Coping with Regional Disparities in Services During a Pandemic

mage courtesy of Centre for Poverty Analysis

NADHIYA NAJAB-10/31/2021

The access to and distribution of public services have a history of uneven and unequal distribution across geographies due to scarce resources, contextual factors and competing interests. This disparity is most visible in our national income poverty rate which stands at a commendable 4.1%. When disaggregated by sector or by district however it is possible to observe the variations. At 8.8%, the estate sector records almost double the poverty rate; while the conflict affected northern and eastern provinces show the highest income poverty levels at 7.7% and 7.3% and is in stark contrast to the 1.7% recorded for the western province.

In a series of focus group discussions held with Regional Government and Civil Society representatives in Nuwara Eliya and Batticaloa (two of the poorest districts in Sri Lanka) in May this year, the participants highlighted some of the current challenges they experienced as a consequence of the pandemic with a particular focus on the health and education sectors.

Accessing health care during a pandemic

The unprecedented nature in the spread of the novel coronavirus has worsened existing disparities. In the healthcare sector where disparities in access, capacity and varied quality of service provision existed pre-pandemic, dealing with COVID-19 has only added fuel to the fire. Since staff capacity does not always match the population density of a region, in some parts of Nuwara Eliya, a single public health midwife may find herself responsible for the wellbeing of 22,000 families. Given existing difficulties in accessing some of these far-flung communities, the stress placed on the healthcare professional as well as the community is quite high. Such ground realities highlight the unequal distribution of resources across the health care system that hampers better services and quality of care, especially to cope with a health pandemic.

On the other hand, patients themselves have faced difficulties in accessing the public healthcare system. Although free healthcare is available through state-run institutions across the country, specialist care (paid and free) is limited mainly to the few national and other larger hospitals in a handful of major cities. Thus scarcity of healthcare facilities in the Nuwara Eliya district, for example, would require a patient to travel an average of 40 to 50 kilometres to access treatment with long wait times due to understaffing. The periods of movement restrictions and the lack of access to public transport resulted in poorer people either having to source alternative modes of transport incurring additional costs or forgoing treatment and/or attending regular check ups.

The lack of facilities within these public healthcare units also weakened the response rate to the spread of COVID-19. As officials in Batticaloa pointed out, only the teaching hospital in Batticaloa had the capacity to conduct PCR tests for the entire province. During the height of the second wave, the capacity proved to be insufficient to identify and direct affected individuals towards quarantine and treatment facilities promptly thus affecting the effective responses.

Widening disparities in education

Another key area of public service that has struggled to cope during these past 18 months is the public education system. Similar to the healthcare sector, regional disparities in access to education have also widened as a consequence of COVID-19. While inequalities in education services existed due to differences in learning facilities, teacher cohorts, skills and qualifications, the sudden shift to distance/digital learning lasting almost a year had considerable impact on students’ ability to learn. It became clear very quickly that access was largely determined by the economic status of the household and access to devices as well as internet coverage. There were also concerns regarding the quality of teaching.

In the Central Province, it is surmised that the switch to a virtual mode of teaching has not been effective primarily as only 40% of the students could be  reached due to poor internet coverage. Stakeholders have raised concerns that the limited access to schooling would be reflected in the next public examination results and would likely result in even higher school drop out rates particularly in the Nuwara Eliya district, which already has the highest drop out rates in the Central Province. The potential for poorer children in non-urban and hard-to-reach communities to be left behind in terms of education attainment is quite high. These disparities would further widen the existing education disparity among students from urban, rural and estate sectors.

More worryingly, concerns are raised about children having to bear the brunt of the loss of incomes and livelihoods of their parents. In some educational zones in Batticaloa, approximately 36% of parents were engaged in daily wage labour and were not able to afford the additional cost associated with online learning due to the decline in income generation opportunities. As priorities for the family shift, it is feared that a significant percentage of young students have left schooling to support their families in their livelihood activities in an attempt to contribute to the household income. When the pandemic eventually settles, these students who dropped out will be at a severe disadvantage compared to their counterparts.

What’s next?

Sri Lanka’s long standing commitment to provide health and education as public services has helped the country reap long term benefits. However, it has taken an unprecedented health emergency to bring into sharp focus the ways in which existing regional disparities can result in poorer and socially marginalised groups in society becoming less able to cope. As state and non-state entities consider how best to support Sri Lanka “build back better”, addressing these existing disparities would be key. The pandemic has indeed provided us with an opportunity to “re-set” and reconsider how best to make optimal use of these public services in order to protect the most vulnerable in societies. This would mean paying closer attention to these identified regions by articulating and adopting a plan that strengthens the service frameworks within these regions.

This article is the third of five published on the CEPA Blog as part of a series to understand the impacts of COVID-19 on poverty and inequality.