Higher income groups accessed govt health facilities better during Covid: Oxfam study

By Rajiv Shah 
A recent report, “India’s Unequal Healthcare Story”, based on 768 respondents from households in seven states, Andhra Pradesh, Maharashtra, Uttar Pradesh, Delhi, Kerala, Bihar and Odisha, has regretted that while all sections faced “a hoard of issues during hospitalization for Covid-19”, the experiences during hospitalization “varied across income groups.”
The survey, which is carried in the report’s chapter titled “Inequality Amidst a Health Emergency”, authored by Apoorva Mahendru, Khalid Khan and Vikrant Wankhede, says that problem with regard to unequal access to health facilities was found to begin with the “arrangement of transportation to the hospital”.
Thus, according to the report, which has been published by top advocacy group Oxfam, “Among the lowest income bracket, that is, households with a monthly income of Rs 15,000 or less, 30 percent had to arrange for transport themselves. Percentage for highest income bracket, that is households with a monthly income of INR 75,000 and above, was half that of low-income groups.”
Comment the authors, “This implies that higher income groups could access government facilities better during the pandemic, hence they did not need to arrange transport themselves as much as low-income groups.” They add, “23.9 percent with income of Rs 30,000 or less raised issues related to the attitude of the medical staff towards them, while those in the highest income bracket did not face any issues in this regard.”
Pointing out that “one of the reasons for this is that private facilities, which are more accessible to the rich, provide a hospitable environment to patients”, the report says, “Other issues faced during hospitalization pertained to a slow response from the government and poor quality of food served at the hospital.”

Says the report, “In households with income of Rs 30,000 or less, 14.8 percent and 22.2 percent faced issues of slow response and quality of food served, respectively. The respondents belonging to the highest income bracket, on the other hand, did not face issues of slow response and only 4.8 percent expressed concern over the quality of food served.” It adds, “This highlights the quality of care accessible to the poor versus the rich.”
Further, according to the report, while 24.3 percent of the respondents “expressed a need to access non-Covid medical services during the pandemic”, of those facing difficulty in accessing these non-Covid medical services, “18.2 percent belonged to the general category. Among the marginalised, 47.4 percent OBCs faced difficulty in accessing these services while 50.7 percent of Scheduled Castes (SCs) and Scheduled Tribes (STs) faced similar difficulties.”
Asserting that “access to improved water and sanitation is also an important determinant in the fight against Covid-19”, the report says, “The findings of the survey suggest that 21.5 percent of the SC respondents depended on open wells for water while this was true for only 7.8 percent from the general category." 

"Similarly", it says, "While only 3.9 percent of those belonging to the general category depended on springs or streams for water consumption, the figure for SCs was four times that of the general category.” It adds, “This highlights the inequalities in access to improved sources of water and sanitation, where the marginalised depend more on unsafe sources.”
As for “isolation, quarantine and social distancing”, which were some of “the unique aspects of the pandemic and has had a direct bearing on mental health”, the report says, “Households with an income of Rs 30,000 or less experienced feelings of anxiety (41.4 percent) and sleep deprivation (32.3 percent) more than the higher income groups where 12.2 percent experienced anxiety and 22 percent experienced sleep deprivation due to the pandemic.”

Noting that “issues related to mental health could be higher for lower-income groups since job loss was also higher for them”, the report quotes Oxfam’s “Supplement to the Global Inequality Report” (2021), which says, “Out of the total 122 million who lost their jobs in the month of April, 75 percent were in the informal sector”, most of them engaged in “small businesses and casual labour.”

Further, according to the report, “33.9 percent female respondents said that they experienced feelings of anxiousness, anger, irritation and sleep deprivation. On the other hand, the same was true for 18.2 percent males, which is half of that of female respondents.” It comments, “This is because of an increase in women’s unpaid care work burden at home, increase in cases of domestic violence, and probability of re-employment of women lesser than that of men post-lockdown.”
Interestingly, issues of discrimination from neighbours were also found to be higher among the lower income group respondents. The report says, “While 35.1 percent respondents belonging to households with a monthly income of Rs 30,000 or less experienced discrimination from their neighbours or community due to being tested positive for the virus, this was only 7.3 percent for the highest income bracket.”
A telephonic survey to assess “ground-level experiences of people across different caste and income groups with regard to response of the government” during the pandemic, majority of its respondents belong to the Hindu community (71.9 percent), followed by Muslims (18.5 percent) and Christians (6.5 percent).
With respect to caste, 29 percent are SCs, 11.1 percent STs, 35.8 percent OBCs, and 23.4 percent are from the general category. Of the respondents, 54.9 percent are male and 45.1 percent are female. Further, a majority of our respondents belong to the lower income categories, with 50 percent of the households earning anywhere between minimum wage to Rs 15,000 per month, followed by 27.2 percent who earn between Rs 15,001 to Rs 30,000, and Rs 12.8 percent earning Rs 30,001 to Rs 45,000 per month.

A significant number of the respondents (18.2 percent) rely on daily wage work for survival. Of them, 15 percent are involved in private menial jobs in offices and elsewhere; 12.2 percent and 11.7 percent are running medium and small businesses, respectively. A majority of the SC respondents are daily wage earners (21.1 percent) and in low paying government jobs (12.3 percent).

Similarly, most ST respondents are daily wage earners (17.6 percent). SCs, STs and OBCs, 31.3 percent, 11.8 percent and 36.67 percent, respectively, relied on additional sources of income.