Tribal Health in India

Dr Purva Shoor
Assistant Professor
Community Medicine

1 07/11/2020
 Definition of Tribes

Generally, tribal people are distinguished through

characteristics specific to them including self-

identification, language, distinct social and cultural
organization, geographic location and more
Hindi word for Tribal people is ‘Adivasis’, Adi

means aboriginal and Vasi means inhabitants

The Scheduled Tribes (STs) are tribes notified

under the Article 342 of constitution of India

2 07/11/2020
 Characteristics of Scheduled Tribes
The list of STs described in the Indian Constitution was

prepared in 1950 on the basis of two criteria-

primitiveness and backwardness
The proportion of STs varies widely across States and

Union Territories
India has the largest tribal population in the world

Tribes can be found in approximately 461 communities

3 07/11/2020
 Characteristics of Scheduled Tribes
The essential characteristic of these communities are:

(Not spelt out in constitution but is well established)

 Primitive traits

 Geographical isolation

 Distinct culture

 Shy at contact with community at large

 Employed mostly in primary sector

 High levels of poverty and illiteracy, low nutrition levels

4 07/11/2020
 Classification according to races
 Proto-Australoids

 Mongoloids

 Negritos

Tribal population of India has been found to speak 105

different languages and 225 subsidiary languages

(dialects) indicating a great deal of variety
According to language spoken they are classified as:

Austro-Asiatic, Tibeto-Chinese, Dravidian, Indo-European

5 07/11/2020
 Classification according to
occupation
 Food gatherers and Hunters- e.g. Birhor of Bihar, Hill

Maria of MP

 Shifting (Jhum) Cultivators- e.g. Khasis of Meghalaya,

Nagas of Assam

 Settled Agriculturists-e.g. Santhal, Munda, Bhil, Mina,

Gond

 Artisans-e.g. basket, tools making, spinning, weaving-

e.g. Kota of Nilgiri Hills

6 07/11/2020
 Classification according to
occupation
The Pastoralists and Cattle Herders-e.g.

Todas of Nilgiris, Gujar of H.P

Wage laborers-e.g. in plantation, mining and

industrial development- Chhotanagpur N.E

tea plantations

Folk Artists-e.g. Pradhans of MP

7 07/11/2020
 Demographic Profile of Tribal
Population
The tribal population is largely concentrated in 10 states

and 8 N.E states

Nearly 90% of them live in rural areas, as forests have

been cut and civilization has encroached upon forest

dwellers in previous years till date
Madhya Pradesh has the largest tribal population

Concentration of tribal population is highest in North-East

states where they live mostly in hilly and forest areas

8 07/11/2020
 Demographic Profile of Tribal
Population
State Population
Madhya Pradesh 15 million
Maharashtra 10 million
Odisha 9 million
Rajasthan 9 million

Profile Number

Tribal Males /females population 52.5 million/52.0 million

Total fertility rate 2.48

Sex ratio 990 (National average 943)

Child-sex ratio (0-6years) 972 in 2001, 957 in 2011 (National

average 914)
9 07/11/2020
 Demographic Profile of Tribal
Population
 Literacy rate in Indian tribal population, according

to census data 2001 was 47.1 %, and 59 % in 2011

 The male literacy rate has increased from 59.4% in

2001 to 68.5% in 2011. Female literacy from 34.8%

to 49.4%
 Life expectancy of tribes is 63.9 years, as

compared to 67 years in general population

10 07/11/2020
Comparison of MCH indicators among Tribal and all
population in 2015-16

S.no. Indicator ST All

population

A. Child Mortality Indicators per 1000

Infant Mortality Rate 44.4 40.7

Neonatal Mortality Rate 31.3 23.2

Post Neonatal Mortality Rate 13.1 8.9

Under-5 Mortality Rate 57.2 49.7

Child Mortality Rate 13.4 6.6

11 07/11/2020
Comparison of MCH indicators among Tribal and all
population in 2015-16
S.no. Indicator ST All
population

B. Immunization Services (%)

Infants fully immunized (%) 55.8 62.0

No Vaccination 9.2 6.0

Measles 77.4 82.8

DPT 1 86.4 89.7

DPT 3 73.5 80.5

Polio 1 87.7 91.0

12 Polio 3 66.3 73.907/11/2020

Comparison of MCH indicators among Tribal and all
population in 2015-16
S.no. Indicator ST All
population

B. Immunization Services (%)

BCG 88.7 92.2

Hepatitis B1 78.0 83.9

Hepatitis B3 56.9 65.1

Polio 0 dose 74.5 79.7

Hepatitis B 0 dose 62.8 64.8

Pregnant women TT 79.0 85.5

13 07/11/2020
Comparison of MCH indicators among Tribal and all
population in 2015-16
S.no. Indicator ST All
population

C. Nutritional Status (%)

Under-5 years children stunted 43.8 38.4

Under-5 years children wasted 27.4 21.0

Under-5 years children underweight 45.3 35.7

D. Maternal Health (%)

Institutional delivery 68.0 78.9

Deliveries attended by skilled health 71.5 81.4

personnel

14 07/11/2020
Comparison of MCH indicators among Tribal and all
population in 2015-16
S.no. Indicator ST All
population

D. Maternal Health (%)

Total fertility Rate 2.48 1.93

Couple using any contraceptive 49.4 57.5

MCH indicators have improved but still there exists an urban-tribal gap, 37 %
PNCs do not receive post natal care within 48 hrs of delivery. Malnutrition and
Anemia are common and cause high maternal mortality. Skilled birth attendance
is poorer among tribal pregnant women. Improvement has occurred but lacunae
still exist, data collection and availability of health services in the outreach is
difficult which is the need of the hour to take action rapidly and impart help to this
15 07/11/2020
ostracized section of our society.
 Tribals Exemplify Women empowerment
A geographically ostracized tribal community, has a better child-

sex, sex ratio

Women in tribal societies enjoy better status, they work for

more hours and contribute more to family income

Tribal women have indigenous knowledge in collection of

NTFP (Non Timber Forest Produce)

They have good skills in maintaining home gardens

Their cooking practices save fuel

Self Help Groups strategy have further improved the status of

tribal women

16 07/11/2020
 Socio-economic factors affecting
tribal health
Barriers to tribal development is geographical

isolation, no transportation facilities

Participatory development focus is on the local

people’s perspective rather than on outsider’s

perspective which has its demerits as people are
uneducated, without resources to allow
sustainable development.

17 07/11/2020
 Socio-economic factors affecting
tribal health
An anthropological viewpoint is to preserve this

community and not indiscriminately deplete forest

reserves
But in the era of technology and industrialization, we

have to preserve ecosystem along with not letting

tribal population be ostracized or left behind in terms
of health, nutrition, education and development

18 07/11/2020
 Triple Burden of disease
Epidemiological transition has occurred even in tribal

areas
Communicable diseases like Tuberculosis, Leprosy

and Malaria still exist with the dual burden of non-

communicable and genetic diseases, which has a
recent evidence
The third great burden has appeared due to

encroachment of civilization, that is, mental ill health

with pre-existing burden of substance abuse
19 07/11/2020
 Triple Burden of disease
With modern health and development methods,

outreach is possible and we have evidence that triple

burden of diseases in the tribal population exists and,
like the motto of sustainable development, “no one

should be left behind” we need to prevent diseases in

this population because they even serve as bridge to
spread certain infections in adjacent rural communities,
and their safety and health should be our concern

because they serve a large populace themselves

20 07/11/2020
 Common diseases in tribal population
 Communicable diseases

 Non-communicable diseases

 Genetic disorders

 Mental disorders and addictions

 Animal attacks and violence in conflict areas

 Socio-cultural and environmental hazards

21 07/11/2020
 Communicable diseases
These include tuberculosis, malaria, leprosy, sexually

transmitted diseases, AIDS/HIV, skin infections, diarrheal

diseases, hepatitis and more
Tuberculosis- estimated prevalence in tribal community

is significantly higher than in the rest of the country, i.e.,

703 against 256 per 100,000 population. RNTCP started
active case finding to improve the case detection rate in
hard to reach areas. Around 40,000 tribal patients have
been diagnosed and treated under RNTCP since 2015.

22 07/11/2020
 Tuberculosis
To improve access to tribal and other marginalized groups, there

is provision for:

A. Additional TB Units and Designated Microscopy Centres

(DMC) in tribal/difficult areas;

B. Compensation for transportation of patient & attendant in tribal

areas;

C. Higher rate of salary to contractual staff posted in tribal areas ;

D. Enhanced vehicle maintenance and travel allowance in tribal

areas ; and

E. Provision of TBHV(TB health visitors) in urban areas

23 07/11/2020
 Tuberculosis
Active TB screening was carried out among clinically

and socially vulnerable population in campaign mode

Phase 1 of the campaign was executed in January,

2017 and the 2nd Phase was implemented in July-

August 2017 . During this campaign , the programme
screened more than 72,000 target tribal population
across the country and diagnosed 27 additional TB
cases.

24 07/11/2020
 Tuberculosis
Deployment of the Mobile TB Diagnostic Van (MTDV)

equipped with X-ray facilities and Sputum

Microscopy facilities which offer diagnostic services
for Tuberculosis at the doorstep of the patient's home
in difficult to reach areas of the tribal populations.
This project has been initially undertaken in 5 States

(Madhya Pradesh, Gujarat, Chhattisgarh , Rajasthan

and Jharkhand) in 17 districts.

25 07/11/2020
 Leprosy
Under the national leprosy eradication programme , state wise

disaggregated data of tribal population is collected on monthly

basis.
During the year 2016- 17, out of 1,35,485 new leprosy cases

detected, 25,474 (18.90%) were scheduled tribes

Under the programme, funds are allotted to NGOs, who are

encouraged to work in tribal areas for providing services like IEC,

prevention of deformity and follow up of cases .
Intensified IEC activities have been taken up through various

media including the rural media under which population residing

in remote, inaccessible and tribal areas is being covered.
26 07/11/2020
 Malaria and other vector borne
diseases
Although tribal communities constitute only about 8% of the

national population, they 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
NVBDCP in North East states is 100 percent centrally

sponsored
World bank assistance is provided for this programme to tribal

and difficult to reach areas, especially global fund in North

Eastern states

27 07/11/2020
 Non Communicable Diseases
Hypertension-
One out of every four tribal adults suffer from HTN

The prevalence of HTN increases significantly with

age, consumption of tobacco, alcohol and a

sedentary lifestyle.
Only 5 per cent men and 9 per cent women

suffering from hypertension knew their hypertensive

status.

28 07/11/2020
 Blindness and Other Visual Impairment
NPCB & VI is a centrally sponsored programme, 90:10 in

North Indian States

Its goal was to reduce blindness to 0.3% by 2020

In tribal areas:

Assistance for construction of dedicated eye units in North-

Eastern states including Sikkim and other hilly states,

 Appointment of contractual ophthalmic manpower (ophthalmic

surgeons, ophthalmic assistants and eye donation counselors)

to meet shortage of ophthalmic manpower in states,

29 07/11/2020
 Blindness and Other Visual
Impairment
Assistance for setting up of multipurpose district mobile

ophthalmic units for diagnosis and medical management

of eye diseases for coverage in difficult areas
Besides cataract, assistance for treatment and

management of other eye diseases viz. diabetic

retinopathy, glaucoma, refractive errors corneal
transplantation, vitreo-retinal surgery and childhood
blindness, is provided.

30 07/11/2020
 Genetic Disorders
Most important cause of genetic disorders in tribal

communities is consanguineous marriages and

lack of awareness and inability to transcend
marriage counseling
The prevalence of sickle cell disease (anemia

and trait together) and thalassemia - another

genetic disorder – varies between 1-40 per cent
in different tribal communities.

31 07/11/2020
 Genetic Disorders

However, most of the prevalence is due to the

heterozygous form of disease. Sickle cell anemia,

the more serious form, is prevalent in 1 in 86
births, and most children affected do not live
beyond 20 years
The prevalence of G6PD deficiency varied from

0. 7 to 15.6 per cent

32 07/11/2020
 Mental Health and addictions

Almost 72 per cent of the tribal men in 15-54

years age group use tobacco as compared to 56

per cent non-tribal men and about 50 per cent
tribal men consume some form of alcohol.
 It also disrupts harmony in relationships,

community and family and breach of law and

order

33 07/11/2020
 Animal attacks and violence in
conflict areas
As tribal areas are often surrounded by forests,

animal bites from snakes, dogs and scorpions are

common.
Crimes and vagrancies are common due to

substance abuse, lack of occupation, and

illiteracy

34 07/11/2020
 Health services under NHM
Provision of 1 sub-center for 3000 tribal

population, 1 PHC for 20,000 population and 1

CHC for 80,000 population has to be set up
But there is a shortage by 27% of sub-centers in

tribal areas, shortage by 40% PHCs and 31%

shortfall of CHCs

35 07/11/2020
 Human Resources
Health care personnel are reluctant to provide their

services because of poor infrastructure, environment,

salaries, time constraint in travelling leading to longer
working hours, uncooperative subordinates
In October 2013, MoHFW and MoTA came up with a

bridge course for local people, which was strongly

opposed by medical practitioners in respective states

36 07/11/2020
 Tribal Nutrition
The aboriginals have traditional knowledge of the flora and

fauna, to which they interact in everyday life to meet their

requirement of food.
For e.g., the tribes of Eastern Ghats of Andhra Pradesh never

kill an animal, bird or cut a tree or plant with which they claim
totemic affiliation.
They maintain symbiotic relationship with environment

They rely on forests for food, timber, medicinal plants, material

for construction of houses

37 07/11/2020
 Tribal Nutrition

Higher prevalence of under nutrition in tribal population is

due to:
Poverty and its consequences

Lack of awareness about, access to and utilization of the

available nutritional supplementation programmes

Social barriers

Poor environmental sanitation and lack of safe drinking

water, leading to high morbidity from water-borne infections

Lack of health care services

Vector borne diseases

38 07/11/2020
 Tribal Nutrition
Tribal diets were generally deficient in calcium,

vitamin A, C, riboflavin and animal protein

Among tribal households, there were serious

deficiencies in the intake of pulses and legumes,

milk and milk products, fats and oils, sugar and
jaggery

39 07/11/2020
 Assignment
1. Discuss the socio-demographic profile of tribals in India.

2. Explain the positive points of a traditional tribal society

3. Enlist the criteria outside constitution to identify tribes

4. Classify the tribal population according to their occupation and

examples

5. Enlist the factors that have affected the nutrition status of tribal
population

6. Enlist strategies for tribal health under NPCB&VI 

40 07/11/2020
 “Let us help sustain the forests
and relocate or empower in
terms of equity and health, the
8% of the Nation’s Tribal
population”
Thank You!!
41 07/11/2020