While the major cities of Tamil Nadu boast of one among the best healthcare infrastructure in the country, the healthcare facilities available to 5.74 lakh odd tribal population in the state is highly inadequate and the quality of service is dismal, according to a study.

As per a social assessment survey conducted by the DANIDA Healthcare Project Phase III, in 33 sample villages spread over six districts with maximum tribal concentration, the nearest Public Health Centre (PHC) was at least 5-9 kilometers away for 36 per cent of the villages while it was 1 to 4 kilometers for 27.3 per cent of the villages. Distance to the nearest district hospital was 20 kilometers or more for 78.8 per cent, and the nearest taluk/general hospital was between 10-19 kilometers for 36.4 per cent, while it was more than 20 kilometers for 30.3 per cent of the villages.

Transport facilities to the nearest healthcare centre was available only for 51.5 per cent, and just 39.4 per cent of the villages had emergency transportation facilities, thanks to the availability of auto rickshaws acting as the mode of emergency transportation for 46.2 per cent of the tribals. Voluntary Health Nurse () was available in the nearest sub-centre in only 36.4 per cent of the villages and Medical Officer (MO) was available for two hours or less in 39.4 per cent of the villages.

The survey also revealed lower socio-economic groups depend entirely on Government run healthcare facilities and the rural population in general lack awareness on the difference between qualified allopathic and ISM practitioners. In PHCs, doctors see patients for a few hours only in the morning, and in remote PHCs, pharmacists often run clinics.

Majority of the survey participants felt rude behavior, long waiting hours and corrupt practices in Government run healthcare centres (often with support of doctors) were the major problems. While the participants rank VHNs first for their service despite over 50 per cent of them do not stay in their sub-centres, the nursing personnel working at their clinics are ranked the last, mainly for their rude behavior as well as soliciting bribes.

The survey says traditional treatment has almost disappeared from the tribal settlements, and majority depends on Government healthcare facilities, primarily because it is free. The survey assesses rude behavior and abusive language of the staff, bribe taking, poor quality of care by MO s, lack of privacy, refusal to attend cases at night, lack of staff after 12 noon, soliciting for private clinics etc. are hampering the tribal healthcare scenario. The causes of death in tribal areas and remote villages were usually due to transportation problems and especially at night. Poor roads, elephant menace and lack of money complicated the issues further, said the survey.

It is to be noted Tamil Nadu has a separate Department for Tribal Welfare, which has identified 36 Scheduled Tribe Communities spread over 13 districts. Out of these six - Toda, Kota, Kurumba, Irular, Pania and Kattunaicken are Primitive Tribal Groups, mainly inhabited in Salem, Nilgiris, Dharmapuri, Namakkal, Trichy etc. An Integrated Tribal Development Programme (ATDP) of the Central Government, and various other healthcare programmes initiated by the centre, state and NGOs were being implemented for the development of tribals, said sources.