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

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.