Rural India vs Covid-19: Train curbs a relief but challenges remain

Railway Minister Piyush Goyal’s announcement on stopping even long-distance train services, barring goods trains, may come as a boon for rural areas. 

The people, reportedly rushing back after governments began shutting down major cities, may well be heading to regions more vulnerable to the pandemic. Many are said to be returning to their families in rural India.

A major pandemic like the coronavirus (COVID-19) is more likely to leave the average rural Indian in greater debt; and he or she is also less likely to be able to find the necessary infrastructure to seek treatment, shows an analysis of the government data. Around 24.9 per cent of rural households reported the major source of hospitalisation expenditure as borrowings. It is 18.2 per cent for urban India (see chart 1). This is based on information from the Key Indicators of Social Consumption in India- Health, 2014, NSS 71st Round data found in the 2019 National Health Profile. Other data from the profile suggests that hospitalisation may itself be a challenge.

Rural India had 3.2 government hospital beds per 10,000 people. The urban number is 11.9 (see chart 2). The data looks at government hospitals as this is most accessible to the public. 

But even government hospitals are skewed in location. Over two-thirds of the population is in rural areas, according to the last Census. But it has only over a third of the hospital beds, the data shows. There are more government hospital beds in urban rather than rural areas individually in the majority of states and Union Territories too, showed an analysis of the data.

Source: NHP 2019

The study also looked at hospital beds relative to their urban or rural population. Many major states have significantly lower number of rural beds than the national average. Uttar Pradesh is at 2.5 beds per 10,000 people in rural areas. Rajasthan and Jharkhand are at 2.4 and 2.3, respectively. Maharashtra, which has seen the largest number of cases, is at 2. Bihar is at 0.6 (see chart 3).

Private sector hospital beds account for 40 per cent of the market, according to an India Brand Equity Foundation’s February 2018 note on India’s health care segment. 

But major hospital chains are concentrated in metro cities, according to an August 2019 ‘Re-engineering Indian Healthcare 2.0’ paper from industry body Federation of Indian Chambers of Commerce and Industry (FICCI) and consultancy firm EY. 

The report also noted that most people find hospitalisation to be a financial blow.

“Cost of a single episode of hospitalisation was at least 2X of the average annual expenditure, if availed in a private facility for the bottom three quintiles of population, i.e., 60 per cent of population,” it said.

The report added that the cost of a single hospitalisation even in a public facility is equal to a whole year’s expenditure for the bottom 20 per cent of the population. 

The introduction of insurance through Ayushman Bharat may provide some cushion, though health coverage is not yet universal.

Source: National Health Profile 2019, Census 2011, BS calculations

The report noted that the total number of hospital beds in India may number 1.6 million, but with a similar skew towards urban areas. The 900,000 doctors mentioned in the report are also largely in urban areas.

Other countries such as Italy and France, which announced lockdowns, reportedly had people fleeing to areas less affected, including provincial towns. This, according to some, may have contributed to the spread of the disease.