Health in Kerala: exploring achievements and remaining challenges of health systems reform using an equity lens

The southern Indian state of Kerala is often regarded as a global model for its impressive health outcomes at a low cost. While the state consistently invests in healthcare and showcases remarkable health indicators, disparities persist, particularly among underserved populations who experience poorer health outcomes. This special issue focuses on research work that examines health equity in the region.

Following an open call for the collection featuring research studies focusing on health equity in Kerala in 2022, we received 29 submissions; four editors handled the submissions, and after peer review, nine articles were finally published as part of the special issue.

The final collection has nine articles which include studies describing health system efforts and user experiences about the control of tuberculosis, two evaluations of Universal Health Coverage (UHC) reforms in the state, a commentary on challenges faced by transgender persons in accessing gender-affirming medical care, two qualitative studies that span the UHC reform process and policies through the lens of a marginalized section of society, a case study on rabies death and a cross-sectional analysis characterizing the impact of COVID 19 pandemic in the mental health of school children.

The special issue contributes to the growing body of literature around health equity in Kerala and India and documents key challenges that plague the state health system like persisting access issues to seek necessary care, lack of acknowledgment of important social determinants in policies, absence of targeted interventions for underserved communities, and shortcomings in engaging with the private sector - that continue to plague the journey of moving towards Universal Health Coverage (UHC). The findings suggest that custom made policies are required to address the specific health needs of underserved population rather than a doing "more of same" approach.