JOIN USCovid-19 exposed rifts in urban healthcare: Experts
A report by Azim Premji University has found that massive social-economic inequalities in cities mean that the Covid-19 pandemic has exposed serious rifts in the healthcare system especially for vulnerable communities.
The report, released on Friday, noted that a third of India’s population is concentrated in urban areas and that the share of urban dwellers rose from 18 per cent in 1960 to 34 per cent in 2019. Out of this, nearly 30 per cent of people are said to be poor, whose already spotty access to healthcare had been highlighted by the novel coronavirus outbreak.
For Ravi Duggal, a health economist associated with the Centre for Enquiry Into Health and Allied Themes (CEHAT), poor primary health service means that up to 70 per cent of patients are being driven to large hospitals for even basic complaints such as cough, cold and fever.
“The root of all this is the budget,” he said. “If one sees urban local body financing, you will see that urban health care services from the 60s to the 80s went from robust to bust.”
According to an author of the report, Prof Arima Mishra of the university’s School of Development, the availability of Primary Health Centres (PHCs) has fallen short by 40 per cent as per the government’s own norms.
Dugga added that this happened when the middle class was given an option by their employer to opt for health insurance. “The middle class was the main user of the public health care system and when they left, public healthcare became the domain of the poor and so it became a poor system,” he said.
He pointed to the example of Mumbai, which during the 60s and 80s allocated a third of its budget to public healthcare. “Today its budget is 9 per cent,” he said.
The researchers stressed that health vulnerabilities are linked to factors, such as basic services such as safe drinking water, sanitation and social security.
“Consequently, life expectancy among the poorest in urban areas compared to the richest quintiles is 9.1 years lower among males and 6.2 among females. The poorest households are four times more likely to report a member with tuberculosis than the richest households. The proportion of underweight urban children in the lowest wealth quintile is 48.8 per cent, as compared to 20.8 per cent in the highest wealth quintile,” Prof Mishra said.
Healthcare Chaos
Drawing on data collected from civil society organisations in Mumbai, Bengaluru, Surat, Lucknow, Guwahati, Ranchi and Delhi, plus analysis of National Family and Health Surveys (NHFS), the Census of India and inputs from state-level health officials, the investigators found that the problem is compounded by chaotic urban health governance, beset by overlaps of administrative jurisdictions.
In the central Bengaluru area, for example, researchers found a mix of PHCs operated by the BBMP as well as the state Department of Health and Family Welfare. All the institutions were classified as “District Hospitals” in the NFHS database but in reality, were only referral centres. Because they were also “clustered in the core BBMP area,” people living in the periphery were more likely to go to a private hospital near their home.
About 30 per cent of even the poorest quintile in India have little recourse but to seek healthcare from the private sector, resulting in greater financial burdens, the researchers added.
Recommendations
The report called for the building a comprehensive and dynamic database on the health and nutrition status, including comorbidities of the diverse, vulnerable populations and strengthening healthcare provisioning through the National Urban Health Mission, especially for primary health care services.
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