Context: A report titled India Inequality Report 2021: India’s Unequal Healthcare Story by Oxfam India states that sharp inequalities exist across different caste, religious, class and gender categories on various health indicators.

• The findings are primarily based on secondary analysis from rounds 3 and 4 of the National Family Health Survey and various rounds of National Sample Survey.

Key highlights of the report
On most health determinants, interventions and indicators

• the general category is better off than the SCs and STs, 
• Hindus are better off than Muslims, 
• the rich are better off than the poor, 
• men are better off than women, and 
• the urban population is better off than the rural population.

Female Literacy: Women’s literacy has improved across social groups over the years, SC and ST women lag behind the general category by 18.6% and 27.9%, respectively. 

• There exists a gap of 55.1% between the top and bottom 20% of the population in 2015-16.
• Though the female literacy rate among Muslims (64.3%) is lower than all religious groups, inequality has reduced over time.

Sanitation

• 65.7% households have access to improved, non-shared sanitation facilities in the general category while SC households are 28.5% behind them and ST are 39.8% behind them.
• While 93.4% of households in the top 20% have access to improved sanitation, only 6% have access in the bottom 20% — a difference of 87.4%.

Health interventions

• Institutional deliveries has increased from 38.7% in 2005-06 to 78.9% in 2015-16, but inequalities persist with ST households 15% below the general category, Muslims 12% behind Hindus and a 35% gap between the poorest and richest 20% of the population.
• Immunisation in ST households at 55.8% is still 6.2% below the national average, and Muslims have the lowest rate across all socio-religious groups at 55.4%.

Life expectancy based on wealth

• 65.1 years for the bottom 20% of the households
• 72.7 years for the top 20%.
• An upper caste woman lives 15 years longer than a Dalit woman.

• The National Health Profile in 2017 recorded one government allopathic doctor for every 10,189 people and one state-run hospital for every 90,343 people. 
• India also ranks the lowest in the number of hospital beds per thousand population among the BRICS nations at 0.5 — it is lower than lesser developed countries such as Bangladesh (0.87), Chile (2.11) and Mexico (0.98).
• Rural India houses 70 percent of the population, while it has 40 percent of hospital beds, the report said.
• The poor provisioning of public healthcare can be attributed to consistently low budget allocations.

Note: In Oxfam’s “Commitment to Reducing Inequality Report 2020”, India ranks 154th in health spending, fifth from the bottom.

Road Ahead

• India needs to recognise the importance of addressing rising inequality and put in place mechanisms for its measurement. 
• India needs to conduct more income/wealth surveys. This is not just about collecting wealth data twice in a decade, but also more consistently tracking the differential impact of specific policies on India’s rich and poor. 
• It would, thus, be important to know the relative access that India’s rich and poor have had to life-saving vaccines. 
• India’s policymakers need to understand the extent to which their actions are really benefiting India’s rich or the poor who need help most.