Mahadevamma (name changed) stays in a village near the Tamil Nadu border of the Chamarajanagar district. During the last month of her pregnancy, feeling suddenly unwell, she sought care from a Primary Health Centre near her home, which promptly referred her to the district hospital.
Given the seriousness of the situation, she was accompanied by her parents to the faraway district hospital, but felt suddenly at sea. Mahadevamma was asked to visit a certain room in the hospital premises, where they could not find anyone. They did not know why they were sent to that room- who were they supposed to meet, what would happen next, nothing.
Mahadevamma and her parents had travelled the entire day just to reach the district hospital from the primary health centre, and they had not eaten anything all day. She had lost a day’s worth of wages and had not even met a doctor. Stranded in an unknown town, Mahadevamma’s panic grew. What is she to do next?
What was the problem?
Mahadevamma’s story is a representative story of how most of the Adivasi people struggle to receive dignified care at public hospitals. India is home to more than 700 distinct Scheduled Tribes (STs), many of whom self-identify as Adivasi (first people), reflecting their historical claim to indigeneity. They comprise more than 8% of the Indian population.
Adivasi communities are one of the most marginalized and vulnerable communities in India. Historically, they have faced structural challenges leading to poor socio-economic development as compared to other communities. This also reflects in the poor health indicators of ST communities across the nation. Both research in Adivasi health as well as the experience of NGOs suggests that this is largely a systemic issue, rather than being due to problems in their healthcare seeking. Both health equity and justice considerations, therefore, require health systems to address this through innovative program design that makes health services responsive to Adivasis.
Universal Health Coverage (UHC) is an important target identified under the SDGs. Universal Health Coverage is the principle that all individuals and communities should have access to the full spectrum of quality health services they need. This includes promotion, prevention, treatment, rehabilitation, and palliative care. These services should be available without resulting in financial hardships for citizens. It is also about building a health system that leaves no one behind, ensuring equity, financial protection, and health security for everyone.
Efforts to improve the health status of Adivasi populations in India have often suffered from a lack of a culturally sensitive and appropriate approach to designing and delivering health care. Meaningful participation platforms for Adivasi communities to engage with health services have also been lacking.
Often, Adivasi community members do not trust modern healthcare facilities. Many report prior care-seeking experiences marred by disrespectful communication. Being ignored by care providers is one of the prime reasons for refusing to access “free” healthcare in government hospitals and primary health centres (PHC). Most of them struggle at each step of the care pathway, much like Mahadevamma and her parents.
