Analysis | Health system's failings were in public domain long before Dr Haris's outburst

Thiruvananthapuram Government Medical College urology department head Dr Haris Chirakkal's outburst on social media about the difficulty of securing essential supplies had annoyed Chief Minister Pinarayi Vijayan. Without taking the doctor's name, the Chief Minister had said that a person's open expression of dissatisfaction would be exploited to show the government in a poor light.

"If someone's disappointment is vented in a way as to empower forces waiting for a chance to undermine Kerala, it will have the effect of distorting all the good work done by the government," the CM said on July 2. This seemed to hint that Dr Haris was the first contrary voice when it came to Kerala's health sector. 

Irony is, on January 2025, the Comptroller and Auditor General's 'Performance Audit on Public Health Infrastructure and Management of Health Services' was tabled in the Assembly. The Audit detailed a multitude of issues: shortage of doctors, especially specialists; poorly manned and equipped family health centres; doctors in the Out-Patient departments of hospitals too inadequate for patients seeking medical care; shortage of essential drugs; inadequate regulatory mechanism and woefully poor infrastructure. Not once was the Chief Minister heard complaining that the THE CAT audit was a conspiracy hatched by the centre to discredit Kerala.

The Audit found huge delays in purchase orders and supply of drugs. Analysis of data for the period from 2016-17 to 2021-22 revealed that 2,975 out of 3,635 ordered drugs (81.84 per cent) were not supplied within the stipulated delivery period. The delay ranged up to 988 days.

Oversight was so tardy that the analysis revealed that drugs and supplies issued to wards had already exceeded the date of expiry in 60 instances in 26 government hospitals (taluk, district and medical college hospitals).

The availability of medical equipment too did not match Indian Public Health Standards. Major shortfall in equipment was noticed in district hospitals in Nedumangad, Neyyattinkara (both Thiruvananthapuram) and Kalpetta (Wayanad). Even a basic instrument like endoscopy equipment was not available in seven taluk hospitals.

Audit examined the purchase records of the major equipment in the test-checked hospitals and "found instances of delay ranging from three to nine years in procurement, defective maintenance leading to underutilisation, idling of equipment due to lack of trained staff, pending repairs." The findings were proof of the veracity of Dr Haris's remarks.

The performance audit had found many instances but here are just three examples of inefficient handling of medical instruments in Thiruvananthapuram Medical College where Dr Haris works: a high-end Bronchoscope used to diagnose respiratory disease was damaged in 2016 and has ever since remained idle; the oxygen sensor of a CPET (Cardio Pulmonary Exercise Test) went kaput in 2018 and has been idle ever since; a sleep machine that is used to treat sleep apnea and sleep-related breathing disorders had been idling for over three years simply because the cost of repair is huge (Rs 70,000).

If these failings were not as widely discussed as when Dr Haris played whistle-blower it was because they were upstaged by a sensational finding in the performance audit. 

The audit had authenticated the charge that there was corruption in the purchase of PPE kits during COVID-19 in 2020. It identified two issues. One, advance payment was made to a firm violating norms. Two, kits were purchased at rates that were 300% higher than the usual rates, even when the product was available at considerably lower rates.