Underfunding of the public health system and the particularly disastrous second wave of Covid-19 worsened health infrastructure and disproportionately affected the health outcomes of marginalized groups, according to an Oxfam India report.
The report titled “Inequality Report 2021: India’s Unequal Healthcare Story” showed that the general category performed better than Scheduled Castes (SC) and Scheduled Tribes (ST); Hindus are more successful than Muslims; the rich do 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. The Covid-19 pandemic has further exacerbated these inequalities.
The data showed that 65.7% of households belonging to the general category have access to improved and unshared sanitation facilities, while only 25.9% of ST households have improved unshared sanitation facilities.
About 12.6 percent more children are stunted in SC households than in households belonging to the general category. And the chances of a child dying before their fifth birthday are three times higher for the poorest 20 percent of the population than for the richest 20 percent.
The rich live on average seven and a half years longer than the poor. Likewise, on average, a woman in the general category lives 15 years longer than a Dalit woman.
Dalits, Adivasis, and OBCs have a higher infant mortality rate (IMR) than the general category. The IMR for Adivasis is 44.4, which is 40% higher than the general category and 10% higher than the national average, according to the report.
In addition, the constant underfunding of the public health system over the past decade has worsened the health infrastructure.
The number of hospital beds per 10,000 population between 2010 and 2020 increased from 9 to 5. Currently India ranks 155 out of 167 countries for bed availability and has 5 beds and 8.6 doctors per 10,000 inhabitants. Rural India is home to 70 percent of the population, while it owns 40 percent of the country’s beds, the report found.
This lack of health infrastructure in rural India led to the devastating effect of the second wave of Covid-19. As of May 2021, one in two cases was in rural areas, while states like Uttar Pradesh and Rajasthan had 75% of their cases in rural areas.
On the other hand, higher allocations for public health have shown a positive effect on health outcomes in the event of a pandemic.
State governments with higher healthcare spending had fewer confirmed cases of Covid-19. States like Odisha and Goa, with higher healthcare spending, also had a higher recovery rate from Covid-19, the report showed.
“The persistent underfunding of public health systems, especially primary health care and inadequate health infrastructure in India, still need to be addressed by the government, even after a devastating second wave. Otherwise, health emergencies will only worsen existing inequalities and come at the expense of the poor and marginalized. Declaring health as a constitutional right can help fill these gaps, ”Amitabh Behar, CEO of Oxfam India, said in a statement.
The report recommends the implementation of universal health coverage (UHC) supported by a strong public health sector, to address these fundamental inequalities in the health system.