Effective Measures to Enhance Health for Marginalised Populations

Health disparities in India are not random. They follow the contours of caste, class, gender, geography, and disability, leaving certain communities perpetually behind. Scheduled Tribes, Scheduled Castes, the urban poor, sexual minorities, persons with disabilities, and migrant workers consistently report poorer health indicators than the general population. Improving their health status is not just a moral obligation but a public health necessity. It requires coordinated action across sectors, well-funded government programmes, and inclusive strategies that treat marginalised groups as active participants rather than passive recipients.

Why marginalised groups need targeted health measures 🔗

The gap between marginalised communities and the general population is stark. Child malnutrition among tribal children stands at 42% compared to 28% in others, and malaria and tuberculosis are three to eleven times more common among tribal people. Though Scheduled Tribes form only 8.6% of India’s population, they account for nearly half of all malaria deaths in the country. Scheduled Caste and Scheduled Tribe women also experience higher maternal mortality and morbidity than other social groups, a pattern that reflects the failure of conventional strategies to ensure health rights of these communities.

These outcomes are produced by a web of factors: difficult terrain, illiteracy, poverty, cultural barriers, language differences, and a chronic shortage of healthcare professionals willing to serve in remote or stigmatised pockets. Addressing them needs more than just building more hospitals. It needs a structural shift in how health systems are designed.

Inter-sectoral collaboration: tackling the roots, not just the symptoms 🔗

Health is shaped by factors that sit largely outside the health sector. Access to clean water, nutritious food, schooling, decent housing, sanitation, and employment all decide whether a person stays well or falls sick. This is why a multidisciplinary, inter-sectoral approach is now considered essential for any serious effort to reduce health inequalities.

The World Health Organization has long argued that “health equity in all policies” should be the ultimate goal, supported by strong intersectoral action that addresses the social determinants of health. India formally adopted this thinking through the 2009 World Health Assembly resolution on a “Health in All Policies” approach. In practice, it means the Ministry of Health works in concert with ministries handling rural development, women and child welfare, education, drinking water, sanitation, and social justice.

How inter-sectoral action looks on the ground 🔗

Consider maternal and child health in a tribal block. A safe delivery depends on a functioning Primary Health Centre, but also on a passable road, an electrified sub-centre, an Anganwadi providing nutrition, a school keeping the girl in education long enough to delay early marriage, and a Public Distribution System supplying iron-fortified rice. A research study in rural Uttar Pradesh used social network analysis to demonstrate that an intersectoral approach acknowledging multiple determinants, actors, and sectors is increasingly seen as critical for achieving meaningful and lasting improvements in population health.

Inter-sectoral collaboration also includes partnerships with civil society. Non-governmental organisations often have deeper community roots than government departments, especially among Adivasis, transgender persons, or sex workers. When these partnerships are formalised, marginalised communities gain a stronger voice in programme design.

Government initiatives and policies targeting marginalised groups 🔗

India has built a layered architecture of schemes that, when implemented well, can substantially improve health for the worst-off. Three programmes stand out for their scale and ambition.

Ayushman Bharat: financial protection and primary care 🔗

Launched in 2018 following the recommendations of the National Health Policy 2017, Ayushman Bharat moves India towards Universal Health Coverage. It has two inter-related components, designed around the principle of leaving no one behind. The first is the network of around 1,50,000 Health and Wellness Centres created by transforming existing Sub-Centres and Primary Health Centres to deliver comprehensive primary care, screenings for non-communicable diseases, maternal health services, and wellness programmes.

The second is the Pradhan Mantri Jan Arogya Yojana (PM-JAY), described as the largest government-funded health assurance scheme in the world. It offers a cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation, targeting the bottom 40% of the population identified through the Socio-Economic Caste Census 2011 deprivation and occupational criteria. The scheme is portable, which is critical for migrant workers who often lose access to entitlements when they move across state lines.

Despite its reach, evidence suggests significant awareness and utilisation gaps. A community-based study in rural Puducherry found that while 62.6% of households were registered under PMJAY, only 2.03% of eligible beneficiaries had actually utilised the scheme. This points to the need for stronger demand-side communication, especially among less-educated and elderly populations.

National Health Mission and ASHA workers 🔗

The National Health Mission (NHM), with its rural and urban arms, remains the backbone of public health delivery for marginalised groups. Its most visible face is the Accredited Social Health Activist, or ASHA. In 2015, the programme matured into the National Health Mission and was extended to marginalised urban areas, and with almost one million ASHAs now selected and trained, it has grown to become one of the largest community health worker programmes in the world.

ASHAs are local women who act as a bridge between the public health system and households that would otherwise go unreached. Studies estimate that access to ASHA services is associated with a 17% increase in first antenatal care visits, a 26% increase in having a skilled birth attendant at delivery, and a 28% increase in facility-based deliveries. Yet, structural gaps remain. ASHAs are often underpaid, lack adequate equipment, and find it hardest to reach the most marginalised, especially Adivasi women in remote habitations.

Schemes for specific marginalised populations 🔗

Beyond the flagship programmes, India has developed targeted schemes for particular groups. The SMILE scheme, launched by the Ministry of Social Justice and Empowerment in 2022, supports transgender persons and people engaged in begging. It includes a comprehensive health package in convergence with PM-JAY, covering general healthcare as well as gender-reaffirmation procedures through empanelled hospitals, along with strict non-discrimination policies. The Garima Greh shelter homes provide safe accommodation, medical care, and skill-building support to transgender persons facing homelessness.

For tribal populations, a National Tribal Health Observatory has been planned in Bhubaneswar, signalling a shift towards evidence-based, culturally rooted solutions for diseases that continue to afflict the country’s most marginalised communities. Such observatories are designed to integrate traditional tribal healing knowledge with modern medical practice, recognising that cultural sensitivity is itself a determinant of whether services are used.

Strategies for social inclusion in healthcare 🔗

Schemes alone do not deliver equity. They need to be supported by a set of strategies that make marginalised groups visible, heard, and protected within the health system.

Data visibility and disaggregated information 🔗

One reason marginalised groups have been historically neglected is that they are often invisible in official data. Aggregate national averages can mask sharp inter-group inequalities. Disaggregating data by caste, tribe, gender identity, disability status, and migration history is essential to track whether health programmes are actually reducing gaps. The widening gap in under-five mortality between Scheduled Tribes and others, even as overall rates fall, is exactly the kind of trend that only disaggregated data can reveal.

Prevention and primary care at the doorstep 🔗

Marginalised populations bear a double burden of communicable and non-communicable diseases. Strengthening preventive services through Health and Wellness Centres, immunisation drives, vector-control programmes, and screening for hypertension, diabetes, and cervical cancer is far more cost-effective than treating advanced illness. Improving accessibility, quality, and cultural appropriateness of healthcare services for tribal groups, through collaboration between government, medical specialists, and the indigenous communities themselves, leads to improved health outcomes and reduced inequalities.

Partnerships with communities and civil society 🔗

Sustainable progress depends on treating communities as partners rather than beneficiaries. Community-Based Organisations run Garima Grehs for transgender persons. NGOs operate mobile clinics in tribal hamlets. Self-Help Groups deliver health messaging in slums. These partnerships add reach, trust, and cultural fluency that government staff alone cannot provide.

Capacity development at every level 🔗

Capacity development must run on two tracks. The first is strengthening the health workforce, especially frontline workers like ASHAs, Auxiliary Nurse Midwives, and Anganwadi workers, with competency-based training, fair pay, supportive supervision, and protection during emergencies. The COVID-19 pandemic exposed how thin this support can be when crises hit. The second is building community capacity, training local leaders, school teachers, panchayat members, and youth volunteers to recognise health risks, demand services, and hold systems accountable.

Legal protection and rights-based approaches 🔗

Social inclusion in health is incomplete without legal protection from discrimination. The Transgender Persons (Protection of Rights) Act, the Rights of Persons with Disabilities Act, and the Mental Healthcare Act all establish entitlements that can be used to push for inclusive services. Translating these rights into routine practice, however, requires sensitisation of healthcare providers and grievance redressal mechanisms that marginalised people can actually use.

The road ahead 🔗

Measures to improve the health of marginalised groups will succeed only when they treat health as a shared responsibility across sectors, fund interventions adequately, use disaggregated data to drive decisions, and centre the voices of the communities being served. Awareness gaps, workforce shortages, and budgetary constraints continue to limit the impact of even well-designed schemes. Yet, the architecture is in place. With sustained political commitment and genuine partnerships, the gap between the marginalised and the mainstream can be narrowed in this generation rather than the next.

What do you think? Which strategy do you believe will make the biggest difference in your own state or district, expanding insurance cover, deepening community health worker programmes, or strengthening inter-sectoral coordination? And how can college students contribute to making health services more inclusive for marginalised communities around them?

References

1. https://iasbaba.com/2022/08/national-tribal-health-mission/
2. https://www.sciencedirect.com/science/article/abs/pii/S0033350619300587
3. https://www.who.int/publications-detail-redirect/sea-he-201
4. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0219786
5. https://nha.gov.in/PM-JAY
6. https://www.myscheme.gov.in/schemes/ab-pmjay
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC12488118/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC6434894/
9. https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004629
10. https://kashmirthunder.in/index.php/2026/04/21/from-margins-to-mainstream/
11. https://www.outlookindia.com/healthcare-spotlight/positioning-tribal-healers-as-health-partners-india-plans-its-first-national-tribal-health-observatory-in-bhubaneswar
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315066/