 "Health and welfare of Tribal Communities: Leaving no one behind")
“India will prosper when our tribal communities prosper, the welfare of tribal communities is our foremost priority.”
Prime Minister Shri Narendra Modi
The government of India follows the mantra of Sabka Saath, Sabka Vikaas, and Sabka Vishwas, the guiding philosophy given by Honourable Prime Minister Shri Narendra Modi, and the path of Antyodaya, shown by Pandit Deendayal Upadhyay. Reaching the benefits of development to all sections of society, especially the most marginalised and vulnerable communities, is the fundamental commitment of the government.
The Ministry of Health and Family Welfare (MoHFW), under Mansukh Mandaviya Ji, has undertaken several interventions in this direction to ensure that the reach of health care delivery is ensured across all sections of society, particularly tribal population subgroups. National Health Mission (NHM), since its inception, has prioritised improving access to equitable, affordable, accountable, and effective health care for all. Provisions have been made to ensure access to care is available for vulnerable populations, including tribal areas. The NHM gave particular focus on decentralised health planning to enable states to provide varied levels of services for their different areas based on local diversities and needs.
The National Health Policy 2017 also highlighted the special health needs of tribal and socially vulnerable population groups and recommended specific measures in the provisioning and delivery of services in these areas. The government of India under Hon’ble Sh. Arjun Munda Ji is committed to address tribal health issues as a priority, taking due cognisance of tribal value systems, traditions, and socioeconomic conditions.
Interventions across the domain areas of health systems have been designed not only to improve access to quality health care for all but also to prioritize and strengthen service delivery in tribal areas. Relaxation of norms for establishing public health facilities and selection of community health workers (ASHAs/ASHA Facilitators) at the habitation level are some steps in this direction.
India’s flagship programme of Ayushman Arogya Mandir (AAM), launched in 2018 in a tribal block of Jangla in Chhattisgarh, has now expanded to also cover rural and tribal areas across the country with 163,000 Ayushman Arogya Mandir made functional so far. While these centres have been designed to provide comprehensive primary health care closer to the community, the secondary and tertiary care services are being made affordable to all through financial protection under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which identifies and includes primitive tribal groups as eligible beneficiaries.
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All tribal majority districts with composite health index below the state average are identified as High Priority Districts (HPD) and receive enhanced resources per capita under the National Health Mission. This also plays an important role in encouraging innovations by states/districts to try new approaches to address specific healthcare challenges faced by tribal population subgroups.
Access to care has been further improved by provisions under NHM, where flexibility has been given to deploy Mobile Medical Units (MMU) or adopt lower population norms under the National Ambulances Services (NAS) to ensure a time-to-care approach.
To address the health workforce needs in these areas, provisions like ‘contracting in’ and ‘contracting out’ of specialist services, negotiation of salaries through the ‘you quote, we pay’ mechanism, hard area allowances and career progression opportunities have been ensured by MoHFW.
To further prioritise and plan interventions in tribal areas, MoHFW and the Ministry of Tribal Affairs have established a tribal health cell in collaboration. This functions as a platform to promote collaborative interventions across the domain of health services in tribal areas.
Community-level interventions have been a critical component in ensuring that tribal areas are covered under different National Health Programmes. Community-level activities like Block Health Melas have been undertaken under NHM with the objective to generate awareness, facilitate the creation of ABHA IDs, preventive and promotive care activities, generation of Ayushman Bharat cards and screening for early diagnosis, basic health care services and teleconsultation services across the country. Inter-departmental coordination has been prioritized while organizing Block Health melas, with adequate participation from the Tribal Health Department. This has ensured that the tribal population is covered and is able to avail of services being provided in these community activities.
Large-scale community-based campaigns like Ayushman Bhav Abhiyan and Viksit Bharat Sankalp Yatra have added to the government's efforts towards saturating essential health services. The campaigns aim to redefine healthcare accessibility and inclusivity across the country and embody a whole-of-nation and whole-of-society approach. The core objective is to extend health care coverage to every village and town, including tribal areas, transcending geographic barriers and ensuring that no one is left behind.
Viksit Bharat Sankalp Yatra has been designed to inform and empower citizens about the government’s flagship schemes, to create awareness and deliver the benefits of welfare programs directly to the people, thus increasing uptake of services at the community level, with a focus on tribal populations.
In disease-specific interventions for tribal areas, the government of India launched the Sickle Cell Anaemia Elimination Mission as a sub-mission of NHM, with the objective of providing affordable and accessible care to all. The awareness and counselling-related activities are being undertaken in collaboration with the Ministry of Tribal Affairs.
In a recent move, the government of India has launched Pradhan Mantri Janjati Adivasi Nyaya Maha Abhiyan PM- JANMAN with a budget of around Rs 24,000 crores to undertake 11 critical interventions through nine-line ministries, including health and nutrition.
With ongoing policy reforms, the government has clearly highlighted tribal health as its foremost priority area, making provisions for accessible, affordable, and equitable quality of care to the last mile. The whole series of policy and programme initiatives together have put the agenda of healthcare of tribal people in the centre stage of the health system’s reforms, and flexibilities for special provisions are facilitating improved access to healthcare for tribal areas across states.
Dr Bharati Pravin Pawar is Union MoS (Health and Family Welfare & Tribal Affairs)