Disease burden in India is growing. Across the country, the infectious diseases, widespread illness and deaths are rapidly escalating, especially communicable and non-communicable diseases. Maternal deaths and child deaths have also been found to be high. Nutrition deficiency in marginalised communities is high due to poor food intake which is linked to poor income.
Despite the government’s claim that there has been progress in improving access to health care, inequalities especially in communities who have low socioeconomic status remain unaddressed. These groups continue to be denied health care services.
The prime cause is the healthcare system’s indifference towards marginalised and the most disadvantaged groups across the country, who are off the radar and therefore denied access to health care and treatment.
Since a majority of these afflicted groups reside particularly in far flung rural areas, there is no health coverage or access to care and quality care.
While disparities are often linked with race and ethnicity there are many other dimensions as well such including disability and gender status and population groups.
In these unreached areas non-communicable and chronic diseases are the leading causes of death among these communities. In some rural settings, it has been found that Tuberculosis and intestinal conditions were the leading cause of deaths.
However, since the extent of disease is not captured, there is no health statistics in rural areas. The outreach is therefore negligible. The population in rural areas therefore face large scale disparities in health care coverage, access to care, and quality of care.
To address these existing gaps, the governance would require the development and use of indicators to measure the determinants and the disease outcomes and systems to measure such indicators. There is also a need to improve and increase the outreach to the most unaddressed areas where along with strengthening the primary health centres and tertiary care centres, there is also the need to provide adequate medication and medical equipments so that the community is able to access health care and treatment on time and lives can be saved.
Since the health system’s outreach in these areas is almost nonexistent, families are unable to access healthcare treatment putting them at high risk. Besides, they are unable to approach the private sector since they cannot afford to afford to pay for their treatment.
Lack of access to healthcare services and medical care, diagnosis and treatment is just not accessible to hundreds of millions of Indians.
This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India
Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing driving several millions of people into poverty each year.
The key reason why there is poor health care as well as equity among the marginalized groups is low financial protection. There is an imbalance in resource allocation, due to which there is limited access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care.
There is an urgent need to bring about a healthcare transformation in India.
It is therefore critical that the government ensures equity in health care across the country. The prime need for the healthcare system is to implement strategies such as monitoring, evaluation and strategic planning as well as, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process to strengthen decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population.
In order to bring about healthcare transformation, the government, both at the Centre and the States needs to increase investments in health care to ensure that across all regions, especially rural areas, the public has access to healthcare human resources, such as health workers, who can are and treatment, especially primary health care centres and sub-centres.
Overall the focus and role of the health system needs to be placed within the broader and bigger context of the social determinants of health, and tackling the root causes of social disadvantage in healthcare. In this way, a health system will build a strong foundation of public health and primary care. Improved water and sanitation, food security, poverty reduction and changes to other structural factors, complemented by a more equitable health system, will help ensure more equitable health for more than a billion people.
(Mohuya Chaudhuri is a senior journalist and researcher)