Abstract

Tribal health is a multi-dimensional concept and understood more by description than definition. While the tribal people of India have been subject of extensive study, researching on their health have been of lesser interest to scholars. However, in the past few years, an increase interest in researching tribal health, particularly traditional medicine, has been observed. Nonetheless, much of the research on tribal health continues to be fragmented and independent of each other with focus on specific health problems limited within specific communities or described as low in comparison to other non-tribal communities and from an etic perspective. Furthermore, most research on tribal health discuss and highlight the causes of their low health status and issues as influenced by problems that lie within their own communities due to socio-cultural practices, beliefs, customs, poverty, behaviour and superstitions thus failing to discuss with exception of a few researchers the importance and role of the government, policy, systems and quality of health care services provided to them. This paper presents the problems and challenges of researching tribal health in India and proposes a way forward for better health research and outcome among them.

 

Key Words: Tribal Health, Tribal Health Research, Research Vulnerability Process, Research Approach, Tribal (Health) Research Ethics

 

Tribal People and their Issues as a Community

Tribal people in India constitute 8.6% of the country’s total population. They are often found residing in the outskirts of forests, hilly areas, or within forested regions and away from ‘main stream’ society. They are characterised as communities with primitive traits, distinct cultures, geographical isolation, a tendency to avoid contact with the larger community, and socio-economic backwardness (Lokur Committee Report, 1961). India recognises 705 communities as Scheduled Tribes (ST). According to the Report of the Expert Committee on Tribal Health (2018) they may be categorised into four major categories as 1) those living in Scheduled V areas of tribal dominated areas, 2) those living in North East India, 3) the particularly vulnerable tribal groups and 4) tribal people living outside Scheduled areas. Despite seventy-seven years after independence they continue to face various forms of challenges including crimes and atrocities like rape, assault on women with the intent to outrage their modesty, kidnapping, abduction, grievous hurt, murder, attempted murder, attempted rape, criminal intimidation, simple assault, trespassing, mischief, and more (National Commission of Scheduled Tribes, 2023). The National Crime Records Bureau, India (2024) reveals an increase in crimes against Scheduled Tribes from 8,802 cases in 2021 to 10,064 cases in 2022, representing a 14.3% rise. Among the states, Madhya Pradesh reported the highest number of crimes with 2,979 cases, followed by Rajasthan with 2,521 cases; and Kerala recorded the highest crime rate of 35.5, followed by Rajasthan with 27.3 against Scheduled Tribes in India in 2022, according to the same report.

The status of tribal people in India continues to be lagging behind in many fronts. For example, their economic status is low, with 45.35% of those living in rural areas and 24.1% in urban areas still below the poverty line (Bodhi, 2023). Additionally, they have a lower literacy rate of 58.96% compared to the national average of 74.04% (Census of India, 2011). Their health status is often described as poor and low (Singh, 2008) with higher malnutrition rate, low birth rate, higher neonatal mortality rate, higher infant mortality rate and higher under five mortality rate (Mutatkar, 2022) and higher rate of communicable and non-communicable as compared to non-tribal people (Kumar et. al., 2020). According to the Ministry of Tribal Affairs (MoTA, 2019) they have a lower life expectancy of 63.9 years than the general population of 67 years and lag behind other non-tribal communities in many parameters including health.

Tribal people face a triple burden of diseases. Firstly, there is malnutrition and communicable diseases like malaria and tuberculosis, which remain widespread among them; secondly, rapid urbanisation, environmental distress, and changing lifestyles are beginning to contribute to the emergence of non-communicable diseases such as cancer, hypertension, and diabetes among them and thirdly, there is the burden of mental illness and addiction  among them (Report of the Expert Committee on Tribal Health (2018). The report further identifies ten specific health challenges faced by tribal communities: 1) malaria, 2) malnutrition, 3) child mortality, 4) maternal and women’s health, 5) population growth and infertility, 6) mental health and substance abuse, 7) sickle cell disease, 8) animal bites, accidents and occupational hazards, 9) knowledge gaps on health, and 10) school health of the tribal population. Addressing these challenges is crucial to ensure that tribal communities enjoy healthy and productive life.

Further, the same report comments on the state and status of health infrastructure, health personnel and health services in tribal areas of India. There was an overall deficit of 20% Health Sub-centers (HSCs), 30% Primary Health Centers (PHCs), and 22% Community Health Centers (CHCs) in tribal areas according to the report. Again, while there is a surplus of 64% Auxiliary Nurse Midwives (ANMs) in HSCs and PHCs, there exists an overall deficit of 49% male health workers in HSCs, 33% allopathic doctors in PHCs, and 84% specialists in CHCs in tribal areas. Reasons for such deficits are caused by unwillingness and refusal of the medical personnel including fresh MBBS graduates to join tribal and rural area posting. For example, about 85% of MBBS graduates between 2018-2020 (Hindustan Times, 2020) and 70% between 2020-2023 (Times of India, 2023) in the state of Gujarat, and about two-thirds of MBBS graduates between 2015-2021 from the Government Medical Colleges of Mumbai (Indian Express, 2023) preferred to pay the penalty than join tribal and rural area posting. The stories are similar in other states across India.

While some of the reasons for not joining such posting include feeling of sense of professional, social and family isolation, perceived salary inequity in comparison to location of posting and lack of amenities such as education for children (Mavalankar, 2016); a vast majority of them just simply feel such posting as punishment (Islary, 2018) and injustice given rise sometimes by lack of communication, proper orientation, transparency in terms of process and practice. Such feeling gets aggravated due to precedence of actual practice where government officials including medical have been transferred or posted to rural, remote and tribal areas as part of departmental or disciplinary action for various reasons including inefficiency, corruption and harassment of various forms in some cases.

Status of Tribal Health Research in India

The tribal people of India have been subject of many studies. While culture, religion, identity, social structure, land issues, social institutions, history, education, movements and governance tend to dominate as research interests, research on tribal health has largely been remaining a left-out interest for research. And the available research on tribal health is diverse in theme ranging from communicable to non-communicable diseases, from environment, nutrition to genetics and heredity factors, from influence of beliefs, practices and behavior to effects of modern education on health to mention a few. According to the Report of the Expert Committee on Tribal Health (2018) the few research available on tribal health are fragmented and on ‘specific diseases like malaria, tuberculosis, and sickle cell diseases or … nutritional status of communities.’

The author of this paper acknowledges the contribution of many books on tribal health and journals including those listed in UGC-CARE List Group I and UGC-CARE List Group II towards understanding the issues and challenges of tribal health in India. In recent times, two significant reports – namely, the Xaxa Committee Report (2014), which encompasses various aspects of tribal issues including health, and the Report of the Expert Committee on Tribal Health (2018), which could be considered the first and most comprehensive report to date related to tribal health in India, have become important sources of references for understanding tribal health issues and planning policies and interventions in the country.

Further, the ICMR-National Institute of Research on Tribal Health (ICMR-NIRTH) regularly brings out its Tribal Health Bulletin which covers various aspects of health and health issues related to tribal communities in India. Beside ICMR-NIRTH there are a number of MoTA financed Tribal Research and Training Institutes across the country which are mandated to assess the various tribal schemes including health.

A trend analysis by Saravanan et. al. (2022) on tribal health research in India published in Scopus indexed journals between the years 2000 to 2020 showed an increased number from 3 to 43 publications through the years covering the aspects of traditional medicine (35.7%), nutrition (15.7%), infectious diseases (14.7%), non-communicable diseases (11.6%), reproductive health (7.3%), genetic diseases (6.3%), child health (3.3%), behavioral health (1.8%), health systems (1.5%), health behavior (1.3%) and health policy (0.8%). From the data it is safe to comment that while tribal/indigenous medicine (often termed as traditional medicine) is of curiosity and interest to research – academics and industries, the need for research on health systems and policy related to tribal health are of least interest to them.

The National Health Policy of India (2017) besides acknowledging the need for strengthening and improving the health status and health needs of tribal people through 1) specific measures and services including outreach programmes as they are vulnerable, 2) providing special attention keeping in mind their geographical and infrastructural challenges and largeness of their population, and 3) engagement of private sector in tribal areas for health awareness and services, also emphasizes on 4) promoting research and validation of tribal medicines.

While lots have been done to understand the status, factors influencing and issues of tribal health in India much still remains to be explored, researched and understood. According to the Report of the Expert Committee on Tribal Health (2018) most research on tribal health are commentaries presenting the findings of localized research carried out by NGOs and there continues to be ‘near complete absence of data on the health situation of different tribal communities’ in India.

Problems and Challenges of Researching Tribal Health in India

Tribal health in simplest term would mean the positive state of physical, social, mental, and spiritual wellbeing of tribal people. It is a term that tries to encapsulate a complex reality of health within these groups across various dimensions and factors that influence their health and wellbeing. However, researching on tribal health has always been problematic and challenging in India due to its wide scope, plethora of health issues and fuzzy intersecting boundaries between ‘what is’ and ‘what is not’ tribal health. The term ‘tribal health’ continues to be vaguely defined and researchers take a broad and diverse interpretation and operationalize the concept to align with the specific focus of their studies. Thus, rather than being explicitly defined, tribal health is typically understood through descriptions and explanations of health issues and associated factors that lead to higher rates of morbidity or mortality and greater incidence or prevalence of health problems among them in comparison to non-tribal communities. Consequently, investigations into tribal health frequently end up narrowing down to examining specific health challenges faced by tribal peoples. This difficulty in defining tribal health stems largely from the multifaceted and heterogeneous nature of health issues that vary widely (Narain, 2019) within tribal population and a variety of factors (Basu, 2000) that encompass both physical and social environments, genetic and heredity and socio-cultural practices among them. For example, while those residing in remote areas report higher rates of maternal and child mortality, malnutrition, and other communicable and non-communicable diseases; those living in urban areas are beginning to report higher rate of non-communicable diseases such as cardiovascular disease, diabetes, and hypertension. Many studies focused on tribal health inadvertently delve into specific health issues prevalent among tribal communities which make them specific and microscopically contextual thus overlooking the need for locating them also within the macro social, political and economic environment, structures and systems.

While it is encouraging to see an increase in interest for research and publications on tribal health over the years, there are also rising ethical concerns on way these researches are carried out. According to Kumar et. al. (2023), besides the lack of clarity and clear explanations to the communities under study, the common practice of using verbal informed consent instead of written consent forms – citing their low literacy rates as the reason – along with the collection and storage of genetic samples without clear explanations of its objectives, pose serious research and ethical concerns. Such studies though sound methodologically scientific fail in ethical standards of research especially among vulnerable communities. The reason cited for frequent use of verbal informed consent in researching among tribes seems rooted either in a blanket understanding of going by average of around 59% literacy rate among them or having overlooked that in some UTs and states of India their literacy rate is as high as 91.7% which is far ahead of national average of 73% (Census of India, 2011).

Researchers especially from other communities and nationalities need also to be mindful and address language and cultural barriers to avoid misinterpretation and better communication (Roy et. al., 2023) so that meaning of data and information are not diluted or lost in the process of translation. Further, there are some scholars who carry with them biases, prejudices and ‘discrimination rooted in social, including caste or race origins’ (Jiloha, 2010) which undermine indigenous/tribal culture and knowledge as ‘undesirable or inferior and incompatible with the modern’ (UN, nd.) that give rise to detrimental research and negative health outcomes. And while on one hand indigenous and tribal people continue to face the challenge of ‘lack of recognition for traditional medicinal knowledge’ as archaic, unscientific and rudimentary by the state and potential users, on the other hand there have been cases of exploitation of such ‘knowledge by researchers’ (WIPO, 2001) for personal gains thus making calls for (tribal) health ethical ‘research regulation that would maximize community benefits and minimize harms’ (Kelley et. at., 2013). This subtle objective could be one reason for a high interest for research on traditional medicine (35.7%) of all tribal health related studies in India. Such approaches and practices by researcher’s risk offsetting the trust and confidence established between tribal communities and health care service providers and systems through participatory and collaborative efforts (Islary, 2021) that is beginning to develop between them.

Further, while low health status and negative health indicators of tribal people are highlighted some positive aspects like tribal people’s knowledge and usage of effective traditional herbal medicines (Kumar et. al., 2020) though is beginning to get the attention and interest to researchers and of them having much higher sex ration (990) than non-tribal communities (943) remain ignored, not discussed and hardly highlighted, and sometimes even dismissed with lighthearted statements of mockery to the laughter and amusement of crowds.

For example, during a conference session a couple of years ago, the higher fertility rate among tribal people compared to non-tribal populations in India was discussed as a challenge to achieving health and national population stabilization targets. While one audience member acknowledged the discussion along with a submission about tribal communities having a better sex ratio than non-tribal populations during a Question & Answer session, another member responded with a casual statement that sounded more like mockery than humor. The member said that the case of tribal people having higher sex ratio than non-tribal people could be because of their lack of ‘knowledge’ and ‘not knowing to do it’ (female feticide). While some laughed at it, a few young participants took it quite seriously and wrote down the comment in their note pads.

Often symposiums, conferences and seminars including those on tribal health are sparsely attended by scholars coming from within tribal communities. In many cases such events end with an evening cultural programme where some members from tribal communities are brought and made to perform dances, songs and some ‘natak’ related to their lifestyle for the entertainment, amusement and relaxation of the delegates after their ‘heavy and exhausting academic and technical sessions.’ Typically, such cultural programmes conclude with photo sessions where delegates pose with the colorfully dressed tribal dancers, musicians, singers and actors for memories and posting in social media sites. Many of these events are also purely academic in nature and a few with objectives of interventions do not go beyond giving recommendations for generation of awareness and education.

Further the few tribal scholars doing research on tribal health are made to articulate the research of their own communities from a third person’s narrative in the name of objectivity, methodological soundness and epistemological acceptability. Attempt to capture and define health and experiences of well-being from emic perspective by them is often treated as noting of vague ideas, sentimental narrations, emotional expressions and inaccurate articulation that are more imaginative than scientific and not within the scope of academics, while at the same time such texts become transcripts for thick descriptions with layered meanings to a scholar coming from outside the community. The author has not been able to locate an ethnographic study on tribal health till the date of writing this paper. Scholars from among tribal communities should be encouraged to do tribal health research using ethnographic approach and write using emic perspective by themselves about health experiences besides others of their own communities. Such practice would encourage inclusion and participation of members including scholars from within tribal communities resulting in gaining useful insights and perspectives of their experiences and needs. According to Xaxa Committee Report (2014) ‘a reason for the inappropriately designed and poorly managed healthcare in Scheduled Areas is the near complete absence of participation of Scheduled Tribes people or their representatives in shaping policies, making plans or implementing services in the health sector’ thus giving rise to poor health outcomes and status among them.

The data on tribal health continues to be ‘severely lacking’, ‘scant’, ‘poor in quality’ and ‘with gaps at all levels’ (Report of the Expert Committee on Tribal Health, 2018) and continues to be over reliant on methodology like Sample Registration System (SRS) which does not provide information on Tribal communities for estimation of their Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR). Often data on tribal health are collected only from accessible and convenient locations that the researchers can reach easily using quick survey methods and convenient approaches which are justified as feasibility of the study, thus leaving out remote, inaccessible or difficult to access areas like forested, hilly, mountainous, arid and riverine habitations due to lack of physical connectivity and other amenities. Such ‘inappropriate methods and practices’ of doing research have proven to be harmful to indigenous/tribal populations (Saravanan et. al., 2022). Besides these, a number of studies on tribal health are also re-analysis of the secondary data found either in public domain or through privy knowledge and privilege access which are collected at the national or district levels by Government and other agencies. According to the Report of the Expert Committee on Tribal Health (2018), combination of ‘secondary data, field visits, consultations with stakeholders, and best practices workshops’ ensure a better and holistic understanding of tribal health issues and dimensions. Similarly, Tanya et. al., (2020) argue that field-based data enables a deeper understanding and facilitates better comparison with data available at the state or national levels.

Studies carried out on tribal health invariably tend to conclude their health status as poor or low in comparison with non-tribal people and as caused by their primitive nature of habitat, inferior culture, low literacy rate, evil practices including superstitions and addictive behaviors with few reports and researchers (Report of the Expert Committee on Tribal Health, 2018; Bagchi et. al., 2020, Mutatkar, 2022 & Roy et. al., 2023) also highlighting the importance of other factors such as lack of human resource, non-availability of drugs, poor infrastructure and quality of service, defunct governance, inefficient health systems and role of health policy as also responsible for poor health outcomes among tribal communities. Thus, many studies directly or indirectly end up by putting the responsibility for poor and low health status among tribal communities on the community people themselves.

Financing on tribal health including tribal health research continues to be underfunded. For example, though the Tribal Sub Plan (TSP) mandates the Ministry of Women and Child Development and the Department of Health and Family Welfare direct all states to earmark 7.5 to 8.2% of their budget outlay for health, only seven states in 2012-13 had allotted some budget for health, but without following the guidelines of having to allot the budget in proportion to the tribal population of their states. Further, though the utilization of the TSP fund was found to be near complete there was no data available related to expenditure on tribal health and research with neither MoTA nor states.

Again, though research on tribal health continues to be carried out at various levels and capacities by individuals and institution both public and private there is no mechanism that coordinates and brings them together to a common platform for a common good making them independent, disjoint and disconnected from each other. Also, researchers need to shift their focus from analyzing tribal health as a problem of and as caused by the tribal people themselves approach to analyzing the importance and role of health policy and health systems including governance and financing in ensuring positive tribal health outcomes. Further research on tribal health could be carried out using the lens of health policy and systems research (hpsr). The recently launched WHO Global Center for Traditional Medicine at Jamnagar, India in 2022 (WHO, 2022) could play a vital role by contributing to tribal health research and ensuring ethical practices in collaboration with other already existing institutions and agencies in the country.

Way Forward

Addressing the problems and challenges of researching tribal health in India would need a concerted effort of many stakeholders at various levels – including at individual, group, institutional, local, regional state, national and international. It would call for collaboration, discussion and sharing of information, findings and designing a framework for further studies both at micro and macro levels. To make process of tribal health research ethical, transparent and accountable, and its outcome beneficial to communities, there need to be policies, systems, guidelines and mechanisms which govern research and that encompass academics, practice and corporates.

The following points listed below most of which are also found in the Report of the Expert Committee on Tribal Health (2018) could act as a way forward for researching tribal health in India –

1. Formulation of tribal health (and research) policy.

2. Following the ethical principles of tribal health research –

• respect (for tribal culture)
• relevance (to tribal communities)
• reciprocity (through two-way process of learning and exchange)
• responsibility (empowerment through active engagement; ensuring that the tribal people face no adverse consequences due to research including denial of access to their traditional knowledge).

3. Following the five approaches for tribal health research –

• multidisciplinary
• participatory and community based which addresses needs of community and ensures findings of the research are transmitted and adopted by the community members
• epidemiologic research which are state and tribe specific which would be foundational for tribal health plan
• implementation research integrated into policy and programmatic decision making and
• evaluation research.

4. Including the following as scope of tribal health research –

• knowledge, attitudes and practices in tribal people
• tribal medicines and practices including scientific evaluation of the same
• epidemiological studies including morbidities, mortalities, rate, trend and intervention studies
• health care delivery systems in tribal areas –priorities, coverage, quality, utilization, barriers and bottlenecks and outcomes and
• policy, governance and financing.

5. Formulating Tribal Health Research Agenda, establishing Tribal Health Directorate and setting up special Tribal Health Research Cell (under MoHFW).

6. Increasing and expanding the network of ICMR and Tribal Research Institutes to districts where tribal population is more than 50%.

7. Streamlining the research activities of NGOs related to Tribal Health.

8. Allotting at least 10% of the budget of Directorate of Health Research for Tribal Health Research.

9. Developing Health Management Information System (HMIS) and making NFHS, DLHS, AHS, NSSO and SRS capture specific information and estimates of tribal health.

10. Regularly monitoring, supervising and evaluating the health policies, programmes and infrastructure to generate knowledge on tribal health.

11. Encouraging ethnographic research and use of emic perspective for tribal health research by scholars from within tribal communities and supporting them with financial grants and fellowships.

12. Developing the research capacity and nurturing the research interest of health workers who are working in tribal areas through training, network and support on how to scientifically design health studies, collection data, write and publish on tribal health based on primary data.

13. Promote application of Health Policy and Systems Research (HPSR) lens in researching tribal health for better health policy, system and outcome among them.

 

References

1. Bagchi,  T. Das, A. Dawad, S & Dalal K. (2020). Non-utilization of Public Healthcare Facilities during Sickness: A National Study in India. Journal of Public Health: From Theory to Practice. Vol. 30. Pp. 943–951.
2. Basu, S. (2000). Dimensions of Tribal Health in India. Health and Population perspectives and Issues, Vol. 23(2). Pp. 61-70.
3. Bodhi, S.R. and Darokar, S.S. (2023). Becoming a Scheduled Tribe in India: The History, Process and Politics of Scheduling. Contemporary Voice of Dalit. Pp. 1-11.
4. Bora, D & Das B. (2022). Nexus Between Poverty and Superstitious Beliefs among Tribal Communities of Assam: A Case Study of Rabha Tribe. Journal of Anthropological Survey of India.  Vol. 71(2). Pp. 185-201.
5. Census of India. (2011). Government of India. Source: https://sansad.in/getFile/annex/262/AU464.pdf?source=pqars#:~:text=(a)%3AAs%20per%20Periodic,not%20available%20in%20PLFS%20report.
6. Hindustan Times (2019). 85 per cent MBBS graduates avoided rural service in Gujarat in two years (Mar. 3, 2020)  Source: https://www.hindustantimes.com/education/85-per-cent-mbbs-graduates-avoided-rural-service-in-gujarat-in-two-years/story-ALoMzOjDthXOFnZm22ovcK.html
7. India: Lokur Committee Report. (1965). The report of the advisory committee on the revision of the lists of Scheduled Castes and Scheduled Tribes. Department of Security, Government of India.
8. India: National Commission of Scheduled Tribes. (2023). Crimes against Scheduled Tribes. https://ncst.nic.in/sites/default/files/2017/Atrocities/1127.pdf
9. India: National Commission of Scheduled Tribes. (2023). Crimes against Scheduled Tribes. https://ncst.nic.in/sites/default/files/2017/Atrocities/1128.pdf
10. India: National Crime Records Bureau. (2024). Crime/Atrocities against Scheduled Tribe(s)- 2020-2022. https://ncrb.gov.in/uploads/nationalcrimerecordsbureau/custom/1702029713TABLE7C1.pdf
11. Indian Express. (2023). Maharashtra: In biggest govt medical college, 2 in 3 graduates chose Rs 10 lakh fine over rural posting (Jan 9, 2023). Source: https://indianexpress.com/article/cities/mumbai/maharashtra-in-biggest-govt-medical-college-2-in-3-graduates-chose-fine-over-rural-posting-8369261/#:~:text=Between%202015%20and%202021%2C%20nearly,compulsory%20one%2Dyear%20rural%20posting.
12. Islary, J. (2019). Pregnancy and Pregnancy Care Practice: The Lived Experience of the Bodos. New Delhi: Mittal Publications.
13. Islary. J. (2021). Ensuring Public Healthcare Service and Health Rights in Communities through Participatory Health Governance. Indian Journal of Health and Wel-being.  Vol. 12(4). Pp. 466-469.
14. Jiloha, R.C. (2010). Deprivation, Discrimination, Human Rights Violation and Mental Health of the Deprived. Indian Journal of Psychiatry. Vol. 52(3). Pp. 207-212.
15. Kumar , R. Dumka, N. & Kotwal, A. (2023). Correspondence article on the research protocol titled ‘Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol’ published in Wellcome Open Research. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568208/pdf/wellcomeopenres-8-20432.pdf
16. Kumar, M. M. Pathak, V.K. & Ruikar, M. (2020).  Tribal Population in India: A Public Health Challenge and Road to Future. Journal of Family Medicine and Primary Care.  Vol. 9(2). Pp. 508-512.
17. Mavalankar, D. (2016). Doctors for Tribal Areas: Issues and Solutions. Indian Journal of Community Medicine. Vol. 41(3). Pp. 172-176.
18. Mutatkar, R.K. (2022). Tribal Health Issues: A Need for Tribal Health Policy. Indian Journal of Medical Research. Vol. 156(2), 182-185.
19. Narain, J.P. (2019). Health of Tribal Populations in India: How Long can We Afford to Neglect? IJMR. Vol. 149(3). Pp. 303-316.
20. National Health Policy 2017, MoHFW, GoI. Source: https://main.mohfw.gov.in/sites/default/files/9147562941489753121.pdf
21. Report of the Expert Committee on Tribal Health. (2018). Tribal Health in India – Bridging the Gap and a Roadmap for the Future.  New Delhi. MoTA.
22. Roy, A. D. Muacevic, D. & Mondol, H. (2023). The Tribal Health System in India: Challenges in Healthcare Delivery in Comparison to the Global Healthcare Systems. Cureus Vol. 15(6). Pp. 1-4.
23. Saravanan, C. Bharathi, P. & Indra, S. (2022). Understanding the Trends of Tribal Research in India through Bibliometric Analysis. Journal of Family Medicine and Primary Care. Vol. 11(10). Pp. 5887-5893.
24. Singh, U.P. (2008). Tribal Health in North East India: A Study of Socio-Cultural Dimension of Health Care Practices. New Delhi Serials Publications.
25. Tanya, S. Velho, N. Narasimhamurti, N. S. &  Srinivas, P. N. (2020). Examining Tribal Health Inequalities around Three Forested Sites n India: Results of a Cross-sectional Survey. Journal of Family Medicine and Primary Care. Vol. 9(9). Pp. 4788-4796.
26. Times of India. (2023). Gujarat: In Past 3 years, 70% MBBS doctors under bond didn’t join govt duty (Sep. 18, 2023). Source: https://timesofindia.indiatimes.com/city/ahmedabad/in-past-3-years-70-mbbs-docs-under-bond-didnt-join-govt-duty/articleshow/103742823.cms
27. (nd.). Sociocultural Biases and Discrimination. Source: https://www.un.org/esa/socdev/rwss/docs/2003/chapter3.pdf
28. WHO. (2022).WHO Launches Traditional Medicine Hub in India. Source: https://www.france24.com/en/live-news/20220419-who-launches-traditional-medicine-hub-in-india
29. WIPO. (2001). Intellectual Property Needs and Expectation of Traditional Knowledge Holders. Geneva: WIPO.
30. Xaxa Committee Report. (2014). Report of the High Level Committee on Socioeconomic, Health and Educational Status of Tribal Communities of India. New Delhi: MoTA.

Dr.Jacob Islary is an Associate Professor of Social Work at St. Xavier’s University, Kolkata and may be contacted at jislary@gmail.com 

Have you like this article?