Understanding Dalit equity: a critical analysis of primary health care policy discourse of Kerala in the context of ‘Aardram’ mission

Abstract

Background The Government of Kerala in 2017 launched the Aardram Mission with the aim to revamp public health delivery in the State. A key strategy under the mission was its focus on comprehensive primary health care to achieve equitable health care delivery through the Family Health Centre (FHC) initiative. Given this, the current study aims to examine the primary health care policy discourse for their perspectives on caste-driven inequities. Methods The study undertook a Critical Discourse Analysis (CDA) of the primary health care policy discourse in Kerala. This included CDA of spoken words by senior health policy actors and policy texts on Aardram Mission and FHC. Results Though equity was a major aspirational goal of the Mission, related policy discourse around equity failed to acknowledge caste as a potential axis of health marginalisation in the State. The dismissal of caste manifested in three major ways within the policy discourse. One, the ‘invisibilisation’ of caste-driven inequities through strategies of (un)conscious exclusion of Dalit issues and ‘obliteration’ of caste differences through the construction of abstract and homogenous groups that invisibilise Dalits. Secondly, locating caste as a barrier to primary health care initiatives and health equity in the state, and finally through the maintenance of an ‘apoliticised’ social determinants discourse that fails to recognize the role of caste in shaping health disparities, specifically among Dalits in Kerala. Conclusion Given Kerala’s renewed commitment to strengthening its public health provisioning, the acknowledgment of caste-driven inequities is invariable in its path toward health equity and social justice.

Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data

“…precluded other social disparities, such as religion and caste, as a potential axis of healthcare marginalization (65). The multivariate regression estimates also underscored the role of enabling factors such as the absence of insurance coverage and treatment-seeking in private facilities to increase the CHE significantly.…”

“…Additionally, other predisposing socio-structural factors, such as affiliation with the marginalized social group and practicing the religion of Hinduism, are associated with higher CHE, which is consonant with the other studies conducted in India ( 62–64 ). Although equity has been a primary goal of the flagship programs launched by the Government of India, the related policy discourse has been focused on the praxis of wealth-related inequalities and has precluded other social disparities, such as religion and caste, as a potential axis of healthcare marginalization ( 65 ). The multivariate regression estimates also underscored the role of enabling factors such as the absence of insurance coverage and treatment-seeking in private facilities to increase the CHE significantly.…”

Correction: Leaving no one behind on the road to Universal Health Coverage: The Kerala story

“…The original publications [ 1 – 5 ] did not contain an abstract in Malayalam. To increase the accessibility of these publications the Malayalam language abstracts of these articles are available as Supplementary files .…”