proper waste disposal and potable drinking water remain major concerns said dr sreejith n kumar former president of the kerala chapter of the indian medical association imabecause of higher health expenses linked to private hospitals and improved facilities at public hospitals there is a shift of patients from private to public hospitals now almost 40 of treatment in kerala happens in government hospitalsincidentally even as the government focuses on improving primary health centres handling the epidemiological transition towards chronic diseases erosion of public health funding and the continued presence of private health care at much higher cost that has pushed the health system to its limits medical practitioners are faced with a new challenge following the rise in attacks on doctors and medical staff the medical fraternity in kerala has been demanding stringent laws to address the issue of growing distrust doctors bodies have been emphasising on improving communication skills as well as coordinating with authorities to initiate action against those who attack staff both in the government and private sectorsbut what works in keralas favour is its continued efforts to innovate to meet the needs of the more vulnerable sections of the population from its painandpalliative programme to its patientfriendly hospital mission aardram to provide quality services at all levels to its mentalhealth programme the state has been a trendsetter and now with startups gaining momentum health minister k k shailaja is looking to companies operating under the kerala startup mission to provide lowcost and cuttingedge solutions in this sector the government will ensure effective and strict implementation of several health programmes the focus now is on lifestyle and infectious diseases said dr m narayanan president of the kerala chapter of the indian academy of pediatrics iap