This slide is about Tribal Health

1. Public Health
Issues in Tribal
Areas
By,
Dr Amruth N
PG resident
Dept of Community medicine
RUHS

2. Contents
 Introduction
 State of health and health care in tribal areas
 RMNCHA
 Burden of disease
 Communicable diseases
 Non communicable diseases
 Genetic disorders
 Nutrition
 Mental health and addictions

3. Contents
 Animal attacks and violence in conflict areas
 Health care in tribal areas
 Health care infrastructure
 Health Human resource
 Health culture and health literacy
 Measures to improve human resources for tribal health
 Mobile medical unit
 Karuna trust

4. Who is a tribal ?
 Article 342 defines scheduled tribes as
‘ Tribes or tribal communities or groups or parts
within tribal communities which the President of
India may specify by public notification’
 Described as-
Group of people, often related families, who live
together , sharing the same language, culture, and
history, not in cities or towns.
Introduction

5. Introduction
 Over 104 million live in India
 Spread across 705 tribes
 8.6 % of country’s population
 MP has the largest tribal population 15million
 7 million Bheels of Rajasthan and MP
 Highest number of tribes are in Orissa 62
 Nearly 450000 live in Ashramshalas in
Maharashtra alone
 Referred to as ADIVASI, VANYAJATI, VANVASI,
PAHARI, ADIMJATI and ANUSUCHIT JAN JATI

6. Introduction cont…
 Widespread poverty, illiteracy, malnutrition,
 Absence of safe drinking water and sanitary
living conditions,
 Poor maternal and child health services
 Ineffective coverage of national health and
nutritional services
DIMENSIONS OF TRIBAL HEALTH IN INDIA. Salil Basu
2000

7. ST population %- 2011 census

8. All India ST
Year Persons Males Females Persons Males Females
1961 28.30 40.40 15.35 8.53 13.83 3.16
1971 34.45 45.96 21.97 11.30 17.63 4.85
1981 43.57 56.38 29.76 16.35 24.52 8.04
1991 52.21 64.13 39.29 29.60 40.65 18.19
2001 64.84 75.26 53.67 47.10 59.17 34.76
2011 73.00 80.90 64.60 59.00 68.50 49.40
Literacy rate among All India &
ST population
Govt of India 2018 Annual report 2017-18 MoTA, New Delhi

9. State of health and health care in
tribal areas
 Life expectancy ; 63.9 compared to 67
 Under reporting of child death
 Complete absence of data
 Contraceptive use 41% vs 49%
 TFR 2.5 close to replacement levels of 2.1

10. 1. RMNCHA
 Early marriage
 Early child birth
 Low BMI- 50% adolescent girls underweight
 High incidence of anemia 65%
 Poor ANC coverage

11. a. Maternal health indicators
Maternal health ST All india
Institutional delivery% 68.0 78.9
Deliveries attended by skilled
health personnel
71.5 81.4
Total fertility rate 2.48 1.93
Couple using any contraceptive % 49.4 57.5
Source -Govt of India 2018 Annual report 2017-18 MoTA, New Delhi

12. b. Child mortality
 IMR - 74 against 62 census 2011
 IMR - 44.4 NFHS-4
 ST IMR highest in the world second to federally
administered area in Pakistan
 Under five mortality shows 58% reduction
 Full immunization 56% compared to 72%
 Low birth weight

13. c. Child mortality indicators per
1000 ( 2015-2016)
ST All population
Infant mortality rate 44.4 40.7
Neonatal mortality rate 31.3 23.2
Post neonatal mortality rate 13.1 8.9
Under 5 mortality rate 57.2 49.7
Child mortality rate 13.4 6.6
Source -Govt of India 2018 Annual report 2017-18 MoTA, New Delhi

14. d. Time trend of IMR in ST
population

15. 2. Burden of disease
 Triple burden of diseases
 Malaria and tuberculosis rampant
 Rapid urban, environmental stress and changing
lifestyles
 Rise in prevalence of cancer, hypertension, diabetes
 Mental illness- addiction

16. National sample survey office data
2014
 High proportion of
 respiratory(18%),
 mental/neurological(5%)
 musculoskeletal(10%)
 Obstetric ailments three times higher
 Fever (8743). STI(8255), Herpes simplex(8032),
ARI (6679), PID(5298)
 39000 cases of malnutrition , 25000 anemia, 4000
conjunctival xerosis, 3000dental caries
 Tribal health care needs are not RMNCHA alone,
but broader

17. 3. Communicable diseases
 Malaria
 Tuberculosis
 Skin infections
 STI
 HIV
 Typhoid
 Cholera
 Diarrheal disease, hepatitis and viral fevers

18. a. Malaria
 Account for 30% cases ( 8% of population)
 More than 60% p.falciparum
 50% mortality
 Prioritize – 2030 elimination goal
 10% of NVBDCP budget
 60 % of the tribal population in Orissa is living
in high-risk areas.

19. Tribal Malaria Action Plan
 Objective- reduce API to less than 1 in tribal
districts
 Seven point strategy
 Ensure adequate human resources
 Introduce surveillance system
 Ensure malaria protection at ASHRAMSHALAS
 Special and emergency services for falciparum
malaria
 Check the spread of vector through abandoned
mines
 Health education and BCC
 Support research

20. b. Tuberculosis
 703 against 256 per lakh 2.74times. significantly
higher
 Only 11% get treated
c. Leprosy
 18.5% of the population
 Difficulty in identifying cases
 Endemic reservoirs

21. 4. Non communicable diseases
Early Epidemiologic transition and associated
rise in NCDs
Hypertension
 One out of every four tribal adult suffers from
hypertension
 Only 5% men and 9% women knew their
hypertensive status

22. 5. Genetic disorders
 Sickle cell anemia, heterozygous form most
prevalent, 1in 86births suffer serious form. Mass
screening and management by SCD program.
 Thalassemia
 G-6-PD enzyme deficiency are highly prevalent
among the tribes of Chhattisgarh
 In the absence of any cure and treatment , just
identifying carriers leads to stigma and social
ostracism.

23. 6. Nutrition
 Mean intake of foods and nutrients below
RDA and has reduced over years
 Indicative of changing dietary habits and
rising food insecurities
 Between 1988-90 and 2008-09 National
Nutrition Monitoring Bureau survey. Cereals
and millets – 50g/CU/day, protiens 3g/CU/day,
vit A117 m/CU/day, energy intake
150kcal/CU/day

24. Nutrition cont….
 29-32% children and 63-74% adults diets
were adequate in protiens and calories
 Only 25% pregnant and lactating women had
adequate diet

25. a. Malnutrition
 Underweight has reduced from 54.5% in
NFHS 3 (2005-06) to 42% in NFHS 4 (2015-
16)
 One and half times the general population
 Increased malnutrition and child death in tribal
pockets in Melghat , Nandurbur , Thane.
Mostly during rainy seasons.

26. b. Paradox of tribal nutrition
 Prevalence of clinical malnutrition in children
and low BMI in adults, has to some extent
decreased in a decade
 Probably because of reduced physical
activity and decrease in nutritional wastage in
infections

27. c. Micronutrient deficiencies
Anemia
 NFHS 3 shows 65% tribal women 15-49yrs
were anemic
 77% ST children were anemic

28. 7. Mental health and addictions
 Exposed to several existential threats and mental stress
 Tribal world over are easy prey for these addictive
substance
 72% men used tobacco compared to 56%
 Above half use some sort of alcohol

29. a. Tobacco, alcohol and drugs
threaten tribal health in 5 ways
 Harm health and increase the incidence of serious
diseases and mortality
 Reduce productivity and increase poverty
 Disrupt family and community harmony
 Generate law and order problems
 Constitute a major out of pocket expense and adversely
affect the family economy

30. b. Excise policy for tribal areas
1976
 No commercial sale of alcohol is permitted in scheduled
areas
 Tribal people are permitted to consume traditional, home
made alcoholic beverages under the community control
 Vigorous educational efforts should be made by schools,
colleges, civil society, tribal leaders to wean away people
from drinking

31. 8. Animal attacks and violence in
conflict areas
 Surrounded by forests
 Animal bites from snakes, dogs and scorpions
are common
 45000-50000 annual snake bite cases in
India, highest in world
 Conflict between man and environment
intensifies as boundaries are constantly
redefined

32. 9. Health care in tribal areas
 Huge gaps in health infrastructure, personnel &
resources.
 Problem of access- poverty, language & social barriers,
geographic and socio-economic barriers
 Nearly 50% visit public heath compared to 18.5% of
other caste
 Qualified & sensitive health functionaries are required

33. 10. Health care infrastructure
 HSC per 3000
 PHC per 20000
 CHC per 80000 population
 Data of 18 states-
 11 states showed 27% shortage of HSC
 7 states showed 40% PHC deficit
 10 states showed 31% CHC shortfall
 Thus in half of the states health infrastucture was
deficient by 27% - 40%

34. 11. Health Human resource
 The paradox of vacant posts of doctors and
specialists in tribal area PHC & CHCs and
non enforcement of bond on 90% doctors is
surprising and tragic
 Limited scope for professional growth &
interaction, feeling of isolation
 Poor working conditions

36. 12. Health Human resource
continued
 One ANM is required for 2000 population
 ASHA is a very appropriate, feasible and
effective way of bridging this gap.
 Lack of appreciation of this fact
 Severe shortage of nursing staff HP77%,
Jharkhand 56%, Orissa 52%
 The total salary of MO s needs to
substantially increase

37. 13. Health culture and health
literacy
 In most tribal areas there is a wealth of
folklore related to health
 Tribal people and forest dwellers collect
leaves, fruits, seed and nuts of medicinal
value
 Traditional healers act as medium between
man, nature and supernatural entity. Spiritual
security and emotional content.

38. 14. Health culture and health
literacy cont…
 Awareness about good health practices &
symptoms of diseases, distress among infants
continues to be poor.
 Tribal societies remained away from scientific
knowledge

39. Measures to improve human
resources for tribal health
 Health care provider should be a local tribal
 Vibrant, responsive and accessible health
workforce- ensuring local tribal people are
trained & deployed in health force
 Centre of gravity of workforce not at the top-
the specialists and doctors- but closer to
communities

40. Mobile Health Unit/MMU
 Mobile Medical Units (MMUs) under NHM -1
MMU / 10 lakh population subject to a cap of
5 MMUs / district
 take healthcare to the doorstep of
populations, particularly rural, remote,
difficult, vulnerable, under-served and
unreached areas.
 This is not meant to transfer patients.

41. Suggested package of services
 Maternal Health, Neonatal and Infant Health, Child and
Adolescent health
 Reproductive Health and Contraceptive Services
 Management of Chronic Communicable Diseases
 Management of Common Communicable Diseases &
basic OPD care (acute simple illnesses)
 Management of Common Non-Communicable Diseases
 Management of mental Illness, Dental Care, Eye
Care/ENT Care, Geriatric Care and Emergency Medicine

42. Karuna trust
 Karuna Trust (India) is an organization involved with
integrated rural development and is affiliated to Vivekananda
Girijana Kalyana Kendra. Both charities were founded
by Hanumappa Sudarshan.
 Motivation to start this trust was the prevalence of leprosy in
Yelandur Taluk of Chamarajanagar district.
 Another focus area is education and livelihood improvement.
Gumballi phc

43. Karuna trust
 Karuna Trust runs 25 Primary Health Care
(PHC) Centres in all the districts of the state
of Karnataka and 9 PHCs in Arunachal
Pradesh.
 The organization promotes Public Private
Partnership with NGOs on a non-profit basis
to achieve primary health care.
 They also pioneered a public health insurance
for low-income Indians

48. References
1. Tribal Health Expert Committee Report_Executive
Summary- MoHFW & MoTA Chairmanship Dr Abhay
Bang-2018
2. Govt of india 2005-06 NFHS-3 MoHFW
3. Govt of india 2017 NFHS-4 MoHFW
4. Govt of india 2018 Annual report 2017-18 MoTA,
New Delhi
5. DIMENSIONS OF TRIBAL HEALTH IN INDIA. Salil
Basu 2000
6. Negi, Dandub & Singh, Monica. (2018). Tribal Health
and Health Care Belief in India : A Systematic
Review.

49. Thank you

50. Ten special problems in tribal
health
1. Controlling malaria
2. Reducing prevalence of malnutrition
3. Reducing child mortality
4. Ensuring safe motherhood and health of
women in tribal communities
5. Providing family planning services and
infertility care

51. Ten special problems in tribal
health cont…
6. Controlling the use of addictive substances &
providing de-addiction and mental health
services
7. Sickle cell disease
8. Ensuring timely treatment of animal bites and
accidents
9. Health literacy in tribal areas
10. Health of children in ASHRAMSHALAS