The healthcare needs of India’s ultra-vulnerable populations – such as HIV-afflicted individuals, transgender persons, sex workers, urban slum dwellers, and displaced communities need more attention. There is an urgent requirement to allow for the communities’ basic fulfillment of healthcare demands – be it essential medication or hygiene supplies, which calls for a rethinking of awareness programs and advocacy efforts. This article explores how positive change can be sparked, as the pandemic seemingly loosens its grip on the country.
According to the National AIDS Control Organization (NACO), in 2020, more than 23 lakh Indians were estimated to be living with HIV – a disease with no cure, which can be managed only with proper medical care. Even though NACO and the Joint United Nations Programme for HIV/AIDS (UNAIDS) have been making efforts to set up and strengthen testing, counselling and awareness programs for patients across the country, with the onset of the pandemic, HIV patients were compelled to figure out their own treatment and repeatedly request attention from medical communities as the crisis continued. Similarly, the mental and physical impact the pandemic has had on transgender persons and Kinnars has been nothing short of debilitating. According to a research study, the examples of barriers to healthcare access faced during COVID-19 – like being tested positive and then admitted to male health wards against will – have worsened the mental health of transgender persons who are already facing stigma daily due to their gender identity.
Although existing schemes such as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) aim to ensure that the poor can gain free treatment up to INR 5 lakhs at public healthcare facilities, many are not aware of this insurance/assurance scheme that is fully financed by the government. However sometimes, ‘free’ also isn’t everything. According to researchers of Adivasi health in Karnataka, a fear of public healthcare centers is permeating indigenous communities – where they’re more keen to stick to Ayurvedic practitioners than being hospitalized. There is also an urgent requirement for State governments to develop programs tailored to local issues while the Ayushman Bharat program looks at improving the management of healthcare woes of India’s ultra-vulnerable.
Understanding the healthcare requirements of marginalized communities and social groups
As a first step, the country’s public healthcare bodies need to understand the behaviour drivers of the most disadvantaged members within their area of jurisdiction. According to the results presented in a research study – women in rural North India are most likely to not access healthcare, and even if they do, they’d consult unqualified healthcare providers. The results of the study support the existing literature that women are less likely to access outpatient healthcare in low and middle-income countries as compared to men.
A simple insight such as this could assist State Governments in North India to tackle the behaviour among women to not reach out to legitimate healthcare providers by showcasing the dangers of heeding unqualified allopathic providers. This could be done through an awareness campaign aimed to highlight the perils of the informal healthcare sector.
Therefore, despite there being progress in the understanding of healthcare needs, a way to build long-term and durable healthcare solutions for ultra-vulnerable communities is to consistently map the chronic health issues and unhealthy behaviours persisting across regions.
Comprehending the mental health impact of uncertainty on vulnerable communities
A research paper states that due to a loss of livelihood during the pandemic, hidden mental health problems among sex workers in India were brought to the forefront. Sex workers were fraught with anxiety about when the pandemic would end, and when they could resume their work and earn a living.
Comprehending and foreseeing this mental struggle for sex workers could have built grounds for providing additional public funding to NGOs that help sex workers find alternate means of work or ones that deal with aiding poor persons with psychiatric afflictions. A discreet campaign to build awareness about the possibility of a new mode of income, run by community-based organizations across the country, would have been beneficial to draw sex workers out of the despair they were facing – towards having some hope of being able to rise from spiralling poverty.
As a crucial second step, Governments should account for widespread mental health protection when improving public health policies and healthcare programs for citizens including vulnerable populations. Organizations that closely work on eliminating the stigma surrounding mental illness should advise the necessary public bodies on how to take account of various contextual factors surrounding mental health when devising health frameworks for all.
Training ASHA workers in soft skills and avoiding language barriers when dealing with ‘invisible’ communities
Healthcare providers like ASHA workers, sometimes the only hope for vulnerable communities to access the public healthcare system, occasionally cannot connect with the communities in a manner that is sensitive. Sometimes, a language barrier or communication gap can sever ties and create trust deficits between the communities and ASHA workers – which can cause further issues for the ASHA workers to help vulnerable populations in garnering essential drugs, finding out about welfare schemes, and accessing healthcare facilities in a fearless manner.
As a third step, the National Rural Health Mission must reach out to the ASHA community health workers and highlight the difficulties that vulnerable communities are facing in improving their healthcare standards. Apart from raising this awareness among ASHA workers through targeted communications and action-focused campaigns, emphasis should also be laid on improving the communication skills of ASHA workers themselves and helping them garner improved soft skills to address the most sensitive of needs of marginalized communities. In case a language gap is causing them to not be able to provide immediate aid to invisible communities, training to understand the basics of the local language/dialect can be beneficial, especially in the case of medical emergencies.
Tackling the diverse healthcare needs of marginalized communities cannot take a homogeneous, ‘one-size-fits-all’ approach. For example, for some sanitation needs are more important – like for the urban poor – while for others, like displaced communities, formal systems of identification to access welfare schemes are of paramount importance. Based on this, it’s important to devise grassroots communications that reassure vulnerable populations that they are entitled to get their healthcare needs met and guide them to the actions that they can take to ensure improved health for themselves and their families. Additionally, population insights (like the social, political, and economic status) need to be consistently analyzed to ensure that governments, non-profits and community-based organizations are acting in the most beneficial way at the right time for providing timely, equitable healthcare to ultra-vulnerable communities.
In the post-pandemic age, having health services isn’t enough, creating an environment that allows marginalized communities to understand their healthcare rights, claim them and feel included within public health programs should be the final pitstop – and communications and awareness campaigns can help in achieving that. There is a strong belief that the Indian healthcare system will get better at extending customized, essential health services among marginalized communities, especially now as we inch closer to the deadline for realizing the 2030 Sustainable Development Goals.
The views expressed in this article are the author's own.