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PRESENTER – Dr MANISH TAYWADE Modrator- Dr Amol Dongre

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1 PRESENTER – Dr MANISH TAYWADE Modrator- Dr Amol Dongre
TRIBAL HEALTH PRESENTER – Dr MANISH TAYWADE Modrator- Dr Amol Dongre

2 Frame work of Seminar History Introduction
Geographical distribution of tribes Health problems in tribal area RCH PROGRAMME IN TRIBAL AREA Goal Objective Strategy Types of services Funding Special shcemes Role of PUBLIC PRIVATE PATERNISHIP Constitutional safe guard for tribals Diseases common in TRIBAL AREAS VECTERBORN DISEASE SICKLE CELL DISEASES

3 HISTORY British enumerated and classified- India’s population into groups and categories one of which was the category of the tribal or adivasi (indigenous people). The word “tribal” half-naked men and women, arrows and spears in their hands, combined with myths of savagery and cannibalism This group has social, cultural, economic, and political traditions and institutions distinct from the mainstream or dominant society and culture The tribes were greatly dependent on the forest for their daily needs, including food, shelter, instruments, medicine, and even clothing.

4 INTRODUCTION In India, Adivasis in Hindi and are recognized as STs. Article-342 of the Constitution defines a tribe as- “an endogemous group (marrying within themselves),with an ethnic identity; who have retained their traditional, cultural, identity; who have distinctive language or dialect of their own; they are economically backward and live in seclusion governed by their own social norm, and largely having a self contained economy” Professor Majumdar:Tribe-as social groups with a territorial affiliation, endogamous,with no specialization of functions ruled by tribal officers,herediatry or otherwise,united in language or dialect,recognising social distance with others tribes or caste,following traditionl beliefs and costums.

5 Geographical distribution of tribes

6 The Fifth Schedule covers Tribal areas in 9 states of India:
Andhra Pradesh Visakhapatnam, East Godavari, West Godavari, Adilabad, Srikakulam, Vizianagaram, Mahboobnagar, Prakasam (only some mandals are scheduled mandals) Jharkhand Dumka, Godda, Devgarh, Sahabgunj, Pakur, Ranchi, Singhbhum (East & West), Gumla, Simdega, Lohardaga, Palamu, Garwa, (some districts are only partly tribal blocks) Chhattisgarh Sarbhuja, Bastar, Raigad, Raipur, Rajnandgaon, Durg, Bilaspur, Sehdol, Chindwada, Kanker Himachal Lahaul and Spiti districts, Kinnaur, Pangi tehsil and Bharmour sub-tehsil in Chamba district Madhya Jhabua, Mandla, Dhar, Khargone, East Nimar (khandwa), Sailana tehsil in Ratlam district, Betul, Seoni, Balaghat, Morena Gujarat Surat, Bharauch, Dangs, Valsad, Panchmahl, Sadodara, Sabarkanta (parts of these districts only) Maharashtra Thane, Nasik, Dhule, Ahmednagar, Pune, Nanded, Amravati, Yavatmal, Gadchiroli, Chandrapur (parts of these districts only) Orissa Mayurbhanj, Sundargarh, Koraput (fully scheduled area in these three districts), Raigada, Keonjhar, Sambalpur, Baudakondmals, Ganjam, Kalahandi, Bolangir, Balasor (parts of these districts only) Rajasthan Banswara, Dungarpur (fully tribal districts), Udaipur, Chittaurgarh, Siroi (partly tribal areas)

7 NFHS 3 (2005-2006) Data indicates that health outcomes for Tribals:
Indicator India Average In percent Scheduled Tribe Scheduled Caste Women age married by age 18 (%) 44.5 55.5 52.7 Total Fertility Rate 2.68 3.12 2.92 Women age using any method of contraception 56.3 48.0 55.0 Women receiving 3 ANC visits during last pregnancy (%) 50.7 40.2 44.3 Institutional birth (%) 40.7 19.6 35.1 Children months fully immunized (%) 43.5 31.4 39.7 Women whose BMI is below normal (%) 33 46.6 39.5 Children 6-35 months who are anemic (%) 79.2 85.1 82.3 Women who have heard of AIDS(%) 57 34.6 50.9

8 Different RCH indicators for the SCs/STs against the rest of the population is given below: source;NFHS II( ) Health Indicator Scheduled Castes Tribes Rest of Population IMR 83.0 84.2 61.8 Under 5 Mortality 119.3 126.6 82.6 % Children underweight 53.5 55.9 41.1 % Children with ARI 19.6 22.4 18.7 % Children with diarrhoea 19.8 21.1 19.1 % Women with anemia 56 64.9 47.6

9 Health Problems common to all Tribes:
Marked lack of Health and Medical Services- High degree of inbreeding and therefore high prevalence of genetically inherited diseases Most of the tribes have high prevalence of goitre, among women of child bearing age groups, habitation in hilly area and lack of access to sea foods Most of tribes studied by anthropologist and voluntary organisation appears to have a few common practices regarding maternal and child care; Expectant mothers are expected to restrict there diet and quantity as there is a common fear that if the baby is too large, delivery would be difficult and might lead to death of the mother Among most of the tribes, gastrointestinal disorders, particularly dysentery and parasitic infection are very common leading to morbidity and malnutrition, diarrhoea, dysentery, skin diseases respiratory diseases. Nutritional problems are also a big issue in these tribe areas, vitamins A,C,B complex deficiencies , under-nutrition of mothers along with anaemia due to food taboos, protein energy under-nutrition and few cases of vitamin deficiencies in children due to general lack of awareness of child care and infant feeding practices

10 Health Problems common to all Tribes continue….
Indebetness: rampant poverty and deficit economy. Loss of tribals rights over land forests Primitive mode of agriculture Ignorance Expenditure beyond their means Adherence to panchayat decision Land alienation Shifting cultivation:12% of Indian tribes, northeastern region and central India, leading to soil erosion, flood in river, ecological imbalance. Bonded labour: Bonded labour act in 1976 and child labour act 1987. Lack of education Industrilization and problems of tribes Problem of tribal forest Communication

11 Problems of accessibility and poor utilization of health services in tribal areas:
Difficult terrain and sparsely distributed tribal population in forests and hilly regions. Locational disadvantage of sub-centers, PHCs, CHCs. Non availability of service providers due to vacant posts and lack of residential facilities. Lack of suitable transport facility for quick referral of emergency cases. Lack of appropriate HRD policy to encourage/motivate the service providers to work in tribal areas. Inadequate mobilization of NGOs. Lack of integration with other health programs and other development sectors. IEC activities not tuned to the tribal: idioms, beliefs and practices. Services not being client friendly in terms of timing, cultural barriers inhibiting utilization. Non involvement of the local traditional faith healers. Weak monitoring and supervision systems.

12 RCH Programme: Goal:To improve the health status of the tribal community
Objective: The main objective of the program is to develop integrated and sustainable system for primary health care services delivery in the tribal areas of the country. Strategy: To attain the above goals and objectives, the strategy will be to: Assess the unmet needs of RCH services in different tribal areas and different tribes. Provide integrated and quality RCH Services Improve service coverage, accessibility, acceptability and its utilization. Promote community participation and inter-sectoral coordination. Promote and encourage tribal system of medicine. Develop a sufficient number of first referral institutions capable of tackling emergencies including obstetric emergencies. Provide associated supplies, management and information

13 Type of Services Tier Service Community Level
Community based worker /ASHA to work as social mobiliser, educator & provider of non-clinical services and to work as Depot holder for contraceptives.To act as DOTs provider for the revised National TB Control Program, to take malaria slides, store and distribute antimalaria drugs, create awareness about sanitation, safe drinking water and participate in the other health care programs. Sub Centre ANC&PNC services, IFA distribution, delivery by skilled attendant, referral for institutional delivery, contraceptive distribution and referral for terminal methods, immunization, management of childhood illness, deworming, nutrition and health education for mothers, treatment of minor aliments including RTI/STI, services under national programme like DOTS, NMCP, counseling services. PHC All above + dispense ayurvedic, home opathic, Unani and Tribal system of medicines. Block PHC/CHC All above+Terminal method of FP EOC+ elective abortion 1stTrimester, MVA, screening and clinical based services for sickle cell anaemia, Thalasemia, G-6 PD deficiency and Lab services.

14 Tribal RCH IN MAHARASHTRA
Five districts have special programmes for tribal as far as family welfare sector is concerned. The Navsanjivani scheme is being implemented in all tribal areas. Special schemes are prepared for tribal areas- 1) Matutva Anudan Yojana 2) Continous Medical education through Dai Meeting 2) Pada Volunteer Scheme 3) Mobile Medical Squad 4) Compensation for loss of daily wages 5) Water Quality Monitoring

15 Flow of fund in tribals GOI state district society/Zilla Panchayat
Block PHC MO/ Block Panchayat

16 Public Private Partnership
NGOs mapping should be carried out in the tribal areas and credible NGOs especially with clinical services backup should be encouraged to take the total responsibility of managing the RCH and health services in the sub-centre/PHC/CHC where public health system is deficient/inadequate. NGOs and corporate sectors should be encouraged to take up CBD projects covering minimum a block population and could coordinate mobile health services, counseling, referral transport, awareness creation and social mobilization. NGOs and private nursing homes/hospitals may be involved in the program including service delivery through a frame work of partnership. Accreditation methods can be followed for private and NGO operated facilities. All facilities within the framework should follow uniform reporting system and referral system. Outsourcing/franchising of discrete services (such as diagnostics) to NGOs/Private Sectors.

17 Constitutional safe guard for Tribals
Article 46 of the constitution, ”The state shall promote, with special care the educational and economic interest of the weaker sections of the people, and in particular of ST and SC,and shall protect them from social injustices and all forms of exploitation”. Article 15 prohibits discrimination on grounds of religion,race,sex and place of birth.free access to temple,hotels,schools and public places. Article 16 provide equal oppurtunities for employment and appointment in public sector and Government service.Article 16(4) provides reservation for jobs 7% for ST. Article 17 provides untouchability abolition.

18 VECTOR BORN DISEASES Tribals constitute only about 8% of the population, they account for about 30% of all cases of malaria, more than 60% of P. Falciparum, and as much as 50% of the mortality associated with malaria ISSUES Inadequate Access to Services Poor Service Delivery Lack of Demand for Services Lack of Consultation

19 Sickle cell Anemia: Sickle cell anemia is rampant in the tribal population, the prevalence of homozygotes for the sickle gene calculated to be over 20% with an estimated five million individuals predicted as carriers. consanguineous marriage practices, there is a dangerously high prevalence of genetic disorders among tribal populations. Along with amino acid irregularities, Glucose-6-Phosphate Enzyme Deficiency, a fatal and genetically carried deficiency in a blood enzyme, is present in about 15 million tribals, who reside in primarily high-incident malaria zones such as Madhya Pradesh, Maharashtra, Tamil Nadu,Orissa, and Assam states.

20 References: Association for Health Welfare in the Nilgiris & Tribal India Health Foundation Sickle Cell Disease Center, OPERATIONS REPORT VERSION 1.7 Website PROJECT IMPLEMENTATION PLAN FOR VULNERABLE GROUPS UNDER RCH II: December Government of India Department of Family Welfare Ministry of Health & Family Welfare. Sahni A,Xirasagar S.Health and Development of the Tribal People in India:Indian society of health adminastrators.1990 Deogaonkar SG. Tribal administration and development. New Delhi:1994 Concepts In Social Sciences And Some Important Issues In Indian Society, Culture And Economy.4th ed. Department of Extra Mural Studies:International Institute For Population Sciences.2003.


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