgraded. If needed, certain older structures will be demolished and new buildings will be constructed in its place. Where we would be constructing new buildings, the costs would be on the higher side, around Rs. 2 crore per centre. We shall actively seek the support of the local administration and people. We would also seek money from various government funds. And once we are complete with first batch of 170 centres, next year we will begin work with the next 170 or a suitable number of them.

What would be the healthcare focus of these Family Health Centres?

The main thrust will be given towards treatment of lifestyle diseases and preventive plans like immunisation programmes. Free medicines will also be made available to the deserving.  Common lifestyle diseases like diabetes and hypertension will get focus. Doctors would also undergo training as part of the scheme. This prevention-centred focus will help in curbing the spread of diseases.

What about the other levels apart from the primary level?

Yes, these include Community Health Centres in each developmen block. We will make necessary improvements and arrangement for its functioning. This will be carried out in cooperation with the Department of Local Self-governance. We have begun deliberations on this and will start with implementation from next year. Next in the rung comes Taluk-level hospitals which will be upgraded into Speciality Hospitals, with each Taluk having its own centre. As a part of this program, 44 taluk hospitals have received dialysis units this year. Recognizing the need for increased number of doctors, we have sent the necessary files for post-creation to the finance ministry. We have asked for the master plan for taluk hospitals, which will be made available soon. We have sanctioned Rs.76 crores for the Punalur Taluk Hospital, but across hospitals, this amount will vary according to the requirements and assessment of each hospital’s plan.

And what are your plans for the District Hospitals?

All District Hospitals will be upgraded to Super Speciality Hospitals. This scheme will be implemented in all 14 districts. I have asked master plans to be submitted. Ernakulum General Hospital and Kannur District Hospital have already been approved for major development projects. Thiruvananthapuram General Hospital’s development master plan is being done by KSIDC and I expect to receive it shortly. It will be a major project. Eight district hospitals have been allowed Cath Labs. Cardiologists will be appointed here and within the next two years these hospitals will work as effective cardiology centres, and thus reduce the rush at our Medical Colleges.

You recently visited Thiruvananthapuram General Hospital, and found it dirty along with empty liquor bottles in the premises. How are you battling this menace?

Yes, I was shocked at the poor hygiene and cleanliness there. Then and there I have ordered strict action to clean up or face action. Today, I visited there again, and found great improvement. While I had to scold them earlier, it worked, and I commended them today for cleaning up swiftly. This incident has spread the word that the Minister might visit any government hospital, and I hear that massive cleaning-up programs are being done in all districts. In any case, with regard to the development programs I mentioned across primary, secondary, & tertiary care levels, hygiene and beautification of the facilities and premises are being given utmost importance.

Now coming to, the highest level of tertiary care, what are your development plans for our medical colleges?

We have five medical colleges, four of them long existing ones at Thiruvananthapuram, Kozhikode, Alappuzha, & Kottayam, and then the one at Kalamassery which we took over. All of them are being upgraded to be Centres of Excellence. Towards this, different super-speciality departments in each medical college would be given adequate funds. Thiruvananthapuram Medical College has been approved for a Rs.400 crore plan, while Rs.100 crores have already been given. Similarly, a Rs.600 crore plan has been approved for Kozhikode Medical College, and Rs.75 crores has been disbursed.

Are you sourcing finance from the new KIIFB fund for all these developments?

We are sourcing both from Plan Fund and KIIFB. Generally speaking, the idea is to source funds for Taluk Hospitals and upward, from KIIFB. Already, Rs.355 crores from KIIFB has been sourced for upgradation of Kalamassery Medical College and for their new Cochin Cancer Centre.

Contagious diseases accompanied by fever, like Dengue and H1N1 are again sweeping the state, causing several deaths. How are you battling it?

It is a very sad development, and it is being attended on a war footing. In fact, this was one year where we had done much preventive measures since January itself with regard to mosquito eradication etc. But the experts are saying that abnormal climate changes along with cyclical outbreaks have played spoilsport this year. For instance, last year there was no death in Kerala due to H1N1. This year there was an outbreak in North India and it has spread to here too. Less than adequate treatment given in private hospitals in the initial stages also contributed to this. But now all these challenges are being addressed properly.

What are the other major initiatives by the Health and Social Welfare Ministries that you head?

There are several initiatives, and one noteworthy one is the introduction of E-Health Register to record, store, and retrieve health records of all patients electronically. It is jointly being done by Central and State Governments. It has already been introduced in 7 districts. Government is set to introduce a new Clinical Establishment Bill in Assembly which will ensure quality and cost standards across private hospitals. The Social Welfare department also has several new schemes, one of which is She-Pad, which supplies sanitary napkins to girl students through schools. It is being implemented by Kerala Women Development Corporation.

Do you think the medical PG fees hike could have been more moderate?

It was very difficult to come up with another solution, as since NEET became mandatory, charging different fees for merit and management quotas became impossible. So, when the cross-subsidy went away, there is only one fee which is higher than the earlier merit fees, but lower than the earlier management fees. But the stipend or scholarship that medical PG students receive has also gone up significantly. So, basically the effective fee has risen from Rs.6.5 lakhs per annum to Rs.8.46 lakhs. It has been fixed by the Fee Committee and government has no role in it. Government has to agree to it, as there was no other solution. Christian Managements have already agreed to this fee, and other managements are also expected to comply. Kerala medical PG fee is still lower than in many other states. You should also realize that not all students who study under merit quota are poor, and that also not all students who study under management quota are rich.