Health care access among Dalits in India
[8] The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form.
[10] Historically, Dalits lived on the outskirts of civilization, worked as bonded labourers, and lacked access to basic amenities.
Auxiliary-trained midwives (ANMs) and nurses refuse to visit Dalit households because of sanitation issues and untouchability.
[6] According to data from the National Family Health Survey, life expectancy at birth for the general caste is 68.0 years.
[19][20] Most Dalits suffer from skin problems, respiratory disease, parasitic illnesses, and diminishing vision and eyesight.
[18] Healthcare indicators have been improving in urban, high-income families; most SC - ST communities are rural and low-income.
In rural areas, Dalit women perform household chores as well as work as bonded labours with little to no pay.
Surveys reveal that Dalit women have to travel long distances on foot to reach the regional healthcare subcentres- which may or may not be functional.
[18][29] Girls and women usually travel long distances for sanitation purposes, which poses a serious challenge to reproductive and menstrual health.
Dalit women are frequently exposed to domestic violence, physical assaults as punishment for being lower castes, human trafficking, and prostitution.
[18] The impact of the complete lockdown in India was felt the most by the poorest of the poor who worked as daily wage workers and labour.
While the government issued guidelines on home quarantine, the fact that most Dalit households do not have basic amenities like a toilet and food supplies was overlooked.
[33] Approximately 11,000 migrant labourers were stranded away from home due to the lockdown and 96 per cent did not receive any government-sponsored ration during this period.
For instance, the Yanadi (SC) community of Vijaywada, Andhra Pradesh was barred from travelling to local markets for buying food and medicine since the lockdown.
[33][36] The municipal corporation is responsible for providing safety equipment like clean clothes, soap, headgear, gloves, rubber boots etc.
The Ministry of Family Health and Welfare recommended that sanitation workers receive personal protective equipment like N-95 masks, sanitisers, rubber gloves and boots during the pandemic as they dealt with biological waste.
To create a level playing field, the Constitution laid out guidelines for reservation and affirmative action for members of lower caste communities in employment, education, and political representation.
The National Rural Health Mission was launched by the prime minister in 2005 to provide equitable healthcare to vulnerable groups.
Some of the key features of NRHM include- the scaling up of public spending to 2–3% of the GDP for vulnerable populations; a focus on primary health care and improvement in secondary and tertiary referral facilities; and the implementation of a conditional cash transfer scheme to encourage facility-based births.
This scheme emphasized achieving universal healthcare in the country by using the sustainable development goals as the guiding principles.
The Ayushman Bharat Program aims to establish 15,000 health and wellness centres to improve the structure of primary healthcare.
[37] Most government-funded health insurance schemes failed because of the financial catastrophes marginalised households experienced in covering out-of-pocket expenses like oral drugs and medical tests.
One of the goals of the National Health Policy, 2017 is the provision of ensuring free access to high-quality primary care through government services.
[52][53][54][16] Other measures that are currently being followed but need to be scaled up include: mandatory medical examinations of SC and ST individuals for detection of HIV, tuberculosis, and other communicable and non-communicable diseases; research is being carried out by the Indian Council of Medical Research on healthcare problem unique to the tribal community; several village based ASHA, Anganwadi workers, and Panchayat workers have been trained to aid the government in monitoring SC-ST health outcome; and the Swacch Bharat Abhiyan has increased focus on access to sanitation and toilets, especially in rural households.
Improved literacy rates, especially in women have shown a positive effect on healthcare utilization by marginalized families.
Studies find that a trickling down of the funds allocated by ministries for Dalit development limits the efficacy of the planned programs.
Studies carried out by NGOs show that empowering local Dalit leaders, training vocal activists, and forming solidarity groups for community monitoring can increase healthcare utilization and outcome.
[15] Affirmative action policies need to be supplemented with improved education to remove social hierarchies from the grassroots.
Vocational and skill-based training can supplement land reform efforts in providing financial independence to Dalit households.
