LESSONS LEARNED: Kerala

The Kerala model of development shows that it is possible to improve health status, even from a low-income country. Kerala is a heavily-populated coastal state in Southwestern India. Not only does it have slow rates of economic growth, it also has a state per capita income lower than most Indian states. Against the odds, the health indicators for this state are the best in the country and rival those in developed countries. Kerala's approach:

• Provided free primary and secondary education; placed emphasis on education for females

• Created widespread primary healthcare centers with access to free basic healthcare and free planning family services

• Programs promoted breastfeeding, maternal and child nutrition, and universal immunization

• Regarded women as assets to families rather than liabilities; they can inherit and own land, which promotes financial independence and power.

• Launched a total literacy campaign; 93% literacy rate

Impact:

• Highest literacy rate in India

• Low infant mortality rates (14 per 1000)

• Relatively smooth demographic transition (see "Weeks 1-2")

• Life expectancy at 73 years (U.S.'s is 78)

Lessons: Political support and funding of community mobilization on social issues reaps great rewards. Kerala, however, has not produced high economic growth despite progress in health and education. It is possible to reach high levels of health development through policy, investment, and community mobilization.

Literacy and health alone is not enough to produce economic growth.