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Health ministry planning to implement national tribal health policy
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Laxmi Yadav, Mumbai
October 16 , 2018
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For the first time in India, the Union health ministry along with Union tribal affairs ministry is coming up with a tribal health policy aiming to bridge the gap in the health status of the tribal population by spreading penetration of healthcare services in tribal belt spread over 151 districts of the country.
The tribal health policy is based on a recommendation of 12-member expert committee on tribal health, set up by both ministries under chairmanship of rural health expert Dr. Abhay Bang in 2013. The committee, tasked with looking into present status of health and health care in tribal areas and drawing out a road map for the future to bridge the gap rapidly, had submitted its report to the government on September 9, 2018.
Both Union health minister and health secretary welcomed the report. The report was also appreciated by Niti Aayog. The country's think tank appealed to health ministry to draft action plan to implement the report. The ministry is currently looking into the expert committee report.
Although tribal communities constitute about 8.6% of the national population, there is a near-complete absence of data on the health situation of different tribal communities. In the absence of a comprehensive health picture of tribal health in the country, policy measures and government programmes are often ad-hoc, pointed out the panel.
The committee relied on data from the 2011 Census, National Family Health Survey (NFHS), National Sample Survey Organisation (NSSO), studies conducted by civil society and a study by the National Institute of Research in Tribal Health.
The tribal population in the country faces a triple burden of diseases. While malnutrition and communicable diseases like malaria and tuberculosis continue to be rampant, rapid urbanization, environmental distress and changing lifestyles have resulted in a rise in the prevalence of non-communicable diseases like cancer, hypertension and diabetes. one out of every four adults suffered from hypertension. To add to this is the third burden of mental illnesses, especially the addiction, said Dr Bang.
Tribal communities account for about 30% of all cases of malaria, more than 60% of P. falciparum, and as much as 50% of the mortality associated with malaria. This results in an economic burden of staggering Rs.6,000 crore per year.
The estimated prevalence of pulmonary tuberculosis in tribal community is significantly higher than rest of the country- 703 against 256 per 100,000.
Despite high rates of infant and child mortality in tribal areas and the heavy burden of diseases, full immunisation coverage remains constantly low among the ST population across states. The intake of various nutrients such as proteins, calories, and vitamins has decreased in tribals in the last decade. Life expectancy among tribals is 63.9 years, while it is 67 years for the general population.
To address healthcare needs of tribals, the panel has come out with a slew of suggestions including allocation of 70% of government's resources for tribal health on provisions of primary care in tribal areas, creation of a cadre of 1,000 tribal health officials in the country which will be appointed as district tribal health official to galvanize public healthcare programme in tribal areas.
Other suggestions include allocation of 15% of tribal affairs ministry's budget on tribal health, introduction of a new Tribal Malaria Action Plan in 91 tribal dominated districts under the National Health Mission, strengthening Home-based Newborn and Child Care (HBNCC) for rapidly reducing NMR, IMR and CMR (30% reduction in 3 years and 50% reduction in 5 years), renaming sub centre in tribal areas as the Tribal Health and Wellness Centre (THWC) which provides about 15 types of preventive, promotive, curative and rehabilitative services. THWC would cover a population of 3,000 initially but then eventually 2,000, usually within a radius of 5 km.
The panel recommended appointment of a trained Ayurvedic doctor or nurse/practitioner at PHC, one ASHA per 50 households or 250 population in tribal areas, deploying two Mobile Outreach Services (MOS) at a PHC for diagnostics and treatment of regular and chronic ailments, epidemic control and health education.
It suggested establishing at the Central and state levels new bodies called Tribal Health Council and Directorate for Tribal Health, with system for generation of data, monitoring and reviewing, and to ensure finances. Providing insurance cover to tribals for secondary and tertiary care and setting up Tribal Health Research Cell (THRC) within the Department of Health Research both at central and state level were also part of the panel's suggestions.
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