Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 150
You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 150
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98
Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 151
You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 151
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98
Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
if (Configure::read('debug')) {
trigger_error($message, E_USER_WARNING);
} else {
$response = object(Cake\Http\Response) {
'status' => (int) 200,
'contentType' => 'text/html',
'headers' => [
'Content-Type' => [
[maximum depth reached]
]
],
'file' => null,
'fileRange' => [],
'cookies' => object(Cake\Http\Cookie\CookieCollection) {},
'cacheDirectives' => [],
'body' => '<!DOCTYPE html>
<!--[if lt IE 7 ]>
<html class="ie ie6" lang='en'> <![endif]-->
<!--[if IE 7 ]>
<html class="ie ie7" lang='en'> <![endif]-->
<!--[if IE 8 ]>
<html class="ie ie8" lang='en'> <![endif]-->
<!--[if (gte IE 9)|!(IE)]><!-->
<html lang='en'>
<!--<![endif]-->
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>
LATEST NEWS UPDATES | Driven to distress -R Krishnakumar </title>
<meta name="description" content="
-Frontline
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number..."/>
<meta name="keywords" content="healthcare,healthcare in india,Access to Health,Access to Healthcare,Access to Medicines,Health Expenditure,Public Health,kerala"/>
<meta name="news_keywords" content="healthcare,healthcare in india,Access to Health,Access to Healthcare,Access to Medicines,Health Expenditure,Public Health,kerala">
<link rel="alternate" type="application/rss+xml" title="ROR" href="/ror.xml"/>
<link rel="alternate" type="application/rss+xml" title="RSS 2.0" href="/feeds/"/>
<link rel="stylesheet" href="/css/bootstrap.min.css?1697864993"/> <link rel="stylesheet" href="/css/style.css?v=1.1.2"/> <link rel="stylesheet" href="/css/style-inner.css?1577045210"/> <link rel="stylesheet" id="Oswald-css"
href="https://fonts.googleapis.com/css?family=Oswald%3Aregular%2C700&ver=3.8.1" type="text/css"
media="all">
<link rel="stylesheet" href="/css/jquery.modal.min.css?1578285302"/> <script src="/js/jquery-1.10.2.js?1575549704"></script> <script src="/js/jquery-migrate.min.js?1575549704"></script> <link rel="shortcut icon" href="/favicon.ico" title="Favicon">
<link rel="stylesheet" href="/css/jquery-ui.css?1580720609"/> <script src="/js/jquery-ui.js?1575549704"></script> <link rel="preload" as="style" href="https://www.im4change.org/css/custom.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery.modal.min.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery-ui.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/li-scroller.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<!-- <link rel="preload" as="style" href="https://www.im4change.org/css/style.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous"> -->
<link rel="preload" as="style" href="https://www.im4change.org/css/style-inner.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel='dns-prefetch' href="//im4change.org/css/custom.css" crossorigin >
<link rel="preload" as="script" href="https://www.im4change.org/js/bootstrap.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.li-scroller.1.0.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.modal.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.ui.totop.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-1.10.2.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-migrate.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-ui.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/setting.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/tie-scripts.js">
<!--[if IE]>
<script type="text/javascript">jQuery(document).ready(function () {
jQuery(".menu-item").has("ul").children("a").attr("aria-haspopup", "true");
});</script>
<![endif]-->
<!--[if lt IE 9]>
<script src="/js/html5.js"></script>
<script src="/js/selectivizr-min.js"></script>
<![endif]-->
<!--[if IE 8]>
<link rel="stylesheet" type="text/css" media="all" href="/css/ie8.css"/>
<![endif]-->
<meta property="og:title" content="LATEST NEWS UPDATES | Driven to distress -R Krishnakumar" />
<meta property="og:url" content="https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html" />
<meta property="og:type" content="article" />
<meta property="og:description" content="
-Frontline
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number..." />
<meta property="og:image" content="" />
<meta property="fb:app_id" content="0" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
<link rel="apple-touch-icon-precomposed" sizes="144x144" href="https://im4change.in/images/apple1.png">
<link rel="apple-touch-icon-precomposed" sizes="120x120" href="https://im4change.in/images/apple2.png">
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="https://im4change.in/images/apple3.png">
<link rel="apple-touch-icon-precomposed" href="https://im4change.in/images/apple4.png">
<style>
.gsc-results-wrapper-overlay{
top: 38% !important;
height: 50% !important;
}
.gsc-search-button-v2{
border-color: #035588 !important;
background-color: #035588 !important;
}
.gsib_a{
height: 30px !important;
padding: 2px 8px 1px 6px !important;
}
.gsc-search-button-v2{
height: 41px !important;
}
input.gsc-input{
background: none !important;
}
@media only screen and (max-width: 600px) {
.gsc-results-wrapper-overlay{
top: 11% !important;
width: 87% !important;
left: 9% !important;
height: 43% !important;
}
.gsc-search-button-v2{
padding: 10px 10px !important;
}
.gsc-input-box{
height: 28px !important;
}
/* .gsib_a {
padding: 0px 9px 4px 9px !important;
}*/
}
@media only screen and (min-width: 1200px) and (max-width: 1920px) {
table.gsc-search-box{
width: 15% !important;
float: right !important;
margin-top: -118px !important;
}
.gsc-search-button-v2 {
padding: 6px !important;
}
}
</style>
<script>
$(function () {
$("#accordion").accordion({
event: "click hoverintent"
});
});
/*
* hoverIntent | Copyright 2011 Brian Cherne
* http://cherne.net/brian/resources/jquery.hoverIntent.html
* modified by the jQuery UI team
*/
$.event.special.hoverintent = {
setup: function () {
$(this).bind("mouseover", jQuery.event.special.hoverintent.handler);
},
teardown: function () {
$(this).unbind("mouseover", jQuery.event.special.hoverintent.handler);
},
handler: function (event) {
var currentX, currentY, timeout,
args = arguments,
target = $(event.target),
previousX = event.pageX,
previousY = event.pageY;
function track(event) {
currentX = event.pageX;
currentY = event.pageY;
}
;
function clear() {
target
.unbind("mousemove", track)
.unbind("mouseout", clear);
clearTimeout(timeout);
}
function handler() {
var prop,
orig = event;
if ((Math.abs(previousX - currentX) +
Math.abs(previousY - currentY)) < 7) {
clear();
event = $.Event("hoverintent");
for (prop in orig) {
if (!(prop in event)) {
event[prop] = orig[prop];
}
}
// Prevent accessing the original event since the new event
// is fired asynchronously and the old event is no longer
// usable (#6028)
delete event.originalEvent;
target.trigger(event);
} else {
previousX = currentX;
previousY = currentY;
timeout = setTimeout(handler, 100);
}
}
timeout = setTimeout(handler, 100);
target.bind({
mousemove: track,
mouseout: clear
});
}
};
</script>
<script type="text/javascript">
var _gaq = _gaq || [];
_gaq.push(['_setAccount', 'UA-472075-3']);
_gaq.push(['_trackPageview']);
(function () {
var ga = document.createElement('script');
ga.type = 'text/javascript';
ga.async = true;
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(ga, s);
})();
</script>
<link rel="stylesheet" href="/css/custom.css?v=1.16"/> <script src="/js/jquery.ui.totop.js?1575549704"></script> <script src="/js/setting.js?1575549704"></script> <link rel="manifest" href="/manifest.json">
<meta name="theme-color" content="#616163" />
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-title" content="im4change">
<link rel="apple-touch-icon" href="/icons/logo-192x192.png">
</head>
<body id="top" class="home inner blog">
<div class="background-cover"></div>
<div class="wrapper animated">
<header id="theme-header" class="header_inner" style="position: relative;">
<div class="logo inner_logo" style="left:20px !important">
<a title="Home" href="https://im4change.in/">
<img src="https://im4change.in/images/logo2.jpg?1582080632" class="logo_image" alt="im4change"/> </a>
</div>
<div class="langhindi" style="color: #000;display:none;"
href="https://im4change.in/">
<a class="more-link" href="https://im4change.in/">Home</a>
<a href="https://im4change.in/hindi/" class="langbutton ">हिन्दी</a>
</div>
<nav class="fade-in animated2" id="main-nav">
<div class="container">
<div class="main-menu">
<ul class="menu" id="menu-main">
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
style="left: -40px;"><a
target="_blank" href="https://im4change.in/">Home</a>
</li>
<li class="menu-item mega-menu menu-item-type-taxonomy mega-menu menu-item-object-category mega-menu menu-item-has-children parent-list"
style=" margin-left: -40px;"><a href="#">KNOWLEDGE GATEWAY <span class="sub-indicator"></span>
</a>
<div class="mega-menu-block background_menu" style="padding-top:25px;">
<div class="container">
<div class="mega-menu-content">
<div class="mega-menu-item">
<h3><b>Farm Crisis</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/farmers039-suicides-14.html"
class="left postionrel">Farm Suicides </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/unemployment-30.html"
class="left postionrel">Unemployment </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/rural-distress-70.html"
class="left postionrel">Rural distress </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/migration-34.html"
class="left postionrel">Migration </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/key-facts-72.html"
class="left postionrel">Key Facts </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/debt-trap-15.html"
class="left postionrel">Debt Trap </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Empowerment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/union-budget-73.html"
class="left postionrel">Union Budget And Other Economic Policies </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/forest-and-tribal-rights-61.html"
class="left postionrel">Forest and Tribal Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-education-60.html"
class="left postionrel">Right to Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-food-59.html"
class="left postionrel">Right to Food </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/displacement-3279.html"
class="left postionrel">Displacement </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-work-mg-nrega-39.html"
class="left postionrel">Right to Work (MG-NREGA) </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/gender-3280.html"
class="left postionrel">GENDER </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-information-58.html"
class="left postionrel">Right to Information </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/social-audit-48.html"
class="left postionrel">Social Audit </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Hunger / HDI</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/poverty-and-inequality-20499.html"
class="left postionrel">Poverty and inequality </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/malnutrition-41.html"
class="left postionrel">Malnutrition </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/public-health-51.html"
class="left postionrel">Public Health </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/education-50.html"
class="left postionrel">Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hunger-overview-40.html"
class="left postionrel">Hunger Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hdi-overview-45.html"
class="left postionrel">HDI Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/pds-ration-food-security-42.html"
class="left postionrel">PDS/ Ration/ Food Security </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/sdgs-113.html"
class="left postionrel">SDGs </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/mid-day-meal-scheme-mdms-53.html"
class="left postionrel">Mid Day Meal Scheme (MDMS) </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Environment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/time-bomb-ticking-52.html"
class="left postionrel">Time Bomb Ticking </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/water-and-sanitation-55.html"
class="left postionrel">Water and Sanitation </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/impact-on-agriculture-54.html"
class="left postionrel">Impact on Agriculture </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Law & Justice</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/social-justice-20500.html"
class="left postionrel">Social Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/access-to-justice-47.html"
class="left postionrel">Access to Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/human-rights-56.html"
class="left postionrel">Human Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/corruption-35.html"
class="left postionrel">Corruption </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/general-insecurity-46.html"
class="left postionrel">General Insecurity </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/disaster-relief-49.html"
class="left postionrel">Disaster & Relief </a>
</p>
</div>
</div>
</div>
</div>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page "><a target="_blank" href="https://im4change.in/nceus_reports.php">NCEUS reports</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children parent-list ">
<a target="_blank" href="https://im4change.in/about-us-9.html">About Us <span
class="sub-indicator"></span></a>
<ul class="sub-menu aboutmenu">
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/objectives-8.html">Objectives</a>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/contactus.php">Contact
Us</a></li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/about-us-9.html">About
Us</a></li>
</ul>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children ">
<a target="_blank" href="https://im4change.in/fellowships.php" title="Fellowships">Fellowships</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/media-workshops.php">Workshops</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/research.php">Research</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/links-64">Partners</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
id="menu-item-539"><a target="_blank" href="https://im4change.in/hindi/"
class="langbutton langlinkfont17">हिन्दी</a></li>
</ul>
</div> </div>
<!-- <div style="float: right;">
<script async src="https://cse.google.com/cse.js?cx=18b4f2e0f11bed3dd"></script>
<div class="gcse-search"></div>
</div> -->
<div class="search-block" style=" margin-left: 8px; margin-right: 7px;">
<form method="get" id="searchform" name="searchform"
action="https://im4change.in/search"
onsubmit="return searchvalidate();">
<button class="search-button" type="submit" value="Search"></button>
<input type="text" id="s" name="qryStr" value=""
onfocus="if (this.value == 'Search...') {this.value = '';}"
onblur="if (this.value == '') {this.value = 'Search...';}">
</form>
</div>
</nav>
</header>
<div class="container">
<div id="main-content" class=" main1 container fade-in animated3 sidebar-narrow-left">
<div class="content-wrap">
<div class="content" style="width: 900px;min-height: 500px;">
<section class="cat-box recent-box innerCatRecent">
<h1 class="cat-box-title">Driven to distress -R Krishnakumar</h1>
<a href="JavaScript:void(0);" onclick="return shareArticle(27468);">
<img src="https://im4change.in/images/email.png?1582080630" border="0" width="24" align="right" alt="Share this article"/> </a>
<a href="https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519/print"
rel="nofollow">
<img src="https://im4change.in/images/icon-print.png?1582080630" border="0" width="24" align="right" alt="Share this article"/>
</a>
</section>
<section class="recent-box innerCatRecent">
<small class="pb-1"><span class="dateIcn">
<img src="https://im4change.in/images/published.svg?1582080666" alt="published"/>
Published on</span><span class="text-date"> Mar 9, 2015</span>
<span
class="dateIcn">
<img src="https://im4change.in/images/modified.svg?1582080666" alt="modified"/> Modified on </span><span class="text-date"> Mar 9, 2015</span>
</small>
</section>
<div class="clear"></div>
<div style="padding-top: 10px;">
<div class="innerLineHeight">
<div class="middleContent innerInput latest-news-updates">
<table>
<tr>
<td>
<div>
<div align="justify">-Frontline</div><p align="justify"><em>Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress. </em></p><p align="justify">KERALA is once again drawing attention to itself, this time for a persistent trend of a large number of households being pushed into financial ruin because of the expenses incurred for medical care.</p><p align="justify">Several studies have now found evidence for the many facets of this worrying development in a State that was known until the mid-1980s for its health care model that offered "good health at low cost" and for its health care indices that were comparable to those in more developed countries. However, today, the highest rate of health-related impoverishment in India is being noticed in Kerala, according to researchers, who also warn that all over the country high private health care spending and high out-of-pocket spending are placing a substantial financial burden on urban and rural households.</p><p align="justify">A committee of health care experts constituted by the Kerala State Planning Board has also cautioned that the health care infrastructure in Kerala and the finances of the common man have come under severe stress, with the State recording the highest per capita public and private health expenditure among major States. The highest out-of-pocket expenditures on health in the country have also been noticed in Kerala, said a concept note prepared in November 2014 by the committee, which was constituted as part of the implementation of the 12th Five Year Plan proposals on the health sector.</p><p align="justify">The committee said that the high cost of treatment and out-of-pocket expenditure led to a large section of people falling below the poverty line (BPL). It said, a study done by Peter Berman and Rajeev Ahuja ("The Impoverishing Effect of Health Care Payments in India: New Evidence and Methodology", published in India Health Beat by the Public Health Foundation of India and the World Bank unit in New Delhi in December 2009) using National Sample Survey Office (NSSO) 2004 survey data estimated that around 12 per cent of rural households and 8 per cent of urban households in Kerala were pushed below the poverty line in that year because of health care expenditure.</p><p align="justify">"A Kerala Sastra Sahitya Parishad [KSSP, the People's Science Movement] study in 1987 showed that the average health expenditure per person per annum in Kerala then was Rs.89. It increased to Rs.549 in 1997 and Rs.1,837 in 2004. The results of the latest KSSP survey in 2012 showed that the average per capita out-of-pocket health expenditure in the State was Rs.5,269.05," said Dr B. Ekbal, public health activist, former president of the KSSP, and national convener of the Jan Swasthya Abhiyan (People's Health Movement India).</p><p align="justify">"There is no doubt that the highest annual out-of-pocket health expenditure is in Kerala. The data obtained from the latest [2014] NSSO survey [conducted every 10 years] are being analysed and the results will be known in a few months. That will show if the RSBY [Rashtriya Swasthya Bima Yojna, the Government of India's national health insurance programme for BPL households] and other government-financed risk protection schemes introduced in the past decade have had any impact," said Arun B. Nair, a consultant (health economics and financing) with the National Health Systems Resource Centre.</p><p align="justify">Health care costs are indeed one of the important causes of impoverishment in all States in India. Berman and Ahuja's study found, among other things, that, compared with other developing countries, private health care spending in India was much higher than government spending; the share of out-of-pocket health spending within private health spending was much higher; and outpatient care, which involved relatively small but more frequent payments, was more impoverishing than inpatient care.</p><p align="justify">According to the Draft National Health Policy 2015 document prepared by the Ministry of Health and Family Welfare last December, over 63 million people are pushed into poverty every year in India because of expenditure on health care. Nearly 18 per cent of all households in 2011-12 faced catastrophic expenditures because of health costs compared with 15 per cent in 2004-05-a reflection surely of the failure of public investment in health to cover the entire spectrum of people's health care needs, according to the document.</p><p align="justify">The Berman and Ahuja study also found that there were significant variations between major States, in comparison with the national average, regarding health-related impoverishment, with Kerala showing the highest effect, and Madhya Pradesh (a State "with high levels of base poverty, low education, and lower access to health care overall") showing a relatively low rate of health-related impoverishment.</p><p align="justify">"The cost of health care is very high in Kerala because, one, nearly 87 per cent of the people in the State use modern medical facilities; two, there has been an increase in the number of people suffering from non-communicable and chronic diseases that require continuous care and affordable medicines; three, the State had witnessed large-scale and unregulated privatisation of health care facilities in the past decades and even the poor are now forced to depend on them; and four, the costs of medicines have gone up," Dr Ekbal told Frontline.</p><p align="justify"><em>Burden of NCDs</em></p><p align="justify">Kerala has been witnessing a "high morbidity and low mortality" trend, which is increasingly influenced by the replacement of infectious diseases and nutrition-related and maternal and child health-related health issues by non-communicable and chronic diseases, including cardiovascular diseases, diabetes, cancer and hypertension.</p><p align="justify">While the growing burden from non-communicable diseases (NCDs) is a reality all over India, the demographic transition in Kerala has meant a dramatic increase in its population of the aged, a higher burden of NCDs, and increasing health-seeking behaviour by its educated population, a trend marked by a growing preference for new and costly technology.</p><p align="justify">Kerala, where the foundation for a modern medical care system accessible to all was already in existence at the time of its formation in 1956, greatly expanded its government health facilities from 1961 to 1986. But what followed thereafter until the early 1990s was a period of intense fiscal crisis for successive State governments, when, in order to meet increasing expenditure on salary, they began to cut back spending on supplies, including drugs and other essentials, to the public hospitals. In a historical analysis of the development of health care facilities in Kerala, published in the journal Health Policy and Planning (OUP, 2000), Dr V. Ramankutty, Professor at the Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, recorded how this neglect destroyed Kerala's secondary health sector, especially the district and taluk government hospitals and the primary sector, consisting of primary health centres. Even as early as 1987, he said, an extensive survey of 10,000 households by the KSSP found that only 23 per cent of the households regularly used government health services for reasons that included "non-availability of drugs in the government hospitals", "lack of proper attention" and "better behaviour in private institutions". "There was a shift away from secondary care, with a drastic reduction in funds available for district and taluk government hospitals. Even now, despite the involvement of local bodies and the availability of funds through them, I am not sure all is well with the secondary care centres. Only some are doing well though the primary health system remains largely protected through a lot of direct central funding. Large-scale privatisation of the Kerala health sector took place during the same time," Dr Ramankutty told Frontline.</p><p align="justify">Kerala's Draft Health Policy notes that the public health care expenditure (as a proportion of the gross state domestic product, or GSDP) decreased by 35 per cent between 1990 and 2002, making Kerala one of the States with the highest reduction in public sector contributions and the highest increase in private funding for health care. The decline in public sector spending for health resulted in an overwhelming expansion of the private sector.</p><p align="justify">For example, the amount allocated for health care in the 2012-13 Kerala Budget was only 0.99 per cent of the GSDP. But, significantly, researchers say, private expenditure on health care was almost nine times as high and nearly two-thirds of the poor sought private sector facilities. According to the National Health Accounts (2004-05), of the total health expenditure in Kerala, the share of the private sector was the highest in the country with 90.27 per cent; the public sector accounted for only 9.7 per cent.</p><p align="justify">The prospering private super speciality hospitals with high-tech facilities are a result of the failure of the government health system to meet the demand for secondary and tertiary care and to manage the growing NCD burden. "But we have also started seeing a new trend of small and medium private hospitals being closed down in significant numbers in the State, making health care inaccessible to a large number of people or forcing them to approach bigger care facilities," Dr Ekbal said.</p><p align="justify">According to Dr Ramankutty, many entrepreneurs are entering the field and buying or selling off established private hospitals. "The profit motive has come to the fore. Hospitals are seen as an investment option for easy profits: there is enough demand; there are no labour disputes in the sector, for example. There is inadequate public health spending by the government and health care is free only in principle in most government institutions. Moreover, facilities for treatment of NCDs are limited and are not completely free in the public sector. The private sector has made use of this opportunity, equipping itself well with the latest technology and facilities, and even the poor are forced to depend on them -at a heavy cost."</p><p align="justify">"Government support has been a key factor in the advancement of health care in the State. An expansion or strengthening of the public health system based on today's requirements has not taken place even as people's aspirations about health care needs have gone up. The care that the State used to provide in the 1980s is not what is required today," he told Frontline. Thus, the State is facing a situation where, because of the growing burden of NCDs, health care costs are leading more and more people (not just low-income families) to financial distress. Hospitalisation, even in the government sector, is leading to catastrophic health expenditure, distress financing and its aftermath; existing insurance and similar financial support schemes are inadequate and offer services only for a limited spectrum of diseases and procedures.</p><p align="justify">A dearth of micro-level studies, especially looking at how this impacts individuals, has meant a general lack of understanding about the seriousness of the evolving situation: of how NCD burden could overwhelm the State's troubled health sector and drive vulnerable sections of Kerala society deeper into poverty and lifelong dependency.</p><p align="justify">"It is important to ensure that treatment options and medicines are accessible and affordable to all. The government has to spend more on health care and should not allow a change to a system where despite the availability of all the facilities in the public or private sector, a substantial section of people are still denied health care," Dr Ekbal said.</p><p align="justify">Most health care researchers, therefore, argue for the reintroduction of the system of accessible and affordable primary care, like the British system of general practitioners or by strengthening the system based on community (public) health centres; more government spending on health, especially to deal with the emerging NCD burden; better regulation and quality control in the private sector; introduction of better financial risk protection measures and their better coordination to help patients deal with catastrophic health expenditure; and measures to ensure availability of medicines and bring down costs in all government facilities.</p><p align="justify">"Public health governance has taken a back seat in Kerala, and hospital administrators are not properly trained to deal with the emerging professional and financial challenges. There is a general complacency when it comes to issues relating to health. We tend to bask in our past glory, smug about our early achievements, when new challenges are already overwhelming us and, in truth, other States are stealing a march over us," Dr Ramankutty said.</p>
</div>
</td>
</tr>
</table>
</div>
</div>
</div>
<div class="clear"></div>
<br><a href="http://www.frontline.in/the-nation/driven-to-distress/article6945294.ece?homepage=true" class="re" target="_blank">Frontline, 20 March, 2015, http://www.frontline.in/the-nation/driven-to-distress/article6945294.ece?homepage=true</a><div class="clear"></div>
<div style="padding-top: 18px;">
<p class="post-tag">Tagged with:
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=healthcare"
title="healthcare">
healthcare </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=healthcare in india"
title="healthcare in india">
healthcare in india </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Health"
title="Access to Health">
Access to Health </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Healthcare"
title="Access to Healthcare">
Access to Healthcare </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Medicines"
title="Access to Medicines">
Access to Medicines </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Health Expenditure"
title="Health Expenditure">
Health Expenditure </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Public Health"
title="Public Health">
Public Health </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=kerala"
title="kerala">
kerala </a>
</p>
</div>
<div class="clear"></div>
<br><br>
<div class="widget-top">
<h4>Related Articles</h4>
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<ul id="recentcomments">
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-s-stretched-health-care-system-fails-millions-in-rural-areas-battling-sickle-cell-disease-abc.html"
title="India's stretched health care system fails millions in rural areas battling sickle cell disease - ABC">
India's stretched health care system fails millions in rural areas battling sickle cell disease - ABC </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/what-data-told-us-about-india-in-2022-akshi-chawla.html"
title="What data told us about India in 2022 - Akshi Chawla">
What data told us about India in 2022 - Akshi Chawla </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/climate-change-will-likely-exacerbate-indian-rural-household-s-debt-burden.html"
title="Climate change will likely exacerbate Indian rural household's debt burden ">
Climate change will likely exacerbate Indian rural household's debt burden </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/the-need-to-make-cancer-drugs-affordable-biswajit-dhar-and-chetali-rao.html"
title="The need to make cancer drugs affordable -Biswajit Dhar and Chetali Rao">
The need to make cancer drugs affordable -Biswajit Dhar and Chetali Rao </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/after-measles-experts-worry-typhoid-could-pose-the-next-health-challenge-as-india-delays-vaccine-tabassum-barnagarwala.html"
title="After measles, experts worry typhoid could pose the next health challenge as India delays vaccine -Tabassum Barnagarwala">
After measles, experts worry typhoid could pose the next health challenge as India delays vaccine -Tabassum Barnagarwala </a>
</li>
</ul>
</div>
<div class="comment-respond" id="respond">
<a name="commentbox"> </a>
<h3 class="comment-reply-title" id="reply-title">Write Comments</h3>
<form method="post" accept-charset="utf-8" role="form" action="/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"><div style="display:none;"><input type="hidden" name="_method" value="POST"/></div> <form class="comment-form" id="commentform" method="post" action="#commentbox" onSubmit="return validate()"
name="cmtform">
<input type="hidden" name="cmttype" value="articlecmt"/>
<input type="hidden" name="article_id" value="27468"/>
<p class="comment-notes">Your email address will not be published. Required fields are marked <span
class="required">*</span></p>
<p class="comment-form-author">
<label for="commenterName">Name</label>
<span class="required">*</span>
<input type="text" aria-required="true" size="30"
value=""
name="commenterName" id="commenterName" required="true">
</p>
<p class="comment-form-email">
<label for="commenterEmail">Email</label> <span class="required">*</span>
<input aria-required="true" size="30" name="commenterEmail" id="commenterEmail" type="email"
value=""
required="true">
</p>
<p class="comment-form-contact">
<label for="commenterPh">Contact No.</label>
<input type="text" size="30"
value=""
name="commenterPh" id="commenterPh">
</p>
<p class="comment-form-comment">
<label for="comment">Comment</label>
<textarea aria-required="true" required="true" rows="8" cols="45" name="comment"
id="comment"></textarea>
</p>
<p class="comment-form-comment">
<label for="comment">Type the characters you see in the image below <span class="required">*</span><br><img
class="captchaImg"
src="https://im4change.in/securimage_show_art.php?tk=760565086" alt="captcha"/>
</label>
</p>
<input type="text" name="vrcode" required="true"/>
<p class="form-submit" style="width: 200px;">
<input type="submit" value="Post Comment" id="submit" name="submit">
</p></form>
</div>
<style>
.ui-widget-content {
height: auto !important;
}
</style>
<div id="share-modal"></div>
<style>
.middleContent a{
background-color: rgba(108,172,228,.2);
}
.middleContent a:hover{
background-color: #418fde;
border-color: #418fde;
color: #000;
}
</style>
<script>
function shareArticle(article_id) {
var options = {
modal: true,
height: 'auto',
width: 600 + 'px'
};
$('#share-modal').html("");
$('#share-modal').load('https://im4change.in/share_article?article_id=' + article_id).dialog(options).dialog('open');
}
function postShare() {
var param = 'article_id=' + $("#article_id").val();
param = param + '&y_name=' + $("#y_name").val();
param = param + '&y_email=' + $("#y_email").val();
param = param + '&f_name=' + $("#f_name").val();
param = param + '&f_email=' + $("#f_email").val();
param = param + '&y_msg=' + $("#y_msg").val();
$.ajax({
type: "POST",
url: 'https://im4change.in/post_share_article',
data: param,
success: function (response) {
$('#share-modal').html("Thank You, Your message posted to ");
}
});
return false;
}
</script> </div>
</div>
<!-- Right Side Section Start -->
<!-- MAP Section START -->
<aside class="sidebar indexMarg">
<div class="ad-cell">
<a href="https://im4change.in/statemap.php" title="">
<img src="https://im4change.in/images/map_new_version.png?1582080666" alt="India State Map" class="indiamap" width="232" height="252"/> </a>
<div class="rightmapbox">
<div id="sideOne" class="docltitle"><a href="https://im4change.in/state-report/india/36" target="_blank">DOCUMENTS/
REPORTS</a></div>
<div id="sideTwo" class="statetitle"><a href="https://im4change.in/states.php"target="_blank">STATE DATA/
HDRs.</a></div>
</div>
<div class="widget widgePadTop"></div>
</div>
</aside>
<!-- MAP Section END -->
<aside class="sidebar sidePadbottom">
<div class="rightsmlbox1" >
<a href="https://im4change.in/knowledge_gateway" target="_blank" style="color: #035588;
font-size: 17px;">
KNOWLEDGE GATEWAY
</a>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/newsletter" target="_blank">
NEWSLETTER
</a>
</p>
</div>
</div>
<div class="rightsmlbox1" style="height: 325px;">
<div>
<p class="rightsmlbox1_title">
Interview with Prof. Ravi Srivastava
</p>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/video/interview-with-prof-ravi-srivastava-on-current-economic-crisis">
<img width="250" height="200" src="/images/interview_video_home.jpg" alt="Interview with Prof. Ravi Srivastava"/>
</a>
<!--
<iframe width="250" height="200" src="https://www.youtube.com/embed/MmaTlntk-wc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>-->
</p>
<a href="https://im4change.in/videogallery" class="more-link CatArchalAnch1" target="_blank">
More videos
</a>
</div>
</div>
<div class="rightsmlbox1">
<div>
<!--div id="sstory" class="rightboxicons"></div--->
<p class="rightsmlbox1_title"><a href="https://im4change.in/list-success-stories" target="_blank">Success Stories</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/interviews" target="_blank">Interviews</a>
</p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a href="https://www.commoncause.in/page.php?id=10" >Donate</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/marquee"
class="isf_link more-link" title="India Focus?" style="border: 4px solid #fdd922;width: 90%;background-color: #fdd922;text-align: center;color: #000000;font-size:18px" target="_blank">India Focus</a></p> </div>
</div>
<div class="rightsmlbox1" style="height: 104px !important;">
<a href="https://im4change.in/quarterly_reports.php" target="_blank">
Quarterly Reports on Effect of Economic Slowdown on Employment in India (2008 - 2015)
</a>
</div>
<!-- <div class="rightsmlbox1">
<a href="https://play.google.com/store/apps/details?id=com.im4.im4change" target="_blank">
</a></div> -->
<!-- <section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">Most Visited</h2>
</section> -->
<!-- accordion Starts here -->
<!-- <div id="accordion" class="accordMarg">
</div> -->
<!-- accordion ends here -->
<!-- Widget Tag Cloud Starts here -->
<div id="tag_cloud-2" class="widget widget_tag_cloud">
<section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">MOST VISITED TAGS</h2>
</section>
<div class="widget-top wiPdTp">
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<div class="tagcloud">
<a href="https://im4change.in/search?qryStr=Agriculture"
target="_blank" class="tag-link-4 font4">Agriculture</a>
<a href="https://im4change.in/search?qryStr=Food Security"
target="_blank" class="tag-link-4 font4">Food Security</a>
<a href="https://im4change.in/search?qryStr=Law and Justice"
target="_blank" class="tag-link-4 font4">Law and Justice</a>
<a href="https://im4change.in/search?qryStr=Health"
target="_blank" class="tag-link-4 font4">Health</a>
<a href="https://im4change.in/search?qryStr=Right to Food"
target="_blank" class="tag-link-4 font4">Right to Food</a>
<a href="https://im4change.in/search?qryStr=Corruption"
target="_blank" class="tag-link-4 font4">Corruption</a>
<a href="https://im4change.in/search?qryStr=farming"
target="_blank" class="tag-link-4 font4">farming</a>
<a href="https://im4change.in/search?qryStr=Environment"
target="_blank" class="tag-link-4 font4">Environment</a>
<a href="https://im4change.in/search?qryStr=Right to Information"
target="_blank" class="tag-link-4 font4">Right to Information</a>
<a href="https://im4change.in/search?qryStr=NREGS"
target="_blank" class="tag-link-4 font4">NREGS</a>
<a href="https://im4change.in/search?qryStr=Human Rights"
target="_blank" class="tag-link-4 font4">Human Rights</a>
<a href="https://im4change.in/search?qryStr=Governance"
target="_blank" class="tag-link-4 font4">Governance</a>
<a href="https://im4change.in/search?qryStr=PDS"
target="_blank" class="tag-link-4 font4">PDS</a>
<a href="https://im4change.in/search?qryStr=COVID-19"
target="_blank" class="tag-link-4 font4">COVID-19</a>
<a href="https://im4change.in/search?qryStr=Land Acquisition"
target="_blank" class="tag-link-4 font4">Land Acquisition</a>
<a href="https://im4change.in/search?qryStr=mgnrega"
target="_blank" class="tag-link-4 font4">mgnrega</a>
<a href="https://im4change.in/search?qryStr=Farmers"
target="_blank" class="tag-link-4 font4">Farmers</a>
<a href="https://im4change.in/search?qryStr=transparency"
target="_blank" class="tag-link-4 font4">transparency</a>
<a href="https://im4change.in/search?qryStr=Gender"
target="_blank" class="tag-link-4 font4">Gender</a>
<a href="https://im4change.in/search?qryStr=Poverty"
target="_blank" class="tag-link-4 font4">Poverty</a>
<a href="https://im4change.in/search?qryStr=Farm Laws" target="_blank" class="tag-link-4 font4">Farm Laws
</a>
<a href="https://im4change.in/search?qryStr=Citizenship Amendment Act" target="_blank" class="tag-link-4 font4">Citizenship Amendment Act
</a>
<a href="https://im4change.in/search?qryStr=CAA NPR NRIC" target="_blank" class="tag-link-4 font4">CAA NPR NRIC
</a>
<a href="https://im4change.in/search?qryStr=Job Losses" target="_blank" class="tag-link-4 font4">Job Losses
</a>
<a href="https://im4change.in/search?qryStr=Migrant Workers" target="_blank" class="tag-link-4 font4">Migrant Workers
</a>
<a href="https://im4change.in/search?qryStr=Unemployment" target="_blank" class="tag-link-4 font4">Unemployment
</a>
<a href="https://im4change.in/search?qryStr=PMGKAY" target="_blank" class="tag-link-4 font4">PMGKAY
</a>
<a href="https://im4change.in/search?qryStr=PM-KISAN" target="_blank" class="tag-link-4 font4">PM-KISAN
</a>
<a href="https://im4change.in/search?qryStr=PM-CARES" target="_blank" class="tag-link-4 font4">PM-CARES
</a>
<a href="https://im4change.in/search?qryStr=LFPR" target="_blank" class="tag-link-4 font4">LFPR
</a>
</div>
</div>
</div>
<!-- Widget Tag Cloud Ends here -->
</aside>
<!-- Right Side Section End -->
</div>
<section class="cat-box cats-review-box footerSec">
<h2 class="cat-box-title vSec CatArcha">Video
Archives</h2>
<h2 class="cat-box-title CatArchaTitle">Archives</h2>
<div class="cat-box-content">
<div class="reviews-cat">
<div class="CatArchaDiv1">
<div class="CatArchaDiv2">
<ul>
<li>
<a href="https://im4change.in/news-alerts-57/moving-upstream-luni-fellowship.html" target="_blank">
Moving Upstream: Luni – Fellowship </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/135-million-indians-exited-multidimensional-poverty-as-per-government-figures-is-that-the-same-as-poverty-reduction.html" target="_blank">
135 Million Indians Exited “Multidimensional" Poverty as per Government... </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/explainer-why-are-tomato-prices-on-fire.html" target="_blank">
Explainer: Why are Tomato Prices on Fire? </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/nsso-survey-only-39-1-of-all-households-have-drinking-water-within-dwelling-46-7-of-rural-households-use-firewood-for-cooking.html" target="_blank">
NSSO Survey: Only 39.1% of all Households have Drinking... </a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/news-alerts-57"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/I51LYnP8BOk/1.jpg"
alt=" Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Short-Video-on-im4change-Hindi-website-Inclusive-Media-for-Change" target="_blank">
Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/kNqha-SwfIY/1.jpg"
alt=" "Session 1: Scope of IDEA and AgriStack" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-1- Scope-of-IDEA-and-AgriStack-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 1: Scope of IDEA and AgriStack" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/6kIVjlgZItk/1.jpg"
alt=" "Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-2-Farmer-Centric-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/2BeHTu0y7xc/1.jpg"
alt=" "Session 3: Future of Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-3-Future-of-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 3: Future of Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="divWidth">
<ul class="divWidthMarg">
<li>
<a href="https://im4change.in/video/Public-Spending-on-Agriculture-in-India-Source-Foundation-for-Agrarian-Studies"
title="Public Spending on Agriculture in India (Source: Foundation for Agrarian Studies)" target="_blank">
Public Spending on Agriculture in India (Source: Foundation for...</a>
</li>
<li>
<a href="https://im4change.in/video/Agrarian-Change-Seminar-Protests-against-the-New-Farm-Laws-in-India-by-Prof-Vikas-Rawal-JNU-Source-Journal-Of-Agrarian-Change"
title="Agrarian Change Seminar: 'Protests against the New Farm Laws in India' by Prof. Vikas Rawal, JNU (Source: Journal Of Agrarian Change) " target="_blank">
Agrarian Change Seminar: 'Protests against the New Farm Laws...</a>
</li>
<li>
<a href="https://im4change.in/video/Webinar-Ramrao-The-Story-of-India-Farm-Crisis-Source-Azim-Premji-University"
title="Webinar: Ramrao - The Story of India's Farm Crisis (Source: Azim Premji University)" target="_blank">
Webinar: Ramrao - The Story of India's Farm Crisis...</a>
</li>
<li>
<a href="https://im4change.in/video/water-and-agricultural-transformation-in-India"
title="Water and Agricultural Transformation in India: A Symbiotic Relationship (Source: IGIDR)" target="_blank">
Water and Agricultural Transformation in India: A Symbiotic Relationship...</a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/videogallery"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</section> </div>
<div class="clear"></div>
<!-- Footer option Starts here -->
<div class="footer-bottom fade-in animated4">
<div class="container">
<div class="social-icons icon_flat">
<p class="SocialMargTop"> Website Developed by <a target="_blank" title="Web Development"
class="wot right"
href="http://www.ravinderkhurana.com/" rel="nofollow">
RAVINDErkHURANA.com</a></p>
</div>
<div class="alignleft">
<a
target="_blank" href="https://im4change.in/objectives-8.html"
class="link"
title="Objectives">Objectives</a> | <a
target="_blank" href="https://im4change.in/about-us-9.html"
class="link" title="About Us">About Us</a> | <a
target="_blank" href="https://im4change.in/media-workshops.php"
class="ucwords">Workshops</a> | <a
target="_blank" href="https://im4change.in/disclaimer/disclaimer-149.html"
title="Disclaimer">Disclaimer</a> </div>
</div>
</div>
<!-- Footer option ends here -->
</div>
<div id="connect">
<a target="_blank"
href="http://www.facebook.com/sharer.php?u=https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"
title="Share on Facebook">
<img src="https://im4change.in/images/Facebook.png?1582080640" alt="share on Facebook" class="ImgBorder"/>
</a><br/>
<a target="_blank"
href="http://twitter.com/share?text=Im4change&url=https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"
title="Share on Twitter">
<img src="https://im4change.in/images/twitter.png?1582080632" alt="Twitter" class="ImgBorder"/> </a>
<br/>
<a href="/feeds" title="RSS Feed" target="_blank">
<img src="https://im4change.in/images/rss.png?1582080632" alt="RSS" class="ImgBorder"/>
</a>
<br/>
<a class="feedback-link" id="feedbackFormLink" href="#">
<img src="https://im4change.in/images/feedback.png?1582080630" alt="Feedback" class="ImgBorder"/>
</a> <br/>
<a href="javascript:function iprl5(){var d=document,z=d.createElement('scr'+'ipt'),b=d.body,l=d.location;try{if(!b)throw(0);d.title='(Saving...) '+d.title;z.setAttribute('src',l.protocol+'//www.instapaper.com/j/WKrH3R7ORD5p?u='+encodeURIComponent(l.href)+'&t='+(new Date().getTime()));b.appendChild(z);}catch(e){alert('Please wait until the page has loaded.');}}iprl5();void(0)"
class="bookmarklet" onclick="return explain_bookmarklet();">
<img src="https://im4change.in/images/read-it-later.png?1582080632" alt="Read Later" class="ImgBorder"/> </a>
</div>
<!-- Feedback form Starts here -->
<div id="feedbackForm" class="overlay_form" class="ImgBorder">
<h2>Contact Form</h2>
<div id="contactform1">
<div id="formleft">
<form id="submitform" action="/contactus.php" method="post">
<input type="hidden" name="submitform" value="submitform"/>
<input type="hidden" name="salt_key" value="a0e0f2c6a0644a70e57ad2c96829709a"/>
<input type="hidden" name="ref" value="feedback"/>
<fieldset>
<label>Name :</label>
<input type="text" name="name" class="tbox" required/>
</fieldset>
<fieldset>
<label>Email :</label>
<input type="text" name="email" class="tbox" required/>
</fieldset>
<fieldset>
<label>Message :</label>
<textarea rows="5" cols="20" name="message" required></textarea>
</fieldset>
<fieldset>
Please enter security code
<div class="clear"></div>
<input type="text" name="vrcode" class="tbox"/>
</fieldset>
<fieldset>
<input type="submit" class="button" value="Submit"/>
<a href="#" id="closefeedbakcformLink">Close</a>
</fieldset>
</form>
</div>
<div class="clearfix"></div>
</div>
</div>
<div id="donate_popup" class="modal" style="max-width: 800px;">
<table width="100%" border="1">
<tr>
<td colspan="2" align="center">
<b>Support im4change</b>
</td>
</tr>
<tr>
<td width="25%" valign="middle">
<img src="https://im4change.in/images/logo2.jpg?1582080632" alt="" width="100%"/> </td>
<td style="padding-left:10px;padding-top:10px;">
<form action="https://im4change.in/donate" method="get">
<table width="100%" cellpadding="2" cellspacing="2">
<tr>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
10
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
100
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
1000
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
50
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
500
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
<input type="text" name="price" placeholder="?" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td colspan="3" align="right">
<input type="button" name="Pay" value="Pay"
style="width: 200px;background-color: rgb(205, 35, 36);color: #ffffff;"/>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div><script type='text/javascript'>
/* <![CDATA[ */
var tievar = {'go_to': 'Go to...'};
/* ]]> */
</script>
<script src="/js/tie-scripts.js?1575549704"></script><script src="/js/bootstrap.js?1575549704"></script><script src="/js/jquery.modal.min.js?1578284310"></script><script>
$(document).ready(function() {
// tell the autocomplete function to get its data from our php script
$('#s').autocomplete({
source: "/autocomplete"
});
});
</script>
<script src="/vj-main-sw-register.js" async></script>
<script>function init(){var imgDefer=document.getElementsByTagName('img');for(var i=0;i<imgDefer.length;i++){if(imgDefer[i].getAttribute('data-src')){imgDefer[i].setAttribute('src',imgDefer[i].getAttribute('data-src'))}}}
window.onload=init;</script>
</body>
</html>'
}
$maxBufferLength = (int) 8192
$file = '/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php'
$line = (int) 853
$message = 'Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853'
Cake\Http\ResponseEmitter::emit() - CORE/src/Http/ResponseEmitter.php, line 48
Cake\Http\Server::emit() - CORE/src/Http/Server.php, line 141
[main] - ROOT/webroot/index.php, line 39
Warning (2): Cannot modify header information - headers already sent by (output started at /home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php:853) [CORE/src/Http/ResponseEmitter.php, line 148]
$response = object(Cake\Http\Response) {
'status' => (int) 200,
'contentType' => 'text/html',
'headers' => [
'Content-Type' => [
[maximum depth reached]
]
],
'file' => null,
'fileRange' => [],
'cookies' => object(Cake\Http\Cookie\CookieCollection) {},
'cacheDirectives' => [],
'body' => '<!DOCTYPE html>
<!--[if lt IE 7 ]>
<html class="ie ie6" lang='en'> <![endif]-->
<!--[if IE 7 ]>
<html class="ie ie7" lang='en'> <![endif]-->
<!--[if IE 8 ]>
<html class="ie ie8" lang='en'> <![endif]-->
<!--[if (gte IE 9)|!(IE)]><!-->
<html lang='en'>
<!--<![endif]-->
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>
LATEST NEWS UPDATES | Driven to distress -R Krishnakumar </title>
<meta name="description" content="
-Frontline
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number..."/>
<meta name="keywords" content="healthcare,healthcare in india,Access to Health,Access to Healthcare,Access to Medicines,Health Expenditure,Public Health,kerala"/>
<meta name="news_keywords" content="healthcare,healthcare in india,Access to Health,Access to Healthcare,Access to Medicines,Health Expenditure,Public Health,kerala">
<link rel="alternate" type="application/rss+xml" title="ROR" href="/ror.xml"/>
<link rel="alternate" type="application/rss+xml" title="RSS 2.0" href="/feeds/"/>
<link rel="stylesheet" href="/css/bootstrap.min.css?1697864993"/> <link rel="stylesheet" href="/css/style.css?v=1.1.2"/> <link rel="stylesheet" href="/css/style-inner.css?1577045210"/> <link rel="stylesheet" id="Oswald-css"
href="https://fonts.googleapis.com/css?family=Oswald%3Aregular%2C700&ver=3.8.1" type="text/css"
media="all">
<link rel="stylesheet" href="/css/jquery.modal.min.css?1578285302"/> <script src="/js/jquery-1.10.2.js?1575549704"></script> <script src="/js/jquery-migrate.min.js?1575549704"></script> <link rel="shortcut icon" href="/favicon.ico" title="Favicon">
<link rel="stylesheet" href="/css/jquery-ui.css?1580720609"/> <script src="/js/jquery-ui.js?1575549704"></script> <link rel="preload" as="style" href="https://www.im4change.org/css/custom.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery.modal.min.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery-ui.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/li-scroller.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<!-- <link rel="preload" as="style" href="https://www.im4change.org/css/style.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous"> -->
<link rel="preload" as="style" href="https://www.im4change.org/css/style-inner.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel='dns-prefetch' href="//im4change.org/css/custom.css" crossorigin >
<link rel="preload" as="script" href="https://www.im4change.org/js/bootstrap.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.li-scroller.1.0.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.modal.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.ui.totop.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-1.10.2.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-migrate.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-ui.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/setting.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/tie-scripts.js">
<!--[if IE]>
<script type="text/javascript">jQuery(document).ready(function () {
jQuery(".menu-item").has("ul").children("a").attr("aria-haspopup", "true");
});</script>
<![endif]-->
<!--[if lt IE 9]>
<script src="/js/html5.js"></script>
<script src="/js/selectivizr-min.js"></script>
<![endif]-->
<!--[if IE 8]>
<link rel="stylesheet" type="text/css" media="all" href="/css/ie8.css"/>
<![endif]-->
<meta property="og:title" content="LATEST NEWS UPDATES | Driven to distress -R Krishnakumar" />
<meta property="og:url" content="https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html" />
<meta property="og:type" content="article" />
<meta property="og:description" content="
-Frontline
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number..." />
<meta property="og:image" content="" />
<meta property="fb:app_id" content="0" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
<link rel="apple-touch-icon-precomposed" sizes="144x144" href="https://im4change.in/images/apple1.png">
<link rel="apple-touch-icon-precomposed" sizes="120x120" href="https://im4change.in/images/apple2.png">
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="https://im4change.in/images/apple3.png">
<link rel="apple-touch-icon-precomposed" href="https://im4change.in/images/apple4.png">
<style>
.gsc-results-wrapper-overlay{
top: 38% !important;
height: 50% !important;
}
.gsc-search-button-v2{
border-color: #035588 !important;
background-color: #035588 !important;
}
.gsib_a{
height: 30px !important;
padding: 2px 8px 1px 6px !important;
}
.gsc-search-button-v2{
height: 41px !important;
}
input.gsc-input{
background: none !important;
}
@media only screen and (max-width: 600px) {
.gsc-results-wrapper-overlay{
top: 11% !important;
width: 87% !important;
left: 9% !important;
height: 43% !important;
}
.gsc-search-button-v2{
padding: 10px 10px !important;
}
.gsc-input-box{
height: 28px !important;
}
/* .gsib_a {
padding: 0px 9px 4px 9px !important;
}*/
}
@media only screen and (min-width: 1200px) and (max-width: 1920px) {
table.gsc-search-box{
width: 15% !important;
float: right !important;
margin-top: -118px !important;
}
.gsc-search-button-v2 {
padding: 6px !important;
}
}
</style>
<script>
$(function () {
$("#accordion").accordion({
event: "click hoverintent"
});
});
/*
* hoverIntent | Copyright 2011 Brian Cherne
* http://cherne.net/brian/resources/jquery.hoverIntent.html
* modified by the jQuery UI team
*/
$.event.special.hoverintent = {
setup: function () {
$(this).bind("mouseover", jQuery.event.special.hoverintent.handler);
},
teardown: function () {
$(this).unbind("mouseover", jQuery.event.special.hoverintent.handler);
},
handler: function (event) {
var currentX, currentY, timeout,
args = arguments,
target = $(event.target),
previousX = event.pageX,
previousY = event.pageY;
function track(event) {
currentX = event.pageX;
currentY = event.pageY;
}
;
function clear() {
target
.unbind("mousemove", track)
.unbind("mouseout", clear);
clearTimeout(timeout);
}
function handler() {
var prop,
orig = event;
if ((Math.abs(previousX - currentX) +
Math.abs(previousY - currentY)) < 7) {
clear();
event = $.Event("hoverintent");
for (prop in orig) {
if (!(prop in event)) {
event[prop] = orig[prop];
}
}
// Prevent accessing the original event since the new event
// is fired asynchronously and the old event is no longer
// usable (#6028)
delete event.originalEvent;
target.trigger(event);
} else {
previousX = currentX;
previousY = currentY;
timeout = setTimeout(handler, 100);
}
}
timeout = setTimeout(handler, 100);
target.bind({
mousemove: track,
mouseout: clear
});
}
};
</script>
<script type="text/javascript">
var _gaq = _gaq || [];
_gaq.push(['_setAccount', 'UA-472075-3']);
_gaq.push(['_trackPageview']);
(function () {
var ga = document.createElement('script');
ga.type = 'text/javascript';
ga.async = true;
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(ga, s);
})();
</script>
<link rel="stylesheet" href="/css/custom.css?v=1.16"/> <script src="/js/jquery.ui.totop.js?1575549704"></script> <script src="/js/setting.js?1575549704"></script> <link rel="manifest" href="/manifest.json">
<meta name="theme-color" content="#616163" />
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-title" content="im4change">
<link rel="apple-touch-icon" href="/icons/logo-192x192.png">
</head>
<body id="top" class="home inner blog">
<div class="background-cover"></div>
<div class="wrapper animated">
<header id="theme-header" class="header_inner" style="position: relative;">
<div class="logo inner_logo" style="left:20px !important">
<a title="Home" href="https://im4change.in/">
<img src="https://im4change.in/images/logo2.jpg?1582080632" class="logo_image" alt="im4change"/> </a>
</div>
<div class="langhindi" style="color: #000;display:none;"
href="https://im4change.in/">
<a class="more-link" href="https://im4change.in/">Home</a>
<a href="https://im4change.in/hindi/" class="langbutton ">हिन्दी</a>
</div>
<nav class="fade-in animated2" id="main-nav">
<div class="container">
<div class="main-menu">
<ul class="menu" id="menu-main">
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
style="left: -40px;"><a
target="_blank" href="https://im4change.in/">Home</a>
</li>
<li class="menu-item mega-menu menu-item-type-taxonomy mega-menu menu-item-object-category mega-menu menu-item-has-children parent-list"
style=" margin-left: -40px;"><a href="#">KNOWLEDGE GATEWAY <span class="sub-indicator"></span>
</a>
<div class="mega-menu-block background_menu" style="padding-top:25px;">
<div class="container">
<div class="mega-menu-content">
<div class="mega-menu-item">
<h3><b>Farm Crisis</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/farmers039-suicides-14.html"
class="left postionrel">Farm Suicides </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/unemployment-30.html"
class="left postionrel">Unemployment </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/rural-distress-70.html"
class="left postionrel">Rural distress </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/migration-34.html"
class="left postionrel">Migration </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/key-facts-72.html"
class="left postionrel">Key Facts </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/debt-trap-15.html"
class="left postionrel">Debt Trap </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Empowerment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/union-budget-73.html"
class="left postionrel">Union Budget And Other Economic Policies </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/forest-and-tribal-rights-61.html"
class="left postionrel">Forest and Tribal Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-education-60.html"
class="left postionrel">Right to Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-food-59.html"
class="left postionrel">Right to Food </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/displacement-3279.html"
class="left postionrel">Displacement </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-work-mg-nrega-39.html"
class="left postionrel">Right to Work (MG-NREGA) </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/gender-3280.html"
class="left postionrel">GENDER </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-information-58.html"
class="left postionrel">Right to Information </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/social-audit-48.html"
class="left postionrel">Social Audit </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Hunger / HDI</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/poverty-and-inequality-20499.html"
class="left postionrel">Poverty and inequality </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/malnutrition-41.html"
class="left postionrel">Malnutrition </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/public-health-51.html"
class="left postionrel">Public Health </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/education-50.html"
class="left postionrel">Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hunger-overview-40.html"
class="left postionrel">Hunger Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hdi-overview-45.html"
class="left postionrel">HDI Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/pds-ration-food-security-42.html"
class="left postionrel">PDS/ Ration/ Food Security </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/sdgs-113.html"
class="left postionrel">SDGs </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/mid-day-meal-scheme-mdms-53.html"
class="left postionrel">Mid Day Meal Scheme (MDMS) </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Environment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/time-bomb-ticking-52.html"
class="left postionrel">Time Bomb Ticking </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/water-and-sanitation-55.html"
class="left postionrel">Water and Sanitation </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/impact-on-agriculture-54.html"
class="left postionrel">Impact on Agriculture </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Law & Justice</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/social-justice-20500.html"
class="left postionrel">Social Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/access-to-justice-47.html"
class="left postionrel">Access to Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/human-rights-56.html"
class="left postionrel">Human Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/corruption-35.html"
class="left postionrel">Corruption </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/general-insecurity-46.html"
class="left postionrel">General Insecurity </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/disaster-relief-49.html"
class="left postionrel">Disaster & Relief </a>
</p>
</div>
</div>
</div>
</div>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page "><a target="_blank" href="https://im4change.in/nceus_reports.php">NCEUS reports</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children parent-list ">
<a target="_blank" href="https://im4change.in/about-us-9.html">About Us <span
class="sub-indicator"></span></a>
<ul class="sub-menu aboutmenu">
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/objectives-8.html">Objectives</a>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/contactus.php">Contact
Us</a></li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/about-us-9.html">About
Us</a></li>
</ul>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children ">
<a target="_blank" href="https://im4change.in/fellowships.php" title="Fellowships">Fellowships</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/media-workshops.php">Workshops</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/research.php">Research</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/links-64">Partners</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
id="menu-item-539"><a target="_blank" href="https://im4change.in/hindi/"
class="langbutton langlinkfont17">हिन्दी</a></li>
</ul>
</div> </div>
<!-- <div style="float: right;">
<script async src="https://cse.google.com/cse.js?cx=18b4f2e0f11bed3dd"></script>
<div class="gcse-search"></div>
</div> -->
<div class="search-block" style=" margin-left: 8px; margin-right: 7px;">
<form method="get" id="searchform" name="searchform"
action="https://im4change.in/search"
onsubmit="return searchvalidate();">
<button class="search-button" type="submit" value="Search"></button>
<input type="text" id="s" name="qryStr" value=""
onfocus="if (this.value == 'Search...') {this.value = '';}"
onblur="if (this.value == '') {this.value = 'Search...';}">
</form>
</div>
</nav>
</header>
<div class="container">
<div id="main-content" class=" main1 container fade-in animated3 sidebar-narrow-left">
<div class="content-wrap">
<div class="content" style="width: 900px;min-height: 500px;">
<section class="cat-box recent-box innerCatRecent">
<h1 class="cat-box-title">Driven to distress -R Krishnakumar</h1>
<a href="JavaScript:void(0);" onclick="return shareArticle(27468);">
<img src="https://im4change.in/images/email.png?1582080630" border="0" width="24" align="right" alt="Share this article"/> </a>
<a href="https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519/print"
rel="nofollow">
<img src="https://im4change.in/images/icon-print.png?1582080630" border="0" width="24" align="right" alt="Share this article"/>
</a>
</section>
<section class="recent-box innerCatRecent">
<small class="pb-1"><span class="dateIcn">
<img src="https://im4change.in/images/published.svg?1582080666" alt="published"/>
Published on</span><span class="text-date"> Mar 9, 2015</span>
<span
class="dateIcn">
<img src="https://im4change.in/images/modified.svg?1582080666" alt="modified"/> Modified on </span><span class="text-date"> Mar 9, 2015</span>
</small>
</section>
<div class="clear"></div>
<div style="padding-top: 10px;">
<div class="innerLineHeight">
<div class="middleContent innerInput latest-news-updates">
<table>
<tr>
<td>
<div>
<div align="justify">-Frontline</div><p align="justify"><em>Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress. </em></p><p align="justify">KERALA is once again drawing attention to itself, this time for a persistent trend of a large number of households being pushed into financial ruin because of the expenses incurred for medical care.</p><p align="justify">Several studies have now found evidence for the many facets of this worrying development in a State that was known until the mid-1980s for its health care model that offered "good health at low cost" and for its health care indices that were comparable to those in more developed countries. However, today, the highest rate of health-related impoverishment in India is being noticed in Kerala, according to researchers, who also warn that all over the country high private health care spending and high out-of-pocket spending are placing a substantial financial burden on urban and rural households.</p><p align="justify">A committee of health care experts constituted by the Kerala State Planning Board has also cautioned that the health care infrastructure in Kerala and the finances of the common man have come under severe stress, with the State recording the highest per capita public and private health expenditure among major States. The highest out-of-pocket expenditures on health in the country have also been noticed in Kerala, said a concept note prepared in November 2014 by the committee, which was constituted as part of the implementation of the 12th Five Year Plan proposals on the health sector.</p><p align="justify">The committee said that the high cost of treatment and out-of-pocket expenditure led to a large section of people falling below the poverty line (BPL). It said, a study done by Peter Berman and Rajeev Ahuja ("The Impoverishing Effect of Health Care Payments in India: New Evidence and Methodology", published in India Health Beat by the Public Health Foundation of India and the World Bank unit in New Delhi in December 2009) using National Sample Survey Office (NSSO) 2004 survey data estimated that around 12 per cent of rural households and 8 per cent of urban households in Kerala were pushed below the poverty line in that year because of health care expenditure.</p><p align="justify">"A Kerala Sastra Sahitya Parishad [KSSP, the People's Science Movement] study in 1987 showed that the average health expenditure per person per annum in Kerala then was Rs.89. It increased to Rs.549 in 1997 and Rs.1,837 in 2004. The results of the latest KSSP survey in 2012 showed that the average per capita out-of-pocket health expenditure in the State was Rs.5,269.05," said Dr B. Ekbal, public health activist, former president of the KSSP, and national convener of the Jan Swasthya Abhiyan (People's Health Movement India).</p><p align="justify">"There is no doubt that the highest annual out-of-pocket health expenditure is in Kerala. The data obtained from the latest [2014] NSSO survey [conducted every 10 years] are being analysed and the results will be known in a few months. That will show if the RSBY [Rashtriya Swasthya Bima Yojna, the Government of India's national health insurance programme for BPL households] and other government-financed risk protection schemes introduced in the past decade have had any impact," said Arun B. Nair, a consultant (health economics and financing) with the National Health Systems Resource Centre.</p><p align="justify">Health care costs are indeed one of the important causes of impoverishment in all States in India. Berman and Ahuja's study found, among other things, that, compared with other developing countries, private health care spending in India was much higher than government spending; the share of out-of-pocket health spending within private health spending was much higher; and outpatient care, which involved relatively small but more frequent payments, was more impoverishing than inpatient care.</p><p align="justify">According to the Draft National Health Policy 2015 document prepared by the Ministry of Health and Family Welfare last December, over 63 million people are pushed into poverty every year in India because of expenditure on health care. Nearly 18 per cent of all households in 2011-12 faced catastrophic expenditures because of health costs compared with 15 per cent in 2004-05-a reflection surely of the failure of public investment in health to cover the entire spectrum of people's health care needs, according to the document.</p><p align="justify">The Berman and Ahuja study also found that there were significant variations between major States, in comparison with the national average, regarding health-related impoverishment, with Kerala showing the highest effect, and Madhya Pradesh (a State "with high levels of base poverty, low education, and lower access to health care overall") showing a relatively low rate of health-related impoverishment.</p><p align="justify">"The cost of health care is very high in Kerala because, one, nearly 87 per cent of the people in the State use modern medical facilities; two, there has been an increase in the number of people suffering from non-communicable and chronic diseases that require continuous care and affordable medicines; three, the State had witnessed large-scale and unregulated privatisation of health care facilities in the past decades and even the poor are now forced to depend on them; and four, the costs of medicines have gone up," Dr Ekbal told Frontline.</p><p align="justify"><em>Burden of NCDs</em></p><p align="justify">Kerala has been witnessing a "high morbidity and low mortality" trend, which is increasingly influenced by the replacement of infectious diseases and nutrition-related and maternal and child health-related health issues by non-communicable and chronic diseases, including cardiovascular diseases, diabetes, cancer and hypertension.</p><p align="justify">While the growing burden from non-communicable diseases (NCDs) is a reality all over India, the demographic transition in Kerala has meant a dramatic increase in its population of the aged, a higher burden of NCDs, and increasing health-seeking behaviour by its educated population, a trend marked by a growing preference for new and costly technology.</p><p align="justify">Kerala, where the foundation for a modern medical care system accessible to all was already in existence at the time of its formation in 1956, greatly expanded its government health facilities from 1961 to 1986. But what followed thereafter until the early 1990s was a period of intense fiscal crisis for successive State governments, when, in order to meet increasing expenditure on salary, they began to cut back spending on supplies, including drugs and other essentials, to the public hospitals. In a historical analysis of the development of health care facilities in Kerala, published in the journal Health Policy and Planning (OUP, 2000), Dr V. Ramankutty, Professor at the Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, recorded how this neglect destroyed Kerala's secondary health sector, especially the district and taluk government hospitals and the primary sector, consisting of primary health centres. Even as early as 1987, he said, an extensive survey of 10,000 households by the KSSP found that only 23 per cent of the households regularly used government health services for reasons that included "non-availability of drugs in the government hospitals", "lack of proper attention" and "better behaviour in private institutions". "There was a shift away from secondary care, with a drastic reduction in funds available for district and taluk government hospitals. Even now, despite the involvement of local bodies and the availability of funds through them, I am not sure all is well with the secondary care centres. Only some are doing well though the primary health system remains largely protected through a lot of direct central funding. Large-scale privatisation of the Kerala health sector took place during the same time," Dr Ramankutty told Frontline.</p><p align="justify">Kerala's Draft Health Policy notes that the public health care expenditure (as a proportion of the gross state domestic product, or GSDP) decreased by 35 per cent between 1990 and 2002, making Kerala one of the States with the highest reduction in public sector contributions and the highest increase in private funding for health care. The decline in public sector spending for health resulted in an overwhelming expansion of the private sector.</p><p align="justify">For example, the amount allocated for health care in the 2012-13 Kerala Budget was only 0.99 per cent of the GSDP. But, significantly, researchers say, private expenditure on health care was almost nine times as high and nearly two-thirds of the poor sought private sector facilities. According to the National Health Accounts (2004-05), of the total health expenditure in Kerala, the share of the private sector was the highest in the country with 90.27 per cent; the public sector accounted for only 9.7 per cent.</p><p align="justify">The prospering private super speciality hospitals with high-tech facilities are a result of the failure of the government health system to meet the demand for secondary and tertiary care and to manage the growing NCD burden. "But we have also started seeing a new trend of small and medium private hospitals being closed down in significant numbers in the State, making health care inaccessible to a large number of people or forcing them to approach bigger care facilities," Dr Ekbal said.</p><p align="justify">According to Dr Ramankutty, many entrepreneurs are entering the field and buying or selling off established private hospitals. "The profit motive has come to the fore. Hospitals are seen as an investment option for easy profits: there is enough demand; there are no labour disputes in the sector, for example. There is inadequate public health spending by the government and health care is free only in principle in most government institutions. Moreover, facilities for treatment of NCDs are limited and are not completely free in the public sector. The private sector has made use of this opportunity, equipping itself well with the latest technology and facilities, and even the poor are forced to depend on them -at a heavy cost."</p><p align="justify">"Government support has been a key factor in the advancement of health care in the State. An expansion or strengthening of the public health system based on today's requirements has not taken place even as people's aspirations about health care needs have gone up. The care that the State used to provide in the 1980s is not what is required today," he told Frontline. Thus, the State is facing a situation where, because of the growing burden of NCDs, health care costs are leading more and more people (not just low-income families) to financial distress. Hospitalisation, even in the government sector, is leading to catastrophic health expenditure, distress financing and its aftermath; existing insurance and similar financial support schemes are inadequate and offer services only for a limited spectrum of diseases and procedures.</p><p align="justify">A dearth of micro-level studies, especially looking at how this impacts individuals, has meant a general lack of understanding about the seriousness of the evolving situation: of how NCD burden could overwhelm the State's troubled health sector and drive vulnerable sections of Kerala society deeper into poverty and lifelong dependency.</p><p align="justify">"It is important to ensure that treatment options and medicines are accessible and affordable to all. The government has to spend more on health care and should not allow a change to a system where despite the availability of all the facilities in the public or private sector, a substantial section of people are still denied health care," Dr Ekbal said.</p><p align="justify">Most health care researchers, therefore, argue for the reintroduction of the system of accessible and affordable primary care, like the British system of general practitioners or by strengthening the system based on community (public) health centres; more government spending on health, especially to deal with the emerging NCD burden; better regulation and quality control in the private sector; introduction of better financial risk protection measures and their better coordination to help patients deal with catastrophic health expenditure; and measures to ensure availability of medicines and bring down costs in all government facilities.</p><p align="justify">"Public health governance has taken a back seat in Kerala, and hospital administrators are not properly trained to deal with the emerging professional and financial challenges. There is a general complacency when it comes to issues relating to health. We tend to bask in our past glory, smug about our early achievements, when new challenges are already overwhelming us and, in truth, other States are stealing a march over us," Dr Ramankutty said.</p>
</div>
</td>
</tr>
</table>
</div>
</div>
</div>
<div class="clear"></div>
<br><a href="http://www.frontline.in/the-nation/driven-to-distress/article6945294.ece?homepage=true" class="re" target="_blank">Frontline, 20 March, 2015, http://www.frontline.in/the-nation/driven-to-distress/article6945294.ece?homepage=true</a><div class="clear"></div>
<div style="padding-top: 18px;">
<p class="post-tag">Tagged with:
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=healthcare"
title="healthcare">
healthcare </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=healthcare in india"
title="healthcare in india">
healthcare in india </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Health"
title="Access to Health">
Access to Health </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Healthcare"
title="Access to Healthcare">
Access to Healthcare </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Medicines"
title="Access to Medicines">
Access to Medicines </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Health Expenditure"
title="Health Expenditure">
Health Expenditure </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Public Health"
title="Public Health">
Public Health </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=kerala"
title="kerala">
kerala </a>
</p>
</div>
<div class="clear"></div>
<br><br>
<div class="widget-top">
<h4>Related Articles</h4>
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<ul id="recentcomments">
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-s-stretched-health-care-system-fails-millions-in-rural-areas-battling-sickle-cell-disease-abc.html"
title="India's stretched health care system fails millions in rural areas battling sickle cell disease - ABC">
India's stretched health care system fails millions in rural areas battling sickle cell disease - ABC </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/what-data-told-us-about-india-in-2022-akshi-chawla.html"
title="What data told us about India in 2022 - Akshi Chawla">
What data told us about India in 2022 - Akshi Chawla </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/climate-change-will-likely-exacerbate-indian-rural-household-s-debt-burden.html"
title="Climate change will likely exacerbate Indian rural household's debt burden ">
Climate change will likely exacerbate Indian rural household's debt burden </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/the-need-to-make-cancer-drugs-affordable-biswajit-dhar-and-chetali-rao.html"
title="The need to make cancer drugs affordable -Biswajit Dhar and Chetali Rao">
The need to make cancer drugs affordable -Biswajit Dhar and Chetali Rao </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/after-measles-experts-worry-typhoid-could-pose-the-next-health-challenge-as-india-delays-vaccine-tabassum-barnagarwala.html"
title="After measles, experts worry typhoid could pose the next health challenge as India delays vaccine -Tabassum Barnagarwala">
After measles, experts worry typhoid could pose the next health challenge as India delays vaccine -Tabassum Barnagarwala </a>
</li>
</ul>
</div>
<div class="comment-respond" id="respond">
<a name="commentbox"> </a>
<h3 class="comment-reply-title" id="reply-title">Write Comments</h3>
<form method="post" accept-charset="utf-8" role="form" action="/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"><div style="display:none;"><input type="hidden" name="_method" value="POST"/></div> <form class="comment-form" id="commentform" method="post" action="#commentbox" onSubmit="return validate()"
name="cmtform">
<input type="hidden" name="cmttype" value="articlecmt"/>
<input type="hidden" name="article_id" value="27468"/>
<p class="comment-notes">Your email address will not be published. Required fields are marked <span
class="required">*</span></p>
<p class="comment-form-author">
<label for="commenterName">Name</label>
<span class="required">*</span>
<input type="text" aria-required="true" size="30"
value=""
name="commenterName" id="commenterName" required="true">
</p>
<p class="comment-form-email">
<label for="commenterEmail">Email</label> <span class="required">*</span>
<input aria-required="true" size="30" name="commenterEmail" id="commenterEmail" type="email"
value=""
required="true">
</p>
<p class="comment-form-contact">
<label for="commenterPh">Contact No.</label>
<input type="text" size="30"
value=""
name="commenterPh" id="commenterPh">
</p>
<p class="comment-form-comment">
<label for="comment">Comment</label>
<textarea aria-required="true" required="true" rows="8" cols="45" name="comment"
id="comment"></textarea>
</p>
<p class="comment-form-comment">
<label for="comment">Type the characters you see in the image below <span class="required">*</span><br><img
class="captchaImg"
src="https://im4change.in/securimage_show_art.php?tk=760565086" alt="captcha"/>
</label>
</p>
<input type="text" name="vrcode" required="true"/>
<p class="form-submit" style="width: 200px;">
<input type="submit" value="Post Comment" id="submit" name="submit">
</p></form>
</div>
<style>
.ui-widget-content {
height: auto !important;
}
</style>
<div id="share-modal"></div>
<style>
.middleContent a{
background-color: rgba(108,172,228,.2);
}
.middleContent a:hover{
background-color: #418fde;
border-color: #418fde;
color: #000;
}
</style>
<script>
function shareArticle(article_id) {
var options = {
modal: true,
height: 'auto',
width: 600 + 'px'
};
$('#share-modal').html("");
$('#share-modal').load('https://im4change.in/share_article?article_id=' + article_id).dialog(options).dialog('open');
}
function postShare() {
var param = 'article_id=' + $("#article_id").val();
param = param + '&y_name=' + $("#y_name").val();
param = param + '&y_email=' + $("#y_email").val();
param = param + '&f_name=' + $("#f_name").val();
param = param + '&f_email=' + $("#f_email").val();
param = param + '&y_msg=' + $("#y_msg").val();
$.ajax({
type: "POST",
url: 'https://im4change.in/post_share_article',
data: param,
success: function (response) {
$('#share-modal').html("Thank You, Your message posted to ");
}
});
return false;
}
</script> </div>
</div>
<!-- Right Side Section Start -->
<!-- MAP Section START -->
<aside class="sidebar indexMarg">
<div class="ad-cell">
<a href="https://im4change.in/statemap.php" title="">
<img src="https://im4change.in/images/map_new_version.png?1582080666" alt="India State Map" class="indiamap" width="232" height="252"/> </a>
<div class="rightmapbox">
<div id="sideOne" class="docltitle"><a href="https://im4change.in/state-report/india/36" target="_blank">DOCUMENTS/
REPORTS</a></div>
<div id="sideTwo" class="statetitle"><a href="https://im4change.in/states.php"target="_blank">STATE DATA/
HDRs.</a></div>
</div>
<div class="widget widgePadTop"></div>
</div>
</aside>
<!-- MAP Section END -->
<aside class="sidebar sidePadbottom">
<div class="rightsmlbox1" >
<a href="https://im4change.in/knowledge_gateway" target="_blank" style="color: #035588;
font-size: 17px;">
KNOWLEDGE GATEWAY
</a>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/newsletter" target="_blank">
NEWSLETTER
</a>
</p>
</div>
</div>
<div class="rightsmlbox1" style="height: 325px;">
<div>
<p class="rightsmlbox1_title">
Interview with Prof. Ravi Srivastava
</p>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/video/interview-with-prof-ravi-srivastava-on-current-economic-crisis">
<img width="250" height="200" src="/images/interview_video_home.jpg" alt="Interview with Prof. Ravi Srivastava"/>
</a>
<!--
<iframe width="250" height="200" src="https://www.youtube.com/embed/MmaTlntk-wc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>-->
</p>
<a href="https://im4change.in/videogallery" class="more-link CatArchalAnch1" target="_blank">
More videos
</a>
</div>
</div>
<div class="rightsmlbox1">
<div>
<!--div id="sstory" class="rightboxicons"></div--->
<p class="rightsmlbox1_title"><a href="https://im4change.in/list-success-stories" target="_blank">Success Stories</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/interviews" target="_blank">Interviews</a>
</p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a href="https://www.commoncause.in/page.php?id=10" >Donate</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/marquee"
class="isf_link more-link" title="India Focus?" style="border: 4px solid #fdd922;width: 90%;background-color: #fdd922;text-align: center;color: #000000;font-size:18px" target="_blank">India Focus</a></p> </div>
</div>
<div class="rightsmlbox1" style="height: 104px !important;">
<a href="https://im4change.in/quarterly_reports.php" target="_blank">
Quarterly Reports on Effect of Economic Slowdown on Employment in India (2008 - 2015)
</a>
</div>
<!-- <div class="rightsmlbox1">
<a href="https://play.google.com/store/apps/details?id=com.im4.im4change" target="_blank">
</a></div> -->
<!-- <section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">Most Visited</h2>
</section> -->
<!-- accordion Starts here -->
<!-- <div id="accordion" class="accordMarg">
</div> -->
<!-- accordion ends here -->
<!-- Widget Tag Cloud Starts here -->
<div id="tag_cloud-2" class="widget widget_tag_cloud">
<section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">MOST VISITED TAGS</h2>
</section>
<div class="widget-top wiPdTp">
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<div class="tagcloud">
<a href="https://im4change.in/search?qryStr=Agriculture"
target="_blank" class="tag-link-4 font4">Agriculture</a>
<a href="https://im4change.in/search?qryStr=Food Security"
target="_blank" class="tag-link-4 font4">Food Security</a>
<a href="https://im4change.in/search?qryStr=Law and Justice"
target="_blank" class="tag-link-4 font4">Law and Justice</a>
<a href="https://im4change.in/search?qryStr=Health"
target="_blank" class="tag-link-4 font4">Health</a>
<a href="https://im4change.in/search?qryStr=Right to Food"
target="_blank" class="tag-link-4 font4">Right to Food</a>
<a href="https://im4change.in/search?qryStr=Corruption"
target="_blank" class="tag-link-4 font4">Corruption</a>
<a href="https://im4change.in/search?qryStr=farming"
target="_blank" class="tag-link-4 font4">farming</a>
<a href="https://im4change.in/search?qryStr=Environment"
target="_blank" class="tag-link-4 font4">Environment</a>
<a href="https://im4change.in/search?qryStr=Right to Information"
target="_blank" class="tag-link-4 font4">Right to Information</a>
<a href="https://im4change.in/search?qryStr=NREGS"
target="_blank" class="tag-link-4 font4">NREGS</a>
<a href="https://im4change.in/search?qryStr=Human Rights"
target="_blank" class="tag-link-4 font4">Human Rights</a>
<a href="https://im4change.in/search?qryStr=Governance"
target="_blank" class="tag-link-4 font4">Governance</a>
<a href="https://im4change.in/search?qryStr=PDS"
target="_blank" class="tag-link-4 font4">PDS</a>
<a href="https://im4change.in/search?qryStr=COVID-19"
target="_blank" class="tag-link-4 font4">COVID-19</a>
<a href="https://im4change.in/search?qryStr=Land Acquisition"
target="_blank" class="tag-link-4 font4">Land Acquisition</a>
<a href="https://im4change.in/search?qryStr=mgnrega"
target="_blank" class="tag-link-4 font4">mgnrega</a>
<a href="https://im4change.in/search?qryStr=Farmers"
target="_blank" class="tag-link-4 font4">Farmers</a>
<a href="https://im4change.in/search?qryStr=transparency"
target="_blank" class="tag-link-4 font4">transparency</a>
<a href="https://im4change.in/search?qryStr=Gender"
target="_blank" class="tag-link-4 font4">Gender</a>
<a href="https://im4change.in/search?qryStr=Poverty"
target="_blank" class="tag-link-4 font4">Poverty</a>
<a href="https://im4change.in/search?qryStr=Farm Laws" target="_blank" class="tag-link-4 font4">Farm Laws
</a>
<a href="https://im4change.in/search?qryStr=Citizenship Amendment Act" target="_blank" class="tag-link-4 font4">Citizenship Amendment Act
</a>
<a href="https://im4change.in/search?qryStr=CAA NPR NRIC" target="_blank" class="tag-link-4 font4">CAA NPR NRIC
</a>
<a href="https://im4change.in/search?qryStr=Job Losses" target="_blank" class="tag-link-4 font4">Job Losses
</a>
<a href="https://im4change.in/search?qryStr=Migrant Workers" target="_blank" class="tag-link-4 font4">Migrant Workers
</a>
<a href="https://im4change.in/search?qryStr=Unemployment" target="_blank" class="tag-link-4 font4">Unemployment
</a>
<a href="https://im4change.in/search?qryStr=PMGKAY" target="_blank" class="tag-link-4 font4">PMGKAY
</a>
<a href="https://im4change.in/search?qryStr=PM-KISAN" target="_blank" class="tag-link-4 font4">PM-KISAN
</a>
<a href="https://im4change.in/search?qryStr=PM-CARES" target="_blank" class="tag-link-4 font4">PM-CARES
</a>
<a href="https://im4change.in/search?qryStr=LFPR" target="_blank" class="tag-link-4 font4">LFPR
</a>
</div>
</div>
</div>
<!-- Widget Tag Cloud Ends here -->
</aside>
<!-- Right Side Section End -->
</div>
<section class="cat-box cats-review-box footerSec">
<h2 class="cat-box-title vSec CatArcha">Video
Archives</h2>
<h2 class="cat-box-title CatArchaTitle">Archives</h2>
<div class="cat-box-content">
<div class="reviews-cat">
<div class="CatArchaDiv1">
<div class="CatArchaDiv2">
<ul>
<li>
<a href="https://im4change.in/news-alerts-57/moving-upstream-luni-fellowship.html" target="_blank">
Moving Upstream: Luni – Fellowship </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/135-million-indians-exited-multidimensional-poverty-as-per-government-figures-is-that-the-same-as-poverty-reduction.html" target="_blank">
135 Million Indians Exited “Multidimensional" Poverty as per Government... </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/explainer-why-are-tomato-prices-on-fire.html" target="_blank">
Explainer: Why are Tomato Prices on Fire? </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/nsso-survey-only-39-1-of-all-households-have-drinking-water-within-dwelling-46-7-of-rural-households-use-firewood-for-cooking.html" target="_blank">
NSSO Survey: Only 39.1% of all Households have Drinking... </a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/news-alerts-57"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/I51LYnP8BOk/1.jpg"
alt=" Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Short-Video-on-im4change-Hindi-website-Inclusive-Media-for-Change" target="_blank">
Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/kNqha-SwfIY/1.jpg"
alt=" "Session 1: Scope of IDEA and AgriStack" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-1- Scope-of-IDEA-and-AgriStack-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 1: Scope of IDEA and AgriStack" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/6kIVjlgZItk/1.jpg"
alt=" "Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-2-Farmer-Centric-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/2BeHTu0y7xc/1.jpg"
alt=" "Session 3: Future of Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-3-Future-of-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 3: Future of Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="divWidth">
<ul class="divWidthMarg">
<li>
<a href="https://im4change.in/video/Public-Spending-on-Agriculture-in-India-Source-Foundation-for-Agrarian-Studies"
title="Public Spending on Agriculture in India (Source: Foundation for Agrarian Studies)" target="_blank">
Public Spending on Agriculture in India (Source: Foundation for...</a>
</li>
<li>
<a href="https://im4change.in/video/Agrarian-Change-Seminar-Protests-against-the-New-Farm-Laws-in-India-by-Prof-Vikas-Rawal-JNU-Source-Journal-Of-Agrarian-Change"
title="Agrarian Change Seminar: 'Protests against the New Farm Laws in India' by Prof. Vikas Rawal, JNU (Source: Journal Of Agrarian Change) " target="_blank">
Agrarian Change Seminar: 'Protests against the New Farm Laws...</a>
</li>
<li>
<a href="https://im4change.in/video/Webinar-Ramrao-The-Story-of-India-Farm-Crisis-Source-Azim-Premji-University"
title="Webinar: Ramrao - The Story of India's Farm Crisis (Source: Azim Premji University)" target="_blank">
Webinar: Ramrao - The Story of India's Farm Crisis...</a>
</li>
<li>
<a href="https://im4change.in/video/water-and-agricultural-transformation-in-India"
title="Water and Agricultural Transformation in India: A Symbiotic Relationship (Source: IGIDR)" target="_blank">
Water and Agricultural Transformation in India: A Symbiotic Relationship...</a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/videogallery"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</section> </div>
<div class="clear"></div>
<!-- Footer option Starts here -->
<div class="footer-bottom fade-in animated4">
<div class="container">
<div class="social-icons icon_flat">
<p class="SocialMargTop"> Website Developed by <a target="_blank" title="Web Development"
class="wot right"
href="http://www.ravinderkhurana.com/" rel="nofollow">
RAVINDErkHURANA.com</a></p>
</div>
<div class="alignleft">
<a
target="_blank" href="https://im4change.in/objectives-8.html"
class="link"
title="Objectives">Objectives</a> | <a
target="_blank" href="https://im4change.in/about-us-9.html"
class="link" title="About Us">About Us</a> | <a
target="_blank" href="https://im4change.in/media-workshops.php"
class="ucwords">Workshops</a> | <a
target="_blank" href="https://im4change.in/disclaimer/disclaimer-149.html"
title="Disclaimer">Disclaimer</a> </div>
</div>
</div>
<!-- Footer option ends here -->
</div>
<div id="connect">
<a target="_blank"
href="http://www.facebook.com/sharer.php?u=https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"
title="Share on Facebook">
<img src="https://im4change.in/images/Facebook.png?1582080640" alt="share on Facebook" class="ImgBorder"/>
</a><br/>
<a target="_blank"
href="http://twitter.com/share?text=Im4change&url=https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"
title="Share on Twitter">
<img src="https://im4change.in/images/twitter.png?1582080632" alt="Twitter" class="ImgBorder"/> </a>
<br/>
<a href="/feeds" title="RSS Feed" target="_blank">
<img src="https://im4change.in/images/rss.png?1582080632" alt="RSS" class="ImgBorder"/>
</a>
<br/>
<a class="feedback-link" id="feedbackFormLink" href="#">
<img src="https://im4change.in/images/feedback.png?1582080630" alt="Feedback" class="ImgBorder"/>
</a> <br/>
<a href="javascript:function iprl5(){var d=document,z=d.createElement('scr'+'ipt'),b=d.body,l=d.location;try{if(!b)throw(0);d.title='(Saving...) '+d.title;z.setAttribute('src',l.protocol+'//www.instapaper.com/j/WKrH3R7ORD5p?u='+encodeURIComponent(l.href)+'&t='+(new Date().getTime()));b.appendChild(z);}catch(e){alert('Please wait until the page has loaded.');}}iprl5();void(0)"
class="bookmarklet" onclick="return explain_bookmarklet();">
<img src="https://im4change.in/images/read-it-later.png?1582080632" alt="Read Later" class="ImgBorder"/> </a>
</div>
<!-- Feedback form Starts here -->
<div id="feedbackForm" class="overlay_form" class="ImgBorder">
<h2>Contact Form</h2>
<div id="contactform1">
<div id="formleft">
<form id="submitform" action="/contactus.php" method="post">
<input type="hidden" name="submitform" value="submitform"/>
<input type="hidden" name="salt_key" value="a0e0f2c6a0644a70e57ad2c96829709a"/>
<input type="hidden" name="ref" value="feedback"/>
<fieldset>
<label>Name :</label>
<input type="text" name="name" class="tbox" required/>
</fieldset>
<fieldset>
<label>Email :</label>
<input type="text" name="email" class="tbox" required/>
</fieldset>
<fieldset>
<label>Message :</label>
<textarea rows="5" cols="20" name="message" required></textarea>
</fieldset>
<fieldset>
Please enter security code
<div class="clear"></div>
<input type="text" name="vrcode" class="tbox"/>
</fieldset>
<fieldset>
<input type="submit" class="button" value="Submit"/>
<a href="#" id="closefeedbakcformLink">Close</a>
</fieldset>
</form>
</div>
<div class="clearfix"></div>
</div>
</div>
<div id="donate_popup" class="modal" style="max-width: 800px;">
<table width="100%" border="1">
<tr>
<td colspan="2" align="center">
<b>Support im4change</b>
</td>
</tr>
<tr>
<td width="25%" valign="middle">
<img src="https://im4change.in/images/logo2.jpg?1582080632" alt="" width="100%"/> </td>
<td style="padding-left:10px;padding-top:10px;">
<form action="https://im4change.in/donate" method="get">
<table width="100%" cellpadding="2" cellspacing="2">
<tr>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
10
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
100
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
1000
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
50
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
500
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
<input type="text" name="price" placeholder="?" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td colspan="3" align="right">
<input type="button" name="Pay" value="Pay"
style="width: 200px;background-color: rgb(205, 35, 36);color: #ffffff;"/>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div><script type='text/javascript'>
/* <![CDATA[ */
var tievar = {'go_to': 'Go to...'};
/* ]]> */
</script>
<script src="/js/tie-scripts.js?1575549704"></script><script src="/js/bootstrap.js?1575549704"></script><script src="/js/jquery.modal.min.js?1578284310"></script><script>
$(document).ready(function() {
// tell the autocomplete function to get its data from our php script
$('#s').autocomplete({
source: "/autocomplete"
});
});
</script>
<script src="/vj-main-sw-register.js" async></script>
<script>function init(){var imgDefer=document.getElementsByTagName('img');for(var i=0;i<imgDefer.length;i++){if(imgDefer[i].getAttribute('data-src')){imgDefer[i].setAttribute('src',imgDefer[i].getAttribute('data-src'))}}}
window.onload=init;</script>
</body>
</html>'
}
$reasonPhrase = 'OK'
header - [internal], line ??
Cake\Http\ResponseEmitter::emitStatusLine() - CORE/src/Http/ResponseEmitter.php, line 148
Cake\Http\ResponseEmitter::emit() - CORE/src/Http/ResponseEmitter.php, line 54
Cake\Http\Server::emit() - CORE/src/Http/Server.php, line 141
[main] - ROOT/webroot/index.php, line 39
Warning (2): Cannot modify header information - headers already sent by (output started at /home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php:853) [CORE/src/Http/ResponseEmitter.php, line 181]
$response = object(Cake\Http\Response) {
'status' => (int) 200,
'contentType' => 'text/html',
'headers' => [
'Content-Type' => [
[maximum depth reached]
]
],
'file' => null,
'fileRange' => [],
'cookies' => object(Cake\Http\Cookie\CookieCollection) {},
'cacheDirectives' => [],
'body' => '<!DOCTYPE html>
<!--[if lt IE 7 ]>
<html class="ie ie6" lang='en'> <![endif]-->
<!--[if IE 7 ]>
<html class="ie ie7" lang='en'> <![endif]-->
<!--[if IE 8 ]>
<html class="ie ie8" lang='en'> <![endif]-->
<!--[if (gte IE 9)|!(IE)]><!-->
<html lang='en'>
<!--<![endif]-->
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>
LATEST NEWS UPDATES | Driven to distress -R Krishnakumar </title>
<meta name="description" content="
-Frontline
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number..."/>
<meta name="keywords" content="healthcare,healthcare in india,Access to Health,Access to Healthcare,Access to Medicines,Health Expenditure,Public Health,kerala"/>
<meta name="news_keywords" content="healthcare,healthcare in india,Access to Health,Access to Healthcare,Access to Medicines,Health Expenditure,Public Health,kerala">
<link rel="alternate" type="application/rss+xml" title="ROR" href="/ror.xml"/>
<link rel="alternate" type="application/rss+xml" title="RSS 2.0" href="/feeds/"/>
<link rel="stylesheet" href="/css/bootstrap.min.css?1697864993"/> <link rel="stylesheet" href="/css/style.css?v=1.1.2"/> <link rel="stylesheet" href="/css/style-inner.css?1577045210"/> <link rel="stylesheet" id="Oswald-css"
href="https://fonts.googleapis.com/css?family=Oswald%3Aregular%2C700&ver=3.8.1" type="text/css"
media="all">
<link rel="stylesheet" href="/css/jquery.modal.min.css?1578285302"/> <script src="/js/jquery-1.10.2.js?1575549704"></script> <script src="/js/jquery-migrate.min.js?1575549704"></script> <link rel="shortcut icon" href="/favicon.ico" title="Favicon">
<link rel="stylesheet" href="/css/jquery-ui.css?1580720609"/> <script src="/js/jquery-ui.js?1575549704"></script> <link rel="preload" as="style" href="https://www.im4change.org/css/custom.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery.modal.min.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/jquery-ui.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel="preload" as="style" href="https://www.im4change.org/css/li-scroller.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<!-- <link rel="preload" as="style" href="https://www.im4change.org/css/style.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous"> -->
<link rel="preload" as="style" href="https://www.im4change.org/css/style-inner.css" onload="this.rel='stylesheet'" media="all" crossorigin="anonymous">
<link rel='dns-prefetch' href="//im4change.org/css/custom.css" crossorigin >
<link rel="preload" as="script" href="https://www.im4change.org/js/bootstrap.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.li-scroller.1.0.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.modal.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery.ui.totop.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-1.10.2.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-migrate.min.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/jquery-ui.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/setting.js">
<link rel="preload" as="script" href="https://www.im4change.org/js/tie-scripts.js">
<!--[if IE]>
<script type="text/javascript">jQuery(document).ready(function () {
jQuery(".menu-item").has("ul").children("a").attr("aria-haspopup", "true");
});</script>
<![endif]-->
<!--[if lt IE 9]>
<script src="/js/html5.js"></script>
<script src="/js/selectivizr-min.js"></script>
<![endif]-->
<!--[if IE 8]>
<link rel="stylesheet" type="text/css" media="all" href="/css/ie8.css"/>
<![endif]-->
<meta property="og:title" content="LATEST NEWS UPDATES | Driven to distress -R Krishnakumar" />
<meta property="og:url" content="https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html" />
<meta property="og:type" content="article" />
<meta property="og:description" content="
-Frontline
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number..." />
<meta property="og:image" content="" />
<meta property="fb:app_id" content="0" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
<link rel="apple-touch-icon-precomposed" sizes="144x144" href="https://im4change.in/images/apple1.png">
<link rel="apple-touch-icon-precomposed" sizes="120x120" href="https://im4change.in/images/apple2.png">
<link rel="apple-touch-icon-precomposed" sizes="72x72" href="https://im4change.in/images/apple3.png">
<link rel="apple-touch-icon-precomposed" href="https://im4change.in/images/apple4.png">
<style>
.gsc-results-wrapper-overlay{
top: 38% !important;
height: 50% !important;
}
.gsc-search-button-v2{
border-color: #035588 !important;
background-color: #035588 !important;
}
.gsib_a{
height: 30px !important;
padding: 2px 8px 1px 6px !important;
}
.gsc-search-button-v2{
height: 41px !important;
}
input.gsc-input{
background: none !important;
}
@media only screen and (max-width: 600px) {
.gsc-results-wrapper-overlay{
top: 11% !important;
width: 87% !important;
left: 9% !important;
height: 43% !important;
}
.gsc-search-button-v2{
padding: 10px 10px !important;
}
.gsc-input-box{
height: 28px !important;
}
/* .gsib_a {
padding: 0px 9px 4px 9px !important;
}*/
}
@media only screen and (min-width: 1200px) and (max-width: 1920px) {
table.gsc-search-box{
width: 15% !important;
float: right !important;
margin-top: -118px !important;
}
.gsc-search-button-v2 {
padding: 6px !important;
}
}
</style>
<script>
$(function () {
$("#accordion").accordion({
event: "click hoverintent"
});
});
/*
* hoverIntent | Copyright 2011 Brian Cherne
* http://cherne.net/brian/resources/jquery.hoverIntent.html
* modified by the jQuery UI team
*/
$.event.special.hoverintent = {
setup: function () {
$(this).bind("mouseover", jQuery.event.special.hoverintent.handler);
},
teardown: function () {
$(this).unbind("mouseover", jQuery.event.special.hoverintent.handler);
},
handler: function (event) {
var currentX, currentY, timeout,
args = arguments,
target = $(event.target),
previousX = event.pageX,
previousY = event.pageY;
function track(event) {
currentX = event.pageX;
currentY = event.pageY;
}
;
function clear() {
target
.unbind("mousemove", track)
.unbind("mouseout", clear);
clearTimeout(timeout);
}
function handler() {
var prop,
orig = event;
if ((Math.abs(previousX - currentX) +
Math.abs(previousY - currentY)) < 7) {
clear();
event = $.Event("hoverintent");
for (prop in orig) {
if (!(prop in event)) {
event[prop] = orig[prop];
}
}
// Prevent accessing the original event since the new event
// is fired asynchronously and the old event is no longer
// usable (#6028)
delete event.originalEvent;
target.trigger(event);
} else {
previousX = currentX;
previousY = currentY;
timeout = setTimeout(handler, 100);
}
}
timeout = setTimeout(handler, 100);
target.bind({
mousemove: track,
mouseout: clear
});
}
};
</script>
<script type="text/javascript">
var _gaq = _gaq || [];
_gaq.push(['_setAccount', 'UA-472075-3']);
_gaq.push(['_trackPageview']);
(function () {
var ga = document.createElement('script');
ga.type = 'text/javascript';
ga.async = true;
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
var s = document.getElementsByTagName('script')[0];
s.parentNode.insertBefore(ga, s);
})();
</script>
<link rel="stylesheet" href="/css/custom.css?v=1.16"/> <script src="/js/jquery.ui.totop.js?1575549704"></script> <script src="/js/setting.js?1575549704"></script> <link rel="manifest" href="/manifest.json">
<meta name="theme-color" content="#616163" />
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta name="apple-mobile-web-app-title" content="im4change">
<link rel="apple-touch-icon" href="/icons/logo-192x192.png">
</head>
<body id="top" class="home inner blog">
<div class="background-cover"></div>
<div class="wrapper animated">
<header id="theme-header" class="header_inner" style="position: relative;">
<div class="logo inner_logo" style="left:20px !important">
<a title="Home" href="https://im4change.in/">
<img src="https://im4change.in/images/logo2.jpg?1582080632" class="logo_image" alt="im4change"/> </a>
</div>
<div class="langhindi" style="color: #000;display:none;"
href="https://im4change.in/">
<a class="more-link" href="https://im4change.in/">Home</a>
<a href="https://im4change.in/hindi/" class="langbutton ">हिन्दी</a>
</div>
<nav class="fade-in animated2" id="main-nav">
<div class="container">
<div class="main-menu">
<ul class="menu" id="menu-main">
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
style="left: -40px;"><a
target="_blank" href="https://im4change.in/">Home</a>
</li>
<li class="menu-item mega-menu menu-item-type-taxonomy mega-menu menu-item-object-category mega-menu menu-item-has-children parent-list"
style=" margin-left: -40px;"><a href="#">KNOWLEDGE GATEWAY <span class="sub-indicator"></span>
</a>
<div class="mega-menu-block background_menu" style="padding-top:25px;">
<div class="container">
<div class="mega-menu-content">
<div class="mega-menu-item">
<h3><b>Farm Crisis</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/farmers039-suicides-14.html"
class="left postionrel">Farm Suicides </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/unemployment-30.html"
class="left postionrel">Unemployment </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/rural-distress-70.html"
class="left postionrel">Rural distress </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/migration-34.html"
class="left postionrel">Migration </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/key-facts-72.html"
class="left postionrel">Key Facts </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/farm-crisis/debt-trap-15.html"
class="left postionrel">Debt Trap </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Empowerment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/union-budget-73.html"
class="left postionrel">Union Budget And Other Economic Policies </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/forest-and-tribal-rights-61.html"
class="left postionrel">Forest and Tribal Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-education-60.html"
class="left postionrel">Right to Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-food-59.html"
class="left postionrel">Right to Food </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/displacement-3279.html"
class="left postionrel">Displacement </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-work-mg-nrega-39.html"
class="left postionrel">Right to Work (MG-NREGA) </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/gender-3280.html"
class="left postionrel">GENDER </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/right-to-information-58.html"
class="left postionrel">Right to Information </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/empowerment/social-audit-48.html"
class="left postionrel">Social Audit </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Hunger / HDI</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/poverty-and-inequality-20499.html"
class="left postionrel">Poverty and inequality </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/malnutrition-41.html"
class="left postionrel">Malnutrition </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/public-health-51.html"
class="left postionrel">Public Health </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/education-50.html"
class="left postionrel">Education </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hunger-overview-40.html"
class="left postionrel">Hunger Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/hdi-overview-45.html"
class="left postionrel">HDI Overview </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/pds-ration-food-security-42.html"
class="left postionrel">PDS/ Ration/ Food Security </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/sdgs-113.html"
class="left postionrel">SDGs </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/hunger-hdi/mid-day-meal-scheme-mdms-53.html"
class="left postionrel">Mid Day Meal Scheme (MDMS) </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Environment</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/time-bomb-ticking-52.html"
class="left postionrel">Time Bomb Ticking </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/water-and-sanitation-55.html"
class="left postionrel">Water and Sanitation </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/environment/impact-on-agriculture-54.html"
class="left postionrel">Impact on Agriculture </a>
</p>
</div>
<div class="mega-menu-item">
<h3><b>Law & Justice</b></h3>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/social-justice-20500.html"
class="left postionrel">Social Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/access-to-justice-47.html"
class="left postionrel">Access to Justice </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/human-rights-56.html"
class="left postionrel">Human Rights </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/corruption-35.html"
class="left postionrel">Corruption </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/general-insecurity-46.html"
class="left postionrel">General Insecurity </a>
</p>
<p style="padding-left:5px;">
<a target="_blank" href="https://im4change.in/law-justice/disaster-relief-49.html"
class="left postionrel">Disaster & Relief </a>
</p>
</div>
</div>
</div>
</div>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page "><a target="_blank" href="https://im4change.in/nceus_reports.php">NCEUS reports</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children parent-list ">
<a target="_blank" href="https://im4change.in/about-us-9.html">About Us <span
class="sub-indicator"></span></a>
<ul class="sub-menu aboutmenu">
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/objectives-8.html">Objectives</a>
</li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/contactus.php">Contact
Us</a></li>
<li class="menu-item menu-item-type-post_type menu-item-object-page"><a
target="_blank" href="https://im4change.in/about-us-9.html">About
Us</a></li>
</ul>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children ">
<a target="_blank" href="https://im4change.in/fellowships.php" title="Fellowships">Fellowships</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/media-workshops.php">Workshops</a>
</li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/research.php">Research</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children "><a
target="_blank" href="https://im4change.in/links-64">Partners</a></li>
<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children"
id="menu-item-539"><a target="_blank" href="https://im4change.in/hindi/"
class="langbutton langlinkfont17">हिन्दी</a></li>
</ul>
</div> </div>
<!-- <div style="float: right;">
<script async src="https://cse.google.com/cse.js?cx=18b4f2e0f11bed3dd"></script>
<div class="gcse-search"></div>
</div> -->
<div class="search-block" style=" margin-left: 8px; margin-right: 7px;">
<form method="get" id="searchform" name="searchform"
action="https://im4change.in/search"
onsubmit="return searchvalidate();">
<button class="search-button" type="submit" value="Search"></button>
<input type="text" id="s" name="qryStr" value=""
onfocus="if (this.value == 'Search...') {this.value = '';}"
onblur="if (this.value == '') {this.value = 'Search...';}">
</form>
</div>
</nav>
</header>
<div class="container">
<div id="main-content" class=" main1 container fade-in animated3 sidebar-narrow-left">
<div class="content-wrap">
<div class="content" style="width: 900px;min-height: 500px;">
<section class="cat-box recent-box innerCatRecent">
<h1 class="cat-box-title">Driven to distress -R Krishnakumar</h1>
<a href="JavaScript:void(0);" onclick="return shareArticle(27468);">
<img src="https://im4change.in/images/email.png?1582080630" border="0" width="24" align="right" alt="Share this article"/> </a>
<a href="https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519/print"
rel="nofollow">
<img src="https://im4change.in/images/icon-print.png?1582080630" border="0" width="24" align="right" alt="Share this article"/>
</a>
</section>
<section class="recent-box innerCatRecent">
<small class="pb-1"><span class="dateIcn">
<img src="https://im4change.in/images/published.svg?1582080666" alt="published"/>
Published on</span><span class="text-date"> Mar 9, 2015</span>
<span
class="dateIcn">
<img src="https://im4change.in/images/modified.svg?1582080666" alt="modified"/> Modified on </span><span class="text-date"> Mar 9, 2015</span>
</small>
</section>
<div class="clear"></div>
<div style="padding-top: 10px;">
<div class="innerLineHeight">
<div class="middleContent innerInput latest-news-updates">
<table>
<tr>
<td>
<div>
<div align="justify">-Frontline</div><p align="justify"><em>Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress. </em></p><p align="justify">KERALA is once again drawing attention to itself, this time for a persistent trend of a large number of households being pushed into financial ruin because of the expenses incurred for medical care.</p><p align="justify">Several studies have now found evidence for the many facets of this worrying development in a State that was known until the mid-1980s for its health care model that offered "good health at low cost" and for its health care indices that were comparable to those in more developed countries. However, today, the highest rate of health-related impoverishment in India is being noticed in Kerala, according to researchers, who also warn that all over the country high private health care spending and high out-of-pocket spending are placing a substantial financial burden on urban and rural households.</p><p align="justify">A committee of health care experts constituted by the Kerala State Planning Board has also cautioned that the health care infrastructure in Kerala and the finances of the common man have come under severe stress, with the State recording the highest per capita public and private health expenditure among major States. The highest out-of-pocket expenditures on health in the country have also been noticed in Kerala, said a concept note prepared in November 2014 by the committee, which was constituted as part of the implementation of the 12th Five Year Plan proposals on the health sector.</p><p align="justify">The committee said that the high cost of treatment and out-of-pocket expenditure led to a large section of people falling below the poverty line (BPL). It said, a study done by Peter Berman and Rajeev Ahuja ("The Impoverishing Effect of Health Care Payments in India: New Evidence and Methodology", published in India Health Beat by the Public Health Foundation of India and the World Bank unit in New Delhi in December 2009) using National Sample Survey Office (NSSO) 2004 survey data estimated that around 12 per cent of rural households and 8 per cent of urban households in Kerala were pushed below the poverty line in that year because of health care expenditure.</p><p align="justify">"A Kerala Sastra Sahitya Parishad [KSSP, the People's Science Movement] study in 1987 showed that the average health expenditure per person per annum in Kerala then was Rs.89. It increased to Rs.549 in 1997 and Rs.1,837 in 2004. The results of the latest KSSP survey in 2012 showed that the average per capita out-of-pocket health expenditure in the State was Rs.5,269.05," said Dr B. Ekbal, public health activist, former president of the KSSP, and national convener of the Jan Swasthya Abhiyan (People's Health Movement India).</p><p align="justify">"There is no doubt that the highest annual out-of-pocket health expenditure is in Kerala. The data obtained from the latest [2014] NSSO survey [conducted every 10 years] are being analysed and the results will be known in a few months. That will show if the RSBY [Rashtriya Swasthya Bima Yojna, the Government of India's national health insurance programme for BPL households] and other government-financed risk protection schemes introduced in the past decade have had any impact," said Arun B. Nair, a consultant (health economics and financing) with the National Health Systems Resource Centre.</p><p align="justify">Health care costs are indeed one of the important causes of impoverishment in all States in India. Berman and Ahuja's study found, among other things, that, compared with other developing countries, private health care spending in India was much higher than government spending; the share of out-of-pocket health spending within private health spending was much higher; and outpatient care, which involved relatively small but more frequent payments, was more impoverishing than inpatient care.</p><p align="justify">According to the Draft National Health Policy 2015 document prepared by the Ministry of Health and Family Welfare last December, over 63 million people are pushed into poverty every year in India because of expenditure on health care. Nearly 18 per cent of all households in 2011-12 faced catastrophic expenditures because of health costs compared with 15 per cent in 2004-05-a reflection surely of the failure of public investment in health to cover the entire spectrum of people's health care needs, according to the document.</p><p align="justify">The Berman and Ahuja study also found that there were significant variations between major States, in comparison with the national average, regarding health-related impoverishment, with Kerala showing the highest effect, and Madhya Pradesh (a State "with high levels of base poverty, low education, and lower access to health care overall") showing a relatively low rate of health-related impoverishment.</p><p align="justify">"The cost of health care is very high in Kerala because, one, nearly 87 per cent of the people in the State use modern medical facilities; two, there has been an increase in the number of people suffering from non-communicable and chronic diseases that require continuous care and affordable medicines; three, the State had witnessed large-scale and unregulated privatisation of health care facilities in the past decades and even the poor are now forced to depend on them; and four, the costs of medicines have gone up," Dr Ekbal told Frontline.</p><p align="justify"><em>Burden of NCDs</em></p><p align="justify">Kerala has been witnessing a "high morbidity and low mortality" trend, which is increasingly influenced by the replacement of infectious diseases and nutrition-related and maternal and child health-related health issues by non-communicable and chronic diseases, including cardiovascular diseases, diabetes, cancer and hypertension.</p><p align="justify">While the growing burden from non-communicable diseases (NCDs) is a reality all over India, the demographic transition in Kerala has meant a dramatic increase in its population of the aged, a higher burden of NCDs, and increasing health-seeking behaviour by its educated population, a trend marked by a growing preference for new and costly technology.</p><p align="justify">Kerala, where the foundation for a modern medical care system accessible to all was already in existence at the time of its formation in 1956, greatly expanded its government health facilities from 1961 to 1986. But what followed thereafter until the early 1990s was a period of intense fiscal crisis for successive State governments, when, in order to meet increasing expenditure on salary, they began to cut back spending on supplies, including drugs and other essentials, to the public hospitals. In a historical analysis of the development of health care facilities in Kerala, published in the journal Health Policy and Planning (OUP, 2000), Dr V. Ramankutty, Professor at the Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, recorded how this neglect destroyed Kerala's secondary health sector, especially the district and taluk government hospitals and the primary sector, consisting of primary health centres. Even as early as 1987, he said, an extensive survey of 10,000 households by the KSSP found that only 23 per cent of the households regularly used government health services for reasons that included "non-availability of drugs in the government hospitals", "lack of proper attention" and "better behaviour in private institutions". "There was a shift away from secondary care, with a drastic reduction in funds available for district and taluk government hospitals. Even now, despite the involvement of local bodies and the availability of funds through them, I am not sure all is well with the secondary care centres. Only some are doing well though the primary health system remains largely protected through a lot of direct central funding. Large-scale privatisation of the Kerala health sector took place during the same time," Dr Ramankutty told Frontline.</p><p align="justify">Kerala's Draft Health Policy notes that the public health care expenditure (as a proportion of the gross state domestic product, or GSDP) decreased by 35 per cent between 1990 and 2002, making Kerala one of the States with the highest reduction in public sector contributions and the highest increase in private funding for health care. The decline in public sector spending for health resulted in an overwhelming expansion of the private sector.</p><p align="justify">For example, the amount allocated for health care in the 2012-13 Kerala Budget was only 0.99 per cent of the GSDP. But, significantly, researchers say, private expenditure on health care was almost nine times as high and nearly two-thirds of the poor sought private sector facilities. According to the National Health Accounts (2004-05), of the total health expenditure in Kerala, the share of the private sector was the highest in the country with 90.27 per cent; the public sector accounted for only 9.7 per cent.</p><p align="justify">The prospering private super speciality hospitals with high-tech facilities are a result of the failure of the government health system to meet the demand for secondary and tertiary care and to manage the growing NCD burden. "But we have also started seeing a new trend of small and medium private hospitals being closed down in significant numbers in the State, making health care inaccessible to a large number of people or forcing them to approach bigger care facilities," Dr Ekbal said.</p><p align="justify">According to Dr Ramankutty, many entrepreneurs are entering the field and buying or selling off established private hospitals. "The profit motive has come to the fore. Hospitals are seen as an investment option for easy profits: there is enough demand; there are no labour disputes in the sector, for example. There is inadequate public health spending by the government and health care is free only in principle in most government institutions. Moreover, facilities for treatment of NCDs are limited and are not completely free in the public sector. The private sector has made use of this opportunity, equipping itself well with the latest technology and facilities, and even the poor are forced to depend on them -at a heavy cost."</p><p align="justify">"Government support has been a key factor in the advancement of health care in the State. An expansion or strengthening of the public health system based on today's requirements has not taken place even as people's aspirations about health care needs have gone up. The care that the State used to provide in the 1980s is not what is required today," he told Frontline. Thus, the State is facing a situation where, because of the growing burden of NCDs, health care costs are leading more and more people (not just low-income families) to financial distress. Hospitalisation, even in the government sector, is leading to catastrophic health expenditure, distress financing and its aftermath; existing insurance and similar financial support schemes are inadequate and offer services only for a limited spectrum of diseases and procedures.</p><p align="justify">A dearth of micro-level studies, especially looking at how this impacts individuals, has meant a general lack of understanding about the seriousness of the evolving situation: of how NCD burden could overwhelm the State's troubled health sector and drive vulnerable sections of Kerala society deeper into poverty and lifelong dependency.</p><p align="justify">"It is important to ensure that treatment options and medicines are accessible and affordable to all. The government has to spend more on health care and should not allow a change to a system where despite the availability of all the facilities in the public or private sector, a substantial section of people are still denied health care," Dr Ekbal said.</p><p align="justify">Most health care researchers, therefore, argue for the reintroduction of the system of accessible and affordable primary care, like the British system of general practitioners or by strengthening the system based on community (public) health centres; more government spending on health, especially to deal with the emerging NCD burden; better regulation and quality control in the private sector; introduction of better financial risk protection measures and their better coordination to help patients deal with catastrophic health expenditure; and measures to ensure availability of medicines and bring down costs in all government facilities.</p><p align="justify">"Public health governance has taken a back seat in Kerala, and hospital administrators are not properly trained to deal with the emerging professional and financial challenges. There is a general complacency when it comes to issues relating to health. We tend to bask in our past glory, smug about our early achievements, when new challenges are already overwhelming us and, in truth, other States are stealing a march over us," Dr Ramankutty said.</p>
</div>
</td>
</tr>
</table>
</div>
</div>
</div>
<div class="clear"></div>
<br><a href="http://www.frontline.in/the-nation/driven-to-distress/article6945294.ece?homepage=true" class="re" target="_blank">Frontline, 20 March, 2015, http://www.frontline.in/the-nation/driven-to-distress/article6945294.ece?homepage=true</a><div class="clear"></div>
<div style="padding-top: 18px;">
<p class="post-tag">Tagged with:
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=healthcare"
title="healthcare">
healthcare </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=healthcare in india"
title="healthcare in india">
healthcare in india </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Health"
title="Access to Health">
Access to Health </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Healthcare"
title="Access to Healthcare">
Access to Healthcare </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Access to Medicines"
title="Access to Medicines">
Access to Medicines </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Health Expenditure"
title="Health Expenditure">
Health Expenditure </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=Public Health"
title="Public Health">
Public Health </a>
<a class="tagcloud5"
href="https://im4change.in/search?qryStr=kerala"
title="kerala">
kerala </a>
</p>
</div>
<div class="clear"></div>
<br><br>
<div class="widget-top">
<h4>Related Articles</h4>
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<ul id="recentcomments">
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/india-s-stretched-health-care-system-fails-millions-in-rural-areas-battling-sickle-cell-disease-abc.html"
title="India's stretched health care system fails millions in rural areas battling sickle cell disease - ABC">
India's stretched health care system fails millions in rural areas battling sickle cell disease - ABC </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/what-data-told-us-about-india-in-2022-akshi-chawla.html"
title="What data told us about India in 2022 - Akshi Chawla">
What data told us about India in 2022 - Akshi Chawla </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/climate-change-will-likely-exacerbate-indian-rural-household-s-debt-burden.html"
title="Climate change will likely exacerbate Indian rural household's debt burden ">
Climate change will likely exacerbate Indian rural household's debt burden </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/the-need-to-make-cancer-drugs-affordable-biswajit-dhar-and-chetali-rao.html"
title="The need to make cancer drugs affordable -Biswajit Dhar and Chetali Rao">
The need to make cancer drugs affordable -Biswajit Dhar and Chetali Rao </a>
</li>
<li class="recentcomments">
<a href="https://im4change.in/latest-news-updates/after-measles-experts-worry-typhoid-could-pose-the-next-health-challenge-as-india-delays-vaccine-tabassum-barnagarwala.html"
title="After measles, experts worry typhoid could pose the next health challenge as India delays vaccine -Tabassum Barnagarwala">
After measles, experts worry typhoid could pose the next health challenge as India delays vaccine -Tabassum Barnagarwala </a>
</li>
</ul>
</div>
<div class="comment-respond" id="respond">
<a name="commentbox"> </a>
<h3 class="comment-reply-title" id="reply-title">Write Comments</h3>
<form method="post" accept-charset="utf-8" role="form" action="/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"><div style="display:none;"><input type="hidden" name="_method" value="POST"/></div> <form class="comment-form" id="commentform" method="post" action="#commentbox" onSubmit="return validate()"
name="cmtform">
<input type="hidden" name="cmttype" value="articlecmt"/>
<input type="hidden" name="article_id" value="27468"/>
<p class="comment-notes">Your email address will not be published. Required fields are marked <span
class="required">*</span></p>
<p class="comment-form-author">
<label for="commenterName">Name</label>
<span class="required">*</span>
<input type="text" aria-required="true" size="30"
value=""
name="commenterName" id="commenterName" required="true">
</p>
<p class="comment-form-email">
<label for="commenterEmail">Email</label> <span class="required">*</span>
<input aria-required="true" size="30" name="commenterEmail" id="commenterEmail" type="email"
value=""
required="true">
</p>
<p class="comment-form-contact">
<label for="commenterPh">Contact No.</label>
<input type="text" size="30"
value=""
name="commenterPh" id="commenterPh">
</p>
<p class="comment-form-comment">
<label for="comment">Comment</label>
<textarea aria-required="true" required="true" rows="8" cols="45" name="comment"
id="comment"></textarea>
</p>
<p class="comment-form-comment">
<label for="comment">Type the characters you see in the image below <span class="required">*</span><br><img
class="captchaImg"
src="https://im4change.in/securimage_show_art.php?tk=760565086" alt="captcha"/>
</label>
</p>
<input type="text" name="vrcode" required="true"/>
<p class="form-submit" style="width: 200px;">
<input type="submit" value="Post Comment" id="submit" name="submit">
</p></form>
</div>
<style>
.ui-widget-content {
height: auto !important;
}
</style>
<div id="share-modal"></div>
<style>
.middleContent a{
background-color: rgba(108,172,228,.2);
}
.middleContent a:hover{
background-color: #418fde;
border-color: #418fde;
color: #000;
}
</style>
<script>
function shareArticle(article_id) {
var options = {
modal: true,
height: 'auto',
width: 600 + 'px'
};
$('#share-modal').html("");
$('#share-modal').load('https://im4change.in/share_article?article_id=' + article_id).dialog(options).dialog('open');
}
function postShare() {
var param = 'article_id=' + $("#article_id").val();
param = param + '&y_name=' + $("#y_name").val();
param = param + '&y_email=' + $("#y_email").val();
param = param + '&f_name=' + $("#f_name").val();
param = param + '&f_email=' + $("#f_email").val();
param = param + '&y_msg=' + $("#y_msg").val();
$.ajax({
type: "POST",
url: 'https://im4change.in/post_share_article',
data: param,
success: function (response) {
$('#share-modal').html("Thank You, Your message posted to ");
}
});
return false;
}
</script> </div>
</div>
<!-- Right Side Section Start -->
<!-- MAP Section START -->
<aside class="sidebar indexMarg">
<div class="ad-cell">
<a href="https://im4change.in/statemap.php" title="">
<img src="https://im4change.in/images/map_new_version.png?1582080666" alt="India State Map" class="indiamap" width="232" height="252"/> </a>
<div class="rightmapbox">
<div id="sideOne" class="docltitle"><a href="https://im4change.in/state-report/india/36" target="_blank">DOCUMENTS/
REPORTS</a></div>
<div id="sideTwo" class="statetitle"><a href="https://im4change.in/states.php"target="_blank">STATE DATA/
HDRs.</a></div>
</div>
<div class="widget widgePadTop"></div>
</div>
</aside>
<!-- MAP Section END -->
<aside class="sidebar sidePadbottom">
<div class="rightsmlbox1" >
<a href="https://im4change.in/knowledge_gateway" target="_blank" style="color: #035588;
font-size: 17px;">
KNOWLEDGE GATEWAY
</a>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/newsletter" target="_blank">
NEWSLETTER
</a>
</p>
</div>
</div>
<div class="rightsmlbox1" style="height: 325px;">
<div>
<p class="rightsmlbox1_title">
Interview with Prof. Ravi Srivastava
</p>
<p class="rightsmlbox1_title">
<a href="https://im4change.in/video/interview-with-prof-ravi-srivastava-on-current-economic-crisis">
<img width="250" height="200" src="/images/interview_video_home.jpg" alt="Interview with Prof. Ravi Srivastava"/>
</a>
<!--
<iframe width="250" height="200" src="https://www.youtube.com/embed/MmaTlntk-wc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe>-->
</p>
<a href="https://im4change.in/videogallery" class="more-link CatArchalAnch1" target="_blank">
More videos
</a>
</div>
</div>
<div class="rightsmlbox1">
<div>
<!--div id="sstory" class="rightboxicons"></div--->
<p class="rightsmlbox1_title"><a href="https://im4change.in/list-success-stories" target="_blank">Success Stories</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/interviews" target="_blank">Interviews</a>
</p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a href="https://www.commoncause.in/page.php?id=10" >Donate</a></p>
</div>
</div>
<div class="rightsmlbox1">
<div>
<p class="rightsmlbox1_title"><a
href="https://im4change.in/marquee"
class="isf_link more-link" title="India Focus?" style="border: 4px solid #fdd922;width: 90%;background-color: #fdd922;text-align: center;color: #000000;font-size:18px" target="_blank">India Focus</a></p> </div>
</div>
<div class="rightsmlbox1" style="height: 104px !important;">
<a href="https://im4change.in/quarterly_reports.php" target="_blank">
Quarterly Reports on Effect of Economic Slowdown on Employment in India (2008 - 2015)
</a>
</div>
<!-- <div class="rightsmlbox1">
<a href="https://play.google.com/store/apps/details?id=com.im4.im4change" target="_blank">
</a></div> -->
<!-- <section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">Most Visited</h2>
</section> -->
<!-- accordion Starts here -->
<!-- <div id="accordion" class="accordMarg">
</div> -->
<!-- accordion ends here -->
<!-- Widget Tag Cloud Starts here -->
<div id="tag_cloud-2" class="widget widget_tag_cloud">
<section class="cat-box recent-box secMarg">
<h2 class="cat-box-title">MOST VISITED TAGS</h2>
</section>
<div class="widget-top wiPdTp">
<div class="stripe-line"></div>
</div>
<div class="widget-container">
<div class="tagcloud">
<a href="https://im4change.in/search?qryStr=Agriculture"
target="_blank" class="tag-link-4 font4">Agriculture</a>
<a href="https://im4change.in/search?qryStr=Food Security"
target="_blank" class="tag-link-4 font4">Food Security</a>
<a href="https://im4change.in/search?qryStr=Law and Justice"
target="_blank" class="tag-link-4 font4">Law and Justice</a>
<a href="https://im4change.in/search?qryStr=Health"
target="_blank" class="tag-link-4 font4">Health</a>
<a href="https://im4change.in/search?qryStr=Right to Food"
target="_blank" class="tag-link-4 font4">Right to Food</a>
<a href="https://im4change.in/search?qryStr=Corruption"
target="_blank" class="tag-link-4 font4">Corruption</a>
<a href="https://im4change.in/search?qryStr=farming"
target="_blank" class="tag-link-4 font4">farming</a>
<a href="https://im4change.in/search?qryStr=Environment"
target="_blank" class="tag-link-4 font4">Environment</a>
<a href="https://im4change.in/search?qryStr=Right to Information"
target="_blank" class="tag-link-4 font4">Right to Information</a>
<a href="https://im4change.in/search?qryStr=NREGS"
target="_blank" class="tag-link-4 font4">NREGS</a>
<a href="https://im4change.in/search?qryStr=Human Rights"
target="_blank" class="tag-link-4 font4">Human Rights</a>
<a href="https://im4change.in/search?qryStr=Governance"
target="_blank" class="tag-link-4 font4">Governance</a>
<a href="https://im4change.in/search?qryStr=PDS"
target="_blank" class="tag-link-4 font4">PDS</a>
<a href="https://im4change.in/search?qryStr=COVID-19"
target="_blank" class="tag-link-4 font4">COVID-19</a>
<a href="https://im4change.in/search?qryStr=Land Acquisition"
target="_blank" class="tag-link-4 font4">Land Acquisition</a>
<a href="https://im4change.in/search?qryStr=mgnrega"
target="_blank" class="tag-link-4 font4">mgnrega</a>
<a href="https://im4change.in/search?qryStr=Farmers"
target="_blank" class="tag-link-4 font4">Farmers</a>
<a href="https://im4change.in/search?qryStr=transparency"
target="_blank" class="tag-link-4 font4">transparency</a>
<a href="https://im4change.in/search?qryStr=Gender"
target="_blank" class="tag-link-4 font4">Gender</a>
<a href="https://im4change.in/search?qryStr=Poverty"
target="_blank" class="tag-link-4 font4">Poverty</a>
<a href="https://im4change.in/search?qryStr=Farm Laws" target="_blank" class="tag-link-4 font4">Farm Laws
</a>
<a href="https://im4change.in/search?qryStr=Citizenship Amendment Act" target="_blank" class="tag-link-4 font4">Citizenship Amendment Act
</a>
<a href="https://im4change.in/search?qryStr=CAA NPR NRIC" target="_blank" class="tag-link-4 font4">CAA NPR NRIC
</a>
<a href="https://im4change.in/search?qryStr=Job Losses" target="_blank" class="tag-link-4 font4">Job Losses
</a>
<a href="https://im4change.in/search?qryStr=Migrant Workers" target="_blank" class="tag-link-4 font4">Migrant Workers
</a>
<a href="https://im4change.in/search?qryStr=Unemployment" target="_blank" class="tag-link-4 font4">Unemployment
</a>
<a href="https://im4change.in/search?qryStr=PMGKAY" target="_blank" class="tag-link-4 font4">PMGKAY
</a>
<a href="https://im4change.in/search?qryStr=PM-KISAN" target="_blank" class="tag-link-4 font4">PM-KISAN
</a>
<a href="https://im4change.in/search?qryStr=PM-CARES" target="_blank" class="tag-link-4 font4">PM-CARES
</a>
<a href="https://im4change.in/search?qryStr=LFPR" target="_blank" class="tag-link-4 font4">LFPR
</a>
</div>
</div>
</div>
<!-- Widget Tag Cloud Ends here -->
</aside>
<!-- Right Side Section End -->
</div>
<section class="cat-box cats-review-box footerSec">
<h2 class="cat-box-title vSec CatArcha">Video
Archives</h2>
<h2 class="cat-box-title CatArchaTitle">Archives</h2>
<div class="cat-box-content">
<div class="reviews-cat">
<div class="CatArchaDiv1">
<div class="CatArchaDiv2">
<ul>
<li>
<a href="https://im4change.in/news-alerts-57/moving-upstream-luni-fellowship.html" target="_blank">
Moving Upstream: Luni – Fellowship </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/135-million-indians-exited-multidimensional-poverty-as-per-government-figures-is-that-the-same-as-poverty-reduction.html" target="_blank">
135 Million Indians Exited “Multidimensional" Poverty as per Government... </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/explainer-why-are-tomato-prices-on-fire.html" target="_blank">
Explainer: Why are Tomato Prices on Fire? </a>
</li>
<li>
<a href="https://im4change.in/news-alerts-57/nsso-survey-only-39-1-of-all-households-have-drinking-water-within-dwelling-46-7-of-rural-households-use-firewood-for-cooking.html" target="_blank">
NSSO Survey: Only 39.1% of all Households have Drinking... </a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/news-alerts-57"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/I51LYnP8BOk/1.jpg"
alt=" Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Short-Video-on-im4change-Hindi-website-Inclusive-Media-for-Change" target="_blank">
Im4Change.org हिंदी वेबसाइट का परिचय. Short Video on im4change.org... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/kNqha-SwfIY/1.jpg"
alt=" "Session 1: Scope of IDEA and AgriStack" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-1- Scope-of-IDEA-and-AgriStack-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 1: Scope of IDEA and AgriStack" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/6kIVjlgZItk/1.jpg"
alt=" "Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-2-Farmer-Centric-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 2: Farmer Centric Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="CatArchaWidth">
<img class="CatArchaImg"
src="https://img.youtube.com/vi/2BeHTu0y7xc/1.jpg"
alt=" "Session 3: Future of Digitalisation in Agriculture" in Exploring...">
<p class="CatArchaPPad">
<a href="https://im4change.in/video/Session-3-Future-of-Digitalisation-in-Agriculture-in-Exploring-Digitalisation-in-Agriculture-29-April-2022" target="_blank">
"Session 3: Future of Digitalisation in Agriculture" in Exploring... </a>
</p>
</div>
<div class="divWidth">
<ul class="divWidthMarg">
<li>
<a href="https://im4change.in/video/Public-Spending-on-Agriculture-in-India-Source-Foundation-for-Agrarian-Studies"
title="Public Spending on Agriculture in India (Source: Foundation for Agrarian Studies)" target="_blank">
Public Spending on Agriculture in India (Source: Foundation for...</a>
</li>
<li>
<a href="https://im4change.in/video/Agrarian-Change-Seminar-Protests-against-the-New-Farm-Laws-in-India-by-Prof-Vikas-Rawal-JNU-Source-Journal-Of-Agrarian-Change"
title="Agrarian Change Seminar: 'Protests against the New Farm Laws in India' by Prof. Vikas Rawal, JNU (Source: Journal Of Agrarian Change) " target="_blank">
Agrarian Change Seminar: 'Protests against the New Farm Laws...</a>
</li>
<li>
<a href="https://im4change.in/video/Webinar-Ramrao-The-Story-of-India-Farm-Crisis-Source-Azim-Premji-University"
title="Webinar: Ramrao - The Story of India's Farm Crisis (Source: Azim Premji University)" target="_blank">
Webinar: Ramrao - The Story of India's Farm Crisis...</a>
</li>
<li>
<a href="https://im4change.in/video/water-and-agricultural-transformation-in-India"
title="Water and Agricultural Transformation in India: A Symbiotic Relationship (Source: IGIDR)" target="_blank">
Water and Agricultural Transformation in India: A Symbiotic Relationship...</a>
</li>
<li class="CatArchalLi1">
<a href="https://im4change.in/videogallery"
class="more-link CatArchalAnch1" target="_blank">
More...
</a>
</li>
</ul>
</div>
</div>
</div>
</div>
</section> </div>
<div class="clear"></div>
<!-- Footer option Starts here -->
<div class="footer-bottom fade-in animated4">
<div class="container">
<div class="social-icons icon_flat">
<p class="SocialMargTop"> Website Developed by <a target="_blank" title="Web Development"
class="wot right"
href="http://www.ravinderkhurana.com/" rel="nofollow">
RAVINDErkHURANA.com</a></p>
</div>
<div class="alignleft">
<a
target="_blank" href="https://im4change.in/objectives-8.html"
class="link"
title="Objectives">Objectives</a> | <a
target="_blank" href="https://im4change.in/about-us-9.html"
class="link" title="About Us">About Us</a> | <a
target="_blank" href="https://im4change.in/media-workshops.php"
class="ucwords">Workshops</a> | <a
target="_blank" href="https://im4change.in/disclaimer/disclaimer-149.html"
title="Disclaimer">Disclaimer</a> </div>
</div>
</div>
<!-- Footer option ends here -->
</div>
<div id="connect">
<a target="_blank"
href="http://www.facebook.com/sharer.php?u=https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"
title="Share on Facebook">
<img src="https://im4change.in/images/Facebook.png?1582080640" alt="share on Facebook" class="ImgBorder"/>
</a><br/>
<a target="_blank"
href="http://twitter.com/share?text=Im4change&url=https://im4change.in/latest-news-updates/driven-to-distress-r-krishnakumar-4675519.html"
title="Share on Twitter">
<img src="https://im4change.in/images/twitter.png?1582080632" alt="Twitter" class="ImgBorder"/> </a>
<br/>
<a href="/feeds" title="RSS Feed" target="_blank">
<img src="https://im4change.in/images/rss.png?1582080632" alt="RSS" class="ImgBorder"/>
</a>
<br/>
<a class="feedback-link" id="feedbackFormLink" href="#">
<img src="https://im4change.in/images/feedback.png?1582080630" alt="Feedback" class="ImgBorder"/>
</a> <br/>
<a href="javascript:function iprl5(){var d=document,z=d.createElement('scr'+'ipt'),b=d.body,l=d.location;try{if(!b)throw(0);d.title='(Saving...) '+d.title;z.setAttribute('src',l.protocol+'//www.instapaper.com/j/WKrH3R7ORD5p?u='+encodeURIComponent(l.href)+'&t='+(new Date().getTime()));b.appendChild(z);}catch(e){alert('Please wait until the page has loaded.');}}iprl5();void(0)"
class="bookmarklet" onclick="return explain_bookmarklet();">
<img src="https://im4change.in/images/read-it-later.png?1582080632" alt="Read Later" class="ImgBorder"/> </a>
</div>
<!-- Feedback form Starts here -->
<div id="feedbackForm" class="overlay_form" class="ImgBorder">
<h2>Contact Form</h2>
<div id="contactform1">
<div id="formleft">
<form id="submitform" action="/contactus.php" method="post">
<input type="hidden" name="submitform" value="submitform"/>
<input type="hidden" name="salt_key" value="a0e0f2c6a0644a70e57ad2c96829709a"/>
<input type="hidden" name="ref" value="feedback"/>
<fieldset>
<label>Name :</label>
<input type="text" name="name" class="tbox" required/>
</fieldset>
<fieldset>
<label>Email :</label>
<input type="text" name="email" class="tbox" required/>
</fieldset>
<fieldset>
<label>Message :</label>
<textarea rows="5" cols="20" name="message" required></textarea>
</fieldset>
<fieldset>
Please enter security code
<div class="clear"></div>
<input type="text" name="vrcode" class="tbox"/>
</fieldset>
<fieldset>
<input type="submit" class="button" value="Submit"/>
<a href="#" id="closefeedbakcformLink">Close</a>
</fieldset>
</form>
</div>
<div class="clearfix"></div>
</div>
</div>
<div id="donate_popup" class="modal" style="max-width: 800px;">
<table width="100%" border="1">
<tr>
<td colspan="2" align="center">
<b>Support im4change</b>
</td>
</tr>
<tr>
<td width="25%" valign="middle">
<img src="https://im4change.in/images/logo2.jpg?1582080632" alt="" width="100%"/> </td>
<td style="padding-left:10px;padding-top:10px;">
<form action="https://im4change.in/donate" method="get">
<table width="100%" cellpadding="2" cellspacing="2">
<tr>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
10
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
100
</td>
<td width="33%" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
1000
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
50
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
500
</td>
<td style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
<input type="text" name="price" placeholder="?" style="font-family: 'Script Font', cursive, Arial;font-size: 20px;font-weight: 700;">
</td>
</tr>
<tr>
<td colspan="3">
</td>
</tr>
<tr>
<td colspan="3" align="right">
<input type="button" name="Pay" value="Pay"
style="width: 200px;background-color: rgb(205, 35, 36);color: #ffffff;"/>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</div><script type='text/javascript'>
/* <![CDATA[ */
var tievar = {'go_to': 'Go to...'};
/* ]]> */
</script>
<script src="/js/tie-scripts.js?1575549704"></script><script src="/js/bootstrap.js?1575549704"></script><script src="/js/jquery.modal.min.js?1578284310"></script><script>
$(document).ready(function() {
// tell the autocomplete function to get its data from our php script
$('#s').autocomplete({
source: "/autocomplete"
});
});
</script>
<script src="/vj-main-sw-register.js" async></script>
<script>function init(){var imgDefer=document.getElementsByTagName('img');for(var i=0;i<imgDefer.length;i++){if(imgDefer[i].getAttribute('data-src')){imgDefer[i].setAttribute('src',imgDefer[i].getAttribute('data-src'))}}}
window.onload=init;</script>
</body>
</html>'
}
$cookies = []
$values = [
(int) 0 => 'text/html; charset=UTF-8'
]
$name = 'Content-Type'
$first = true
$value = 'text/html; charset=UTF-8'
header - [internal], line ??
Cake\Http\ResponseEmitter::emitHeaders() - CORE/src/Http/ResponseEmitter.php, line 181
Cake\Http\ResponseEmitter::emit() - CORE/src/Http/ResponseEmitter.php, line 55
Cake\Http\Server::emit() - CORE/src/Http/Server.php, line 141
[main] - ROOT/webroot/index.php, line 39
LATEST NEWS UPDATES | Driven to distress -R Krishnakumar
Kerala is facing a situation where health care costs are leading more and more people, not just low-income families, to financial distress.
KERALA is once again drawing attention to itself, this time for a persistent trend of a large number of households being pushed into financial ruin because of the expenses incurred for medical care.
Several studies have now found evidence for the many facets of this worrying development in a State that was known until the mid-1980s for its health care model that offered "good health at low cost" and for its health care indices that were comparable to those in more developed countries. However, today, the highest rate of health-related impoverishment in India is being noticed in Kerala, according to researchers, who also warn that all over the country high private health care spending and high out-of-pocket spending are placing a substantial financial burden on urban and rural households.
A committee of health care experts constituted by the Kerala State Planning Board has also cautioned that the health care infrastructure in Kerala and the finances of the common man have come under severe stress, with the State recording the highest per capita public and private health expenditure among major States. The highest out-of-pocket expenditures on health in the country have also been noticed in Kerala, said a concept note prepared in November 2014 by the committee, which was constituted as part of the implementation of the 12th Five Year Plan proposals on the health sector.
The committee said that the high cost of treatment and out-of-pocket expenditure led to a large section of people falling below the poverty line (BPL). It said, a study done by Peter Berman and Rajeev Ahuja ("The Impoverishing Effect of Health Care Payments in India: New Evidence and Methodology", published in India Health Beat by the Public Health Foundation of India and the World Bank unit in New Delhi in December 2009) using National Sample Survey Office (NSSO) 2004 survey data estimated that around 12 per cent of rural households and 8 per cent of urban households in Kerala were pushed below the poverty line in that year because of health care expenditure.
"A Kerala Sastra Sahitya Parishad [KSSP, the People's Science Movement] study in 1987 showed that the average health expenditure per person per annum in Kerala then was Rs.89. It increased to Rs.549 in 1997 and Rs.1,837 in 2004. The results of the latest KSSP survey in 2012 showed that the average per capita out-of-pocket health expenditure in the State was Rs.5,269.05," said Dr B. Ekbal, public health activist, former president of the KSSP, and national convener of the Jan Swasthya Abhiyan (People's Health Movement India).
"There is no doubt that the highest annual out-of-pocket health expenditure is in Kerala. The data obtained from the latest [2014] NSSO survey [conducted every 10 years] are being analysed and the results will be known in a few months. That will show if the RSBY [Rashtriya Swasthya Bima Yojna, the Government of India's national health insurance programme for BPL households] and other government-financed risk protection schemes introduced in the past decade have had any impact," said Arun B. Nair, a consultant (health economics and financing) with the National Health Systems Resource Centre.
Health care costs are indeed one of the important causes of impoverishment in all States in India. Berman and Ahuja's study found, among other things, that, compared with other developing countries, private health care spending in India was much higher than government spending; the share of out-of-pocket health spending within private health spending was much higher; and outpatient care, which involved relatively small but more frequent payments, was more impoverishing than inpatient care.
According to the Draft National Health Policy 2015 document prepared by the Ministry of Health and Family Welfare last December, over 63 million people are pushed into poverty every year in India because of expenditure on health care. Nearly 18 per cent of all households in 2011-12 faced catastrophic expenditures because of health costs compared with 15 per cent in 2004-05-a reflection surely of the failure of public investment in health to cover the entire spectrum of people's health care needs, according to the document.
The Berman and Ahuja study also found that there were significant variations between major States, in comparison with the national average, regarding health-related impoverishment, with Kerala showing the highest effect, and Madhya Pradesh (a State "with high levels of base poverty, low education, and lower access to health care overall") showing a relatively low rate of health-related impoverishment.
"The cost of health care is very high in Kerala because, one, nearly 87 per cent of the people in the State use modern medical facilities; two, there has been an increase in the number of people suffering from non-communicable and chronic diseases that require continuous care and affordable medicines; three, the State had witnessed large-scale and unregulated privatisation of health care facilities in the past decades and even the poor are now forced to depend on them; and four, the costs of medicines have gone up," Dr Ekbal told Frontline.
Burden of NCDs
Kerala has been witnessing a "high morbidity and low mortality" trend, which is increasingly influenced by the replacement of infectious diseases and nutrition-related and maternal and child health-related health issues by non-communicable and chronic diseases, including cardiovascular diseases, diabetes, cancer and hypertension.
While the growing burden from non-communicable diseases (NCDs) is a reality all over India, the demographic transition in Kerala has meant a dramatic increase in its population of the aged, a higher burden of NCDs, and increasing health-seeking behaviour by its educated population, a trend marked by a growing preference for new and costly technology.
Kerala, where the foundation for a modern medical care system accessible to all was already in existence at the time of its formation in 1956, greatly expanded its government health facilities from 1961 to 1986. But what followed thereafter until the early 1990s was a period of intense fiscal crisis for successive State governments, when, in order to meet increasing expenditure on salary, they began to cut back spending on supplies, including drugs and other essentials, to the public hospitals. In a historical analysis of the development of health care facilities in Kerala, published in the journal Health Policy and Planning (OUP, 2000), Dr V. Ramankutty, Professor at the Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, recorded how this neglect destroyed Kerala's secondary health sector, especially the district and taluk government hospitals and the primary sector, consisting of primary health centres. Even as early as 1987, he said, an extensive survey of 10,000 households by the KSSP found that only 23 per cent of the households regularly used government health services for reasons that included "non-availability of drugs in the government hospitals", "lack of proper attention" and "better behaviour in private institutions". "There was a shift away from secondary care, with a drastic reduction in funds available for district and taluk government hospitals. Even now, despite the involvement of local bodies and the availability of funds through them, I am not sure all is well with the secondary care centres. Only some are doing well though the primary health system remains largely protected through a lot of direct central funding. Large-scale privatisation of the Kerala health sector took place during the same time," Dr Ramankutty told Frontline.
Kerala's Draft Health Policy notes that the public health care expenditure (as a proportion of the gross state domestic product, or GSDP) decreased by 35 per cent between 1990 and 2002, making Kerala one of the States with the highest reduction in public sector contributions and the highest increase in private funding for health care. The decline in public sector spending for health resulted in an overwhelming expansion of the private sector.
For example, the amount allocated for health care in the 2012-13 Kerala Budget was only 0.99 per cent of the GSDP. But, significantly, researchers say, private expenditure on health care was almost nine times as high and nearly two-thirds of the poor sought private sector facilities. According to the National Health Accounts (2004-05), of the total health expenditure in Kerala, the share of the private sector was the highest in the country with 90.27 per cent; the public sector accounted for only 9.7 per cent.
The prospering private super speciality hospitals with high-tech facilities are a result of the failure of the government health system to meet the demand for secondary and tertiary care and to manage the growing NCD burden. "But we have also started seeing a new trend of small and medium private hospitals being closed down in significant numbers in the State, making health care inaccessible to a large number of people or forcing them to approach bigger care facilities," Dr Ekbal said.
According to Dr Ramankutty, many entrepreneurs are entering the field and buying or selling off established private hospitals. "The profit motive has come to the fore. Hospitals are seen as an investment option for easy profits: there is enough demand; there are no labour disputes in the sector, for example. There is inadequate public health spending by the government and health care is free only in principle in most government institutions. Moreover, facilities for treatment of NCDs are limited and are not completely free in the public sector. The private sector has made use of this opportunity, equipping itself well with the latest technology and facilities, and even the poor are forced to depend on them -at a heavy cost."
"Government support has been a key factor in the advancement of health care in the State. An expansion or strengthening of the public health system based on today's requirements has not taken place even as people's aspirations about health care needs have gone up. The care that the State used to provide in the 1980s is not what is required today," he told Frontline. Thus, the State is facing a situation where, because of the growing burden of NCDs, health care costs are leading more and more people (not just low-income families) to financial distress. Hospitalisation, even in the government sector, is leading to catastrophic health expenditure, distress financing and its aftermath; existing insurance and similar financial support schemes are inadequate and offer services only for a limited spectrum of diseases and procedures.
A dearth of micro-level studies, especially looking at how this impacts individuals, has meant a general lack of understanding about the seriousness of the evolving situation: of how NCD burden could overwhelm the State's troubled health sector and drive vulnerable sections of Kerala society deeper into poverty and lifelong dependency.
"It is important to ensure that treatment options and medicines are accessible and affordable to all. The government has to spend more on health care and should not allow a change to a system where despite the availability of all the facilities in the public or private sector, a substantial section of people are still denied health care," Dr Ekbal said.
Most health care researchers, therefore, argue for the reintroduction of the system of accessible and affordable primary care, like the British system of general practitioners or by strengthening the system based on community (public) health centres; more government spending on health, especially to deal with the emerging NCD burden; better regulation and quality control in the private sector; introduction of better financial risk protection measures and their better coordination to help patients deal with catastrophic health expenditure; and measures to ensure availability of medicines and bring down costs in all government facilities.
"Public health governance has taken a back seat in Kerala, and hospital administrators are not properly trained to deal with the emerging professional and financial challenges. There is a general complacency when it comes to issues relating to health. We tend to bask in our past glory, smug about our early achievements, when new challenges are already overwhelming us and, in truth, other States are stealing a march over us," Dr Ramankutty said.
Write Comments