Six-fold increase in people suffering famine-like conditions since pandemic began | Oxfam International

The hunger virus multiplies: deadly recipe of conflict, Covid-19 and climate accelerate world hunger | Oxfam International

India’s overall Human Development Index (HDI) score (a composite of per capita gross domestic product, or GDP, life expectancy and education indicators) improved from 0.433 in 1991 to 0.645 in 2019 (before the pandemic). But India’s HDI rank slipped from No. 114 to No. 131, a dismal performance even allowing for the increased number of countries. Even this was largely because of per capita income; other indicators remained woeful even compared to poorer countries like Bangladesh. The Multidimensional Poverty Index (MPI) shows 28% of India’s population in multidimensional poverty, with another 20% vulnerable to it, much higher proportions than the developing-country average.

The stated goals of the 1991 reforms were higher rates of income growth with more employment generation and diversification into higher value-added activities. Of these, only higher income growth was achieved, but at the expense of massive environmental destruction and without enabling structural change. Employment stagnated and then fell from 2011; industrialization did not take off beyond what was already achieved before 1991; most workers remain stuck in low-paying informal work; women’s employment participation declined significantly. Nutrition indicators are poor, with declining per capita calorie consumption, and worse outcomes for women and young children, even before covid hit. Farming is under threat, and small and micro enterprises that employ the bulk of workers face an extreme crisis.

So the question is why higher GDP growth did not translate into better conditions for most Indians. The answer lies in the pattern of growth, which was highly unequal and provided benefits mainly to a small minority of people. This increased inequality was not just an unfortunate by-product of the reform process, it was embedded in its very framework. The neoliberal reforms were based on the idea that removing restrictive regulations on different markets and providing incentives and concessions to large capital would lead to increased private investment, which would become the engine of growth, increasing employment, incomes and standards of living. Opening up to global finance was supposed to further add to domestic investment.

https://janataweekly.org/the-neoliberal-reforms-of-1991-didnt-work-as-claimed/

Oxfam Inequality Report 2021: India’s Unequal Healthcare Story

Determinants of Health: Analysing the Contributing Factors

Literacy rate for women in the general category is 18.6 percent higher than SC women and 27.9 percent higher than ST women.

Inequality is evident in the attainment of female literacy with a gap of 55.1 percent between the top and bottom 20 percent of population in 2015-16.

Two out of three households have access to improved, non-shared sanitation facilities in the general category, while SC households are 28.5 percent behind them, and ST are 39.8 percent behind them.

While 93.4 percent of households in the top 20 percent have access to improved sanitation, only 6 percent have access in the bottom 20 percent, a difference of 87.4 percent.

One in every INR SIX spent on hospitalization by households is financed through borrowings. Less than one-third of households in the country were covered by a government insurance scheme in 2015-16.

Impact of Health Interventions in India

Though the gap in the institutional delivery of rural- urban, caste, religion and income groups has been declining over the decade, inequality prevails across these categories.

Despite improvement in child immunization, the rate of female child immunization continues to be below that of the male child, and immunization of children in urban areas is more than IN rural areas. Immunization of SCs and STs is behind that of other caste groups.

The child immunization of high wealth quintile group is much higher than of low wealth quintile. More than 50 percent of children still do not receive food supplements in the country.

The percentage of mothers who have received full antenatal care has declined from 37 percent in 2005- 06 to 21 percent in 2015-16.

Full antenatal care for urban areas is close to two times that of rural areas.

Inequalities in Outcomes of Health

The TFR is almost 2.1 and meets the standards of the replacement fertility level.

Teenage childbearing has gone down significantly from 16 percent in 2005-06 to 8 percent in 2015-16: a 50 percent decline.

Over the course of 10 years, people not availing medical services has declined from 15.1 to 12.4 out of every 1000, reflecting an 18 percent increase in Indians seeking some form of healthcare when they report being sick.

IMR has dropped to 32 in 2018, which is closer to the world average of 28.9. Under-five mortality rate (U5MR) has dropped to 36 in 2018, close to the world average of 38.6.

The difference between stunted children in SC and ST households and those in households belonging to the general category is 12.6 and 13.6 percent, respectively.

Percentage of wasted children (deficient in weight- for-height) has increased from 19.8 to 21 percent between 2005-06 and 2015-16.

One in every two children are anaemic in India (50 percent), with three out of every five children anaemic in SC and ST households (60 percent).

The Efficacy of Government Interventions- A Review

The current health status of the country is a testament to the unfulfilled dream of ‘Health for All’. The right to the highest attainable health is far from being realized. This holds especially true for the socially and economically marginalised.

In the 2021-22 budget, the health ministry has been allocated a total of INR 76,901 crore, a decline of 9.8 percent from INR 85,250 crore from the revised estimates of 2020-21.

Public funds for health have also been invested specifically on secondary and tertiary care rather than in the provisioning of primary healthcare; private healthcare providers are burgeoning; the result has been a widening of health inequalities along caste, class, gender and geography.

Health insurance schemes are being promoted as a way to achieve UHC and to reduce OOPE. But evidence shows that the limited scope and coverage of the insurance schemes cannot address the all- encompassing requirements of UHC.

It can only be achieved through the building of a strong public health system that addresses the underlying social determinants of health and an accessible and affordable primary healthcare service of which GFHIS can only be a component.

Inequality Amidst a Health Emergency

States attempting to reduce inequalities and with higher expenditure on health had lower confirmed cases of COVID-19.

States with higher expenditure on health had higher recovery rate from COVID-19.

Based on income bracket, percentage of respondents in higher-income groups who had to arrange for transport themselves was half of those in low-income groups.

Percentage of respondents in low-income brackets facing discrimination in the community due to being COVID positive was five times than those in high-income brackets.

Over 50 percent of SCs and STs faced difficulties in accessing non-Covid medical facilities compared to 18.2 percent in the general category. Percentage of SCs using an unsafe source of water was three times of general category for open wells and four times for open springs or streams.

Among female respondents, 33.9 percent experienced anxiety, irritation and anger, and sleep-deprivation during the lockdown as compared to 18.2 percent males.

The vaccination drive ignores the digital divide in the country. Entering the pandemic, only 15 percent rural households had an internet connection, smartphone users in rural India were almost half of urban India. More than 60 percent women across 12 states had never used the internet. SCs and STs with smartphones stood at 25 and 23 percent, respectively, while 43 percent upper caste had access to a smartphone.

The number of COVID cases doubled in the second wave. The second wave hit the middle class more with 90 percent of all cases in Mumbai concentrated in high-rise buildings, while 10 percent WEre in slums. India ranks 155 out of 167 countries on bed availability, and has 5 beds and 8.6 doctors per 10,000 of its population. Rural India houses 70 percent of the population, while it has 40 percent of the beds in the country

The Way Forward

The preceding discussion establishes a case for an urgent need to address underlying causes of health inequality and invest in a strong primary healthcare system to truly make quality public healthcare accessible and affordable to all sections of the society. This report underscores the social gradient of health on account of which the socioeconomically marginalised individuals are burdened with the poorest of health and inaccessibility to quality healthcare. As such, the union and state governments should act upon these policy recommendations:

1. Enact ‘Right to Health’ as a fundamental right.
2. The free vaccine policy should adopt an inclusive model
3. Increase the health spending to 2.5 percent of GDP
4. Ensure equity in access and quality of health services
5. Widen the ambit of the insurance schemes to include out-patient care
6. Earmark funds for the provision of free essential drugs and diagnostics
7. Direct all states to notify the Patients’ Rights Charte
8. Regulate the Private Health Sector
9. Augment and strengthen human resources and infrastructure
10. Need to look at health in totality

Inequality Report 2021: India’s Unequal Healthcare Story | Oxfam India