ON MARCH 13, 27-year-old Vishnu from Ranni, in Kerala’s Pathanamthitta district, was returning to Kochi—where he worked in aluminium fabrication—after visiting his father, Biju, an autorickshaw driver recovering from a serious fall. But tragedy struck en route: Vishnu met with a major road accident. His right leg was crushed, both tibia and fibula fractured and exposed. Overnight, life changed for him and his family.
He was rushed to Government Medical College Hospital (GMCH), Kottayam—one of Kerala’s oldest and most crucial public hospitals. “Surgery was urgent, but the hospital didn’t have the required metal rod implant,” Vishnu recalled. “The doctor—one of the seniormost in the department—asked us to buy it from an outside agency.”
“At the agency, the implants were laid on the ground to be sorted,” said Biju. “We bought them for Rs28,000 to avoid delays and rushed them to the hospital. I still don’t know if they were sterilised before surgery.”
Post surgery, complications followed. Vishnu developed multiple pus-draining wounds and a severe infection. “My condition kept getting worse,” he says. When they returned to the hospital—overcrowded and overwhelmed—the doctor allegedly downplayed the issue.
With the infection worsening and confidence in the public hospital eroding, Vishnu was shifted to a private super-speciality hospital in Thiruvalla. “On day one, they gave us a bill of Rs12,000 just for tests,” he said. Biju was prepared to risk everything—including the family’s ten cents of land—to ensure his son’s recovery. “I just wanted to see my boy walk again,” he said.
Vishnu stayed at the private hospital for seven days. The infection was brought under partial control, but doctors revealed a grim news after an MRI: amputation appeared to be the only option. The family panicked.
That is when a doctor from another private hospital—where Vishnu had been going for dressing his wound—offered help. She arranged for his admission to GMCH, Thiruvananthapuram. With resources running low, Vishnu had no option but to once again turn to the public health care system. He was admitted on May 30. On June 3, he underwent another surgery—the infected rod was removed, a triangular external fixator applied, and a skin graft done.
He was discharged on June 16 and is now undergoing follow-ups.
“Everything—including ambulance transport—costs a lot. If the bones don’t heal, I may need another surgery,” Vishnu said. Meanwhile, the family has sunk deep into debt. They believe the “negligence” at GMCH, Kottayam, triggered their ordeal, but they do not have the means to seek legal recourse. “At least, in Thiruvananthapuram, we didn’t have to buy anything from outside for surgery,” he said.
THE WEEK met Vishnu at GMCH, Thiruvananthapuram, just days after Kerala’s much-lauded “health model” came under fire. Dr Harris Chirakkal, head of the urology department in the same institution, publicly flagged a critical shortage that was delaying life-saving procedures. Health Minister Veena George later admitted, “The problem lies with the system and needs correction.” Yet, she dodged questions about whether the health department had prior knowledge of the shortage.
Public outrage intensified on July 3, when an old building at GMCH, Kottayam, collapsed, killing a female bystander. George’s initial response—that the collapsed block was unused—and her emphasis on the construction of a new wing under the Left Democratic Front government were seen as tone-deaf, especially as rescue efforts were still underway. She was accused of trivialising the tragedy.
As protests and calls for her resignation grew, the government and the ruling CPI(M) dismissed the backlash as politically motivated, insisting that Kerala remained No 1 in health outcomes.
Following Chirakkal’s whistle-blowing, the equipment shortage he flagged was swiftly resolved. But he later warned that systemic issues remain unresolved—and that no doctor should be pushed to commit “professional suicide” just to have clinical needs addressed.
Many people believe that Kerala’s health sector, though more advanced than in many other states, is buckling under a structural crisis.
The roots of Kerala model’s success go deep: the princely states of Travancore and Kochi embraced both Ayurveda and European medicine by the 19th century. A royal decree in 1879 made vaccination mandatory for public servants, prisoners and students. Initiatives for safe drinking water and missionary hospitals in remote areas had laid a solid foundation by the time Kerala was formed in 1956.
Public health expert V. Raman Kutty notes that the period between 1956 and the early 1980s saw rapid expansion of government health services. Government health spending grew annually at 13.04 per cent, outpacing government expenditure (12.45 per cent) and economic growth (9.8 per cent). By 1986, government hospitals had 36,000 allopathic beds.
But, after the mid-1980s, growth slowed. Between 1986 and 1996, the private sector outpaced the public system—a trend that continues. According to the latest National Sample Survey, the private sector now provides 52.5 per cent of outpatient and 62.7 per cent of inpatient care (excluding childbirth). The bed strength in the public system, at 38,525, remains near the 1980s levels.
Pramod Kumar, former senior adviser with the United Nations Development Programme, cited the National Health Accounts Report (2021-22): only 32.5 per cent of Kerala’s total health expenditure comes from the government; the rest is borne by the people. “Of this remaining portion, a fraction is covered by employer insurance; but for many, it’s their own money,” he said.
The latest report from the Comptroller and Auditor General has diagnosed two critical problems: shortage of doctors, especially specialist doctors, at all levels; and staff deficiency—from nurses and pharmacists to lab technicians and ASHA workers. The report also flagged the shortage of drugs in hospitals, delays in procurement, inadequate quality checks, and poor equipment maintenance—factors that lead to compromised patient care.
To resolve issues, successive governments—especially LDF-led ones—have taken significant measures. Decentralising the health sector is one such initiative. Hospital development societies now handle repairs, maintenance, and equipment and consumables procurement in medical college hospitals.
But red tape remains. Anchal Job, a member of the development committee at GMCH, Thiruvananthapuram, said the effectiveness of government schemes depended on how the bureaucracy responded to them. Often, the response is slow and inadequate.
Kumar said the bureaucracy was not the only problem. “You also need to allocate more money,” he said.
Economist Mary George noted that only 0.74 per cent of Kerala’s GDP goes to health. “The latest CAG report says Kerala’s health spending is nowhere near the 2017 National Health Policy’s recommendation of over 8 per cent of budget expenditure,” she said. According to her, the revenue expenditure in health care was so huge that there is hardly anything left for capacity building.
Veena George cited the rise in outpatient registrations—from 8.3 crore in 2015–16 (when the Congress-led United Democratic Front ruled) to 13.5 crore in 2024–25—as evidence of improved public infrastructure. But many attribute this increase to a section of the middle class, once able to afford private care, turning to government hospitals post-Covid. Critics also point out that the government’s health spending has not kept pace with the rising patient numbers.
Today, Kerala records the highest out-of-pocket health care expenditure among states in India—Rs8,655 (per household in a year) in rural areas and Rs10,341 in urban ones. The minister claimed improvement, saying the figures were higher in 2016: Rs17,054 and Rs23,123, respectively.
Dr C. Ravindran, former principal of Government Medical College, Kozhikode, who currently serves as senior consultant and chief of medical services at Baby Memorial Hospital, said government medical colleges do provide quality care, but they are overwhelmed. “They handle far more patients than they are equipped to,” he said.
He also blamed patient behaviour. “People often bypass primary health centres and taluk hospitals, and head straight to tertiary care facilities for even minor ailments. They also jump between specialities, driving up costs,” he said.
The referral system to regulate patient flow remains ineffective. As a result, medical colleges are overcrowded. “Overburdened public hospitals push those who can afford it to private care,” he said. In 2020-21, when Kerala dropped from first to ninth in health rankings, its high suicide rate, road accident deaths, and high per capita out-of-pocket expenditure were contributing factors.
Dr S.S. Lal, veteran public health expert with experience at the World Health Organization, warned that as more people abandoned the public system, Kerala risked losing control over health surveillance. Vital data on vaccination, childbirth and unnatural deaths could be missed. Also, private hospitals do not focus on preventive care, weakening the overall health care system. “In the long run, it could undermine the very indicators Kerala is proud of—high life expectancy and low birth and maternal mortality rates,” he said.
According to him, Kerala urgently needs a policy shift, considering that it is undergoing an epidemiological and demographical transition. “Epidemiological transition means more people are now dying from noncommunicable and lifestyle diseases, while demographic transition points to Kerala’s rapidly ageing population,” he said. “We need forward-thinking policies—at least looking ahead to 2050.”
While Kerala has achieved life expectancy figures comparable to the west, Lal pointed out that the quality of life in old age remained poor. “Women live up to 80—but how many can still walk beyond that age? I have seen people in the US driving into their 90s. Here, most 80-year-old women are bedridden, incontinent and immobile. Most of the income of elderly women go to hospitals,” he said.
He also highlighted a gender crisis: Kerala’s women live longer than men—by about seven years—and many spend their last decade as widows, often without support, pension, or an enabling environment for a dignified life.
“That,” he said, “is the real crisis.”