The Nipah Outbreak and Kerala’s Public Health Systems

On May 25, the Ministry for Health & Family Welfare announced that the Nipah outbreak in Kerala had been contained. This came as a relief as the highly contagious virus had already claimed 18 lives.

The Indian Express has a good report that applauds Kerala’s public health systems for containing the spread:

By the time the NiV virus was confirmed, the health infrastructure in the district had been promptly spruced up by setting up isolation wards at the Medical College and the local hospitals. In the days that followed, people who had been in direct contact with the infected were immediately transferred to the isolation wards as they began showing symptoms thus breaking any further chance of spread of infection. Family members of the infected were put on home quarantine, their samples taken and their daily health parameters routinely checked by local officials. “We didn’t allow the virus to proceed in its natural cycle. Otherwise, there would have been a lot more fatalities. We were able to intervene at the right time,” said Dr Arun Kumar. [The Indian Express, May 26]

While the report appreciates the co-ordinated response of the Kerala and Union governments in dealing with this outbreak, it fails to highlight another important point: the highly decentralised nature of Kerala’s public health systems. In fact, in a study we completed last year on Public Health Expenditure in India (2005 – 2015), Kerala stood out in devolution of implementation functions in healthcare to its urban and rural local governments.

The differentiating feature is:

Unlike most other states, Kerala also does not provide much by the way of specific purpose transfers to panchayats and Municipal Councils in health. Instead, Kerala gives large amounts of general purpose transfers to local bodies (nearly 25 percent of the plan expenditures), some of which can be used for health and other expenditures. The local governments then decide how these funds should be allocated. Kerala also has an “Information Knowledge Mission” dedicated to running a system of accounts and payments for all local bodies in Kerala. They maintain a database that can disaggregate local body expenditures in health, water & sanitation and other sectors [Public Expenditure on Health in India: 2005-06 to 2014-15, Pavan Srinath et al].

My hypothesis is that this well-settled decentralised form of health administration had a big role to play in containing the outbreak. The empowered local governments were able to move quickly, without having to wait for explicit directives from the higher levels of government.

This claim needs more investigation but it is worth studying because it can help shape the self-governance debate in India.


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