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Taking health care to tribal heartland 

Instead of tribals going to New Delhi, New Delhi had come to the tribals.
Photo: Singam Venkataramana
The Hindu

Instead of tribals going to New Delhi, New Delhi had come to the tribals. Photo: Singam Venkataramana

New Delhi travelled to tribal heartland. The expert group offers hope; an opportunity to ensure that the tribals have a say in policies that are framed for them.

Earlier this month, a motley group of 50 academicians, government officials and activists gathered at Shodhgram village in Maharashtra’s Gadchiroli district. This is an area known for malaria, malnutrition and Maoists, not necessarily in that order.

Everyone left technology behind (mobile phones and gadgets) to ensure that there were no distractions to the flow of conversation over three uninterrupted days. It was to talk about an ‘x’ number of India’s 100 million tribal population.

The Health Ministry had decided to hold the workshop on “Best Practices in Tribal Health” in tribal heartland; on a campus surrounded by lush forests and designed as a Gond village. Instead of tribals going to New Delhi, New Delhi had come to the tribals.

What led to this meeting was another first: the government’s recognition of the differential and unique health needs of tribal communities. In October 2013, the Ministry of Health and Family Welfare and the Ministry of Tribal Affairs’s expert group was to frame a national policy on tribal health, given the unique socio-cultural realities of these communities.

Its chairperson, Dr. Abhay Bang, who along with his wife, Dr. Rani Bang, has, for almost three decades, led community-based action and research for and on the health of India’s neo-nates and tribal people.

Seeking scaleable solutions

As a result, we now have access to multidimensional, national level data; data that has not only been missing from our statistical databases but also from our consciousness. The results will be presented along with the group’s report at the end of this year.

The three days were fruitful. The group identified 26 areas that have the potential to break some of the biggest barriers to tribal health. Some are malaria, malnutrition, maternal and child mortality and fluorosis.

“In 1995, the district collector of Mandla contacted the National Institute for Research in Tribal Health (NIRTH) at Jabalpur. In Tilaipani village, all the children had knock-knees and severe pain. They had fluorosis,” said Dr. Tapas Chakma, senior scientist with NIRTH. His team then focussed on a commonly grown weed, rich in calcium, iron and vitamin C that could help mitigate fluorosis.

Dr. Sudarshan from the Karuna Trust showed how public-private partnerships with north-east Indian governments have taken health to the hinterlands. The Chhattisgarh government highlighted its outsourcing human resource recruitment, while doctors from Jan Swasthya Sahyog, Bilaspur, pushed for community-run crèches to fight malnutrition. Village women trained by the Society For Education, Action and Research in Community Health demonstrated how they treated sepsis and used ambubags to save newborn children.

Policy priorities

Each of the practices offered a ray of hope for a population that has long been relegated to the peripheries of India’s development story.

Now some key policy issues that could determine the state of tribal health in India. For instance, is outsourcing the answer to providing quality care in tribal areas? Is volunteerism in health services sustainable? Can Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoepathy doctors or nurses fulfill the human resource gap created by lack of doctors in tribal areas? Most importantly, what are the priorities for tribal health and who determines them?

Dr. Soumya Swaminathan, Director General of the Indian Council of Medical Research (ICMR) called for greater collaboration between academia, civil society and government to conduct multi-centric evidence studies. “It is important to include anthropologists, sociologists and economists in health research,” she said, while asking for a sharing of ideas and evidence in tackling the sickle cell disease.

Sickle cell disease is an inherited condition where the hemoglobin in red blood cells is abnormal and may block the passage of oxygen, resulting in severe pain and gradual damage to vital organs. It can only be prevented, not cured. According to ICMR, the sickle cell gene is widely prevalent among some tribal groups, with a prevalence rate of 1-40 per cent.

“We have launched a screening programme in 18 States. This will enable us to know the problem. But what of the solution? At the end of the programme, lakhs of people would know that they carry the disease or the gene for it,” she said.

“What recourse will we offer them?” Dr. Swaminathan asked. She laid stress on the need for projects that reduce morbidity and mortality among sickle cell carriers.

Evidence from Gujarat, which initiated sickle cell screening in 2006, shows that pre-marital counseling to prevent transmission does not work. It also presents itself as an ethical conundrum. The State needs to ensure that carriers, particularly girls, do not face discrimination.

Perhaps the Bangs’s experience of sickle cell testing best frames the policy question. “When we started work in Gadchiroli in 1986, we detected sickle cell disease and tried to discuss the way forward with the tribals. They laughed and said, “Who told you this is our problem?” For them, malaria and child mortality are much bigger issues as most sickle carriers lead normal lives.”

So, who determined that sickle cell screening is a priority in tribal health? Did someone study the impact of sickle cell on the life and productivity of tribals?

This takes us back to the main question. Do our policies address the priorities of tribals or do they set priorities for them? Unfortunately, it has been the latter. But this time New Delhi travelled to tribal heartland. The expert group offers hope; an opportunity to ensure that the tribals have a say in policies that are framed for them.

Will we let it move forward? Only time will tell.


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