This study reflects perceptions of a tribal community on implications of watershed management for public health. According to the perceptions of the participants, agricultural and socio-economic development, education and awareness, hygiene and sanitation and improved water availability resulting from the implementation of an integrated watershed management programme have a positive impact on physical, mental and social health of the people. Effective use of available water for household and agricultural purpose was viewed as a key factor for improvement in health through safe drinking water, proper nutrition and increase in income level. The perceptions of participants suggest that watershed management might be a good approach to empower tribal families with enhanced health status by increasing their income level, educational opportunities and by building their self confidence for the sustenance of life. The results of our study and analysis suggest that the tribal people, who participated in our study, perceived watershed management programme as empowering them to claim their right to water and right to health.
Participants perceived that scarcity of water is a major constraint in the overall development of their villages, which limits their capabilities for obtaining health benefits. It affected their income level and socio-economic development. These findings are consistent with a model developed on water and economic growth, where it is suggested that economic growth is positively associated with effective utilization of water resources . An earlier study from India has informed on importance of socioeconomic status in reducing population-level health disparities in the society . Our study indicates that socio-economic development achieved by overcoming water scarcity through watershed management, can result in improved public health for the society.
In India, indicators of agricultural performance or income level have a strong relationship with indices of under-nutrition among children and adults . The view of our study participants about low productivity in agriculture and subsequent malnutrition are in accordance with this.
The selection of tree species for plantation, depending upon the type of soil and average rainfall, in a particular area, is very important as it decides the fate of ground water . A majority of the participants perceived that plantation of trees across the slopes, a part of watershed management programme, helps to stop soil erosion and also improves ground water table. Some participants also perceived that Eucalyptus tree plantation reduces ground water table, which has been shown to be true at least in an African setting . The mention of association of Eucalyptus trees with depletion of ground water shows the keen observation of the tribal people of their natural surroundings.
Seasonal agriculture results in no work in other seasons, which forces tribal people to migrate in search of employment, a migration which often leads to various health problems/challenges. Earlier studies present similar views in relation to health issues of migrants and seasonal farm workers. For example, work related health problems and chronic illness  and poor quality of accommodation, geographical isolation, crowding, deficient toilets and poor cooking facilities were identified as determinants of poor health under such conditions . Also, according to Borre, et al. , food insecurity, poverty and dependency is rooted in the cultural lifestyle of farm work. Women participants viewed that, sometimes they are treated as being in a lower class in social structure when they migrate, which makes them feel uncomfortable and suppressed mentally. This is consistent with the findings of Kim-Godwin and Bechtel , who inform that 51 percent of the migrants perceived themselves being under stress which put them at a greater risk of experiencing psychological difficulties. Participants view on transmission of communicable diseases like malaria during migration is consistent with the findings of Saxena and Devadethan , who report that seasonal migration of labour has impact on the spread of malaria. Similar results are reported from studies conducted in rural Venezuela , Northern Thailand  and Rajasthan, India . Though in our study, participants were not much aware of HIV/AIDS, a study on migration and HIV epidemic in south west India suggests that there is an increased risk of spread of HIV infection during seasonal migration . Due to lack of awareness and illiteracy, tribal people may even be at a greater risk of getting HIV infection during migration. However, migration along with families, as reported in our study, may be a factor that restricts the spread of sexually transmitted infections and hence the participants were unaware of HIV/AIDS infections. In view of our participants, watershed management can overcome the problem of seasonal agriculture and subsequent migration by effective utilization of available water resource to increase the productivity, thus indirectly helping to solve public health challenges associated with migration.
All the women participants perceived that improper sanitation practices like open air defecation are due to water scarcity. One important aspect mentioned by participants is that if they have one assured drinking water source all the time, it is more likely that it will get disinfected regularly, thus reducing the occurrence of diarrhoeal diseases associated with water. This shows that watershed management plays a role in the reduction of water borne infectious diseases like diarrhoeal epidemics and results in improved public health status. Thus, it can be said that access to water is inter-related to the right to health of tribal people. In India, about 25 percent of villages do not have assured drinking water source for about four to five months per year .
Interestingly, hygiene at household level was not perceived by women participants as a possible reason for contamination of household drinking water. This is in contrast with earlier research, which suggests that microbiological quality of drinking water declines from source to point-of-use .
In general, participants said that they follow superstitious or traditional health measures like going to ‘Bhagat’ because of lack of education, poor infrastructural health facilities, their income level, time constraint, etc. However, participants from WM village informed that some of them can now afford to go to private practitioners at town place which indicates that the slight increase in their income level resulting from watershed management allows them to spend more on health.
In all FGDs, the perception of all participants was that, in the tribal community, women play a key role in the functioning of the family. Similar view has been put forward by an earlier study in India . Unless women are involved in the decision making process, long term sustainability of developmental efforts cannot be achieved . It appears that if women are involved and play a central role in the watershed management programme, it will help in attaining improvement in social health.
In watershed management villages, men and women showed respect to each other’s work. The respect shown to opposite genders’ work might be a step towards more gender equality brought about by watershed management.
The perceptions of women participants suggest that plantation of trees associated with the watershed management programme saves their time and energy spent in the collection of firewood. This indicates that the development work like plantation not only helps to protect natural environment by rejuvenating resources but also reduces the hard work of women in tribal areas. These perceptions of women participants are supported by the study of Singh et al.  which states that in majority of the states of India the workload of women is reduced up to one to two hours daily as an impact of watershed management. According to the FAO , along with poor diet, heavy workload weakens women’s health. A reduction in hard work as a result of watershed management may thus be helpful in the improvement of women’s health.
Education was also perceived as a domain of empowerment by women participants. Importance given to their daughter’s education is a reflection about their awareness about education. Time saved by women and girls as a result of developmental work in watershed management programme can be spent on educational activities which makes them feel empowered.
Drawing from earlier experiences, the Government of India formulated common guidelines for watershed development projects in 2008, in which formation of self-help groups (SHGs) is recommended . Women from all study villages found SHGs useful to unite at a place regularly as it gives them a platform to discuss issues of importance to them and find solutions for them. In tribal areas, union of women at village level can solve the social issues like alcoholism. Women participants found it as a key of empowerment to them. Thus, through education and awareness, watershed management helps in the empowerment of women which is a key rights issue. This empowerment will in turn lead to women being able to claim their rights in various fields leading to improved psychological, social and physical health.
Various studies support the link between alcoholism and intimate partner violence in different parts of the world [31, 32]. Jaysuriya et al.  reported that in Sri-Lanka, young women are at increased risk of violence from their alcohol addicted partners. Study participant’s perceptions suggest that the intensity of alcohol addiction varied in men according to the watershed development there and at the same time women’s reaction on it also varied accordingly in respective villages. This suggests that social issues are associated with development in that locality which facilitates women in handling the unwanted situations. Earlier research supports the views among our participants regarding the relationship between socio-economic development, alcoholism in men and intimate partner violence [26, 27]. Watershed management might be a pathway in the improvement of social health through socio-economic development of tribal community.
From the foregoing, it appears that tribal participants perceive that implementation of a watershed management programme has a positive impact on both public health and socioeconomic development and the improved socio-economy resulting from watershed management has a further augmentative effect on public health. Parkes et al.  pointed out that research is needed to improve our understanding of how public health, wellness and watershed-based management fit together. We hope that this paper makes such a contribution.
Our findings suggest that public health problems in tribal areas are complex and several of them are directly and/or indirectly associated with water availability. As far as the potential of watershed management in tribal areas is concerned, we suggest developing an area - geographical area - specific health policy that has an integrated water, health, agriculture and socio-economic management approach. In this context, the definition of ‘area’ is, ‘a village or group of villages with similar agro-ecosystem that come under one watershed’.
We propose that as a precursor for facilitating their right to health and well being, people should identify their problems and should integrate at local level to find solution to their problems. There should be a public policy that promotes the awareness among community regarding such integrated efforts and when people come forward with a solution, there should be enough support from local authorities/government to achieve the desired results.
Watershed management is integral to right to water issues, which are a fundamental element of the right to health. This paper gives us a better understanding of the impact of right to water issues on the right to health of tribal populations as we chose a qualitative research methodology that allowed us to listen to the voices of those most in need of watershed management and whose voices are often not heard. Though not exactly similar, the approach is akin to the ‘localising human rights approach’, with focus on empowerment for attaining better public health standards, a key human rights concept .
We suggest that with respect to the right to access to water, which has a high impact on physical, social and mental health, researchers and policy implementing states/agencies should take a ‘bottom up’ view, which will help in identifying the real problems by listening to the voices of those affected by rights deprivations.
The Government of India (2008) developed guidelines for watershed management projects that have a holistic approach. This approach needs government’s efforts as well as participation of the people to make watershed management successful so that it is a sustainable development resulting in achieving better health status. The guidelines also suggest the responsibility of the people to act, to be able to claim their rights. We propose that wherever people suffer from lack of appropriate access to water (either due to deficient rainfall or topography resulting in quick loss of rainfall water), governments all over the world should take up holistic watershed management programmes, to fulfill the rights of their people to have access to water and access to health. In this effort, peoples’ participation is a key for sustainability, as people need to develop an ownership feeling to derive best benefits.
FGD is a technique, used in qualitative research which is open to explore anticipated as well as unanticipated issues. It requires a fairly low budget and gives relatively quick results . For this study, FGD was suitable, as most of the participants were not literate and it was easier for them to express their views in group rather than in individual interviews. During the data analysis, we used data triangulation to increase the trustworthiness of the study. Cross checking of the translated data with recorded data was done to avoid misinterpretation of the data. The strength of the study is that all authors have a public health perspective, have experience in qualitative research and have varied professional backgrounds viz. agriculture, environmental health, nursing and pharmacy. The different educational, geographical and cultural backgrounds of the authors, with extensive experience in their own field of research brought a unique perspective to the study that enhanced the conformability of the results. Member check was carried out with informal discussion with study participants to find out that their perceptions were interpreted correctly. This is a qualitative study based on focus group discussions, conducted in a tribal belt of India. The results might however be of value for readers from a wide range of contexts with similar types of water scarcity.