Communities cannot thrive without good health, but sadly, good health can be elusive for communities on the margins of society. Even before covid, tribal and indigenous people all over the world have routinely experienced lower life expectancies, poor maternal and child health, and higher rates of both infectious and non-communicable diseases.
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The coronavirus pandemic—food insecurity, isolation, and loss of income that have followed—have only exacerbated these trends and pushed vulnerable tribal and indigenous populations further to the margins.
But India is particularly well placed to reverse these trends. As home to 28% of the world’s tribal people, developing holistic bottom-up strategies to improve health and well-being in local settings. India can become the forerunner of new initiatives to improve tribal health, creating a model for the rest of the world to empower indigenous communities.
By working with local leaders to bridge knowledge gaps, strengthening last mile service delivery and leveraging the potential of new technologies and partnerships, India can vastly improve the well-being of its 104 million tribal citizens and help the world reach its Sustainable Development Goals for 2030.
To be clear, this task will not be easy. Due to a variety of factors, the life expectancy of tribal and indigenous people worldwide is up to 20 years lower than the rest of the population. More than half of indigenous adults over 35 suffer from type-2 diabetes.
In India, while there is limited data, sources suggest that a tribal woman is twice as likely to die during pregnancy and childbirth. India’s tribal population also accounts for 50% of malaria deaths in the country, and tuberculosis is five times more prevalent.
Nonetheless, India has both the ability and responsibility to transform how its most vulnerable citizens and communities receive healthcare. Doing so is critical not only to India’s future, but to that of tribal and indigenous populations all over the world.
The challenge of improving tribal health and nutrition can be tackled with a three-pronged approach. First, there must be enough available knowledge and tribal de-segregated data to make evidence-based policy decisions. Complicated problems cannot be solved without an in-depth understanding of the root causes.
India is not a homogenous population; linguistic barriers, coupled with generally poor or no data, might further lead to a lack of context-specific policies and interventions. Thus, it becomes imperative to create and disseminate knowledge around tribal health and nutrition, both to inform policy and help address myths within communities that might discourage people from accessing healthcare if and when available.
Second, working alongside governments at every level, we must strengthen health service delivery in the last mile. While universal access to healthcare has remained elusive to date, the government is making its best attempts to bridge the gap with tribal focused plans, including by operationalizing health and wellness centres in remote and tribal areas.
In past, be it in the aspirational districts of India or working in other parts of the world, affordable and accessible healthcare does not become a reality unless both the delivery of health services and health-seeking behaviour of the community work towards each other. In other words, to achieve the audacious goal of impacting 104 million people, both the demand and supply sides of health services will have to be bolstered in parallel.
Finally, leveraging new technologies and partnerships can improve both decision-making and patient care. New digital innovations, especially mobile apps and platforms, can connect people longitudinally, vertically, and horizontally.
Introducing point-of-care devices can improve data collection and accountability throughout the health services sector. The national digital health mission is an important step in the right direction and can help expedite this digital transformation.
Similarly, bringing together multiple partners around the shared vision of improving tribal health can focus efforts for positive change. Several philanthropic organizations (including the Piramal Foundation and Bill & Melinda Gates Foundation) and civic groups working in the tribal health space have recently come together to create the Tribal Health Collaborative.
This unique and exciting initiative has set an ambitious goal of ending all preventable diseases among India’s tribal communities in the next decade. If successful, it will improve the lives of 100 million of India’s most marginalized citizens and save more than 5 million lives from disease.
Through data, delivery, innovation, and partnership—guided by a spirit of sewa, or selfless service—we can help reduce the burdens of disease, malnutrition, and poor health for millions of people in India and around the world.
Creating robust knowledge infrastructure could enhance policymaking, effective implementation at the last mile can ensure the optimal use of healthcare services, and new technology platforms could help knit these aspects together and close the tribal health and nutrition loop.
This tripartite model of knowledge, implementation, and technology can help us realize our collective goal of a more equitable society. If we commit ourselves to it and invest now in improving tribal health and nutrition, we can make a world of difference to those in need.
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- In the Large States category (overall), Chhattisgarh ranks 1st, followed by Odisha and Telangana, whereas, towards the bottom are Maharashtra at 16th, Assam at 17th and Gujarat at 18th. Gujarat is one State that has seen startling performance ranking 5th in the PAI 2021 Index outperforming traditionally good performing States like Andhra Pradesh and Karnataka, but ranks last in terms of Delta
- In the Small States category (overall), Nagaland tops, followed by Mizoram and Tripura. Towards the tail end of the overall Delta ranking is Uttarakhand (9th), Arunachal Pradesh (10th) and Meghalaya (11th). Nagaland despite being a poor performer in the PAI 2021 Index has come out to be the top performer in Delta, similarly, Mizoram’s performance in Delta is also reflected in it’s ranking in the PAI 2021 Index
- In terms of Equity, in the Large States category, Chhattisgarh has the best Delta rate on Equity indicators, this is also reflected in the performance of Chhattisgarh in the Equity Pillar where it ranks 4th. Following Chhattisgarh is Odisha ranking 2nd in Delta-Equity ranking, but ranks 17th in the Equity Pillar of PAI 2021. Telangana ranks 3rd in Delta-Equity ranking even though it is not a top performer in this Pillar in the overall PAI 2021 Index. Jharkhand (16th), Uttar Pradesh (17th) and Assam (18th) rank at the bottom with Uttar Pradesh’s performance in line with the PAI 2021 Index
- Odisha and Nagaland have shown the best year-on-year improvement under 12 Key Development indicators.
- In the 60:40 division States, the top three performers are Kerala, Goa and Tamil Nadu and, the bottom three performers are Uttar Pradesh, Jharkhand and Bihar.
- In the 90:10 division States, the top three performers were Himachal Pradesh, Sikkim and Mizoram; and, the bottom three performers are Manipur, Assam and Meghalaya.
- Among the 60:40 division States, Orissa, Chhattisgarh and Madhya Pradesh are the top three performers and Tamil Nadu, Telangana and Delhi appear as the bottom three performers.
- Among the 90:10 division States, the top three performers are Manipur, Arunachal Pradesh and Nagaland; and, the bottom three performers are Jammu and Kashmir, Uttarakhand and Himachal Pradesh
- Among the 60:40 division States, Goa, West Bengal and Delhi appear as the top three performers and Andhra Pradesh, Telangana and Bihar appear as the bottom three performers.
- Among the 90:10 division States, Mizoram, Himachal Pradesh and Tripura were the top three performers and Jammu & Kashmir, Nagaland and Arunachal Pradesh were the bottom three performers
- West Bengal, Bihar and Tamil Nadu were the top three States amongst the 60:40 division States; while Haryana, Punjab and Rajasthan appeared as the bottom three performers
- In the case of 90:10 division States, Mizoram, Assam and Tripura were the top three performers and Nagaland, Jammu & Kashmir and Uttarakhand featured as the bottom three
- Among the 60:40 division States, the top three performers are Kerala, Andhra Pradesh and Orissa and the bottom three performers are Madhya Pradesh, Jharkhand and Goa
- In the 90:10 division States, the top three performers are Mizoram, Sikkim and Nagaland and the bottom three performers are Manipur and Assam
In a diverse country like India, where each State is socially, culturally, economically, and politically distinct, measuring Governance becomes increasingly tricky. The Public Affairs Index (PAI 2021) is a scientifically rigorous, data-based framework that measures the quality of governance at the Sub-national level and ranks the States and Union Territories (UTs) of India on a Composite Index (CI).
States are classified into two categories – Large and Small – using population as the criteria.
In PAI 2021, PAC defined three significant pillars that embody Governance – Growth, Equity, and Sustainability. Each of the three Pillars is circumscribed by five governance praxis Themes.
The themes include – Voice and Accountability, Government Effectiveness, Rule of Law, Regulatory Quality and Control of Corruption.
At the bottom of the pyramid, 43 component indicators are mapped to 14 Sustainable Development Goals (SDGs) that are relevant to the States and UTs.
This forms the foundation of the conceptual framework of PAI 2021. The choice of the 43 indicators that go into the calculation of the CI were dictated by the objective of uncovering the complexity and multidimensional character of development governance
The Equity Principle
The Equity Pillar of the PAI 2021 Index analyses the inclusiveness impact at the Sub-national level in the country; inclusiveness in terms of the welfare of a society that depends primarily on establishing that all people feel that they have a say in the governance and are not excluded from the mainstream policy framework.
This requires all individuals and communities, but particularly the most vulnerable, to have an opportunity to improve or maintain their wellbeing. This chapter of PAI 2021 reflects the performance of States and UTs during the pandemic and questions the governance infrastructure in the country, analysing the effectiveness of schemes and the general livelihood of the people in terms of Equity.
Growth and its Discontents
Growth in its multidimensional form encompasses the essence of access to and the availability and optimal utilisation of resources. By resources, PAI 2021 refer to human resources, infrastructure and the budgetary allocations. Capacity building of an economy cannot take place if all the key players of growth do not drive development. The multiplier effects of better health care, improved educational outcomes, increased capital accumulation and lower unemployment levels contribute magnificently in the growth and development of the States.
The Pursuit Of Sustainability
The Sustainability Pillar analyses the access to and usage of resources that has an impact on environment, economy and humankind. The Pillar subsumes two themes and uses seven indicators to measure the effectiveness of government efforts with regards to Sustainability.
The Curious Case Of The Delta
The Delta Analysis presents the results on the State performance on year-on-year improvement. The rankings are measured as the Delta value over the last five to 10 years of data available for 12 Key Development Indicators (KDI). In PAI 2021, 12 indicators across the three Pillars of Equity (five indicators), Growth (five indicators) and Sustainability (two indicators). These KDIs are the outcome indicators crucial to assess Human Development. The Performance in the Delta Analysis is then compared to the Overall PAI 2021 Index.
Key Findings:-
In the Scheme of Things
The Scheme Analysis adds an additional dimension to ranking of the States on their governance. It attempts to complement the Governance Model by trying to understand the developmental activities undertaken by State Governments in the form of schemes. It also tries to understand whether better performance of States in schemes reflect in better governance.
The Centrally Sponsored schemes that were analysed are National Health Mission (NHM), Umbrella Integrated Child Development Services scheme (ICDS), Mahatma Gandh National Rural Employment Guarantee Scheme (MGNREGS), Samagra Shiksha Abhiyan (SmSA) and MidDay Meal Scheme (MDMS).
National Health Mission (NHM)
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)
MID- DAY MEAL SCHEME (MDMS)
SAMAGRA SHIKSHA ABHIYAN (SMSA)
MAHATMA GANDHI NATIONAL RURAL EMPLOYMENT GUARANTEE SCHEME (MGNREGS)