Health is a non-negotiable human right which is essential for realisation of basic human needs for a dignified life. With increasing privatisation of health sector and involvement of insurance companies, a growing inequality in access to healthcare is increasingly felt.
The poor often remain at the receiving end. Privatisation of health sector has come as a challenge to right to health and the constitutional guaranty of health as a fundamental right of every citizen of the country.
The State Government needs to intervene with affirmative action to ensure equity in health service with public healthcare programmes and ensure space for the poor within the expanding private sector. The State’s investment in health sector should continue in the interest of the marginalised poor with more budgetary allocations.
Admittedly the State Government has failed to ensure the primary healthcare for all in the backward regions and for people of disadvantageous groups like people in BPl, SCs, STs, women and children. The infant mortality rate (IMR) of Odisha is still highest in India and in many of the health indicators like population to bed ratio, prevalence of serious communicable diseases and maternal mortality rate (MMR) the State lags behind all India averages. Odisha, Bihar, MP, Rajasthan and UP have 60 per cent of child death in India.
It shows that the poor health status is very much linked to the socio-economic condition of the people. The IMR is higher among SCs and STs residing in backward and tribal areas of the State. Many of the health study reports revealed that chronic energy deficiency among the tribals is higher and they suffer more from malaria, tuberculosis, sexually transmitted diseases, genetic disorder, sickle cell, anemia and nutritional deficiency diseases in comparison to other social groups.
Many of the well designed schemes like Pradhan Mantri Swasta Surakshya Yojana, Rastriya Arogya Nidhi, State illness assistance fund, Swasta Bima, National vector borne disease control programme etc have not yet properly been grounded and reached to the people in backward areas and marginalized social groups. The budgetary allocation of the State for health has been consistently low. The death of pregnant women and children, under nutrition, diarrhoea, malaria, dengue and skin diseases is high and widespread in the tribal and backward regions. The water and air pollution in mining and industrial areas has been contributing to a poor health status.
The poor people in mining and industrial areas of Keonjhar, Jajpur and Angul are suffering from vector borne diseases like dengue, malaria and chikungunya etc. The diseases have affected thousands of people and many people died without proper treatment locally. The residential schools of SC and ST children are in regular news for death of children due to malaria, diarrhoea and food poisoning etc. The Agawanbadi centers for children of mining and industrial workers also lack basic healthcare. The Health Department has made no effort to serve the institutions having poor children. The related departments like ST and SC Development, WCD and Health have no collective effort to address the health issues of vulnerable groups in remote and critical areas.
The commitments shown in the National Health Policy 2002, Millennium Development Goal (MDG), Planning Commission’s plans and State health vision have not yet been translated into reality. Rather, health service became a commodity in market with a fairer access for those who can buy it.
It is very important in Odisha to invest more on basic services sector like health. The health of the majority of the people is linked to employment and growth of the domestic production in primary sector where mostly poor people are engaged in large number as seasonal workers with low wage. They are prone to unemployment, migration and food insecurity and thus lack minimum access to healthcare. Historically for the last sixty years, the State involvement in health sector has been urban centered and limited to the employees of organised sectors and public sector. Many of the hospitals run by private and public sector companies are restricting their services to their employees without any benefit to the local poor there while these companies are polluting the local environment. The backward areas of Odisha have not been provided with adequate health infrastructure. The people in remote and rural areas, SCs and STs and families below poverty line always have a less share in State sponsored health services because of their vulnerability and minimal access. The doctors are not willing to stay in remote tribal areas for a number of reasons and very few doctors have shown the commitment to serve the poor in remote areas.
There is no specific law relating to the provisions of healthcare of SCs and STs. The Health department should spend as per the prescribed provisions of tribal sub plan and scheduled caste sub plan for the healthcare of the SCs and STs and funds available for backward region development should have a priority on spending on healthcare.
The Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANM), village health and sanitation committee (VHSC) and Rogi Kalyan Samiti are village level institutions operating under the National Rural Health Mission. The primary healthcare system in remote areas needs to be improved to provide service to the people. The number of PHC with adequate health personnel, medicine, equipment and infrastructure should be made available under different schemes and programme so that the access of the poor to healthcare can be ensured.
The State should encourage doctors with additional benefits while they are serving in inaccessible areas with all kinds of risk. It is also important to promote more number of health related personnel from among Adivasis, Dalits, women and children in remote areas like KBK to serve the local people.
There is lack of disaggregated data on health status of SCs and STs to know the status and plan and monitor the health programmes and its impact on vulnerable groups in order to ensure equity in health service.
The health infrastructure needs to be upgraded both qualitatively and quantitatively in remote tribal areas by utilizing the TSP and SCSP funds. The Government must build special hospitals in the KBK region at par with hospitals in the capital cities to provide health service to the people in the region by mobilising resources from different sources. The mining and other companies who have been operating in the region for a long time should pay back to the local people by investing on public health.
(The writer is a rights activist and can be reached at ojaabbsr@gmail.com)