Tribal Health Status in India 3 18 2018 1

Tribal Health Status in India 3/18/2018 1

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 3/18/2018 2

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 3/18/2018 3

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. 3/18/2018 7

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

Andaman Primitive Tribal Communities 3/18/2018 9

The uncontacted tribes 3/18/2018 10

AERIAL FOOTAGE OF UNCONTACTED TRIBES Mere contact with outsiders was often sufficient to set off deadly epidemics 3/18/2018 11

The Andamanese Tribes Great Andamanese, estimated 53 Jarawa now estimated 250 to 300 Jangil -90 to 100 Onge, now fewer than 100 Sentinelese, now estimated to be 39 3/18/2018 12

Extinction 3/18/2018 13

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 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) 3/18/2018 15

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 3/18/2018 16

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 3/18/2018 17

Extinction of Bo Community 3/18/2018 18

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. 3/18/2018 20

Distribution of Scheduled Tribe Population by States - 2011

Tribal population of Tamilnadu Tribal population: 1% of total male: 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) 3/18/2018 24

DIFFERENT TYPES OF TRIBES

Tribal classification Agriculturists Cattle herder Folk artisans Labourers Food gatherers and hunters

Key Indicators

Key health indicators

Sex Ratio & Child Sex Ratio (Females per 1000 males) Indicator Total Population Total Rural Urban Scheduled Castes Total Rural Urban Scheduled Tribes Total Rural Urban Sex Ratio 2001 2011 933 946 900 943 949 929 936 939 923 945 946 978 981 944 990 991 980 INDIA Child Sex Ratio 2001 2011 927 919 934 923 907 905 938 933 941 936 924 922 973 957 974 959 951 940 Source: Primary Census Abstract for Total population, Scheduled Castes and Scheduled Tribes, 2011 Office of the Registrar General & Census Commissioner, India

Literates & Literacy Rate (Persons) Indicator Literates 2001 Total Population Total 56, 06, 87, 797 Rural 36, 17, 36, 601 Urban 19, 89, 51, 196 Scheduled Castes Total 7, 53, 18, 285 Rural 5, 58, 06, 266 Urban 1, 95, 12, 019 Scheduled Tribes Total 3, 23, 86, 821 Rural 2, 82, 94, 749 Urban 40, 92, 072 2011 INDIA Effective Literacy Rate 2001 2011 76, 34, 98, 517 48, 26, 53, 540 28, 08, 44, 977 64. 8 58. 7 79. 9 73. 0 67. 8 84. 1 11, 37, 59, 907 8, 20, 232 3, 17, 39, 675 54. 7 51. 2 68. 1 66. 1 62. 8 76. 2 5, 16, 35, 423 4, 46, 31, 645 70, 03, 778 47. 1 45. 0 69. 1 59. 0 56. 9 76. 8 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 State/ Literacy rate Union Territory # Top 5 Bottom 5 Daman & Diu # Mizoram Tripura D & N Haveli # Kerala Lakshadweep # Mizoram Nagaland Sikkim Tripura Scheduled Castes 92. 6 Bihar 92. 4 Jharkhand 89. 4 Rajasthan 89. 4 Uttar Pradesh 88. 7 Andhra Pradesh Scheduled Tribes 91. 7 Andhra Pradesh 91. 5 Jammu & Kashmir 80. 0 Madhya Pradesh 79. 7 Bihar 79. 1 Odisha Source: Primary Census Abstract for Total population, Scheduled Castes and Scheduled Tribes, 2011 Office of the Registrar General & Census Commissioner, India 48. 6 55. 9 59. 7 60. 9 62. 3 49. 2 50. 6 51. 1 52. 2

LR 3/18/2018 32

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 3/18/2018 33

Diseases Encountered 3/18/2018 37

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. G 6 PD 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 3/18/2018 40

G 6 PD Deficiency 13 lakh Tribal Population > 15 % among tribal population in Tamil. Nadu, Orissa, Maharastra, Madhyapradesh 3/18/2018 41

Mental Health Issues 20/1000 (73) 11/1000 Depression (20) 3/1000 Hysteria 2/1000 Phobia 1/1000 Schizophrenia (1. 5) 0. 4/1000 Mania 3/18/2018 42

AIDS 2. 9/1000 per among tribes (2. 8) Heterosexual transmission Blood and Blood related products Homosexual Transmission Vertical Transmission Needle stick Injuries 3/18/2018 43

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) 3/18/2018 44

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. 3/18/2018 52

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 subcentres 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 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 3/18/2018 56

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 3/18/2018 57

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 3/18/2018 60

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. 3/18/2018 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 3/18/2018 64

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 3/18/2018 65

THI 3/18/2018 66

www. Tribes. India. com 3/18/2018 67

Eshop. Tribesindia. com -Ministry of Tribal Affairs 3/18/2018 68

Minister OF Tribal Affairs Jual Oram – 27 May 2014 69

Tribal Minister Of Tamilnadu Thiru N. Subramanian Adi Dravidar Welfare and Welfare of Hill Tribes and Bonded Labour 3/18/2018 70

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 3/18/2018 71

Quotes of Survival International . ’ 3/18/2018 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. 72

Proud not primitive Eat vegetables- they do it Drink pure and clean water-they do it Walk a lot-they do it Live amidst naturethey do it Don’t destroy forest to reduce pollutionthey 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 3/18/2018 74

Latest Battle Vedanta Resources, a British company, lost a battle to dig an openpit bauxite mine on Niyamgiri mountain in India. 3/18/2018 75

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. 3/18/2018 76

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. ” 3/18/2018 77

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. 3/18/2018 78

3/18/2018 79