Between rhetoric and reality: dignified health care for the Soliga adivasi community in Chamarajanagar district, Karnataka, India

Background: Despite national and regional efforts toward universal health coverage, Adivasi communities like the Soligas in Karnataka in India, continue to face barriers to dignified health care. This analysis explores how human dignity is upheld or neglected within formal, State-regulated health care services. It highlights the health care experiences of Soliga Adivasi communities in the Chamarajanagar district of Karnataka, Southern India, as they navigate institutional formal health services. Methods: We employed Interpretative Phenomenological Analysis (IPA) to investigate how dignity is compromised in health care within a context where respect, rights, and citizen agency are not actively promoted. Our study included 33 in-depth interviews with care-seeking individuals from Soliga community, their families, and NGO-affiliated health care providers. We also drew on insights from six community meetings, one participatory workshop, and a multi-stakeholder gram panchayat meeting involving elected officials, government representatives, health workers, and community leaders. These activities formed part of a long-term participatory action research initiative with Soliga Adivasi collectives in Chamarajanagar district. The qualitative data was analysed for attributes of dignified care, guided by existing literature and the Indian constitutional framework. Results: Systemic barriers, including delays, neglect, lack of autonomy and informed consent, disrespect, privacy breaches, culturally insensitive care, and exclusion from health governance spaces, undermined dignified health care for Soliga Adivasi communities. These challenges must be understood within the broader context of structural violence, shaped by displacement linked to forest conservation, inadequate social protection, and adverse social determinants such as poverty, limited education, poor housing, and ongoing human-wildlife conflict in forest regions where Soligas live. Conclusion: The Soliga Adivasi communities’ health care experiences reveal everyday dignity violations in formal health care facilities, reflecting broader systemic inequities. This study emphasises the need for addressing the deeper social inequities and co-creating a health care context with policies, programmes and practices where the agency, self-respect and autonomy of Adivasi communities are valued and preserved through dignity-oriented health care service delivery frameworks and practice.