Are Primary Health Centres Equally Distributed in Kerala? An Equity Analysis across Districts

Abstract

Equitable distribution of primary healthcare has been at the core of the achievements in Kerala’s public health. The paper analyses the distribution of Public Health centers (PHC) in the state using the 2024 25 district-level data. A multipronged statistical measure was implemented in the paper, such as descriptive statistics provided the PHC density baseline, correlation analysis evaluated the associations between PHC density and socio-demographic factors, Lorenz curves and Gini coefficients reflected inequality, and an index of vulnerability was made up so as to define structurally disadvantaged districts with regard to the distribution the PHCs in Kerala. The study shows that the average PHC density is 1.7 per 100,000 population, with Wayanadu the highest (2.85) and Kollam the lowest (1.20) districts. The PHC density shows a strong positive correlation with the Scheduled Tribe share and a moderate positive correlation with poverty and rurality. However, its relationship with literacy and the Scheduled Caste share shows weak correlation. Close to the equality line is the Lorenz curve, yielding a Gini coefficient of 0.15, indicating very low inequality in the distribution of PHCs in Kerala. However, the vulnerability index identifies Palakkad, Kollam, Idukki, and Wayanad as priority districts because of geographical disadvantages related to overlapping socio-demographic disadvantages. These results show that Kerala has achieved a fairly balanced PHC distribution and identified the districts where access is constrained due to demographic burdens. It is also necessary to reinforce initiatives targeting areas in need to boost equity in healthcare and ensure that Kerala continues to be seen as a beacon of primary healthcare in India.