Inter-State Variations In Health Outcomes And Health System Capacity: A Study Of Kerala And Rajasthan
Keywords:
Inter-state health disparities; Health system capacity; Kerala; Rajasthan; NFHS-5; Sample Registration System; Public health expenditure; Maternal and child health; Health workforce; IndiaAbstract
The federal health system in India shows significant inter state differences in health outcomes and capacity of the system which are influenced by differences in socio-economic status, governance and investment by the people. This paper is a comparative analysis of Kerala and Rajasthan in the examination of how the variations in healthcare financing, infrastructure, and human resources, translate into the different population health outcomes. The analysis of primary healthcare centres, healthcare workforce availability, life expectancy at birth, infant and maternal mortality, maternal and child health service coverage, nutritional status, and anaemia prevalence are considered as the key indicators examined using secondary data (National Family Health Survey, NFHS-5), Sample Registration System (SRS) available data, state budget reports (2024-25), and official health department reports.
The results show that Kerala has been performing significantly better than Rajasthan on most of its health outcome indicators such as life expectancy (75.1 vs. 69.4 years), infant mortality (5 vs. 30 per 1,000 live births), and maternal mortality (30 vs. 87 per 100,000 live births) as compared to Rajasthan, even though it spends a smaller share of its Gross State Domestic Product on health. The high performance of Kerala is closely related to the good primary health care facilities, the good doctor to patient and nurse to population ratios, the institutional deliveries are almost universal and also the female literacy is high. Though with higher proportional health spending and significant improvements over the years, Rajasthan still has significant workforce shortages, access to primary care and child malnutrition and a high rate of anaemia.
The paper finds that the effect of the amount of the health expenditure alone on health outcomes is not as high as the organisation of the health system, the distribution of human resources, and social factors (education and gender equity) do have a significant impact. This comparative evidence highlights the need to enhance the primary healthcare, invest in human resource, and tackle structural inequalities to decrease the inter-state health disparities and promote progress towards the Sustainable Development Goal 3 in India.
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