The pandemic taught us that healthcare should be government’s responsibility: KK Shailaja

Former health minister of Kerala KK Shailaja has been feted within India and internationally for the way she handled the outbreak of the deadly Nipah virus and then the Covid pandemic. Her recently published memoir titled 'My Life as 'a Comrade, reveals how her upbringing in a family steeped in Communist ideology drove her vision for Kerala’s public health system as one accessible for all. She talked to Sunday Times about the Kerala paradox of high female literacy co-existing with gender discrimination and of the challenges of building a robust health system frugally.


Kerala has been largely successful in breaking feudalism and caste, but not gender discrimination. Why?

We might be better in Kerala but the overall feudal attitude in India survives in Kerala too. To an extent the women in Kerala are more free, but we need to admit that since we have managed to do so much, our gender perspective should have been stronger.

Does such feudalism survive within the Party too?

Party is no different from society. Marx and Lenin too say this-all the evils existing in society will enter the communist party also. That’s why every now and then communist party conducts campaigns inside the party and outside for course correction.

In your book you talk of women’s struggle to maintain a professional life along with doing domestic chores. Do comrades cook?

Rarely. But in the modern context, not only comrades, even the youth, especially those in the IT sector, have to cook together if both have to leave for work early in the morning.

Is there enough emphasis in Left’s study classes for members on equality in household work?

Definitely. We are fighting continuously for that and in comrades’ families at least there is an acknowledgement and realization that the person doing the cooking is doing a huge amount of work. Just recently, Brinda Karat took classes in Delhi for the Central Committee members of the party, men and women, on gender issues. I can say that there are some results also. In the earlier days the men would be out the whole day doing party work and get back home to be served the meal by a mother, sister or wife. But situations are changing. For instance, earlier, the husbands of women panchayat presidents would insist that they be home by 5 pm. But now there is acknowledgement that she is the president and she has to go whenever there is a problem. But feudal culture does persist and what I talk about in the book is the need for a big mindset change, not that there has not been any change.

Only 38% of the population uses government facilities for hospitalization in Kerala. Why is the usage so low?

Now it is more than 52%. Earlier the usage was less because of lack of facilities. Our intention is not free treatment for everyone. Free treatment is for those below the poverty line (BPL) and affordable treatment for the middle income group. The higher income group can go to the private hospitals. We cannot spend our meagre resources in giving them free treatment in government hospitals. The middle income is middle because they have education, a small house, a job, they are not starving and are progressively improving their standards of living. But any illness and they have out of pocket expenditure which can push them into poverty. From 2016-21 the attempt has been to address the problems of this middle income group by improving the facilities available in government hospitals. Their treatment in government hospitals cost them a fraction of what it would have cost in a private hospital. In Covid we ensured free treatment for everyone. In many states people fell below the poverty line paying for treatment. In Kerala there was no increase in poverty due to Covid treatment.

Where do you go for treatment?

Till now, I have always gone to government hospitals for treatment.

Why do government officials and politicians go to private hospitals for treatment?

There was a time when people avoided government hospitals as they did not have enough facilities. Now even people who are well off are coming to the government sector. The staff tell me that some of the people coming to the government hospital have BMWs parked at home and I tell them that we should be happy because it shows that they trust the government sector. But even now the most modern technology is not available in government hospitals. We are trying to change that but it will take time.

On not getting a second tenure as health minister you say in the book that your only concern was whether the changes you had started for remodelling the health system would be left incomplete. Are you satisfied now?

I also said that my fear was baseless because the Left government got a second tenure. I am satisfied that they are continuing everything. Complete satisfaction will be when what was undertaken will be fulfilled. That will take time. Trivandrum Medical College is supposed to get Rs 750 crore worth work done. Only Rs 60 crore worth of work has been completed. But I am happy that the medical college has a fully functional well-organised trauma centre with all facilities which was set up with the help of doctors from AIIMS which is as good as the one in AIIMS, Delhi. We are starting such centres in all our medical colleges. It will take 3-4 years to be completed. It is a huge sense of satisfaction to see something you started reaching fruition right before your eyes.

When you talk about improving labour rooms, is there no more yelling at pregnant mothers or slapping of women in labour?

It has not totally ended. But it is a process. Earlier, labour wards were forbidding places with ramshackle rusted beds. In this atmosphere, some people were rude to the women. Some women cry loudly in pain because that is their nature. There is no point in hitting the person who is crying aloud because they are crying out of unbearable pain. It’s unacceptable and so we need a behaviour change among the staff. When the atmosphere changes it is easier to change behaviour also. Now we have neat and clean labour rooms with all facilities. But understaffing is not an acceptable excuse. I have cited some of the cases in my book where hospitals have been transformed even with less staff. So it is possible.

You ask why government hospitals cannot be aspirational and emphasise that they need to look good with a welcoming reception area and garden. Why is that important?

In a socialist set up, resources have to be distributed among the people. But if we say we can change things only when we finally bring in socialism, we would not be able to change anything for generations. The chief minister has also emphasized that within this generation we should be able to effect changes. If we stop our jobs from becoming purely transactional, as just money being paid for work done, and instead transform our work to services to be rendered, then, even with few people you can achieve a lot more. For instance, the casualty ward of a medical college I visited had a ceiling festooned with cobwebs. When asked about it they said they did not have enough staff. How is it possible that a medical college does not have enough staff to clean the one room of the casualty ward? I already had information about their staff strength. They had 250 cleaning staff, and were short by just 50 people who they could have hired through the hospital development society funds if they wanted to. But for that you need intention. If your attitude is that this is all public property and that government hospitals are like that, then things will remain like that. It’s not about shortage. It’s about a shift in the mindset.

You cite the way Kerala dealt with the surge in oxygen demand to say you can tackle a problem with intent despite having little money. How real is that?

We really did a good job on oxygen. IIT Kanpur had predicted a surge in cases in the future. We took that seriously and since the infection involved the lungs we knew we would need oxygen. We can’t go hunting for oxygen after the crisis hits and so we decided to stock in advance. We discussed all the ways in which we could boost production. The government extended help to INOX, a company producing oxygen and which had a plant in Palakkad, to finish an unfinished plant in a record time of two months. We planned with commercial oxygen producers how to convert a part of their output to medical oxygen and what changes that would require. By planning ahead not only did we prevent scarcity of oxygen when we needed it, we could also help out Tamil Nadu and Karnataka. We need to plan how to locate all our resources and utilize them. For instance, we did not have money to upgrade all the hospitals right up to the grassroots as we were spending on the bigger hospitals. But we used the resources at the grassroot level such as the MLA fund, self-government units and asked for help from affluent people in an area and the Rotary and Lions clubs. Some who could not give money contributed by furnishing rooms or sponsoring a garden for the hospital or a breastfeeding room in memory of their mother or father. A business family even built an entire three-storey family health centre in memory of their father. The government might not have money to do such things but resources are hidden everywhere in Kerala. We need to find them and use them. We have proved that this is possible.


You write: “When a man proclaims his successes, he’s stating facts. When it’s a woman, she’s showing off.” Did you face this?

Not too much, but inadvertently, I came to be very well known. It was a collective work and I was part of it. It was not a single individual working but since I was in a leadership position a lot of the media praised the work happening in Kerala and named the health minister of Kerala for the work. The Guardian newspaper did a piece on me. It’s not as if I knew the Guardian correspondent, Laura Spinney personally or that I knew her from before. But she called me directly. I don’t have any PR group or firm. I only have my staff. At that time Kerala had done a good job of containment of Covid till we could get the vaccine. That’s when Kerala came into the limelight on how it did it. It was a Congress leader who criticized in cheap language about me being called a rockstar health minister by the Guardian. He said it was all a gimmick. The criticism was done in a derogatory manner. They can’t imagine that a woman in a leadership position can achieve this. I have wondered if it was because it was a woman leading that it evoked such scorn and derision/ridicule. While I might not have been attacked personally for being a woman, it is there, it is the mindset.

You state that increasing access to public services in healthcare is the best option as private health sector investments do not translate to social commitments. Is that true?

Healthcare has to be the government’s responsibility. The pandemic was a litmus test of the governance systems of the world. Take the example of America. They have the money and very high technology. But what happened there? New York state has over two crore people. Kerala has 3.5 crore. In the first phase of Covid, thousands died in New York. Lakhs died in the US. Shouldn’t a country with so much resources and wealth be able to provide better facilities to their people? Why couldn’t they do it? So money alone is not enough. Even in a public health system like the NHS in the UK, a person cannot go to a facility because they are feeling sick. You can’t just walk into a facility. Where is the accessibility? If a person feels sick they should have a place they can walk into seeking care. That’s accessibility. We should create it. I have heard that in the private sector, when wheeling you to an operation theatre they want to know if you have insurance or want to know about your bank account. In the government sector there has to be a place people can run to, to save a person’s life. Segregating, triaging, deciding where to send the person for treatment etc are secondary. First there has to be an accessible place.

What the world has taught us is that health and education are two sectors that should not be forced towards privatization. It has been scientifically proven that in the time of a crisis it is best to have these sectors with the government. That has been proved by Kerala and by what happened in the world during Covid. We have a predominantly privatized system and the push for privatization is happening the world over. But we cannot change our ideology because of that. We have to keep fighting. As much as possible and as long as Left rule survives in Kerala , till then, we will fight to save public health and public education. We welcome private investment in the state because we need it to boost production so that the state can earn money to use it for welfare work. But we insist that basic human rights should be ensured and for that we need regulation. The struggle to sustain welfare measures for common people is what the Left endeavours to do and that is the Kerala model.

Do you think the “vaccine socialism” that you recommend in the book is workable?

Yes, we need it. No one is safe until everyone is safe. That’s our slogan. The world has become one. In earlier days a virus couldn’t take a flight. It would take months and years to travel from one region to another. Now, within hours it is spreading throughout the world. Thus it spread to Italy and America from Wuhan. In this context we need quick access to vaccines. The main reason why vaccine technology went to one company in India is because of being driven by capitalistic ideology. We asked the central government to share the technology so that public sector companies could produce it. Telangana asked for it to be produced in a Hyderabad PSU. Why couldn’t vaccines be produced in a decentralised manner? The government could have done it. Then we could have distributed the vaccine more easily and at a much cheaper rate. The reason that didn’t happen is because of capitalist ideology.