Presentation at the India Alliance Conclave 2021 based on the process and outcomes of THETA project. For more on THETA project, see https://wellcomeopenresearch.org/articles/4-202

1. Prashanth N Srinivas MBBS, MPH, PhD (public health)
Faculty & DBT/WellcomeTrust India Alliance Fellow &
Assistant Director (Research)
Institute of Public Health, Bengaluru (IPH Bengaluru)
PATTERNS, PROCESS& ACTION ON TRIB AL HEALTH:
MAPPING OF PROCESS & OUTCOMES UNDER
TOWARDS HEALTH EQUITY & TRANSFORMATIVE ACTION
ON TRIB AL HEALTH
Collaborators: C Madegowda, Deepa Bhat, Giridhara Babu, M D Madhusudan, NandiniVelho, Sumanth M Majigi,Tanya Seshadri
Mentors: Sundari Ravindran (2017-2020), Rakhal Gaitonde (2020 onwards)
Sponsor:AD Admin, IPH Bengaluru
External sponsor: Bruno Marchal

2. “…BEHIND EVERYONE, EVERYWHERE”*
• MMH Soliga photo Bhargav
2
* Anderson et. al 2016 The Lancet
Bhargav
Shandilya/
PLA
Project

3. BRINGING IN THEORY & HISTORY
3
• “…you finished off your
tigers and your forests and
are now coming here to
lecture to us on tiger
conservation”
• “…nice of you to ask us
how to conserve forests.
Just leave it alone….it will
conserve itself”

4. TRIBAL HEALTH
RESEARCH FIELD
BUILDING/EXPANDING
4
Asha George, Kerry Scott,Veloshnee GovenderWHO Alliance for HPSR/HRH Reader

5. 5
PATTERNS
PROCESS
ACTION

6. 6
PATTERNS
PROCESS
ACTION
OUTPUTS
NEXT STEPS

7. 7
PATTERNS
DATA: SCALE MATTERS
• Lack of fine-scale data from NFHS & design
issues (NFHS-4/5 offers “finer” scale but..)
• Episodic health-problem based prevalence
surveys focusing only on ST; lack of
comparison and characterization of inequities
• So, are the nationwide or even state-wide
patterns hold at finer scales? Are tribal
communities worse-off everywhere?
• Current narrative drives a nationwide
common solution (a national mission for eg.)

8. 8
8
PATTERNS

9. 9
9
Yogish CB .Nityashri SN Mahantesh SK
Sabu J
Sumanth M M
Yogish CB Mahantesh SK
Nandini Velho
Julee Jerang
Tanya Seshadri
PATTERNS

10. Kadakalkandi Solega settlement in BR Hills
PATTERNS
10

11. S U RV E Y S I T E :
L O C AT I O N S
Gaajagadi, a Kattunaika settlement in Wayanaad, Kerala
PATTERNS
11

12. 12
Baijalpur tribal settlement, Madhya Pradesh
PATTERNS

13. 13
Nere, a settlement of the Nyishi, a scheduled tribe in Arunachal Pradesh
PATTERNS

14. SURVEY TOOLS & SMARTPHONE APP
14
Screenshot of fulcrum app on smart phone
PATTERNS
Prashanth
NS/THETA
Project

15. Green is PA boundary (BRH to left & MMH to right); yellow zone is buffer around
PA from where sampling done; locations in yellow & green sampled on a gradient
of remoteness; QGIS output from THETA Project
LIST OF VARIABLES AND THEIR CORRESPONDING
RESPONDENTS
15
Settlement level socio-geographic geo-
spatial data
PATTERNS

16. THETA
QUANT
DATASET
•
16
Site wise survey details
Sr
no
Site
covered
Total
settlement
covered
Site wise
household
details Individual (children’s) Individual(Women)
ST
Non-
ST->
ST
(<5)
Non -
ST
(<5)
ST
(>5) Non- ST (>5) ST Non-ST
1
Arunachal
Pradesh 19 292 194 65 49 348 238 282 185
2 BR Hills 45 239 197 92 86 572 486 383 351
3 Kanha 34 212 208 68 84 470 473 339 358
4 Kerala 82 328 275 152 94 749 675 570 514
5 MM Hills 37 217 198 115 83 664 559 443 381
Total 217 1288 1072 492 396 2803 2431 2017 1789
Biomedical details
Sr no. Total village covered Total Households Total Male Total Female
ST Non-ST ST Non-ST ST Non-ST
1 62 349 259 110 90 239 169
PATTERNS

17. PATTERNS
SITE-WISE RESULTS
• Child & adult undernutrition & inequalities within site & within
ST (among different Adivasi communities)
• Characterising clustering of unfavourable healthcare/health
outcomes at settlement, site/state, social identity at finer
scales than available with NFHS/routine data
• Upcoming
• Special issue on Tribal Health of Ind J of Med Research based on our
data from Arunachal Pradesh (led by Julee Jerang)
• Testing the core hypothesis: how does healthcare access/outcomes
vary with respect to remoteness in/around forest areas; how does PA
policy/regime affect Adivasi/ST health (led by Prashanth)
• Nature of NCD risk in ST & non-ST populations from 3 regions in
India (led by Yogish)
• Conducting biomedical & public health surveys in remote rural and
Adivasi populations: Implications for data quality & tools
17

18. INTERSECTIONAL SUB-
GROUP ANALYSIS FROM
SECONDARY DATA
PATTERNS
18

19. 19
Sumanth M M
Deepa Bhat
PATTERNS
• Evaluating use of non-invasive Hb estimation
device in field settings
• Characterize dyslipidemia and NCD risk-
factors in southern Karnataka Adivasi
population
• Geo-spatial epidemiology & genotyping of SCD
among multiple Adivasi communities in
southern Karnataka
HYPERGLYCEMIA, DYSLIPIDEMIA &
SICKLE CELL DISEASE

20. 20
PATTERNS
PROCESS
ACTION
OUTPUTS
NEXT STEPS

21. 21
PROCESS
WHY ARE SYSTEMS
FAILING IN TRIBAL
HEALTH
• Common thread from
NGO/social movement
work in tribal areas: drivers
of poor health status are
pre-dominantly social,
structural….systemic
So, why & how are systems
(not only services) failing tribal
health?
Source: CHC/SOCHARA

22. SHARED OUTCOMES HIDE
MULTIPLE
PATHS/COMMUNITIES
• (Contested) Forest rights
• Rapid natural-resources extraction &
industrialization
• Socio-cultural “distance” from the
“mainstream”
• Colonial “label” of a “tribe” vs “caste”
Often history-dependent context specific
drivers, almost always Social.
For example (from experience/social
movements)
• Discrimination based on identity (Siddhi &
Koraga)
• Inter-tribal differences (heterogeneity; for
instance Adivasi vs ST in Karnataka)
• Indigenous vs AdivasiVs ST (counter-intuitive
ST-Adivasi relationships in Arunachal/NEI)
• Local feudal/colonial and/or exploitative
relationships with other communities 22
PROCESS

23. OVERARCHING
EXPLANATIONS/NARRATIVES –
LIMITED EMPIRICAL THEORIZING IN
PUBLIC HEALTH
• Geographical isolation (“They are staying too far
away….”)
• Cultural distinctness (“They have their own
culture, ways of life …..”)
• Romantic notions (“they also want/have
TV/mobile?,“live in harmony with nature”)
• Poor health outcomes, education etc. etc (“They
are lagging behind….”,“ignorance is a problem”)
23
Bhargav
Shandilya
PROCESS

24. 24
PROCESS

25. SOCIAL CONSTRUCTION OF
REMOTENESS &
DISADVANTAGE
25
• Neighborhood disadvantage and access to
healthcare - The case of sickle cell disease in two
Adivasi communities in central and southern India
• Experience of remoteness in diverse socio-
geographical settings in southern Karnataka
PROCESS

26. HEALTHCARE EXPERIENCE
& PATIENT RIGHTS
26
• How adverse healthcare experience shapes Adivasi
communities’ health-seeking behaviour in
secondary & tertiary hospitals?
• Preliminary work on notions of patient rights
among Adivasi communities
PROCESS
Meena Putturaj Mahadevamma

27. 27
PATTERNS
PROCESS
ACTION
OUTPUTS
NEXT STEPS

28. 28
ADVANCING PAR PRACTICE
ACTION

29. Transformative action on tribal health:
Interventions & policy engagement
29
ACTION

30. Transformative action on tribal health:
Interventions & policy engagement
30
ACTION
Transformative action on tribal health:
Interventions & policy engagement
theorise
Co-design
implement
Learn/reflect
Youth engagement through sports clubs (9) & inclusive
public “platforms”

31. Transformative action on tribal health:
Interventions & policy engagement
31
ACTION
Transformative action on tribal health:
Interventions & policy engagement
Youth engagement through sports clubs (9) & inclusive
public “platforms” à Community-based alcohol &
tobacco cessation services

32. Transformative action on tribal health:
Interventions & policy engagement
32
ACTION
Transformative action on tribal health:
Interventions & policy engagement
Healthcare navigation at secondary & tertiary care for
Adivasi patients

33. Transformative action on tribal health:
Interventions & policy engagement
33
ACTION
Transformative action on tribal health:
Interventions & policy engagement
Yogish CB
INCARE

34. Transformative action on tribal health:
Interventions & policy engagement
34
ACTION
Transformative action on tribal health:
Interventions & policy engagement
• Comprehensive action plan for GoK ST welfare on
systemic gaps in tribal health
• 7 recommendations of which all accepted & funding
secured; at least 2 implemented
• Tribal health research cell in medical colleges guidelines
being written
• Representation of Solega & Koraga in national Adivasi
platforms
Policy engagement with Koraga &
Solega social moment
(ADEQUATE Project)
Madesh Thammayya Susheela Kenjoor

35. Transformative action on tribal health:
Interventions & policy engagement
35
ACTION
Transformative action on tribal health:
Interventions & policy engagement
• Agenda-setting on health and healthcare within the Solega
& Koraga social movements
• Examining role of secure forest rights in health/healthcare
• First-ever census of the entire Solega people ongoing
• Strengthening existing federeated Sanghatane among the
Solega
Total 105 FRC strengthening meetings conducted in
Chamarajanagar district with1086 Adivasi membership.
C.Madegowda

36. Transformative action on tribal health:
Interventions & policy engagement
36
ACTION
Transformative action on tribal health:
Interventions & policy engagement
• Focused participatory Adivasi COVID-19 engagement
• Shared lessons with Governments & articles in media
• Vaccination support covering Adviasi communities in the
district
• First-ever exclusive Adivasi COVID care facility in state

37. 37
PATTERNS
PROCESS
ACTION
OUTPUTS
NEXT STEPS

38. HPSR FIELD-BUILDING: COVID-19 &
HEALTH SYSTEMS GOVERNANCE
38
OUTPUTS

39. STRENGTHENING SOCIAL SCIENCE
INQUIRY WITHIN ONEHEALTH
39
OUTPUTS

40. EDITORIAL & INVITATIONS
40
OUTPUTS

41. 41
OUTPUTS
3 à 9
Figures in black for 2017 at start of fellowship & figures in red status as on 2021
1 à 3
0 à 3
0 à 8
0 à 5
4 Masters thesis & 20 internships

42. 42
PATTERNS
PROCESS
ACTION
OUTPUTS
NEXT STEPS

43. DEEPENING AND EXPANDING
43
NEXT STEPS

44. Lead PI: Giridhara R Babu (IIPH-BLR, PHFI)
Co-PIs: Prashanth NS (IPH), Gauri Divan and Supriya Bhavnani (Sangath), Prashanth Thankachan (SJRI),
Poornima Prabhakaran (CEH, PHFI)
Senior Research Staff: Sumathi Swaminathan (SJRI), Debarati Mukherjee and Deepa R (IIPH-BLR,
PHFI), Siddhartha Mandal,Aditi Roy, Jyothi Menon, Ruby Gupta (CEH, PHFI)
PhD students: Eunice Lobo (IPH/IIPH-BLR) and SmitaTodkar (Sangath)
Nutritional, Psychosocial and Environmental Determinants
of Neurodevelopment and Child mental health (COINCIDE)
Funding: DBT/Wellcome Trust India Alliance Team Science Grant
TEAM
NEXT STEPS

45. LONG-TERM ENGAGEMENT THROUGH
FIELD STATION
45
NEXT STEPS

46. ACKNOWLEDGEMENTS
• India Alliance Grants Administrators: Sachin Sharma, Mahesh
• Upendra Bhojani, Pragati Hebbar,Tanya Seshadri, N Devadasan and Akshay
Dinesh and several others among IPH staff & well-wishers; Devaki Nambiar,
Sundari Ravindran & Rakhal Gaitonde; Giridhara Babu, Sumanth M M, Deepa
Bhat,Tanya Seshadri, M D Madhusudan & NandiniVelho
• Vivekananda Girijana Kalyana Kendra (BR Hills) & Zilla Budakattu Girijana
Abhivruddhi Sangha, Chamarajanagar
• District Administration and Zilla Panchayat of Chamarajnagar, particularly
DHO Dr.Vishweshwarayya
• Department of health & family Welfare & ST Welfare departments in
Chamarajanagar district
• Health, Forests & Environment, Rural Development and Panchayati Raj
Department & ST Welfare departments, Government of Karnataka
• Forests and tribal affairs departments in Kerala
• Friends and colleagues from IPH Bengaluru Health equity cluster & other IPH
Bengaluru colleagues
46
THETA team (former and current; in alphabetical order of first names): Anika Juneja, Bhagya, Jose Thomas, Julee Jerang, Mahadevamma, Mahantesh Kamble,
Madesh Thammayya, Mahesh, Shivamma, NandiniVelho, Nagesh, Nityasri S Narasimhamurthi, Pande Gowda, Puneet, Sabu K Kochupurackal, Santosh Sogal, Shekar,
Susheela Kenjoor, Yogish Channabasappa