Moderated by Deputy Associate Editor Udit Misra, this edition had panelists discuss healthcare provisions for migrants, the need for community-based health services and universal health coverage
On need for policy interventions
AJOY MEHTA: What are the kind of policy interventions that we are looking at when we look at the health of migrants? First and foremost, let us not look at it as an enforcement issue or demographic danger. It is a human problem that needs to be dealt with compassion. Mumbai provides free healthcare in its corporation hospitals, which are well stocked in terms of human resource and equipment, but how many migrants know that medical care here is free? Even if they knew, how many migrants would walk into a municipal hospital and demand the service?
On gender specific issues
DR VANDANA PRASAD: Single-person migration is mostly male, but we have women who come as construction workers, teachers and nurses for the rest of their families. So the economic distress has a strong kind of feminisation to it. That has also translated into health issues because we know that malnutrition and anaemia amongst women are very high in India. Also, when migrants went back home, in many places they were welcomed, and panchayats made efforts to take them back. In many places, it was the opposite. So arranging for community-based facilities for quarantine, isolation, particularly with respect to migrants who are coming back, is important.
On the alienation of migrants
DR PAVITRA MOHAN: What we were seeing (last March) was not so much affected by Covid, but was related to the closure of all health services, absence of transportation, an acute shortage of food, which led to an increase in diseases like tuberculosis. Government services were focused either on Covid or nothing, and because of that childbirth significantly increased at home, leading to an increased risk of maternal deaths, etc. In some areas, we saw what is known as a syndemic, where Covid was there, but it was also associated with a sharp increase in tuberculosis. In high migration areas, the malaria epidemic also started rising with very limited access to care.
In villages, we saw a one-and-a-half times increase in malnutrition levels among children.
For the next several months, when Covid, even in the cities, declined before the second wave, one of the things that was a remnant of the first wave was the way migrants were treated when they returned. In general, they don’t feel assimilated in the cities. But during this time, they felt further alienated. That had a huge impact before the second wave, when immunisation was being promoted. That alienation from the system led to a lot of distrust and failure to accept vaccines. Reclaiming of trust among the migrant population is extremely important.
On community participation
UMA Mahadevan: We’ve been talking about community-based healthcare services. My team has created a platform for a pandemic response, connecting requests for help with the offices of support, mapping of all the government facilities, service delivery units, nearest anganwadi, nearest Primary Health Center, post office, bank branch, police station, Indra canteens. It’s possible to connect with nearby civil society groups who may be able to help. It should be doable and in (different) languages. We can have call centres and migrant resource centres and can give welcome kits to all migrants with details of the nearest services.
On universal health coverage
K Srinath REDDY: It’s not really useful for us to say that we should only examine what happened to them (migrants) during the Covid period. That was an acute exacerbation of long-standing neglect. There are a number of sections of our population who are actually deprived of essential health services, in terms of accessibility, appropriate care and affordability. That is why we call for universal health coverage, not merely to protect human productivity, which seems to be the preoccupation of those who look at migrants as a human resource, but also looking at it as an essential human right.
On the need for better living conditions
Dr Pavitra Mohan: Living conditions are one of the very central determinants of the health of the migrants. You cannot talk of health if 50 people are living in a room without water, without a toilet, without ventilation. In times of Covid, we have understood the value of ventilation. But, before that, a lot of them were suffering from tuberculosis. Maybe, subsequently, we can think of what are the policy ways to promote safe, secure and healthy housing. Most developed countries have invested in safe housing for migrants and for the population in the cities and that has been central to how public health developed. The second is working conditions. We see so many cases of silicosis in south Rajasthan, where people are dying in their 30s and 40s because they have been involved in stone carving or mining.
The third is access to healthcare. It is not portability alone because, as a citizen of the country, health is a fundamental right. Ideally, you should not need to carry anything. The policy should be towards universalising access to healthcare for migrants, irrespective of whether the documentation is there or not.