Health inequities around gender, disability and internal migration: are local governments doing enough
Authors
M Nair
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
S Kumar
Prajaahita Foundation, Kozhikode, India
S Babu
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
B Chandru
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
K Kunjumon
Prajaahita Foundation, Kozhikode, India
C Divya
Health Action by People, Thiruvananthapuram, India
R Varma
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Keywords:
structural vulnerability, social vulnerability, sustainable development goals, decentralization
Abstract
SETTING:
The Kerala health system in India has more than 25 years of decentralised implementation experience. Decentralization could assist in addressing health disparities such as gender, disability, and migration.
OBJECTIVE:
To explore how inequity issues comprising gender, disability and internal migrations were being addressed at present by the decentralised Kerala health system.
DESIGN:
Our approach was qualitative, using document review, key informant interviews and in-depth interviews with policy makers, health staff and other stakeholders.
RESULTS:
Gender aspects were incorporated into planning and budgeting, with 10% funds earmarked for women. Projects were gender-specific to women, and within conventional social roles of livelihood, welfare or reproductive health. Recently, transgender focused projects were also initiated. Schemes for people with disabilities remained welfare-centric and driven by top-down policies. The local governments performed beneficiary identification and benefit disbursal. Migrant health aspects were focused on infectious diseases surveillance and later living conditions of migrant workers.
CONCLUSION:
The importance that health systems place on socioeconomic determinants of health and fundamental human rights is reflected in the health interventions for marginalised communities. In Kerala, there is now a passive application of central rules and a reluctance to utilise local platforms. Changing this is a necessary condition for achieving equal development.
Keywords: structural vulnerability, social vulnerability, sustainable development goals, decentralization
Author Biographies
S Babu, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Health Action by People, Thiruvananthapuram, India
R Varma, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Health Action by People, Thiruvananthapuram, India
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