While great gains have been made in both understanding and eradicating disease burdens for indigenous populations, health systems studies, and studies assessing service utilization and delivery are limited. Further, Community Health Workers, or ASHAs, have helped in improving maternal and child health outcomes as well as reducing the toll of infectious diseases – the very service areas where tribal populations face great barriers. Given the recent focus on universal health coverage reform, and the recommendations of expert groups, there is a need to more deeply enhance and improve the contribution of CHW programmes in service of tribal health needs. In this study, we draw attention to tribal minority populations in the Nilgiri Biosphere Reserve region, spanning the southern Indian states of Karnataka and Kerala. Notwithstanding that both states have relatively strong health systems, by virtue of being a small and relatively isolated, tribal populations have limited access to programmes and services– they are being left behind. The methods used in this study include key informant and in depth interviews, focus group discussions in close coordination with local implementer groups and government agencies.