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Assessing the Healthcare Infrastructure in Rural India During the COVID Pandemic

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Pooja Paswan
January 24, 2022

“Disease, sickness and old age touch every family. Tragedy doesn’t ask who you voted for. Health care is a basic human right.”—Elizabeth Warren, senior United States Senator from Massachusetts

The three consecutive waves of COVID-19 and Mucormycosis have left rural health infrastructure in India absolutely shattered. But during the second wave of the pandemic, it was rural population who was struggling the most. They are struggling to get prompt and quality health care. The key role of health-care facilities in the rural areas is to provide regular and comprehensive health-care needs guided by the World Health Organization’s (WHO) principle of Universal Health Coverage, “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship”.

What makes for an ideal health care system?

Four criteria could be suggested- First, universal access, and access to an adequate level and access without excessive burden. Second, fair distribution of financial costs for access and fair distribution of burden in rationing care and capacity and a constant search for improvement to a more just system. Third, training providers for competence, empathy and accountability, pursuit of quality care and cost effective use of the results of relevant research. Fourth, special attention to vulnerable groups such as children, women, disabled and the aged population.

Forecasting in Health Sector

In general, predictions about future health—of individuals and populations—can be notoriously uncertain. However, all projections of health care in India must in the end, rest on the overall changes in its political economy—on progress made in poverty mitigation (health care to the poor), in reduction of inequalities (health inequalities affecting access/quality), and in generation of employment /income streams (to facilitate capacity to pay and to accept individual responsibility for one’s health).

Disparity between rural and urban health care sector

The difference between rural and urban indicators of health status and the wide interstate disparity in health status are well known. Clearly the urban rural differentials are substantial and range from childhood up to 5 years, increasing the gap as one grows. Sheer survival apart, there is also the well-known underprovision in rural areas in practically all social sector services. For the children growing up in rural areas, the disparities naturally tend to get even worse when compounded by the widely practiced discrimination against women.

States like Kerala, that have had some prior experience with pandemics, have fared better in COVID-19 management due to participation of civil society in outbreak control and health service delivery. Team building among frontline functionaries and community leaders was spontaneous, without any political or religious barriers, as people had experience through the previous outbreaks of H1N1 in 2009, Nipah in 2018 and leptospirosis in 2019. According to Antony KR, a Kochi based public health expert and an independent monitor of the National Health Mission, mobilizing volunteers who are ready to go the extra mile, has been a deliberate strategy adopted by Kerala since 2008 through the People’s Campaign for Decentralised Planning.

Where are we headed now?

There is no doubt that the pandemic has pushed the rural economy further towards a massive technology upgradation phase with e-commerce channels developing, low ticket electronic items becoming essential commodities and mobile phones becoming household necessities for education and other purposes. While it would have been easy to assume that the rural economy’s boom during the first wave would be enough to see India through the pandemic years, it is also clear that there is a need to strike a balance between the rural and urban economies so that the country’s economic revival can be initiated in a manner that places it on the path of sustainable growth and development. 

While the steps taken to nudge rural recovery were essential to reduce income disparity and regional inequity in the long run, localization of industries and employment is the need of the hour. Apart from providing enhanced access to credit in agriculture and MSME sectors via Direct Benefit Transfers (DBTs), there is also a need to work on institutional factors and a robust governance framework for effective implementation of these policies.
The future of plural systems in medical understanding and evaluation of comparative levels of competence and reliability in different systems—a task in which the separate department for Indian systems of medicine and homeopathy will play a leading role in inducting quality into the indigenous medical practices. A renewed focus on using of agricultural technology, promoting Fintech, creating opportunities for self-employment and entrepreneurship, as well as building resilient value chains in both rural and urban markets, will go a long way in making the economy disaster-resilient for the future.


Author: Pooja Paswan is currently enrolled at the John.F. Kennedy School of Government, Harvard University. She is an Assistant Professor in the Department of Political Science at Jamia Millia Islamia University, New Delhi, India. She has Ph. D in Public Administration and specializes in Public Policy. She was recipient of the ASPA 2019 Founders Fellow. She has worked extensively in the area of development administration and policy. She can be reached at https://jmi.academia.edu/PoojaPaswan and [email protected]. Twitter @poojapaswan

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