India’s low spending on public health systems and an emphasis on supporting private health care has resulted in serious inequalities in access to health care, especially during the Covid 19 pandemic, according to a new study.

Oxfam’s report – “Inequality Report 2021: India’s Unequal Healthcare Story” – released on Tuesday indicates that states attempting to reduce existing inequalities and with higher health spending had fewer confirmed cases of Covid-19.

“There are two sides to what we found. First, states that have been reducing inequalities in recent years, such as inequalities in access to health between the general category and the SC and ST populations, have fewer confirmed cases of Covid – such as Telangana, Himachal Pradesh and Rajasthan. On the other hand, states that have had higher GDP spending on health, like Assam, Bihar and Goa, have higher recovery rates from Covid cases, ” said Apoorva Mahendra, researcher. to Oxfam India and one of the authors of the report.

The report marks Kerala as a success in dealing with the pandemic.

“Kerala has invested in infrastructure to create a tiered health system, designed to provide first contact access to basic services at the community level and expand primary health care coverage to access a range of preventive services and curative… increased the number of medical services. facilities, hospital beds and doctors… ”he noted.

The report indicated that people in the highest income brackets and with access to health infrastructure faced fewer visits to hospitals and Covid centers than those in lower income groups. People in lower income groups also faced five times more discrimination when found to be Covid positive than those in higher income groups, he reported.

More than 50% of people in the SC and ST communities encountered difficulties accessing non-Covid medical facilities, compared to 18.2% of people in the “general” category.

The report emphasizes that the vaccination campaign against Covid-19 ignores the country’s digital divide – at the start of the pandemic, only 15% of rural households had an Internet connection; smartphone users in rural India were almost half of those in urban areas. More than 60% of women in 12 states had never used the internet, he reported.

“Our analysis reveals that existing socio-economic inequalities precipitate inequalities in the health system in India,” said Amitabh Behar, CEO of Oxfam India. “So (people in) the general category perform 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.

Behar said that while India has made strides in providing health care, it has further supported private – not public – health care leaving the underprivileged at a great disadvantage.

Average medical expenditure per hospital case tripled between 2004 and 2017, making it difficult for the poorest and rural households, he said. The report noted that one in every Rs 6 rupee spent on hospitalization came from a loan; while urban households depended on savings, rural households depended on loans. This need to borrow further discourages the marginalized from accessing health care, he said. Less than a third of the country’s households were covered by a government insurance plan in 2015-16, he said.

The report said: “India’s low spending on public health has left the poor and marginalized with two difficult options: sub-optimal and weak public health care or expensive private health care. In fact, direct health expenditure of 64.2 percent in India is higher than the global average of 18.2 percent. The exorbitant prices of health care have forced many people to sell household assets and go into debt. Although the sale of assets has declined to some extent, more than 63 million people are pushed into poverty each year because of health costs alone, according to government estimates.

Other socio-economic factors also promote access to health, which has affected the outcome of the pandemic, he reported. For example, the literacy rate of women in the general category is 18.6% higher than that of women SC and 27.9% higher than that of women ST, which means that women in the general category have not only a better understanding of the health infrastructure available, but also have better access.

The literacy rate for women is highest among Sikhs and Christians at over 80 percent, followed by Hindus at 68.3 percent and Muslims at 64.3 percent, according to the report.

Despite improvements in childhood immunization, the immunization rate for girls remains lower than that for boys; immunization of children in urban areas is higher than that of children in rural areas; and immunization of SCs and STs lags that of other caste groups, according to the study. The vaccination rate of children in the high wealth quintile group is much higher than that of the low wealth quintile. More than 50 percent of children still do not receive dietary supplements in the country, he reported.

The percentage of mothers who received comprehensive antenatal care increased from 37% in 2005-06 to 21% in 2015-16, he found. Comprehensive antenatal care for urban areas is almost twice that of rural areas, and immunization among Muslims is the lowest – lower than that of SC / ST populations.

“These existing inequalities are further exacerbated during a health crisis like the pandemic,” Mahendra said. “Investment in public health infrastructure is so low that the number of beds in the country has actually declined – from 9 beds per 10,000 people in the 2010 Human Development Report to just 5 beds per 10,000 people today. ‘hui. “

The National Health Profile in 2017 recorded one government allopathic doctor for 10,189 people and one public hospital for 90,343 people. India also ranks lowest in the number of hospital beds per thousand population among the BRICS countries at 0.5 – this is lower than less developed countries such as Bangladesh (0.87), the Chile (2.11) and Mexico (0.98).

Rural India is home to 70 percent of the population, while it has 40 percent of hospital beds, according to the report.

The poor provision of public health care can be attributed to consistently low budget allocations, Mahendra noted.

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