Without specializing in tribal people’s health, India cannot achieve SDGs

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According to the UN Department of Economic and Social Affairs, tribal communities report disproportionately high levels of maternal and infant mortality, malnutrition, cardiovascular illnesses, HIV/AIDS and other infectious diseases comparable to malaria and tuberculosis in comparison with non-tribal populations. There is an alarming rise in non-communicable diseases amongst tribal populations globally. Underlying aspects like poverty and malnourishment further perpetuate the vicious cycle of such diseases. Often, public health programs are unable to succeed in tribal populations due to geographic remoteness, and cultural and language barriers. 

The UN Declaration on the Rights of Indigenous Peoples asserts that indigenous people have the suitable to traditional ways of healthcare-seeking practices and ‘an equal right to the enjoyment of the highest attainable standard of physical and mental health,’ with none discrimination. It is time that the states take progressive and culturally sensitive motion toward the development of tribal health. 

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One-third of the world’s tribal and indigenous population, that’s, over 104 million tribal people live in India. (Tribal Health Report 2018) The majority of the tribal population continues to live below the poverty line, have poor literacy rates, suffer from poor health indicators, lack access to equitable healthcare, and are vulnerable to displacement.

As tribal communities need culture-sensitive public health interventions, there have only been a few examples of such organisations: SEARCH has not only transformed the lives of the tribal people in Gadchiroli but in addition demonstrated the model of home-based neonatal care. Similarly, Jan Swasthya Sahayog in Bilaspur, Chhattisgarh; Ekjut India in Chakradharpur, Jharkhand; Tribal Health Initiative in Sittilingi, Tamil Nadu; SEWA Rural in Bharuch, Gujarat; Tata Steel CSR in Jharkhand and Odisha. Though this just isn’t an exhaustive list, these are among the organisations which have favourably impacted the health of the tribal communities.

A lack of awareness of tribal culture and imposition of schemes and mechanisms which can be culturally alien to the tribal peoples, contribute to the impoverished state of health and nutrition of tribal peoples. (Tribal Health Report 2013) This leads to ad-hoc and linear policy measures and government initiatives resulting in an absence of community participation. Understandably, despite substantial investment, government-driven research and development programmes are sometimes not capable of achieve the specified result. Without lively people’s involvement, the federal government alone cannot steer the programme in the specified direction. (AIRTSC 2015) Inclusive participation helps the federal government to make any developmental programme more responsive, transparent and accountable.   

Anamaya: The Tribal Health Collaborative

Recognising the necessity for a collaborative approach, Piramal Foundation, and Bill and Melinda Gates Foundation joined hands to collate learnings, experiences and insights from social organisations and experts working on tribal health issues, government stakeholders at the numerous levels, and members of tribal communities. This effort resulted within the conceptualisation and launch of Anamaya – the Tribal Health Collaborative by union health and tribal affairs ministries in 2021.

Anamaya, the tribal health collaborative is a multi-stakeholder initiative committed to promoting health, and ending preventable deaths amongst tribal and marginalised communities in India. It is working towards converging and consolidating efforts of presidency and non-government organisations, philanthropists, international organisations, academic institutions, civil society organisations, indigenous organisations, and others to perform its commitment. It goals to construct a sustainable, high-performing health ecosystem to handle the important thing health challenges faced by the tribal population of India.

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Our collective experience of working with tribal communities, consultations with tribal experts and our current engagement with Anamaya have encouraged us to explore and develop approaches to design sensitive and inclusive tribal health projects. Some of the preliminary approaches are:  

Sustainable Development Goal as a Framework

For tribal communities, traditional ways of life, livelihoods and practices are increasingly under threat owing to a variety of things, including lack of recognition and protection of their rights, exclusionary public policies, and the impacts of climate change. (Dhir 2016) Their livelihoods and beliefs immensely influence their health-seeking practices and behavior, which must be closely studied and understood while developing community health programs. Observing the holistic SDG framework as a criterion provides a chance for inclusive development of the health and social points of tribal populations.

Sensitivity to Tribal Practices

Tribal health must be understood by the social, cultural and financial system, geophysical environment, religious beliefs and practices of the people. There is considerable interconnectedness between the treatment of disease and the supply, accessibility, effectiveness, socio-cultural beliefs, awareness level, and attitude of providers. (Islary 2014) There is a dire need to enhance health literacy amongst tribal communities. Behaviour-change-communication interventions which can be rooted in tribal culture and involve local influencers receive greater trust and acceptance from the community, relatively than the same old one-size-fits-all approach. 

Sustainable Medical Materialist Approach with Scope for Medical Pluralism

The medical materialistic approach of recent medicine has been extremely pathbreaking for curative services in health, but in relation to public health amongst indigenous communities more humane approaches ought to be adopted. (Knibb-Lamouche 2013) The perspective of medical pluralism is crucial as tribal communities for hundreds of years have practised alternative and herbal medicines, and seek care from traditional healers. This must be considered when designing public health programs for such communities.

Art and Culture as Enablers of Health

The ‘mandala of health’ concept defines human ecology because the constant interaction of culture and environment. The interactions amongst culture, community, and family lead to variations in lifestyle with special reference to a person’s interrelated biological, spiritual, and psychological experiences. An individual’s perspective on illness, health, health beliefs, and health practices is formed by cultural and community contexts. (Lai et.al. 2007) The Repository for Arts & Health Resources underscores that art and culture also weave a net of social connections and supply a way of safety and belongingness that encourage individuals and collectives.

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Engaging with Tribal Communities

There is a unanimous agreement on how crucial community engagement and participation are for a healthcare system to deliver its desired outcomes. There are many existing policies aimed to enhance community participation that face implementation challenges and want community-rooted approaches, especially within the context of tribal and marginalised populations. Anamaya focuses on the communitisation of healthcare. Currently, Anamaya is working with among the key community stakeholders comparable to (i) local governments (Panchayati Raj Institutions), (ii) self-help groups, (ii) traditional healers (iii) non-governmental organisations (iv) tribal youth groups and (v) community influencers on the local level.

Various research institutions are specializing in different points of the tribal communities, curating, and creating scientific and authentic knowledge on tribal cultures, including their health. The need of coming together from such government institutions, non-governmental bodies, and social groups to make collaborative efforts is now greater than ever for India to realize the SDGs.  

Global Implications: Implementation of a multi-stakeholder framework like Anamaya at a national scale will definitely yield profound learnings about indigenous health and community-rooted public health models that may contribute to enriching the worldwide understanding of inclusive indigenous health. It has the potential to foster multi-country, knowledge-sharing prospects between global universities and institutions which have spearheaded indigenous health research. Lastly, such a magnanimous, long-term public health initiative will widen the scope for global evidence-based policy makings in tribal health. 

Madhu Raghavendra leads the Centre of Excellence, North East India at Anamaya, the Tribal Health Collaborative. He is a public health practitioner, artist and curator, and emphasises leveraging arts and culture for social development. 

Tathagata Basu leads Knowledge Management at Anamaya, the Tribal Health Collaborative. She has worked across problems with education, youth empowerment, gender, and health and closely worked with children and youth in danger, tribal communities, and vulnerable artists.

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