Tribal Health in India

Tribal health in India is still an area of concern after more than seven decades of independence. They are the most neglected population when it comes to healthcare. There have been committees set up and reports published on the matter but more attention and action are still needed. Read here to understand more.

There is a vast disparity between the health outcomes of India’s tribal population vis-à-vis its non-tribal population.

Aggravating this problem is the near complete absence of data and information on the health and nutrition situation of different tribal communities. This often emerges as the biggest bottleneck to decision-makers as they design policies and interventions to address these gaps.

Tribal Health in India

In India, tribal people make up 8.9% of the total population, yet they continue to be the most underserved and ignored group in terms of access to healthcare.

• In tribal communities, newborn mortality is 63% higher than the national average, according to a study by the Ministry of Tribal Affairs, and the death rate is 44% higher.
• This demonstrates the essential need to empower native communities and guarantee them fair access to healthcare.
• Their problems are complex and include things like a lack of money, medical staff, infrastructure, connection, cost, and a variety of other things.

The “Particularly Vulnerable Tribal Groups” (PVTGs), often referred to as the “Primitive Tribes,” comprise around 2.6 million (2.5%) of the total population of Schedule Tribes and are the most underprivileged of all Schedule Tribe populations.

• They are dispersed over several states but are more prevalent in Madhya Pradesh, Maharashtra, Odisha, Chhattisgarh, Rajasthan, the NER states, and the Andaman & Nicobar Islands.

In India, tribal groups deal with a variety of difficulties and disadvantages related to poverty, illiteracy, malnutrition, health, employment, infrastructure, and human rights.

• Indicators of human development including income, education, health, sanitization, and gender equality show that they trail behind the national average in these areas.
• Additionally, non-tribal individuals and institutions abuse them via violence, exploitation, relocation, and prejudice. The possibilities and resources available to them for empowerment and involvement are scarce.

The United Nations Declaration on the Rights of Indigenous Peoples (tribal populations) refers specifically to the right to health (articles 21, 23, 24, and 29), with particular attention to the needs of indigenous elders, women, youth, children, and persons with disabilities.

• It states that indigenous peoples have the right to be actively involved in developing and determining their health programs, the right to their traditional medicines, maintain their health practices, and the equal right to the enjoyment of the highest attainable standard of physical and mental health.

Challenges for Tribal Health care

• Tribal people do not consume enough or the proper kind of food to maintain their health. They struggle with malnutrition, anemia, stunting, wasting, and hunger.
• Due to several conditions, including inadequate sanitation and hygiene, and limited access to healthcare, tribal people are more susceptible to contracting communicable diseases such as malaria, Tuberculosis, leprosy, HIV/AIDS, diarrhea, respiratory infections, and diseases carried by insects or animals.
• People from tribal groups are also susceptible to developing chronic illnesses including cancer, cardiovascular disease, diabetes, hypertension, and mental problems.
• Genetic diseases like sickle cell anemia are also prevalent among the tribal population.
• Compared to 56% and 30% of non-tribal males, more than 72% of tribal men aged 15 to 54 use cigarettes, and more than 50% drink alcohol.
• Most tribals don’t know their age or date of birth which hinders the census of life expectancy for healthcare planning.
• Early marriage, early childbirth, low BMI, and high incidence of anemia are critical reasons for high maternal mortality.
• Child health indicators for the scheduled tribes are poor and worse than the general population.
• Micronutrient deficiency among the tribal population is rampant according to the National Nutrition Monitoring Bureau (NNMB).

Rapid deforestation and forest laws that limit access to forest produce have robbed many tribal communities of food, fodder, shelter, and livelihoods.

• Migration and displacement of the tribal population due to loss of livelihoods, floods, famines, and large-scale infrastructure and mining projects have a serious impact on the security, safety, and mental and physical health of the tribal people.
• It limits their access to facilities like the ICDS and schools. Such tribal migrants are doubly vulnerable as they do not have access to the special schemes and programs being run for STS in the scheduled areas.

Government Initiatives for tribal health

“Public Health and Hospital” is a state subject, the primary responsibility of ensuring the availability of healthcare facilities including access to healthcare facilities in tribal-dominated areas lies with the respective State Governments including Madhya Pradesh. However, the Ministry of Health and Family Welfare, Government of India provides technical and financial support to the States/UTs to strengthen the public healthcare facilities through National Health Mission.

Swasthya

• Swasthya is a one-stop solution presenting the health and nutrition status of the tribal population of India.
• It provides information and data as well as curates innovative practices, research briefs, case studies, and best practices collected from different parts of India to facilitate the exchange of evidence, expertise, and experiences.
• It is envisaged that information available on Swasthya will provide insights to all stakeholders working with the tribal population of India, in the areas of health and nutrition.
• Swasthya is maintained by the Centre of Excellence for Knowledge Management for Health and Nutrition, established by the Ministry of Tribal Affairs.

Report on Tribal Health in India

In 2018, an expert committee, constituted jointly by the Ministry of Health and Family Welfare and the Ministry of Tribal Affairs released the first comprehensive report on Tribal Health in India. Recommendations of the report were:

• Implement Universal Health Assurance under the National Health Policy (2017) in tribal areas.
• Utilize Aarogya Mitra, trained local tribal youth, and ASHA workers for primary care in tribal communities with support from the gram sabha.
• Provide financial protection through government medical insurance schemes for secondary and tertiary care.
• Introduce ST Health Cards for tribal people living outside scheduled areas to facilitate access to benefits at any healthcare institution.
• Implement a Tribal Malaria Action Plan in tribal-dominated districts under the National Health Mission.
• Strengthen Home-Based Newborn and Child Care (HBNCC) programs to reduce infant and child mortality.
• Enhance food security and strengthen Integrated Child Development Services (ICDS) to address malnutrition.
• Publish a state of tribal health report every three years and establish a Tribal Health Index (THI) to monitor tribal health.
• Establish a National Tribal Health Council as an apex body, along with Tribal Health Directorate and Tribal Health Research Cell, at both central and state levels.

Other health schemes in tribal areas

• National Health Mission (NHM): The main programmatic components include Health System Strengthening in rural and urban areas, Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.
• Ayushman Bharat– Health and Wellness Centres (HWCs) are established by transforming the Sub-Health Centres (SHCs) and Primary Health Centres (PHCs), as part of the Ayushman Bharat.
• Under NHM, States/UTs have been given the flexibility to deploy Mobile Medical Units (MMUs) to provide a range of health care services for the population particularly living in remote, inaccessible, un-served and under-served areas, as per the needs identified by the respective States/UTs.
• To minimize the Out-of-Pocket Expenditure incurred on health services, National Free Drugs Service Initiative and National Free Diagnostic Service Initiative have been rolled out.
• The medicines are provided adequately to all health facilities, including the health facilities in vulnerable areas, as per the essential medicines lists for respective levels of facilities.
• The ASHA program guidelines provide for the recruitment of ASHA at the habitation level, in hilly, tribal, and difficult areas.
• All tribal majority districts whose composite health index is below the State average have been identified as High Priority Districts (HPDs) and these districts receive more resources per capita under the NHM as compared to the rest of the districts in the State.

Way forward

There is still a long way to go to improve and bring tribal health in India to par with the general population. Some aspects that can be carefully looked into are:

• addressing the discrepancy in indigenous groups’ health-seeking patterns and access to healthcare.
• recognizing and appreciating the services that tribal communities’ traditional healers give.
• empowering tribal groups to make wise decisions regarding their health through health literacy programs.
• putting into practice targeted recruiting and retention tactics to draw medical professionals to tribal areas. And improving connections by making investments in the construction of road networks, transportation infrastructure, and communication networks.

-Article written by Swathi Satish