The tribal communities in our country are particularly vulnerable to forced displacement, inadequate rehabilitation, and the subsequent loss of their indigenous culture. Stereotyped as ‘backward’, they often end up getting the raw end of the deal in the name of ‘development’.
Apart from the lack of education and livelihood opportunities, one of the biggest issues faced by the communities is the systemic lack of healthcare.
Focus on three States
In order to understand the nature of health and illnesses within the public health system, focusing particularly on its subsequent impact on the tribal community, voluntary organisation Sama-Resource Group for Women and Health carried out a year-long study, supported by the National Human Rights Commission.
Exploring specific districts in the three States of Jharkhand, Chhattisgarh, and Odisha, research was conducted through qualitative methods and data collection from both primary and secondary sources among 25 tribal groups, between April 2017 and June 2018.
Sama chose these particular States and the districts within them because of the significant proportion of tribal communities present there, keeping in mind their poor socio-economic status and indifferent health status. Access to public healthcare was also looked at closely.
The report it released, titled From the Margins to the Centre : A study on the health inequities among the tribal communities in selected districts of Chhattisgarh, Jharkhand, and Odisha , came up with some important conclusions and recommendations that could well do with the urgent attention of policymakers.
The report concluded that the healthcare system in the country, particularly in the context of the tribal population, leaves a lot to be desired. And though tribals have traditionally used folk medicine to address health issues, today these “practices face a challenge with increasing displacement, deforestation and urbanisation as well as the hegemony of other knowledge systems.” Sama pointed out that according to the report of the High Level Committee headed by Virginius Xaxa and. published in May 2014, while the tribal communities represent around only 8.6 per cent of the population, they “disproportionally represent the people living below the poverty line, are illiterate, and suffer from extremely poor physical health”.
Towards solutions
The health inequalities between the tribal and non-tribal populations, including the unavailability of proper healthcare services for the former, show the absence of the tribal communities to fully realise their economic, political, and social potential. Healthcare providers in the country often miss out on the local context of the health needs and remedies of these populations, additionally not taking into account their perspectives.
Sama raised another important point. Given that the country derives its primary powers from its Constitution, the right to a life with dignity is being severely compromised with respect to these communities. And here is where it made recommendations that could bring about some improvement to the health status of diverse tribal communities.
Pointing to issues of access, Sama felt health and wellness centres needed to be established close to where the communities lived. The services available needed to be enlarged, ranging from health education to childcare service. These must also be extended to primary health centres, community health centres, as well as district hospitals. Besides, front line workers in these centres should be trained adequately, for only good capacity building could help provide better services to these populations.
Referring to specific illnesses such as malaria, tuberculosis, leprosy, non-communicable diseases, cancer, reproductive health, and animal attacks, it recommended improving access to nutrition, sanitation, and safe drinking water.
Other social determinants further complicate the issue, such as migration and related conflict and displacement, Sama said.
The Sama report reiterated its recommendation of decentralised governance and improved policies by various ministries of the Government. It argued for a need for convergence between different ministries, such as the Ministry of Tribal Affairs and Ministry of Women and Child Development, to jointly establish policy directives and a larger budgetary allocation for public health.
The writer has just completed her post-graduation from South Asian University, Delhi