Tribal health

Tribal health Presentation

1. Tribal Health Community Medicine GMCH

2. Introduction Tribal population in India- >104 million Tribes- 705 Proportion of total population- 8.6% Distinct socio-cultural structures and way of life

3. Landmarks for tribal policy Constitution of India Panchsheel Principles PESA act

4. Problems in tribal India Lack of infrastructure Lack of developmental facilities and services Poor representation of tribal area on public fronts Malnutrition Child mortality and Malaria, TB, Leprosy are exceptionally high in Tribal population

5. Question Why tribal people suffer from inequity in health and health care compared to others? How can this gap be bridged rapidly?

6. Definition Who is tribal : Article 342 of Indian Constitution defines “Scheduled Tribes” as the tribes or tribal communities or parts of or groups within tribal communities which the President of India may specify by public notification. Location Tribal people living in schedule V areas and in tribal dominated blocks Tribal population in North-East India Vulnerable tribal groups

7. Essential characteristics Primitive traits Geographical isolation Distinct culture Shy of contact with community at large Economically backward

8. Distribution MP (15 million), Maharashtra (10 million), Odisha (9 million), Rajasthan (9 million) More than 2/3rd of population lives in 7 states (+CG+JH+GUJ) Concentration of tribes is highest amongst North-East. 90% of tribal population lives in rural areas.

9. The tribal population lives predominantly in hilly and forested area. They are scattered across large areas with low density of population. Growth of ST population 8.2% to 8.6% (2001-2011) TFR is 2.5 Sex ratio=990/1000

10. Socio-economic status Mainly agriculture, collectors of forest produce, hunters, herders Dependent heavily on agriculture 40% lives below poverty line (BPL) Access to tap water-10.7% Open defecation-74.7% Illiterate-41% Only 6.7% of ST population above 18 years have completed 12 years of education.

11. Governance mechanisms In 1999, a separate ministry of Tribal Affairs was created to ensure the socio-economic development of scheduled tribes. The Scheduled Tribes and Other Traditional Forest Dwellers Act 2006 introduced to redress issue of injustice against forest dwellers. Ministry of Tribal Affairs is the nodal agency for planning and safeguarding the welfare of tribal people.

12. Health states among tribal people Life expectancy- 63.9 years as compared to 67 years (general popn ) Maternal health-Early marriage, early child birth, Low BMI, Anemia 50% girls (15-18 years) are underweight. Anemia prevalence is 65%. Full ANC coverage is only 15% Institutional delivery rate is 70.1% 27% tribal women deliver at home Infant Mortality Rate-44.4 (NFHS-4)

13. Comparison of U5MR in ST’s and Others

14. Burden of disease Triple burden of diseases Malnutrition and Communicable diseases Non-communicable diseases Mental health (Addiction) Communicable disease Malaria-30% of all cases Tuberculosis-703/lac prevalence Leprosy-18.5% of all cases

15. Non-communicable disease Hypertension-1/4 Diabetes Sickle cell disorder-1%-40% G6PD deficiency-0.7%-15.6% Nutrition Malnutrition Micronutrient deficiencies Burden of disease

16. Mental health & addictions Tobacco-72% Alcohol-50% Animal attacks and Violence in conflict areas Snakes, dogs, scorpions Tribal health in North-East India High incidence of NCD’s & Cancer High mental health problems, drug use, tobacco & alcohol High HIV/AIDS incidence due to IV drug use Malaria with API>5 Burden of disease

17. Burdens of Tribal Health Communicable disease NCD’s with mental ill-health Injuries Difficult areas & harsh environments Worse socio-economic conditions Poor quality and inappropriate health care Limited human resource Low funding Lack of data & monitoring Poor political representation

18. Norms for Health infrastructure & manpower Centre Plain area Hilly/Tribal area Sub-Centre 5,000 3,000 Primary Health Centre 30,000 20,000 Community Health Centre 1,20,000 8,00,00 Health Worker 5,000 3,000

19. RCH services Goal To improve the health status of tribal community Objectives Assess the unmet needs of RCH services in different tribal areas Improve service coverage, accessibility, acceptability Develop sufficient number of FRU’s Provide supplies, management and information

20. Provisions for health in Tribals Health guide made available for each village Incentives to Doctors and paramedical staff Safe drinking water Awareness of family planning Basic laboratory services Training of local ST girls and boys as MPHW School health programmes Anti snake venom and anti-rabies vaccine

21. Mobile Medical Unit The mobile medical unit comprises a Doctor, lab technician, nurse, ANM and driver. Vehicle is fitted with all necessary equipment including microscope and mini-lab. Doctors will screen tribal people for diabetes, cardiac diseases, hypertension, leprosy, TB etc.

22. Agencies for tribal health Bhartiya Adimjati Sewak Sangh Indian Council for Child Welfare Central Social Welfare Board Role of NGO’s is important as lack of government funding and manpower often act as deterrent of health services to tribals . World Bank, Bill Melinda Gates assisted NGO’s/Projects provide services in tribal states.

23. New avenues Involving tribal youth Role of traditional healers Training of local health care providers Employing health workers from tribal communities Raising awareness of health issues

24. Research in Tribal Health NIRTH, Jabalpur (ICMR) Central Council for Research in Ayurvedic Science (CCRAS)