Improving Tribal Populations’ Access to Health Services
India’s poor tribal people have far worse health indicators than the general
population. Most tribal people live in remote rural hamlets in hilly, forested
or desert areas where illiteracy, trying physical environments, malnutrition,
inadequate access to potable water, and lack of personal hygiene and sanitation
make them more vulnerable to disease.
This is compounded by the lack of awareness among these populations about the
measures needed to protect their health, their distance from medical facilities,
the lack of all-weather roads and affordable transportation, insensitive and
discriminatory behaviour by staff at medical facilities, financial constraints
and so on. Government programs to raise their health awareness and improve their
accessibility to primary health care have not had the desired impact. Not
surprisingly, tribal people suffer illnesses of greater severity and duration,
with women and children being the most vulnerable. The starkest marker of tribal
deprivation is child mortality, with under-five mortality rates among rural
tribal children remaining startlingly high, at about 100 deaths per 1,000 live
births in 2005 compared with 82 among all children.
Three World Bank-supported State Health Systems Projects - in Rajasthan,
Karnataka, and Tamil Nadu adopted a number of innovative strategies to improve
the health of tribal groups. Given the wide diversity among these groups and
their various levels of socioeconomic development, the interventions adopted
were multipronged and area-specific. Almost all these initiatives were provided
through public-private partnerships (PPP).
The popularity of these initiatives and their impact on the health of tribal
populations has prompted all
three states to expand most of these endeavours
in a phased manner. While gaps still remain - such as the lack of credible
private health care providers, budget constraints, the need for better
oversight
mechanisms, and improved capacity for the effective management of
PPP contracts - there is considerable scope to expand these initiatives for the
benefit of tribal populations in regions that continue to be underserved.
Context
Over 84 million of India’s people belong to Scheduled Tribes. While tribal
populations make up only 8 percent of India’s population, they account for over
a quarter of the country’s poorest people. Although these groups have seen
considerable progress over the years-poverty among tribal groups declined by
more than a third between 1983 and 2005 - nearly half the country’s Scheduled
Tribe population
remains in poverty, due to their low starting point.
Rajasthan has the largest population of Scheduled Tribes in the country,
constituting over 12 percent
of the state’s population. They are concentrated
in the southern tribal and western desert regions of
the state. Young tribal
girls enter the reproductive age as victims of undernourishment and
anemia,
and face greater health risks as a result of early marriage, frequent
pregnancies, unsafe deliveries,
and sexually transmitted diseases. Women’s
low social status makes them more likely to seek
treatment only when the
ailment is well advanced. Societal attitudes towards pregnancy, which is
generally not considered a condition that requires medical treatment,
nourishment or care, hinder efforts to deliver antenatal services.
Tamil Nadu is second to Kerala in terms of human development indicators.
Scheduled Tribes make up just 1 percent of the population, with most living in
the forests of the Nilgiri Hills and the Eastern and Western Ghats. While many
of the state’s tribal women enjoy almost equal status with men - reflected in
their balanced sex ratios - the Infant Mortality Rate, Maternal Mortality Rate,
Neo- Natal Mortality Rate and Under-5 Mortality Rate for tribals have not
improved to the same extent as those for the general population. Certain tribal
groups also suffer a high incidence of sickle cell anemia.
In Karnataka, scheduled tribes constitute 6 percent of the population.
Malaria, pneumonia, respiratory
disorders, snake and scorpion bites, diarrhea
and fever are commonly reported ailments. Tribal
people have lower levels of
antenatal care, fewer institutional deliveries, lower levels of
immunization,
and higher prevalence of reproductive tract and sexually
transmitted infections. While Government
of India norms for the provision of
health care facilities were found to have been met, accessibility continued to
be poor.
NFHS-3
Differentials in health status in
Rajasthan, Karnataka and Tamil Nadu
| |
Infant
mortality/1000 |
Under 5
mortality/1000 |
% of children 6-59
months classified as having any anemia |
| |
Rajasthan Karnataka TN |
Rajasthan Karnataka TN |
Rajasthan Karnataka TN |
| Scheduled Castes (SCs) |
|
|
|
| Scheduled Tribes (STs) |
|
|
|
| Other disadvantaged |
|
|
|
| Others |
|
|
|
*not provided as based on fewer than 250 unweighted
cases
|
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