Nearly 66 per cent of households of people from the general category have access to improved and non-shared sanitation facilities, while the percentage for scheduled tribes households is 25.9, according to a new report.
The India Inequality Report 2021 by Oxfam also said over 50 per cent of scheduled castes (SC) and scheduled tribes (ST) households faced difficulties in accessing non-Covid medical facilities, compared to 18.2 per cent for the general category. “Data shows that 65.7 per cent of households belonging to the general category have access to improved, non-shared sanitation facilities, while only 25.9 per cent scheduled tribes households have improved, non-shared sanitation facilities,” the report said.
It also found that 12.6 per cent more children were stunted in SC households than those in households of people of the general category. 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, the report said. The report provides an analysis of health outcomes across different socioeconomic groups to gauge the level of health inequality that persists in the country.
It noted that the Covid pandemic has further exacerbated these inequalities. Hindu households are performing better than Muslim households, especially on indicators of access to healthcare, the report stated. Institutional births and access to food supplements under Integrated Child Development Services (ICDS) are 10 per cent less for Muslim households as compared to Hindu households; eight per cent less children are immunised in Muslim households, it said.
Those in low-income brackets facing discrimination in the community because of being Covid positive was five times than those in high-income brackets, the report found. “Higher-income groups who had to arrange for transport themselves was half of those in low-income groups. Low-income brackets facing discrimination in the community due to being Covid positive was five times than those in high-income brackets,” the report said. It said 33.9 per cent females experienced anxiety, irritation and anger, and sleep-deprivation during lockdown as compared to 18.2 per cent males. The report said the rate of female child immunisation continues to be below that of the male child, and immunisation of children in urban areas is more than in rural areas.
Immunisation among SC and ST is behind that of other caste groups, it said.
The report also noted that states attempting to reduce inequalities and with higher expenditure on health had lower confirmed cases of Covid. “States with higher expenditure on health had higher recovery rate from COVID-19,” it said.
Noting that 63 million people are pushed into poverty every year due to health costs, the report said 67.8 per cent of total expenditure on health in India was paid out of pocket, while the world average is just 18.2 per cent. The availability of free medicines in public healthcare facilities has declined from 31.2 per cent to 8.9 per cent for in-patient care and from 17.8 per cent to 5.9 per cent for out-patient care over the last two decades, the report said. Our healthcare infrastructure has many gaps and it adversely impacts the lives of people from marginalised background. Women, tribals, dalits, muslims, informal sector workers and the poor have been doubly affected due to the current COVID-19 pandemic,” CEO Oxfam India Amitabh Behar said. Policymakers and the government need to focus on more investment in the health sector to provide quality healthcare for the marginalized population, he said. The report recommended an increase in health spending to 2.5 per cent of the Gross Domestic Product (GDP) to ensure a more equitable health system in the country and that union budgetary allocation in health for SCs and STs is proportionate to their population. It suggested on prioritising primary health by ensuring that two-thirds of the health budget is allocated for strengthening primary healthcare and that state governments allocate their expenditure on health to 2.5 per cent of Gross State Domestic Product (GSDP); The Centre should extend financial support to the states with low per capita health expenditure to reduce inter-state inequality in health, the report suggested.
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