The private health sector in India from the lens of Dalits and Adivasis

A 2019 Delhi-based study published in the journal Health & Social Care in the Community  stated that private hospitals account for 38 per cent of total hospitalizations and 42.6 per cent of sites treating chronic illnesses. The discrimination faced by Dalits and Adivasis in government hospitals and health centres results in them relying on private hospitals. However, this can lead to their financial exploitation by the for-profit institutions and further abuses of their rights.

According to the 75th round of the National Sample Survey conducted in 2017-18, the average medical expenditure for every hospitalization was Rs. 11,315 (in rural areas) and Rs.18,380 (in urban areas) for Dalit patients. For Adivasi patients, the average expenditure was Rs. 14,857 and Rs.19,492 in rural and urban areas respectively. The brief points out that these costs are too high especially for people from marginalised communities, who are more likely to be poor.

The brief also highlights instances of unethical procedures on marginalised people. It cites a 2017 news report on hospitals that performed hysterectomies on around 2,200 young women belonging to the Adivasi Lambani and Dalit communities when the procedures were not necessary.

The study done for the book Untouchability in Rural India found that 21.3 per cent villages (of the 565 surveyed across 11 states of the country) denied Dalits entry into private health centres. The Oxfam India publication Inequality Report 2021 also talked about the difficulty Dalits and Adivasis faced in accessing non covid-19 medical facilities during the pandemic. Over 50 per cent of Dalits and Adivasis experienced difficulties availing medical facilities in private hospitals compared to 18.2 per cent people from the ‘general’ category.

Citing a 2015 study, the brief notes that in 2011-12, of the overall health professionals (except nursing) in India, only 8.7 per cent were from Scheduled Tribes and 18.8 per cent from Scheduled Castes. Even in nursing, people from SC and ST communities were very few in number – only 1.9 per cent and 10.7 per cent respectively.

Nearly 67 per cent of private hospitals registered with Pradhan Mantri Jan Arogya Yojana (PMYAJ) are situated in big cities showcasing an urban bias, the brief says.  A September 2020 study in the Journal of Family Medicine and Primary Care conducted in forest areas in three states showed a clear deficit of healthcare providers. It recorded a percentage deficit in auxiliary nurse midwives (64 per cent) at sub centres and primary health centre, allopathic doctors (33 per cent) at primary health centres, and specialists (84 per cent) at community health centres indicating a lack of quality health care.

The policy brief makes several recommendations including the establishment of a  special monitoring cell to oversee public spending on healthcare. It also urges the government to address financial exploitation and unethical treatments in private hospitals by introducing regulations. These could include standardizing prices and treatment protocols. 

The brief also makes specific recommendations for addressing the challenges faced by Dalits and Adivasis. It suggests strengthening grievance redressal mechanisms and establishing helplines in tribal and other local languages to make the process more accessible. It also calls for the development of training and conduct modules to sensitise health workers on issues specific to marginalised communities.

Focus and Factoids by Roha Sidhu.

PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.