Tribal Health in India

• 25 May 2023

For Prelims: Tribal communities, Article 342, Tribal Health

For Mains: Healthcare challenges faced by tribal communities, Impact of infrastructure and workforce constraints on healthcare access

Why in News?

Recently, the healthcare challenges faced by tribal communities in India have come into focus. Despite India's remarkable achievements, such as emerging as the world's 5^th-largest economy and its contribution to the global vaccination drive, tribal communities continue to experience significant healthcare disparities.

• As India celebrates its accomplishments at India@75, it is crucial to address the urgent need for equitable healthcare access for tribal communities.

What is the Status of Tribal Communities in India?

• Demographic Status:
  • Tribal communities in India constitute a significant portion of the country's population, accounting for approximately 8.9%.
    • Out of the total Schedule Tribe population, approximately 2.6 million (2.5%) belong to “Particularly Vulnerable Tribal Groups” (PVTGs) known as the “Primitive Tribes” - the most disadvantaged of all the Schedule Tribe communities.
  • They are spread across various states, with higher concentrations in states like Madhya Pradesh, Maharashtra, Odisha, Chhattisgarh, Rajasthan, the NER states and the Andaman & Nicobar Islands.
• Cultural Status:
  • Tribal communities in India have their own rich and diverse culture, language, and traditions.
  • They have a symbiotic relationship with nature and depend on forests and hills for their livelihood.
    • They have their own beliefs, practices, and preferences regarding health, education, religion, and governance.
• Related Constitutional and Statutory Provisions:
  • Certain tribal communities in India are recognized as Scheduled Tribes (STs) under Article 342 of the Constitution of India.
    • They are entitled to special provisions and safeguards for their social, economic, educational, and political development.
  • Their interests are safeguarded by various laws and policies such as the 5^th and 6gh Scheduled areas, Forest Rights Act 2006, and the PESA Act 1996.
  • They also have representation in the Parliament and State Legislatures through reserved seats.
    • Draupadi Murmu is India's first tribal President.
• Developmental Status:
  • Tribal communities in India face multiple challenges and disadvantages in terms of poverty, illiteracy, malnutrition, health, employment, infrastructure, and human rights.
    • They lag behind the national average on various indicators of human development such as income, education, health, sanitation, and gender equality.
    • They also face discrimination, exploitation, displacement, and violence from non-tribal people and institutions. They have limited access to resources and opportunities for their empowerment and participation.

What are the Main Tribal Health Issues?

• Malnutrition:
  • Tribal people don’t get enough food or the right kind of food to stay healthy. They suffer from hunger, stunting, wasting, anemia, and lack of vitamins and minerals.
• Communicable Diseases:
  • Tribal people are more likely to catch infectious diseases such as malaria, tuberculosis, leprosy, HIV/AIDS, diarrhoea, respiratory infections, and diseases spread by insects or animals due to several factors like poor sanitation and hygiene, and limited access to healthcare.
• Non-Communicable Diseases:
  • Tribal people are also at risk of getting chronic diseases such as diabetes, hypertension, cardiovascular diseases, cancer, and mental disorders.
    • According to a study, about 13% of tribal adults have diabetes and 25% have high blood pressure.
• Addictions:
  • The above-mentioned diseases can be caused by factors such as tobacco use, alcohol consumption, and substance abuse.
  • More than 72% tribal men 15–54 years of age use tobacco and more than 50% consume alcohol against 56% and 30% non-tribal men, respectively.

What are the Challenges in Tribal Health?

• Lack of Infrastructure:
  • Inadequate healthcare facilities and infrastructure in tribal areas.
  • Insufficient access to clean water and sanitation facilities.
• Shortage of Medical Professionals:
  • Limited presence of doctors, nurses, and healthcare professionals in tribal regions.
  • Difficulty in attracting and retaining skilled healthcare personnel in remote areas.
  • Imbalance in the distribution of healthcare professionals, with a concentration in urban areas.
• Connectivity and Geographic Barriers:
  • Remote locations and difficult terrain hinder access to healthcare services.
  • Lack of proper roads, transportation facilities, and communication networks.
  • Challenges in reaching tribal communities during emergencies and providing timely medical assistance.
• Affordability and Financial Constraints:
  • Limited financial resources and low-income levels among tribal communities.
  • Inability to afford healthcare expenses, including medical treatments, medicines, and diagnostics.
  • Lack of awareness about available healthcare schemes and insurance options.
• Cultural Sensitivities and Language Barriers:
  • Unique cultural practices and beliefs that impact healthcare-seeking behavior.
  • Language barriers between healthcare providers and tribal communities, leading to miscommunication and inadequate care.
  • Lack of culturally sensitive healthcare services that respect tribal customs and traditions.
• Limited Access to Essential Services:
  • Insufficient availability of essential healthcare services, such as maternal and child health, immunization, and preventive care.
  • Inadequate access to specialized care, diagnostic facilities, and emergency medical services.
  • Limited awareness about health issues, preventive measures, and healthcare rights among tribal communities.
• Inadequate Funding and Resource Allocation:
  • Limited allocation of funds for healthcare in tribal areas.
  • Insufficient investment in healthcare infrastructure, equipment, and technology.
  • Lack of dedicated funding for addressing tribal health challenges and implementing targeted interventions.

What is the GoI’s Report on Tribal Health in India?

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

Way Forward

• Addressing the disparity in health-seeking behavior and health-care delivery among tribal populations.
• Recognizing and acknowledging the services provided by traditional healers in tribal communities.
• Empowering tribal communities through health literacy programs to enable them to make informed decisions about their health.
• Implementing targeted recruitment and retention strategies to attract healthcare professionals to tribal regions. And Investing in the development of road networks, transportation facilities, and communication networks to enhance connectivity.

UPSC Civil Services Examination Previous Year Question (PYQ)

Prelims

Q1. Every year, a month long ecologically important campaign/festival is held during which certain communities/tribes plant saplings of fruit-bearing trees. Which of the following are such communities/ tribes? (2014)

(a) Bhutia and Lepcha
(b) Gond and Korku
(c) Irula and Toda
(d) Sahariya and Agariya

Ans: (b)

Q2. The provisions in Fifth Schedule and Sixth Schedule in the Constitution of India are made in order to (2015)

(a) protect the interests of Scheduled Tribes
(b) determine the boundaries between States
(c) determine the powers, authority and responsibilities of Panchayats
(d) protect the interests of all the border States

Ans: (a)

Q3. Under which Schedule of the Constitution of India can the transfer of tribal land to private parties for mining be declared null and void? (2019)

(a) Third Schedule
(b) Fifth Schedule
(c) Ninth Schedule
(d) Twelfth Schedule

Ans: (b)

Q4. If a particular area is brought under the Fifth Schedule of the Constitution of India, which one of the following statements best reflects the consequence of it? (2022)

(a) This would prevent the transfer of land of tribal people to non-tribal people.
(b) This would create a local self-governing body in that area.
(c) This would convert that area into a Union Territory.
(d) The State having such areas would be declared a Special Category State.

Ans: (a)

---

Mains

Q. What are the two major legal initiatives by the State since Independence addressing discrimination against Scheduled Tribes (STs)? (2017)

Source: IE