title: The Impact of General Strike on Government Healthcare Delivery in Kerala State in India.
abstract: General strike (also known as hartal) is used as a mode of protest by organizations and political parties in India. It is generally thought that hartals negatively impact the healthcare delivery in a society. We used the Right to Information Act to obtain data from government health centers in Kerala state in India for four hartal days (H-day) and two control days (A-day and B-day) for each H-day, from sixteen health centers including 6 Community Health Center (CHC), 6 Secondary Health Center (SHC), and 4 Tertiary Health Center (THC). Data on emergency room visits was available for six HCs. 15 HCs had a statistically significant decrease in the number of outpatient visits on H-day. There was no difference in the number of outpatient visits between the two control days (A and B) in 15 HCs, suggesting the lack of a posthartal surge in visits. Median decrease in outpatient visits in CHCs, SHCs, and THCs was 50.4%, 59.5%, and 47.4%, respectively. Hartal did not impact the number of emergency room visits in 6 out of 7 health centers assessed. Our study identified a significant harmful impact on government healthcare delivery due to hartals in Kerala. These findings have major public health implications.
authors.affiliation: Department of Internal Medicine, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, USA.
authors.forename: Aasems
authors.initials: A
authors.lastname: Jacob
authors.affiliation: University of Kentucky, 800 Rose Street, CC448, Lexington, KY 40536, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Weiss
authors.affiliation: University of Kentucky, 800 Rose Street, CC447, Lexington, KY 40536, USA.
authors.forename: Aju
authors.initials: A
authors.lastname: Mathew
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data; D006078:Government Programs / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D013219:State Government; D013317:Strikes, Employee / Q000706:statistics & numerical data