Inequity in health care sector in India: A case study of district level in four Indian states

Across the nations, national health policies, including that of India, have emphasised a preference for equitable health care facilities. Keeping this emphasis on equity in mind we explored four Indian states using sub-state level (or district level) data. We applied mainly three well established indicators, namely Gini coefficient and Thiel’s T and L indices to gauge magnitudes of inequity. We compared our results between two periods for the same state which included one high income and another low income Indian state. Also we compared across four states, namely, Punjab, Karnataka, Madhya Pradesh and West Bengal using the information for latest available year. Our results indicate that government investment in three tier health facilities expansion indeed has resulted in low inequities in terms of health facilities available. However, private health facilities or certain specific public health facilities do not seem to be much equitable particularly at the substate level. Our results focus on availability aspects and thus necessarily do not indicate equitable utilisation of health care facilities or health care outcomes at the district levels.