[Answered]“While health outcomes have greatly improved, tribal communities still lag behind.” Examine.

Tribal people account for 8.6% of the country’s population and their problems like health, poverty stillis an issue. The health status of India’s tribal communities is in need of special attention. Being among the poorest and most marginalised groups in India, tribals experience extreme levels of health deprivation. The tribal community lags behind the national average on several vital public health indicators, with women and children being the most vulnerable.

Tribal health issues:

1. Child Mortality: There are improvements in parameters but there is certainly a gap between tribals and rest of India.Under-five mortality rate declined from 135 in 1988 to 57 in 2014.Under-five child mortality for the rest of India was around 39 in 2014.
2. Malnutrition- The percentage of underweight ST children is around 40% in 2015-16. Tribal constitutes 8% of India’s total population but they have 30% of all cases of Malaria. Prevalence of TB in rest of India is 256 per 100,000 cases but in tribals, it is 703 cases per 100,000 almost three times.
3. Women health:Several studies on maternal health show poorer nutritional status, higher levels of morbidity and mortality, and lower utilisation of antenatal and postnatal services among tribals. Starvation deaths continue to be reported from tribal areas, including from advanced States like Kerala.
4. Diseases: Health problems prevalent in tribal areas include endemic infectious diseases like malaria, tuberculosis, and diarrhoeal diseases, apart from malnutrition and anaemia.Prevalence of chronic diseases such as hypertension and diabetes mellitus, hitherto rare in these populations, is rising, and stroke and heart disease are now the leading causes of death.

Reasons for poor health care of tribal population:

1. Reasons for poor health Research has shown that 75 per cent of India’s tribal population defecates in the open and 33 per cent does not have access to a clean source of drinking water.
2. Insanitary conditions, ignorance, lack of health education and poor access to healthcare facilities are the main factors responsible for the poor health of tribals.
3. Further, displacement from their traditional forest homes and natural source of food and lack of livelihoods makes them dependent on the public distribution system (PDS). Most tribal groups are traditionally hunter-gatherers and not accustomed to agriculture their diets.
4. Posts of doctors and paramedicals are often vacant.Additionally, the non-availability of essential drugs and equipment, inadequate infrastructure, difficult terrain and constraints of distance and the lack of transport and communication facilities further hinder healthcare delivery.
5. The geographical and infrastructural challenges to public health and the lack of health-related knowledge among tribals are exploited by quacks (unqualified medical practitioners), who are often available at the doorstep.
6. Levels of illiteracy are high, with 47 per cent in rural areas and 21.8 per cent in urban areas being unable to read and write.

What should be done?

1. Primary care in the community should be taken care by trained local tribal youth and ASHA’s with support from gram sabha.
2. Financial protection through government medical insurance scheme should be provided to tribals for secondary and tertiary care.
3. For tribal people living outside scheduled areas committee recommends ST Health Card which will help them to avail their benefits at any like insurance at any health care institutions.
4. To provide doctors dedicated to working in tribal areas, there should be dedicated medical colleges in tribal districts exclusively for tribal areas.
5. To reduce malnutrition food security should be ensured and Integrated Child Development Services should be strengthened.
6. A state of tribal health report should be published every 3 years and placed before the nation.
7. Various national surveys should aim to estimate various health parameters in tribal areas.
8. It is necessary that all tribals whether living within or outside tribal areas should be covered under the health insurance scheme.

Despite the high dependence of tribals on the public health care system.  It continues to be characterized by low quality, low output, and low outcome delivery system, often targeting wrong priorities.It is necessary to restructure and strengthen the public health care system in accordance with the needs and aspirations of the tribal communities, with their full participation.