Inequality and Inclusion in Primary Health Care System in India: An Interstate Analysis

The trajectory of primary health care system in India is at crossroad with the gradual withdrawal of state from health sector. However, there are efforts to revamp the organisation and delivery of health care in rural areas with the introduction of National Rural Health Mission (NRHM) in 2005. Within this context the present study tries to analyse the internal differences in health care outcome in India and its relation to the social determinants of health. Secondary data analysis showed that there are wide inequalities existing between different states in terms of various indicators of health development. The state of Kerala stands out in terms of its achievements on major indicators and often hailed as kerala model of health development, whereas the state of Assam performs lowest in most of these indicators. However the state of Assam is the only state in India, which included health as one of the basic right to its citizen. A secondary analysis combined with an ethnographic field work in these two states revealed that the inequalities between these states and within the states are complex and a unitary model of inequity determinants fails to answer the complexity. Thus the social health determinants models needs to be re-looked from the vantage points of the local context. The study also highlights the pitfalls of government policy of inclusive health development, which still struck with the centralized decentralization of primary health care. Thus the policy of including the excluded in the delivery of health care in India needs to be informed by the local complexity of inequity structures and processes.