Improving Tribal Health: Opportunities and Policy Recommendations

Tribal communities make up roughly 8.6% of India’s population, yet on almost every health indicator they lag behind the rest of the country. The Expert Committee on Tribal Health, set up jointly by the Ministry of Health and Family Welfare and the Ministry of Tribal Affairs, called this gap a national concern that demands targeted action rather than blanket rural health policies. The good news is that the roadmap already exists. What’s needed now is stronger political will, smarter spending, better infrastructure, and reliable data. This post walks through the key opportunities and policy recommendations that can genuinely transform tribal health outcomes.

Why tribal health needs its own roadmap 🔗

For decades, the health needs of Scheduled Tribes were folded into general rural health programmes, on the flawed assumption that rural and tribal populations face the same problems. They do not. Tribal communities face a triple burden of disease: persistent malnutrition and communicable illnesses like tuberculosis, malaria and leprosy; a rising tide of non-communicable diseases like hypertension and diabetes; and a growing crisis of mental illness and addiction. According to the first comprehensive report on tribal health, TB prevalence among tribals is nearly three times the national average, and one in four tribal adults suffers from hypertension.

This unique disease profile, combined with geographical isolation, language barriers, cultural distance from the formal health system, and chronic shortages of doctors in tribal areas, means tribal populations need a dedicated approach. The Expert Committee, chaired by Dr. Abhay Bang, spent four years studying this gap and recommended an entirely tribal-focused framework rather than minor adjustments to existing rural schemes.

Policy prioritization and budget allocation 🔗

Money follows priorities, and tribal health has historically been underfunded. The Expert Committee made a clear financial recommendation: spending on tribal health should be proportional to the tribal population, with adequate allocations under the Tribal Sub Plan and the National Health Mission. The committee suggested that 2.5% per capita of GDP be allocated to tribal health, and that 9.3% of the state health budget should reach secondary and tertiary care for tribal populations.

Operationalising the Tribal Sub Plan 🔗

The Tribal Sub Plan is meant to ensure that funds for tribal welfare are not diverted to general programmes, but in practice the mechanism has often been weakly enforced. Strengthening Tribal Sub Plan compliance, making allocations non-divertible, and publishing tribal health expenditure separately would create the kind of accountability the committee envisaged. The Ministry of Health and Family Welfare has noted that high-priority districts, many of which are tribal-majority, already receive more per-capita resources under the National Health Mission, but this needs to be deepened and made transparent.

Universal Health Assurance starting with tribal areas 🔗

The committee proposed something powerful: that the promise of Universal Health Assurance under the National Health Policy should begin with tribal populations, in the spirit of Antyodaya. This means free primary care delivered through Health and Wellness Centres, government insurance covering secondary and tertiary care, and an ST Health Card that lets tribal people living outside scheduled areas access these benefits at any health facility.

Infrastructure and health services 🔗

Even where budgets exist, infrastructure on the ground often does not. The Expert Committee found that in nearly half the states with tribal populations, healthcare institutions in tribal areas fell below required numbers. Vacancies of allopathic doctors and specialists in primary health centres and community health centres in tribal regions remain stubbornly high.

A National Institute for Tribal Health 🔗

One of the standout structural recommendations is the creation of a dedicated National Institute for Tribal Health, along with state-level Tribal Health Directorates and Research Cells. India already has the National Institute of Research on Tribal Health (NIRTH) in Jabalpur, but a higher-level apex institution would set tribal-specific clinical guidelines, train a tribal health workforce, design culturally appropriate interventions, and act as a knowledge hub. The committee also recommended creating medical colleges in tribal districts with quotas for tribal students, on the principle that tribal youth trained as doctors are far more likely to return and serve their own communities.

Strengthening primary care through local cadres 🔗

The Accredited Social Health Activists, better known as ASHAs, have already proven their value in tribal areas. The committee recommended building on this by training local tribal youth as Aarogya Mitras to deliver primary care at the community level, with support from the gram sabha. Population norms for setting up sub-health centres, primary health centres and community health centres have already been relaxed for tribal and hard-to-reach areas, but staffing these facilities and ensuring continuity of care remains the bigger challenge.

Telemedicine to bridge the distance 🔗

Geography is one of the biggest barriers to tribal healthcare. Many habitations are hours away from the nearest specialist. This is where telemedicine has become genuinely transformative. The eSanjeevani platform, India’s national telemedicine service, runs on a hub-and-spoke model where sub-centres and primary health centres act as spokes, while district hospitals and specialist centres function as hubs. The provider-to-provider variant, eSanjeevani AB-HWC, allows community health officers at Health and Wellness Centres to connect tribal patients to specialists in real time.

Maharashtra’s public health department has already extended telemedicine to high-focus and tribal districts in places like Chikhaldara in Amravati and Gokunda in Nanded. Reports from Wayanad in Kerala show tribal communities near the Wildlife Sanctuary now consulting ENT specialists in Chennai, something that was logistically impossible a few years ago. For telemedicine to scale, however, internet connectivity, power supply, digital literacy among community health officers, and awareness in tribal households all need simultaneous investment.

Data collection and research 🔗

You cannot fix what you cannot measure, and tribal health has long suffered from a data void. Most national surveys aggregate tribal data with rural data, making it impossible to design tribe-specific interventions. The Expert Committee made this a central concern.

Disaggregated data as a policy foundation 🔗

The committee recommended that national surveys like the National Family Health Survey, the Sample Registration System and the National Sample Survey explicitly disaggregate data for tribal populations, and where possible, for individual tribes and Particularly Vulnerable Tribal Groups. PVTGs, of which there are 75 recognised groups in India, often have health profiles that differ sharply from larger tribal communities. For instance, sickle cell prevalence varies significantly between Bonda, Didayi, Juang and Paudi Bhuyan PVTGs in Odisha alone, ranging from 2.26% to 7.1%. Treating them as a single statistical block hides these differences and leads to one-size-fits-all programming.

A Tribal Health Index and periodic reporting 🔗

The committee proposed creating a Tribal Health Index to capture the state of tribal health across communities, and recommended that a State of Tribal Health Report be published every three years and placed before the nation. This kind of regular, transparent reporting builds public accountability the way periodic economic or education surveys do for other policy areas.

Tribal health observatories and ethical research 🔗

Recent initiatives are encouraging. India is moving towards setting up its first National Tribal Health Observatory in Bhubaneswar under Project DRISTI, building on Odisha’s earlier Tribal Health Observatory and Tribal Family Health Survey. These platforms generate granular, tribe-specific evidence on anaemia, undernutrition, maternal and child health, and chronic disease awareness. The committee was also clear that research in tribal areas must follow ethical principles of respect, community participation, and a guarantee that the research itself does no harm to the communities studied.

Governance and community participation 🔗

Structural reform on paper means little without governance changes. The committee recommended a National Tribal Health Council as the apex policy body, supported by Tribal Health Directorates and Research Cells at the central and state levels. It also proposed appointing Prime Minister Tribal Health Fellows as District Tribal Health Officers to drive on-ground implementation in tribal districts.

Equally important is the integration of traditional knowledge. The committee recommended that tribal health practitioners and healers be respectfully integrated into the primary care system rather than dismissed or sidelined. Healers can play a role in early screening for conditions like sickle cell disease, in promoting maternal and child health messages, and in building trust between communities and the formal health system. Tobacco use among tribal men aged 15 to 54 stands at around 70%, far above the non-tribal average, and tackling such behavioural challenges requires community-led approaches more than top-down campaigns.

The way forward 🔗

The opportunities for improving tribal health are not hypothetical. They are spelled out in a detailed government-commissioned roadmap, validated by years of fieldwork and consultation. What remains is implementation. Higher budget allocations matched to tribal population shares, a national institute dedicated to tribal health, medical colleges in tribal districts, telemedicine that actually reaches remote habitations, disaggregated data that informs policy, and governance structures that put tribal voices at the centre. The launch of the Pradhan Mantri PVTG Development Mission and the National Sickle Cell Elimination Mission shows that political momentum is building, but converting policy into measurable improvements in tribal lifespans, child survival and disease burden will require sustained effort over years, not budget cycles.

What do you think? Should India’s commitment to Universal Health Assurance genuinely begin with tribal populations, as the Expert Committee recommended? And how can the rest of us, outside government, contribute to closing a health gap that has persisted for over seven decades?

References

1. https://www.drishtiias.com/daily-news-analysis/report-by-expert-committee-on-tribal-health
2. https://tribalhealthreport.in/web-portal-articles/
3. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1846227
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC11414145/
5. https://phd.maharashtra.gov.in/en/scheme/telemedicine/
6. https://www.gavi.org/vaccineswork/telemedicine-booms-india
7. https://link.springer.com/article/10.1186/s41043-024-00671-8
8. https://www.outlookindia.com/healthcare-spotlight/positioning-tribal-healers-as-health-partners-india-plans-its-first-national-tribal-health-observatory-in-bhubaneswar