Caste and care: is Indian healthcare delivery system favourable for Dalits?
The development literature in the recent past has brought out the stark differences in the social and economic status of Dalits and Adivasis as compared to other social groups in India. Most of these studies tended to focus on the correlates of group identity, material deprivation and poverty of these groups to their development deficit.
Dominant discussions in public health in India have often tended to sideline the questions of discrimination while examining the gap in health status among social groups mainly due to the over influence of more visible issues such as unbalanced resource allocation and spending, poor coverage of services, infrastructure lacuna, human resource shortage, affordability and issues of governance. Whilst not many, there, are evidences that discrimination and resulting deprivation have an impact on health of the people in the Indian context.
The paper examines whether the dalit castes are adequately represented in the health service system in rural India in the context of the already established caste based discrimination in service delivery. Drawing from official data, the paper shows an overall domination of non-dalits in healthcare services. The paper presents two scenarios to understand it further. Fist is the similarities in health disparities between Scheduled Castes (SCs) and non-SC/Scheduled Tribes (STs) of Bihar and Tamil Nadu, which have huge presence of non SC/STs in significant positions of healthcare delivery. Second is the case of Andhra Pradesh (undivided), which has less intergroup disparities and better distribution of health personnel from dalit castes at all levels of health services. These cases confirm the persistence of unfavourable environments for dalits with the domination of non-dalits in health services.