Title:

Health and Health Seeking Behaviour

among Tribal Communities in India: A
Socio-Cultural Perspective

Author (s):
Islary Jacob

Source:
Journal of Tribal Intellectual Collective India
(ISSN 2321 5437), Vol.2 Issue 1, No. 1, pp. 1
to 16, June 2014

Published by:
Daltri Journals

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The Journal of Tribal Intellectual Collective India engages with tribal life world. It is a joint endeavour by
academics, critical tribal social workers and tribal activists towards a critical theoretical engagement with
contemporary realities of tribes in India. In part, the goal is to assist us collectively in recognizing the
current potential for social justice towards a tribe‐sensitive reality. We propose that through dialogue
there exists the possibility of evolving alternative ideas and paradigms about protection, promotion and
preservation of tribes in India.

Daltri Journals are non profit journals that aim to problematise Indian academic content leading to
indigenisation and innovative reformulation in Applied Social Sciences. The journals envision relevant,
meaningful and efficacious theoretical engagement with contemporary Dalit and Tribal reality.
Journal of Tribal Intellectual Collective India
Vol. 2 Issue 1, June 2014

HEALTH AND HEALTH SEEKING BEHAVIOUR AMONG TRIBAL

COMMUNITIES IN INDIA: A SOCIO-CULTURAL PERSPECTIVE

Jacob Islary

Abstract

Health defined as a state of ‘well being’ is understood from a functionalist

perspective among tribes – a perspective which considers a person as afflicted by
disease often only when one’s capability to perform one’s expected roles in life is
impeded either partially or completely. When such situation arises they seek health
services from various health care systems influenced by socio-cultural factors where
one lives in. Often one finds them shifting between health care systems or using more
than one health care system at the same time. This study brings out concept of health
as conceptualization by the tribal communities in India, their health issues and status,
and health seeking behaviour from socio-cultural perspective. The study is based on
review of secondary literature and attempt made to develop a model of health seeking
behaviour among the tribes.

Mr. Jacob Islary is Asst. Professor, Assam Don Bosco University, Guwahati and can be reached at
[email protected]

Introduction
Health is defined as ‘a state of complete physical, mental and social well-being and
not merely the absence of diseases or infirmity’ (WHO: 1948). Thus the state of well-being of
a person at personal as well as social levels with all aspects is taken into consideration as the
determinants of health. According to Clements (1932) as cited in Bailey (2000) health is a
global concern and is of universal interest; and keeping with this tune the World Health
Organisation (WHO) in 1977 initiated and launched a movement of ‘Health for All’ by 2000
with an aim of attaining a level of health status that would improve the quality of life of all.

Health is also understood as a state of dynamic equilibrium between an organism and

its environment. Thus involving a constant and complex interaction of organism with the
physical - environmental and geographical variations such as mountainous, plains, plateaus
and deserts, as well as cultural differences- customs, practices, food taboos etc. Good health
would mean ‘dynamic stability, normal function and homeostatic control’ (Sonowal &
Praharaj 2007) and ill health correspond ‘to a state of instability, loss of function and failure
of self-regulation’ (Sonowal 2010) with oneself and the environment. This concept of health
as related to the environment has found expressions in public health policies too, where

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human health is considered from an ecological relationship point of view with all things in
nature and ‘human-made habitats’ (Milio 1988: 263-274).

In keeping with the above understanding of health the Indian context presents a varied
and diversified health issues (i) by the varied climatic conditions and environmental
variations ranging from the sub-freezing mountainous ranges in the North and some parts of
Northeast to the warm topical and costal climatic conditions in the South to the arid and dry
climate in the North Western regions and; (ii) there are differences in customs and practices
among the people made complex by conditions of social, economic and political inequality.

Methodology
The study is based on the assumption that perception of health and disease varies
across cultures, which in turn influence the health seeking behaviour among people. This
finds expression even more evidently among tribal communities since most are alienated not
only from the mainstream society but also among themselves. It is qualitative in nature and
reviews and analyses literature and secondary data to understand health as conceptualized by
tribal communities and behaviour in health seeking practices.

Understanding Tribal Health

The status of tribal health in India is ‘very poor’ and is affected by the general
‘widespread poverty, illiteracy, malnutrition, absence of safe drinking water and sanitary
living conditions, poor maternal and child health services ineffective coverage of national
health and nutritional services’ which make for the ‘dismal health conditions prevailing
among these vulnerable population’ (Singh 2008: 118).

In India the tribal groups differ from each other in various aspects- language they
speak, cultural practices and traditions and socio-economic categories. As the majority of
them live in remote areas like forest and hilly terrains, they often remain isolated and
untouched by civilization and are largely unaffected by the developmental processes that go
on around them.

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Tribal health is closely related to culture, environment and the social structure as can
be observed from the cultural and medical system in their classification of diseases and its
aetiology making ‘health, disease and medicine’ as inseparably linked with their ‘social
relationship’ and the ‘magico-religious world’ (Kaushal 2004: 301-30). Health in a tribal
society is understood not as phenomena in isolation but in relation to the magico-religious
fabric of existence. Also most tribal communities define health, medical care and aetiology of
disease in relation to social context (Sonowal & Praharaj 2007). Tribal health according to
Singh (2008: 106-107; 154) is largely ‘influenced by interplay of the complexity of social,
economic and political factors’... and their health behaviour by their culture. Thus
understanding the culture of tribal groups is important in understanding the concept of tribal
health.

Among the tribes health is understood more in functional terms than clinical
(Mahapatra 1994; Kshatriya 2004). This inference is derived from general observed
phenomena among them wherein withdrawal from work when they are not well is seen. Thus
ill-health or affliction by disease among tribes is often taken as incapacitation of an individual
from perform his/her normal or routine work which s/he is expected to carry out in society.
This functional understanding of health among tribes make them often neglect symptoms of
cough, cold, headache, weakness etc., as not serious since such symptoms often do not hinder
them from carrying out their daily activities.

Also, one universality of perception of disease at individual, family or society level

among tribes is the interpretation of ‘breach of trust’ either by commission or omission of act
(committed or omitted by either an individual, family or a society) which displease the spirits
or disease causing agent. Such perception are revealed in the rituals that they perform by
burning of incense sticks, ghee and offering of liquor and meat to propitiate the gods/spirits
or the disease causing agent/s that have been displeased by either commission or omission of
some act by an individual or the people (Kshatriya 2004: 28-29; Singh 2008). Diseases such
as measles, chicken pox, unsafe delivery, snake bite, fever, typhoid, malaria, pneumonia,
tetanus, fits are believed to be caused by evil spirits and curse of gods (Singh 2008). A study
by Pramuk & Palkumar (2006: 4) among the tribes of the Eastern Ghats found existence of
belief that ‘whenever any person is possessed by evil spirits, the person’s pulse becomes very

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weak and his/her hands become as cold as ice and the patient appears restless’ and they resort
to treatment by performing rituals (which are often dramatic) to cure the patients.

Broadly speaking tribal communities believe in four types of supernatural powers ‘(1)
protective spirits who always protect them; (2) benevolent spirits who are worshipped at the
community and familial level regularly otherwise they may bring diseases or death; (3)
malevolent spirits-the evil spirits who control smallpox, fever, abortion, etc. and (4) Ancestral
spirits, the spirits of the ancestors who always protect them (Sonowal et al. 2007).

Forrest Clements in his ‘Primitive Concept of Disease’ (1932) identifies five

categories of disease causation concepts based on illustration on their worldwide distribution.
They are (1) Sorcery, (2) Breach of taboo, (3) Intrusion by disease objects, (4) Intrusion by
spirits and (5) Loss of spirit (Bailey 2000).

Tribal health has also to be understood from cultural contexts, as well as a part of
social structure and organization which is changing continuously and adapting itself to
changes in a wider society (Sachchidananda 1994). ‘Interpretation of illness is a culturally
informed process’ (Singh 2008: 138). This cultural context may range from simple food
habits to a complex traditional practices and ‘health culture’ that people practice. Health
culture of a community is referred to as the ‘cultural factors influencing the health of a
community, cultural meaning of health problems, diffusion of health practices from outside,
cultural innovations by the current generations to deal more effectively with health problems
and the overall health-related behaviour of the community’ (Basu 1996 quoting Banerjee
1973). According Basu understanding the health culture of a community is important because
health problems and their care are influenced by complex socio-cultural factors and
understanding of such socio-cultural factors help in the implementation of health services
(1996: 195). If the understanding of such health related culture of the people are neglected
intervention at the community levels will not be effective.

Tribal health has also to be understood from the context of it being placed in the
modern world with all its modernity and the tribal concepts and understanding of their health
related to practices and beliefs. It is a state of dilemma between the two opposing forces of

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‘tradition’ which people feel has worked in the past and the ‘modern’ which perceives new as
better than the old.

Disease Patterns and Health Concerns

Tribes are known for living in isolation from the mainstream society as well as from
among themselves. They have their own traditions and practices related to beliefs, means of
livelihoods and health practices. Disease or illness as aforementioned is generally understood
among them as incapacitation of an individual from performing one’s work. It is this
‘functional’ concept of health and illness coupled with their habitation characterized by
backwardness and terrainous ecological niche, blended with lack of awareness, ignorance,
and lack of personal hygienic practices that often make the tribes have disease patterns and
health concerns that are specifically of them. These health concerns have to be addressed
specifically each with different strategy. It becomes thus a challenge and a task in addressing
this concern. Some of the disease patterns and health concerns among the tribals are
discussed below.

The Commissioner Report for Scheduled Tribe and Scheduled Caste, 1986-87, states
at the primitive tribal communities of India have special health problems and genetic
abnormalities like sickle cell anemia, G-6-PD red cell enzyme deficiency and sexually
transmitted diseases. And Kate (2000) summarised the health problems of among tribal
communities of Maharashtra in following points:
1. Deficiency of essential components in diet leading to malnutrition, protein calorie
malnutrition and micronutrient deficiencies (vit A, iron and iodine) are common. Goitre of
various grades is also endemic in some of the tribal areas.
2. Water borne and communicable diseases: Gastrointestinal disorders, particularly dysentery
and parasitic infections are very common, leading to marked morbidity and malnutrition.
Malaria and tuberculosis still remain a problem in many tribal areas, while the spectrum of
viral and venereal diseases have not been studied in-depth.
3. High prevalence of genetic disorders mostly involving red blood cells: Genetically
transmitted disorders like sickle cell anaemia, glucose 6 phosphate dehydrogenise deficiency
and different forms of thalassaemia are also common. All these defects lead to the early
destruction of red blood cells and add to the overall anaemia.

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4. Excess consumption of alcohol: The brewing of alcohol from Mohua flower and fruits has
been practiced traditionally. However, the switch over to commercially available liquor is
likely to be a major threat.
5. Superstitions particularly related to health problems.
6. Extreme poverty.

Kate (2000) also revealed that sickle cell anaemia and thalassemia are the major
public health problems in India. Thalassemia was found to be prevalent amongst all
population groups irrespective of caste, religion and creed and sickle cell disorder is mostly
confined to socio-economically backward groups, like scheduled castes (SC), scheduled
tribes (ST) and nomadic tribes (NT). About 13 lakh tribals in India are affected by G-6-P D
deficiency. The prevalence of this deficiency is especially high among the tribes and
scheduled castes of Madhya Pradesh, Maharashtra, Tamil Nadu, Orissa, Assam (more than 15
per cent) especially in hyperendemic malarial zones (Basu 2000: 67).

There is also a variation in the health issues among the tribals related to their
nutritional intake that is influenced by socio-economic, socio-cultural and ecological setting.
Often health issues related to lack of iodine that cause goitre and mental retardedness is found
among the tribals especially living in the hilly, terrainous and forest areas. Basu (2000: 67)
points out that nutritional aneima are rampant among women in India especially among the
tribals and rural India. Malnutrition is common not only among children but also among
women, especially pregnant women. Among some tribal community in India ‘expectant
mothers are advised to take lesser amount of food by the sixth month of the pregnancy in
order to reduce the size of the baby to avoid the problem of delivery’ (Sonowal & Praharaj
2007). This makes them weak and incapable of coping with the stress that related to work and
daily activities of life thus making them vulnerable. Tribal diet has been found to the
‘deficient in calcium, vitamin-A, vitamin-C, riboflavin and animal protein (Basu: 2000).
Anemia is found to be more common among women than men in tribal community (Health
Status... ICMR 2003: 2-3).

Upper respiratory tract infection is again found to be rampant among them. A study by
ICMR (2003: 3) reveals that upper respiratory tract infection is second to anemia that affected

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the tribals of Orissa ((14.9% in Bondo, 16.6% in Didayi, 13.6% in Kondha and 8.3% in
Juanga) and similar observation was seen among the tribals of Madhya Pradesh (Birhor
(11.2%) and Sahariya (57.5% in children aged 0-4 years and 56.9% in children aged 5 –14
years).

Malaria is found to the most wide spread health concern among the tribals of India. Of the
total population affected by malaria in India about 25% of the cases are among the tribal
communities of which Orissa contributes 23% of malaria cases- 40% of Plasmodium
falciparum cases and 50% of malaria deaths in the country (ICMR 2003: 3). These figures are
important because the tribes constitute about 8.8% of the total population of India. Malaria is
also found to be endemic in many of the tribal regions.

Waterborne diseases like gastrointestinal disorders such as diarrhoea is found to be causing

high morbidity and mortality among the tribal population. This problem is related to
unhygienic living conditions, lack of safe drinking water and poor sanitation coupled with
low literacy, low socio-economic development, superstitious beliefs and lack of access to
medical service. Often diarrhoea and cholera are found to break out every year especially
during the rainy season (ICMR 2003: 3).

Intestinal protozoan and helminthic infestations (Intestinal Parasitism) are also found to
be rampant among the tribal communities of Orissa and Madhya Pradesh. It was observed
that children aged between 0-14 years were more affected than adults. the main cause of the
disease was found to be indiscriminate defection in the open field, barefoot walking an lack
of health awareness and hygiene (ICMR 2003: 3-4).

Nutritional disorder due to lack of consumption of balanced diet and diarrhoea which
causes loss of nutrients from the body cause micronutrient deficiency in the body. Tribals
often consume diet that are low in iron, iodine, vitamin-A, vitamin -B, vitamin-C etc. These
micronutrients are vital for physical growth and overall development of the body and mind.
Thus due to lack of such micronutrients tribal people are likely to suffer from anemia, goitre,
night-blindness etc. It is also observed that deficiency of iodine during pregnancy has been
‘linked with intra-uterine brain damage and possible foetal wastage’ (ICMR Bulletin 2003).

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Nutritional anemia is found to be a ‘major problem among women in India’ especially in

tribal and rural belt (Singh 2008: 120).

Lack of health awareness and personal hygiene leads to skin problems like scabies
among the primitive tribal communities. A study carried out in Orissa showed that 20.6% of
Bondo, 6.9% of Didayi, 10.7% of Juanga and 15% of Kutia Kondha tribes were affected by
scabies (Health Status... ICMR 2003). Hand wash by soap is rarely practiced among tribes
even after use of toilet (they often use mud and water to wash after defecation) and though
mouth and teeth are washed daily, few use toothpaste and brush while majority use sticks and
twigs for the purpose (Naik 2001).

Communicable diseases like Tuberculosis, leprosy, yaw, and venereal diseases are also
found to be of common among various tribal groups. (Singh 2008: 131). These diseases are
mainly related to the unhygienic living condition and lack of personal hygiene coupled with
lack of awareness and non availability of health care facilities. Diseases such as Tuberculosis,
Malaria and stomach disorder are also related to the ecological imbalance arising out of
greater global crises (ibid: 131; Basu 2000: 68) thus placing the tribal people living in close
proximity to nature at great risk. Leprosy according to Singh is prevalent among some tribes
of Jharkhand, Chhattisgarh, Assam, Orissa, Uttar Pradesh, Tripura, Gujarat and others (Singh
2008: 131).

Sexually Transmitted Infections and Sexually Transmitted Diseases (STIs/STDs)

were found to be highly prevalent among the tribal people. ‘VDRL was found to be positive
in 17.12 per cent cases (reactive in dilution of 1:8 or more) of polyandrous Jaunsaris of
Chakrata, Dehradun. Out of 17 per cent, 9.92 percent was found among males and 7.19 per
cent among females. Among the Santals of Mayurbhanj district, Orissa, 8.90 per cent cases
(reactive in dilution of 1:8 or more of VDRL were observed, out of which 4.99 per cent were
females and 3.91 per cent were males’ (ibid: 67).

Mother and Child health issues are of great concern among the tribal community. The
need for such concern arises due to customs and traditions that are related to sexual behaviour
and child bearing. Studies have revealed that there are practices among some tribes of

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limiting the consumption of food from sixth month of pregnancy with an intention of making
the process of delivery easy (Sonowal &Praharaj 2007). Anemia is rampant among women
(especially among the pregnant women) which causes not only slowness in the development
of the foetus but also causes mental retardedness- thus raising morbidity and mortality among
tribal women and children (Singh 2008: 120).

Maternal mortality is high among various tribal groups. The main causes are
unhygienic and primitive practices of parturition such as self delivery practices among Kutia
Khondhs in half squatting position supporting herself by holding on a rope tied to the roof of
the hut, or some crude method practices like among the Kharias, Gonds, Santals, Kutia
Khondhs of Orissa. Maternal morbidity and mortality is also aggravated due to non-intake of
balanced diet. Often pregnant mothers are not allowed to consume some food and in some
cases in limited amount for fear of vomiting, or the foetus growing too large (Basu 2000: 65-
66).

Besides these, the tribal expectant mothers are not inoculated against tetanus while
vitamin, iron and calcium intake has been found to be limited among tribal women while
most of them continue to consume alcohol even during pregnancy. They also continue to
carry out normal activities of labour and work which are often strenuous. It has been
observed that 90% deliver at home assisted by some elderly lady of the house or
neighbourhood. Also unhygienic practices during the delivery process increase susceptibility
to various infections to both the mother and the child (ibid: 66).

Infant morbidity and mortality too is high among tribal groups. The health of the
foetus is directly related to the health of the mother. Thus a malnourished pregnant mother is
going to give birth to a child who is retarded and underdeveloped (Singh 2008: 119-120).
‘Low birth weight indicates that the infant was malnourished in the womb and/or that the
mother was malnourished during her own infancy, childhood, adolescence and pregnancy’
(Navaneetham & Jose 2005, a draft paper before publication). And after delivery the babies
are often not initiated to early breastfeeding and more than often colostrums is discarded
(Singh 2008: 127). Often vaccination and immunization is low among tribal children thus

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causing them to be highly susceptible to whooping cough, diphtheria, measles, influenza etc.
IMR varies from 36/1000 in Kerala to 168/1000 in Uttar Pradesh among tribal population.

Tribal health has to be understood in relation to the Social, Cultural & Economic
system; Geophysical environment, Religious Beliefs and Practices of the people. These
factors influence health seeking behaviour among the tribal community thus making them
seek either from traditional or modern systems of medicine. There is consistent relationship
between factors that influence treatment of disease and the availability, accessibility,
effectiveness, socio-cultural beliefs, awareness level, and attitude of providers.

Tribal health has to be understood in relation to the social, cultural and economic
system; geophysical environment, religious beliefs and practices of the people. These factors
influence health seeking behaviour among people of tribal community thus making them seek
either from traditional or modern systems of medicine and sometimes to even use self
treatment for illnesses. There is consistent relationship between factors that influence
treatment of disease and the availability, accessibility, effectiveness, socio-cultural beliefs,
awareness level, attitude of providers.

Often these socio-cultural factors coupled with inadequacy of health infrastructure

and services rendered among them aggravates their issues related to health thus resulting in
frequent outbreak of diseases, and high morbidity and mortality rates among them.

Health Seeking Behaviour: A Socio-Cultural Perspective

Health seeking behaviour among tribal groups is determined by their socio-cultural
and magico-religious beliefs (Kaushal 2004: 301-30), beliefs, customs and practices (Singh
2008: 148) and the choice of their health care system by socio-economic and cultural factors
(ibid: 69). According to Sharma (2004: 72) beliefs, customs and practices determine the
health seeking behaviour of tribals and ‘health status are indicated by social and economic
conditions, nutrition and living conditions, dietary habits, housing, education, child rearing
practices, socio-religious beliefs, taboos and superstitions, etc.’

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However, in today’s world of globalization accompanied by generation of mass

awareness through media and communication (especially in areas related to reproductive
health services, including institutional delivery, safe abortions, treatment of RTIs, and family-
planning services, to meet unmet needs while ensuring full reproductive choice to women,
National Rural Health Mission (NRHM) with its components of Information, Education and
Communication (IEC) and Behavioural Communication Change (BCC) have been targeting
to bring about change in health seeking behaviour among people especially in rural-
including tribal areas) the tribal people have come closer to the main stream society and
system. The ‘unprecedented wave of non-traditional elements entering into their social and
cultural life (Sonowal & Praharaj 2007: 136) has not only affected their economy and
commerce but also the health care systems- thus putting their traditional health care system
into a complex situation of medical pluralism.

The tribal communities seem to be taking a turn towards modern system of medicine
though they still have faith in the traditional medicinal system. A study by Sonowal and
Praharaj (2008: 140-141) shows that though the Santhals of Orissa believe in the traditional
system of medicine the percentage of those accepting traditional system of medicine was
declining irrespectively of their level of education and age. The study also revealed that
younger generation are more inclined than the older ones to turn towards modern system of
medicine. The factors related to such a shift according to the authors are effectiveness,
availability and affordability of health care service provision, and good behaviour of the
service providers under the modern medical system. The study also revealed that the choice
of health seeking behaviour of the tribal people depend on their perception of the agent that
caused the disease. The overall tendency to access modern medical health care service if it
was accessible was high. The coming in of the pluralism in the health care system in society
has affected the health seeking behaviour of the tribal groups which can also be seen among
the Santhal Tribe of Orissa.

A study carried out by Muthu et al. (2006) on the other hand found that among the
rural people in Kancheepuram in Tamil Nadu people preferred the traditional medical system
for treatment of both ‘simple and complicated diseases’ like cold, cough, fever, headache,
poison bites, skin diseases and tooth infections though western medicine was accessible. A

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study carried out by Raj Pramukh & Palkumar (2006) among the tribal communities of the
Eastern Ghats and the Western Ghats found the association of disease to supernatural – ‘when
possessed by evil spirits the person’s pulse becomes week and... hands become cold like
ice...’ and treatment was done by invoking the spirits through rituals and chanting of
‘mantras’. They also have methods of diagnosis- for both identification of which ghost or
spirit possesses the patient and what kind of disease is affecting the patient and thereafter
recommended treatment accordingly.

Factors that affect health seeking behaviour of tribal people have been analysed by
different researchers. Some of these factors that are responsible are socio-cultural and
magico-religious beliefs and traditions (Kaushal 2004: 301-30; Raj Pramukh & Palkumar
2006: 5; Singh 2008: 150), beliefs, customs and practices, and socio-economic factors,
illiteracy and unawareness (Singh 2008: 148; 151), destruction of forests leading to non-
availability of herbal and medicinal plants, accessibility and affordability of modern medical
system and globalization (Sonowal & Praharaj 2007: 140) and effectiveness. In short it can
be concluded that tribal people though seek medical treatment from traditional medical
system are shifting towards modern system of medicine. This can be largely attributed to the
availability, accessibility and affordability of modern medical system that is provided to the
people under Government controlled administration and implementation besides education
playing a major role. There is general agreement among researchers that tribal health is
affected by ‘socio-cultural setting and eco-systems’ (Singh 2008, 153).

Health seeking behaviour among tribal women related to parenthood is taking a

gradual change. This could be due to efforts made to provide quality reproductive health
services- including institutional delivery, safe abortions, treatment of RTIs, and family-plan-
ning services, to meet unmet needs while ensuring full reproductive choice to women.
National Rural Health Mission (NRHM) with its components of Information, Education and
Communication (IEC) and Behavioural Communication Change (BCC) have been targeting
to bring about change in health seeking behaviour among people especially in rural as well as
tribal areas. This has given some result since more rural women including tribal are accessing
the health care services provided by the PHCs for antenatal services (ANC), delivery as well
as post natal services (PNC). However health seeking behaviour among tribal women

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including during pregnancy was found to be directly related to their socio-economic and
educational level (Maiti et al. 2005: 37-39). Hand it is observed that among tribal groups no
‘special care’ is given to pregnant woman except in critical cases (Singh 2008: 151) which
could be due to lack of awareness and education.

It has been observed that tribal people in parallel with the treatment by traditional
system of medicine also adopt allopathic system of medicine for aliments and had more faith
in private practitioner than the government doctor. Tribals want immediate relief and so often
‘prefer injection to medicine’ (ibid: 151).

Another factor that affects the health seeking behaviour among tribal groups is the
degree of autonomy that one exercise in making of choices relating to treatment of diseases-
often their decisions are related to some advice based on experiential knowledge of elders or
some senior member in the family. This is even more among women folk and especially in
areas related to sexual and reproductive health. The kind of social network also determines
the health seeking behaviour among people- thus a group of people who believe that
traditional system is better will resort to traditional while a group that believes in modern
system will resort to modern- sometimes such social network may even prove to be
detrimental for success of public health programmes; for example it has been found that
among some religious groups there is a belief that polo drops cause impotency later in life
(though this is reducing) thus causing failure in the achievement of target.

Lack of awareness and education among tribal groups also determine their health
seeking behaviour. In Jharkhand lack of awareness and education coupled by difficulty in
accessing the service caused 72% of the births to tribal mothers to have no antenatal check-
ups as they felt it customarily not necessary, compared to 65% of non-tribal women’ (Maiti et
al. 2005: 41). Among the tribal communities of Manipur a study carried out by Nembiakkim
(2008: 20-21) showed that awareness and education imparted by Christian missionaries has
led to practice of hygienic practices and decline in them seeking health care services from
quacks and traditional practices. Following the above discussion the following framework of
health seeking behaviour is constructed.

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Socio-Cultural

External Personal Perceived

Environment Predisposition Morbidity

Traditional • Accessibility
• Affordability
• Availability
Behaviour • Acceptability

Modern Self Therapy

Figure 1: Socio-culturally determined health seeking behaviour model

• External environment: geophysical environment, politics, policies, health systems, media.

• Personal predispositions: beliefs, socio-cultural structures and status of an individual and
demography that are to be influenced by socio-cultural setting.
• Perceived morbidity: functionalist understanding of health and illness which is highly
determined by socio-cultural backgrounds.
• Behaviour: choices between traditional, self and modern treatment of illnesses.
• Traditional system: folk medicine embedded in tradition.
• Self therapy: treatment of self by application of herbs or other drugs which are available
on preparation or procurement.
• Modern system: the allopathic (biomedical model of approach).

Factors like external environment, personal predisposition and perceived morbidity

influence the health seeking behaviour of individuals. The behaviour can and often moves
between different options– traditional, self therapy and modern. These practices can be seen
as they are accessible, affordable, available and acceptable to all.
Traditional/Indigenous medicine is embedded in folk systems and literate tradition. They
consist of treatment by use of herbs, animals, minerals and other substances. The skills are
learnt by observation of symptoms and practical by application of herbs, animals, minerals or
such other substances which are available in nature, culturally acceptable, cheap and
affordable and based on ancient knowledge and wisdom. These herbs, animals, minerals, and
other substances used have both preventive/promotive and curative effects which in turn
reinforces the traditional system of medicine in a tribal community. Given option backed by
availability and affordability there is a high tendency of seeking health service from modern

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Vol. 2 Issue 1, June 2014

system. There is also a tendency of reverting back to traditional system if modern system
fails.

Conclusion
The concept of health is understood more in functional terms than clinical among the
tribal groups. It is related to environment, habitat and socio-cultural and magico-religious
beliefs and customs, social and economic conditions, nutrition and living conditions, dietary
habits, housing, education, child rearing practices, socio-religious beliefs, taboos and
superstitions. The health seeking behaviour among them is closely related to their
conceptualization of diseases and health. However the great dilemma in health seeking
behaviour that a tribal individual often faces is the choice that s/he has to make between
custom bound practices and beliefs which are laden with socio-religious values, and the
modern system which is often projected as better than the other by media and professionals
who are often strangers.

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