Evidence map›Paper›PMID 40176134›Full record

ArticleInternational journal for equity in health2025

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

Hari Sankar D, Anish Thekkumakara Surendran, Rakhal Gaitonde, Devaki Nambiar

Abstract read
In one paragraph

Article in International journal for equity in health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Hari Sankar DThe George Institute for Global Health, New Delhi, India. vaidyarsankar@gmail.com.
Anish Thekkumakara SurendranGovernment Medical College, Kozhikode, India.
Rakhal GaitondeAchutha Menon Centre for Health Science Studies, Thiruvananthapuram, India.
Devaki NambiarThe George Institute for Global Health, New Delhi, India.

Funding

Wellcome Trust
6 · The paper itself

Abstract

backgroundThe 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.

methodsFollowing 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.

resultsThe 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.

conclusionThe 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.

Indexed as

Health Care ReformHealth EquityCOVID-19Healthcare DisparitiesHumansIndiaUniversal Health Insurance

Identifiers

PMID40176134
PMCPMC11966890

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.