The World Health Organization (WHO) Constitution (1946) and Article 25 of the United Nations’ Universal Declaration of Human Rights (1948) consider the highest possible achievable standard of health as a fundamental right of every individual.
Communicable or infectious diseases such as tuberculosis and malaria continue to have the highest fatality rates across the world, with the poorest populations affected disproportionately. The impact of poor health is exacerbated when people experience marginalisation on the basis of ethnicity, caste, language, class, gender, age or sexual orientation, and that, in turn, perpetuates intergenerational poverty.
A rights-based approach to health precedes health policies and their implementation, prioritising the needs of the marginalised for achieving equity and a better quality of life. This principle has been adopted in the 2030 Agenda for Sustainable Development and Universal Health Coverage. In India, the right to health is protected under the Constitution of India in several ways. Right to Health is a part of Right to Life, and is a fundamental right guaranteed to all under the Constitution’s Article 21.
Tribal communities residing in hard to reach areas are displaced from their land, deprived of forest produce, have low literacy and financial poverty, and poor access to the health system. As a result, they have dangerously low health indicators, with high prevalence of morbidity, mortality, and malnutrition. Public health facilities are not easily accessible, have inefficient process management, lack human resources and equipment, drugs and services. This coupled with lack of understanding of local tribal culture and nuanced requirements, and socio-cultural discrimination further alienates tribal communities from access to basic health services.
Anamaya, the Tribal Health Collaborative, established with an aim to end preventable deaths among tribal and marginalised communities works through a collaborative approach to address the complex issue of tribal health art scale and with a sense of urgency. Its approach of communitisation – institutionalizing communities’ ownership for health aims to enable tribal peoples assert their right to health and realise positive health as communities.
Improving access to health for marginalised communities warrants an understanding of their needs, barriers to access, and developing contextual solutions available in a timely manner, at minimal cost, and with dignity. MAAdol drive, a multi-stakeholder intervention funded by USAID and implemented by PATH and Piramal Foundation to strengthen the Wage Compensation Scheme (WCS) by the government of Assam, is one such example. It was launched in 2018 to extend support to pregnant women from tea tribes, a group of marginalised tribal communities from the tea garden areas of Assam. Many women, working at the tea gardens although eligible, were unable to furnish relevant documents as it meant losing a day’s wages. MAAdol drive increases access to maternal and neonatal child health services by addressing gaps and delays in linkage of pregnant women who lack awareness about benefit entitlement through improved convergence at the last mile.
Access to health services for marginalised communities also improves when they are able to articulate their needs and trust service providers. The Aashwasan campaign has been addressing vaccine hesitancy amongst tribal populations supported by frontline health workers. Despite the prevalence of Covid-19 within the community, most people in Gogapur (Nandurbar district) were fearful of getting vaccinated due to abounding myths. Rekha, an ASHA worker, spent time with each family to address their concerns, often citing the example of her own vaccination experience. She promised to bear responsibility should any person experience any negative side-effects, and sat by community members while they got their vaccine shots, thereby succeeding in getting her community vaccinated.
Anamaya, the Tribal Health Collaborative identifies TB champions who have survived the disease to help community members get tested and complete their treatment. One such TB champion Reshma, a mother of three, from Pati (Barwani district, Madhya Pradesh) who was diagnosed with pulmonary tuberculosis had to give up her job at Panchayat Bhavan, leaving her family who depended on her earnings in dire circumstances. Despite that, she adhered to the treatment regime until she recovered. “I felt inspired and encouraged to work as a TB champion and help people in my community after interacting with the team of Piramal Foundation. I never thought of doing this work before. But now I don’t want to stop. I want to keep doing this work and help people as much as I can.”
Given the multiplicity of marginalisation of India’s tribal communities, it is imperative to create a responsive and sensitive health system that provides equitable access and right to health to these communities. Interventions such as MAAdol, and Aashwasan help bring appropriate services to the communities, and build their trust in the health system by improving their experience of health delivery. Through collaboration and co-creation, we can successfully ensure equitable health provisioning, and ensure that India@100 as a developed nation becomes a reality.
The article has been authored by Swati Piramal, vice-chairperson, Piramal Group and Shobha Ekka, chief of party, Tribal TB Initiative.