Tribal Health

Among all the states in India, Jharkhand hold 6th and 10th position in terms of Schedule Tribe population and the percentage share of the ST population to the total population of the state, respectively. The growth of the ST population in the state has been lower than the growth of the total population during 1991-2001.Population density of the state is 338 per sq. Km, which clearly indicates that the inhabitants of the state are scattered. The ST population is primarily rural, as 92 percent reside in the villages. The state has a total of 30 ST groups. District-wise distribution of the ST population shows that the majority resides in Simdega (72%), Gumla (70%), West Singbhum (66%) and Lohardaga(56%) districts. The ST constitutes more than half of the total population in Lohardaga and West Singhbhum districts. Santhal is the most populas tribal group, numbering 2,410,509 and constituting 34 percent of the total ST population of the state. Other major tribes are Oraon (20%), Munda(15%) and Ho(11%). District-wise distribution of individual STs shows that the highest numbers of Santhals are in Dumka district, followed by East Singhbhum, Pakur and Sahebganj, but they constitute the highest proportion of the total ST population in Giridih (90%), followed by dumka (90%) and Pakur(85%) districts. The other six major tribes, namely Oraon, Munda, Ho, Khairwar, Lohra, and Kharia are concentrated in Ranchi, West Singbhum and Palamu, East Singbhum and Gumla districts. Among the Schedule Tribes in Jharkhand, there are certain tribal communities who have declining or stagnant population, low level of literacy, pre-agriculture level of technology and are economically backward. Nine such groups exist in Jharkhand, which are identified and categorised as Primitive Tribal Groups (PTGs), recently known as Particularly Vulnerable Tribal Group (PVTGs). Most of these groups are small in number (numbering just over two lakhs), have not attained any significant level of social and economic progress, and generally inhabit remote localities with poor infrastructure. Therefore, they have become the most vulnerable sections among the ST and priority is required to be accorded for their protection, checking the declining trend of their population and their overall development. The PTGs in Jharkhand are Asur, Birhor, Birija , Hill Kharia, Korwa, Mal Pahariya, Parhaiya, Sauria Pahariya and Savar. Tribal communities are especially vulnerable and often faced social exclusion because of their habitation in remote hard to reach areas and social networking pattern, low level of awareness, poor penetration of media, and lack of availability and accessibility of basic health services. It has also experienced that external influences like left wing extremist activities has also affects the public health service delivery in tribal areas. In general it has been found that awareness level among tribal women is lower. The awareness regarding prevention, services regarding diagnosis, treatment and care are low among tribal people. Treatment seeking behaviour for most health problems including RCH, revealed initial resort to home remedies, followed by visits to the traditional healers as the socio-religious customs still prevails in these communities. Health facilities are visited only when the problem become serious. It has also been found that tribal world view of close linkage between human, nature and spirit are act as an important factor that influence their health seeking behaviour. Some group of diseases are also believed to be caused by spirits and therefore treatments by traditional healers are preferred.

Tribal health strategies:

• Setting up tribal friendly integrated quality health care services.
• Outreach activities ? health camps in tribal hats. VHND
• IEC/BCC activities which are tribal focussed.
• Special training of Tribal VHCs, PTG area VHCs; Expansion of Sahiya and VHCs to adequately cover the tribal areas.
• Intensified communication strategies by providing BCC/IEC materials in local/tribal languages.
• Drugs for Snake bite, dog bite, animal bite to be made available in all remote facilities.
• Periodical monitoring by a special monitoring team to the facilities in the tribal area
• MoUs with the private and public sector undertaking health facilities in tribal areas for providing health care services
• Special research programme for malaria control and sickle cell anaemia programme in tribal areas