Roadmap for tribal health

Tribal communities in India account for 8.6% of the country's total population but are lagging far behind non-tribal communities in several health indices. This calls for prioritising the task of building resilience of tribal people against COVID-19 and other pandemics through improvement in health system in tribal areas. The country's northeast region has the highest concentration of tribal people that has given the region a unique identity of a melting pot of diverse cultures, languages, and ethnicity. Tribal population in the region accounts for 12% of the total tribal population in the country. Poor healthcare infrastructure and shortage of required human resources in tribal-dominated states in the region and elsewhere in the country speak volume of the critical gap. Official estimates show that life expectancy at birth for Scheduled Tribe (ST) population in India is 63.9 yeaTribal communities in India account for 8.6% of the country's total population but are lagging far behind non-tribal communities in several health indices. This calls for prioritising the task of building resilience of tribal people against COVID-19 and other pandemics through improvement in health system in tribal areas. The country's northeast region has the highs compared to 67 years for non-tribal population. A report of the Expert Committee on tribal health titled "Tribal Health in India" states that 50% adolescent girls between the ages of 15 and 19 years are underweight. National Family Health Survey data reveal that 65% tribal women suffer from anaemia. The report has also brought to light disturbing fact that tribal population in the country faces triple burden of diseases. "While malnutrition and communicable diseases like malaria, tuberculosis continue to be rampant, rapid urbanization, environmental distress and changing lifestyles have resulted in a rise in the prevalence of non-communicable diseases like cancer, hypertension and diabetes. To add to this is the third burden of mental illnesses, especially the addiction," says the report. The expert committee found that tribal people report an alarmingly high proportion of respiratory (18 %), mental/neurological (5 %) and Musculo-skeletal (10 %) condition. Despite high rates of infant and child mortality in tribal areas, full immunization coverage remains "consistently low" among the ST populations across states. The coverage is as low as 56% as against 72% among all other social groups. The committee's findings regarding burden of malaria among tribal people calls for focused attention by the Central and the state governments. Tribal people account for 30% of all cases of malaria and as much as 50 per cent of the mortality associated with malaria. It expressed concern that while this reflects a high economic burden of Rs 6,000 crore only 10 per cent of budget for National Vector Borne Disease Control Programme is earmarked for Tribal Sub Plan. Even though prevalence of pulmonary tuberculosis is "significantly higher" than rest of the country only 11% of the cases among tribal population get treated. Tribal areas in northeast region have better healthcare as compared to rest tribal areas but "there are huge gaps", according to the committee, in availability of health functionaries across all states in the region and position with respect to availability of doctors and specialists is much worse than national level. Such deficiencies call for immediate attention of the Centre and the states in the region to undertake result-oriented plans and programmes to create the protective shields against disease burdens among tribal communities. Innovative public health care system to overcome the challenges of difficult terrains and poor connectivity could be an answer. Setting up medical colleges, nursing colleges in the north-eastern states along with facilitating local students through free coaching by experts to qualify in the competitive entrance examinations for admissions into such medical institutions will help partly address the problem of human resource shortage in tribal areas of the region. The States and the Centre need to take note of the committee's observation that organization of public health delivery system in tribal areas suffers from serious design flaws and take corrective measures to improve the situation. In order to achieve improvement in health sector, improvement in education, augmenting the household income, improvement in water supply and sanitation, connectivity need focused attention. Rich biodiversity and organic cultivation practice in the northeast region provide the tribal people of the region a natural advantage of having better nutritional status as compared to rest tribal areas. As many as 67 tribes in northeast region have population less than 5,000. Such communities with small population become highly vulnerable in pandemic situation like COVID-19 and or outbreak of any epidemic if left without the shield of adequate healthcare facilities. Building atlas of areas with such highly vulnerable tribal population and easily accessible database on available health infrastructure, human resources by the State government concerned will make identifying the gaps and timely review of execution of plans and programmes easier. The health intervention programmes in the region, providing the space for application of traditional knowledge of the tribal communities which have been scientifically and medically proved to be effective will supplement the modern healthcare practices. Making the communities equal stakeholders can only ensure success of healthcare interventions in tribal areas.