Ratna Bharali Talukdar

Date of Publish: 2020-04-10

COVID 19 pandemic alarm bell in India’s Northeast: Poor access to healthcare services makes smaller indigenous communities more vulnerable

As in rest of the world, COVID-19 pandemic has sounded an alarm bell for the State Governments in India’s northeast to take stock of the access of the smaller indigenous communities to healthcare. For, such pandemics put these communities to the risk of being wiped out if authorities fail to take timely action. The smaller the population, greater is the vulnerability.

The Bomdo tribe in Arunachal Pradesh, for instance, has only 14 households with a population of 26 (male 12, female 14). The Hrusso tribe of the state has a total household of 35 and a population of 57 ( 35 male and 22 female, Sex ratio – 629) and Adi bori with a total household of 65 and a population of 183 (91 male and 92 female), according to Statistical Profile of Scheduled Tribes in India 2013. (https://tribal.nic.in/ST/StatisticalProfileofSTs2013.pdf)

Official data, however, reveal an alarming picture. They show that most of the indigenous communities, some of whom are enlisted as Scheduled Tribes (ST), have poor access to healthcare services. Extreme poverty, poor access to health care services and safe drinking water have made the challenge of preventing a COVID-19 outbreak in their areas tougher.

Photo courtesy : DIPRO, Tawang

One of the main advisories to prevent Covid-19 from is to frequently wash hands with soap-water or use hand-sanitizer. However, the Tribal Health of India (http://tribalhealthreport.in ) report states only 10.7 per cent of the tribal population have access to tap water, against 28.5 per cent of the non-tribal population. It further says that 40.6 per cent tribal population in India live below poverty line against 20.5 per cent of non-tribal population of the country.

Immunisation coverage in some states of the region too is poor. In Nagaland, for instance, where ST population constitute 86.5 per cent of the entire population, immunisation of children was only 47 per cent, according to reports of NSS 75th Round (July 2017-June 2018) round on key indicators on Social Consumption in India: Health. It was only 58 percent in Meghalaya, 69 in Sikkim, and 70 in Arunachal Pradesh.

Table 1: Immunisation coverage

States	Immunization percentage
Arunachal Pradesh	70
Assam	84
Manipur	88
Meghalaya	58
Mizoram	87
Nagaland	47
Sikkim	69
Tripura	87

 

Source: NSS 75th Round (July 2017-June 2018) round on key indicators on Social Consumption in India: Health. (Source: https://nhm.gov.in/WriteReadData/l892s/50923145171570520489.pdf )

According to Tribal Health in India, a report jointly published by Ministry of Tribal Affairs and the Ministry of Health and Family Welfare, (http://tribalhealthreport.in/) the eight states of the region are home to 145 indigenous communities, Altogether 78 communities among them are large and have population of over 5000 while 67 communities have less than 5000 population.

The Tribal Health Report ( http://tribalhealthreport.in/ ) states many states including Arunachal Pradesh, Assam and Nagaland lack proper human resources; transfer and posting policy; irregular recruitments and acute shortage of specialists. Arunachal Pradesh for instance has not appointed regular specialists since 1990, and allied medical staff since 2003, it says. It also says that lack of training, performance review, and promotion; poor retention policies; poor working and living conditions with no incentives and absence or slow pace of salary review are some of the major findings of a study conducted by National Health Systems Resource Centre during 2012-2014 in north east.

Table 2: Health care infrastructure in north-eastern states

States	Tribal Population (Rural)	Sub-centres		PHCs		CHCs
		Required	Shortfall	Required	Shortfall	Required	Shortfall
Arunachal Pradesh	7,89,846	263	0	39	0	9	0
Assam	36,65,405	1221	0	183	0	45	14
Manipur	7,91,125	263	37	39	0	9	2
Meghalaya	21,36,891	712	276	106	0	26	0
Mizoram	5,07,467	168	0	25	0	6	0
Nagaland	13,06,838	435	39	65	0	16	0
Sikkim	1,67,146	55	7	8	0	2	2
Tripura	11,17,566	372	0	55	8	13	5

Source – Rural Health Statistics, 2017 As analysed by NHSRC, State of Tribal Health in India.

“The health infrastructure in the north-eastern states seems to be better than the rest of the country, as far as the norms are concerned. However, this does not necessarily mean greater access to healthcare for the population. This is because the terrain on most north-eastern states is mountainous and habitants are few and far in between. Further, when it comes to secondary care and presence of CHCs, there is a huge deficit” the report says.

As per Rapid Survey on Children, 2013 prevalence of malnutrition Manipur records the highest percentage (43.1) of stunted children followed by Meghalaya (42.5). The all India average of stunted children according to the report is 42.3. Arunachal Pradesh records highest percentage of severely wasted children with 7.2, against the national average of 5.3.

Table 3:

States	Stunted	Wasted	Severely wasted	Underweight
Arunachal Pradesh	27.6	17	7.2	24.7
Assam	33.5	6.8	2	14.8
Manipur	43.1	6.7	2	17
Meghalaya	42.5	13.7	5.6	32.8
Mizoram	27.3	14.4	6.2	14.9
Nagaland	29.9	11.4	4.6	19.4
Sikkim	25.7	4.1	1	15.4
Tripura	31	16.3	7.2	29.6

Source: Rapid Survey on Children, 2013, Tribal Health in India (http://tribalhealthreport.in/)

Traditionally living isolated pockets, indigenous people around the world preserve unique culture and heritage of humankind. They also safeguard large part of biodiversity and nature around the world. The World Bank report (https://www.worldbank.org/en/topic/indigenouspeoples) says that indigenous communities constitute 5 per cent of world population, living in 90 different countries, account for about 15 per cent of the extreme poor and safeguard 80 per cent of the World’s remaining biodiversity. North east India has the highest concentration of tribal population and is home to 60 per cent of the country’s total tribal population.

Acute poverty, lack of infrastructure and livelihood risks have driven many of them, particularly the youths to come out of their traditional pockets to eke out a job in city areas. With the announcement of world’s largest three weeklong lockdown in India in the wake of COVID-19 outbreak around the globe, many of them had to immediately return to their original villages. They spent two weeklong mandatory quarantine, either in their homes, or in quarantine camps.

Tribal population in eight north-eastern states constitute from 12 per cent to 94.4 percentage of total population. Accept Sikkim all these states have sex ratio higher than the national average of 933. of these states Mizoram, which has the highest percentage of (94.4) of indigenous people has a sex ratio of 976 according to Census, 2011. Meghalaya having as ST population of 86.1 percentage with a sex ratio of 989 per thousand.

Significantly, sex ratio of ST population in some of these states are even much higher than the state average, according Tribal Health of India, Report (http://tribalhealthreport.in/ )

“As in the rest of India, sex ratio among the tribal communities in NE is much higher than in the non-tribal population. The tribal population in case of Arunachal Pradesh (1032), Mizoram (1007) and Meghalaya (1013) shows a sex ratio above thousand, while at 960 Sikkim has the lowest tribal sex ratio among north eastern states,” it says.

Table 4: North-East India- Percentage of tribal population, sex ratio, sex ratio of ST population and child Sex ratio of ST population

 

States	Percentage of tribal population	State sex ratio 2011	Sex ratio of tribal population	Child Sex ratio of tribal population
Arunachal Pradesh	68.8	938	1032	977
Assam	12.4	958	985	957
Manipur	35.1	987	984	920
Meghalaya	86.1	989	1003	1043
Mizoram	94.4	976	1007	971
Nagaland	86.5	931	976	942
Sikkim	33.8	890	960	961
Tripura	31.8	960	983	957
All India	8.6	933	990

Source -1. Tribal Health of India, Report

2. Census of India, 2011

3.Statistical Profile of Scheduled Tribes in India 2013 http://https://tribal.nic.in/ST/StatisticalProfileofSTs2013.pdf

Assam, with a 12 per cent ST population, records life expectancy of less than national average in both male (63.5) and female (66.9) with and Tripura with 31.8 percentage of indigenous population records life expectancy of less than national average in case of male (66.6),according to India: Health of the Nations State, Ministry of Health and Family Welfare, 2017. (https://www.healthdata.org/sites/default/files/files/policy_report/2017/India_Health_of_the_Nation%27s_States_Report_2017.pdf )

The National average of life expectancy is 66.9 in case of male and 70.3 in case of female according to the report.

The report says in case of male Ischaemic heart disease, was the main cause behind most year of life lost in 2016 in 3 states(Nagaland Sikkim, Tripura), lower respiratory infection(Arunachal Pradesh and Tripura) and stroke (Assam, Manipur) in two states, malaria (Mizoram) in one state.

In case of female, Lower respiratory infection was the main cause behind most year in 2016 in Meghalaya, Mizoram and Sikkim. Ischaemic heart disease was the main cause behind most year in Manipur, Nagaland and Tripura. Diarrhoeal disease was the main cause behind most year of life lost in Arunachal Pradesh and Assam.

Table 5:

States	Life expectancy		What caused most year of life lost in 2016		Under five mortality
	Male	Female	Male	Female
Arunachal Pradesh	68.2	72.7	Lower respiratory infection	diarrhoeal disease	30.6
Assam	63.5	66.9	Stroke	diarrhoeal disease	37.8
Manipur	68	72.8	Stroke	Ischaemic heart disease	24.8
Meghalaya	66.8	72.4	Lower respiratory infection	Lower respiratory infection	33.3
Mizoram	68.3	73.8	Malaria	Lower respiratory infection	26.2
Nagaland	69.1	74.5	Ischaemic heart disease	Ischaemic heart disease	22.1
Sikkim	70.5	75.8	Ischaemic heart disease	Lower respiratory infection	22.5
Tripura	66.6	71.5	Ischaemic heart disease	Ischaemic heart disease	35.1
All India	66.9	70.3	Ischaemic heart disease	diarrhoeal disease	37

Source – India: Health of the Nations State, Ministry of Health and Family Welfare, 2017

These data show that such underlying conditions could pose even greater life risk to these communities if COVID 19 pandemic is spread among them.

Ratna Bharali Talukdar