Jump to content

User:Rb1429/Health care access among Dalits in India

From Wikipedia, the free encyclopedia
Dalit Community in India

Achieving Universal Health Care has been a key goal of the Indian Government since the Constitution was drafted. In the last few decades, the Government has launched several programs and policies to realize ‘Health for All’ in the nation [1][2]. These measures are in line with the sustainable development goals set by the United Nations[3][4]. Health disparities generated through the Hindu caste system have been a major roadblock in realizing these goals.[5][6][7] The Dalit (untouchables) community occupies the lowest stratum of the Hindu caste system. Historically, they have performed menial jobs like- manual scavenging, skinning animal hide, and sanitation.[8] The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form. However, caste and its far-reaching effects are still prominent in several domains including healthcare. Dalits (Scheduled Caste or SC) and Adivasis (Scheduled Tribes or ST) have the lowest healthcare utilization and outcome percentage.[9] Their living conditions and occupations put them at high risk for disease exposure. This, clubbed with discrimination from healthcare workers and lack of awareness makes them the most disadvantaged groups in society.[10]

Health care utilisation

[edit]
Lack of basic amenities and sanitation in Indian villages

Historically, Dalits lived on the outskirts of civilization, worked as bonded labourers, and lacked access to basic amenities. They were denied access to water, land, and education. They had limited access to doctors and healers.[11][12] According to research, socioeconomic discrimination affects health outcomes in three ways- 1) health status, 2) quality of healthcare services, and 3) healthcare access.[13]  The inequalities in health created by the caste system are prominent even today.

Most of the Dalit population resides in rural areas and face challenges in travelling to healthcare centres. In urban areas, Dalit families can be found in urban slums [14][15]. Most do not avail healthcare subsidies due to a lack of identification documents [16][17]. Surveys reveal that there is mutual distrust between Dalit communities and healthcare workers. This is a form of institutionalized discrimination. Auxillary-trained midwives (ANMs) and nurses refuse to visit Dalit households because of sanitation issues and untouchability. Dalits often complain that they receive differential treatment from workers at regional health subcenters [10] . As a result, they prefer to rely on unqualified healers and doctors and end up paying a lot. Increased privatization of the healthcare system has only worsened the problem due to price hikes [6].

According to data from the National Family Health Survey, life expectancy at birth for the general caste is 68.0 years. The life expectancy of SC and ST is significantly lower at 63.0 and 64.0 years respectively- with the life expectancy of men lower than that of women; this is likely due to the uncertain and unsafe conditions they are exposed to [18][19]. Dalits are at a higher risk of contracting HIV-AIDS [20][21]. Most Dalits suffer from skin problems, respiratory disease, parasitic illnesses, and diminishing vision and eyesight [13]. The India Inequality Report of 2021 reports that SC and ST communities have the highest fertility rates yet the infant mortality rate and under-5 mortality rate in these communities are higher than the national average. The percentage of stunted children in SC and ST households is 12.6 and 13.6% higher than that in general castes. A majority of these children are also anaemic [22]. Dalit children also face discrimination through the mid-day meal program, defeating its purpose. Nonetheless, there have been some encouraging results from government programs. Due to an increased push from the government for childhood vaccinations and appropriate antenatal care in mothers, there is an increasing trend in vaccine utilization during infancy and pregnancy, however, the degree of adherence is still low and most individuals do not complete their vaccination schedule. The gap between institutional births between SC & ST and the general category is also decreasing. SC & ST households receive higher food supplements than the national average, indicating improvements in government food programs.[19]

Healthcare indicators have been improving in urban, high-income families; most SC - ST communities are rural and low-income. Although household medical expenditures have improved over the years, an average general category household spent 1.7 times higher than Dalits in 2017-18. Huge out-of-pocket expenses on medication and tests discourage these communities from seeking healthcare [19][23]. Dalit practitioners in the healthcare workforce are rare, despite measures for affirmative action [6][10]. All these factors, skew the healthcare experience received by different social groups [24].

Dalit women

[edit]
An urban slum in Delhi, India

Dalit women face the double burden of being lower caste and female[25]. This can be attributed to the lack of safety, sanitation, and exposure to diseases as an occupational hazard. In rural areas, Dalit women perform household chores as well as work as bonded labours with little to no pay.[26] In urban areas, they usually work in households as maids.[17] These women lack any form of social security in society. Most women are married by the age of 20 and are responsible for the care of multiple children.[27] In most households, the men are the primary decision-makers. Studies reveal that healthcare utilisation is higher in households where the woman has the freedom to make decisions of her own. Surveys reveal that Dalit women have to travel long distances on foot to reach the regional healthcare subcentres- which may or may not be functional. Even though the government provides antenatal care medications like- anti-parasitic tablets, folic acid tablets, tetanus shots, and education for pregnancy- very few women can avail these.[28][17][19]

According to a study on healthcare-seeking behaviour and healthcare spending by young mothers in India, women from lower castes spent less on public sector practitioners than higher caste women. Additionally, lower caste women also spent less on private practitioners and self-medication than higher caste women and non-Hindu women, yet experienced more self-reported morbidities than women from higher castes.[29] Only 23.7% of Dali households have access to toilets.[19][30] Girls and women usually travel long distances for sanitation purposes, which poses a serious challenge to reproductive and menstrual health.[13] Another study on the utilisation of antenatal care among women in southern India found that lower-caste women were less likely to have received maternal healthcare than women from higher castes. In the state of Andhra Pradesh, scheduled castes and scheduled tribes were 30 per cent less likely to have received antenatal care than women from higher castes- even when potentially confounding factors, such as age, birth order, and education level, were held constant. Also, while controlling for other factors, women belonging to scheduled castes or scheduled tribes in the state of Karnataka were about 40% less likely to have had antenatal care during the first trimester of pregnancy than women from higher castes. The study also found that women belonging to scheduled casts or scheduled tribes were less likely to give birth at hospitals and to be assisted by a health professional during delivery than women from higher castes [31]. The country witnessed a 45 per cent rise in reported cases of rape in Dalit women between 2015 and 2020. Dalit women are frequently exposed to domestic violence, physical assaults as punishment for being lower castes, human trafficking, and prostitution [32][33]. Dalit women's literacy has improved their social status, however, the situation remains glum.

The effect of COVID-19

[edit]
Stranded migrant workers during the lockdown

The COVID-19 pandemic sheds more light on the healthcare disparities in India [19]. The impact of the complete lockdown in India was felt the most by the poorest of the poor who worked as daily wager workers and labour. While the government issued guidelines on home quarantine, the fact that most Dalit households do not have basic amenities like a toilet and food supplies was overlooked [34]. Approximately 11,000 migrant labourers were stranded away from home due to the lockdown and 96 per cent did not receive any government-sponsored ration during this period [35]. Several migrant workers chose to walk on foot across state borders and were met with severe hostility. This period also saw a spike in hate crimes against Dalits [36]. The guidelines on ‘social distancing’ reinforced the means of caste-based discrimination. For instance, the Yanadi (SC) community of Vijaywada, Andhra Pradesh was barred from travelling to local markets for buying food and medicine since the lockdown [34][37]. The municipal corporation is responsible for providing safety equipment like clean clothes, soap, headgear, gloves, rubber boots etc. to manual scavengers. The Ministry of Family Health and Welfare recommended that sanitation workers receive personal protective equipment like N-95 masks, sanitisers, rubber gloves and boots during the pandemic as they dealt with biological waste. This recommendation was barely acted on by the Municipal Corporations. Thus, Dalits were at a higher risk of being exposed to COVID and received little government support during the lockdown [13][38].

During the pandemic, the SC-ST groups faced greater difficulty in securing healthcare. 21% of villages did not allow SC families access to public health centres during the pandemic. Most lacked the connections to arrange for transportation, oxygen tanks, or beds in private hospitals. Reports also suggest that these communities faced serious travel accessing non-COVID-related care during this period [19][39]. During the vaccination drive, high-income, urban dwellers were able to secure vaccine appointments through private hospitals at a higher cost [40]. Poor marginalized communities queued up outside government centres for receiving their vaccination. Vaccine distribution between hospitals was also unequal. In a country with a huge digital literacy gap, schemes to digitize vaccinations only made COVID- care more inaccessible to Dalit families [41] .

Current programs and policies

[edit]
Anganwadi programs for rural children

Led by B.R. Ambedkar, the Dalit Movement gained momentum in 1956. He was also one of the authors of the Indian Constitution which provides guidelines to ensure equality and prevent discrimination in society. Article 17 laid out stipulations for abolishing 'untouchability' of any kind. To create a level playing field, the Constitution laid out guidelines for reservation and affirmative action for members of lower caste communities in employment, education, and political representation. The Prevention of Atrocities Act of 1989, recognized the discrimination and threat to lower caste individuals. Despite these efforts, Dalits receive little benefit that the State promised them- Dalits are still subject to hate crimes, affirmative action provisions have failed to reduce grassroots-level issues in primary education, Dalit students have a high dropout ratio and employees are less trained, and discrimination against Dalits is evident across the health sector [42][43][6].

The Dalit sub-plan adopted during the fifth and sixth Five Year Plan of India, laid out stipulations for all 23 ministries to allocate 2-32 per cent of their budget to Dalit development. This resulted in a significant boost in Dalit welfare program funding in comparison to the previous plans [44]. Recently, the government discontinued the five-year plans, resulting in concerns about the allocation of funds to Dalit welfare [45].

Health centres and schemes

[edit]

The National Health Policy of 1983 focused on primary healthcare and aimed to reduce infant mortality rates, maternal mortality, and the occurrence of anaemia in girls among other things. According to the World Health Organization, the creation of a robust primary healthcare system will reduce healthcare disparities. In recent years, a push towards private investment in healthcare has resulted in a narrow focus on improved technology, digitization, and a specialized focus on certain diseases [46][47]. While this benefits high-income populations, most marginalized SC-ST communities exist without basic medical care. The primary healthcare system comprises sub-centres and primary health centres. A sub-centre serves a small population (3,000 - 5,000) and is run by a male and female nurse (at least). A primary health centre is a unit of six sub-centres and enables access to a medical officer. The patient-to-doctor and patient-to-bed ratio are extremely poor in these centres and there is limited availability of medication. Infrastructural growth of these centres would incentivize working in these centres. This again highlights the relationship between good healthcare and the economy [19][48].

There are a several government-funded health insurance schemes: Employees' State Insurance Scheme (1952), Central Government Health Scheme [49](1954), Universal Health Insurance Scheme [50] (2003), Aam Aadmi Bima Yojana [51], Rashtriya Swasthya Bima Yojana (RSBY, 2008), and Ayushman Bharat- Pradhan Mantri Jay Arogya Yojana (PM-JAY, 2018). In addition to this, there are State specific insurance schemes. The National Rural Health Mission was launched by the prime minister in 2005 to provide equitable healthcare to vulnerable groups. Some of the key features of NRHM include- the scaling up of public spending to 2–3% of the GDP for vulnerable populations; a focus on primary health care and improvement in secondary and tertiary referral facilities; and the implementation of a conditional cash transfer scheme to encourage facility-based births. The RSBY scheme targeted families living below the poverty line (BPL). It works by sharing the risk of a major health catastrophe by pooling the risks across many households. This scheme was succeeded by the PM-JAY scheme. This scheme emphasized achieving universal healthcare in the country by using the sustainable development goals as the guiding principles. The Ayushman Bharat Program aims to establish 15,000 health and wellness centres to improve the structure of primary healthcare. PM-JAY provide coverage of up to Rs. 5 lakhs per family for secondary and tertiary healthcare; it is the largest health insurance scheme in the world [52][53]. According to the Indian Inequality Report of 2021, only 14 per cent of both SC and ST households are enrolled in PM-JAY [19]. Most government-funded health insurance schemes failed because of the financial catastrophes marginalised households experienced in covering out-of-pocket expenses like oral drugs and medical tests. Although these plans hoped to target underprivileged families, a majority of families availing these schemes are on the higher income end. One of the goals of the National Health Policy, 2017 is the provision of ensuring free access to high-quality primary care through government services. This would require an increased expenditure in healthcare from the current 0.32 per cent of annual GDP [54][55][56][17].

Other measures that are currently being followed but need to be scaled up include: mandatory medical examinations of SC and ST individuals for detection of HIV, tuberculosis, and other communicable and non-communicable diseases; research is being carried out by the Indian Council of Medical Research on healthcare problem unique to the tribal community; several village based ASHA, Anganwadi workers, and Panchayat workers have been trained to aid the government in monitoring SC-ST health outcome; and the Swacch Bharat Abhiyan has increased focus on access to sanitation and toilets, especially in rural households [57][58][16]. The Niti Aayog recommends improving data linkages between the National Digital Health Mission and the National Health Mission to leverage data on health outcomes [53]. However, the government would have to address the digital divide in India. Thus we see that the government has taken several steps to improve healthcare access and coverage but a shift towards a robust primary healthcare structure integrated with awareness and economic development is essential for uprooting caste-based disparities in healthcare [59][60].

Future outlook

[edit]

Since independence, the Indian government has recognized the importance of improving Dalit health. There is an increased emphasis on studying the cross-cutting interactions of caste and income and how it affects health outcomes. Literacy, economic status, and health are positively correlated with each other. Improved literacy rates, especially in women have shown a positive effect on healthcare utilization by marginalized families [61][62]. Similarly, land redistribution schemes have been seen as an important step in Dalit empowerment. However, most states failed to implement this policy. For instance, in Maharashtra, only 5% of 8,54,000 Dalit families received any land. Studies find that a trickling down of the funds allocated by ministries for Dalit development limits the efficacy of the planned programs [63] [64] [65].

The rise of Dalit political parties and organizations has created pressure to allocate more funds to Dalit development [66]. Currently, the census does not collect information on healthcare outcomes by social group. Researchers suggest that improved data availability will enable better policy analysis [67][53][19]. To improve Dalit healthcare access, the government is advised to improve its healthcare expenses and also establish Dalit-centric programs. The India Inequality Report recommends that the government increase primary healthcare funding to strengthen all basic healthcare access The report also highlights the positive correlation between low socioeconomic polarity and improved health outcomes [19]. Educational campaigns to eradicate the societal roots of caste-based discrimination are key in achieving healthcare equality. Studies carried out by NGOs show that empowering local Dalit leaders, training vocal activists, and forming solidarity groups for community monitoring can increase healthcare utilization and outcome [16][68]. Affirmative action policies need to be supplemented with improved education to remove social hierarchies from the grassroots. Vocational and skill-based training can supplement land reform efforts in providing financial independence to Dalit households. While the percentage of Dalit households covered by some form of insurance is higher than that in general caste households, due to a high-income gap and high out-of-pocket expenses these households still access less medical care. Increasing insurance coverage using public-private partnerships has been emphasized by economists [6][19]. Improved spending in general healthcare and targeted funding towards Dalit programs is needed. Programs led by NGOs show that community-based monitoring, designating and training community activists, and forming solidarity groups can improve healthcare utilization in Dalit communities [16]. Successful execution of these efforts can potentially help India improve healthcare access for marginalized castes and move towards universal healthcare.

See also

[edit]

References

[edit]
  1. ^ Zodpey, Sanjay; Farooqui, Habib Hasan (April 2018). "Universal Health Coverage in India: Progress achieved & the way forward". Indian Journal of Medical Research. 147 (4): 327–329. doi:10.4103/ijmr.IJMR_616_18. ISSN 0971-5916. PMC 6057252. PMID 29998865.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ "Understanding India's Healthcare System". International Citizens Insurance. Retrieved 2022-10-11.
  3. ^ "India's National Health Policy 2017 and 2030 Agenda for Sustainable Development - International Institute for Global Health". iigh.unu.edu. Retrieved 2022-10-11.
  4. ^ Gera, Rajeev; Narwal, Rajesh; Jain, Manish; Taneja, Gunjan; Gupta, Sachin (2018). "Sustainable Development Goals: Leveraging the Global Agenda for Driving Health Policy Reforms and Achieving Universal Health Coverage in India". Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine. 43 (4): 255–259. doi:10.4103/ijcm.IJCM_41_18 (inactive 2022-10-26). ISSN 0970-0218. PMC 6319280. PMID 30662175.{{cite journal}}: CS1 maint: DOI inactive as of October 2022 (link) CS1 maint: unflagged free DOI (link)
  5. ^ Kowal, Paul; Afshar, Sara (2015-01-31). "Health and the Indian caste system". The Lancet. 385 (9966): 415–416. doi:10.1016/S0140-6736(15)60147-7. ISSN 0140-6736. PMID 25706969. S2CID 3202649.
  6. ^ a b c d e Thapa, Raksha; van Teijlingen, Edwin; Regmi, Pramod Raj; Heaslip, Vanessa (November 2021). "Caste Exclusion and Health Discrimination in South Asia: A Systematic Review". Asia-Pacific Journal of Public Health. 33 (8): 828–838. doi:10.1177/10105395211014648. ISSN 1010-5395. PMC 8592103. PMID 34024157.
  7. ^ "India's inequality in healthcare: the caste divide". Humanitarian Aid Relief Trust. Retrieved 2022-10-11.
  8. ^ Hays, Jeffrey. "DALITS (UNTOUCHABLES) | Facts and Details". factsanddetails.com. Retrieved 2022-10-11.
  9. ^ maria (2021-08-13). "India's health inequality severely affects Dalits". International Dalit Solidarity Network. Retrieved 2022-10-11.
  10. ^ a b c Verma, Sonia; Acharya, Sanghmitra Sheel (2018-05-04). "Social identity and perceptions about health care service provisioning by and for the Dalits in India". Social Identities. 24 (3): 327–338. doi:10.1080/13504630.2017.1376280. ISSN 1350-4630. S2CID 148799934.
  11. ^ Ghose, Sagarika (2003). "The Dalit in India". Social Research: An International Quarterly. 70 (1): 83–109. doi:10.1353/sor.2003.0032. ISSN 1944-768X.
  12. ^ Sutradhar, R. (2014). "Dalit Movement in India: In the light of four Dalit literatures". Iosr Journal of Dental and Medical Sciences. 13 (4): 91–97. doi:10.9790/0853-13459197. S2CID 1113226.
  13. ^ a b c d Ramaiah, Avatthi. "Health Status of Dalits in India". {{cite journal}}: Cite journal requires |journal= (help)
  14. ^ Refugees, United Nations High Commissioner for. "Refworld | World Directory of Minorities and Indigenous Peoples - India : Dalits". Refworld. Retrieved 2022-10-11.
  15. ^ Chandra, Priti (2021-08-18). "Understanding Reproductive Health Services in Eastern Uttar Pradesh, India: A Dalit Feminist Approach". Contemporary Voice of Dalit: 2455328X2110257. doi:10.1177/2455328X211025786. ISSN 2455-328X. S2CID 238698582.
  16. ^ a b c d "NGO's Role in Community Based Monitoring of Primary Health Care Services for Dalit Women in Urban Slums – Rupkatha Journal on Interdisciplinary Studies in Humanities". rupkatha.com. Retrieved 2022-10-11.
  17. ^ a b c d NimbleO, J.; Chinnasamy, A. (2020). "Financial Distress and Healthcare: A Study of Migrant Dalit Women Domestic Helpers in Bangalore, India". S2CID 221493480. {{cite journal}}: Cite journal requires |journal= (help)
  18. ^ Kumari, Meena; Mohanty, Sanjay K (2020-08-20). "Caste, religion and regional differentials in life expectancy at birth in India: cross-sectional estimates from recent National Family Health Survey". BMJ Open. 10 (8): e035392. doi:10.1136/bmjopen-2019-035392. ISSN 2044-6055. PMC 7440832. PMID 32819936.
  19. ^ a b c d e f g h i j k l "Inequality Report 2021: India's Unequal Healthcare Story | Oxfam India". www.oxfamindia.org. Retrieved 2022-10-11.
  20. ^ Borick, J. (2014-07-11). "HIV in India: the Jogini culture". Case Reports. 2014 (jul11 1): bcr2014204635. doi:10.1136/bcr-2014-204635. ISSN 1757-790X. PMC 4112301. PMID 25015167.
  21. ^ Bam, Kiran; Thapa, Rajshree; Newman, Marielle Sophia; Bhatt, Lokesh Prasad; Bhatta, Shree Krishna (2013-09-05). "Sexual Behavior and Condom Use among Seasonal Dalit Migrant Laborers to India from Far West, Nepal: A Qualitative Study". PLOS ONE. 8 (9): e74903. doi:10.1371/journal.pone.0074903. ISSN 1932-6203. PMC 3764178. PMID 24040359.
  22. ^ Vart, Priya; Jaglan, Ajay; Shafique, Kashif (2015-06-05). "Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005–2006". BMC Public Health. 15: 537. doi:10.1186/s12889-015-1881-4. ISSN 1471-2458. PMC 4456806. PMID 26044618.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  23. ^ Balla, Shalem; Sk, Md Illias Kanchan; Ambade, Mayanka; Hossain, Babul (2022-03-03). "Distress financing in coping with out-of-pocket expenditure for maternity care in India". BMC Health Services Research. 22 (1): 288. doi:10.1186/s12913-022-07656-5. ISSN 1472-6963. PMC 8892690. PMID 35241077.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  24. ^ Rawat, Ramu; Unisa, Sayeed (2021-10-01). "Association between nutritional status of scheduled caste children and their educational performance in rural Barabanki district, Uttar Pradesh, India". Clinical Epidemiology and Global Health. 12: 100849. doi:10.1016/j.cegh.2021.100849. ISSN 2213-3984.
  25. ^ Sabharwal, Nidhi Sadana; Sonalkar, Wandana (2015-07-27). "Dalit Women in India: At the Crossroads of Gender, Class, and Caste". Global Justice : Theory Practice Rhetoric. 8 (1). doi:10.21248/gjn.8.1.54. ISSN 1835-6842.
  26. ^ Thapa, Raksha; Teijlingen, E. van; Regmi, P.; Heaslip, V. (2018-12-20). "Uptake of Health Services by People from the Dalit Community". Journal of BP Koirala Institute of Health Sciences. 1 (2): 1–6. doi:10.3126/jbpkihs.v1i2.22072. ISSN 2616-0390. S2CID 169475504.
  27. ^ Rao, Nitya (2018-10-31). "Fertility, Reproduction and Conjugal Loyalty: Renegotiating Gender Relations amongst Dalits in Rural Tamil Nadu". South Asia Multidisciplinary Academic Journal (19). doi:10.4000/samaj.4575. ISSN 1960-6060. S2CID 150240636.
  28. ^ Awasthi, Mamata Sherpa; Awasthi, Kiran Raj; Thapa, Harish Singh; Saud, Bhuvan; Pradhan, Sarita; Khatry, Roshani Agrawal (2018-11-01). "Utilization of Antenatal Care Services in Dalit Communities in Gorkha, Nepal: A Cross-Sectional Study". Journal of Pregnancy. 2018: e3467308. doi:10.1155/2018/3467308. ISSN 2090-2727. PMC 6236651. PMID 30515327.
  29. ^ Bhatia, J. C.; Cleland, J. (March 2001). "Health-care seeking and expenditure by young Indian mothers in the public and private sectors". Health Policy and Planning. 16 (1): 55–61. doi:10.1093/heapol/16.1.55. ISSN 0268-1080. PMID 11238431.
  30. ^ Dutta, Swarup; Sinha, Ishita; Parashar, Adya (June 2018). "Dalit Women and Water: Availability, Access and Discrimination in Rural India". Journal of Social Inclusion Studies. 4 (1): 62–79. doi:10.1177/2394481118774487. ISSN 2394-4811. S2CID 158083595.
  31. ^ Navaneetham, K.; Dharmalingam, A. (November 2002). "Utilization of maternal health care services in Southern India". Social Science & Medicine (1982). 55 (10): 1849–1869. doi:10.1016/s0277-9536(01)00313-6. ISSN 0277-9536. PMID 12383469.
  32. ^ Kumar, Ajay (2021-10-08). "Sexual Violence against Dalit Women: An Analytical Study of Intersectionality of Gender, Caste, and Class in India". Journal of International Women's Studies. 22 (10): 123–134. ISSN 1539-8706.
  33. ^ Welle (www.dw.com), Deutsche. "India: Will sexual violence against Dalits ever end? | DW | 19.09.2022". DW.COM. Retrieved 2022-10-11.
  34. ^ a b Das, R, "How caste is disproportionately affecting the Dalits of South Asia in COVID-19 pandemics", International Dalit Solidarity Network
  35. ^ Jesline, Joshy; Romate, John; Rajkumar, Eslavath; George, Allen Joshua (2021-10-14). "The plight of migrants during COVID-19 and the impact of circular migration in India: a systematic review". Humanities and Social Sciences Communications. 8 (1): 1–12. doi:10.1057/s41599-021-00915-6. ISSN 2662-9992. S2CID 238862700.
  36. ^ Mondal, Sandip; Karmakar, Ranjan (2021-08-27). "Caste in the Time of the COVID-19 Pandemic". Contemporary Voice of Dalit: 2455328X2110363. doi:10.1177/2455328X211036338. ISSN 2455-328X. S2CID 239651245.
  37. ^ Agoramoorthy, Govindasamy; Hsu, Minna J. (2021). "How the Coronavirus Lockdown Impacts the Impoverished in India". Journal of Racial and Ethnic Health Disparities. 8 (1): 1–6. doi:10.1007/s40615-020-00905-5. ISSN 2197-3792. PMC 7587164. PMID 33104967.
  38. ^ Amnesty International, Wateraid, and International Dalit Solidarity Network, 'South Asia: Authorities must urgently protect sanitation workers risking their lives on the COVID-19 frontlines', Index Number: ASA 04/3349/2020, 19 November 2020, https://www.amnesty.org/en/wp-content/uploads/2021/05/ASA0433492020ENGLISH.pdf
  39. ^ Malik, Gayadhar (2022-08-27). "Response of Local Government towards the Rural Dalits during the Second Wave of COVID-19: A Ground Experience from Remuna Block in the Balasore District of Odisha". Contemporary Voice of Dalit: 2455328X2211156. doi:10.1177/2455328X221115610. ISSN 2455-328X. S2CID 251916344.
  40. ^ Saxena, Akanksha (2021-11-25). "33% Muslims, 20% Dalits And Tribals Faced Discrimination On Accessing Healthcare: Oxfam Study". thelogicalindian.com. Retrieved 2022-10-11.
  41. ^ Chandola, Basu. "Exploring India's Digital Divide". ORF. Retrieved 2022-10-11.
  42. ^ Kumar, Dhananjay; Kumar, Dhiraj (November 2016). "Dalit Children Dropout in Schools: Need for Inclusive Curriculum". Contemporary Voice of Dalit. 8 (2): 124–135. doi:10.1177/2455328X16631053. ISSN 2455-328X. S2CID 152072512.
  43. ^ Thorat, Sukhadeo; Attewell, Paul (2007). "The Legacy of Social Exclusion: A Correspondence Study of Job Discrimination in India". Economic and Political Weekly. 42 (41): 4141–4145. ISSN 0012-9976. JSTOR 40276548.
  44. ^ Gowtham Devanoor P, Bhanupratap A., M.Dileep Kumar and Dr. B.P.Mahesh Chandra Guru "Social Change and Development of Dalits" Published in International Journal of Trend in Research and Development (IJTRD), ISSN: 2394-9333, Volume-4 | Issue-1 , February 2017, URL: http://www.ijtrd.com/papers/IJTRD7713.pdf
  45. ^ Aug 26, Subodh Ghildiyal / TNN /; 2016; Ist, 05:43. "Five-year plan junked, fate of Dalit sub-plans worries MP | India News - Times of India". The Times of India. Retrieved 2022-10-11. {{cite web}}: |last2= has numeric name (help)CS1 maint: numeric names: authors list (link)
  46. ^ Monaghan, B. J.; Malek, A. M.; Simson, H. (2001). "Public-private partnerships in healthcare: criteria for success". Healthcare Management Forum. 14 (4): 44–49. doi:10.1016/S0840-4704(10)60424-3. ISSN 0840-4704. PMID 11855210. S2CID 42492026.
  47. ^ Ganesan, Deekshitha (June 2022). "Human Rights Implications of the Digital Revolution in Health Care in India". Health and Human Rights. 24 (1): 5–19. ISSN 1079-0969. PMC 9212836. PMID 35747286.
  48. ^ "Rural Health Care System in India".
  49. ^ "Central Government Health Scheme".
  50. ^ "Universal Health Insurance Scheme".
  51. ^ "Aam Aadmi Bima Yojana".
  52. ^ "National Health Authority | GOI". nha.gov.in. Retrieved 2022-10-11.
  53. ^ a b c Sarwal and Kumar. "The Long Road to Universal Health Coverage".
  54. ^ "Healthcare Continues to Remain Inaccessible for Dalits and Adivasis, Says Study". NewsClick. 2022-04-30. Retrieved 2022-10-11.
  55. ^ Kabir, Ashraful; Maitrot, Mathilde Rose Louise; Ali, Ahsan; Farhana, Nadia; Criel, Bart (2018-12-14). "Qualitative exploration of sociocultural determinants of health inequities of Dalit population in Dhaka City, Bangladesh". BMJ Open. 8 (12): e022906. doi:10.1136/bmjopen-2018-022906. ISSN 2044-6055. PMC 6303619. PMID 30552259.
  56. ^ Mishra, Prem Shankar; Veerapandian, Karthick; Choudhary, Prashant Kumar (11 March 2021). "Impact of socio-economic inequity in access to maternal health benefits in India: Evidence from Janani Suraksha Yojana using NFHS data". PLOS ONE. 16 (3): e0247935. doi:10.1371/journal.pone.0247935. ISSN 1932-6203. PMID 33705451.
  57. ^ Ministry of Health and Family Welfare Facilities, https://main.mohfw.gov.in/sites/default/files/2752433081Facilities%20for%20SC-ST.pdf
  58. ^ Thakur, Gargi; Thakur, Shalvi; Thakur, Harshad (2020-10-12). "Status and challenges for tuberculosis control in India – Stakeholders' perspective". The Indian Journal of Tuberculosis. 68 (3): 334–339. doi:10.1016/j.ijtb.2020.10.001. ISSN 0019-5707. PMC 7550054. PMID 34099198.
  59. ^ Mosse, David (2018-10-01). "Caste and development: Contemporary perspectives on a structure of discrimination and advantage". World Development. 110: 422–436. doi:10.1016/j.worlddev.2018.06.003. ISSN 0305-750X. S2CID 158517614.
  60. ^ Nancharaiah, G. (September 2000). "Economie development of dalits and 50 years of Independence: A macro analysis". Social Change. 30 (3–4): 123–142. doi:10.1177/004908570003000409. ISSN 0049-0857. S2CID 143195823.
  61. ^ Saurabh, Suman; Sarkar, Sonali; Pandey, Dhruv K. (2013). "Female Literacy Rate is a Better Predictor of Birth Rate and Infant Mortality Rate in India". Journal of Family Medicine and Primary Care. 2 (4): 349–353. doi:10.4103/2249-4863.123889. ISSN 2249-4863. PMC 4649870. PMID 26664840.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  62. ^ Lam, Yukyan; Broaddus, Elena T.; Surkan, Pamela J. (2013-12-13). "Literacy and healthcare-seeking among women with low educational attainment: analysis of cross-sectional data from the 2011 Nepal demographic and health survey". International Journal for Equity in Health. 12 (1): 95. doi:10.1186/1475-9276-12-95. ISSN 1475-9276. PMC 3878725. PMID 24330671.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  63. ^ Gokhale, Nihar. "Across India, Dalits are still fighting to claim lands promised to them". Scroll.in. Retrieved 2022-10-11.
  64. ^ Mohanty, B. B. (2001). "Land Distribution among Scheduled Castes and Tribes". Economic and Political Weekly. 36 (40): 3857–3868. ISSN 0012-9976. JSTOR 4411206.
  65. ^ Vimala Ramachandran and Sapna Goel, Tracking Funds for India’s Most Deprived: The Story of the National Campaign for Dalit Human Rights’ “Campaign 789”, Study No. 6, August 2011, https://internationalbudget.org/wp-content/uploads/LP-case-study-NCDHR.pdf
  66. ^ Webster, John C. B. (1996). "Understanding the Modern Dalit Movement". Sociological Bulletin. 45 (2): 189–204. doi:10.1177/0038022919960203. ISSN 0038-0229. JSTOR 23620218. S2CID 148340370.
  67. ^ ICAAD (2017-11-10). "Expanding Data Collection for Dalit Communities in New Delhi". ICAAD. Retrieved 2022-10-11.
  68. ^ Fraser, Erik (2010-06-23). "The Dalits of India: education and development". E-International Relations. Retrieved 2022-10-11.