COVID-19 hospitalisation experiences varied across income groups: Report

By Rajiv Shah*

A new report India’s Unequal Healthcare Story based on 768 respondents from households in Andhra Pradesh, Maharashtra, Uttar Pradesh, Delhi, Kerala, Bihar and Odisha has said while all sections faced "a hoard of issues during hospitalisation for COVID-19," the experiences during hospitalisation "varied across income groups."

The survey carried in the report’s chapter titled 'Inequality Amidst a Health Emergency', authored by Apoorva Mahendru, Khalid Khan and Vikrant Wankhede, says that problem with regard to unequal access to health facilities was found to begin with the "arrangement of transportation to the hospital."

Image is for representational purposes only

According to the report published by Oxfam, "Among the lowest income bracket, that is, households with a monthly income of Rs 15,000 or less, 30 per cent had to arrange for transport themselves. Percentage for highest income bracket, that is households with a monthly income of INR 75,000 and above, was half that of low-income groups."

The authors state, "This implies that higher income groups could access government facilities better during the pandemic, hence they did not need to arrange transport themselves as much as low-income groups." They further add that "23.9 per cent with income of Rs 30,000 or less raised issues related to the attitude of the medical staff towards them, while those in the highest income bracket did not face any issues in this regard."

Pointing out that "one of the reasons for this is that private facilities, which are more accessible to the rich, provide a hospitable environment to patients," the report further states “Other issues faced during hospitalisation pertained to a slow response from the government and poor quality of food served at the hospital."

"In households with income of Rs 30,000 or less, 14.8 per cent and 22.2 per cent faced issues of slow response and quality of food served, respectively. The respondents belonging to the highest income bracket, on the other hand, did not face issues of slow response and only 4.8 per cent expressed concern over the quality of food served." It adds, "This highlights the quality of care accessible to the poor versus the rich."

According to the report, while 24.3 per cent of the respondents "expressed a need to access non-Covid medical services during the pandemic," of those facing difficulty in accessing these non-Covid medical services, "18.2 per cent belonged to the general category. Among the marginalised, 47.4 per cent OBCs faced difficulty in accessing these services while 50.7 per cent of Scheduled Castes (SCs) and Scheduled Tribes (STs) faced similar difficulties."

Asserting that "access to improved water and sanitation is also an important determinant in the fight against Covid-19," the report states, "The findings of the survey suggest that 21.5 per cent of the SC respondents depended on open wells for water while this was true for only 7.8 per cent from the general category." 

"Similarly, while only 3.9 per cent of those belonging to the general category depended on springs or streams for water consumption, the figure for SCs was four times that of the general category." It adds, "This highlights the inequalities in access to improved sources of water and sanitation, where the marginalised depend more on unsafe sources."

As for "isolation, quarantine and social distancing," which were some of "the unique aspects of the pandemic and has had a direct bearing on mental health," the report says, "Households with an income of Rs 30,000 or less experienced feelings of anxiety (41.4 per cent) and sleep deprivation (32.3 per cent) more than the higher income groups where 12.2 per cent experienced anxiety and 22 per cent experienced sleep deprivation due to the pandemic."

Noting that "issues related to mental health could be higher for lower-income groups since job loss was also higher for them," the report quotes Oxfam’s Supplement to the Global Inequality Report (2021) which says, "Out of the total 122 million who lost their jobs in the month of April, 75 per cent were in the informal sector," most of them engaged in "small businesses and casual labour."

Further, according to the report, "33.9 per cent female respondents said that they experienced feelings of anxiousness, anger, irritation and sleep deprivation. On the other hand, the same was true for 18.2 per cent males, which is half of that of female respondents." As per the report, "This is because of an increase in women’s unpaid care work burden at home, increase in cases of domestic violence, and probability of re-employment of women lesser than that of men post-lockdown."

Interestingly, issues of discrimination from neighbours were also found to be higher among the lower income group respondents. The report says, "While 35.1 per cent respondents belonging to households with a monthly income of Rs 30,000 or less experienced discrimination from their neighbours or community due to being tested positive for the virus, this was only 7.3 per cent for the highest income bracket."

In a telephonic survey to assess "ground-level experiences of people across different caste and income groups with regard to response of the government" during the pandemic, majority of its respondents belong to the Hindu community (71.9 per cent), followed by Muslims (18.5 per cent) and Christians (6.5 per cent).

With respect to the caste, 29 per cent are SCs, 11.1 per cent STs, 35.8 per cent OBCs, and 23.4 per cent are from the general category. Of the respondents, 54.9 per cent are male and 45.1 per cent are female. Further, a majority of the respondents belong to the lower income categories, with 50 per cent of the households earning anywhere between minimum wage to Rs 15,000 per month, followed by 27.2 per cent who earn between Rs 15,001 to Rs 30,000, and Rs 12.8 per cent earning Rs 30,001 to Rs 45,000 per month.

A significant number of the respondents (18.2 per cent) rely on daily wage work for survival. Of them, 15 per cent are involved in private menial jobs in offices and elsewhere; 12.2 per cent and 11.7 per cent are running medium and small businesses, respectively. A majority of the SC respondents are daily wage earners (21.1 per cent) and in low paying government jobs (12.3 per cent). Similarly, most ST respondents are daily wage earners (17.6 per cent). Among the SCs, STs and OBCs, 31.3 per cent, 11.8 per cent and 36.67 per cent, respectively, rely on additional sources of income.

* The writer is Editor of Counterview. A version of this article first appeared here.

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