Health Minister Veena George acknowledged systemic issues in Kerala’s public health sector, admitting delays in procurement and infrastructure lapses.
Published Jul 10, 2025 | 9:00 AM ⚊ Updated Jul 10, 2025 | 9:00 AM
Health Minister Veena George with the family of Bindu, who died in the building collapse.
Synopsis: CAG audit findings, mounting tragedies, and a series of exposés lay bare a grim reality: Kerala, once lauded as a model for public healthcare, is now grappling with a system in decline.
A mother earning just ₹300 a day died under the rubble of an “abandoned” building on the premises of a government medical college in Kerala—not as a patient, but as a bystander caring for her ailing daughter. Her death was no accident; it was a brutal indictment of a system that fails the poor even in places meant for healing.
Ministers rushed to the scene, only to prematurely declare that no one was seriously injured—delaying rescue efforts and possibly costing her life. This isn’t just about a collapsing building. It’s about the collapse of public trust in Kerala’s much-touted healthcare model.
A performance audit by the Comptroller and Auditor General (CAG) covering 2016–2022 reveals critical gaps undermining India’s healthcare system. The report flags persistent doctor shortages across all levels of public hospitals, especially specialists, along with similar shortfalls in AYUSH facilities. Nurses, pharmacists, and lab technicians were also in short supply. These deficits, the CAG notes, have strained infrastructure and limited access to quality care.
In Kerala, two districts had the worst doctor-to-population ratios, and ASHA worker shortages ranged from 3% to 33% in 13 districts. Official data reveal that around 7,500 positions across various Health Directorates remained vacant as of March 2023.
Eighty-seven posts—7.75 percent—of specialist doctors in District Hospitals (DHs) and General Hospitals (GHs), and 49 posts—6.61 percent—in Taluk Hospitals (THs) and Taluk Headquarters Hospitals (THQHs) remained vacant, according to official data.
The CAG audit found that doctor numbers in Outpatient Departments (OPDs) were far below what was needed, resulting in long waits, overworked staff, and compromised care. Many hospitals failed to meet Indian Public Health Standards (IPHS), lacking basic pathology services and essential equipment.
On average, doctors handled 55 patients per day across 62 hospitals, with seven hospitals recording over 100 patients per doctor daily. At the PHC in Pallikkal, Malappuram, one doctor managed an alarming 208 patients a day. Malappuram also faced a shortfall of 34 PHCs, highlighting severe overburdening across healthcare tiers.
Kerala’s healthcare infrastructure lags in both scale and quality. Compared to IPHS norms, the state has 14% fewer Primary Health Centres and 35% fewer Community Health Centres. The CAG audit cited slow progress in infrastructure development, pointing to poor planning, statutory delays, land issues, and chronic fund shortages.
One striking example is the ₹500-crore (approximate) surgical block at Government Medical College, Kottayam. Funded by the Kerala Infrastructure Investment Fund Board (KIIFB), the building was completed earlier this year but remains unopened—its delayed inauguration sparking sharp criticism and political controversy.
The issue came under renewed public scrutiny after a disused, 68-year-old building near the orthopaedics ward collapsed last Thursday, killing the 52-year-old mother, a bystander visiting her daughter, and injuring three others.
Records show the Public Works Department had declared the structure unsafe as early as 2013, with prior assessments recommending demolition over costly repairs.
Opposition leaders have accused the state government of deliberately delaying the opening of the new surgical block to align it with upcoming assembly elections, rather than addressing pressing public health needs.
On the financial front, Kerala’s health spending has shown inconsistency. While the state managed to utilise nearly 99 percent of its health budget in 2021–22, this was a rebound from a dip to just 93.28 percent in 2020–21. More worryingly, only 4.24 percent of the total ₹48,735 crore spent on health during the audit period was directed towards capital investment—significantly below the 8 percent benchmark set by the National Health Policy 2017.
The audit also scrutinized the performance of the Kerala Medical Services Corporation Limited (KMSCL), set up to ensure uninterrupted drug supplies to public hospitals. The findings were grim: frequent drug stockouts, inadequate indenting due to budget caps, delays in delivery by vendors—82% of drug suppliers failed to meet delivery timelines—and lax penalty enforcement. The corporation’s limited quality checks—only 10% of drug batches were tested—meant that 46 drugs and supplies from 14 vendors completely escaped scrutiny during the audit period.
Adding to the woes, many essential medical equipment were either unavailable or lying defunct due to delayed procurement and the absence of a regular maintenance system. In tertiary hospitals, there was no mechanism for equipment upkeep, leading to denied services for patients in critical need.
A few weeks ago, Dr Haris Chirakkal, Head of the Urology Department at Thiruvananthapuram Medical College Hospital, ignited a controversy when he posted on Facebook that three out of four scheduled surgeries were postponed due to a lack of essential surgical equipment—and that patients were forced to buy their own tools.
Though he later deleted the post, Dr Chirakkal said bureaucratic red tape finally unravelled after he went public: files pending for months were cleared, and missing equipment flown in within days. The Health Minister appointed a four-member inquiry panel to investigate systemic lapses in procurement.
Health Minister Veena George acknowledged systemic issues in Kerala’s public health sector, admitting delays in procurement and infrastructure lapses. She assured that corrective steps are underway, including audits, fast-tracking files, and improving accountability across the health administration.
Shockingly, some blood banks were operating without licences, and radiographic equipment in certain hospitals was being used without approval from the Atomic Energy Regulatory Board.
Alarmingly, the state has not yet drafted an action plan or vision document to meet its Sustainable Development Goals (SDGs). Due to poor performance on indicators like suicide rate, road accident deaths, and out-of-pocket health expenses, Kerala slipped from first to ninth place in the national health index rankings in 2020–21. The state now has the second-highest per capita health expenditure borne by households in India.
The audit findings, mounting tragedies, and a series of exposés lay bare a grim reality: Kerala, once lauded as a model for public healthcare, is now grappling with a system in decline. Without urgent interventions—be it in staffing, drug procurement, infrastructure, or the execution of welfare schemes—the state’s healthcare commitments risk becoming little more than rhetoric.
Unfortunately, the cost of this crisis is borne by ordinary Keralites. Those who can, increasingly turn to private hospitals; those who can’t are left behind. Kerala now ranks second in the country for out-of-pocket health expenditure, with 59.1% of its total health spending coming directly from people’s pockets—just behind Uttar Pradesh at 63.7%.
As the World Health Organization warned in 2022, such crushing healthcare costs are driving 55 million Indians into poverty every year. The question is no longer whether the system is broken—it’s how many more will suffer before it is fixed.
(Rejimon Kuttappan is an independent journalist and author of Undocumented=Penguin 2021. Views are personal. Edited by Majnu Babu).
