On June 28, following India’s devastating second wave of the Covid-19 pandemic, the Union Finance Ministry announced a relief package worth Rs 6.2-lakh crore. The recovery package announced after the biggest health crisis in the history of independent India has hardly addressed systemic problems in the country’s health system that disproportionately affect the marginalised. Only 3% of the total economic recovery package amount (Rs 23,220 crore) has been allocated for health as per the latest announcements.

Unfortunately, this is not the first time when systemic issues in the country’s health system have been neglected amidst the pandemic. When the Covid-19 hit first, actual allocations for health in India’s first fiscal stimulus package were less than 1% (0.0075% or Rs 1,5000 crore to be specific) of the Rs 20 lakh recovery package that offered subsidies to the private sector.

Neglect of healthcare

India’s first pandemic budget also repeated this mistake in February when the Finance Ministry slashed the health budget by 9.8% amidst the pandemic if revised estimates are to be believed. This failure looks even more massive when we consider that the Union government has repeatedly failed to reach its own target of spending 2.5% of the Gross Domestic Product on health since 2017, a year when an ambitious National Health Policy was launched. The latest Economic Survey revealed that India ranked 179 out of 189 countries in prioritisation given to health in its government budgets.

But these are not just mere figures on the government’s balance sheet, health budget cuts affect the lives of billions of Indians especially the marginalised. The historical neglect of healthcare by India is affecting India’s Dalits, Adivasis, Muslims and women.

The exceptionalism of the Covid-19 crisis cannot be used to hide the shortcoming of the historically neglected public healthcare system in India. Photo credit: Tauseef Mustafa / AFP

Oxfam India’s “India Inequality Report 2021: India’s Unequal Health Story” shows how the general category performs better than the Scheduled Castes and Scheduled Tribes, Hindus perform better than Muslims, the rich perform better than the poor, men are better off than women, and the urban population is better off than the rural population on various health indicators such as life expectancy, infant mortality rate and nutrition.

The systemic discrimination in the health system continued during the pandemic. Oxfam India’s survey across seven states revealed that over 50% of Scheduled Castes and Scheduled Tribes faced difficulties in accessing non-Covid-19 medical facilities compared to 18.2% in the general category.

The percentage of respondents in the low-income brackets facing discrimination in the community due to being Covid-19 positive was five times those in high-income brackets. The availability of hospital beds has sharply declined in the last ten years from nine hospital beds available per 10,000 people in 2010 to only five beds in 2020, according to Oxfam India’s India Inequality Report 2021- India’s Unequal Health Story.

Effect on marginalised

Rural India has faced the brunt of the underfunding of healthcare has only 40% of these beds despite having 70% of the population, notes the report.

The exceptionalism of the Covid-19 crisis cannot be used to hide the shortcoming of the historically neglected public healthcare system in India. Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana, the Union government’s flagship scheme to make healthcare accessible to the poor and marginalised continued to face issues in terms of equity and lack of universal coverage.

Touted as the “world’s largest government-funded healthcare program”, Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana only covers less than 30% of hospital charges affecting Scheduled Castes, Scheduled Tribes and poor who are enrolled in the scheme by default.

The information obtained through Right to Information has shown only 6.05 lakh people have availed Covid-19 treatment under the scheme between March 2020 and June 2021, exposing the need to address structural issues in the program.

India can provide quality and affordable healthcare for all marginalised groups provided the public health sector is given priority over private profits. In September 2020, Oxfam’s Commitment to Reducing Inequality Report ranked India 154th in health spending, fifth from the bottom.

In the same year, India has been ranked 10th in Medical Tourism Index out of 46 destinations of the world by Medical Tourism Association for providing cutting edge healthcare worth $5 billion-$6 billion. This comes at a time when pandemic has increased the fortunes of India’s 100 billionaires by Rs 12.97 trillion.

But Muslims (64%), Dalits (86%), Nomadic and Denotified Tribes (78%) have reported an increase in indebtedness and loans. This rising inequality shows the immediate need to design a healthcare system that does not leave the marginalised behind. The time has come to introduce the “right to health” as a fundamental right to enable access to healthcare for all.

Akshay Tarfe is a media specialist at Oxfam India.