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India's tribal communities battle disease and discrimination
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India’s tribal communities battle disease and discrimination For more information on the cholera outbreak in Orissa, India see Lancet Infect Dis 2007; 7: 641
Patralekha Chatterjee
For more information on the draft National Tribal Policy: a policy for the scheduled tribes of India see http://tribal.nic.in/ finalContent.pdf
In India, tribal indigenous communities make headlines for all the worst reasons. Orissa, India’s poorest state, was in the news earlier this year following a cholera outbreak in three tribal-dominated districts. Official sources said that 155 people died of cholera and other diarrhoeal diseases in the three districts of Koraput, Rayagada, and Kalahandi during the epidemic, with more than 8000 people affected. The aid agency ActionAid, which has been active in the affected area for some time, claims that at least 250 people died in the cholera-hit districts. “The scarcity of doctors and a weak local health system added to the death toll”, said Bratindi Jena (ActionAid, Orissa, India). Teams of doctors had to be called from other districts to deal with the emergency, she said, because of ongoing staff shortages in these tribal areas. Additionally, noted Jena, many of these indigenous tribal communities live in remote rural areas, “so there is a tendency to blame the tribal way of life for disease outbreaks”. As a result, nothing changes and nothing improves. “The argument of remoteness and inaccessibility is used to deny tribal communities basic services”, she told TLID. Officials have acknowledged that poor access to safe drinking water is a major issue in the three tribal-
A community worker visiting a remote hamlet in Orissa’s tribal-dominated Mayurbhanj district
702
dominated districts affected by the recent epidemic. “Most villages in the tribal areas do not have a functioning hand pump. People in these areas are forced to drink water from streams and rivers, the same water sources they use for bathing, cleaning, and washing clothes”, said Jena. Indeed, the recent cholera outbreak in Orissa’s tribal belt is a grim reminder of the institutional apathy and lack of coordination among various government departments in India, warn experts. Poor infrastructure and weak healthdelivery systems still hamper efforts to combat communicable diseases across rural India, particularly in hard-to-reach tribal areas in central, northeastern, and southern parts of the country. Tribal communities make up over 8% of India’s 1 billion population. Although the Indian constitution provides safeguards for these rural tribal communities and various government schemes promote tribal health and welfare, many agencies working in these areas are critical of the official efforts to date. Despite some progress, tribal communities on the whole have a poor health status and remain overwhelmingly poor. The health status of tribal children remains a particular concern. According to official data, under5 mortality among tribal children currently stands at 126·6 per 1000. 56% of tribal children are regarded to be underweight, with girls from tribes or castes and from rural areas known to be at risk for malnutrition, largely because of poor dietary intake and infection. According to WHO, India currently accounts for around 80% of reported malaria cases in the WHO SouthEast Asia region and 30% of the global burden of tuberculosis. Tribal communities are known to have a disproportionate burden of malaria deaths. Tapas Chakma, Deputy Director at the Regional Medical Research
Centre for Tribals (Jabalpur, Madhya Pradesh, India) said: “There are special regimens for malaria control in tribal areas because these regions are often inaccessible and forested. Unfortunately, national tuberculosis and malaria programmes do not have the desired impact in tribal areas mainly because of a shortage of manpower. 30–40% of the fieldworkers’ posts are vacant and posts for medical officers also remain unfilled…this is one of the major obstacles in implementing the national programmes in these areas”. Furthermore, health infrastructure needs to be improved; there are fewer primary health centres on average in tribal areas than in non-tribal areas. Health education needs to be done in these remote areas to encourage tribal communities to use health services where they exist, and the government is exploring ways to better align the tribal system of diagnosis and treatment of diseases, developed over centuries, with modern medicine. The absence of reliable data about the health status of these tribal communities compounds the problem of weak public-health systems in tribaldominated districts, said Chakma. “There is as yet no national database for tribal health, and this needs to be rectified as a starting point”. There are hopeful signs that things could improve. The government’s National Tribal Policy, drafted last year, sets out an ambitious plan to tackle current shortfalls in data collection, infectious diseases, and much needed improvements in infrastructure over the next few years. Special attention will be given to promoting immunisation and preventing severe malnutrition among children and improving access to health services, with a target set to equalise the substantial gap in the human development index that currently exists between tribal groups and the general population by 2020.
Patralekha Chatterjee
http://infection.thelancet.com Vol 7 November 2007
India’s tribal communities battle disease and discrimination For more information on the cholera outbreak in Orissa, India see Lancet Infect Dis 2007; 7: 641
Patralekha Chatterjee
For more information on the draft National Tribal Policy: a policy for the scheduled tribes of India see http://tribal.nic.in/ finalContent.pdf
In India, tribal indigenous communities make headlines for all the worst reasons. Orissa, India’s poorest state, was in the news earlier this year following a cholera outbreak in three tribal-dominated districts. Official sources said that 155 people died of cholera and other diarrhoeal diseases in the three districts of Koraput, Rayagada, and Kalahandi during the epidemic, with more than 8000 people affected. The aid agency ActionAid, which has been active in the affected area for some time, claims that at least 250 people died in the cholera-hit districts. “The scarcity of doctors and a weak local health system added to the death toll”, said Bratindi Jena (ActionAid, Orissa, India). Teams of doctors had to be called from other districts to deal with the emergency, she said, because of ongoing staff shortages in these tribal areas. Additionally, noted Jena, many of these indigenous tribal communities live in remote rural areas, “so there is a tendency to blame the tribal way of life for disease outbreaks”. As a result, nothing changes and nothing improves. “The argument of remoteness and inaccessibility is used to deny tribal communities basic services”, she told TLID. Officials have acknowledged that poor access to safe drinking water is a major issue in the three tribal-
A community worker visiting a remote hamlet in Orissa’s tribal-dominated Mayurbhanj district
702
dominated districts affected by the recent epidemic. “Most villages in the tribal areas do not have a functioning hand pump. People in these areas are forced to drink water from streams and rivers, the same water sources they use for bathing, cleaning, and washing clothes”, said Jena. Indeed, the recent cholera outbreak in Orissa’s tribal belt is a grim reminder of the institutional apathy and lack of coordination among various government departments in India, warn experts. Poor infrastructure and weak healthdelivery systems still hamper efforts to combat communicable diseases across rural India, particularly in hard-to-reach tribal areas in central, northeastern, and southern parts of the country. Tribal communities make up over 8% of India’s 1 billion population. Although the Indian constitution provides safeguards for these rural tribal communities and various government schemes promote tribal health and welfare, many agencies working in these areas are critical of the official efforts to date. Despite some progress, tribal communities on the whole have a poor health status and remain overwhelmingly poor. The health status of tribal children remains a particular concern. According to official data, under5 mortality among tribal children currently stands at 126·6 per 1000. 56% of tribal children are regarded to be underweight, with girls from tribes or castes and from rural areas known to be at risk for malnutrition, largely because of poor dietary intake and infection. According to WHO, India currently accounts for around 80% of reported malaria cases in the WHO SouthEast Asia region and 30% of the global burden of tuberculosis. Tribal communities are known to have a disproportionate burden of malaria deaths. Tapas Chakma, Deputy Director at the Regional Medical Research
Centre for Tribals (Jabalpur, Madhya Pradesh, India) said: “There are special regimens for malaria control in tribal areas because these regions are often inaccessible and forested. Unfortunately, national tuberculosis and malaria programmes do not have the desired impact in tribal areas mainly because of a shortage of manpower. 30–40% of the fieldworkers’ posts are vacant and posts for medical officers also remain unfilled…this is one of the major obstacles in implementing the national programmes in these areas”. Furthermore, health infrastructure needs to be improved; there are fewer primary health centres on average in tribal areas than in non-tribal areas. Health education needs to be done in these remote areas to encourage tribal communities to use health services where they exist, and the government is exploring ways to better align the tribal system of diagnosis and treatment of diseases, developed over centuries, with modern medicine. The absence of reliable data about the health status of these tribal communities compounds the problem of weak public-health systems in tribaldominated districts, said Chakma. “There is as yet no national database for tribal health, and this needs to be rectified as a starting point”. There are hopeful signs that things could improve. The government’s National Tribal Policy, drafted last year, sets out an ambitious plan to tackle current shortfalls in data collection, infectious diseases, and much needed improvements in infrastructure over the next few years. Special attention will be given to promoting immunisation and preventing severe malnutrition among children and improving access to health services, with a target set to equalise the substantial gap in the human development index that currently exists between tribal groups and the general population by 2020.
Patralekha Chatterjee
http://infection.thelancet.com Vol 7 November 2007