3. INTRODUCTION
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⚫ Defined by Lokur committee(1965) as:
Those communities which have primitive traits,
distinctive culture, geographical isolation, shyness of
the contact with the community at large, and
backwardness
⚫ Constitution of India – tribal groups are specified
under Article 366 (25) and 342
⚫ Article 366 (25) defined scheduled tribe as “such
tribes or tribal communities or parts of or group within
such tribes or tribal communities as are deemed
under 342 to be Scheduled tribes for the purpose of
this constitution.
4. Cont...
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4
⚫ The word “tribal” - half-
naked men and women,
arrows and spears in
their hands, combined
with myths of savagery
and cannibalism.
⚫ Greatly dependent on the
forest for their daily
needs, including food,
shelter, instruments,
medicine, and even
clothing.
5. GEOGRAPHICAL DISTRIBUTION
OF TRIBES
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⚫ India has 2nd largest Tribal population in the world
⚫ 8.6% of total population and 15% of total land area
⚫ Total of 104 million tribal people and there is 705
tribes (Census 2011)
⚫ Geographically- resides mainly in central India and
North East India
⚫ 10 states- A.P, Telangana, Assam, Jharkhand,
Gujarat, Chhattisgarh, Maharashtra, Odisha,
Rajasthan and West Bengal
⚫ 89.97 % living in rural areas and 10.03% in urban
areas
⚫ Madhya Pradesh has the highest number
8. 5 regional groups based on ecological,
social, administrative and ethnic factors
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⚫ Himalayan region: 3 sub regions - (a)North-Eastern
Himalayan region (b)Central Himalayan region (c)North
Western Himalayan region
⚫ Middle region: constitutes of more than 55% tribal
population - Bihar, Jharkhand, Chhattisgarh, West
Bengal, Odisha, Madhya Pradesh
⚫ Western region: Rajasthan, Gujarat, Maharashtra,
Goa, Dadra and Nagar Haveli
⚫ Southern region - Andhra Pradesh, Telangana,
Tamilnadu, Karnataka, and Kerala
⚫ Island region - Andaman and Nicobar islands and
Lakshadweep islands
10. Economic typology of tribes
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⚫ Food gatherers and hunters. Eg: Jenukurubas of
Karnataka, Rajis of Uttar Pradesh, Chenchus of
Hyderabad, Kadars of Cochi, Jarwa and the
Andamanese of Andaman islands.
⚫ Shifting cultivators. Eg: Nagas of Assam, Khasis of
Meghalaya, Korwa of Bihar, Saora of Odisha.
⚫ Settled agriculturists. Eg: Mundas
⚫ Artisans (making things by hand). Eg: Kota of Nilgiris
⚫ Pastoralists and cattle handlers. Eg: Todas of Nilgiris,
Bakerwal and Gaddi in Himachal Pradesh.
11. Cont...
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⚫ Folk artists. Eg : Pradhans of Madhya pradesh
⚫ Wage labourers. Eg: Santhals of Bihar
⚫ Acculturated layer: They have travelled farthest from
their original habitat (civilised). Eg : Minas
⚫ Settled schedule tribe agriculturists: They have
come quite some way from their original habitat. Eg:
Santal
⚫ Those who have hardly shifted from their original
habitat. Eg: Khasis
⚫ Those encysted in their original habitat. Eg: Kadars
13. DEMOGRAPHIC PROFILE
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Scheduled tribe Normal
population
Sex ratio 990 943
Child sex ratio(0 to
6 years)
957 914
Literacy rate 59% 73%
Life expectancy at
birth
63.9 years 67 years
•Population of tribal male – 52.5% and female –
47.5%
•Total fertility rate – 2.48 (1.93 in normal)
14. Cont...
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Poverty rate – 45.3% in rural (25.7% in general
population) and 24.1% in urban areas (16.3% in general)
Housing and household amenities –
15. Reproductive, maternal, newborn, child health
indicators
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⚫ Girls marrying below 18 years is up to 60%.
⚫ 43% of tribal pregnant women do not receive any
antenatal check up
⚫ 21% do not receive any Tetanus Toxoid injections
⚫ 51% do not receive Iron and Folic acid tablets.
17. The health problems of the
tribes arise from:
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❑ Socio-cultural – low literacy, poverty, difficult
geographical terrains
❑ In-breeding leads to genetic disorders
❑ Environmental conditions (Forest indwelling) -
Vector borne diseases- 30% of all cases of malaria
❑ Poor maternal & child health services.
18. Cont...
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❑ Inaccessibility to safe drinking water & sanitation
Gastrointestinal disorders like Helminthiasis, Amoebiasis,
Giardiasis and Diarrhoeal disease
❑ Belief in taboos, spiritual powers, stigmas - STIs
(Syphilis) & other venereal diseases
❑ Lack of manpower and health infrastructure, -
Communicable diseases - Chronic infections like TB,
Leprosy, etc
❑ Poor health seeking behaviour, alcohol and tobacco
consumption – non communicable diseases
19. Cont..
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❑ Poor personal hygiene - Yaws, Scabies.
❑ Poor menstrual hygiene – reproductive tract
infections
❑ The tribal population are considered as “son of soil”
and they consume what is produced in soil which
makes them more vulnerable for nutritional
deficiencies - Poor nutrition / Malnutrition - Nutritional
problems.
❑ Cultural practice of consuming Alcohol- Its
accepted culturally and traditionally in tribes of North
East India -: Alcoholism
20. Burden of diseases
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1. Nutritional
2. Communicable
3. Non-communicable
4. Genetic
5. Mental health and addictions
6. Animal attacks and violence in conflict areas -Accidents,
trauma and snake bites
7. Maternal & Child Health
22. Cont..
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⚫ 25.2% of men and 31.7% of women are thin
⚫ 9.8% of men and 10% of women are overweight
⚫ Prevalence of Anemia is high – 39.6% in men and
68.5% in women
⚫ The consumption of essential vitamins and minerals is
below the recommended dietary allowances
⚫ Percentage of ST children consuming food rich with
vitamin A is 43.8% which is lower than National average
24. Cont....
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⚫ RNTCP provides free diagnosis and treatment
⚫ Around 40,000 tribal patients treated since 2015
⚫ To improve access to tribal people -
1. There is additional TB units and designated microscopic
centres in tribal areas
2. Compensation for transport of patient and attendant
3. Higher rate of salary for those who working in tribal
areas
4. Enhanced vehicle maintenance and travel allowance
25. Cont...
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⚫ The programme finds case through systematic active TB
screening in a campaign mode
⚫ Door to door case finding efforts are carried out
⚫ During the campaign, it screened more than 72,000 target
tribal population and diagnosed 27 additional TB cases
⚫ Most significant aspect of this project is the introduction of
mobile TB diagnostic van (MTDV) equipped with X- ray
and sputum microscopy facilities- initially in 5 states- MP,
Gujarat, Chhattisgarh, Rajasthan and Jharkhand)
27. Cont..
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⚫ Under the national leprosy
eradication programme, state wise
disaggregated data of tribal
population is collected on monthly
basis.
⚫ Funds are given to NGOs to
encourage there work in tribal areas.
29. Cont..
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⮚ Malaria and other vector borne
diseases
⮚ National vector borne disease control
program- (Malaria, Dengue, Chikungunya,
JE, Kala-Azar, Filaria)
⚫ Focused attention for tribal people in
North eastern states and parts of Andhra
Pradesh, Chhattisgarh, Gujarat, MP,
Maharashtra and Odisha
⚫ World bank support is also provided for
elimination of Kala Azar and Malaria.
30. Non-communicable diseases
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⮚ Hypertension-
⚫ One out of every four tribal adults suffer from
hypertension
⚫ Prevalence 14.8 to 19.9% in male and 11 to 18.5% in
female
⚫ It increase with age, consumption of tobacco, alcohol
and sedentary life.
⚫ Only 5% men and 9% women having hypertension knew
their hypertensive status
⮚ Diabetes mellitus-
⚫ Prevalence is 6.6% in men and 5.5% in women
(National institute of nutrition)
⮚ Cancers– Highest incidence of cancer – Mizoram & AP
⚫ women - cancer of cervix & men oral cancer
31. Cont..
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⮚ Blindness and visual impairment –
⚫ The NPCB is a centrally sponsored scheme having a goal
to reduce the prevalence of Blindness to 0.3 by 2020-
tribal people also getting the benefits of this scheme
⚫ Following schemes are there especially for NE states
including Sikkim –
✔ Assistance for construction of dedicated eye units
✔ Appointment of ophthalmic manpower to meet the
shortage
✔ Assistance for treatment of Cataract, Diabetic retinopathy,
Glaucoma, refractive errors, Corneal transplantation,
childhood blindness and Vitreo-Retinal surgeries
32. Genetic disorders
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⚫ Prevalence of sickle cell disease and Thalassemia-
varies between 1-40% in tribes
⚫ Sickle cell anaemia - 1 in 86 births in tribes of central
India
⚫ G6PD deficiency - prevalence varied from 0.7 to
15.6 % in tribal populations showing a high frequency
of sickle gene.
⚫ Haemoglobin E is most commonly seen in tribes of
North-Eastern states
⚫ Thalassemia – 12.7% of tribal population of Parajan
bhuyan, Kutia kondh, Lodha ect.
33. Mental health and addictions
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⚫ 72% of tribal men in 15-54 years age use Tobacco
(56% in non-tribal men) and 50% of them consume
alcohol
⚫ This addictions are risk factors for non-communicable
diseases and increases mortality.
⚫ Also reduce productivity and increase poverty,
generate law and order problems
34. Reproductive, maternal, newborn
health
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⚫ Factors responsible for high mortality rate :
1. Early marriage
2. Early child birth
3. Low BMI
4. High incidence of Anaemia
5. Inadequate antenatal, postnatal and neonatal care
35. Menstrual health
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⚫ There is lack of awareness regarding menstruation,
hygiene practices during menstruation and the physical and
psychological changes associated with puberty.
⚫ Taboos regarding this issue in the society - prevent girls
and women from articulating their needs, and the problems
of poor menstrual hygiene have been ignored or
misunderstood.
⚫ Religious restrictions, sleeping on the floor, not touching
the stored food items and restrictions to eat certain food
during menstruation were some cultural practices observed
among tribal adolescent girls
36. RMNCH-A STRATERGY
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⮚ AIM
⚫ Reach their services to maximum number of people in
the remote areas of country especially tribal areas
⚫ Continuum of services
⚫ Constant innovations
⚫ Routine monitoring
38. Health care delivery in Tribal
Population
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⚫ One sub-centre for 3000 population
⚫ One PHC for 20,000 population
⚫ One CHC for 80,000 population
⚫ According to rural health statistics,
- shortfall of doctors in PHCs and specialists in
CHCs in the tribal areas.
❑ Sub-centres: short fall of 4996 (27% of the required
number)
❑ PHCs: short fall of 1023 (40%)
❑ CHCs: short fall of 209 (31%)
39. Special schemes to tribal
population:
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⚫ The Navsanjivani scheme - In all tribal areas of
Maharashtra - To reduce IMR / MMR
⚫ Matrutva Anudan Yojana - 400 Rupees for pregnant
women, medicine worth Rs 400
⚫ Pada Volunteer Scheme
⚫ Mobile Medical Squad
40. National institute of research in
Tribal health-
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⚫ Jabalpur, Madhya Pradesh
⚫ Formed in march 1st 1984 –
institution by Indian council of
medical research
⚫ Recognized by WHO
⚫ Objectives –
⚫ Do research projects on Malaria,
Tuberculosis, Filariasis, Diarrhoea,
Flurosis etc.
⚫ Has a sickle cell clinic, referral
laboratory for TB, state referral lab
for HIV/AIDS
41. Ministry of Tribal Affairs:
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⚫ Constituted in October 1999
⚫ Present minister : Arjun Munda
⚫ Objective :To provide more focused attention on the
integrated socio-economic development of the most
under-privileged sections of the Indian society- the
Scheduled Tribes (STs), in a coordinated and planned
manner.
⚫ Nodal Ministry for the overall policy, planning and
coordination of programmes for development of STs.
42. Programmes for development of
STs:
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⚫ Social security and social insurance to the
Scheduled Tribes.
⚫ Tribal Welfare: Tribal welfare planning, project formulation,
research, evaluation, statistics and training.
⚫ Promotion and development of voluntary efforts on tribal
welfare
⚫ Scholarship for students belonging to such tribes
⚫ Scheduled Castes and the Scheduled Tribes (Prevention
of Atrocities) Act, 1989
43. Reservations for SCs
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⚫ As per Article 330 and 332 - reservation of seats for
STs
⚫ In central government funded higher education
institutions - 22.5 % for SC and ST students (7.5% for
STs)
⚫ STs has also got reservations for government jobs
and public sector jobs
⚫ In Karnataka - State reservation is 3% for STs
44. National Commission for
Scheduled Tribes:
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⮚ The statutory National Commission for Scheduled Castes
and Scheduled Tribes came in 2003 Constitution (89th
Amendment) Act – 338A
⚫ Health guide should be made available for each village
⚫ Providing incentives to doctors and paramedical staff
⚫ Provision of safe drinking water.
⚫ Creation of awareness regarding family planning.
45. Cont...
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⚫ Provision of accommodation in sub centres for health
worker.
⚫ Provision of basic laboratory facility in sub centre
⚫ Training of local ST girls and boys as multipurpose health
workers(MPHW).
⚫ CHC’s should be equipped with operation theatres
⚫ Arrangement for at least one ambulance in CHC’s
⚫ Anti-snake venom and anti-rabies vaccine
46. Initiatives by World Bank
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⚫ Works by public private partnership (PPP)
⚫ There are many objectives
1. Raising awareness of health issues – by education
and communication campaigns- teach about
importance of hand washing, regular ante-natal
checkups, institutional deliveries and immunization
2. Changing the behaviour of health care providers
3. Providing financial supports
47. Cont...
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4. Bringing health services to remote population-
⚫ By mobile health clinics(mainly by NGOs) - consists of
a qualified doctor, two ANMs, a pharmacist, a lab
technician, and a male/female support staff
⚫ In Karnataka - over 25,000 tribal patients getting
benefits of this initiative
5. Providing emergency transportation for mothers
6. Employing health workers from tribal communities -
⚫ In Karnataka - in every batch of ANM training, 10
seats are reserved for tribal girls in each districts who
has passed 10th class
48. Role of NGO's:
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⚫ The National Health Policy emphasised the role of
NGOs in two vital areas of tribal health i.e.,
1. Primary health care
2. Population stabilization
⚫ These NGOs are funded by the government under
the grants-in aid provision.
⚫ NGO’s in India :
⚫ Bharatiya Adimjati Sewak Sangh – sociocultural and
econmic devolopment of tribes – Newdelhi
⚫ Indian Council for Child Welfare
⚫ Central Social Welfare board
49. NGO's in Karnataka:
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⚫ Nagarahole Tribal Rights Restoration Committee of
Hunsur and Kodagu
⚫ Vanavasi Girijana Mahila Sangha
⚫ Nisarga of H.D. Kote
⚫ Coorg Organisation for Rural Development
⚫ Samruddhi
⚫ Tribal Joint Action Committee.
⚫ Vivekananda Girijana Kalyana Kendra (VGKK)
50. 2/7/2024
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SUMMARY-
•Tribal groups are specified under Article
366(25) and 342
•Total of 104 million tribal people and there is
705 tribes
•Madhya Pradesh has the highest number
•43% of tribal pregnant women do not
receive any antenatal check up
•Health issues arising from-
- Inaccessibility to safe drinking water &
sanitation, poverty, illiteracy
- Belief in taboos, spiritual powers.
- Lack of manpower and health infrastructure
•National institute of research in Tribal
health-Jabalpur
51. REFERENCES
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⚫ Park’s textbook of preventive and social
medicine, 25rd edition
⚫ IAPSM textbook of community medicine
⚫ AFMC textbook of public health and
community medicine
⚫ Govt. Of India, Report of the expert committee on tribal
health, ministry of Health and family welfare
⚫ https://www.worldbank.org/en/news/feature/2012/02/28/im
proving-health-services-for-tribal-populations
⚫ India's first comprehensive tribal health report by Ayesha
Marfatia
https://www.worldbank.org/en/news/feature/2012/02/28/im
proving-health-services-for-tribal-populations
