REACHING OUT IMPROVING TRIBAL HEALTH

Transcription

1 REACHING OUT IMPROVING TRIBAL HEALTH

2 Tribal communities in Tamil Nadu Tribal communities constitute less than one per cent of the total population in the State (population around 6.25 lakh). These communities are spread throughout the State, but there is a higher concentration in 12 districts which are referred to as the Tribal districts. Historically, tribal communities in Tamil Nadu have not enjoyed adequate healthcare services. Inaccessibility and cultural factors are some of the reasons for this. Tribal communities are spread both in the plains and hilly terrain, and communities located in remote areas pose a challenge when it comes to providing healthcare services. Studies indicate that only one to two per cent of the tribal communities access the hospital facilities most of the patients being non-tribals from the area, even though tribal communities constitute 20 to 30 per cent of the population in that area. 2

3 Quick facts on tribal communities in Tamil Nadu Tribals constitute around one per cent of Tamil Nadu s population Settled mostly in 12 districts spread in 2860 villages located in 63 blocks Totally, 173 PHCs, 611 health centers serve this population Tribal communities have not enjoyed adequate healthcare services - inaccessibility and cultural factors being dominant causes As one of the main aims of the Tamil Nadu Health Systems Project is to increase access to quality healthcare for poor and disadvantaged people, the Project undertook the task of improving healthcare services to tribal communities in Tamil Nadu. 3

4 Building the foundation Adopting a systematic approach in tackling the challenge of providing healthcare services to tribal communities, initially, a tribal development plan was created. This plan was based on consultations with members of tribal communities, non-governmental organizations, and tribal development consultants. The plan was also influenced by studies done on burden of diseases involving the tribal communities, and health seeking behavior of tribal communities. As a result of this plan, TNHSP undertook six interventions, including mobile outreach services to improve accessibility, diagnosis and treatment of sickle cell anemia, providing peer counselors, promotion of institutional deliveries, provision of bed grants and IEC activities. 4

5 A friendly interface: patient counseling services Counselors from tribal communities were appointed at 30 healthcare centers (25 hospitals, 5 primary healthcare centers) to increase the comfort-levels of the members of tribal communities accessing the hospitals. As these counselors are from tribal communities, they instill confidence and help in removing fears and apprehensions the tribals faced over the years. These counselors will assist patients from the tribal communities visiting hospitals and also maintain detailed records of their visits. The counselors were given training in HMDI Salem in November 2008 and reorientation training in March This intervention has helped increase attendance of members of tribal communities in hospitals. 5

6 Mobile outreach services To overcome accessibility issue, mobile outreach services were provided in partnership with non-governmental organizations in the districts of Nilgiris, Coimbatore, Dharmapuri, Krishnagiri, Vellore, Salem, Namakkal, Dindigul, Kanyakumari, and Villupuram. The services were monitored by the district administration. Vehicles equipped with a doctor, nurse, lab technician, and a pharmacist would visit difficult-to-access areas once in 15 days. In Nilgiris district, three vans were provided as it has a higher concentration of tribal population. From data gathered, it is seen that between April 2009 and Sep 2009, except for Coimbatore all other districts saw more than 90 per cent of planned visits being achieved. Apart from out-patient services, the mobile outreach services also provide ante-natal and post-natal checkup. and newborns are provided vaccination. Laboratory services and IEC services are also provided. the expenditure for this programme is provided by the National Rural Health Mission. Future plans include adding eight more mobile vans to cover those districts not yet included, such as Tiruchi, Erode, and Tiruvannamalai. 6

7 Sickle cell anemia: prevention and treatment Sickle cell disease is characterized by a mutation in the shape of the red blood cell from a smooth, donut-shape to a crescent or half moon shape. The cells lack plasticity and can block small blood vessels, impairing blood flow. This condition leads to shortened red blood cell survival, and subsequent anemia, often called sickle cell anemia. Poor blood oxygen levels and blood vessel blockages in people with sickle cell disease can lead to chronic acute pain syndromes, severe bacterial infections, and necrosis (tissue death). In Tamil Nadu, sickle cell anemia is prevalent mostly among tribal communities in the Gudalur and Pandalur taluks of the Nilgiris district. According to the studies done by ICMR and NAWA in this area, there is an estimated 500 patients with sickle cell disease, considering the current population of 25,000. Sickle cell trait: Sickle cell anemia is caused by a defective haemoglobin gene. If an individual receives this defective gene from both parents, then he or she will suffer from sickle cell disease. If an individual receives one copy of a normal gene and one copy of a defective gene, he or she will exhibit a sickle cell trait, which produces no harmful side effects. 7

8 A study by All India Institute of Medical Sciences reported an alarming prevalence of sickle cell disease: Name of tribe Sickle cell disease Sickle cell trait Kurumba 5.1 % 20.4 % Paniya 1.5 % 13.7% Adiya 1.4% 16.2 % Kattunaicka 0.6 % 11.6% In order to prevent and treat this disease, various interventions were undertaken. The approach was to combine screening and identification of sickle cell patients, along with counseling and treatment. Two NGOs, Ashwini Hospital, Gudalur and Nawa Hospital, Kotagiri, run these sickle cell anemia centers. A standard management protocol in diagnosis and treatment was developed and is followed in these hospitals. A survey was done to find how many people had sickle cell anemia, and how many were likely to get the disease, so that interventions could be provided accordingly. Treatment cards were issued to positive patients. Premarital counseling was provided to ensure that two people with sickle cell anemia did not marry to ensure that any offspring they may have would not contract the disease. Out-patient services such as vaccination are provided against pneumococci and treatment for minor ailments During emergency, which occurs during a sickle cell crisis, blood transfusions are provided Hydroxy urea tablets are provided throughout the lifetime of a sickle cell anemia patient 8

9 Bed grants In two hospitals as a pilot program all the costs associated with inpatient care for tribals are reimbursed. This is administered through NGO partnerships. These hospitals are Aswini Hospital in Gudalur, Nilgiris, and NGO Hospital of Nilgiris Wayanad Tribal Welfare Society. The table below shows the total number of tribal inpatients for whom care was provided by both these hospitals between April 09 and Sep 09. Period April 09 May 09 Jun 09 July 09 Aug 09 Sep 09 Total Patients Fellowships for doctors Medical officers working in tribal districts are given fellowships for a diploma course in CMC Vellore under a distant education and contact course in Family Medicine. The total budget alloted for this is Rs. 15 lakhs. Initially, 46 doctors were selected for the course, duration of which is two years. Currently, 43 doctors have been selected and are undergoing the course. 9

10 Sensitization workshops Sensitization workshops were conducted for leaders of the tribal communities on healthcare services provided, in CMC Vellore in May 2009 at Chennai. Apart from tribal leaders from 10 districts, this workshop was attended by NGO partners and other officials. Apart from healthcare issues, education and economic concerns were discussed. The recommendation from this workshop, and another consultative workshop conducted at Ooty in April 2009 have been shared with World Bank. It was decided that TNHSP along with other departments such as NRHM, DMS, and DPH will take care of the tribal healthcare issues. A committee with officials from various departments has been planned to tackle other issues. Convergence In order to comprehensively improve all services provided to tribal communities, consultative meetings were held with district officials to ensure that along with healthcare services, water, food, sanitation, and housing services were also addressed. Action plans were developed in these meetings to address these needs. 10

11 Stayal plan for antenatal mothers Women in tribal communities shy away from institutional deliveries because of inhibitions and other cultural factors, which leads to a higher preventable maternal and neonatal mortality and morbidity. To address this, a pilot programme was implemented by TNHSP in four primary health centers where expectant mothers are brought in from their place of residence to a PHC three days before their expected delivery date. The cost of shelter, medical attention, and food is taken care of by the State for the mother and an attender. Soon, this will be expanded to all tribal districts through the National Rural Health Mission. 11

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