Co-Written by Dr. Anamika Roy, Dr. Chandrima Chatterjee & Dr. Parul Malik
The tribal population of India comprises of the indigenous people dwelling in the hinterlands who are sometimes extremely susceptible to high levels of inaccessibility to health resources. The health inequalities which have been faced by these people are an evidence of the fundamental failure of the realization of their human rights in terms of social, economic, and political capabilities. Numerous examples testify this reality- like the incident in Kalahandi in Odisha, where a man had to carry his deceased wife on a cycle for 50 kms to get proper cremation or the very famous Dashrath Majhi who had constructed a road out of a mountain in memory of his wife, who died in labor, unable to reach the hospital. Such incidents bring to light the basic loopholes present the construct of the society which are responsible for giving rise to these problems.
India is a diverse country and the tribal population is culturally different too. Over 84 million people belonging to 698 communities have been identified as members of the scheduled tribes (STs) and constitute approximately 8.2% of the Indian population. Clear governmental policies targeted towards scheduled tribes exist for affirmative actions as STs have been considered as a distinct and discriminated community by the Indian Constitution, dating back to 1950.
In the era of globalization, India’s population including those belonging to scheduled tribes is undergoing socio-economic and health transformation. Health disparities tend to manifest when a contrast is drawn between indigenous and non-indigenous people. The health indicators for the tribal people remain very poor. According the National Family Health Survey 4 (NFHS-4) (2015-16), the under-five mortality among the indigenous population was 57.2 per 1000 live births whereas for the non-indigenous population it was reported to be 38.5 per 1000 live births. Similarly, a higher rate of infant mortality (IMR) was reported, 44.4 per 1000 live births. If we investigate further, the habits of consumption of alcohol or tobacco chewing, they are higher in the indigenous people, possibly due to lack of awareness about the negative health outcomes of these and because of other social factors. One major possibility that makes the health of indigenous population to be subjected to vulnerability is the existing limited health research on specific indigenous groups.
Poverty and child malnutrition are also significantly higher in the tribal population. The prevailing situation is in large part since ST population has for centuries suffered from neglect from policy point of view. Even today, areas where tribal live, the health services remain grossly underdeveloped and population access to good quality health services is at best abysmal. During the COVID-19 pandemic, a report dating as late as end of August, showed that some isolated tribes in Chattisgarh had never heard about the disease. Remotest areas in Odisha and Great Nicobar, also reported cases infected with the coronavirus. An ongoing assessment of tribal areas about the impact of lockdown also described the various health challenges the tribes were subjected to- absence of healthcare facilities, compromised health conditions and low immunity, barriers to testing and monitoring of the disease, to list a few.
One of the main reasons for the poorly planned and poorly administered tribal health service found by the GOI Tribal Special Committee on Tribal Issues was the “nearly complete lack of involvement by members of the Scheduled Tribes or their representatives in policy-making, planning or delivery of health services.” These disparities call for an understanding of the existing systems and focused attempts to bridge the gap. Many of the infectious and parasitic diseases, which are quite prevalent among this population, are preventable with timely intervention, health awareness, and information, education and communication (IEC) activities.
A majority of the health care needs of the tribal population are taken care of either by the trained health personnel at the primary health care level or by their own traditional indigenous health practitioners at village level. Their health system and medical knowledge over ages known as ‘Traditional Health Care System’ depends on both- the herbal and the psychosomatic lines of treatment. With plants, flowers, seeds, animals and other naturally available substances forming the major basis of treatment, this practice has always had a touch of mysticism, supernatural and magic, for many. The primary health care infrastructure provides the first level of contact between the population and health care providers. It provides integrated promotive, preventive, curative and rehabilitative services to the population close to their homes. Those requiring specialized care are referred to secondary and tertiary sector.
The compromised state of tribal health can possibly be improved by taking certain steps into consideration – financial incentives for the doctors posted in the tribal areas, mandatory tribal service with fair posting and transfer policies, special separate cadre for tribal areas, task shifting by empowering the nurses, ANMs, male multipurpose workers pharmacists capable of providing basic primary health care at the PHCs. A proper Health Technology Assessment (HTA), could also aid in providing equitable healthcare to the indigenous population. Though this may seem much like a Utopian Dream, but, with proper strategy and resource allocation, this could be and needs to be achieved, to minimize health inequities and disparities.
Dr Anamika Roy is a dental surgeon and currently a postgraduate student, pursuing Master of Public Health (Health Policy) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.
Dr. Chandrima Chatterjee is a dental surgeon and currently a postgraduate student, pursuing Master of Public Health (Global Health) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.
Dr. Parul Malik is a medical doctor with a Master of Public Health (Global Health) degree from Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.