The Impact of General Strike on Government Healthcare Delivery in Kerala State in India

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. � 2016 aasems jacob et al.