Context

• The United Nation’s State of the World’s Indigenous Peoples Report states that “for indigenous peoples, health is equivalent to the harmonious co-existence of human beings with nature, with themselves and with others, aimed at integral well-being, in spiritual, individual, and social  wholeness and tranquillity.”
• It goes on to declare that when it comes to appropriate health systems for the indigenous context, models of healthcare must take into account the indigenous concept of health and preserve and strengthen indigenous health systems as a strategy to increase access and coverage of health care.
• However globally, most health systems struggle at different degrees to reach adequate and appropriate healthcare to their indigenous people.

Indian Scenario

• In India, there are challenges both in terms of reaching care, and in moving beyond disease-centred healthcare to integrated approaches to health and development of the tribal people.
• The most significant limitation is that the different conversations on health seldom acknowledge the impact of various critical social determinants of health and the people’s struggle with forest rights that impact these determinants significantly.
• A tribal family that does not yet have legitimate ownership over ancestrally cultivated and owned lands, lives in a state of perpetual food and livelihood  insecurity, possibly prioritising child health and education less than more pressing daily living needs.

Health Status  

• Despite decades of focus on reproductive and child health across the country, there still remains severe deficiencies for access to antenatal, delivery and postnatal services across tribal communities. In most areas these programmes are not adapted to local geographical or sociocultural contexts, thereby worsening utilisation and quality of services provided.
• A uniform family welfare approach across the country prevents adaptation to family welfare needs of Particularly Vulnerable Tribal Groups (PVTG) and other tribal communities. For instance, restrictions currently apply for some groups hindering their reproductive rights, while others are in need of infertility care and/or safe abortion services.
• Appropriate treatment for childhood illnesses in tribal children is poor when compared to their non-tribal counterparts; infant mortality and under-five mortality are higher among tribal children in most States.
• Sub-optimal protein, calorie and micronutrient intake is a problem in several tribal communities. Prevalence of undernutrition among school children is generally higher than non-tribal counterparts.
• Anaemia and other nutritional deficiency disorders are higher among tribal women and children, contributing to adverse pregnancy outcomes and increased vulnerability of tribal children.
• Incidences of infectious diseases such as malaria are more frequent and have higher morbidity and mortality in most tribal areas.
• Certain tribal communities are reported to have significantly high prevalence of Non-Communicable Diseases (such as hypertension among tribes of Assam working in tea-gardens).
• Environmental health is a neglected area in general but in these communities, it is a key social determinant of health. Tribal areas are undergoing rapid transition due to pressures of mining, resource extraction and often adverse impacts of other policies. However tribal health systems are not prepared to deal with health problems arising out of such transitions.

Health Systems  

• There is a need to explore the inter-linkages of health with other dimensions of human development like education, land tenure, and empowerment, and that these can no longer be neglected particularly in relation with tribal communities across India.
• Poor governance in tribal districts accounts for various deficiencies in delivery of health programmes, schemes and services. Tribal health services are severely underfinanced and need higher allocations to improve equitable growth. There is a disproportionate shortage of health workers in tribal areas; moreover, tribal representation in the health workforce is considerably inadequate, further hampering adaptation and implementation of health programmes in these areas.
• Rich traditional health knowledge exists in tribal communities, however the health systems do not harness the potential of positive traditional health practices. At the same time, specific interventions are needed in some areas to curb adverse cultural practices.

Way Forward

• The term Scheduled Tribes (STs) is a broad category that has over 700 communities with wide differences in genetic, ethnic, cultural and social differences between them. However, despite all these differences, the health indicators in nearly every State for its ST people, lags significantly behind the other people of the State.
• The persistent poor health outcomes of tribal people, their particular socio-economic and political scenario and decades of marginalisation from the social, economic, political and cultural mainstream, necessitate a special approach towards tribal people, especially their health.  
• The diversity of landscapes and socio-political environment within which tribal people live, necessitates the need for inclusive governance and local-level planning and sensitisation at the level of health centres and local governments at district levels and below.
• The need of the hour is to focus on collaborative partnerships with civil society and community-based organisations to customise and implement local health reforms in partnership with the communities.