The outbreak of chikungunya, claiming 86 lives in Alappuzha and other parts of Kerala [Images], has exposed the weaknesses of the public health care system in the state, which used to boast about it for decades.

Though Kerala's basic health parameters like birth and death rates and multi-tier network of government hospitals covering the length and breadth of the state far surpassed the health delivery system in other parts of the country, experts feel the failure to quickly contain chikungunya betrayed the system's inability to cope with new challenges.

Besides the system weaknesses, the dismal record in keeping the environs clean and hygienic is seen as a key factor for epidemics, especially in the water-logged Cherthala area of Alappuzha, known for long for the prevalence of mosquito-spread diseases like filariasis.

The socio-economic fallout of the chikungunya outbreak and the delayed response to it is all the more serious in a place like Cherthala, a densely populated area where vast majority of people are marginal farmers, fishermen and daily wage earners who rely heavily on government hospitals.

Located on the banks of the Vembanad lake, with small canals, inlets and muddy pools, whose brackish and stilted water is carpeted with African weeds, the area is a fertile breeding ground for mosquitos, tackling which has been a major health task for decades.

"We can no longer rest on the past laurels. It is time that we thoroughly overhauled our health policy and delivery system to equip them to face emerging challenges," Dr Churchin Ben, former additional director of state Health Department,
told PTI.

Kerala is now paying a "heavy price" for the "long neglect" of basic public health concerns like sanitation, waste disposal, environmental protection and mass education, which together require an inter-sectoral co-ordinated approach, Ben said.

Deterioration of the primary health delivery system was a major reason for panic reaction to emergencies like the outbreak of epidemics, he said.

Despite being the base of the public healthcare pyramid, Primary Health Centres had over the years been rendered weak with their main job being that of referring the patients to taluk or district hospitals, instead of providing curative support at the village level itself, Ben said.

Going up the pyramid, there was an urgent need to put in place a policy framework that would enable the system to draw up region-specific plans.

This was so important in a state like Kerala whose international exposure and inter-border transit made it vulnerable to viral diseases, Dr Ben said.

There was an urgent need to create in-built scientific institutions within the system to ascertain the exact cause and magnitude of community health problems so that emergency situations could be coped with far more quickly and effectively, Ben said.

"For instance, the Vector Control Research Centre at Cherthala had been rendered virtually dysfunctional for the last several years on the presumption that filariasis in the area had been contained. Only after the current epidemic outbreak did the authorities realise the folly of having ignored the unit," he said.

"Of course, there had been a multi-speciality boom in Kerala spurred by private sector health providers. But the solutions offered by them are often beyond the reach of the common man, as had been evident from the chikungunya outbreak," he said.

"In the present case, for several days we could not even confirm it was chikungunya. We had to depend on national agencies and experts for that. If the state had its well-equipped institutions, this could have been avoided," he said.

According to K G Parameswaran Nair, author and journalist who had covered the state for over 50 years, "This has been the worst epidemic outbreak in Travancore region in the last several decades."