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                                                                          (Photo: Singularity Hub)

  Men form one-third of a typical medical school’s population; Rest of the seats are all occupied by women. The pay gap in the healthcare sector is 25% higher than any other sector. Most women agree to work at low wages because of the financial crises they face. Gender inequality is leading to a shortage of healthcare workers in the sector. Women in India face “extensive gender discrimination” in access to healthcare. Gender inequality is leading to a shortage of healthcare workers in the sector because obviously only one-third of the seats were taken by men. 

Under the National Health Mission, the government has launched several schemes. The most important program launched by the government is Rashtriya Arogya Nidhi which provides financial assistance to the patients that are below poverty line and are suffering from life-threatening diseases.  Rashtriya Swasthya Bima Yojana is a government-run health insurance program for the Indian poor. It aims to provide health insurance coverage to the unrecognized sector workers belonging to the below poverty line.  National AIDS Control Organization was set up so that every person living with HIV has access to quality care and is treated with dignity.  Anganwadi Workers and the ASHA workers are the grassroots level functionaries under the umbrella ICDS Scheme and the National Health Mission respectively.  Both these functionaries being closely connected with the rural and urban poor families, play a pivotal role in addressing their nutrition and health related problems/issues.

How the Government has failed them ?

·        Do not have regular salaries, partly because their work is supposed to be voluntary and part-time.

·        Even though the Code on Social Security, 2020 aims to include formal and informal sectors under a social safety net, it excludes several categories of workers, including ASHA and Anganwadi workers. The Code on Wages, too, has left this constituency out of its coverage, depriving employees of a fixed minimum wage.

·        As per Modi government’s definition, Anganwadi and ASHA workers are not ‘workers’ but only ‘volunteers’, who do not receive any ‘wage’ but only an ‘honorarium’! So the principle of minimum wage would not apply to these scheme workers.”

Also a gender issue

·  Limited space for career progression is linked to low institutional recognition, demotivation, and curtailed opportunities for growth. ASHAs face sexual harassment by other health workers and community members, linked to their mobility and public profile. ASHAs have worked to further women’s interests, particularly in Chhattisgarh state where Mitanins(the name for ASHAs there) have mobilized protests against alcoholism, supported women’s collectives and taken action against gender based violence. ASHAs have begun taking action to mobilize their peers to reduce gender based violence. ASHAs have reported an increased sense of empowerment and personal growth, in part through their belief in the social value of their work.

     Gender as a social determinant of health

  •     The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.
  •          The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.
  •        The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:

              1.Income and social protection

              2. Education

              3.Unemployment and Job security

  •      Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.
  •     Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil .
  •      Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.”
  •      In addition to the more material attributes of “place, ” the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services and, environments free of life-threatening toxins.
     Reproductive rights in India
     Reproductive Rights are rights of individual to decide freely and responsibly the number, spacing and timing of children. It is individual’s right to decide whether to reproduce and have reproductive health. The Supreme Court of India and several state high courts have recognized the importance of reproductive rights and have observed that the denial of reproductive rights is violation of women's fundamental and human rights.
     Courts have been at the forefront of expanding, protecting, and promoting reproductive rights. court through its various judgements from time to time has promoted and protected the reproductive rights of women. for instance, Puttaswamy judgment, Suchita Srivastava V. Chandigarh Administration, Navtej Singh Johar V. UOI. 
     Role of socio-physical environment in health care
     Social determinants of health are the conditions in the environment where people sustain, i.e. they born, live, learn etc., which affects the health, functioning and quality of life outcomes and risks. Health starts from our localities, our homes, schools, communities where it is also examined by our access to social and economic opportunities. So, social determinants of health are designed to identity ways to create social and physical environment that promote good health.


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