|Author(s):||N. K. Gupta1|
|Affiliation(s):||1Prayas Centre for Health Equity, Prayas, Jaipur, India|
|Keywords:||Tribals, community based monitoring, participatory health planning|
Tribals, as a community in India experience unfair health inequities on account of poor economic abilities and remote residence. This causes sustained harm to their health. High prevalence of infectious morbidity chief cause of premature mortality and large scale temporary or long term disability amongst them are clear evidences. An action research initiative of a civil society group “Prayas” to construct demand amongst tribals for “Safe, rational, effective and quality health & therapeutic care” by formulating sustainable convergence between public health care providers and users has shown reduction in grave health fatalities. Project area of this initiative was Chhotisadari block, Chittorgarh Dt. of India. Project initially covered 25 villages with total population of 19,638. Out of it 89.23% belonged to tribal community. Project’s assumption was that public health care services could be improved by establishing forums for communication and shared responsibilities between community and health services institutions. Morbidity and mortality data from 25 villages showed poor immunization coverage, very little antenatal care, almost no trained attendance during deliveries and excessively high out of pocket expenditure in medication. Other social indicators viz. literacy and awareness about entitlements were weak. Lack of livelihood opportunities and poor infrastructural development added complexities in life of people. While community had bagful of complaints towards insensitive attitude of health providers, the health personnel had their share of woes regarding people’s attitude. This led to tribals deprived of essential healthcare. Treatment seeking behaviour showed poor indulged in self treatment and very poor almost did nothing for illnesses. Many borrowed money to buy medication causing further impoverishment.
Interventions included - participatory health mapping to build community diagnosis, community based monitoring and awareness forums; formation of women’s and adolescent health groups; gender sensitivity and socioepidemiological skills building workshops of providers; organisation of representative village health assembly and committees comprising of community & providers; setting up of village health goals and charter; formation of convergence committees at primary and community health centres. Committee jointly reviewed and planned monthly health activities; organisation of public dialogues/hearing on access to health care.
Assessment after two years showed 76.53% increase in institutional deliveries, 74.95% rise in immunization of tetanus toxoid amongst pregnant women, artificial feeding which was 19% before the interventions reduced to 5.15%, hand washing by soap increased to 34.665 from 18.1%. Number of households having toilets increased from 1.1% to 11.74% and private bathrooms from 18.2% to 47.0%. As a result the decline in morbidity and premature mortality was significant.