India’s Unequal Healthcare Story.....editorial

The emergence and rapid spread of the deadly virus COVID-19 last year brought the world to its knees and exposed the inadequacies of public healthcare systems in coping with such health emergencies. India was no exception to this. In the initial months, when the virus grew and raged through the country, there was shortage of PPE kits, masks, sanitizers, hospital beds, ICUs and other critical care facilities.

In the latter half of March 2020, India imposed one of the strictest lockdowns across the country bringing the economy to a standstill and crippling it. Approximately 93 percent of India’s economy is in the informal sector with no job security, no security of wages and no social protection systems. Millions of informal sector workers—the blue collar workers—lost their jobs. 

 In the absence of transportation, food, income and housing, many migrants started the arduous journey of walking hundreds of miles back to their villages, thus precipitating a massive humanitarian crisis. Images of migrants walking back in the heat with no food or water was heart-wrenching. Many perished under the harsh conditions. 

Migrants who did manage to reach their home states were put in inhuman quarantine centres with not even the basic facilities available. Indeed their basic human rights and dignity were wantonly trampled over and violated. Ironically, the government has no data on how many migrants died because of COVID-19 and the pandemic-induced difficulties from the lockdown.

 Oxfam India has been working on issues of provisioning and strengthening public healthcare in the country for several years. Public healthcare is a great leveller and directly helps in reducing health inequalities. The pandemic was thus the springboard for developing the next India Inequality Report 2021 on Inequalities in Health in India. 

 Our analysis finds that existing socio-economic inequalities precipitate inequalities in the health system in India. Thus the general category performs better than the Scheduled Castes (SCs) and Scheduled Tribes (STs), Hindus perform better than Muslims, the rich perform better than the poor, men are better off than women, and the urban population is better off than the rural population on various health indicators. 

Over the last few decades, India has made great progress in healthcare provisioning. Yet, progressively, the trend has been towards supporting the growth of the private sector in healthcare. This growth has only exacerbated the existing inequalities leaving the poor and the marginalised with no viable healthcare provisions. High costs of health services and lack of quality leads to further impoverishment of the disadvantaged.

 The public sector has prioritized secondary and tertiary care over primary care. Yet, experts acknowledge that primary care is the cornerstone of achieving equitable delivery and access to quality healthcare by all. While focus has been put on achieving Universal Healthcare in India; successive governments have selectively focused on the insurance model. Even with the best of intentions, the insurance model is limiting and financially poor people demonstrate low health seeking behaviour because of the high cost of health services in the country. 

 While the pandemic has been the catalyst for this year’s India Inequality Report 2021, the report is not restricted to the inequalities precipitated by COVID-19. It goes far beyond to address structural inequalities and inadequacies of the government interventions to address the existing inequalities in the health system in India. 

We believe, that unless the fundamentals of the healthcare system in India are addressed and inequalities reduced, such health emergencies will only aggravate existing inequalities and work as a detriment for the poor and the marginalised.

 

I hope you will read and engage with this report and support our fight to ensure equitable healthcare for all so that the poor and the marginalised, women and children do not suffer from lack of immunization, nutrition and other health services. We are committed to advocating for a healthy India with equal access to good quality health services for all.