Healthcare Continues to Remain Inaccessible for Dalits and Adivasis, Says Study

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The high healthcare costs were expected to be addressed through the introduction of health insurance by the Union government, but it covers less than 30% of hospital charges leaving a heavy financial burden on the poor.

Health outcomes have remained grossly unequal, with India's dalits and adivasis living shorter lives of poorer quality, as per a recent paper published by Oxfam India. Private infrastructure now accounts for nearly 62% of India's health infrastructure. However, only 4% adivasis and 15% dalits utilise private facilities. According to the 75th round of the National Sample Survey for inpatient care, Out of Pocket Expenditure (OOPE) in private facilities is 524% higher than in public facilities. This is unaffordable for a large section of the marginalised communities, as 45.9% of adivasis and 26.6% of dalits are in the lowest wealth quintile.

Dalits and adivasis together constitute 25.2% of India's population.

"Both communities have faced systemic discrimination and have been denied access to basic services. Persistent structural and deep-rooted poverty and deprivation among dalits and adivasis manifest in all aspects of their lives," the paper said.

On average, a dalit woman lives 15 years less than an upper-caste Hindu woman. About 65% of scheduled tribe (ST) women suffer from anaemia compared to 47.6% of non-ST women. They miss out on access to healthcare. While 15% of upper-caste women did not receive prenatal care, such care was not received by 26% of dalit women. Only about 61% of ST mothers received tetanus vaccination, compared to 81% of non-SC/ST women.

"They also face direct discrimination in the healthcare system," the report added. "One study found that 94% of dalit children surveyed faced discrimination in the form of touch (where they were touched sympathetically when accessing healthcare), dispensing of medicines (91%) and the conduct of pathological tests (87%); 81% of dalit children were not given as much time as other children."

In India, only 37% of the population in the rural areas has access to public health care services within a five-km radius, and only 68% of the population has access to a basic outpatient health facility. Therefore, a large share of dalits and adivasis, particularly women, consult private medical practitioners in their locality, and many of these may be quacks, highlighted the paper. One study of dalits in Rajasthan found this proportion to be 74%, and another in Bihar at 84%. Even in an urban settlement like Delhi, 48.9% of dalits/adivasis sought help from unqualified practitioners for episodic illnesses.

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