Health Service Inequities as a Challenge to Health Security | Infant Mortality

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In developing countries, an individual’s social, regional, and/or economic standing determines the quality of health care that they are entitled to. In India, those of a lower status and/or who have a lower income, suffer both worse health and restricted access to health services – largely the result of inequality. This Oxfam India paper focuses on the issues of financing, provisioning, and governance of health services in both the public and private sectors across India's States. It uses data collected from the States of Tamilnadu, Kerala, Uttar Pradesh, and Bihar on infant mortality rates and presents findings demonstrating the links between standard of living and health outcomes.
  Oxfam India working   papers series September 2010OIWPS - IV  Rama V. BaruRamila Bisht  Essential Services Health Service Inequities as Challenge to Health Security  While the last two decades have been marked by sustained high economic growth, they have also witnessed growing concern about unequal gains in health outcomes. This is partly due to factors pertaining to fi nancing, provisioning, and governance of health services in both, the public and private sectors. Several studies as well as government policy have recognized the lacunae in the present state of health services and the multiple axes of inequities that characterize it. The fi rst section of the paper provides an overview of the inequities in health outcomes and their variation across regional, social, and economic groups. It seeks to explain these variations by focusing on health services as a determinant of the health status. It identi fi es and analyses the key drivers of inequities in health services, namely, weak public provisioning and rampant commercialization. These factors have implications for equity and cost across income quintiles, especially for those who are socio-economically marginalized. Abstract Disclaimer: Oxfam India Working Paper Series disseminates the fi nding of the work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the fi ndings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The fi ndings, interpretations, and conclusion expressed in this paper are entirely those of the authors. They do not necessarily represent the views of Oxfam India. Produced by:   Oxfam India  For more information, please contact:  Avinash Kumar  Theme Lead - Essential ServicesOxfam IndiaPlot No. 1, Community Centre2nd Floor (Above Sujan Mahinder Hospital)New Friends Colony, New Delhi - 110 025Tel: 91 11 4653 8000Website:  Authors:  Rama V. Baru and Ramila Bisht Rama Baru  is Professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi. Her research focus is on health policy, international health, privatisation of health services and inequalities in health. She is the author of Private Health Care in India: Social Characteristics and Trends and more recently has edited a volume on School Health Services in India: The Social and Economic Contexts both published by Sage. She is the recipient of the Balzan Fellowship by the UCL, London and the Indo- Shastri Canadian Fellowship. Rama is the regional editor for South Asia for Global Social Policy published by Sage. Email: Ramila Bisht   is an Associate Professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University (JNU), Delhi. She holds an M.A. in Psychology from the University of Lucknow and M.Phil and Ph.D. in Social Sciences in Health from JNU. She has earlier taught at the Centre for Health Policy, Planning and Management, Tata Institute of Social Sciences, Mumbai, where she was also involved in a several health services research projects and programme evaluations studies. Her research interests comprise issues related to health disparities, women’s health; health policy and administration; comparative health policy and health care reform. She is the author of the book Environmental Health in Garhwal Himalayas  (Indus publication, New Delhi, 2002) and several research papers. Email:; Study Supported by Oxfam India in collaboration with Institute for Human Development, New Delhi Copyright @ 2010 Oxfam IndiaReproduction of this publication for educational or other non-commercial purposes is authorized, without prior written permission, provided the source is fully acknowledged.   1  Introduction Over the last two decades there has been growing recognition of the persistence, and in some cases, the widening of inequities in health outcomes as well as access to health services in India. The Health Policy Document of 2002 and the subsequent Plan documents have highlighted these concerns in some detail: ‘... Also, the statistics bring out the wide differences between the attainments of health goals in the better- performing States as compared to the low-performing States. It is clear that national averages of health indices hide wide disparities in public health facilities and health standards in different parts of the country. Given a situation in which national averages in respect of most indices are themselves at unacceptably low levels, the wide inter-State disparity implies that, for vulnerable sections of society in several States, access to public health services is nominal and health standards are grossly inadequate.’ (GoI: 2002). This observation is reinforced by some studies that show the growing inequities in mortality and nutrition at All India level, across states, as well as within states and social groups (Deaton & Dreze: 2009). These studies show the persistence of inequities and worsening of health outcomes for vulnerable groups such as scheduled caste, scheduled tribes, and women, especially those belonging to the lower caste-class combine. These groups have faced social and economic discrimination that disadvantages them in terms of access to resources and basic needs which is reflected in poor health outcomes. TAKING STOCK OF INEQUITIES IN HEALTH Table 1 compares inequities in health outcomes in terms of Infant Mortality Rate, Life Expectancy at Birth and Maternal Mortality Rate for India with some South  Asian countries. It clearly shows that India is among the poor performers despite high economic growth rates in recent times. Compared to countries that enjoy sustained high growth like China, Japan, Malaysia, and Korea, India is extremely
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