Set up separate tribal health system, panel tells state govt

The ‘State Committee Report on Strengthening Tribal Health in Maharashtra’, submitted to the state health department, recommends that the state create a separate tribal health system for these communities

MUMBAI: Despite significant improvements in tribal health indicators, a state-level committee has warned that Maharashtra’s tribal communities continue to lag behind the state’s overall population on key health outcomes. Gaps in last-mile delivery, healthcare personnel, data, nutrition, and access to emergency care require a fundamental overhaul.

Set up separate tribal health system, panel tells state govt

The ‘State Committee Report on Strengthening Tribal Health in Maharashtra’, submitted to the state health department, recommends that the state create a separate tribal health system for these communities.

The department has constituted a committee headed by Nandurbar district collector Dr Mittali Sethi to oversee the implementation of its recommendations, after another committee headed by her submitted the report.

Maharashtra has 10.5 million tribal people, accounting for 9.35% of the state’s population, according to the 2011 Census. Last-mile delivery of government schemes was the primary challenge. Difficult terrain, poor connectivity, staff shortages, weak follow-up systems, inadequate data, and socio-cultural barriers leave remote tribal communities vulnerable.

Infant mortality and under-five mortality rates are key indicators that health care is not being delivered to tribal communities, according to the report.

Anaemia a major concern

The report states anaemia is a serious concern among tribal women and children, and linked it to inadequate intake of iron and folate, recurrent infections, and haemoglobin disorders.

The committee has called for anaemia to be tackled through a broader nutrition strategy rather than iron supplementation alone. It also recommends point-of-care haemoglobin testing to enable earlier detection and treatment closer to tribal communities.

High-risk pregnancies

The committee has proposed Health Action Centres to tackle a critical weakness in the existing system—poor follow-up of high-risk pregnancies and children, while referring to district‐level NFHS‐5 data shows that tribal‐dominant districts in Maharashtra consistently report poorer perinatal outcomes. The centres would integrate information across health programmes and track patients through referrals instead of leaving families to navigate the system themselves. The committee notes that while pregnancies are registered, high-risk cases may not be consistently followed up and referrals may not be completed.

Health outlay

The committee recommends a substantial increase in health’s share of the Tribal Sub-Plan, recommending that 12-15% of TSP resources be earmarked for health. In 2018-19, the state health department received only 3% of the ₹ 255 crore under the Tribal Sub-Plan. It has proposed a 12-15% allocation, which would translate into ₹ 1,100-1,500 crore annually based on current TSP outlays.

Gaps in sanitation

Only 65.5% of tribal households reported access to toilets, with the figure dropping to 61.1% among rural tribal households. The committee says the problem goes beyond toilet construction, with water availability, unsuitable designs, maintenance, and electricity affecting actual use.

No quarters, no doctors

The report identifies the inability to attract and retain healthcare personnel in remote areas as a major obstacle to improving services.

Health workers posted to tribal facilities frequently lack habitable accommodation, secure rest spaces, or reliable sanitation, the report states, adding that the problem is compounded for women health workers. It has made several recommendations for improvements in residential quarters for essential staff, including prefabricated, modular, and even 3D-printed housing.

Roads and ambulances

The report recommends ‘health enabling infrastructure’ be improved in tribal areas, which are often remote. This includes the construction of all‐weather roads, footbridges over rivers, and mobile network expansion. It says no village should be unreachable.

Data gap masks crisis

A major recommendation is to create a Tribal Disaggregated Public Health Dataset that tracks health indicators down to the block, village and pada levels. The committee says district-level averages can mask severe disparities in mixed-population districts.

It has proposed that the Tribal Health Cell publish the state’s first comprehensive Tribal Health Report within one year and progressively digitise antenatal, postnatal, child-health and disease-surveillance records with tribal identifiers.

The proposed Tribal Health Dashboard would allow frontline workers to identify children due for vaccination, pregnant women nearing delivery, adolescents flagged for anaemia and families returning from seasonal migration. At the state level, the system could also be used to detect emerging disease risks, including potential malaria outbreaks.