A policy brief by the ILO in May underlines that the evolving pandemic brings new socio-economic repercussions, affecting over 476 million indigenous and tribal people (constituting over 6% of the global population) substantively. Lack of basic healthcare infrastructure, precarious birth practices, poor nutrition and unsafe water are some of the features of rural India. As a significant chunk of the tribal population belongs to rural areas, it is expected that healthcare facilities for them are not as robust compared to facilities availed by other communities.
The National Family Health Survey-4 (2015-2016) reports that various indicators of childhood mortality rates—neonatal and postnatal, infant, child, and under-five—are higher among STs compared to others. The under-five mortality among our tribal population is 57.2 per 1,000 live births, while the figures are 49.7 at the all-India level and 38.5 among other categories. The condition of Odisha’s tribals are worse, as the figure stands at 65.6. In a recent study in The Lancet, Anderson et. al. (2016) show an ST child in India has a 19% and 45% greater risk of dying in the neonatal period and post-neonatal period respectively as compared to a child from other communities.
The prevalence of TB is significantly higher among the tribal population—703 and 256 per 100,000 among STs and total population respectively. Haemoglobinopathies and thalassemia are two unique conditions that fall under major health challenges among the tribal population from Andaman and Nicobar Islands, MP, the Northeast, Odisha and Bengal. As per NFHS-4, 59.9% of tribal women have some form of anaemia, whereas it is 49.8% among women from other communities.
The Statistical Profile of Scheduled Tribes, 2013, reported a deficiency of 268 community health centres, 1,086 primary health centres and 5,638 sub-centres in India’s tribal areas. Tribal people are far behind in availing the benefits from the three-pronged healthcare network constructed to increase the health status of the rural population.
Distance to the health facility, dependence on transport, unavailability of drugs and people responsible for providing them, etc., are some key obstacles for tribal women as compared to women from other groups; 56.5% of tribal women cite ‘no drugs available’ as the major problem in accessing medical advice or treatment when sick against 49.5% women from other groups. Around 55.8% of children aged 12-23 months among the tribal community received all basic vaccinations, while other categories are better placed at 64.5%. Over a prolonged period, severe shortages of basic healthcare facilities are believed to be the prime cause of malnutrition and the prevalence of diseases such as malaria, leprosy and TB.
Road ahead: In the wake of Covid-19, health experts have often highlighted that compromised health conditions, low immunity and lack of proper medical facilities make people vulnerable to the virus. Tribal and forest communities are primarily exposed. So the government should ensure adequate awareness and healthcare infrastructure to protect their rights and livelihoods. It is impossible in the short run to bring a big change in their health conditions, but the establishment of awareness cells with better sensitisation and adequate supply of health workers to deal with Covid-19 can be a pragmatic option.
The lockdown restrictions have also affected access to forests and livelihood activities of the particularly vulnerable tribal groups (PVTG). Broadly two types of health resources in their areas are adversely affected. Firstly, their herbal medicine—a system that has almost collapsed over the years. Second, access to modern medicine through healthcare systems. Tribals are again expected to be badly dealt with, given the fact that the health centres themselves are under tremendous stress.
As per the latest statistics given by the Ministry of Health and Family Welfare, Covid-19 may not have yet caused havoc in the pockets of tribal-dominated people but have hit them hard in terms of their livelihood. Some global evidence on the impact of Covid-19—in particular, increasing infections in Brazil among indigenous people—indicate new challenges in the Indian context. The mortality rate in Brazil among indigenous people is double the national average. India, with a similar economic structure to Brazil and a sizable tribal population, may also face such a situation. Hence, preparedness in terms of healthcare availability, accessibility, affordability, adequacy and acceptability in tribal areas are the need of the hour.
Pratap C Mohanty
Assistant Prof, Dept of Humanities & Social Sciences, IIT Roorkee
Chandan K Mohanty
(pratap.mohanty@hs.iitr.ac.in, chandaneco.jnu@gmail.com)