Without focusing on the health of tribal people, India cannot achieve the SDGs
According to the United Nations Department of Economic and Social Affairs, tribal communities report disproportionately high levels of maternal and infant mortality, malnutrition, cardiovascular disease, HIV/AIDS and other infectious diseases such as malaria and tuberculosis. compared to non-tribal populations. There is an alarming increase in non-communicable diseases among tribal people around the world. Underlying factors such as poverty and malnutrition further perpetuate the vicious cycle of these diseases. Often, public health programs are unable to reach tribal populations due to geographic remoteness and cultural and language barriers.
The United Nations Declaration on the Rights of Indigenous Peoples affirms that Indigenous peoples have the right to traditional practices of health care seeking and “an equal right to the enjoyment of the highest attainable standard of physical and mental health” , without any discrimination. It is time for states to take progressive and culturally sensitive steps to improve tribal health.
One third of the world’s tribal and indigenous population, ie more than 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 low literacy rates, suffer from poor health indicators, lack access to equitable health care and are vulnerable to displacement.
As tribal communities need culturally sensitive public health interventions, there were only a few examples of such organizations: SEARCH not only transformed the lives of Gadchiroli tribal people, but also demonstrated the model of neonatal home care. Likewise, 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. Although this list is not exhaustive, here are some of the organizations that have had a favorable impact on the health of tribal communities.
A lack of understanding of tribal culture and the imposition of culturally alien patterns and mechanisms on tribal peoples contribute to the impoverishment of tribal peoples’ health and nutrition. (Tribal Health Report 2013) This results in ad hoc and linear policy measures and government initiatives leading to a lack of community participation. Naturally, despite substantial investment, government-led research and development programs are often unable to achieve the desired result. Without the active participation of the population, the government alone cannot steer the program in the desired direction. (AIRTSC 2015) Inclusive participation helps government make any development program more responsive, transparent and accountable.
Anamaya: tribal collaboration for health
Recognizing the need for a collaborative approach, the Piramal Foundation and the Bill and Melinda Gates Foundation have partnered to bring together lessons, experiences and ideas from social organizations and experts working on tribal health issues, government stakeholders at many levels and members of tribal communities. This effort culminated in the conceptualization and launch of Anamaya – the Tribal Health Collaborative by the 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 among tribal and marginalized communities in India. It works to converge and consolidate the efforts of governmental and non-governmental organizations, philanthropists, international organizations, academic institutions, civil society organizations, indigenous organizations and others to carry out its commitment. It aims to build a sustainable and successful health ecosystem to address major health challenges faced by the tribal population of India.
Our collective experience working with tribal communities, our consultations with tribal experts, and our current engagement with Anamaya have encouraged us to explore and develop approaches to designing 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 due to a range of factors including lack of recognition and protection of their rights, public policies of exclusion and the impacts of climate change. (Dhir 2016) Their livelihoods and beliefs greatly influence their health practices and behaviors, which need to be closely studied and understood when developing community health programs. Observing the holistic framework of the SDGs as a benchmark provides an opportunity for inclusive development of the health and social aspects of tribal people.
Sensitivity to tribal practices
Tribal health must be understood by the social, cultural and economic system, geophysical environment, religious beliefs and practices of people. There is considerable interconnection between the treatment of illness and the availability, accessibility, effectiveness, socio-cultural beliefs, level of awareness and attitude of providers. (Islary 2014) There is an urgent need to improve health literacy among tribal communities. Behavior change and communication interventions that are rooted in tribal culture and involve local influencers receive greater community trust and acceptance, rather than the usual one-size-fits-all approach.
Sustainable medical materialist approach with scope for medical pluralism
The materialistic medical approach of modern medicine has been extremely innovative for curative health services, but when it comes to public health among indigenous communities, more humane approaches should be adopted. (Knibb-Lamouche 2013) The perspective of medical pluralism is crucial because tribal communities have practiced alternative and herbal medicine for centuries and seek healing from traditional healers. This needs to be considered when designing public health programs for these communities.
Art and culture as catalysts for health
The concept of “health mandala” defines human ecology as the constant interaction of culture and environment. Interactions between culture, community and family result in variations in lifestyle with particular reference to an individual’s interrelated biological, spiritual and psychological experiences. An individual’s perspective on illness, health, health beliefs, and health practices is shaped by cultural and community contexts. (Lai et.al. 2007) The Repository for Arts & Health Resources points out that art and culture also weave a web of social bonds and provide a sense of security and belonging that inspires individuals and collectives.
Engage with Tribal Communities
There is a unanimous consensus on the critical importance of community engagement and participation for a health system to produce the desired results. There are many policies aimed at improving community participation that face implementation challenges and require community-based approaches, especially in the context of tribal and marginalized populations. Anamaya focuses on the communitization of health care. Currently, Anamaya works with some of the major community stakeholders such as (i) local governments (Panchayati Raj Institutions), (ii) self-help groups, (ii) traditional healers (iii) non-governmental organizations ( iv) tribal youth groups and (v) grassroots community influencers.
Various research institutions focus on different aspects of tribal communities, maintaining and creating scientific and authentic knowledge about tribal cultures, including their health. The need to bring together these government institutions, non-governmental organizations and social groups to make collaborative efforts is now more necessary than ever for India to achieve the SDGs.
Global Implications: Implementing a multi-stakeholder framework like Anamaya at the national level is sure to yield in-depth learnings about Indigenous health and community-based public health models that can help enrich the global understanding of Indigenous health inclusive. It has the potential to foster opportunities for knowledge sharing in multiple countries between universities and global institutions that have spearheaded Indigenous health research. Finally, such a magnanimous and long-term public health initiative will expand the scope of evidence-based global policymaking in tribal health.
Madhu Raghavendra heads the North East India Center of Excellence at Anamaya, the Tribal Health Collaborative. He is a public health practitioner, artist and curator, and emphasizes leveraging arts and culture for social development.
Tathagata Basu leads knowledge management at Anamaya, the Tribal Health Collaborative. She has worked on education, youth empowerment, gender and health issues and has worked closely with at-risk children and youth, tribal communities and vulnerable artists.