India’s poor tribal people have far worse health indicators than the general population. Most tribal people live in remote rural hamlets in hilly, forested or desert areas where illiteracy, trying physical environments, malnutrition, inadequate access to potable water, and lack of personal hygiene and sanitation make them more vulnerable to disease.

This is compounded by the lack of awareness among these populations about the measures needed to protect their health, their distance from medical facilities, the lack of all-weather roads and affordable transportation, insensitive and discriminatory behaviour by staff at medical facilities, financial constraints and so on. Government programs to raise their health awareness and improve their accessibility to primary health care have not had the desired impact. Not surprisingly, tribal people suffer illnesses of greater severity and duration, with women and children being the most vulnerable. The starkest marker of tribal deprivation is child mortality, with under-five mortality rates among rural tribal children remaining startlingly high, at about 100 deaths per 1,000 live births in 2005 compared with 82 among all children.

Three World Bank-supported State Health Systems Projects – in Rajasthan, Karnataka, and Tamil Nadu adopted a number of innovative strategies to improve the health of tribal groups. Given the wide diversity among these groups and their various levels of socioeconomic development, the interventions adopted were multipronged and area-specific. Almost all these initiatives were provided through public-private partnerships (PPP).

The popularity of these initiatives and their impact on the health of tribal populations has prompted all three states to expand most of these endeavours in a phased manner. While gaps still remain – such as the lack of credible private health care providers, budget constraints, the need for better oversight mechanisms, and improved capacity for the effective management of PPP contracts – there is considerable scope to expand these initiatives for the benefit of tribal populations in regions that continue to be underserved.