Understanding Dalit equity: a critical analysis of primary health care policy discourse of Kerala in the context of 'Aardram' mission.

BACKGROUND: The Government of Kerala in 2017 launched the Aardram Mission with the aim to revamp public health delivery in the State. A key strategy under the mission was its focus on comprehensive primary health care to achieve equitable health care delivery through the Family Health Centre (FHC) initiative. Given this, the current study aims to examine the primary health care policy discourse for their perspectives on caste-driven inequities. METHODS: The study undertook a Critical Discourse Analysis (CDA) of the primary health care policy discourse in Kerala. This included CDA of spoken words by senior health policy actors and policy texts on Aardram Mission and FHC. RESULTS: Though equity was a major aspirational goal of the Mission, related policy discourse around equity failed to acknowledge caste as a potential axis of health marginalisation in the State. The dismissal of caste manifested in three major ways within the policy discourse. One, the 'invisibilisation' of caste-driven inequities through strategies of (un)conscious exclusion of Dalit issues and 'obliteration' of caste differences through the construction of abstract and homogenous groups that invisibilise Dalits. Secondly, locating caste as a barrier to primary health care initiatives and health equity in the state, and finally through the maintenance of an 'apoliticised' social determinants discourse that fails to recognize the role of caste in shaping health disparities, specifically among Dalits in Kerala. CONCLUSION: Given Kerala's renewed commitment to strengthening its public health provisioning, the acknowledgment of caste-driven inequities is invariable in its path toward health equity and social justice.

A critique of the policy discourse on primary health care under the Aardram mission of Kerala.

In 2017, the State of Kerala in India, launched the 'Aardram' mission for health. One of the aims of the mission was to enhance the primary health care (PHC) provisioning in the state through the family health centre (FHC) initiative. This was envisaged through a comprehensive PHC approach that prioritized preventive, promotive, curative, rehabilitative and palliative services, and social determinants of health. Given this backdrop, the study aimed to examine the renewed policy commitment towards comprehensive PHC and the extent to which it remains true to the globally accepted ideals of PHC. This was undertaken using a critical discourse analysis (CDA) of the policy discourse on PHC. This included examining the policy documents related to FHC and Aardram as well as the narratives of policy-level actors on PHC and innovations for them. Through CDA we examined the discursive representation of PHC and innovations for improving it at the level of local governments in the state. Though the mission envisaged a shift from the influence of market-driven ideas of health, analysis of the current policy discourse on PHC suggested otherwise. The discourse continues to carry a curative care bias within its ideas of PHC. The disproportionate emphasis on strategies for early detection, treatment and infrastructural improvements meant limited space for preventive, protective and promotive dimensions, thus digressing from the gatekeeping role of PHC. The reduced emphasis on preventive and promotive dimensions and depoliticization of social determinants of health within the PHC discourse indicates that, in the long run, the mission puts at risk its stated goals of social justice and health equity envisioned in the FHC initiative.

COVID-19 and Multiple Inequalities The Case of a Coastal Community in Kerala.

Despite the overall achievements, Kerala's handling of its first case of community transmission in the coastal village of Poonthura came under severe criticism. In this article, the potential pathways to the resistance raised by the fisherfolk in Poonthura are explored, thereby placing their responses as historically and politically embedded ones.

Felt needs and expectations of adolescents regarding sexual and reproductive health from schools and health systems: A descriptive study.

BACKGROUND: Much focus has been given to find ways to overcome the barriers that exist among adolescents in the utilization of sexual and reproductive health (SRH) services. This study attempts to explore the felt needs of adolescents regarding SRH education at schools and their expectations regarding SRH care from a health system. METHODOLOGY: A cross-sectional study was conducted among 400 1st-year arts and science college students in Puducherry, India. Data collection and analysis were done from January 2015 to February 2015. Data were captured using a self-administered pretested questionnaire. RESULTS: Seventy percent participants felt that it is necessary to have educational contents on SRH at schools and 33.5% felt that the current SRH education is inadequate. About 28.9% felt uncomfortable to discuss their doubts on SRH with teachers. Almost 90% preferred schools as the source of SRH education in the community. Nearly 42% of adolescents thought that they would consult a doctor in the instance of a sexual illness. Thirty-nine percent preferred specialized SRH clinics. More than half expected privacy and confidentiality and the presence of a same sex doctor as the most important feature of an SRH-care facility. The least preferred SRH-care facility was government clinics (18%), and the major reasons for not preferring government facilities were lack of quality (43%) and overcrowding (43%). CONCLUSION: It is important to conceive schools as the foundation for providing SRH education among the adolescents supported by a friendly and responsive health system.