Background <p>India’s multi-tiered public health system caters to rural and tribal populations. Previous studies have noted limited access to care among tribal populations. However, a systematic nationwide analysis remains missing. Hence, we retrospectively analyzed the capacities and disparities in public health systems between tribal and non-tribal rural areas.</p> Methods <p>We extracted Rural Health Statistics (RHS) data from 2011 to 2021 on the numbers of required and functional SCs, PHCs, and CHCs for states with a tribal population &gt; 25% of their total population. We captured healthcare access using the ratio of functional to required centers for each health facility type, separately for rural and tribal areas. We used tribal-to-rural odds ratios to assess relative differences in tribal-rural healthcare access.</p> Results <p>Nationally, both the Tribal Health System Capacity Index (C) and the Tribal-Rural Health System Disparity Index (D) decreased from 2011 to 2021. The national disparity of the tribal health system decreased in facility-wise disparity indices for SCs (1.16 to 0.97), PHCs (1.09 to 0.99), and CHCs (1.20 to 1.12). State-level values for facility-wise and overall tribal-rural health system disparity index showed some improvement over the years.</p> Conclusion <p>There was an overall decline in health system capacity, with limited access to healthcare in tribal areas compared to rural India. Despite some improvement in areas with higher tribal populations, there is still a need to address healthcare access for the country’s tribal population. Incorporating data on resource availability in future studies can provide a more accurate assessment and inform the development of effective solutions.</p>