Poor healthcare leaves Scheduled Tribe more vulnerable to diseases

Members of the Scheduled Tribe (STs) make up for 8.6 percent or 104 million of India's total population, according to the 2011 census. Around 40.6 percent of them live below poverty line (BPL), which is almost double when compared to non-STs.

But what's appalling, is their healthcare statistics.

A report submitted by a 12-member expert committee on tribal health chaired by social activist Dr Abhay Bang, submitted to the government in August points out to the glaring gaps in tribal healthcare.

Bang, who is based out of Gadchiroli in Maharashtra, is well known for his work on community health.

The report released after nearly five years of extensive research made several recommendations to strengthen the tribal healthcare apparatus, including strict implementation of tribal sub plans.

Here are some of the findings of the report:

Tribal people account for almost 30 percent of all malaria cases in the country. The prevalence of tuberculosis is almost three times higher than other communities, and only 11 percent of those infected receive treatment.

In terms of leprosy - STs constitute 18.5 percent of all cases diagnosed in the country.

While malnutrition and communicable diseases continue to be rampant, rapid urbanisation, environmental distress and changing lifestyles are taking a toll on their health.

There is a dramatic rise in the prevalence of non-communicable diseases like cancer, hypertension and diabetes. One out of every four tribal adults suffers from hypertension.

There is also mental illnesses and alcohol and tobacco addiction, which are rampant among tribal people. Almost 72 percent of the tribal men in the 15-54 years age group use tobacco and 50 percent consume alcohol.

Further, infant mortality rate is at 44.4 percent compared to 32.1 among non tribal people per 1,000 live births. The under-five child mortality is 57.2 per 1,000 live births compared to 38.5 in other communities and only 55.7 percent tribal children were immunised compared to 71.6 percent.

Expert committee recommendations

Some of the key recommendations made by the committee include strengthening public primary healthcare system in tribal areas, raising budgetary allocation, expanding human resources and healthcare infrastructure and involving tribal people in planning, decision making and implementation of healthcare programmes.

To be specific, the committee recommends implementation of the National Health Policy, 2017 proposal to increase healthcare spend to 2.5 percent of GDP.

"If you apply the goal of 2.5 percent of GDP on per-capita basis to tribal population, it means nearly 30,000 crore per year allocation," Bang told Moneycontrol.

He stressed on the need for a stronger public healthcare system as nearly 50 percent of outpatient visits by tribal people are to public hospitals, and more than two third of the indoor hospitalisation of tribal people is in government health services.

Bang called for a dedicated tribal health service with 1,000 strong cadre.

"The governance structure is tribal health is very bad. There is no separate governing structure. No one knows what is the tribal mortality, how much is the budget, how much money spent," he added.

Speaking about engaging people from within the community as human resources, Bang said, "For the past 70 years, we have been depending on outside doctors and outside nurses to go, they wouldn't go, as they don't stay there. So that model has failed. That's why posts are vacant. So we must train from tribal youth for Arogya Mitra, Asha workers, nurses and medical graduates."

He observed that despite reservations in medical colleges for STs, not many doctors are coming from the community and alleged that those seats were being filled by bogus ST candidates with fake reservation certificates.

Bang called for improving access to clean drinking water, sanitation facilities, drainage facilities and clean cooking fuels to improve broader health indicators.