Social Inequities in Private Health Sector Workforce in India: Religion, Caste, Class, and Gender

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the “Medicine at people’s doorstep” (Makkalai Thedi Maruthuvam — MTM) scheme in which screening and medications for NCDs are delivered at people’s doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community. We analysed the MTM policy document using the intersectionality-based policy analysis framework. This analysis was supplemented further with literature review to enhance understanding of the various intersecting axes of inequities, such as gender discrimination, caste oppression, poverty, disabilities and geographical access barriers. The MTM policy document, while it removes the physical access barrier, does not frame the problem of NCDs from an intersectionality perspective. This can increase the chances of inequities in access to NCD services persisting despite this scheme. We also recommend interventions for the short, intermediate and long term to make NCD care more accessible. Creation of a gender, caste, class, geographical access, and disabilities disaggregated database of patients with NCDs, using this database for monitoring the delivery of MTM services, dynamic mapping of vulnerability of the target populations for delivery of MTM services and long term ongoing digital surveillance of factors inducing inequities to access of NCD services can all help reduce inequities in access to NCD care.

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“…Screening for and treatment of NCDs can be largely viewed as preventive services. Access to such preventive services are also inequitable [14].…”

Section: What Inequities Actually Exist In Relation To the Problem?mentioning

confidence: 99%

‘Makkalai Thedi Maruthuvam’ scheme in Tamil Nadu: an intersectionality-based analysis of access to NCD care.

Thiagesan¹,

Soundari²,

Kalpana³

et al. 2023

IJME

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“…The public health care system in India is marred not only with insufficient provisions but also with an unequal distribution of whatever little there is (Baru et al, 2010). Association between poverty and health is well known and the health indicators strongly correlate with per capita income, these also show a strong correlation with expenditure on health care.…”

Section: Public Health Care System In Indiamentioning

confidence: 99%

“…On the whole, states with low initial values recorded larger gains. Also, to be noted is the fact that female life expectancy has increased in all the states, and is higher than male life expectancy, though with a huge variation (by 1% in Bihar to 8% in Kerala) (Dreze and Sen, 2014) (Baru et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Sub-optimal Investments in Public Health: A Case for Persisting Poverty

Akhter

Naqvi²

2023

ARSS

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Investment in Human capital is one of the most important variables that determine long run economic growth of an economy, even more so for low income, capital deficient, labour abundant economies. In the context of additions to value added, endowments of education and health of workers take prominence. This paper theoretically and empirically shows that suboptimal investments in health care lead to slowing down of economic growth in the long run and causes poverty and inequality to persist. This persistence of poverty can be despite rapid rates of economic growth in the short run. The paper uses endogenous growth models to argue that investments in health are necessary for long run, sustainable economic growth. It also uses secondary data to draw an overview of the public health scenario in India, bringing to fore the inadequacies of the structure and the need for a greater and more dedicated intervention by the state.

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“…The country has made considerable progress in the health infrastructure since the National Rural Health Mission (NRHM) was launched. However, the progress remained uneven across the regions, with large-scale inter-state variations [11,17,22]. The accessibility to health care facilities is extremely limited in many backward regions of the country.…”

Section: Rationale Of the Studymentioning

confidence: 99%

“…The interstate variation in the utilization of services may be best shown by comparing Uttar Pradesh with Kerala. The former is among the worst states, while the latter is the best state regarding health care utilization [17]. Compared with the other states of the country, Kerala has the highest rate of outpatient care, with 88% percent of ill people reported using outpatient care services [18].…”

Section: Introductionmentioning

confidence: 99%

Unmet need for treatment-seeking from public health facilities in India: An analysis of sociodemographic, regional and disease-wise variations

Yadav

Shekhar

2022

PLOS Glob Public Health

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Treatment-seeking behaviour is closely associated with the health status of individuals and countries. About 800 million people have no access to health services in the developing world. Though the situation has been improving, the inequalities across geographical regions, socioeconomic status, and disease types continued to persist. The available literature suggests research gaps in examining the unmet need for treatment-seeking from public health facilities across sociodemographic characteristics, regions, and specific diseases. Data for this study comes from the three rounds of National Sample Survey (NSS) (2004, 2014, 2018). We applied descriptive, bivariate, and multivariable analysis to investigate the unmet need for treatment-seeking for public health facilities across sociodemographic characteristics, regions, and specific diseases between 2004 and 2018. The unmet need for treatment-seeking from public health facilities remained high at 60% in 2004 to 62% in 2018. However, the proportion of respondents who did not seek treatment has reduced 12% to 3% from 2004 to 2018. In states like Andhra Pradesh, Madhya Pradesh, Maharashtra, Punjab, Telangana, Uttar Pradesh, and West Bengal, the unmet need for treatment-seeking from public health facilities was more than 60% in 2018. For 2018, the quality of services at public health facilities was the main reason for showing a higher unmet need for treatment-seeking in the richer MPCE quintiles. On the other hand, the ailment not considered serious as the main reason for the unmet need for treatment-seeking from any sources has got nearly doubled from 36% in 2004 to 71% in 2018. This study concludes that improving the availability of various kinds of services at public health facilities should be a priority under India’s universal health coverage program. Education plays a vital role in treatment-seeking. Thus, there is an urgent need for increasing awareness among people for treatment-seeking. Ensuring a minimum quality of health care services and reducing long waiting timing would reduce the apathy to receive services from the public health facilities.

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Social Inequities in Private Health Sector Workforce in India: Religion, Caste, Class, and Gender

Cited by 28 publications

References 7 publications

‘Makkalai Thedi Maruthuvam’ scheme in Tamil Nadu: an intersectionality-based analysis of access to NCD care.

‘Makkalai Thedi Maruthuvam’ scheme in Tamil Nadu: an intersectionality-based analysis of access to NCD care.

Sub-optimal Investments in Public Health: A Case for Persisting Poverty

Unmet need for treatment-seeking from public health facilities in India: An analysis of sociodemographic, regional and disease-wise variations

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