Nickeled & Dimed

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By Praharsh Prasoon

“Financial problems are so severe we barely manage two rounds of meals a day, forget about healthcare and living,” said Mahendri, a resident of Narela.

Disclaimer: The following investigative report was originally conducted in December 2021 to highlight the dimensions of urban poverty. The author directly interviewed the residents of Narela. The interviewees consented to be quoted in the report that, they were informed, would be published.

“…A lump has grown over my son’s chest because of chronic asthma. There are no affordable hospitals around where we live which has made it very difficult for us to give him proper medical care,” said Vikas, 34, a housekeeping staff member at Ashoka University, a private university in Sonipat, Haryana. Vikas lives in Indira Nagar, Narela, a sub-city tehsil located in the North Delhi district of Delhi, forming the border of Delhi with Haryana.

The State of Healthcare in India

In her book The Commodification of India’s Healthcare Services, Kaveri Gill, a political economist and Associate Professor at the Department of International Relations and Governance Studies, Shiv Nadar University, New Delhi, argues that access to healthcare in India is still highly uneven among people from different classes. The country is reeling under a “dual-disease burden” of both communicable (24.4 percent) and non-communicable (39.1 per cent) diseases. Gill also mentions that for low- and middle-income communities, availing proper healthcare facilities becomes extremely difficult because India’s healthcare system is one of the most heavily privatized in the world on various terms, with government spending revolving around 1 percent of the GDP for decades.

“We have so far been able to afford my son’s medicines only because of a card the support staff have received from the university that reimburses our cost of medicines. But the pharmacists don’t share the bills with us despite our requests.”

Vikas also mentioned that his son’s condition had gotten critical one night and he had to rush him to the nearest government hospital which is around 25 kilometers from his house in Rohini. But the doctor denied treating his son unless he got the bills for the medicine his son had taken previously. “One thing is that it takes quite long to reach the hospital and upon this, the doctors get adamant about unnecessary issues regardless of our urgency.” On asking why he didn’t go to a nearby hospital, he said, “All of them are private. They will charge us thousands of rupees if we go. Where will we eat from then? I earn merely 11,000 a month.”

According to a National Sample Survey Office survey in 2015, India’s private healthcare can cost 20 percent of the poorest Indians more than 15 times their average monthly expenditure. Contrarily, the government hospitals, though cheaper, lack cleanliness and basic amenities. According to Oxfam’s Commitment to Reducing Inequality Report 2020, India ranks 154th in health spending, fifth from the bottom. A 2021 Oxfam Report on India’s Healthcare says that between 2010 and 2020, the number of hospital beds per 10,000 people reduced from 9 to 5. Currently, India ranks 155 out of 167 countries on the availability of beds and has 8.6 doctors per 10,000 of its population.

Sagar, 32, a landless agricultural laborer in Singhola village which is located in Narela Tehsil of North West Delhi, was denied treatment in a government hospital due to a lack of sufficient beds. “After looking after him for two days, we rushed him to a nearby government hospital. But we were told to go back as beds weren’t available. We treated him with medicines and hot fluids for ten days. He survived by God’s mercy.” On asking whether he tried going to a private hospital, he said, “We couldn’t even think of private hospitals. I earn 10,000 a month. There is no question, I could not have afforded it.”

An official in the Department of Health and Family Welfare in the Delhi Government who did not want to be named said, “During the second wave of COVID-19, the situation varied in different hospitals across Delhi. In some hospitals, there were sufficient beds for patients while in others, there was a shortage of beds. We tried our best to increase the bed availability in these hospitals. We also demanded around 7,000 beds from the Center and received over 2,000 as was highlighted in the news then. Overall, the situation was tight – there is no question about that.”

Mahendri, 46, a housekeeping support staff member at Ashoka University from Pana Udyan, Ravidas Nagar, Narela, has a similar plight as Sagar’s. “My salary is 11,600 a month and after deductions, I get around 9,500 a month…Financial problems are so stiff we barely manage two rounds of meals a day, forget about healthcare and living,” she said.

Mahendri’s salary once got deducted further as she had to take a few days off for his son’s medical treatment. “My son has had chronic seizures. And while we are fortunate to have his medical expenses covered by his university, we still had to spend around 800-1,000 from our pocket. There is a government hospital nearby but the facilities are so poor. We have to wait for hours to get an appointment. And the doctors are rude to us too. We usually have to visit private pharmacies in our locality that charge exorbitantly. We have no option but to delay our health-related needs often because…where will we manage all this in a meager income? We have barely managed to find a house worth living in for ourselves.”

Lack Of Safe And Affordable Housing

Building regulations were not applicable in urban villages in Delhi until recently where a large proportion of the urban poor now resides, a Business World report by Ranjit Sabikhi points out. As a result, several floors were added to some buildings on an ad hoc basis, consisting of single-room bed-sitters and two-room apartments affordable for students and small families. These villages have now gotten heavily overbuilt.

The dingy, congested one-room house that Mahendri rents costs her 5,000 a month. “We have a small house in my father-in-law’s name, even though there has been no registry of houses in the village. We just informally know who owns them.”

Sagar lives in a room that his employer, who is a landowning farmer, has given him at one corner of his residence. Sagar’s family lives in a rented one-room house that costs him 3,500 a month.

While Vikas has inherited a small two-floor house in Narela and 120-acre land at Sonparakh in Nangloi, a locality in the West district of Delhi, from his father, the land has been barren for decades because of financial constraints. His father bought the land from Vikas’s uncle, who is an administrative officer, and was asked to pay in installments. “My uncle is well-off but keeps pressing us for payment at times,” says Vikas. “I would have used the land for cultivation. We would at least have got some food for ourselves. That would have put a lot of burden off my shoulders.”

The Broken PDS System

Vikas can barely afford food at market prices. But there are no functioning Public Distribution System shops nearby. He had made a ration card earlier whose details turned out to be incorrect. By the time he submitted the application for correction, the card was canceled. “We cannot get it remade because we have been told the government has closed the applications. So, we borrow food from the grocery stores as and when needed.”

An audit of ration shops undertaken by Delhi Rozi Roti Adhikar Abhiyan (DRRAA) of 110 ration shops in Delhi found that nearly 40% of the shops visited were closed during working hours. The report also mentions that while food grains are being provided only to people with valid ration cards under the Public Distribution System of the National Food Security Act, about 72.7 lakh people, that is, roughly 37% of the population of Delhi, have ration cards. 

Mahendri’s multiple visits to government offices for getting the ration card made has left her disappointed. “The clerks asked me to fill an online form. I went to the cybercafé to fill out the online application but they told me that the government had closed the application and that it would reopen only after elections. I have been going for years and getting the same answers. So, I just pay for the ration at the end of the month. But I haven’t been able to pay regularly because it gets difficult to manage this with my children’s education.”

The Delhi government made the regular allotment free under the National Food Security Act. But as per the report, the benefits of these announcements have still not reached several targeted groups.

“Kejriwal had said that he would provide free ration for six months. But I got it only once, when I went to the PDS shop around July. When I went again, the shopkeeper said it had been closed,” said Mahendri.

Sharat Kumar, Sub-Divisional Magistrate of Narela, could not be contacted for queries about the situation of the Public Distribution System in Narela.

Sagar is also now fed up of making rounds of government offices for his ration card and hearing they are yet to open the applications. On asking whether he tried to reach out to a higher government authority for this issue, he said, “You know these babus. We are here and they are far up there. Who among us would want to get into trouble?”

While the government schemes and provisions to uplift the urban poor have been highly appreciated, especially during the pandemic, its infrequent and uneven benefits are testimony to the fact that there is much more that still needs to be done.

Praharsh Prasoon is a final-year undergraduate student majoring in Psychology and minoring in Media Studies.

Image credits – News Pathways

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