Tribal development and health are vital for national development

                     

                                                                      Tribal Girl

     Improving Tribal Health Will do Wonders to the Health of the Nation. 
Lessons learnt from the Tribal Health Report 2018

March 10, 2019. Pravin J P Arapurakal

Dr Ajay Bang, prefaces the 2018 Tribal Health Report by reminding us that the “Constitution of India recognizes the special status of tribal people” providing safeguards to protect their lives and culture. He admits that despite numbering 104 million in the 2011 census, scheduled tribes have remained socio-politically marginal. The tribal population spreads over 705 tribes and accounts for some 8.6 percent of the Indian people. The gaps in the healthcare of tribals need immediate remediation.

Procedures for the administration of tribal rights overall have not been properly implemented: 

After the Forest Rights Act (that governs land use procedures in Forests) was passed in 2006, it fell to the Government (especially local Grama Sabha’s to follow through and implement procedures that allow for the recognition of land use rights by Tribal families. In many cases at the Panchayat and State level, the provisions of the Act have not been adequately followed up, resulting in the possible eviction of hundreds of thousands of forest dwellers. Fortunately the Indian Government requested the Supreme Court for a stay on any evictions. Much remains to be done in this area and the government at all levels should be held accountable for doing its part.

Expert Committee on Tribal Health: It is encouraging that the Indian Ministry of Health & Family Welfare and the Indian Ministry of Tribal Affairs together constituted the Expert Committee on Tribal Health, which together the Tribal Health Report over a five year period that begin in 2013.

According to the Preface of the Tribal Health Report, the Government of India has laid down three landmark policy protections for the protection of tribal populations. These are:

-          - The Constitution of India

-          - The Panchsheel Principles and

-          - The PESA Act (for the protection and development of tribal communities.}

The government has in place a program called the “Tribal Sub Plan” which should ensure that funds spent by various departments also benefit the tribal populations at least in proportion to the population.

It is in the area of health that the tribal populations are impacted most. The various indices as they apply to the tribal population are worth a closer look, especially when compared with the population at large:

Health Indices	Tribal Population	Gen. Population
Life expectancy at birth	63.9 years	67 years
Child mortality	74/thousand	73/thousand
Pulmonary Tuberculosis	7.03/thousand	2.56/thousand
Anemia (women, 15-49)	65%	49%
Tobacco use (men 15-49)	72%	56%
Alcohol consumption	Over 50%	30%

(Life expectancy at birth for tribals is likely to be an over estimate as child deaths often go unreported). Further only 25 percent of expectant or lactating mothers get adequate nutrition leading to low birth weight and stunting in scandalous proportions. The presence of underweight children is around 1.5 times the rate for the general population.

States that have significant tribal populations include:

States	Tribal	Tribal	Tribal %
	Hseholds	Individuals	of state
Madhya Pradesh	3.12 million	15.36 mn	21.15
Maharashtra	2.15 mn.	10.51 mn	9.35
Odisha	2.16 mn.	9.59 mn	22.94
Rajasthan	1.78 mn.	9.24 mn	13.48
Chattisgarh	1.74 mn	7.82 mn.	30.61
Gujarat	1.69 mn	8.91 mn.	14.74
Jharkhand	1.59 mn	8.64 mn.	26.19

 t    More than two thirds of the nation’s scheduled tribe populations live in these seven states. Ninety percent of India’s tribal population live in rural areas. In the North Eastern States, populations though numerically small are overwhelmingly tribal such as: Mizoram (94.4%), Nagaland (86.5%), Meghalaya (86.1%), Arunachal Pradesh (68.8%), Manipur (35.1%), Tripura (31.8%), Assam (12.4%). Some 2 percent of the national tribal population lives in the North East.
      
      Since tribal peoples are spread out over large relatively undeveloped areas, they are much more likely to be impacted by development activity. “During 1951-1990 almost 40 percent of the 2.13 crore people displaced on account of dams, mines, industries etc., belonged to Scheduled Tribes.”
    
      Economically, 40.6 percent of tribals live below the poverty line of Rs 27,000 per year in income vs. 20.5 percent in the general population. (Rs 27,000 per year works out to Rs 75 per day.)

 Tribal populations are 25 percent more illiterate than the regular population (41 vs 31 percent.)

The drive against open defecation has yet to seriously benefit India’s tribal population as 74.7 percent of tribal citizens continue to defecate in the open. 

 Only 10.7 percent of the tribal population have access to tap water as opposed to 28.5 percent of the general population.

Key Recommendations: 
      - Given Tribal need for autonomy planners should adopt flexible healthcare models without trying to enforce a one size fits all approach. 

 - Smaller but numerous health delivery locations are needed given the spread of the   population.

- One Public Health Center needed for every 20,000 in population.

- One Tribal Health & Wellness Center needed for every region with 2,00 tribal members.

-       - More public private partnerships and

-        - More welfare programs administered through schools.

Some of the Special Problems in Tribal Health:

1.      Controlling Malaria in tribal populations. Just 24 districts with 8 percent of the population        account for 49 percent of the Malaria cases,

2.      Reducing the incidence of chronic malnutrition among tribal children and expectant     mothers.

3.       Focusing on safe motherhood and family planning

4.       Controlling addictions, providing for addiction and mental health support.

5.       Ensuring timely treatment for animal bites and accidents.

6.       Improving health literacy, the Tribal Health Report has specific suggestions for this.

7.       Tribal Healers and practices need to be integrated,

8.       Children in Ashramashalas (450,000 in Maharashtra alone) need more funding & better        care.

Tribals have not always been passive recipients of Government handouts. In the area that later became Jharkhand they opposed the East India Company’s incursions there, long before the Sepoy Mutiny of 1857. Efforts need to be made to build up entrepreneurial skills among the tribal populations so that they can better utilize the natural wealth of the Forests they live in.

The Tribal Health Report in its entirely can be accessed at http://tribalhealthreport.in/

A Guide to the Forest Rights Act of 2006, published by the Ministry of Tribal Affairs, Government of India: https://tribal.nic.in/FRA/data/FRARulesBook.pdf