India File

Tribal healthcare lost in the woods

Maitri Porecha | Updated on October 22, 2018 Published on October 22, 2018

The writing on the wall A tribal woman waits to get examined by a doctor in the Bamni sub-centre run by Jan Swasthya Sahyog in Chhattisgarh Maitri Porecha

India’s adivasis languish outside the health coverage net, with little access to hospitals and doctors

Kalindri Pandaria (23) died in July this year, while giving birth to her second baby. On the fateful night, when she developed labour pain, it was raining heavily in her hamlet Niwaspara, deep inside the jungles of Achanakmar Tiger Reserve in Mungeli District of Chhattisgarh, about 30 km away from the pucca road.

To make things worse, rivers Kasnai and Maniyari, which surround her hut, were both in spate on the day she died.

A glance at her medical papers reveals that her delivery was a ‘high risk’ one. Her first baby Ritu, now 19-months old, was born through a caesarean section in a hospital. For her second delivery, she needed help to reach the hospital, 52 km away.

Many hurdles loomed. How could she and her family cross flooded rivers? Even if they acquired a vehicle at night, how would they navigate 30 km of a bumpy, rocky, mud road to reach the highway?



Helpless, Kalindri delivered her second baby at home. But, in the process, she bled to death. She underwent a Vaginal Birth after Caesarean (VBAC), a highly risky process, with the help of a Dai (an elderly village lady who helps with pregnancies) and her mother-in-law, Milaapa Bai. They were clearly ill-equipped to deal with the fatal complications that led to Kalindri’s death.

A month before her death, on June 6, 2018, the Union Health Ministry reported in a press release that there was a 22 per cent reduction in maternal mortality since 2013. With the total number of maternal deaths going down to 32,000, for the first time, every day, 30 more pregnant women were now being saved in India as compared to 2013. Sadly, Kalindri was not among the lucky ones.

According to the latest figures, up to 130 mothers still die in India for every thousand live births, during pregnancy.

Milaapa Bai holds on to Kalindri’s baby Ritu, trying to pacify her. Ritu is fed up of chomping on boiled egg, and smears the remnants of the yellow yolk over her face. She then strews egg white pieces in the courtyard, oblivious to the conversation around her young mother’s death.

Milaapa Bai hands out Kalindri’s portrait. A young smiling woman stares out of the frame. Kalindri’s photo haunts Milaapa Bai. She breaks out into a soft sob. There is nothing left to say. People in small places do not have small problems.

Lack of data, other challenges

The Expert Committee jointly constituted by the Ministry of Health and Family Welfare (MoHFW) and Ministry of Tribal Affairs (MoTA), in a recently released report, Tribal Health in India - Bridging the Gap and a Roadmap for the Future, states that “27 per cent tribal women still deliver at home. This could be part attributed to the unfriendly attitude of health workers, language and understanding gap, and lack of trust in an alien system, maternal health services provided by the government are often not in tune with the health beliefs and practices of the tribal people.”

The report further notes that the cost of institutional delivery, distance and lack of transport continue to be deterrents. The average expenditure on child birth at a health centre is ₹4,000 — way more than the costs covered by the Janani Suraksha Yojana (JSY).

Kalindri’s death is a microcosm of everything that is wrong with conditions of tribals in India. There are an estimated 10.4 crore of them, spread across 705 tribes in ten Central States and eight States in the North-East. They form 8.6 per cent of India’s population.

“Sixty-six years of Independence later and eleven Five-Year plans down, we still need to review tribal people’s health as a serious and special concern,” Dr Abhay Bang, Chairman of the Expert Committee, told BusinessLine.

As the report points out, the popular perception is that tribals are those “semi-naked wild people who live somewhere in the forests and mountains, and who sometimes appear in the news because their children are malnourished.”

The committee that was constituted in 2013 to submit the first-ever report on tribal health took four-and-a-half long years to finish the gargantuan task — as against the planned six months. “It proved to be a most challenging work. To our dismay we found that besides data on tribal healthcare and finances not being available, the institutional mechanisms to generate such data also did not exist or function. The darkness of information was astounding. For example, nobody knows what the infant mortality rate is amongst the tribal population or how much money is spent on tribal health,” Dr Bang says.

The report notes that as against the rest of the country, tribals are trapped in a unique situation, where they have to deal with a triple burden of diseases — the first is malnutrition, communicable diseases like malaria, tuberculosis (TB) and so on; the second is non-communicable diseases like cancer, hypertension and diabetes and the third is mental health issues and addiction to alcohol and tobacco.


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Published on October 22, 2018
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