Where Care Meets Justice: Kerala Leads with Queer-Inclusive Public Healthcare Reform

In a transformative step for inclusive healthcare in India, Kerala is setting a new benchmark. Through a unique partnership between the State Health Systems Resource Centre – Kerala (SHSRC-K) and Mariwala Health Initiative (MHI), the state is embedding queer-affirmative practices into its public health infrastructure, aiming to make government hospitals safe and dignified spaces for queer and trans persons.

A Vision of Dignity and Access for All

For years, trans and queer individuals in India have faced widespread discrimination in healthcare—from insensitive remarks to outright denial of services. This initiative, led by Dr. V Jithesh (Executive Director, SHSRC-K) and Pooja Nair (Director, MHI), seeks to shift the narrative. The mission is bold: to reimagine hospitals not just as clinical spaces but as inclusive ecosystems that reflect care, respect, and justice.

“Trans persons have a right to affordable, affirming healthcare. Public systems must take proactive steps to ensure care is accessible and respectful,” emphasizes Nair.

 

Four-Pronged Strategy to Tackle Systemic Discrimination

At the heart of this initiative is the recognition that bias exists across all levels of healthcare delivery—from entry-level staff to senior medical professionals. The program addresses this with a robust four-part framework:

1. Sensitisation Workshops for all hospital personnel, including security guards, receptionists, nurses, and doctors.

2. Queer Affirmative Counselling Training for mental health professionals operating in government hospitals.

3. Peer Counselling Programs for transgender individuals trained as Community Link Workers (CLWs) who serve as bridges between communities and healthcare providers.

4. Train-the-Trainer Modules to ensure long-term sustainability by building internal champions of queer-inclusive healthcare within the system.

Kerala’s Unique Advantage

Kerala’s progressiveness in healthcare and social equity gives this initiative fertile ground. The state already boasts a strong public health network and in 2015 became the first Indian state to adopt a comprehensive transgender policy, recognizing gender self-identification and offering provisions like healthcare, insurance, shelters, and HIV prevention programs.

Unlike many other Indian states where outreach organizations struggle for entry, in Kerala, the healthcare system has shown a willingness to engage and evolve. As Pooja Nair observes:

“Elsewhere, we knock on doors to even begin conversations. In Kerala, we are working with stakeholders who admit gaps and want to improve. That changes everything.”

Building on Existing Mental Health Infrastructure

Through Kerala’s Bhoomika program, which places trained counsellors in public hospitals, MHI is enhancing queer-affirmative mental health services. These professionals not only offer direct support but also guide patients through often-confusing bureaucratic processes.

“Most states don’t even have counsellors in hospitals. Kerala does. This allows us to build, not start from zero,” Nair notes.

Persistent Gaps—and Community-Led Calls for Reform

Despite this momentum, ground realities remain difficult. Devutty Shaji, a veteran trans rights activist and trained CLW, points out that implementation of the 2015 transgender policy is still patchy across departments. She continues to advocate for:

• Pensions for trans persons over 45, who face heightened health vulnerabilities from years of systemic neglect.

• Strict action against doctors who harass or mistreat trans patients.

Shaji also voices concern over the lack of Sex Reassignment Surgery (SRS) in government hospitals, a glaring gap that disproportionately affects economically marginalized trans persons.

“We’ve been told that doctors will be trained abroad for SRS, but nothing has happened. An entire community is denied their right to transition because of this delay,” she says.

Tragedy and the Push for Safer Surgeries

Kerala has witnessed heartbreaking cases like that of Anannyah Kumari Alex, the state’s first transgender radio jockey, who died by suicide in 2021 following post-surgery complications and alleged negligence. The case underscored the urgent need for skilled, trans-affirmative surgical care in public institutions.

Shakhiya S, a transman and advisor to MHI on this project, adds:

“We need doctors who not only have technical skill but also empathy and respect for our community. That’s what we’re trying to build.”

The Role of Community Link Workers

The CLW model is inspired by Kerala’s Migrant Link Worker program, which supported non-Malayali workers during the COVID-19 crisis. Now, trans CLWs act as patient navigators, peer counsellors, and advocates, ensuring trans individuals receive dignified care without facing systemic hostility.

This community-led approach is pivotal. As Nair explains:

“Even the best private hospitals fall short on inclusion, and they're often unaffordable. Public health systems are where rights are actualized.”

Trust, Confidence, and Cultural Shift

Shakhiya believes this initiative is helping trans persons in Kerala reclaim their voice:

“Earlier, we didn’t even feel confident asking for our rights. Now, with MHI backing us and the government listening, we finally feel we are in safe hands.”

Looking Ahead: A Scalable Model for the Nation?

Kerala’s queer-inclusive healthcare model, while still evolving, offers a powerful blueprint for other states. With sustained government support, community involvement, and institutional training, public hospitals can become truly inclusive spaces—not just for queer and trans individuals, but for everyone pushed to the margins.

This project reminds us that healthcare is not merely about treatment—it’s about dignity, access, and the right to exist fully and freely. Kerala’s journey offers hope that care and justice can coexist—and that systems can, with intent and effort, be transformed.