A report by Oxfam India titled, “India Inequality Report 2021: India’s Unequal Healthcare Story,” reveals how socio-economic disparities continue to pervade India’s health sector. These disparities adversely affect the health outcomes of marginalized communities due to the lack of Universal Health Coverage (UHC). The report suggests that states making attempts to minimize existing inequalities and spending more on healthcare reported fewer confirmed Covid-19 cases.
Detailed Analysis of Health Outcomes
The report analyzes health outcomes across different socio-economic sections to measure the persisting health inequality in the country. Data for this report is sourced from rounds 3 and 4 of the National Family Health Survey and several rounds of the National Sample Survey.
The report indicates that performance on various health indicators is better for the general category than SCs and STs, Hindus than Muslims, the rich than the poor, men than women, and the urban population than the rural population. It also highlights that the Covid-19 pandemic has exacerbated these discrepancies further.
Performance of Indian States
States like Telangana, Himachal Pradesh, and Rajasthan that have been working towards reducing inequalities show fewer confirmed Covid-19 cases. States with higher health expenditure such as Assam, Bihar, and Goa are realizing higher recovery rates from Covid-19.
Kerala stands out as a state investing in infrastructure to establish a multi-layered health system. This effort aims to provide first-contact access for basic services at the community level and expand primary healthcare coverage.
The Rural-Urban Health Divide
During the second wave of the Covid-19 pandemic, rural areas faced shortages of tests, oxygen, and hospital beds, underlining the evident rural-urban divide in healthcare. For instance, the National Health Profile in 2017 reported one government allopathic doctor per 10,189 people and one state-run hospital per 90,343 people. The number of beds per 10,000 persons has diminished from 9 in the 2010 Human Development Report to a mere 5 beds currently.
Healthcare Resources Amongst BRICS Nations
India’s performance on healthcare resources is worrying when compared with other BRICS nations. The country has the lowest number of hospital beds per thousand population at 0.5, trailing behind countries like Bangladesh (0.87), Chile (2.11), and Mexico (0.98).
Social Inequalities and Healthcare
Inequality in women’s literacy rates across social groups persists. While women’s literacy has seen overall improvements over the years, SC and ST women lag behind the general category by 18.6% and 27.9%, respectively. A gap of 55.1% exists between the top and bottom 20% of the population in 2015-16.
Access to sanitation facilities also reflects stark inequalities. Only 65.7% of households in the general category have access to improved, non-shared sanitation facilities, while SC households lag by 28.5% and ST by 39.8%. The difference widens further when considering the top 20% and bottom 20% of households, with a disparity of 87.4%.
Immunisation rates also vary based on socio-religious groups. The immunisation rate in ST households at 55.8% is below the national average, with Muslims having the lowest rate across all socio-religious groups at 55.4%. Furthermore, the rate of immunisation of girls remains lower than that of boys.
Life Expectancy, Antenatal Care, and Infant Mortality Rate
Life expectancy based on wealth reveals a disparity of roughly 7.6 years between the bottom 20% and the top 20% of the households. The percentage of mothers who received full antenatal care declined from 37% in 2005-06 to 21% in 2015-16. The Infant Mortality Rate (IMR) has seen overall improvements, but it remains higher among Dalits, Adivasis, and OBCs compared to the general category.
Recommendations
The report recommends enacting health as a fundamental right and making it obligatory for the government to ensure equal access to timely, acceptable, and affordable healthcare. It also suggests increasing health spending to 2.5 percent of GDP and ensuring budgetary allocation in health for SCs and STs is proportionate to their population numbers.
Furthermore, it advocates widening insurance schemes to include out-patient care as most health expenditures happen through out-patient costs. The report suggests developing a centrally sponsored scheme for providing free essential drugs and diagnostics at all public health facilities and establishing contingency plans for scenarios like the second wave of the pandemic.
Finally, it stresses the need for inter-sectoral coordination to address issues like water and sanitation, literacy, etc., which directly impact health conditions.
