Covid pandemic widens socio-economic inequalities: Oxfam

Constant underfunding of public healthcare system in last decade has weakened health infrastructure, shows latest report

Hyderabad: Growing socio-economic inequalities in India are disproportionately affecting health outcomes of marginalised groups due to the absence of Universal Health Coverage (UHC), and the Covid-19 pandemic has further exacerbated these inequalities, reveals Oxfam India’s Inequality Report 2021: India’s Unequal Health Story.

Data shows that 65.7 per cent of the households belonging to the general category have access to improved, non-shared sanitation facilities while only 25.9 per cent scheduled tribes (ST) households have improved, non-shared sanitation facilities. And the chances of a child dying before his fifth birthday is three times higher for the bottom 20 per cent of the population as compared to the top 20 per cent.

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India’s particularly disastrous Covid-19 second wave exposed the weakness of the public healthcare system. The National Health Profile (NHP) in 2017 data showed that there is only one government allopathic doctor for every 10,189 people and one state run hospital for every 90,343 people. The number of hospital beds per thousand population in India (0.5) is lower than some of the lesser developed countries such as Bangladesh (0.87), Kenya (1.4), and Chile (2.1).

Health infrastructure

The Oxfam India report shows that constant underfunding of the public healthcare system in the last decade has also worsened health infrastructure. The number of hospital beds per 10,000 population between 2010 and 2020 reduced from nine to five.

Currently, India ranks 155 out of 167 countries on bed availability and has five beds and 8.6 doctors per 10,000 of its population. Rural India houses 70 per cent of the population, while it has 40 percent of the beds in the country.

Amitabh Behar, CEO, Oxfam India said, “Persistent underfunding of the public health system, especially primary health care and inadequate health infrastructure in India remain to be addressed by the government even after devastating second wave. Otherwise, health emergencies will only aggravate existing inequalities and work as a detriment for the poor and the marginalised. Declaring health as a constitutional right can help to bridge these gaps.”

To address these fundamental inequalities in the health system, the report recommends implementation of UHC supported by a strong public health sector. Marginalised communities face a disproportionate burden of Out-of-Pocket expenditure (OOPE) on health. According to government estimates, six crore people are pushed into poverty every year due to healthcare expenditure.

Systemic issues

In Oxfam’s Commitment to Reducing Inequality Report 2020, India ranks 154th in health spending, fifth from the bottom. In the 2021-22 union budget, a year following a pandemic, the Ministry of Health and Family Welfare (MoHFW) was allocated a total of Rs 76,901 crore, a decline of 9.8 per cent from Rs 85,250 crore from the revised estimates of 2020-21.

Higher public health allocations have shown a positive effect on health outcomes in pandemic. State governments with higher expenditure on health had lower confirmed cases of Covid-19.

The report shows that the limited scope and coverage of the insurance schemes cannot address the all-encompassing requirements of UHC. Recently obtained data via Right to Information (RTI) showed that only 19 people got Covid-19 treatment under the Union Government’s Ayushman Bharat in Bihar, one of the worst affected states in the second wave.

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