Indigenous or tribal population are the most socio economically vulnerable group in India. Their health-seeking behaviour is in turn influenced by socio-cultural perceptions of health and access to health care. Addressing forgone health care in tribal populations is essential for reducing health disparities and improving public health outcomes. To estimate the foregone health care in the tribal community of central India and determine its associations with the socioeconomic status and financial risk protection measures. A cross-sectional study was undertaken in 2020-21 among 2085 households belonging to tribal communities in Ramtek block of Nagpur district in Maharashtra, India. Multi stage stratified sampling procedure was followed to choose households. Trained field investigators collected data from the eligible tribal households using a structured interview schedule in local language (Marathi). Factor analysis (principal component analysis-PCA) was applied to determine the wealth scores, and subsequently asset quintiles were calculated. Total family annual income was used to calculate income quintiles. Association of socio economic and health system access factors with forgone health care are presented as unadjusted and adjusted prevalence ratio with 95% CI. Mean (SD) age of the respondents was 37.98 (13.98) years. Forgone healthcare was reported by 72.4% (1510/2085) of the tribal population. Median (IQR) total annual income of the family was INR 56,000 (38400,86400). PCA revealed 25 assets to be included in the wealth scores assessment. Unadjusted and adjusted analysis revealed a significant association of the lower wealth and income quintiles with the forgone healthcare (p < 0.001). Health insurance showed no association with forgone healthcare (p = 0.273). In addition to economic status, type of tribe and low literacy level and head of household were independently associated with more forgone care. High foregone healthcare among the households of tribals from central India was noted. Low economic status (in terms of assets and income) was significantly associated with foregone healthcare. Initiatives aim to achieve universal health coverage should target socially and economically vulnerable tribal households as a priority.
Gandhi et al. (Mon,) studied this question.