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Healthcare Inequities Exposed by COVID-19 Pandemic — Global Issues


Migrant workers queue in Kashmir to return to their homes. The second wave of COVID-19 in India has seen masses of people leave cities and towns to return to their rural homes. Credit: Umer Asif / IPS
  • by Ranjit Devraj (new delhi)
  • Joint press service

India has consistently challenged the estimates published by leading scientific journals such as fingertipscausing the death toll to exceed the country by 4 million between January 1, 2020 and December 31, 2021.

On April 16 an official notes from the Press Information Bureau in response to a New York Times article said, “India’s fundamental objection is not to the results (whatever they may be) but to the methodology applied.” similar use.”

Of India’s concern are the estimates projected in the paper, titled “India is hindering WHO’s efforts to publicize COVID deaths globally,” for one country. have the same geographic size and population as smaller countries. “Such a scale fits all approaches, and models that are true for smaller countries like Tunisia may not be applicable to India with a population of 1.3 billion,” the official note said. know.

But independent public health experts say the concern is that India’s aggression against the WHO is downplaying a more serious problem that the country’s wobbly health-delivery system cannot cope with. deal with the pandemic.

“Forget the actual number of people who die from COVID-19 or from comorbidities such as diabetes, high blood pressure or cardiovascular disease – the reality is still an unusually large number of people die during a pandemic because of the systemic Medical service providers are overwhelmed,” says Mira Shiva, founding member international People’s Health Movement.

“One could say that the pandemic acts like a stress test on how well healthcare services are doing and what they really want,” said Shiva. “Not surprisingly, it is the poor and marginalized groups that bear the brunt of it all – more people die of undocumented causes than usual as reflected in some calculations based on numbers. excessive dead.”

Shiva says that, at the best of times, a cause of death is not properly registered in India. “We can only guess from the very large number of bodies seen drifting into the main Ganges and Yamuna rivers during the second wave of the pandemic in 2021. There are also widely circulated images of corpses. could be lined up on the riverbanks – but clearly those of those whose loved ones could not afford firewood for cremation. “

Satya Mohanty, a former government secretary and now an assistant professor of economics at Jamia Milia Islamia University in New Delhi, said: “You can argue until the cows come home but the number will be between four and five million deaths as shown in some studies and any controversy would require strong data rather than bland denials. “

“If the average crude death rate is one-thousandth per month, anything above that average over a two-year period could be considered a single-factor death – in this case. is the COVID and post-COVID effects,” said Mohanty. “There cannot be any other reason unless other differentiators are at play and to the best of our knowledge there are no other differentiators.”

Sandhya Mahapatro, assistant professor at the AN Sinha Institute of Social Studies (ANSISS) in Patna, Bihar state, said that “while India has made great strides in reducing inequality in healthcare, large access gap according to socioeconomic status remains. Our studies show that 38% of outpatients in Bihar, a state with a population of 128 million, do not have access to public health care. “

“There is growing concern about the distributive consequences of welfare initiatives on different socioeconomic groups,” added Mahapatro. “Disadvantages in access to health care for women and disadvantaged groups continue, with factors such as caste, class and gender intersecting at different levels to create advantages for some departments and disadvantages for others,” she said.

An article published by Mahapatro and her colleagues in a peer-reviewed journal Open health policy in December 2021 shows that social status clearly determines whether a person can access health care, despite a commitment to equity in health care delivery and a commitment to aligned with United Nations Sustainable Development Goal 3 (SDGs) – providing quality health services for all. affordable cost.

“The problem of inequality unfolding during the COVID-19 pandemic disproportionately affects the poor and marginalized,” said Mahapatro. “Internal migrants have been greatly affected by the shutdowns with an incredible economic burden falling on them. Pre-existing inequalities have widened and are expected to increase further as a result of the pandemic.”

Mahapatro said a study conducted at ANSISS during the post-lockdown period uncovered a familiar pattern of health care shortages as seen in previous studies. “The burden of unmet health care needs is basically significantly higher among the poor, women and those from the lower classes,” said Mahapatro. “Unmet health care needs are particularly high among women from lower caste groups.”

“Importantly, our studies show that health spending patterns have remained unchanged for decades and that households remain the main source of financing for health care before and after,” she added. during the pandemic.

A local priest and relative of a family member who died of Covid while watching the funeral pyre at Garh Ganga Ghat in Mukteshwar, in Uttar Pradesh on May 4, 2021. (Mukteshwar, Hapur/File-Amit Sharma )

Mahapatro said: “The ongoing economic crisis caused by the pandemic and inadequate health care capacity will clearly limit the use of health care services by disadvantaged sections of society, in It is domestic migrants who are hardest hit by the shutdowns.”

According to the 2011 census, 450 million Indians are internal migrants, representing 37% of the total population. A national lockdown was imposed with a 4-hour notice on 24 March 2020 leaving most of these internal migrants with no choice but to make the long journey back. home with little money or food.

The national lockdown, widely considered the strictest globally, has gone through three more phases with increasingly relaxed restrictions on economic and human activity through June 7.

“Nearly 80 per cent of the migrant workers we surveyed lost their jobs during the shutdown,” said Mahapatro. This of course affects their access to health care, with major nutritional implications for them as well as for their women and children.”

Mahapatro added: “If the unmet needs of such large and deprived social groups go unmet, equity in health care and the UN SDGs on health will remain a dream. distant”.

© Inter Press Service (2022) – All rights reservedOrigin: Inter Press Service



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