Issues of Unequal Access to Public Health in India

Health in India is a state subject. Although the central government shares a significant part in establishing health care infrastructure, each of the Indian states determines their priorities for health care financing, and provides services to the population. India’s 12th plan document1 promises to build upon the initiatives that were taken in the 11th plan and expand the reach and coverage of health care to achieve the long-term objective of “universal health care.” Irrespective of the ability to pay, people in India increasingly seek private health care even for minor illnesses like cold, fever, and diarrhea. Private health care in India, however, is not only expensive but also suffers severely from a lack of trained and skilled manpower as compared to the public sector (2). Access to health care facilities is significantly urban biased. So, people living in the rural areas face the additional handicap of such a situation and they form a disproportionately larger share of the unhealthy population. With respect to access to health care, the 12th plan document states that “Barriers to access would be recognized and overcome especially for the disadvantaged and those living far from facilities.” The document goes on to mention that “... the SC and ST,2 the particularly vulnerable tribal groups, the de-notified3 and nomadic tribes, the Musahars4 and the internally displaced must be given special attention while making provisions for, setting up and renovating sub-centers and anganwadis5.” These groups need special attention as they not only suffer from unequal and lower access but also produce the worst health outcomes in the country. This is primarily because these groups have been traditionally excluded and discriminated, and therefore suffer from high incidences of poverty and low levels of education (health care awareness), among other disadvantages, which have made their access to public health care tougher. While the public health care system required to have ensured better care and treatment for these marginalized communities, evidence shows that access remains the lowest among these population group. In this paper, we focus on the issues of unequal access to health care in India by rural–urban residence, economic status, and caste/religion identity.