Rift between urban and rural medicine in India proves to be a complex issue
Vaanya B.
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There are two opposite sides of the healthcare system in India: urban and rural. Though both urban and rural areas are in the same country, the differences when it comes to the accessibility of healthcare can distinctly be seen. Though being the second most populous country in the world and ranking 5th for the largest GDP in the world, India ranks 66th when it comes to healthcare security. As someone who lived in urban areas of India for a lot of my life, there is a large divide in the healthcare system that isn’t acknowledged and given enough attention to by the majority of urban population in the country. This must be solved because everyone requires access to adequate healthcare.
Rural-Urban divide in India is obvious, even at first glance (the Guardian and Mahindra Lifespaces)
India as a whole, including both urban and rural areas has seen great developments when it comes to growing healthcare as countless new funds, as listed by the IBF, have been inputed to expand the healthcare system in the country. According to the Hindustan Times, India is known to deliver world class healthcare for cheap prices for tourists, making it a medical tourism hotspot. Furthermore, the country is known to provide a combination of both modern and traditional healthcare, as expressed by Invest India.
My personal experience with healthcare in India was a positive one. After getting treatments in another country, my family and I felt that a consultation in India would be a great idea. This shows that not only tourists go to India for medical treatments, but even Indian expats from foreign countries. So if tourists seek healthcare in India, why are there Indians that receive inadequate healthcare?
Access to adequate healthcare is a vital human right, administered by the WHO, that should be provided to each and every individual, regardless of wealth status or area of residency. As stated in a World Bank Article, poverty is a large issue that is faced across rural areas, making it a healthcare detriment. Often healthcare is associated with very costly expenses, especially for people under the poverty line. The problem in rural healthcare is a significantly complex problem with no exact root cause, which makes it even harder to tackle.
One of the key, and most obvious issue, would be people below the poverty line not being able to afford adequate healthcare for themselves. A TOI article proved that, within India, 63% of all medical payments are paid OOP (out of pocket), making it the country with the largest OOP healthcare expenditure. Not just this, reports by Brookings India prove that an estimated 7% of the country’s population are thrown into poverty as a consequence of OOP expenditure. In order to help reduce this statistic countless initiatives to give healthcare insurance to as many people were put into order. For example, the most effective initiative was ‘PMJAY’.
Bar graph showing % of people enrolled for healthcare insurances (Data From NITI Aayog)
This initiative provided 7000 USD for 40% of the countries least financially stable families as expressed in a MINT news article. Even though this is a large initiative, there are still people who lack financial resources, including healthcare insurance. This system allows people enrolled to access hospitals that have agreed to be a part of this initiative, which is why the options are rather limited since not a lot of large scale hospitals would be willing to join. According to an NHA (National Health Authority) official “most of the private hospitals find treatment package rates very low and that seems to be the reason that it does not interest most of these private healthcare providers”.
Based on the NHA’s response to the effectiveness of this initiative, which was released in 2019, a viable solution to this would be to enlarge the existing public facilities for families without health insurance to utilize, since public healthcare is free for all citizens in the country. If public facilities were to be developed to the point where the population feel safe to solely rely on it for healthcare, rather than them feeling that private hospitals are more reliable, it would be a potential solution for people who have a lack of insurance. Even if government officials believe that there are other solutions, it is something that must be acted upon in order to achieve equality in the medical world.
Woman sits on rickety bed in a run down rural hospital. (Pulitzer Center)
During the COVID-19 pandemic, this divide between healthcare in rural areas compared to urban areas was further enhanced; government resources, including beds, were allotted in an unsuitable manner. Based on data collected by the World Bank, a mere 37% of 713,986 beds were allotted to rural India, which is where nearly 65% of India’s population reside, whereas 63% of government beds were given to the urban population. In comparison this proves a large disparity between the resources the urban population receives and the resources given to the rural population. Furthermore, according to NPR, testing was very limited in rural areas, making confirmed cases lower than the actual number of active cases. As a consequence of this there was a lack of caution and fewer restrictions in rural areas because of fewer records. This meant that the virus was able to easily spread due to a lack of caution.
Not just this, 63% of people in rural areas in India were not able to easily access proper healthcare due to a lack of nearby pharmacies within a 5km radius, as mentioned by TOI. The lack of action during the COVID pandemic should be and must be addressed for growth towards providing easy access to healthcare within rural communities all across the country.
Another large issue faced in rural areas would be the fact that there are not enough doctors and physicians present in rural areas. India as whole has accomplished the recommended doctor to patient ratio by a large margin: as expressed by an article in the Economic Times, India has 1:854, whereas the WHO recommends 1:1000. In contrast to this, according to an article on YOURSTORY, rural parts of India face an entirely different situation, where there is 1 physician per 25,000 patients (1:25 000).
Not only this, but according to an article on BW disrupt, 3% of all the physicians in India reside in completely rural areas, leaving them with an overbearing amount of work and countless residents with delayed medical treatments and consultations. Getting delayed consultations allows diseases and infections to get stronger and therefore often worsening one’s condition. Not only this but the US department of Health and Human Services states that the absence of healthcare would likely result in the lack of precautions and preventive measures for countless chronic diseases.
As the world strives towards being a better place where everyone is given equal opportunities, it is vital that action is taken in rural parts of not just India but in other countries as well because far too many people face this issue all over the world and it must be solved because everyone requires easy access to adequate healthcare.
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