Tribal Health Status in India

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Introduction  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

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Definition

A tribe is a distinct people, dependent on their land for their livelihood, who are largely self-sufficient, and not integrated into the national society

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PART OF INDIAN CONSTITUTION

According to Article 342 of the Constitution, Officially recognized by the Indian government

as "Scheduled Tribes" in the Fifth Schedule of the Constitution of India,

eligible for certain affirmative action measures. The community should be declared as TRIBES

by the President through a public notification

Tribal constitute 8.61% of the total

population (2011 Census) and cover about 15% of the country’s area.

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Tribal Communities 705 Tribal communities in India 75 Primitive tribal communities Not found in Punjab and Haryana

Andaman Primitive Tribal Communities

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The uncontacted tribes

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AERIAL FOOTAGE OF UNCONTACTED TRIBES

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 Mere contact with outsiders was often sufficient to set off deadly epidemics 

The Andamanese Tribes

Great Andamanese, estimated 53   Jarawa now estimated 250 to 300 Jangil -90 to100 Onge, now fewer than 100 Sentinelese, now estimated to be 39

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Extinction

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Sentinelese Tribes the most isolated people

39 individuals-21 males and 18 females

In 2006, Sentinelese archers killed two fishermen who were fishing illegally within range of the island

14

Jarawa Tribes

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250–300

Healthiest

Optimal Nutritional Status

( when they felt the earthquake, they are said to have stuck their bows and arrows in the ground in an effort to reduce the intensity)

Time ticking for India's Jarawa tribe

"There are instances of Measles and Malaria outbreak among the Jarawa as a result of frequent contact with outsiders and it could well be the beginning of the end for the tribe,“

According to experts, one of the key reasons for the changes in Jarawa lifestyle has been the construction of the ATR

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  Andaman Trunk Road

In 2002, the supreme court ordered the closure of the road , but the authorities have defied this, not only keeping the road open but actually widening it

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Extinction of Bo Community

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POPULATION DISTRIBUTION Central Indian states have the country's

largest tribes, and, taken as a whole, roughly 75% of the total tribal population live there.

Indian Tribal Belt

India Tribal Belt stretches from Gujarat in the west up to Assam in the

east across the states of Madhya Pradesh, Chhattisgarh and Jharkhand.

It is among the poorest regions of the country.

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Distribution of Scheduled Tribe Population by States - 2011

Tribal population of Tamilnadu Tribal population:1% of totalmale: total:4,01,068 Rural :3,33,178 Urban:67890 Female:total:3,93,629 Rural:3,27,102 Urban:66527 In accordance with The Scheduled Castes and Scheduled Tribes Orders (Amendment) Act, 1976:

36 tribal communities

Sex ratio per thousand Total:981 Rural:982 Urban:980

Primitive tribes in tamilnadu Kattu Nayakans . Kotas . Kurumbas . Irulas . Paniyans . Todas (polyandry)

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DIFFERENT TYPES OF TRIBES

Tribal classification

Agriculturists Cattle herder Folk artisans Labourers Food gatherers and hunters

Key Indicators

Key health indicators

Indicator Sex Ratio Child Sex Ratio2001 2011 2001 2011

Total Population Total 933 943 927 919Rural 946 949 934 923Urban 900 929 907 905

Scheduled Castes Total 936 945 938 933Rural 939 945 941 936Urban 923 946 924 922

Scheduled Tribes Total 978 990 973 957Rural 981 991 974 959Urban 944 980 951 940

Sex Ratio & Child Sex Ratio (Females per 1000 males) INDIA

Source: Primary Census Abstract for Total population, Scheduled Castes and Scheduled Tribes, 2011 Office of the Registrar General & Census Commissioner, India

Indicator Literates Effective Literacy Rate

2001 2011 2001 2011Total Population

Total 56,06,87,797 76,34,98,517 64.8 73.0Rural 36,17,36,601 48,26,53,540 58.7 67.8Urban 19,89,51,196 28,08,44,977 79.9 84.1

Scheduled CastesTotal 7,53,18,285 11,37,59,907 54.7 66.1Rural 5,58,06,266 8,20,20,232 51.2 62.8Urban 1,95,12,019 3,17,39,675 68.1 76.2

Scheduled TribesTotal 3,23,86,821 5,16,35,423 47.1 59.0Rural 2,82,94,749 4,46,31,645 45.0 56.9Urban 40,92,072 70,03,778 69.1 76.8

Literates & Literacy Rate (Persons) INDIA

Source: Primary Census Abstract for Total population, Scheduled Castes and Scheduled Tribes, 2011 Office of the Registrar General & Census Commissioner, India

Literacy Rate (Persons) INDIA

Source: Primary Census Abstract for Total population, Scheduled Castes and Scheduled Tribes, 2011 Office of the Registrar General & Census Commissioner, India

State/Union Territory #

Literacy rate State/Union Territory #

Literacy rate

Top 5 Bottom 5

Scheduled CastesDaman & Diu # 92.6 Bihar 48.6Mizoram 92.4 Jharkhand 55.9Tripura 89.4 Rajasthan 59.7D & N Haveli # 89.4 Uttar Pradesh 60.9Kerala 88.7 Andhra Pradesh 62.3

Scheduled TribesLakshadweep # 91.7 Andhra Pradesh 49.2Mizoram 91.5 Jammu & Kashmir 50.6Nagaland 80.0 Madhya Pradesh 50.6Sikkim 79.7 Bihar 51.1Tripura 79.1 Odisha 52.2

LR

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Nutritional Status Nutritional Status: 46.6% ST women have BMI below 18.5, indicating a high

prevalence of nutritional deficiency. 68.5 % (55%)of women and 39.6 % (25%) of men are

anemic – highest among all social groups Only 21% of ST children age 12-35 months received

vitamin A supplements Among children age 6-59 months, the figure drops

further to only 14.6%.

76.8% of ST children are anaemic - 26.3 % mild, 47.2 % moderate & 3.3 % severe

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Diseases Encountered

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COMMUNICABLE DISEASES Water borne and communicable

diseases: Gastrointestinal disorders are very

common, leading to marked morbidity and malnutrition.

Malaria and tuberculosis. Spectrum of viral and venereal

diseases.

GENETIC DISORDERS High prevalence of

genetic disorders mostly involving red blood cells: Genetically transmitted disorders like sickle cell anaemia.

G6PD deficiency and different forms of Thalassaemia are also common.

Sickle cell Disease > 19% Sickle cell

disease in 35 Tribal groups

>40% Sickle Cell trait

Irula ,Paniyan of Nilgiri Hills

Adiyan of Kerala

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G6PD Deficiency 13 lakh Tribal

Population > 15 % among tribal

population in TamilNadu, Orissa,Maharastra,Madhyapradesh

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Mental Health Issues 20/1000 (73)

11/1000 Depression (20)

3/1000 Hysteria

2/1000 Phobia

1/1000 Schizophrenia (1.5)

0.4/1000 Mania05/03/23 42

AIDS 2.9/1000 per among tribes (2.8)

Heterosexual transmission Blood and Blood related products Homosexual Transmission Vertical Transmission Needle stick Injuries

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Malaria in Madyapradesh 30% of Malaria Cases

60% of Falciparam cases

50% of Malaria Death

(According to the report, malaria control in Madhya Pradesh is complex because of vast tracts of forest with tribal settlement)

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IMPROPER NUTRITION Deficiency of essential components in

diet leading to malnutrition, protein calorie malnutrition and micronutrient deficiencies.

Goitre of various grades is also endemic in some of the tribal areas.

Long way to go?

WAYS Regular clinics in all villages to see all pregnant

mothers and children less than five years. Refreshing and sharing knowledge with tribal

women. Tribal girls working as Health Workers. Postnatal checkups in all villages once a week . Health education and discussion of social

problems. Dramas and cultural shows to spread

information. Outpatients & Inpatients seen at the Tribal

Hospital.

Ensuring availability of adequate

infrastructure and personnel. Area specific RCH programmes.

Effective implementation of the Health & Family Welfare programmes.

Close monitoring, early detection of problems in implementation and midcourse correction.

Incentives Almost every State in the country is facing

tough challenge to retain doctors in remote tribal pockets

In Chhattisgarh, specialists are being offered up to Rs. 1 lakh

In Madhya Pradesh, doctors in difficult areas get double the salary of those in normal areas

 Under outreach referral services in Gujarat, paediatricians and gynaecologists are being paid Rs. 2,500 to Rs. 3,000 per visit to difficult areas as against Rs. 1,500 for normal areas.

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TRIBALS PERSPECTIVES Establish a NGO including tribal representatives. Establish especially a higher educational institution in tribal area Conduct seminars and conferences in tribal areas Appropriate findings should be presented that address limitations also Eliminate “mediators” who absorb all benefits which are the rights of

tribes Do not close down primary schools even if there are just 1 or 2 students Design & develop flexible & contextual education curriculum (local

dialect). Design community schools with seasonal flexibility Family centred education. Inadequate and forceful resettlement policies and lack of rehabilitation Urging researchers to help the tribes give them their rights

WHAT CAN RESEARCHERS DO? Gather empirical evidence of effectiveness of the programs such as Integrated Tribal Development Programme. Present evidence to government for further appropriate action Gather qualitative aspects which bring to light the real causes of

situations like school drop outs, education etc. Explore how technology and social media can alleviate various

problems Design and evaluate if schools like Navodaya Model School can

be started in all tribal settings. Emphasis on tribal medicine research

GOVERNMENT INITIATIVES Till June 30, 2006 there were 20097 sub-centres

functioning against a requirement of 28383 sub-centres for tribal areas.

The number of functioning PHCs were 3260 against a requirement of 4180 and functioning CHCs were 446 against a requirement of 492.

There are also 1122 Dispensaries and 120 Hospitals and 78 Mobile Clinics in Modern Medicine .

1106 Dispensaries and 24 Hospitals in Ayurveda. 251 Dispensaries and 28 Hospitals in Homeopathy.

Eklavya

Ekalavya Model Residential School (EMRS) the government gives one time Rs 30 lakh grant for

establishing the school, thereafter up to Rs. 30 lakh per school annually.

Additional cost is borne by state governments.

By 2007, 72 Eklavya Model Residential Schools (EMRS) were established in tribal areas across India, including highest 10 in Orissa, followed by 8 each in Andhra Pradesh, Gujarat, Madhya Pradesh and Chhattisgarh states

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Mobile Medical Unit The mobile medical unit

comprises a doctor, lab technician, nurse, auxiliary mid wife and driver. The vehicle is fitted with all necessary equipment, including, microscope and a mini-lab.

Doctors will screen tribal people for diabetes, cardiac diseases, hypertension, symptoms of tuberculosis

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Goal

Improvement of healthcare infrastructure. Developing a flawless referral system. Provide diagnostic facilities for genetic defects. Follow up of anemic and other severe patients. Carry out population genetic survey programs. Health education. Genetic counseling. Marriage counseling. Provide prenatal diagnosis.

Tribal welfare programmes/schemes in India 1. Integrated Tribal Development Project 2. Nursery-cum-Women Welfare Centres 3. Mid Day Meal Scheme 4. Janshala Programme 5. Tribal Alternate Education Programme 2002-2007 6. Scheme of strengthening education among scheduled tribe girls in

low literacy districts 7. Incentives for education 8. Ashram schools 9. Pre matric hostels 10. Post matric hostels 11. Grant in aid schemes for welfare of scheduled tribes 12. Scholarships 13. Tribes India 14. National Overseas Scholarships 15. Book Bank Scheme 16. Central Sector Scheme for up gradation of merit of SC/ST students 17. Tribal research centre

Role of NGOs

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Tribes do not believe NGOs role in their development

High exploitation of tribes by NGOs

The funds availed from governments by NGOs for the betterment of tribes not

reaching the main beneficiary.. Empty promises and

innumerable surveys for data without any benefits or

improvement in the status of the tribal participants

NGOs in India - 99% Fraud

The Delhi high court has called for toughening of licensing norms for NGOs observing that 99% of them are "fraud" and "merely money making devices".

"Most private run so called philanthropic organizations do not understand their social responsibilities.05/03/23 62

Tribal Health Initiative

a non profit organisation located in the Sittilingi valley in Dharmapuri district, Tamil Nadu

Tribal Health Initiative

It works for the welfare of the local people who are predominantly Malavasi tribals.

As of 2010 it has grown to include a 24-bed

hospital with a labour room, neonatal unit, operation theatre, diagnostic laboratory and imaging facilities, a community health outreach programme

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Achievement Imr =147/1000 in 1992

Imr=20/1000 in 2012

The proportion of pregnant mothers coming for AN check-ups has increased from 11 per cent to 90 per cent 

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THI

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www.TribesIndia.com

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Eshop.Tribesindia.com -Ministry of Tribal Affairs

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Minister OF Tribal Affairs

Jual Oram – 27 May 2014

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Tribal Minister Of Tamilnadu

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Thiru N.SubramanianAdi Dravidar Welfare and Welfare of Hill Tribes and  Bonded Labour

Survival International- an NGO A human

rights organisation formed in 1969 that campaigns for the rights of tribal people

guided by the principle that tribal ways of living are not deficient, but in fact are desirable and should be maintained

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Quotes of Survival International

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Tribal people are not ‘backward’, they haven’t been ‘left behind’. They choose to live on their land, in their own ways.PROUD, NOT PRIMITIVE.

.’

Proud not primitive Eat vegetables- they

do it Drink pure and clean

water-they do it Walk a lot-they do it Live amidst nature-

they do it Don’t destroy forest to

reduce pollution-they do it

Avoid stress-they do it

SI – Campaign 1. use multiple media. 2.writing letters to

governments, 3. spreading the word

through sponsorships, 4. leaflets 5.demonstrations 6.film shows, and 7.collecting money from

a variety of events

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Vedanta Resources, a British company, lost a battle to dig an open-pit bauxite mine on Niyamgiri mountain in India.

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Latest Battle

ILO 169 The only international

law that can secure tribal peoples’ land rights

 ILO 169 recognizes and protects tribal peoples’ land ownership rights, and sets a series of minimum UN standards regarding consultation and consent.

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International Day –August 9 observed on August 9 each year to

promote and protect the rights of the world’s indigenous population.

The theme of this year’s International Day of the World’s Indigenous Peoples was “Bridging the gap — implementing the rights of indigenous people.”

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Conclusion Tribals’ right to good healthcare must be

addressed using modern technology and innovative approaches involving the community.

 Health is intimately linked to inclusive development with food and nutrition security, safe housing and availability of sanitation and clean drinking water.

There are many successful examples of good healthcare delivery in remote tribal areas in our country

These models need to be scaled up in order to improve the lives of the most vulnerable and marginalised citizens of our country.05/03/23 78

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