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OBJECTIVES: The health system of Kerala, India has won many accolades in having health indicators comparable to developed countries. But oral health has not received its due importance at the policy level. With the burden of oral diseases on the rise in the state, a critical introspection of the existing system is warranted. The objective of this review was to assess the oral health care system in Kerala to provide policy solutions. METHODS: This study adopted a mixed methodological approach that gathered information from the primary and secondary sources, which included health facility surveys, key informant interviews, review of published literature, and websites of governmental and non-governmental bodies. The WHO framework of health system building blocks was adapted for the assessment. RESULTS: A review of epidemiological studies conducted in Kerala suggests that the prevalence of oral diseases is high with the prevalence of dental caries at the age of 12 years ranging from 37-69%. The state has a dentist population ratio of 1:2200 which is well within the prescribed ratio by WHO (1:7500). Only 2% of dentists in Kerala work with government sector catering to 0.6 million of the approximately 33.4 million population. This point to the absence of oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure. CONCLUSION: Despite having the best health indicators, the oral health system of Kerala is deficient in many aspects. Reorientation of oral health services is required to combat the burden of diseases.

INTRODUCTION: Health promoting school (HPS) is a holistic concept where health and learning coexist. The objective of this study was to assess the health promoting standards of schools in Kerala. METHODOLOGY: A cross-sectional study was designed in Kerala, India, with schools in Kerala as a study unit. A questionnaire which consisted of 37 items across eight domains of the HPS concept was developed and validated. The schools were then graded into compliant and not compliant categories based on scores obtained. Bivariate and multivariate analysis was also done. RESULTS: Of 120 schools, 90.8% were compliant toward health education domain and only 8.3% were compliant with nutrition services. Majority of schools showed compliance with the other six domains. Average overall scores were 153 (58.8%) with the equal number of schools in both compliant and not compliant categories. There was a significant association between health education and physical education domain with respect to the type of school, i.e., privately managed had six times more chances of being compliant toward health education domain compared to government schools (odds ratio [OR] 6.05; 95% confidence interval [CI] 1.10–33.29). Hence, also private schools had two times more chance of being compliant toward physical education compared to government schools (OR 2.52; 95% CI 1.0 – 4.32). Physical education domain showed a significant association with respect to geographic region, i.e., the schools in North Kerala were found to be three times more compliant compared to South Kerala (OR 3.48; 95% CI 1.05–11.53). CONCLUSIONS: Despite the good health and social indicators in Kerala, there is a deficiency in schools promoting health of children. A coordinated effort by the government and the education system can convert existing schools into health promoting.